bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk-Based Therapeutic Strategies
Authors: Corre Jill , Avet-Loiseau Hervé 
Published: January 2019

Abstract
Although therapeutic strategies have been adapted to age and comorbidities of myeloma patients for a long time, all patients currently experiment the same treatment whatever their genomic risk. However, high-risk patients should benefit right now from the most efficient drugs combinations. Herein, we review and discuss how to optimally define risk to adapt treatment and why a modern multiparametric definition of genomic risk is urgently needed. Minimal residual disease status will probably also take a growing place in patient's management, including in treatment adaptation. We also discuss how next-generation sequencing will definitively represent an essential tool to manage risk-based therapeutic strategies. Finally, despite an explosive knowledge of myeloma molecular landscape, targeted therapy perspectives remain poor, with only few exceptions.
Postoperative Outcomes in Obese Patients That Undergo Ventral Hernia Repair versus Ventral Hernia Repair with Concurrent Panniculectomy
Authors: Diaconu Silviu C. , McNichols Colton H. L. , AlFadil Sara , Liang Yuanyuan , Bai Jennifer , Silverman Ronald P. , Grant Michael P. , Nam Arthur J. , Rasko Yvonne M. 
Published: January 2019

Background:
The safety of concurrent panniculectomy during ventral hernia repair remains a widely debated topic. This study aims to compare outcomes in obese patients who undergo ventral hernia repair with concurrent panniculectomy versus ventral hernia repair alone.

Methods:
An 8-year retrospective cohort study was performed on obese patients who underwent ventral hernia repair. Patients were divided into those who underwent concurrent panniculectomy and those who did not. Postoperative complications were compared between these groups.

Results:
A total of 223 patients were analyzed: 122 in the ventral hernia repair with concurrent panniculectomy group and 101 in the ventral hernia repair–only group. Median follow-up duration was 141 days. Patients in the ventral hernia repair with concurrent panniculectomy group had more surgical-site occurrences (57 percent versus 40 percent; p = 0.012). Both groups had similar rates of surgical-site occurrences that required an intervention (39 percent versus 31 percent; p = 0.179) and similar rates of hernia recurrence (23 percent versus 29 percent; p = 0.326). Multivariate analysis showed that concurrent panniculectomy increased the risk of surgical-site occurrences by two-fold; however, it did not increase the risk of surgical-site occurrences that required an intervention.

Conclusions:
The addition of a panniculectomy to ventral hernia repair increases surgical-site occurrences but does not increase complications that require an intervention. As such, ventral hernia repair with concurrent panniculectomy can be considered in obese patients with a symptomatic panniculus who wish to have a single-stage operation and the lifestyle benefits of a panniculectomy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Intramedullary Screw Fixation of Metacarpal Fractures Results in Excellent Functional Outcomes: A Literature Review
Authors: Beck Christina M. , Horesh Elan , Taub Peter J. 
Published: January 2019

Background:
Intramedullary fixation of a comminuted subcapital metacarpal fracture using a headless compression screw was first described in 2010. The purpose of this study was to identify and evaluate all studies reporting clinical outcomes of intramedullary screw fixation of metacarpal fractures.

Methods:
A comprehensive search of the literature was performed under Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify all relevant studies. Outcome measures included mean follow-up, evidence of radiographic union, functional outcomes, and quality-of-life measures.

Results:
Nine articles for a total of 169 metacarpal fractures were identified. Average patient age was 32 years; 86.5 percent of the patients were men; and the majority of fractures occurred in the small finger (74 percent). Most fractures occurred in the neck (n = 66), followed by shaft (n = 31) and head (n = 10). The average follow-up was 11 months, with an average metacarpophalangeal joint flexion of 86 degrees (n = 83) and digit total active motion of 251 degrees (n = 72). Radiographic union was achieved in 100% of reported cases (n = 132) at or before the latest follow-up. Grip strength in four studies showed an average of 96 percent compared to the contralateral hand. No serious complications were reported. Nine minor complications were reported, including four cases of hardware removal in asymptomatic patients.

Conclusion:
The review of the literature suggests intramedullary fixation of metacarpal neck and shaft fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option resulting in excellent clinical outcomes.
Skin and soft tissue infections after breast surgery
Authors: Corcione Silvia , Lupia Tommaso , De Rosa Francesco G. 
Published: January 2019

Purpose of review
Breast surgery is considered a clean surgical procedure; nevertheless, infection rates are often higher than those reported after other similarly considered clean surgeries (e.g., thyroid, hernia). Acute bacterial skin and soft tissue infections, mostly surgical site infections and implant-associated infections are commonest events that could complicate postoperative care.

Recent findings
Risk of infection is closely related to surgery procedure itself and patients host factors. Gram-positive bacteria with pattern of antimicrobial resistance are increasingly isolated and before today less frequent causes such as gram negative and mycobacteria infections. Impact of postoperative complications is underestimated and lacking an appropriate care and education for local and systemic management.

Summary
We report the current evidence on the management of infections after breast surgery. New drugs options for methicillin-resistant Staphylococcus aureus and other gram positive should have a place in this setting. Stewardship activities aiming at reducing infections risks with the correct considerations of host, microbiological and surgical risk factors.
Ultrashort Time to Echo Magnetic Resonance Evaluation of Calcium Pyrophosphate Crystal Deposition in Human Menisci
Authors: Finkenstaedt Tim , Biswas Reni , Abeydeera Nirusha A. , Siriwanarangsun Palanan , Healey Robert , Statum Sheronda , Bae Won C. , Chung Christine B. 
Published: January 2019

Objectives
In human menisci, we aimed to investigate whether calcium pyrophosphate crystal deposition (CPPD) affects biomechanical and quantitative MR properties, and their zonal distribution.

Materials and Methods
From 9 cadaveric knees, sectioned triangular meniscus pieces were harvested. Samples were classified into “normal” or “CPPD” groups based upon visual inspection. Micro computed tomography scan verified CPPD. Using magnetic resonance imaging, ultrashort echo time (UTE) T2* and spin echo (SE) T2, quantitative values in 3 zones (red, red-white, and white) were determined. Using biomechanical test, indentation forces in the same zones were determined. Effects of CPPD and meniscal zone on indentation force and quantitative MR values were compared.

Results
On UTE MRI scans, CPPD-affected menisci exhibited punctate dark regions, found mostly (92%) in avascular white and red-white zones. Indentation forces were significantly higher for CPPD samples in the red-white (all P < 0.02) and white (all P < 0.004) zones but not in the vascular red zone (all P > 0.2). Similarly, UTE T2* red zone values were similar between both groups (~6.6 milliseconds, P = 0.8), whereas in the red-white and white zones, CPPD samples had significantly lower values (~5.1 milliseconds, P = 0.005 to 0.007). In contrast, SE T2 values showed no difference with CPPD (P = 0.12 to 0.16). UTE T2*, but not SE T2, correlated significantly with indentation force (R = −0.29, P = 0.009).

Conclusions
Dark CPP deposits were detectable on UTE images featuring high signal intensity from surrounding meniscal tissue. Preliminary results indicate that CPP deposits were almost exclusively found in the avascular zones. Compared with normal, CPPD menisci featured higher indentation stiffness and lower UTE T2* values in the affected zones.
Transcutaneous Electrical Nerve Stimulation on Acupuncture Points Improves Myofascial Pain, Moods, and Sleep Quality
Authors: Chiou Yar-Fang , Yeh Mei-Ling , Wang Yu-Jen 
Published: January 2019

Abstract

Purpose
The aim of this study was to evaluate the effects of transcutaneous electrical nerve stimulation at acupuncture points versus trigger points on myofascial pain, moods, and sleep quality.

Design
A randomized controlled study recruited 64 patients with spinal cord injury with myofascial pain.

Methods
Outcomes of pain, moods, and sleep quality were measured and analyzed by the generalized estimation equation, analysis of covariance, and paired t test. Transcutaneous electrical nerve stimulation was applied for seven consecutive days at Hegu (LI4) and Daling (PC7) acupuncture points or myofascial trigger points.

Finding
Significant differences were found in pain intensity from Day 3 forward, after controlling for confounders. Significant within-group differences were found in pain, moods, and sleep quality.

Conclusions
Transcutaneous electrical nerve stimulation at acupuncture and trigger points effectively improved pain, moods, and sleep quality in patients with spinal cord injury with myofascial pain. Acupuncture points had superior improvement in pain intensity and slight improvement in sleep quality than did trigger points.

Clinical Relevance
Transcutaneous electrical nerve stimulation at acupuncture points could be applied for improving myofascial pain.
The Reliability and Validity of the Korean Short Version of the Stroke-Specific Quality of Life Scale
Authors: Yoon Susie , Kim Sung Reul , Kim Hye Young , Yoo Sung-Hee , Choi Jay Chol 
Published: January 2019

Abstract

Purpose
The aim of this study was to assess the reliability and validity of the Korean short version of the Stroke-Specific Quality of Life Scale (SS-QoL-12K).

Design
A descriptive, cross-sectional design was used.

Methods
We recruited 233 outpatients with ischemic stroke.

Findings
The Cronbach’s alpha coefficients for internal consistency was .93, and the test–retest reliability value was .98. Confirmatory factor analysis identified two dimensions for the SS-QoL-12K. The SS-QoL-12K was correlated positively with the 36-Item Short Form Health Survey score and Instrumental Activities of Daily Living and negatively with the modified Rankin Scale score. The SS-QoL scores in the National Institutes of Health Stroke Scale mild group were higher than those in the National Institutes of Health Stroke Scale moderate and severe groups.

Conclusions
This study shows that the SS-QoL-12K has a satisfactory level of reliability and validity in patients with ischemic stroke.

Clinical Relevance
This instrument will be helpful in advancing research and clinical care for stroke patients.
Constructing Recovery Narratives: Experiences and Expectations Following Spinal Cord Injury
Authors: Bender Alexis A. , Burgess Elisabeth O. 
Published: January 2019

Abstract

Purpose
This study aimed to explore how married individuals construct narratives following spinal cord injury (SCI).

Design
Prospective qualitative study.

Methods
Eighteen married people with SCI were recruited during inpatient hospitalization. In-depth interviews were conducted at approximately 1, 4, and 7 months post-SCI. Interviews were analyzed using thematic analysis.

Findings
Participants constructed three primary narrative types (optimistic, anxious, and stability) about their trajectories following SCI, focusing on their expectations about recovery and their past and current experiences with their spouse, peers, and health professionals. These narrative types are the foundation for understanding how people make sense of the rehabilitation experience in relation to others.

Conclusions
Findings provide an initial understanding of how expectations of life with SCI as well as social interactions in the healthcare setting influence experiences of injury and recovery.

Clinical Relevance
Findings can inform future interventions during SCI rehabilitation to ease transitions and decrease anxiety following SCI.
Prepectoral Wise-Pattern Staged Implant-Based Breast Reconstruction for Obese or Ptotic Patients
Authors: Thuman Jenna , Freitas Alessandrina M. , Schaeffer Christie , Campbell Chris A. 
Published: January 2019

Introduction
The obese or ptotic breast demonstrates significant difficulty in breast reconstruction after mastectomy with increased rates of perioperative complications compared with the general population, regardless of reconstruction type. Implant-based reconstruction in this patient population with the traditional horizontal elliptical skin-sparing mastectomy tends to have aesthetically displeasing qualities secondary to skin flap redundancy and blunting of the breast contour. Wise-pattern closures have been described with submuscular direct-to-implant and 2-stage reconstructions, with more favorable complication profile when staged. Our study aims to report outcomes and safety of a prepectoral 2-stage wise-pattern closure technique in the obese and/or ptotic population.

Methods
A retrospective chart review was performed to identify all overweight, obese, and/or grade III ptotic patients who have undergone a 2-stage, wise-pattern skin closure with prepectoral placement of tissue expander by a single surgeon. Patient demographics, comorbidities, and perioperative descriptors were reported. Delayed wound healing, infection, seroma formation, and explantation or reoperation were recorded for each patient involved in the study.

Results
Thirty-seven obese and/or ptotic breasts among 21 patients underwent immediate prepectoral tissue expander placement with wise-pattern skin reduction closure with mean body mass index of 35.3 kg/m2, and 25% of patients were diabetic The most common complication rates by breast were seroma formation (50%) and wound/dehiscence at T-point (28.6%), which all ultimately healed with intervention as described. One major (2.7%) and 1 minor (2.7%) infection were successfully treated with antibiotics. There were no cases of implant exposure. Two operative complex repairs and 1 elective explantation were performed. Diabetes and increasing body mass index were statistically associated with an increased overall perioperative complication rate.

Conclusions
Prepectoral, 2-stage breast reconstruction with wise-pattern skin reduction performs well in obese and/or ptotic patients with favorable rates of perioperative complications. Wound dehiscence was prevalent but managed with wound care when complex repair was not required to expedite adjuvant chemotherapy. Infection rates and reoperation rates were low, and all patients reported positive aesthetic results at the completion of reconstruction.
Passot-Type Immediate Breast Reconstruction Obviates the Use of Aceullular Dermal Matrix in Grades 2 and 3 Ptosis
Authors: Rivet Joshua J. , Day Kristopher M. , Rau Jeffrey F. , Waldrop Jimmy L. , Brzezienski Mark A. 
Published: January 2019

Purpose
Acellular dermal matrices (ADMs) are commonly used for immediate breast reconstruction after skin-sparing mastectomy (SSM). Regnault grades 2 and 3 ptotic breasts feature significant mastectomy flap redundancy that may be incorporated into the reconstruction. This allows surgeons to use patients' de-epithelialized inferior dermal pedicle instead of ADM.

Methods
All consecutive SSM patients with Regnault grade 2 or 3 ptosis who underwent Passot-type immediate breast reconstruction (IBBR) with tissue expanders (TEs) and de-epithelialized inferior dermal pedicle without an ADM were included. Patient data from the electronic medical record, clinical photographs, and a comparative cost analysis of ADM versus additional operative time are provided.

Results
Thirty-eight patients with an average age of 52.7 years, weight 210.5 lb, and body mass index of 35.1 kg/m2 were treated (34 bilateral, 4 unilateral; 72 reconstructed breasts). Average mastectomy specimens weighed 962.8 g. Tissue expanders were filled to 265.0 mL (41.6% capacity) intraoperatively, and final implant volume averaged 710.9 ± 118.5 mL after an average of 628.6 ± 74.1-mL expansion. Operative times for Passot-type IBBR was 124.3 ± 37.7 versus 92.5 ± 27.9 minutes (P = 0.0001) for submuscular TE placement with ADM. The operative technique is described in detail. There were 8 TE explantations (21.1%) included: intractable infection (10.5%; n = 4), symptomatic capsular contracture (7.9%; n = 3), and spontaneous TE deflation (2.6%; n = 1). All but 3 patients (92.1%) successfully completed Passot reconstruction, with 2 patients declining salvage latissimus dorsi flap reconstruction and 1 patient lost to follow-up. Total cost savings in this case series was $89,724 ($2361 ± $3529/case).

Conclusions
Additional prospective comparison studies are needed to determine whether Passot-type IBBR results in higher complication rates than conventional IBBR with ADM in this challenging patient population. Passot-type IBR after SSM is safe, demonstrates acceptable rates of successful breast reconstruction, confers cost savings by obviating the use of ADM, and provides favorable aesthetic results.
Alloplastic Cranioplasty Reconstruction
Authors: Oliver Jeremie D. , Banuelos Joseph , Abu-Ghname Amjed , Vyas Krishna S. , Sharaf Basel 
Published: January 2019

Background
Acquired defects of the cranium represent a reconstructive challenge in patients with calvarial bone loss due to trauma, infection, neoplasia, congenital malformations, or other etiologies. The objective of this study was to compare postoperative rates of infection, local complications, and allograft failures following cranioplasty reconstruction using titanium mesh (Ti), polymethyl methacrylate (PMMA), polyether ether ketone (PEEK), and Norian implants in adult patients.

Methods
This constitutes the first systematic review of available literature on 4 different methods of alloplastic cranioplasty reconstruction, including Ti, PMMA, PEEK, and Norian implants, using the Newcastle-Ottawa Quality Assessment Scale guidelines for article identification, screening, eligibility, and inclusion. Electronic literature search included Ovid MEDLINE/PubMed, EMBASE, Scopus, Google Scholar, and Cochrane Database. Pearson exact test was utilized at P < 0.05 level of significance (J.M.P. v11 Statistical Software).

Results
A total of 53 studies and 3591 patients (mean age, 40.1 years) were included (Ti = 1429, PMMA = 1459, PEEK = 221, Norian = 482). Polymethyl methacrylate implants were associated with a significantly higher infection rate (7.95%, P = 0.0266) compared with all other implant types (6.05%). Polyether ether ketone implants were associated with a significantly higher local complication rate (17.19%, P = 0.0307, compared with 12.23% in all others) and the highest ultimate graft failure rate (8.60%, P = 0.0450) compared with all other implant types (5.52%).

Conclusions
This study qualifies as a preliminary analysis addressing the knowledge gap in rates of infection, local surgical complication, and graft failure in alloplastic cranioplasty reconstruction with different implant types in the adult population. Longer-term randomized trials are warranted to validate associations found in this study.
Can Head Circumference Be Used as a Proxy for Intracranial Volume in Patients With Craniosynostosis?
Authors: Hashmi Asra , Cahill Gabrielle L. , Zaldana Michelle , Davis Greta , Cronin Brendan J. , Brandel Michael G. , Beletsky Alexander , Taj Raeda , Buckstaff Taylor M. , Vinocur Daniel , Lance Samuel , Meltzer Hal S. , Gosman Amanda A. 
Published: January 2019

BackgroundCalculation of intracranial volume from neuroimaging can be complex and time consuming. In the adult population, there is evidence suggesting that owing to its strong correlation, head circumference (HC) may be used as a surrogate for intracranial volume (ICV). We were interested in studying the correlation between HC and ICV in patients with craniosynostosis.MethodsAfter institutional review board approval, a retrospective review was performed on patients with craniosynostosis. GE Healthcare AdW 4.3 volume assessment software was used to calculate ICV and HC based on preoperative computed tomographic scans. Pearson correlation was used to estimate correlation coefficients between ICV and HC for this patient population, with 0 to 0.3 considered a weak correlation, 0.4 to 0.6 considered a moderate correlation, 0.7 to 1 considered a strong correlation, andP< 0.05 was considered statistically significant.ResultsA total of 196 craniosynostosis patients were included in this study. There were 121 male and 75 female patients. Seventy-nine patients had metopic, 45 had coronal, 64 had sagittal, and 8 had lambdoid synostosis. Mean age was 8.2 months. Mean HC and ICV were 42.9 cm and 829 cm3, respectively. Overall, there was a strong correlation between HC and ICV (r= 0.81). Patients were further categorized by craniosynostosis type. Very strong correlation was obtained for patients with coronal (0.89), metopic (0.98), and lambdoid craniosynostosis (0.97). Strong correlation was obtained for patients with sagittal synostosis (0.73). When categorized by sex, a stronger correlation was obtained for female patients (0.84) compared with male patients (0.80). Statistical significance was reached for all reported correlations.ConclusionOur preliminary data suggest that a very strong correlation exists between HC and ICV for male and female patients with all types of craniosynostosis, making HC a useful surrogate for ICV in this patient population.
National Surgical Quality Improvement Program Analysis of 9110 Reduction Mammaplasty Patients
Authors: Young Zachary T. , Close Michaela , Herrera Fernando A. 
Published: January 2019

Background
The purpose of this study was to identify preoperative risk factors in patients undergoing reduction mammoplasty as well as identify any increased complication risk in patients older than 60 years undergoing reduction mammoplasty.

Methods
The American College of Surgeons National Surgical Quality Improvement Program data from years 2013–2015 was reviewed. Patients were identified using Current Procedural Terminology code 19318 specific for reduction mammoplasty. Only patients undergoing bilateral procedures were included, and no reconstructive procedures were included. Patient demographics, comorbidities, and 30-day complications were analyzed. Comparative analysis was performed between patients younger than 60 years and patients 60 years and older, identifying risk factors associated with complications in the geriatric population.

Results
A total of 9110 patients undergoing reduction mammoplasty were identified. Of these 1442 (15.83%) were patients older than 60 years. Mean age of all patients was 42 years (range, 18–85 years). Eighty hundred fifty-nine patients were active smokers. Four hundred eighty-two patients were diabetic. Overall, 798 complications occurred with an incidence of 8.7%. Group 1 (<60 years) mean age was 39 years (range, 18–59). Group 2 (>60 years) mean age was 66 years (range, 60–85 years). The geriatric population showed a higher risk of cerebral vascular accidents (P < 0.00006), myocardial infarction (P < 0.02), and readmission (P < 0.03). Smoking was found to be a statistically significant risk factor for superficial surgical site infection, and deep space infection. Diabetes was found to be a statistically significant risk factor for readmission.

Conclusions
Reduction mammoplasty is a common surgical procedure. It is not uncommon for patients older than 60 years to undergo elective reduction mammoplasty (15.83% incidence), resulting in a cumulative complication rate of 11.65% in the geriatric population compared with 8.89% in the group of patients younger than 60 years. Smoking and diabetes were found to be independent risk factors for complications, regardless of age.