bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unani – eine vergessene traditionelle europäische Medizin
Authors: Ather Amina 
Published: December 2018

SummaryDie Unani-Medizin spielt v.a. in Afghanistan, Pakistan und Indien eine Rolle in der Gesundheitsversorgung. Sie wird an Hochschulen gelehrt und an vielen Krankenhäusern praktiziert. Auch wenn die Wurzeln der Unani-Medizin in Europa liegen, ist das mehr als 2000 Jahre alte Medizinsystem hier weitgehend in Vergessenheit geraten. Der Beitrag stellt das System der Unani-Medizin vor, nimmt Bezug auf das mögliche Potenzial in der Therapie und konkretisiert die gegenwärtigen Herausforderungen für Unani-Wissenschaftler.
Attempted Nose and Lip Replantation after Partial Animal Digestion
Authors: Cuellar Trajan , Westbom Catherine , Orgill Dennis , Pribaz Julian , Caterson Edward , Talbot Simon 
Published: December 2018

AbstractWe report a case of a 71-year-old female patient who sustained a severe midface soft tissue avulsion injury from a family canine. The removed tissue was recovered from the canine's digestive tract and transferred to the hospital where emergent microvascular replantation was performed. The tissue survived for 72 hours, but then developed vascular compromise. Despite aggressive revision of multiple anastomoses with extensive use of vein grafting, the replanted segment was lost. Reconstruction then proceeded along traditional lines with an acceptable cosmetic outcome and good functional outcomes.
Cardiomyocyte-specific loss of RNA polymerase II subunit 5-mediating protein causes myocardial dysfunction and heart failure
Authors: Zhang Jian , Sheng Jingyi , Dong Liwei , Xu Yinli , Yu Liming , Liu Yu , Huang Xiaoru , Wan Song , Lan Hui-Yao , Wang Huishan 
Published: December 2018

AbstractAimsMyocardial dysfunction is an important cause of heart failure (HF). RNA polymerase II subunit 5 (RPB5)-mediating protein (RMP) is a transcriptional mediating protein which co-ordinates cellular processes including gene expression, metabolism, proliferation, and genome stability. However, its role in cardiac disease remains unknown. We aimed to determine the role and regulatory mechanisms of RMP in cardiomyocyte function and the development of HF.Methods and resultsMyocardial RMP expression was examined in human heart tissues from healthy controls and patients with advanced HF. Compared to normal cardiac tissues, RMP levels were significantly decreased in the myocardium of patients with advanced HF. To investigate the role of RMP in cardiac function, Cre-loxP recombinase technology was used to generate tamoxifen-inducible cardiomyocyte-specific Rmp knockout mice. Unexpectedly, cardiomyocyte-specific deletion of Rmp in mice resulted in contractile dysfunction, cardiac dilatation, and fibrosis. Furthermore, the lifespan of cardiac-specific Rmp-deficient mice was significantly shortened when compared with littermates. Mechanistically, we found that chronic HF in Rmp-deficient mice was associated with impaired mitochondrial structure and function, which may be mediated via a transforming growth factor-β/Smad3-proliferator-activated receptor coactivator1α (PGC1α)-dependent mechanism. PGC1α overexpression partially rescued chronic HF in cardiomyocyte-specific Rmp-deficient mice, and Smad3 blockade protected against the loss of PGC1α and adenosine triphosphate content that was induced by silencing RMP in vitro.ConclusionsRMP plays a protective role in chronic HF. RMP may protect cardiomyocytes from injury by maintaining PGC1α-dependent mitochondrial biogenesis and function. The results from this study suggest that RMP may be a potential therapeutic agent for treating HF.
Cardioaortic replacement for a ruptured root pseudoaneurysm with pulsatile subcutaneous extension
Authors: Wang Hanjay , Shudo Yasuhiro , Hittinger Scott A , Woo Y Joseph 
Published: December 2018

Abstract
Orthotopic heart transplantation with concomitant aortic surgery is rarely performed. Herein, we describe the successful management of a patient with an otherwise inoperable, ruptured aortic root pseudoaneurysm using combined cardioaortic replacement under hypothermic circulatory arrest.
Results of the Induced Membrane Technique in the Management of Traumatic Bone Loss in the Lower Limb: A Cohort Study
Authors: Giotikas Dimitris , Tarazi Nadim , Spalding Lynette , Nabergoj Marko , Krkovic Matija 
Published: December 2018

Objective:
To present our technique and early results using the Masquelet technique.

Design:
Retrospective cohort study.

Patients/Participants:
Thirteen patients with 14 open fractures of the femur and tibia were included between November 2013 and December 2014.

Intervention:
A Masquelet technique was used to manage the open fractures.

Main outcome measure:
Infection and union rate.

Results:
The mean follow-up was 17 months. The mean bone defect was 56.6 mm. Eight fractures (57.1%) progressed to union at an average of 42.1 weeks. Infection developed in 3 fractures (21.4%). Overall, the induced membrane technique was abandoned in 5 (35.7%) cases.

Conclusions:
The induced membrane technique showed a substantial rate of failure in the acute trauma setting in the lower limb. In the absence of sound published evidence, the authors now use the technique in selected cases only.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Dedifferentiated Melanoma With Expression of Cytokeratin and GATA3 in a Patient With History of Breast Carcinoma
Authors: Alkhasawneh Ahmad , Nassri Ammar , John Ivy 
Published: December 2018

Abstract:
Melanoma is one of the great mimickers in pathology because it has diverse morphologies and can be mistaken for carcinoma or sarcoma. In most cases, immunochemistry is helpful in supporting the diagnosis and excluding other differentials. However, metastatic melanoma may lose immunohistochemical melanocytic markers and express nonmelanocytic lineage markers, which often poses a diagnostic dilemma and may be misdiagnosed as a poorly differentiated carcinoma or sarcoma. We report the case of a 52-year-old woman who had a history of recurrent melanoma on her right shoulder with axillary lymph node metastasis (BRAF V600K–mutated melanoma) and right-side breast-invasive ductal carcinoma (stage pT1b N0sn). One year later, she presented with a left-sided chest wall mass and enlarging left axillary lymph nodes. Needle core biopsies were obtained from both lesions, and histologic examination showed a poorly differentiated tumor with pleomorphic/anaplastic morphology and necrosis. The tumor cells were strongly immunoreactive for GATA-3 without expression of melanocytic markers (S100, Melan A, HMB45, SOX10, MITF, and tyrosinase). The history of melanoma prompted molecular analysis, and the lesion was found to harbor the BRAF V600K mutation, consistent with metastatic dedifferentiated melanoma. Recognition of metastatic dedifferentiated melanoma is important to avoid misdiagnosis of carcinoma, especially in patients with a previous history of carcinoma.
Immediate Implant-based Breast Reconstruction with Acellular Dermal Matrix Compared with Tissue-expander Breast Reconstruction: Rate of Infection
Authors: Carminati Marcello , Sempf Darja , Bonfirraro Pier Paolo , Devalle Luca , Verga Maurizio , Righi Bernardo , Mevio Gabriele , Leone Francesco , Fenaroli Privato , Robotti Enrico 
Published: December 2018

Background:
The risk of infection continues to be a subject of discussion within the field of implant-based breast reconstruction. Studies have shown the feasibility of immediate single-stage procedures with acellular dermal matrix (ADM), yet 2-stage tissue expander techniques continue to be the procedure most often performed. The purpose of this study was to evaluate postoperative infections and to identify associated predictors.

Methods:
A retrospective study at Papa Giovanni XXIII Hospital was conducted between 2013 and 2017. Patients’ demographic data were compared between single-stage and 2-stage procedures. Rate of infection and predictors were examined. Minor infections could be treated by oral antibiotics only, major infections required inpatient treatment. Healing was considered a successful treatment with antibiotics only, whereas any supplementary surgical intervention resulting in the preservation of an implant device was considered salvage. Breast reconstruction was defined a failure in case of implant loss or need for autologous reconstruction.

Results:
Three hundred ninety-three patients underwent 336 monolateral and 57 bilateral implant-based breast reconstruction. Ninety-two patients had a submuscular direct-to-implant reconstruction with ADM with an infection rate of 11.4% compared with an infection rate of 7.8% among the 268 patients with a 2-stage tissue expander procedure. Beta-binomial regression showed obesity and preoperative radiotherapy as significant predictors for infection (OR, 4.65, P = 0.038, and OR, 7.13, P = 0.015, respectively). Average time of onset of infection among the submuscular direct-to-implant with ADM group was 67.1 days compared with 80.1 days among tissue-expander group with postoperative chemotherapy and preoperative radiotherapy having a significant effect on time of infection onset (P = 0.014, P = 0.034, respectively).

Conclusions:
Direct-to-implant breast reconstruction with ADM is a procedure with acceptable risks of infection in comparison to tissue expander procedures. A profound patient selection pre- and intraoperatively is the basis of successful breast reconstruction.
Local Flaps with Negative Pressure Wound Therapy in Secondary Reconstruction of Myelomeningocele Wound Necrosis
Authors: Banda Chihena H. , Narushima Mitsunaga , Ishiura Ryohei , Fujita Minami , Furuya Megumi 
Published: December 2018

Summary:
Major wound necrosis is an uncommon yet critical complication of meningomyelocele surgical repair with few reports available. Management is demanding and often requires further reconstructive surgery. We report a case of a neonate who developed extensive wound necrosis with dehiscence following primary repair of myelomeningocele. The large defect was reconstructed using transposition fasciocutaneous flaps and negative pressure wound therapy applied over the flap donor sites resulting in wound closure, alleviating the need for further surgery. We report this case to highlight the importance of local flap design in reconstruction of the complex wounds seen following meningomyelocele repair wound necrosis. Additionally, we report the unique utilization of negative pressure wound therapy in the management of myelomeningocele.
Inframammary Flap Excision Method in Breast Augmentation: Improving Symmetry of NAC and IMF
Authors: Go Ju Young , Jeong Dae Kyun , Han Daniel Seungyoul , Bae Seong Hwan 
Published: December 2018

Background:
When we perform a breast augmentation through the inframammary fold (IMF) approach, incision placement at the new IMF is a key element of the planning process. In the majority of the previously published methods, the new IMF was planned based on the nipple-areola complex (NAC) position. However, these methods can lead to asymmetry in the IMF if the NAC is not symmetrical.

Methods:
We present the IMF flap excision method for correction of asymmetries of NAC and IMF. The new IMF position was marked based on the ICE technique. We have redesigned the higher side IMF to the same height as the lower side. And then we removed the amount of the skin and soft tissue, which corresponded to the difference between the 2 IMF. We dissected the submuscular breast pocket higher than in the usual cases, making it easier to move the breast tissue downward.

Results:
This method was performed on 21 patients, with an average follow-up time of 6 months (range, 2–9 months). The average correction amount of asymmetry of the NAC ranged from 3 to 15 mm and was maintained throughout the follow-up period. NAC downward positioning and symmetry of IMF were observed. Almost all patients showed improvement or complete resolution of their nipple asymmetry.

Conclusion:
The IMF flap excision method corrected the asymmetries in the NAC and IMF without additional scars. This method should be strongly considered in patients undergoing a primary breast augmentation procedure with mild NAC asymmetry.
Comparative Analysis of Adverse Events After Esophageal Balloon and Bougie Dilations in Children
Authors: Mark Jacob A. , Anderson Bradley T. , Pan Zhaoxing , Menard‐Katcher Calies , Kramer Robert E. 
Published: December 2018

ABSTRACTBackground:Pneumatic balloon and bougie dilation are widely used methods for pediatric esophageal dilation. There are no studies directly comparing the safety of these techniques in pediatric patients. This study compared adverse events (AEs) of balloon and bougie dilation in children at a single institution.Methods:AEs were identified by means of a prospective clinical registry of all procedure related AEs from 2012 to 2015 at a single institution. Identified AEs underwent retrospective review of procedural and clinical details. The category of each AE was recorded and severity was assigned using a 5‐point scoring system. AEs were compared between balloon and bougie dilation for different severities.Results:There were 105 patients who underwent 246 dilation sessions. Balloon dilation was performed more commonly (n = 190, 77%) as compared to Maloney dilators (n = 56, 23%). Patients with balloon dilation were younger (3.0 vs 14.5 years, P = 0.0001) and more likely to have strictures from caustic ingestion (42% vs 2%, P < 0.0001) or surgical anastomoses (34% vs 5% P < 0.0001). Bougie dilation was used more commonly in patients with eosinophilic esophagitis (77% vs 7%, P < 0.0001)). In multivariate analysis, each year of increasing age was associated with a 12% increase in any AEs (P = 0.015), but no difference in clinically significant AEs (grade 2 or higher) was identified between dilation methods.Conclusions:Bougie and balloon dilation did not have significant differences in AE rates, but the patient populations differed between the 2 methods. The dilation method should depend on stricture characteristics and endoscopist expertise with each method.
Concordance Between Intracervical and Fundal Injections for Sentinel Node Mapping in Patients With Endometrial Cancer?
Authors: Farazestanian Marjaneh , Yousefi Zohreh , Zarifmahmoudi Leili , Hasanzadeh Mofrad Malihe , Kadkhodayan Sima , Sadeghi Ramin 
Published: December 2018

Objective
A major controversy in sentinel node (SN) biopsy of endometrial cancer is the injection site of mapping material. We compared lymphatic drainage pathways of the uterine cervix and uterine body in the same patients by head-to-head comparison of intracervical radiotracer and fundal blue dye injections.

Methods
All patients with pathologically proven endometrial cancer were included. Each patient received 2 intracervical injections of 99mTc-phytate. At the time of laparotomy, the uterus was exposed, and each patient was injected with 2 aliquots of patent blue V (2 mL each) in the subserosal fundal midline locations. The anatomical locations of all hot, blue, or hot/blue SNs were recorded.

Results
Overall, 45 patients entered the study. At least 1 SN could be identified in 75 of 90 hemipelves (83.3% overall detection rate, 82.2% for radiotracer [intracervical] alone, and 81.1% for blue dye [fundal] alone). In 71 hemipelves, SNs were identified with both blue dye (fundal) and radiotracer (intracervical) injections. In 69 of these 71 hemipelves, at least 1 blue/hot SN could be identified (97.18% concordance rate). In 10 patients, para-aortic SNs were identified. All of these nodes were identified by fundal blue dye injection, and only 2 were hot.

Conclusions
Our study shows that lymphatic drainage to the pelvic area from the uterine corpus matches the lymphatic pathways from the cervix, and both intracervical and fundal injections of SN mapping materials go to the same pelvic SNs.
A Rare Case of Neutrophil-Rich, ALK-Negative Anaplastic Large Cell Lymphoma in the Lung Mimicking a Pulmonary Abscess on 18F-FDG PET/CT
Authors: Wang Li-Juan , Wu Hu-Bing , Zhang Yin , Zhou Wen-Lan , Wang Quan-Shi 
Published: December 2018

Abstract
A 21-year-old man complained of cough, fever, and hemoptysis for 15 days. Peripheral neutrophil cell (33.8 × 109/L) was markedly increased, and a mass in the left lung was detected by chest radiography. 18F-FDG PET/CT was referred for characterizing the lesion and found a large mass with multiple cavities in the left lung, which had markedly high uptake of 18F-FDG, mimicking pulmonary abscess. Surprisingly, the lesion was eventually proved to be neutrophil-rich anaplastic large cell lymphoma. After 4 cycles' chemotherapy, the lesion shrank significantly.
Imaging and Treatment of Post–90Y Radioembolization Radiation Dermatitis
Authors: Huang Hian Liang , Venkatanarasimha Nanda , Chan Chung Yip 
Published: December 2018

Abstract

90Y microspheres have been widely used for treatment of liver-dominant malignancies. There have been a few case reports of radiation dermatitis post–inadvertent falciform artery 90Y radioembolization and a few retrospective studies with prophylactic coiling or use of ice packs prior to radioembolization. Our patient had inadvertent falciform artery radioembolization, which was not predicted on pretherapy angiography or 99mTc–macroaggregated albumin SPECT/CT but was localized on posttherapy 90Y PET/CT and treated with topical betamethasone valerate 0.1% BD and ice packing immediately postprocedure. He subsequently developed a small area of periumbilical radiation dermatitis, which resolved after 4 weeks.
Anatomical Basis for Lip Reconstruction
Authors: Tong Charles C. L. , Vandegriend Zachary P. , Lee Yan H. , Lawson William 
Published: December 2018

Objective
The aim of this study was to establish the anatomic basis for functional upper and lower lip reconstruction with locoregional flaps.

Design, Setting, and Participants
This article is an anatomic fresh cadaver study.

Results
For lower lip reconstruction, the modified Bernard-Webster and Karapandzic flaps preserve the modiolus, buccinator, zygomaticus major muscle, and buccal branches of the facial nerve. The Bernard-Webster flap allowed for a larger oral aperture despite a larger defect, but required transection of the lower lip depressors and orbicularis oris. For upper lip reconstruction, the reverse fan flap preserves the modiolus and its muscle attachments. The reverse Karapandzic flap required transection of the lower lip depressors, buccinator, and the zygomaticus major.

Conclusions and Relevance
Locoregional flaps remain the workhorse for lip reconstruction. This study provides the anatomic basis for the modiolus and its muscular attachments that permit techniques such as the Bernard-Webster flap and the Karapanzic flap to achieve functional lip reconstruction with innervated and denervated tissue.
Long Term Follow Up of a Vascularized Osteocutaneous Free Flap for Reconstruction in Charcot Neuroarthropathy
Authors: Abbate Olivia A. , Lakhiani Chrisovalantis , Janhofer David E. , Elmarsafi Tammer , Zarick Caitlin S. , Higgins James P. , DeFazio Michael V. , Evans Karen K. 
Published: December 2018

Abstract
Vascularized osteocutaneous free flaps have seen increasing use in foot and ankle surgery for the repair of bony defects secondary to chronic nonunion, osteomyelitis, and fractures. One example is the Medial Femoral Condyle (MFC) Flap. The utility of the MFC flap for the repair of a bony defect in a diabetic patient, however, has yet to be explored. We report the long-term results of a case describing the use of an MFC flap to reconstruct an osseous defect resulting from first metatarsophalangeal joint resection in a diabetic patient.
Modified V-Y Fasciocutaneous Flap Reconstruction After Abdominoperineal Resection in Irradiated Patients Prevents Wound Dehiscence and Associated Complications
Authors: Kokosis George , Phillips Brett T. , Soo Joanne , Poveromo Luke , Erdmann Detlev , Mantyh Christopher R. , Migaly John , Levinson Howard 
Published: December 2018

Background
Primary perineal closure following abdominal perineal resection (APR) is reported to have a wound complication rate as high as 66%, whereas flap reconstruction reduces wound complications to 15% to 35%. A modified de-epithelialized V-Y fasciocutaneous flap aims to further improve results in this patient population.

Methods
To study the breaking force of a simple interrupted suture in either skin or subcutaneous fat, various quantitative assessments were performed in a porcine flap model using uniaxial static tensile testing with an Instron tensiometer, with a single or triple row of 3 Vicryl sutures in both skin and fat.
An outcomes analysis was performed in 24 patients who underwent modified V-Y flap reconstruction after APR. Primary outcome was wound complications including infection, dehiscence, seroma, hematoma, and pelvic fluid collections.

Results
Tensile strength of sutures anchored in skin was found to be up to 8 times stronger than sutures anchored in subcutaneous fat in a single row and 3 times as strong in 3 rows (breaking force, 500.2 N vs 263.7 N). In our patient cohort of 24 irradiated cancer patients, 10 (42%) had wound healing complications. Wound dehiscence of various degrees accounted for 80% of these complications. Five patients with wound complications (50%) had associated pelvic fluid collections (infection, 1; wound dehiscence, 4). Minor dehiscence was more likely to occur after suture removal and less likely to be associated with pelvic collections compared to patients with major dehiscence. Our study yields total complication rates lower than what is reported in the literature for anterolateral thigh or gracilis flap including much lower infection rates, and almost similar results to the commonly used vertical rectus myocutaneous muscle.

Conclusion
Tension-free de-epithelialized V-Y flap use after APR effectively reconstructs the defect while eliminating an additional donor site. Benchtop studies suggest enhanced flap integrity yielded by layered closure. Wound complications can be managed with local care in their majority (90%). Staggering or delaying suture removal can decrease minor dehiscence. Based on analysis of our results, review of the literature and consideration of donor site morbidity, we believe that modified V-Y flap is the best approach for APR reconstruction in irradiated patients.
Origins of Gender Affirmation Surgery
Authors: Siotos Charalampos , Neira Paula M. , Lau Brandyn D. , Stone Jill P. , Page James , Rosson Gedge D. , Coon Devin 
Published: December 2018

Background
Gender-affirming care, including surgery, has gained more attention recently as third-party payers increasingly recognize that care to address gender dysphoria is medically necessary. As more patients are covered by insurance, they become able to access care, and transgender cultural competence is becoming recognized as a consideration for health care providers. A growing number of academic medical institutions are beginning to offer focused gender-affirming medical and surgical care. In 2017, Johns Hopkins Medicine launched its new Center for Transgender Health. In this context, history and its lessons are important to consider. We sought to evaluate the operation of the first multidisciplinary Gender Identity Clinic in the United States at the Johns Hopkins Hospital, which helped pioneer what was then called “sex reassignment surgery.”

Methods
We evaluated the records of the medical archives of the Johns Hopkins University.

Results
We report data on the beginning, aim, process, outcomes of the clinic, and the reasons behind its closure. This work reveals the function of, and the successes and challenges faced by, this pioneering clinic based on the official records of the hospital and mail correspondence among the founders of the clinic.

Conclusion
This is the first study that highlights the role of the Gender Identity Clinic in establishing gender affirmation surgery and reveals the reasons of its closure.