bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unplanned Emergency Department Visits within 30 Days of Mastectomy and Breast Reconstruction
Authors: Nasser Jacob S. , Huetteman Helen E. , Chung Ting-Ting , Chung Kevin C. 
Published: September 2018

Background:
Unplanned emergency department visits are often overlooked as an indicator of care quality. The authors’ objectives were to (1) determine the rate of 30-day emergency department visits following mastectomy with or without immediate reconstruction, (2) perform a risk analysis of potential factors associated with emergency department return, and (3) assess for potentially preventable visits with a focus on returns for pain.

Methods:
Using the Healthcare Cost and Utilization Project data, the authors identified adult women who underwent mastectomy with or without reconstruction. Multivariable logistic regression was performed to evaluate risk of unplanned emergency department visits. The authors identified and sorted diagnostic codes to investigate why patients were seeking emergency department care. In addition, the authors performed a subgroup analysis on patients returning with a pain-related diagnosis to evaluate risk.

Results:
Of 159,275 cases of mastectomy with or without immediate reconstruction, 4917 (3.1 percent) experienced an unplanned return to the emergency department within 30 days of operation. A substantial proportion of those who returned (23 percent) presented with a pain-related diagnosis. Only 0.9 percent of cases with a 30-day emergency department return were readmitted.

Conclusions:
Numerous patients return to the emergency department within 30 days of mastectomy with or without immediate reconstruction. There is a need for policy makers and physicians to implement strategies to reduce discretionary emergency department use, specifically among younger or publicly insured patients. Combining unplanned emergency department visits with readmission rates as a care quality indicator warrants consideration.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
The Relationship between Bone Remodeling and the Clockwise Rotation of the Facial Skeleton: A Computed Tomographic Imaging–Based Evaluation
Authors: Cotofana Sebastian , Gotkin Robert H. , Morozov Sergey P. , Kim Stanislav Y. , Gombolevskiy Victor A. , Laipan Albina S. , Pyatnitskiy Ilya A. , Movsisyan Tigran V. , Frank Konstantin 
Published: September 2018

Background:
Information on the onset and gender differences of midfacial skeletal changes, including the complete understanding of the theory behind the clockwise rotational theory, remains elusive.

Methods:
One hundred fifty-seven Caucasian individuals (10 men and 10 women aged 20 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, 70 to 79 years, and 80 to 89 years, and eight men and nine women aged 90 to 98 years) were investigated. Multiplanar computed tomographic scans with standardized angle and distance measurements in all three anatomical axes and in alignment to the sella-nasion (horizontal) line were conducted.

Results:
Both men and women displayed an increase in orbital floor angle (p < 0.001, maximum at 60 to 69 years), decrease in maxillary angle (p = 0.035, 40 to 49 years), increase in palate angle (p < 0.001, 50 to 59 years), increase in vomer angle (p = 0.022, 30 to 39 years), but a decrease in the pterygoid angle (p = 0.002, 80 to 89 years). Orbital width decreased (p < 0.001, 60 to 69 years), pyriform aperture width increased (p = 0.015, 60 to 69 years), and midfacial height decreased with aging (p < 0.001, 60 to 69 years).

Conclusions:
Age-related changes of the midfacial skeleton occurred independently of gender, but at various time points in different locations. The observed changes seem to be driven by a bone resorption center located in the posterior maxilla, rather than by a rotational movement of the facial skeleton.
Implant Testing and the “Strain Energy” Concept
Authors: Caplin David A. 
Published: September 2018

Summary:
Benchtop performance test methodologies differ between manufacturers as regulatory agencies often leave the interpretation of testing standards up to manufacturer discretion, resulting in an inability to directly compare implants across manufacturers. Furthermore, traditional benchtop test methodologies focus on mechanical performance standards to address objective endpoints such as shell strength. However, other more difficult to define clinical performance requirements such as softness and natural feel are often difficult to measure via these methods. This review aims to discuss the evolution of breast implant testing standards, discuss the discrepancies in benchtop characterizations of implants, and highlight one manufacturer’s novel approach to utilizing benchtop methodologies to quantify previously subjective endpoints such as firmness and natural feel and define their clinical relevance.
Reporting Time Horizons in Randomized Controlled Trials in Plastic Surgery: A Systematic Review
Authors: Mowakket Sadek , Karpinski Marta , Gallo Lucas , Gallo Matteo , Banfield Laura , Murphy Jessica , Waltho Daniel , Copeland Andrea , Moltaji Syena , Thoma Achilleas 
Published: September 2018

Background:
Current guidelines for randomized controlled trial reporting do not require authors to justify their choice of time horizon. This is concerning, as the time horizon when an outcome is assessed has important implications for the interpretation of study results, and resources allocated to an investigation. Therefore, this study seeks to examine the standards of time horizon reporting in the plastic surgery literature.

Methods:
This is a systematic review of plastic surgery randomized controlled trials published within the past 4 years. The MEDLINE database was searched to yield relevant studies. All studies included were English language, prospective, nonpharmaceutical randomized controlled trials, comparing two plastic surgical interventions. Studies were classified into plastic surgery domains, and information regarding study population, time horizon reporting, and justification of chosen time horizon, was extracted.

Results:
The search retrieved 720 articles, of which 103 were eligible for inclusion. Time horizons were reported as either a standardized time point at which all patients were assessed, or a follow-up duration range, or were not reported at all. Although most studies (85.4 percent) reported a standardized time horizon, the majority (85.4 percent) failed to provide a valid justification to support their selection of time horizon.

Conclusions:
Clinical investigators failed to justify their choice of time horizon in the majority of published randomized controlled trials. To limit heterogeneity, time horizons for given interventions should be standardized to improve validity of outcome assessments, enable future pooling of results, and increase research efficiency.
The Fibula Osteoseptocutaneous Flap: Concise Review, Goal-Oriented Surgical Technique, and Tips and Tricks
Authors: AL Deek Nidal F. , Kao Huang-Kai , Wei Fu-Chan 
Published: September 2018

Summary:
The fibula osteoseptocutaneous flap is a workhorse flap for bone reconstruction. Mastery of the flap is essential for a rewarding reconstruction. However, there is no complete work on this versatile flap. The authors provide a concise review of the literature, address the myths and challenges associated with the flap, and describe their refined techniques for different reconstruction scenarios and possible anatomical variations.
Using Lean Six Sigma to Improve Delayed Intracranial Hemorrhage Screening in a Geriatric Trauma Population
Authors: Birmingham Lauren E. , Sedorovich Ashley , Mann Nolan , George Richard L. 
Published: September 2018

Purpose:
Geriatric trauma patients taking preinjury anticoagulant or antiplatelet (ACAP) medications are at greater risk for delayed intracranial hemorrhage (DICH), a rare but potentially life-threatening condition. Routine repeat head computed tomography (RRHCT) scans can identify DICH. Our objective was to decrease the rate of missed RRHCT in a level 1 Midwest trauma center geriatric minor trauma population on preinjury ACAP medications.

Objective:
The objective of the quality improvement project was to identify the root cause of the missed RRHCTs and to implement a comprehensive solution to reduce rates of missed RRHCTs.

Methods:
Medical records from before and after the intervention were evaluated. Frequencies and percentages were calculated. In addition, χ2 and logistic regression were utilized. The Lean Six Sigma (LSS) DMAIC (Define, Measure, Analyze, Improve, and Control) process was used to drive process improvement.

Results:
At baseline, 15% (41 of 267) of RRHCTs were missed. After solution implementation, missed RRHCTs dropped to 4% (2 of 50). Of the 2 that were missed, zero were clinically inappropriate misses, making the postimplementation rate effectively 0%.

Conclusion:
The LSS DMAIC process helped health care professional to facilitate improved adherence to the department's practice guideline with respect to RRHCT. Adherence with this guideline can help providers identify patients with DICH, a potentially life-threatening condition.
The Relationships Between Use of Quality-of-Care Feedback Reports on Chronic Diseases and Medical Engagement in General Practice
Authors: Ahnfeldt-Mollerup Peder , Søndergaard Jens , Barwell Fred , Mazelan Patti M. , Spurgeon Peter , Kristensen Troels 
Published: September 2018

Background:
There is a limited knowledge on how medical engagement influences quality of care provided in primary care. The extent of the use of feedback reports from a national quality-of-care database can be considered as a measure of process quality. This study explores relationships between the use of feedback reports and medical engagement among general practitioners, general practitioner demographics, clinic characteristics, and services.

Methods:
A cross-sectional combined questionnaire and register study in a sample of 352 single-handed general practitioners in 2013. Logistic regression analysis was used to explore associations between the use of feedback reports for diabetes and chronic obstructive pulmonary disease and medical engagement.

Results:
For both diabetes and chronic obstructive pulmonary disease, a higher degree of medical engagement was associated with an increased use of feedback reports. Furthermore, we identified positive associations between using feedback reports and general practitioner services (spirometry, influenza vaccinations, performing annual reviews for patients with chronic diseases) and a negative association between usage of quality-of-care feedback reports and the number of consultations per patient.

Conclusion:
Using feedback reports for chronic diseases in general practice was positively associated with medical engagement and also with the provision of services in general practice.
Preoperative Evaluation of Pancreatic Fibrosis and Lipomatosis
Authors: Schawkat Khoschy , Eshmuminov Dilmurodjon , Lenggenhager Daniela , Endhardt Katharina , Vrugt Bart , Boss Andreas , Petrowsky Henrik , Clavien Pierre-Alain , Reiner Caecilia S. 
Published: September 2018

Objectives
The purpose of this study was to evaluate the diagnostic performance of magnetization transfer (MT) imaging and multigradient echo magnetic resonance imaging (MRI) to quantify pancreatic fibrosis and lipomatosis in patients before pancreatoduodenectomy for postoperative risk stratification with histopathology as the reference standard.

Materials and Methods
Twenty-four patients (age, 68 ± 8 years, 16 males) prospectively underwent quantitative MT imaging using a 2-dimensional gradient echo sequence with and without MT prepulse and multigradient echo imaging on a 3 T MRI 1 day before pancreatoduodenectomy due to adenocarcinoma of the pancreatic head region (n = 20), neuroendocrine tumor (n = 3), or intraductal papillary mucinous neoplasm (n = 1). Magnetization transfer ratio (MTR) and proton density fat fraction (PDFF) were measured in pancreatic tail (PT) and at the resection margin (RM). Histopathologically, pancreatic fibrosis was graded as mild, moderate, or severe (F1–F3), lipomatosis was graded as 0% to 10%, 11% to 30%, and greater than 30% fat deposition (L1–L3). In addition, MTR and histopathologic fibrosis was assessed in pancreatic adenocarcinoma. Mann-Whitney U test and Spearman correlation were used.

Results
Patients with advanced pancreatic fibrosis (F3) showed a significantly higher MTR compared with the F1 group at the RM and PT (38 ± 4 vs 32.3 ± 1.6, P = 0.018 and 39.7 ± 5.5 vs 31.2 ± 1.7, P = 0.001). Spearman correlation coefficient of MTR and fibrosis grade was r = 0.532 (P = 0.011) and 0.554 (P = 0.008), respectively. Pancreatic parenchyma with advanced fat deposition (L2–L3) showed significantly higher PDFF compared with lipomatosis grade L1 (RM: P = 0.002 and PT: P = 0.001). Proton density fat fraction of pancreatic parenchyma exhibited a moderate and significant correlation with histopathologic lipomatosis grade (RM: r = 0.668 and PT: r = 0.707, P < 0.001). Magnetization transfer ratio was significantly higher in pancreatic adenocarcinoma compared with pancreatic parenchyma (44 ± 5.5 vs 36.0 ± 4.4 and 37.4 ± 5.4, P = 0.004).

Conclusions
Multiparametric MRI of the pancreas including MTR and PDFF maps may provide quantitative and noninvasive information on pancreatic fibrosis and lipomatosis before surgery.
Thyroid Metastasis From Hepatocellular Carcinoma Visualized by 18F-FDG PET/CT Imaging
Authors: Yin Hongyan , Luo Rongkui , Xiu Yan , Hu Yan , Shi Hongcheng 
Published: September 2018

Abstract
Thyroid metastasis from hepatocellular carcinoma (HCC) is very rare. We present a case of a 41-year-old man with a markedly elevated serum α-fetoprotein (2,297 ng/mL) and a left neck mass 6 months after a hepatolobectomy for a primary HCC. 18F-FDG PET/CT imaging showed a focal uptake in the left thyroid lobe corresponding to a mass. The patient underwent a left hemithyroidectomy. Subsequent pathology confirmed HCC metastasis to the thyroid.
Venous Congestion in Pedicled Frontal Branch Superficial Temporal Artery Flaps Reconstructions for Head and Neck Defects
Authors: Loh Charles Yuen Yung , Shanmugakrishnan R. Raja , Nizamoglu Metin , Tan Alethea , Duarte Marco , Khan Waseem Ullah , El-Muttardi Naguib 
Published: September 2018

Abstract
The superficial temporal artery (STA) flap is a versatile flap for head and neck defect reconstruction. It can be based on the frontal branch of the STA and an islanded 360-degree rotation arc for various defects on the scalp, cheek, and auricular region. It provides a nonmicrosurgical option for reconstructing such defects, which is itself relatively easy to perform. However, venous congestion is a problem than often can cause worry to the clinician and hence preclude its use. In this review, we revisit this flap in head and neck reconstruction, with case examples used for reconstruction of defects on the scalp, maxilla, lip, ear, and retroauricular area. The STA flap in our review can be used either as a fasciocutaneous flap or with its fascia alone. The main issue with the STA flap is that it is generally a high-inflow flap with variable outflow. Venous congestion is frequently encountered in our practice, and adequate management of the venous drainage in the postoperative period is crucial in ensuring its success as a versatile and viable option for head and neck reconstruction.
Nasal Reconstruction
Authors: Fernandes Justin R. , Pribaz Julian J. , Lim Alan A. , Guo Lifei 
Published: September 2018

Abstract
The nose, with its conspicuous location, intricate convexities, and delicate 3-dimensional structure, continues to challenge the reconstructive surgeon. Today, there are a myriad of options available for reconstruction. The practitioner must take into account the location of the defect as well as the components needed to be restored. This article addresses the current practices in nasal reconstruction, including the different strategies for skin coverage, nasal lining, and structural support. We discuss both the newest techniques as well as basic principles of this long-standing procedure.
Body Wall Reconstruction for Conjoined Twins
Authors: Wu Shun , Guo Ke , Xiao Peng , Yang Jie , Sun Jiaming 
Published: September 2018

Background
Conjoined twinning is a rare congenital malformation, and the resultant huge body wall defects after separation of conjoined twins represent a real challenge to surgeons.

Methods
From 2004 to 2009, authors performed body wall reconstruction for 2 pairs of thoraco-omphalopagus twins and 1 pair of ischiopagus tetrapus twins. Before separation, the techniques of tissue expansion and tractive training were adopted to acquire sufficient skin for final coverage. After separation, the defects of thoracic cage and abdominal myofascial system were repaired with synthetic materials. The closure of the wounds was performed with artificial skin temporarily or by the use of local flaps in 1 stage.

Results
The first pair of thoraco-omphalopagus twins died of circulatory and respiratory failure after emergency surgery, and the other 2 pairs of conjoined twins survived. The second pair of thoraco-omphalopagus twins had wound dehiscence and partial flap necrosis after surgery. The expanded polytetrafluoroethylene mesh in 1 sister of the ischiopagus twins was removed because of local infection 4 years after surgery.

Conclusions
Compressive anatomical understandings and advanced skills in plastic surgery are required for body wall reconstruction in the separation of conjoined twins. In addition, the multidisciplinary team approach has an important role for obtaining satisfactory final surgical outcome.
Effect of Posthospital Syndrome on Health Care Utilization After Abdominal Contouring Surgery
Authors: Swiatek Peter R. , Johnson Shepard P. , Wang Lu , Liu Mochuan , Chung Ting-Ting , Chung Kevin C. 
Published: September 2018

Background
Posthospital syndrome (PHS) is a transient condition after acute hospitalizations when patients are physiologically deconditioned. The objective of this study was to determine if having PHS at the time of abdominal contouring surgery increased the incidence of postoperative adverse medical events.

Methods
We conducted a retrospective cohort study of patients enrolled in the MarketScan Databases who underwent outpatient functional or cosmetic abdominal contouring surgery (ie, abdominoplasty, liposuction, or panniculectomy) from April 2010 to August 2015. Patients were separated into 2 groups based upon PHS exposure, defined by hospitalization within 90 days before surgery. Differential health care utilization within 30 days after surgery was compared between cohorts.

Results
Among the 18,947 patients included in the final cohort, 1045 patients (6%) had PHS at the time of abdominal contouring surgery. Patients with PHS experienced more emergency department visits (0.16 vs 0.08 visits; adjusted odds ratio, 1.60; P < 0.001) and more episodes of hospitalization (0.11 vs 0.04 episodes; adjusted odds ratio, 1.70; P < 0.001) within 30 days postoperatively. The mean unadjusted health care utilization after abdominal contouring surgery for patients with PHS was US $7888 (SD, 17,659) versus US $2943 (SD, 9096) in patients without PHS. After controlling for confounders, such as comorbidity burden, PHS was associated with US $3944 greater cost than patients without PHS (P < 0.001).

Conclusions
Among patients undergoing outpatient abdominal contouring surgery, having PHS increased the incidence of adverse medical events requiring medical attention in the 30-day postoperative period. These findings support the inclusion of PHS in preoperative evaluation and preparation for patients seeking abdominal contouring surgery.
Vascularized Fibula Epiphysis Transfer for Pediatric Extremity Reconstruction
Authors: Kurlander David E. , Shue Shirley , Schwarz Graham S. , Ghaznavi Amir M. 
Published: September 2018

Background
Vascularized fibula epiphysis transfer for pediatric extremity reconstruction intends to preserve growth potential. However, few cases are reported, and outcomes are poorly characterized.

Methods
Systematic review was performed through a MEDLINE search using keywords “pediatric” or “epiphyseal” and “vascularized fibula.” Patients were divided into upper extremity or lower extremity groups. Functional and growth outcomes were assessed, and indications, pedicle, complications, and need for secondary surgery were recorded.

Results
Twenty publications with 62 patients were included. Mean age was 5.9 years, and mean follow-up was 5.8 years. Indications included sarcoma (60%), congenital deformity (21%), trauma (13%), and infection (6%). Anterior tibial pedicle was most common (63%) and was associated with significantly improved growth outcomes compared with the peroneal pedicle (23%; P < 0.001). Fifty-three patients underwent upper extremity reconstruction, with the most common complication being fracture (35%) and most common secondary surgery flap salvage (7%). Among upper extremity patients, full function was achieved in 25% and impaired function in 75%. Full growth was observed in 63% of patients, partial growth in 31%, and no growth in 4%. Nine patients underwent lower extremity reconstruction, with the most common complication being fracture (22%) and most common secondary surgery derotational osteotomy (22%). Among lower extremity patients, full function was achieved in 44% and impaired function in 56%. Full growth was observed in 56% of patients, partial growth in 22%, and no growth in 22%.

Conclusions
Vascularized fibula epiphysis transfer can accomplish full long-term growth and function. However, complications, revision surgery, and chronic impairment are common.
Patient-specific 3D Printing
Authors: Chandak Pankaj , Byrne Nicholas , Coleman Andrew , Karunanithy Narayan , Carmichael Jim , Marks Stephen D. , Stojanovic Jelena , Kessaris Nicos , Mamode Nizam 
Published: September 2018

Objective:
The authors investigated a novel application of patient-specific three-dimensional (3D) printing, to enhance preoperative, multidisciplinary planning in complex, living-donor pediatric renal transplantation.

Summary Background Data:
For children with end-stage kidney disease, the transplantation of adult-sized, living-donor kidneys into small recipients (<20 kg) with increasingly complex structural anomalies can be difficult. Establishing the operative feasibility in such cases demands a surgical understanding of anatomy to be derived from medical imaging. However, this is hampered by the representation of complex structures in 2D, the inherent interpretive expertise this demands, and the challenge of conveying this appreciation to others.

Methods:
We report the novel use of patient-specific 3D printed models to achieve personalized management for 3 children who underwent living-donor renal transplantation. Each presented a unique surgical challenge that would otherwise prevent preoperative determination of transplantation feasibility. Patient-specific geometries were segmented from imaging data and fabricated using polyjet, 3D printing technology. Models were verified by an expert radiologist and presented during multidisciplinary discussion and surgical simulation.

Results:
3D printed models enhanced preoperative deliberation and surgical simulation and allowed on-table exploration of a small child to be avoided. We have critically determined specific clinical indications, technical insights, limitations, and outcomes of this approach. At latest follow-up (>16 mo) all patients remain well with functioning renal allografts.

Conclusions:
We report the new and safe integration of patient-specific 3D printing into complex pediatric renal transplantation. This technique enhances surgical planning and can inform operative feasibility in those cases which would otherwise be uncertain.