bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digital Imaging in Secondary Rhinoplasty
Authors: Lehrman Craig R. , Lee Michael R. , Ramanadham Smita , Rohrich Rod J. 
Published: May 2016

Background:
Rhinoplasty remains one of the most commonly performed operations in plastic surgery. Little is known regarding the use of imaging in secondary rhinoplasty. Secondary rhinoplasty is a far more complex operation than primary rhinoplasty. The objective of this study was to assess the role of software imaging in patients undergoing secondary rhinoplasty.

Methods:
A retrospective review was performed to identify patients undergoing secondary rhinoplasty performed by the senior author (R.J.R.) from January of 2000 to August of 2013. Forty consecutive patients met inclusion criteria. The degree of improvement was graded in comparison with both the preoperative photographs and software imaging using a graded scale.

Results:
A total of 40 patients met inclusion criteria. There were 35 women (87.5 percent) and five men (12.5 percent). The nasal dorsum was found to have an average rating of 2.36 between the two observers, the midvault had an average rating of 2.65, the nasal tip had an average rating of 2.27, the nasal alae had an average rating of 2.63, and the nasal base had an average score of 2.99

Conclusions:
Based on the results of this study, the authors have determined that preoperative digital imaging can provide a reasonable expectation for patients undergoing secondary rhinoplasty. However, digital imaging must be used with caution, as secondary rhinoplasty patients have heightened expectations and unknown anatomy from their previous operation. The nasal tip and dorsum are especially difficult to adequately predict, and this should be discussed with the patient before surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Town and Gown Differences Among the 100 Largest Medical Groups in the United States
Authors: Welch W. Pete , Bindman Andrew B. 
Published: May 2016

Purpose
The authors undertook a study to determine whether large academic and community-based medical groups differ in terms of their financial stake in Medicare Advantage or Medicare Accountable Care Organizations (ACOs) and whether their participation in these alternative payment models is related to their size, specialty mix, and Medicare physician market share in their local area.

Method
The authors used the 2013 Medicare Data on Provider Practice and Specialty database and a national database of ACOs to conduct a cross-sectional descriptive study of the 100 largest medical groups in the United States. Medical groups were categorized as academic or community based on matches of their name with a list of U.S. medical schools or the results of a series of Internet search procedures.

Results
Sixty-eight of the 100 largest groups were academic, and 32 were community based. On average, community-based groups had more than twice the percentage of primary care physicians as academic groups (mean, 38.4%; 95% CI, 34.7%–42.0%; vs. 18.3%; 95% CI, 17.0%–19.6%). Community groups were significantly (P < .001) more likely than academic groups to have a financial stake in a Medicare ACO or Medicare Advantage plan, but this difference was no longer significant when the percentage of primary care physicians in the group was added to the model.

Conclusions
The specialty mix within academic medical groups may hinder their ability to transform themselves into organizations that can manage the financial responsibilities of caring for a patient population through a Medicare ACO or Medicare Advantage.
Variation in Treatment of Displaced Geriatric Acetabular Fractures Among 15 Level-I Trauma Centers
Authors: Manson Theodore T. , Reider Lisa , O'Toole Robert V. , Scharfstein Daniel O. , Tornetta Paul , Gary Joshua L. ,   the Major Extremity Trauma Research Consortium (METRC)*
Published: May 2016

Objectives:
To document the initial treatment of displaced acetabular fractures among older adults across multiple trauma centers and to investigate the factors that influence the decision to operate and the choice of operative procedure [open reduction internal fixation (ORIF) vs. total hip arthroplasty (THA)].

Design:
Retrospective observational study.

Setting:
Fifteen US level-I trauma centers participating in the Major Extremity Trauma Research Consortium.

Patients/Participants:
Overall, 269 patients aged 60 years or older admitted for the treatment of a displaced acetabular fracture.

Intervention:
None.

Main Outcome Measurements:
Treatment.

Results:
Sixty percent of fractures (n = 162) were treated operatively. Younger age (<80 years), injury from high-energy mechanism, fractures with femoral head impaction, and fractures without hip congruency were significantly associated with receiving operative treatment (P < 0.05). Significant site variation in operative versus nonoperative treatment occurred even after accounting for these factors (P = 0.0044). Among operatively treated patients, 88% (n = 142) received ORIF and 12% (n = 20) received THA as the initial treatment. Women were more likely to be treated with initial THA compared with men; of the known risk factors for poor outcomes with ORIF (ie, dome or roof impaction, femoral head impaction, or posterior wall involvement), only dome impaction was significantly associated with receiving initial THA (P < 0.05).

Conclusions:
Currently, no treatment guidelines exist for acetabular fractures in older adults, which likely explains the significant site variation in operative versus nonoperative treatment. This study identifies patient and injury factors that drive treatment decisions, which will be important in planning and designing future trials needed to determine the best treatment for these fractures.
Extraperiosteal Dual Plate Fixation of Acute Mid-Shaft Clavicle Fractures: A Technical Trick
Authors: Shannon Steven F. , Chen Xiaobin , Torchia Michael , Schoch Bradley 
Published: May 2016

Summary:
Historically, surgical treatment of acute mid-shaft clavicle fractures has excellent outcomes with low rates of nonunion. More complex fracture patterns with significant comminution may limit the fixation that can be obtained with a single plate. The authors describe the surgical technique and case series of patients treated with extraperiosteal dual plating for acute mid-shaft clavicle fractures.
Cutaneous Extranodal Natural Killer/T-Cell Lymphomas Histopathologically Mimicking Benign Inflammatory Disease
Authors: Lee Woo Jin , Kang Hyun Ji , Won Chong Hyun , Chang Sung Eun , Choi Jee Ho , Lee Mi Woo 
Published: May 2016

Abstract:Few studies have evaluated the histopathological features of cutaneous extranodal NK/T-cell lymphoma (ENKTL). The authors' study aims to describe cases of cutaneous ENKTL that histopathologically mimic benign inflammatory dermatosis. The authors searched the database of Asan Medical Center to identify cases of cutaneous ENKTL that were confirmed by skin biopsy between January 1998 and December 2014. The authors included cases that were initially diagnosed as benign inflammatory disorders on the histopathological examination, but finally diagnosed as cutaneous ENKTL on further evaluation. This study included 10 cases of cutaneous ENKTL. Six cases demonstrated nonspecific perivascular cellular infiltration, 2 cases demonstrated lupus erythematosus-like histological features, 1 case demonstrated psoriasiform lichenoid reaction, and 1 case demonstrated vasculitis-like features on histopathological examination. All cases were positive for CD56 and Epstein–Barr virus in situ hybridization. Perivascular infiltrations throughout the superficial and deep dermis with vasculopathy and panniculitic infiltration were common histopathological findings. The clinical features included 7 cases of erythematous to purpuric patches, 2 cases of facial swelling, and 1 case of cellulitis-like swelling. In conclusion, cutaneous ENKTL can histopathologically mimic benign inflammatory dermatosis. Cutaneous ENKTL should be suspected when histopathology shows perivascular dermal infiltration with vasculopathy and panniculitic cellular infiltration.
Insular balance of glutamatergic and GABAergic signaling modulates pain processing
Authors: Watson Christopher J. 
Published: May 2016

Abstract
Neuroimaging studies of patients with chronic pain have shown that neurotransmitter abnormalities, including increases in glutamate and decreases in GABA, could be responsible for the cortical hyperactivity and hyperalgesia/allodynia observed in some pain conditions. These finding are particularly evident in the insula, a brain region known to play a role in both the sensory–discriminative and the affective–motivational aspects of pain processing. However, clinical studies are not entirely able to determine the directionality of these findings, nor whether they are causal or epiphenomenon. Thus, a set of animal studies was performed to determine whether alterations in glutamate and GABA are the result of injury, the cause of augmented pain processing, or both. Compared with controls, the excitatory neurotransmitters glutamate and aspartate are significantly higher in the rat insula after chronic constriction injury of the sciatic nerve (CCI). The CCI also produced significant increases in allodynia (mechanical and cold), thermal hyperalgesia, and nociceptive aversiveness. Unilateral microinjection of ionotropic glutamate receptor antagonists restored these nociceptive behaviors to preinjury values. Increasing endogenous levels of GABA or enhancing signaling at inhibitory glycinergic receptors had similar effects as the glutamate receptor antagonists. In naive rats, increasing endogenous levels of glutamate, decreasing endogenous levels of GABA, or blocking strychnine-sensitive glycine receptors in the insula significantly increased thermal hyperalgesia and mechanical allodynia. These data support the hypothesis that an altered balance of excitatory and inhibitory neurotransmitters in brain regions such as the insula occurs in chronic pain states and leads to augmented central pain processing and increased pain sensitivity.
Swedish Translation and Reliability of the Full Outline of Unresponsiveness Score
Authors: Hickisch Annika , Holmefur Marie 
Published: May 2016

ABSTRACT

Background: It is important for patient safety that the patient’s level of consciousness is assessed and documented in a structured and reliable manner. The Full Outline of Unresponsiveness (FOUR) score measures the level of consciousness more comprehensively than the coma scales that are commonly used in Sweden. Therefore, there was a need to translate the FOUR score into Swedish and to evaluate its use in a Swedish healthcare context. Objectives: The aim of this study was to translate the FOUR score into Swedish and to evaluate the reliability of the Swedish version compared with the reliability of the Glasgow Coma Scale (GCS). Methods: The English version of the FOUR score was translated into Swedish and evaluated in terms of interrater reliability and internal consistency on fictitious patient cases with an advanced high-fidelity patient simulator. Two nurses rated 30 patient cases with the FOUR score and the GCS. Interrater reliability for items was determined by quadratic-weighted kappa and for the total score by intraclass correlation coefficient. Internal consistency was calculated with Cronbach’s alpha. Results: The fourth version of the Swedish translation reached consensus in the expert panel. The back-translation was approved by the author of the original FOUR score. Interrater reliability of the Swedish version of the FOUR score was excellent; the weighted kappa was 0.94–1, and intraclass correlation coefficient = .99 (95% CI [0.97, 0.99]), and these were equal to the reliability of the GCS. Cronbach’s alpha showed a high degree of internal consistency for the FOUR score (α = .92 for rater A and .91 for rater B), which was slightly higher than that for the GCS. Conclusions: The Swedish version of the FOUR score is equivalent to the original English version and has shown excellent reliability using fictitious patient cases with an advanced patient simulator.
A Comparative Study of Glasgow Coma Scale and Full Outline of Unresponsiveness Scores for Predicting Long-Term Outcome After Brain Injury
Authors: McNett Molly M. , Amato Shelly , Philippbar Sue Ann 
Published: May 2016

ABSTRACTPurpose:The aim of this study was to compare predictive ability of hospital Glasgow Coma Scale (GCS) scores and scores obtained using a novel coma scoring tool (the Full Outline of Unresponsiveness [FOUR] scale) on long-term outcomes among patients with traumatic brain injury. Preliminary research of the FOUR scale suggests that it is comparable with GCS for predicting mortality and functional outcome at hospital discharge. No research has investigated relationships between coma scores and outcome 12 months postinjury.Methods:This is a prospective cohort study. Data were gathered on adult patients with traumatic brain injury admitted to urban level I trauma center. GCS and FOUR scores were assigned at 24 and 72 hours and at hospital discharge. Glasgow Outcome Scale scores were assigned at 6 and 12 months.Results:The sample size wasn= 107. Mean age was 53.5 (SD= ±21, range = 18–91) years. Spearman correlations were comparable and strongest among discharge GCS and FOUR scores and 12-month outcome (r= .73,p< .000;r= .72,p< .000). Multivariate regression models indicate that age and discharge GCS were the strongest predictors of outcome. Areas under the curve were similar for GCS and FOUR scores, with discharge scores occupying the largest areas.Conclusion:GCS and FOUR scores were comparable in bivariate associations with long-term outcome. Discharge coma scores performed best for both tools, with GCS discharge scores predictive in multivariate models.
Natural Antibodies to Human Papillomavirus 16 and Recurrence of Vulvar High-Grade Intraepithelial Neoplasia (VIN3)
Authors: Madeleine Margaret M. , Johnson Lisa G. , Doody David R. , Tipton Elaine R. , Carter Joseph J. , Galloway Denise A. 
Published: May 2016

Objectives
Approximately 30% of women treated for squamous high-grade intraepithelial neoplasia (VIN3), often associated with human papillomavirus (HPV), have recurrent disease. In this study, we assess predictors of recurrence that may provide targets for early prevention or treatment.

Materials and Methods
Women with VIN3 who participated in a previous population-based case-control study with blood and tumor samples completed a follow-up telephone interview an average of 5 years after initial diagnosis. The risk of recurrence was determined by proportional hazards modeling.

Results
Women with VIN3 in the follow-up study (n = 65) were similar to women with VIN3 in the parent study (n = 215) with regard to age at primary diagnosis, level of current cigarette smoking (>60%), and lifetime number of partners. We found that 22 (33.8%) of 65 participants had a vulvar recurrence and that 73.4% recurred within 3 years of treatment. Recurrences occurred more often among women with common warts in the decade before diagnosis (hazard ratio [HR] = 2.5, 95% CI = 1.1–5.8) and among those with a previous anogenital cancer (HR = 2.7, 95% CI = 1.2–6.3). Interestingly, recurrence was less frequent among women who mounted a natural antibody response to HPV16 (HR = 0.4, 95% CI = 0.2–0.9).

Conclusions
These data provide strong preliminary evidence that VIN3 recurrence was less frequent among those with HPV16 antibodies. Vaccination with the currently licensed HPV vaccine as part of adjunctive therapy for VIN3 would increase antibody response and may decrease risk of recurrence. Randomized controlled trials are needed to determine whether HPV vaccination is effective against VIN3 recurrence.
Characteristics and Service Use of Medicare Beneficiaries Using Federally Qualified Health Centers
Authors: Chang Chiang-Hua , Lewis Valerie A. , Meara Ellen , Lurie Jon D. , Bynum Julie P.W. 
Published: May 2016

Background:
Federally Qualified Health Centers (FQHCs) provide primary care for millions of Americans, but little is known about Medicare beneficiaries who use FQHCs.

Objective:
To compare patient characteristics and health care service use among Medicare beneficiaries stratified by FQHC use.

Research Design:
Cross-sectional analysis of 2011 Medicare fee-for-service beneficiaries aged 65 years and older.

Subjects:
Subjects included beneficiaries with at least 1 evaluation and management (E&M) visit in 2011, categorized as FQHC users (≥1 E&M visit to FQHCs) or nonusers living in the same primary care service areas as FQHC users. Users were subclassified as predominant if the majority of their E&M visits were to FQHCs.

Measures:
Demographic characteristics, physician visits, and inpatient care use.

Results:
Most FQHC users (56.6%) were predominant users. Predominant and nonpredominant users, compared with nonusers, markedly differed by prevalence of multiple chronic conditions (18.2%, 31.7% vs. 22.7%) and annual mortality (2.8%, 3.8% vs. 4.0%; all P<0.05). In adjusted analyses (reference: nonusers), predominant users had fewer physician visits (RR=0.81; 95% CI, 0.81–0.81) and fewer hospitalizations (RR=0.84; 95% CI, 0.84–0.85), whereas nonpredominant users had higher use of both types of service (RR=1.18, 95% CI, 1.18–1.18; RR=1.09, 95% CI, 1.08–1.10, respectively).

Conclusions:
Even controlling for primary care delivery markets, nonpredominant FQHC users had a higher burden of chronic illness and service use than predominant FQHC users. It will be important to monitor Medicare beneficiaries using FQHCs to understand whether primary care only payment incentives for FQHCs could induce fragmented care.
The Face Transplantation Update: 2016
Authors: Sosin Michael , Rodriguez Eduardo D. 
Published: May 2016

Background:
Ten years after the first face transplantation, the available data in peer-reviewed literature, various media outlets, and recent specialty meetings and courses are conflicting and inconsistently reported. The purpose of this study was to consolidate the available data by means of multiple sources to reflect an accurate and current state of facial vascularized composite allotransplantation as of December of 2015.

Methods:
Using applied search terms pertaining to face transplantation, a systematic PubMed search, Google search, and review of Plastic Surgery Education Network News Connection e-mailed newsletters were performed, and data presented at three meetings (i.e., the most recent American Society of Reconstructive Transplantation biennial meeting, the American Society of Reconstructive Microsurgery annual meeting, and the biennial AO North America State of the Art: Face Reconstruction and Transplantation course) were consolidated to capture the most contemporary and accurate data in face transplantation.

Results:
A total of 37 face transplants have been performed (20 partial and 17 full face) from 2005 to December of 2015. A discrepancy between actual transplantations performed and peer-reviewed reports exists at multiple time points, with a propensity for underreporting. Ten cases were described through media outlets but were not reported by the surgical teams in peer-reviewed literature. Two clinical cases were not described in peer-reviewed literature or media. There have been a total of five deaths, and posttransplant malignancy and revision surgery have been underreported.

Conclusions:
This serves as the most contemporary and all-inclusive face transplantation review. There is a critical need for timely reporting and outcome transparency in the reconstructive transplant community.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Principles and Planning in Nasal and Facial Reconstruction: Making a Normal Face
Authors: Menick Frederick J. 
Published: May 2016

Learning Objectives:
After reading this article, the participant should be able to: 1. Understand the rationale and value of principles of facial reconstruction in the complex patient. 2. Understand the importance of diagnosis and planning. 3. Appreciate the value of surgical staging. 4. Modify tissues to the requirements of the defect. 5. Know how to treat ischemic cover and lining complications. 6. Learn methods of late revision.

Summary:
It is easy to be overwhelmed by a complex defect. What to do? How? When? In what order? Success is determined by careful planning, guided by principles. The aesthetic and anatomical deficiencies must be identified. Then, what is absent, both visually and anatomically, and what is missing must be determined. What are the priorities? What is the best timing for each stage? What are the available options and what will be the likely result? Should I choose another option? How can the surgeon maintain vascularity, transfer tissue, and improve tissue quality and contour? What are potential backup salvage maneuvers? Sound surgical principles based on the contributions of Gillies and Millard provide strategic instructions that help the surgeon “make sense” of a complex problem. They provide coordinated rules that clarify the diagnosis, planning, timing, and stages of repair. These should be combined with a regional unit approach to facial repair that provides tactical rules to establish the skin quality, border outline, and three-dimensional shape of the normal face.
Rheumatic Diseases in Chihuahua, México
Authors: Del Río Nájera Danyella , González-Chávez Susana Aideé , Quiñonez-Flores Celia María , Peláez-Ballestas Ingris , Hernández-Nájera Norma , Pacheco-Tena César F. 
Published: May 2016

Background
Rheumatic diseases (RDs) represent a global problem for health care systems and patients. Community Oriented Program for Control of Rheumatic Diseases (COPCORD) is a low-cost screening tool for detecting musculoskeletal (MSK) pain and RDs.

Objective
The aim of this study was to examine the pattern of MSK pain and RDs in clinic population in Chihuahua City, Mexico.

Methods
A cross-sectional study was conducted in 7 primary health clinics using the COPCORD methodology in subjects older than 18 years. People with MSK pain not induced by trauma (positive cases) were evaluated by primary care physicians and rheumatologists.

Results
The study included 1006 individuals with a mean age of 46.0 (SD, 15.8) years; 751 (74.7%) were women. Musculoskeletal pain in the previous 7 days was reported by 571 individuals (56.75%; 95% confidence interval [CI], 53.8%–60.1%), and 356 cases (35.4%; 95% CI, 32.5%–38.4%) were COPCORD positive. The mean pain intensity in visual analog scale was 6.62 (SD, 2.4). The most common painful joint was the knee (54.7%; 95% CI, 51.1%–59.0%). Two hundred eighty subjects with MSK pain (49.0%) previously sought medical attention, and 375 (65.7%) were under treatment. Functional impairment was reported by 69.8% of the COPCORD-positive subjects. The prevalence of RDs was 21.4% (95% CI, 18.9%–23.8%). The most prevalent disease was osteoarthritis (10.3%; 95% CI, 8.6%–12.4%), followed by regional pain syndromes (5.5%; 95% CI, 4.1%–7.0%), rheumatoid arthritis (1.4%; 95% CI, 0.8%–2.2%), and mechanical low-back pain (1.4%; 95% CI, 0.7%–2.2%).

Conclusions
Musculoskeletal pain is an important problem that affects our community. The data provided in this study will be presented to the local authorities to help in the development of prevention strategies.