bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Mediating Role of Implicit and Explicit Emotion Regulation in the Relationship Between Academic Emotions and Approaches to Learning
Authors: Rentzios Christos , Kamtsios Spiridon , Karagiannopoulou Evangelia 
Published: July 2019

Abstract
The present study belongs to a new strand of research in learning in higher education focusing on emotions and emotion regulation, including defense mechanisms. The purpose of the study was to investigate the mediating role of implicit and explicit emotion regulation in the relationship between academic emotions and approaches to learning. Participants were composed of 226 undergraduates (40 males and 186 females studying in a social science department). They completed the following questionnaires: Emotion Regulation Questionnaire, Student Experience of Emotions Inventory, Defense Style Questionnaire, and Approaches to Learning and Studying Inventory. Both the moderating (interaction) and the mediational (indirect) effects were examined using the PROCESS program. Results failed to indicate the moderating role of emotion regulation in the association between academic emotions and approaches to learning. Instead, results revealed the dominant mediating role of emotion regulation and particularly the role of immature defense style in the relationship between negative emotions and approaches to learning. Moreover, reappraisal and suppression seemed to act as mediators in the relationship between positive and negative emotions with deep and surface approaches, respectively. The results of the study are discussed in the context of the recent literature. Implications for higher-education institutions regarding the role of unconscious cognitive processes are also discussed.
Resolution of Symptoms and Resumption of Sex After Diagnosis of Nongonococcal Urethritis Among Men Who Have Sex With Men
Authors: Chambers Laura C. , Hughes James P. , Glick Sara N. , Morgan Jennifer L. , Lowens M. Sylvan , Robinson Tashina S. , Romano Sarah S. , Leipertz Gina L. , Jensen Jørgen S. , Khosropour Christine M. , Fredricks David N. , Golden Matthew R. , Manhart Lisa E. 
Published: July 2019

Background
Standard counseling at nongonococcal urethritis (NGU) diagnosis includes advice to abstain from sex for at least 7 days and until symptoms resolve.

Methods
From December 2014 to July 2018, we enrolled men who have sex with men and received azithromycin (1 g) for NGU at the Public Health–Seattle and King County STD Clinic. Over 12 weeks of follow-up, participants reported daily urethral symptoms and sexual activity on web-based diaries. Nongonococcal urethritis was defined as urethral symptoms or visible urethral discharge plus 5 or greater polymorphonuclear leukocytes per high-power field. Time of symptom resolution was defined as the first of 5 consecutive asymptomatic days.

Results
Of 100 participants with NGU and no Chlamydia trachomatis (CT)/Mycoplasma genitalium (MG) coinfection, 36 (36%), 22 (22%), and 42 (42%) had CT-NGU, MG-NGU, and non-CT/non-MG NGU, respectively. Among men with MG-NGU, 94% had a macrolide resistance mutation. For all etiologies, median time to symptom resolution after azithromycin was 7 days (95% confidence interval [CI], 5–9); 37% had symptoms lasting longer than 7 days. For men with CT-NGU, MG-NGU, and non-CT/non-MG NGU, median time to symptom resolution was 4 days (95% CI, 2–6; 16% >7 days), undefined days (95% CI, 7 to undefined; 60% >7 days), and 7 days (95% CI, 5–11; 46% >7 days), respectively. Median time to first sexual activity (any type) was 12 days (95% CI, 11–17); it was 16 days (95% CI, 12–18) to first urethral sexual exposure. Twenty-seven percent did not avoid urethral exposure for the recommended period.

Conclusions
Counseling at NGU diagnosis should educate patients that symptoms may persist more than 7 days, particularly for non-CT NGU, and emphasize the rationale for the 7-day abstinence period.
Autologous Breast Reconstruction after Failed Implant-Based Reconstruction: Evaluation of Surgical and Patient-Reported Outcomes and Quality of Life
Authors: Coriddi Michelle , Shenaq Deana , Kenworthy Elizabeth , Mbabuike Jacques , Nelson Jonas , Pusic Andrea , Mehrara Babak , Disa Joseph J. 
Published: July 2019

Background:
There is a subset of patients who initially undergo implant-based breast reconstruction but later change to autologous reconstruction after failure of the implant reconstruction. The purpose of this study was to examine outcomes and quality of life in this group of patients.

Methods:
After institutional review board approval, a retrospective chart review of a prospectively maintained database was performed and BREAST-Q surveys were evaluated.

Results:
One hundred thirty-seven patients underwent autologous breast reconstruction following failed implant-based reconstruction with 192 total flaps. Failure of implant reconstruction was defined as follows: capsular contracture causing pain and/or cosmetic deformity [n = 106 (77 percent)], dissatisfaction with the aesthetic result [n = 15 (11 percent)], impending exposure of the implant/infection [n = 8 (6 percent)], and unknown [n = 8 (6 percent)]. Complications requiring operative intervention included partial flap loss [n = 5 (3 percent)], hematoma [n = 5 (3 percent)], vascular compromise requiring intervention for salvage [n = 2 (1 percent)], and total flap loss [n = 1 (1 percent)]. Thirty-four patients (23 percent) had BREAST-Q surveys. There was a statistically significant increase in overall outcomes (p < 0.001), satisfaction with appearance of breasts (p < 0.001), psychosocial well-being (p < 0.001), and physical well-being of the chest (p = 0.003). A statistically significant decrease in physical well-being of the abdomen was observed (p = 0.001).

Conclusions:
Autologous breast reconstruction after failed implant-based reconstruction has an acceptable complication rate and is associated with significantly improved patient satisfaction and quality of life.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Weighted Genetic Risk Score Predicts Surgical Recurrence Independent of High-Risk Clinical Features in Dupuytren’s Disease
Authors: Riesmeijer Sophie A. , Manley Oliver W. G. , Ng Michael , Nolte Ilja M. , Broekstra Dieuwke C. , Werker Paul M. N. , Furniss Dominic 
Published: July 2019

Background:
Dupuytren’s disease is a very common, highly heritable palmar fibromatosis. In a recent genome-wide association study, 26 single-nucleotide polymorphisms were found to be associated with development of Dupuytren’s disease. The authors generated a weighted genetic risk score based on the genotype at these single-nucleotide polymorphisms. In two independent cohorts, they tested the association among high weighted genetic risk score, clinical features that predict a high risk of recurrence, and recurrence after surgery.

Methods:
Clinical data were obtained from patient questionnaires and clinical records, with missing data accounted for by imputation. Genotyping was performed as part of the recent genome-wide association study. Logistic regression was performed to study the association among weighted genetic risk score, high-risk clinical features, and recurrence, with a weighted genetic risk score analyzed as a continuous variable, and also grouped into four categories.

Results:
Using univariable logistic regression, a high weighted genetic risk score was associated with the presence of all high-risk clinical features: early age of onset, bilateral disease, ectopic disease, and a positive family history (p ≤ 0.004). After multivariable logistic regression accounting for these factors, an increased weighted genetic risk score was still associated with the need for repeated Dupuytren’s disease surgery (p = 0.004).

Conclusions:
The authors’ results suggest that a weighted genetic risk score is useful in predicting the risk of disease recurrence, and may be used by surgeons to personalize prognostication. In the future, a weighted genetic risk score may be useful for determining the most appropriate initial surgical procedure in patients with Dupuytren’s disease.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Reuse of the Masseteric Nerve for Dynamic Reanimation in Facial Palsy Patients with Previously Failed One-Stage Dynamic Smile Reanimation
Authors: Mohanty Ahneesh J. , Hembd Austin , Thrikutam Nikhitha , Rozen Shai M. 
Published: July 2019

Summary:
Failed primary dynamic smile reanimation procedures present significant challenges for the patient and surgeon alike. This is particularly true in older patients with a history of previous neck dissection and radiation therapy who underwent previous reconstruction with a free functional muscle transfer innervated with an ipsilateral masseter nerve. The objective of this study was to demonstrate feasibility, describe surgical technique, and assess results of reusing the masseter nerve to reinnervate a new free functional muscle transfer. Patients presenting between 2007 and 2017 to a single center after previously failed dynamic smile reanimation using the masseteric nerve who underwent a salvage dynamic procedure involving reuse of the masseteric nerve were analyzed for demographics, history of radiation therapy or chemotherapy, surgical techniques, and objective measurements using the MEEI Facegram software. The average age was 50 years, the average duration of palsy was 6.2 years, and the average preoperative House-Brackmann score was 6. Causes of palsy included Bell palsy in one, parotid malignancies in two, and a seventh cranial nerve schwannoma in one patient, with two patients requiring radiation therapy preoperatively. Three patients failed to achieve any motion after the first reanimation, and the fourth patient initially achieved excursion; however, because of cancer recurrence and resection of free functional muscle transfer, motion was subsequently lost. Average smile excursion after salvage was 11.32 mm and philtral deviation correction was 1.3 mm. Reusing the masseter nerve for dynamic smile restoration with free functional muscle transfer in previously failed reanimation patients is feasible and may provide successful reanimation. Careful patient evaluation and clear understanding of previous procedures are essential for success.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Preliminary Study of the Effects of Venous Drainage Position on Arterial Blood Supply and Venous Return within the Conjoined Flap
Authors: Xi Shanshan , Cheng Sheng , Lou Junsheng , Qiu Lingfeng , Yang Qingwen , Yu Wanping , Mei Jin , Tang Maolin 
Published: July 2019

Background:
Conjoined flap viability is associated with arterial blood supply and venous return. This study aimed to assess the effects of venous drainage position on arterial blood supply and venous return within the conjoined flap.

Methods:
Fifty-four rats were divided randomly into three groups (n = 18 per group). In experimental group 2, only the right intercostal posterior artery and the left iliolumbar vein were maintained; meanwhile, only the right intercostal posterior artery and the left intercostal posterior vein were preserved in experimental group 1. The control group had only the right intercostal posterior artery and vein preserved. The distances between angiosomes were measured. At 7 days after surgery, flap survival was evaluated, lead oxide–gelatin flap angiography was performed, and average microvessel density was assessed by hematoxylin and eosin staining, and lactate levels were assessed.

Results:
The distance between angiosomes I and II was the shortest, whereas angiosomes I and III were most distant (p < 0.05). At 7 days after surgery, survival rates in experimental group 2 and experimental group 1 were both 100 percent, whereas 86.5 ± 1.6 percent of controls survived. Furthermore, angiogenesis was more obvious in experimental group 2 than in experimental group 1 and controls. Moreover, lactate levels were lower in experimental group 2 (7.47 ± 0.17 mM) and experimental group 1 (8.03 ± 0.31 mM) compared with control values (9.98 ± 0.37 mM; p < 0.05).

Conclusion:
Changes in position of venous drainage might cause continuous arterial high-pressure perfusion and venous superdrainage, which improves flap survival.
Multiplane Forehead Shortening: Sparing the Frontalis Muscle and Supraorbital Nerve
Authors: Ahn Yong Su , Park Yun Yong , Chang Jung Woo 
Published: July 2019

Background:
An appropriate forehead-to-face ratio is an important factor contributing to a balanced and attractive face. Conventional methods have been used to correct long forehead, but these methods have drawbacks. The primary objective of this study was to introduce a modified technique with better results.

Methods:
Between March of 2015 and March of 2017, 525 patients with long forehead underwent multiplane forehead shortening with sparing of the frontalis muscle and supraorbital nerve. The operation began with a design indicating the area of skin excision. The sensory nerves were preserved during the skin excision, and the frontalis muscle was not cut. Subgaleal dissection was performed through a small window on the galea. The postoperative assessments included the change in forehead length, sensory changes on the scalp, the presence of a scar, alopecia, and synchronous movement of the flap.

Results:
A mean forehead shortening of 2.0 cm (range, 1.1 to 2.8 cm) was observed. Sensory deficits were observed only in the anteromedian scalp, which the supratrochlear nerve innervates. However, sensation recovered to the normal level within 6 months. Scars were barely visible or not visible at all in 85.5 percent of the patients. Postoperative alopecia occurred in only two cases. The synchronous movement of the forehead and scalp was natural in all cases.

Conclusion:
This modified technique of multiplane forehead shortening with sparing the frontalis muscle and supraorbital nerve provided both cosmetic and functional benefits.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Topical Oxandrolone Reduces Ear Hypertrophic Scar Formation in Rabbits
Authors: Sobec Raluca L. , Fodor Lucian , Bodog Florian 
Published: July 2019

Background:
Wound healing is a complex process. Despite extensive studies, hypertrophic and keloid scars still occur, and can be functionally and cosmetically problematic. In an attempt to prevent hypertrophic scar formation, the effects of topical oxandrolone, using hyaluronic acid as a biomaterial, were studied on ear wounds in rabbits.

Methods:
Deep second-degree burns were inflicted on each ear in 10 New Zealand rabbits. On the left ears, considered the control side, hyaluronic acid gel was applied, whereas on the right ears, the study side, a combination of oxandrolone and hyaluronic acid was applied. Dressings were changed every 2 days for 2 weeks. At week 10, biopsy specimens from the postburn scars were harvested for histologic and immunohistochemical examinations.

Results:
Fourteen wounds were studied, half on the control side and half on the study side. Six hypertrophic scars were encountered on the control side and only one scar was encountered on the study side. In addition, an increased degree of inflammation, an increased amount of collagen and fibroblast cellularity, increased vascularization, and increased myofibroblast activity were observed on the control side.

Conclusion:
Topical administration of oxandrolone using hyaluronic acid as a biomaterial led to better healing and prevented hypertrophic scar formation.
Risk-to-Benefit Relationship of Contralateral Prophylactic Mastectomy: The Argument for Bilateral Mastectomies with Immediate Reconstruction
Authors: Alba Brandon , Schultz Benjamin D. , Cohen Danielle , Qin Alex L. , Chan William , Tanna Neil 
Published: July 2019

Background:
The increasing trend of women with unilateral breast cancer to electively undergo contralateral prophylactic mastectomy in addition to treatment of the index breast has been controversial. The authors set out to better frame the risks and benefits of contralateral prophylactic mastectomy in the treatment of unilateral breast cancer by evaluating outcomes of a large, consecutive cohort of patients.

Methods:
An institutional review board–approved review of a single-surgeon (N.T.) experience (2013 to 2018) was conducted of all consecutive patients with unilateral breast cancer treated with mastectomy and immediate reconstruction. Patient characteristics, surgical pathologic results, and 30-day complications were assessed. Outcomes of patients with unilateral cancer who underwent unilateral mastectomy versus bilateral mastectomy (with one breast being contralateral prophylactic mastectomy) were compared. Logistic regression models evaluated various risk factors for potential associations with positive pathologic findings in the contralateral prophylactic mastectomy specimen and/or postoperative complications.

Results:
Of 244 patients, 68 (27.9 percent) underwent unilateral mastectomy and 176 (72.1 percent) underwent contralateral prophylactic mastectomy. Surgical pathologic results of the prophylactic breast revealed occult ductal carcinoma in situ or invasive cancer in 13 patients (7.3 percent) and lobular carcinoma in situ in eight patients (4.6 percent). Incidence of complications was similar between groups [unilateral mastectomy, 19.12 percent (n = 13); contralateral prophylactic mastectomy, 13.07 percent (n = 23); p = 0.234].

Conclusions:
Immediate reconstruction for unilateral mastectomy and contralateral prophylactic mastectomy have similar complication risk profiles, among patients as a whole and between individual breasts. These findings contribute to our understanding of the clinical impact prophylactic mastectomy and reconstruction may have on optimizing the counseling among extirpative surgeons, reconstructive surgeons, and patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Natural Course of Ophthalmoplegia after Iatrogenic Ophthalmic Artery Occlusion Caused by Cosmetic Filler Injections
Authors: Yang Hee Kyung , Lee Yunjin , Woo Se Joon , Park Kyu Hyung , Kim Ji-Soo , Hwang Jeong-Min 
Published: July 2019

Background:
Besides the devastating complication of blindness, paralysis of the eye muscles, namely ophthalmoplegia, may occur after cosmetic facial filler injection. However, little is known of the clinical characteristics and prognosis of such complications. This study was performed to investigate the natural course of ophthalmoplegia and development of sensory strabismus secondary to blindness after iatrogenic occlusion of the ophthalmic artery and its branches resulting from cosmetic facial filler injection.

Methods:
A retrospective study of 21 patients with occlusion of the ophthalmic artery and its branches after cosmetic facial filler injection was performed. The clinical characteristics and prognosis of ophthalmoplegia after cosmetic filler injection were evaluated. At the final examination, development of sensory strabismus defined as deviation of the eye secondary to unilateral vision loss was evaluated.

Results:
At initial presentation, ophthalmoplegia was found in 15 of 21 patients (71 percent) and was significantly associated with the presence of anterior segment ischemia (p = 0.017). Among patients with ophthalmoplegia at initial presentation, ocular motility recovered completely in 77 percent and incomplete recovery was found in 23 percent. At the final examination, sensory strabismus developed in 42 percent after an average follow-up of 2.5 years.

Conclusions:
Ophthalmoplegia frequently occurs after iatrogenic occlusion of the ophthalmic artery and its branches caused by cosmetic facial filler injection. Ocular motility recovers spontaneously in most patients. However, as most patients are blind, sensory strabismus may develop in nearly half of patients during follow-up that requires strabismus surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, IV.
Direct Lateral Canthal Approach to the Zygomaticotemporal Branch of the Trigeminal Nerve for Surgical Treatment of Migraines
Authors: Hamawy Adam , Li Xingchen , Sanniec Kyle , Amirlak Bardia 
Published: July 2019

Summary:
Surgical treatment of migraine headaches involves avulsion or decompression of the affected peripheral nerves. One of the sites targeted is site II, the zygomaticotemporal branch of the trigeminal nerve. Although traditionally the procedure involved either an endoscopic or transpalpebral approach to access the nerve, both methods involve general anesthesia in an operating room. The senior authors developed a new technique to directly access the nerve by means of a transverse lateral canthal extension incision that can be performed under local anesthesia in an office setting. A cadaver dissection to assess safety and anatomical variability was performed with visualization and complete avulsion of the zygomaticotemporal branch of the trigeminal nerve in all cases, with no injury to surrounding structures. An office-based procedure for zygomaticotemporal branch of the trigeminal nerve compression can help reduce the risks and costs associated with a general anesthetic and can be used for patients with isolated migraines localized to the zygomaticotemporal branch of the trigeminal nerve or recurrent secondary triggers to that area.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
The Importance of Reproducibility in Plastic Surgery Research
Authors: Ascha Mona , Ascha Mustafa S. , Gatherwright James 
Published: July 2019

Summary:
With the advent of big data and database-driven research, the need for reproducible methods has become especially relevant. Given the rise of evidence-based practice, it is crucial to ensure that findings making use of big data can be consistently replicated by other physician-scientists. A call for transparency and reproducibility must occur at the individual, institutional, and national levels. Given the rising popularity of national and large databases in research, the responsibility of authors to ensure reproducibility of clinical research merits renewed discussion. In this article, the authors offer strategies to increase clinical research reproducibility at both the individual and institutional levels, within the context of plastic surgery.
Optimizing Outcomes in 2-Stage Prepectoral Breast Reconstruction Utilizing Round Form-Stable Implants
Authors: Sbitany Hani , Lee Kenneth R. 
Published: July 2019

Summary:
Prepectoral breast reconstruction carries many benefits to patients, including its minimally invasive (muscle-sparing) nature, and its reduction in symptoms such as pain and animation deformity, relative to subpectoral reconstruction. However, without the traditional use of the pectoralis major muscle to mask the upper pole of the implant, and dictate the shape of the upper pole, certain steps must be taken to ensure the optimal aesthetic outcome in prepectoral reconstruction. Surgeons have utilized acellular dermal matrices, fat grafting, and highly cohesive implants to improve outcomes. Among the most important steps is the proper implant selection. To this end, the authors routinely utilize round form-stable gel implants, when performing prepectoral breast reconstruction. These implants offer improved aesthetic outcomes, given their ability to reduce rates of rippling and edge visibility. Furthermore, the characteristics of a soft and naturally shaped breast are achieved despite the lack of muscle coverage. The authors believe that reproducibly successful prepectoral reconstruction is dependent on proper technique. In this article, we present the proper techniques necessary for optimizing outcomes when using these implants in 2-stage prepectoral breast reconstruction.