bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three-Dimensional Anatomy of the Palatopharyngeus and Its Relation to the Levator Veli Palatini Based on Micro–Computed Tomography
Authors: Di Wu , Zhao Jiuli , Ma Hengyuan , Song Tao , Wang Yongqian , Yin Ningbei 
Published: August 2021

Background:
Although multiple studies have been reported on the palatopharyngeus and levator veli palatini, their subtle anatomy and functions remain unclear. The authors elucidated the relationship between these muscles and their functional implications based on three-dimensional digital techniques.

Methods:
Cadaveric specimens were stained with iodine–potassium iodide and scanned using micro–computed tomography. The muscle fibers were drawn on the exported Imaging and Communications in Medicine images to reconstruct a three-dimensional model and further simplified.

Results:
In the soft palate, the palatopharyngeus was divided into three bundles. The largest inferior head was found to attach to the palatine aponeurosis, soft palate, and the hard palate on the oral side, which occupied approximately the anterior 28.4 to 36.2 percent of the soft palate in the midline. The superior head was thin and attached to the palatine aponeurosis and the surrounding mucosa on the nasal side. The posterior head was located posterior to the levator veli palatini with fibers attaching to the levator veli palatini and the median portion of the uvula. The levator veli palatini was clasped by the three heads of the palatopharyngeus. The fasciculi of the palatopharyngeus converged into a bundle of muscles at the pharynx and inserted into the lateral and posterior pharyngeal wall.

Conclusions:
The palatopharyngeus is the largest muscle that connects the soft palate and pharyngeal wall; it closely coordinates with the levator veli palatini to control levator veli palatini overlifting, narrow the velopharyngeal port with the help of the superior constrictor, and elevate the pharynx. The palatopharyngeus and levator veli palatini help each other in velopharyngeal closure through coordination from other muscles.
Short- and Long-Term Outcomes following Severe Traumatic Lower Extremity Reconstruction: The Value of an Orthoplastic Limb Salvage Center to Racially Underserved Communities
Authors: Naga Hani I. , Azoury Saïd C. , Othman Sammy , Couto Javier A. , Mehta Samir , Levin L. Scott , Butler Paris D. , Kovach Stephen J. 
Published: August 2021

Background:
Previous studies have demonstrated that nonwhite race and disadvantaged socioeconomic status negatively impact outcomes following lower extremity reconstruction. The authors sought to characterize differences in outcomes between racial groups in patients necessitating traumatic lower extremity reconstruction at an orthoplastic limb salvage center.

Methods:
A retrospective review between 2002 and 2019 was conducted of patients who underwent free flap lower extremity reconstruction at an orthoplastic limb salvage center. Patient demographics were identified, and permanent addresses were used to collect census data. Short-term complications and long-term functional status were recorded.

Results:
One hundred seventy-three patients underwent lower extremity reconstruction and met inclusion criteria. Among all three groups, African American patients were more likely to be single (80 percent African American versus 49 percent Caucasian and 29.4 percent other; p < 0.05) and had significantly lower rates of private insurance compared with Caucasian patients (25 percent versus 56.7 percent; p < 0.05). African American patients demonstrated no significant differences in total flap failure (4.9 percent versus 8 percent and 5.6 percent; p = 0.794), reoperations (10 percent versus 5.8 percent and 16.7 percent; p = 0.259), and number of readmissions (2.4 versus 2.0 and 2.1; p = 0.624). Chronic pain management (53.3 percent versus 44.2 percent and 50 percent; p = 0.82), full weight-bearing status (84.2 percent versus 92.7 percent and 100 percent; p = 0.507), and ambulation status (92.7 percent versus 100 percent and 100 percent; p = 0.352) were similar among groups.

Conclusions:
Outcomes are equivalent between racial groups presenting to an orthoplastic limb salvage center for lower extremity reconstruction. The postoperative rehabilitation strategies, follow-up, and overall support that an orthoplastic limb salvage center ensures may lessen the impact of socioeconomic disparities in traumatic lower extremity reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
The Effects of the COVID-19 Pandemic on Resident Education and Wellness: A National Survey of Plastic Surgery Residents
Authors: Crowe Christopher S. , Lopez Joseph , Morrison Shane D. , Drolet Brian C. , Janis Jeffrey E. ,   On behalf of the Resident Council Wellness and Education Study Group
Published: August 2021

Background:
The coronavirus disease of 2019 (COVID-19) pandemic has had a profound effect on surgical training programs, reflecting decreases in elective surgical cases and emergency restructuring of clinical teams. The effect of these measures on U.S. plastic surgery resident education and wellness has not been characterized.

Methods:
An institutional review board–exempted anonymous survey was developed through expert panel discussion and pilot testing. All current U.S. plastic surgery trainees were invited to complete a cross-sectional 28-question survey in April of 2020. Respondents were queried regarding demographic information, educational experiences, and wellness during the COVID-19 pandemic.

Results:
A total of 668 residents responded to the survey, corresponding to a 56.1 percent response rate. Sex, training program type, postgraduate year, and region were well represented within the sample. Nearly all trainees (97.1 percent) reported restructuring of their clinical teams. One-sixth of respondents were personally redeployed to assist with the care of COVID-19 patients. A considerable proportion of residents felt that the COVID-19 pandemic had a negative impact on their education (58.1 percent) and wellness (84.8 percent). Residents found virtual curriculum effective and meaningful, and viewed an average of 4.2 lectures weekly. Although most residents did not anticipate a change in career path, some reported negative consequences on job prospects or fellowship.

Conclusions:
The COVID-19 pandemic had a considerable impact on U.S. plastic surgery education and wellness. Although reductions in case volume may be temporary, this may represent a loss of critical, supervised clinical experience. Some effects may be positive, such as the development of impactful virtual lectures that allow for cross-institutional curriculum.
Long-Term Effectiveness of Ear Molding in Infants Using the EarWell Infant Correction System in China
Authors: Zhong Zhen , Zhang Junbo , Xiao Shuifang , Liu Yuhe , Zhang Yanmei 
Published: August 2021

Background:
Ear molding is a safe and effective way to treat babies born with ear deformities. In this study, the authors explored the long-term effectiveness of ear molding and determined the factors that relate to recurrence.

Methods:
A retrospective review of 200 consecutive infants treated with the EarWell System from March of 2018 to August of 2019 was performed. Immediate and long-term effectiveness was evaluated and compared.

Results:
A total of 190 children (314 ears) were included. The mean age at presentation was 16.2 days (range, 0 to 100 days). The most common deformity was constricted ear [172 ears (54.8 percent)], and the rarest deformity was cryptotia [four ears (1.3 percent)]. At the completion of treatment, 10 constricted ears were evaluated to be unsuccessful. The immediate success rates of mild and severe constricted ears were 95.7 percent and 93.1 percent, respectively. The average long-term follow-up was 336 days (range, 180 to 660 days) after completion of treatment. Twenty-two ears (7.2 percent) reverted to their original shape. The long-term success rates of severe constricted ears and prominent ears decreased most significantly, 83.3 percent (p = 0.030) and 66.7 percent (p = 0.042), respectively. Family history led to a decrease of long-term effectiveness of prominent ears. Age at application, sex, duration of molding, and retention taping were not correlated to the long-term outcome.

Conclusions:
Long-term follow-up demonstrated that in a percentage of babies, the ear deformities did recur after an initially successful treatment. Severe constricted ears and prominent ears are most likely to relapse.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Comparing Outcomes of Wise-Pattern, Two-Stage Breast Reduction-Reconstruction with and without Acellular Dermal Matrix
Authors: Patel Ashraf A. , Kayaleh Hana , Sala Luke A. , Peterson Dylan J. , Upadhyaya Prashant K. 
Published: August 2021

Background:
Aesthetic results in breast reconstruction for ptotic/obese breasts may be improved when using Wise-pattern closures compared with nipple-sparing mastectomies. In two-stage reconstruction, acellular dermal matrix is commonly used to support the prosthesis. This study tests the efficacy of an alternate technique that uses deepithelialized excess breast skin in lieu of acellular dermal matrix. To better understand whether acellular dermal matrix is necessary, the authors compared postoperative outcomes from reduction-reconstructions that used matrix to those that did not.

Methods:
The authors retrospectively reviewed the outcomes of patients who underwent staged breast reconstruction following Wise-pattern closures between September of 2016 and October of 2019. Two cohorts were created based on whether acellular dermal matrix was used. Charts were reviewed for incidence of postoperative complications.

Results:
A total of 164 breasts were reconstructed in 85 female patients. The acellular dermal matrix cohort consisted of 68 breasts, whereas the non–acellular dermal matrix cohort included 96 breasts. After the first stage, the incidence of one or more complications was similar between cohorts (acellular dermal matrix, 32.4 percent; nonmatrix, 35.4 percent; p = 0.684). Minor infection rates were significantly higher in reconstructions using acellular dermal matrix (16.2 percent versus 6.3 percent; p = 0.040). After the second stage, the complication incidence was also similar between cohorts (acellular dermal matrix, 16.2 percent; nonmatrix, 13.5 percent; p = 0.638). Final follow-up time was 445.2 days.

Conclusions:
Overall complication rates following both stages of reconstruction were similar with and without acellular dermal matrix. When acellular dermal matrix was used, minor infection rates were higher following expander placement. In patients desiring a reduction-reconstruction, the authors find the deepithelialized dermal flap provides ample prosthesis support, without the need for acellular dermal matrix.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Neurotization Preferences in Smile Reanimation: A Discrete Choice Experiment
Authors: Dusseldorp Joseph R. , Naunheim Matthew R. , Quatela Olivia , Fortier Emily , Hadlock Tessa A. , Jowett Nate 
Published: August 2021

Background:
Common donor nerve options in smile reanimation include ipsilateral trigeminal motor or contralateral facial nerve branches. Neurotization preference may be influenced by multiple factors, whose relative importance remains poorly understood. In this article, decision-making in smile reanimation is assessed using a stated preference model.

Methods:
Qualitative interviews with facial palsy patients identified five relevant attributes for study: smile type (“smile when biting” versus “smile spontaneously” as proxies for trigeminal versus cross-facial neurotization), number of operations, success rates, complication rates, and side effects. Community volunteers (n = 250) completed a discrete-choice experiment relevant to free muscle transfer for smile reanimation. Preoperative and postoperative states were demonstrated through video vignettes, together with explanation of surgical risks, consequences, and benefits. Attribute importance was modeled using hierarchical Bayes estimation.

Results:
Two hundred forty-one responses met quality controls. Attribute importance ranked as follows: chance of success, 37.3 percent; smile type, 21.4 percent; side effects, 13.9 percent; complication rates, 13.8; and number of operations, 13.6 percent. All attributes significantly correlated with decision making (p < 0.0001). An aggregate response model revealed most participants (67.6 percent; standard error, 3.0 percent) preferred smile reanimation by cross-facial (assuming a success rate of 80 percent) as opposed to ipsilateral trigeminal motor branch neurotization. When the success rate for cross-facial neurotization was reduced below 67 percent, trigeminal neurotization was preferred.

Conclusions:
Despite a higher risk of failure, most respondents preferred a cross-facial as opposed to trigeminal neurotization strategy for smile reanimation. These findings highlight the complexity of decision-making and need for individualized risk tolerance assessment in the field of facial reanimation.
Resident Selection: The Role of Assessment of Emotional Intelligence and Grit
Authors: Luce Edward A. 
Published: August 2021

Summary:
The ability of our resident selection process to identify individuals who will ultimately become competent plastic surgeons is crucial to the specialty’s future. Current criteria in use are not productive of that outcome. The presence of emotional intelligence and the element of grit have been incorporated in business and the military as factors to be evaluated in potential candidates. Plastic surgery should initiate an investigation of inclusion of a similar assessment of resident applicants.
Sexually transmitted infections and depot medroxyprogesterone acetate do not impact protection from simian HIV acquisition by long-acting cabotegravir in macaques
Authors: Vishwanathan Sundaram Ajay , Zhao Chunxia , Luthra Roopa , Khalil George K. , Morris Monica M. , Dinh Chuong , Gary Michelle J. , Mitchell James , Spreen William R. , Pereira Lara E. , Heneine Walid , García-Lerma J. Gerardo , McNicholl Janet M. 
Published: August 2021

Objective:
We had previously shown that long-acting cabotegravir (CAB-LA) injections fully protected macaques from vaginal simian HIV (SHIV) infection. Here, we reassessed CAB-LA efficacy in the presence of depot medroxyprogesterone acetate and multiple sexually transmitted infections (STIs) that are known to increase HIV susceptibility in women.

Design:
Two macaque models of increasing vaginal STI severity were used for efficacy assessment.

Methods:
The first study (n = 11) used a double STI model that had repeated exposures to two vaginal STI, Chlamydia trachomatis and Trichomonas vaginalis. Six animals were CAB-LA treated and five were controls. The second study (n = 9) included a triple STI model with repeated exposures to C. trachomatis, T. vaginalis and syphilis, and the contraceptive, depot medroxyprogesterone acetate (DMPA). Six animals were CAB-LA treated and three were controls. All animals received up to 14 vaginal SHIV challenges. A survival analysis was performed to compare the number of SHIV challenges to infection in the drug-treated group compared with untreated controls over time.

Results:
All six CAB-LA treated animals in both models, the double STI or the triple STI-DMPA model, remained protected after 14 SHIV vaginal challenges, while the untreated animals became SHIV-infected after a median of two challenges (log-rank P < 0.001) or one challenge (log-rank P = 0.002), respectively. Both models recapitulated human STI disease, with vaginal discharge, ulcers, and seroconversion.

Conclusion:
In these high and sustained susceptibility models spanning more than 3 months, CAB-LA maintained complete efficacy, demonstrating robustness of the CAB-LA dose used in clinical trials, and suggesting its insensitivity to multiple STIs and DMPA.
Irradiation of the Subventricular Zone and Subgranular Zone: an Atlas-based analysis on Overall Survival in High- and Low-Grade Glioma Patients
Authors: Bruil Danique E. , David Szabolcs , Nagtegaal Steven H.J , de Sonnaville Sophia F.A.M , Verhoeff Joost J.C. 
Published: August 2021

AbstractBackgroundNeural stem cells in the subventricular- (SVZ) and subgranular zone (SGZ) are hypothesized to support growth of glioma. Therefore, irradiation of the SVZ and SGZ might reduce tumor growth and might improve overall survival (OS). However, it may also inhibit the repair capacity of brain tissue. The aim of this retrospective cohort study is to assess the impact of SVZ and SGZ radiotherapy doses on OS of patients with high-grade (HGG) or low-grade (LGG) glioma.MethodsWe included 273 glioma patients who received radiotherapy. We created an SVZ atlas, shared openly with this work, while SGZ labels were taken from the CoBRA atlas. Next, SVZ and SGZ regions were automatically delineated on T1 MR-images. Dose and OS correlations were investigated with Cox regression and Kaplan-Meier analysis.ResultsCox regression analyses showed significant hazard ratios for SVZ dose (univariate: 1.029/Gy,p<0.001; multivariate: 1.103/Gy,p= 0.002) and SGZ dose (univariate: 1.023/Gy,p<0.001; multivariate: 1.055/Gy,p<0.001) in HGG patients. Kaplan-Meier analysis showed significant correlations between OS and high/low dose groups for HGG patients (SVZ: respectively 10.7 months (>30.33 Gy) vs 14.0 months (<30.33 Gy) median OS,p= 0.011; SGZ: respectively 10.7 months (>29.11 Gy) vs 15.5 months (<29.11 Gy) median OS,p<0.001). No correlations between dose and OS were not found for LGG patients.ConclusionIrradiation doses on neurogenic areas correlate negatively with OS in patients with HGG. Whether sparing of the SVZ and SGZ during radiotherapy improves OS, should be subject of prospective studies.Key PointsNeural stem cells in the SVZ and SGZ are hypothesized to support growth of glioma.Higher radiation doses on the SVZ and SGZ correlate with lower OS in HGG patients.Avoidance of neurogenic niches should be considered to improve OS of HGG patients.Importance of StudySurvival rates and quality of life of patients with glioma are still suboptimal, therefore improvement of radiation treatment planning and delivery is required. The SVZ and SGZ of the adult human brain are a source of brain tissue repair but may also be the source of glioma growth enhancement. By investigating the effects of radiotherapy on SVZ and SGZ, we gain insight into associations between tumor progression and survival. We included 273 adult patients with high- and low- grade glioma who received radiation treatment. We found that irradiation doses on neurogenic areas correlate with lower OS in patients with HGG. Avoidance of SVZ and SGZ should be considered to improve OS. These study results will contribute to optimization of brain tumor radiotherapy, focused on increasing OS. In order to facilitate future research into the role of the SVZ, we also provide stereotaxic standard space atlas labels for SVZ and SGZ.
Reduction in initiations of HIV treatment in South Africa during the COVID pandemic
Authors: Benade Mariet , Long Lawrence , Rosen Sydney , Meyer-Rath Gesine , Tucker Jeanne-Marie , Miot Jacqui 
Published: August 2021

AbstractBackgroundIn response to the global pandemic of COVID-19, countries around the world began imposing stay-at-home orders, restrictions on transport, and closures of businesses in early 2020. South Africa implemented a strict lockdown in March 2020 before its first COVID-19 wave started, gradually lifted restrictions between May and September 2020, and then re-imposed restrictions in December 2020 in response to its second wave. There is concern that COVID-19-related morbidity and mortality, fear of transmission, and government responses may have led to a reduction in antiretroviral treatment (ART) initiations for HIV-infected individuals in countries like South Africa.MethodsWe analyzed national, public sector, facility-level data from South Africa’s District Health Information System (DHIS) from January 2019 to March 2021 to quantify changes in ART initiation rates stratified by province, setting, facility size and type and compared the timing of these changes to COVID-19 case numbers and government lockdown levels. We excluded facilities with missing data, mobile clinics, and correctional facilities. We estimated the total number of ART initiations per study month for each stratum and compared monthly totals, by year.ResultsAt the 2471 facilities in the final data set (59% of all ART sites in the DHIS), 28% fewer initiations occurred in 2020 than in 2019. Numbers of ART initiations declined sharply in all provinces in April-June 2020, compared to the same months in 2019, and remained low for the rest of 2020, with some recovery between COVID-19 waves in October 2020 and possible improvement beginning in March 2021. Percentage reductions were largest in district hospitals, larger facilities, and urban areas. After the initial decline in April-June 2020, most provinces experienced a clear inverse relationship between COVID-19 cases and ART initiations but little relationship between ART initiations and lockdown level.ConclusionsThe COVID-19 pandemic and responses to it resulted in substantial declines in the number of HIV-infected individuals starting treatment in South Africa, with no recovery of numbers during 2020. These delays may lead to worse treatment outcomes for those with HIV and potentially higher HIV transmission. Exceptional effort will be needed to sustain gains in combating HIV.
Predominance of antibody-resistant SARS-CoV-2 variants in vaccine breakthrough cases from the San Francisco Bay Area, California
Authors: Servellita Venice , Sotomayor-Gonzalez Alicia , Gliwa Amelia S. , Torres Erika , Brazer Noah , Zhou Alicia , Hernandez Katherine T. , Sankaran Maddie , Wang Baolin , Wong Daniel , Wang Candace , Zhang Yueyuan , Reyes Kevin R , Glasner Dustin , Deng Xianding , Streithorst Jessica , Miller Steve , Frias Edwin , Rodgers Mary , Cloherty Gavin , Hackett John , Philip Susan , Topper Scott , Sachdev Darpun , Chiu Charles Y. 
Published: August 2021

AbstractAssociations between vaccine breakthrough cases and infection by SARS coronavirus 2 (SARS-CoV-2) variants have remained largely unexplored. Here we analyzed SARS-CoV-2 whole-genome sequences and viral loads from 1,373 persons with COVID-19 from the San Francisco Bay Area from February 1 to June 30, 2021, of which 125 (9.1%) were vaccine breakthrough infections. Fully vaccinated were more likely than unvaccinated persons to be infected by variants carrying mutations associated with decreased antibody neutralization (L452R, L452Q, E484K, and/or F490S) (78% versus 48%, p = 1.96e-08), but not by those associated with increased infectivity only (N501Y) (85% versus 77%, p = 0.092). Differences in viral loads were non-significant between unvaccinated and fully vaccinated persons overall (p = 0.99) and according to lineage (p = 0.09 – 0.78). Viral loads were significantly higher in symptomatic as compared to asymptomatic vaccine breakthrough cases (p < 0.0001), and symptomatic vaccine breakthrough infections had similar viral loads to unvaccinated infections (p = 0.64). In 5 cases with available longitudinal samples for serologic analyses, vaccine breakthrough infections were found to be associated with low or undetectable neutralizing antibody levels attributable to immunocompromised state or infection by an antibody-resistant lineage. Taken together, our results suggest that vaccine breakthrough infecions are overrepresnted by circulating antibody-resistant SARS-CoV-2 variants, and that symptomatic breakthrough infections may potentially transmit COVID-19 as efficiently as unvaccinated infections, regardless of the infecting lineage.