bluuebunny/crossref_metadata_2025_split huggingface dataset:
Synchronous Breast Implant–associated Anaplastic Large Cell Lymphoma and Invasive Carcinoma: Genomic Profiling and Management Implications
Authors: Mukhtar Rita A. , Holland Michael , Sieber David A. , Wen Kwun Wah , Rugo Hope S. , Kadin Marshall E. , Bean Gregory R. 
Published: April 2019

SUMMARY:
A 59-year-old woman with a history of cosmetic implants developed ipsilateral synchronous breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) and invasive ductal carcinoma in the left breast. Each tumor was subjected to next-generation sequencing, and separate analyses revealed mutually exclusive aberrations: an activating STAT3 mutation in the lymphoma and a PIK3CA in-frame deletion in the carcinoma. The patient was treated with removal of implants, capsulectomy, partial mastectomy, sentinel node biopsy, radiotherapy, and endocrine therapy with no evidence of recurrence for 1 year. This case illustrates the importance of obtaining thorough evaluation for concomitant malignancies in the breast at the time of diagnosis of BIA-ALCL. Herein, we review the current recommendations for evaluation and management of BIA-ALCL.
Reconstructive Surgery for Mycetoma: Is There a Need to Establish an Algorithm?
Authors: Abdelrahman Mohamed , Saad Eltaib A. , Abdulla Gamal M. , Mohamed Abdelsamie 
Published: April 2019

Background:
Mycetoma is a chronic, progressive, disfiguring, and destructive disease. It caused by a variety of microorganisms including fungi and higher bacteria. It is primarily an infection of the skin and soft tissue, most frequently affecting the lower extremity and the hand and spread through fascial planes and lymphatics.

Methods:
Current medical and surgical management are still inadequate and the recurrence rate is high with severe disabilities.

Results:
This review describes some reconstructive techniques that were performed to address essential aspects with regard to mycetoma surgical management that include coverage of large skin and soft-tissue defects left after local excisions, enhancing the rate of chronic mycetoma wound healing, and preservation or restoration of functional status of the affected limbs.

Conclusion:
These applied techniques—which had acceptable preliminary outcome—have to be considered by the surgeons dealing with mycetoma to improve the functional and cosmetic outcomes and to minimize tremendous morbidities and disabilities that are associated with this neglected disease.
Consensus Opinions on Facial Beauty and Implications for Aesthetic Treatment in Middle Eastern Women
Authors: Kashmar Mohamad , Alsufyani Mohammed A. , Ghalamkarpour Fariba , Chalouhi Micheline , Alomer Ghanima , Ghannam Sahar , El Minawi Hisham , Saedi Babek , Hunter Nahla , Alkobaisi Abeer , Rafla Karim , Zari Shadi , Abdel Razzak Elsayed Mohamed , Hamdan Firas , Santangelo Samantha , Khater Mohamed , Rogers John D. 
Published: April 2019

Background:
Middle Eastern women worldwide increasingly seek aesthetic treatment to enhance their beauty and improve self-esteem, but literature describing standards of beauty across the Middle East are scarce. Knowledge of facial anthropometry and Middle Eastern subregional beauty preferences and aesthetic weaknesses are key to develop an effective facial enhancement strategy that does not jeopardize ethnic identity or facial harmony.

Methods:
Dermatologists and plastic surgeons from 8 Middle Eastern countries who had 7.5–25 (mean 13.5) years of experience in aesthetic medicine examined female Middle Eastern beauty in 4 geographic subregions: the Gulf (comprising Bahrain, Kuwait, Saudi Arabia, and the United Arab Emirates), Iran, Lebanon, and Egypt. They developed consensus opinions regarding facial beauty, aesthetic deficiencies, and injectable treatment solutions.

Results:
Facial anthropometry differs between Middle Eastern and Western women, and also within the region. Although subregional differences are seen, beauty is generally recognized by an oval or round face; temple fullness; pronounced, elevated, arched eyebrows; large almond-shaped eyes; well-defined, laterally full cheeks; a small, straight nose; full lips; a well-defined jawline; and a prominent, pointed chin. The relative prominence of the nose necessitates attention to the lips and the shape and projection of the chin. Aging is often accompanied by midface sagging that leads to increased heaviness in the lower facial third.

Conclusions:
Middle Eastern beauty is characterized by striking eyes, defined cheeks, and full lips. These consensus opinions inform aesthetic practitioners who treat Middle Eastern women worldwide about their aesthetic ideals and the implications for treatment.
3-DIEPrinting: 3D-printed Models to Assist the Intramuscular Dissection in Abdominally Based Microsurgical Breast Reconstruction
Authors: Jablonka Eric M. , Wu Robin T. , Mittermiller Paul A. , Gifford Kyle , Momeni Arash 
Published: April 2019

Summary:
Harvest of the deep inferior epigastric vessels for microsurgical breast reconstruction can be complicated by an intricate and lengthy subfascial dissection. Although multiple preoperative imaging modalities exist to help visualize the vascular anatomy and assist in perforator selection, few can help clearly define the intramuscular course of these vessels. The authors introduce their early experience with 3D-printed anatomical modeling (to-scale) of the infraumbilical course of the deep inferior epigastric subfascial vascular tree to better assist in executing the intramuscular dissection.
Routine Laser-assisted Indocyanine Green Angiography in Immediate Breast Reconstruction: Is It Worth the Cost?
Authors: Mirhaidari Shayda , Azouz Vitali , Wagner Douglas S. 
Published: April 2019

Background:
Laser-assisted indocyanine green angiography (LAIGA) has been proven to accurately detect mastectomy skin flap necrosis (MSFN) intraoperatively and prevent postoperative complications in breast reconstruction. The purpose of this study was to examine the cost-effectiveness of the routine use of LAIGA in immediate breast reconstruction and to perform a break-even point analysis.

Methods:
This is a retrospective review of prospectively gathered data from all patients who underwent immediate breast reconstruction from January 2014 to January 2015. LAIGA was routinely used in all cases. Patients were followed for at least 90 days to capture postoperative complications. Costs were calculated by reviewing itemized bills and Medicare Reimbursement Current Procedural Terminology codes to assess surgeon fees. Outcomes and costs were compared with a historical cohort of patients who underwent breast reconstruction before the implementation of LAIGA.

Results:
Two-hundred-and-six immediate breast reconstructions (126 patients) were performed using LAIGA for a total cost of $210,700. The average cost of MSFN in our LAIGA cohort was $30,496. The routine use of LAIGA decreased the MSFN rate from 12.4% to 6.3% and prevented MSFN on 13 breasts resulting in a gross cost savings of $396,453, and net savings of $185,753. Break-even point analysis demonstrated that number of cases needed to break even decreases as the average MSFN cost and MSFN reduction rate increase.

Conclusion:
The routine use of LAIGA in immediate breast reconstruction is cost-effective in reducing the incidence of MSFN, implant loss, and overall unexpected reoperation rate.
Outcomes of a Modified Trabeculectomy Closure Technique
Authors: Lee Moon Jeong , Bajaj Rohan P. , Mihailovic Aleksandra , Iyer Jayant V. , Jampel Henry D. , Friedman David S. 
Published: April 2019

Precis:
A modified closure for trabeculectomy in which the conjunctiva is incised posterior to the limbus and reapproximated using 2 nylon sutures, provided similar surgical outcomes to the standard trabeculectomy closure technique.

Purpose:
To examine the surgical outcomes of a modified trabeculectomy closure technique in which the conjunctiva is incised posterior to the limbus and reapproximated using 2 sutures, burying the posterior conjunctiva under an anterior lip of conjunctiva.

Materials and Methods:
This retrospective review included 73 eyes that underwent trabeculectomies between 2015 and 2017 at Johns Hopkins Hospital by a single surgeon. We analyzed traditional closures used from January 2015 to May 2016, and modified closures used from July 2016 to March 2017. The main outcome measures were a reduction in intraocular pressure at 3, 6, and 12 months, reduction in the number of medications at 12 months, and total number of postoperative complications.

Results:
There was no difference in reduction of intraocular pressure at 3 months (9.9±8.2 vs. 10.5±8.7 mm Hg), 6 months (10.8±9.6 vs. 10.6±8.3 mm Hg), or 12 months (12.2±8.9 vs. 10.0±9.3 mm Hg) in the standard (n=44) and modified groups (n=29), respectively. There was a similar reduction in the use of glaucoma medications in the standard group (1.2±1.5 vs. 1.0±1.1) compared with the modified group and no difference in the number of postoperative complications (25.0% vs. 17.2%, respectively) (P>0.05 for all).

Conclusions:
The modified closure provided similar results to the standard closure for trabeculectomy. Further studies are needed to determine whether the 2 techniques differ in surgical outcomes over a longer follow-up or other surgical parameters (eg, ease, surgical time, learning curve).
Glaucoma in Phacomatosis Pigmentovascularis in a Young African Adolescent Boy: A Case Report
Authors: van der Merwe Ernst B. , Bhika Raquel E. , Meyer David 
Published: April 2019

Background:
Phacomatosis pigmentovascularis (PPV) has previously almost exclusively been reported in Asians and in dermatological journals. In this report, we present a case of a young black South African adolescent boy referred to our eye clinic.

Case Report:
A 15-year-old male patient presented with gradual, painless loss of vision in his right eye. Clinical examination revealed a port-wine stain with ocular involvement on the right as well as a nevus of Ota. Fundoscopy on the right revealed an advanced glaucomatous optic disc and raised intraocular pressure. A diagnosis of glaucoma associated with PPV was made.

Conclusion:
We present the first case of PPV in an African male individual with associated glaucoma seen at our tertiary hospital.
The Association Between Visual Field Reliability Indices and Cognitive Impairment in Glaucoma Patients
Authors: Raman Pushpa , Khy Ching Yeap , Sivagurunathan Premala D. , Ramli Norlina , Mohd. Khalid Khairul H. 
Published: April 2019

Precis:This prospective cross-sectional study found that patients with cognitive impairment (CI) are more likely to produce unreliable visual field (VF) tests, especially with higher false-negative (FN) responses and consequent overestimation of mean deviation (MD).Aim:Aging-associated CI can impair the ability of individuals to perform a VF test and compromise the reliability of the results. We evaluated the association between neurocognitive impairment and VF reliability indices in glaucoma patients.Methods:This prospective, cross-sectional study was conducted in the Ophthalmology Department, Hospital Kuala Pilah, Malaysia, and included 113 eyes of 60 glaucoma patients with no prior diagnosis of dementia. Patients were monitored with the Humphrey Visual Field Analyzer using a 30-2 SITA, standard protocol, and CI was assessed using the clock drawing test (CDT). The relationships between the CDT score, MD, pattern standard deviation, Visual Field Index (VFI), fixation loss (FL), false-positive values, and FN values were analyzed using the ordinal regression model.Results:Glaucoma patients older than 65 years had a higher prevalence of CI. There was a statistically significant correlation between CDT scores and glaucoma severity, FL, FN, and VFI values (rs=−0.20,P=0.03;rs=−0.20,P=0.04;rs=−0.28,P=0.003;rs=0.21,P=0.03, respectively). In a multivariate model adjusted for age and glaucoma severity, patients with lower FN were significantly less likely to have CI (odds ratio, 0.91; 95% confidence interval, 0.89-0.93) and patients with higher MD were more likely to have CI (odds ratio, 1.10; 95% confidence interval, 1.05-1.16); false positive, FL, pattern standard deviation, and VFI showed no significant correlation.Conclusion:Cognitive decline is associated with reduced VF reliability, especially with higher FN rate and overestimated MD. Screening and monitoring of CI may be important in the assessment of VF progression in glaucoma patients.
Photodistributed Rash on the Upper Extremities and Chest
Authors: Tao Joy , Lake Eden Pappo 
Published: April 2019

ABSTRACT
This is a case of a pruritic, photodistributed rash on the arms and chest of an adult patient who recently started a new medication. A multiple-choice question is presented, and readers will be challenged to identify the correct drug that triggered this rash based on case presentation and patient history. An answer is given followed by a discussion of causes, clinical features, and appropriate management of the rash.
A Case of Folliculitis Decalvans With Concomitant Acne Keloidalis Nuchae, Androgenic Alopecia, and Profound Postinflammatory Hyperpigmentation
Authors: Gleed Mitchell , Carlson Kim 
Published: April 2019

ABSTRACT
Folliculitis decalvans is a cicatricial alopecia of the parietal scalp and vertex characterized by erythematous, scarred, confluent patches of alopecia with scattered peripheral pustules and scale. It is most common among middle-aged men and is frequently associated with acne keloidalis nuchae. The pathogenesis of folliculitis decalvans is not completely understood, but it likely involves an inappropriate inflammatory response to components of Staphylococcus aureus. Folliculitis decalvans is a chronic disease characterized by periods of remission and exacerbation. Patients with long-standing, undertreated disease can experience severe hair loss and postinflammatory hyperpigmentation. Treatment is focused on reducing inflammation and bacterial load using oral antibiotic therapy. Early recognition and treatment is paramount to alleviate symptoms and limit irreversible hair loss.
Canadian Centre for Mental Health and Sport (CCMHS) Position Statement: Principles of Mental Health in Competitive and High-Performance Sport
Authors: Van Slingerland Krista J. , Durand-Bush Natalie , Bradley Lindsay , Goldfield Gary , Archambault Roger , Smith Danika , Edwards Carla , Delenardo Samantha , Taylor Shaunna , Werthner Penny , Kenttä Göran 
Published: April 2019

Abstract:The brave decision made by many Canadian athletes to share their experience with mental illness has fed a growing dialogue surrounding mental health in competitive and high-performance sport. To affect real change for individuals, sport culture must change to meet demands for psychologically safe, supportive, and accepting sport environments. This position statement addresses mental health in competitive and high-performance sport in Canada, presenting solutions to current challenges and laying a foundation for a unified address of mental health by the Canadian sport community. The paper emerged from the first phase of a multidisciplinary Participatory Action Research (PAR) project, in which a sport-focused mental health care model housed within the Canadian Centre for Mental Health and Sport (CCMHS) is currently being designed, implemented, and evaluated by a team of 20 stakeholders, in collaboration with several community partners and advisors.
Optimal Retention Force of Audio Processor Magnets
Authors: Wagner Luise , Hönig Elisabeth , Fröhlich Laura , Plontke Stefan , Rahne Torsten 
Published: April 2019

Hypothesis:
Audio processor magnets used in transcutaneous active hearing implants vary in retention force. We hypothesized that a range of optimal magnetic retention forces could be derived, based on objective in-situ measurements of individual retention forces.

Background:
The magnetic force required to retain the proper placement of transcutaneous active hearing implants varies among patients. Currently, audiologists rely on personal experience in deciding which magnet to use. Insufficient force causes frequent loss of the single-unit processors or external coils of behind-the-ear devices, and excessive force causes pain and skin irritations.

Methods:
We experimentally determined magnetic retention force as a function of the distance between two magnets for different processor-implant magnet combinations. In addition, we studied individual in situ retention forces in 100 patients with hearing devices. Skin status was evaluated by a physician and assessed by patient self-reporting and a questionnaire.

Results:
Force–distance functions showed that different magnet strengths had differential effects only at distances less than 6 mm. Examiner and patient skin status assessments and comfort scores showed that optimal retention force range was 0.23 to 0.4 N.

Conclusion:
We found that the currently available magnet types restrict the range of feasible skin flap thicknesses to a maximum of 6 mm. Further we conclude that retention forces between 0.23 and 0.4 N could provide the appropriate trade-off between the risk of losing device fixation and of causing skin irritations. We recommend measuring the retention force in all patients.
Intracochlear Electrocochleography: Influence of Scalar Position of the Cochlear Implant Electrode on Postinsertion Results
Authors: Riggs William J. , Dwyer Robert T. , Holder Jourdan T. , Mattingly Jameson K. , Ortmann Amanda , Noble Jack H. , Dawant Benoit M. , Valenzuela Carla V. , O’Connell Brendan P. , Harris Michael S. , Litvak Leonid M. , Koka Kanthaiah , Buchman Craig A. , Labadie Robert F. , Adunka Oliver F. 
Published: April 2019

Hypothesis:
Electrocochleography (ECochG) recorded during cochlear implant (CI) insertion from the apical electrode in conjunction with postinsertion ECochG can identify electrophysiologic differences that exist between groups with and without a translocation of the array from the scala tympani (ST) into the scala vestibuli (SV).

Background:
Translocation of the CI electrode from ST into SV can limit performance postoperatively. ECochG markers of trauma may be able to aid in the ability to detect electrode array-induced trauma/scalar translocation intraoperatively.

Methods:
Twenty-one adult CI patients were included. Subjects were postoperatively parsed into two groups based on analysis of postoperative imaging: 1) ST (n = 14) insertion; 2) SV (n = 7) insertion, indicating translocation of the electrode. The ECochG response elicited from a 500 Hz acoustic stimulus was recorded from the lead electrode during insertion when the distal electrode marker was at the round window, and was compared to the response recorded from a basal electrode (e13) after complete insertion.

Results:
No statistically significant change in mean ECochG magnitude was found in either group between recording intervals. There was a mean loss of preoperative pure-tone average of 52% for the nontranslocation group and 94% for the translocation group.

Conclusions:
Intraoperative intracochlear ECochG through the CI array provides a unique opportunity to explore the impact of the CI electrode on the inner ear. Specifically, a translocation of the array from ST to SV does not seem to change the biomechanics of the cochlear region that lies basal to the area of translocation in the acute period.
Comparison of Satisfaction Between Patients Using Percutaneous and Transcutaneous Bone Conduction Devices
Authors: Svagan Matija , Povalej Brzan Petra , Rebol Janez 
Published: April 2019

Background:
Bone conduction devices are widely used to treat conductive and mixed hearing loss as well as single-sided deafness (SSD). A transcutaneous system was introduced recently with the clear advantage of fewer local reactions. Our goal was to evaluate and compare the satisfaction of patients with percutaneous and transcutaneous bone conduction devices.

Methods:
We divided a cohort of 72 patients into groups by type of hearing loss and their relation to the use of the percutaneous or transcutaneous system. The Glasgow Benefit Inventory (GBI) questionnaire, adapted for hearing aids, was employed to assess patient satisfaction, along with an additional questionnaire covering the general usefulness of the devices.

Results:
Overall median daily wearing time was 12 hours for the percutaneous and seven for the transcutaneous groups (p < 0.001). We found no correlation between the bone conduction level at any frequency and the GBI satisfaction score. The median total GBI score of the entire patient cohort was 30.1; median values for general, social support, and physical health subscales were 0, 37.5, and 16.7, respectively. People suffering from SSD had the lowest satisfaction rates, and these were significantly lower for the patients who used transcutaneous aids than for those with percutaneous devices (p = 0.033). Similarly, the percutaneous system brought more satisfaction to combined hearing loss patients than did the transcutaneous (p = 0.010).

Conclusion:
Both types of bone conduction devices provide a safe and efficient way to improve hearing for candidates within correct indications. Our study revealed that patients wore the transcutaneous device less than they did the percutaneous. Satisfaction was the lowest among SSD patients who used the transcutaneous device; hence it is especially important to carry out preoperative counseling for such patients.
The Effect of a Bone Groove Against Cochlear Implant Electrode Migration
Authors: Leinung Martin , Helbig Silke , Adel Youssef , Stöver Timo , Loth Andreas G. 
Published: April 2019

Hypothesis:
The risk of electrode migration in cochlear implant (CI) surgery can be reduced by securing the electrode lead in a bone groove in the chorda-facial angle.

Background:
Electrode migration is an important complication in CI surgery, which affects hearing performance, may induce pain and facial nerve stimulation, and requires surgical revision. A potential method to secure the electrode is to use a bone groove created in the facial recess to fixate the electrode lead. This surgical measure is a standard procedure for lateral wall electrodes (LWE) in our clinic since 2013.

Methods:
Retrospective analysis of consecutive CI cases of a tertiary referral center from 2006 to 2016 and comparison of incidence rates between group A (without bone groove, years 2006–2012) and group B (with bone groove fixation, years 2013–2016). Clinical cases were reviewed with respect to electrode type, migration length, time interval to migration, and findings during revision surgery.

Results:
Seventeen cases of electrode migration were found in a total of 1,603 cochlear implantations. Only LWE designs were affected by migration. The cumulative incidence for LWE in group B (0.5%) was significantly lower than in group A (3.7%, p < 0.01). The two migration cases in group B revealed insufficient geometric design of the bone grooves. Only one patient experienced a remigration after revision surgery.

Conclusion:
The fixation in a bone groove in the chorda-facial angle is an effective measure against migration of LWE. Proper surgical execution is mandatory to ensure a tight and enduring fit.