bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of mini-fragment plates on the mechanical properties of long-bone plate fixation
Authors: Knox Riley , Curran Patrick , Herfat Safa , Kandemir Utku , Marmor Meir 
Published: April 2019

Abstract

Objective:
Mini-fragment plates (MFPs) are increasingly used in fracture surgery to provide provisional fixation. After definitive fixation, the surgeon decides whether to remove the plates or leave them in place as additional fixation, based on the perceived biomechanical influence of the MFP. However, there are no current biomechanical studies to guide this decision. Therefore, the purpose of this study was to evaluate the influence of MFPs on the four-point bending and torsional stiffness of long bone transverse and simple wedge fracture fixation constructs.

Methods:
Fourth-generation composite bone cylinders were cut to produce transverse (AO-OTA classification 12-A3) and simple wedge (AO-OTA classification 12-B2) fracture models. The specimens were fixed using a low-contact dynamic compression plate (LC-DCP) and MFPs. Specimens were tested in four-point bending and torsion utilizing 3 different MFP orientations.

Results:
No statistically significant differences in bending stiffness were found between control and MFP groups for transverse fracture constructs. MFPs significantly increased the bending stiffness for wedge fracture constructs under certain loading conditions. This increase was observed when MFPs were positioned both orthogonal (85.1% increase, P = .034) and opposite (848.2% increase, P < .001) to the LC-DCP. MFPs significantly increased the torsional stiffness for both transverse and wedge fracture constructs when MFPs were positioned both orthogonal (transverse: 27.7% increase, wedge: 16.7% increase) and opposite (transverse: 28.4%, wedge: 24.2% increase) to the LC-DCP.

Conclusions:
Our results indicate that including MFPs in definitive fixation can increase the bending and torsional stiffness of a long-bone fracture fixation construct. This suggests that the biomechanical influence of MFPs should be considered. However, clinical studies will be required to test the applicability of these findings to the clinical setting.
Medicolegal Investigations in Cases of Double Suicidal Gunshots to the Head Using 2 Different Handguns
Authors: Moreschi Carlo , Da Broi Ugo , Ciccone Leonardo , Stocca Tiziano 
Published: April 2019

AbstractSuicides committed by firing 2 gunshots to the head are rare events and pose a significant challenge for coroners and forensic pathologists. The evaluation of the victim's ability to fire 2 shots simultaneously, or to act after a first gunshot, is crucial for the reconstruction of the death scene and to differentiate between homicide and suicide. We report an unusual case of suicide involving 2 gunshot wounds to the head. The medicolegal investigations hypothesized that the victim had either fired 2 shots near simultaneously or he suffered from rapid incapacitation after the first gunshot but was still able to fire a second consecutive and fatal shot to the head. This article focuses on the diagnostic difficulties involved, together with analysis of the death scene and autopsy findings, in cases where the courts demand confirmation that a double gunshot to the head is in fact a case of suicide.
Expression of Indoleamine 2, 3-dioxygenase 1 (IDO1) and Tryptophanyl-tRNA Synthetase (WARS) in Gastric Cancer Molecular Subtypes
Authors: Lu Shaolei , Wang Li Juan , Lombardo Kara , Kwak Yoonjin , Kim Woo Ho , Resnick Murray B. 
Published: April 2019

Aims:
Developments in genomic pathology have led to novel molecular classification schemes in gastric cancers. Two of these new subtypes, Epstein-Barr virus (EBV)-associated and microsatellite instability-high (MSI-H), are associated with a dominant T-cell–mediated immune response. The roles of the immune modulators, indoleamine 2, 3-dioxygenase 1 (IDO1) and tryptophanyl-tRNA synthetase (WARS), have not been investigated in the context of this classification.

Methods and Results:
Using in situ hybridization and immunohistochemistry we subclassified 421 primary gastric adenocarcinomas into 5 subtypes, EBV-associated, epithelial to mesenchymal transition, MSI-H, p53-aberrant, and p53-wildtype tumors. Tumor-infiltrative lymphocytes were counted and protein expression of IDO1 and WARS was graded on tissue microarrays of these 421 tumors. High tumor-infiltrative lymphocytes as well as high expression of both IDO1 and WARS was found in EBV and MSI-H tumors. The prognostic effects of IDO1 and WARS expression were tumor subtype dependent. Although high expression levels of IDO1 and WARS were associated with poor prognosis in p53-aberrant, p53-wildtype, and all cancers combined, WARS expression was associated with better prognosis in MSI tumors.

Conclusions:
The immunomodulators, IDO1 and WARs, are upregulated and have prognostic significance in EBV-associated and MSI-H tumors. Novel therapies targeting these proteins should be considered in the treatment of these patients.
Examining the Implementation of Play Streets: A Systematic Review of the Grey Literature
Authors: Bridges Christina N. , Prochnow Tyler M. , Wilkins Emily C. , Porter Keshia M. Pollack , Meyer M. Renée Umstattd 
Published: April 2019

Context:
Outdoor play has been described as essential for healthy childhood development. Lack of safety is one barrier to children participating in outdoor play. Play Streets are an intervention to help increase outdoor play by temporarily closing public streets (closures are recurring or episodic) to traffic, creating a safe place for active play.

Objective:
This systematic grey literature review aimed to examine and describe what is known about implementing Play Streets using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, which is widely used in implementation research.

Design:
A systematic search for and review of nonacademic, or grey, literature was conducted using Academic Search Complete, Google Scholar, and a general Google search.

Eligibility Criteria:
Included literature was published in English, through December 2017, in nonacademic sources (ie, organizational/grant/municipal reports, newspapers, conference presentations, previous intervention advertisement materials, Web-based articles) or found in reference lists of academic articles about Play Streets, Pop-up Parks, or Open Streets/Ciclovías with a Play Street component.

Study Selection:
Resources were selected that documented Play Streets, which are defined as recurring or episodic temporary street closures to traffic that provide the public with a no-cost, safe space to actively play and be physically active. These approaches are designed primarily for youth and may include various marked play areas, loose equipment, and/or group activities.

Main Outcome Measures:
RE-AIM measures guided data extraction.

Results:
Of the 36 articles composing the final sample, 100% reported on implementation, although the level of detail varied. Only 14 of 36 articles reported measures of effectiveness; limited information was provided for other RE-AIM components.

Conclusions:
In the grey literature, there are several inconsistencies in how the implementation of Play Streets is reported and level of detail. Specific details regarding implementing and evaluating Play Streets are needed to support widespread replication.
The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up
Authors: Bürker Britta S. , Gullestad Lars , Gude Einar , Havik Odd E. , Relbo Authen Anne , Grov Ingelin , Andreassen Arne K. , Fiane Arnt E. , Haraldsen Ira R. , Dew Mary Amanda , Andersson Stein , Malt Ulrik F. 
Published: April 2019

ABSTRACT

Objective
Current understanding of the prognostic impact of depression on mortality after heart transplantation (HTx) is limited. We examined whether depression after HTx is a predictor of mortality during extended follow-up. Subsequently, we explored whether different symptom dimensions of depression could be identified and whether they were differentially associated with mortality.

Methods
Survival analyses were performed in a sample of 141 HTx recipients assessed for depression, measured by self-report of depressive symptoms (Beck Depression Inventory – version 1A [BDI-1A]), at median 5.0 years after HTx, and followed thereafter for survival status for up to 18.6 years. We used uni- and multivariate Cox proportional hazard models to examine the association of clinically significant depression (BDI-1A total score ≥10), as well as the cognitive-affective and the somatic subscales of the BDI-1A (resulting from principal component analysis) with mortality. In the multivariate analyses, we adjusted for relevant sociodemographic and clinical variables.

Results
Clinically significant depression was a significant predictor of mortality (hazard ratio = 2.088; 95% confidence interval = 1.366–3.192; p = .001). Clinically significant depression also was an independent predictor of mortality in the multivariate analysis (hazard ratio = 1.982; 95% confidence interval = 1.220–3.217; p = .006). The somatic subscale, but not the cognitive-affective subscale, was significantly associated with increased mortality in univariate analyses, whereas neither of the two subscales was an independent predictor of mortality in the multivariate analysis.

Conclusions
Depression measured by self-report after HTx is associated with increased mortality during extended follow-up. Clinical utility and predictive validity of specific depression components require further study.
Neural Processing of Food and Erotic Cues in Bulimia Nervosa
Authors: Delgado-Rodríguez Rafael , Hernández-Rivero Isabel , Fernández-Santaella M. Carmen , Vila Jaime , Guerra Pedro , Miccoli Laura 
Published: April 2019

ABSTRACTObjectiveEvent-related brain potential (ERP) studies have shown that bulimia nervosa (BN) is associated with facilitated processing of disorder-specific stimuli, visible in altered early components during presentation of food cues and bodies varying in size. Less is known about BN and late ERPs, typically less influenced by perceptual features and regarded as more reliable indices of motivational relevance. The purpose of this study was to use the late positive potential (LPP) to investigate the motivational significance of BN-relevant stimuli.MethodsHighly salient stimuli, such as pictures of personal binge foods and images that are pleasant, neutral, and unpleasant (e.g., human attacks) were presented to 24 women with bulimia and 24 healthy women (19.7 ± 2.1 and 20.5 ± 2.6 years, respectively). Pictures of erotic couples, previously shown to prompt the greatest appetitive reactions in healthy women, were used as pleasant cues. Based on BN aversion to body cues, we hypothesized that the motivational significance of erotic cues could be increased in bulimic women.ResultsConsistent with the literature, the LPP was modulated by the salience of the pictures (F(2.8,130.7) = 24.6,p< .001). An additional interaction with diagnostic group (F(2.8,130.7) = 2.8,p= .047) indicated that bulimic women showed a larger LPP than healthy controls during pictures displaying binge foods (p= .037) and erotic couples (p= .031).ConclusionsThe findings provide objective evidence that BN is characterized by dysregulated emotional processing that is not limited to food cues. The implications are discussed within a transdiagnostic perspective on food-related disorders.
Training Surgeons in Gender Confirmation Surgery
Authors: Schechter Loren S. , Schechter Rebecca B. 
Published: April 2019

Abstract
Gender confirmation surgery can be an important component in helping individuals alleviate gender dysphoria. Increased advocacy, awareness, and acceptance of these medically necessary procedures have resulted in a greater demand for such procedures, exceeding the number of qualified surgeons able to perform them. It is recognized that formal training guidelines and fellowship programs are needed so as to assure that surgeons performing these procedures are adequately experienced. Here, the authors discuss a potential framework by which a multidisciplinary training program in gender confirmation surgery can be developed and implemented.
A Craniometric Analysis of the Posterior Cranial Base After Posterior Vault Distraction
Authors: Mazzaferro Daniel M. , ter Maaten Netanja S. , Wes Ari M. , Naran Sanjay , Bartlett Scott P. , Taylor Jesse A. 
Published: April 2019

Background:
Posterior vault distraction osteogenesis (PVDO) has been demonstrated to effectively increase intracranial volume, treat increased intracranial pressure, and improve head shape in syndromic patients. The purpose of this study is to compare changes along the posterior cranial base before and after distraction.

Methods:
A retrospective review was completed of subjects who underwent PVDO with computed tomography scans at 2 time-points: within 3 months preoperatively and 1 to 6 months postoperatively. Using Mimics software, craniometric landmarks were identified and surface area of the foramen magnum was calculated. A comparison of pre- to postoperative measurements was completed using Wilcoxon matched-paired signed rank tests and linear regression.

Results:
A total of 65 PVDO subjects were identified, 12 subjects met inclusion criteria. Mean operative age was 3.0 ± 4.0 years. The cranial vault was distracted on average 25.0 ± 6.0 mm, with those < 12 months of age distracted 29.5 ± 4.9 mm and >12 months of age distracted 22.0 ± 4.9 mm (P = 0.0543). There was a significant increase in pre- to postoperative foramen magnum surface area (52.1 ± 63.2 mm2, P = 0.002), length (0.9 ± 1.4 mm, P = 0.050), and width (0.6 ± 1.0 mm, P = 0.050). Similarly, linear distances between nasion and posterior cranial base landmarks such as foramen magnum (3.4 ± 4.2 mm, P = 0.010), and occipital protuberance (9.1 ± 9.6 mm, P = 0.003) were increased. Subjects under 12 months had a greater percentage increases in posterior vault length than those over 12 months.

Conclusion:
Posterior vault distraction osteogenesis is associated with an increase in size of the foramen magnum, and lengthening of the posterior cranial base, both of which may be beneficial in patients with turribrachycephaly.
Surgical Treatment of Polyostotic Craniomaxillofacial Fibrous Dysplasia Associated With Acromegalia: The McCune – Albright Syndrome
Authors: Franco Jéferson Martins Pereira Lucena , Rêgo Roberto Dias , Gomes George Matos Ferreira , Santos Daniel Facó da Silveira , Santos Eliardo Silveira 
Published: April 2019

Introduction:
The McCune–Albright syndrome (MAS) is a complex congenital disorder caused by the embryonic post-zygotic somatic activating mutations in the GNAS1 gene. In such syndrome, phenotypes are heterogeneous and comprised polyostotic/monostotic fibrous dysplasia, café au lait macules, and hyperfunctioning endocrinopathies as the excess growth hormone. Likewise, acromegaly, as a manifestation of the endocrine hyperfunction, is unusual and affects about 20% of patients with MAS.

Case Presentation:
This research study describes a case of a 31-year-old female subject presenting polyostotic fibrous dysplasia with severe facial involvement, along with acromegaly and the MAS. The case was satisfactorily managed by surgical re-alignment and presented no clinical signs of relapse in a 12-year follow-up period. Finally, a literature review was conducted to discuss the standard protocols and the controversies when treating such cases.

Conclusion:
Patients with craniomaxillofacial fibrous dysplasia associated with acromegaly may present significant facial deformities that can be satisfactorily treated by cosmetic treatment, especially in patients with psychological problems and severe social acceptance.
Cranial Base Superimposition of Cone-Beam Computed Tomography Images: A Voxel-Based Protocol Validation
Authors: Haas Junior Orion Luiz , Guijarro-Martínez Raquel , Sousa Gil Ariane Paredes de , Méndez-Manjón Irene , Valls-Otañón Adaia , de Oliveira Rogério Belle , Hernández-Alfaro Federico 
Published: April 2019

Objectives:
The primary objective of the present study was to find the gold-standard accuracy of voxel-based superimposition of cone-beam computed tomography (CBCT) datasets with a protocol developed for the Dolphin Imaging 3D software. The secondary objectives were to analyze reproducibility and efficiency of this protocol.

Study Design:
Twenty-five CBCT datasets of patients with dental implants present were selected. Each Base Volume dataset was duplicated to create a second volume. Subsequently, both volumes were superimposed with a voxel-based protocol consisting of 3 successive steps “Side-by-side Superimposition”; “Overlay Superimposition”; and “Export Orientation to 2nd Volume”. The protocol's accuracy was evaluated by measuring the mean distance between the apex of each dental implant on the Base Volume and second volume datasets. Efficiency was given by the mean time needed to complete all superimposition steps. Reproducibility was analyzed by calculating the intraclass correlation coefficients.

Results:
Mean time needed to complete the protocol was 198 seconds. The protocol had a rotational accuracy of 0.10° to 019° and a translational accuracy of 0.20 to 0.24 mm. Intra-observer and inter-observer reproducibility were 1 and 0.921 to 1, respectively.

Conclusions:
The protocol is accurate, precise, reproducible, and efficient. The validation of this method enables unbiased analysis of surgical outcomes based on a single, user-friendly software product that is widely available in academic and clinical settings.
Evaluation of the Facial Soft-Tissue Thickness in Patients With Cleft Lip and Palate
Authors: Erdur Emire Aybuke , Baka Zeliha Muge , Fidanboy Merve , Erdur Omer 
Published: April 2019

Aim:
In this study the authors aimed to evaluate craniofacial morphology and facial soft tissue thickness of the patients with cleft lip and palate.(CLP), and to compare the results with a sex and age-matched noncleft healthy control group.

Methods:
Craniofacial and soft tissue thickness measurements of 20 patients with unilateral cleft lip palate (UCLP) and 20 patients with bilateral cleft lip palate (BCLP) were compared with 20 noncleft control subjects. Angles between Sella-Nasion-A point, Sella-Nasion-B point, Nasion-A and Nasion-B line, Sella-Nasion line and Gonion-Gnation line, and linear (glabella, rhinion, subnasale, labrale superius, stomion, labrale inferius, labiomentale, pogonion, and gnathion) measurements were assessed on lateral cephalometric radiographs. Group differences were evaluated with 1-way analysis of variance and post hoc Tukey test.

Results:
Unilateral cleft lip palate and BCLP groups demonstrated lower values of skeletal measurements than control group except for Sella-Nasion line and Gonion-Gnation line value (P < 0.01). Maxillary incisors were retruded in BCLP group compared with the other groups (P < 0.001). Thickness of the rhinion, subnasale, and stomion demonstrated no significant difference between UCLP and BCLP groups (P > 0.05). Thickness of rhinion and stomion was found significantly higher in both groups, and thickness of the subnasale was found significantly lower than the healthy group (P < 0.05).

Conclusion:
Findings of the study suggested that patients with CLP showed differences on craniofacial morphology and facial soft tissue thickness. Before planning orthodontic treatment and esthetic surgeries, soft tissue thickness should be taken into consideration in addition to skeletal measurements in CLP patients.
Unusual Presentation of a Large Multilocular Second Branchial Cleft Cyst
Authors: Al Sukhun Jehad , El Naggar Mohamad 
Published: April 2019

Abstract
Second branchial cleft cysts (BCCs) are the most common type of branchial abnormalities and usually found high in the neck. Oropharyngeal presence of a BCC is very rare. The authors report a rare case of oropharyngeal, second branchial, multilocular, cleft cyst in a 9-year-old child (8.0 × 5.0 cm in maximum diameter). The cyst was removed completely via extra/intraoral approach and did not have tract-like structure. The anatomic location together with the histopathology results, which showed a squamous epithelium-lined cystic wall with lymphoid aggregation, were characteristic findings of a BCC. Patient was discharged without any complication, and a regular follow-up of 6 months showed no evidence of recurrency. Having reviewed the literature, it seems to be that this is the first case to be reported of a multilocular BCC, excised of this size, from the oropharyngeal area in a child. Other pathological lumps of the neck have similar presentation with BCC, which makes it difficult, sometimes, to reach an accurate diagnosis. Clinicians should be aware of this pathology because it can be easily misdiagnosed as an odontogenic cyst and/or salivary gland infection, especially if it develops high up in the neck.
Retrieval of Gallbladder Via Umbilical Versus Epigastric Port Site During Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Clark Matthew C. , Barratt Owain A. , Taktak Samih , Subar Daren , Henley Natasha 
Published: April 2019

Objective:
The objective of this study was to evaluate the comparative efficacy of gallbladder retrieval via the epigastric and umbilical port during laparoscopic cholecystectomy.

Methods:
We systematically searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, ISRCTN Register, and bibliographic reference lists. Postoperative pain intensity, port-site infection, hernia, bleeding, and retrieval time were outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models.

Results:
We identified 5 randomized controlled trials and 1 prospective cohort study reporting a total of 2394 patients who underwent laparoscopic cholecystectomy with retrieval of the gallbladder via the umbilical port (n=1194) or epigastric port (n=1200). Our initial analysis demonstrated that gallbladder retrieval via the umbilical port was associated with a nonsignificant reduction in pain assessed by visual analogue scale at 24 hours [mean difference (MD): −0.49, 95% confidence interval (CI): −1.06 to 0.08, P=0.09] compared with the epigastric port. However, after sensitivity analysis and eliminating the source of heterogeneity, it reached statistical significance (MD: −0.66, 95% CI: −0.85 to −0.48, P<0.00001). Moreover, gallbladder retrieval via the umbilical port was associated with significantly shorter retrieval time (MD: −1.83, 95% CI: −3.18 to −0.49, P=0.008) but similar risk of port-site infection (odds ratio: 1.99, 95% CI: 0.53-7.44, P=0.31) and hernia (odds ratio: 0.33, 95% CI: 0.03-3.20, P=0.34).

Conclusions:
Our analysis demonstrated that retrieval of the gallbladder via the umbilical port may be associated with less postoperative pain in patients undergoing laparoscopic cholecystectomy compared with epigastric port retrieval. It may also be associated with shorter gallbladder retrieval time. However, the available evidence is limited.