bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beware of the force of the horse: mechanisms and severity of equestrian-related injuries
Authors: Van Balen Pieter-Jan , Barten Dennis G. , Janssen Loes , Fiddelers Audrey A.A. , Brink Peter R. , Janzing Heinrich M.J. 
Published: October 2017

Background
Equestrian-related injuries (ERIs) are relatively severe compared with injuries in other popular sports. Previous studies on epidemiology of ERIs vary widely and mainly focus on incidence instead of severity of the injury.

Purpose
The aim of this study was to determine incidence, mechanisms and severity of ERIs in two Dutch hospitals (level 1 and level 2 trauma centers) over a 5-year period.

Patients and methods
All patients with ERIs who visited the emergency departments of VieCuri Medical Centre in Venlo and Maastricht University Medical Centre+ in Maastricht, The Netherlands, between July 2010 and June 2015 were retrospectively included. Clinical data were extracted from medical records.

Results
Most ERIs occurred in mounted riders (646 events; 68%); 94.9% of which involved a fall. Being kicked (42.5%) or trapped (30.1%) was the most common cause of injury in unmounted riders. Most frequently injured body parts were the upper extremities (43.8%) in mounted riders and lower extremities (40.5%) in the unmounted group. A relatively high percentage of facial injuries (9.7%) were found in the unmounted group. Seventeen per cent of all ERIs required admission. The median Injury Severity Score was 5 in the admitted population and 1 in the total population.

Conclusion
Horseback riding is a risky activity. Prior studies particularly studied admitted patients in level 1 trauma centers outside of Europe and demonstrated a high risk of significant injury. However, our study demonstrates that these studies in selected groups might have overestimated the severity of ERIs in the general population.
Metacognition Is Necessary for the Emergence of Motivation in People With Schizophrenia Spectrum Disorders
Authors: Luther Lauren , Bonfils Kelsey A. , Firmin Ruth L. , Buck Kelly D. , Choi Jimmy , Dimaggio Giancarlo , Popolo Raffaele , Minor Kyle S. , Lysaker Paul H. 
Published: October 2017

Abstract
Metacognition deficits are a putative cause of reduced motivation in people with schizophrenia spectrum disorders. However, it is unclear whether certain levels of metacognition are necessary for motivation to emerge. This study used a Necessary Condition Analysis to test whether metacognition was necessary for the presence of motivation and to identify the minimum level of metacognition necessary for high motivation to be possible in people with schizophrenia spectrum disorders (N = 175). Participants completed clinician-rated measures of metacognition and motivation. Necessary Condition Analysis revealed that metacognition is a necessary condition for motivation and that high levels of motivation were only possible, although not guaranteed, when at least a basic level of metacognition was present. The findings suggest that metacognition is a necessary building block for the development of motivation. Results suggest that targeting metacognition may be essential for improving motivation among people with schizophrenia spectrum disorders who do not meet this metacognition threshold.
Current Trends in Postmastectomy Breast Reconstruction
Authors: Panchal Hina , Matros Evan 
Published: October 2017

Summary:
Postmastectomy immediate breast reconstruction in the U.S. continues to experience an upward trend owing to heightened awareness, innovations in reconstructive technique, growing evidence of improved patient-reported outcomes, and shifts in mastectomy patterns. Women with unilateral breast cancer are increasingly electing to undergo contralateral prophylactic mastectomy, instead of unilateral mastectomy or opting for breast conservation. The ascent in prophylactic surgeries correlates temporally to a shift toward prosthetic methods of reconstruction as the most common technique. Factors associated with the choice for implants include younger age, quicker recovery time, along with documented safety and enhanced aesthetic outcomes with newer generations of devices. Despite advances in autologous transfer, its growth is constrained by the greater technical expertise required to complete microsurgical transfer and potential barriers such as poor relative reimbursement. The increased use of radiation as an adjuvant treatment for management of breast cancer has created additional challenges for plastic surgeons who need to consider the optimal timing and method of breast reconstruction to perform in these patients.
Evolving Approaches to Tissue Expander Design and Application
Authors: Morrison Kerry A. , Ascherman Benjamin M. , Ascherman Jeffrey A. 
Published: October 2017

Summary:
Prosthetic reconstruction utilizing a 2-stage saline tissue expander-to-implant procedure is the most common technique for breast reconstruction in the United States. For nearly the past 50 years, 2-stage breast reconstruction using saline tissue expanders has been the standard of care. However, in December 2016, a carbon dioxide–filled, remote-controlled tissue expander received U.S. Food and Drug Administration clearance. This tissue expander, known as the AeroForm Tissue Expander System (AirXpanders, Inc., Palo Alto, Calif.), is a novel, patient-controlled, needle-free expander operated by a wireless remote control device, which allows patients the comfort and convenience of home expansion, precluding the need for percutaneous saline injections. A multicenter, randomized, prospective clinical trial has revealed statistically significant shorter times to full expansion as well as shorter overall reconstructive times. It is the first tissue expander device designed successfully with an alternative filling medium to saline, namely carbon dioxide. This CO2-filled expander thus provides several potential advantages over previous expander designs, including patient-controlled expansion, obviation of saline injections, and shorter expansion times.
Developing, Conducting, and Publishing Appropriate Systematic Review and Meta-Analysis Articles
Authors: Kelley Brian P. , Chung Kevin C. 
Published: October 2017

Summary:
The volume of medical literature is growing at a rate that renders decision-making difficult without specialized summary tools. Systematic reviews and meta-analyses are important research instruments used to condense and clarify a broad scope of information into manageable summaries. When used effectively, these reports can pool cumulative data across primary studies, formulate clinical guidelines, and guide future research endeavors. However, errors in study design can result in ineffective or misleading analyses. This article presents the appropriate uses for systematic review and meta-analysis by introducing a framework for creating summary studies, and supplying specific examples of pitfalls in study design and execution.
Surgical Hypercorrection of Trigonocephaly: Evaluation of Surgical Outcomes
Authors: Bennett Katelyn G. , Liang Fan , Ranganathan Kavitha , Muraszko Karin M. , Vercler Christian J. , Buchman Steven R. 
Published: October 2017

Background:
A lasting correction of trigonocephaly is difficult to achieve, as a durable correction requires significant expansion to overcome galeal restriction and soft tissue recoil of the scalp. High rates of relapse have been reported throughout the literature. The specific aim of this study was to determine if the senior author's method of “hypercorrection” decreases relapse and the need for subsequent revisional surgery.

Methods:
Patients who underwent operative correction of metopic craniosynostosis between 1988 and 2011 were reviewed. All patients underwent the “hypercorrection” technique performed by the senior author. Hypercorrection consisted of a fronto-orbital advancement of 2.5 to 3.5 cm and a concomitant hyperexpansion of bitemporal projection. Split cranial bone grafting ensured adequate coverage of the significantly expanded cranial vault. Only patients who had at least 5 years of follow-up were included for review of outcomes. Relapse was defined as recurrence of bitemporal constriction or lateral orbital retrusion, requiring surgical correction.

Results:
Fifty-eight patients met criteria. Mean age at the time of surgery was 11 months. Mean follow-up was 9.0 years. During this time, 2 patients exhibited relapse requiring camouflage procedures. Cranial bone defects were found in 4 patients (7%), 3 of whom underwent cranial bone grafting, while 1 underwent methylmethacrylate placement at an outside institution. One patient underwent fat grafting for areas of soft tissue irregularity. No patients exhibited persistent sequelae of hypercorrection significant enough to require repeat fronto-orbital advancement.

Conclusion:
Surgical hypercorrection of trigonocephaly seems to minimize relapse and the need for revision in long-term follow-up and is therefore an important technique to consider.
Single-Stage Repair of Palatal Fistula and Velopharyngeal Incompetence by the New L Flap
Authors: El-Anwar Mohammad Waheed , Elsheikh Ezzeddin , Askar Sherif 
Published: October 2017

Objective:
To describe and assess the results of use of the new L-shaped posterior pharyngeal flap for repair of both palatal fistula and velopharyngeal incompetence.

Methods:
This study included 10 patients who were diagnosed to have soft palate fistula and persistent velopharyngeal insufficiency (VPI). L-shaped superiorly based pharyngeal flap was harvested from oropharynx and inserted into the soft palate closing the fistula after fistula trimming. The palatal part of the flap (transverse limb) was spread 1 cm horizontally and 1 cm in the anteroposterior direction in soft palate at fistula site closing it without tension. Prior to and after surgery, patients were assessed by examination, video-nasoendoscopy, and speech assessment.

Results:
Closure of the palatal fistula could be achieved in all patients. Postoperative speech assessment showed significant improvement in the nasal emission, resonance, intraoral pressure, and articulation defects. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in all patients. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea reported.

Conclusion:
The new used L-shaped pharyngeal flap could properly close palatal fistula and correct velopharyngeal functions (closure and speech) in patients with persistent VPI with no reported significant complication and without the need for palatal dissection or flaps.
More Than Meets the Eye: The Effect of Intercanthal Distance on Perception of Beauty and Personality
Authors: Naran Sanjay , Wes Ari M. , Mazzaferro Daniel M. , Bartlett Scott P. , Taylor Jesse A. 
Published: October 2017

Abstract
In judging normalcy, surgeons rely on established facial anthropometric measures and proportions. However, there exists a range of “normal,” and a degree of disproportion may be considered more attractive. The authors set out to determine how changes in only intercanthal distance affect the layperson's perception of beauty and personality traits of a face. The authors used Amazon.com's Mechanical Turk (MTurk), a crowdsourcing tool, to determine how changes in intercanthal distance affect overall perception of beauty and personality. MTurk respondents provided demographic information and were asked to survey 16 female subjects, each digitally edited to be hypoteloric or hyperteloric. Data were collected from 490 MTurk crowd raters. Paired t test analysis found that respondents perceived subjects to be more submissive, friendly, and attractive with increased intercanthal distance (P < 0.05). Women respondents were less likely to perceive change in regards to how unthreatening and how intelligent the subject appeared upon intercanthal widening (P < 0.05). Compared with Caucasian respondents, minorities (Asian- and African-American) were more likely to perceive difference in submissiveness, threat, intelligence, and attractiveness with increased intercanthal distance (P < 0.05). All respondents >46 years of age were less likely to perceive a change in any of the 7 traits upon intercanthal widening, compared with respondents between 18 and 25 years of age (P < 0.05). The layperson perceives significant increases in a female subject's submissivness, friendliness, and attractiveness with an intercanthal distance increase of 10% from normal. Surgeons should be aware of this when correcting hypertelorism, given the potential positive impact of a slightly increased intercanthal distance on perceived beauty and personality.
Alterations in Nasal Sensibility Following Calcium Hydroxyapatite Dorsal Augmentation
Authors: Alharethy Sami 
Published: October 2017

Background:
There are a many types of filler products that surgeons used for soft tissue augmentation. Soft Tissue Fillers, also known as injectable grafts, is a medical device implants. One of the materials used in soft tissue fillers is calcium hydroxylapatite (CaHA) that is commonly used for treating nasal deformities and nasal reshaping too. Calcium hydroxylapatite is a kind of mineral that can be found in human teeth and bones. It is considered long-lasting but nonpermanent filler and is biocompatible with human tissue.

Aim:
The aim of this study is to measure the alterations in sensibility and patient satisfaction following CaHA filler injection.

Patient/Methods:
In a prospective study, 30 patients who underwent CaHA filler injections from January to December 2016 at a Private Tertiary Care Hospital in Riyadh, Saudi Arabia were included.

Results:
Means and standard deviations were measured for pressure threshold values at each test area preprocedure 2 weeks after procedure (Table 1

JOURNAL/jcrsu/04.03/00001665-201803000-00070/table1/v/2023-10-09T171147Z/r/image-tiff

). Alterations between pre and postprocedure values were verified using the match-paired Student t test preprocedures. None of the patients had any subjective sensory symptoms. Majority of patients were extremely satisfied with the results.

Conclusion:
With correct anatomic knowledge and precise technique in doing the CaHA gel injection procedure, nasal sensibility will not be altered. In addition, injection of CaHA gel can be valuable tool for plastic surgeons to consider for nasal reshaping.
The Southampton Consensus Guidelines for Laparoscopic Liver Surgery
Authors: Abu Hilal Mohammad , Aldrighetti Luca , Dagher Ibrahim , Edwin Bjorn , Troisi Roberto Ivan , Alikhanov Ruslan , Aroori Somaiah , Belli Giulio , Besselink Marc , Briceno Javier , Gayet Brice , D’Hondt Mathieu , Lesurtel Mickael , Menon Krishna , Lodge Peter , Rotellar Fernando , Santoyo Julio , Scatton Olivier , Soubrane Olivier , Sutcliffe Robert , Van Dam Ronald , White Steve , Halls Mark Christopher , Cipriani Federica , Van der Poel Marcel , Ciria Ruben , Barkhatov Leonid , Gomez-Luque Yrene , Ocana-Garcia Sira , Cook Andrew , Buell Joseph , Clavien Pierre-Alain , Dervenis Christos , Fusai Giuseppe , Geller David , Lang Hauke , Primrose John , Taylor Mark , Van Gulik Thomas , Wakabayashi Go , Asbun Horacio , Cherqui Daniel 
Published: October 2017

Objective:
The European Guidelines Meeting on Laparoscopic Liver Surgery was held in Southampton on February 10 and 11, 2017 with the aim of presenting and validating clinical practice guidelines for laparoscopic liver surgery.

Background:
The exponential growth of laparoscopic liver surgery in recent years mandates the development of clinical practice guidelines to direct the speciality's continued safe progression and dissemination.

Methods:
A unique approach to the development of clinical guidelines was adopted. Three well-validated methods were integrated: the Scottish Intercollegiate Guidelines Network methodology for the assessment of evidence and development of guideline statements; the Delphi method of establishing expert consensus, and the AGREE II-GRS Instrument for the assessment of the methodological quality and external validation of the final statements.

Results:
Along with the committee chairman, 22 European experts; 7 junior experts and an independent validation committee of 11 international surgeons produced 67 guideline statements for the safe progression and dissemination of laparoscopic liver surgery. Each of the statements reached at least a 95% consensus among the experts and were endorsed by the independent validation committee.

Conclusion:
The European Guidelines Meeting for Laparoscopic Liver Surgery has produced a set of clinical practice guidelines that have been independently validated for the safe development and progression of laparoscopic liver surgery. The Southampton Guidelines have amalgamated the available evidence and a wealth of experts’ knowledge taking in consideration the relevant stakeholders’ opinions and complying with the international methodology standards.
Use of Prophylactic Mesh When Creating a Colostomy Does Not Prevent Parastomal Hernia
Authors: Odensten Christoffer , Strigård Karin , Rutegård Jörgen , Dahlberg Michael , Ståhle Ulrika , Gunnarsson Ulf , Näsvall Pia 
Published: October 2017

Objective:
The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.

Background:
Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.

Methods:
Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.

Results:
After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.

Conclusions:
The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.
The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma
Authors: Ghaneh Paula , Kleeff Jorg , Halloran Christopher M. , Raraty Michael , Jackson Richard , Melling James , Jones Owain , Palmer Daniel H. , Cox Trevor F. , Smith Chloe J. , O’Reilly Derek A. , Izbicki Jakob R. , Scarfe Andrew G. , Valle Juan W. , McDonald Alexander C. , Carter Ross , Tebbutt Niall C. , Goldstein David , Padbury Robert , Shannon Jennifer , Dervenis Christos , Glimelius Bengt , Deakin Mark , Anthoney Alan , Lerch Markus M. , Mayerle Julia , Oláh Attila , Rawcliffe Charlotte L. , Campbell Fiona , Strobel Oliver , Büchler Markus W. , Neoptolemos John P. 
Published: October 2017

Objective and Background:
Local and distant disease recurrence are frequently observed following pancreatic cancer resection, but an improved understanding of resection margin assessment is required to aid tailored therapies.

Methods:
Analyses were carried out to assess the association between clinical characteristics and margin involvement as well as the effects of individual margin involvement on site of recurrence and overall and recurrence-free survival using individual patient data from the European Study Group for Pancreatic Cancer (ESPAC)-3 randomized controlled trial.

Results:
There were 1151 patients, of whom 505 (43.9%) had an R1 resection. The median and 95% confidence interval (CI) overall survival was 24.9 (22.9–27.2) months for 646 (56.1%) patients with resection margin negative (R0 >1 mm) tumors, 25.4 (21.6–30.4) months for 146 (12.7%) patients with R1<1 mm positive resection margins, and 18.7 (17.2–21.1) months for 359 (31.2%) patients with R1-direct positive margins (P < 0.001). In multivariable analysis, overall R1-direct tumor margins, poor tumor differentiation, positive lymph node status, WHO performance status ≥1, maximum tumor size, and R1-direct posterior resection margin were all independently significantly associated with reduced overall and recurrence-free survival. Competing risks analysis showed that overall R1-direct positive resection margin status, positive lymph node status, WHO performance status 1, and R1-direct positive superior mesenteric/medial margin resection status were all significantly associated with local recurrence.

Conclusions:
R1-direct resections were associated with significantly reduced overall and recurrence-free survival following pancreatic cancer resection. Resection margin involvement was also associated with an increased risk for local recurrence.
Time of Metastasis and Outcome in Colorectal Cancer
Authors: Rahbari Nuh N. , Carr Prudence R. , Jansen Lina , Chang-Claude Jenny , Weitz Jürgen , Hoffmeister Michael , Brenner Hermann 
Published: October 2017

Objective:
The aim of this study was to evaluate outcomes of metastases at various time intervals after colorectal cancer (CRC) diagnosis.

Background:
Earlier studies have indicated a short time interval between CRC diagnosis and distant metastases to be associated with poor prognosis. The majority of studies assessed outcome from CRC diagnosis or metastasis resection rather than from metastasis diagnosis and might be subject to immortal time bias.

Methods:
Patients in the population-based DACHS study were stratified: metastases at/within 1 month (immediate), 2 to 6 months (early), 7 to 12 months (intermediate), and >12 months (late) after CRC diagnosis. The primary endpoint was overall survival (OS) from metastasis diagnosis. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CI). HRs were adjusted for important confounders and immortal time.

Results:
A total of 1027 patients were included. T4 (P < 0.0001) and node-positive tumors (P < 0.0001) were more frequent in the immediate group. Lung metastases (P < 0.0001) and single-site metastases (P < 0.0001) were more prevalent in the late group. In multivariable analysis, immediate metastases were not associated with poor OS compared to metastases at later time points (late vs immediate: HR 1.21; 95% CI, 0.98–1.48). Subgroup analyses revealed poor OS of late versus immediate metastases for females (1.45; 1.08–1.96), proximal colon cancer (1.54; 1.09–2.16), and N0 (1.46; 1.00–2.12) or N1 disease (1.88; 1.17–3.05).

Conclusions:
Immediate or early metastases are not associated with unfavorable outcome compared to late metastases. These findings challenge the current notion of poor outcome for CRC with immediate or early metastases.