bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prophylactic application of human adipose tissue-derived products to prevent radiation disorders
Authors: Sowa Yoshihiro , Inafuku Naoki , Kishida Tsunao , Mori Masanori , Mazda Osam , Yoshimura Kotaro 
Published: February 2023

Introduction:
Radiation therapy is now a mainstay treatment for malignancies, but it can induce deterministic adverse effects in surrounding healthy tissues, including atrophy, fibrosis, ischemia, and impaired wound healing. In this exploratory study, we aimed to investigate whether a prophylactic administration of products containing adipose tissue-derived stem cells immediately after radiotherapy could prevent the development of long-term functional disorders in irradiated tissues.

Methods:
A total irradiation dose of 40 Gy (10 Gy, four times weekly) was delivered to the dorsal skin of nude mice. Subsequently, a prophylactic treatment with vehicle, fat tissue, stromal vascular fraction (SVF), or micronized cellular adipose matrix (MCAM) was subcutaneously injected into the irradiated area. Six months after these prophylactic treatments, a cutaneous punch wound was created to evaluate histological changes and wound healing.

Results:
Histological assessments demonstrated dermal thickening, atrophy, and increased collagen deposits in the subcutaneous fatty layer 6 months after radiotherapy. In addition, wound healing was significantly delayed. The prophylactic treatments with three different types of human adipose tissue-derived products significantly prevented the radiation-induced histological changes and accelerated wound healing compared with the vehicle-treated irradiated group.

Conclusion:
This is the first study to demonstrate a potential of the prophylactic treatments after radiotherapy, which could prevent the progression of chronic radiation disorders. The results could have a substantial impact on current anticancer radiotherapies; a next-generation radiation therapy may need to be always combined with a stem cell therapy. Such prophylactic treatments have the potential to improve wound healing of irradiated tissue and clinical outcomes of reconstructive surgery required after cancer radiotherapy.
Outcomes, Evolving Concepts, Technical Refinements, and Challenges in the Repair of Full-Thickness Nasal Defects Requiring Microvascular Lining
Authors: Menick Frederick , Salibian Arthur 
Published: February 2023

Repair of full thickness nasal defects may require distant tissue, when local or regional donors are inadequate or unavailable. Our microvascular designs, technical details, and complications using a radial forearm flap to restore nasal lining have been described in past publications. In this paper, we review Stages 2-5, using a forehead flap and rib grafts to resurface the nose and build a support framework. We examine our complications, long term aesthetic and functional outcomes, clinical refinements, and continuing reconstructive challenges.

Materials and Methods:
38 full thickness nasal defects were repaired between 2001 and 2018. Records review identified the type and frequency of complications and their management. Patients were surveyed to determine their overall satisfaction, quality of life, restoration to a normal appearance, donor scars, the value of a late revision, airway function and need for nasal stents. Postoperative results were classified by independent evaluators as very good, good, fair, and poor.

Results:
Repair was completed in 35 of 38 patients. 53% of patients returned an anonymous survey. 85% were very satisfied. 75% declared excellent, very good or good breathing. 75% used stents never/rarely. 95% looked normal. 95% would recommend to other patients. An independent review classified the aesthetic results as 94% very good to good, 3% fair and 3% poor.

Conclusions:
A folded Radial Forearm Lining Flap, a 3 Stage Full Thickness Forehead Flap for cov er and a Late Revision can repair difficult nasal defects, as shown in a large series of patients with long term follow-up.
Impact of Adding Carpal Tunnel Release or Trigger Finger Release to Carpometacarpal Arthroplasty on Postoperative Complications”
Authors: Trinh Pavin , Luan Anna , Tawfik Vivianne L. , Sheckter Clifford , Rochlin Danielle , Fox Paige , Curtin Catherine 
Published: February 2023

Background:
This study assessed whether adding trigger finger or carpal tunnel release at the time of thumb carpometacarpal (CMC) arthroplasty would increase postoperative opioid use, readmissions, complications, and development of CRPS.

Methods:
Using the IBM ® MarketScan ® Research Databases from 2012 to 2016, we identified a two groups of CMC arthroplasty patients. The “CMC only” group only had a CMC arthroplasty on the day of operation. The “multiple procedures” group had a CMC arthroplasty and concurrent carpal tunnel and / or trigger finger release. Between the two groups, we compared persistent opioid use, 30-day readmissions, 30-day complications, and diagnosis of complex regional pain syndrome (CRPS).

Results:
The CMC only group consisted of 18,010 patients. The multiple procedures group consisted of 4,064 patients. These patients received a CMC arthroplasty and a carpal tunnel release (74%), a trigger finger release (20%), or both (6%). CMC only patients had lower rates of persistent opioid use compared to patients who underwent multiple procedures (16% vs 18%). Readmission rates were also lower for CMC only patients (3% vs 4%). CMC only patients had decreased odds of persistent opioid use (OR=0.85; 95% CI, 0.75-0.97, p=0.013) and readmissions (OR=0.80; 95% CI, 0.67-0.96, p=0.016). The most common reason for readmission was pain (16%).

Conclusions:
Adding another procedure to a CMC arthroplasty slightly increases the odds of adverse outcomes such as persistent opioid use and readmission. Patients and providers should weigh the efficiency of doing these procedures concurrently against the risk of performing multiple procedures at once.

Clinical Question / Level of Evidence:
Risk, II
Systematic review: Platelet-rich plasma (PRP) use in facial rejuvenation.
Authors: Gentile Pietro , Garcovich Simone 
Published: February 2023

Background:
An increasing interest in maintaining a youthful appearance has led to the development of innovative and non-invasive aesthetic procedures for the treatment of facial aging as the recent use of Autologous Platelet-Rich Plasma (PRP).

Objectives:
This article aims to review the literature and critically appraise the available evidence regarding the efficacy of autologous activated PRP (AA-PRP) and/or not-activated PRP (ANA-PRP) injection used for facial rejuvenation.

Methods:
A systematic review regarding the clinical use of AA-PRP and ANA-PRP injection in facial rejuvenation against signs of aging was performed using PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Scopus, and Cochrane databases. The protocol was developed following the Preferred Reporting for Items for Systematic Reviews-Protocols (PRISMA-P) guidelines. The included studies had to match predetermined criteria according to the PICOS approach.

Results:
Eleven of the twelve studies identified, including three randomized split-face trials, showed improved results despite differences in study design and outcome measures, many of which were subjective.

Conclusions:
Further randomized controlled trials and related systematic reviews, as evidence-based medicine (EBM) studies of level 1 are required to confirm PRP injection efficacy in facial rejuvenation, to consolidate the promising results of the studies identified in this systematic review.
Five Principle and Five Step Liquid Rhinoplasty
Authors: Rohrich Rod J. , Novak Matthew , Alleyne Brendan , Bellamy Justin 
Published: February 2023

Summary:
Liquid rhinoplasty, otherwise known as nonsurgical or filler rhinoplasty, has earned increased attention for its ability to provide surgical rhinoplasty results at a fraction of the cost and without incising the skin. However, significant complications can arise such as tissue necrosis, filler embolus, and vascular compromise if performed without considering the principles and anatomy of the face and nose. As demonstrated in the following article, a stepwise and patient specific approach to performing liquid rhinoplasty will ensure safe, consistent, and desirable results.
Compound Muscle Action Potential Amplitude as a Predictor of Functional and Patient-Reported Outcomes in Ulnar Neuropathy at the Elbow
Authors: Florczynski Matthew M. , Kong Lingxuan , Burns Patricia B. , Wang Lu , Chung Kevin C. 
Published: February 2023

Background:
Ulnar neuropathy at the elbow (UNE) is a debilitating upper extremity condition that often leaves patients with residual symptoms even after surgical treatment. The role of electrodiagnostic studies (EDX) in guiding the treatment of UNE is not well established, and conventional electrodiagnostic parameters may not reflect the severity of disease. Compound muscle action potential (CMAP) amplitude is a parameter that corresponds with axonal injury and motor symptoms and may more accurately predict the severity of neurologic injury.

Methods:
This prospective multi-center study recruited 78 patients in the Surgery of the Ulnar Nerve (SUN) project. Patients underwent electrodiagnostic testing, clinical assessment of motor and sensory function, and completed patient-reported outcome (PRO) questionnaires, including the Michigan Hand Questionnaire (MHQ), Disability of the Arm, Shoulder and Hand (DASH) questionnaire, and Carpal Tunnel Questionnaire (CTQ). Correlations were measured among each of the electrodiagnostic parameters and outcomes and predictive models for each outcome were subsequently developed.

Results:
Of all the electrodiagnostic parameters measured, only CMAP amplitude was predictive of scores on the MHQ, DASH, CTQ function scale, and motor impairment in grip and pinch strength. None of the parameters were predictive of scores on the CTQ symptom scale or sensory impairments as measured with 2-point discrimination or Semmes-Weinstein monofilament testing.

Conclusions:
CMAP amplitude, but not other conventional electrodiagnostic parameters, is predictive of functional outcomes in UNE. This electrodiagnostic measurement can alert the clinician to severe cases of UNE and inform surgical decision-making.
The fate of sensation in non-innervated perforator free flaps in the lower extremity
Authors: Kim Hyung Bae , Cho Jung Mok , Abdelfattah Usama , López Roberto Vilchis , Pak Changsik John , Suh HyunSuk Peter , Hong Joon Pio 
Published: February 2023

Introduction:
The recovery of sensation for non-innervated perforator flap is not well understood. This prospective study aims to evaluate the quality, tendency and related factors for recovery of sensation.

Material and Methods:
Total of 187 patients over a 6-year period were evaluated at 3, 6, 12, +24 months intervals for demographic data and sensory tests (Semmes-Weinstein(SW) monofilament test, static two-point discrimination(2PD), temperature and pain) on peripheral and central region of the flap. Further detailed assessment using SW monofilament test was made according to flap thickness, size, type and recipient sites. Factors correlated to poor recovery was evaluated.

Results:
Among the flaps tested, 5.07 SW monofilament test revealed the peripheral flap sensory recovery was achieved in 72% at +24 months with a significantly increasing linear trend (P<0.001). However, the central recovery was noted only in 26-28%. The 2PD was achieved in 21% without a significant trend whereas temperature and pain showed significant improvement achieving 49% and 64% on the peripheral and 22% and 31% for central region respectively. The flap thickness, size, type and recipient sites did not exert significance. Only smoking was a significant factor of 13-times higher odds hindering sensory recovery.

Conclusion:
The SW monofilament test, temperature and pain sensation on the periphery of the flap showed increasing trend of recovery over the +24 months. Among the various factors, only smoking attenuated recovery. Understanding the fate of sensory recovery in non-innervated perforator flaps will allow the surgeons to further customize the reconstruction based on the defect and maximize efficiency.
Prevention and resolution of silicone implant related problems in secondary rhinoplasty with cross-linked human acellular dermal matrix (MegaDerm TM)
Authors: Kook Won Suk , Ryu Da Hye , Baek Wooyeol , Kook Hye Min , Jang Yoon young , Lew Dae Hyun 
Published: February 2023

Background:
Silicone implant augmentation rhinoplasty along with various tip plasties are commonly performed in Asians but requires a revision rhinoplasty due to various problems frequently. Secondary rhinoplasties are often done using silicone, dermo-fat, costal cartilage block or diced rib cartilage, but often result in unsatisfactory outcomes. This study assessed the surgical outcomes and complications of cross-linked-ADM as an alternative biological substitute for silicone implant in secondary rhinoplasty.

Methods:
We prospectively studied 56 patients with a minimum follow-up of 1 year among 104 patients who underwent secondary rhinoplasty in our clinic between Jan.2015-Dec.2018. Silicone implant, capsule, scar tissue were removed, underwent dorsal augmentation with ADM, and tip plasty using autogenous cartilage for all of them. The results were assessed using modified ROE consisting of 10-item questionnaire which were fulfilled on 3 separate occasions, preoperative, 6 months postop and over 1 year postop.

Result:
One infection and 3 cases of excessive resorption were noted with no other major complications. The mean modified ROE score was 31.7 on preoperative evaluation, 77.3 on postop. 6 month and 81.4 on a year over postop. (mean difference was 45.6, 49.7 respectively; P<0.001).

Conclusion:
Various problems that occur after the primary rhinoplasty using silicone implant can be successfully resolved with the secondary rhinoplasty by dorsal augmentation using the cross-linked human ADM along with various nasal tip works using autogenous cartilage. Surgical outcome showed favorable resolution of contracture deformities, low infection rate, firm fixation of the implant, good skin texture/thickness of SSTE, and gain of desired height and dorsal line.
Cranial Shape Changes in Non-syndromic Unilateral Lambdoid Synostosis after Open Posterior Vault Remodeling
Authors: Nguyen Andy , Purnell Chad , Mercan Ezgi , Lee Amy , Birgfeld Craig B. , Susarla Srinivas , Ellenbogen Richard G. , Hopper Richard A. 
Published: February 2023

Background:
The purpose was to quantify change in cranial morphology in non-syndromic unilateral lambdoid craniosynostosis (ULC) patients from presentation (t0), after open posterior switch-cranioplasty (t1), and at two-year follow-up (t2).

Methods:
Volumetric, linear and angular analysis were performed on computed tomographic scans at the three timepoints and against normal controls. Significance was set at p<0.05.

Results:
Twenty-two patients were included. ULC cranial vault asymmetry index (CVAI) was higher than controls before surgery (6.22 ± 3.55) but decreased after surgery (3.00 ± 2.53) to become comparable to the normal asymmetry range present in the controls. After surgery both diagonals increased, but more on the fused side. In the two years after surgery, both diagonals in ULC grew proportionately, but the fused diagonal remained slightly shorter than the patient side. Total cranial volume was higher in ULC than controls after surgery but became comparable at t2. Cranial base angulation improved by t2 but did not approach normal and ear position remained unchanged. The facial twist was higher than controls at t0 and t1 but was comparable at t2. Coronal asymmetry improved with surgery but remained under-corrected at t2, with the greatest residual asymmetry at opisthion.

Conclusions:
Open switch cranioplasty normalizes CVAI by increasing the fused cranial diagonal more than the patent and is stable at two years. Skull base twist does not normalize but facial twist approaches normal. Technique improvement should focus on residual coronal asymmetry present at opisthion.

LEVEL OF EVIDENCE:
III
“Facial Expression After Face Transplant: The First International Face Transplant Cohort Comparison”
Authors: Dorante Miguel I. , Wang Alice T. , Kollar Branislav , Perry Bridget J. , Ertosun Mustafa G. , Lindford Andrew J. , Kiukas Emma-Lotta , Özkan Ömer , Özkan Özlenen , Lassus Patrik , Pomahac Bohdan 
Published: February 2023

Background:
Assessment of motor function restoration following face transplant (FT) is difficult as standardized, bilateral tests are lacking. This study aims to bolster support for software-based analysis through international collaboration.

Methods:
FaceReader (Noldus, Wageningen, Netherlands), a facial expression analysis software, was used to analyze post-transplant videos of 8 FT patients from Boston, USA (range, 1–9 years), 2 FT patients from Helsinki, FIN (range, 3–4 years), and 3 FT patients from Antalya, TUR (range, 6.5–8.5 years). Age-matched healthy controls from respective countries had no history of prior facial procedures. Videos contained patients and controls performing facial expressions evaluated by software analysis using the Facial Action Coding System. Facial movements were assigned intensity score values between 0 (absent) and 1 (fully present). Maximum values were compared to respective healthy controls to calculate percent restoration.

Results:
Out of 13 FT patients, 8 were full FT, 5 were partial FT and 2 patients were female. Compared to healthy controls, the median restoration of motor function was 36.9% (IQR 28.8%-52.9%) for all patients with FT (p=0.151). The median restoration of smile was 37.2% (IQR 31.5%- 52.7%) in all patients with FT (p=0.065). When facial nerve coaptation was performed at distal branch level, average motor function restoration was 42.7% ± 3.61% compared to 27.9% ± 6.71% at proximal trunk coaptation level (p=0.032). Use of interpositional nerve grafts had no influence on motor outcomes.

Conclusion:
Software-based analysis is suitable to assess motor function after FT. International collaboration strengthens outcome data for FT.
Variable Anatomy of the Lateral Upper Arm Lymphatic Channel: A Potential Anatomic Risk Factor for the Development of Breast Cancer Related Lymphedema
Authors: Granoff Melisa D. , Pardo Jaime , Shillue Kathy , Fleishman Aaron , Teller Paige , Lee Bernard T. , James Ted , Singhal Dhruv 
Published: February 2023

Background:
The lateral upper arm channel is an accessory lymphatic pathway that drains the upper extremity via the deltopectoral groove and supraclavicular nodes, thereby bypassing the axilla. Its variable connectivity to the forearm has not been studied in vivo.

Methods:
Indocyanine green (ICG) lymphography was performed pre-operatively to map the superficial and functional arm lymphatics in breast cancer patients without clinical or objective evidence of lymphedema. A retrospective review was performed to extract demographic, ICG imaging, and surgical data.

Results:
Sixty patients underwent ICG lymphography prior to axillary lymph node dissection between June 2019 and October 2020. In 59%, the lateral upper arm lymphatic channel was contiguous with the forearm (long bundle). In 38%, the lateral upper arm lymphatic channel was present but not contiguous with the forearm (short bundle). In 3%, the lateral upper arm pathway was entirely absent. Seven patients developed at least one sign of lymphedema during post-operative surveillance, of which 71% demonstrated the short bundle variant.

Conclusions:
While the lateral upper arm pathway is most often present, its connections to the forearm are frequently absent (short bundle) and, in this pilot report, appears to represent a potential risk factor for the development of lymphedema.
Reducing Medication Errors in Children’s Hospitals
Authors: Liu Kai-Wen , Shih Ya-Fen , Chiang Yi-Jung , Chen Lih-Ju , Lee Cheng-Han , Chen Hsiao-Neng , Chen Jia-Yuh , Hsiao Chien-Chou 
Published: February 2023

Objectives
Knowledge of the prevalence and characteristics of medication errors in pediatric and neonatal patients is limited. This study aimed to evaluate the incidence and medication error characteristics in a pediatric hospital over 5 years and to determine whether serial error prevention programs to optimize a computerized physician order entry (CPOE) system reduce error incidence.

Methods
We retrospectively reviewed medication errors documented between January 2015 and December 2019.

Results
A total of 2,591,596 prescriptions were checked, and 255 errors were identified. Wrong dose prescriptions constituted the most common errors (56.9%). Medications with the highest rate of errors were antibiotics/antiviral drugs (36.9%). Oral route medications comprised the highest portion (60.8%), followed by intravenous ones (28.6%). The most common stage for medication errors was physician ordering (93.3%). Junior residents were responsible for most errors (45.9%). Most errors occurred in the pediatric ward (53.7%). In total, 221 (86.7%) errors were near misses. Only 4 errors (1.6%) were considered significant and required active monitoring or intervention. Type of error, stage of error, staff composition, and severity level of errors were significantly related to the number of errors in different years. There was a statistically significant decrease in errors per 100,000 prescriptions across different years after optimizing the CPOE system.

Conclusions
The incidence of medication errors decreased with extensive use of the CPOE system. Continuous application of the CPOE optimization program can effectively reduce medication errors. Further incorporation of pediatric-specific decision-making and support tools and error prevention measures into CPOE systems is needed.
Race Differences in a Malpractice Event Database in a Large Healthcare System
Authors: Thomas Angela D. , Pandit Chinmay , Krevat Seth A. 
Published: February 2023

Objectives
This study aimed to determine whether potential malpractice events reported by employees, malpractice events involving claims, and malpractice lawsuits differ based on patient race in a large 10-hospital healthcare system.

Methods
Data in a healthcare system’s malpractice database from July 1, 2012, to June 30, 2017, were stratified by patient race using “Black,” “White,” and “other” categories. χ
2 Goodness-of-fit tests were used to compare differences in race proportions in employee-reported observations of events that could lead to payment of a claim, claims not involving the court, and lawsuits involving the court.

Results
There were significantly more employee-reported observations and claims for White patients and significantly fewer observations and claims for Black patients than expected based on the race proportions in the overall healthcare system patient population (P < 0.001). There were no significant race differences in lawsuits (Black patients, P = 0.146; White patients, P = 0.061; other patients, P = 0.458). Four of the 10 hospitals in the healthcare system had significant race differences in potential malpractice events (hospital A, P < 0.001; hospital B, P = 0.011; hospital E, P < 0.001; hospital G, P = 0.010).

Conclusions
Our findings reveal the existence of race differences in potential malpractice events in a large healthcare system. By proactively investigating, understanding, and addressing racial disparities in patient safety events, including those recorded in malpractice databases, healthcare systems can help advance initiatives to provide high-quality and equitable care to patients.