bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reevaluating the Current Model of Rhinoplasty Training and Future Directions: A Role for Focused, Maneuver-Specific Simulation
Authors: Zammit Dino , Ponnudurai Nirros , Safran Tyler , Gilardino Mirko 
Published: October 2019

Background:
Rhinoplasty is known for its complexity in planning and execution. For trainees, knowledge acquisition is often adequately attained. The mastery of skills, however, occurs by means of hands-on exposure, which continues to be a challenge. This article discusses the positive progress made in rhinoplasty training, and objectively demonstrates a need for more hands-on rhinoplasty exposure for residents.

Methods:
A systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Concurrently, an online survey was developed, assessing resident comfort and training in rhinoplasty, and e-mailed to Canadian and U.S. plastic surgery training programs.

Results: One hundred thirty-eight
residents completed the survey, 62 junior (first- to third-year residents) and 76 senior residents (fourth- to sixth-year residents). Seventy-two percent of senior residents (95 percent of sixth-year residents) reported adequate rhinoplasty exposure, as opposed to 13 percent of junior residents. Seventy-five percent of senior residents most often participated as observers or first assistants, 25 percent participated as co-surgeons, and 73.9 percent did not perform a key rhinoplasty step more than five times. Residents felt the three most difficult steps of rhinoplasty were nasal osteotomy (76.1 percent), caudal septum/anterior nasal spine manipulation (65.2 percent), and nasal tip sutures (55.8 percent), and 73.9 percent felt that simulator training would substantially improve confidence.

Conclusions:
Despite sufficient exposure to rhinoplasties, residents were least confident in performing rhinoplasties relative to other aesthetic procedures, likely because of the high proportion of rhinoplasty exposure that is observational as opposed to hands-on acquisition of surgical maneuvers in the operating room. The survey established the maneuvers residents find the most difficult, and as programs adopt competency-based training, developing rhinoplasty simulators targeting specific identified steps may help improve competence for rhinoplasty skills.
A Matched-Pair Analysis of Prepectoral with Subpectoral Breast Reconstruction: Is There a Difference in Postoperative Complication Rate?
Authors: Momeni Arash , Remington Austin C. , Wan Derrick C. , Nguyen Dung , Gurtner Geoffrey C. 
Published: October 2019

Background:
The development of acellular dermal matrices has revolutionized implant-based breast reconstruction. The most recent development has been the introduction of prepectoral breast reconstruction. However, concerns have been expressed related to the quality of soft-tissue coverage and infectious complications. Thus, the authors felt it prudent to perform a matched-pair analysis of clinical outcomes following prepectoral and subpectoral tissue expander placement.

Methods:
A retrospective study of patients who underwent immediate breast reconstruction by means of prepectoral (group 1) and dual-plane subpectoral (group 2) tissue expander placement was performed. Patients in each group were matched for age, body mass index, history of radiotherapy, and type of acellular dermal matrix. Of note, patients in group 1 received perioperative antibiotic prophylaxis for less than 24 hours, whereas patients in group 2 received antibiotic prophylaxis for at least 1 week.

Results:
A total of 80 patients (138 breast reconstructions) were included in the study (group 1, n = 40; group 2, n = 40). No difference in total postoperative complication rate (p = 0.356) and mastectomy skin necrosis rate (p = 1.0) was noted. Observed differences in major complications (p = 0.06), major infection (p = 0.09), and loss of reconstruction (p = 0.09) were not found to be significant.

Conclusion:
Immediate prepectoral tissue expander insertion with anterior acellular dermal matrix coverage and less than 24 hours of antibiotic prophylaxis is safe and compares favorably to subpectoral tissue expander placement with an inferior acellular dermal matrix sling and a prolonged course of antibiotics.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Intraoperative Surgical Navigation Reduces the Surgical Time Required to Treat Acute Major Facial Fractures
Authors: Bergeron Léonard , Bouchard Sandrine , Bonapace-Potvin Michelle , Bergeron François 
Published: October 2019

Background:
Assessing bone reduction and implant placement in facial fractures is time-consuming because of limited visibility. An intraoperative navigation system allows real-time confirmation of bone positioning and implant placement on the patient’s computed tomographic scan. This circumvents the visibility problem and therefore appears to shorten the surgery time. The goal of this study was therefore to determine whether intraoperative navigation reduces the surgical time required to treat patients with acute major facial fractures.

Methods:
In this retrospective quasi-experimental study, 50 patients with major facial fractures were identified and randomly assigned to treatment groups. Twenty-two were treated without the use of a navigation system, and 28 were treated using navigation. The Facial frActure Severity Score (FASS) was devised to better assess and control for complexity of cases and control for possible selection bias.

Results:
The FASS was directly linked to surgery time, whether or not navigation was used. An analysis of covariance demonstrated that the surgical time required to treat major facial fractures, taking into account the FASS, was reduced by 36.1 percent (124.8 minutes) when navigation was used.

Conclusions:
This study compared the surgical time required to treat patients with major facial fractures, with and without a navigation system. The use of a navigation system reduced the surgical time by 36.1 percent. This is a significant improvement in reducing the length of craniomaxillofacial procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Efficacy of Ear Molding in Infants using the EarWell Infant Correction System and Factors Affecting Outcome
Authors: Chan Stephanie L. S. , Lim Gale J. S. , Por Yong Chen , Chiang Ming Fang , Ho Shuxian , Saffari Seyed Ehsan , Chia Hui-Ling 
Published: October 2019

Background:
One-third of infants have ear anomalies, and less than one-third self-correct. Correction of ear deformities by molding exploits the plasticity of the auricular cartilage because of circulating maternal estrogen during infancy. In this study, the authors assess the efficacy of the EarWell Infant Correction System in the correction of ear deformities and determine the factors that affect its outcome.

Methods:
The authors conducted a single-center prospective study over a 3-year period. Consecutive full-term infants who underwent ear molding with the EarWell system were recruited. Primary outcome was successful correction of ear anomaly. Secondary outcomes included complications and maintenance of ear shape. Factors identified included type of anomaly, age at application, duration of application, and breastfeeding.

Results:
Sixty-seven patients with a total of 105 ears were recruited. The anomalies were classified into deformations (66.7 percent) and malformations (33.3 percent). The median age group at presentation was 0 to 7 days (67 percent). Average duration of application was 4.1 weeks. Successful correction was achieved in 86 percent of patients. Ear deformations achieved a significantly higher rate of successful outcome (98 percent) compared with malformations (64 percent) (p < 0.001). Skin complications were common (46 percent) and attributed to our tropical climate. Patients with complications were of a higher mean age (22.1 days) compared with patients with no complications (10.6 days) (p = 0.037).

Conclusions:
The EarWell system is an effective nonsurgical option for the treatment of ear anomalies. The type of anomaly was the only predictor of successful correction, whereas age at application, duration of molding, and breastfeeding were not. Complications were more common in older infants.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
“Like a Normal Person Again”: A Qualitative Analysis of the Impact of Headache Surgery
Authors: Afifi Ahmed M. , Schwarze Margaret L. , Stilp Emmaline K. , Orne Jason , Smith Jeremy P. , Abd-Elsayed Alaa A. , Anderson Brooke M. , Salem Ahmed , Macdonald Cameron L. , Israel Jacqueline S. 
Published: October 2019

Background:
Outcomes after migraine surgery have been previously assessed using quantitative measurements, including the migraine headache index. Qualitative methodologies offer the ability to analyze patients’ perceptions and pain experience, and may point to changes in domains not captured by quantitative instruments. The purpose of this study was to characterize individual patients’ experiences with migraines and to analyze how patients’ experience of headaches changes in relation to surgery.

Methods:
Patients who previously underwent migraine surgery performed by a single surgeon participated in semistructured interviews at least 1 year after surgery. Purposive sampling was used to recruit patients [n = 15 (73 percent female)]. Interviews were transcribed verbatim. A multidisciplinary team with backgrounds in surgery, pain management, medicine, and health services research coded and analyzed transcripts.

Results:
Participants reported improvements in one or more domains of pain following surgery, and changes in medication use and effectiveness. Even in individuals with persistent pain postoperatively, surgery appeared to facilitate an improvement in headache self-efficacy, including an ability to participate in daily activities. Migraineurs frequently described a new degree of control over at least one aspect of their pain.

Conclusions:
Migraine surgery appears to positively impact patients’ lives in ways that support and expand on previously published outcomes. Patients report benefiting from surgery in ways that are not currently captured in commonly used metrics. This study’s findings support the need for more specific patient-reported outcome measures to help clinicians and patients understand the impact of surgery and which outcomes matter most to patients.
Change Is Happening: An Evaluation of Gender Disparities in Academic Plastic Surgery
Authors: Smith Brandon T. , Egro Francesco M. , Murphy Carolyn P. , Stavros Alex G. , Kenny Elizabeth M. , Nguyen Vu T. 
Published: October 2019

Background:
Gender disparities in academic plastic surgery are known; however, recently, professional societies have endorsed a culture of gender diversification. This study aims to evaluate the effects of these changes at faculty and leadership positions.

Methods:
A cross-sectional study was conducted in June of 2018 to evaluate gender representation among U.S. academic plastic surgery faculty, and compare career qualifications, years of experience, and faculty positions.

Results:
A total of 938 academic plastic surgeons were identified, of which only 19.8 percent were women. Female surgeons graduated more recently than men (2009 versus 2004; p < 0.0001) and predominantly from integrated residency programs (OR, 2.72; 95 percent CI, 1.87 to 3.96), were more likely to be an assistant professor (OR, 2.19; 95 percent CI, 1.58 to 3.05), and were less likely to be a full professor (OR, 0.20; 95 percent CI, 0.11 to 0.35) or program chair (OR, 0.32; 95 percent CI, 0.16 to 0.65). After adjustment for differences in years of postresidency experience, only disparities at the full professor position remained significant (OR, 0.34; 95 percent CI, 0.16 to 0.17), indicating that experience-independent gender inequality is prominent at the full professor level and that current differences in cohort experience are a significant contributor to many of the observed positional disparities. Lastly, programs led by a female chair employed significantly more female faculty (32.5 percent versus 18.2 percent; p = 0.016).

Conclusions:
Gender diversity in academic plastic surgery remains a significant issue, but may see improvement as the disproportionately high number of junior female academics advance in their careers. However, leadership and promotion disparities between men and women still exist and must be addressed.
Recognizing Racial Heterogeneity in the Latino Nose: Aesthetic Concepts for an Individualized Approach
Authors: Perez Justin L. , Mohan Raja , Rohrich Rod J. 
Published: October 2019

Background:
Latinos are one of the fastest growing ethnic groups in the United States, and there is a growing demand for aesthetic rhinoplasty in these patients. The authors provide an individualized, systematic approach for evaluation and improvement of surgical outcomes in Latino patients.

Methods:
A retrospective review of patients identified as Latino who underwent primary rhinoplasty and those who did not but had documented nasal photographs was performed. Photographs and operative records were reviewed in detail. Specific aesthetic nasal characteristics, individualized surgical techniques, and aesthetic results were recorded.

Results:
The Latino nose has some characteristic nasal traits, including thick soft-tissue envelope, bulbous and underrotated tips, fatty hanging alae with propensity for anterior notching, weak underlying cartilaginous structures, and a propensity for alar flare worsened by depressor septi hyperactivity. Case review, however, demonstrates that there is moderate variability, with some patients demonstrating features more consistent with a European Caucasian nose and others displaying features more congruent with the black nose.

Conclusions:
Addressing the Latino nose requires a firm understanding of the racial heterogeneity that exists within this patient population, ranging from features more consistent with the black nose to features more congruent with a European Caucasian nose. A patient’s aesthetic goals should be thoroughly discussed to avoid racial incongruity. The authors provide an individualized, component approach to improving aesthetic outcomes in Latino rhinoplasty.
FDG PET/CT Image for a Rosai-Dorfman Disease With Pituitary and Bone Involvement in a Pediatric Patient
Authors: Kong Ziren , Wang Yu , Ma Wenbin , Cheng Xin 
Published: October 2019

Abstract
Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy, is a rare nonneoplastic histiocytic disorder that often involves the lymph nodes and occasionally the central nervous system or skeleton. However, the presence of extranodal Rosai-Dorfman lesions without lymphadenopathy is extremely rare. Here we present a case of a pathological confirmed Rosai-Dorfman disease with pituitary and skeletal involvement without lymph nodes involvement.
Excellent Response to 177Lu-DOTATATE Peptide Receptor Radionuclide Therapy in a Patient With Progressive Metastatic Castration-Resistant Prostate Cancer With Neuroendocrine Differentiation After 177Lu-PSMA Therapy
Authors: Liu Chen , Liu Teli , Zhang Jingjing , Baum Richard P. , Yang Zhi 
Published: October 2019

Abstract
Prostate cancer with neuroendocrine differentiation is associated with a poor prognosis, rapid disease progression, and treatment resistance, and constitutes a diagnostic and therapeutic dilemma. We present images of 177Lu-DOTATATE scan and 68Ga-DOTATATE PET/CT scan conducted on a 65-year-old man with prostate cancer with neuroendocrine differentiation, whose disease progressed despite conventional treatment and 177Lu-PSMA radioligand therapy; however, an extraordinary radiographic tumor remission, biochemical response, and improvement of clinical symptoms were observed after the patient underwent 177Lu-DOTATATE peptide receptor radionuclide therapy.
Contemporary Concepts of Primary Dynamic Facial Nerve Reconstruction in the Oncologic Patient
Authors: Klein Holger Jan , Guedes Tiago , Tzou Chieh-Han John , Rodriguez-Lorenzo Andrés 
Published: October 2019

Abstract
Transection of the facial nerve and its branches during extensive ablative procedures in the oncologic patient causes loss of control of facial mimetic muscles with severe functional and aesthetic sequelae. In such patients with advanced tumorous disease, copious comorbidities, and poor prognosis, rehabilitation of the facial nerve has long been considered of secondary priority. However, recent advances in primary facial nerve reconstruction after extensive resection demonstrated encouraging results focusing on rapid and reliable restoration of facial functions. The authors summarize 3 innovative approaches of primary dynamic facial nerve reconstruction by using vascularized nerve grafts, dual innervation concepts, and intra-facial nerve transfers.
A Relationship Between the Supratrochlear Nerve and Trochlea: Anatomical Study and Application to Migraine Headaches
Authors: Kikuta Shogo , Iwanaga Joe , Watanabe Koichi , Kusukawa Jingo , Tubbs R. Shane 
Published: October 2019

Abstract
Supratrochlear nerve (STN) is a terminal branch of the frontal nerve arising from the ophthalmic nerve (V1). Compression of the STN by adjacent structures might result in migraine headaches. The aim of this study was to explore the relationship of the STN and trochlea for a better understanding of potential entrapment of the STN. Nineteen orbits from ten fresh-frozen cadaveric heads were dissected. The relationship of the STN and the trochlea was classified into three types: In type I, the STN passed lateral to the trochlea; In type II, the STN passed through the trochlea; In type III, the STN passed medial to the trochlea. Type I was found in 52.6% (10/19 sides), type II was found in 42.1% (8/19 sides), and type III was seen in 3.4% (1/19 sides). In type III, both the STN and infratrochlear nerve were identified as separate branches. The authors propose a new classification of the pathway of the STN based on its relationship with the trochlea. This study might shed light on headaches emanating from this region.
Fabrication of Nasoalveolar Molding Devices for the Treatment of Cleft Lip and Palate, Using Stereolithography Additive Manufacturing Processes and Computer-Aided Design Manipulation Software
Authors: Ahmed Mairaj K. , Ahsanuddin Sofia , Retrouvey Jean-Marc , Koka Krishna Sai , Qureshi Haider , Bui Anthony H. , Taub Peter J. 
Published: October 2019

Introduction:
Nasoalveolar molding (NAM) is a presurgical orthopedic treatment modality that attempts to reorient misaligned bony and soft tissue structures in patients with clefting of the lip and palate. The NAM devices are implemented prior to surgical intervention in order to minimize the gap across the cleft and thereby reduce tension across the eventual repair. Currently, NAM devices are fabricated in a laboratory and then refined chairside by the provider. The present article describes the potential of three-dimensional (3D) printing and computer-aided design (CAD) software for the fabrication of NAM devices.

Material and methods:
A workflow was developed to demonstrate the use of 3D printing and CAD software to design NAM devices. This workflow encompasses scanning an impression into CAD software, performing a series of manipulations, and then printing the digital model.

Results:
To test the workflow, a cleft palate plaster model was scanned into CAD software. Through a series of linear and angular freeform manipulations of the body, the model was modified to display a cleft with a reduced alveolar gap. Sequential molding devices were produced which would gradually apply pressure to targeted areas of hard and soft tissue until the cleft is minimized. The resulting devices are printed using a stereolithography printer.

Conclusions:
The use of 3D printing and CAD software shows promise in improving the accuracy, speed, and cost-effectiveness of designing NAM devices. The accuracy and flexibility from digitally visualizing the manipulations made to an appliance before its creation can result in a more personalized device for the patient.
The Transareola Endoscopic Approach Yields Adequate Oncological Dissection as Open Approach in the Treatment of Papillary Thyroid Carcinoma
Authors: Gao Hengyuan , Chen Chen , Liu Xinjie , Xu Nan , Wang Yuanyang , Qu Rui , Yu Xiaofang 
Published: October 2019

Objective:
This study aimed to evaluate and discuss whether the transareola endoscopic surgery has similar outcome outcomes to open surgery in the treatment of papillary thyroid carcinoma (PTC).

Method:
A total of 102 patients with PTC were enrolled in this study. Among them, 53 patients were treated by transareola endoscopic surgery (endoscopic group) and 49 patients were treated by open surgery (open group). Some specific factors, including thyroglobulin (Tg), radioactive iodine uptake (RAIU), postoperative nuclide imaging in thyroid area, postoperative nuclide imaging of lymph nodes suspicious for metastasis (PNILNSM), etc. were analyzed and compared between the 2 groups.

Results:
There were no significant differences between the 2 groups regarding body mass index (22.9±3.4 vs. 24.0±3.3, P=0.103), operation time (173.3±43.2 vs. 158.8±47.9 min, P=0.110), intraoperative blood loss (41.8±19.4 vs. 35.8±31.0 mL, P=0.251, P=0.251), tumor diameter (19.0±6.8 vs. 20.2±7.2 mm, P=0.400), and overall complications (11.3% vs. 10.2%, P=0.868). No significant difference was found in the specific factors between the 2 groups concerning RAIU-2h/24h (2.44±1.34 vs. 2.58±1.65%/2.83±3.75 vs. 2.35±3.44%, P=0.646/ P=0.506), number of dissected lymph nodes (4.4±1.4 vs. 4.6±1.5, P=0.595), Tg before radioiodine therapy (4.46±5.50 vs. 5.60±8.36; P=0.495), Tg after radioiodine therapy (1.03±1.93 vs. 1.11±1.61, P=0.812, P=0.812), postoperative nuclide imaging in thyroid area (1.76±1.50 vs. 2.19±1.85 cm2, P=0.195), PNILNSM before radioiodine (none: 79.2% vs. 83.7%, P=0.566; central: 17.0% vs. 12.2%, P=0.653; lateral: 1.9% vs. 4.1%, P=0.450; central+lateral: 1.9% vs. 0%, P=1.000), and PNILNSM after radioiodine (none: 94.3% vs. 95.9%, P=0.111; central: 3.8% vs. 2.0%, P=1.000; lateral: 0 vs. 2.0%, P=0.480; central+lateral: 1.9% vs. 0%, P=1.000).

Conclusions:
Transareola endoscopic total thyroidectomy and central lymph nodes dissection are safe and effective. According to the evaluated postoperative specific factors, this technique achieves similar outcomes to open surgery in selected patients with PTC.
Ocular hypertension drives remodeling of AMPA receptors in select populations of retinal ganglion cells
Authors: Sladek Asia L. , Nawy Scott 
Published: October 2019

AbstractAMPA receptors in the CNS are normally impermeable to Ca2+ but aberrant expression of Ca2+-permeable AMPA receptors (CP-AMPARs) occurs in pathological conditions such as ischemia or epilepsy, or in degenerative diseases such as ALS. Here we show that select populations of retinal ganglion cells (RGCs) similarly express high levels of CP-AMPARs in a mouse model of glaucoma. CP-AMPAR expression increased dramatically in both α On and α transient Off RGCs, and this increase was prevented by genomic editing of the GluA2 Q/R site. α On RGCs with elevated CP-AMPAR levels displayed profound synaptic depression, which was reduced by selectively blocking CP-AMPARs, buffering Ca2+ with BAPTA, or with the CB1 antagonist AM251, suggesting that depression was mediated by a retrograde transmitter which might be triggered by influx of Ca2+ through CP-AMPARs. Thus OHT alters the composition of AMPARs and modulates patterns of synaptic activity in select populations of RGCs.