bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative Comparison of Anatomical versus Round Implants in Breast Augmentation: A Randomized Controlled Trial
Authors: Hidalgo David A. , Weinstein Andrew L. 
Published: February 2017

Background:
The purpose of this randomized controlled trial was to determine whether anatomical implants are aesthetically superior to round implants in breast augmentation.

Methods:
Seventy-five patients undergoing primary breast augmentation had a round silicone implant of optimal volume, projection, and diameter placed in one breast and an anatomical silicone device of similar volume and optimal shape placed in the other. After intraoperative photographs were taken, the anatomical device was replaced by a round implant to complete the procedure. A survey designed to measure breast aesthetics was administered to 10 plastic surgeon and 10 lay reviewers for blind evaluation of the 75 cases.

Results:
No observable difference in breast aesthetics between anatomical and round implants was reported by plastic surgeons in 43.6 percent or by lay individuals in 29.2 percent of cases. When a difference was perceived, neither plastic surgeons nor lay individuals preferred the anatomical side more often than the round side. Plastic surgeons judged the anatomical side superior in 51.1 percent of cases and the round side superior in 48.9 percent of cases (p = 0.496). Lay individuals judged the anatomical side superior in 46.7 percent of cases and the round side superior in 53.3 percent (p = 0.140). Plastic surgeons identified implant shape correctly in only 26.5 percent of cases.

Conclusions:
This study provides high-level evidence supporting no aesthetic superiority of anatomical over round implants. Given that anatomical implants have important and unique disadvantages, a lack of proven aesthetic superiority argues against their continued use in breast augmentation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, I.
Safety and Efficacy of Subfascial Calf Augmentation
Authors: Andjelkov Katarina , Sforza Marcos , Husein Rodwan , Atanasijevic Tatjana C. , Popovic Vesna M. 
Published: February 2017

Background:
Calf augmentation surgery is one of the least popular procedures among plastic surgeons; in contrast, it is by far one of the most gratifying procedures among patients. In this article, the authors present a retrospective analysis of a surgeon’s extensive experience with calf implants.

Methods:
The authors retrospectively analyzed 134 patients having calf augmentation for cosmetic and reconstructive surgery in their practice from 2003 to 2015. All patients were divided into two groups: primary cases and patients who had previously been operated on and who were referred to our service as patients who had complications after calf augmentation surgery. The subfascial approach was the preferred approach by authors for all primary cases. The authors analyzed indications, complication rates, results, and pitfalls. Secondary cases were further divided into three groups according to the origin of the problem and some possible solutions.

Results:
Subfascial calf augmentation surgery is safe and easy to reproduce, with a short recovery period and a low complication rate (<1 percent). To achieve the best aesthetic results, surgeons should choose appropriate implants for each case. In secondary cases, fat grafting is a powerful tool and can be used alone or in combination with calf implants.

Conclusions:
There are several groups of patients seeking calf augmentation surgery (e.g., bodybuilders, women, those with reconstructive problems). Therefore, treatment should be planned individually. The development of a new implant is necessary and should be based on detailed anatomical findings and in accordance with surgical techniques. The process is intriguing and rewarding.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
The Importance of the Anterior Septal Angle in the Open Dorsal Approach to Rhinoplasty
Authors: Rohrich Rod J. , Dauwe Phillip B. , Pulikkottil Benson J. , Pezeshk Ronnie A. 
Published: February 2017

Summary:
Functional and aesthetic manipulation of the nose relies on a detailed understanding of nasal anatomy and a meticulous dissection. Maneuvers are performed in four regions of the nose: nasal tip, dorsum, posterior septum, and caudal septum. Positioned at the cornerstone of these regions, the anterior septal angle acts as a point of reference, especially in secondary rhinoplasty. Identification of the anterior septal angle early in the nasal dissection aids in reliable exposure, either wide or limited, and facilitates desired maneuvers. In addition, alteration of the position of the anterior septal angle can affect nasal tip projection, especially in cases such as the tension tip deformity. The authors emphasize the importance of the anterior septal angle in their simplified methodology for the open dorsal approach in rhinoplasty.
The Effect of Antiseptics on Adipose-Derived Stem Cells
Authors: Kim Bong-Sung , Ott Veronica , Boecker Arne Hendrick , Stromps Jan-Philipp , Paul Nora Emilie , Alharbi Ziyad , Cakmak Ercan , Bernhagen Jürgen , Bucala Richard , Pallua Norbert 
Published: February 2017

Background:
Although chemical antiseptics are the most basic measure to control wound infection and frequently come into contact with subcutaneous adipose tissue, no studies have evaluated their toxicity on adipose tissue and its cell fractions. In the present study, the effects of five different antiseptics on adipose-derived stem cells were evaluated.

Methods:
Human adipose-derived stem cells were harvested from healthy donors. Adipose-derived stem cell viability was measured after treatment with different concentrations of antiseptics over 5 days. Furthermore, the effect on the proliferation, adipogenic differentiation, and apoptosis/necrosis of adipose-derived stem cells was analyzed. Finally, the mRNA expression of the stem cell markers CD29, CD34, CD73, CD90, and CD105 was detected.

Results:
Octenisept and Betaisodona significantly reduced cell proliferation and differentiation and led to considerable adipose-derived stem cell necrosis. Octenisept decreased stem cell viability at the lowest concentrations tested, and all stem cell markers were down-regulated by Octeniseptr and Betaisodona. Lavasept and Prontosan both led to reduced stem cell viability, proliferation, and differentiation, and increased apoptosis/necrosis, although the effects were less pronounced compared with Octenisept and Betaisodona. Adipose-derived stem cells survived treatment with mafenide acetate even at high concentrations, and mafenide acetate showed minimal negative effects on their proliferation, adipogenic differentiation, cell death, and stem cell marker expression.

Conclusions:
Mafenide acetate may be regarded as a feasible antiseptic for the treatment of wounds with exposed adipose tissue because of its low adipose-derived stem cell toxicity. Lavasept and Prontosan are possible alternatives to mafenide acetate. Octenisept and Betaisodona, by contrast, may be used only in highly diluted solutions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
The Double Opposing Z-Plasty Plus or Minus Buccal Flap Approach for Repair of Cleft Palate: A Review of 505 Consecutive Cases
Authors: Mann Robert J. , Martin Matthew D. , Eichhorn Mitchell G. , Neaman Keith C. , Sierzant Charles G. , Polley John W. , Girotto John A. 
Published: February 2017

Background:
Standard methods of cleft palate repair rely on existing palatal tissue to achieve closure. These procedures often require relaxing incisions, causing scars and growth restriction, and may result in insufficient palatal length and suboptimal positioning of the velar musculature. The Furlow double opposing Z-plasty improves palatal length and repositions the velar musculature; however, relaxing incisions may still be needed. The addition of buccal flaps to the Furlow repair obviates the need for relaxing incisions and allows the Furlow repair to be used in wide clefts.

Methods:
A retrospective review was performed on 505 patients; all patients were treated with the double opposing Z-plasty plus or minus buccal flap approach. Outcomes included nasal resonance, secondary speech surgery, and postoperative complications. A comparison was made between patients treated with double opposing Z-plasty alone and those treated with double opposing Z-plasty plus buccal flaps.

Results:
The average nasal resonance score was 1.38 and was equivalent in both the double opposing Z-plasty alone and with buccal flap groups, despite significantly more wide clefts in the buccal flap group (56 percent versus 8 percent). The secondary surgery rate for velopharyngeal insufficiency was 6.6 percent and the fistula rate was 6.1 percent. The large fistula rate (>2 mm) was 2.7 percent.

Conclusions:
The double opposing Z-plasty plus or minus buccal flap approach is a useful alternative to standard palate repairs. Speech outcomes were excellent, even in wider clefts, and postoperative complications were minimal. Buccal flaps allow the benefits of the Furlow repair to be applied to any size cleft, without the need for relaxing incisions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Principles of Cleft Lip Repair: Conventions, Commonalities, and Controversies
Authors: Marcus Jeffrey R. , Allori Alexander C. , Santiago Pedro E. 
Published: February 2017

Learning Objectives:
After reading this article, the participant should be able to: 1. Understand the principles of contemporary methods for repair of unilateral and bilateral cleft lip. 2. Understand the design elements of a poor repair that predispose to a suboptimal outcome.

Summary:
The authors describe the evaluation and management of unilateral and bilateral cleft lip (with or without cleft alveolus and with or without cleft palate). Each deformity is presented in a “principles-based” manner. For unilateral cleft lip, the authors discuss common modifications of rotation-advancement and Fisher’s anatomical subunit approach. In expert hands, both techniques can give excellent results. For bilateral cleft lip, Mulliken’s method is presented. Methods for synchronous correction of the cleft lip nasal deformity are also discussed.
Facial Feminization Surgery: Simultaneous Hair Transplant during Forehead Reconstruction
Authors: Capitán Luis , Simon Daniel , Meyer Teresa , Alcaide Antonio , Wells Alan , Bailón Carlos , Bellinga Raúl J. , Tenório Thiago , Capitán-Cañadas Fermín 
Published: February 2017

Background:
Reconstruction of the frontonaso-orbital complex is one of the best-described and most commonly used procedures in the field of facial feminization surgery. To a large extent, this complex determines the facial expression and plays a key role in the visual identification of facial gender. After the forehead, the hairline pattern is the second most important feature of gender identification within the upper third of the face. The combined evaluation of these two features should be a basic premise of facial feminization surgery.

Methods:
The authors present a new surgical sequence developed by their group in which reconstruction of the frontonaso-orbital complex and redefinition of the hairline by means of an autologous hair transplant are carried out during the same operation: forehead reconstruction and simultaneous hair transplantation.

Results:
Sixty-five male-to-female transgender patients treated with forehead reconstruction and simultaneous hair transplantation are presented along with the surgical technique, sequence used, and the results obtained. A classification method for hairlines in male-to-female transgender patients is proposed based on the observation of 492 patients. A modified temporoparietooccipital coronal (posterior coronal) approach is also described.

Conclusion:
The forehead reconstruction and simultaneous hair transplant technique makes it possible to address the entire upper third of the face in a single facial feminization operation.
Classification of Newborn Ear Malformations and their Treatment with the EarWell Infant Ear Correction System
Authors: Daniali Lily N. , Rezzadeh Kameron , Shell Cheryl , Trovato Matthew , Ha Richard , Byrd H. Steve 
Published: February 2017

Background:
A single practice’s treatment protocol and outcomes following molding therapy on newborn ear deformations and malformations with the EarWell Infant Ear Correction System were reviewed. A classification system for grading the severity of constricted ear malformations was created on the basis of anatomical findings.

Methods:
A retrospective chart/photograph review of a consecutive series of infants treated with the EarWell System from 2011 to 2014 was undertaken. The infants were placed in either deformation or malformation groups. Three classes of malformation were identified. Data regarding treatment induction, duration of treatment, and quality of outcome were collected for all study patients.

Results:
One hundred seventy-five infant ear malformations and 303 infant ear deformities were treated with the EarWell System. The average age at initiation of treatment was 12 days; the mean duration of treatment was 37 days. An average of six office visits was required. Treated malformations included constricted ears [172 ears (98 percent)] and cryptotia [three ears (2 percent)]. Cup ear (34 ears) was considered a constricted malformation, in contrast to the prominent ear deformity. Constricted ears were assigned to one of three classes, with each subsequent class indicating increasing severity: class I, 77 ears (45 percent); class II, 81 ears (47 percent); and class III, 14 ears (8 percent). Molding therapy with the EarWell System reduced the severity by an average of 1.2 points (p < 0.01). Complications included minor superficial excoriations and abrasions.

Conclusion:
The EarWell System was shown to be effective in eliminating or reducing the need for surgery in all but the most severe malformations.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Drivers of Academic Success in Cleft and Craniofacial Centers: A 10-Year Analysis of over 2000 Publications
Authors: Plana Natalie M. , Massie Jonathan P. , Stern Marleigh J. , Alperovich Michael , Runyan Christopher M. , Staffenberg David A. , Koniaris Leonidas G. , Grayson Barry H. , Diaz-Siso J. Rodrigo , Flores Roberto L. 
Published: February 2017

Background:
Cleft and craniofacial centers require significant investment by medical institutions, yet variables contributing to their academic productivity remain unknown. This study characterizes the elements associated with high academic productivity in these centers.

Methods:
The authors analyzed cleft and craniofacial centers accredited by the American Cleft Palate-Craniofacial Association. Variables such as university affiliation; resident training; number of plastic surgery, oral-maxillofacial, and dental faculty; and investment in a craniofacial surgery, craniofacial orthodontics fellowship program, or both, were obtained. Craniofacial and cleft-related research published between July of 2005 and June of 2015 was identified. A stepwise multivariable linear regression analysis was performed to measure outcomes of total publications, summative impact factor, basic science publications, total journals, and National Institutes of Health funding.

Results:
One hundred sixty centers were identified, comprising 920 active faculty, 34 craniofacial surgery fellowships, and eight craniofacial orthodontic fellowships; 2356 articles were published in 191 journals. Variables most positively associated with a high number of publications were craniofacial surgery and craniofacial orthodontics fellowships (β = 0.608), craniofacial surgery fellowships (β = 0.231), number of plastic surgery faculty (β = 0.213), and university affiliation (β = 0.165). Variables most positively associated with high a number of journals were craniofacial surgery and craniofacial orthodontics fellowships (β = 0.550), university affiliation (β = 0.251), number of plastic surgery faculty (β = 0.230), and craniofacial surgery fellowship (β = 0.218). Variables most positively associated with a high summative impact factor were craniofacial surgery and craniofacial orthodontics fellowships (β = 0.648), craniofacial surgery fellowship (β = 0.208), number of plastic surgery faculty (β = 0.207), and university affiliation (β = 0.116). Variables most positively associated with basic science publications were craniofacial surgery and craniofacial orthodontics fellowships (β = 0.676) and craniofacial surgery fellowship (β = 0.208). The only variable associated with National Institutes of Health funding was craniofacial surgery and craniofacial orthodontics fellowship (β = 0.332).

Conclusion:
Participation in both craniofacial surgery and orthodontics fellowships demonstrates the strongest association with academic success; craniofacial surgery fellowship, university affiliation, and number of surgeons are also predictive.
Torsed and Nontorsed Inguinal Undescended Testis: Comparison of Computed Tomography Findings
Authors: Klang Eyal , Kanaan Nadin , Soudack Michalle , Kleinbaum Yeruham , Heiman Zehava , Raskin Steve , Amitai Marianne Michal 
Published: February 2017

Objective
The aim of this study was to compare the computed tomography imaging features of a torsed inguinal testis with nontorsed inguinal testes.

Methods
Computed tomography scans of patients with undescended testes were retrospectively collected (2011–2016). Imaging features of nontorsed undescended testis were compared with a case of an inguinal torsed testis. Observations included location of the undescended testis, size (length × width) and texture of each testis, peritesticular findings, position of testicular vessels, and enhancement patterns.

Results
Twelve nontorsed inguinal undescended testes were compared with 1 torsed undescended testicle. Torsed testis was larger than nontorsed (44 × 27 mm vs 32.9 ± 6.1 × 22.9 ± 4.9 mm), surrounded by fat stranding and fluid, with heterogeneous texture, enhancement of its outer layers, and an upward kink of its vessels.

Conclusions
Because torsed undescended testis can mimic a groin abscess and because torsion is a medical emergency, radiologists should be aware of this entity and its distinguishing imaging features. Color Doppler examination can ascertain absence/reduction of blood flow.
Computed Tomography Pulmonary Angiogram Dynamic Parameter Correlation With Pulmonary Pressure and Pulmonary Hypertension Etiologies
Authors: Siegel Yoel , Bleicher Drew , Gordon Michael Kurt , Fertel Debra 
Published: February 2017

Objective
Pulmonary hypertension (PH) is caused by etiologies that differ in pathophysiology. Patients with undiagnosed PH may have a computed tomography pulmonary angiography (CTPA) scan during workup. Static measurements on computed tomography correlate with PH; however, dynamic parameters have received less attention. We studied the correlation between CTPA dynamic parameters and PH and assessed whether these parameters differ among PH etiologies. We also propose a method for PH screening.

Methods
Patients who underwent right-heart catheterization and CTPA within 45 days of each other were included. Charts were reviewed for presence and etiology of PH. The time it took to reach the CTPA trigger threshold during bolus tracking (TT) was recorded and compared with pulmonary pressure measured on pulmonary artery catheterization. The correlation between TT values and pulmonary pressure was studied, as well as the sensitivity and specificity of TT for PH.

Results
Twenty-seven patients with 28 examinations were included. A significant correlation was found between pulmonary pressure and TT, as well as TT and right ventricular decreased function, P < 0.01. Left heart failure showed the longest TT among PH subgroups and significantly longer TT in patients with both PH and right ventricular decreased function. Time to trigger demonstrated a sensitivity range of 75% to 92% and specificity between 56% and 88% for pulmonary pressure of 40 mm Hg or greater.

Conclusions
Dynamic parameters of flow measured on CTPA significantly correlate with pulmonary pressure and can potentially help screen for PH. Left heart failure seems to have the greatest impact on TT among patients with PH.
Comparison of the Timing of Hepatic Arterial Phase and Image Quality Using Test-Bolus and Bolus-Tracking Techniques in Gadolinium–Ethoxybenzyl–Diethylenetriamine Pentaacetic Acid–Enhanced Hepatic Dynamic Magnetic Resonance Imaging
Authors: Iyama Yuji , Nakaura Takeshi , Yokoyama Koichi , Kidoh Masafumi , Utsunomiya Daisuke , Oda Seitaro , Namimoto Tomohiro , Yamashita Yasuyuki 
Published: February 2017

Objectives
The aim of this study was to compare the image quality, the degree of artifacts and the percentage of timing of the optimal hepatic arterial phase (HAP) between test-bolus and bolus-tracking methods on gadolinium–ethoxybenzyl–diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)–enhanced magnetic resonance imaging (MRI).

Methods
In this prospective study, 60 patients who underwent 3-dimensional dynamic Gd-EOB-DTPA–enhanced hepatic 3-T MRI were enrolled in this study. We randomly assigned the 30 patients to the bolus-tracking method, and another 30 patients to the test-bolus method. Signal-to-noise ratios of the liver and spleen in HAP were compared in the 2 groups. Two radiologists independently assessed the ratio of optimal timing of HAP and the degree of ringing and motion artifacts of the 2 protocols.

Results
The signal-to-noise ratios of the liver (24.0 [SD, 6.4] vs 20.4 [SD, 4.0]) and spleen (30.0 [SD, 13.3] vs 23.6 [SD, 9.9]) were significantly higher in the test-bolus protocol than in the bolus-tracking protocol. The ratio of optimal timing was also significantly higher with the test-bolus protocol than with the bolus-tracking protocol (76.7% vs 40.0%). The degree of ringing and motion artifacts of test-bolus protocol was significantly lower than that of the bolus-tracking protocol (P < 0.01).

Conclusions
The test-bolus protocol in dynamic 3-T MRI can yield better qualitative image quality and more optimal timing of HAP images, while reducing the degree of artifacts compared with the bolus-tracking protocol.
Correlation Between Bile Reflux Gastritis and Biliary Excreted Contrast Media in the Stomach
Authors: Hyun Jong Jin , Yeom Suk Keu , Shim Euddeum , Cha Jaehyung , Choi Inyoung , Lee Seung Hwa , Chung Hwan Hoon , Cha Sang Hoon , Lee Chang Hee 
Published: February 2017

Objective
This study aimed to evaluate the relationship between biliary excreted contrast media in the stomach and the presence of bile reflux gastritis.

Methods
Consecutive 111 patients who underwent both gadoxetic acid–enhanced magnetic resonance cholangiography (gadoxetic MRC) and gastric endoscopy were included in this study. We performed a review of the gadoxetic-MRC image sets acquired 60 minutes after intravenous injection of contrast media and endoscopic images. We recorded amount of contrast media in the stomach. The sensitivity, specificity, and accuracy of duodenogastric bile reflux diagnosis were evaluated for the gadoxetic MRC. Statistical analysis was performed using the Fisher exact test and the linear-by-linear association test.

Results
Among the 111 patients, 39 had 60-minute delayed images showing the presence of contrast media in the stomach. Of these 39 patients, 13 had bile reflux gastritis and 5 showed bile in the stomach without evidence of erythematous gastritis. Of the 72 patients who did not show contrast media in the stomach, none had bile reflux gastritis and 2 patients showed bile staining in the stomach without evidence of erythematous gastritis. Bile reflux gastritis was significantly more frequent in patients with contrast media in the stomach on gadoxetic MRC than in those without. Patients with high-grade extension of contrast media in the stomach had significantly frequent bile reflux gastritis than did those with low-grade extension.

Conclusion
Biliary excreted contrast media in the stomach on 60-minute delayed gadoxetic MRC has a correlation with the presence of bile reflux gastritis on endoscopic examination.