bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Uptake and Translocation of 99Tc, 133Cs, 237Np, and 238U Into Andropogon Virginicus With Consideration of Plant Life Stage
Authors: Montgomery Dawn A. , Edayilam Nimisha , Tharayil Nishanth , Powell Brian A. , Martinez Nicole E. 
Published: June 2018

Abstract
Hydroponic uptake studies were conducted to evaluate the uptake and translocation of 99Tc, 133Cs (stable analog for 137Cs), 237Np, and 238U into established and seedling Andropogon virginicus specimens under controlled laboratory conditions. Plant specimens were grown in analyte-spiked Hoagland nutrient solution for 24 h, 3 d, and 5 d. Translocation to shoots was greatest for 99Tc and 133Cs, likely due to their analogous nature to plant nutrients, while 238U (and 237Np to a lesser extent) predominantly partitioned to root tissue with less extensive translocation to the shoots. Plant age contributed significantly to differences in concentration ratios for all nuclides in shoot tissues (p ≤ 0.024), with higher concentration ratios for seedling specimens. Additionally, duration of exposure was associated with significant differences in concentration ratios of 133Cs and 99Tc for seedlings (p = 0.007 and p = 0.030, respectively) while plant part (root or shoot) was associated with significant differences in concentration ratios of established plants (p < 0.001 for both nuclides). Statistically significant increases in radionuclide uptake in seedling specimens relative to established plants under controlled conditions suggests that, in addition to geochemical factors, plant life stage of wild grasses may also be an important factor influencing radionuclide transport in the natural environment.
Orbital Expansion in Cranial Vault After Minimally Invasive Extradural Transorbital Decompression for Thyroid Orbitopathy
Authors: Ramesh Sathyadeepak , Nobori Alexander , Wang Yi , Rootman Daniel , Goldberg Robert Alan 
Published: June 2018

Purpose:
To test the hypothesis that the orbit expands in the cranial vault after wide dural exposure after minimally invasive extradural transorbital decompression for thyroid eye disease.

Methods:
A cross-sectional cohort study of 36 patients (60 orbits). Preoperative and postoperative (6 months) orbital CT following extradural transorbital decompression was analyzed. Primary outcome measure was the percentage area of the cranial vault occupied by orbital and brain tissue in a predefined window before and after surgery. Secondary outcome measures were displacement of the anteriormost aspect of the temporal lobe, reduction in clinical proptosis, change in clinical activity score, and change in diplopia.

Results:
The mean percentage of the selected area of the cranial vault preoperatively was 0% orbital and 44% ± 15% brain tissue, compared with 70% ± 16% orbital and 28% ± 14% brain tissue postoperatively (p < 0.001). Posterior movement of the brain was demonstrated in 59 of 60 orbits, with a mean displacement of 2.0 mm ± 1.3 mm (p < 0.001). Mean proptosis reduction was 11.2 mm ± 3.6 mm (p < 0.001). The proportion of patients with clinical activity score <3 compared with clinical activity score ≥3 was not significantly different after surgery (p = 0.163). Improved diplopia was noted in 5 patients (14%), and worsening diplopia was noted in 3 patients (8%), although these changes were not significant (p = 0.772). Intraoperative dural tear with cerebrospinal fluid leak was reported in 2 orbits (3%), which was successfully managed with fibrin glue, with no sequelae. No other complications were noted, including infection, spontaneous orbital pulsations, postoperative hemorrhage (intracranial or intraorbital), or reactivation of disease.

Conclusion:
With wide exposure of the middle cranial fossa dura following extradural transorbital decompression, orbital tissue typically expands in the cranial vault.
Impacting diabetes self-management in women with gestational diabetes mellitus using short messaging reminders
Authors: Johnson Quinetta B. , Berry Diane C. 
Published: June 2018

ABSTRACT:

Background and purpose:
Gestational diabetes mellitus (GDM) has been associated with multiple complications, including increase risk of gestational hypertension, cesarean delivery, macrosomia, stillbirth, and preeclampsia. The purpose of this study was to determine the acceptability of text messaging in women with GDM and further refine intervention materials and study procedures (recruitment, enrollment, intervention, retention, and data collection).

Methods:
Nineteen women diagnosed with GDM completed a baseline demographic questionnaire followed by 4 weeks of daily text messages that included either a direct reminder to test their blood glucose levels and keep up with their treatment plan or an educational message. A postintervention survey was administered to assess the satisfaction with the messaging program.

Conclusion:
The use of daily text messages in the treatment plan of patients diagnosed with GDM seems to be acceptable shown by an overall satisfaction with the messages and a willingness to use the messages in future pregnancies. Half of the participants also felt that the messages helped them to eat healthier.

Implications for practice:
This study demonstrated a real opportunity for a low-cost intervention in the management plan of GDM.
Surgical Impact of Coupling an Active Middle Ear Implant to Short Incus Process
Authors: Schraven Sebastian P. , Rak Kristen , Cebulla Mario , Radeloff Andreas , Grossmann Wilma , Hagen Rudolf , Mlynski Robert 
Published: June 2018

Introduction:
Since 1996 the active middle-ear implant Vibrant Soundbridge (VSB) is used to treat mild-to-severe sensorineural hearing losses. The former standard surgical approach for incus vibroplasty included a mastoidectomy and a posterior tympanotomy, crimping the Floating-Mass Transducer (FMT) to the long incus process. The introduction of the short process (SP) coupler allows the attachment of the FMT to the incus body making the procedure of a posterior tympanotomy unnecessary. The aim of this study was to evaluate the duration of surgery (surgical case length) and to compare the audiological results of SP coupling with the former standard surgical approach to the long incus process.

Materials and Methods:
Patients undergoing an incus vibroplasty between October 2009 and February 2016 were included in this cohort study. The patients received an incus vibroplasty with crimping the FMT to the long incus process (former standard application) (n = 25) and with the SP coupler (n = 17) respectively. The surgical case length as well as the functional audiological outcome was assessed 12 months postoperatively using pure-tone audiometry and speech audiometry.

Results:
The surgical case length was significantly shorter in the SP coupler group compared to the standard application incus vibroplasty (85 ± 29 min vs. 114 ± 50 min). Additionally, patients receiving the SP coupler had an increased speech perception if compared to the standard application (Freiburger monosyllables at 65 dB SPL: 76.1 ± 16.1% vs. 66.2 ± 23.5%).

Conclusion:
The SP coupler leads to a shortened time of surgery and by the less invasive surgery to reduced risks for facial nerve and chorda tympani. Speech perception is significantly improved by SP coupling compared to classic long incus coupling.
Epidemiology of Clinically Significant Tinnitus: A 10-Year Trend From Nationwide Health Claims Data in South Korea
Authors: Lee Hyun Min , Han Kyung do , Kong Soo Keun , Nam Eui Cheol , Park Shi Nae , Shim Hyun Joon , Byun Jae Yong , Park Hong Ju , Im Gi Jung , Lee Il-Woo 
Published: June 2018

Objectives:
Prevalence of tinnitus has been reported to vary according to the target population and definition of tinnitus. To improve the understanding of tinnitus, authors used the nation-wide health claim data to study the tinnitus in the entire population of South Korea.

Study Design:
Retrospective big data review.

Setting:
Analysis of big data from the National Health Information Database.

Patients:
Patients diagnosed with tinnitus according to International Classification of Diseases code 10th edition (ICD-10) and requested to receive National Health Insurance claim at least once from January 2006 to December 2015.

Intervention:
None.

Main Outcome Measure:
Epidemiologic data, association of tinnitus with the otologic and systemic diseases.

Results:
The number of patients who received medical care because of tinnitus was 1.44% (0.78 million per 51 million) in 2015. There was a higher prevalence of tinnitus in women, and the overall prevalence increased with increasing age of patients and peaked at patients in their 70s (4.43%). The prevalence of tinnitus among patients aged 10 to 30 years, showed a tendency to increase during study period. In the regional analysis, highest prevalence was observed in Gwangju (2.02%). In comparison with the control group, the patients with tinnitus showed a higher frequency in otologic and systemic disease. Especially, noise induced hearing loss (adjusted odds ratio [AOR] = 82.1, 95% confidence interval [95% CI] = 74.8–90.2) and sudden sensorineueal hearing loss (AOR = 49.7, 95% CI = 48.4–51.0) showed high frequency in tinnitus patient group.

Conclusions:
The prevalence and incidence of tinnitus in this study for entire nation were lower than previously reported studies. These results have limitation because the study only covered patient using the medical service for tinnitus and missed tinnitus sufferers not seeking medical service. However, this study is meaningful in that it was targeting entire nation, reflected the characteristics of clinically significant tinnitus patient enough to visit medical service
Less or more hemodynamic monitoring in critically ill patients
Authors: Jozwiak Mathieu , Monnet Xavier , Teboul Jean-Louis 
Published: June 2018

Purpose of review
Hemodynamic investigations are required in patients with shock to identify the type of shock, to select the most appropriate treatments and to assess the patient's response to the selected therapy. We discuss how to select the most appropriate hemodynamic monitoring techniques in patients with shock as well as the future of hemodynamic monitoring.

Recent findings
Over the last decades, the hemodynamic monitoring techniques have evolved from intermittent toward continuous and real-time measurements and from invasive toward less-invasive approaches. In patients with shock, current guidelines recommend the echocardiography as the preferred modality for the initial hemodynamic evaluation. In patients with shock nonresponsive to initial therapy and/or in the most complex patients, it is recommended to monitor the cardiac output and to use advanced hemodynamic monitoring techniques. They also provide other useful variables that are useful for managing the most complex cases. Uncalibrated and noninvasive cardiac output monitors are not reliable enough in the intensive care setting.

Summary
The use of echocardiography should be initially encouraged in patients with shock to identify the type of shock and to select the most appropriate therapy. The use of more invasive hemodynamic monitoring techniques should be discussed on an individualized basis.
Dermatologic considerations in pediatric transplant recipients
Authors: Bhat Trisha , Coughlin Carrie C. 
Published: June 2018

Purpose of review
The pediatric transplant patient population is growing as the number of solid organ transplants and indications for hematopoietic stem cell transplant increase. Understanding cutaneous sequelae of pediatric transplant and treatment strategies to manage these outcomes is vital to the care of these patients.

Recent findings
Important work in the past year enhances our understanding of the cutaneous implications of pediatric transplantation, including further work in areas of malignancy, infection, and graft versus host disease as well as newly reported risks.

Summary
This review highlights recent developments in the recognition and management of dermatological complications of pediatric transplant that will be useful for the practicing pediatrician or dermatologist.
Incidence and Factors Associated With Attentional Fatigue in Working Long-term Breast Cancer Survivors
Authors: Crouch Adele , Von Ah Diane 
Published: June 2018

Purpose:
The purpose of this study was to examine the incidence of attentional fatigue and the relationship between sleep disturbance and attentional fatigue in working long-term breast cancer survivors (BCS).

Methods:
A descriptive, correlation design was used. The data for this study were drawn from a larger descriptive study designed to understand the impact of cognitive dysfunction on work-related outcomes. Breast cancer survivors completed questionnaires regarding sleep disturbance, attentional fatigue, and demographic and medical characteristics. Sleep disturbance, a subscale of the Pittsburgh Sleep Quality Index, is measured by asking 9 questions about sleep disturbances. Attentional fatigue was measured by the Attentional Function Index. Descriptive statistics and multiple regression were performed to assess the impact of sleep disturbance on attentional fatigue, controlling for covariates.

Results:
Sixty-eight female BCS, ranging from 29 to 68 years old (mean [SD], 52.1 [8.6] years old) and, on average, 4.97 (SD, 3.36) years posttreatment, participated. Thirty-four percent of BCS had poor to moderate attention function. Sleep disturbance significantly predicted attentional fatigue (P < .05), explaining 16% of the variance, F
4,57 = 2.68, P < .04, R
2 = 0.16.

Conclusions:
Clinicians can assess and intervene to decrease sleep disturbance, which may also improve attentional fatigue in BCS. However, sleep disturbance is only 1 contributing factor. Further investigation into factors contributing to attentional fatigue in BCS is warranted.
Role of Fractionated Fat in Blending the Lid-Cheek Junction
Authors: Rohrich Rod J. , Mahedia Monali , Shah Nilay , Afrooz Paul , Vishvanath Lavanya , Gupta Rana K. 
Published: June 2018

Background:
Fat grafting has been used extensively in plastic surgery in the past two decades. Here, the authors report the retrospective comparison of patients who underwent fractionated fat injection to blend the lid-cheek junction with those who had regular fat injection.

Methods:
After obtaining institutional review board approval, a retrospective review of patients who underwent lower blepharoplasty with fractionated fat injection for blending the lid-cheek junction from January of 2014 through October of 2015 was performed. The results were compared to those of lower blepharoplasty patients who did not have fractionated fat injected before January of 2014. Twelve prospectively selected patients underwent histopathologic and gene expression comparisons.

Results:
A comparison of complications between the two groups revealed no significant differences. Furthermore, there was no significant difference between the two groups for sequelae of fractionated fat injection and regular fat injection. The gene expression analysis of the fractionated and regular fat did not show any difference between undifferentiated and differentiated cells. In addition, Oil Red O staining of the fractionated and regular fat after differentiation showed that cells from both fat groups differentiated equally well.

Conclusions:
Fractionated fat injection appears to be a safe addition in blending the lid-cheek junction in the five-step lower blepharoplasty. There is no fat nodule formation with injection of fractionated fat injection compared with injection of regular fat performed superficially in the tear trough area. Contrary to what has previously been shown, the presence of viable cells in fractionated fat was noted.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
When Is Teenage Plastic Surgery versus Cosmetic Surgery Okay? Reality versus Hype: A Systematic Review
Authors: Rohrich Rod J. , Cho Min-Jeong 
Published: June 2018

Summary:
Plastic surgery in teenagers has become popular in past decades because of an increase in self-awareness and desire to “fit in” with their peers. In 2016, over 229,551 cosmetic procedures were performed in patients who are younger than 19 years. The trend of plastic surgery in adolescents is increasing, and it is important for plastic surgeons to perform safe and appropriate procedures in this group. To this date, there is a myriad of literature on the psychological and ethical issues concerning plastic surgery in teenagers. However, studies regarding the safety of performing plastic surgery in this population are scarce. The rationale for this article is to study this issue in depth by means of a systematic review. The authors discuss the current indications, safety, patient satisfaction, and ethical considerations of teenage plastic surgery and make recommendations for future studies on this important area.
Optimizing Perforator Selection: A Multivariable Analysis of Predictors for Fat Necrosis and Abdominal Morbidity in DIEP Flap Breast Reconstruction
Authors: Hembd Austin , Teotia Sumeet S. , Zhu Hong , Haddock Nicholas T. 
Published: June 2018

Background:
This study aims to elucidate the important predicting factors for fat necrosis and abdominal morbidity in the patient undergoing deep inferior epigastric artery perforator flap reconstruction.

Methods:
The authors conducted a retrospective review of 866 free-flap breast reconstructions performed at one institution from 2010 to 2016. Twenty-eight potential predictors were included in multivariable analyses to control for possible confounding interactions.

Results:
Four hundred nine total deep inferior epigastric artery perforator flaps were included in the statistical analysis. Of these, 14.4 percent had flap fat necrosis, 21.3 percent had an abdominal wound or complication, and 6 percent had an abdominal bulge or hernia. Analysis showed an increase in the odds of fat necrosis with increasing flap weight (OR, 1.002 per 1-g increase; p = 0.0002). A decrease in the odds of fat necrosis was seen with lateral row (OR, 0.29; p = 0.001) and both medial and lateral row perforator flaps (OR, 0.21; p = 0.001), if indocyanine green angiography was used (OR, 0.46; p = 0.04), and with increasing total flow rate of the flap (OR, 0.62 per 1-mm/second increase; p = 0.05). Increased odds of abdominal bulge or hernia were seen with lateral row or both medial and lateral row perforators (OR, 3.21; p = 0.05) versus medial row perforator-based flaps, and with patients who had an abdominal wound postoperatively (OR, 2.59; p = 0.05).

Conclusions:
The authors’ results suggest that using larger caliber perforators and perforators from the lateral row alone, or in addition to medial row perforators, can decrease fat necrosis more than simply harvesting more perforators alone. However, lateral and both medial and lateral row perforator flaps come at the cost of increasing abdominal bulge rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Transversus Abdominis Plane Blocks in Microsurgical Breast Reconstruction: Analysis of Pain, Narcotic Consumption, Length of Stay, and Cost
Authors: Salibian Ara A. , Frey Jordan D. , Thanik Vishal D. , Karp Nolan S. , Choi Mihye 
Published: June 2018

Background:
Transversus abdominis plane blocks are increasingly being used in microvascular breast reconstruction. The implications of these blocks on specific reconstructive, patient, and institutional outcomes remain to be fully elucidated.

Methods:
Patients undergoing abdominally based microvascular breast reconstruction from 2015 to 2017 were reviewed. Length of stay, complications, narcotic consumption, donor-site pain, and hospital expenses were compared between patients who did and did not receive transversus abdominis plane blocks with liposomal bupivacaine. Outcomes were subsequently compared in patients with elevated body mass index.

Results:
Fifty patients (43.9 percent) received blocks [27 (54.0 percent) under ultrasound guidance] and 64 patients (56.1 percent) did not. Patients with the blocks had significantly decreased oral and total narcotic consumption (p = 0.0001 and p < 0.0001, respectively) and significantly less donor-site pain (3.3 versus 4.3; p < 0.0001). There was no significant difference in hospital expenses between the two cohorts ($21,531.53 versus $22,050.15 per patient; p = 0.5659). Patients with a body mass index of 25 kg/m2 or greater who received a block had a significantly decreased length of stay (3.8 days versus 4.4 days; p = 0.0345) and decreased narcotic consumption and postoperative pain compared with patients without blocks. Patients with a body mass index less than 25 kg/m2 did not have a significant difference in postoperative pain, narcotic consumption, or length of stay between groups.

Conclusions:
Transversus abdominis plane blocks with liposomal bupivacaine significantly reduce oral and total postoperative narcotic consumption and donor-site pain in all patients after abdominally based microvascular breast reconstruction without increasing hospital expenses. The blocks also significantly decrease length of stay in patients with a body mass index greater than or equal to 25 kg/m2.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Seasonal Impact on Surgical-Site Infections in Body Contouring Surgery: A Retrospective Cohort Study of 602 Patients over a Period of 6 Years
Authors: Duscher Dominik , Kiesl David , Aitzetmüller Matthias Michael , Wenny Raphael , Schableger Karl , Staud Clement Johannes , Pollhammer Michael Stefan , Shamiyeh, M.D. Andreas , Huemer Georg M. 
Published: June 2018

Background:
Postoperative surgical-site infections are severe complications following body contouring surgery. Here, the authors evaluate whether surgical-site infection rates are influenced by higher temperatures during the summer season.

Methods:
We enrolled 602 patients who underwent body contouring surgery between 2009 and 2015 in a retrospective cohort study. Data collected included demographics, surgical data, and postoperative outcome. Body contouring surgery procedures included lower and upper body lift, abdominoplasty, breast reduction, mastopexy, brachioplasty, and thigh lift. Infection rates were calculated on a seasonal basis and compared using Fisher’s exact test and logistic regression analysis.

Results:
There were 136 patients (125 women and 11 men) in the warm season [June to August; with an average temperature of 67.622°F (19.79°C)] and 466 patients (438 women and 28 men) in the cold seasons group [September to May, with an average temperature of 45.45 °F (7.47°C)]. The composition of the study cohorts was comparable. The average age was 40 years and the average body mass index was 27 kg/m2. From a total of 602 patients, the authors observed 33 surgical-site infections, representing a rate of 5.48 percent. A statistically significant increase of postoperative surgical-site infections could be detected during summer (10.29 percent versus 4.08 percent; p = 0.0071), representing an increase of 150 percent. In addition, a logistic regression analysis determined “season” as the strongest predictor for surgical-site infections, with a risk increase of 2.693 times in the warm season.

Conclusions:
Body contouring operations are elective procedures, making careful risk consideration an absolute prerequisite. The authors demonstrate a significantly increased infection risk during summer and establish a causal link between the warm season and surgical-site infection accumulation. Consequently, preoperative patient information and operative planning should be adjusted accordingly.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.