bluuebunny/crossref_metadata_2025_split huggingface dataset:
Technical Challenges in “Micro” Lymph Node Identification during Vascularized Submental Lymph Node Flap Harvesting
Authors: Yodrabum Nutcha , Patchanee Krittayot , Oonjitti Thanaphorn , Piyaman Parkpoom 
Published: January 2021

Background:The outcome of autologous lymph node (LN) transfer has depended on the number of LNs in the donor site. Unknown accuracy of the LN counting method has thrown some doubts on the reliability of the previous statistics. This study aimed to assess the accuracy of naked eye (NK) and stereo microscopy (SM) as tools for LN count.Methods:In total, 40 vascularized submental LN flaps were harvested from 23 fresh cadavers. The colored polymer was injected into the external carotid arteries before the harvest. LNs in each flap were counted by NK, SM, and histology in sequential order.Results:An estimated 175 LNs were confirmed, 4.4 ± 1.8 per flap. NK sensitivity was 33.7% compared with that of SM at 63.5%. Both methods missed all micro-lymph nodes (micro-LNs), contributing to 5.1% (9 nodes) of all LNs. Non-LN structures (647 negative counts) were composed of fat lobules, salivary gland lobules, and muscle fibers. NK specificity was 98.0%, compared with that of SM at 96.1%. SM showed a higher false positive rate at 14.3%, compared with NK at 7.4%. False positive counts were located mostly in Ib sublevel.Conclusions:NK and SM are imperfect tools for LN count due to poor sensitivity. If the method needs to be applied, points of considerations are (1) undetectable micro-LNs, (2) interposition of LNs with the digastric muscle and submandibular salivary gland, (3) confusion of LNs with lobules of salivary gland supplied by glandular artery or fat lobules supplied by lobular artery.
The Impact of the COVID-19 Pandemic on Plastic Surgery Consultations in the Emergency Department
Authors: Paiva Marcelo , Rao Vinay , Spake Carole S.L. , King Victor A. , Crozier Joseph W. , Liu Paul Y. , Woo Albert S. , Schmidt Scott T. , Kalliainen Loree K. 
Published: January 2021

Background:
Stay-at-Home (SAH) orders implemented in the United States to combat COVID-19 had a significant impact on health care delivery for patients with all conditions. In this study, we examined the effect SAH orders had on the Emergency Department (ED) consultation volume, injury patterns, and treatment of patients managed by our plastic surgery service.

Methods:
In Rhode Island, SAH orders were instituted from March 28, 2020, to June 30, 2020. A retrospective chart review of patients presenting to our Level-1 academic medical center was performed. Patient demographics, types of injuries, and need for treatment in the ED or operating room (OR) were collected. Tests of significance were conducted using a comparison group spanning the same time period, in 2019.

Results:
There was a 36% decrease in ED consultations to plastic surgery during SAH orders when compared with those in 2019. No observed differences were noted in patient demographics between time periods. There were significant increases in the proportions of hand injuries secondary to power tools and facial injuries secondary to falls. No observed differences were identified in injury severity and need for either operating-room interventions or ED interventions for patients seen in consultation during SAH orders.

Conclusions:
SAH orders resulted in a decreased volume of plastic surgery consults in the ED but did not alter patient demographics, injury severity, or need for procedural interventions. There was a 2.9% positivity rate for COVID-19 for asymptomatic patients presenting in the ED with primary hand and facial injuries.
EIGHTEEN-MONTH RESULTS OF INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR ON VISION AND MICROCIRCULATION IN RADIATION MACULOPATHY
Authors: Eandi Chiara M. , Polito Maria S. , Schalenbourg Ann , Zografos Leonidas 
Published: January 2021

Purpose:
To evaluate 18 months' results of a strict anti–vascular endothelial growth factor protocol for radiation maculopathy following proton therapy in choroidal melanoma.

Methods:
Retrospective, comparative, nonrandomized study of 74 radiation maculopathy patients presenting macular lipid deposits, hemorrhages, microaneurysms, cystoid edema, nerve layer infarction, telangiectasia, or capillary nonperfusion. The study group included 52 consecutive patients injected with intravitreal anti–vascular endothelial growth factors (bevacizumab/ranibizumab: 46/6) every two months for the first and every 3 months for the second year, with minimum 12 months' follow-up. The control group consisted of 22 patients having declined this treatment. Best-corrected visual acuity, spectral domain-optical coherence tomography and optical coherence tomography angiography were recorded at baseline, 6, 12, and 18 months. The foveal avascular zone and capillary density were measured at the superficial capillary plexus.

Results:
Radiation maculopathy was diagnosed at 2 years (1.5–3.5) after proton therapy. Best-corrected visual acuity at baseline, 12 and 18 months improved in the study group from 0.45, 0.3 to 0.2 logarithm of the minimum angle of resolution, but decreased in the control group from 0.5, 0.9 to 1.0 logarithm of the minimum angle of resolution respectively (P < 0.001 at 12 months). Simultaneously, foveal avascular zone enlargement was less in the study (from 0.377, 0.665 to 0.744 mm2) than control group (from 0.436, 1.463 to 2.638 mm2) (P = 0.05 at 12 months). CMT (280 and 276 µm) and capillary density (37% and 38%, at baseline, respectively) did not evolve significantly different.

Conclusion:
Intravitreal anti–vascular endothelial growth factors, every 2 months for the first and every 3 months for the second year, slow down, over up to 18 months, vision loss and anatomical degradation in radiation maculopathy following proton therapy for choroidal melanoma.
Biomarker-guided management of acute kidney injury
Authors: Kane-Gill Sandra L. , Meersch Melanie , Bell Max 
Published: January 2021

Purpose of review
The current narrative review discusses practical applications of stress and damage biomarkers for the management of acute kidney injury (AKI) based on clinical trials and real-world evaluations.

Recent findings
In 2013 with the discovery and validation study of biomarkers for AKI (Sapphire) advancement in care was provided allowing for the early identification of patients at high risk for developing AKI. It was the combination of new biomarkers and the Kidney Disease Improving Global Outcomes (KDIGO) guidelines for managing patients with AKI that provided an opportunity to improve patient care. In 2017, the PrevAKI study implemented KDIGO guideline management in high-risk patients identified by biomarkers followed in 2018 with the BigPAK study that used a similar approach, both of which demonstrated positive outcomes in patient care. Next, real-world evaluations followed supporting biomarker guided management of AKI in clinical practice. Also, proposals for better nephrotoxin management, a major modifiable exposure to prevent AKI, were provided with the foresight in identifying high-risk patients.

Summary
Stress and damage biomarker-based approaches to patient care seem to be promising for identifying patients at high risk for developing AKI and thus offers an opportunity for early management to prevent and ameliorate AKI and drug-associated AKI.
Prognostic significance of inflammation-based score in patients with hepatocellular carcinoma after liver transplantation
Authors: Kong Weihao , Qu Enze , Sheng Nan , Zhang Jianfeng , Li Xutong , Zheng Jun , Gao Yufeng 
Published: January 2021

Background
Recent studies have revealed that combining of the platelet to lymphocyte ratio (PLR) and the neutrophil to lymphocyte ratio (NLR) [(combination of neutrophil–lymphocyte ratio and platelet–lymphocyte ratio (CNP)] links with dismal prognosis in diverse cancers. Here, we elucidated the prognostic significance of CNP, acting as a novel inflammation-based score, for predicting the survival of hepatocellular carcinoma (HCC) patients following liver transplantation.

Method
We retrospectively recruited 100 patients with HCC who met the Hangzhou criteria for liver transplantation. The Kaplan–Meier approach, univariate, and multivariate assessments were employed to examine prognostic factors. We determined the optimal cutoff values for NLR, PLR, and haematological parameters using the receiver operating characteristic (ROC) curve evaluation. On the basis of the ROC curve, the optimal cutoff values for PLR and NLR were 3.4 and 114.6, discretely. Patients with increased NLR (>3.4) and high PLR (>114.6) scored 2, while one or none scored 1 or 0, respectively.

Results
Distinct differences were reported between CNP and Fibrinogen (P = 0.002), White blood cell (P = 0.048), NLR (P < 0.001), and PLR (P < 0.001). Based on the findings of Kaplan–Meier assessments, the CNP score linked to dismal overall survival (OS; P < 0.0001), as well as recurrence-free survival (RFS; P < 0.0001) in HCC patients after liver transplantation. Furthermore, multivariate assessments indicated that the CNP score was an independent prediction factor for OS (P = 0.002) and RFS (P < 0.001) in HCC patients after liver transplantation.

Conclusion
The CNP score can be considered as an effective predictor of survival events in HCC patients after liver transplantation.
Benign Pseudoglandular Mesothelial Cell Inclusions in Cervical Lymph Nodes of a Patient With Multiple Malignancies: Case Report and Review of Literature
Authors: Stefanko Daniel P. , Lin Grace Y. , Orosco Ryan K. , Vavinskaya Vera 
Published: January 2021

Abstract
Mesothelial cell inclusions in cervical lymph nodes are of exceedingly rare occurrence and can be mistaken for metastatic adenocarcinoma. We report the case of a 27-year-old woman with a history of chronic myelogenous leukemia, diagnosed at age 5 years, and a recent diagnosis of alveolar soft part sarcoma of the left parotid gland. The patient underwent a left parotidectomy and neck dissection with intraoperative finding of abnormal lymph nodes in levels II to V. Histological examination revealed clusters of bland cells with pseudoglandular formation in 6 of 14 level IV/V lymph nodes. Immunological stains were consistent with mesothelial origin, and the diagnosis of benign mesothelial cell inclusions was made. Recognition of this entity in the evaluation of lymph nodes is important to prevent misdiagnosis of metastatic disease, particularly in a patient with multiple known malignancies.
A Guide to Differentiating Thrombotic Microangiopathies Through a Case of Catastrophic Antiphospholipid Syndrome
Authors: Hardy Naomi , Stashek Kristen 
Published: January 2021

Abstract
Thrombotic microangiopathies are rare life-threatening diseases that require prompt diagnosis and treatment to increase patient survival. The prototypical thrombotic microangiopathies are classic hemolytic-uremic syndrome, caused by enterohemorrhagic Escherichia coli, and thrombotic thrombocytopenic purpura. Included in the differential diagnoses and showing overlapping clinical features is antiphospholipid syndrome (APS) and the more severe form, catastrophic APS. Here, we discuss the general approach to thrombotic microangiopathies through a case of APS that later developed into its catastrophic variant.
Poorly Controlled Pediatric Fracture Pain Requiring Unplanned Medical Assistance or Advice
Authors: Kopp Tara M. , Frey Theresa M. , Zakrajsek Mark , Nystrom Jennifer , Koutsounadis Gena N. , Falcone Kelly S. , Zhang Yin , Wall Eric , Byczkowski Terri , Mittiga Matthew R. 
Published: January 2021

ObjectivesThis study aimed to define the proportion of children who seek assistance for poorly controlled fracture pain, identify factors associated with requesting help, and explore caregivers' opioid preferences.MethodsWe enrolled 251 children and their caregivers in the orthopedic surgery clinic of a tertiary care children’s hospital. Children 5 to 17 years old presenting within 10 days of injury for follow-up for a single-extremity, nonoperative long bone fracture(s) were eligible. The primary outcome was seeking unscheduled evaluation or advice for poorly controlled pain before the first routine follow-up appointment by telephone call, medical visit, or rescheduling to an earlier appointment. Factors associated with the outcome were assessed using bivariable analysis.ResultsOverall, 7.3% (95% confidence interval, 4.1%–10.6%) of participants sought unscheduled evaluation or advice for poorly controlled pain. The 2 most common reasons were to obtain over-the-counter analgesic dosage information (64.7%) and a stronger analgesic (29.4%). These children were more likely to have a leg fracture, have an overriding or translated fracture, or require manual reduction under procedural sedation. These children had higher Patient-Reported Outcomes Measurement Information System Pain Behavior and Pain Interference scores and more anxious caregivers. One-third of caregivers expressed hesitancy or refusal to use opioids to treat severe pain, and 45.7% reported potential addiction or abuse as the rationale.ConclusionsA notable proportion of children seek assistance for poorly controlled fracture-related pain. Medical providers should target discharge instructions to the identified risk factors and engage caregivers in shared decision making if opioids are recommended.
Did COVID-19 Affect Time to Presentation in the Setting of Pediatric Testicular Torsion?
Authors: Littman Annalise R. , Janssen Karmon M. , Tong Li , Wu Hang , Wang May D. , Blum Emily , Kirsch Andrew J. 
Published: January 2021

Objectives
To determine if boys with acute testicular torsion, a surgical emergency requiring prompt diagnosis and treatment to optimize salvage of the testicle, delayed presentation to a medical facility and experienced an extended duration of symptoms (DoS), and secondarily, a higher rate of orchiectomy, during the coronavirus disease 2019 (COVID-19) pandemic.

Methods
Single-center, descriptive retrospective chart review of boys presenting with acute testicular torsion from March 15, to May 4, 2020 (“during COVID-19” or group 2), as well as for the same time window in the 5-year period from 2015 to 2019 (“pre–COVID-19” or group 1).

Results
A total of 78 boys met inclusion criteria, group 1 (n = 57) and group 2 (n = 21). The mean age was 12.86 ± 2.63 (group 1) and 12.86 ± 2.13 (group 2). Mean DoS before presentation at a medical facility was 23.2 ± 35.0 hours in group 1 compared with 21.3 ± 29.7 hours in group 2 (P < 0.37). When DoS was broken down into acute (<24 hours) versus delayed (≥24 hours), 41 (71.9%) of 57 boys in group 1 and 16 (76.2%) of 21 boys in group 2 presented within less than 24 hours of symptom onset (P < 0.78). There was no difference in rate of orchiectomy between group 1 and group 2 (44.7% vs 25%, P < 0.17), respectively.

Conclusions
Boys with acute testicular torsion in our catchment area did not delay presentation to a medical facility from March 15, to May 4, 2020, and did not subsequently undergo a higher rate of orchiectomy.
Motor Unit Number Index in Evaluating Patients With Lumbar Spinal Stenosis
Authors: Cai Haibi , Kroll Mitchell , Annaswamy Thiru 
Published: January 2021

Objective
Motor unit number index is a quantitative electrophysiological measure that provides an index of the number of motor neurons supplying a muscle. The aim of this exploratory study was to assess the utility of motor unit number index in the evaluation of patients with lumbar spinal stenosis.

Design
Participants were assigned to three groups: clinical and radiological lumbar stenosis (lumbar spinal stenosis with neurogenic intermittent claudication), group A; radiological lumbar spinal stenosis without neurogenic intermittent claudication, group B; and a control group, group C. Patients self-rated their pain and functional disability using the numerical rating scale and a series of functional questionnaires. An electromyographer performed nerve conduction tests, electromyography, and motor unit number index testing.

Results
Seventeen patients completed the study. There were 9, 5, and 3 patients in groups A, B, and C, respectively. There were no discernable differences in motor unit number index values of any individual muscle or combined motor unit number index score between the three groups. Motor unit number index values did not correlate to pain/functional measures.

Conclusions
In this exploratory study, motor unit number index did not demonstrate discriminatory ability between patients with lumbar spinal stenosis and was not correlated with pain and functional measures. Further study is needed to explore motor unit number index’s role in longitudinal evaluation of patients with the clinical syndrome of lumbar spinal stenosis.
Absorbable Versus Non-Absorbable Sutures in Open Rhinoplasty: Analysis of Columellar Scarring
Authors: Bozan Aykut , Dizdar Denizhan 
Published: January 2021

Introduction:
Open rhinoplasty involving columellar incision has gained popularity since the 1930s. Many surgical incision techniques have been employed to obtain better results in terms of postoperative scarring. This study evaluated and compared the results of absorbable and non-absorbable sutures used in open technique rhinoplasty, assessed scar properties regardless of the techniques used, from the perspectives of patients and surgeons.

Objective:
This study evaluated and compared the results of absorbable and nonabsorbable sutures used in open technique rhinoplasty from the perspectives of patients and surgeons.

Material and Methods:
Study population included 70 patients who underwent primary open rhinoplasty between 2013 and 2018. Rhinoplasty Operations were performed in 2 different centers by a total of 2 rhinoplasty surgeons. Both surgeons used suture materials, which can be used for columellar closure, regardless of patients’ skin characteristics. Columellar scars were assessed at an outpatient clinic at least 6 months postoperatively. Patients who could not come to the clinic were excluded from the study. Columellar Scars were assessed using the Turkish Patient Observer Scar Assessment Questionnaire. Patients were also asked to complete a Scar Assessment Analysis Questionnaire at the outpatient clinic, and were photographed from the front, basal, and right and left oblique sides. Three surgeons, who were not part of the research team but routinely performed rhinoplasty, completed the Observer Scar Assessment Questionnaire by examining patients in person at the clinic as well as their photographs.

Results:
Observer Scar Assessment Questionnaire results; for the Vicryl group, surgeons ranked pigmentation of the scar as the best criterion (3.34 ± 0.97) and irregularity of the scar as the worst (3.82 ± 1.01). For the Prolene group, surgeons ranked irregularity as the best criterion (3.30 ± 0.97) and stiffness as the worst (3.54 ± 0.94). Although there was no statistically significant result between the two groups in the criteria, the mean scores of the Prolene group were less than the Vicryl group. (3.36 ± 0.46, 3.50 ± 0.65 respectively).
Scar Assessment Analysis Questionnaire Results; patients in both the Vicryl and Prolene groups ranked pain as the least important factor (mean 2.9 ± 1.11 and 3.33 ± 1.35, respectively). The Prolene group scored lower than the Vcryl group in terms of overall scarring (3.49 ± 0.72, 3.66 ± 1.37, respectively, P > 0,05).

Conclusions:
Absorbable sutures are a convenient alternative to nonabsorbable sutures

Level IV:
Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
An Investigation of Three-Dimensional Maxillary Arch Morphometry of Children With Unilateral Cleft Lip and Palate
Authors: Haque Sanjida , Khamis Mohd Fadhli , Alam Mohammad Khursheed , Ahmad Wan Muhamad Amir Wan 
Published: January 2021

AbstractThe aim of this study was to evaluate the effects of multiple factors (congenital and postnatal treatment factors) on the treatment outcome by assessing the maxillary arch dimension of children with unilateral cleft lip and palate (UCLP). Eighty-five Pakistani children with UCLP were taken who received cheiloplasty and palatoplasty. Laser scanned 3D digital models of UCLP subjects were prepared before any orthodontic treatment and bone grafting at 7.69 ± 2.46 (mean ± standard deviation) years of age. Inter-canine width (ICW), inter-molar width (IMW), and arch depth (AD) measurements of maxillary arch were measured with Mimics software. Multiple linear regression analyses were used to evaluate the association between congenital factors (age, gender, UCLP side, family history of cleft) and postnatal treatment factors (techniques of cheiloplasty and techniques of palatoplasty) with maxillary arch dimensions (ICW, IMW, and AD).Pvalue was set at 5%. The mean (standard deviation) dimensions of ICW, IMW, and AD are 26.7 (5.70) mm, 43.3 (4.66) mm, and 27.1 (5.26) mm, respectively. There is no significant association found between multiple factors and maxillary arch dimensions. This regression analysis shows no significant association between multiple factors and MAD in this sample.
Versatile Approach to Septonasal Deformity: Skyscraper Construction Based on an Old Relic
Authors: Anlatici Recep , Demiralay Sarp , Ozerdem Omer R. 
Published: January 2021

Introduction:
Severely deformed noses usually harbor a combination of both bony pyramid and septal deformities. In this retrospective study, the authors aimed to evaluate our results of repair in patients with severe nasal deformities and importance of a versatile approach in these cases.

Materials and Methods:
A total of 32 cases with congenital or acquired (traumas or surgeries) severe nasal deformity were included in this retrospective study. Gender, age, etiology, reconstruction methods, complications, and results were recorded. Preoperative and postoperative pictures were compared; additionally, patients’ reviews on the esthetic and functional outcomes were noted. Open approach, weak L-strut template preparation attached to a strong keystone skeleton and reconstruction with a stable L- or T-strut on this template were carried out in all cases. In addition, glabellar flaps were used in 2 cases to restore the contracted skin envelope and wide-angle L-shape cartilage grafts in 7 cases for extensive alar cartilage reconstruction.

Results:
Favorable esthetic and functional results were obtained in most of the patients. The postoperative problems were recorded as intranasal synechiae; costochondral graft displacement; residual external deviation; nostril asymmetry; residual alar, columellar and tip problems; and prolonged edema.

Conclusions:
Sufficient sizes and amounts of skin, mucosa, cartilage, and bone tissue must be available to plan versatile repair using flaps and grafts according to the needs of each patient. Preserved stability of the keylock area is substantial. The authors advocate construction of a new structure based on the native weakened skeleton free from the extrinsic and intrinsic forces is an effective method.

EBM LEVEL 4