bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preschool Age Anthropometric Evaluation of the Nose After Bilateral Complete Cleft Lip Repair
Authors: Winaikosol Kengkart , Patthanapalakornskul Jirapat , Jenwitheesuk Kamonwan , Punyavong Pattama , Surakunprapha Palakorn , Chowchuen Bowornsilp 
Published: April 2019

Objective:
To evaluate the aesthetic outcomes of surgery in preschool-aged bilateral complete cleft lip patients by comparing their nasal aesthetic parameters with those of normal children.

Setting and Sample Population:
Twenty-six 4 to 6-year-old (preschool age) patients with bilateral complete cleft lip who underwent primary cheiloplasty and a control group of 30 children in Northeast Thailand of the same age were enrolled.

Materials and Methods:
Nasal aesthetic parameters were analyzed in terms of 3 ratios and 1 angle using three-dimensional photographs. The data from bilateral cleft lip patients were compared with those from a control group.

Results:
The nasal parameters of patients in the cleft group were the same as those in the control group in terms of nasal tip height (NTH), columella height (CH), and dome height (DH) (P values were 0.361, 0.494, and 0.086), but nasal width (NW) was greater in the cleft group (P < 0.001). The nasal aesthetic parameters differed significantly between the 2 groups in terms of CLA (P < 0.001) and ratio of NTH and NW (P < 0.001), but not in terms of the CH:NW (P = 0.190) and DH:CH ratios (P = 0.147).

Conclusion:
This treatment protocol for bilateral cleft lip was able to achieve most of the aesthetic goals in terms of NTH, CH, DH, ratio of CH to NW, and ratio of DH to CH. However, more surgical correction of NW and CLAs may be needed.
Cost-Effective Technique of Fabrication of Polymethyl Methacrylate Based Cranial Implant Using Three-Dimensional Printed Moulds and Wax Elimination Technique
Authors: Desai Jimish B. 
Published: April 2019

Objective:
Cranioplasty is one of the oldest known neurosurgical procedure performed. Many materials have been used for cranioplasty since ages. Polymethyl methacrylate (PMMA) has become the workhorse for fabrication of cranial implants since World War II in cases where autologous bone is not available or cannot be harvested. The aim of the present study is to present author's experience in the management of cranioplasty using acrylic implants fabricated using 2 different techniques.

Methods:
The author conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between October 2016 and January 2018. The surgical results were classified based on surgical time, blood loss, and the 3 scales of patient satisfaction, improvement of facial symmetry, and need for additional surgery along with the rate of wound complications.

Results:
Thirty patients underwent cranioplasty with PMMA-based implants, whether fabricated using alginate impression technique (56.67%) or fabricated using 3-dimensional (3D) printed patient-specific moulds (43.33%). Complications included infection (13.3%). The authors considered the craniofacial aesthetics based on patient satisfaction excellent (69%) with the degree of improvement of craniofacial symmetry satisfactory (92.3%), and 1 patient requiring resurgery in alginate impression technique fabricated implants.

Conclusion:
The author recommends a unique technique for fabrication of PMMA-based implants using 3D printed moulds to achieve a better fitting implant and highly cosmetic outcome for cranioplasty at affordable cost.
Extrusion of Alloplastic Septal Silicone Implant: 25 Years After Rhinoplasty
Authors: Safakogullari Hasan , Yalcinozan Eda Tuna , Tinazli Remzi , Kazikdas Kadir Cagdas , Safak Mustafa Asim 
Published: April 2019

Abstract
Multiple techniques and a variety of materials used for grafting have been described and applied over the years. Silicone implants are one of the most widely used alloplastic materials in Asian rhinoplasty, however, there are several complications. The authors report a case of an Asian woman who presented with implant rejection after 25 years later as a late complication of rhinoplasty. The patient was underwent revision augmentation rhinoplasty and stayed uneventful for 6 months as she was satisfied with aesthetic results and nasal airflow. The silicone implants are still going to be the most popular grafts in Asian augmentation rhinoplasty even so the long term complications must be kept in mind.
Long-term Physical Activity Levels and Physical Functioning Outcomes After Midurethral Sling
Authors: Shinnick Julia K. , Raker Christina A. , Sung Vivian W. 
Published: April 2019

Objectives
The objective of this study was to describe changes in leisure physical activity (PA) levels and physical functioning (PF) in women 60 months or more after midurethral sling for stress urinary incontinence (SUI).

Methods
This is a long-term follow-up study of a previously published prospective study of women undergoing outpatient midurethral sling for SUI from 2009 to 2011. Women completed questionnaires for incontinence, PA, and PF at baseline, 6, 12, and 60 months or more postoperatively. Women were categorized as having sedentary, insufficient, or sufficient leisure PA levels by metabolic equivalents (MET min/week on the International Physical Activity Questionnaire). Physical functioning was measured from the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System. Physical activity and PF levels were compared preoperatively and at 60 months or more. Statistical tests were applied as appropriate with a P < 0.05 considered significant.

Results
Of the 85 women enrolled in the primary study, contact was made with 49, and 35 completed surveys. The follow-up range was 5.8 to 8 years (median, 6.8). Baseline mean age was 49.8 (SD, 8) years. Urinary Impact Questionnaire scores were lower at 60 months or more postprocedure (33.33 vs 0, P < 0.001), with no differences at 6, 12, and 60 months or more. At baseline, 31.3% of patients had sedentary, 12.5% had moderate, and 56.3% had sufficient leisure PA levels. On long-term follow-up, this improved to 21.9% sedentary, 12.5% moderate, and 65.6% sufficient leisure PA levels. Physical functioning also improved (mean, 44.95 vs 53.18 points; P < 0.001).

Conclusions
Midurethral sling procedures are associated with modest improvements in leisure PA levels and significant improvements in PF 60 months or more after surgery.
Critical Anatomy for Robotic Sacrocolpopexy: A Long-term Follow-up Study
Authors: Crisp Catrina C. , Herfel Charles V. , Kleeman Steven D. , Pauls Rachel N. 
Published: April 2019

Objective
This study aimed to assess anatomy relative to sacral sutures 20 to 24 months after robotic sacrocolpopexy.

Methods
This was an institutional review board–approved prospective anatomy study of women undergoing robotic sacrocolpopexy. After placement of suture into the anterior longitudinal ligament, a small vascular clip was secured on the base of the suture. Subjects were imaged at 6 weeks and between 20 and 24 months after surgery. Measurements were calculated by the primary investigator and radiologist coinvestigator.

Results
Of the 11 subjects enrolled in the initial 6-week postoperative study, 5 (45%) completed the long-term follow-up. Regarding the vascular anatomy, no significant changes were documented. Similarly, the major urologic structure, the right ureter, was stable at 16 mm from the clip. A significant change was noted, however, in the distance from the apex of the vagina to the sacral suture. At 6 weeks postoperatively, the mean (SD) distance from the vaginal apex to the clip was 69.3 (14) mm; this increased to 85.2 (11.3) mm at the long-term follow-up (P = 0.004).

Conclusions
Reassuringly, the position of the clip remained stable, which is reflected in the constancy of the measurements to the vascular landmarks. Nevertheless, alteration in the distance to the vaginal apex suggests elongation of the mesh or vaginal tissue with time. Although the increase in length was greater than 1.5 cm, it may bear clinical relevance in certain patients. This information may help guide surgeons regarding appropriate mesh tensioning during this critical step of the procedure.
Sarcopenia Predicts Post-transplant Mortality in Acutely Ill Men Undergoing Urgent Evaluation and Liver Transplantation
Authors: Kuo Selena Z. , Ahmad Myra , Dunn Michael A. , Montano-Loza Aldo J. , Carey Elizabeth J. , Lin Shezhang , Moghe Akshata , Chen Hui-Wei , Ebadi Maryam , Lai Jennifer C. 
Published: April 2019

Background.
We examined the association between sarcopenia and post-transplant mortality in acutely ill inpatients with cirrhosis who underwent urgent liver transplantation.

Methods.
Included were inpatients at 4 centers who were urgently listed as nonstatus 1 and transplanted from 2005 to 2017 with an abdominal computed tomography scan <90 days before transplantation. Skeletal muscle index (SMI) = total skeletal muscle cross-sectional area at the L3 vertebral level, normalized to height. Cox regression associated SMI with post-transplant mortality. Optimal search identified SMI cutoffs to detect survival.

Results.
Of 126 inpatients, 63% were male patients, model for end-stage liver disease (MELDNa) was 32, and follow up was 5.1 years. Among men, 23% died. Median SMI was lower in men who died versus survived (45 versus 51 cm2/m2). SMI was associated with post-transplant mortality (hazard ratio [HR] = 0.96 per cm2/m2, 95% CI 0.92-0.99). Patients with SMI ≤ 48 cm2/m2 versus >48 cm2/m2 experienced higher rates of death at 1 year (86% versus 95%) and 3 years (73% versus 95%) (Log-rank P = 0.01). In MELD-adjusted analysis, sarcopenia was strongly associated with post-transplant mortality (HR = 4.39, 95% CI 1.49-12.97). Among women, 35% died. Median SMI was similar in women who died versus survived (45 versus 44 cm2/m2). SMI was not associated with post-transplant mortality (HR = 1.02, 95% CI 0.96-1.09). Optimal search did not identify any SMI cutoff that predicted post-transplant mortality.

Conclusions.
Among patients who underwent urgent inpatient evaluation and liver transplantation, we identified an SMI cutoff value of 48 cm2/m2 to predict post-transplant mortality in men. Our data support the use of SMI as a tool to capture the impact of muscle depletion on post-transplant mortality in acutely ill men with cirrhosis undergoing urgent liver transplantation.
Pituitary Adenylate Cyclase-activating Polypeptides Prevent Hepatocyte Damage by Promoting Yes-associated Protein in Liver Ischemia-Reperfusion Injury
Authors: Liu Yuan , Lu Tianfei , Zhang Cheng , Xue Zhengze , Xu Jin , Busuttil Ronald W. , Xia Qiang , Xu Ning , Kupiec-Weglinski Jerzy W. , Ji Haofeng 
Published: April 2019

Background.
Hepatic ischemia-reperfusion injury (IRI) is a severe complication in liver transplantation, hepatectomy, and hemorrhagic shock. As neuropeptides transmit the regulatory signal between nervous and immune systems communication, our previous study documented that pituitary adenylate cyclase-activating polypeptides (PACAP) depressed hepatic Toll-like receptor 4 immune response in liver IRI.

Methods.
Here, we focused on how PACAP suppressed hepatocellular damage and enhanced hepatocyte regeneration in a murine model of partial liver warm IRI.

Results.
Yes-associated protein (YAP), a cellular modulator of tissue regeneration, was readily induced in wild type (WT) mouse IR-livers. As its induction was failed in PACAP-deficient livers, PACAP supplement enhanced YAP expression in WT mouse and promoted its nuclear translocation and downstream antioxidative/regenerative genes expression both in vivo and in vitro. Further, verteporfin, a YAP transcriptional inhibitor, abolished PACAP-mediated hepatoprotection significantly. Meanwhile, blockade of protein kinase A (PKA)–CRE-binding protein (CREB) signaling recreated liver damage in PACAP-protected liver as well as impeded stimulation on YAP and its downstream gene expressions. Consistently, inhibition of PKA-CREB decreased PACAP-promoted YAP expression in primary hepatocytes culture, and made them vulnerable to H2O2 stress in vitro. In addition, lysophosphatidic acid, another Hippo pathway inhibitor, failed to affect PACAP-mediated hepatoprotection or hepatocellular YAP induction. This implies that PACAP regulated YAP through PKA-CREB pathway at the transcriptional level rather than canonical hippo pathway.

Conclusions.
Our study discovered the neural modulation of PACAP-YAP axis in hepatic cytoprotection and homeostasis in liver IRI. These reveal a novel insight of neuropeptide PACAP in combating liver IRI in clinical patients.
Assessing the Limits in Kidney Transplantation: Use of Extremely Elderly Donors and Outcomes in Elderly Recipients
Authors: Arcos Emma , Pérez-Sáez María José , Comas Jordi , Lloveras Josep , Tort Jaume , Pascual Julio 
Published: April 2019

Background.
Patient survival with end-stage renal disease is longer after kidney transplantation (KT) compared with those remaining on dialysis. Nevertheless, this remains uncertain when receiving a kidney from a donor ≥80 years old.

Methods.
In a longitudinal mortality study in the Catalan Renal Registry including 2585 patients ≥60 years old on dialysis and placed on the KT waiting list, 1084 received a first KT from a deceased donor aged 60 to 79 years and 128 from a deceased donor ≥80 years. We calculated adjusted risk of graft loss by means of competing-risks regression, considering patient death with functioning graft as a competing event. To assess patient survival benefit from KT, we calculated the adjusted risk of death by nonproportional hazard analysis, taking the fact of being transplanted as a time-dependent effect. Considering all KT ≥60 (n = 1212), we assessed whether the benefit of KT varied per different recipient characteristics by calculating the interaction effect between all potential mortality risk factors and the treatment group.

Results.
Compared with kidneys from donors 60 to 79 years old, graft survival was significantly lower for kidneys from donors aged ≥80 years (subhazard ratio = 1.55; 95% confidence interval, 1.00-2.38; P = 0.048). In comparison with those who remained on dialysis, adjusted risk of death 12 months after transplantation in recipients with a kidney from donors ≥80 years was 0.54 (95% confidence interval, 0.38-0.77; P < 0.0001).

Conclusions.
Despite KT from octogenarian deceased donors being associated with reduced graft survival, recipients had lower mortality rates than those remaining on dialysis, even if the kidney came from an extremely aged donor.
High Frequency of Concomitant Food Allergy Development and Autoantibody Formation in Children Who Have Undergone Liver Transplantation
Authors: Käppi Timo , Rabe Hardis , Lingblom Christine , Hesselmar Bill , Kullberg-Lindh Carola , Wold Agnes E. , Wennerås Christine , Saalman Robert 
Published: April 2019

Background.
Allergy and other immune-mediated diseases are more frequently reported in children who have undergone liver transplantation. Furthermore, autoantibodies are also prevalent, suggesting a state of immune dysregulation in these patients. Whether or not these processes occur simultaneously in the same individual has not been studied previously.

Methods.
A cohort of 43 children who had undergone liver transplantation for nonautoimmune liver disease at median age of 1.3 years was investigated for allergy and autoimmune disease. Sensitization to food and inhalant allergens was assessed, and autoantibodies were measured.

Results.
The prevalence of food allergy was 26% and that of respiratory allergy was 23%, whereas 33% and 26% of the subjects were sensitized to food and inhalant allergens, respectively. Autoimmune disease (ie, autoimmune hepatitis) occurred in a single individual (2%), whereas autoantibodies were present in 44% of the children. Food allergy and autoantibodies occurred concomitantly in 19% of the children, which was almost twice the frequency expected by chance (11%, P = 0.04). Respiratory allergy and the presence of autoantibodies were unrelated (12% concurrence versus the expected 10%, P = 0.73). In the logistic regression analysis, autoantibody formation was associated with discontinued immunosuppression and food allergy, with odds ratios of 13 (P = 0.01) and 7.1 (P = 0.03), respectively.

Conclusions.
In contrast to respiratory allergy, food allergy and autoantibody formation occurred together in the same children who underwent liver transplantation at a frequency higher than would be expected by chance. This may reflect an underlying immune dysregulation that impairs immune tolerance to both food allergens and autoantigens.
Kidney Transplant From Uncontrolled Donation After Circulatory Death: Contribution of Normothermic Regional Perfusion
Authors: Antoine Corinne , Savoye Emilie , Gaudez François , Cheisson Gaelle , Badet Lionel , Videcoq Michel , Legeai Camille , Bastien Olivier , Barrou Benoit 
Published: April 2019

Background.
The French uncontrolled donors after circulatory death (DCD) protocol restricts donor age to <55 years, no-flow time to <30 minutes, and functional warm ischemia time to <150 minutes. In situ kidney perfusion can be performed at either 4°C (in situ cooling [ISC]) or 33–36°C (normothermic regional perfusion [NRP]). Hypothermic machine perfusion is systematically used. Only nonimmunized first transplant recipients were eligible. To improve the management of uncontrolled DCD, we tried to identify factors predictive of outcome.

Methods.
We identified all kidney transplants from uncontrolled DCD between 2007 and 2014 from the French Transplant Registry. Risk factors for primary nonfunction (PNF; n = 37) and poor renal function (estimated glomerular filtration rate < 30 mL/min or graft loss at 1 y, n = 66) were analyzed by using a multivariate logistic model.

Results.
This study analyzed 499 kidney transplantations, 50% of which were performed with NRP. Mean functional warm ischemia time was 135 minutes. Mean cold ischemia time was 14 hours. The principal PNF risk factor was young donor age (odds ratio [OR] = 0.95; P = 0.002). A sensitivity analysis showed a higher risk of PNF with ISC than with NRP (OR = 4.5; P = 0.015). Risk factors for poor renal function were donor body mass index (OR = 1.2; P < 0.001) and ISC versus NRP. Univariate analysis of uncontrolled DCD–specific risk factors showed no-flow time, functional warm time, and cold ischemia time did not affect the risk of PNF or poor renal function.

Conclusions.
Uncontrolled DCD kidneys are an additional source of valuable transplants. NRP appears to decrease graft failure by restoring oxygenated blood as the first step of preconditioning.
Impact of Model for End-stage Liver Disease Score-based Allocation System in Korea: A Nationwide Study
Authors: Lee Juhan , Kim Deok Gie , Lee Jee Youn , Lee Jae Geun , Joo Dong Jin , Kim Soon Il , Kim Myoung Soo 
Published: April 2019

Background.
In June 2016, the Korean Network for Organ Sharing implemented a Model for End-stage Liver Disease (MELD) score-based allocation system to better prioritize deceased-donor liver transplant (DDLT) candidates. The aim of this study was to assess the impact of this allocation system.

Methods.
We compared waiting list and posttransplant outcomes during the first year of operation of the MELD allocation system (from June 2016 to May 2017) with an equivalent period before its implementation (from June 2015 to May 2016).

Results.
A total of 3041 candidates were listed for DDLT (1464 pre-MELD, 1577 post-MELD era) and 892 patients received DDLT during the study period. A decrease in waiting list mortality and an increase in DDLT rate were observed after MELD implementation. However, the number of living donor liver transplants did not differ significantly pre- to post-MELD. As was expected, introduction of the MELD allocation system increased mean MELD scores at DDLT (24.1 ± 8.3 pre-MELD, 34.5 ± 7.0 post-MELD era, P < 0.001). Posttransplant patient survival rates at 1-year were 79.9% in pre-MELD era and 76.2% in post-MELD era (P = 0.184). The proportion of interregional organ transfer increased from 25.1% to 40.5%. Furthermore, transplant benefits increased with MELD scores.

Conclusions.
The MELD system was found to address the goal of fairness well. Implementation of the MELD system improved equity in terms of access to DDLT regardless of regions. Although a greater proportion of more severely ill patients received DDLT after MELD implementation, posttransplant survivals remained unchanged.
The Impact of Preexisting and Post-transplant Diabetes Mellitus on Outcomes Following Liver Transplantation
Authors: Aravinthan Aloysious D. , Fateen Waleed , Doyle Adam C. , Venkatachalapathy Suresh V. , Issachar Assaf , Galvin Zita , Sapisochin Gonzalo , Cattral Mark S. , Ghanekar Anand , McGilvray Ian D. , Selzner Markus , Grant David R. , Selzner Nazia , Lilly Leslie B. , Renner Eberhard L. , Bhat Mamatha 
Published: April 2019

Background.
Diabetes mellitus (DM) is said to adversely affect transplant outcomes. The aim of this study was to investigate the impact of pre-existing and new-onset DM on liver transplantation (LT) recipients.

Methods.
A single-center retrospective analysis of prospectively collected data of LT recipients (1990–2015) was undertaken.

Results.
Of the 2209 patients, 13% (n = 298) had Pre-DM, 16% (n = 362) developed post-transplant diabetes mellitus (PTDM), 5% (n = 118) developed transient hyperglycemia (t-HG) post-LT, and 65% (n = 1431) never developed DM (no DM). Baseline clinical characteristics of patients with PTDM were similar to that of patients with Pre-DM. Incidence of PTDM peaked during the first year (87%) and plateaued thereafter. On multivariate analysis (Bonferroni-corrected), nonalcoholic fatty liver disease and the use of tacrolimus and sirolimus were independently associated with PTDM development. Both Pre-DM and PTDM patients had satisfactory and comparable glycemic control throughout the follow-up period. Those who developed t-HG seem to have a unique characteristic compared with others. Overall, 9%, 5%, and 8% of patients developed end-stage renal disease (ESRD), major cardiovascular event (mCVE), and de novo cancer, respectively. Both Pre-DM and PTDM did not adversely affect patient survival, retransplantation, or de novo cancer. The risks of ESRD and mCVE were significantly higher in patients with Pre-DM followed by PTDM and no DM.

Conclusions.
In this largest nonregistry study, patients with Pre-DM and PTDM share similar baseline clinical characteristics. Pre-DM increases the risk of ESRD and mCVE; however, patient survival was comparable to those with PTDM and without diabetes. Understanding the impact of PTDM would need prolonged follow-up.