bluuebunny/crossref_metadata_2025_split huggingface dataset:
Visualizing the Pharmacologic Preconditioning Effect of Botulinum Toxin Type A by Infrared Thermography in a Rat Pedicled Perforator Island Flap Model
Authors: Chen Miao , Li Xiucun , Jiang Zhenmin , Gong Xu 
Published: August 2019

Background:
Surgical delay can improve flap viability, leading to vasodilation, neovascularization, and vessel reorganization. Experiments suggest a similar positive effect of botulinum toxin type A on pedicled flap viability. However, whether it may convert choke anastomoses into true anastomoses and how to identify the optimal timing for flap transfer remain unclear.

Methods:
One hundred fifty-four Sprague-Dawley rats were divided into a control group, three saline injection groups, and three botulinum toxin type A injection groups defined by time of injection (2, 3, and 4 weeks before flap harvest). A pedicled 11 × 3-cm flap was marked on the unilateral dorsum of each rat. Before flap harvest, the flap donors were assessed by infrared thermal imaging, postmortem arteriography, immunohistochemical staining of CD31, and enzyme-linked immunosorbent assay. Flap survival area percentage was measured on postoperative day 7.

Results:
In the control and saline groups, infrared thermography showed three independent white hotspots interspaced by red zones over flaps, whereas it presented a continuous white band in the botulinum toxin type A groups. There was a significant increase in flap survival area, flap surface temperatures, numbers of identifiable vessels in the choke zones, microvascular density, and vascular endothelial growth factor concentration in the botulinum toxin type A groups.

Conclusions:
Botulinum toxin type A can convert choke anastomoses into true anastomoses, and its preconditioning effect cannot increase over time; it is appropriate to choose the timing point when the infrared thermal images show a continuous white band existing over flaps for flap transfer.
Arthroscopic Suture Repair With Additional Pronator Quadratus Advancement for the Treatment of Acute Triangular Fibrocartilage Complex Tear With Distal Radioulnar Joint Instability
Authors: Lee Sang Ki , Chun Young Sub , Bae Jin Hyun , Yu Young Tak , Choy Won Sik 
Published: August 2019

Abstract
Treatment of acute triangular fibrocartilage complex (TFCC) tear using arthroscopic suture repair has been used as a general treatment method, but it is difficult to obtain perfect results in all cases. We evaluated clinical and radiologic outcomes of the acute TFCC tear with distal radioulnar joint instability using the arthroscopic suture repair with pronator quadratus (PQ) advancement. Altogether, 80 patients (48 male, 32 female; mean ± SD age, 37.3 ± 11.5 years; mean ± SD follow-up, 23.7 ± 11.4 months) were enrolled in the study. Follow-up was at least 12 months (range, 12–38 months). Patients were divided into group 1 with arthroscopic suture repair alone (34 patients; 17 male, 17 female; mean ± SD age, 35.2 ± 10.8 years; mean ± SD follow-up, 28.1 ± 15.1 months) and group 2 with additional PQ advancement (46 patients; 29 male, 17 female; mean ± SD age, 38.9 ± 11.9 years; mean ± SD follow-up, 18.4 ± 6.2 months), and clinical and radiological assessment was performed. We also compared the ulnar translation of the injured wrist with that of the uninjured wrist using the Push Pull gauge.
There was no difference in the range of motion and the grip strength between the 2 groups. However, the disabilities of the arm, shoulder, and hand score (P = 0.042) at 6-month follow-up and disabilities of the arm, shoulder, and hand score (P = 0.015) and patient-rated wrist evaluation score (P = 0.012) at 12-month follow-up were improved in group 2, and patients' satisfaction (P = 0.032) was also higher in group 2. The ulnar translation rate was also improved in group 2 at 6-month follow-up (P = 0.015) and 12-month follow-up (P = 0.045).
Arthroscopic suture repair with PQ advancement provided more clinical improvement and proper stability; therefore, it will be an acceptable effective treatment option for acute TFCC tear with distal radioulnar joint instability.
Comparative Antimicrobial Activity of Commercial Wound Care Solutions on Bacterial and Fungal Biofilms
Authors: Harriott Melphine M. , Bhindi Nayan , Kassis Salam , Summitt Blair , Perdikis Galen , Wormer Blair A. , Rankin Timothy M. , Kaoutzanis Christodoulos , Samaha Mario , Stratton Charles , Schmitz Jonathan E. 
Published: August 2019

Background
Biofilms represent a complex milieu of matrix-enclosed microorganisms, which can significantly contribute to the pathology of chronic wounds. In this study, we compare the activity of 3 commercial antimicrobial wound care solutions, Vashe (HOCl based), PhaseOne (HOCl based), and Sulfamylon (mafenide acetate), for their in vitro activity against bacterial and fungal biofilms.

Methods
Reference and clinical isolates of 6 Gram-negative bacterial species (36 total strains), 3 Gram-positive bacteria (21 strains), and 3 Candida species (9 strains) were used to create biofilms. Various working concentrations of the 3 antiseptic agents were incubated with the biofilms in microwell plates; they were monitored from 1 minute to 24 hours to compare bacterial and fungal viability through colony forming unit analysis.

Results
Vashe and PhaseOne displayed excellent bactericidal and fungicidal activity, whereas Sulfamylon demonstrated minimal activity against the biofilms tested. With the exception of Candida albicans, all biofilms were eliminated at either 1 or 10 minutes using Vashe and PhaseOne solutions. In most cases, mafenide was unable to eliminate both bacterial and fungal biofilms, even with 24 hours of treatment.

Conclusions
Biofilms represent a major clinical challenge, with no clear consensus for treatment of chronic wounds or prosthetic devices. Our results suggest that hypochlorous acid–based wound solutions such as Vashe and PhaseOne are more efficacious than mafenide in eliminating bacterial and fungal biofilms. Further studies are necessary to investigate and compare the in vivo efficacy of these products in clinical care.
Anterior Neck Resurfacing Using a Single Free Flap
Authors: Angrigiani Claudio , Neligan Peter , Thrikutam Nikhitha 
Published: August 2019

Background
Burn sequelae involving the anterior neck and thorax produce a difficult challenge for reconstruction because contracture of anterior thoracic burns in addition to functional movement of the chest wall can result in downward displacement of the neck unit. The purpose of this study was to understand the influence of burn sequelae of the anterior thorax on anterior neck flap descent, function, and aesthetics.

Methods
Ten patients with burn sequelae of only the anterior neck (group 1) and 10 additional patients with burn sequelae of the anterior neck and thorax (group 2) were retrospectively identified. All 20 patients were treated with scar release and a single extended circumflex scapular free flap for neck resurfacing. Patients were followed for an average of 10 years, at which time flap descent from the sternal notch, deficit of neck extension, and subjective reports of discomfort were measured.

Results
Patients in group 1 experienced a median flap descent of 0 [interquartile range (IQR), 1.62 cm] and a median deficit of 0° (IQR, 5°) during neck extension. Patients in group 2 experienced a median flap descent of 8 cm (IQR, 1.75 cm) and a median deficit of 12.5° (IQR, 10°) during neck extension. Retrospective analysis of the 10 patients with burn sequelae of the anterior neck and thorax (group 2) demonstrated a significantly greater degree of flap descent and deficit of neck extension compared with the 10 patients with burn sequelae of only the anterior neck (group 1). Patients in group 1 also subjectively reported less discomfort at follow-up compared with patients in group 2.

Conclusions
We conclude that patients with burn sequelae involving the anterior neck and thorax have a significantly greater degree of flap descent and neck extension compared with patients with burn sequelae involving only the anterior neck. Flaps of a larger surface area or use of multiple flaps for neck resurfacing may be considered to avoid significant flap descent associated with burn sequelae involving both the anterior neck and thorax.
Triangular Fossa Graft for Philtral Reconstruction After Facial Burns
Authors: Roh Danny Sam , Bojovic Branko , Woolard Alexander C. , Donelan Matthias B. 
Published: August 2019

Background
Upper lip burns and skin grafts used for the resulting deformities all contract, leading to distortion of regional tissues and producing a flattened upper lip devoid of normal anatomic landmarks. Absence of the philtral contour draws attention to the upper lip and can accentuate other reconstructive inadequacies. Philtral restoration requires a 3-dimensional reconstruction capable of resisting contractile forces to restore and maintain normal relationships between the upper and lower lips.

Methods
This was a 34-year retrospective review of a single surgeon's experience using a composite triangular fossa graft from the ear for philtral reconstruction. Ten patients were identified and analyzed using records of follow-up examinations, long-term clinical evaluations, and photographic documentation.

Results
Five males and 5 females were identified with 2- to 34-year follow-up. Age at operation ranged from 14 to 52 years. Percent total body surface area ranged from less than 1% to greater than 90%. Previous upper lip grafts prior to the auricular graft included 5 full-thickness skin grafts and 5 split-thickness skin grafts. No significant complications were noted. All patients were satisfied with the end aesthetic result and donor site morbidity.

Conclusions
A triangular fossa composite graft restores and preserves the philtral dimple and corrects the obvious visible deformity of a featureless upper lip. Addition of tissue loosens the lip transversely, and the cartilage component provides a consistent and predictable upper lip position. This results in improved projection, a concave shape to the upper lip, and a better relationship with the lower lip. Restoration of this anatomic landmark creates a more normal-appearing upper lip and helps to minimize the negative impact of other abnormalities in this vitally important area. The overall improvement in total facial appearance can be profound.
Establishing Orbital Floor Symmetry to Support Mirror Imaging in Computer-Aided Reconstruction of the Orbital Floor
Authors: Jozaghi Yelda , Chan Harley H.L. , Davies Joel C. , Irish Jonathan C. 
Published: August 2019

Background:
Surgical precision in the reconstruction of the orbital floor is crucial to functional visual and aesthetic outcomes. Increasingly, computer-aided design is being utilized to aid in precise preoperative planning by using the mirror images of the unaffected side. The authors aim to use 3-dimensional (3D) quantitative analysis to establish whether the native orbital floor topography is sufficiently symmetric to support this practice.

Methods:
Ten high resolution head and neck computed tomography scans of patients without periorbital pathology were obtained. These were imported into a 3D medical image processing software and segmented to isolate bilateral orbital floors. Each native orbital floor was compared to the mirror image of the contralateral side by conformance map computation. Data collection included measures of 25% and 75% quartile, median, mean, standard deviation, and root-mean-square (RMS).

Results:
The topographic analysis demonstrated a high degree of topographic conformance with a mean RMS of 0.58 ± 0.37 mm. Further volumetric analysis comparing the total orbital volume between each side also demonstrates a high degree of volumetric symmetry with a mean difference of 0.55 mL (P = 0.30).

Conclusion:
Comparison of the native orbital floor and the mirror image of the contralateral side by conformance map computation and volumetric analysis demonstrated a high degree of morphologic similarity. The native orbital floor topography provides optimal symmetry to support mirror imaging techniques used in orbital floor reconstruction.
Assessing the Role of Virtual Surgical Planning in Mandibular Reconstruction With Free Fibula Osteocutaneous Graft
Authors: Saini Varun , Gaba Sunil , Sharma Shagun , Kalra Praveen , Sharma Ramesh K. 
Published: August 2019

Background:
The role of virtual surgical planning and three-dimensional printing in improving the accuracy, precision, functional and aesthetic outcomes have been demonstrated in the literature; however, there is a dearth of studies evaluating these parameters.

Objective:
This study was carried out at a tertiary care center in North India to assess the accuracy of virtual surgical planning in mandibular reconstruction.

Method:
All the included patients were preoperatively assessed with a contrast enhanced computed tomography (CECT) of head and neck. Based on the dimensions a patient-specific fibula cutting guide was fabricated by three-dimensional printing. All patients were evaluated with a postoperative CECT at 6 months of follow-up. The precision outcomes were measured by comparing surgical results with the images of the preoperative virtual planning based on several measurements on the reconstructed mandible such as anteroposterior measurement, transverse measurement, height of the mandible, angle of the mandible, and lateral tilt.
The secondary outcomes analyzed were the mean total operative time, mean ischemia time, and morbidity parameters.

Result:
Twelve consecutive patients (6 male, 6 female) with mean age of 33.1 ± 11 years who underwent free fibula graft mandibular reconstruction were included in the study. The mean difference in the anteroposterior, transverse, and height dimensions were 0.87 ± 0.43 mm (P = 0.24), 2.43 ± 3.72 mm (P = 0.64), and 1.08 ± 0.67 (P = 0.88), respectively. The difference in the angles of the reconstructed mandible was 2.37 ± 3.92 degrees (P = 0.51) and of lateral tilt was 1.57 ± 1.5 degrees (P = 0.54). The mean total operative time was 639 ± 27.2 minutes and mean ischemia time was 88.4 ± 8.6 minutes.

Conclusion:
All the patients had satisfactory aesthetic results and good oral function at 6 months postoperative period.
Sometimes the Power of Science is Driven by the Ratio of Love
Authors: Geurtsen Madelon , Otte Rob , Corel Linda , Mathijssen Irene , Joosten Koen 
Published: August 2019

Abstract
An infant with Crouzon syndrome was in need of cranial surgery. The optimum surgical correction was not possible, because at that time she was supported with continuous positive airway pressure attached to her occiput. However, the parents wanted the best craniofacial option and her father designed a respiratory support device with attachment to the forehead. Therefore, the most optimum cranial surgery could continue.
Role of Tumor Necrosis Factor-α in vascular hyporeactivity following endotoxic shock and its mechanism
Authors: Zhao HongLiang , Kuang Lei , He JiaoJiang , Zhang ZiSen , Zheng DanYang , Duan ChenYang , Zhu Yu , Wu Yue , Zhang Jie , Peng XiaoYong , Li BingHu , Yang GuangMing , Li Tao , Liu LiangMing 
Published: August 2019

BACKGROUND
Vascular hyporeactivity plays an important role in organ dysfunction induced by endotoxic shock. Given that cytokine, such as TNF-α, plays an important role in endotoxic shock, the aim of the present study is to investigate the role of Tumor Necrosis Factor (TNF)-α in vascular hyporeactivity following endotoxic shock and the mechanisms.

METHODS
Lipopolysaccharide (LPS) (1 mg/kg) injection was used for replicating the endotoxic shock model in the rabbit. The changes in the level of TNF-α in plasma in the rabbits model and the contractile response of superior mesenteric arteries (SMA) to norepinephrine (NE) and Ca2+ were observed. The mechanisms in TNF-α–induced vascular hyporeactivity were further explored.

RESULTS
The levels of TNF-α in plasma were gradually increased after 1 hour of LPS administration and reached the peak at 6 hours. The contractile responses of SMA to NE were decreased at 1 hour of LPS and lowest at 6 hour. TNF-α (200 ng/mL) incubation decreased contractile response of SMA to NE significantly. Further studies found that calcium desensitization participated in the occurrence of TNF-α–induced vascular hyporeactivity, the changes were consistent with the changes of vascular reactivity, calcium sensitivities were decreased significantly at 1 hour, 2 hours, 4 hours, and 6 hours after LPS injection. TNF-α (200 ng/mL) incubation could significantly reduce the contractile response of SMA to Ca2+. The activity of Rho-kinase and the changes of myosin light chain 20 (MLC20) phosphorylation level were significantly decreased at 6 hours following LPS administration, and TNF-α (200 ng/mL) incubation led to a decrease of Rho-kinase and MLC20 phosphorylation. Arginine vasopressin significantly antagonized TNF-α (200 ng/mL)-induced the decrease of the vascular reactivity and calcium sensitivity.

CONCLUSION
TNF-α is involved in vascular hyporeactivity after endotoxic shock. Calcium desensitization plays an important role in TNF-α–induced vascular hyporeactivity after endotoxic shock. Rho-kinase/MLC20 phosphorylation pathway takes part in the regulation of calcium desensitization and vascular hyporeactivity induced by TNF-α. Arginine vasopressin is beneficial to endotoxic shock in TNF-α-induced vascular hyporeactivity.
Vancomycin dosing in critically ill trauma patients: The VANCTIC Study
Authors: Villanueva Ruben D. , Talledo Oscar , Neely Stephen , White Bryan , Celii Amanda , Cross Alisa , Kennedy Ryan 
Published: August 2019

BACKGROUND
Current guidelines from the Infectious Diseases Society of America and the American Society of Health-System Pharmacists recommend vancomycin troughs of 15 mg/L to 20 mg/L for serious methicillin-resistant Staphylococcus aureus infections. The pharmacokinetics of vancomycin are altered in critically ill patients, leading to inadequate serum levels. Rates of initial therapeutic vancomycin troughs have ranged from 17.6% to 33% using intermittent infusions (i.e., 15–20 mg/L) and approximately 60% using continuous infusions (i.e., 15–25 mg/L) in critically ill trauma patients (1–4). We hypothesized that our dosing protocol would achieve higher rates of initial therapeutic troughs compared with previously published reports due to more aggressive loading doses than those seen in previously published reports.

METHODS
This was a retrospective study of all critically ill trauma patients admitted to a Level I trauma intensive care unit over a 39-month period who had a suspected serious infection, who were treated with empiric vancomycin per the “pharmacy to dose” protocol, and who had an appropriately drawn steady state trough level. The primary outcome was the rate of initial therapeutic troughs, which was defined as 14.5 mg/L to 20.5 mg/L.

RESULTS
One hundred ninety-seven patients were screened. Seventy patients met inclusion criteria. The study cohort had a median age of 47.5 years and a median Injury Severity Score of 28. Augmented renal clearances were observed, with a median creatinine clearance of 159.1 mL/min and a median Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score of 7. The median vancomycin loading dose was 24.6 mg/kg with an initial maintenance dose of 17.71 mg/kg. An every eight hour dosing interval was initiated on 47.14% of the patients, and 45.71% of the patients were initially started on an every 12 hour dosing interval. Only 15.71% of the study patients achieved an initial therapeutic trough; 42.86% were less than 10 mg/L, and 8.57% were greater than 20.5 mg/L. Acute kidney injury occurred in 10% based on the Infectious Diseases Society of America/American Society of Health-System Pharmacists vancomycin guidelines and in 11.4% based on the Acute Kidney Injury Network criteria.

CONCLUSION
Our incidence of initial therapeutic troughs was slightly below previously reported studies. Based on our results, which are consistent with previous literature, it would appear that our guideline-adherent protocol of intermittent vancomycin is insufficient to achieve troughs of 15 mg/L to 20 mg/L.

LEVEL OF EVIDENCE
Therapeutic, level III.
PATHway to success: Implementation of a multiprofessional acute trauma health care team decreased length of stay and cost in patients with neurological injury requiring tracheostomy
Authors: Perry Alvin , Mallah Mike M. , Cunningham Kyle W. , Christmas A. Britton , Marrero Jennifer J. , Gombar Meridith A. , Davis Michael L. , Miles William S. , Jacobs David G. , Fischer Peter E. , Sing Ronald F. , Thomas Bradley W. 
Published: August 2019

BACKGROUND
The aim of this study was to determine whether the implementation of a dedicated multiprofessional acute trauma health care (mPATH) team would decrease length of stay without adversely impacting outcomes of patients with severe traumatic brain and spinal cord injuries. The mPATH team was comprised of a physical, occupational, speech, and respiratory therapist, nurse navigator, social worker, advanced care provider, and physician who performed rounds on the subset of trauma patients with these injuries from the intensive care unit to discharge.

METHODS
Following the formation and implementation of the mPATH team at our Level I trauma center, a retrospective cohort study was performed comparing patients in the year immediately prior to the introduction of the mPATH team (n = 60) to those in the first full year following implementation (n = 70). Demographics were collected for both groups. Inclusion criteria were Glasgow Coma Scale score less than 8 on postinjury Day 2, all paraplegic and quadriplegic patients, and patients older than 55 years with central cord syndrome who underwent tracheostomy. The primary endpoint was length of stay; secondary endpoints were time to tracheostomy, days to evaluation by occupational, physical, and speech therapy, 30-day readmission, and 30-day mortality.

RESULTS
The median time to evaluation by occupational, physical, and speech therapy was universally decreased. Injury Severity Score was 27 in both cohorts. Time to tracheostomy and length of stay were both decreased. Thirty-day readmission and mortality rates remained unchanged. A cost savings of US $11,238 per index hospitalization was observed.

CONCLUSION
In the year following the initiation of the mPATH team, we observed earlier time to occupational, physical, and speech therapist evaluation, decreased length of stay, and cost savings in severe traumatic brain and spinal cord injury patients requiring tracheostomy compared with our historical control. These benefits were observed without adversely impacting 30-day readmission or mortality.

LEVEL OF EVIDENCE
Therapeutic/care management, Level III.