bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comprehensive Drilling of C1-2 Facets and Multiplanar Realignment for Atlanto-Axial Dislocation and Basilar Invagination: 2-Dimensional Operative Video
Authors: Salunke Pravin , Sahoo Sushanta K 
Published: June 2018

Abstract
The management for congenital atlantoaxial dislocation (AAD) and basilar invagination (BI) has significantly changed in the last 2 decades. Authors operate these cases through a direct posterior approach by opening and manipulating the C1-2 joints (irrespective of C1 assimilation), modifying Goel's technique. The joints in these cases are often oblique in both sagittal and coronal planes giving rise to anteroposterior and vertical slip of C1 on C2. Asymmetry on either side gives rise to coronal/lateral angular tilt along with rotational component. The authors have described comprehensive drilling of the facets (osteotomies) in sagittal and coronal planes to release the joints. Metallic spacers with graft window packed with bone chips are inserted to compensate for the drilled bone. Screws are inserted in C1 lateral mass and C2 pedicle. A rod is fastened between the screw heads and further multiplanar realignment can be achieved by manipulating the rod. The technique obviates the need for transoral decompression and the C1-2 joints are closely fused. The facetal osteotomies coupled with manipulation for realignment in all planes provides a composite solution for even the extremely complex lateral dislocation or complete spondyloptosis with severely deformed C1-2 joints that may be difficult with techniques described earlier. There is no need to include occipital squama and multiple cervical vertebrae in the construct, irrespective of the C1 assimilation. The authors have operated over 200 cases of irreducible CAAD/BI with good outcome and have illustrated their technique in this video. Proper informed consent was obtained from the patient.
Failure on the Foam Eyes Closed Test of Standing Balance Associated With Reduced Semicircular Canal Function in Healthy Older Adults
Authors: Anson Eric , Bigelow Robin T. , Studenski Stephanie , Deshpande Nandini , Agrawal Yuri 
Published: June 2018

Objectives:
Standing on foam with eyes closed (FOEC) has been characterized as a measure of vestibular function; however, the relative contribution of vestibular function and proprioceptive function to the FOEC test has not been well described. In this study, the authors investigate the relationship between peripheral sensory systems (vestibular and proprioception) and performance on the FOEC test in a cohort of healthy adults.

Design:
A total of 563 community-dwelling healthy adults (mean age, 72.7 [SD, 12.6] years; range, 27 to 93 years) participating in the Baltimore Longitudinal Study of Aging were tested. Proprioceptive threshold (PROP) was evaluated with passive motion detection at the right ankle. Vestibulo-ocular reflex (VOR) gain was measured using video head impulses. Otolith function was measured with cervical and ocular vestibular-evoked myogenic potentials. Participants stood on FOEC for 40 sec while wearing BalanSens (BioSensics, LLC, Watertown, MA) to quantify center of mass sway area. A mixed-model multiple logistic regression was used to examine the odds of passing the FOEC test based on PROP, VOR, cervical vestibular-evoked myogenic potential, and ocular vestibular-evoked myogenic potential function in a multisensory model while controlling for age and gender.

Results:
The odds of passing the FOEC test decreased by 15% (p < 0.001) for each year of increasing age and by 8% with every 0.1 reduction in VOR gain (p = 0.025). Neither PROP nor otolith function was significantly associated with passing the FOEC test.

Conclusions:
Failure to maintain balance during FOEC may serve as a proxy for rotational vestibular contributions to postural control. Semicircular canals are more sensitive to low-frequency motion than otoliths that may explain these relationships because standing sway is dominated by lower frequencies. Lower VOR gain and increased age independently decreased the odds of passing the test.
A Computed Tomography Study of the C7 Vertebra Screws Fixation in Children
Authors: Liu Junhao , Ji Wei , Huang Zucheng , Kong Ganggang , Liu Qi , Huang Zhiping , Wu Xiuhua , Zhu Qingan 
Published: June 2018

Study Design.
Retrospective analysis of computed tomographic images of 92 normal pediatric cervical vertebrae.

Objective.
The aim of this study was to ascertain the feasibility of the pedicle, intralaminar, and lateral mass screws fixation in children.

Summary of Background Data.
Fixation techniques of C7 vertebrae are technically challenging in the pediatric population. Although the techniques offer alternatives to screws placement at C7 spine in adult, there is no consensus to apply these screws in children.

Methods.
A total of 92 patients (59 males and 33 females) from 3- to 16-year old divided into three groups (group 1, 1–6 years; group2, 7–10 years; group 3, 11–16 years) were included. Measurements were taken through computed tomography (CT) imaging without evidence of spinal trauma. Length, width, and angle of lamina and pedicle were measured, and lateral mass length was also assessed.

Results.
There was no statistical difference between the left and right sides, as well as the sexes. In 1 to 6 years’ age group, 83.3% of the laminas and 87.5% of the pedicles measured have thicknesses of >3.5 mm. In 7 to 10 years’ age group, 84.0% of the laminas and all the pedicles observed have thicknesses of >3.5 mm. In 11 to 16 years’ age group, 88.4% of the laminas and 97.7% of the pedicles measured have thicknesses of >3.5 mm. Most of the spinolaminar angles were between 42.5° and 56°. There are three cases (3.3%) having lateral mass length >12 mm.

Conclusion.
It is feasible to insert a screw (Ø 3.5 mm) in C7 lamina in children, and the intralaminar screw fixation is a safe and reliable technique. Around 49°, the spinolaminar angle with axial position, can be used as reference for placing screws in the C7 lamina. Preoperative CT scan will help surgeons to insert the laminar screw safely and accurately.

Level of Evidence: N/A
Concurrent and Overlapping Surgery
Authors: Bryant Jessica , Markes Alexander , Woolridge Tiana , Cerruti Dede , Dzeng Elizabeth , Koenig Barbara , Diab Mohammad 
Published: June 2018

Study Design.
Prospective cross-sectional survey.

Objective.
To determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis (AIS) regarding simultaneous surgery and trainee participation.

Summary of Background Data.
Simultaneous (“at the same time”) surgery is under scrutiny by the public, government, payers, and the medical community. The objective of this study is to determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis. Our goal is to inform the national conversation on this subject with real patient and family voices.

Methods.
A survey was prospectively administered to 31 consecutive parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis at a large academic medical center. “Overlapping” was defined as simultaneity during “noncritical” parts of an operation. “Concurrent” was defined as simultaneity that includes “critical” part(s) of an operation. Participants were asked to provide levels of agreement with overlapping and concurrent surgery and anesthesia, as well as with trainee involvement.

Results.
On average, respondents “strongly agree” with the need to be informed about overlapping or concurrent surgery. They “disagree” with both overlapping and concurrent scheduling, and “disagree” with trainees operating without direct supervision, even for “noncritical” parts. Informing parents about the presence of a back-up surgeon or research demonstrating safety of simultaneous surgery did not make them agreeable to simultaneous scheduling.

Conclusion.
Parents have a strong desire to be informed of simultaneous spinal surgery and anesthesia as part of consent on behalf of their children. Their disagreement with simultaneous surgery, as well as with trainees operating without direct supervision, suggests discordance with current guidelines and practice and should inform the national conversation moving forward.

Level of Evidence: N/A
Eccrine Porocarcinoma: New Insights and a Systematic Review of the Literature
Authors: Nazemi Azadeh , Higgins Shauna , Swift Reyna , In Gino , Miller Kimberly , Wysong Ashley 
Published: June 2018

BACKGROUND
Eccrine porocarcinoma (EPC) is a rare cutaneous neoplasm with high potential for morbidity and mortality. Due to its rarity, there is a paucity of data profiling diagnosis, work-up, and management.

OBJECTIVE
To consolidate reported information on demographics, diagnostics, clinical behavior, treatment modalities, and patient outcomes in EPC to provide a reference tool to optimize diagnosis and management.

METHODS
A comprehensive PubMed search was performed from 1963 to November 2017 using PRISMA guidelines. This yielded 155 articles detailing 206 cases of porocarcinoma.

RESULTS
Eccrine porocarcinoma most often presents in elderly patients on the head and neck or lower limbs. Metastatic disease at presentation is not uncommon (22%). Primary tumor location is significantly correlated with presence of metastasis (p = .038). The most common treatment is excision followed by Mohs micrographic surgery (MMS), although the outcomes after MMS were superior to those after surgical excision.

CONCLUSION
This systematic review of individual patient data reveals that all patients should have a histological diagnosis with imaging considered for high-risk cases. Primary tumor location should also be considered in diagnostic and therapeutic decision-making. Although wide local excision (WLE) is currently the first-line treatment, MMS is becoming increasingly used, with evidence indicating improved outcomes as compared to those seen with WLE.
The Influence of Radiotherapy on the Mechanical Properties of Silicone Breast Implants
Authors: Bachour Yara , Oei Lisanne J. , Van der Veen Albert J. , Vos Bart E. , Louis Andre , Heukelom Stan , Ritt Marco J. P. F. , Niessen Frank B. , Koken Phil W. , Winters Hay A. H. 
Published: June 2018

Background:
Silicone breast implants have been used for decades for cosmetic breast augmentation or reconstruction after mastectomy. In selected cases, postmastectomy adjuvant radiotherapy is given with the breast implants in situ. Previous clinical studies have shown that radiotherapy may lead to complications such as capsular contracture and infection and that removal of the implant may be required. Yet, the effect of radiotherapy on silicone breast implants themselves is unknown. The aim of this study was to investigate if irradiation of breast implants influences their mechanical properties.

Methods:
This was an ex vivo study on 32 ready-to-use silicone breast implants (Mentor and Silimed). Half of the implants of each brand were irradiated with 1 × 60 Gy, the other half were not irradiated. Tensile, mechanical hysteresis, and rheology tests were performed. Differences in mechanical properties between the irradiated and nonirradiated implants were determined.

Results:
No significant differences were found in tensile strength, mechanical hysteresis, and rheological properties between irradiated and nonirradiated implants.

Conclusions:
Breast implants’ mechanical properties for these 2 brands were not significantly affected after single-dose irradiation in an ex vivo setting.
The Use of a Novel Local Flap Trainer in Plastic Surgery Education
Authors: Kite Amy C. , Yacoe Morgan , Rhodes Jennifer L. 
Published: June 2018

Summary:
With the limitations of work hour restrictions and legal liability surgical resident’s operative experience is declining. We sought to find other methods of training using tactile surgical simulations for plastic surgery. With the collaborative efforts of a local artist, a local flap trainer was designed to simulate the natural properties, layers, and interaction between layers of tissue. A session was held with Plastic Surgery faculty, residents, and students to review and practice local flaps using the trainer. Afterward, the participants filled out a survey evaluating the simulated skin and tissue model and the effectiveness of the class as a teaching model. The survey given had multiple questions asking the participant to provide a ranking from 1 to 10. The results show that the class utilizing the new suture pad was an effective teaching tool with an average score of 9.56. The suture pad was given a score of 6.77 for simulating realistic skin. Overall, the group rated increased understanding and confidence of local flaps after the class. Surgical skill simulations are becoming increasingly more important with the decline of resident operative experience. There are limited options for surgical simulations that provide a realistic experience. We designed a suture pad that is effective at simulating human tissue. The surveys show that using this suture pad in flap workshops provides a valuable teaching tool.
Maxillary Reconstruction Using a Gullwing Fibula Osteofascial Flap and Flexor Hallucis Longus Muscle
Authors: Mitchell Stuart L. , Seth Akhil K. , Matros Evan , Cordeiro Peter G. 
Published: June 2018

Summary:
The appropriate reconstruction of an infrastructure maxillectomy defect requires vascularized bone for maxillary arch restoration, soft tissue bulk for filling the residual defect extending up to the orbital floor, and a thin tissue layer for resurfacing the palate and adjacent cheek mucosa. Although several free tissue flaps have been previously described as reconstructive options, each possesses limitations. We describe the fibula osteofascial flap with flexor hallucis longus muscle, no skin paddle, and a “gullwing” fascial component, as an ideal reconstructive option for these specific maxillary defects. It satisfies the necessary requirements of bone, restoration of intraoral surfaces, as well as additional soft tissue volume to provide the optimal aesthetic and functional result. It also has the added benefit of minimizing morbidity to, and improving aesthetics of, the donor site. This is demonstrated through a case presentation and review of the existing literature.
Ex Vivo Major Histocompatibility Complex I Knockdown Prolongs Rejection-free Allograft Survival
Authors: Chang Jessica B. , Rifkin William J. , Soares Marc A. , Duckworth April , Rao Nakul , Low Yee Cheng , Massie Jonathan P. , Rabbani Piul S. , Saadeh Pierre B. , Ceradini Daniel J. 
Published: June 2018

Background:Widespread application of vascularized composite allotransplantation (VCA) is currently limited by the required lifelong systemic immunosuppression and its associated morbidity and mortality. This study evaluated the efficacy of ex vivo (after procurement but before transplantation) engineering of allografts using small interfering RNA to knockdown major histocompatibility complex I (MHC-I) and prolong rejection-free survival.Methods:Endothelial cells (ECs) were transfected with small interfering RNA targeted against MHC-I (siMHC-I) for all in vitro experiments. MHC-I surface expression and knockdown duration were evaluated using quantitative polymerase chain reaction (qPCR) and flow cytometry. After stimulating Lewis recipient cytotoxic lymphocytes (CTL) with allogeneic controls or siMHC-I–silenced ECs, lymphocyte proliferation, CTL-mediated and natural killer–mediated EC lysis were measured. Using an established VCA rat model, allografts were perfused ex vivo with siMHC-I before transplantation. Allografts were analyzed for MHC-I expression and clinical/histologic evidence of rejection.Results:Treatment with siMHC-I resulted in 80% knockdown of mRNA and 87% reduction in cell surface expression for up to 7 days in vitro (P< 0.05). Treatment of ECs with siMHC-I reduced lymphocyte proliferation and CTL-mediated cytotoxicity (77% and 50%, respectively,P< 0.01), without increasing natural killer–mediated cytotoxicity (P= 0.66). In a rat VCA model, ex vivo perfusion with siMHC-I reduced expression in all tissue compartments by at least 50% (P< 0.05). Knockdown prolonged rejection-free survival by 60% compared with nonsense-treated controls (P< 0.05).Conclusions:Ex vivo siMHC-I engineering can effectively modify allografts and significantly prolong rejection-free allograft survival. This novel approach may help reduce future systemic immunosuppression requirements in VCA recipients.
Robotic Nipple-sparing Mastectomy and Immediate Breast Reconstruction with Gel Implant
Authors: Lai Hung-Wen , Lin Shih-Lung , Chen Shou-Tung , Chen Shu-Ling , Lin Ya-Ling , Chen Dar-Ren , Kuo Shou-Jen 
Published: June 2018

Background:
The experience of application of robotic surgery platform in the management of breast cancer was limited. The preliminary experience and results of robotic nipple-sparing mastectomy (R-NSM) and immediate breast reconstruction (IBR) with Gel implant was reported.

Methods:
The medical records of patients who underwent R-NSM and IBR with Gel implant for breast cancer during the period March 2017 to October 2017 were collected from single institution. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications, and recurrence were analyzed to determine the effectiveness and oncologic safety of R-NSM. Patients’ oriented cosmetic outcome report was also obtained.

Results:
A total of 15 patients was analyzed, and the mean age of them was 46.5 ± 10.0 years. The pathologic stage was 30.8% ductal carcinoma in situ, 30.8% stage I, 30.8% stage II, and 7.7% stage III. The mean operation time was 282.8 ± 70.4 minutes, and mean hospital stay was 6.7 ± 1.2 days. The positive surgical margin rate was 0%. One patient suffered from delayed axillary wound healing. Two patients (13.3%) with transit nipple ischemia change, but no total nipple areolar complex necrosis case was observed. No local recurrence, distant metastasis, or case mortality was found during mean 6.3 ± 2.1 months follow-up. All 15 patients were satisfied with the postoperative aesthetic outcome.

Conclusion:
From our preliminary experience, R-NSM and IBR with Gel implant is a safe procedure, with good cosmetic results, and could be a promising new technique for breast cancer patients indicated for mastectomy.
Risk Factors for Loss of Lung Sliding in a Medical Intensive Care Population With Acute Respiratory Failure
Authors: Mallow Christopher , Isakow Warren 
Published: June 2018

Background:
Point of care bedside ultrasound is widely utilized as a rapid technique to evaluate patients with acute pulmonary emergencies, including acute pneumothorax. The presence of a pneumothorax is a known cause of loss of lung sliding by ultrasound examination, but no other risk factors have been clearly identified. We attempted to identify demographic and patient characteristics that are risk factors for loss of ultrasonographic lung sliding in the absence of a pneumothorax.

Methods:
Data were collected on 159 patients admitted to the medical intensive care unit with acute respiratory failure, undergoing routine admission lung ultrasound. The lung ultrasound examination consisted of 3 views of each hemithorax using a phased array abdominal probe.

Results:
There were 4 confirmed pneumothoraces out of 20 patients with loss of lung sliding at ≥1 ultrasound interrogation points on either hemithorax. Hypercarbic respiratory failure [odds ratio (OR), 5.59] and low body mass index (OR, 0.88) were statistically significant risk factors for the loss of lung sliding in the absence of pneumothorax. There was a trend toward significance in patients with a known history of a decreased forced expiratory volume 1/forced vital capacity ratio (OR, 0.02), COPD/asthma exacerbation as the cause of their respiratory failure (OR, 4.52) and previous pneumothorax (OR, 11.53).

Conclusion:
Common diagnoses and comorbidities are associated with the loss of ultrasonographic lung sliding, in the absence of pneumothorax.
Postdischarge Feeding of Very‐low‐birth‐weight Infants
Authors: Francis Jane , Unger Sharon , Bando Nicole , Vance Ashleigh , Gibbins Sharyn , Kiss Alex , Church Paige , Sellen Daniel , O'Connor Deborah L. ,   GTA‐DoMINO Feeding Group
Published: June 2018

ABSTRACTObjectives:Infant feeding guidelines are important public health strategies to promote optimal growth, development, and chronic disease prevention, but their effectiveness is contingent upon families’ ability to adhere to them. Little is known of adherence to guidelines among nutritionally vulnerable infants, specifically those born very‐low‐birth‐weight (VLBW) (<1500 g). This study investigated whether postdischarge feeding practices for VLBW infants align with current recommendations and explored parental and infant baseline sociodemographics related to these practices.Methods:Prospectively collected data from families of 300 VLBW infants participating in a randomized clinical trial (ISRCTN35317141) were used. Baseline demographics were obtained at enrollment and postdischarge feeding practices via monthly telephone questionnaires to 6 months corrected age (CA).Results:At discharge, 4 and 6 months CA, 72%, 39%, and 29% of infants received any amount of mother's milk, respectively; exclusive breast‐feeding rates were 49%, 20%, and 6%, respectively. Among infants receiving mother's milk, rates of vitamin D supplementation were ≥83%. Recommendations for introducing solids between 4 and 6 months CA were followed by 71% of the cohort and for iron supplementation by 58%. Overall, 12% of infants adhered to all aforementioned recommendations. Mothers with university degrees were more likely to provide mother's milk, whereas mothers of Middle Eastern/South Asian ethnicity were less likely to provide mother's milk.Conclusions:Low rates of partial and exclusive breast‐feeding of VLBW infants to 6 months CA were reported. Overall adherence to iron supplementation was low. Strategies to provide increased support for mothers identified as at‐risk should be developed.