bluuebunny/crossref_metadata_2025_split huggingface dataset:
Re-excision Rate after Partial Mastectomy in Oncoplastic Breast-Conserving Surgery
Authors: Benjamin Martin A. , Sinnott Catherine , Bawa Sheina , Kaufman David I. , Guarino Katie , Addona Tommaso 
Published: March 2019

Background
Applying oncoplastic techniques to breast conservation therapy is believed to improve cosmetic and oncologic outcomes, compared with standard breast conservation therapy alone. This study aimed to perform a comprehensive review of the literature comparing outcomes of oncoplastic breast conservation therapy (BCT + R) with that of standard breast conservation therapy alone (BCT). A secondary objective was to compare these results to outcomes after oncoplastic breast conservation therapy performed at our institution (BCT + r).

Methods
A literature search was performed in PubMed using key words, “oncoplastic,” “partial breast reconstruction,” and “breast conservation therapy.” Case reports, case series, and studies with fewer than 10 patients and studies that did not report re-excision rates were excluded. A retrospective chart review was performed from 2011 to 2017 of all cases of oncoplastic breast conservation therapy performed at our institution by a single 2-surgeon team consisting of 1 breast surgeon and 1 plastic surgeon. Outcomes were assessed by comparing re-excision rates between the 3 comparison groups (BCT, BCT + R, BCT + r).

Results
The BCT group was made of 5965 patients (22 articles), and the BCT + R group comprised 2564 patients (41 articles). Re-excision rates in the BCT + R group were lower (4.0%) than the BCT group (17.2%, P = 0.0001). One hundred seventy-two patients comprised the BCT + r group and underwent oncoplastic breast conservation therapy during the study period at our institution. The re-excision rate in the BCT + r group was 1.7% and was significantly lower than the BCT group (P = 0.0001) and lower but not significantly different from the BCT + R group (P = 0.2113).

Conclusions
Oncoplastic breast conservation therapy leads to lower re-excision rates compared with standard breast conservation therapy. Oncoplastic breast conservation therapy may improve oncologic outcomes compared with standard breast conservation therapy by allowing for more extensive resection without compromising aesthetic results.
A Comparison of Early Versus Late Prenatal Magnetic Resonance Imaging in the Diagnosis of Cleft Palate
Authors: Laifer-Narin Sherelle , Schlechtweg Kathryn , Lee James , Booker Whitney , Miller Russell , Ayyala Rama S. , Imahiyerobo Thomas 
Published: March 2019

Background
Prenatal ultrasound is the standard modality to screen for fetal craniofacial malformations, but can be limited by sonographer experience, oligohydramnios, and maternal obesity. Fetal magnetic resonance imaging (MRI) can be used as an adjunct to ultrasound, but there is a paucity of literature on its performance. The objective of this study was to examine the accuracy of fetal MRI for prenatal diagnosis of craniofacial abnormalities in an at-risk patient population and to determine if accuracy is maintained before and after 24 weeks gestational age (GA).

Methods
This was a retrospective review of a single-center fetal MRI database including cases from March 2011 to November 2018. All cases were referred for MRI due to a suspected orofacial cleft or micrognathia upon screening ultrasound. Magnetic resonance imaging was performed and interpreted by dedicated fetal MRI radiologists. Prenatal findings were correlated with postnatal anatomy.

Results
Sixty-one cases were identified. Ten were lost to follow-up and 9 underwent termination of pregnancy. Among the remaining 42 cases, MRI possessed a sensitivity of 91.7% and negative predictive value (NPV) of 90% for prenatal diagnosis of cleft palate. When performed at early GA, fetal MRI (n = 20) demonstrated sensitivity and NPV of 100% for cleft palate diagnosis. For cleft lip, MRI had 93.1% sensitivity and 86.7% NPV without significant decrease in accuracy at early GA. For micrognathia, MRI demonstrated 100% sensitivity and NPV overall, as well as at early and late gestational ages.

Conclusions
Fetal MRI is an accurate method for prenatal diagnosis of cleft palate, cleft lip, and micrognathia. Furthermore, it remains highly accurate even when performed before 24 weeks GA. We advocate the use of fetal MRI as an adjunct imaging modality to standard ultrasound for the evaluation of suspected fetal craniofacial anomalies to provide complete and accurate counseling to prospective parents and facilitate the planning of appropriate postnatal care.
Wireless Pressure Ulcer Sensor
Authors: Hickle Kelli , Slamin Robert , Baez Angel , Sen Devdip , Evan-Browning Eric , Tessier Heather , Mendelson Yitzhak , McNeill John , Dunn Raymond 
Published: March 2019

Abstract
Pressure ulcers are increasingly prevalent in an aging population. The most commonly used method of pressure ulcer prevention is pressure off-loading achieved by physically turning bedbound patients or by using expensive, single application devices such as wheelchair cushions. Our aim is to approach the problem of pressure ulcer prevention in a new way: a wireless sensor worn by the patient at locations susceptible to pressure injury. The sensor will monitor local pressure over time and transmits the data wirelessly to a base station (in a hospital setting) or smartphone (for home care). When a condition that would be harmful to tissue is reached, an alert would enable immediate direct intervention to prevent development of a pressure ulcer. The goal of this study was to validate the sensor's use in a live animal model and to lay the foundation for building time-pressure curves to predict the probability of pressure injury. Sprague-Dawley rats underwent surgical implantation of bilateral steel discs deep to the latissimus dorsi muscles. After the animals recovered from the surgical procedure, pressure was applied to the overlying tissue using magnets of varying strengths (30–150 mm Hg) for between 1 and 8 hours. Our sensor was placed on the skin prior to magnet application to wirelessly collect data regarding pressure and time. Three days after pressure application, animals were killed, injuries were graded clinically, and biopsies were collected for histological analysis. Results reveal that all animals with magnet application for more than 2 hours had clinical evidence of ulceration. Similarly, histological findings of hemorrhage were associated with increased time of pressure application. However, at high pressures (120–150 mm Hg), there were ischemic changes within the muscular layer without corresponding skin ulceration. We have developed a wireless sensor that can be placed on any at-risk area of the body and has the potential to alert caregivers when patients are at risk of developing a pressure injury. Our sensor successfully transmitted pressure readings wirelessly in a live, mobile animal. Future studies will focus on safety and efficacy with human use and development of algorithms to predict the probability of pressure ulcer formation.
Implications of Facial Fracture in Airway Management of the Adult Population
Authors: Le Thuy-My T. , Oleck Nicholas C. , Khan Wajiha , Halsey Jordan N. , Liu Farrah C. , Hoppe Ian C. , Lee Edward S. , Granick Mark S. 
Published: March 2019

Purpose
Facial fractures are a harbinger when it comes to airway management. Facial fractures can cause airway obstruction or preclude the use of intubation. We aim to examine the etiologies, types of facial fractures, and the risk factors that may lead to requirement of an advance airway.

Methods
A retrospective chart review was performed of all facial fractures in the adult population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and course of hospital stay.

Results
During the period examined, 2626 patients were identified as 18 years or older and with facial fracture. Among these patients, 443 received airway management. Mean age was 34.21 years (range, 18–95 years), with a male predominance of 91.9%. One hundred nineteen patients were intubated on, or before, arrival to the trauma bay. One hundred three patients required surgical airways on arrival to the trauma bay, and 91 of these patients were also reported to have been intubated before arrival. There were a total of 741 fractures identified on radiologic imaging. The most common fractures observed were orbital fractures, frontal sinus fractures, and nasal fractures. Mean Glasgow Coma Scale score on arrival was 9.45 (range, 3–15). Gunshot wound was also the most common etiology among those who were intubated and those who received a surgical airway. The most common concomitant injuries were traumatic brain injury, intracranial hemorrhage, and skull fracture. Forty-one patients died, most of which were intubated during their hospital course.

Conclusions
There is a dearth of literature detailing standardization of airway management for patients who present with facial fractures. The difference between intubation and surgical airway is often a subjective judgment call, but the authors believe that a more streamlined process can be elucidated after analyzing previous trends as well as variabilities in patient survival and prognosis.
Periprosthetic Capsule Formation and Contracture in a Rodent Model of Implant-Based Breast Reconstruction With Delayed Radiotherapy
Authors: Wright Matthew A. , Samadi Arash , Lin Alexandra J. , Lara Daniel O. , Harper Alice D. , Zhao Runlei , Spector Jason A. 
Published: March 2019

Introduction
Capsular contracture (CC) is the most common complication of breast implantation, with an incidence of nearly 50% in patients undergoing breast reconstruction with subsequent radiotherapy. Although the move toward submuscular (SM) device placement led to a decreased incidence of CC, subcutaneous (SQ) implantation has seen a resurgence. The purpose of this study was to use a rodent model of breast reconstruction with smooth silicone implants and delayed radiotherapy to assess the occurrence of CC in SQ versus SM implantation.

Methods
Custom 2 mL smooth round silicone implants were placed bilaterally into 12 female Sprague Dawley rats that were randomized into 4 groups of 3, with each group differing by implantation plane (SQ vs SM) and irradiation status (irradiated vs nonirradiated). Rats from the SQ group received implants bilaterally underlying the skin on the flank. Rats in the SM groups received implants bilaterally under the latissimus dorsi muscle. Irradiated rats received 20 Gy localized to each implant on postoperative day 10. One rat from each group was imaged with a micro–computed tomography scanner at baseline and at explant 3 months later, whereupon capsules from all rats were examined histologically.

Results
Rats in the SQ group showed evidence of contracture on gross examination and greater evidence of morphologic disruption per micro–computed tomography scan. There was no evidence of contracture or morphologic disruption in either SM group. Mean ± SD capsule thickness was 39.0 ± 9.0 μm in the SQ versus 37.6 ± 9.8 μm in the SM nonirradiated groups and 43.9 ± 14.9 μm in the SQ versus 34.3 ± 8.3 μm in the SM irradiated groups (all P > 0.05).

Conclusions
In a rodent model of smooth silicone breast implantation and delayed radiotherapy, although there did not appear to be differences in capsule thickness regardless of device placement plane, SQ implants demonstrated gross evidence of CC. These data indicate that capsule thickness is only part of a larger pathogenetic picture, which should take into consideration the contribution from all peri-implant tissue.
Clinical Value of Single-photon Emission Computed Tomography Combined With Computed Tomography for Sentinel Lymph Node Identification in Melanoma
Authors: McGregor Andrew , Kim Samuel , Norwich-Cavanaugh Amanda , Sun Alexander H. , Abbate Deena S. , Hsia Henry C. , Narayan Deepak 
Published: March 2019

Introduction
Melanoma is the deadliest form of skin cancer and has the ability to metastasize widely. Accurate diagnosis of sentinel lymph nodes (SLN) is crucial to its management. The gold standard for SLN identification is planar lymphoscintigraphy. Recently, single-photon emission computed tomography combined with computed tomography (SPECT/CT) has been used as a hybrid method to map lymphatic drainage networks. We aim to better characterize the utility of this tool in head and neck melanoma by evaluating its effectiveness in the preoperative setting for melanoma patients undergoing sentinel lymph node biopsy (SLNB).

Methods
We performed a retrospective chart review at the West Haven Veterans Affairs Hospital. Inclusion criteria were patients with melanoma with a thickness greater than 0.75 mm and SPECT/CT use before operative sentinel lymph node excision. Exclusion criteria included clinically palpable lymph nodes, evidence of distant metastatic disease, melanoma with a Breslow depth less than 0.75 mm, and melanoma in situ. Our primary endpoints were correlation with intraoperative findings and whether the test had any influence on the operative plan.

Results
Thirty-five patients between 2011 and 2017 met our criteria. SPECT/CT correlated with the sentinel node biopsy based on intraoperative lymphoscintigraphy in 30 (86%) of 35 cases, and there were no changes to the operative plan after SPECT/CT was performed. Sentinel lymph nodes were correctly identified in all 35 cases.

Conclusions
The role of SPECT/CT in SLNB is uncertain. According to some studies, SPECT/CT can help decision making and change surgical approach in up to 35% of patients. However, other studies have reported questionable correlation with intraoperative findings and no added intraoperative value in over 50% of patients. We have demonstrated that preoperative SPECT/CT was consistent with intraoperative findings in 86.0% of cases but did not change the surgical approach for the SLNB. Surveillance over a period of 12 months did not reveal any signs of melanoma recurrence. A possible advantage of SPECT/CT is potentially decreasing costs by lowering operative time. However, financial cost in the literature suggests SPECT/CT is costlier than lymphoscintigraphy and therefore this must be weighed against any potential benefit. Overall, we did not find that SPECT/CT gives added value when compared with lymphoscintigraphy.
Malignant and High-Risk Lesions in the Contralateral Breast Symmetry Mastopexy and Reduction Specimens When Performing Large-Volume Displacement Oncoplastic Surgery
Authors: Liang Yuanxin , Muse-Fisher Christopher , Rambukwella Mishan , Naber Stephen P. , Chatterjee Abhishek 
Published: March 2019

Background
Large-volume displacement oncoplastic surgery using mastopexy/reduction mammaplasty designs is becoming increasingly popular in breast cancer surgery. A contralateral symmetry operation using similar mastopexy or breast reduction designs is also commonly performed by the plastic surgeon. Our goal was to analyze contralateral symmetry specimens to review the prevalence of high-risk or malignant lesions.

Methods
We conducted a retrospective study of the first consecutive 100 large-volume displacement oncoplastic surgeries at our institution between August 2015 and June 2018. Eighty-five patients had an immediate symmetry operation performed on the contralateral breast. Information on malignant lesions and high-risk lesions was obtained from the patient's pathology report.

Results
Seven different surgical techniques were used for both the cancerous and contralateral breasts. The WISE pattern skin incision pattern was most frequently used, along with the superomedial pedicle design. Fourteen cases (16.5%) had malignant and/or high-risk lesions incidentally detected. Specifically, there was a breast cancer prevalence of 4.8% in the contralateral symmetry breast specimen.

Conclusion
Plastic surgeons should be aware that there is a substantial minority of contralateral specimens that have high-risk or malignant lesions, which underscores the importance of specimen orientation and communication with the associated pathologist.
Fascia Lata Harvesting: The Donor Site Closure Morbidity
Authors: Giovannetti Filippo , Barbera Giorgio , Priore Paolo , Pucci Resi , Della Monaca Marco , Valentini Valentino 
Published: March 2019

Objective:
Fascia lata (FL) is a worldwide adopted source of autologous grafts. In our Department, the endoscopic endonasal transphenoidal surgery (EETS) has been performed regularly for anterior and middle cranial fossa lesions, and FL graft has commonly been a practical resource in repairing tissue defects after EETS.
Enough, we used routinely harvesting FL to restore symmetry in facial palsy. To our known, this is the biggest case series about FL harvesting to repare tissue defects after EET. The purpose of our study was to evaluate our experience with the harvesting of FL, in particularly the donor site morbidity.

Study design:
This is a prospective study case series, which evaluated by questionnaire the morbidity of FL donr site.

Methods:
The details of 44 patients were analyzed from 2011 to 2016. Thirty-eight patients needed cranial base reconstruction and 6 patients needed facial reanimation.

Results:
Adequate length of FL was harvested in all our patients. There were no intraoperative complications. We did not use drain in any case. We analyzed 18 women (40%) and 26 men (59.9%). The estimated median age at presentation was 51.53.

Conclusion:
For little FL's gap, diameter until 3 × 6 cm, it's possible to suture FL's margin with Nylon, but for bigger gap it's necessary to reconstruct with allograft to avoid muscle bulge or compartmental syndrome.
Chondroma of the Tongue
Authors: Dimitrijevic Milovan V. , Sopta Jelena , Ivisevic Tjasa B. , Dudvarski Zoran 
Published: March 2019

Introduction:
Chondromas are rare mesenchymal benign tumors that are most often encountered in pelvis and ribs, and rarely in head and neck region. They account for about 10% of all benign chondroid proliferations and the rarest occurrence of soft tissue chondromas is within oral cavity.

Case:
A 10-year-old female patient was referred to our Clinic because of moderate speech impairment, swallowing disturbances and foreign body sensation in tongue. On clinical examination and MRI scans, hard, painless, clearly demarcated submucosal mass was observed on the left side of the tongue. Surgery was perfomed using intraoral incision approach, and the tumor was completly removed. Histopathological examination of the specimen was positive for chondroma.

Conclusion:
Chondromas benign tumors of mature hyaline cartillage localized in soft tissues of head and neck region. Growing slowly, and painlessly, they remain silent for some period, until reaching certain dimensions, and becoming symptomatous. Magnetic resonance imaging scan provides complete information about localization, size, growth of the tissue, and contributes significantly to the decision of appropriate surgical approach.
Administration of Candida Albicans to Dextran Sulfate Solution Treated Mice Causes Intestinal Dysbiosis, Emergence and Dissemination of Intestinal Pseudomonas Aeruginosa and Lethal Sepsis
Authors: Hiengrach Pratsanee , Panpetch Wimonrat , Worasilchai Navaporn , Chindamporn Ariya , Tumwasorn Somying , Jaroonwitchawan Thiranut , Wilantho Alisa , Chatthanathon Piraya , Somboonna Naraporn , Leelahavanichkul Asada 
Published: March 2019

ABSTRACT
The influence of gut fungi in chronic colitis was investigated by repeated oral administration of Candida albicans in a 3% dextran sulfate solution (DSS) induced-colitis mouse model. Candida administration in the DSS (DSS+Candida) model enhanced the mortality rate and induced bacteremia (without candidemia) resulting from a gut perm-selectivity defect despite similar diarrheal severity in mice treated with DSS alone. The dominant fecal bacteria in DSS+Candida and DSS alone mice were Pseudomonas spp. and Enterobacter spp., respectively, implying that Candida induced gut dysbiosis. Interestingly, chloramphenicol-resistant bacterial colonies, predominantly Pseudomonas spp., appeared in the feces and blood of DSS+Candida mice (not the DSS alone group) during fungal culture. These antibiotic-resistant bacteria were also isolated, ex vivo, by incubating mouse feces with DSS and heat-killed Candida or (1→3)-β-D-glucan, suggesting bacterial fermentation on fungi. Administration of Pseudomonas aeruginosa isolated from chloramphenicol-resistant bacteria in the DSS+Candida model enhanced the severity of disease, and increased growth of isolated P aeruginosa in blood agar containing heat-killed Candida was demonstrated. These data suggested the selection of a highly virulent bacterial strain following fecal Candida presentation in the gut. Additionally, reduction of fecal fungi with fluconazole decreased the burden of chloramphenicol-resistant bacteria, attenuating the severity of DSS+Candida. In conclusion, gut Candida induced bacteremia in the DSS model through an inflammation-induced gut perm-selectivity defect and facilitated the growth of some gut bacteria. Treatment strategies aimed at reducing gut fungi could attenuate disease severity. Further investigation of gut fungi in inflammatory bowel disease is warranted.
The Influence of Etoricoxib on Pain Control for Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Trials
Authors: Qiu Jin , Xie Mian , Qu Ronglan 
Published: March 2019

Introduction:
The efficacy of etoricoxib on pain control for laparoscopic cholecystectomy remains controversial. We conduct a systematic review and meta-analysis to explore the impact of etoricoxib on pain intensity after laparoscopic cholecystectomy.

Materials and Methods:
We searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2018 for randomized controlled trials assessing the effect of etoricoxib versus placebo on pain management after laparoscopic cholecystectomy. This meta-analysis was performed using the random-effect model.

Results:
Four randomized controlled trials involving 351 patients are included in the meta-analysis. Overall, compared with control group for laparoscopic cholecystectomy, etoricoxib has no important impact on pain scores within 4 hours [mean difference (MD)=−1.48; 95% confidence interval (CI)=−3.54 to 0.58; P=0.16] and 8 hours (MD=−0.65; 95% CI=−1.43 to 0.12; P=0.10), but can significantly decrease pain intensity within 12 hours (MD=−1.16; 95% CI=−1.93 to −0.38; P=0.003) and 24 hours (MD=−1.10; 95% CI=−1.98 to −0.22; P=0.01), as well as postoperative analgesic consumption (standard MD=−1.21; 95% CI=−2.19 to −0.23; P=0.02), with no increase in nausea and vomiting (risk ratio=0.68; 95% CI=0.42-1.10; P=0.11), and headache (risk ratio=0.96; 95% CI=0.44-2.09; P=0.92).

Conclusions:
Etoricoxib can substantially reduce pain intensity in patients with laparoscopic cholecystectomy.