bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Psychosocial Interactions of Adolescent and Young Adult Cancer Survivors and the Possible Relationship With Their Development
Authors: Cameron Nicole , Ross Kirsty , Baken Don , Bimler David 
Published: July 2019

Background
Adolescents and young adults (AYAs; 16–25 years old) with cancer may be particularly affected by social interactions, as they can be grappling with a serious illness and normal developmental challenges.

Objectives
The aims of this study were to explore interactions relevant to AYA survivors and cancer and to investigate whether specific interactions are experienced as more and less helpful.

Methods
Ten semistructured interviews were conducted with AYAs, with questions pertaining to their psychosocial interactions and any developmental effects from having cancer. Five follow-up interviews were conducted approximately 12 months later, a 50% response rate.

Results
Thematic analysis identified a range of themes including the importance of personal privacy and controlled sharing of information, independence, identity formation, positivity, acknowledgement of cancer versus being treated normally, and receiving support instead of supporting others. In the 1-year follow-up interviews, half of these themes remained constant; however, the personal privacy, independence, and supporting others themes changed.

Conclusions
Overall, social support, social interactions, and developmental stage seem to influence the overall cancer experience. Development seems to be impacted by cancer for both adolescents and young adults, but this impact lessened over a 1-year period for the 50% of participants who participated in both interviews.

Implications for Practice
It is believed that a more comprehensive understanding of AYA patients’ psychosocial experiences related to cancer will enable those who interact with this group to provide more positive support through their interactions with individuals.
Burnout and Its Relationships With Alexithymia, Stress, Self-Esteem, Depression, Alcohol Use Disorders, and Emotional Intelligence
Authors: Lahoud Nathalie , Zakhour Maha , Haddad Chadia , Salameh Pascale , Akel Marwan , Fares Kassandra , Hallit Souheil , Obeid Sahar 
Published: July 2019

Abstract
Our aim was to assess the relationship between personality and psychological traits, and burnout among the Lebanese population. A questionnaire-based cross-sectional study was conducted with multiple validated scales used to measure burnout and other characteristics. A cluster analysis was then performed to split the population into mutually exclusive groups with different profiles according to the burnout scales using the K-mean method. A multivariate analysis of covariance was carried out to compare multiple measures between the cluster groups under comparison. The study, conducted between November 2017 and March 2018, enrolled 789 participants. The results showed that 100 (14.0%) had high emotional work fatigue, whereas 443 (62.5%) and 680 (95.4%) had high mental and physical work fatigue, respectively. People with high physical work fatigue (cluster 1) had lower alcohol dependence (β = −2.78), alexithymia (β = −3.16), depression (β = −7.20), anxiety (β = −6.99), perceived stress (β = −2.53), social phobia (β = −11.49), suicidal ideation (β = −0.35), emotional awareness (β = −4.54), emotional managament (β = −1.71), social emotional awareness (β = −9.27), and relationship management (β = −9.12). People with high emotional work fatigue (cluster 2) had higher alcohol dependence (β = 2.11), alexithymia (β = 6.51), depression (β = 2.48), anxiety (β = 4.11), perceived stress (β = 4.30), and lower emotional awareness (β = −6.68), emotional management (β = −7.80), social emotional awareness (β = −3.71), and relationship management (β = −3.05). Higher levels of burnout were found to be associated with multiple psychological factors. The results would help understand the burnout dimensions and their correlated factors in the Lebanese population.
Serum Uric Acid Level and Outcome of Patients With Ischemic Stroke
Authors: Lei Zhihao , Cai Jingjing , Hong Hua , Wang Yidong 
Published: July 2019

Background:
The issue of whether serum uric acid (SUA) is associated with the outcome of acute ischemic stroke is controversial. This study aimed to evaluate the correlation between the SUA level and outcome of patients with ischemic stroke by performing a meta-analysis.

Materials and Methods:
Studies were included by a systematic search of several databases through December 01, 2018, followed by reviewing reference lists of obtained articles. Studies that included odds ratios (ORs) for ischemic stroke outcome per unit SUA level with 95% confidence intervals (95% CIs) were eligible for the meta-analysis. A random-effects model was used to calculate the pooled risk estimate. Publication bias was detected by Begg’s test.

Results:
Fifteen studies with a total of 12,739 cases of stroke were included. Overall, higher SUA levels were associated with a significantly better outcome of ischemic stroke (OR, 1.13; 95% CI, 1.07-1.18; P<0.00001). For patients receiving thrombolytic therapy, a subgroup meta-analysis showed a positive association between SUA level and patient outcome (OR, 1.26; 95% CI, 1.14-1.40; P<0.00001). In addition, the pooled estimate of patients with a modified Rankin Scale score ≤2 at 90 days also showed a positive association (OR, 1.07; 95% CI, 1.01-1.133; P<0.00001). Furthermore, we found that the average SUA level in patients with a good outcome was higher than in those with a poor outcome (mean difference, 0.24 µmol/L; 95% CI, 0.16-0.32; P<0.00001).

Conclusions:
This meta-analysis suggested that there was a significant positive association between SUA level and the outcome of ischemic stroke.
The Public’s Preferences on Plastic Surgery Social Media Engagement and Professionalism: Demystifying the Impact of Demographics
Authors: Fan Kenneth L. , Graziano Francis , Economides James M. , Black Cara K. , Song David H. 
Published: July 2019

Background:
Social media discussions are alive among plastic surgeons. This article represents a primer on beginning to understand how the public would seek out plastic surgeons and how demographics shape their preferences.

Methods:
An anonymous 31-question survey was crowdsourced by means of MTurk.

Results:
There were a total of 527 respondents. Of these respondents, 33 percent follow plastic surgeons on social media, with those aged younger than 35 years 3.9 times more likely to do so. Google was the first place people would look for a plastic surgeon (46 percent). When asked what was the most influential of all online methods for selecting a surgeon, practice website ranked first (25 percent), but social media platforms ranked higher as a whole (35 percent). Those considering surgical or noninvasive procedures are thee times more likely to select social media platforms as the most influential online method in selecting a surgeon and five times more likely to follow a plastic surgeon on social media. The majority would prefer not seeing the surgeon’s private life displayed on social media (39 percent). Respondents were evenly split regarding whether graphic surgical images would lead them to unfollow accounts. Ninety-six percent of the general public were unclear of the type of board certification a plastic surgeon should hold.

Conclusions:
Clear differences in engagement and perception exist in the public based on age, sex, parental status, and reported country of origin. Social media will soon become a critical strategy in outreach and engagement and a valuable tool in clearing misconceptions within plastic surgery.
Efficacy of Surgical Treatment of Migraine Headaches Involving the Auriculotemporal Nerve (Site V)
Authors: Long Tobias , Ascha Mona , Guyuron Bahman 
Published: July 2019

Background:
This study reports the surgical technique and efficacy of treatment for the less commonly studied auriculotemporal nerve (site V). The aim was to evaluate symptom relief and differences in migraine headache parameters (i.e., intensity, duration, and migraine-free days) after site V surgery.

Methods:
Patients undergoing site V surgery for auriculotemporal nerve–triggered migraine headaches were analyzed. Charts were reviewed retrospectively for age, sex, dates of surgery and follow-up, preoperative migraine data, types of surgery, and laterality. Postoperatively, patients completed a migraine headache questionnaire by means of office visit, phone, e-mail, or video conference.

Results:
Forty-three patients were included in the study (36 women; median age, 50 years; interquartile range, 40 to 57 years). The majority of patients underwent bilateral surgery (n = 36) and reported site-specific relief (n = 34). The average follow-up was 17.2 months. The number of migraine-free days (per month) increased from 12.6 days before surgery to 25.1 days after surgery (median increase, 12.6 days; p < 0.005). Median migraine intensity scores decreased from 8.3 to 3.2 after surgery (median decrease, 5.1; p < 0.005) on 10-point severity scale. Migraine duration decreased from 1.2 hours/day to 0.5 hour/day after surgery (median decrease, 0.7 hour/day, p < 0.005). The median difference in migraine duration was the only value found not to be statistically significant, defined as p < 0.005. On both univariate and multivariate analyses, patient-reported site relief was significantly associated with decreased migraine intensity.

Conclusions:
Surgery for auriculotemporal nerve–triggered migraine headaches improves migraine headache parameters. This study is the first to examine surgical efficacy of this less commonly studied trigger site.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Head-to-Head Comparison of the Vascular Basis of the Transverse Myocutaneous Gracilis, Profunda Artery Perforator, and Fasciocutaneous Infragluteal Flaps: An Anatomical Study
Authors: Zaussinger Maximilian , Tinhofer Ines E. , Hamscha Ulrike , Meng Stefan , Weninger Wolfgang J. , Pollhammer Michael S. , Huemer Georg M. , Schmidt Manfred 
Published: July 2019

Background:
Perforator flaps of the upper thigh or buttock provide a valuable secondary choice in autologous breast reconstruction. The purpose of this study was to compare the vascular territories and supplying vessels of the transverse myocutaneous gracilis flap, the profunda artery perforator flap, and the fasciocutaneous infragluteal flap.

Methods:
In total, 26 lower limbs from 13 fresh specimens were investigated. All flap pedicles were selectively injected with methylene blue, eosin red, or green ink. The pedicle external diameters, lengths, and locations were measured. The dimensions of angiosomes, their intraindividual and interindividual correlations, and their relations to anatomical landmarks were analyzed.

Results:
The profunda artery perforator pedicle had the greatest mean external diameter with 3.6 ± 0.7 mm, followed by the transverse myocutaneous gracilis and fasciocutaneous infragluteal pedicles with 2.9 ± 0.6 mm and 2.9 ± 0.7 mm, respectively. The fasciocutaneous infragluteal pedicle was longest with a mean length of 12.5 ± 1.5 cm, whereas the profunda artery perforator and transverse myocutaneous gracilis pedicles had lengths of 8.8 ± 1.0 cm and 6.7 ± 1 cm on average. The profunda artery perforator angiosome provided the largest size, with a mean area of 98.5 ± 26.7 cm2, followed by the fasciocutaneous infragluteal angiosome (77.2 ± 9.0 cm2) and the transverse myocutaneous gracilis angiosome (74.1 ± 32.1 cm2).

Conclusions:
The authors’ anatomical findings about the transverse myocutaneous gracilis, profunda artery perforator, and fasciocutaneous infragluteal territories provide clinically valuable data for flap selection in breast reconstruction if an abdominal flap is not feasible.
Redefining the Role of Resection Weight Prediction in Reduction Mammaplasty and Breaking the “One-Scale-Fits-All” Paradigm
Authors: Boukovalas Stefanos , Padilla Pablo L. , Spratt Heidi , Tran Jacquelynn P. , Li Ramon T. , Boson Alexis L. , Howland Nicholas , Phillips Linda G. 
Published: July 2019

Background:
Reduction mammaplasty is a highly effective procedure for treatment of symptomatic macromastia. Prediction of resection weight is important for the surgeon and the patient, but none of the current prediction models is widely accepted. Insurance carriers are arbitrarily using resection weight to determine medical necessity, despite published literature supporting that resection weight does not correlate with symptomatic relief. What is the most accurate method of predicting resection weight and what is its role in breast reduction surgery?

Methods:
The authors conducted a retrospective review of patients who underwent reduction mammaplasty at a single institution from 2012 to 2017. A senior biostatistician performed multiple regression analysis to identify predictors of resection weight, and linear regression models were created to compare each of the established prediction scales to actual resected weight. Patient outcomes were evaluated.

Results:
Three-hundred fourteen patients were included. A new prediction model was created. The Galveston scale performed the best (R
2 = 0.73; p < 0.001), whereas the Schnur scale performed the worst (R
2 = 0.43; p < 0.001). The Appel and Descamps scales had variable performance in different subcategories of body mass index and menopausal status (p < 0.01). Internal validation confirmed the Galveston scale’s best predictive value; 38.6 percent and 28.9 percent of actual breast resection weights were below Schnur prediction and 500-g minimum, respectively, yet 97 percent of patients reported symptomatic improvement or relief.

Conclusions:
The authors recommend a patient-specific and surgeon-specific approach for prediction of resection weight in breast reduction. The Galveston scale fits the best for older patients with higher body mass indices and breasts requiring large resections. Medical necessity decisions should be based on patient symptoms, physical examination, and the physician’s clinical judgment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
Poly(ε-Caprolactone) Nanofiber Wrap Improves Nerve Regeneration and Functional Outcomes after Delayed Nerve Repair
Authors: Lopez Joseph , Xin Kevin , Quan Amy , Xiang Sinan , Leto Barone Angelo A. , Budihardjo Joshua , Musavi Leila , Mulla Sara , Redett Richard , Martin Russell , Mao Hai-Quan , Lee W. P. Andrew , Ibrahim Zuhaib , Brandacher Gerald 
Published: July 2019

Background:
The purpose of this study was to assess the efficacy of biodegradable, electrospun poly(ε-caprolactone) nanofiber nerve conduits in improving nerve regeneration.

Methods:
The authors used a rat forelimb chronic denervation model to assess the effects of poly(ε-caprolactone) conduits on improving nerve regeneration and upper extremity function. Three groups of rats were examined: (1) negative-control animals (n = 5), which underwent 8 weeks of median nerve chronic denervation injury followed by repair with no conduit; (2) experimental animals (n = 5), which underwent 8 weeks of median nerve chronic denervation followed by repair and poly(ε-caprolactone) nerve conduit wrapping of the nerve coaptation site; and (3) positive-control animals (n = 5), which were naive controls. All animals underwent compound muscle action potential and functional testing. At 14 weeks after repair, the median nerve and flexor muscles were harvested for histologic analysis.

Results:
Histomorphometric analysis of regenerating median nerves demonstrated augmented axonal regeneration in experimental versus negative control animals (total axon count, 1769 ± 672 versus 1072 ± 123.80; p = 0.0468). With regard to functional recovery, experimental and negative-control animals (1.67 ± 0.04 versus 0.97 ± 0.39; p = 0.036) had regained 34.9 percent and 25.4 percent, respectively, of baseline hand grip strength at 14 weeks after repair. Lastly, less collagen deposition at the nerve coaptation site of experimental animals was found when compared to control animals (p < 0.05).

Conclusion:
Biodegradable, poly(ε-caprolactone) nanofiber nerve conduits can improve nerve regeneration and subsequent physiologic extremity function in the setting of delayed nerve repair by decreasing the scar burden at nerve coaptation sites.
CLEFT-Q: Detecting Differences in Outcomes among 2434 Patients with Varying Cleft Types
Authors: Wong Riff Karen W. Y. , Tsangaris Elena , Forrest Christopher R. , Goodacre Tim , Longmire Natasha M. , Allen Gregory , Courtemanche Douglas J. , Goldstein Jesse , O’Mahony Aisling , Pusic Andrea L. , Slator Rona , Swan Marc C. , Thoma Achilleas , Vargas Federico , Klassen Anne F. 
Published: July 2019

Background:
Measuring the patient perspective is important in evaluating outcomes of cleft care. Understanding how treatment outcomes vary depending on cleft type may allow for better planning of treatments, setting of expectations, and more accurate benchmarking efforts. The CLEFT-Q is a patient-reported outcome measure for patients with cleft lip and/or palate.

Methods:
The 12 CLEFT-Q scales measuring appearance (i.e., face, nose, nostrils, lips, cleft lip scar, teeth, and jaws), function (i.e., speech), and health-related quality of life (i.e., psychological, school, social, and speech-related distress) were field tested in a cross-sectional study in 30 centers in 12 countries. Patients with cleft lip and/or cleft palate aged 8 to 29 years were recruited from clinical settings. Differences in CLEFT-Q scores by cleft subtypes were evaluated using one-way analysis of variance or Kruskal-Wallis H tests, with Tukey or Dunn procedure with Bonferroni corrections post hoc analyses, respectively. Scores are presented using radar charts to visualize all outcomes simultaneously.

Results:
The field test included 2434 patients. Scores on all CLEFT-Q scales varied significantly with cleft subtype. Patients with unilateral or bilateral cleft lip and/or palate scored lower on all appearance scales compared with patients with cleft palate or unilateral incomplete cleft lip. Scores on the speech function and speech-related distress scales decreased with each progressive group in the Veau classification. Patients with complete bilateral cleft lip and palate scored lowest on the social, school, and psychological scales.

Conclusions:
Patient-reported outcomes measured with the CLEFT-Q vary significantly with cleft type. Visualizing multiple outcomes simultaneously with radar charts allows for an understanding of a patient’s overall status in a single graph.
Primary Open Rhinoplasty
Authors: Rohrich Rod J. , Afrooz Paul N. 
Published: July 2019

Learning Objectives:
After studying this article and viewing the videos, the participant should be able to: 1. Describe the operative technique necessary to perform open rhinoplasty. 2. Summarize the steps necessary in performing a component dorsal reduction. 3. Develop a surgical plan for nasal tip shaping and cephalic rotation of the nasal tip. 4. Identify the need for aesthetic improvement of the alar base, and perform successful alar base surgery. 5. Demonstrate consistency, safety, and predictability in rhinoplasty.

Summary:
Rhinoplasty remains one of the most challenging procedures in plastic surgery, and continues to be one of the top five aesthetic surgical procedures, with over 223,000 performed in 2016. Rhinoplasty may be performed by means of the “open” or the “closed” approach, and each approach has its advantages and disadvantages. This article focuses on the open approach, and the principles and techniques necessary to achieve consistent and gratifying results. As with all plastic surgery procedures, successful rhinoplasty begins with a thorough clinical analysis, definition of the goals, meticulous preoperative planning, precise operative execution, vigilant postoperative management, and a critical analysis of one’s results.
The Importance of Tissue Perfusion in Reconstructive Breast Surgery
Authors: Frey Jordan D. , Salibian Ara A. , Choi Mihye , Karp Nolan S. 
Published: July 2019

Summary:
Immediate breast reconstruction relies on healthy mastectomy flaps for success. Tissue perfusion of these mastectomy flaps is dependent on multiple patient-, operative-, and surgeon-specific factors, which must be optimized. Unfortunately, tissue perfusion is also notoriously difficult to accurately assess and investigate. In this review, we discuss the importance of tissue perfusion in successful reconstructive breast surgery with an emphasis on perfusion assessment and techniques to ensure that anatomic mastectomy flap perfusion is maintained for immediate breast reconstruction after mastectomy. Preoperative and patient-specific factors should be considered with operative plans modified to minimize ischemic risk. Intraoperatively, incision planning and mastectomy dissection will dictate skin flap perfusion. Most importantly, mastectomy dissection in a plane at the breast capsule will maximize preservation of the subdermal plexus and subcutaneous perforators that supply the breast skin envelope while also maximizing oncologic parenchymal resection. Such anatomic dissection has been demonstrated to decrease risk of ischemic complications in immediate breast reconstruction. Postoperatively, any potential or actual areas of impaired perfusion and ischemia must be diagnosed appropriately and managed proactively to ensure a successful reconstruction. It is also important for surgeons to be aware of imaging modalities and adjunctive technologies that can help promote and assess optimal mastectomy flap tissue perfusion. Plastic surgeons and breast surgeons must actively and collaboratively work together to ensure their mutual goals are met, and optimal outcomes are attained for patients undergoing immediate breast reconstruction after mastectomy.
Outcomes Utilizing Inspira Implants in Revisionary Reconstructive Surgery
Authors: Sigalove Steven , Maxwell G. Patrick , Gabriel Allen 
Published: July 2019

Background:
Inspira round implants have a higher fill ratio than standard round implants and the 3 available implant types have increasing gel cohesivity. Collectively, these features may help provide a fuller upper pole and help reduce the risk of rippling, visible implant edges, and palpability and may be particularly beneficial in patients undergoing prepectoral reconstruction. Patient outcomes after prepectoral revision reconstruction with these implants are reviewed in this study.

Methods:
This retrospective study included consecutive patients who had previously undergone subpectoral (dual plane), implant-based, breast reconstruction and presented for revision reconstruction between June 2015 and January 2018. Reasons for revision included animation deformity, pain, asymmetry implant malposition, size change, capsular contracture, and rippling. Revision reconstruction involved implant removal, site change from subpectoral to prepectoral, and immediate implant replacement in all patients. Complications after revision reconstruction were obtained from patient records.

Results:
A total of 64 patients (124 breasts) met the inclusion criteria. During a mean follow-up period of 18.9 months, complications occurred in 4 breasts (3.2%) and included implant loss (1.6%), seroma (1.6%), hematoma (0.8%), surgical site infection (0.8%), and skin necrosis (0.8%). There was no incidence of capsular contracture and presenting complaints were resolved in all cases.

Conclusions:
Prepectoral reconstruction, in conjunction with Inspira round implants, appears to be a safe and effective approach in suitable patients presenting for revision surgery, at least in the short term. Implant features facilitate prepectoral implant placement, resulting in pleasing aesthetic outcomes. Whether these outcomes will withstand the test of time remains to be seen.