bluuebunny/crossref_metadata_2025_split huggingface dataset:
Virtual Reality to Improve the Experience of the Mohs Patient—A Prospective Interventional Study
Authors: Higgins Shauna , Feinstein Shera , Hawkins Makenzie , Cockburn Myles , Wysong Ashley 
Published: March 2019

BACKGROUND
Nonmelanoma skin cancer is the most common cancer in the United States with significant quality of life impact.

OBJECTIVE
To assess the utility of a highly immersive virtual reality (VR) experience in the context of outpatient skin cancer surgery as a means to minimize patient-reported feelings of anxiety or pain. The authors also sought to assess the effects on patient-reported overall satisfaction.

MATERIALS AND METHODS
Patients completed a pre-VR experience survey after completion of their first Mohs surgery layer, followed by a 10-minute VR experience, and a post-VR experience survey. Differences in the pre-VR survey and post-VR survey were compared using the chi-square test. The anxiety scores were compared using a t-test.

RESULTS
In all but 2 questions, there was a trend toward improvement of the anxiety-related sensations after completion of the VR experience. There were statistically significant differences for 4 questions: “Are you currently feeling unable to relax” (p = .0013), “are you currently feeling fear of the worst happening” (p < .0001), “are you currently feeling terrified or afraid” (p = .0046), and “are you currently feeling nervous” (p < .0001).

CONCLUSION
Virtual reality experiences during the Mohs surgical day significantly improved measures of anxiety and patient satisfaction.
Practical Guidelines for Hyaluronic Acid Soft-Tissue Filler Use in Facial Rejuvenation
Authors: Lee Won , Hwang Seung-Gook , Oh Wook , Kim Chang-Yeol , Lee Jin-Liang , Yang Eun-Jung 
Published: March 2019

BACKGROUND
Hyaluronic acid (HA) fillers are the most commonly used fillers for soft-tissue augmentation. The face is a dynamic structure. Facial rejuvenation by filler products depends on mechanical forces on the region of the face. The successful use of injectable HA fillers requires an understanding of the options available.

OBJECTIVE
The purpose of this study is to measure the rheological properties of HA fillers and to clarify how to select these fillers considering their rheological properties.

MATERIALS AND METHODS
Rheological characterization was performed on 41 fillers. Physical parameters directly linked to product performance were measured.

RESULTS
The properties of the HA fillers varied. These findings provide a basis for selection guideline regarding rheological properties in facial rejuvenation.

CONCLUSION
The authors' report is the largest study to determine the rheological properties of HA fillers to date. Understanding the fillers' properties can help physicians select the appropriate fillers for more predictable and sustainable results.
Botulinum Toxin Injections for Masseter Reduction in East Asians
Authors: Cheng Judy , Hsu Sarah H. , McGee Jean S. 
Published: March 2019

BACKGROUND
Cultural ideals for a slimmer face have led to an upsurge in interest in facial contouring among East Asians. Although surgical resection has traditionally been the main treatment option, botulinum toxin injection is becoming a popular, noninvasive alternative.

OBJECTIVE
To describe the use of botulinum toxin injection for masseter reduction in East Asians.

METHODS
An electronic search of the PubMed database was performed for studies published from 2000 to 2017 that meet the word combination of botulinum toxin, masseter, hypertrophy, and/or lower face contouring. Only the studies conducted in East Asian countries were analyzed in this review, exception of one study from Thailand.

RESULTS
A total of 12 publications were identified. Each study was reviewed to extract relevant information on patient selection, injection techniques, efficacy, dosage, frequency, and main side effects of treating masseters with botulinum toxin.

CONCLUSION
Botulinum toxin injection for masseter reduction in East Asians is efficacious and generally considered safe with no significant side effects. Future areas for investigation include defining the criteria for benign masseteric hypertrophy, minimum effective dosage of botulinum toxin, and the potential long-term effects of the injection.
Impact of Preservation Solutions on the Trichogenicity of Hair Micrografts Ascertained by Dermal Papilla Gene Expression
Authors: Castro Ana Rita , Portinha Carlos , Logarinho Elsa 
Published: March 2019

BACKGROUND
Appropriate storage of human hair follicle (HF) grafts during follicular unit excision (FUE) is crucial toward successful hair shaft implantation. Several commercial storage solutions are currently used to ensure ex vivo maintenance of follicular grafts viability and trichogenicity. However, quantitative experimental evidence demonstrating molecular changes in HF cells associated with the usage of different storage solutions is largely missing.

OBJECTIVE
To identify gene expression changes in HF cells caused by ex vivo storage of hair grafts in different preservation conditions.

METHODS
The authors performed gene expression analysis in dermal papilla (DP) isolated from HF stored under different temperatures and solutions. The expression signature of key genes controlling hair growth and cycling, apoptosis, inflammation, and senescence was assessed for (1) chilled versus room temperature (RT) and (2) DP cell medium, saline, Hypothermosol, platelet-rich plasma, and ATPv-supplemented saline.

RESULTS
The authors found chilled versus RT to prevent inflammatory cytokine signaling. Under chilled conditions, ATPv-supplemented saline was the best condition to preserve the expression of the trichogenic genes HEY1 and LEF1.

CONCLUSION
Data disclose DP gene expression analysis as a useful methodology to ascertain the efficacy of preserving solutions and elucidate about the best currently available option for FUE clinical practice.
Implementing Precision Medicine and Artificial Intelligence in Plastic Surgery: Concepts and Future Prospects
Authors: Kim You J. , Kelley Brian P. , Nasser Jacob S. , Chung Kevin C. 
Published: March 2019

Summary:
Precision medicine, or the individualization of evidence-based medicine, is forthcoming. As surgeons, we must be prepared for the integration of patient and system factors. Plastic surgeons regard themselves as innovators and early adopters. As such, we need our adaptability now more than ever to implement digital advancements and precision medicine into our practices. The integration of artificial intelligence (AI) technology and the capture of big data techniques should foster the next great leaps in medicine and surgery, allowing us to capture the detailed minutiae of precision medicine. The algorithmic process of artificial neural networks will guide large-scale analysis of data, including features such as pattern recognition and rapid quantification, to organize and distribute data to surgeons seamlessly. This vast digital collection of information, commonly termed “big data,” is only one potential application of AI. By incorporating big data, the cognitive abilities of a surgeon can be complemented by the computer to improve patient-centered care. Furthermore, the use of AI will provide individual patients with increased access to the broadening world of precision medicine. Therefore, plastic surgeons must learn how to use AI within the contexts of our practices to keep up with an evolving field in medicine. Although rudimentary in its practice, we present a glimpse of the potential applications of AI in plastic surgery to incorporate the practice of precision medicine into the care that we deliver.
Evaluation of Long-term Outcomes of Facial Sensation following Cranial Vault Reconstruction for Craniosynostosis
Authors: Dengler Jana , Ho Emily S. , Klar Erin L. , Phillips John H. , Forrest Christopher R. 
Published: March 2019

Background:
Cranial vault reshaping to correct craniosynostosis in infants may injure terminal branches of the trigeminal nerve, namely the supraorbital, supratrochlear, zygomaticofacial, and zygomaticotemporal nerves, especially if a fronto-orbital advancement is performed. Despite numerous studies demonstrating successful esthetic outcome after FOA, there are no long-term studies assessing facial sensation after possible damage to these nerves as the result of surgery.

Methods:
A cross-sectional case-control research design was used to evaluate facial sensory threshold in the trigeminal branches after cranial vault reconstruction in children with isolated, nonsyndromic metopic, and unicoronal craniosynostosis, compared with those with sagittal craniosynostosis and age-matched nonaffected controls. Study participants were recruited from the Hospital for Sick Children between the ages of 6 and 18 years. Sensory outcome was determined using the Weinstein Enhanced Sensory Test, the Ten Test, and self-reported facial sensibility function questionnaire.

Results:
The sensory outcomes of 28 patients and 16 controls were examined at an average age of 9.6 years and 10.3 years, respectively. No subjective or objective sensory deficit was noted in supraorbital, supratrochlear, zygomaticofacial, or zygomaticotemporal nerve distributions between groups. Qualitative reports of facial sensibility function indicated no difference in subjective sensation, protective sensation, or motor behavior between groups.

Conclusions:
These results suggest that while sensory nerve injury during routine FOA may occur, it does not result in a quantifiable nor clinically significant long-term sensory deficit threshold. Patients do not develop long-term neuropathic pain following surgical intervention.
Mosaic Fleur-de-Profunda Artery Perforator Flap for Autologous Breast Reconstruction
Authors: Bourn Lynn , Torabi Radbeh , Stalder Mark W. , St. Hilaire Hugo , Allen Robert J. , Delatte Stephen J. , Matatov Tim S. , Torabi Rozbeh , Zakhary Joseph , Tessler Oren 
Published: March 2019

Summary:
Perforator-free flaps, in autologous breast reconstruction, have expanded to exploit tissue available at smaller donor sites while retaining high success and low risk rates. Abdominal based flaps, such as the deep inferior epigastric perforator, remain the most common; however, when the abdomen is not an appropriate donor site, lower extremity flaps are options. The profunda artery perforator has the benefit of hiding unsightly scar in the gluteal crease but has the drawback of poor donor site volume. Our mosaic fleur-de-profunda artery perforator flap technique for breast reconstruction has shown to increase volume with the addition of a vertical limb, include full angiosome of perforators, and exhibit donor site morbidity equivalent to a medial thigh lift.
Identification of a Novel ZNF469 Mutation in a Pakistani Family With Brittle Cornea Syndrome
Authors: Micheal Shazia , Siddiqui Sorath Noorani , Zafar Saemah Nuzhat , Gabriëla Niewold Ilse Therésia , Khan Muhammad Imran , Bergen Arthur A. B. 
Published: March 2019

Purpose:
Brittle cornea syndrome (BCS) is a rare recessive disorder affecting connective tissues, most prominently in the eye. Pathogenic mutations causing BCS have been identified in PRDM5 and ZNF469 genes. This study investigates the genetic cause of BCS in a large, consanguineous Pakistani family with 4 affected and 3 unaffected individuals.

Methods:
The coding region and exon–intron splice junctions of PRDM5 and ZNF469 genes were amplified by polymerase chain reaction, and bidirectional Sanger sequencing was performed to find the pathogenic change responsible for causing the disease in the family.

Results:
A novel homozygous duplication c.9831dupC (p.Arg3278GlnfsX197) in the ZNF469 gene was identified, which was found to be co-segregating with the disease in the family.

Conclusions:
This is the first report of a ZNF469 homozygous mutation causing a BCS phenotype in a consanguineous Pakistani family. Our data extend the mutation spectrum of ZNF469 variants implicated in BCS.
Keratoconus Corneal Posterior Surface Characterization According to the Degree of Visual Limitation
Authors: Vega-Estrada Alfredo , Alio Jorge L. 
Published: March 2019

Purpose:
To characterize posterior corneal surface features in patients with keratoconus and healthy controls and correlate them with the severity of the disease according to visual limitation.

Methods:
Retrospective, comparative, clinical study including 477 cases, 374 keratoconic eyes and 103 healthy corneas. Patients were classified according to the degree of visual limitation. The corneal posterior surface including shape indices and keratoconus screening indices was evaluated using the rotating Scheimpflug camera and Placido disc topographer.

Results:
Dioptric power of the posterior corneal surface increases linearly as corrected distance visual acuity deteriorates (r > 0.700; P < 0.001). A significant correlation was also observed between shape indices root mean square per unit of area (RMS/A) (posterior surface irregularity) and corrected distance visual acuity (r = −0.750; P < 0.001). In addition, keratoconus screening indices such as posterior corneal aberrations and posterior ectasia vertex (KVb) also showed significant correlation with the degree of visual limitation (r = −0.687; P < 0.001 and r = −0.789; P < 0.001, respectively). Receiver operating characteristic curves demonstrate that RMS/A and KVb showed highest discriminating capabilities between normal and mild keratoconus cases with an area under the curve of 0.96 and 0.97, respectively, with a sensitivity and specificity of more than 93% for the RMS/A and 89% and 84% for the KVb.

Conclusions:
Posterior corneal surface characteristics correlate with the degree of visual impairment and can be used for classifying patients with keratoconus. RMS/A, KVb, and posterior corneal aberrations are the most representative variables of visual function deterioration and are also useful to differentiate normal from mild keratoconus cases.
Outcomes of Cyanoacrylate Tissue Adhesive Application in Corneal Thinning and Perforation
Authors: Yin Jia , Singh Rohan Bir , Al Karmi Rani , Yung Ann , Yu Man , Dana Reza 
Published: March 2019

Purpose:
To report the outcomes of cyanoacrylate tissue adhesive (CTA) application in corneal thinning and perforation.

Methods:
A retrospective interventional case series of 137 patients receiving CTA for corneal thinning and perforation in 140 eyes between 2001 and 2018 at a single center was reviewed. Success rate and factors associated with glue failure were analyzed.

Results:
Median age of the cohort was 63 years and 69 (50%) were women. One hundred fifteen patients (84%) had at least 1 systemic condition, 46 (34%) had autoimmune diseases. Eighty-nine eyes (64%) presented with perforation and 51 (36%) with thinning. The perforation/thinning was central/paracentral in 82 eyes (59%) and peripheral in 57 eyes (41%). Median size of perforation was 3.1 mm2. Causes of perforation and thinning were microbial infection in 75 (55%), sterile melt in 49 (35%), laceration in 10, and keratoprosthesis melt in 8 eyes. Median glue retention was 58 days. Success rate of glue application (defined as intact globe without surgical intervention) was 72%, 61%, and 46% at 10, 30, and 90 days after glue application, respectively. Larger size of perforation/thinning, perforation (vs. thinning), and single glue application (vs. multiple) were correlated with higher failure rate. Systemic conditions, use of topical corticosteroid, etiologies, and location of perforation/thinning were not significantly correlated with glue failure.

Conclusions:
CTA application was moderately effective in stabilizing corneal perforation and thinning in the very short-term. Multiple applications are often required. Maintenance of globe integrity after glue application decreases with time and the need for surgical intervention remains high.
Corneal Biofilm Plaques: A Novel Clinical Presentation
Authors: Córdoba Andrea , Graue-Hernandez Enrique O. , Bermudez-Magner Jose A. , Ramirez-Miranda Arturo , Irusteta Leire , Bautista-de Lucio Victor M. , Ponce-Angulo Diana G. , Bautista-Hernandez Luis A. , Navas Alejandro 
Published: March 2019

Purpose:
To report a novel clinical presentation of corneal biofilms, consisting of formation of superficial and recurrent corneal plaques.

Methods:
Interventional case report. A 9-year-old boy presented with subepithelial, whitish, avascular, and recurrent corneal plaques without any clinical manifestations of active corneal inflammation and/or infection. He had a history of minor ocular trauma; otherwise, his medical history was unremarkable.

Results:
An excisional biopsy was performed under topical anesthesia. Histological analysis identified these plaques as clusters of gram-negative bacilli surrounded by an extracellular matrix. Samples were further evaluated with special stains (calcofluor white, Flamingo fluorescent dye, propidium iodide, and Gomori–Grocott) that demonstrated biofilm structures.

Conclusions:
Corneal plaques are a very rare clinical presentation of corneal biofilms that allow prolonged survival of microorganisms even in the absence of prosthetic material and clinical signs or symptoms of corneal active inflammation and/or infection.
Predictors of Local Recurrence for Eyelid Sebaceous Carcinoma: Questionable Value of Routine Conjunctival Map Biopsies for Detection of Pagetoid Spread
Authors: Sa Ho-Seok , Tetzlaff Michael T. , Esmaeli Bita 
Published: March 2019

Purpose:
To identify clinicopathologic factors associated with local recurrence of eyelid sebaceous carcinoma and determine whether routine conjunctival map biopsies are necessary to detect pagetoid spread.

Methods:
The authors searched PubMed for articles on eyelid sebaceous carcinoma and pagetoid spread published in English during 1982 to 2018, and they reviewed 99 consecutive patients with eyelid sebaceous carcinoma who underwent surgical excision with frozen section control of margins performed by 1 author (BE) during 1999 to 2017.

Results:
Local recurrence rates after surgery were 5% to 25% in the literature and 6% in the authors’ cohort. Risk factors for local recurrence included T3b (>20 mm) or worse disease according to the AJCC Cancer Staging Manual, eighth edition, pagetoid spread, diffuse growth pattern, and multicentric origin. Pagetoid spread was observed in 8.3% to 70% of patients in the literature and 31% of patients in the authors’ cohort. The literature review showed that surgical excision with frozen section control is the mainstay of management of eyelid sebaceous carcinoma, with topical chemotherapy and cryotherapy used in cases with pagetoid spread. The authors found no solid evidence for added value from routine 4-quadrant conjunctival map biopsies, and some studies called into question their accuracy and yield.

Conclusions:
In patients with eyelid sebaceous carcinoma, meticulous microscopic margin control is appropriate in all cases and particularly for tumors >20 mm and adjuvant topical chemotherapy should be considered for tumors with conjunctival pagetoid spread. Routine conjunctival map biopsies are not essential, but targeted map biopsies of areas with signs suggestive of pagetoid intraepithelial spread may be appropriate to guide future closer observation or adjuvant treatments.
Lateral Canthal Clefts of the Eyelid
Authors: Lessa Sergio , Sebastiá Roberto , Pontello Joao 
Published: March 2019

Purpose:
Facial clefts are congenital anomalies classified by Tessier based on their anatomical position. Tessier 8 craniofacial clefts extend from the lateral canthus to the temporal region, including bone cleft at the frontozygomatic suture, and it is characterized by the interposition of a strip of skin at the lateral canthus that disrupts the continuity of the orbicularis muscle, preventing its normal functioning.

Methods:
This is a retrospective study of 6 patients with congenital eyelid coloboma, of whom 5 underwent surgery for the removal of dermolipoma and reconstruction of the lateral canthus. After surgery, the shape and symmetry of the lid fissure was restored, and motility was maintained. Vertical and horizontal measurements of the palpebral fissure were carried out before and after surgery.

Results:
Five cases of lateral colobomas were evaluated after surgical treatment up to a year post operatively. The surgical correction with limited resection of the tumor was very effective, and the resulting small horizontal scar almost disappeared over time. In all cases, motility was maintained, and there were no cases of symblepharon. After surgery, there was improvement in the shape and symmetry of the eyelid fissures.

Conclusions:
Tessier’ Number 8 facial cleft coloboma is characterized by the interposition of a skin strip, constituting a dermolipoma between the upper and lower eyelids that disrupts the continuity of the orbicularis muscle, and lateral bone alteration. The surgical correction of dermolipoma should be performed conservatively with limited resection of the tumor. A simple canthoplasty was very effective, and the small scar practically disappears over time. The absences of bone alteration in the cases presented suggest a unusual variation of lateral canthal cleft.
CO2 Laser Lash Tilt Technique for the Treatment of Mild to Moderate Lash Ptosis and Augmentation of Upper Eyelid Blepharoplasty Results
Authors: Langelier Nicole A. , Liss Jason , Leyngold Ilya M. , Weller Christopher L. , Stinnett Sandra , Woodward Julie A. 
Published: March 2019

Purpose:
To assess the safety, efficacy, and patient satisfaction of a newly described technique for the treatment of mild to moderate lash ptosis performed as augmentation to upper eyelid blepharoplasty.

Methods:
Patient medical records for 27 consecutive cases of upper eyelid blepharoplasty between January 2016 and June 2017 and 19 consecutive cases of upper eyelid blepharoplasty with the laser lash tilt procedure between July 2016 and January 2017 performed by the senior author were retrospectively reviewed. Lash position in preoperative and postoperative photographs was graded in a randomized masked fashion on a 4-point scale by 5 oculoplastic surgeons.

Results:
There was a significant improvement in mean lash position scores for the control group (0.52 ± 0.34, p < 0.001) with mean lash score improving from 1.14 ± 0.46 before surgery to 0.62 ± 0.46 after blepharoplasty alone. There was also significant improvement in mean lash position scores for the laser lash group (0.98 ± 0.52, p < 0.01) with mean lash score improving from 1.66 ± 0.62 before surgery to 0.68 ± 0.50 after blepharoplasty with laser lash treatment. The improvement in lash position seen in the laser lash group was significantly greater than the improvement seen in the control group (p = 0.001). There were no complications and all patients were satisfied with their results.

Conclusions:
Compared with upper eyelid blepharoplasty alone, the addition of the CO2 laser lash tilt technique provides a significant improvement in the upward tilt of the eyelashes as they emerge from the eyelid margin.