bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Single Incision Minimally Invasive (SIMI) Neck Lift
Authors: Kaplan Jonathan L. 
Published: May 2019

Background:
With the increased focus on the neck and chin in the era of selfies and social media, neck contouring continues to be an in-demand procedure. Full correction of the neck typically requires both submental and postauricular incisions, but the postauricular incisions can be unsightly and painful. This article introduces a viable alternative for the patient.

Methods:
A case series of appropriate candidates undergoing a novel neck lift technique (the single incision minimally invasive neck lift) is described. Participants include men and women with an age range of 30–70. The surgical technique incorporates shifting of the typical submental incision used in a full neck lift to a cervicomental incision, and when accompanied by wide undermining, the postauricular incisions are avoided entirely.

Results:
Among the 20 patients in this case study, photographs show that it is possible to achieve results commonly associated with a full neck lift but without the postauricular incisions typically associated with a full neck lift.

Conclusions:
The single incision minimally invasive neck lift allows the surgeon to offer an effective procedure for appropriate candidates who want to treat excess fat, a sagging platysma muscle and loose, misplaced skin in the submental region without postauricular incisions typically utilized in a traditional full neck lift.
Cultural Competence and Ethnic Diversity in Healthcare
Authors: Nair Lakshmi , Adetayo Oluwaseun A. 
Published: May 2019

Summary:
Today’s model of healthcare has persistent challenges with cultural competency, and racial, gender, and ethnic disparities. Health is determined by many factors outside the traditional healthcare setting. These social determinants of health (SDH) include, but are not limited to, education, housing quality, and access to healthy foods. It has been proposed that racial and ethnic minorities have unfavorable SDH that contributes to their lack of access to healthcare. Additionally, African American, Hispanic, and Asian women have been shown to be less likely to proceed with breast reconstructive surgery post-mastectomy compared to Caucasian women. At the healthcare level, there is underrepresentation of cultural, gender, and ethnic diversity during training and in leadership. To serve the needs of a diverse population, it is imperative that the healthcare system take measures to improve cultural competence, as well as racial and ethnic diversity. Cultural competence is the ability to collaborate effectively with individuals from different cultures; and such competence improves health care experiences and outcomes. Measures to improve cultural competence and ethnic diversity will help alleviate healthcare disparities and improve health care outcomes in these patient populations. Efforts must begin early in the pipeline to attract qualified minorities and women to the field. The authors are not advocating for diversity for its own sake at the cost of merit or qualification, but rather, these efforts must evolve not only to attract, but also to retain and promote highly motivated and skilled women and minorities. At the trainee level, measures to educate residents and students through national conferences and their own institutions will help promote culturally appropriate health education to improve cultural competency. Various opportunities exist to improve cultural competency and healthcare diversity at the medical student, resident, attending, management, and leadership levels. In this article, the authors explore and discuss various measures to improve cultural competency as well as ethnic, racial, and gender diversity in healthcare.
Stem Cells in Keloid Lesions: A Review
Authors: Lim Kim H. , Itinteang Tinte , Davis Paul F. , Tan Swee T. 
Published: May 2019

Summary:
Keloid disorder (KD) is a fibroproliferative condition caused by dysregulated wound healing following wounding of the skin. The pathogenesis of KD has not been fully elucidated and current treatment is unsatisfactory. There is increasing evidence of the role of stem cells in KD. This review discusses the role of embryonic stem (ESC)-like cells and mesenchymal stem cells in the pathogenesis of KD. It is proposed that dysfunction of the ESC-like population localized to the endothelium of the microvessels and perivascular cells within the keloid-associated lymphoid tissues may give rise to the aberrant fibroblasts and myofibroblasts via a mesenchymal stem cell intermediate in keloid lesions, by undergoing an endothelial-to-mesenchymal transition. We also discuss the role of the renin-angiotensin system (RAS), the immune system, and the inflammatory response, on stem cell proliferation and differentiation. The understanding of the precise roles of these stem cells and interplay of the associated regulatory pathways could lead to the development of targeted therapy for this enigmatic and challenging condition. The demonstration of the expression of components of the RAS and cathepsins B, D, and G that constitute bypass loops of the RAS, by the ESC-like population, suggests that the primitive population may be a therapeutic target by modulation of the RAS, using existing medications.
Efficacy of Local Anesthesia in the Face and Scalp: A Prospective Trial
Authors: Safran Tyler , Zammit Dino , Kanevsky Jonathan , Khanna Manish 
Published: May 2019

Background:
The use of local anesthesia has allowed for the excision and repair of lesions of the head and neck to be done in an office-based setting. There is a gap of knowledge on how surgeons can improve operative flow related to the onset of action. A prospective trial was undertaken to determine the length of time for full anesthesia effect in the head and neck regions.

Methods:
Consecutive patients undergoing head and neck cutaneous cancer resection over a 3-month period were enrolled in the study. Local anesthesia injection and lesion excision were all done by a single surgeon. All patients received the standard of care of local anesthesia injection.

Results:
Overall, 102 patients were included in the prospective trial. The upper face took significantly longer (153.54 seconds) compared with the lower face and ears (69.37 and 60.2 seconds, respectively) (P < 0.001) to become fully anesthetized. In addition, there was no significant difference found when adjusting for the amount of local anesthesia used, type, and size of lesion (P > 0.05). Using the time to full anesthesia effect for each local injection, a heat map was generated to show the relative times of the face and scalp to achieve full effect.

Conclusions:
This prospective trial demonstrated that for the same local anesthetic and concentration, upper forehead and scalp lesions take significantly longer to anesthetize than other lesions in the lower face and ear. This can help surgeons tailor all aspects of their practice, which utilizes local anesthesia to help with patient satisfaction and operative flow.
Red blood cell distribution width for predicting significant liver inflammation in patients with autoimmune hepatitis
Authors: Wang Huali , Wang Jian , Huang Rui , Xia Juan , Zuo Lingyun , Yan Xiaomin , Yang Yongfeng , Wu Chao 
Published: May 2019

Background
Red blood cell distribution width (RDW) was reported to be associated with the severity of liver diseases. We aimed to investigate the association between RDW and severity of liver inflammation in autoimmune hepatitis (AIH).

Patients and methods
Ninety-two consecutive AIH patients who underwent liver biopsy during 2016–2017 were included. Liver histology was evaluated using the Scheuer scoring system. Logistic regression analysis was used to analyze the risk factors for significant inflammation. The diagnostic accuracy was evaluated by the area under the receiver operating characteristic curve.

Results
The RDW level was higher in AIH patients with significant inflammation (14.6%, interquartile range: 13.2–16.3%) than in patients with mild inflammation (13.2%, interquartile range: 12.6–13.8%). The RDW level was correlated positively with the grades of liver inflammation (r=0.356, P < 0.001). The area under the receiver operating characteristic curve of RDW in predicting significant inflammation was 0.739 (95% confidential interval: 0.634–0.843, P < 0.001), with 67.80% sensitivity and 75.76% specificity. The diagnostic performance of RDW for significant inflammation was better than alanine aminotransferase (P = 0.003) and immunoglobulin G (P = 0.049). RDW (odds ratio = 1.702, P = 0.001) was identified as an independent predictor for significant inflammation by logistic multivariable analysis.

Conclusion
The RDW level was correlated positively with the severity of liver inflammation in AIH patients. RDW can be a promising indicator for predicting significant liver inflammation in AIH.
Case Report: Adaptation of a Telescope with a Minus Lens Cap for Highly Myopic Patient
Authors: Matchinski Tracy L. , Rimkus John J. , Theisen Kelli M. 
Published: May 2019

SIGNIFICANCE
This case report demonstrates a novel approach of using the optical principle of vergence amplification to correct for a visually impaired patient's ametropia while using a telescope system. This approach is easy to apply clinically.

PURPOSE
The purpose of this study was to present a novel approach of correcting high myopia for a patient with visual impairment using a spectacle-mounted telescope.

CASE REPORT
A 51-year-old man desired improved distance vision for television viewing and facial recognition. His refractive error was −18.00 diopter sphere in each eye with best-corrected acuities of 5/225 (20/900 Snellen equivalent) for the right eye and 10/225 (20/450) for the left eye. Over the years, multiple attempts at contact lens use were unsuccessful, and the patient used spectacle prescription. After evaluating telescope systems, the patient was successful with a 7 × 30 Beecher Mirage Keplerian telescope system. This system cannot be worn over glasses. To correct his ametropia, a −0.25-diopter minus lens cap was applied in front of the objective lens of the telescope, capitalizing on the property of vergence amplification. In addition, the tube length was adjusted. Adding lenses in front of the telescope and focusing the telescope can both affect the angular magnification of the system. Depending on the lenses used, type of telescope, and refractive error, there can be an increase or decrease in angular magnification. In this case, the minus lens at the front of the telescope decreased the power of the objective lens, and the focusing for the remaining uncorrected myopia increased the power of the ocular lens. Both of these factors contributed to increased resultant angular magnification for this patient. The patient achieved 10/30 (20/60) vision and reported success with his distance vision.

CONCLUSIONS
Minus-powered lens caps over the objective lens are a viable option for highly myopic individuals who wish to use premanufactured spectacle-mounted telescopes.
The Use of Prophylactic Antibiotics before Primary Palatoplasty Is Not Associated with Lower Fistula Rates: An Outcome Study Using the Pediatric Health Information System Database
Authors: Jodeh Diana S. , Nguyen Anh Thy H. , Cray James J. , Rottgers S. Alex 
Published: May 2019

Background:
Previous attempts to study the effect of prophylactic antibiotics on the outcomes of cleft palate surgery have been hampered by the need for a very large sample size to provide adequate power to discern a potentially small therapeutic effect. This limitation can be overcome by querying large databases created by health care governing bodies.

Methods:
Data from the Pediatric Health Information System database were used for this analysis. Patients, aged 6 to 18 months, who had undergone primary palatoplasty (International Classification of Diseases, Ninth Revision, code 27.62) between 2004 and 2009 were included. Subsequent repair of an oronasal fistula between 2004 and 2015 was identified by International Classification of Diseases, Ninth Revision, procedure code 21.82. Pharmacy billing records were used to determine antibiotic administration. Associations between antibiotic administration and fistula repair were assessed using random-intercept logistic regression adjusting for age, sex, race, and cleft type.

Results:
Seven thousand one hundred sixty patients were available for analysis; of these, 460 (6.4 percent) had a subsequent repair of an oronasal fistula. Fistula rates were 5.9, 11.4, and 5.2 percent among patients given preoperative antibiotics, only postoperative antibiotics, and no antibiotics, respectively (p < 0.001). Multivariable analysis results showed that the odds of having an oronasal fistula among patients who were administered preoperative antibiotics did not differ significantly (statistically) from patients who did not receive antibiotics (OR, 0.88; 95 percent CI, 0.59 to 1.31).

Conclusions:
The treatment goal of primary palatoplasty is the successful repair of the cleft without an oronasal fistula. Administration of preoperative antibiotics did not significantly reduce the odds of subsequent fistula repair within the same Pediatric Health Information System institution following primary palatoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Minimal-Invasive Robot-Assisted Image-Guided Resection of Prostate-Specific Membrane Antigen–Positive Lymph Nodes in Recurrent Prostate Cancer
Authors: van Leeuwen Fijs W. B. , van Oosterom Matthias N. , Meershoek Philippa , van Leeuwen Pim J. , Berliner Christoph , van der Poel Henk G. , Graefen Markus , Maurer Tobias 
Published: May 2019

Abstract
With the rapid expansion of robot-assisted surgical procedures, the need for robot-compliant image guidance technologies has also increased. Examples hereof are the integrated firefly fluorescence camera, the drop-in ultrasound probe, and the recently introduced DROP-IN gamma probe. Combined with 68Ga–prostate-specific membrane antigen–(PSMA)–11 PET/CT (staging) and 99mTc-PSMA-I&S SPECT/CT (preoperative imaging), the latter DROP-IN gamma probe technology recently allowed us to perform the first clinical cases of robot-assisted PSMA-guided salvage surgery of lymphatic metastases.
Compressed Central Zone Uptake on PSMA PET/CT—A Potential Pitfall in Interpretation
Authors: Ganeshalingam Rueben , Hsiao Edward 
Published: May 2019

Abstract
The case of a 66-year-old man undergoing a staging PSMA PET/CT after a recent diagnosis of prostate carcinoma is presented. In addition to uptake within the prostate consistent with primary tumor activity, mild symmetrical and diffuse uptake is also noted within central zone. The appearance is not consistent with likely tumor activity. Comparison is made with histopathology after a radical prostatectomy, and no correlating tumor is noted in the region of central zone uptake. Increased PSMA uptake within the compressed central zone of the prostate may represent a potential pitfall in PSMA PET/CT imaging.
Complete Metabolic Response Assessed by FDG PET/CT to FOLFIRI-Aflibercept in Second-Line Treatment of Metastatic Colorectal Cancer
Authors: Amrane Karim , Ollivier Luc , Salaun Pierre-Yves , Metges Jean-Philippe , Abgral Ronan 
Published: May 2019

Abstract
FOLFIRI-aflibercept chemotherapy is indicated in second-line treatment of metastatic colorectal cancer (mCRC) after progression under FOLFOX (±bevacizumab). Nevertheless, its proven therapeutic efficacy in clinical trials was based on partial responses. And to date, only 2 cases of complete response assessed by CT were reported in literature. We report a complete metabolic response assessed by FDG PET/CT in a 50-year-old woman with mCRC treated by FOLFIRI-aflibercept. This also confirms that FDG PET/CT is emerging as a useful approach for therapeutic assessment of targeted drugs in mCRC.
Benign High-Flow Priapism With a Diffuse and Intense 18F-FDG Uptake on 18F-FDG PET/CT Scanning
Authors: Nasiri Zakieh , Zarehparvar Moghadam Soroush , Kiamanesh Zahra , Emami Farshad , Sadeghi Ramin 
Published: May 2019

Abstract
We present benign high-flow priapism with intensive 18F-FDG uptake as an unusual finding in a case of testicular teratocarcinoma with a history of left orchiectomy and chemotherapy. 18F-FDG PET/CT scan showed pulmonary metastases, left obturator node involvement, and intense 18F-FDG uptake in the penis. Upon examination, the patient had a painless erection that lasted for couple of days. Because of pulmonary metastases, second-line chemotherapy regimen was started by his physician. The patient's priapism resolved spontaneously, with no episode of recurrence at 2 years' follow-up.
68Ga-DOTA-Exendin PET-MRI Fusion Imaging in a Case of Insulinoma
Authors: Sood Apurva , Basher Rajender Kumar , Kang Mandeep , Shukla Jaya , Behera Arunanshu , Walia Rama , Nada Rithambhra , Mittal Bhagwant Rai , Bhattacharya Anish 
Published: May 2019

Abstract
Persistent hyperinsulinemic hypoglycemia in adults is most commonly caused by insulinomas, which pose a diagnostic challenge to physicians, surgeons, and radiologists and require multimodality imaging for precise localization and staging. PET tracers such as 18F-FDOPA and glucagon-like peptide 1 receptor analogs have been used for imaging insulinomas. Glucagon-like peptide 1 receptor analogs have recently shown promising results in preoperative localization of these tumors, as all insulinomas express glucagon-like peptide 1 receptors. 68Ga-DOTA-Exendin PET and MRI done in the present case helped in precise localization and management of the culprit lesion, whereas contrast-enhanced CT and 18F-FDOPA PET failed to do so.
FDG PET/CT of Gardnerella vaginalis Infection
Authors: Foret Thibault , Dhomps Anthony , Dauwalder Olivier , Skanjeti Andrea , Tordo Jeremie 
Published: May 2019

Abstract
We report the case of a 23-year-old woman with a history of cystic fibrosis and bilung transplantation, who presented clinically cervical swollen lymph nodes with alteration of her general state. 18F-FDG PET/CT was performed because of lymphoma suspicion and showed cervical and pelvic hypermetabolic lymphadenopathies, with linear vaginal hypermetabolism. There was an increase of lactate dehydrogenase, and Epstein-Barr virus detection was negative. A right cervical lymph node biopsy was performed, with no lymphoma involvement. Complementary microbiological investigations showed positive results for Gardnerella vaginalis.
18F-FDG PET/CT lymphatic node hypermetabolism is not specific to lymphoma, particularly in immunocompromised patients.
Bilateral Adrenal Extremely Intense Metabolic Activity on 18F-FDG PET/CT in a Patient With Pheochromocytomas
Authors: Chen Xueqi , Chen Guoqian , Fu Zhanli , Li Qian 
Published: May 2019

Abstract
Bilateral adrenal masses were found by ultrasound on a 55-year-old man with sudden onset of chest distress and palpitation after drinking alcohol. After the negative laboratory tests of plasma catecholamine and urinary vanillylmandelic acid, the 18F-FDG PET/CT revealed extremely intense metabolic activity in the bilateral adrenal lesions, and the subsequent 131I-meta-iodobenzylguanidine scintigraphy also showed increased radioactivity in the lesions. The pathology of surgery confirmed the diagnosis of bilateral pheochromocytomas.
Outcome Comparison of Single-port Versus Multiport Versus Under Direct View Completion Proctectomy With Ileal-Pouch Anal Anastomosis for Patients With Ulcerative Colitis
Authors: Li Wanglin , Rencuzogullari Ahmet , Costedio Meagan , Benlice Cigdem , Kessler Hermann , Stocchi Luca , Gorgun Emre 
Published: May 2019

Purpose:
Whether the reported theoretical benefits of single-port laparoscopic (SPL) approach can be converted to superior clinical outcomes is still unknown for ulcerative colitis (UC) patients undergoing second-stage proctectomy. This study aimed to compare the short-term postoperative and long-term pouch-related functional outcomes of SPL, multiport laparoscopic (MPL), and direct view (DV) completion proctectomy with ileal-pouch anal anastomosis (CP/IPAA).

Materials and Methods:
Patients who underwent either SPL, MPL, or under DV CP/IPAA for UC between August 2009 and August 2014 were identified from an institutional review board-approved, prospectively maintained institutional database and reviewed. Demographics, patient characteristics, short-term and long-term complications, and morbidity were compared between the 3 groups. Multivariate logistic or Cox regression analysis was conducted for covariate adjustments.

Results:
Groups (SPL: n=36; MPL: n=67; DV: n=97) were comparable in terms of preoperative characteristics and demographics except for age. The SPL group was associated with reduced estimated blood loss, reduced length of stay compared with the MPL and DV groups, and shorter operating time compared with the MPL group (P<0.001). Similar short-term postoperative and long-term pouch-related functional outcomes were noted without significant differences in quality of life scores among the 3 groups.

Conclusions:
SPL CP/IPAA for UC can be safely performed with superior short-term outcomes such as reduced intraoperative blood loss and length of hospital stay compared with MPL and under direct view approaches, and shorter operating time compared with MPL.
Adverse Effects on the Postoperative Urinary Function After Combined Resection of Inferior Vesical Artery in Laparoscopic Lateral Pelvic Lymph Node Dissection: Retrospective Analysis of Consecutive 95 Series
Authors: Manabe Tatsuya , Koga Yasuo , Kubo Hiroshi , Baba Koichi , Nagayoshi Kinuko , Nagai Shuntaro , Ueki Takashi , Nakamura Masafumi , Noshiro Hirokazu 
Published: May 2019

Background:
The combined resection of the vesical artery (VA) in laparoscopic lateral pelvic lymph node dissection (L-LPLD) was reported to facilitate the safe dissection of metastatic lymph nodes. However, whether or not the combined VA resection affects the urinary function remains controversial.

Purpose:
The purpose of the present study was to examine the risk factors for the postoperative urinary dysfunction (PUD) after L-LPLD followed by total mesorectal excision and to clarify the effects of the combined VA resection in L-LPLD on PUD.

Patients and Methods:
L-LPLD was performed in 95 patients with advanced rectal cancer at Saga University Hospital and Kyushu University Hospital from January 2013 to December 2017. The risk factors for PUD after L-LPLD were investigated.

Results:
The univariate analysis revealed that the combined resection of the inferior vesical artery (IVA) was a risk factor for PUD. To examine by the type of IVA resection, the incidence of PUD significantly increased with the bilateral IVA resection, but the unilateral IVA resection induced PUD on the same level with the preservation of IVA.

Conclusions:
Bilateral IVA resection in L-LPLD could increase the incidence of PUD. Thus, if possible, the preservation of the unilateral IVA through L-LPLD should be considered.