bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three-Dimensional Virtual Treatment Planning: Presurgical Evaluation
Authors: Farronato Giampietro , Galbiati Guido , Esposito Luca , Mortellaro Carmen , Zanoni Federica , Maspero Cinzia 
Published: March 2018

Objective:
This article describes a virtual protocol designed to optimize surgical orthodontic diagnosis and treatment plan.

Methods:
A total of 15 patients undergoing orthodontic-surgical treatment have been analyzed with a presurgical virtual three-dimensional (3D) treatment planning, which involves 9 steps. All the patients have been treated with the use of occlusal splint guides projected on the basis of the surgical and orthodontic visualized treatment objective .

Results:
In all the analyzed patients, a precise and optimal orthodontic presurgical preparation has been obtained.

Conclusions:
The 3D analysis seems more precise to interpret than two-dimensional; it provides information and images of craniofacial structures free from perspective distortion and it reduces the steps of the presurgical diagnosis. The simplicity of the protocol described in this paper makes possible to apply it in everyday practice.
The study described here allows high-precision planning of orthodontic-surgical therapy and optimization of each treatment phase, with consequent advantages in clinical practice: a more accurate orthognathic surgery with predictable results.
Anatomical Study of the Zygomaticofacial Foramen and Its Related Canal
Authors: Iwanaga Joe , Badaloni Filippo , Watanabe Koichi , Yamaki Koh-ichi , Oskouian Rod J. , Tubbs R. Shane 
Published: March 2018

Abstract
The zygomaticofacial branch (ZFb) of the zygomatic nerve passes through the lateral wall of the orbit anterolaterally and traverses the zygomaticofacial foramen (ZFFOUT). However, in terms of intraorbital course, only a few studies have focused on the orbital opening of the ZFb (ZFFIN) and related canal. Therefore, this study aimed to locate the orbital opening and exit of the ZFb of the zygomatic nerve. Twenty sides from 10 fresh frozen cadaveric Caucasian heads were used in this study. The vertical distance between inferior margin of the orbit and ZFFIN (V-ZFFIN), the horizontal distance between the lateral margin of the orbit and ZFFIN (H-ZFFIN), diameter of the ZFFIN (D-ZFFIN), the vertical distance between the inferior margin of the orbit and ZFFOUT (V-ZFFOUT), the horizontal distance between the lateral margin of the orbit and ZFFOUT (H-ZFFOUT), and the diameter of the ZFFOUT (D-ZFFOUT) were measured, respectively. The ZFFIN were located 5.1 ± 2.0 mm superior to the inferior margin of the orbit and 4.3 ± 1.6 mm medial to the lateral margin of the orbit. The ZFFOUT was located 1.2 ± 2.9 mm inferior to the inferior margin of the orbit and 1.1 ± 3.0 mm lateral to the lateral margin of the orbit. The diameter of the ZFFOUT was significantly larger than that of the ZFFIN. Additional knowledge of the zygomatic nerve and its branches might decrease patient morbidity following invasive procedures around the inferolateral orbit.
Does a Vascularized Fibula Free Bone Grafted Immediately After Hemimandibulectomy in a Child Grow or Relapse During Adolescence?
Authors: Okuyama Kohei , Yamashiro Masashi , Kaida Atsushi , Kawamata Aya , Mizutani Miho , Michi Yasuyuki , Uzawa Narikazu , Yano Tomoyuki , Tohyama Rei , Yamaguchi Satoshi 
Published: March 2018

Abstract
For young growing children before the end of skeletal maturity, the growth activity of the grafted bone after hemimandibulectomy is not well-known. After an adolescence, such a patient may have facial deformity because the anterior growth point of the mandible is in the condylar neck. A 13-year-old boy was performed hemimandibulectomy with immediate mandibular reconstruction by fibula free flap (FFF) because of a huge ameloblastic fibroma. The authors evaluated the length of FFF on the images of computed tomography (CT) at 5 and 60 months after the operation and compared them by calculating growth rates. Five years after surgery, his facial appearance was symmetry and mandibular function was satisfaction. Although the mandibular bone in the contralateral side grew during 5-year follow-up, the vascularized FFF grafted in the child patient did not significantly grow. Moreover, spontaneous regeneration (SR) and the gradual osteosclerosis were confirmed on the left distal edge of the FFF on the CT imaging. The arrival of SR at the left distal edge of the FFF was considered a part of the reason to compensate the unchanging growth rate of the grafted FFF and contribute for the postoperative good functional and esthetic results.
Long-Term Outcomes of Acellular Dermal Allograft as a Tarsal Substitute in the Reconstruction of Extensive Eyelid Defects
Authors: Vahdani Kaveh , Siapno Debrelle Lou , Lee Jung Hye , Woo Kyung In , Kim Yoon-Duck 
Published: March 2018

Purpose:
To report the long-term outcomes of using acellular dermal allograft (ADA) as a tarsal substitute for reconstruction of large full-thickness eyelid defects where ipsilateral or contralateral eyelid donor tissue was either not available or tarsoconjunctival transfer was insufficient to cover the full extent of the defect.

Methods:
A retrospective review of a consecutive series of 10 patients between May 2003 and April 2012. Main outcome measures were anatomical and functional outcomes and complications.

Results:
The study cohort included 4 males and 6 females with a mean age of 48.1 years (range 31–64 years). Indications for reconstruction were extensive full-thickness eyelid defects (upper or lower or both) resulting from tumor excision (n = 6), traumatic eyelid defect (n = 2), electrical burn (n = 1), and eyelid necrosis (n = 1). The mean postoperative follow-up was 84.3 months (range 33–164 months). The reconstructive procedure included a variety of techniques using ADA as the posterior lamellar graft. Overall, 7 patients achieved excellent anatomical, cosmetic, and functional results. Reoperation was required in 3 patients (for postoperative upper lid retraction, upper lid entropion, and lower fornix reconstruction) despite acceptable initial results. There were no intraoperative complications, postoperative allergic or immunologic rejection associated with the use of allograft, nor any long-term sequelae.

Conclusion:
The extensive upper and lower eyelid defects with large vertical component can be successfully repaired using ADA as a tarsal substitute. The results of our study with long-term follow-up indicate excellent functional and cosmetic outcomes with minimal morbidity.
Determining the Patient-Specific Optimum Osteotomy Line for Severe Mandibular Retrognathia Patients
Authors: Şensoy Abdullah Tahir , Kaymaz Irfan , Ertaş Ümit , Kiki Ali 
Published: March 2018

Purpose:
The purpose of this study is to suggest a patient-specific osteotomy line to optimize the distractor position and thus to minimize the disadvantages of conventional mandibular distraction osteogenesis (MDO) protocols. In addition, this study also aims to compare the conventional MDO protocols with the new MDO protocol proposed in this study in terms of both orthodontic outcomes and mechanical effects of osteotomy level on callus stabilization by means of the finite element method.

Methods:
A preoperative patient-specific 3-dimensional bone model was created and segmented by using computed tomography images of an individual patient. Virtual orthodontic set-up was applied to the segmented model prior to the virtual surgery. In order to compare the proposed osteotomy line with the conventional lines used in clinical applications, virtual surgery simulations were performed and callus tissues were modelled for each scenario. The comparison of the success of each osteotomy line was carried out based on the occlusion of the teeth.

Results:
The osteotomy line determined using the method proposed in this study has resulted in far less malocclusion than the conventional method. Namely, any angular deviation from the optimum osteotomy line determined in this study might result in deep-bite or open-bite. On the other hand, the finite element analysis results have indicated that this deviation also negatively affects the callus stability.

Conclusion:
In order to achieve a better MDO treatment in terms of occlusion of the teeth and the callus stability, the location of the osteotomy line and the distractor position can be computationally determined. The results suggest that MDO protocol developed in this study might be used in clinic to achieve a better outcome from the MDO treatment.
Craniometric Analysis of Frontal Cranial Morphology Following Posterior Vault Distraction
Authors: ter Maaten Netanja S. , Mazzaferro Daniel M. , Wes Ari M. , Naran Sanjay , Bartlett Scott P. , Taylor Jesse A. 
Published: March 2018

Background:
Posterior vault distraction osteogenesis (PVDO) is believed to improve frontal contour in infants with syndromic craniosynostosis and turribrachycephaly. This study provides an objective craniometric analysis to determine how PVDO affects anterior cranial morphology.

Methods:
A retrospective chart review of patients who underwent PVDO was performed. Inclusion criteria included pre- and postoperative computed tomography (CT) scans within 3 months before surgery and another 1 to 6 months after device removal. Volumetric and craniometric data were derived using Mimics software and compared using paired t-test and Wilcoxon rank-sum test.

Results:
About 65 patients underwent PVDO, and 13 patients met inclusion criteria. Mean age at intervention was 3.4 ± 4.2 years. Total cranial volume increased 249 ± 159 cm3 in all patients (P = 0.0001) and 380 ± 128 cm3 in patients younger than 1 year of age (n = 6, P =0 .0008). Supraorbital retrusion decreased from 5.44 ± 3.89 to 4.54 ± 3.91 mm postoperatively (P = 0.0004), decreasing significantly in patients without previous frontal surgery and not in those with previous frontal surgery (P = 0.2115; comparison P = 0.0047). Basofrontal angle decreased by 2.92 ± 2.16 degrees (P = 0.0004) with a greater decrease of 3.33±2.68 degrees in those younger than 12 months (P = 0.0289) and 2.58±1.74 degrees in those older (P = 0.0079). No change was found in anterior cranial height and anterofrontal angle (P > 0.05).

Conclusion:
PVDO improves frontal contour by decreasing supraorbital retrusion and reducing frontal bossing in syndromic craniosynostosis patients with turribrachycephaly. When combined with its demonstrated efficacy for cranial expansion, these frontal changes likely reinforce PVDO's ability to influence the timing of, and to a degree, the need for frontal surgery in this group.
The Association Between the Neutrophil-to-Lymphocyte Ratio and Mortality in Patients With Acute Respiratory Distress Syndrome: A Retrospective Cohort Study
Authors: Li Weijing , Ai Xiaolin , Ni Yuenan , Ye Zengpanpan , Liang Zongan 
Published: March 2018

ABSTRACT

Purpose:
Systemic inflammation relates to the initiation and progression of acute respiratory distress syndrome (ARDS). As neutrophil-to-lymphocyte ratio (NLR) has been shown to be a prognostic inflammatory biomarker in various diseases, in this study, we sought to explore whether NLR is a prognostic factor in patients with ARDS.

Methods:
A retrospective study was performed on patients diagnosed as ARDS admitted to the intensive care unit (ICU). We calculated the NLR by dividing the neutrophil count by the lymphocyte count and categorized patients into four groups based on quartile of NLR values. The association of NLR quartiles and 28-day mortality was assessed using multivariable Cox regression. Secondary outcomes included ICU mortality and hospital mortality.

Results:
A total of 224 patients were included in the final analysis. The median (interquartile range) NLRs from first quartile to fourth quartile were as follows: 6.88 (4.61–7.94), 13.06 (11.35–14.89), 20.99 (19.09–23.19), and 39.39 (32.63–50.15), respectively. The 28-day mortalities for the same groups were as follows: 10.7%, 19.6%, 41.4%, and 53.6% (P < 0.001). Cox regression analysis showed NLR was a significant risk factor predicting 28-day mortality (first quartile, reference group; second quartile, adjusted hazard ratio [HR]= 1.674, 95% confidence interval [CI], 0.462–6.063, P = 0.432; third quartile, HR = 5.075, 95% CI, 1.554–16.576, P = 0.007; fourth quartile, HR = 5.815, 95% CI, 1.824–18.533, P = 0.003). Similar trends were observed for ICU mortality and hospital mortality.

Conclusions:
High NLR was associated with the poor outcome in critically ill patients with ARDS. The NLR therefore seems to be a prognostic biomarker of outcomes in critically ill patients with ARDS. Further investigation is required to validate this relationship with data collected prospectively.
Antibiotic-induced Disruption of Intestinal Microbiota Contributes to Failure of Vertical Sleeve Gastrectomy
Authors: Jahansouz Cyrus , Staley Christopher , Kizy Scott , Xu Hongliang , Hertzel Ann V. , Coryell Jessi , Singroy Stephanie , Hamilton Matthew , DuRand Meri , Bernlohr David A. , Sadowsky Michael J. , Khoruts Alexander , Ikramuddin Sayeed 
Published: March 2018

Objective:
The aim of this study was to test whether the perioperative composition of intestinal microbiota can contribute to variable outcomes following vertical sleeve gastrectomy (VSG).

Summary of Background Data:
Although bariatric surgery is the most effective treatment for obesity, metabolic outcomes are variable.

Methods:
Diet-induced obese mice were randomized to VSG or sham surgery, with or without exposure to antibiotics that selectively suppress mainly gram-positive (fidaxomicin, streptomycin) or gram-negative (ceftriaxone) bacteria on postoperative days (POD) 1-4. Fecal microbiota was characterized before surgery and on POD 7 and 28. Mice were metabolically characterized on POD 30-32 and euthanized on POD 35.

Results:
VSG resulted in weight loss and shifts in the intestinal microbiota composition relative to sham-operated mice. Antibiotic exposure resulted in sustained reductions in alpha (within-sample) diversity of microbiota and shifts in its composition. All antibiotic treatments proved to be detrimental to metabolic VSG outcomes, regardless of antimicrobial specificity of antibiotics. These effects involved functionally distinct pathways. Specifically, fidaxomicin and streptomycin markedly altered hepatic bile acid signaling and lipid metabolism, while ceftriaxone resulted in greater reduction of key antimicrobial peptides. However, VSG mice exposed to antibiotics, regardless of their specificity, had significantly increased subcutaneous adiposity and impaired glucose homeostasis without changes in food intake relative to control VSG mice.

Conclusion:
Dysbiosis induced by brief perioperative antibiotic exposure attenuates weight loss and metabolic improvement following VSG. Potential mechanisms include disruption of bile acid homeostasis and reduction in the production of gut antimicrobial peptides. Results of this study implicate the intestinal microbiota as an important contributor to metabolic homeostasis and a potentially modifiable target influencing clinical outcomes following VSG.
Mortality of the Severely Obese
Authors: Moussa Osama M. , Erridge Simon , Chidambaram Swathikan , Ziprin Paul , Darzi Ara , Purkayastha Sanjay 
Published: March 2018

Objective:
This study aimed to analyze the Clinical Practice Research Datalink to identify the prognostic factors of all-cause mortality in the severely obese.

Background:
Patients who are severely obese [body mass index (BMI) ≥35 kg/m2] are at increased risk of all-cause mortality as a result of metabolic sequelae including hyperlipidemia, hypertension, and diabetes. Bariatric surgery has been shown to reduce the severity of the metabolic complications of obesity.

Method:
A case-controlled analysis was carried out of patients with a BMI of 35 kg/m2 or more from the Clinical Practice Research Datalink, a UK database of primary care clinics. Clinicopathological characteristics at baseline diagnosis were extracted. Cases of all-cause mortality were identified as a clinical endpoint. A Cox proportional hazard model was used to calculate hazard ratios (HRs) for different patient factors. A P value less than 0.050 was defined as significant.

Results:
A total of 187,061 records were identified for analysis. Median follow-up time was 98.0 months (range: 3.0–1095.0). A total of 8655(4.6%) were identified as having died during the study period. The median time from baseline obesity diagnosis until death was 137.0 months (range: 3.0–628.7). Multivariate analysis found bariatric surgery to be associated with reduced risk of all-cause mortality (HR: 0.487; P < 0.001). The following were associated with increased risk of death: male sex (HR: 1.805; P < 0.001), BMI of 60 or greater (HR: 2.541; P < 0.001), hypertension (HR: 2.108; P < 0.001), diabetes (HR: 2.766; P < 0.001), and hyperlipidemia (HR: 1.641; P < 0.001).

Conclusions:
Factors such as high BMI, diabetes, hyperlipidemia, and hypertension at first diagnosis of severe obesity were each independently associated with an increased risk of death. Bariatric surgery was shown to be associated with reduced risk of all-cause mortality. Improving access to bariatric surgery and public health campaigns can improve the prognosis of severely obese patients.
The combined utility of extended focused assessment with sonography for trauma and chest x-ray in blunt thoracic trauma
Authors: Schellenberg Morgan , Inaba Kenji , Bardes James M. , Orozco Nicholas , Chen Jessica , Park Caroline , Kang Tarina , Demetriades Demetrios 
Published: March 2018

BACKGROUND
Portable chest x-ray (CXR) and extended focused assessment with sonography for trauma (EFAST) screen patients for thoracic injury in the trauma bay. It is unclear if one test alone is sufficient, if both are required, or if the two investigations are complementary. Study objectives were to define the combined diagnostic yield of EFAST and CXR among stable blunt thoracic trauma patients and to determine if a normal EFAST and CXR might obviate the need for computed tomography (CT) scan of the chest.

METHODS
All blunt trauma patients 15 years or older presenting to LAC+USC Medical Center in 2016 were screened. Only patients who underwent CT thorax were included. Patients were excluded if they presented more than 24 hours after injury, were transferred, or if they did not undergo EFAST and CXR. Demographics, physical examination (PEx) of the thorax, injury data, investigations, procedures, and outcomes were collected. The EFAST, CXR, and PEx findings were compared to the gold standard CT thorax to calculate the diagnostic yield of each investigation and combinations thereof in the assessment for clinically significant thoracic injury.

RESULTS
One thousand three hundred eleven patients met inclusion/exclusion criteria. Most common mechanisms of injury were motor vehicle collision (n = 385, 29%) and auto versus pedestrian trauma (n = 379, 29%). Mean Injury Severity Score was 11 (1–75), with mean Abbreviated Injury Scale chest score of 1.6 (1–6). The sensitivities of EFAST, CXR, and PEx, either individually or in combination, were less than 0.73 in the detection of clinically significant thoracic injury. The most common missed clinically significant injuries were sternal fractures, scapular fractures, clavicular fractures, and pneumothoraces. Motorcycle collisions and auto versus pedestrian traumas resulted in the highest rates of missed injury.

CONCLUSION
Even in conjunction with the physical examination, the sensitivity of EFAST+CXR in the detection of clinically significant thoracic injury is low. Therefore, if clinical suspicion for injury exists after blunt thoracic trauma, a normal EFAST+CXR is insufficient to exclude injury and CT scan of the chest should be performed.

LEVEL OF EVIDENCE
Diagnostic tests/criteria, level III.
Shock volume: Patient-specific cumulative hypoperfusion predicts organ dysfunction in a prospective cohort of multiply injured patients
Authors: McKinley Todd O. , McCarroll Tyler , Metzger Cameron , Zarzaur Ben L. , Savage Stephanie A. , Bell Teresa M. , Gaski Greg E. 
Published: March 2018

BACKGROUND
Multiply injured patients are at risk of developing hemorrhagic shock and organ dysfunction. We determined how cumulative hypoperfusion predicted organ dysfunction by integrating serial Shock Index measurements.

METHODS
In this study, we calculated shock volume (SHVL) which is a patient-specific index that quantifies cumulative hypoperfusion by integrating abnormally elevated Shock Index (heart rate/systolic blood pressure ≥ 0.9) values acutely after injury. Shock volume was calculated at three hours (3 hr), six hours (6 hr), and twenty-four hours (24 hr) after injury. Organ dysfunction was quantified using Marshall Organ Dysfunction Scores averaged from days 2 through 5 after injury (aMODSD2-D5). Logistic regression was used to determine correspondence of 3hrSHVL, 6hrSHVL, and 24hrSHVL to organ dysfunction. We compared correspondence of SHVL to organ dysfunction with traditional indices of shock including the initial base deficit (BD) and the lowest pH measurement made in the first 24 hr after injury (minimum pH).

RESULTS
SHVL at all three time intervals demonstrated higher correspondence to organ dysfunction (R
2 = 0.48 to 0.52) compared to initial BD (R
2 = 0.32) and minimum pH (R
2 = 0.32). Additionally, we compared predictive capabilities of SHVL, initial BD and minimum pH to identify patients at risk of developing high-magnitude organ dysfunction by constructing receiver operator characteristic curves. SHVL at six hours and 24 hours had higher area under the curve compared to initial BD and minimum pH.

CONCLUSION
SHVL is a non-invasive metric that can predict anticipated organ dysfunction and identify patients at risk for high-magnitude organ dysfunction after injury.

LEVEL OF EVIDENCE
Prognostic study, level III.
The design of an adaptive clinical trial to evaluate the efficacy of platelets stored at low temperature in surgical patients
Authors: Krachey Elizabeth , Viele Kert , Spinella Philip C. , Steiner Marie E. , Zantek Nicole D. , Lewis Roger J. 
Published: March 2018

BACKGROUND
Storage of platelets at 4°C compared with 22°C may increase both hemostatic activity and storage duration; however, the maximum duration of cold storage is unknown. We report the design of an innovative, prospective, randomized, Bayesian adaptive, “duration finding” clinical trial to evaluate the efficacy and maximum duration of storage of platelets at 4°C.

METHODS
Patients undergoing cardiac surgery and requiring platelet transfusions will be enrolled. Patients will be randomized to receive platelets stored at 22°C up to 5 days or platelets stored at 4°C up to 5 days, 10 days, or 15 days. Longer durations of cold storage will only be used if shorter durations at 4°C appear noninferior to standard storage, based on a four-level clinical hemostatic efficacy score with a NIM of a half level. A Bayesian linear model is used to estimate the hemostatic efficacy of platelet transfusions based on the actual duration of storage at 4°C.

RESULTS
The type I error rate, if platelets stored at 4°C are inferior, is 0.0247 with an 82% probability of early stopping for futility. With a maximum sample size of 1,500, the adaptive trial design has a power of over 90% to detect noninferiority and a high probability of correctly identifying the maximum duration of storage at 4°C that is noninferior to 22°C.

CONCLUSION
An adaptive, duration-finding trial design will generate Level I evidence and allow the determination of the maximum duration platelet storage at 4°C that is noninferior to standard storage at 22°C, with respect to hemostatic efficacy. The adaptive trial design helps to ensure that longer cold storage durations are only explored once substantial supportive data are available for the shorter duration(s) and that the trial stops early if continuation is likely to be futile.