bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastrostomy Placement Rates in Infants with Pierre Robin Sequence: A Comparison of Tongue-Lip Adhesion and Mandibular Distraction Osteogenesis
Authors: Susarla Srinivas M. , Mundinger Gerhard S. , Chang Christopher C. , Swanson Edward W. , Lough Denver , Rottgers S. Alex , Redett Richard J. , Kumar Anand R. 
Published: December 2016

Background:
This study was conducted to compare the gastrostomy rates in infants with Pierre Robin sequence treated with tongue-lip adhesion or mandibular distraction osteogenesis.

Methods:
This was a retrospective study of symptomatic plastic and reconstructive surgery patients treated over an 8-year period. The primary predictor variable was surgical intervention (tongue-lip adhesion or distraction osteogenesis). Secondary predictor variables were categorized as demographic and clinical factors. The primary outcome was the need for gastrostomy tube placement. Secondary outcomes were complication rates, costs, and length of stay.

Results:
Thirty-one tongue-lip adhesion and 30 distraction osteogenesis patients were included in the study. The groups were statistically comparable with regard to demographic and clinical factors (p > 0.18). Gastrostomy rates were higher in patients who underwent tongue-lip adhesion (48 percent) versus those who underwent distraction osteogenesis (16.7 percent; p = 0.008). In an adjusted model, subjects undergoing tongue-lip adhesion were more likely to require gastrostomy tube for nutritional support (OR, 6.5; 95 percent CI, 1.7 to 25.2; p = 0.007). There were two major complications in the tongue-lip adhesion group and none in the distraction osteogenesis group. There were three minor complications in the tongue-lip adhesion group and five in the distraction osteogenesis group. Total operating room costs were higher for distraction osteogenesis (p = 0.05), and total hospital costs and length of stay were higher for tongue-lip adhesion (p < 0.05).

Conclusions:
Among infants with symptomatic Pierre Robin sequence, treatment by distraction osteogenesis is associated with a lower risk for gastrostomy placement for nutritional support. Hospital costs are higher for tongue-lip adhesion.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Very Low Prevalence of Intracranial Hypertension in Trigonocephaly
Authors: Cornelissen Martijn J. , Loudon Sjoukje E. , van Doorn Frida E. C. , Muller Rogier P. M. , van Veelen Marie-Lise C. , Mathijssen Irene M. J. 
Published: December 2016

Background:
Trigonocephaly is caused by metopic suture synostosis. It is treated by fronto-orbital remodeling, not only to correct the deformity but also to prevent intracranial hypertension, the reported prevalence in trigonocephaly of which ranges from 0 to 33 percent. To support treatment analysis and the design of a treatment protocol for intracranial hypertension in these patients, the authors wished to more accurately quantify the prevalence of preoperative and postoperative intracranial hypertension in a large patient cohort.

Methods:
The authors included all trigonocephaly patients born between 2001 and 2013 who had all been operated on at a single center. During follow-up, the presence of intracranial hypertension was evaluated by funduscopy, and occipitofrontal head circumference was measured. The occipitofrontal head circumference curve was analyzed and its relation to intracranial hypertension assessed.

Results:
In total, 262 patients with trigonocephaly were included. Before surgery, 1.9 percent of them had intracranial hypertension; after surgery, 1.5 percent did (mean age at last follow-up, 4.9 years). Sixteen of 176 patients (9 percent) had occipitofrontal head circumference curve stagnation, which was significantly related to intracranial hypertension (p = 0.001, Fisher’s exact test).

Conclusions:
Intracranial hypertension occurs only sporadically in patients with metopic suture synostosis. Occipitofrontal head circumference measurement should take a prominent place in the postoperative follow-up of metopic suture synostosis patients; stagnation of the occipitofrontal head circumference requires additional screening for intracranial hypertension.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Selective Nerve Root Transection in the Rat Produces Permanent, Partial Nerve Injury Models with Variable Levels of Functional Deficit
Authors: Poppler Louis H. , Schellhardt Lauren M. , Hunter Daniel A. , Yan Ying , Mackinnon Susan E. , Wood Matthew D. , Moore Amy M. 
Published: December 2016

Background:
The goal of this study was to develop a partial, nonregenerative nerve injury model in a rat that results in permanently reduced motoneuron numbers and function. This model could serve as a platform for the study of therapeutics, such as a reverse end-to-side nerve transfer (i.e., supercharge). The authors hypothesized that transection of one or more of the L4 to L6 nerve roots supplying the sciatic nerve would cause a permanent reduction in muscle force.

Methods:
Rats were randomized into five groups that underwent variations of nerve root transections or sham injury. The L4 to L6 nerve roots were selectively transected and capped to prevent regeneration. Tibial and common peroneal nerves were harvested for quantitative histology and retrograde-labeled to assess the number of motoneurons projecting axons. Muscle force and relative muscle mass were assessed as metrics of postinjury motor function.

Results:
At 6 months, the number of motoneurons projecting axons and myelinated axon counts were reduced in both the tibial and common peroneal nerves after injury in all groups. Transecting both L4 and L5 or both L4 and L6 reduced motoneuron numbers sufficiently below sham numbers to reduce muscle force and mass in major muscles of the hindlimb innervated by both nerves. Transecting L4 reduced muscle force and mass in common peroneal–innervated muscles, whereas transecting L5 reduced muscle force and mass in tibial-innervated muscles. These findings were stable over time.

Conclusion:
Transection of nerve roots produces stable (time-independent) partial nerve injury models with a selective decrease in motor function.
Intranasal Pathology in the Migraine Surgery Population: Incidence, Patterns, and Predictors of Surgical Success
Authors: Lee Michelle , Erickson Cameron , Guyuron Bahman 
Published: December 2016

Background:
The purpose of this study was to identify patterns of nasal pathology in patients with rhinogenic migraine headaches (site III).

Methods:
A retrospective review was performed on patients with rhinogenic migraine headaches. Demographics, pre– and post–migraine surgery symptoms, and pathology seen on preoperative computed tomographic scans were reviewed.

Results:
Twenty percent of 98 patients had preoperative sinus disease. The following abnormalities were seen on computed tomographic scan: septal deviation, 75 (77 percent); septal spur, 33 (34 percent); middle concha bullosa, 48 (49 percent); sinus pathology, 20 (20 percent); and intranasal contact points, 62 (62 percent). A higher incidence of clinical sinusitis (20 percent migraine versus 5 to 15 percent in the general population) was also seen. Septoplasty was performed in 89 percent of patients, and conservative turbinectomy was performed in 60 percent of patients. Patients who failed surgery (<50 percent reduction in migraine headache index) had a significantly higher incidence of contact points (80 percent versus 56 percent; p = 0.034) than successful migraine patients. The surgery success group also had a higher incidence of preoperative middle concha bullosa compared with the failure group (71 percent versus 48 percent; p = 0.035).

Conclusions:
This is the first cohort study to identify the incidence and pattern of nasal pathology in migraine III patients. It is likely that the failure to achieve more successful outcomes in this patient population was the consequence of conservative nasal management and residual contact points because of concern for the development of nasal dryness. More frequent middle turbinate surgery may result in better clinical outcomes in this group of patients.
Comparing Round and Anatomically Shaped Implants in Augmentation Mammaplasty: The Experts’ Ability to Differentiate the Type of Implant
Authors: Rubi Carlos G. , Lozano Jose Angel , Pérez-Espadero Alberto , Leache M. Elena 
Published: December 2016

Background:
The purpose of this study was to determine whether the aesthetic results of subpectoral augmentation mammaplasty using anatomically shaped versus round prostheses are differentiable.

Methods:
Thirty observers (i.e., plastic surgeons and nurses) assessed preoperative and postoperative photographs (frontal and oblique views) of 30 patients who had undergone subpectoral augmentation mammaplasty with cohesive silicone gel implants, with an average implant volume of 295 cc (range, 220 to 340 cc). The observers classified each case as round or shaped on two different occasions with a 12-week time interval. A statistical concordance analysis was performed, calculating the overall concordance rate, the interobserver, the intraobserver, and the overall intraobserver kappa indexes, to evaluate the expert observers’ capacity to differentiate the implant type.

Results:
Among the total of 1800 observations (30 observers assessed 30 cases on two occasions), the overall concordance rate was 50.33 percent (95 percent CI, 47.99 to 52.67). The interobserver kappa value was 0.010 (95 percent CI, 0.0025 to 0.04). The overall intraobserver kappa value was 0.0602 (95 percent CI, 0.0025 to 0.123). The observers were unable to recognize the type of implant used, nor was interobserver concordance noted. An agreement was not reached before the different observers, nor was an intraobserver concordance seen between the first and second classifications of the same cases by each observer.

Conclusion:
The results obtained from subpectoral augmentation mammaplasty using anatomically shaped and round prostheses with a volume of 340 cc or less are indistinguishable, not justifying the systematic use of anatomically shaped implants in this patient.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Microporous Polysaccharide Hemospheres Potentiate Ischemia-Induced Skin Flap Necrosis in a Murine Model
Authors: Offodile Anaeze C. , Chen Bin , Aherrera Andrew S. , Guo Lifei 
Published: December 2016

Background:
Microporous polysaccharide hemospheres are an increasingly used adjunctive measure for obtaining operative field hemostasis. However, the impact of these agents on survival of vascularly challenged tissues is unknown. The aim of this study was to investigate the effect, if any, of microporous hemospheres on tissue survival in a murine model.

Methods:
Eighteen Sprague-Dawley rats underwent creation of two flanking dorsal, modified McFarlane-style flaps using a length-to-width ratio of 4:1. Microporous polysaccharide hemospheres were applied to the underside of only one flap in each animal. In a subset of five rats, tissue malondialdehyde activity was measured at 24 hours. The remaining 13 animals were killed after 7 days, and the area of flap necrosis was measured photographically. Histopathologic analysis was also performed on the margins of the necrotic area.

Results:
Size comparison showed a significantly larger area of necrosis in the microporous polysaccharide hemosphere–treated flaps relative to controls (1.69 ± 1.21 cm2 versus 0.28 ± 0.28 cm2; p = 0.00135). Higher malondialdehyde levels were also found in the microporous polysaccharide hemosphere–treated flaps at 24 hours (0.462 ± 0.098 versus 0.315 ± 0.065; p = 0.047). The areas of skin necrosis were noted to be partial thickness on histologic examination.

Conclusions:
Microporous polysaccharide hemospheres are associated with an increased incidence of distal tip necrosis in dorsal rat skin flaps. Despite their efficacy in surgical hemostasis, their use should be judicious, especially with marginally perfused tissues such as mastectomy skin flaps.
Important Developments in Burn Care
Authors: Zuo Kevin J. , Medina Abelardo , Tredget Edward E. 
Published: December 2016

Learning Objectives:
After studying this article, the participant should be able to: 1. Explain the epidemiology of severe burn injury in the context of socioeconomic status, gender, age, and burn cause. 2. Describe challenges with burn depth evaluation and novel methods of adjunctive assessment. 3. Summarize the survival and functional outcomes of severe burn injury. 4. State strategies of fluid resuscitation, endpoints to guide fluid titration, and sequelae of overresuscitation. 5. Recognize preventative measures of sepsis. 6. Explain intraoperative strategies to improve patient outcomes, including hemostasis, restrictive transfusion, temperature regulation, skin substitutes, and Meek skin grafting. 7. Translate updates in the pathophysiology of hypertrophic scarring into novel methods of clinical management. 8. Discuss the potential role of free tissue transfer in primary and secondary burn reconstruction.

Summary:
Management of burn-injured patients is a challenging and unique field for plastic surgeons. Significant advances over the past decade have occurred in resuscitation, burn wound management, sepsis, and reconstruction that have improved outcomes and quality of life after thermal injury. However, as patients with larger burns are resuscitated, an increased risk of nosocomial infections, sepsis, compartment syndromes, and venous thromboembolic phenomena have required adjustments in care to maintain quality of life after injury. This article outlines a number of recent developments in burn care that illustrate the evolution of the field to assist plastic surgeons involved in burn care.
Optimizing Outcomes in Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience of 294 Cases
Authors: Sharaf Basel , Xue Amy , Solari Mario G. , Boa Olivier , Liu Jun , Hanasono Matthew M. , Skoracki Roman , Yu Peirong , Selber Jesse C. 
Published: December 2016

Background:
Pharyngoesophageal reconstruction is a complex endeavor that poses many challenges. This 10-year series examines factors impacting the need for neck skin resurfacing and evaluates the impact of reconstructive modalities on outcomes.

Methods:
A review identified 294 patients who underwent pharyngoesophageal reconstruction from 2002 to 2012. Patients were divided based on neck skin resurfacing requirements. Patients undergoing neck resurfacing were further subdivided into reconstructive technique, including a second skin paddle or muscle component from the same free flap pedicle, a local flap, or a second free flap. All groups were compared by comorbidities, complications, and functional outcomes.

Results:
Of 294 patients, 179 (60.9 percent) required neck skin resurfacing. In the resurfaced group, there were 90 circumferential defects (50.3 percent) and 89 partial defects (49.7 percent). In the resurfaced group, 110 (61.4 percent) underwent reconstruction with a second skin paddle from the same free flap pedicle, 21 (11.7 percent) underwent reconstruction with a muscle component from the same pedicle, and 25 (13.9 percent) received a pectoralis major flap. There were five external paddle flap losses in the resurfaced group (2.8 percent) and no internal flap losses. Overall complications were similar among groups. The resurfaced group had a lower pharyngocutaneous fistula rate (4.5 percent) compared with the primary closure group (11.3 percent) (p = 0.026). Prior neck surgery and radiation therapy were strong predictors of neck skin resurfacing (p < 0.001).

Conclusions:
Neck resurfacing is often required in salvage pharyngoesophageal reconstruction. Providing additional vascularized tissue over the neoconduit is predictive of lower pharyngocutaneous fistula rates. An algorithmic approach to neck resurfacing is presented.
Outcomes of Prosthetic Reconstruction of Irradiated and Nonirradiated Breasts with Fat Grafting
Authors: Komorowska-Timek Ewa , Turfe Zaahir , Davis Alan T. 
Published: December 2016

Background:
Fat grafting may be beneficial in prosthetic reconstruction of irradiated tissues, but there is a paucity of data on the complication rates associated with this clinical scenario.

Methods:
All consecutive patients who had undergone fat grafting and prosthetic reconstruction from 2010 to 2013 were enrolled. Variables obtained related to fat grafting and history of irradiation. Implant-related complications in relation to irradiation status were also noted.

Results:
Eighty-five patients (age 49 ± 10 years) underwent 117 fat grafting procedures. The mean follow-up was 2.6 ± 0.7 years. Fat grafting was predominantly performed to correct soft-tissue deficiency [112 of 117 (95.7 percent)] or to alter skin after irradiation [five of 117 (4.3 percent)]. Thirty-two procedures (27.4 percent) were associated with a complication, with the most common being palpable fat necrosis (23.1 percent). Volume of transferred fat averaged 151.2 ± 76.6 ml per breast. Fat grafting complications did not depend on donor site, technique of fat processing, volume of transferred fat, number of procedures, or irradiation. Implant-related complications were observed after 26 of 117 overall procedures (22.2 percent). No association between implant-related complications and irradiation was observed (OR, 1.3; 95 percent CI, 0.4 to 4.1; p = 0.63). Overall complications following fat grafting in nonirradiated [37 of 82 (45.1 percent)] and irradiated [16 of 35 (45.7 percent)] breasts were not statistically different (OR, 1.02; 95 percent CI, 0.41 to 2.57; p = 0.96).

Conclusion:
Similar outcomes of irradiated and nonirradiated prosthetic breast reconstruction can be achieved with additional fat grafting.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Definitive Management of Persistent Frontal Sinus Infections and Mucocele with a Vascularized Free Fibula Flap
Authors: Sinno Sammy , Rodriguez Eduardo D. 
Published: December 2016

Summary:
Chronic frontal sinus infections in the setting of previous trauma or tumor removal are challenging clinical scenarios. To remove and débride all chronically infected tissue, obliterate dead space, and provide a stable reconstructive yet aesthetic contour are critical tasks in managing these patients. The vascularized free fibula is an ideal flap for this situation; in this article, the authors detail their technique in a patient with chronic frontal sinus infections complicated by mucocele formation.
Impact of Panic Attacks on Bronchoconstriction and Subjective Distress in Asthma Patients With and Without Panic Disorder
Authors: Boudreau Maxine , Bacon Simon L. , Paine Nicola J. , Cartier André , Trutschnigg Barbara , Morizio Alexandre , Lavoie Kim L. 
Published: December 2016

ABSTRACT

Objective
Panic disorder (PD) is common among asthma patients and is associated with worse asthma outcomes. This may occur because of psychophysiological factors or cognitive/affective factors. This study evaluated the impact of panic attacks (PAs) on bronchoconstriction and subjective distress in people who have asthma with and without PD.

Methods
A total of 25 asthma patients (15 with PD who had a PA [PD/PA], 10 without PD who did not have a PA [no PD/no PA]) were recruited from an outpatient clinic. They underwent a panic challenge (one vital capacity inhalation of 35% carbon dioxide [CO2]) and completed the Panic Symptom Scale, the Subjective Distress Visual Analogue Scale, and the Borg Scale before and after CO2. Forced expiratory volume in 1 second was assessed pre- and post-CO2; respiratory (i.e., CO2 production, minute ventilation, tidal volume) was continuously recorded, and physiological measures (i.e., systolic and diastolic blood pressure [SBP/DBP]) were recorded every 2 minutes.

Results
Analyses adjusting for age, sex, and provocative concentration of methacholine revealed no significant differences between groups in forced expiratory volume in 1 second change after CO2 inhalation (F(1, 23) < 0.01, p = .961). However, patients with PD/PA reported more panic (F(1, 22) = 18.10, p < .001), anxiety (F(1, 22) = 21.93, p < .001), worry (F(1, 22) = 26.31, p < .001), and dyspnea (F(1,22) = 4.68, p = .042) and exhibited higher levels of CO2 production (F(1, 2843) = 5.89, p = .015), minute ventilation (F(1, 2844) = 4.48, p = .034), and tidal volume (F(1, 2844) = 4.62, p = .032) after the CO2 challenge, compared with patients with no PD/no PA.

Conclusions
Results, presented as hypothesis generating, suggest that asthma patients with PD/PA exhibit increased panic-like anxiety, breathlessness, and a respiratory pattern consistent with hyperventilation that was not linked to statistically significant drops in bronchoconstriction.
Self-Transcendent Values and Neural Responses to Threatening Health Messages
Authors: Kang Yoona , O'Donnell Matthew Brook , Strecher Victor J. , Taylor Shelley E. , Lieberman Matthew D. , Falk Emily B. 
Published: December 2016

ABSTRACT

Objective
Prioritizing self-transcendent values such as family and friends more than nontranscendent values such as wealth and privilege is associated with lower stress response. In this study, we tested whether having self-transcendent values can reduce specific responses in the brain in the context of potentially threatening health communications.

Methods
Sedentary adults (N = 67) who would likely feel threatened by health messages that highlight the risk of sedentary behavior were recruited. Participants indicated the degree to which they prioritize self-transcendent values more than nontranscendent values. Using functional magnetic resonance imaging, participants' neural responses to health messages were assessed within neural regions implicated in threat responses, including bilateral amygdala and anterior insula (AI).

Results
A tendency to prioritize self-transcendent more than nontranscendent values was associated with lower reactivity during exposure to health messages within anatomically defined regions of left amygdala (t(55) = −2.66, p = .010, 95% confidence interval [CI] = −0.08 to −0.01), right amygdala (t(55) = −2.22, p = .031, 95% CI = −0.06 to 0.0), and left AI (t(55) = −2.17, p = .034, 95% CI = −0.04 to 0.0), as well as a mask functionally defined to be associated with “threat” using an automated meta-analysis (t(55) = −2.04, p = .046, 95% CI = −0.05 to 0.0). No significant effect was obtained within the right AI (t(55) = −1.38, p = .17, 95% CI = −0.04 to .01). These effects were partially enhanced by reinforcing important values through self-affirmation, remained significant after accounting for self-reported social connection, and were specific to health message processing (versus generic self-related information).

Conclusions
Attenuated neural reactivity to potentially threatening health messages may be a novel way that prioritizing self-transcendent values could lead to positive health behaviors.