bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proptosis Correction in Pre-Adolescent Patients With Syndromic Craniosynostosis by Le Fort III Distraction Osteogenesis
Authors: Gibson Travis L. , Grayson Barry H. , McCarthy Joseph G. , Shetye Pradip R. 
Published: May 2018

Abstract
Le Fort III distraction osteogenesis may be indicated in the treatment of syndromic craniosynostosis with severe midface retrusion and proptosis. This study assesses the stability of proptosis correction over 10-years.
A retrospective review identified 15 patients with syndromic craniosynostosis treated by Le Fort III distraction prior to age 10 (9 males, 6 females; age 4.9 ± 1.5 years). Untreated, non-craniosynostotic age- and gender-matched controls were obtained from historical growth records. Lateral cephalometric tracings at pre-surgery (T1), immediate (T2), 1 year (T3), 5 years (T4), and 10 years (T5) (n = 11) post-distraction were superimposed using the best-fit of cranial base. Proptosis severity was defined as the horizontal distance between the Ant. Globe cephalometric point and orbital rim landmarks Orbitale and Lat. Orbit.
The orbital rim advanced 10.54 ± 3.78 mm (P < 0.001) at Orbitale and 9.73 ± 4.54 mm (P > 0.001) at Lat. Orbit from T1 to T2; Ant. Globe advanced 3.13 ± 3.02 mm (p 0.001). Proptosis decreased 7.41 ± 5.29 mm (P < .001) from Orbitale and 6.60 ± 6.50 mm (p 0.002) from Lat. Orbit. Comparison to controls demonstrated phenotypic correction. In craniosynostotic patients from T2 to T5, the bony orbital rim demonstrated non-significant remodeling posteriorly and inferiorly. Anterior Globe moved 3.79 ± 1.47 mm anteriorly (P < .001), which did not differ significantly from controls. Proptosis increased by 4.18 ± 2.94 mm in craniosynostotic patients from T2 to T5.
Le Fort III distraction was stable, with no significant anteroposterior relapse of the maxilla or bony orbit. Phenotypic relapse of proptosis to pre-treatment levels occurred through deficient growth of the midface, surface resorption at the orbital rim, and preservation of normal forward movement of Ant. Globe.
Educational Exposure to Transgender Patient Care in Otolaryngology Training
Authors: Massenburg Benjamin B. , Morrison Shane D. , Rashidi Vania , Miller Craig , Grant David W. , Crowe Christopher S. , Velasquez Nathalia , Shinn Justin R. , Kuperstock Jacob E. , Galaiya Deepa J. , Chaiet Scott R. , Bhrany Amit D. 
Published: May 2018

Objective:
Gender dysphoria is estimated to occur in over 1 million people in the United States. With decreasing stigma regarding the transgender population, it is likely more patients will seek medical and surgical gender transition as parts of their treatment. However, otolaryngologists may lack training in gender-confirming surgery. This study aims to determine the current state of transgender-related education in the United States otolaryngology training programs and to evaluate trainee perceptions regarding the importance of such training.

Methods:
A cross-sectional survey was performed among the United States otolaryngology training programs. A representative sample of 22 training programs divided within 4 US Census regions completed a cross-sectional 9-question survey between March and May 2017. Respondents were queried regarding demographics, transgender curricular exposure (didactic and/or clinical), and perceived importance of training in transgender patient care.

Results:
A total of 285 trainees responded (69.3% response rate). Thirty percent of respondents reported education on or direct exposure to transgender care during residency. Among those with experiences in gender-confirming surgery, more than half were exposed to facial (masculinization or feminization) or pitch alteration surgery. Overall, the majority of respondents believed training in gender-confirming surgery is somewhat important and 63.2% supported incorporation of transgender patient care in existing subspecialty fellowship training.

Conclusion:
Less than one-third of otolaryngology trainees are exposed to transgender patient care. The majority of trainees endorsed the importance of residency and subspecialty fellowship training in gender-confirming surgery. To better serve the transgender population, formal didactics on gender-confirming surgery should be offered.
The Arterialized Facial Artery Musculo-Mucosal Island Flap for Post-Oncological Tongue Reconstruction
Authors: Moro Alessandro , Saponaro Gianmarco , Doneddu Piero , Cervelli Daniele , Pelo Sandro , Gasparini Giulio , Garagiola Umberto , D’Amato Giuseppe , Todaro Mattia 
Published: May 2018

Background:
In 1992, Pribaz described the facial artery musculomucosal flap (FAMM), an axial musculomucosal flap based on the facial artery. The FAMM flap, a modification of the nasolabial and buccal mucosal flaps, is widely used in the reconstruction of defects in the oral cavity. Many modifications of this flap have been described in the literature. Here we aimed to explore the use of an arterialized tunnelized FAMM island flap (a-FAMMIF) for the reconstruction tongue defects after tumor resection.

Method:
From January 2015 to December 2016, five cases of tongue cancer were selected for the use of arterialized FAMMIF flap to reconstruct defects after tumor resection.

Results:
Reconstruction was successful in all cases, except one case of total flap necrosis; partial necrosis of the flap occurred in two patients, which were solved with medications.

Conclusion:
The authors consider the a-FAMMIF an unreliable flap in the reconstruction of tongue defects.
The authors recommend avoiding tunneling and island modification when the vein is not included in the pedicle.
Family Functions and Life Quality of Parents of Children With Cleft Lip and Palate
Authors: Aslan Belma I. , Gülşen Ayşe , Tirank Şadiye B. , Findikçioğlu Kemal , Uzuner F. Deniz , Tutar Hakan , Üçüncü Neslihan 
Published: May 2018

Objective:
This study was designed to identify variables affecting family functions and life quality of parents with cleft lip and/or palate children.

Materials and Methods:
Family Assesment Scale (FAS) and short form of World Health Organization quality of life (WHOQOL-BREF-TR) were used to measure family functions and life quality of parents. Questionnaire Forms were given to 146 parents: 74 having cleft lip and/or palate children (cleft-group), and the other 72 with healthy children (control-group). Parents were divided into 3 subgroups according to children's age as 0 to 6, 7 to 12, and 13 to 18 years. Kruskal-Wallis and Mann–Whitney U tests were used to evaluate differences between the groups.

Results:
Behavior of cleft patients’ parents was found to be problematic in behavioral control, required attention and role areas at 0 to 6 years, required attention area at ages 7 to 12 and 13 to 18 years. When compared to control group, significant differences were detected in required attention at ages 0 to 6 years, problem-solving, and communication areas at 7 to 12 years. Findings of life quality were found to be over medium level in physical, social, psychological and environmental areas in cleft group at all age groups; however, life quality was found better in control group in physical, psychological, and social subtests at age 13 to 18 years.

Conclusion:
Cleft children influence family functions in behavioral control, required attention and role areas at early childhood, and continue to affect required attention through adolescence. Also social, physical, and psychological fields of life quality were found lower in cleft parents compared to control group at adolescence.
Application of Autologous Human Bone Marrow-Derived Mesenchymal Stem Cells in Distraction Osteogenesis for the Treatment of Bilateral Mandibular Hypoplasia
Authors: Lim Hun Jun , Lee Eui Mook , Kim Won Ki , Kim Han Jong , Kim Bong Chul , Lee Jun 
Published: May 2018

Abstract
Distraction osteogenesis a surgical procedure conducted to improve craniofacial deformities. Compared with conventional operations, this technique has advantages such as the ability to lengthen the soft tissue and hard tissue. Therefore, this method is used to treat severe craniofacial abnormalities.
The major disadvantage of distraction osteogenesis is the long treatment period. If the consolidation period is not sufficiently long after the distraction period, complications such as discontinuity or contraction of newly formed bone may occur. Recently, many researchers have attempted to develop methods for enhancing the ossification of newly formed bone, reducing shrinkage, and shortening the overall treatment period.
The authors injected autologous bone marrow-derived mesenchymal stem cells during the consolidation phase after distraction osteogenesis surgery in a bilateral mandibular hypoplasia patient. Here, the authors report the treatment results, which were found to be favorable.
Face Transplantation: An Update for the United States Trauma System
Authors: Farber Scott J. , Kantar Rami S. , Diaz-Siso J. Rodrigo , Rodriguez Eduardo D. 
Published: May 2018

Abstract
Face transplantation has evolved over the last 12 years into a safe and feasible reconstructive solution, with good aesthetic and functional outcomes for patients with severe facial defects who are not amenable to reconstruction through conventional and autologous approaches. Among patients who underwent face transplantation to date, a significant proportion did so following trauma, mostly ballistic and thermal injuries. It is therefore important for trauma surgeons who deal with these injuries regularly to be familiar with the literature on face transplantation following traumatic injuries. In this study, we provide a focused review on this topic, with an emphasis on highlighting the limitations of conventional craniomaxillofacial reconstruction, while emphasizing data available on the risks, benefits, surgical indications, contraindications, as well as aesthetic and functional outcomes of face transplantation. The authors also provide an update on all face transplants performed to date including traumatic mechanisms of injury, and extent of defects. They finally describe 2 cases performed by the senior author for patients presenting with devastating facial ballistic and thermal injuries. The authors hope that this work serves as an update for the trauma surgery community regarding the current role and limitations of face transplantation as a craniomaxillofacial reconstructive option for their patient population. This can potentially expedite the reconstructive process for patients who may benefit from face transplantation.
Facial Paralysis in Patients With Hemifacial Microsomia: Frequency, Distribution, and Association With Other OMENS Abnormalities
Authors: Li Qiang , Zhou Xu , Wang Yue , Qian Jin , Zhang Qingguo 
Published: May 2018

Abstract
Although facial paralysis is a fundamental feature of hemifacial microsomia, the frequency and distribution of nerve abnormalities in patients with hemifacial microsomia remain unclear. In this study, the authors classified 1125 cases with microtia (including 339 patients with hemifacial microsomia and 786 with isolated microtia) according to Orbital Distortion Mandibular Hypoplasia Ear Anomaly Nerve Involvement Soft Tissue Dependency (OMENS) scheme. Then, the authors performed an independent analysis to describe the distribution feature of nerve abnormalities and reveal the possible relationships between facial paralysis and the other 4 fundamental features in the OMENS system. Results revealed that facial paralysis is present 23.9% of patients with hemifacial microsomia. The frontal–temporal branch is the most vulnerable branch in the total 1125 cases with microtia. The occurrence of facial paralysis is positively correlated with mandibular hypoplasia and soft tissue deficiency both in the total 1125 cases and the hemifacial microsomia patients. Orbital asymmetry is related to facial paralysis only in the total microtia cases, and ear deformity is related to facial paralysis only in hemifacial microsomia patients. No significant association was found between the severity of facial paralysis and any of the other 4 OMENS anomalies. These data suggest that the occurrence of facial paralysis may be associated with other OMENS abnormalities. The presence of serious mandibular hypoplasia or soft tissue deficiency should alert the clinician to a high possibility but not a high severity of facial paralysis.
Combined Access for the Treatment of Medial Orbital Wall Fracture: Subciliary and Upper Eyelid Sulcus Incisions
Authors: de Moraes Mariana Alcantara Rodrigues , Rocha Biló João Pedro , Pereira Max Domingues 
Published: May 2018

Abstract
The present study presents a new surgical approach to treat medial orbital wall fractures, that is, the combined transcutaneous access through subciliary and upper eyelid sulcus incisions. The study performed the retrospective analysis of medical records belonging to 14 consecutive patients with medial orbital wall fracture, who were treated in the Plastic Surgery Division at Federal University of São Paulo, from 2005 to 2013, through the combination of subciliary and upper eyelid sulcus incisions to access the fracture foci. The mean age of the patients was 35.4 years, ranging from 8 to 66 years. Seven out of the 14 patients were women. Ten patients had fractures in the medial and inferior walls, whereas 4 patients had isolated medial wall fracture. Diplopia was found in all cases. Six patients had some type of extraocular muscle limitation. A computed tomography of the face was performed in the postoperative period to assess the orbital contour and the correct position of the grafts, whenever applicable. The patients were assessed for diplopia, enophthalmos, and scar quality. Four patients (28.6%) kept on showing diplopia at supraversion, whereas 2 patients (14.2%) evolved to enophthalmos. There was no need of reoperating the patients to reposition the grafts or the absorbable plaque. No patient evolved to ectropion or apparent scarring. The combined transcutaneous access through subciliary and upper eyelid sulcus incisions provides ample operative field, rapid exposure of the fracture foci, and adequate wall reconstruction. It can also present inconspicuous scar.
Use of Emergency Manuals During Actual Critical Events in China: A Multi-Institutional Study
Authors: Huang Jeffrey , Wu Jiayan , Dai Christina , Zhang Xianwei , Ju Hui , Chen Yiqi , Zhang Chunyuan , Ye Fan , Tan Yi , Zong Yongbo , Liu Telong 
Published: May 2018

Introduction
Emergency manuals (EMs) can help healthcare providers respond to crises more efficiently. Three anesthesia EMs have been translated into Chinese. These EMs have been made publicly available as a free document downloadable in China. A year after these Chinese versions of EMs were published, we conducted a multi-institutional survey in China to assess the progress of how well EM had been adapted and used in the setting of critical events.

Methods
Our study used a multi-institutional, anonymous electronic survey. We included hospitals that had conducted group studies of EMs as well as simulation trainings. The survey consisted of the five-point Likert scale, yes or no boxes, and multiple-choice questions with five possible choices. Statistical analysis included Pearson correlation coefficient and χ2 test.

Results
Nine hospitals were included in the study. The overall response rate was 56.4%. More than 70% of all respondents reported using an EM during at least one critical event within the past 6 months in China. A total of 87.7% of all respondents self-reviewed or group studied EMs. A total of 69% participated in multidisciplinary simulation training. Emergency manual use during a critical event showed a positive correlation with multidisciplinary simulation training (R
2 = 0.896) and self-review/group study (R
2 = 0.5234). The average self-reported use of EMs during clinical critical events is twice per anesthesiologist.

Conclusions
This study demonstrated the nascent success of EM implementation in multiple Chinese institutions. Simulation training enhances the implementation and clinical usage of EM. Simulation training in an operating room was sufficient to learn how to use EM.
A Method for Functional Task Alignment Analysis of an Arthrocentesis Simulator
Authors: Adams Reid A. , Gilbert Gregory E. , Buckley Lisa A. , Nino Fong Rodolfo , Fuentealba I. Carmen , Little Erika L. 
Published: May 2018

Introduction
During simulation-based education, simulators are subjected to procedures composed of a variety of tasks and processes. Simulators should functionally represent a patient in response to the physical action of these tasks. The aim of this work was to describe a method for determining whether a simulator does or does not have sufficient functional task alignment (FTA) to be used in a simulation.

Methods
Potential performance checklist items were gathered from published arthrocentesis guidelines and aggregated into a performance checklist using Lawshe's method. An expert panel used this performance checklist and an FTA analysis questionnaire to evaluate a simulator's ability to respond to the physical actions required by the performance checklist.

Results
Thirteen items, from a pool of 39, were included on the performance checklist. Experts had mixed reviews of the simulator's FTA and its suitability for use in simulation. Unexpectedly, some positive FTA was found for several tasks where the simulator lacked functionality.

Conclusions
By developing a detailed list of specific tasks required to complete a clinical procedure, and surveying experts on the simulator's response to those actions, educators can gain insight into the simulator's clinical accuracy and suitability. Unexpected of positive FTA ratings of function deficits suggest that further revision of the survey method is required.
High-Value, Cost-Conscious Communication Skills in Undergraduate Medical Education
Authors: Natt Neena , Starr Stephanie R. , Reed Darcy A. , Park Yoon Soo , Dyrbye Liselotte N. , Leep Hunderfund Andrea N. 
Published: May 2018

Introduction
Training in high-value, cost-conscious care (HVCCC) is increasingly being incorporated into medical school curricula, but students may have limited opportunities to engage patients in HVCCC conversations. The aim of this study was to develop two standardized patient scenarios with associated checklists, hypothesizing that resulting scores would allow for valid formative assessments of HVCCC communication skills.

Methods
Scenarios were designed to generate a less-is-more conversation (in response to a patient requesting an unnecessary test) and a shared decision-making conversation (in response to a patient choosing between multiple effective treatment options). Checklists were developed by experts and informed by the existing literature. Validity evidence was collected from content, response process, internal structure, relations to other variables, and consequences of testing.

Results
Ninety-three third-year medical students participated during 2014–2015. Mean checklist scores were 79% (SD = 18, Cronbach α = 0.72) and 72% (SD = 13, Cronbach α = 0.62) for the less-is-more and shared decision-making scenarios, respectively. Checklist scores correlated with global ratings of performance (r = 0.65 and 0.54, respectively, both P < 0.001), and overall interrater reliability was good (r = 0.66). Checklist scores discriminated between higher and lower performers (discrimination indices of 0.84 and 0.65, respectively, both P < 0.001). Most students (83/90, 92%) agreed that the session improved their HVCCC communication skills.

Conclusions
This study provides validity evidence supporting the use of scores derived from two standardized patient scenarios for formative assessment of HVCCC communication skills among third-year medical students. These scenarios can help equip students with practical, patient-centered strategies for promoting value in clinical encounters.
Comparing Short-term and Oncologic Outcomes of Minimally Invasive Versus Open Pancreaticoduodenectomy Across Low and High Volume Centers
Authors: Torphy Robert J. , Friedman Chloe , Halpern Alison , Chapman Brandon C. , Ahrendt Steven S. , McCarter Martin M. , Edil Barish H. , Schulick Richard D. , Gleisner Ana 
Published: May 2018

Objective:
To compare short-term and oncologic outcomes of patients with cancer who underwent open pancreaticoduodenectomy (OPD) versus minimally invasive pancreaticoduodenectomy (MIPD) using the National Cancer Database.

Summary Background Data:
MIPD, including laparoscopic and robotic approaches, has continued to gain acceptance despite prior reports of increased short-term mortality when compared with OPD.

Methods:
Patients with pancreatic cancer diagnosed from 2010 to 2015 undergoing curative intent resection were selected from the National Cancer Database. Patients submitted to OPD were compared with those submitted to MIPD. Laparoscopic and robotic approaches were included in the MIPD cohort. The primary outcome was 90-day mortality; secondary outcomes included 30-day mortality, hospital length of stay, unplanned 30-day readmission, surgical margins, number of lymph nodes harvested, and receipt of adjuvant chemotherapy. Propensity score-weighted random effects logistic regression models were used to examine the adjusted association between surgical approach and the specified outcomes.

Results:
Between 2010 and 2015, 22,013 patients underwent OPD or MIPD for pancreatic cancer and 3754 (17.1%) were performed minimally invasively. On multivariable analysis, there was no difference in 90-day mortality between MIPD and OPD (OR, 0.92; 95% CI, 0.75–1.14). Patients undergoing MIPD were less likely to stay in the hospital for a prolonged time (OR, 0.75; 95% CI, 0.68–0.82). 30-day mortality, unplanned readmissions, margins, lymph nodes harvested, and receipt of adjuvant chemotherapy were equivalent between groups. Regardless of surgical approach, patients operated on at high volume centers had reduced 90-day mortality.

Conclusion:
Patients selected to receive MIPD for cancer have equivalent short-term and oncologic outcomes, when compared with patients who undergo OPD.
Repression of divergent noncoding transcription by a sequence-specific transcription factor
Authors: Wu Andrew CK , Patel Harshil , Chia Minghao , Moretto Fabien , Frith David , Snijders Ambrosius P. , van Werven Folkert 
Published: May 2018

SummaryMany active eukaryotic gene promoters exhibit divergent noncoding transcription, but the mechanisms restricting expression of these transcripts are not well understood. Here we demonstrate how a sequence-specific transcription factor represses divergent noncoding transcription at highly expressed genes in yeast. We find that depletion of the transcription factor Rap1 induces noncoding transcription in a large fraction of Rap1 regulated gene promoters. Specifically, Rap1 prevents transcription initiation at cryptic promoters near its binding sites, which is uncoupled from transcription regulation in the protein-coding direction. We further provide evidence that Rap1 acts independently of chromatin-based mechanisms to repress cryptic or divergent transcription. Finally, we show that divergent transcription in the absence of Rap1 is elicited by the RSC chromatin remodeller. We propose that a sequence-specific transcription factor limits access of basal transcription machinery to regulatory elements and adjacent sequences that act as divergent cryptic promoters, thereby providing directionality towards productive transcription.
Simultaneous in vivo time-lapse stiffness mapping and fluorescence imaging of developing tissue
Authors: Thompson Amelia J. , Pillai Iva K. , Dimov Ivan B. , Holt Christine E. , Franze Kristian 
Published: May 2018

AbstractTissue mechanics is important for development; however, the spatio-temporal dynamics of in vivo tissue stiffness is still poorly understood. We here developed tiv-AFM, combining time-lapse in vivo atomic force microscopy with upright fluorescence imaging of embryonic tissue, to show that in the developing Xenopus brain, a stiffness gradient evolves over time because of differential cell proliferation. Subsequently, axons turn to follow this gradient, underpinning the importance of time-resolved mechanics measurements.