bluuebunny/crossref_metadata_2025_split huggingface dataset:
Polydactyly MAS Classification
Authors: Althobaity Adil Nasir , Alkabbaa Saud Abdullah , Aljaied Sarah S. , AlKahtani Mohammed M. 
Published: December 2018

Background:
Polydactyly is considered to be one of the common congenital hand anomalies. Classification of congenital hand anomalies by Swanson groups similar forms of deficits affected by specific embryological failures. Each type of polydactyly has its separate classification. This case series suggested classification that could include the radial and ulnar variants of polydactyly in one classification and direct the management in algorithmic approach.

Methods:
Case series of 11 cases, who were diagnosed with polydactyly of the hand consecutively at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Cases were described by physical assessment and x-ray, then categorized by the proposed MAS classification.

Results:
Description of 11 cases by the suggested MAS classification: A- Soft tissue attachment. B-Bone attachment. I. Attached to metacarpal bone. II. Attached to the proximal phalanx. III. Attached to the middle phalanx. IV. Attached to the distal phalanx. C- Joint attachment. I. Attached to carpometacarpal joint. II. Attached to metacarpophalangeal joint. III. Attached to the proximal interphalangeal joint. IV. Attached to the distal interphalangeal joint. Treatment according to the algorithmic approach: type A, treat it with soft-tissue excision; type B, bony excision with or without reinsertion of abnormal muscle attachment; and type C, excision of collateral ligaments and reconstruction with or without K wire fixation and reinsertion of abnormal muscle attachment.

Conclusions:
MAS classification demonstrates a potential to be applied to both ulnar and radial polydactyly. It is simple, easy to recall, anatomically and surgically oriented for practical purposes. Thus, it needs to be validated in extensive studies.
Direct-to-implant Breast Reconstruction with Autoderm
Authors: McFadden Eoin M. , Lopez-Obregon Beatriz , Stone Jill P. , Webb Carmen E. , Temple-Oberle Claire F. 
Published: December 2018

Background:Traditional transverse mastectomies yield suboptimal results in women with higher body mass index, wide breast footprint, and ptotic breasts. An option for this patient population is a reduction-pattern style mastectomy, and recruiting an inferiorly based dermal flap using the lower mastectomy flap. This is analogous to a vascularized dermal matrix supporting the lower pole of the implant, termed “Autoderm” breast reconstruction. This allows for aesthetically appealing skin reduction mastectomies with the added safety of a vascularized dermal flap to facilitate an immediate direct-to-implant breast reconstruction. This study assesses patient satisfaction using the validated BRECON-31 questionnaire to enhance shared-decision making with women contemplating breast reconstruction.Methods:A 2-year retrospective review of women who underwent Autoderm direct-to-implant breast reconstruction comparing patients who underwent unilateral and bilateral reconstruction in terms of characteristics, complications, and BRECON-31 scoring.Results:Overall patient scores were high (81.6 of 100). In particular, women scored very high on self-image (85.0), arm concerns (86.4), intimacy (87.4), satisfaction (88.3), and expectations subscales (85.5). Women choosing bilateral reconstruction outperformed unilateral reconstruction in every subgroup, but only attained statistical significance in the “self-consciousness” subgroup. Compared with a historical cohort of a mix of implant reconstruction types, Autoderm patients showed improved satisfaction (88.3 versus 82.5;P= 0.07) and breast appearance (73.9 versus 66.8;P= 0.06), approaching significance. Safety was demonstrated by low major complications (4.7%) and low implant loss rates (2.3%).Conclusions:Autoderm breast reconstruction is a safe option in women with large, ptotic breasts, with patients reporting high satisfaction using a validated instrument.
Managing Postoperative Infection following Breast Reconstruction with the Sientra AlloX2 Tissue Expander
Authors: Momeni Arash 
Published: December 2018

Background:
Implant-based breast reconstruction is the most common reconstructive modality in the United States. Significant advances in surgical technique and technology have resulted in improvement of clinical outcomes. A recent innovation has been the introduction of a tissue expander with an integral drain that permits access to the periprosthetic space. A new use for this drain port is presented in patients with postoperative surgical-site infection.

Methods:
Patients who underwent staged implant-based breast reconstruction with the Sientra AlloX2 tissue expander and experienced postoperative infection that warranted inpatient management with intravenous antibiotics were included in the study. The integral drain port was used in these patients to perform washout of the periprosthetic space at the bedside. The ability to salvage the tissue expander in the setting of infection without the need for surgical revision in the operating room was determined.

Results:
Of 31 patients who underwent a total of 52 staged breast reconstructions with the Sientra AlloX2 tissue expander, 3 patients (8.7%) with a mean age of 50.3 years (range, 34–76 years) and mean body mass index of 23.3 kg/m2 (range, 22.3–24.1 kg/m2) met inclusion criteria. Salvage of the device with successful progression through expansion and eventual expander-implant exchange was achieved in 2 patients. One patient failed the salvage attempt and required removal of the device.

Conclusion:
Using the integral drain port of the AlloX2 tissue expander has the potential for device salvage in a subset of patients with surgical-site infection without the need for surgical revision.
Strategies to improve antibiotic use in the neonatal ICU
Authors: Willis Zachary , de St. Maurice Annabelle 
Published: December 2018

Purpose of review
Neonates are at a high risk of infection and may have nonspecific signs of sepsis. Accordingly, they are heavily exposed to antimicrobials. Neonates are also uniquely at risk of both short-term and long-term complications from antibiotic exposure. This review discusses advances in antibiotic stewardship in the neonatal population.

Recent findings
Antimicrobial utilization is highly variable among NICUs in excess of case-mix variation. Rates of early-onset sepsis because of Group B Streptococcus have decreased substantially with the introduction of intrapartum antibiotic prophylaxis. Recent epidemiologic studies have created evidence-based tools to more accurately estimate a newborn's risk of early-onset sepsis. Antibiotic selection and duration for late-onset sepsis and necrotizing enterocolitis are variable among centers, with inadequate evidence to guide practice. Novel diagnostic methods and biomarkers are increasingly used to assist with diagnosing infection, but inadequate specificity in many cases may result in excess antibiotic exposure. Published antimicrobial stewardship experiences in the neonatal inpatient setting have largely been successful and well tolerated.

Summary
Recent publications have identified many ways to safely reduce antimicrobial exposure and developed strategies to implement antimicrobial stewardship in the neonatal inpatient setting. However, new approaches are needed to further improve antibiotic use and to implement these interventions more universally in NICUs.
The Effect of Gluten‐free Diet on Cardiovascular Risk Factors in Newly Diagnosed Pediatric Celiac Disease Patients
Authors: Zifman Eyal , Waisbourd‐Zinman Orith , Marderfeld Luba , Zevit Noam , Guz‐Mark Anat , Silbermintz Ari , Assa Amit , Mozer‐Glassberg Yael , Biran Neta , Reznik Dana , Poraz Irit , Shamir Raanan 
Published: December 2018

ABSTRACTObjectives:Although gluten‐free diet (GFD) is the only proven therapy for celiac disease (CD), its effect on cardiovascular disease (CVD) risk factors is still unclear. Our aim was to determine whether adherence to GFD affects CVD risk factors among newly diagnosed pediatric CD subjects.Methods:We prospectively enrolled pediatric subjects undergoing upper gastrointestinal endoscopy for suspected CD. We collected anthropometric and laboratory parameters related to CVD risk factors at the time of CD diagnosis and 1 year after initiation of a GFD and evaluated changes in CVD risk factors. Paired t tests or Wilcoxon nonparametric tests were used, each when appropriate.Results:One hundred ten newly diagnosed CD pediatric subjects were included in the analysis. There were 64 (58.2%) girls and the mean age at diagnosis was 6.8 ± 3.4 years. Median body mass index z scores (P = 0.84), rates of underweight or overweight (P = 0.32), and rates of elevated blood pressure (P = 0.78) remained unchanged. Although median fasting insulin levels increased (1.9 vs 5.4 μU/mL, P < 0.001), insulin resistance as measured by homeostatic model assessment did not increase after 1 year of GFD (P = 0.16). Although rates of dyslipidemia remained unchanged, median high‐density lipoprotein levels increased on GFD (47 vs 51 mg/dL, P < 0.001).Conclusions:In this pediatric CD cohort, GFD for 1 year was not associated with increased CVD risk factors. The long‐term significance of these mild changes is yet to be determined.
Development of Acute Malnutrition Despite Nutritional Supplementation in Malawi
Authors: Kaimila Yankho , Pitman Ryan T. , Divala Oscar , Hendrixson D. Taylor , Stephenson Kevin B. , Agapova Sophia , Trehan Indi , Maleta Ken , Manary Mark J. 
Published: December 2018

ABSTRACTMalnutrition in children is most often attributed to inadequate nutrient intake. Utilizing data from 2 prospective, randomized controlled trials of complimentary feeding with supplemental legumes (n = 693, ages 6–24 months) in 2 Malawian villages, Masenjere, and Limera, we document a high rate 70/693 (10.1%) of acute malnutrition (AM). Risks for AM in this setting, as determined by Cox regression analysis, include study village (hazard ratio [HR] 3.0), prior malnutrition (HR 4.12), stunting (HR 2.87), and a marker of food insecurity (HR 1.89). Comparison of Masenjere to Limera demonstrate adequate and similar nutritional intake yet an increased rate of AM in Masenjere, 56 of 400 (14.0%) versus 14 of 293 (4.8%), and stunting, 140 of 400 (35%) versus 80 of 293 (27%), environmental enteric dysfunction 246 of 400 (71%) versus 181/293 (67%), and infectious symptoms (cough and diarrhea). Masenjere did have cleaner water and less food insecurity 200 of 399 (50.5%) versus 204 of 293 (69.6%). These findings suggest adequate complementary nutrient intake does not protect young children against AM.
Multilocus variable number tandem repeat analysis and antimicrobial susceptibility pattern of Staphylococcus epidermidis isolates in Tehran, Iran
Authors: Mirzaei Rasoul , Sadeghi Kalani Behrooz , Shokri Moghadam Mohammad , Mahdiun Faeze , Irajian Gholamreza 
Published: December 2018

Objective:
Detection of sources of outbreaks caused by coagulase-negative Staphylococcus relies on molecular epidemiology methods. Little is known about the genetic diversity of the Staphylococcus epidermidis isolates isolated from various sources in Iran. We assessed the molecular epidemiology of S. epidermidis isolates collected from clinical and nonclinical sources from Tehran counties during 2014 to 2016 using MLVA (multilocus variable number tandem repeat analysis).

Methods:
One hundred and three clinical and nonclinical S. epidermidis isolates were collected from two hospitals in Tehran. Antibiotic susceptibility testing of isolates was evaluated for cefoxitin, tetracycline, erythromycin, clindamycin, mupirocin, vancomycin and linezolid according to Clinical and Laboratory Standards Institute, as well as prevalence of mecA gene was evaluated by PCR method. In addition, genetic relatedness of isolates was assessed by MLVA method.

Results:
Resistant rate to cefoxitin, tetracycline, erythromycin, clindamycin and mupirocin were 64, 36, 72, 44 and 23% in all isolates. All clinical and nonclinical isolates were susceptible to linezolid and vancomycin. In all, 49.5% of S. epidermidis isolates were multidrug resistant. Prevalence of mecA was 64%. The MLVA profile consists of a series of allele numbers, corresponding to the number of repeats at each variable number tandem repeat locus. The results of MLVA showed 64 types among all 103 isolates. There were 16 MLVA types that were common in two hospitals and 15 MLVA types were existed in various sources of S. epidermidis isolates. The diversity index obtained with MLVA was 0.989 (95% confidence interval [0.984–0.993]) for the 103 S. epidermidis isolates. A range of one to six alleles was identified at variable number tandem repeats loci with Simpson's diversity values between 0.526 and 0.781.

Conclusion:
Our study demonstrated presence of high molecular diversity among S. epidermidis isolates. In addition, the main conclusion was that some MLVA types can be disseminated over the wards and between the hospitals. In other hand, resistance to various antibiotics in S. epidermidis isolates and prevalence of methicillin-resistant S. epidermidis and multidrug resistant S. epidermidis isolates to be increasing.
Neonatal Death Caused by Interrupted Aortic Arch Associated With 22q11.2 Deletion Syndrome
Authors: Shinkawa Norihiro , Yamaguchi Masatoshi , Ozaki Mamoru , Yukawa Nobuhiro 
Published: December 2018

Abstract
A case of clinically unsuspected fatal interrupted aortic arch (IAA) is described. A 17-day-old Japanese girl unexpectedly entered respiratory arrest at home. On autopsy, the heart was hypertrophic, with no apparent connection between the ascending and descending aortas. The ascending aorta branched into common carotid and right subclavian arteries, whereas the left subclavian artery arose from the descending aorta, which was supplied by the ductus arteriosus, indicating type B IAA. In addition, ventricular septal defect, bicuspid aortic valve, patent foramen ovale, and thymic aplasia were identified. The immediate cause of death was assumed to be “ductal shock.” Because of the known strong association between type B and 22q11.2 deletion, her parents received genetic counseling and requested chromosomal analysis of the child. Fluorescence in situ hybridization worked well on a frozen blood sample, identifying the suspected deletion. This case was thus diagnosed as 22q11.2 deletion syndrome exhibiting IAA and thymic defect.
FDG PET/CT Imaging of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus
Authors: Zhang Wei , Fang Cheng , Liu Huipan , Chen Yue 
Published: December 2018

Abstract
Hepatocellular carcinoma rarely involves the major bile duct. Here, we reported a 46-year-old man with liver cancer who underwent FDG PET/CT for staging. The images showed abnormal FDG uptake in the left lobe and hilum of the liver, which was confirmed as hepatocellular carcinoma and hepatic portal bile duct tumor thrombus, respectively, by the pathology.
Incidental Detection of Plasma Cell Neoplasm on 18F-Choline PET/CT Imaging
Authors: Paudel Jiwan , Singla Navneet , Bhattacharya Anish , Basher Rajender Kumar , Mittal Bhagwant Rai 
Published: December 2018

Abstract

18F-Fluorocholine is a relatively new, extremely versatile radiotracer for detecting proliferative or mitogenic activity. Its diagnostic potential has been explored in cancers of the prostate, liver, esophagus, breast, brain, and lung, as well as lymphoma, sarcoma, melanoma, and parathyroid adenomas. The authors present a case where fluorocholine PET/CT performed for characterizing a space-occupying lesion in the brain revealed intensely tracer-avid skull lesions with intracranial soft tissue component and multiple other skeletal lesions. Fine-needle aspiration cytology from the skull and chest wall lesions confirmed the diagnosis of plasma cell neoplasm.
Comparisons Between PET With 11C-Methyl-l-Methionine and Arterial Spin Labeling Perfusion Imaging in Recurrent Glioblastomas Treated With Bevacizumab
Authors: Beppu Takaaki , Sato Yuichi , Sasaki Toshiaki , Terasaki Kazunori , Yamashita Fumio , Sasaki Makoto , Ogasawara Kuniaki 
Published: December 2018

PurposeThe aim of this study was to clarify whether arterial spin labeling (ASL) perfusion imaging can assess biological effects from bevacizumab (BEV) therapy as reliably as PET with11C-methyl-l-methionine (11C-met-PET).Materials and MethodsTwenty-four patients with recurrent glioblastoma were examined using both ASL and11C-met-PET before and 4 and 8 weeks after starting BEV treatment. Tumor-to-normal brain (T/N) ratios, fluctuations in T/N ratio, and tumor volumes were compared between ASL and11C-met-PET. Accuracy of predicting patient with long progression-free survival (PFS) was assessed for T/N ratios and fluctuations for ASL and11C-met-PET in each phase and in each period using receiver operating characteristic curves. Between 2 groups of patients assigned by cutoff values from receiver operating characteristic curves, PFS was compared in each phase or in each period.ResultsT/N ratios, fluctuations in ratio, and tumor volumes correlated significantly between ASL and11C-met-PET at all time points and all periods. Arterial spin labeling was eligible as a predictor for long PFS only in assessment of fluctuations in T/N ratio. However, the most accurate predictors for long PFS were T/N ratio from11C-met-PET at 8 weeks and the fluctuation from baseline to 4 weeks in T/N ratio from11C-met-PET.ConclusionsBlood flows on ASL correlated with accumulations of11C-met on PET in recurrent glioblastoma under BEV treatment. Although11C-met-PET offered superior accuracy for predicting patients with long PFS from time points, ASL offered reliable prediction of long PFS, provided that fluctuations in T/N ratio between consecutive scans are assessed.
Point Spread Function Reconstruction for Integrated 18F-FET PET/MRI in Patients With Glioma
Authors: Rogasch Julian Manuel Michael , Albers Josefine , Steinkrüger Ferdinand L. , Lukas Mathias , Wedel Florian , Amthauer Holger , Furth Christian 
Published: December 2018

Purpose
Semiquantitative 18F-FET PET assessment using the tumor's SUV or tumor-to-background ratios (TBRs) can separate gliomas from peritumoral tissue or progression from pseudoprogression. This study investigated if point spread function (PSF) reconstruction of 18F-FET PET data affects SUV-based dignity assessment.

Materials and Methods
This study is a retrospective analysis of 87 glioma patients (female, 36; male, 51; age, 48 [13–81] years) undergoing 18F-FET PET/MRI for staging (n = 17) or restaging (n = 70). PET was reconstructed using ordered-subset expectation maximization with and without PSF. Lesions were delineated with semiautomated background-adapted thresholding relative to SUVmax; background was delineated contralaterally. Comparative measurements with a National Electrical Manufacturers Association International Electrotechnical Commission PET body phantom (sphere-to-background ratios, 8:1 and 4:1) were performed.

Results
PSF showed significantly higher tumor SUVmax (median difference, +0.1; interquartile range, 0.04–0.18), SUVmean (+0.05; 0.03–0.08), TBRmax|mean (+0.1; 0.04–0.2), and TBRmean|mean (+0.06; 0.03–0.09) than non-PSF (P < 0.001). Background SUVmean was unaffected. In patients and phantom, differences between PSF and non-PSF increased with TBR and decreased with lesion's PET volume. Differences only exceeded 0.2 SUV for SUVmax or 0.1 SUV for SUVmean if TBR was greater than 3 and lesion's PET volume was less than 10 mL (d = 27 mm). Dignity assessment by PSF and non-PSF was concordant in all patients examined for staging (cutoff, TBRmean|mean > 1.6; positive, 14; negative, 3) and restaging (cutoff, TBRmax|mean > 2.0; positive, 67; negative, 3).

Conclusions
PSF increased tumor SUVmax and SUVmean compared with non-PSF 18F-FET PET/MRI data, especially in small lesions with high TBR (>3). However, dignity assessment using established TBR cutoffs was not affected.
Quick Calculation of Breast Resection Mass Using the Schnur Scale
Authors: Dvoracek Lucas A. , Gusenoff Jeffrey A. , Peter Rubin J. , Manders Ernest K. 
Published: December 2018

Abstract
In 1991, Dr Paul Schnur and his colleagues published an article correlating the weight of breast tissue to be removed in a breast reduction operation with the total body surface area (BSA) of the patient. They presented a very cogent argument for selecting three groups of patients: those with medical indications for operation, those who merit review, and those whose operation could be considered cosmetic. The Schnur Sliding Scale is widely used by insurance companies in the western United States in the process of preauthorizing breast reduction operations, and its use may be spreading eastward. The Schnur group presented a nomogram for calculating BSA and a scale in the form of a table for guiding a determination of whether the patient is a reconstructive patient as opposed to an aesthetic patient. We have combined the scale and the BSA nomogram for a simplified nomogram calculator that facilitates rapid determination of anticipated tissue weight of resection for a patient of a given size. This calculator yields the required weight of tissue to remove with just knowledge of the patient's height and weight and the use of a straight edge. We demonstrate and compare performance of this calculation by hand and by nomogram. There is ample evidence that the practice of applying the Schnur Sliding Scale may be prohibitive to symptomatic patients seeking reduction mammaplasty and should be abandoned. While this practice continues, our simplified Schnur Sliding Scale nomogram is meant to help easily determine the insurer-required minimum breast resection weight and thereby both improve patient counseling prior to planning surgery and assist the surgeon with achieving insurer reimbursement for the procedure while avoiding rejected claims.
Acquired Localized Hypertrichosis Following Pressure Garment and/or Silicone Therapy in Burn Patients
Authors: Uslu Asim , Sürücü Abdullah , Korkmaz Mehmet Ali , Uygur Fatih 
Published: December 2018

Abstract
Hypertrichosis is characterized by excessive and abnormal hair growth anywhere on the skin and may develop after prolonged local irritation, such as application of a cast, injury, or a bite. Pressure garment/silicone therapy is often used to prevent hypertrophic scar formation. The adverse effects of gel sheet application include rash, skin breakdown, cessation of scar responsiveness, pruritus, contact dermatitis, and dry skin. We report on 7 burn patients who developed hypertrichosis following application of pressure garment/silicone therapy to prevent hypertrophic scarring.
Y-Peg-in-a-Round-Hole Closure for Immediate Periareolar Mastectomy Expander Reconstruction
Authors: Grinsell Damien , Baker Caroline , Nielsen Hans Henrik Møller , Alexander K. Skaria 
Published: December 2018

Introduction
Mastectomies closed with a linear scar can distort the resulting shape of the breast. We present our novel Y-peg-in-a-round-hole closure method of the mastectomy scar, which improves the shape of the reconstructed breast while maintaining reliable healing, implant coverage, and minimum scar size for covering by tattoo.

Materials and methods
A retrospective review of all breast reconstruction cases performed by the senior surgeon during the period from January 2010 to January 2017 was undertaken. Data were analyzed for wound healing problems, infection rates and mastectomy skin flap necrosis.

Results
Data were extracted for 126 consecutive patients with 154 breast reconstructions. Twelve breasts (7.7%) experienced wound healing problems, for which 7 (4.5%) required revisionary surgery. Eighteen breasts (11.7%) developed an infection requiring antibiotics, of which 8 (5.2%) needed a further operation. Four breasts (2.6%) needed removal of the implant. No patients were lost to follow-up.

Conclusion
After nipple resecting mastectomy, the Y-peg-in-a-round-hole scar minimizes radial size and contour deformity but allows for reliable wound healing.