bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pirfenidone Inhibits Transforming Growth Factor β1-induced Extracellular Matrix Production in Nasal Polyp-derived Fibroblasts
Authors: Shin Jae-Min , Park Joo-Hoo , Park Il-Ho , Lee Heung-Man 
Published: December 2015

Purpose Pirfenidone has been shown to have antifibrotic and anti-inflammatory effects in the lungs. The purpose of this study was to evaluate the inhibitory effects of pirfenidone on transforming growth factor (TGF)-β1-induced myofibroblast differentiation and extracellular matrix accumulation. We also determined the molecular mechanisms of pirfenidone in nasal polyp-derived fibroblasts (NPDF). Methods NPDFs were isolated from nasal polyps from eight patients who had chronic rhinosinusitis with nasal polyp. Pirfenidone was used to treat TGF-β1-induced NPDFs. Cytotoxicity was evaluated by using a 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl-tetrazolium bromide assay. Fibroblast migration was evaluated with scratch assays. Expression levels of α-smooth muscle actin (SMA), fibronectin, and phosphorylated Smad2/3 were determined by Western blot and/or reverse transcription-polymerase chain reaction and immunofluorescent staining. Total collagen production was analyzed with the Sircol collagen assay and contractile activity was measured by a collagen gel contraction assay. Results Pirfenidone (0-2 mg/mL) has no significant cytotoxic effects in TGF-β1-induced NPDFs. Migration of NPDFs was significantly inhibited by pirfenidone treatment. The expression levels of α-SMA and fibronectin were significantly reduced in pirfenidone-treated NPDFs. Collagen contraction and production were also significantly decreased by pirfenidone treatment. Finally, pirfenidone significantly inhibited phosphorylation of the Smad2/3 pathway in TGF-β1-induced NPDFs. Conclusions Pirfenidone has an inhibitory effect on TGF-β1-induced migration, myofibroblast differentiation (α-SMA), extracellular matrix accumulation, and collagen contraction by blocking the phosphorylation of Smad2/3 pathways in NPDFs. Thus, pirfenidone may inhibit TGF-β1-induced extracellular matrix by regulating Smad2/3.
Endonasal Extended Columellar Strut in Asian Rhinoplasty
Authors: Kim Jong-Yeup , Choi Myoung Su 
Published: December 2015

Background Recently, sculpturing of projected and sharp nasal tips, as is usual in the white population, has been of great concern in Asian rhinoplasty. However, tip surgery in Asians should be performed in a different way due to anatomic differences. The authors used an endonasal rhinoplasty to correct the position of lower lateral cartilage by adopting a modified columellar strut. This novel technique of an endonasal extended columellar strut (EECS) could project the nasal tip significantly while avoiding hard fixation. This study aimed to evaluate the usefulness of the EECS in Asians. Materials and Methods A retrospective study was performed with 40 patients who underwent EECS from March 2012 to August 2014. Photographs taken preoperatively and postoperatively were analyzed. The tip projection, the ratio of the length of the infratip lobule to the total length of the tip, and a columellar labial angle change were measured. Overall, surgical outcomes were rated into three grades (excellent, good, and fair) by two experienced rhinoplasty surgeons (J.Y.K., M.S.C.). All the patients were asked to rate their cosmetic satisfaction by using a visual analog scale (10 points). Results Postoperative nasal tip projection significantly increased, from 24.2 to 26.7 mm (p < 0.01). The ratio of the length of the infratip lobule to the total length of the tip mildly increased, from 0.45 to 046 in men, and remained unchanged, at 0.48, in women. The columellar labial angle significantly increased, from 86.9° to 93.7° (p < 0.01). Surgical outcomes were rated by two experienced surgeons as excellent (40%), good (42%), and fair (18%). Subjectively, patients graded their satisfaction at ∼8.7 on the visual analog scale. Conclusion This novel EECS technique enabled satisfactory tip projection in Asians while maintaining a natural ratio of infratip lobule to total length of tip and leaving no external scar.
Endoscopic Endonasal Orbital Transposition to Expand the Frontal Sinus Approaches
Authors: Karligkiotis Apostolos , Pistochini Andrea , Turri-Zanoni Mario , Terranova Paola , Volpi Luca , Battaglia Paolo , Bignami Maurizio , Castelnuovo Paolo 
Published: December 2015

Background The management of frontal sinus disease still remains a challenging issue for rhinologists. Although endoscopic frontal sinus surgery has significantly advanced over the past years, there are some conditions in which the external approaches are still necessary. Recently, the increasing experience in endoscopic sinus surgery together with important technologic advancements have allowed expansion of the indications for selected lesions localized more and more lateral into the frontal sinus. Objective The aim of this study was to describe the endoscopic endonasal approach to the far lateral portion of the frontal sinus and to evaluate the outcomes of this technique. Methods A retrospective evaluation was carried out with patients at a single institution, who, from 2004 to 2012, underwent an exclusive endoscopic transnasal approach to the far lateral portion of the frontal sinus at a single institution. The surgical technique included the Draf IIb procedure, a modified Lothrop procedure (Draf III), and endoscopic lateralization of the orbit, differently associated according to the needs of each case. Results Twenty-four patients were eligible for the present study. The lesions included were mucoceles in 9 cases, fibro-osseous lesions in 10 cases, and inverted papillomas in 5 cases. The overall follow-up ranged from 12 to 120 months (mean, 40.6 months). At the time of the last follow-up, no recurrence of disease was observed in the patients treated; in one case of osteoma, a small and stable in size (1 mm) persistent lesion was observed in an asymptomatic patient. One scheduled and one accidental cerebrospinal fluid leak with immediate skull base reconstruction occurred. No intraoperative or postoperative early or late orbital complication was observed in any case. Conclusion The endoscopic endonasal orbital transposition seems to facilitate the endoscopic management of selected far-lateral frontal sinus lesions. However, it is a demanding procedure that requires experience and skill to avoid intraoperative skull base and orbital complications.
Nasal Tip Sutures: Techniques and Indications
Authors: Cingi Cemal , Muluk Nuray Bayar , Ulusoy Seçkin , Söken Hakan , Altintoprak Niyazi , Şahin Ethem , Ada Servet 
Published: December 2015

Objectives The surgical anatomy of the nasal tip is determined by intrinsic factors, such as the nasal tip volume, shape, definition, and symmetry. These factors are intimately related to the morphology of the lower lateral cartilages. Tip sutures reduce the need for grafts and allow the surgeon to manipulate the tip with a high degree of precision and better long-term clinical outcomes. In this review, we evaluated common nasal tip suture techniques to clarify the similarities and differences among them. Methods The following nasal tip suture techniques were investigated: medial crural fixation suture, middle crura suture, transdomal (dome creating, dome binding, domal definition) suture, interdomal suture, lateral crural mattress suture, columella septal suture, intercrural suture, tip rotation suture, craniocaudal transdomal suture, lateral crural spanning suture, suspension suture, tongue-in-groove technique, and lateral crural steal. Results Tip sutures increase tip projection, narrow the tip, provide stabilization, and provide tip rotation. The sutures may be used separately or together. Conclusion Nasal tip sutures have long been used as noninvasive suture techniques. Each suture technique has unique benefits, and various key points must be considered when using these techniques.
Nasal Nitric Oxide in Relation to Quality-of-life Improvements after Endoscopic Sinus Surgery
Authors: Fu Chia-Hsiang , Huang Chi-Che , Chen Yi-Wei , Chang Po-Hung , Lee Ta-Jen 
Published: December 2015

Background The level of nasal nitric oxide (nNO) in patients with chronic rhinosinusitis (CRS) has been proven to increase after surgical treatment. The relationship between nNO and treatment outcome has not been documented to date. Objective To evaluate the levels of and changes in nNO after sinus surgery and its effects on quality-of-life improvements for patients with CRS after surgical treatment. Methods By using a clinical cohort study design, we identified patients who were receiving bilateral endoscopic sinus surgery for CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) with a 1-year follow-up. We assessed the demographics, preoperative prognostic predictors, pre- and postoperative nNO levels, and disease-related quality of life via a questionnaire. Results Sixty-nine patients were enrolled, including 53 with CRSwNP and 16 with CRSsNP. The CRSwNP group had lower initial nNO levels and higher endoscopic and image scores but similar demographics and questionnaire scores. In the patients with CRSwNP, nNO levels recovered and reached a plateau at the third month after surgery. However, nNO levels in the CRSsNP group continued to increase until 6 months after surgery before reaching a steady level. Higher preoperative nNO levels were significantly related to better quality-of-life improvements at 3 months after surgery in both groups. Conclusion The nNO levels in patients with CRS increased and reached a plateau after sinus surgery for both groups. Under similar subjective disease severity, the CRSsNP group had higher preoperative nNO levels and maintained a continuously longer rise before reaching a steady level after surgery. For both CRS groups, a higher initial nNO level brought better quality-of-life improvements and could be provided as a preoperative prognostic indicator.
MOJE Ceramic Metatarsophalangeal Arthroplasty: Disappointing Clinical Results at Two to Eight Years
Authors: Dawson-Bowling Sebastian , Adimonye Anthony , Cohen Adam , Cottam Howard , Ritchie James , Fordyce Michael 
Published: December 2015

Background: Among the surgical treatment options for osteoarthritis of the first metatarsophalangeal joint (MTPJ) are a number of different designs of total arthroplasty, including the MOJE, a ceramic press fit arthroplasty. We present a 2- to 8-year followup of 31 procedures. Methods: Thirty-two MOJE arthroplasties were undertaken for painful hallux rigidus in 30 patients (nine male, 21 female) over 6 years (mean age 61.9; range, 37 to 76). At followup patients' symptoms, levels of function and radiographs were scored using SF-36, modified Kitaoka and AOFAS systems. Followup rate was 97%, with mean followup time 58 months (range, 28 to 97). Results: Mean scores were: Kitaoka 53.8 (15 to 75), AOFAS 61.3/100 (range, 18 to 100), SF-36 physical combined 48.6 (27.6 to 58.7) SF-36 mental score 52.2 (19.5 to 62.2). Sixteen showed radiological evidence of component loosening (either lucency, subsidence or both) and one radiograph revealed component fracture. Eight implants have been revised. In patients who had not undergone subsequent fusion, 15 had less than 36 degrees of movement, nine had 36 to 45 degrees, four were in the 46 to 60 range, and only one had more than 60 degrees. There were no infections. Conclusion: Although previous studies have suggested favorable initial outcomes with the MOJE prosthesis, all have focused only on the early results. In our series, the reoperation rate of 26% at up to 8 years is worryingly high, especially given that 16 (52%) showed loosening. Although there appears to be a cohort of patients who have satisfactory outcomes with the MOJE, we would suggest that these results do not support the continued use of this implant. Level of Evidence: IV, Retrospective Case Series
Radiologic Changes of Ankle Joint after Total Knee Arthroplasty
Authors: Lee Jung Hee , Jeong Bi O 
Published: December 2015

Background: The authors noticed that ankle joint osteoarthritis was not uncommon when lower extremity malalignment, such as a knee varus deformity, was present as a result of severe osteoarthritis of the knee. The purpose of this study was to analyze radiologic changes of the ankle joint after total knee arthroplasty. Methods: This study included 142 cases in 110 patients who underwent total knee arthroplasty and were followed for at least 3 years. The varus knee group included 128 cases and the valgus knee group included 14 cases. On anteroposterior standing lower extremity radiographs, varus and valgus angles of the knee were measured preoperatively and at the last follow-up. The angle between the ground surface and the distal tibial plafond as well as the upper talus was also measured. In addition, tibial anterior surface angle, talar tilt, space between the medial malleolar distal tip and the medial articular surface of the talus, and medial tibiotalar joint space of the ankle joint were measured. Results: Out of 142 cases, 50 (35.2%) had arthritis in the ankle before total knee arthroplasty and 31 (21.8%) had newly developed or progressive arthritis after surgery. In particular, the varus knee group demonstrated statistically significant differences in preoperative varus deformity, preoperative talar tilt, and postoperative correction angle between the cases that developed or had progressive arthritis and those that did not show any changes ( p < .05). Conclusions: After total knee arthroplasty, arthritis developed or progressed in the ankle of many cases radiographically. In particular, when the preoperative talar tilt increased medial to the ankle or the postoperative correction angle was large, the incidence of arthritis in the ankle joint increased. The authors recommend more cautious follow-up on the symptoms of the ankle joint after total knee arthroplasty. Level of Evidence: III, Retrospective Study
Immediate Weight Bearing after Modified Percutaneous Achilles Tendon Repair
Authors: Chandrakant Vishal , Lozano-Calderon Santiago , McWilliam James 
Published: December 2015

Background: Controversy exists regarding postoperative treatment of Achilles tendon repair. The purpose of this study was to evaluate the results of immediate weight bearing following modified percutaneous Achilles tendon repair using readily available materials. Methods: Fifty-two patients who were treated at a single center from 2000 to 2009 underwent percutaneous Achilles tendon repair by a single surgeon and were allowed immediate weight bearing. They were followed for on average of 2 years postoperatively and evaluated with functional and subjective outcomes. Results: The average American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 96 points (range, 81 to 100), with 95% confidence interval ranging from 89.1 to 102.9. Subjective evaluation demonstrated that 47 patients (90%) were able to return to a desired level of activity, with an overall complication rate of 11.5%. Conclusion: Immediate weight bearing after percutaneous Achilles tendon repair had a low overall complication rate with good clinical and functional outcomes. Level of Evidence: IV, Retrospective Case Series
Minimally Invasive Forefoot Surgery: A Cadaveric Study
Authors: Dhukaram Vivekanandan , Chapman Anna Prasthofer , Upadhyay Piyush Kumar 
Published: December 2015

Background: Minimally invasive surgery (MIS) aims to improve cosmesis and minimize soft tissue disruption by using small skin incisions. When using MIS in the forefoot, there is concern about iatrogenic neurovascular and tendon damage. The aim of this anatomical study was to assess the risk of iatrogenic injury while performing MIS techniques. Methods: Ten normal cadaveric feet were used. All of the procedures were performed in a cadaveric lab using a mini-C-arm by two surgeons: a consultant who has attended a cadaveric MIS training course but does not perform MIS in his regular practice (eight feet) and a registrar (resident) who was supervised by the same consultant (two feet). In each foot, the surgeon performed a lateral release, a minimally invasive chevron and Akin (MICA) procedure for the correction of hallux valgus, and a minimally invasive distal metatarsal extra-articular osteotomy (DMO). Each foot was then dissected to identify any neurovascular or tendon injury and photographed. Results: The dorsal medial cutaneous and the plantar interdigital nerves were intact in all specimens. There was no apparent damage to the arterial plexus supplying the first metatarsal head. No flexor or extensor tendon injuries were identified. On examination of the osteotomies, the cuts were found not to be in the desired plane. In both MICA and DMO, the dissection also revealed some intact soft tissue at the osteotomy site, which may preserve vascularity and add stability to the osteotomy. Conclusions: Although there has been concern regarding neurovascular and tendon injury, the findings were consistent with minimal risk, which is consistent with reports in the literature. This study also reflects the challenges associated with performing the osteotomy in the desired plane, which may be related to the learning curve. Clinical Relevance: This cadaveric study has demonstrated a minimal risk of neurovascular and tendon injury associated with minimally invasive techniques in the forefoot. However, the study emphasizes the need for excellent three-dimensional anatomy and suggests additional cadaveric training prior to attempting these techniques in clinical practice.
Prospective, multidisciplinary recording of perioperative errors in cerebrovascular surgery: is error in the eye of the beholder?
Authors: Michalak Suzanne M. , Rolston John D. , Lawton Michael T. 
Published: December 2015

OBJECT
Surgery requires careful coordination of multiple team members, each playing a vital role in mitigating errors. Previous studies have focused on eliciting errors from only the attending surgeon, likely missing events observed by other team members.

METHODS
Surveys were administered to the attending surgeon, resident surgeon, anesthesiologist, and nursing staff immediately following each of 31 cerebrovascular surgeries; participants were instructed to record any deviation from optimal course (DOC). DOCs were categorized and sorted by reporter and perioperative timing, then correlated with delays and outcome measures.

RESULTS
Errors were recorded in 93.5% of the 31 cases surveyed. The number of errors recorded per case ranged from 0 to 8, with an average of 3.1 ± 2.1 errors (± SD). Overall, technical errors were most common (24.5%), followed by communication (22.4%), management/judgment (16.0%), and equipment (11.7%). The resident surgeon reported the most errors (52.1%), followed by the circulating nurse (31.9%), the attending surgeon (26.6%), and the anesthesiologist (14.9%). The attending and resident surgeons were most likely to report technical errors (52% and 30.6%, respectively), while anesthesiologists and circulating nurses mostly reported anesthesia errors (36%) and communication errors (50%), respectively. The overlap in reported errors was 20.3%. If this study had used only the surveys completed by the attending surgeon, as in prior studies, 72% of equipment errors, 90% of anesthesia and communication errors, and 100% of nursing errors would have been missed. In addition, it would have been concluded that errors occurred in only 45.2% of cases (rather than 93.5%) and that errors resulting in a delay occurred in 3.2% of cases instead of the 74.2% calculated using data from 4 team members. Compiled results from all team members yielded significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays (p = 0.001 and p = 0.028, respectively).

CONCLUSIONS
This study is the only of its kind to elicit error reporting from multiple members of the operating team, and it demonstrates error is truly in the eye of the beholder—the types and timing of perioperative errors vary based on whom you ask. The authors estimate that previous studies surveying only the attending physician missed up to 75% of perioperative errors. By finding significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays, this study shows that these surveys provide relevant and useful information for improving clinical practice. Overall, the results of this study emphasize that research on medical error must include input from all members of the operating team; it is only by understanding every perspective that surgical staff can begin to efficiently prevent errors, improve patient care and safety, and decrease delays.
Hemodynamic and morphological characteristics of unruptured posterior communicating artery aneurysms with oculomotor nerve palsy
Authors: Lv Nan , Yu Ying , Xu Jinyu , Karmonik Christof , Liu Jianmin , Huang Qinghai 
Published: December 2015

OBJECT
Unruptured posterior communicating artery (PCoA) aneurysms with oculomotor nerve palsy (ONP) have a very high risk of rupture. This study investigated the hemodynamic and morphological characteristics of intracranial aneurysms with high rupture risk by analyzing PCoA aneurysms with ONP.

METHODS
Fourteen unruptured PCoA aneurysms with ONP, 33 ruptured PCoA aneurysms, and 21 asymptomatic unruptured PCoA aneurysms were included in this study. The clinical, morphological, and hemodynamic characteristics were compared among the different groups.

RESULTS
The clinical characteristics did not differ among the 3 groups (p > 0.05), whereas the morphological and hemodynamic analyses showed that size, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, normalized wall shear stress (WSS), and percentage of low WSS area differed significantly (p < 0.05) among the 3 groups. Furthermore, multiple comparisons revealed that these parameters differed significantly between the ONP group and the asymptomatic unruptured group and between the ruptured group and the asymptomatic unruptured group, except for size, which differed significantly only between the ONP group and the asymptomatic unruptured group (p = 0.0005). No morphological or hemodynamic parameters differed between the ONP group and the ruptured group.

CONCLUSIONS
Unruptured PCoA aneurysms with ONP demonstrated a distinctive morphological-hemodynamic pattern that was significantly different compared with asymptomatic unruptured PCoA aneurysms and was similar to ruptured PCoA aneurysms. The larger size, more irregular shape, and lower WSS might be related to the high rupture risk of PCoA aneurysms.