bluuebunny/crossref_metadata_2025_split huggingface dataset:
How to Improve Projection in Nipple Reconstruction: A Modified Method Using Acellular Dermal Matrix Disk and Fragments
Authors: Lee Hun Joo , Ock Jae Jin 
Published: March 2019

Background:
Nipple reconstruction is an essential, final stage in breast reconstruction. However, postoperative reduction in nipple projection often results in low patient satisfaction. The authors studied the causes of the projection decline and developed a new method using acellular dermal matrix. This research studies the effectiveness of the new method.

Methods:
The nipple flap was elevated using a modified C-V flap, and acellular dermal matrix disk was fixed onto the floor. A column was made, into which acellular dermal matrix fragments were put in to retain the projection. The footprint diameter and projection at 1 year were compared with those of the control group, in which acellular dermal matrix was not used. The authors studied the correlation between diameter and projection and whether reconstruction method caused any impact.

Results:
At 1-year follow-up, the nipple diameter and projection in the acellular dermal matrix group were measured to be 102.90 percent and 64.19 percent, respectively, of the baseline. Compared with the control group, the diameter was significantly smaller (p = 0.00) and the projection was higher (p = 0.00). A significant correlation was identified between nipple diameters and projections, at 1-year follow-up, across the total 90 reconstructed nipples (p = 0.00). Different reconstruction methods did not show significant differences in terms of nipple diameter and projection, but the projections at 1 year were highest in the latissimus dorsi flap plus implant group, followed by the expander group and the transverse rectus abdominis musculocutaneous flap group.

Conclusion:
Nipple reconstruction using acellular dermal matrix disk and fragments prevents downward shifting of the nipple tissue and broadening of the footprint diameter and thus is favorable for long-term maintenance of nipple projection.
Quantitative Analysis of Paralyzed Lower Eyelid Elevation Technique: Suspension Sling versus Supporting Midcheek Lift
Authors: Min Kyunghyun , Lee Joo-Heon , Kim Sung Chan , Choi Jong Woo , Oh Tae Suk 
Published: March 2019

Background:
Restoration of paralytic lower eyelid retraction is challenging in the surgical management of facial paralysis. In this study, quantitative measurements were compared between the suspension sling and lower eyelid–supporting midcheek lift techniques.

Methods:
From 2014 to 2016, 36 operations were performed on 28 patients with a mean age of 45.6 years (range, 7 to 80 years), a mean denervation time of 13.5 years (range, 0.2 to 44 years), and a mean follow-up period of 636 days (range, 261 to 1143 days). The surgical techniques included autologous tendon sling (n = 9), Mitek suspension (n = 12), and midcheek lift (n = 15). The distance from the pupil center to the lower eyelid margin was measured, and the ratio of the distance on the paralyzed side to that on the normal side was analyzed.

Results:
The change in the ratio between the paralyzed side and the normal side was 0.098 (from 1.264 to 1.166; p = 0.353) in the autologous tendon sling group, 0.104 (from 1.231 to 1.127; p = 0.243) in the Mitek suspension group (p = 0.05), and 0.179 (from 1.234 to 1.055; p = 0.038) in the midcheek lift group. Two patients in the Mitek suspension group developed foreign body infection.

Conclusions:
The midcheek lift group showed the greatest change in the ratio between the distance from the pupil center to the eyelid margin on the paralyzed side and that on the normal side. Eyelid-supporting midcheek lift is superior to suspension sling for restoration of paralytic eyelid retraction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Beware the Alar Base Optical Illusion in Assessment of Unilateral Cleft Lip Nasal Deformity
Authors: Isaac Kathryn V. , Tan Robin A. , Ganske Ingrid M. , Mulliken John B. 
Published: March 2019

Background:
After repair of unilateral cleft lip, lateral drift of the alar base is expected and may require revision. Although the alar base appears wider than on the noncleft side, by measurement it could be symmetric or narrow. Is this an optical illusion?

Methods:
This is a retrospective photographic evaluation of children who underwent repair of unilateral complete cleft lip and palate. On submental standardized photographs, raters judged whether the alar base position was wider, equal to, or narrower than on the noncleft side. The true alar base position was measured by photogrammetry and the frequency of alar base misjudgment was assessed. On control photographs, the cleft side alar base was wider than the noncleft side. On test photographs, the cleft side alar base was narrower than the noncleft side. Possible association between misjudgment and nasal features was also evaluated. Data were analyzed using the Fisher’s exact test.

Results:
Three raters assessed 61 patients aged 6 to 9 years and treated between 1995 and 2015. In 77 percent of control photographs, raters correctly judged the cleft side alar base as wider. In 65 percent of test photographs, raters incorrectly judged the alar base position as wider on the cleft side. Asymmetry of nostril outline and a transverse nostril axis were associated with misjudged photographs (p < 0.05).

Conclusions:
Alar base assessment can be altered by an optical illusion. Simple anthropometry counters this misperception. Measurement should be repeated after correction of the deviated anterocaudal septum and elevation of the lower lateral cartilage. Thereafter, a decision is made on altering the alar base position.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, II.
Genotypic and phenotypic adaptation of pathogens: lesson from the genus Bordetella
Authors: Linz Bodo , Ma Longhuan , Rivera Israel , Harvill Eric T. 
Published: March 2019

Purpose of review
To relate genomic changes to phenotypic adaptation and evolution from environmental bacteria to obligate human pathogens, focusing on the examples within Bordetella species.

Recent findings
Recent studies showed that animal-pathogenic and human-pathogenic Bordetella species evolved from environmental ancestors in soil. The animal-pathogenic Bordetella bronchiseptica can hijack the life cycle of the soil-living amoeba Dictyostelium discoideum, surviving inside single-celled trophozoites, translocating to the fruiting bodies and disseminating along with amoeba spores. The association with amoeba may have been a ‘training ground’ for bacteria during the evolution to pathogens. Adaptation to an animal-associated life style was characterized by decreasing metabolic versatility and genome size and by acquisition of ‘virulence factors’ mediating the interaction with the new animal hosts. Subsequent emergence of human-specific pathogens, such as Bordetella pertussis from zoonoses of broader host range progenitors, was accompanied by a dramatic reduction in genome size, marked by the loss of hundreds of genes.

Summary
The evolution of Bordetella from environmental microbes to animal-adapted and obligate human pathogens was accompanied by significant genome reduction with large-scale gene loss during divergence.
Contextual Conditions and Performance Improvement in Primary Care
Authors: Hung Dorothy Y. , Harrison Michael I. , Liang Su-Ying , Truong Quan A. 
Published: March 2019

Background:
Although organizational context can affect the implementation of quality initiatives, we know less about the influence of contextual conditions on quality outcomes. We examined organizational features of primary care clinics that achieved greatest performance improvements after implementing Lean redesigns.

Methods:
We used operational data and baseline (ie, pre-Lean implementation) surveys of 1333 physicians and staff in 43 primary care clinics located across a large ambulatory care system. Segmented regression with interrupted time series analysis was used to identify clinics with highest improvements in workflow efficiency, physician productivity, and patient satisfaction following Lean redesign. We conducted independent-samples t tests to identify contextual features of clinics that showed greatest improvements in performance outcomes.

Results:
Clinics with highest increases in efficiency had most prior experience with quality improvement, compared with all other clinics. Efficiency gains were also found in clinics reporting highest levels of burnout and work stress prior to redesign. Highest improvements in physician productivity were associated with a history of change, staff participation, and leadership support for redesigns. Greatest improvements in patient satisfaction occurred in least stressful environments with highest levels of teamwork, staff engagement/efficacy, and leadership support.

Conclusions:
Our findings encourage careful evaluation of clinic characteristics and capacity to effectively implement redesigns. Such evaluations may help leaders select interventions most appropriate for certain clinics, while identifying others that may need extra support with implementing change.
Value of the Cinematic Rendering From Volumetric Computed Tomography Data in Evaluating the Relationship Between Deep Soft Tissue Sarcomas of the Extremities and Adjacent Major Vessels: A Preliminary Study
Authors: Li Kun , Yan Ruiying , Ma Huan , Zhang Da-fu , Ding Yingying , Li Zhen-hui 
Published: March 2019

ObjectiveThe aim of the study was to assess the value of cinematic rendering (CR) from volumetric computed tomography data in evaluating the relationship between deep soft tissue sarcomas (STSs) of the extremities and the adjacent major vessels.MethodsPreoperative contrast-enhanced axial imaging (CEAI) in the arterial phase with three-dimensional volume rendering (VR) and CR of contrast-enhanced computed tomography were used to assess adjacent vascular invasion in 43 cases of deep STSs of the extremities. The imaging assessments were compared with surgical findings and interpreted as negative (no vascular invasion) or positive (vascular invasion was present). Intrareader and interreader agreement were assessed using Cohen κ statistics. The diagnostic performance of CEAI, VR, and CR was evaluated by receiver operating curve analysis and compared using the DeLong test.ResultsThirty-four and nine cases were classified as negative and positive, respectively, in surgery. Intrareader agreement values for the CEAI, VR, and CR assessments were all excellent (0.984, 0.934, and 0.914, respectively), whereas the interreader agreement for CEAI assessments was greater than that for VR and CR (0.969 vs 0.804 and 0.761). Cinematic rendering showed lower accuracy (0.698), sensitivity (0.778), specificity (0.676), positive predictive values (0.389), and negative predictive values (0.920) for vascular invasion diagnosis than CEAI or VR; the accuracy, sensitivity, specificity, positive predictive values, and negative predictive values increased to 0.767, 0.889, 0.735, 0.471, and 0.962 for both CEAI and VR. The results were not statistically significant (allP> 0.05).ConclusionsCinematic rendering has the potential to be used to evaluate vascular invasion in cases of deep STSs of the extremities, but it should be used alongside the traditional methods such as CEAI.
Congenital Unilateral Zygomatico-Maxillo-Mandibular Fusion
Authors: Decaux Jerome , Olszewski Raphael , Laloux Marc , Mahy Pierre 
Published: March 2019

Abstract
Congenital fusion of the jaws (syngnathia) is a rare and severe disorder. The authors report a case of bony fusion of the left mandible with the maxilla and zygomatic complex in a 5-day-old male who was not able to feed and open his mouth normally. Early surgery was performed to release the bony fusion on the tenth day of life. The authors present a new technique based on the intraoperative use of 3-dimensional surgical guides.
Facial Anthropometric Proportion of Chinese Han Nationality
Authors: Yang Yu-han , Wang Bing , Ding Ya , Shi Yan-Wei , Wang Xiao-Guang 
Published: March 2019

Abstract
Facial anthropometric measurements play an important part not only in forensic cases but also in clinical treatments. The utilization of 2D photograph methods in facial anthropometric studies to found database with age, gender, ethnicity, and region was expanded by other races but little for Han nationality. This study was undertaken to describe reference ranges of facial anthropometric proportions of Han nationality and compare the anthropometric characteristics with other ethnicities. Our subjects focused on full-face photos of Han nationality in South China which consisted of 1176 healthy person (425 adult males, 421 adult females and 157 underage boys and 173 underage girls). Eight anthropometric landmarks on photos were examined by ImageJ software, and 7 anthropometric ratios were analyzed. The results indicated sex- and age- and ethnics-related anthropometric variations in Chinese Han nationality in South China. For adults, females have larger ratios in intercanthal–nasal width and lip height index and smaller nose width index; for impubes, boys were larger in lip height index and smaller in lip width ratios than girls, but as age achieved, the underage boys and girls exhibited a significantly larger nose width index and lip width index, smaller canthal index, intercanthal–nasal width and lip height index. Comparing with Japanese, India, North American and Persian, Chinese Han showed great difference in facial anthropometric proportions.
The Application of a Jigsaw Puzzle Flap Based on a Freestyle Perforator and an Aesthetic Unit for Large Facial Defects
Authors: Yu Daojiang , Cao Shikun , Zhang Shuyu 
Published: March 2019

Background:
The single-stage reconstruction of large facial defects remains a conundrum due to the balance between function and aesthetics after skin cancer radical resection.

Objective:
The goal of this study was to explore a novel surgical procedure for large facial defects that not only resurfaces the large defect in single stage but also improves aesthetic outcomes for both defects and donor sites.

Methods:
The reconstructions were performed using local flaps in the form of a “jigsaw puzzle” flap based on a freestyle perforator and facial aesthetic unit. This procedure starts with a Doppler signal of the perforator and proceeds sequentially in conjunction with adjacent flaps, similar to fitting puzzle pieces, to create a new, large, jigsaw puzzle-like flap that complies with the concept of a facial aesthetic unit. All defects achieved tensionless primary closure with suturing in a concealed area.

Results:
Procedures were performed for 40 patients; the average size of the defects was 37 cm2 (range, 6–51 cm2). The patients were followed up for a range of 6 months to 2 years, and reconstruction without flap loss was 100% successful.

Conclusion:
Via a jigsaw puzzle flap based on a freestyle perforator and an aesthetic unit, we can take advantage of a greater freedom of flap selection and have a more versatile aesthetic design. The jigsaw puzzle flap concept represents a safe and favorable approach to the reconstruction of large facial defects.
Radiologic Appearance of Cranial Involvement of Rosai–Dorfman Disease
Authors: Polat Gökhan , Pirimoğlu Berhan 
Published: March 2019

Abstract
Rosai–Dorfman disease is very an important histoproliferative disorders. It rarely involves cranial and facial bones. It can make intracranial and extracranial region extension. Therefore, it can mimic dermal and dural pathologies. Target sign is an important sign for diagnosis on computed tomography and magnetic resonance imaging.
Frontal Sinus Osteoma: From Direct Excision to Endoscopic Removal
Authors: Karunaratne Yasiru G. , Gunaratne Dakshika A. , Floros Peter , Wong Eugene H. , Singh Narinder P. 
Published: March 2019

Abstract
Frontal sinus osteomas are benign bone-forming neoplasms. Ongoing advancements in endoscopic surgery have allowed less invasive surgical approaches to be adopted for removal. The authors systematically reviewed the literature to provide analysis and recommendations for management.
One hundred ninety-three publications encompassing 1399 patients met inclusion, with mean age 42.1 ± 13.8 years and a male predominance (59.2%). Symptoms included pain (70.8%); orbital/ocular (20.7%); sinonasal (36.4%); neurologic (6.0%); other (14.5%); and asymptomatic (4.8%). Osteoma was isolated to the frontal sinus (82.9%) or extended into the ethmoid (16.6%), maxillary (0.3%), and sphenoid sinuses (0.2%). There was intracranial extension in 9.5% and intraorbital extension in 18.7%. Of those proceeding to surgery, majority (59.8%) underwent open approaches, followed by endoscopic (25.0%) and combined (11.5%). A significant (P < 0.01) increase in proportion of cases utilizing endoscopic approaches versus open/combined was observed over the period studied. Seventy-one postoperative complications were reported, in 7.5% of endoscopic cases, 27% of open, and 8.8% of combined. Complications were more likely in open/combined surgery, compared with endoscopic (22.3% versus 7.5%, P < 0.001). In 181 patients, completeness of resection was reported (complete resection; 87.8%) and found to be a significant predictor (P < 0.01) for disease recurrence/progression. Mean length of stay for the endoscopic group was 3.1 ± 1.3 days, compared with 7.9 ± 3.1 for open/combined (P < 0.0001).
In the management of frontal sinus osteoma, indications for selecting endoscopic versus open approaches have expanded over the past 30 years, as techniques, equipment, and understanding of pathophysiology have evolved. Where endoscopic approaches are possible, they are associated with reduced morbidity and length of stay compared with open approaches.
Influencing Factors on the Outcome in Female Groin Hernia Repair
Authors: Köckerling Ferdinand , Lorenz Ralph , Hukauf Martin , Grau Henning , Jacob Dietmar , Fortelny René , Koch Andreas 
Published: March 2019

Objective:
Based on an analysis of data from the Herniamed Registry, this study aims to identify all factors influencing the outcome in female groin hernia repair.

Background:
In a systematic review and meta-analysis of observational studies, female sex was found to be a significant risk factor for recurrence. In the guidelines, the totally extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) laparo-endoscopic techniques are recommended for female groin hernia repair. However, even when complying with the guidelines, a less favorable outcome must be expected than in men. To date, there is no study in the literature for analysis of all factors influencing the outcome in female groin hernia repair.

Methods:
In all, 15,601 female patients from the Herniamed Registry who had undergone primary unilateral groin hernia repair with the Lichtenstein, Shouldice, TEP or TAPP technique, and for whom 1-year follow-up was available, were selected between September 1, 2009 and July 1, 2017. Using multivariable analyses, influencing factors on the various outcome parameters were identified.

Results:
In the multivariable analysis, a significantly higher risk of postoperative complications, complication-related reoperations, recurrences, and pain on exertion was found only for the Lichtenstein technique. No negative influence on the outcome was identified for the TEP, TAPP, or Shouldice techniques. Relevant risk factors for occurrence of perioperative complications, recurrences, and chronic pain were preoperative pain, existing risk factors, larger defects, a higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification and postoperative complications. Higher age had a negative association with postoperative complications and positive association with pain rates.

Conclusions:
Female groin hernia repair should be performed with the TEP or TAPP laparo-endoscopic technique, or, alternatively, with the Shouldice technique, if there is no evidence of a femoral hernia. By contrast, the Lichtenstein technique has disadvantages in terms of postoperative complications, recurrences, and pain on exertion. Important risk factors for an unfavorable outcome are preoperative pain, existing risk factors, higher ASA classification, higher BMI, and postoperative complications. A higher age and larger defects have an unfavorable impact on postoperative complications and a more favorable impact on chronic pain.
Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?
Authors: Yeung Kai Tai Derek , Penney Nicholas , Ashrafian Leanne , Darzi Ara , Ashrafian Hutan 
Published: March 2019

Objective:
The aim of this study was to appraise the prevalence of gastroesophageal reflux disease (GERD), esophagitis, and Barrett's esophagus (BE) after sleeve gastrectomy (SG) through a systematic review and meta-analysis.

Background:
The precise prevalence of new-onset or worsening GERD after SG is controversial. Subsequent esophagitis and BE can be a serious unintended sequalae. Their postoperative prevalence remains unclear.

Methods:
A systematic literature search was performed to identify studies evaluating postoperative outcomes in primary SG for morbid obesity. The primary outcome was prevalence of GERD, esophagitis, and BE after SG. Meta-analysis was performed to calculate combined prevalence.

Results:
A total of 46 studies totaling 10,718 patients were included. Meta-analysis found that the increase of postoperative GERD after sleeve (POGAS) was 19% and de novo reflux was 23%. The long-term prevalence of esophagitis was 28% and BE was 8%. Four percent of all patients required conversion to RYGB for severe reflux.

Conclusions:
The postoperative prevalence of GERD, esophagitis, and BE following SG is significant. Symptoms do not always correlate with the presence of pathology. As the surgical uptake of SG continues to increase, there is a need to ensure that surgical decision-making and the consent process for this procedure consider these long-term complications while also ensuring their postoperative surveillance through endoscopic and physiological approaches. The long-term outcomes of this commonly performed bariatric procedure should be considered alongside its weight loss and metabolic effects.