bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microsurgical Reconstruction of the Smile
Authors: Sue Gloria R. , Ho Oscar H. 
Published: March 2019

Background
Facial paralysis is a significant problem with functional, psychological, and esthetic consequences. Free muscle transfer for reanimation of the smile has been established as the preferred reconstructive method. However, little has been reported on the complications after this procedure. We sought to perform a critical analysis of these complications and their ultimate outcomes.

Methods
A retrospective review was performed on consecutive patients undergoing microsurgical reconstruction of the smile by the senior author from 2013 through 2017. Patient demographics including age, race, body mass index, and medical comorbidities were recorded. The cause of facial palsy and type of microsurgical reconstruction were assessed. Patient outcomes including complications and management of the complication were analyzed. All statistical analyses were performed using nonparametric analyses.

Results
We identified 17 patients who underwent microsurgical reconstruction of the smile, with 1 patient undergoing bilateral procedures, for a total of 18 microsurgical smile reanimation procedures performed. Sixteen of these were 1-stage reconstructions with the coaptation of the nerve to the masseter, whereas 2 were 2-stage reconstructions using cross-facial nerve grafts. The gracilis muscle was used as the donor muscle in all cases. The patients had a median age of 26.5 and a median follow-up of 1.04 years from surgery. There were no major early complications observed in our cohort. Eight (44.4%) reanimations developed a minor complication that required subsequent reoperation. The reoperations were performed at a median of 0.97 years after the microsurgical procedure. The most common indication for reoperation was lateral retraction of the insertion of the transplanted muscle, which occurred in 5 (62.5%) patients. One patient underwent surgical exploration for an abrupt loss of transplanted muscle function after trauma to the cheek. Another patient had less than expected transplanted muscle activity at 1 year postoperatively and underwent exploration of the cross-facial nerve graft and a neurorrhaphy revision. Lastly, 1 patient developed significant rhytids over the transplanted muscle secondary to tethering of the skin to the underlying muscle. This patient underwent 2 subsequent revisions, with placement of acellular dermal matrix between the muscle and skin and fat grafting. All patients had functional animation of the transplanted muscle postoperatively.

Conclusions
Complications occurred in 44.4% of patients undergoing microsurgical reanimation of the smile. Most complications were minor in nature and were readily addressed with advancement of the transplanted muscle. All patients in our series had muscle function after the muscle transplantation.
Contribution of the Use of a Pen-Type Endoscope to Evaluate and Treat Ears Simultaneously During Cleft Palate Surgery in Late Presented Cases
Authors: Guneren Ethem , Ture Nurullah , Karabekmez Furkan Erol , Zahir Khalique 
Published: March 2019

Background:
The prevalence of secretory otitis media is very high among the nonoperated cleft palate patients.

Methods:
Ninety-one cleft palate operations were performed on late presented cases in Sudan, Africa. The surgeries were performed according to the Veau–Wardill–Kilner push-back technique. A laptop connected pen-type endoscopic camera was used to evaluate the tympanic membrane and address middle ear disease in all patients simultaneously. The procedure was performed after removing wax from the external auditory canal. A small incision was made with a myringotomy knife through the layers of the tympanic membrane if any sign of fluid collection was observed, after which the middle ear effusion was evacuated and the ventilation tube was inserted.

Results:
This procedure was undertaken in 182 ears; 41 ears (22.5%) were healthy, 19 ears (10.5%) had chronic perforations, 122 ears (67%) underwent myringotomy procedures, and 54 (44.2%) were treated by inserting a ventilation tube. Despite the challenging work environment, standard monitoring facilities were available and all operations were completed with no early complications.

Conclusion:
The pen-type camera instead of an operating microscope was a tremendous contribution, as it was easy to handle and contributed to the good outcomes. The use of this technique is strongly recommended in surgical camps.

Level of Evidence: III
Rare Intrasellar Arachnoid Cyst Distinguishing From Other Benign Cystic Lesions and its Surgical Strategies
Authors: Chen Binghong , Miao Yifeng , Hu Yaomin , Liao Yu , Tu Mei , Yang Xi , Qiu Yongming 
Published: March 2019

Abstract
The study reported a case of an intrasellar arachnoid cyst with visual disturbances as the main symptom. Arachnoid cyst is a common intracranial benign space-occupying lesion, but rarely seen in intrasellar region with less than 100 cases reported available in English language literature. Therefore, it is still controversial about the diagnosis and treatment of such patients. This article reviewed previous literature and discussed the differential diagnosis and surgical strategies of intrasellar arachnoid cyst in combination with our own case.
Does Maxillary Advancement Influence the Nasolabial Angle?
Authors: Shmuly Tom , Chaushu Gabreial , Allon Dror Michael 
Published: March 2019

Purpose:
To know whether there is a correlation between maxillary advancement and the nasolabial angle change allows to preoperatively predict the precise affect a planned maxillary advancement will have over the nasolabial angle. The aim of this study was to determine the relationship between the maxillary advancement and the nasolabial angle.

Methods:
The study is a retrospective analysis of 32 patients (12 males and 20 females, mean age 21 ± 3.4 years) who underwent a maxillary advancement. Lateral cephalometric radiographs were taken preoperatively and postoperatively. The lateral cephalograms were traced. Measurements were evaluated statistically using paired sample t-test and Pearson's correlation test.

Results:
The mean maxillary advancement was 4.81 ± 3.01 mm with a mean vertical change of −0.28 ± 2.80 mm. The nasolabial angle decreased by a mean of 3.78 ± 9.64° with statistical significance of P = 0.03 using a paired sample t-test, however using Pearson's correlation test, no direct correlation between maxillary advancement and the nasolabial angle was found. Furthermore, the study contains a review of the literature from the last 25 years, which shows that in most studies there was no correlation and in some patients even opposite results.

Conclusion:
Maxillary advancement might influence the nasolabial angle; however, preoperatively predicting the influence a maxillary advancement will have over the nasolabial angle is difficult, and further studies need to be conducted.
Aneurysms Arising From the Fenestrated Middle Cerebral Artery
Authors: Xue Xiying , Li Yunlong , Yin Yingchun , Yuan Xunhui , Xiao Hang , Wei Lin 
Published: March 2019

Abstract
Intracranial artery fenestration is segmental duplication of the lumen into 2 distinct channels and is known to have a low angiographical incidence of 0.3 to 0.9%. Intracranial artery fenestration is frequently associated with aneurysms, and aneurysms arising at the site of fenestrated middle cerebral artery (MCA) is extremely rare. To our best knowledge, there are only 10 such patients have been reported. Herein, the authors describe the 11th case of aneurysm arising from the fenestrated MCA. As the characteristics of fenestrated MCA aneurysms has not been well determined until now, these interesting patients are investigated and summarized.
Internal Jugular Vein Thrombosis With Serious Cervical Necrotizing Fasciitis
Authors: Zhang Wenhao , Qian Wentao , Shi Huimin , Zhang Weijie , Chen Minjie , Liang Xiang , Cai Xieyi 
Published: March 2019

Abstract
Internal jugular vein thrombosis (IJVT) is a rare complication of cervical necrotizing fasciitis (CNF) which may lead to life threat. This article reports a patient with severe CNF complicated with IJVT, and combined with the literature to analyze the diagnosis and treatment of CNF and IJVT.
Vascularized Combined with Nonvascularized Fibula Flap for Mandibular Reconstruction: Preliminary Results of a Novel Technique
Authors: Lin Bo , Yang Hongyu , Yang Huijun , Shen Shiyue 
Published: March 2019

Background:
Repair of long-span mandibular defects with vascularized free fibular grafts is now a routine procedure. Vertical discrepancy between a graft segment and the occlusal plane can be resolved through several options, including delayed onlay bone graft, iliac bone reconstruction, fibula distraction, and double-barrel fibula flap grafts. The present study (level of evidence: level IV, case series) introduces a new method for mandibular augmentation, wherein a vascularized fibular segment was used to simulate the superior alveolar ridge of the neomandible, whereas a nonvascularized fibular segment was used to reconstruct the inferior border.

Methods:
Patients who underwent mandibular reconstruction with this technique between January 2014 and May 2017 were retrospectively reviewed for complications, vertical height, bone resorption rates, and crown to implant (C/I) ratios.

Results:
The study included 10 patients. Flap loss occurred in 1 patient. A sufficiently long vascular pedicle could be maintained when the average fibular length was up to 15.3 cm to reconstruct long-span mandibular defects. Mean height of the neomandible at 2 weeks and 1 year after surgery was 34.1 and 29.4 mm, respectively. Mean resorption rates of vascularized and nonvascularized fibulas were 10.3% and 3.4%, respectively, at 1 year after surgery. Dental implants were placed in 4 patients with a mean C/I ratio of 1:1.15.

Conclusion:
The present method to reconstruct the alveolar ridge and basal portion of the mandible with vascularized and nonvascularized fibular flaps was safe and effective. It provided sufficient vertical height for lip support and implantation as well as adequate length for long-span mandibular reconstruction.
Treatment of Large Scars in Children Using Artificial Dermis and Scalp Skin Grafting
Authors: Wang Qian , Wang Min , Xu Yuan , Ni Xiao-Dong , Cang Zheng-Qiang , Yuan Si-Ming 
Published: March 2019

Background and Objectives:
Large scars formed after burns injury can seriously hamper appearance and function in children. Surgical resection of scars and secondary skin or flap grafting often brings severe damages to donor sites, which may lead to physiological and psychological development disorders in children. Here, we introduce the use of artificial dermis and skin grafts from scalps to treat large scars in children to minimize the donor site morbidity.

Methods:
A retrospective char review was performed including 7 children with large scars between January 2016 and December 2017. First, the scars were resected, and artificial dermis was applied to the secondary wounds. Twelve days later, outer silicone membrane was removed. Another 2 days later, scalp skin grafts of 0.3 mm were transplanted to the wounds. Manchester Scar Scale and Visual Analog Scale were used to evaluate scar appearance before and after the treatment respectively. One special patient with extensive scars was treated twice at an interval of 1 year. The first therapy was performed with both conventional method of resection and skin grafting and the new method described above. In the second therapy, 4 samples were taken from 4 different sites—the normal skin, scars, the skin where artificial dermis and scalp skin grafting were performed, and the skin where only scalp skin grafting was performed. H-E staining, Masson staining, Aldehyde fuchsin staining, and scanning electron microscopy were used for histological observation.

Results:
All skin grafts survived well. The Manchester Scar Scale score of the graft area was significantly reduced (P < 0.01) after the treatment. Histological examination showed obviously better dermis arrangement where artificial dermis and scalp grafting was performed.

Conclusion:
The therapy achieves better appearances and minimizes donor site morbidity. It is beneficial to physical and psychological development of children and provides an alternative to treat children with large scars.
Obesity as protective against, rather than a risk factor for, postoperative Clostridium difficile infection: A nationwide retrospective analysis of 1,426,807 surgical patients
Authors: Meier Karien , Nordestgaard Ask T. , Eid Ahmed I. , Kongkaewpaisan Napaporn , Lee Jae M. , Kongwibulwut Manansun , Han Kelsey R. , Kokoroskos Nikolaos , Mendoza April E. , Saillant Noelle , King David R. , Velmahos George C. , Kaafarani Haytham M.A. 
Published: March 2019

BACKGROUND
Recent studies suggest that obesity is a risk factor for Clostridium difficile infection, possibly due to disruptions in the intestinal microbiome composition. We hypothesized that body mass index (BMI) is associated with increased incidence of C. difficile infection in surgical patients.

METHODS
In this nationwide retrospective cohort study in 680 American College of Surgeons National Surgical Quality Improvement Program participating sites across the United States, the occurrence of C. difficile infection within 30 days postoperatively between different BMI groups was compared. All American College of Surgeons National Surgical Quality Improvement Program patients between 2015 and 2016 were classified as underweight, normal-weight, overweight, or obese class I-III if their BMI was less than 18.5, 18.5 to 25, 25 to 30, 30 to 35, 35 to 40 or greater than 40, respectively.

RESULTS
A total of 1,426,807 patients were included; median age was 58 years, 43.4% were male, and 82.9% were white. The postoperative incidence of C. difficile infection was 0.42% overall: 1.11%, 0.56%, 0.39%, 0.35%, 0.33% and 0.36% from the lowest to the highest BMI group, respectively (p < 0.001 for trend). In univariate then multivariable logistic regression analyses, adjusting for patient demographics (e.g., age, sex), comorbidities (e.g., diabetes, systemic sepsis, immunosuppression), preoperative laboratory values (e.g., albumin, white blood cell count), procedure complexity (work relative unit as a proxy) and procedure characteristics (e.g., emergency, type of surgery [general, vascular, other]), compared with patients with normal BMI, high BMI was inversely and incrementally correlated with the postoperative occurrence of C. difficile infection. The underweight were at increased risk (odds ratio, 1.15 [1.00–1.32]) while the class III obese were at the lowest risk (odds ratio, 0.73 [0.65–0.81]).

CONCLUSION
In this nationwide retrospective cohort study, obesity is independently and in a stepwise fashion associated with a decreased risk of postoperative C. difficile infection. Further studies are warranted to explore the potential and unexpected association.

LEVEL OF EVIDENCE
Prognostic/Epidemiologic, Level IV.
Artificial oxygen carriers and red blood cell substitutes: A historic overview and recent developments toward military and clinical relevance
Authors: Bialas Christopher , Moser Christopher , Sims Carrie A. 
Published: March 2019

ABSTRACT
Packed red blood cells are a critical component in the resuscitation of hemorrhagic shock. The availability of donor-derived blood products, however, suffers from issues of supply, immunogenicity, and pathogenic contamination. Deployment in remote or austere environments, such as the battlefield, is further hindered by the inherent perishability of blood products. To address the significant limitations of allogenic packed red blood cells and the urgent medical need for better resuscitative therapies for both combat casualties and civilians, there has been significant research invested in developing safe, effective, and field deployable artificial oxygen carriers. This article provides a comprehensive review of the most important technologies in the field of artificial oxygen carriers including cell-free and encapsulated hemoglobin-based oxygen carriers, perfluorocarbon emulsions, natural hemoglobin alternatives, as well as other novel technologies. Their development status, clinical, and military relevance are discussed.

LEVEL OF EVIDENCE
Systematic review.
Identifying patients with time-sensitive injuries: Association of mortality with increasing prehospital time
Authors: Chen Xilin , Guyette Francis X. , Peitzman Andrew B. , Billiar Timothy R. , Sperry Jason L. , Brown Joshua B. 
Published: March 2019

BACKGROUND
Trauma is a time-sensitive disease. However, recognizing which patients have time-critical injuries in the field is challenging. Many studies failed to identify an association between increasing prehospital time (PHT) and mortality due to evaluation of heterogenous trauma patients, as well as inherent survival bias from missed deaths in patients with long PHT. Our objective was to determine if a subset of existing trauma triage criteria can identify patients in whom mortality is associated with PHT.

METHODS
Trauma patients 16 years or older transported from the scene in the National Trauma Databank 2007 to 2015 were included. Cubic spline analysis used to identify an inflection where mortality increases to identify a marginal population in which PHT is more likely associated with mortality and exclude biased patients with long PHT. Logistic regression determined the association between mortality and PHT, adjusting for demographics, transport mode, vital signs, operative interventions, and complications. Interaction terms between existing trauma triage criteria and PHT were tested, with model stratification across triage criteria with a significant interaction to determine which criteria identify patients that have increased risk of mortality associated with increasing PHT.

RESULTS
Mortality risk increased in patients with total PHT of 30 minutes or less, comprising a study population of 517,863 patients. Median total PHT was 26 minutes (interquartile range, 22–28 minutes) with median Injury Severity Score of 9 (interquartile range, 4–14) and 7.4% mortality. Overall, PHT was not associated with mortality (adjusted odd ratio [AOR], 0.984 per 5-minute increase; 95% confidence interval [CI], 0.960–1.009; p = 0.20). Interaction analysis demonstrated increased mortality associated with increasing PHT for patients with systolic blood pressure less than 90 mm Hg (AOR, 1.039; 95% CI, 1.003–1.078, p = 0.04), Glasgow Coma Scale score of 8 or less (AOR, 1.047; 95% CI, 1.018–1.076; p < 0.01), or nonextremity firearm injury (AOR, 1.049; 95% CI, 1.010–1.089; p < 0.01).

CONCLUSION
Patients with prehospital hypotension, Glasgow Coma Scale score of 8 or less, and nonextremity firearm injury have higher mortality with increasing PHT. These patients may have time-sensitive injuries and benefit from rapid transport to definitive care.

LEVEL OF EVIDENCE
Prognostic/Epidemiologic III; Therapeutic/Care Management IV.
The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal trauma: Results from the Multi-Institutional Genitourinary Trauma Study
Authors: Keihani Sorena , Putbrese Bryn E. , Rogers Douglas M. , Zhang Chong , Nirula Raminder , Luo-Owen Xian , Mukherjee Kaushik , Morris Bradley J. , Majercik Sarah , Piotrowski Joshua , Dodgion Christopher M. , Schwartz Ian , Elliott Sean P. , DeSoucy Erik S. , Zakaluzny Scott , Sherwood Brenton G. , Erickson Bradley A. , Baradaran Nima , Breyer Benjamin N. , Fick Cameron N. , Smith Brian P. , Okafor Barbara U. , Askari Reza , Miller Brandi , Santucci Richard A. , Carrick Matthew M. , Kocik Jurek F. , Hewitt Timothy , Burks Frank N. , Heilbrun Marta E. , Myers Jeremy B. 
Published: March 2019

BACKGROUND
Indications for intervention after high-grade renal trauma (HGRT) remain poorly defined. Certain radiographic findings can be used to guide the management of HGRT. We aimed to assess the associations between initial radiographic findings and interventions for hemorrhage after HGRT and to determine hematoma and laceration sizes predicting interventions.

METHODS
The Genitourinary Trauma Study is a multicenter study including HGRT patients from 14 Level I trauma centers from 2014 to 2017. Admission computed tomography scans were categorized based on multiple variables, including vascular contrast extravasation (VCE), hematoma rim distance (HRD), and size of the deepest laceration. Renal bleeding interventions included angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Mixed-effect Poisson regression was used to assess the associations. Receiver operating characteristic analysis was used to define optimal cutoffs for HRD and laceration size.

RESULTS
In the 326 patients, injury mechanism was blunt in 81%. Forty-seven (14%) patients underwent 51 bleeding interventions, including 19 renal angioembolizations, 16 nephrectomies, and 16 other procedures. In univariable analysis, presence of VCE was associated with a 5.9-fold increase in risk of interventions, and each centimeter increase in HRD was associated with 30% increase in risk of bleeding interventions. An HRD of 3.5 cm or greater and renal laceration depth of 2.5 cm or greater were most predictive of interventions. In multivariable models, VCE and HRD were significantly associated with bleeding interventions.

CONCLUSION
Our findings support the importance of certain radiographic findings in prediction of bleeding interventions after HGRT. These factors can be used as adjuncts to renal injury grading to guide clinical decision making.

LEVEL OF EVIDENCE
Prognostic and Epidemiological Study, Level III and Therapeutic/Care Management, Level IV.
Age-related mortality in abusive head trauma
Authors: Nuño Miriam , Ugiliweneza Beatrice , Bardini Renee L. , Ozturk Arzu , Stephenson Jacob T. , Magaña Julia N. 
Published: March 2019

BACKGROUND
Abusive head trauma (AHT) peaks during early infancy and decreases in toddler years. Infants and toddlers experience different injuries, possibly impacting the risk of mortality. We aimed to evaluate the association of age with mortality.

METHODS
We conducted a retrospective study of AHT hospitalizations in 2000, 2003, 2006, 2009, and 2012 from the Kid's Inpatient Claims Database. An accidental head trauma cohort was included to hypothesize that the association between age and mortality is unique to abuse. A nested multivariable logistic regression was used to perform the analysis.

RESULTS
Children aged 2 years to 4 years experienced higher mortality than those younger than 2 years (22% vs. 10%, p < 0.0001; adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1–2.2). The presence of subarachnoid hemorrhage (OR, 1.9; 95% CI, 1.3–2.9), cerebral edema (OR, 4.0; 95% CI, 2.9–5.4), and retinal hemorrhage (OR, 1.9; 95% CI, 1.5–2.5) were associated with an increase risk in mortality. Children younger than 2 years experienced more fractures and hemorrhage (subdural, subarachnoid, retinal) while children aged 2 years to 4 years encountered more internal injuries and cerebral edema.
In children with accidental head trauma, those aged 2 years to 4 years have a lower mortality compared with those younger than 2 years (OR, 0.4; 95% CI, 0.3–0.6). Among children younger than 2 years, AHT and accidental trauma had comparable risk of mortality (OR, 0.9; 95% CI, 0.6–1.3). However, among those aged 22 years to 4 years, AHT had a higher risk of mortality than accidental trauma (OR, 3.3; 95% CI, 2.1–5.1).

CONCLUSION
There is a considerable risk of mortality associated with age at diagnosis in children with AHT.
Children younger than 2 years and those aged 2 years to 4 years present with different types of injuries. The high risk of mortality in the children aged 2 years to 4 years is unique to AHT. Efforts should be made to increase awareness about the risk of mortality and identify factors that can aide in a timely accurate diagnosis.

LEVEL OF EVIDENCE
Prognostic and epidemiological study, level III.