bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomical Uniqueness of Ear Morphology: A Novel Metrical Approach through Three-Dimensional Superimposition
Authors: Gibelli Daniele , Pucciarelli Valentina , Ferrario Virgilio F. , Dolci Claudia , Sforza Chiarella 
Published: January 2018

Summary:
Uniqueness of ear morphology has been a widely debated issue in cephaloscopy, but past studies used only two-dimensional approaches. In the current investigation, the right and left ears of 10 healthy adults were imaged twice by stereophotogrammetry at the interval of a few seconds. The ear images obtained from the two acquisitions were superimposed both within subject (group of matches) and among subjects (group of mismatches). A point-to-point root mean square distance was calculated between the two three-dimensional models. Differences according to side and group were assessed by two-way analysis of variance. In total, 200 superimpositions were performed. On average, the point-to-point root mean square distance was 0.31 mm in cases of matches and 1.43 mm in cases of mismatches: differences were statistically significant (p < 0.01). Results provided quantitative data for the assessment of uniqueness of ear morphology, highlighting differences based on their three-dimensional morphology.
Conditioned Medium Obtained from Amnion-Derived Mesenchymal Stem Cell Culture Prevents Activation of Keloid Fibroblasts
Authors: Sato Chigusa , Yamamoto Yuhei , Funayama Emi , Furukawa Hiroshi , Oyama Akihiko , Murao Naoki , Hosono Hidetaka , Kawakubo Kazumichi , Sakamoto Naoya , Ohnishi Shunsuke 
Published: January 2018

Background:
Mesenchymal stem cells are a valuable cell source in regenerative medicine, and conditioned medium obtained from mesenchymal stem cells reportedly inhibits inflammation. Keloids are characterized by abnormal fibrosis, caused by fibroblasts in response to inflammation. In this study, the authors evaluated whether conditioned medium obtained from amnion-derived mesenchymal stem cells suppressed activation of keloid fibroblasts.

Methods:
Keloid (n = 7), mature (n = 5), and normal (n = 5) fibroblasts were harvested from patients. Fibroblasts were stimulated with transforming growth factor (TGF)-β, and the effects of conditioned medium obtained from amnion-derived mesenchymal stem cells on cell proliferation, activation, and expression of extracellular matrix–related genes were analyzed. The effect of concentrating the conditioned medium by ultrafiltration on fibroblast activation was also analyzed.

Results:
Conditioned medium obtained from amnion-derived mesenchymal stem cells significantly up-regulated proliferation of mature fibroblasts but tended to suppress that of keloid fibroblasts. Conditioned medium obtained from amnion-derived mesenchymal stem cells significantly suppressed the TGF-β–induced up-regulation of α-smooth muscle actin in keloid and normal fibroblasts and collagen I in keloid fibroblasts, but not in mature fibroblasts. The conditioned medium obtained from amnion-derived mesenchymal stem cells concentrated by ultrafiltration and the filtrate significantly suppressed TGF-β–induced α-smooth muscle actin expression.

Conclusion:
Conditioned medium obtained from amnion-derived mesenchymal stem cells prevents proliferation and activation of keloid fibroblasts and is a promising keloid treatment for administration as a topical agent.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Polyethylene Ear Reconstruction: A State-of-the-Art Surgical Journey
Authors: Reinisch John , Tahiri Youssef 
Published: January 2018

Background:
The use of a porous high-density polyethylene implant for ear reconstruction is gradually gaining acceptance because it allows for a pleasing ear reconstruction in young children before they enter school. In response to this growing interest, the authors decided to write an article clarifying in detail all the steps of this challenging procedure. In this article, the authors also answer all the common questions that surgeons have when they come to observe the operation, or when they go back to their respective practices and start performing this procedure.

Methods:
The authors describe in detail the operative steps that allow for a successful ear reconstruction using porous high-density polyethylene. The key parts of this operation are to meticulously harvest a well-vascularized superficial temporoparietal fascia flap and to use appropriate color-matched skin grafts.

Results:
This method allows for a pleasing ear reconstruction with excellent definition, projection, symmetry, and long-term viability.

Conclusion:
The use of porous high-density polyethylene with a thin superficial temporoparietal fascia flap coverage is the authors’ preferred method of ear reconstruction because it can be performed at an earlier age, in a single stage, as an outpatient procedure, and with minimal discomfort and psychological trauma for the patients and parents.
A Library of Logic Models to Explain How Interventions to Reduce Diagnostic Errors Work
Authors: Kletter Maartje , Melendez-Torres G.J. , Lilford Richard , Taylor Celia 
Published: January 2018

Objectives
We aimed to create a library of logic models for interventions to reduce diagnostic error. This library can be used by those developing, implementing, or evaluating an intervention to improve patient care, to understand what needs to happen, and in what order, if the intervention is to be effective.

Methods
To create the library, we modified an existing method for generating logic models. The following five ordered activities to include in each model were defined: preintervention; implementation of the intervention; postimplementation, but before the immediate outcome can occur; the immediate outcome (usually behavior change); and postimmediate outcome, but before a reduction in diagnostic errors can occur. We also included reasons for lack of progress through the model. Relevant information was extracted about existing evaluations of interventions to reduce diagnostic error, identified by updating a previous systematic review.

Results
Data were synthesized to create logic models for four types of intervention, addressing five causes of diagnostic error in seven stages in the diagnostic pathway. In total, 46 interventions from 43 studies were included and 24 different logic models were generated.

Conclusions
We used a novel approach to create a freely available library of logic models. The models highlight the importance of attending to what needs to occur before and after intervention delivery if the intervention is to be effective. Our work provides a useful starting point for intervention developers, helps evaluators identify intermediate outcomes, and provides a method to enable others to generate libraries for interventions targeting other errors.
Computed Tomography Images of the Scapula Taken With Reduced Dose Can Yield Segmented Models of Sufficient Accuracy: A Pilot Study
Authors: Herteleer Michiel , Vancleef Sanne , Nijs Stefaan , Vander Sloten Jos 
Published: January 2018

Objective
The aim of the study was to investigate the influence of tube current reduction on the segmentation accuracy of the scapula.

Methods
A human cadaver was computed tomography scanned multiple times while reducing tube current amperage. The images were segmented using 2 different segmentation methods (N = 28). Subsequently the scapula was dissected and all soft tissues were removed. An optical laser scan of the dissected scapula was aligned and compared with the segmented meshes of the different computed tomography scans.

Results
The mesh accuracy remained fairly constant with diminishing tube currents. All segmented meshes had a larger volume than the reference mesh (n = 27). The mean 3-dimensional deviation varied between 1.17 mm (max) and −0.759 mm (min) and the total mean (SD) 3-dimensional deviation was −0.45 (0.38) mm. Radiation dosages were reduced from 7.1 to 0.3 mSv.

Conclusions
Computed tomography tube current can be largely reduced without losing the surface segmentation accuracy of segmented scapula meshes.
Role of Scientific Theory in Simulation Education Research
Authors: Pusic Martin V. , Boutis Kathy , McGaghie Willam C. 
Published: January 2018

Summary Statement
Scientific theories are consistent explanations about how the world works. They have been shown to be plausible not only from a large amount of independent confirmatory evidence but also because rigorous attempts at falsification have failed. Other desirable features include parsimony, scalability, explanatory, and predictive power. Scientific theories differ from models and laws in the amount of evidence available and/or the degree to which they explain nature. Learning curve theory is a scientific theory with direct applicability to simulation education researchers. In this article, the authors use the example of learning curve theory to illustrate the key features of scientific theories and how they provide a meaningful foundation for simulation-based education research programs.
American Urogynecologic Society Consensus Statement: Cystoscopy at the Time of Prolapse Repair
Authors: Cohen Seth A. , Carberry Cassandra L. , Smilen Scott W. 
Published: January 2018

Abstract
Injury to the urinary tract is a known risk of surgical repair of anterior and apical pelvic organ prolapse. Cystoscopy at the time of surgical prolapse repair is a low-risk procedure that can identify genitourinary tract injury by inspecting the bladder and urethra as well as by visualizing the ureters and ureteral efflux. There are several techniques to assist with visualization of ureteral efflux. Identifying injury intraoperatively may allow for mitigation of the morbidity of the injury. Universal cystoscopy should be performed at the time of all pelvic reconstructive surgeries, with the exception of operations solely for posterior compartment defects.
Abdominal Sacrocolpopexy for Repair of Pelvic Organ Prolapse After Radical Cystectomy
Authors: Zimmern Philippe E. , Wang Connie N. 
Published: January 2018

Introduction
Most case series describing surgical repair for pelvic organ prolapse (POP) after radical cystectomy (RC) focus on transvaginal repairs. We present our experience of POP after RC repaired by abdominal mesh sacrocolpopexy (ASC) with long-term follow-up.

Methods
Two women with previous RC with ileal conduit diversion underwent open ASC for repair of apical prolapse with concomitant enterocele. Prolapse severity was assessed using the POP quantification staging system, whereas pelvic imaging was performed with magnetic resonance imaging defecography.

Results
One patient had no POP recurrence at follow-up of 45 months after ASC. The other patient had anterior enterocele recurrence at 11 months after ASC and was treated with a limited outpatient transvaginal repair. She had no POP recurrence at 12 months after secondary repair. Both ASC procedures had technical challenges related to pelvic dissection of adhesed loops of bowels, access to the promontory, and retroperitonealization requiring the assistance of a general surgeon. Neither case had perioperative complications.

Conclusion
In women with large enterocele or vaginal vault prolapse after RC, repair with ASC, although technically challenging, can offer durable POP outcomes.
Effect of door-to-angioembolization time on mortality in pelvic fracture: Every hour of delay counts
Authors: Matsushima Kazuhide , Piccinini Alice , Schellenberg Morgan , Cheng Vincent , Heindel Patrick , Strumwasser Aaron , Benjamin Elizabeth , Inaba Kenji , Demetriades Demetrios 
Published: January 2018

INTRODUCTION
Angioembolization (AE) is widely used for hemorrhagic control in patients with pelvic fracture. The latest version of the Resources for Optimal Care of the Injured Patient issued by the American College of Surgeons Committee on Trauma requires interventional radiologists to be available within 30 minutes to perform an emergency AE. However, the impact of time-to-AE on patient outcomes remains unknown. We hypothesized that a longer time-to-AE would be significantly associated with increased mortality in patients with pelvic fracture.

METHODS
This is a 2-year retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2014. We included adult patients (age ≥ 18 years) with blunt pelvic fracture who underwent pelvic AE within 4 hours of hospital admission. Patients who required any hemorrhage control surgery for associated injuries within 4 hours were excluded. Hierarchical logistic regression was performed to evaluate the impact of time-to-AE on in-hospital and 24-hour mortality.

RESULTS
A total of 181 patients were included for analysis. The median age was 54 years (interquartile range, 38–68) and 69.6% were male. The median injury severity score was 34 (interquartile range, 27–43). Overall in-hospital mortality rate was 21.0%. The median packed red blood cell transfusions within 4 and 24 hours after admission were 4 and 6 units, respectively. After adjusting for other covariates in a hierarchical logistic regression model, a longer time-to-pelvic AE was significantly associated with increased in-hospital mortality (odds ratio, 1.79 for each hour; 95% confidence interval, 1.11–2.91; p = 0.018).

CONCLUSION
The current study showed an increased risk of in-hospital mortality related to a prolonged time-to-AE for hemorrhagic control following pelvic fractures. Our results suggest that all trauma centers should allocate resources to minimize delays in performing pelvic AE.

LEVEL OF EVIDENCE
Therapeutic/care management, level IV.
Abdominal trauma surgery during recent US combat operations from 2002 to 2016
Authors: Stockinger Zsolt T. , Turner Caryn A. , Gurney Jennifer M. 
Published: January 2018

BACKGROUND
Abdominal surgery constitutes approximately 13% of surgical procedures performed for combat injuries. This study examines the frequencies and type of abdominal surgical procedures performed during recent US Military operations.

METHODS
A retrospective analysis of the Department of Defense Trauma Registry was performed for all Role 2 (R2) and Role 3 (R3) medical treatment facilities (MTFs), from January 2002 to May 2016. The 273 International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes that were identified as abdominal surgical procedures were stratified into 24 groups based on anatomic and functional classifications and then grouped by whether they were laparoscopic. Procedure grouping and categorization were determined, and adjudicated if necessary, by subject matter experts. Data analysis used Stata version 14 (College Station, TX).

RESULTS
A total of 26,548 abdominal surgical procedures were identified at R2 and R3 MTFs. The majority of abdominal surgical procedures were reported at R3 facilities. The largest procedure group at both R2 and R3 MTFs were procedures involving the bowel. There were 18 laparoscopic procedures reported (R2: 4 procedures, R3: 14 procedures). Laparotomy not otherwise specified was the second largest procedure group at both R2 (1,060 [24.55%]) and R3 (4,935 [22.2%]) MTFs. Abdominal caseload was variable over the 15-year study period.

CONCLUSIONS
Surgical skills such as open laparotomy and procedures involving the bowel are crucial in war surgery. The abundance of laparotomy not otherwise specified may reflect inadequate documentation, or the plethora of second- and third-look operations and washouts performed for complex abdominal injuries. Traditional elective general surgical cases (gallbladder, hernia) were relatively infrequent. Laparoscopy was almost nonexistent. Open abdominal surgical skills therefore remain a necessity for the deployed US Military General Surgeons; this is at odds with the shifting paradigm from open to laparoscopic skills in stateside civilian and military hospitals.

LEVEL OF EVIDENCE
Epidemiologic study, level III.
Functional stability of the TEG 6s hemostasis analyzer under stress
Authors: Meledeo Michael Adam , Peltier Grantham C. , McIntosh Colby S. , Voelker Chet R. , Bynum James A. , Cap Andrew P. 
Published: January 2018

BACKGROUND
Viscoelastic measurements of coagulation provide much needed information, including guidance for triage and insight into bleeding disorders. The current clinical standards for these devices are the thromboelastogram (TEG) 5000 and the rotational thromboelastometer (ROTEM) delta, but a new product, the TEG 6s, has recently come to market, designed to simplify the user experience, reduce the required blood volume, and conduct multiple assays simultaneously. This study compares the performance of these three devices and examines the resiliency of the TEG 6s under various stresses.

METHODS
The variances of coagulation metrics obtained by the TEG 6s (prototype and production models), TEG 5000, and ROTEM delta were compared using manufacturers' reagents and citrate-collected blood from healthy donors. Variability between devices was examined, and their performances under various motion and temperature stresses were compared by placing one unit on a linear or orbital shaker, in the cold, or in the heat while a counterpart remained stationary at room temperature.

RESULTS
Although most comparable parameters had low degrees of variance, there were small but significantly increased variances found in some ROTEM delta and TEG 5000 parameters versus comparable TEG 6s parameters. Orbital rotation of the TEG 6s had no effect on means of any parameter but resulted in increased variance of 2 parameters, but linear motion with sudden striking had no observed impact on results. Similarly, 7-day exposure to heat (45°C) or cold (4°C) only resulted in minor deviations within normal ranges of the TEG 6s.

DISCUSSION
The TEG 6s provides several improvements over other coagulation analyzers: it is easier to use and robustly resilient against motion and temperature stresses. These features suggest that it may be capable of deployment not only in the clinical laboratory but also to a variety of austere settings.

LEVEL OF EVIDENCE
Diagnostic test, level III.
A review of the landscape: Challenges and gaps in trauma response to civilian high threat mass casualty incidents
Authors: Callaway David W. 
Published: January 2018

ABSTRACT
The ultimate goal of the emergency response and trauma system is to reduce potentially preventable death from trauma. Tremendous advances in trauma care emerged from the past 15 years of United States’ combat engagements around the globe. Unfortunately, combat and insurgency tactics have also metastasized to the civilian world, resulting in increasingly complex and dynamic acts of intentional mass violence. These high threat active violent incidents (AVIs) pose significant preparedness, response, and clinical care challenges to the civilian healthcare systems. Currently, there are several operational and policy gaps that limit the successful preparedness and response to AVIs and dynamic MCIs in the United States.
Improved Cuff Technique and Intraoperative Detection of Vascular Complications for Hind Limb Transplantation in Mice
Authors: Kim Minhyung , Fisher Daniel T. , Powers Colin A. , Repasky Elizabeth A. , Skitzki Joseph J. 
Published: January 2018

Background
Vascularized composite tissue allotransplantation (VCA) from a cadaveric donor has now become a clinical reality and the treatment modality of choice for patients with devastating injuries, deformities, and complex tissue defects. However, many VCA patients experience severe toxicities due to the strong immunosuppression required secondary to high antigenicity of the grafts. To improve immunosuppressive protocols for VCA, feasible and reliable preclinical models are necessary. The purpose of this study was to introduce new techniques to an established preclinical VCA model to accelerate future investigations.

Methods
C57BL/6 (H-2b) and BALB/c (H-2d) mice were used to perform VCA as recipients and donors, respectively. Surgery time, success rate, associated complications, and mortality were analyzed. Blood flow in grafts was interrogated with laser speckle image (LSI).

Results
A nonsuture cuff technique was used with the abdominal aorta for end-to-end anastomosis. The cuff technique demonstrated efficiency for donor surgery (52 ± 10 minutes for donor vs. 45 ± 8 minutes for recipient surgery). Successful revascularization was achieved in 27 (90%) of 30 transplants. The majority of surgical complications occurred within 48 hours including artery occlusion, venous occlusion, cerebral stroke, and minor bleeding without mortality. LSI was useful in detecting intraoperative vascular complications with display patterns predictive of complication type.

Conclusions
The described techniques may facilitate a more efficient heterotopic hind limb transplantation mouse model of VCA.
Risk of Acute Ischemic Stroke in Patients With Monocular Vision Loss of Vascular Etiology
Authors: Zhang Lucy Y. , Zhang Jason , Kim Richard K. , Matthews Jared L. , Rudich Danielle S. , Greer David M. , Lesser Robert L. , Amin Hardik 
Published: January 2018

Background:
To evaluate the risk of concurrent acute ischemic stroke and monocular vision loss (MVL) of vascular etiology.

Design:
Retrospective, cross-sectional study.

Subjects:
Patients aged 18 or older diagnosed with MVL of suspected or confirmed vascular etiology who had no other neurologic deficits and who received brain MRI within 7 days of onset of visual symptoms were included.

Methods:
A medical record review was performed from 2013 to 2016 at Yale New Haven Hospital. Patients were included if vision loss was unilateral and due to transient monocular vision loss (TMVL), central retinal artery occlusion (CRAO), or branch retinal artery occlusion (BRAO). Any patients with neurologic deficits other than vision loss were excluded. Other exclusion criteria were positive visual phenomena, nonvascular intraocular pathology, and intracranial pathology other than ischemic stroke.

Main Outcome Measures:
The presence or absence of acute stroke on diffusion-weighted imaging (DWI) on brain MRI.

Results:
A total of 641 records were reviewed, with 293 patients found to have MVL. After excluding those with focal neurologic deficits, there were 41 patients who met the inclusion criteria and received a brain MRI. Eight of the 41 subjects (19.5%) were found to have findings on brain MRI positive for acute cortical strokes. The proportion of lesion positive MRI was 1/23 (4.3%) in TMVL subjects, 4/12 (33.3%) in CRAO subjects, and 2/5 (40%) in BRAO subjects. Brain computed tomography (CT) scans were not able to identify the majority of acute stroke lesions in this study.

Conclusions:
Patients with MVL of vascular etiology such as TMVL, CRAO, or BRAO may have up to 19.5% risk of concurrent ischemic stroke, even when there are no other neurologic deficits. These strokes were detected acutely with brain MRI using DWI but were missed on CT.
Reference-dependent preferences arise from structure learning
Authors: Hunter Lindsay E. , Gershman Samuel J. 
Published: January 2018

AbstractModern theories of decision making emphasize the reference-dependency of decision making under risk. In particular, people tend to be risk-averse for outcomes greater than their reference point, and risk-seeking for outcomes less than their reference point. A key question is where reference points come from. A common assumption is that reference points correspond to expectations about outcomes, but it is unclear whether people rely on a single global expectation, or multiple local expectations. If the latter, how do people determine which expectation to apply in a particular situation? We argue that people discover reference points using a form of Bayesian structure learning, which partitions outcomes into distinct contexts, each with its own reference point corresponding to the expected outcome in that context. Consistent with this theory, we show experimentally that dramatic change in the distribution of outcomes can induce the discovery of a new reference point, with systematic effects on risk preferences. By contrast, when changes are gradual, a single reference point is continuously updated.