bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosing Recently Defined and Uncommon Salivary Gland Lesions in Limited Cellularity Specimens: Cytomorphology and Ancillary Studies
Authors: Rossi Esther Diana , Baloch Zubair , Faquin William , Pantanowitz Liron 
Published: January 2021

AbstractFine-needle aspiration (FNA) has proven to be an essential step in the preoperative evaluation of patients with salivary gland lesions. The diagnosis rendered on FNA specimens helps streamline clinical and/or surgical management. However, despite its usefulness, FNA has known limitations. Fine-needle aspiration may fail to provide a specific diagnosis in some cases because of limited aspirated material, cellular makeup, and/or morphologic heterogeneity. The field of salivary gland pathology is rapidly changing because of the identification of new entities and reclassification of existing lesions based on morphologic features and emerging antigenic and molecular profiles. A management-based cytological diagnosis of these newly reclassified and/or uncommon neoplasms is possible using characteristic morphologic features and specific translocations. Herein, we review the salient morphologic features, immunohistochemistry, and molecular profile of several recently described salivary gland neoplasms in light of clinical management.
Now Is the Time
Authors: Bosques Glendaliz , Ankam Nethra Sridhara , Kasi Ravi , Rydberg Leslie , Sauter Carley , Therattil Maya , Tolchin Dorothy W. 
Published: January 2021

Abstract
One in four noninstitutionalized adults in the United States lives with a disability. People with disabilities have frequent interactions with the medical community and the healthcare system yet experience disparities in access and outcomes. The Association of American Medical Colleges has included disability in its definition of diversity as one of the aspects of patient care that may affect health equity. However, training in the lived experience of disability is not always included in medical education. Physiatrists make excellent disability champions in medical schools, given their training and experience in the care of individuals with disabilities. Here, we describe strategies for physiatrists to increase disability education in medical schools and an overview of standards and tools (Liaison Committee on Medical Education standards; Commission on Osteopathic College Accreditation standards; International Classification of Functioning, Disability and Health language; and the Core Competencies on Disability for Health Care Education published by the Alliance for Disability in Health Care Education) physiatrists can use to facilitate interactions with medical school educational leadership. Specific examples are provided along with a framework to guide the development of disability champions in medical schools.
The Important Impact of COVID-19 Pandemic on the Reorganization of a Rehabilitation Unit in a National Healthcare System Hospital in Italy
Authors: Maccarone Maria Chiara , Masiero Stefano 
Published: January 2021

Abstract
Since March 2020, when COVID-19 pandemic broke out, the world’s healthcare systems’ main concern has been fighting the pandemic. However, patients with other diseases, also requiring rehabilitation evaluations and treatments, continued to need care. Our rehabilitation unit managed to maintain contact with patients through alternative communication methods even during the lockdown period and in a situation of staff shortage. If face-to-face evaluations and treatments were necessary, preventive measures were followed to avoid hospital-associated contagion. Rehabilitation beds were cleared to leave them to the acute wards, and consultations for the acute care patients were carried out using personal protective equipment. In the future, the lessons from our experience could contribute toward drawing a plan of measures applicable in similar situations and some of these actions could become part of the rehabilitative practice.
Extending the Depth and Breadth of Physiatry Care
Authors: Brooks Forrest A. , Tolchin Dorothy W. 
Published: January 2021

Abstract
Hospice and palliative medicine is one of seven accredited fellowship subspecialties available to graduates of physical medicine and rehabilitation residency programs. Hospice and palliative medicine and physical medicine and rehabilitation share many of the same principles and practices, and physical medicine and rehabilitation residency training can be excellent preparation for hospice and palliative medicine fellowship. However, unlike the other six physical medicine and rehabilitation subspecialties, there is currently no requirement for hospice and palliative medicine training during physical medicine and rehabilitation residency. As a result, physical medicine and rehabilitation residents may encounter limited hospice and palliative medicine exposure or education, and lack explicit opportunities to develop the basic set of palliative care symptom management and communication tools that can be applied across the spectrum of physiatry care. Here, we provide five strategies that residents can use within their own programs to develop knowledge and experience in hospice and palliative medicine.
The Association of Overall Annual Hospital Volume and Perioperative Outcomes following Free Flap Breast Reconstruction
Authors: Shammas Ronnie L. , Ren Yi , Thomas Samantha M. , Phillips Brett T. , Hollenbeck Scott T. , Greenup Rachel A. 
Published: January 2021

Background:Hospital volume has been correlated with improved outcomes in oncologic care and complex surgical procedures. The authors sought to determine the relationship between overall annual hospital volume and perioperative outcomes following free flap breast reconstruction.Methods:Free flap breast reconstruction patients (n= 7991) were identified at 1907 centers using the Healthcare Cost and Utilization Project National Inpatient Sample database. Logistic regression characterized the association of hospital volume (total discharges per year) with systemic, surgical, and microsurgical complications. Patients were categorized as being treated at low- versus high-volume hospitals based on identified threshold volumes, and the association with the incidence of complications was estimated.Results:Initially, restricted cubic spline analysis suggested potential threshold volumes of 13,018 (95 percent CI, 7468 to 14,512) and 7091 (95 percent CI, 5396 to 9918) discharges per year, at which the risk for developing systemic and microsurgical complications may change, respectively. However, further patient-level evaluation of treatment at low- versus high-volume hospitals demonstrated that hospital volume did not predict the risk of developing perioperative systemic (OR, 1.28; 95 percent CI, 0.75 to 2.18;p= 0.36) or microsurgical complications (OR, 1.06; 95 percent CI, 0.78 to 1.44;p= 0.73).Conclusions:Perioperative complications after free flap breast reconstruction did not differ between patients treated at low- versus high-volume hospitals after in-depth multiprong analysis. Patient outcomes are more likely associated with surgeon and programmatic experience. Overall annual hospital volume should not serve as a proxy for high-quality breast free flap care. CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, III.
An Option for Shaft-Only Gender-Affirming Phalloplasty: Vaginal Preservation and Vulvoscrotoplasty. A Technical Description
Authors: Chen Wendy , Cylinder Isabel , Najafian Alireza , Dugi Daniel D. , Berli Jens U. 
Published: January 2021

Summary:
Genital masculinizing gender-affirming surgery is a growing field. Because of a spectrum of gender identity, gender expression, sexual expression, patient desires, and patient tolerance for complications, options for surgery vary accordingly. Shaft-only phalloplasty avoids urethral lengthening, but may still be accompanied by hysterectomy, vaginectomy, scrotoplasty, clitoroplasty (burying of the clitoris), glansplasty, and placement of erectile devices and testicular implants. Patients who desire retention of vaginal canal patency are candidates for vaginal preservation vulvoscrotoplasty; however, there is a paucity of literature describing the procedure and its outcomes. In this article, the authors review the technique used by the senior author at Oregon Health and Science University and report surgical outcomes for four patients. Future studies regarding patient-recorded outcome measures, aesthetics, sexual function, urologic function, patient satisfaction, and conversion to other options will help surgeons better understand patients pursuing gender-affirming surgery through shaft-only phalloplasty.
Laser-Assisted Rhinoplasty: The Future Generation Rhinoplasty Technique to Preserve Anatomy? A Series of Patients Compared to Patients Undergoing Standard Open Rhinoplasty
Authors: Bertossi Dario , Marchetti Alberto , Sbarbati Andrea , Nocini Pierfrancesco 
Published: January 2021

Background:
Rhinoplasty is the cosmetic procedure that is most difficult to master. Anatomical preservation should represent the main goal of rhinoplasty. One emerging tool appears to be erbium:yttrium-aluminum-garnet laser bone and cartilage reshaping. The authors developed a new small laser hand probe to perform what we called laser-assisted rhinoplasty. The authors evaluate the feasibility of the laser-assisted rhinoplasty and the aesthetic and functional result of laser-assisted rhinoplasty compared to classic rhinoplasty.

Methods:
A total of 50 patients were enrolled and randomized into two cohorts: the first cohort of patients was submitted to classic rhinoplasty, and the second cohort to laser-assisted rhinoplasty. The laser beam was used to perform both the resection of the crura and the resection of the nasal hump and osteotomies.

Results:
Laser-assisted rhinoplasty is a safe and reproducible technique. At a clinical assessment, lateral crura reshaping showed a visible step or excessive skin retraction in 12 percent of the classic rhinoplasty population with thick cartilage and/or thin skin, and this was not present in the laser-assisted rhinoplasty population at 12-month follow-up. The patient satisfaction rate was higher in the laser-assisted rhinoplasty population compared with standard open rhinoplasty. The authors also clinically noted a reduction in edema in the immediate postoperative period in the laser-assisted rhinoplasty population and a more rapid complete resolution of the swelling.

Conclusion:
The laser-assisted rhinoplasty technique is feasible and safe and has no major complication, and the aesthetic and functional results can be superimposed onto classic rhinoplasty but with a higher degree of intraoperative precision, higher patient satisfaction, a cleaner field, and less bleeding.
Application of Spare Parts in Combination with Targeted Muscle Reinnervation Surgery
Authors: Valerio Ian L. , Larsen Michael , Eberlin Kyle R. 
Published: January 2021

Summary:
Targeted muscle reinnervation is a contemporary technique designed to enhance an amputee’s ability to operate a myoelectric prosthesis. This technique has been shown to decrease neuropathic pain, including neuroma and phantom limb pain. In certain amputations, especially forequarter and hindlimb levels, there may be no nearby recipient muscle sites, or the residual nerve may be too short to perform targeted muscle reinnervation. Applying the spare parts concept can help solve this problem by providing nerve autograft or additional muscle recipient sites within the spare parts flap for successful targeted muscle reinnervation surgery procedures. A retrospective review of all patients that underwent spare parts targeted muscle reinnervation reconstructions between 2016 and 2019 at two institutions was performed. Patients were assessed for healing, neuroma and phantom limb pain, and function. Twelve patients underwent targeted muscle reinnervation during spare parts reconstruction; eight were male and four were female. The mean patient age was 55.3 years (range, 16 to 72 years). For those with known soft-tissue deficit size, the surface area of the donor site spared by using spare parts reconstruction ranged from 216 to 856 cm2. None of the 12 patients subsequently experienced neuroma, and 75 percent had no phantom limb pain after 3 months. Three patients have obtained insurance-approved myoelectric prosthetics, and all three demonstrated intuitive control of targeted muscles. Using a spare parts reconstruction in conjunction with targeted muscle reinnervation may optimize reconstructive efforts in the setting of major limb amputations and aid in decreasing phantom limb and neuroma pain, and facilitate the possibility of functional prosthetic and/or myoelectric prosthesis use.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Cone Beam Computed Tomography Evaluation of the Morphological Variation and Width in Mandibular Condyle
Authors: Al-Ghurabi Zainab H. , Al-Bahrani Zainab M. 
Published: January 2021

Purpose:
Classify the normal morphology of mandibular condyle to facilitate the diagnosis of any pathology or abnormal conditions associated with it using cone beam computed tomography (CBCT).

Material and method:
A total of 100 joints of 50 subjects with age range of 20 to 50 years were examined prospectively using CBCT images. The mandibular condylar morphology was classified into convex, round, flat, and angled the widest area of the condylar head measured to evaluate the size variation in different age groups for both genders and side.

Results:
Round shape condyle is more frequent than other varieties and angled shape was the less frequent shape. There was no significant difference between gender and condyle shape but the round and angled shape were more obvious in females than males. Convex type was more prevalent to shown bilateral symmetrical shape than other varieties, the condylar head mean of width measuring was 14.85 mm in age group 20 to 29 comparable to 14.45 mm and 14.42 mm in age groups 30 to 39 and 40 to 50 years, respectively.

Conclusion:
CBCT facilitates the precise examination of TMJ in 3 planes that play a great role in an accurate visualization of the condyle to provide early diagnosis for any disorder in the region.
“Zipper” Concept for Designing Expanded Forehead Flap in Facial-Cervical Reconstruction
Authors: Chen Hongbo , Su Zhiguo , Tian Jia 
Published: January 2021

Background:
Skin defect of the lower part of the face and neck is a severe condition for many patients with burn and traumatic injuries or skin lesions. The expanded forehead flap with anterofrontal temporal vessel pedicles has been widely used in lower cheeks, chin, and neck reconstruction. (In this study, we introduce a new concept- “Zipper concept” of the flap design.) The aim of this study is to evaluate the feasibility and outcome of using expanded forehead flap with a vertical incision with or without a small transverse incision in the central part.

Methods:
From March 2010 to September 2016, 27 patients who suffered from lower cheeks and chin skin defects were reconstructed by expanded forehead flap with anterofrontal temporal vessel pedicles. After the lesion was excised, the upper or the lower part of the flap was cut in half with a vertical incision with or without a small transverse incision in the middle part as needed for cheeks, upper lip or neck reconstruction, and the other part of the flap was remained to be one piece for chin reconstruction.

Results:
All flaps survived completely without any congestion or necrosis. All patients achieved satisfactory results both functionally and aesthetically.

Conclusions:
A vertical incision with or without a small transverse incision in the central part of the expanded forehead flap with anterofrontal temporal vessel pedicles is a safe modification of the flap design. It is practical and could bring the expanded forehead flap to more indications.
Part 1: Surgical Correction in 231 Trigonocephaly Patients – The Alder Hey Experience
Authors: Hennedige Anusha , Richardson David , Duncan Christian , Parks Christopher , Sinha Ajay , Ellenbogen Jonathan , Robertson Benjamin 
Published: January 2021

Abstract
Isolated metopic synostosis presents with a range of severity, from a palpable ridge as the sole presenting feature to a constellation of features resulting in trigonocephaly. At our unit, patients on the moderate to severe end of the phenotypic spectrum of trigonocephaly are offered fronto-orbital advancement and remodeling. The authors present our series of trigonocephaly patients who have undergone surgical correction. From January 2000 to January 2020, the authors operated on 231 patients with trigonocephaly. The average age at surgery was 18 months, with an average follow-up of 77.4 months. Seventy-nine percent of patients had no comorbidity. Ten percent of patients sustained a dural tear with no long-term consequences. The total early complication rate was 12.1%. The most common early complications were wound infection and wound dehiscence at 7.4% and 3.9% respectively. The total reoperation rate was 6.5%. The introduction of infection prevention and control measures over the 2 decades at our unit reduced the reoperation rate to 1.1%. The most common late complication was temporal recession in 20.8% of patients, none of whom required aesthetic correction. The recurrence rate of a metopic ridge was 2.3% with no patients requiring further surgery. None of our patients required calvarial remodeling for raised intracranial pressure after the primary fronto-orbital advancement and remodeling. There were no life-threatening complications or mortalities in our cohort. The authors present recommendations which include an infection control care bundle, cessation of surgical drains, and practice adjustments to reduce risks of infection and risk of requiring further calvarial remodelling for raised intracranial pressure.
A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum
Authors: Nieto-Calvache Albaro José , Vergara-Galliadi Lina María , Rodríguez Fernando , Ordoñez Carlos A. , García Alberto Federico , López María Camila , Manzano Ramiro , Velásquez Jorge , Carbonell Juan Pablo , Bryon Adriana Messa , Echavarría Maria Paula , Escobar Maria Fernanda , Carvajal Javier , Benavides-Calvache Juan Pablo , Burgos Juan Manuel 
Published: January 2021

INTRODUCTION
The main complication of placenta accreta spectrum (PAS) is massive bleeding. Endoarterial occlusion techniques have been incorporated into the management of this pathology. Our aim was to examine the endovascular practice patterns among PAS patients treated during a 9-year period in a low-middle income country in which an interdisciplinary group’s technical skills were improved with the creation of a PAS team.

METHODOLOGY
A retrospective cohort study including all PAS patients treated from December 2011 to November 2020 was performed. We compared the clinical results obtained according to the type of endovascular device used (group 1, internal iliac artery occlusion balloons; group 2, resuscitative endovascular balloons of the aorta; group 3, no arterial balloons due to low risk of bleeding) and according to the year in which they were attended (reflects the PAS team level of experience). A fourth group of comparisons included the woman diagnosed during a cesarean delivery and treated in a nonprotocolized way.

RESULTS
A total of 113 patients were included. The amount of blood loss decreased annually, with a median of 2,500 mL in 2014 (when endovascular occlusion balloons were used in all patients) and 1,394 mL in 2020 (when only 38.5% of the patients required arterial balloons). Group 3 patients (n = 16) had the lowest bleeding volume (1,245 mL) and operative time (173 minutes) of the entire population studied. Group 2 patients (n = 46) had a bleeding volume (mean, 1,700 mL) and transfusions frequency (34.8%) slightly lower than group 1 patients (n = 30) (mean of 2,000 mL and 50%, respectively). They also had lower hysterectomy frequency (63% vs. 76.7% in group 1) and surgical time (205 minutes vs. 275 in group 1) despite a similar frequency of confirmed PAS and S2 compromise.

CONCLUSION
Endovascular techniques used for bleeding control in PAS patients are less necessary as interdisciplinary groups improve their surgical and teamwork skills.

LEVEL OF EVIDENCE
Therapeutic care management, level III.
Motor vehicle crashes in pregnancy: Maternal and fetal outcomes
Authors: Owattanapanich Natthida , Lewis Meghan R. , Benjamin Elizabeth R. , Wong Monica D. , Demetriades Demetrios 
Published: January 2021

BACKGROUND
Motor vehicle crashes (MVCs) are a leading cause of death in pregnant women. Even after minor trauma, there is risk of fetal complications. The purpose of this study was to compare injuries and outcomes in pregnant with matched nonpregnant women after MVC and evaluate the incidence and type of pregnancy-related complications.

METHODS
Retrospective study at a Level I trauma center included pregnant MVC patients, admitted 2009 to 2019. Pregnant patients were matched for age, seatbelt use, and airbag deployment with nonpregnant women (1:3). Gestation-related complications included uterine contractions, vaginal bleeding, emergency delivery, and fetal loss.

RESULTS
During the study period, there were 6,930 MVC female admissions. One hundred forty-five (2%) were pregnant, matched with 387 nonpregnant. The seat belt use (71% in nonpregnant vs. 73% in pregnant, p = 0.495) and airbag deployment (10% vs. 6%, p = 0.098) were similar in both groups. Nonpregnant women had higher Injury Severity Score (4 vs. 1, p < 0.0001) and abdominal Abbreviated Injury Scale (2 vs. 1, p < 0.001), but a smaller proportion sustained abdominal injury (18% vs. 53%, p < 0.0001). Mortality (1% vs. 0.7%, p = 0.722), need for emergency operation (6% vs. 3%, p = 0.295) or angiointervention (0.3% vs. 0%, p = 0.540), ventilator days (3 vs. 8, p = 0.907), and intensive care unit (4 vs. 4, p = 0.502) and hospital length of stay (2 vs. 2, p = 0.122) were all similar. Overall, 13 (11.1%) patients developed gestation-related complications, most commonly uterine contractions (6.3%), need for emergency delivery (3.5%), and vaginal bleeding (1.4%).

CONCLUSION
Most pregnant patients hospitalized for MVC suffered minor injuries. Pregnant women had lower Injury Severity Score and abdominal Abbreviated Injury Scale than matched nonpregnant women. However, there was still a considerable incidence of gestation-related complications. It is imperative that pregnant patients be closely monitored even after minor trauma.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level III