bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Tracheostomy in Patients With Traumatic Cervical Spinal Cord Injury Appears Safe and May Improve Outcomes
Authors: Flanagan Christopher D. , Childs Benjamin R. , Moore Timothy A. , Vallier Heather A. 
Published: December 2017

Study Design.
Retrospective case series.

Objective.
To characterize outcomes associated with tracheostomy timing following traumatic cervical spinal cord injury (CSCI).

Summary of Background Data.
The morbidity associated with cervical spine trauma is substantially increased in the setting of concomitant CSCI. Despite recent evidence, it remains uncertain if early tracheostomy following traumatic CSCI can improve outcomes.

Methods.
From January 1, 2007 to December 31, 2015, retrospective chart review identified 70 patients who presented to a single Level 1 trauma center with traumatic CSCI and received tracheostomy for management of respiratory compromise. Patients were subdivided into two groups based on time from initial intubation to tracheostomy procedure: early (tracheostomy ≤7 d from initial intubation) and late (>7 d from initial intubation).

Results.
This series included 75.7% males and 24.3% females with mean age 50.5 years. A chest injury was present in 31.4% of patients. AIS A was the most common AIS score (41.4%), and 70.1% of patients had an injury level at C4 or above. Early tracheostomy was performed in 52.4% of patients. Factors most predictive of early tracheostomy were more severe AIS score (odds ratio [OR] = 1.72) and higher neurological level of injury (OR = 1.91) (P < 0.001, pseudo-R
2 = 0.241). Controlling for AIS and neurological level of injury, early tracheostomy was associated with fewer ventilator days (23.9 vs. 36.9, P = 0.0268), fewer days to decannulation (53.0 vs. 74.3, P = 0.0075), and shorter intensive care unit (ICU) stays (20.7 vs. 26.0, P = 0.0217). Rates of pneumonia, surgical site infection, in-hospital mortality, 90-day mortality, and 90-day readmission rates were not different between groups.

Conclusion.
Tracheostomy within 7 days of intubation may improve respiratory outcomes in patients with traumatic CSCI, regardless of level or severity of injury, without increasing complication rates.

Level of Evidence: 4
DYNAMIC RETINA VESSEL COLOR CHANGE DURING OCULAR COMPRESSION IN SEVERE LIPEMIA RETINALIS
Authors: Benson Maria , Wong Robert W. , Young Ryan C. , Gibson James B. , Fan Yuxin , Harper Clio Armitage 
Published: December 2017

Purpose:
The aim of this study was to describe dynamic color change in retinal vessels from white to coral pink due to externally applied ocular pressure in a 6-week-old infant with lipemia retinalis secondary to type 1b familial hyperlipoproteinemia.

Methods:
Fundus images and fluorescein angiogram were taken with RetCam3 camera. Color photographs of pooled blood were taken during phlebotomy.

Results:
Genetic analysis revealed a rare genetic mutation in the APOC2 gene, a lipoprotein lipase activator. Intraocular pressure applied to the globe induced a color change in the retinal arteries from white to coral pink. Disruption in laminar flow leading to this change is described.

Conclusion:
This is the first report to attribute the retinal vessel color change to disrupted laminar flow and the intermixing of larger erythrocytes and smaller chylomicrons in a patient with lipemia retinalis. In addition, this is a rare example of congenital hyperlipidemia in the offspring of nonconsanguineous parents.
Evaluation of Use of Prosthesis, Mobility, and Quality of Life in Young and Adult Persons with Unilateral Above-Knee Amputation 7 Years after the 2008 Sichuan Earthquake
Authors: Chan SzeYing , Li WingSum , Chau WaiWang , Law SheungWai , Chan KaiMing 
Published: December 2017

ABSTRACT

Background
The 2008 Sichuan earthquake resulted in many casualties, also leaving a great number of persons with amputation who require long-term rehabilitation.

Objectives
This study aims to evaluate the use of prostheses, mobility, and quality of life and to determine factors associated with better rehabilitation outcomes 7 years after the earthquake for individuals from the StandTall rehabilitation program with traumatic unilateral above-knee amputation due to earthquake injuries.

Method
This is a cross-sectional study. Twenty-four individuals with unilateral above-knee amputation were recruited either at home visits or during clinic sessions between December 2014 and May 2015. Main outcome measures were 12-Item Short Form Survey Version 2, Amputee Mobility Predictor, Houghton Scale, and Trinity Amputation and Prosthesis Experience Scales.

Results
Adults with unilateral above-knee amputation experienced worse psychological adjustment to limitation (p = 0.018), more social activity restrictions (p = 0.072), and suffered from more residual limb pain (p = 0.024), and phantom pain (p = 0.044). Rehabilitation success was associated with less athletic restriction (p = 0.053), less functional restriction (p = 0.077), and greater prosthetic satisfaction (p = 0.085).

Conclusions
Adults with unilateral above-knee amputation experienced greater difficulties in psychological adjustment to limitation and social activities, even 7 years after the amputation. Residual limb and phantom pain were greatly affected by age. Prosthetic daily wearing time correlated with better functional outcome for individuals with unilateral transfemoral amputation. This study provides information regarding long-term rehabilitation outcomes of individuals with traumatic unilateral above-knee amputation. Age, daily prosthetic wearing time, and residual limb pain and phantom pain are main factors affecting rehabilitation outcomes of individuals with amputation. Physical quality of life and psychosocial quality of life are both impaired by amputation.
Vestibular Outcome After Cochlear Implantation Is Not Related to Surgical Technique: A Double Blinded, Randomized Clinical Trial of Round Window Approach Versus Cochleostomy
Authors: Korsager Leise Elisabeth Hviid , Schmidt Jesper Hvass , Faber Christian , Wanscher Jens Højberg 
Published: December 2017

Objective:
To establish whether the round window approach (RWA) leads to less vestibular dysfunction and dizziness than the standard cochleostomy approach (SCA) during cochlear implant (CI) surgery, as assessed using the video head impulse test (vHIT).
Additionally, objective findings were compared with the subjective dizziness perceived by the patient.

Study Design:
Double blinded, clinical randomized trial.

Setting:
University Hospital.

Patients:
Fifty-two ears from 46 patients were included. Inclusion criterion was a gain value more than 0.50.

Intervention:
Patients were randomized to the RWA or the SCA. Evaluation with the vHIT was performed before surgery, 1 day after surgery, and 1 month after surgery. Subjective dizziness was measured using a visual analogue scale (VAS) and the dizziness handicap inventory (DHI).

Main Outcome Measures:
Gain values and the incidence of catch-up saccades.

Results:
Three out of 23 patients in the SCA group experienced catch-up saccades compared with no patients in the RWA group, indicating the occurrence of objective vestibular dysfunction after CI surgery; the difference was not statistically significant. The VAS increased in both groups the day after surgery. The difference between the groups was not statistically significant. No statistically significant changes in the gain value or the DHI score could were observed between the two groups.

Conclusion:
No statistically significant difference between the cochleostomy approach and the round window approach using the vHIT and subjective dizziness perceived by the patient was found.
Cochlear Implantation After Partial or Subtotal Cochleoectomy for Intracochlear Schwannoma Removal—A Technical Report
Authors: Plontke Stefan K. , Kösling Sabrina , Rahne Torsten 
Published: December 2017

Objective:
To describe the technique for surgical tumor removal, cochlear implant (CI) electrode placement and reconstruction of the surgical defect in patients with intracochlear schwannomas.

Study Design:
Retrospective case review.

Setting:
Tertiary referral center.

Patients:
Ten patients (five men, five women, mean age 48 ± 12 yr) with profound or severe to profound hearing loss due to intralabyrinthine schwannomas with intracochlear location.

Interventions:
Surgical tumor removal through extended round window approach, partial or subtotal cochleoectomy with or without labyrinthectomy and reconstruction of the surgical defect with cartilage, perichondrium or temporal muscle fascia, and bone pâté. Eight patients received a cochlear implant in the same procedure.

Main Outcome Measures:
Retrospective evaluation of clinical outcome including safety aspects (adverse events) and audiological performance at early follow up in cases of cochlear implantation.

Results:
The tumor was successfully removed in all cases without macroscopic (operation microscope and endoscope) tumor remnants in the bony labyrinth apart from one case with initial transmodiolar growth. One patient needed revision surgery for labyrinthine fistula. At short-term follow up (3-month post-surgery), good hearing results with the cochlear implant were obtained in all but one patient with a word recognition score of 100% for numbers, and 64 ± 14% for monosyllables (at 65 dB SPL in quiet).

Conclusions:
Surgical tumor removal and cochlear implantation is a promising treatment strategy in the management of intralabyrinthine schwannoma with intracochlear location, further extending the indication range for cochlear implantation. It is, however, of importance to observe the long-term outcome in these patients and to address challenges like follow up with magnetic resonance imaging.
Bone Mineral Density of Very Long‐term Survivors After Childhood Liver Transplantation
Authors: Ee Looi C. , Noble Charlton , Fawcett Jonathan , Cleghorn Geoffrey J. 
Published: December 2017

ABSTRACTObjectives:Liver transplant patients are at risk of osteopenia and fractures but limited information is available in long‐term survivors after childhood transplantation. This study aimed to assess bone mineral density (BMD) of very long‐term, >5 years, survivors after liver transplantation in childhood.Methods:Patients aged <18 years at transplant, having survived >5 years after transplant were potentially eligible but only those with ongoing review in our state were included. Dual‐energy x‐ray absorptiometry (DXA) was used to measure BMD. Patients aged <20 years had lumbar spine (LS) and total body (TB) measurements whereas those aged 20 years or more had LS and femoral neck but not TB. BMD z‐scores for LS and TB, if available, were used in this study. BMD z‐score ⩽−2.0 was considered reduced. Pre‐pubertal children had radiologic bone age assessment.Results:Forty‐two patients, 17 boys, participated of whom 64% had biliary atresia. Median age at transplant was 2.22 (range 0.38–14.25) years; time since transplant 10.10 (5.01–25.98) years; and age at DXA 14.64 (6.59–38.07) years. Mean BMD z‐scores were LS −0.15 ± 1.07, and TB −0.76 ± 1.14, with no sex difference noted. Four (9.5%) patients had reduced LS BMD, and although ongoing steroid use was more frequent in these patients, other comorbidities were likely important. Age at transplant, time since transplant, height, weight, and body mass index at DXA did not predict LS BMD. Pathologic fractures occurred in 2 of 42 (5%) patients; all within 18 months of transplant.Conclusions:Very long‐term survivors after childhood liver transplant have LS BMD within the normal range.
The Local Health Department Mandate and Capacity for Community Engagement in Emergency Preparedness: A National View Over Time
Authors: Schoch-Spana Monica , Nuzzo Jennifer , Ravi Sanjana , Biesiadecki Laura , Mwaungulu Geoffrey 
Published: December 2017

Context:
Local health departments (LHDs) perform the highly valued, yet time- and staff-intensive work of community engagement in public health emergency preparedness (CE-PHEP) when the Great Recession has had lingering effects on their organizational capacity.

Objective:
Track the extent to which LHDs still embrace collaborative, whole community approaches to PHEP in a historically low resource environment.

Design:
National survey in 2015 of LHDs using a self-administered online questionnaire regarding LHD practices and resources for CE-PHEP first fielded in 2012 (“The Community Engagement for Public Health Emergency Preparedness Survey”). Differences in 2015 survey responses were reviewed, and comparisons made between 2012 and 2015 responses.

Setting:
Randomized sample of 811 LHDs drawn from 2565 LHDs that were invited to participate in the 2010 National Profile of LHDs and participated in the 2012 CE-PHEP survey. Sample selection was stratified by geographic location and size of population served.

Participants:
Emergency preparedness coordinators reporting on the LHDs they serve.

Main Outcome Measure:
Community engagement in public health emergency preparedness intensity as measured by a scoring system that valued specific practices on the basis of the community capacity and public participation they represented.

Results:
Survey response was 30%; 243 LHDs participated. The CE-PHEP activities and intensity scores remained unchanged from 2012 to 2015. Local health departments that reported having an explicit CE-PHEP policy and experienced CE-PHEP staff member-–2 of the top 3 predictors of CE-PHEP intensity-–have dropped between 2012 and 2015. The numbers of LHDs with a CE-PHEP budget, also an important predictor of intensity, have not increased in a statistically significant way during that same period.

Conclusions:
Local health departments appear to be in a CE-PHEP holding pattern, presumably pushed forward by the doctrinal focus on partner-centered preparedness but held back by capacity issues, in particular, limited staff and partner support. Local health departments operating in low-resource environments are encouraged to formalize their CE-PHEP policy to advance performance in this arena.
Outcome Analysis of Free Flap Salvage in Outpatients Presenting with Microvascular Compromise
Authors: Largo Rene D. , Selber Jesse C. , Garvey Patrick B. , Chang Edward I. , Hanasono Matthew M. , Yu Peirong , Butler Charles E. , Baumann Donald P. 
Published: December 2017

Background:Extensive flap salvage attempts are routinely performed in patients with late-onset flap vascular crisis despite low flap survival rates. A knowledge gap exists in management of compromised free flaps in patients who present with perfusion-related complications after hospital discharge.Methods:A retrospective review of 7443 free flaps used in 7128 cancer patients at a single institution from January of 2001 to March of 2015 was performed.Results:Of 7443 free flap reconstructions, 856 patients (12 percent) were taken back to the operating room. Also, 261 patients (4 percent) suffered from microvascular compromise, of whom 110 (1 percent) experienced total flap loss. The authors identified 17 patients (10 breast cancer patients and seven head and neck cancer patients) who had vascular flap compromise and underwent reoperation after hospital discharge (median, 10 days; range, 4 to 107 days) after free flap reconstruction. Of these 17 patients, nine breast cancer patients and two head and neck cancer patients underwent flap salvage attempts. Salvage procedures included thrombectomy, thrombolytic and heparin injections, and reanastomoses (11 patients); vein grafting (four patients); vein supercharging with cephalic turndown (two patients); and change of recipient vessels (two patients). Sixteen of the 17 patients (94 percent) experienced total flap loss, and one patient (6 percent) had partial flap loss requiring long-lasting wound treatment.Conclusions:Outpatient free flap salvage has a low success rate regardless of flap type, recipient site, or patient population. The authors’ study suggests that immediate second-line reconstruction is more effective for late-onset flap vascular crisis than extensive flap salvage procedures.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, V.
Postoperative Nausea and Vomiting with Plastic Surgery: A Practical Advisory to Etiology, Impact, and Treatment
Authors: Manahan Michele A. , Johnson Debra J. , Gutowski Karol A. , Bonawitz Steven C. , Ellsworth Warren A. , Zielinski Marta , Thomsen Robert W. , Basu C. Bob 
Published: December 2017

Summary:
Ambulatory surgery is common in plastic surgery, where many aesthetic and reconstructive procedures can be performed in hospitals, ambulatory surgery centers, or office-based surgery facilities. Outpatient surgery offers advantages to both the patient and the surgeon by increasing accessibility, flexibility, and convenience; lowering cost; and maintaining high-quality care. To optimize a patient’s experience and comfort, postoperative nausea and vomiting (PONV) should be prevented. However, in those patients who develop PONV, it must be appropriately managed and treated. The incidence of PONV is variable. It is often difficult to accurately predict those patients who will develop PONV or how they will manifest symptoms. There are a variety of recommended “cocktails” for PONV prophylaxis and treatments that are potentially effective. The decision regarding the type of treatment given is often more related to provider preference and determination of side-effect profile, rather than targeted to specific patient characteristics, because of the absence of large volumes of reliable data to support specific practices over others. Fortunately, there are several tenets for the successful prevention and treatment of PONV we have extracted from the literature and summarize here. The following is a summary for the practicing plastic surgeon of the current state of the literature regarding PONV cause, risk factors, prophylaxis, and treatment that may serve as a guide for further study and practice management.
MBN 2016 Aesthetic Breast Meeting BIA-ALCL Consensus Conference Report
Authors: Nava Maurizio Bruno , Adams William P. , Botti Giovanni , Campanale Antonella , Catanuto Giuseppe , Clemens Mark W. , Del Vecchio Daniel A. , De Vita Roy , Di Napoli Arianna , Hall-Findlay Elisabeth , Hammond Dennis , Heden Per , Mallucci Patrick , Martin del Yerro Josè Luis , Muti Egle , Rancati Alberto , Randquist Charles , Salgarello Marzia , Stan Constantin , Rocco Nicola 
Published: December 2017

Summary:
Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon neoplasia occurring in women with either cosmetic or reconstructive breast implants. The actual knowledge about BIA-ALCL deriving from the literature presents several limits, and it remains difficult to make inferences about BIA-ALCL epidemiology, cause, and pathogenesis. This is the reason why the authors decided to organize an evidence-based consensus conference during the Maurizio Bruno Nava (MBN 2016) Aesthetic Breast Meeting held in Milan in December of 2016. Twenty key opinion leaders in the field of plastic surgery from all over the world have been invited to express and discuss their opinion about some key questions on BIA-ALCL, trying to reach a consensus about BIA-ALCL cause, pathogenesis, diagnosis, and treatment in light of the actual best evidence.
Staying Safe during Gluteal Fat Transplantation
Authors: Villanueva Nathaniel L. , Del Vecchio Daniel A. , Afrooz Paul N. , Carboy Jourdan A. , Rohrich Rod J. 
Published: December 2017

Summary:
Gluteal augmentation with fat transplantation is increasing in demand but has been associated with a concerning number of fatality reports. Despite these reports, various surgeons have safely performed gluteal fat transplantation on a large number of patients with no reported mortality. The important aspects of safely performing gluteal fat transplantation are reviewed. Proper patient selection, favorable instrumentation, patient positioning, proper technique, and knowledge of anatomy are critical to improving the safety of this procedure. Adherence to these key principles should allow a reduction in mortality from this procedure, which would safely allow its continued offering in the setting of increasingly high demand.
Thenar Dysplasia in Radial Polydactyly Depends on the Level of Bifurcation
Authors: Saito Susumu , Ueda Maho , Murata Mai , Suzuki Shigehiko 
Published: December 2017

Background:
Little is known about thenar dysplasia in radial polydactyly, other than that thenar hypoplasia occasionally occurs in radial polydactyly with triphalangism. In particular, the phenotype and level of duplication associated with thenar dysplasia remain unclear.

Methods:
The abductor pollicis brevis and flexor pollicis brevis muscles were visualized using three-dimensional ultrasound, and their horizontal geometry was assessed using a biaxial level classification system. Subjects were categorized into three phenotypes according to the developmental condition of the radial thumb. The relationship between the level of distribution of the muscles and the level of the bifurcation of the radial thumb was investigated.

Results:
Nineteen patients with radial polydactyly without triphalangism were included. There were 10 patients with the nonfloating type, three with the floating type, and six with the rudimentary type. All patients with bifurcation at or more distal to the metacarpophalangeal joint had normal thenar muscle distribution, but the muscles in patients with bifurcation at or more proximal to the level of the metacarpals were confined, regardless of phenotype. The level of muscle distribution was strongly correlated with the level of the bifurcation of the radial thumb.

Conclusions:
These findings suggest that formation of the thenar muscles in the longitudinal direction in radial polydactyly might depend on the level of bifurcation of the radial thumb. The presence of thenar dysplasia even in floating-type or rudimentary-type duplications is of clinical and etiologic importance.
Ability to Cope with Pain Puts Migraine Surgery Patients in Perspective
Authors: Gfrerer Lisa , Lans Jonathan , Faulkner Heather R. , Nota Sjoerd , Bot Arjan G. J. , Austen William Gerald 
Published: December 2017

Background:
Candidates for migraine surgery are chronic pain patients with significant disability. Currently, migraine-specific questionnaires are used to evaluate these patients. Analysis tools widely used in evaluation of better understood pain conditions are not typically applied. This is the first study to include a commonly used pain questionnaire, the Pain Self-Efficacy Questionnaire (PSEQ) that is used to determine patients’ pain coping abilities and function. It is an important predictor of pain intensity/disability in patients with musculoskeletal pain, as low scores have been associated with poor outcome.

Methods:
Ninety patients were enrolled prospectively and completed the Migraine Headache Index and PSEQ preoperatively and at 12 months postoperatively. Scores were evaluated using paired t tests and Pearson correlation. Representative PSEQ scores for other pain conditions were chosen for score comparison.

Results:
All scores improved significantly from baseline (p < 0.01). Mean preoperative pain coping score (PSEQ) was 18.2 ± 11.7, which is extremely poor compared with scores reported for other pain conditions. Improvement of PSEQ score after migraine surgery was higher than seen in other pain conditions after treatment (112 percent). Preoperative PSEQ scores did not influence postoperative outcome.

Conclusions:
The PSEQ successfully demonstrates the extent of debility in migraine surgery patients by putting migraine pain in perspective with other known pain conditions. It further evaluates functional status, rather than improvement in migraine characteristics, which significantly adds to our understanding of outcome. Poor preoperative PSEQ scores do not influence outcome and should not be used to determine eligibility for migraine surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.