bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Epinephrine Safe for Infant Digit Excision? A Retrospective Review of 402 Polydactyly Excisions in Patients Younger than 6 Months
Authors: Mantilla-Rivas Esperanza , Tan Pamela , Zajac Jocelyn , Tilt Alexandra , Rogers Gary F. , Oh Albert K. 
Published: July 2019

Background:
Conventional dogma suggests that the use of local anesthetic with epinephrine is contraindicated in the digits because of fear of ischemia and necrosis. Although several reports have refuted this notion, the precept is still propagated in many clinical forums. For many years, the authors have used lidocaine with epinephrine to perform removal of postaxial polydactyly in infants and have observed few complications and no cases of digital ischemia or necrosis. This investigation details the authors’ outcomes with this anesthetic modality in neonates and supports the growing body of literature documenting the safety of using lidocaine with epinephrine in the digits.

Methods:
A retrospective review of all infants younger than 6 months who underwent preaxial and postaxial polydactyly excision and removal of their sequelae of the hand or foot under local anesthesia, from 2011 to 2017, was completed. All demographic characteristics, frequency of complications, and descriptive statistics of the sample clinical group were documented.

Results:
In the 215 patients who met inclusion criteria, a total of 402 procedures were performed. Mean follow-up was 19.9 months for 140 patients, or 264 procedures (65.7 percent). The total complication rate was 2.6 percent. There were two cases of minor bleeding, one wound dehiscence, and four surgical-site infections.

Conclusions:
In 402 procedures of surgical excision of polydactyly in infants, there were few short-term complications, none of which were necrosis or any vascular complication related to the use of epinephrine. The authors believe that, with the use of a low-dose epinephrine injection (1:200,000), the risk for digital infarction is low in this population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Ethicists’ Opinions Regarding the Permissibility of Face Transplant
Authors: Suchyta Marissa A , Sharp Richard , Amer Hatem , Bradley Elizabeth , Mardini Samir 
Published: July 2019

Background:
Face transplantation can offer functional and aesthetic restoration to patients who have exhausted their reconstructive options, improving quality of life and psychosocial integration. Ethical issues in face transplantation abound, including questions of patient selection and evaluation before transplantation. To date, there has been no study of ethicists’ opinions regarding face transplantation.

Methods:
An online survey of attendees of the 2015 International Conference on Clinical Ethics Consultation (n = 401) assessed ethicists’ opinions about face transplantation. Questions examined the risk-to-benefit ratio of immunosuppression; permissibility of face transplantation in subpopulations (including children and blind patients); donor-recipient age, sex, and ethnicity mismatches; and ethical oversight.

Results:
Most ethicists (84 percent) agreed that it is permissible to perform a face transplantation on an adult in the absence of clear medical contraindications. Most respondents also agreed that it is permissible to perform a face transplantation on a child (62 percent) or a blind patient (61 percent), yet demonstrated less consensus regarding the permissibility of performing a face transplantation on patients with an increased risk of immune rejection. Respondents were generally supportive of age, sex, and ethnicity mismatches, with 43 percent indicating that it is permissible to have a sex mismatch. The majority answered that face transplantation should be covered by federal insurance (74 percent).

Conclusions:
This study provides insight into clinical ethicists’ views regarding face transplantation. Most ethicists support the ethical permissibility of face transplantation, and did not have concerns about age, sex, and ethnicity mismatches. These findings highlight emerging areas of consensus regarding the ethical permissibility of face transplantation.
Odontogenic Tumors: Imaging-Based Review of the Fourth Edition of World Health Organization Classification
Authors: Abdel Razek Ahmed Abdel Khalek 
Published: July 2019

Abstract
The fourth edition of World Health Organization (2017) classified odontogenic tumors according to the tissue of origin. Epithelial odontogenic tumors include ameloblastomas, calcifying epithelial odontogenic tumors, adenomatoid odontogenic tumors, and squamous odontogenic tumors. Mixed epithelial and mesenchymal odontogenic tumors include odontomas, ameloblastic fibromas, dentigenic ghost cell odontogenic tumors, and primordial odontogenic tumors. Mesenchymal odontogenic tumors include cementoblastomas, cement-ossifying fibromas, odontogenic fibromas, and odontogenic myxomas. Malignant odontogenic tumors are either carcinomas or sarcomas. The imaging appearance of odontogenic tumors varies according to its category. Computed tomography and magnetic resonance imaging play an important role in localization, characterization, and extension of odontogenic tumors to the teeth and surrounding tissue.
Breast Magnetic Resonance Spectroscopy at 3 T in Biopsy-Proven Breast Cancers
Authors: Galati Francesca , Luciani Maria Laura , Caramanico Claudia , Moffa Giuliana , Catalano Carlo , Pediconi Federica 
Published: July 2019

Objectives
The role of functional techniques, such as magnetic resonance spectroscopy (1H-MRS), as noninvasive tools to increase breast MR imaging reliability has been widely investigated during the last 2 decades. Considering the growing interest in tumor biology and its influence on functional parameters, the aim of this study was to investigate the relationship between 1H-MRS parameters and breast cancer biomarkers and to evaluate whether the results of 1H-MRS at 3 T can correlate with established breast cancer prognostic factors in our clinical experience.

Materials and Methods
One hundred two patients with biopsy-proven breast cancer underwent 3 T breast MR imaging. Single-voxel 1H-MRS was performed after the T1-weighted sequence, using a PRESS water-suppressed sequence (BREASE). Data were collected from a single rectangular volume of interest that encompassed the lesion. Magnetic resonance images and spectra of 102 Breast Imaging Reporting and Data System 6 lesions were prospectively evaluated by 2 radiologists in consensus. 1H-MRS results were considered positive if the choline peak signal-to-noise ratio was 2 or higher. 1H-MRS findings were then compared with morphological features and to histological findings, such as lesion size, nuclear grade, Ki-67, hormone receptor status, and Her2 expression.

Results
Elevated levels of total choline were detectable in 68/102 cases (66.67%) and undetectable in 34/102 (33.33%). A statistically significant association between the presence of choline peak and higher tumor grading (P < 0.0001), greater Ki-67 value (P < 0.0001), and larger lesion size (P < 0.0001) was found. No statistically significant associations were observed between choline peak and the luminal subgroups, even if higher levels of choline were more frequent in nonluminal A lesions.

Conclusions
Our study confirms that 3 T breast 1H-MRS can be a valid additional tool to obtain further information about breast cancer biology and to predict tumor aggressiveness, because the detection of elevated levels of total choline in the spectrum is associated with a biologically aggressive breast cancer phenotype (large dimensions, grade 3, high values of Ki-67). Our results need to be validated in standardized larger-scale studies.
Description and Impact of a Comprehensive Multispecialty Multidisciplinary Intervention to Decrease Opioid Prescribing in Surgery
Authors: Kaafarani Haytham M. A. , Eid Ahmed I. , Antonelli Donna M. , Chang David C. , Elsharkawy Ahmed E. , Elahad Joana Abed , Lancaster Elizabeth A. , Schulz John T. , Melnitchouk Serguei I. , Kastrinakis William V. , Hutter Matthew M. , Masiakos Peter T. , Colwell Amy S. , Wright Cameron D. , Lillemoe Keith D. 
Published: July 2019

Introduction:
Diversion of excess prescription opioids contributes to the opioid epidemic. We sought to describe and study the impact of a comprehensive departmental initiative to decrease opioid prescribing in surgery.

Methods:
A multispecialty multidisciplinary initiative was designed to change the culture of postoperative opioid prescribing, including: consensus-built opioid guidelines for 42 procedures from 11 specialties, provider-focused posters displayed in all surgical units, patient opioid/pain brochures setting expectations, and educational seminars to residents, advanced practice providers, residents and nurses. Pre- (April 2016–March 2017) versu post-initiative (April 2017–May 2018) analyses of opioid prescribing at discharge [median oral morphine equivalent (OME)] were performed at the specialty, prescriber, patient, and procedure levels. Refill prescriptions within 3 months were also studied.

Results:
A total of 23,298 patients were included (11,983 pre-; 11,315 post-initiative). Post-initiative, the median OME significantly decreased for 10 specialties (all P values < 0.001), the percentage of patients discharged without opioids increased from 35.7% to 52.5% (P < 0.001), and there was no change in opioids refills (0.07% vs 0.08%, P = 0.9). Similar significant decreases in OME were observed when the analyses were performed at the provider and individual procedure levels. Patient-level analyses showed that the preinitiative race/sex disparities in opioid-prescribing disappeared post-initiative.

Conclusion:
We describe a comprehensive multi-specialty intervention that successfully reduced prescribed opioids without increase in refills and decreased sex/race prescription disparities.
Long-term Patient-reported Outcomes Following Postmastectomy Breast Reconstruction
Authors: Nelson Jonas A. , Allen Robert J. , Polanco Thais , Shamsunder Meghana , Patel Aadit R. , McCarthy Colleen M. , Matros Evan , Dayan Joseph H. , Disa Joseph J. , Cordeiro Peter G. , Mehrara Babak J. , Pusic Andrea L. 
Published: July 2019

Objective:
To better understand the long-term patient-reported outcomes (PROs) in satisfaction and health-related quality of life (QOL) following post-mastectomy reconstruction (PMR) using the BREAST-Q, comparing PROs from patients undergoing implant-based breast reconstruction (IBR) or autologous breast reconstruction (ABR).

Summary of Background Data:
Multiple studies have demonstrated growth in mastectomy rates and concurrent increase in PMR utilization. However, most studies examining PMR PROs focus on short postoperative time periods—mainly within 2 years.

Methods:
BREAST-Q scores from IBR or ABR patients at a tertiary center were prospectively collected from 2009 to 2017. Mean scores and standard deviations (SDs) were calculated for satisfaction with breast, satisfaction with outcome, psychosocial well-being, physical well-being of the chest, and sexual well-being. Satisfaction with breasts and physical well-being of the chest were compared using regression models at postoperative years 1, 3, 5, and 7.

Results:
Overall, 3268 patients were included, with 336 undergoing ABR and 2932 undergoing IBR. Regression analysis demonstrated that ABR patients had greater postoperative satisfaction with breast scores at all timepoints compared with IBR patients. Postoperative radiation and mental illness adversely impacted satisfaction with breast scores. Furthermore, mental illness impacted physical wellbeing of the chest at all timepoints. IBR patients had satisfaction scores that remained stable over the study period.

Conclusion:
This study presents the largest prospective examination of PROs in PMR to date. Patients who opted for ABR had significantly higher satisfaction with their breast and QOL at each assessed time point, but IBR patients had stable long-term satisfaction and QOL postoperatively.
New Nodal Staging for Primary Pancreatic Neuroendocrine Tumors
Authors: Zhang Xu-Feng , Xue Feng , Dong Ding-Hui , Lopez-Aguiar Alexandra G. , Poultsides George , Makris Eleftherios , Rocha Flavio , Kanji Zaheer , Weber Sharon , Fisher Alexander , Fields Ryan , Krasnick Bradley A. , Idrees Kamran , Smith Paula M. , Cho Cliff , Beems Megan , Lv Yi , Maithel Shishir K. , Pawlik Timothy M. 
Published: July 2019

Objective:
To determine the prognostic role of metastatic lymph node (LN) number and the minimal number of LNs for optimal staging of patients with pancreatic neuroendocrine tumors (pNETs).

Background:
Prognosis relative to number of LN metastasis (LNM), and minimal number of LNs needed to evaluate for accurate staging, have been poorly defined for pNETs.

Methods:
Number of LNM and total number of LN evaluated (TNLE) were assessed relative to recurrence-free survival (RFS) and overall survival (OS) in a multi-institutional database. External validation was performed using Surveillance, Epidemiology and End Results (SEER) registry.

Results:
Among 854 patients who underwent resection, 233 (27.3%) had at least 1 LNM. Patients with 1, 2, or 3 LNM had a comparable worse RFS versus patients with no nodal metastasis (5-year RFS, 1 LNM 65.6%, 2 LNM 68.2%, 3 LNM 63.2% vs 0 LNM 82.6%; all P < 0.001). In contrast, patients with ≥4 LNM (proposed N2) had a worse RFS versus patients who either had 1 to 3 LNM (proposed N1) or node-negative disease (5-year RFS, ≥4 LNM 43.5% vs 1–3 LNM 66.3%, 0 LNM 82.6%; all P < 0.05) [C-statistics area under the curve (AUC) 0.650]. TNLE ≥8 had the highest discriminatory power relative to RFS (AUC 0.713) and OS (AUC 0.726) among patients who had 1 to 3 LNM, and patients who had ≥4 LNM in the multi-institutional and SEER database (n = 2764).

Conclusions:
Regional lymphadenectomy of at least 8 lymph nodes was necessary to stage patients accurately. The proposed nodal staging of N0, N1, and N2 optimally staged patients.
Behavioural ecology and infectious disease: implications for conservation of biodiversity
Authors: Herrera James , Nunn Charles L. 
Published: July 2019

Behaviour underpins interactions among conspecifics and between species, with consequences for the transmission of disease-causing parasites. Because many parasites lead to declines in population size and increased risk of extinction for threatened species, understanding the link between host behaviour and disease transmission is particularly important for conservation management. Here, we consider the intersection of behaviour, ecology and parasite transmission, broadly encompassing micro- and macroparasites. We focus on behaviours that have direct impacts on transmission, as well as the behaviours that result from infection. Given the important role of parasites in host survival and reproduction, the effects of behaviour on parasitism can scale up to population-level processes, thus affecting species conservation. Understanding how conservation and infectious disease control strategies actually affect transmission potential can therefore often only be understood through a behavioural lens. We highlight how behavioural perspectives of disease ecology apply to conservation by reviewing the different ways that behavioural ecology influences parasite transmission and conservation goals.This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation’.
Mate choice in a polluted world: consequences for individuals, populations and communities
Authors: Candolin Ulrika , Wong Bob B. M. 
Published: July 2019

Pollution (e.g. by chemicals, noise, light, heat) is an insidious consequence of anthropogenic activity that affects environments worldwide. Exposure of wildlife to pollutants has the capacity to adversely affect animal communication and behaviour across a wide range of sensory modalities—by not only impacting the signalling environment, but also the way in which animals produce, perceive and interpret signals and cues. Such disturbances, particularly when it comes to sex, can drastically alter fitness. Here, we consider how pollutants disrupt communication and behaviour during mate choice, and the ecological and evolutionary changes such disturbances can engender. We explain how the different stages of mate choice can be affected by pollution, from encountering mates to the final choice, and how changes to these stages can influence individual fitness, population dynamics and community structure. We end with discussing how an understanding of these disturbances can help inform better conservation and management practices and highlight important considerations and avenues for future research.This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation’.
Behaviour, life history and persistence in novel environments
Authors: Maspons Joan , Molowny-Horas Roberto , Sol Daniel 
Published: July 2019

Understanding what affects population growth in novel environments is fundamental to forecast organisms' responses to global change, including biological invasions and land use intensification. Novel environments are challenging because they can cause maladaptation, increasing the risk of extinction by negative population growth. Animals can avoid extinction by improving the phenotype–environment match through behavioural responses, notably matching habitat choice and learning. However, the demographic consequences of these responses remain insufficiently understood in part because they have not been analysed within a life-history context. By means of an individual-based model, we show here that matching habitat choice and learning interact with life history to influence persistence in novel environments. In maladaptive contexts, the likelihood of persisting is higher for life-history strategies that increase the value of adults over the value of offspring, even at the cost of decreasing reproduction. Such a strategy facilitates persistence in novel environments by reducing the costs of a reproductive failure while increasing the benefits of behavioural responses. Our results reinforce the view that a more predictive theory for extinction risk under rapid environmental changes requires considering behavioural responses and life history as part of a common adaptive strategy to cope with environmental changes.
This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation’.
Integrating social behaviour, demography and disease dynamics in network models: applications to disease management in declining wildlife populations
Authors: Silk Matthew J. , Hodgson David J. , Rozins Carly , Croft Darren P. , Delahay Richard J. , Boots Mike , McDonald Robbie A. 
Published: July 2019

The emergence and spread of infections can contribute to the decline and extinction of populations, particularly in conjunction with anthropogenic environmental change. The importance of heterogeneity in processes of transmission, resistance and tolerance is increasingly well understood in theory, but empirical studies that consider both the demographic and behavioural implications of infection are scarce. Non-random mixing of host individuals can impact the demographic thresholds that determine the amplification or attenuation of disease prevalence. Risk assessment and management of disease in threatened wildlife populations must therefore consider not just host density, but also the social structure of host populations. Here we integrate the most recent developments in epidemiological research from a demographic and social network perspective, and synthesize the latest developments in social network modelling for wildlife disease, to explore their applications to disease management in populations in decline and at risk of extinction. We use simulated examples to support our key points and reveal how disease-management strategies can and should exploit both behavioural and demographic information to prevent or control the spread of disease. Our synthesis highlights the importance of considering the combined impacts of demographic and behavioural processes in epidemics to successful disease management in a conservation context.
This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation’.
Bridging the divide between scientists and decision-makers: how behavioural ecologists can increase the conservation impact of their research?
Authors: Durant Sarah M. , Groom Rosemary , Kuloba Bernard , Samna Abdoulkarim , Muzuma Uakendisa , Gadimang Phemelo , Mandisodza-Chikerema Rose , Ipavec Audrey , Mitchell Nicholas , Ikanda Dennis , Msuha Maurus 
Published: July 2019

Effective conservation management is underpinned by science. Yet, there are often barriers against the incorporation of up-to-date scientific research into decision-making and policy. Here, we draw on experience from a multi-nation approach to conserve cheetah and African wild dogs across Africa, using relationships between scientists and managers established over more than a decade, to better understand scientific information needs of managers. While our analysis focuses on Africa, many of our findings are likely to be relevant to other regions. Managers view science as critical to their decision-making processes and strongly support scientific research, particularly when research directly addresses their information needs. However, managers reported problems in accessing final results and highlighted the need to access raw ecological data from research undertaken within protected areas. Fundamental to improving the management relevance of scientific research is the need for scientists to engage with managers through all steps of the research process, from project design and implementation through to scientific publication and end-of-project agreements. Effective engagement requires open and clear communication; including agreed processes for access to biodiversity data and submission of final results. In order to foster future scientific endeavours and collaborations, systems should be established to better facilitate information exchange, while also safeguarding the rights of scientists to publish their data and protect their academic freedom. Our analysis also calls for a greater awareness of the geo-political context under which science is undertaken, and for increased scientific participation through an inclusive approach that recognizes, and gives credit to, a wider diversity of scientific contributions and expertise.
This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation’.