bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decision-Making Around Positive Tracheal Aspirate Cultures: The Role of Neutrophil Semiquantification in Antibiotic Prescribing
Authors: Yalamanchi Sirisha , Saiman Lisa , Zachariah Philip 
Published: June 2019

Objectives:
Ventilator-associated infections are a major contributor to antibiotic use in the PICU. Quantitative or semiquantitative assessment of neutrophils (microscopic purulence) is routinely reported in positive cultures from tracheal aspirates. The role of microscopic purulence in guiding antibiotic therapy or its association with symptoms of ventilator-associated infections is less described in children. We examine microscopic purulence as an independent predictor of antibiotic use for positive tracheal aspirate cultures in the PICU.

Design:
Retrospective cohort study.

Setting:
Tertiary care pediatric hospital.

Patients:
Children admitted to the PICU, neuro-PICU, or cardiac PICU with a positive tracheal aspirate culture from January 1, 2016, to December 31, 2016.

Interventions:
None.

Measurements and Main Results:
Positive tracheal aspirate cultures were reviewed. The outcome variable was antibiotic treatment that targeted the positive tracheal aspirate culture. The predictor variable was microscopic purulence, defined as moderate or many neutrophils on Gram stain report. Competing predictors included demographics, comorbidities, vital signs changes, respiratory support, and laboratory values. Of 361 positive cultures in the cohort, 81 (22%) were treated with antibiotics. Positive cultures with microscopic purulence were targeted for therapy more frequently (30% vs 11%). Microscopic purulence was the strongest predictor for antibiotic therapy (odds ratio, 3.3; 95% CI, 1.6–6.8) compared with fever (odds ratio, 2.0; 95% CI, 1.0–4.1) or increased respiratory support (odds ratio, 2.3; 95% CI, 1.2–4.3). There was no significant variation in symptomatology between microscopic purulence reported as moderate or many versus other (e.g., fever –24% vs 22%, increased respiratory support –36% vs 28%). Microscopic purulence was less prevalent with longer ventilator durations at the time of sampling.

Conclusions:
Microscopic purulence was an independent predictor of antibiotic therapy for positive tracheal aspirate cultures in our PICUs. However, microscopic purulence was not associated with clinical symptomatology.
Trauma Bay Disposition of Infants and Young Children With Mild Traumatic Brain Injury and Positive Head Imaging
Authors: Noje Corina , Jackson Eric M. , Nasr Isam W. , Costabile Philomena M. , Cerullo Marcelo , Hoops Katherine , Rasmussen Lindsey , Henderson Eric , Ziegfeld Susan , Puett Lisa , Robertson Courtney L. 
Published: June 2019

Objectives:
To describe the disposition of infants and young children with isolated mild traumatic brain injury and neuroimaging findings evaluated at a level 1 pediatric trauma center, and identify factors associated with their need for ICU admission.

Design:
Retrospective cohort.

Setting:
Single center.

Patients:
Children less than or equal to 4 years old with mild traumatic brain injury (Glasgow Coma Scale 13–15) and neuroimaging findings evaluated between January 1, 2013, and December 31, 2015. Polytrauma victims and patients requiring intubation or vasoactive infusions preadmission were excluded.

Interventions:
None.

Measurements and Main Results:
Two-hundred ten children (median age/weight/Glasgow Coma Scale: 6 mo/7.5 kg/15) met inclusion criteria. Most neuroimaging showed skull fractures with extra-axial hemorrhage/no midline shift (30%), nondisplaced skull fractures (28%), and intracranial hemorrhage without fractures/midline shift (19%). Trauma bay disposition included ICU (48%), ward (38%), intermediate care unit and home (7% each). Overall, 1% required intubation, 4.3% seizure management, and 4.3% neurosurgical procedures; 15% were diagnosed with nonaccidental trauma. None of the ward/intermediate care unit patients were transferred to ICU. Median ICU/hospital length of stay was 2 days. Most patients (99%) were discharged home without neurologic deficits. The ICU subgroup included all patients with midline shift, 62% patients with intracranial hemorrhage, and 20% patients with skull fractures. Across these imaging subtypes, the only clinical predictor of ICU admission was trauma bay Glasgow Coma Scale less than 15 (p = 0.018 for intracranial hemorrhage; p < 0.001 for skull fractures). A minority of ICU patients (18/100) required neurocritical care and/or neurosurgical interventions; risk factors included neurologic deficit, loss of consciousness/seizures, and extra-axial hemorrhage (especially epidural hematoma).

Conclusions:
Nearly half of our cohort was briefly monitored in the ICU (with disposition mostly explained by trauma bay imaging, rather than clinical findings); however, less than 10% required ICU-specific interventions. Although ICU could be used for close neuromonitoring to prevent further neurologic injury, additional research should explore if less conservative approaches may preserve patient safety while optimizing healthcare resource utilization.
Distally Based Posterior Tibial Artery Perforator Flaps for Reconstruction of the Defects in Achilles Region
Authors: Li Pandeng , Li Zhihua , Shen Guoliang 
Published: June 2019

Background
Patients with Achilles region defects remain a challenge for clinicians. The purpose of this article is to evaluate the surgical procedure to reconstruct the defects in Achilles region using distally based posterior tibial artery perforator flaps.

Methods
Between May 2015 and May 2017, 10 patients (aged from 35 to 68 years. 4 females and 6 males) with soft-tissue defects (sizes from 3 × 2 cm to 8 × 4 cm) in Achilles region received surgical therapy of posterior tibial artery perforator flap transplantation in the Affiliated Hospital of Xuzhou Medical University.

Results
The length of hospital stay ranged from 10 to 15 days (mean, 12 days). Local small superficial necrosis (5% of the area) was observed in only 1 case; however, it healed well after dressing was changed. All the others survived and healed well. At follow-up ranging from 12 to 24 months, all patients were satisfied with the aesthetic and functional aspects.

Conclusions
Using the posterior tibial artery perforator flaps to cover the Achilles region defects is a promising, feasible, first-line, safe option and should be extensively applied in clinical therapy.
The Molecular Pathogenesis of Dupuytren Disease
Authors: Sayadi Lohrasb R. , Alhunayan Danah , Sarantopoulos Nikolaos , Kong Christina , Condamoor Shreya , Sayadi Jamasb , Banyard Derek A. , Shaterian Ashkaun , Leis Amber , Evans Gregory R. D. , Widgerow Alan D. 
Published: June 2019

Background
Ever since the classification of Dupuytren disease into the proliferative, involutional, and residual stages, extensive research has been performed to uncover the molecular underpinnings of the disease and develop better treatment modalities for patients. The aim of this article is to systematically review the basic science literature pertaining to Dupuytren disease and suggest a new approach to treatment.

Methods
Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was conducted using the MEDLINE database to identify basic science literature on Dupuytren pathophysiology falling under 1 or more of the following categories: (1) Molecular alterations, (2) Structural alterations, and (3) Genetic predisposition.

Results
A total of 177 articles were reviewed of which 77 studies met inclusion criteria. Articles were categorized into respective sections outlined in the study methods.

Conclusion
The pathophysiological changes involved in Dupuytren’s disease can be divided into a number of molecular and structural alterations with genetic predisposition playing a contributory role. Understanding these changes can allow for the development of biologics which may disrupt and halt the disease process.
Labiolysis, Corrective Surgery for Iatrogenic Labium Minus Fusion
Authors: Ostrzenski Adam 
Published: June 2019

Background
In this study, corrective labium minus iatrogenic fusion was termed labiolysis. This procedure is a new surgical concept for the therapy of iatrogenic, symptomatic labium minus fusion by revising scar and releasing the labium minus from iatrogenic unnatural fusion with the labium majus and intralabial crease. This study presents a new surgical technique and a review of the pertinent literature on labial fusion and its therapy. In addition, this investigation identified labial fusion risk factors associated with esthetic labioreduction of the labia minora and the likelihood of prevention of this surgical complication. The objectives were to (a) describe step-by-step labiolysis surgical intervention, (b) ascertain surgical outcomes of labiolysis, (c) authenticate specific symptom(s) associated with iatrogenic labium minus fusion and how these symptoms affect the quality of life, (d) assess the labiolysis' ability to relief symptoms of labium minus iatrogenic fusion, and (e) present a specific postoperative care.

Methods
A prospective cohort study with a control group was conducted. The study group consists of 7 subjects associated with iatrogenic, symptomatic labium minus fusion and the control group, which also consists of 7 women who were subjected to fenestration labioreduction of the labia minora. The follow-up was conducted for 3 years in both groups. All subjects, from both groups, consented in writing their participation in the study. Validated instruments were used before and after labiolysis to evaluate the outcomes.

Results
There are no data in the medical literature describing a conservative medical or surgical treatment for iatrogenic, symptomatic labium minus fusion. In both groups, surgeries were performed under local anesthesia. In either group, no reoperation was performed, and no major or minor complications were observed. All preoperative symptoms associated with iatrogenic labial fusion were cured by labiolysis. Anatomical deformities were either corrected or classified as a satisfactory anatomical outcome. In both groups, the postoperative course was uneventful with full ambulation on the first postoperative day, driving a car on the third day, and returning back to work within 1 week.

Conclusions
Labiolysis is a simple surgical operation with a short learning curve, which relieves symptoms, improves quality of life associated with iatrogenic labium minus fusion, and provides an esthetically pleasing surgical outcome. In this study group, no minor and no major surgical complications were observed, and no reoperation was performed.
Keloid Excision and Adjuvant Treatments
Authors: Siotos Charalampos , Uzosike Akachimere C. , Hong Hwanhee , Seal Stella M. , Rosson Gedge D. , Cooney Carisa M. , Cooney Damon S. 
Published: June 2019

Background
Keloid disease treatment continues to be unsatisfactory with high recurrence rates. We evaluated the literature regarding the effectiveness of keloid excision with various adjuvant treatments following surgery and assessed recurrence rates.

Methods
We systematically searched databases through November 2016. We performed pairwise meta-analyses and Bayesian network meta-analyses on the number of recurrences.

Results
Following screening, 14 studies including 996 patients with various types of keloids were eligible for inclusion. Patients were categorized based on the receipt of surgery and the type of adjuvant treatment employed afterward. Paired meta-analysis (6 meta-analyses) showed that “excision + 1 adjuvant drug” led to statistically significantly higher odds of recurrence compared to “excision + radiation” (odds ratio [OR], 3.22; 95% confidence interval [CI], 1.35–7.67). Based on the network meta-analyses, the ORs of keloid recurrence following various treatments compared to no excision were as follows: “excision + pressure, 0.18 (95% CI, 0.01–7.07); excision + 2 adjuvants drugs, 0.47 (95% CI, 0.02–12.82); excision + radiation, 0.39 (95% CI, 0.04–3.31); excision + skin grafting, 0.58 (95% CI, 0.00–76.10); excision + 1 adjuvant drug, 1.76 (95% CI, 0.17–21.35); and excision only, 2.17 (95% CI, 0.23–23.95).

Conclusions
According to our results, “excision + radiation” had significantly better outcomes than excision alone. “Excision + pressure” had better outcomes than excision + any other treatment modality, and excision + nonradiation adjuvant therapies were also better than “excision only,” although these findings did not reach statistical significance.
Micro/nanobubbles
Authors: Sayadi Lohrasb R. , Alexander Michael , Sorensen Alexandria M. , Sarantopoulos Nikolaos , Lau Hien , Klopfer Michael , Ziegler Mary E. , Banyard Derek A. , Evans Gregory R. D. , Lakey Jonathan R. T. , Widgerow Alan D. 
Published: June 2019

Purpose
The preservation of transplantable tissue is directly tied to and limited by the ischemia time. Micro/nanobubbles (MNBs) are miniature gaseous voids that allow for the oxygenation of tissue given their high oxygen-carrying capacity. One of the current limitations of islet cell transplantation for type 1 diabetes is poor islet survival, caused by hypoxia, after harvesting the cells from pancreata. As such, the purpose of this study was to elucidate whether MNBs, when added to standard culture medium, improve islet cell survival postharvest.

Materials and Methods
Islet cells were harvested from Sprague-Dawley rat pancreas tissue via a standard collagenase digestion and gradient purification. To create the MNB solution, a shear-based generation system was used to produce both air- and oxygen-filled MNBs in standard Connaught Medical Research Laboratories (CMRL) medium. Four groups, consisting of 500 islet equivalents, were cultured with either the standard CMRL medium, macrobubble-CMRL, MNB (air)-CMRL, or MNB (O2)-CMRL, and they were incubated at 37°C. Each treatment solution was replenished 24 hours postincubation, and after 48 hours of culture, dithizone staining was used to determine the islet cell counts, and the viability was assessed using Calcein AM/propidium iodide staining.

Results
Islet cells that were preserved in macrobubble-CMRL, MNB (air)-CMRL, and MNB (O2)-CMRL conditions showed an increased survival compared with those cultured with standard CMRL. The islet cells cultured in the MNB (air)-CMRL condition demonstrated the greatest cell survival compared with all other groups, including the pure oxygen-carrying MNBs. None of the MNB treatments significantly altered the viability of the islet cells compared to the control condition.

Conclusions
The addition of MNBs to culture medium offers an innovative approach for the oxygenation of transplantable tissue, such as islet cells. This study demonstrated that MNBs filled with air provided the most optimal addition to the islet cell culture medium for improving islet cell survival amongst the treatment groups we tested. Given these findings, we hypothesize that MNBs may also improve the oxygenation and survival of a variety of other tissues, including fat grafts from lipoaspirate, chronic wounds, and solid organs.
Fully Automatic Robot-Assisted Surgery for Mandibular Angle Split Osteotomy
Authors: Sun Mengzhe , Chai Yuanhao , Chai Gang , Zheng Xiaohu 
Published: June 2019

Abstract
With the development of computer-assisted surgery, preoperational design is detailed in software. However, it is still a challenge for surgeons to realize the surgical plan in the craniofacial surgery. Robot-assisted surgery has advantages of high accuracy and stability. It is suitable for the high-stress procedures like drilling, milling, and cutting. This study aims to verify the feasibility for automatic drilling without soft tissues in model test based on an industrial robot platform.
This study chose the data from digital laboratory in Shanghai 9th People's Hospital. The mandibular was reconstructed in software and surgical plan was also designed. Then, the coordinate data was input to the robot's software and matrix conversion was calculated by 4 marked points. The trajectory generation was calculated by inverse kinematics for target coordinates and robot coordinates. The model was fixed and calibrated for automatic drilling. At last, the accuracy was calculated by optic scanning instrument.
The installment and preparation cost 10 minutes, the drilling procedure cost 12 minutes. The outside position error was (1.71 ± 0.16) mm, the inside position error was (1.37 ± 0.28) mm, the orientation error was (3.04 ± 1.02)°. Additionally, a total of 5 beagles were tested, with an accuracy error of (2.78 ± 1.52) mm. No postoperative complications occurred.
This is the first study reported for robot-assisted automatic surgery in craniofacial surgery. The result shows it is possible to realize the automatic drilling procedure under the condition of no interference like soft tissues. With the development of artificial intelligence and machine vision, robot-assisted surgery may help surgeons to fulfill more automatic procedures for craniofacial surgery.
The Drilling Guiding Templates and Pre-Bent Titanium Plates Improves the Operation Accuracy of Orthognathic Surgery With Computer-Aided Design and Computer-Aided Manufacturing Occlusal Splints for Patients With Facial Asymmetry
Authors: Hu Pei , Li Jiayang , Du Wen , Ji Huanzhong , Xu Chunwei , Luo En 
Published: June 2019

Abstract
Facial asymmetry is a common maxillofacial deformity which requires surgery to recover the 3-dimensional relationship of bones. The computer-aided design and computer-aided manufacturing (CAD/CAM) has been developed and applied to improve orthognathic analysis and surgery design. How to accurately realize the preoperative design of orthognathic surgery with CAD/CAM occlusal splints during operation remains a big problem. In this study, 24 consecutive patients with facial asymmetry were recruited and assigned to 2 groups. For Group A, CAD/CAM was applied to designing and producing not only the occlusal splints, but also the drilling guiding templates and pre-bent titanium plates, and for Group B CAD/CAM was applied for occlusal splints only. Postoperative clinical examinations, symmetry evaluation through 3D cephalometric analysis, accuracy comparison using color distance maps and quantitative accuracy analysis were performed. Symmetry evaluation showed that patients of both groups achieved improved facial symmetry after surgery. The color distance maps and quantitative accuracy analysis together demonstrated significantly less difference found between virtual simulated surgery and postoperative CT scan data in Group A than in Group B. In conclusion, by navigation with the drilling guiding templates and pre-bent titanium plates, the facial symmetry for patients with facial asymmetry was successfully restored after orthognathic surgery, same as applying CAD/CAM occlusal splints only. However, the drilling guiding templates and pre-bent titanium plates would provide a more accurate performance according to preoperative simulation, especially for proximal mandibular segments.
Spontaneous Osteogenesis of a Traumatic Mandibular Defect in the Pediatric Population
Authors: Gornitsky Jordan , Azzi Alain Joe , Cugno Sabrina 
Published: June 2019

Abstract
Spontaneous osteogenesis of traumatic mandibular defects in the pediatric population remains a relatively rare phenomenon with only 2 patients reported in the literature. In the adult population, a low threshold exists for bone graft placement in the presence of small mandibular gaps, with no role for spontaneous osteogenesis in significant mandibular defects. The approach to traumatic mandibular defects in the pediatric population is not clearly described in the literature and the risks and benefits associated with donor site morbidity of bone graft harvest must be tempered by the possibility for potential spontaneous osteogenesis. The present study reports 1 such patient in whom a significant mandibular defect healed by means of rigid fixation of the defect and spontaneous osteogenesis, with no functional or esthetic sequelae at long-term follow-up. A review of the pertinent literature was performed, and the authors’ approach is discussed. The authors propose that traumatic mandibular defects of < 3 cm in patients under the age of 10 years should be considered for treatment with rigid internal fixation alone and spontaneous osteogenesis.
Objective Measurement of Eyelid Force in Ptosis Versus Controls
Authors: Pillar Shani , Almog Yehoshua , Sharon Tal , Dar Nimrod , Segal Ori , Nemet Arie Y. 
Published: June 2019

Abstract
Thorough evaluation of the upper eyelid is essential for diagnosis and management planning in blepharoptosis. In a previous study, our group described a novel force gauge for direct assessment of upper lid force in healthy subjects. In this study, the authors apply the same technique for measuring muscle forces in ptotic eyelids.
Patients scheduled to undergo surgical repair of aponeurotic blepharoptosis or dermatochalasis, from July 2017 to August 2018, in a tertiary care medical center, were enrolled in this prospective case series. When the eyelid disorder was unilateral, the normal eye was designated as control. The upward force generated by the eyelid was measured directly using a handheld dynamometer noninvasively attached to the upper eyelid. Measurements were conducted with and without fixation of the frontalis muscle, to differentiate between total lid force, levator force, and frontalis contribution.
A total of 56 eyes was included in the study: 34 in the ptosis group, 11 in the dermatochalasis group, and 11 as controls. Both the ptosis group and the dermatochalasis group had significantly lower total muscle force and levator force measurements when compared with control (P <0.05). Calculated frontalis force contribution to upgaze did not differ significantly between groups. In the control group, calculated frontalis force contribution to upgaze strongly correlated to marginal reflex distance1 (r = 0.75, P = 0.05)
In conclusion, the authors present a simple, inexpensive, new portable force gauge for direct eyelid force measurements in eyelid pathologies. Distinct differences between ptotic and healthy eyelids are demonstrated, suggesting potential applications in patient evaluation and management.
Brazilian-Portuguese Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcome Instrument
Authors: Denadai Rafael , Raposo-Amaral Cassio Eduardo , Sabbag Anelise , Ribeiro Rafael Andrade , Buzzo Celso Luiz , Raposo-Amaral Cesar Augusto , Hung Man , Skirko Jonathan R. 
Published: June 2019

Background:
The purpose of this study was to conduct a linguistic validation of the velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for use in Brazilian-Portuguese patients with VPI.

Methods:
The original English version of the VELO instrument was translated into Brazilian-Portuguese, back-translated, and adapted among the Brazilian patients (n = 21) with VPI and their parents, based on the standardized guidelines for the cross-culture adaption process. Discrepancies in the forward and backward translation steps were computed. Comprehension rates were captured for each debriefing interview. The content validity index (CVI) per item (I-CVI) and of the scale (S-CVI universal agreement [S-CVI/UA] and averaging [S-CVI/Ave]) were calculated.

Results:
Reconciliation of the 2 forward translations and the comparison between the back translation and the original VELO version resulted in some item wordings with discrepancies which were reviewed by the research team (translators, expert committee, and original developers of instrument). Three rounds of cognitive interviews also led to some revisions of wording. Comprehension rates of patients and their parents were 60% to 100%, 80% to 100%, and 100% in the first, second, and third rounds of cognitive interviews, respectively. The I-CVI, S-CVI/AU, and SCI/Ave for the Brazilian-Portuguese VELO version were 0.83 (or higher), 0.83 (or higher), and 0.97, respectively.

Conclusions:
The linguistic validation process of the VELO instrument created a cross-culturally equivalent Brazilian-Portuguese version for use in Brazilian-Portuguese speaking patients with VPI.