bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of acute diverticulitis with pericolic free gas (ADIFAS): an international multicenter observational study
Authors: Tejedor Patricia , Pastor Carlos , Pellino Gianluca , Di Saverio Salomone , Gorter-Stam Marguerite , Sylla Patricia , Francis Nader ,   on behalf of the Collaborative Study Group
Published: April 2023

Background:
There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid.

Methods:
A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure.

Results:
A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II–IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4–64, P=0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2–19.9, P=0.023), with 88% of success compared to 96% without free fluid (P<0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%.

Conclusion:
Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation.
Skin problems among the wheelchair users: a prospective cross-sectional study
Authors: Alkhalifah Azzam , Aljohani Moath , Almasaud Weam , Alsalamah Rola , Alhomili Amjad , Almasaud Abdulrahman , Tobeigei Faisal H. 
Published: April 2023

Background:
Skin is the largest and the outermost body organ. It is directly affected by the external environment. The biomechanical differences in wheelchair users compared to healthy people make them prone to different risk factors of skin problems. Nevertheless, these patients are under-represented in the dermatologic literature.

Objective:
The primary objective was to determine the frequency of different skin problems among wheelchair users. The secondary objective is to determine the different precautions they are taking to prevent these problems.

Methods:
The prospective study followed a cross-sectional design, conducted during the period of the coronavirus disease 2019 curfew between May and June 2020. The survey’s link was distributed among adult wheelchair users in Saudi Arabia. The questionnaire was administered using google forms. All statistical analyses were performed using SPSS version 22.

Results:
The results show that the vast majority of wheelchair users (85%) experienced skin problems. Pressure ulcer (PU) is the most frequently reported skin condition (54%), followed by traumatic wounds, fungal infections, and hand skin dryness and thickening. The commonest preventive measure was using cushions to avoid PUs.

Conclusion:
Most of wheelchair users reported having a history of skin complaints, of which PU was the most common followed by traumatic wounds and fungal infections. Thus, spreading awareness of the risk factors and preventive methods would help them avoid its development and prevent its negative impact on quality of life. Assessing the different kinds of wheelchairs and cushions to avoid PUs would be an interesting area for future studies.
Intermediate risk of choledocholithiasis: are we on the right path?
Authors: Girón Felipe , Rodríguez Lina M. , Conde Danny , Rey Chaves Carlos E. , Vanegas Marco , Venegas David , Gutiérrez Fernando , Nassar Ricardo , Hernández Juan D. , Jiménez Daniel , Núñez-Rocha Ricardo E. , Niño Laura , Rojas Susana 
Published: April 2023

Introduction:
The risk of choledocholithiasis should be assessed in every patient undergoing cholecystectomy to define the next step. The American Society for Gastrointestinal Endoscopy proposed a stratified predictor scale of choledocholithiasis. Therefore, we aimed to describe our experience managing patients with an intermediate risk of choledocholithiasis according to the American Society for Gastrointestinal Endoscopy guidelines and the actual presence of bile duct stones in magnetic resonance cholangiopancreatography.

Methods:
A retrospective observational study with a prospective database was conducted. The analysis included sociodemographic data, laboratory values, and imaging. Bivariate, multivariate, and receiver operating characteristic analysis were performed.

Results:
Three hundred twenty-seven patients had an intermediate risk for choledocholithiasis. Half the patients were at least 65 years old. 24.77% were diagnosed with choledocholithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocholithiasis is associated with an age odds ratio (OR): 1.87 (P 0.02), alkaline phosphatase OR: 2.44 (P 0.02), and bile duct dilation greater than 6 mm OR: 14.65 (P 0.00).

Conclusions:
High variability in the accuracy of imaging techniques results in a large number of patients classified as intermediate risk without choledocholithiasis in cholangioresonance. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.
Management of a floating shoulder accompanied by a scapular surgical neck fracture: a case report and review of the literature
Authors: Sharifpour Sadula , Mirghaderi Peyman , Ghaseminejad Raeini Amirhossein , Mirghaderi Reza , Moharrami Alireza , Kalantar Seyed Hadi 
Published: April 2023

Introduction and Importance:
In this article, we want to present a floating shoulder case accompanied by a scapular surgical neck fracture and review the literature about its diagnosis and management.

Case Presentation:
Our patient was a 40-year-old man who suffered a severe left shoulder injury as a result of a car-to-pedestrian accident. Computed tomography scan revealed a scapular surgical neck and body fracture, a spinal pillar fracture, and a dislocation of the acromioclavicular (AC) joint. The medial-lateral displacement and glenopolar angle were 21.65 mm and 19.8°, respectively. There was a 37° angular displacement and a greater than 100% translational displacement.
Initially, the AC joint dislocation was approached via a superior incision on the clavicle and reduced with a single hook plate. A Judet approach was then used to expose the scapula fractures. The scapular surgical neck was fixed with a reconstruction plate. The spinal pillar was stabilized with two reconstruction plates following reduction.
Following a year of follow-up, the patient’s shoulder range of motion was acceptable, and an American Shoulder and Elbow Surgeons score of 88 was achieved.

Discussion and Conclusion:
Floating shoulder management is still controversial. Floating shoulders are often treated surgically due to their consequent instability and potential risk of nonunion and malunion. As shown in this article, the indications for operating on isolated scapula fractures may also apply to floating shoulders. A well-planned approach to fractures is also imperative, and the AC joint should always be a priority.
Coexistence of a huge Brenner’s tumour and mucinous cystadenoma in a 62-year-old female: a case report from Syria
Authors: Zahlout Jaafar , Shmayyes Nour A. , Zahlout Batoul , Kassab Yahya , Alshehabi Zuheir 
Published: April 2023

Introduction and importance:
The coexistence of a benign Brenner tumour and a mucinous cystadenoma is rare, and their relationship and origin are still enigmatic and challenging.

Case presentation:
In this manuscript, the authors report a case of a 62-year-old nulliparous Syrian woman who presented with severe abdominal distension, which was followed by laparotomy and the excision of a 25×20 cm-cyst; its pathological examination confirmed a benign Brenner’s tumour and mucinous cystadenoma.

Clinical discussion:
Ovarian Brenner and mucinous are usually benign and can rarely grow asymptomatically to very big sizes. Herein, the authors aim to emphasize the importance of excluding malignancy by pathology examination.

Conclusion:
Walthard cell nests undergo metaplasia to give rise to different kinds of Brenner and mucinous neoplasm formations according to their genetic alterations. This paper adds to the available literature, which is still poor, by providing evidence of the first case of this rare combination from Syria with a review of different theories of origin and differential diagnoses. More studies directed towards exploring this combination’s genetic origin are needed to boost our understanding of ovarian tumours in general.
Afterhours patient phone calls: a quality improvement study
Authors: Tideman Grace , Hadley Morgan , Campbell Tanner , Templeton Kimberly 
Published: April 2023

Objective:
The objective was to determine the most common topic of patient phone calls received by on-call orthopedic residents at a single academic institution in order to identify areas of improvement for patient outcome and resident workload and wellbeing.

Design:
Patient phone calls over 82 shifts were documented from May 2020 to January 2021 by on-call orthopedic residents. The length, nature, and associated attending physician of each call were recorded, as well as whether the call resulted in an emergency department visit. The nature of each phone call was categorized into one of 12 categories.

Setting:
An urban, tertiary care academic institution in the Midwest, USA.

Participants:
All orthopedic residents on-call during this period logged the phone calls that they received and related relevant data.

Results:
Orthopedic surgery residents took an average of 8.6 patient phone calls (average 53.3 total minutes) per shift. The most common reasons for the phone calls were pain, prescription, and pharmacy concerns, which together represented over half of the calls. Twenty-one (4.1%) phone calls resulted in an emergency department visit.

Conclusion:
Concerns about pain and prescriptions were among the most common reasons for patient phone calls. This information points to opportunities for interventions that could help guide how postoperative pain is discussed with patients, including providing patients with reasonable expectations for pain control, function, and tools for better self-efficacy. This approach could not only enhance patient care but also decrease resident on-call workload and improve resident wellbeing.
An Elegant Method for Removing Breast Implants - a Novel Surgical Device
Authors: Gronovich Yoav , Maisel-Lotan Adi 
Published: April 2023

Summary:
The use of breast implants is constantly on the rise due to the increase in aesthetic and reconstructive breast surgery. Implant rupture is a potential complication, the rate of which has increased over time. Consequently, implant removal or replacement is a common procedure, inevitable for all breast implants at some point during the patient's lifetime. Currently, surgical removal of ruptured implants is messy, cumbersome, time consuming and, in all, unpleasant. We have developed a custom-made device that effectively removes a silicone implant, whether ruptured or intact. In order to determine its efficiency, we conducted a prospective clinical trial of 25 women (45 breasts) undergoing removal or replacement of breast implants with our device between January 2019 and January 2022. Device safety and efficiency were assessed, and the need for the device was evaluated through a survey among 25 board certified plastic surgeons. In our trial, the mean implant age was 12.8 years and mean volume, 370gr. Mean time to extract the implant with the device was 10.7 seconds. Twenty-two implants (49%) were ruptured. There were no minor or major complications during the procedure or follow-up. Mean follow-up period was six months. Surgeons’ intentions to use this device in their own practices for removal of intact and ruptured implants was very high. In conclusion, our novel device may prove indispensable for explantation of both intact and ruptured silicone implants.
Hybrid breast augmentation, double benefit or double risk? A comparative study of 932 cases
Authors: Li Zhengyao , Zhang Ziying , Zhang Zixuan , Guan Xiaoyu , Xin Minqiang 
Published: April 2023

Background
We propose a hybrid breast augmentation (HBA) method combining implants and fat grafting and explore the outcome and safety through a retrospective, single-center, propensity score-matched (PSM) comparative study.

Method
Outcome, satisfaction, and complications were compared between the HBA group (302 cases) and the implant-based breast augmentation (IBA) group (353 cases), the HBA group and the autologous fat grafting (AFG) group (277 cases).

Result
The mean follow-up period was 31.7 months. After PSM, 270 cases were matched between the HBA and IBA groups, and 156 cases were matched between the HBA and AFG groups. Compared to the IBA group: HBA achieved higher scores of implant visibility/palpability and upper pole contour with the specialists’ evaluations (before and after PSM, P<0.05). Regarding patient satisfaction, the scores of softness (before and after PSM), smoothness of the upper pole (before PSM), and overall satisfaction (after PSM) of the HBA group were better (P<0.05). Implant-related complications occurred at a similar rate. Compared to the AFG group: HBA achieved higher scores of shape (before and after PSM) and symmetry (after PSM) with evaluations of specialists (P<0.05). The scores of shape, symmetry and overall satisfaction in the HBA group were better (before and after PSM, P<0.05). The HBA group showed a lower incidence of palpable cysts, fat necrosis, oil cysts, and fat calcification (before PSM, P<0.05).

Conclusion
By comparing the three techniques objectively, HBA presented better indices of aesthetic outcomes, satisfaction and acceptable complications rates when compared to IBA and AFG.
Novel Clinical Anatomic Consideration of the Superficial and Deep Layers of the Deep Temporal Fascia
Authors: Lee Hyung-Jin , Kim Hyoung Moon , Ahn Hyo-Sang , Lee Ji-Hyun , Kim Hee-Jin 
Published: April 2023

Background:
The deep temporal fascia provides anchoring during thread lifting, which is a minimally invasive facelifting procedure. However, anatomic studies involving the deep temporal fascia as well as effective and safe thread lifting procedures are scarce. We clarified the anatomy of the superficial layer of the deep temporal fascia and its surrounding structure using ultrasonography, histologic sections, and cadaveric dissection to propose an effective thread lifting procedure guideline.

Methods:
We included 20 healthy young South Korean participants. Real-time, two-dimensional, B-mode ultrasonography was performed. Longitudinal scanning was performed along three vertical lines: the line passing through the jugale, the anterior margin of the condylar process of the mandible, and the midpoint between the jugale and anterior margin of the condylar process. Histologic samples from three fresh adult cadavers were harvested from 2.5 cm above and below the zygomatic arch. Eighteen fresh adult hemifaces of South Korean cadavers (six males, three females; age, 67.3 ± 7.2 years) were used to confirm the morphology of the deep temporal fascia.

Results:
The superficial layer of the deep temporal fascia crossed the zygomatic arch and was connected to the origin of the zygomaticus major muscle at the line passing through the jugale. The superficial layer continued inferiorly to the parotidomasseteric fascia at the line passing through the midpoint and condylar process of the mandible.

Conclusions:
This study yielded the novel anatomy of the superficial layer of the deep temporal fascia, and this anatomic structure may be used for an ideal thread lifting procedure.
Internal Fixation of Redistributed Orbital Fat in Transconjunctival Lower Eyelid Blepharoplasty
Authors: Gu Jieyu , Duan Ran , Wei Boxuan , Xie Feng , Liu Caiyue , Gao Bowen 
Published: April 2023

Summary:
Fat redistribution combined with release of the tear trough ligament in transconjunctival lower blepharoplasty is widely performed to correct lower eyelid bags and tear trough deformities, but the method of suturing the released fat in such a narrow, dissected space remains a challenge during the procedure. The purpose of this study was to introduce a new surgical technique of internal fixation that advances and sutures the pedicled orbital fat firmly to the midcheek through premaxillary and prezygomatic spaces. Twenty-two patients (range, 22 to 39 years) diagnosed with predominant orbital fat prolapse and tear trough deformity without noticeable lower eyelid skin laxity were treated with this method, all of whom presented impressive correction of the eyelid bags and tear trough deformities and were aesthetically pleased during an average follow-up of 11.8 months (range, 10 to 14 months). No patients complained about postoperative hematoma, ectropion or midface numbness. The maneuver of internal fixation of redistributed orbital fat provides a novel and safe approach to correct eyelid bags and tear trough deformities without additional percutaneous sutures in transconjunctival lower eyelid blepharoplasty.
Mapping the Design Space of Technology-Based Solutions for Better Chronic Pain Care: Introducing the Pain Tech Landscape
Authors: Janevic Mary R. , Murnane Elizabeth , Fillingim Roger B. , Kerns Robert D. , Reid M. Cary 
Published: April 2023

ABSTRACT

Objectives
Technology has substantial potential to transform and extend care for persons with chronic pain, a burdensome and costly condition. To catalyze the development of impactful applications of technology in this space, we developed the Pain Tech Landscape (PTL) model, which integrates pain care needs with characteristics of technological solutions.

Methods
Our interdisciplinary group representing experts in pain and human factors research developed PTL through iterative discussions. To demonstrate one potential use of the model, we apply data generated from a narrative review of selected pain and technology journals (2000–2020) in the form of heat map overlays, to reveal where pain tech research attention has focused to date.

Results
The PTL comprises three two-dimensional planes, with pain care needs on each x axis (measurement to management) and technology applications on the y axes according to a) user agency (user- to system-driven), b) usage time frame (temporary to lifelong), and c) collaboration (single-user to collaborative). Heat maps show that existing applications reside primarily in the “user-driven/management” quadrant (e.g., self-care apps). Examples of less developed areas include artificial intelligence and Internet of Things (i.e., Internet-linked household objects), and collaborative/social tools for pain management.

Conclusions
Collaborative development between the pain and tech fields in early developmental stages using the PTL as a common language could yield impactful solutions for chronic pain management. The PTL could also be used to track developments in the field over time. We encourage periodic reassessment and refinement of the PTL model, which can also be adapted to other chronic conditions.
The Accuracy and Stability of Intentional Change of Frontal-Ramal Inclination in Orthognathic Surgery for Facial Asymmetry Patients
Authors: Ha Sung-Ho , Meny Arwa Habib , Jeong Chun-Gi , Yeo Je-Hyeok , Baek Seung-Hak , Choi Jin-Young 
Published: April 2023

Facial asymmetry can be defined as differences in the left and right sides of the face, and most of the patients with facial asymmetry have different left and right frontal-ramal inclinations (FRIs). Restoring the symmetry of both FRIs is important in the surgery of facial asymmetry patients, but it is very difficult to achieve perfect symmetry through conventional orthognathic surgery. However, by using 3-dimensional (3D) virtual planning and CAD/CAM technolo gies, intentional change of FRIs can be possible so the symmetry can be improved. The purpose of this study is to evaluate the surgical accuracy and long-term stability of intentional change of FRIs by 3D virtual surgery, CAD/CAM-assisted orthognathic surgery for patients with facial asymmetry. The study included 20 patients who had undergone orthognathic surgery for skeletal class III malocclusion from January 2019 to December 2021. To evaluate the accuracy of surgery, 3D facial cone beam computed tomography (CBCT) taken immediately after surgery (T1) and virtual surgery data (Tv) were measured and the difference values were calculated. The evaluation of the long-term stability of intentional change of FRI was performed by measuring T1 and T2 (3D facial cone beam computed tomography images taken 6 mo after surgery) and the difference values were calculated. The difference values of FRIs in the left and right proximal segments of each patient were calculated. And then, for comparison depending on the direction of rotation, increased FRI groups (n=20, medial rotation) and decreased FRI groups (n=20, lateral rotation) were analyzed separately. As a result, all difference values at both (ΔT1−Tv) and (ΔT2−T1) were <1 degree. As a result of analyzing the entire FRI by dividing it into decreasing and increasing groups, the mean value of (ΔT1−Tv) was 0.225 degrees for the decreasing group and 0.275 degrees for the increasing group. It means that the proximal segment moved less than the movement implemented by the virtual surgery through actual surgery but it shows a very small error, which means that the overall operation almost accurately implements the virtual surgical planning. Compared with (ΔT1−Tv), the mean value of (ΔT2−T1) showed a much smaller error value, and no specific tendency was observed. This indicates that the stability after surgery is very good. Based on this study, using 3D virtual surgery planning and CAD/CAM technologies for treating patients with facial asymmetry was very useful, and surgery could be performed accurately and predictably. In particular, left-right symmetry was almost perfectly achieved through virtual simulation and could be implemented through actual surgery. Therefore, it can be said that the use of these 3D technologies is recommended for the surgical approach of facial asymmetry.