bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse outcomes following hand surgery in patients with rheumatoid arthritis
Authors: Menchaca-Tapia Victor M , Rodríguez Elizabeth M , Contreras-Yáñez Irazú , Iglesias-Morales Martin , Pascual-Ramos Virginia 
Published: March 2018

Background Up to 70% of patients with long-standing rheumatoid arthritis (RA) may present with rheumatic hand disease and benefit from hand surgical procedures (HSPs). Objective Through retrospective review, the present study aimed to report HSPs in RA patients at a tertiary care centre to identify patient adverse outcomes (AOs) and their predictors. Methods From 1989 to 2013, 96 patients who underwent ≥1 HSP(s) were identified from two local registries; their clinical records were independently reviewed by two trained physicians (surgeon and clinical) who used a standardized format. AOs were defined by consensus; data abstracter agreement was found in 90% of cases. Descriptive statistics were used in addition to Kaplan-Meier curves to determine the time to each AO, while logistic regression models were used to determine predictors of AOs. Results At first HSP, 89.6% of patients were female, had a mean (± SD) age of 49.1±12 years, a disease duration of 12.2±7.2 years, 93.6% were positive for rheumatoid factor and 24% were receiving intensive treatment. A total of 130 HSPs were performed: the most frequent interventions were arthrodesis (25.4%), resection of the ulnar head (15.4%) and tenorrhaphy (14.6%). During follow-up, 33 AOs were reported in 27 (28.1%) patients, 87% of which occurred after the first HSP. The most frequent AO subsets were impaired wound healing (18.2%) and exposed pin (15.2%). Longer disease duration at first HSP (OR 3.07 [95% CI 1.04 to 9.08]; P=0.04) and intensive treatment (OR 1.08 [95% CI 1.002 to 1.156]; P=0.045) were predictors of AOs. The optimal disease duration cut-off to predict AOs was 20.1 years. Conclusion Early referral of long-standing RA patients for hand surgery, along with less aggressive treatment, favoured improved surgical outcomes.
A modified mini-incisional technique for double-eyelid blepharoplasty
Authors: Hu Xiaogen , Ma Haihuan , Xue Zhiqiang , Qi Huijie , Chen Bo , Zhou Yang , Huang Wengang 
Published: March 2018

Background Double-eyelid blepharoplasty is one of the most popular cosmetic surgeries in Asia. Objective To introduce a modified mini-incisional technique to form a double eyelid. Methods A total of 372 patients (325 women, 47 men) were involved in the study between July 2008 and August 2014. Their age ranged from 16 to 34 years, with a mean age of 24 years. All patients underwent the modified mini-incisional upper blepharoplasty. In the technique, four 2 mm incisions were made along the designed fold. The orbicularis muscle overlying the levator aponeurosis was removed. The removal of the lateral fat pad was completed accordingly. The medial fat pad was also removed if necessary. Suture was used to fix the skin to pretarsal fascia along the double-eyelid line. The double-eyelid crease was formed after the operation. Results The follow-up period was three to 12 months (mean nine months). Most of the double eyelids were natural. During the follow-up period, 92% (342 of 372) patients were satisfied with the blepharoplasty. The most common complications were swelling within first week after the operation, which subsided spontaneously. Asymmetries occurred in 17 patients; six patients had multiple eyelids and seven patients experienced shifting of the fold. These were corrected six months after the operation. Disappearance of the fold was not observed. The scars of the stab incision became invisible after one full year of recovery. No other severe complications were found. Conclusion The four mini-incisional blepharoplasty technique was successful for the formation of a natural-appearing and long-lasting double eyelid. Except for individuals with obvious skin redundancy, patients with a single eyelid are suitable candidates for the technique.
Late postoperative massive bleeding in septorhinoplasty: A prospective study
Authors: Ors Safvet , Ozkose Mehmet 
Published: March 2018

Background There are various complications that can occur in septorhinoplasty, most of which are related to postoperative failure to achieve the desired aesthetic result. However, there are also many other complications, including postoperative bleeding, which is one of the most common nonaesthetic-related complications. Objective The present study was a prospective analysis involving a total of 750 septorhinoplasty patients, and included individuals who experienced massive bleeding after postoperative day 8. Results The incidence of bleeding was 2% among all patients. One percent of cases with bleeding occurred between postoperative days 8 and 14. None of the patients exhibited an abnormality in preoperative or postoperative coagulation tests. Mean blood loss was approximately 1 unit. In all patients, clots in the nose were cleaned, bleeding was subsequently controlled by placement of a polyvinyl alcohol sponge tampon soaked in adrenalin and tranexamic acid, and intravenous administration of 250 mg tranexamic acid in isotonic saline solution. This treatment was sufficient for all cases. None of the patients expereinced recurrent bleeding nor did they require a blood transfusion. Conclusion Late bleeding in septorhinoplasty is rare. It may be prevented by completely filling the nasal cavity so that there is no dead space between the septal mucosal membranes and the drainage opening. If bleeding occurs, it can be treated by placement of a tampon soaked in adrenalin and tranexamic acid plus intravenous administration of 250 mg tranexamic acid.
Techniques to refine the upper outer breast aesthetic subunit in alloplastic breast reconstruction: The lateral capsular flap
Authors: Degeorge Brent R , Campbell Christopher A 
Published: March 2018

Background Lateral displacement of breast implants and axillary fullness are common causes of patient dissatisfaction and reoperation following prosthetic breast reconstruction. Suture plication of the capsule and acellular dermal matrix slings have been described to address lateral implant malposition, but with unacceptably high rates of recurrence and additional cost, respectively. Objective To describe a novel technique using a lateral capsular flap to provide durable correction of implant malposition and, at the same time, redefinition of the lateral breast border, thereby restoring balance to the breast aesthetic subunits. Methods Sixteen patients presented with lateral malposition of tissue expanders or breast implants during staged implant-based breast reconstruction, four of whom had additional unwanted axillary soft tissue fullness. An anteriorly based lateral capsular flap was performed for each breast to reconstruct the lateral border of the breast, return the implant to its appropriate position and address axillary fullness when indicated. Results Lateral capsular flaps were performed for 16 patients (20 breasts) resulting in durable medial repositioning of the implant for a minimum of six months follow-up (range six to 60 months). Eight patients presented after implant placement with subsequent malposition while the remainder presented after tissue expander placement alone. For the eight patients with axillary fullness, elevation of the capsular flap allowed access to axillary contents for excision (four cases) or incorporation of axillary fat into the flap to prevent lateral implant palpability. No major complications, infectious complications or wound healing complications were reported. All patients showed satisfactory results, and reported high cosmetic and functional satisfaction with the appearance of their reconstructed breasts and axillary comfort. Conclusions In the authors' experience, the lateral capsular flap represents a simple, safe and reliable technique to correct breast implant lateral malposition, reconstruct the lateral breast border, and address unwanted axillary fullness in primary or revision implant-based breast reconstruction with improved cosmetic appearance and balance of the breast.
Evaluation of a new tension relief system for securing wound closure: a single-centre, Chinese cohort study
Authors: Huahui Zhang , Dan Xue , Hongfei Jiang , Hang Hu , Chunmao Han , Haitao Ren , Jianxin Yu , Zhiping Tao 
Published: March 2018

Background Wounds that have been closed under excessive tension, and skin defects that cannot be closed primarily, pose a daily challenge for the reconstructive surgeon. Objective To evaluate a new tension relief system (TRS) device for skin stretching and secure wound closure. Methods From September 2013 to March 2014, a consecutive series of 41 Chinese patients with 43 wounds were enrolled for application of 50 cycles of TRS therapy. TRS was used for two main clinical applications: closure of a variety of surgical/traumatic wounds; and securing wound closure after high-tension suture closure. Basic information and details regarding this therapy and its complications were recorded. Follow-up visits were conducted three to six months after wound closure. Results Mean residual wound width decreased approximately 20% every two days during cycles of TRS therapy. Infection was the most common complication (five cases). Other complications included dehiscence (two cases) and pressure ulcer (one case). At the six-month follow-up visit, (21 wounds in 20 patients), both the extent of healing and the scar were acceptable. Discussion There are no absolute contraindications to TRS therapy. The authors have formulated instructions for the prevention and treatment of the most common complications. Conclusions The results demonstrate that TRS therapy is a simple, effective method for primary closure of difficult wounds, and large skin and soft-tissue defects. Larger randomized studies are required to further evaluate of the effectiveness, indications, complications and cost effectiveness of this innovative TRS therapy.
Airway Management in Pierre Robin Sequence: The Vancouver Classification
Authors: Li Wai-Yee , Poon Alana , Courtemanche Douglas , Verchere Cynthia , Robertson Sandra , Bucevska Marija , Malic Claudia , Arneja Jugpal S. 
Published: March 2018

Background: Pierre Robin sequence (PRS) is a triad of micrognathia, glossoptosis, and respiratory distress. There is no standard clinical classification used in the management of neonatal airway in patients with PRS. The goal of our study was to review the presentation and management of patients with PRS and formulate a clinical grading system and treatment algorithm. Methods: A 10-year retrospective review of all neonates diagnosed with PRS was performed after obtaining institutional ethics approval. Patients were identified using our cleft lip and palate program database. Inclusion criteria were 2 of the following 3 clinical features—glossoptosis, retrognathia, or airway obstruction. We collected demographic data, clinical information (coexisting airway morbidity, maxillary-mandibular discrepancy, type of intervention used, complications, and outcomes (feeding, length of stay, and airway status) during the first year of life. Results: Sixty-three patients met our inclusion criteria. Of these, 55 (87%) had cleft palate and 17 (27%) were syndromic. Forty-eight (76%) patients were managed by prone positioning. Of the 15 surgically managed patients, the initial procedure was floor of mouth release in 7, mandibular distraction osteogenesis (MDO) in 4, and tongue-lip adhesion in 4. Five patients with coexisting airway morbidity needed a second surgery; 2 had MDO and 3 tracheostomies (one patient was later decannulated). Seven (47%) of the surgically managed patients required a gastrostomy tube. Conclusion: At present, there is no consensus on neonatal airway management in infants with PRS. From our review of 63 patients with PRS, we hereby propose a simple 4-point classification system and treatment algorithm, based on clinical features.
Comparing the Use of 3D Photogrammetry and Computed Tomography in Assessing the Severity of Single-Suture Nonsyndromic Craniosynostosis
Authors: Ho Olivia A. , Saber Nikoo , Stephens Derek , Clausen April , Drake James , Forrest Christopher , Phillips John 
Published: March 2018

Purpose: Single-suture nonsyndromic craniosynostosis is diagnosed using clinical assessment and computed tomography (CT). With increasing awareness of the associated risks of radiation exposure, the use of CT is particularly concerning in patients with craniosynostosis since they are exposed at a younger age and more frequently than the average child. Three-dimensional (3D) photogrammetry is advantageous—it involves no radiation, is conveniently obtainable within clinic, and does not require general anaesthesia. This study aims to assess how 3D photogrammetry compares to CT in the assessment of craniosynostosis severity, to quantify surgical outcomes, and analyze the validity of 3D photogrammetry in craniosynostosis. Methods: Computed tomography images and 3D photographs of patients who underwent craniosynostosis surgery were assessed and aligned to best fit. The intervening area between the CT and 3D photogrammetry curves at the supraorbital bar (bandeau) level in axial view was calculated. Statistical analysis was performed using Student t test. Ninety-five percent confidence intervals were determined and equivalence margins were applied. Results: In total, 41 pairs of CTs and 3D photographs were analyzed. The 95% confidence interval was 198.16 to 264.18 mm2 and the mean was 231.17 mm2. When comparisons were made in the same bandeau region omitting the temporalis muscle, the 95% confidence interval was 108.94 to 147.38 mm2, and the mean was 128.16 mm2. Although statistically significant difference between the modalities was found, they can be attributable to the dampening effect of soft tissue. Conclusion: Within certain error margins, 3D photogrammetry is comparable to CT in assessing the severity of single-suture nonsyndromic craniosynostosis. However, a dampening effect can be attributable to the soft tissue. Three-dimensional photogrammetry may be more applicable for severe cases of craniosynostosis but not milder deformity. It may also be beneficial for assessing the overall appearance and aesthetics but not for determining underlying bony severity.
Aesthetic Refinements in Forehead Flap Reconstruction of the Asian Nose
Authors: Hsiao Yen-Chang , Chang Chun-Shin , Zelken Jonathan 
Published: March 2018

Background: Traditional paramedian forehead flap reconstruction exploits the aesthetic subunit principle. Refinements and outcomes of forehead flap nasal reconstruction largely reflect Western experience. Differences in ethnic Asian anatomy and wound healing may foster suboptimal outcomes. We modified methods to address Asian features by extending subunit and flap boundaries, minimizing flap thinning, and overbuilding the nasal framework to combat contraction and suboptimal scarring. Methods: Between November 2010 and September 2015, 40 Asians were treated for nasal reconstruction with a modified forehead flap technique. Average age of 26 men and 14 women was 50.2 years (range: 10-87 years). Oncologic, traumatic, congenital, and infectious defects involving 1 (37%) or more (63%) subunits were reconstructed. Modifications to the classic forehead flap were extension of involved subunits and flap, conservative flap thinning, and framework overbuilding. Results: Patients were followed for 20 months (range: 16 months to 4 years 8 months). Nasal lining was reconstructed with hinge-over lining flaps, forehead flaps, free flaps, or regional flaps. Cartilage was reconstructed in 44 (88%) patients with autologous septum or ear in 33 (75%) cases. Costal cartilage was needed in 11 (25%) cases. In 48 (96%) cases, the ipsilateral forehead was used. There were 5 (10%) wound infections, 2 (4%) dehisced wounds, and 2 (4%) occurrences of distal flap necrosis. Nasal aesthetic results were 72.6% good, 23.3% fair, and 4% poor. Donor site aesthetic results were 74% good and 26% fair. Three case reports are included. Conclusion: We report favourable results of forehead flap nasal reconstruction using refinements tailored to ethnic Asians.
Treatment of Constriction Bands of Limbs by Fat Injection: An Additional Modality
Authors: Daya Mahendra 
Published: March 2018

Background: Constriction bands in the majority of cases presents as a contour deformity. The gold standard of treatment is a single-stage constriction ring excision and serial Z-plasty. The expense is unsightly scarring. We present case reports of deformity correction by serial fat injections Methods and Participants: Three case studies of children in whom this modality was used in limbs to correct the deformity are presented. Results: Two participants showed a good correction of the deformity and in a single-case treatment failed requiring excision and serial Z-plasty for correction. Conclusion: Fat injection in combination with Khouri’s technique of aponeurotomies is an attractive modality of managing superficial constriction bands of limbs.
How Well Are We Doing at Teaching Critical Appraisal Skills to Our Residents? A Needs Assessment of Plastic Surgery Journal Club
Authors: Hryciw Nicole , Knox Aaron , Arneja Jugpal S. 
Published: March 2018

Objective: To perform a needs assessment of journal club in plastic surgery residency programs. Specifically, this study focused on potential gaps in journal club associated with teaching and assessing critical appraisal of the literature, an important component of medical education and practice. Methods: This is a qualitative study that utilized an online survey tool to collect information about the characteristics of journal club in plastic surgery residency programs in both Canada and the United States. Both program directors and residents were surveyed. Results: When presented with a range of objectives, both program director and resident responses identified that teaching critical appraisal skills was often the main goal of journal club in their program (67.1%). Most trainees perceived that journal club was at least somewhat effective in improving their critical appraisal skills. Despite this perception, many residents felt that they had minimal to no experience in critical appraisal of the literature upon entry into their respective residency programs (46.2%), and only 29.2% indicated that they received formal instruction regarding critical appraisal. Three-quarters of residents indicated that there was no tool provided to aid them in their analysis of the literature. Finally, most residents also responded that they were not assessed objectively with regard to their performance. Conclusions: Although residents in our study perceive journal club to at least somewhat improve their critical appraisal skills, evidence in the literature has been controversial. It cannot be assumed that residents are learning the skills they need by simply attending and reading the articles associated with journal club. Future study should focus on the best way to meet these objectives.
Balancing the Need for Clinical Photography With Patient Privacy Issues: The Search for a Secure SmartPhone Application to Take and Store Clinical Photographs
Authors: Dumestre Danielle O. , Fraulin Frankie O. G. 
Published: March 2018

Background: Physicians are increasingly using smartphones to take clinical photographs. This study evaluates a smartphone application for clinical photography that prioritizes and facilitates patient security. Methods: Ethics approval was obtained to trial a smartphone clinical photography application, PicSafe Medi. Calgary plastic surgeons and residents used the application to obtain informed consent and photograph patients. Surveys gauging the application’s usability, consent process, and photograph storage/sharing were then sent to surgeons and patients. Results: Over a 6-month trial period, 15 plastic surgeons and residents used the application to photograph 86 patients. Over half of the patients (57%) completed the survey. The majority of patients (96%) were satisfied with the application’s consent process, and all felt their photographs were secure. The majority (93%) of surgeons/residents completed the survey. The application was felt to overcome issues with current photography practices: inadequate consent and storage of photographs (100%), risk to patient confidentiality (92%), and unsecure photograph sharing (93%). Barriers to regular use of the application included need for cellphone service/Internet (54%), sanitary concerns due to the need for patients to sign directly on the phone (46%), inability to obtain proactive/retroactive consent (85%), and difficulty viewing photographs (80%). The majority of surgeons (85%) believe a smartphone application would be suitable for clinical patient photography, but due to its limitations, only 23% would use the trialed application. Conclusions: A smartphone clinical photography application addresses the patient confidentiality risks of current photography methods; however, limitations of the trialed application prevent its broad implementation.
Textural and mineral-chemistry constraints on columbite-group minerals in the Penouta deposit: evidence from magmatic and fluid-related processes
Authors: Alfonso P. , Hamid S. A. , Garcia-Valles M. , Llorens T. , López Moro F. J. , Tomasa O. , Calvo D. , Guasch E. , Anticoi H. , Oliva J. , Parcerisa D. , García Polonio F. 
Published: March 2018

ABSTRACTThe Penouta Sn-Ta deposit, in the northwest of Spain, is a greisenized granitic cupola where Ta minerals occur mainly as disseminations in a leucogranite body intruded in Precambrian–Lower Cambrian gneisses and mica-schists. This leucogranite is a medium- to fine-grained inequigranular rock consisting mainly of quartz, albite, K-feldspar and muscovite. Accessory minerals are mainly of spessartine, zircon, cassiterite, Nb-Ta oxides, monazite, xenotime, native bismuth and pyrite. The alteration processes were mainly albitization, muscovitization and kaolinitization.This leucogranite is peraluminous and P-poor, with 0.03–0.07 wt.% P2O5, 900–1500 ppm Rb, 30–65 ppm Cs, 120–533 ppm Li, 80–140 ppm Ta, 51–81 ppm Nb and up to 569 ppm of Sn.Mineralogical characterization of Nb-Ta oxide minerals was determined by X-ray diffraction, scanning electron microscopy, electron microprobe analysis and mineral liberation analysis. Mn-rich members of the columbite-group minerals (CGM) are the most common Ta-bearing phases, but microlite, wodginite, tapiolite and Ta-rich cassiterite occur also. CGM crystals are commonly zoned concentrically, with a Nb-rich core surrounded by a Ta-rich rim, with a sharp boundary between them. Convoluted zoning occurs also. Dissolution textures resulting from the corrosion of columbite and tantalite rims, in particular, are common. The Mn/(Mn + Fe) ratio varies between 0.33 and 0.97 and the Ta/(Ta + Nb) ratio between 0.07 and 0.93. Wodginite and microlite formed as late replacements of CGM and occur associated with tantalite and cassiterite. Subhedral to anhedral cassiterite crystals, usually up to 200 μm across, occur in two generations: the earlier one is Nb,Ta-poor whereas in the later generation, the Ta content can reach >9 wt.% of Ta2O5and 1.7 wt.% of Nb. The presence of a fluid phase in the apical zone of the granite, probably related to the separation of a fluid/vapour of the melt, could explain the sponge-like textures, the Ta enrichment associated with these textures, the occurrence of Ta-enriched mineral phases (microlite and wodginite) and their common interstitial character.
Stable lines and clones of long-term proliferating normal, genetically unmodified murine common lymphoid progenitors
Authors: Kawano Yohei , Petkau Georg , Stehle Christina , Durek Pawel , Heinz Gitta Anne , Tanimoto Kousuke , Karasuyama Hajime , Mashreghi Mir-Farzin , Romagnani Chiara , Melchers Fritz 
Published: March 2018

Key Points
We have established a novel culture system for long-term proliferating murine lymphoid progenitors without any genetic manipulation. The cultured lymphoid progenitors can differentiate to lymphoid and myeloid lineages in vitro and in vivo.