bluuebunny/crossref_metadata_2025_split huggingface dataset:
A revised classification of the cleft lip and palate
Authors: Khan Mansoor , Ullah Hidayat , Naz Shazia , Iqbal Tariq , Ullah Tahmeed , Tahir Muhammad , Ullah Obaid 
Published: February 2017

Background Submucous cleft palate is characterized by muscular diastasis of the velum in the presence of intact mucosa with variable combinations of bifid uvula and hard palatal defect. Submucous cleft palate is indicated as a separate entity in most previous classifications but it has never been properly classified on an anatomical basis. Objectives To revise the Smith-modified Kernahan ‘Y’ classification of cleft lip and palate deformities, and to describe the different anatomical subtypes of submucous cleft palate. Methods The present study was conducted in Hayatabad Medical Complex, Abasin Hospital and Aman Hospital Peshawar, Pakistan, from November 2010 to December 2011. All patients who presented to the outpatient departments with cleft lip and palate, with the exception of previously operated cases, were included. All cases were described according to the Smith-modified Kernahan ‘Y’ classification and the authors' revised Smith-modified Kernahan ‘Y’ classification. All of the data were organized and analyzed using SPSS version 17 (IBM Corporation, USA). Results A total of 163 cases of cleft lip and palate deformities were studied, of which 59.5% were male and 40.5% were female. Smith modification of the Kernahan ‘Y’ classification completely described the cleft deformities in 93.9% of patients. However, while the Kernahan ‘Y’ classification represented the submucous cleft palate, it did not describe its different anatomical subtypes in 6.13% of patients. The revised Smith-modified Kernahan ‘Y’ classification completely described the cleft deformities of the entire study population, including the different submucous cleft palate patients. Discussion The Smith alphanumeric modification of the Kernahan ‘Y’ classification of cleft lip and palate came into existence after a long search and a series of modifications over the past century. This classification system describes the cleft region, site of the cleft, degree of the cleft, rare and asymmetrical clefts, and are computer database friendly. However, this classification did not describe the different anatomical subtypes of submucous cleft palate that have variable relationships with velopharyngeal insufficiency. Conclusion The revised Smith-modified Kernahan ‘Y’ classification described in the present study can describe all types of cleft lip and palate deformities in addition to the different types of submucous cleft palate deformities.
Breast reduction surgery in Ontario: Changes in practice, 1992 to 2008
Authors: Alshanawani Bisher , Alarfaj Nawarah , Alshomer Feras , Mamdani Muhammad , Gomes Tara , Mahoney James 
Published: February 2017

Background Symptomatic mammary hypertrophy impacts physical function and patient quality of life. Breast reduction mammoplasty, a surgical procedure performed to reduce breast size, has been used for many years to reduce these symptoms. Objective To evaluate variations in the surgical practice of breast reduction mammoplasty among women ≥15 years of age (approximately 6.4 million population in 2008) over a 17-year period in Ontario. Method A population-based, cross-sectional time series analysis was conducted to examine temporal trends in 87,049 breast reduction surgeries performed between January 1, 1992 and December 30, 2008. Results Breast reduction rates have been relatively stable over time, with 83 per 100,000 of the female population undergoing breast reduction surgery annually. However, a significant decrease in the rate of inpatient surgeries were observed over the study period (from 69.3 per 100,000 in 1992 to 25.7 per 100,000 in 2008). At the beginning of the study period, the highest annual rates of this procedure were observed among women 21 to 30 years of age (116.6 procedures per 100,000); however, by the end of the observation period, this shifted to women 31 to 50 years of age (109.9 procedures per 100,000). Furthermore, the annual procedure rate among women ≥51 years of age almost doubled, rising from 36.4 procedures per 100,000 in 1992 to 66.6 procedures per 100,000 in 2008. This was likely related to changing demographics and social factors. Conclusion These data suggest that breast reduction mammoplasty will continue to be requested, with an increased proportion of patients who are older and desire improved quality of life and physical function.
Donor-site morbidity of the inferior gluteal artery perforator flap for breast reconstruction in teenagers
Authors: Godbout Emilie , Farmer Lucie , Bortoluzzi Patricia , Laberge Louise Caouette 
Published: February 2017

Background/Objective Few options, apart from the buttock area, are available for autologous breast reconstruction in thin teenagers. The aim of the present study was to objectively evaluate and compare donor-site morbidity of the inferior gluteal artery perforator (IGAP) flap with that of the previously described inferior gluteal musculocutaneous flap. Method A retrospective review of all IGAP flaps for breast reconstruction performed in teenagers between June 2006 and April 2011 at the Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, was performed. Patients were invited to undergo a specific physical evaluation and complete a questionnaire on aesthetic and functional outcomes. Results Thirteen records and 11 photographic charts were reviewed. Lateral buttock flattening was noticeable in nine of 11 cases. Three patients experienced some degree of inferior displacement of the gluteal crease. All six patients available for the appointment presented with a zone of dysesthesia or hypoesthesia in the territory of the operated buttock and/or posterior thigh. No motor impairment was found. The questionnaire, completed by eight patients, revealed that six were satisfied or very satisfied with the surgery. Appearance of the operated buttock was rated 3.4 on a scale from 1 to 5 (5 = normal) compared with the normal side. Conclusions The IGAP flap remains a suitable option for breast reconstruction in slim teenagers. Similar to the myocutaneous flap, the major donor-site morbidity of the IGAP flap remains sensory impairment involving the posterior femoral cutaneous nerve. There is, however, less visible lateral depression when it is harvested as a perforator flap.
Factors influencing prioritization for carpal tunnel syndrome consultation
Authors: Chung Bryan , Morris Steven F 
Published: February 2017

Background In a socialized medicine model, prioritization of referrals for specialist consultation is highly important in the distribution of heath care. For high-burden diseases, such as carpal tunnel syndrome (CTS), the factors that influence prioritization are not well understood. Objective To determine the factors that influence the prioritization of referrals for CTS consultation by plastic surgeons in Canada. Methods All members of the Canadian Society of Plastic Surgery with e-mail addresses were invited to participate in an online survey regarding the method by which they prioritize referrals for CTS. Results Forty per cent of invited members completed the survey (150 surgeons). Of these, 118 (79%) stated that they performed CTS surgery. The majority of respondents who performed CTS surgery prioritized their consultation list chronologically (77%). Factors that would alter the chronological order or prioritization included subsequent contact by the referring physician (24%); personal relationship with the patient (16%); and specific information in the referral letter (15%), which usually involved symptom severity or electromyography findings. Sixty-six per cent of plastic surgeons stated that there was no conscious decision on how they came to choose the method of prioritization they used for referrals regarding CTS. Discussion The majority of plastic surgeons in Canada prioritize referrals for consultation on CTS chronologically. A minority of respondents reported reassigning priority based on clinical severity. The rationale for the methods by which Canadian Society of Plastic Surgery members prioritize these referrals is poorly understood. Further study on developing evidence-based prioritization methods may be useful in assisting surgeons and their patients in outcome-based decisions.
Catheter use and infection reduction in plastic surgery
Authors: Barnes Zach J , Mahabir Raman C 
Published: February 2017

Background Catheter-associated urinary tract infections (CAUTI) are the most common hospital-associated infection and can result in increased health care costs, morbidity and even mortality. In 2009, The Scott & White Memorial Hospital/Texas A&M Health Science Center (Texas, USA) system's CAUTI rate placed it in the upper quartile (ie, highest rate) for the country, necessitating a system-wide change. Objective To design and implement a guideline to reduce the incidence of CAUTI. Methods A multidisciplinary team was formed and completed both a root cause analysis and a review of the available literature. Consolidating the best evidence, the team formulated a best practice guideline detailing the proper indications for insertion of, improper use of and techniques to minimize infection with catheters. Included as part of this protocol was nursing and patient education, changes in identifying patients with a catheter and automatic termination orders. Three-, six- and 12-month reviews identifying additional opportunities for improvement at the end of 2010 were completed. Results In 2009, the hospital's CAUTI rate was 1.46 per 1000 catheter days. In 2011 – the first complete year of the finalized guideline – the hospital's CAUTI rate was 0.52 per 1000 catheter days, ranking the institution in the bottom quartile (ie, lowest rate) for the country. The surgery and plastic surgery subgroup analyses also demonstrated statistically significant reduction in both catheter use and CAUTI. Conclusion The incidence of CAUTI was successfully reduced at The Texas A&M Healthcare Center. The guideline, its development and how it applies to plastic surgery patients are discussed.
The Once-Twice Test for Evaluation of the Completely Anesthetic Digit
Authors: Mccabe Steven J , Breidenbach Warren C , Herrand Hector A 
Published: February 2017

SJ McCabe, WC Breidenbach, HA Herrand. The once-twice test for evaluation of the completely anesthetic digit. Can J Plast Surg 1998;6(1):21-22. A test to aid in the evaluation of the completely anesthetic digit – the once-twice test – is described. This rapid, easily performed clinical test can help identify patients with anesthesia of the digits of nonphysiological origin.
Effect of Dimethyl Sulphoxide On Necrosis of Skin Flaps in Rats
Authors: Da Silva Duarte Ivone , De Carvalho Gomes Heitor Francisco , Ferreira Lydia Masako 
Published: February 2017

I da Silva Duarte, HF de Carvalho Gomes, LM Ferreira. Effect of dimethyl sulphoxide on necrosis of skin flaps in rats. Can J Plast Surg 1998;6(2):93-97. The effect of dimethyl sulphoxide (DMSO) on necrosis of the distal portion of random skin flaps was studied. Twenty-eight Wistar-EPM rats each had a random skin flap created that measured 10×4 cm. A plastic barrier was interposed between the flap and the bed. Rats in group 1 received distilled water and those in group 2 received DMSO 2 mL/kg/day by intragastric lavage for seven days. The percentages of necrotic area were calculated in the two groups, and malondialdehyde (MDA) was measured in the serum, in the samples of normal skin and in the transition region from viable to necrotic skin. Statistical analysis showed that DMSO was efficient in reducing the necrotic areas and MDA values compared with results from group 1. Statistical analysis also revealed that the action of DMSO as an antioxidant can be inferred to be the mechanism responsible for the results obtained.
Digital Adrenaline Injection Injuries: A Case Series and Review
Authors: Elmaraghy MW , Elmaraghy AW , Evans HB 
Published: February 2017

MW ElMaraghy, AW ElMaraghy, HB Evans. Digital adrenaline injection injuries: A case series and review. Can J Plast Surg 1998;6(4):196-200. Accidental digital adrenaline autoinjection is an uncommon injury, with only a few case reports existing in the literature. A six-case series of digital EpiPen injection injuries, a review of the literature and treatment protocols with their pathophysiological and pharmacological basis are presented. Oral nifedipine, topical 2% nitroglycerine paste, digital block using lidocaine and warm water immersion are ineffective in acutely reversing digital ischemia. Clinical and experimental evidence demonstrating spontaneous resolution of digital vasospasm may support the expectant management of these injuries. If medical intervention is undertaken, safe and rapid reversal of adrenaline-induced digital ischemia can be achieved with local and/or regional infiltration of phentolamine mesylate. Based on a review of the current case series and the literature, the authors’ preferred method of treatment includes simultaneous digital block with a mixture of phentolamine and 2% lidocaine and local injection of phentolamine at the puncture site. Initially, the authors suggest using 5 mg phentolamine mesylate in 2 mL of 2% lidocaine, and injecting 1 mL (2.5 mg) of the solution into the ulnar and 1 mL (2.5 mg) into the radial aspect of the base of the involved digit, followed by injecting the injury site with a 5 mg/mL solution of phentolamine.
Postoperative Drainage Is Recommended in Ulnar Nerve Transposition
Authors: Deune E Gene , Mackinnon Susan E 
Published: February 2017

EG Deune, SE Mackinnon. Postoperative drainage is recommended in ulnar nerve transposition. Can J Plastic Surg 1998;6(4):201-203. Surgery to transpose the ulnar nerve is a common treatment for cubital tunnel syndrome. Postoperative hematoma is a rare, but well recognized complication of this surgery, whereas postoperative bruising is a common sequela. A retrospective review of 138 cases of anterior submuscular transposition performed between December 1991 and December 1995 was conducted to evaluate the merits of postoperative drainage. Various parameters (patient, surgical, and anesthetic) were compared to determine their effect on drainage. Males had a higher postoperative drainage volume than females (P<0.0001). Other patient, surgical and anesthetic factors did not correlate significantly with the drainage volume. The mean drainage during the first postoperative day was 41.2±2.5 mL (range 3 mL to 190 mL). This volume is significant and warrants drainage with an indwelling catheter when anterior submuscular transposition of the ulnar nerve is performed.
Use of Google Scholar public profiles in orthopedics
Authors: Tetsworth Kevin , Fraser Dave , Glatt Vaida , Hohmann Erik 
Published: February 2017

Introduction: The purpose of this study was to survey the growth of Google Scholar public profiles in orthopedics over a 12-month period and to investigate global patterns. Methods: Data was prospectively acquired from June 2013 to June 2014. Google Scholar queries specific to orthopedic surgery were performed at 90-day intervals. Demographic aspects of each user were also compiled, including gender, current location, and primary interests. To determine differences between the growth of Google Scholar public profile registrations and citation counts, as well as differences in growth in different regions, repeated measures of analysis of variance (RMANOVA) were used. Results: RMANOVA revealed statistically significant differences ( p = 0.0001) for regional growth. The largest growth was observed in the United Kingdom ( p = 0.009, 289%), followed by the Asia-Pacific region ( p = 0.004, 177%) and “Other” ( p = 0.006, 172%). The mean growth per 90-day interval is 19.9% ( p = 0.003) and the mean 12-month growth is 107% ( p = 0.05). Statistically significant differences between gender (male vs. female) and basic and clinical sciences ( χ2 = 22.4, p = 0.0001) were observed. Conclusion: This study suggests an exponential growth in the number of authors in the field of orthopedic surgery creating a Google Scholar public profile, and at the current rate participation doubles every 10.6 months.
Visible glove perforation in total knee arthroplasty
Authors: Jid Lee Qunn , Ping Mak Wai , Chung Wong Yiu , Leung Wai Yuk 
Published: February 2017

Purpose: The risk of superficial surgical site infection (SSI) and periprosthetic joint infection (PJI) after glove perforation is not evident. This study was to identify risk factors for glove perforation in primary TKR (total knee replacement) and the risk of subsequent superficial SSI and PJI. Methods and materials: Results of visible glove perforation of both inner and outer gloves during TKR were reviewed. A case–control analysis was performed on the preoperative and operative variables to identify predictive risk factors for glove perforation. Rate of SSI and PJI was compared between perforation and non-perforation groups, including 1226 series and 183 case–control subset. Results: One thousand two hundred twenty-six primary TKR from 2011 to 2014 was reviewed. Fifty-five knees had visible glove perforations. The operation perforation rate was 4.5%. Risk factors identified were body mass index (BMI) > 30, bilateral surgery, operation time >120 min and non-trainee surgeons. Superficial SSI was significantly higher in glove perforation group (9.15 vs. 0.51% and 0.55%). PJI was not significantly different (1.82% vs. 0.60% and 1.1%). The adjusted odds ratio for superficial SSI after perforation was 15.2, independent of BMI and operation time. Conclusion: Visible glove perforation in TKR is associated with several risk factors. The risk of superficial SSI is higher after perforation.
High-Grade Partial and Retracted (<2 cm) Proximal Hamstring Ruptures
Authors: Piposar Jonathan R. , Vinod Amrit V. , Olsen Joshua R. , Lacerte Edward , Miller Suzanne L. 
Published: February 2017

Background: High-grade partial proximal hamstring tears and complete tears with retraction less than 2 cm are a subset of proximal hamstring injuries where, historically, treatment has been nonoperative. It is unknown how nonoperative treatment compares with operative treatment. Hypothesis: The clinical and functional outcomes of nonoperative and operative treatment of partial/complete proximal hamstring tears were compared. We hypothesize that operative treatment of these tears leads to better clinical and functional results. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review identified patients with a high-grade partial or complete proximal hamstring rupture with retraction less than 2 cm treated either operatively or nonoperatively from 2007 to 2015. All patients had an initial period of nonoperative treatment. Surgery was offered if patients had continued pain and/or limited function refractory to nonoperative treatment with physical therapy. Outcome measures were each patient’s strength perception, ability to return to activity, Lower Extremity Functional Scale (LEFS) score, Short Form–12 (SF-12) physical and mental component outcome scores, distance traversed by a single-leg hop, and Biodex hamstring strength testing. Results: A total of 25 patients were enrolled in the study. The 15 patients who were treated nonoperatively sustained injuries at a mean age of 55.73 ± 14.83 years and were evaluated 35.47 ± 30.35 months after injury. The 10 patients who elected to have surgery sustained injuries at 50.40 ± 6.31 years of age ( P = .23) and were evaluated 30.11 ± 19.43 months after surgery. LEFS scores were significantly greater for the operative group compared with the nonoperative group (77/80 vs 64.3/80; P = .01). SF-12 physical component scores for the operative group were also significantly greater ( P = .03). Objectively, operative and nonoperative treatment modalities showed no significant difference in terms of single-leg hop distance compared with each patient’s noninjured leg ( P = .26) and torque deficit at isokinetic speeds of 60 and 180 deg/s ( P = .46 and .70, respectively). Conclusion: Patients who undergo operative and nonoperative treatment of high-grade partial and/or complete proximal hamstring tears with <2 cm retraction demonstrate good clinical and functional outcomes. In our series, 40% of patients treated nonoperatively with physical therapy went on to have surgery. For those patients with persistent pain and/or loss of function despite conservative treatment, surgical repair is a viable treatment option that is met with good results.
Reducing sedentary time and fat mass may improve glucose tolerance and insulin sensitivity in adults surviving 6 months after stroke: A phase I pilot study
Authors: Borschmann Karen N , Ekinci Elif I , Iuliano Sandra , Churilov Leonid , Pang Marco YC , Bernhardt Julie 
Published: February 2017

Introduction Deranged glycaemic control is common post-stroke, increasing risks of recurrent stroke and development of diabetes. The aim of the study is to examine glucose metabolism in relation to body composition, physical activity and sedentary time post-stroke. Patients and methods Observational study: Non-diabetic adults, unable to walk independently, were recruited within 2 weeks of first stroke. Primary outcome: 2-h glucose level (mmol/l, oral glucose tolerance test), assessed at baseline and 6 months. Homeostasis Model Assessment of Insulin Sensitivity, total body fat and lean mass (dual energy X-ray absorptiometry), sedentary time (lying or sitting), standing and walking (PAL2 accelerometer) were assessed at baseline, 1, 3 and 6 months. Generalised estimating equations were used to examine change over time and associations between outcome measures. Results Thirty-six participants (69.5 years (standard deviation 11.7), 13 (36.1%) female, moderate stroke severity (National Institute of Health Stroke Scale 11.5 (interquartile range 9.75, 16)). Within 6 months, adjusting for age and National Institute of Health Stroke Scale, every month 2-h glucose reduced by 4.5% ( p < 0.001), Homeostasis Model Assessment of Insulin Sensitivity improved 3% ( p = 0.04) and fat mass decreased 490 g (95% confidence interval 325, 655; p = 0.01). For every extra kilogram of body fat, 2-h glucose increased by 1.02 mmol/L (95% confidence interval 1.01, 1.02; p = 0.001); Homeostasis Model Assessment of Insulin Sensitivity reduced by 0.98% (95% confidence interval 0.97, 0.99; p = 0.001). Time spent sedentary reduced from 98.5% of measurement period (interquartile range 94.3, 99.8) to 74.3% (interquartile range 65.5, 88.6), by 2.8% monthly (95% confidence interval 1.8, 3.9, p < 0.001). For every additional 5% sedentary time, 2-h glucose increased by 1.05 mmol/L (95% confidence interval 1.04, 1.07; p < 0.001). Conclusion Reducing sedentary time and fat mass within 6 months of stroke may improve glucose tolerance and insulin resistance.