bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemodynamic Study of Three Patterns of Flaps on Rats with a Novel Panoramic Photographing Technique Involved
Authors: Zhuang Yuehong , Xie Yun , Wu Zhihai , Xue Lan , Tang Yingying , Zheng Heping , Fang Fang 
Published: September 2016

Background:
No study heretofore has been conducted to investigate the hemodynamic characteristics of the perforator, perforator-plus, and random flaps on an animal model.

Methods:
Thirty Sprague-Dawley rats were equally divided into three groups: the perforator group, the perforator-plus group, and the random group. Laser Doppler flowmetry was adopted for measurement of blood perfusion of the flaps at six time points. Another nine rats were equally divided into three groups and underwent the corresponding surgery. On day 7, the flaps were photographed for calculation of the necrosis rate. The vascular network of flaps in each group was photographed immediately postoperatively and at days 3 and 7 after surgery with a special technique first proposed by us.

Results:
No significant difference in flap necrosis could be detected in the perforator and perforator-plus flaps. Other than on day 1, when perfusion of the perforator was significantly stronger than that of the perforator-plus flap, there was no significant difference between the perforator and perforator-plus flaps. The three perforasomes in the perforator and perforator-plus flaps could all survive because of considerable dilation of vessels. On day 7, the vascular network between the iliolumbar perforator and the sacrococcygeal perforators underwent tremendous enlargement in diameter in the random flap group.

Conclusions:
The perforator flap and the perforator-plus flap are equal in blood perfusion. The survival of the random flap depends on the dilation of the vascular network between the pedicle and the nearest potential perforator.
Impact of Prior Unilateral Chest Wall Radiotherapy on Outcomes in Bilateral Breast Reconstruction
Authors: de Araujo Thiago B. , Jue Xu Mary , Susarla Srinivas M. , Shmelev Karen , Jiang Wei , Pribaz Julian J. , Hergrueter Charles , Carty Matthew J. , Caterson Stephanie , Chun Yoon S. 
Published: September 2016

Background:
The purpose of this study was to evaluate the impact of prior unilateral chest wall radiotherapy on reconstructive outcomes among patients undergoing bilateral immediate breast reconstruction.

Methods:
A retrospective evaluation of patients with a history of unilateral chest wall radiotherapy was performed. In each patient, the previously irradiated and reconstructed breast was compared to the contralateral nonirradiated side, which served as an internal control. Descriptive and bivariate statistics were computed. Multiple regression statistics were computed to identify adjusted associations between chest wall radiotherapy and complications.

Results:
Seventy patients were included in the study. The mean follow-up period was 51.8 months (range, 10 to 113 months). Thirty-eight patients underwent implant-based breast reconstruction; 32 patients underwent abdominal autologous flap reconstruction. Previously irradiated breast had a significantly higher rate of overall complications (51 percent versus 27 percent; p < 0.0001), infection (13 percent versus 6 percent; p = 0.026), and major skin necrosis (9 percent versus 3 percent; p = 0.046). After adjusting for age, body mass index, reconstruction method, and medical comorbidities, prior chest wall radiotherapy was a significant risk factor for breast-related complications (OR, 2.98; p < 0.0001), infection (OR, 2.59; p = 0.027), and major skin necrosis (OR, 3.47; p = 0.0266). There were no differences between implant-based and autologous reconstructions with regard to complications (p = 0.76).

Conclusion:
Prior chest wall radiotherapy is associated with a 3-fold increased risk of postoperative complications following immediate breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
How Should Results of Nonsurgical Subcutaneous Fat Removal Be Assessed? Accuracy of B-Mode Ultrasound
Authors: Barton Fritz E. , Dauwe Phillip B. , Stone Tara , Newman Elizabeth 
Published: September 2016

Background:
Nonsurgical fat reduction has become extremely popular among patients; however, a reliable method of measuring its efficacy has not been established.

Methods:
Ultrasound measurement of human female abdominal subcutaneous fat thickness was carried out on five volunteers. Forty-seven measurements were performed using a GE Venue 40 diagnostic ultrasound device with a 12-MHz transducer. Transducer pressure measurements were recorded simultaneously according to the protocol described by Toomey et al..

Results:
Reproducible measurements of abdomen subcutaneous fat could be consistently achieved with a margin of error (95 percent CI) of ±0.558 mm.

Conclusions:
Using a protocol with a transducer pressure less than 1 N (Toomey protocol) allows accurate and reliable measurement of subcutaneous fat. The authors further conclude that such a protocol is practically reproducible in the clinical setting and should be the standard for evaluating the results of nonsurgical fat removal, particularly in the abdomen.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
The Feasibility and Validity of PROMIS: A Novel Measure of Quality of Life among Children with Cleft Lip and Palate
Authors: Ranganathan Kavitha , Shapiro Danielle , Carlozzi Noelle E. , Baker Michaella , Vercler Christian J. , Kasten Steven J. , Warschausky Seth A. , Buchman Steven R. , Waljee Jennifer F. 
Published: September 2016

Background:Health-related quality of life is inconsistently captured among children with cleft lip and palate. The Patient-Reported Outcomes Measurement Information System (PROMIS) captures health-related quality of life, with the added benefit of comparability across clinical conditions. In this study, the authors define the validity and feasibility of PROMIS among children with clefts.Methods:Children with cleft lip and palate who were at least 5 years old and able to complete instruments independently were eligible for inclusion (n= 93). Children completed PROMIS anxiety, depression, and peer relationship item banks as short forms or computerized adaptive tests. Participants also completed the Pediatric Quality of Life Inventory. Construct validity was measured by Spearman correlations between PROMIS and the Pediatric Quality of Life Inventory controlling for race, sex, age, and income. Feasibility was measured using instrument completion time, reading level, and floor/ceiling effects.Results:PROMIS computerized adaptive tests (peer relationship,r= 0.49; depression,r= −0.56; and anxiety,r= −0.36) and short forms (peer relationship,r= 0.65; depression,r= −0.54; and anxiety,r= −0.56) demonstrated moderate correlation with the Pediatric Quality of Life Inventory. Computerized adaptive tests had fewer floor (0 percent versus 0 percent) and ceiling (8.6 to 19.3 percent versus 21.8 to 41.9 percent) effects than short forms, and demonstrated better readability. Computerized adaptive tests required more time than short forms (peer relationship, 0.84 ± 0.67 versus 1.3 ± 0.92; depression, 0.52 ± 0.38 versus 1.1 ± 0.73; and anxiety, 0.53 ± 0.23 versus 1.1 ± 0.62;p= 0.001), as each computerized adaptive test included on average four more questions.Conclusions:PROMIS correlates well with the Pediatric Quality of Life Inventory and demonstrates similar accuracy, with better readability and efficiency. Use of PROMIS will improve our ability to compare children with cleft lip and palate to diverse populations and clinical conditions.CLINICAL QUESTION/LEVEL OF EVIDENCE:Diagnostic, II.
Making the End as Good as the Beginning: Financial Planning and Retirement for Women Plastic Surgeons
Authors: Johnson Debra J. , Shenaq Deana , Thakor Manisha 
Published: September 2016

Summary:
Financial planning is critically important to ensure financial security both during a plastic surgical career and in retirement. Unfortunately, plastic surgery training includes very little in the way of financial planning. The information that is available in the literature is mostly geared toward men. Women, with longer lifespans and more family care responsibilities, have unique needs when it comes to financial planning. Adequate attention must also be paid to life after retirement. A plastic surgical career can be all-encompassing, and thus women need to carefully plan volunteer activities, new hobbies, and even a second career to make their retirement years fulfilling and enjoyable. Key points regarding financial planning during the various phases of a woman plastic surgeon’s career are discussed. Options for retirement are presented.
Computer Simulation and Digital Resources for Plastic Surgery Psychomotor Education
Authors: Diaz-Siso J. Rodrigo , Plana Natalie M. , Stranix John T. , Cutting Court B. , McCarthy Joseph G. , Flores Roberto L. 
Published: September 2016

Summary:
Contemporary plastic surgery residents are increasingly challenged to learn a greater number of complex surgical techniques within a limited period. Surgical simulation and digital education resources have the potential to address some limitations of the traditional training model, and have been shown to accelerate knowledge and skills acquisition. Although animal, cadaver, and bench models are widely used for skills and procedure-specific training, digital simulation has not been fully embraced within plastic surgery. Digital educational resources may play a future role in a multistage strategy for skills and procedures training. The authors present two virtual surgical simulators addressing procedural cognition for cleft repair and craniofacial surgery. Furthermore, the authors describe how partnerships among surgical educators, industry, and philanthropy can be a successful strategy for the development and maintenance of digital simulators and educational resources relevant to plastic surgery training. It is our responsibility as surgical educators not only to create these resources, but to demonstrate their utility for enhanced trainee knowledge and technical skills development. Currently available digital resources should be evaluated in partnership with plastic surgery educational societies to guide trainees and practitioners toward effective digital content.
Biomechanical Analysis of Barbed Suture in Flexor Tendon Repair versus Conventional Method: Systematic Review and Meta-Analysis
Authors: Shin Jin Yong , Kim Jin Soo , Roh Si-Gyun , Lee Nae-Ho , Yang Kyung-Moo 
Published: September 2016

Background:
The barbed suture technique uses newly developed materials for flexor tendon repair. In this study, the authors examine the effectiveness of using barbed sutures in flexor tendon repair compared with conventional methods.

Methods:
A systematic literature review and meta-analysis was performed using MEDLINE, Embase, and Cochrane databases. Barbed suture and conventional suture methods were extracted as predictor variables, and maximum force, gap formation force, and cross-sectional area were extracted as outcome variables. Subgroup analyses were performed according to the source of suture materials and the number of strands. The Newcastle-Ottawa Scale was used to assess the quality of studies. Publication bias was evaluated using funnel plots.

Results:
The search strategy identified 86 publications. After screening, 12 articles were selected for review. Barbed sutures are comparable in effectiveness to conventional methods in terms of maximum force, gap formation force, and cross-sectional area. In the subgroup analysis, barbed sutures also have comparable effects to conventional methods in terms of maximum force and gap formation force.

Conclusions:
The authors’ meta-analysis found that the use of barbed sutures in flexor tendon repair was competitive compared to conventional methods in terms of maximum force and gap formation force. Long-term in vivo studies are needed to confirm these findings.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Revision Vaginoplasty: A Comparison of Surgical Outcomes of Laparoscopic Intestinal versus Perineal Full-Thickness Skin Graft Vaginoplasty
Authors: Van der Sluis Wouter B. , Bouman Mark-Bram , Buncamper Marlon E. , Mullender Margriet G. , Meijerink Wilhelmus J. 
Published: September 2016

Background:
Vaginal (re)construction can greatly improve the quality of life of indicated patients. If primary vaginoplasty fails, multiple surgical approaches exist for revision. The authors compared surgical results of laparoscopic intestinal versus full-thickness skin graft revision vaginoplasty.

Methods:
A retrospective chart review of patients who underwent revision vaginoplasty at the authors’ institution was conducted. Patient demographics, surgical characteristics, complications, hospitalization, reoperations, and neovaginal depth for both surgical techniques were recorded and compared.

Results:
The authors studied a consecutive series of 50 transgender and three biological women who underwent revision vaginoplasty, of which 21 were laparoscopic intestinal and 32 were perineal full-thickness skin graft vaginoplasties, with a median clinical follow-up of 3.2 years (range, 0.5 to 19.7 years). Patient demographics did not differ significantly. There was no mortality. Two intraoperative rectal perforations (10 percent) occurred in the intestinal group versus six (19 percent) in the full-thickness skin graft group. Operative time was shorter for the full-thickness skin graft vaginoplasty group (131 ± 35 minutes versus 191 ± 45 minutes; p < 0.01). Hospitalization length did not differ significantly. Successful vaginal (re)construction was achieved in 19 intestinal (91 percent) and 26 full-thickness skin graft (81 percent) vaginoplasty procedures. A deeper neovagina was achieved with intestinal vaginoplasty (15.9 ± 1.4 cm versus 12.5 ± 2.8 cm; p < 0.01).

Conclusions:
Both laparoscopic intestinal and full-thickness skin graft vaginoplasty can be used as secondary vaginal reconstruction. Intraoperative and postoperative complications do not differ significantly, but rectal perforation was more prevalent in the full-thickness skin graft vaginoplasty group. Although the operative time of laparoscopic intestinal vaginoplasty is longer, adequate neovaginal depth was more frequently achieved than in secondary perineal full-thickness skin graft vaginoplasty.

CLINCAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
A Retrospective Analysis of Secondary Revisions after Face Transplantation: Assessment of Outcomes, Safety, and Feasibility
Authors: Aycart Mario A. , Alhefzi Muayyad , Kueckelhaus Maximilian , Krezdorn Nicco , Bueno Ericka M. , Caterson Edward J. , Pribaz Julian J. , Pomahac Bohdan 
Published: September 2016

Background:
Face transplantation has emerged as a viable option for certain patients in the treatment of devastating facial injuries. However, as with autologous free tissue transfer, the need for secondary revisions in face transplantation also exists. The authors’ group has quantified the number of revision operations in their cohort and has assessed the rationale, safety, and outcomes of posttransplantation revisions.

Methods:
A retrospective analysis of prospectively collected data of the authors’ seven face transplants was performed from April of 2009 to July of 2015. The patients’ medical records, preoperative facial defects, and all operative reports (index and secondary revisions) were critically reviewed.

Results:
The average number of revision procedures was 2.6 per patient (range, zero to five procedures). The median time interval from face transplantation to revision surgery was 5 months (range, 1 to 10 months). Most interventions consisted of debulking of the allograft, superficial musculoaponeurotic system plication and suspension, and local tissue rearrangement. There were no major infections, allograft skin flap loss, or necrosis. One patient suffered a postoperative complication after autologous fat grafting in the form of acute rejection that resolved with pulse steroids.

Conclusions:
Secondary revisions after face transplantation are necessary components of care, as they are after most conventional free tissue transfers. Secondary revisions after face transplantation at the authors’ institution have addressed both aesthetic and functional reconstructive needs, and these procedures have proven to be safe in the context of maintenance immunosuppression. Patient and procedure selection along with timing are essential to ensure patient safety, optimal function, and aesthetic outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
The Concepts of Propeller, Perforator, Keystone, and Other Local Flaps and Their Role in the Evolution of Reconstruction
Authors: Mohan Anita T. , Sur Yoo Joon , Zhu Lin , Morsy Mohamed , Wu Peter S. , Moran Steven L. , Mardini Samir , Saint-Cyr Michel 
Published: September 2016

Learning Objectives:
After studying this article, the participant should be able to: 1. Understand the history and physiology of perforator flaps. 2. Understand the concept of “free-style” perforator flaps and principles in design and harvest. 3. Understand the uses of perforator flaps in reconstruction and applications in new settings. 4. Understand new principles in single and multiple perforator flap harvest and adjunct techniques that can be used in perforator flaps. 5. Highlight pertinent anatomy and techniques for selected perforator flaps described.

Summary:
Extended knowledge of vascular anatomy has propagated the development of perforator flaps, which preserve muscle function and reduce morbidity. This has been achieved through the exemplary works of Manchot, Salmon, Milton, Taylor, and many others. With over 350 clinically relevant perforators in the body, this has created new flap options and a sense of creative freedom for reconstruction tailored toward a specific defect, without constraints of specific landmarks and using a “free-style” approach. Dominant perforators may be found in zones of high perforator density or “hot spots,” which can help to conceptualize local flap options and aid flap design. This article aims to outline the history, physiology, and principles of flap design and harvest, and highlight traditional and evolving concepts and modifications of contemporary and traditional flaps that are changing reconstructive practice. This is a broad overview focusing on clinical applications, highlighting key concepts in a selection of new or evolving flaps being used in clinical practice and providing source references to acquire detailed flap descriptions.
Quantification of the Latent HIV-1 Reservoir Using Ultra Deep Sequencing and Primer ID in a Viral Outgrowth Assay
Authors: Lee Sook-Kyung , Zhou Shuntai , Baldoni Pedro L. , Spielvogel Ean , Archin Nancie M. , Hudgens Michael G. , Margolis David M. , Swanstrom Ronald 
Published: September 2016

Background:
In this study, we measured the latent HIV-1 reservoir harboring replication-competent HIV-1 in resting CD4+ T cells in participants on highly active antiretroviral therapy, quantitating the frequency of latent infection through the use of a Primer ID-based Ultra Deep Sequencing Assay (UDSA), in comparison to the readout of the quantitative viral outgrowth assay (QVOA).

Methods:
Viral RNA derived from culture wells of QVOA that scored as HIV-1 p24 capsid antigen positive were tagged with a specific barcode during cDNA synthesis, and the sequences within the V1–V3 region of the HIV-1 env gene were analyzed for diversity using the Primer ID-based paired-end MiSeq platform. We analyzed samples from a total of 19 participants, 2 initially treated with highly active antiretroviral therapy in acute infection and 17 treated during chronic infection. Phylogenetic trees were generated with all viral lineages detected from culture wells derived from each participant to determine the number of distinct viral lineages growing out in each well, thus capturing another level of information beyond the well being positive for viral antigen. The infectious units per million (IUPM) cell values estimated using a maximum likelihood approach, based on the number of distinct viral lineages detected (VOA-UDSA), were compared with those obtained from QVOA measured using limiting dilution.

Results:
IUPM estimates determined by VOA-UDSA ranged from 0.14 to 3.66 and strongly correlated with the IUPM estimates determined by QVOA (r = 0.94; P < 0.0001).

Conclusions:
VOA-UDSA may be an alternative readout for that currently used for QVOA.
Genome-wide profiling of heritable andde novoSTR variations
Authors: Willems Thomas , Zielinski Dina , Gordon Assaf , Gymrek Melissa , Erlich Yaniv 
Published: September 2016

AbstractShort tandem repeats (STRs) are highly variable elements that play a pivotal role in multiple genetic diseases, population genetics applications, and forensic casework. However, STRs have proven problematic to genotype from high-throughput sequencing data. Here, we describe HipSTR, a novel haplotype-based method for robustly genotyping, haplotyping, and phasing STRs from whole genome sequencing data and report a genome-wide analysis and validation ofde novoSTR mutations.
Co-operation, competition and crowding: a discrete framework linking Allee kinetics, nonlinear diffusion, shocks and sharp-fronted travelling waves
Authors: Johnston Stuart T. , Baker Ruth E. , McElwain D.L. Sean , Simpson Matthew J. 
Published: September 2016

AbstractInvasion processes are ubiquitous throughout cell biology and ecology. During invasion, individuals can become isolated from the bulk population and behave differently. We present a discrete, exclusion-based description of the birth, death and movement of individuals. The model distinguishes between individuals that are part of, or are isolated from, the bulk population by imposing different rates of birth, death and movement. This enables the simulation of various co-operative or competitive mechanisms, where there is either a positive or negative benefit associated with being part of the bulk population, respectively. The mean-field approximation of the discrete process gives rise to 22 different classes of partial differential equation, which can include Allee kinetics and nonlinear diffusion. Here we examine the ability of each class of partial differential equation to support travelling wave solutions and interpret the long time behaviour in terms of the individual-level parameters. For the first time we show that the strong Allee effect and nonlinear diffusion can result in shock-fronted travelling waves. We also demonstrate how differences in group and individual motility rates can influence the persistence of a population and provide conditions for the successful invasion of a population.