bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Outcomes after Endoscopic-Assisted Strip Craniectomy and Orthotic Therapy for Syndromic Craniosynostosis.”
Authors: Chiang Sarah N , Skolnick Gary B , Naidoo Sybill D , Smyth Matthew D , Patel Kamlesh B 
Published: February 2023

Background:
Endoscopic craniosynostosis repair has emerged as an effective alternative to open repair, but data are limited on treatment of the 15-24% of patients with syndromic diagnoses. Here, we examine postoperative outcomes after endoscopic repair in syndromic craniosynostosis.

Methods:
Retrospective review was performed of all consecutive patients undergoing endoscopic repair and all syndromic patients undergoing open repair from 2006-2021. Demographics, complications, and reoperations were compared between groups. Patient-reported measures of stigma and cognitive function were recorded at age 5 years and greater.

Results:
335 patients underwent endoscopic repair, of which 38 (11%) had syndromic craniosynostosis. Syndromic craniosynostosis was associated with bicoronal involvement (p<0.001) and female sex (p=0.003). Secondary procedures were significantly more common in the syndromic group (24% vs 2.4%, p<0.001), as were transfusions (18% vs 6.4%, p=0.018). Secondary procedures were performed at a mean 2.8 years of age (range 10 months to 8 years), and most commonly consisted of fronto-orbital advancement (7 in syndromic group, 3 in non-syndromic). Patient-reported stigma was higher in patients with syndromes (p=0.002), but cognitive function did not differ significantly (p=0.065). Incidence of reoperations after open repair was 13%, but baseline differences precluded direct comparison with the endoscopic group.

Conclusions:
Minimally invasive approaches in early infancy can alleviate the need for additional cranial procedures in the growing child. Syndromic craniosynostoses are a complex and heterogeneous group, and in more severe cases, endoscopic repair can be considered an adjunct technique to reduce the number of major craniofacial procedures.
Risk Factors of Isolated Microtia: A Systematic Review and Meta-Analysis
Authors: Huang Ying , Huang Ximeng , Li Kexuan , Yang Qinghua 
Published: February 2023

Background:
Isolated microtia is a congenital facial anomaly and its etiology is unclear. This study systematically investigated related suspicious factors.

Methods:
A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Four databases were searched for eligible case-control and cohort studies. Odds Ratios and 95% confidence intervals were calculated for each exposure variable if data from at least two eligible studies were provided. If not, narrative syntheses were performed.

Results:
28 articles were included. Meta-analyses were conducted with 22 articles and 25 factors were identified to have significant association with isolated microtia. Moderate evidence showed that parental low education level, low birth weight (<2500g), parity≥2, family history of malformation (especially microtia), maternal intake of antibiotics, benzodiazepines, NSAIs, progesterone and traditional Chinese medicine, as well as maternal non-gestational diabetes, upper respiratory infection and radiation exposure increased the risk of microtia in offspring. Limited evidence showed that maternal Hispanic race, pesticides exposure, threaten abortion, history of spontaneous abortion, pet contact and male infant were associated with increased risk. Maternal race of Black, non-Hispanic and living in urban area were two protective factors found with moderate and limited evidence, respectively.

Conclusions:
This study has provided an initial investigation of potential factors associated with isolated microtia and evidence-based conclusion supporting prevention over modifiable factors.
The Comparative Benefits of Open Versus Closed Reduction of Condylar Fractures: A Systematic Review and Meta-Analysis
Authors: Jazayeri Hossein E. , Lopez Joseph , Khavanin Nima , Xun Helen , Lee Urie K. , Best David L. , Reategui Alvaro , Urata Mark M. , Dorafshar Amir H. 
Published: February 2023

Purpose:
Many fractures of the mandibular condylar neck are amenable to both open reduction and internal fixation (ORIF) and closed treatment (CT). Clinical outcomes following these two modalities remains a topic of debate. This systematic review critically appraises the literature to compare them following these treatment options.

Methods:
A systematic review and meta-analysis was performed to test the null hypothesis of no difference in clinical outcomes in ORIF versus CT of mandibular condyle fractures. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried from 1946 to 2020. The quality of evidence was determined using Grading of Recommendations Assessment, Development, and Evaluation methodology.

Results:
Of 1507 screened articles, 14 met inclusion criteria. ORIF was favored significantly when evaluating temporomandibular joint pain (RR 0.3; 95% CI 0.1-0.7) (NNTp 3; 2-6), laterotrusive movements of the mandible (MD 2.3; 1.7-3.0) (SMD 0.9; 0.4-1.3), and malocclusion (RR 0.5; 0.4-0.7) (NNTp 19; 10-200). However, ORIF yielded higher incidence of postoperative infection (RR 3.6; 95% CI 0.9-13.8) and must be weighed against the understood risk of facial nerve injury.

Conclusion:
Meta-analysis of high-level evidence in randomized controlled trial suggests that ORIF significantly improves functional outcomes, decreases pain, and restores occlusion and jaw symmetry. These long-term benefits must be weighed against the increased risk of postoperative infection and exposure of the facial nerve to potential injury.
A Simple Scoring Model for Evaluation of Concomitant Vascular Injuries in Patients with Lower Extremity Open Fractures
Authors: Su Chun-Lin , Hsu Chung-Chen , Liao Chien-Hung , Hsieh Chi-Hsun , Cheng Chi-Tung , Fu Chih-Yuan 
Published: February 2023

Background:
Timely diagnosis and management of concomitant vascular injuries is usually needed for the management of lower extremity open fractures. In the current study, a prediction model and simplified scoring system of vascular injuries were developed for the primary evaluation of patients with lower extremity open fractures.

Methods:
Patients with lower extremity open fractures were retrospectively reviewed from 2017 to 2020. Multivariate logistic regression analysis was used to evaluate independent risk factors for concomitant vascular injuries in these patients using data collected in 2017–2019, and a prediction scoring model was created accordingly. Model performance was validated with data from 2020.

Results:
In total, 949 lower extremity open fracture patients (development cohort, 705 patients, 2017–2019; validation cohort, 244 patients, 2020) were enrolled. Concomitant vascular injuries occurred in 44 patients in the development cohort (6.2%). Three clinical variables were identified for a prediction scoring model with weighted points, including hard/soft vascular signs (3 points), segmental fractures (2 points) and degloving soft tissue injury (1 point). The model showed good discrimination [area under the receiver operating characteristic curve (AUC)=0.928], calibration (Hosmer-Lemeshow Ĉtest, p=0.661) and precision (Brier score=0.041). Subsequent management regarding different aspects (observation only, further imaging study or direct surgical exploration) can thus be decided. The model also demonstrated good discrimination (AUC=0.949), good calibration (Hosmer-Lemeshow Ĉ-test, p=0.174) and good precision (Brier score=0.042) in the validation cohort.

Conclusions:
This model may guide the subsequent management of vascular injuries associated with lower extremity open fractures.
Impact of Physician Extenders and Midlevels in Plastic Surgery
Authors: Seyidova Nargiz , Lin Samuel J 
Published: February 2023

Background:
With the rapidly changing healthcare marketplace, there is constant pressure on the healthcare industry to progress and to ensure high-quality yet cost-effective service delivery. The aim of this article is to review the economic value and to evaluate the effectiveness and safety of the independent services provided by physician extenders in the plastic surgery field.

Methods:
The PubMed database was used to review the literature. The search was performed using key word “plastic surgery AND (“nurse practitioner” OR “physician assistant” OR “physician extenders”). Inclusion criteria involved any study which evaluated economic value associated with the integration of the physician extenders, as well as safety and effectiveness of the independently provided services by midlevels in plastic surgery.

Results:
The PubMed search yielded 182 articles. Following evaluation of the titles and abstracts, twenty-seven articles were included in a qualitative review of manuscript content. Out of these articles, ten were ultimately included, four of which analyzed economic value and six effectiveness and safety of the independently provided services by physician extenders in plastic surgery. All four articles were associated with financial gain and six articles demonstrated safe and effective provision of the independently provided services by physician extenders.

Conclusion:
The integration of physician extenders has the potential to achieve more efficient workflow with well-coordinated and high-quality care for patients. Our review suggests the integration of physician extenders in plastic surgery adds economic value to the practice, as well as safely improves effectiveness and efficiency of the workflow.
Comparing direct-to-implant and two-stage breast reconstruction in the Australian Breast Device Registry
Authors: Hoque Sheymonti S. , Zhou Jieyun , Gartoulla Pragya , Hansen Jessy , Farrell Gillian , Hopper Ingrid 
Published: February 2023

Background:
There remains a lack of clarity surrounding the benefits, risks and outcomes between two-stage expander/implant reconstruction and single-stage direct-to-implant reconstruction. This study utilised a national dataset to examine real-world outcomes of two-stage and DTI reconstructions.

Methods:
A cohort study was conducted examining patients in the Australian Breast Device Registry from 2015-2018 who underwent prosthetic breast reconstruction post-mastectomy. Direct-to-implant and two-stage cohorts after definitive implant insertion were compared. Rate of revision surgery, reasons for revision and patient-reported outcome measures were recorded. Statistical analysis was undertaken using Fisher’s exact or chi-square, Wilcoxon rank-sum or student t-tests, Nelson-Aalen cumulative incidence estimates and Cox proportional hazards regression.

Results:
5,152 breast reconstructions were recorded, including 3,093 two-stage and 2,059 direct-to-implant reconstructions. Overall revision surgery rates were 15.6% for direct-to-implant (median follow-up 24.7 months), compared with 9.7% in the two-stage cohort (median follow-up 26.5 months) (p<0.001). Most common reasons for revision for DTI and two-stage were capsular contracture (25.2% vs 26.7%, p=0.714) and implant malposition (26.7% vs 34.3%, p=0.045). Multivariate analysis found acellular dermal matrix usage (p=0.028) was significantly associated with a higher risk of revision. The influence of radiotherapy on revision rates was unable to be studied. Patient satisfaction levels were similar between reconstructive groups; however, patient experience was better in direct-to-implant than two-stage.

Conclusions:
The Australian Breast Device Registry dataset demonstrated that direct-to-implant reconstruction had a higher revision rate than two-stage, but with comparable patient satisfaction and better patient experience. Capsular contracture and device malposition were leading causes of revision in both cohorts.
Decreasing Opioids in Outpatient Breast Surgery with an Enhanced Recovery after Surgery Program and Preoperative Education
Authors: Wong Stacy , Lombana Nicholas F. , Falola Reuben A. , Park Peter , Saint-Cyr Michel H. 
Published: February 2023

INTRODUCTION:
Enhanced Recovery After Surgery (ERAS) programs have been detailed in the literature predominantly in the inpatient setting. The purpose of our study was to determine the effect of an ERAS protocol with a preoperative educational class on opioid prescribing and patient outcomes for outpatient breast surgery.

METHODS:
An ERAS protocol was formulated, focusing on pre-operative education, multimodal pain control, and an intraoperative block. The study was conducted as an IRB-approved retrospective review. Women undergoing breast reconstruction revision, breast reduction, delayed insertion of prosthesis, tissue expander to implant exchange, and matching procedures were included.
The patients were separated into non-ERAS and ERAS cohorts. Data on demographics, PACU length of stay (LOS), PACU oral morphine equivalent (OME) consumption, outpatient OME prescriptions, major and minor complications, and need for additional opioid prescriptions was collected. Analysis was performed with Fisher’s Exact Test and Chi-square test as appropriate.

RESULTS:
Group 1 (pre-ERAS) consisted of 68 patients, and Group 2 (ERAS) consisted of 68 patients. Both cohorts had similar age, BMI, diabetes status and tobacco use of patients. Group 1 was prescribed an average of 216 OMEs, compared to 126.4 OMEs for Group 2—a 41.5% decrease (p<0.0001). The pre-ERAS group consumed an average of 23.3 OMEs in the PACU versus 16.6 OMEs in the ERAS group (p=0.005). Fewer ERAS patients required additional prescriptions for narcotic pain medication at post-op follow-up (p=0.116). No differences were seen in major or minor complications.

CONSCLUSION:
An ERAS protocol which utilizes a multimodal approach to pain control and preoperative patient education has utility in the outpatient setting and can help decrease opioid consumption
Oral antibiotics do not prevent infection or implant loss after immediate prosthetic breast reconstruction: Evidence from 683 consecutive reconstructions without prophylaxis.
Authors: Sisco Mark , Kuchta Kristine , Alva Duanny , Seth Akhil K. 
Published: February 2023

Background:
Infectious complications following implant-based postmastectomy breast reconstruction (PMBR) are a significant cause of morbidity. Nationwide, antimicrobial stewardship efforts have sought to reduce the use of prophylactic antibiotics after surgery. However, there are conflicting data regarding the utility of extended antibiotic prophylaxis (EAP) after PMBR and many surgeons continue to prescribe them.

Methods:
Retrospective study of 1,077 women undergoing immediate prosthetic PMBR from January 2008 to May 2020. All patients received intravenous antibiotics before and up to 24 hours after surgery. Before October 2016, patients were also prescribed oral antibiotics until drain removal; thereafter, this practice was abandoned. 90-day outcomes were compared between EAP(+) and EAP(-) patients. Descriptive statistics and multivariable logistic regression analysis were used to assess efficacy of EAP in preventing infection-related complications.

Results:
There were 1,004 breasts in the EAP(+) group and 683 breasts in the EAP(-) group. 361 reconstructions (21.4%) were prepectoral. Multivariable analysis demonstrated no difference in surgical site infection (SSI) (OR=0.83 [0.56-1.25], p=0.38), admission (OR=0.78 [0.41-1.48], p=0.44), reoperation (OR=1.01 [0.68-1.48], p=0.97) or explantation rates (OR=1.06 [0.66-1.71], p=0.81) between the EAP(+) and EAP(-) groups. The EAP(+) group was more likely to develop gram-negative infections (p<0.001). Thirteen EAP(+) women (2.0%) developed allergic reactions and four (0.6%) developed clostridium difficile colitis attributable to the EAP.

Conclusion:
EAP after post-mastectomy breast reconstruction did not improve outcomes. Although the use of EAP did not appear to worsen clinical outcomes, marked differences in the microbiology of associated infections may render them more difficult to treat. Moreover, a small but significant proportion of women suffered adverse reactions to the EAP.
Chin Augmentation Techniques: A Systematic Review
Authors: Oranges Carlo M. , Grufman Vendela , di Summa Pietro G. , Fritsche Elmar , Kalbermatten Daniel F. 
Published: February 2023

Introduction:
Chin augmentation has over the past decades maintained a high level of popularity among patients and facial plastic surgeons. Several procedures exist to enhance the appearance of a small chin. The aim of this study was to perform a systematic literature review to determine outcomes and complications associated to the different techniques described.

Material and Methods:
MEDLINE®, PubMed, PubMed Central (PMC) and Cochrane Central Registry of Controlled Trials (CENTRAL) database were screened using a search algorithm. The techniques were classified and related outcomes and complications tabulated and analyzed.

Results:
54 studies on primary chin augmentation published from 1977 to 2020 met inclusion criteria, representing 4897 treated patients. Six main surgical techniques were identified: chin augmentation with implants (Silicone, Gore-Tex, Mersilene, Prolene, Medpor, Proplast, Hard Tissue Replacement (HTR), Porous Block Hydroxylapatite (PBHA), and Acrylic; n=3344); osteotomy (n = 885), autologous grafts (fat/bone/derma/cartilage; n = 398), fillers (hyaluronic acid, hydroxyapatite, biphasic polymer; n= 233), and local tissue rearrangements (n= 32), combination of implants placement and osteotomy (n= 5). All techniques provided consistently satisfactory cosmetic outcomes. The overall complication rate of the most represented groups was 15.7% for implants and 19.7% for osteotomy, including 2.4% and 16.4% cases of transient mental nerve related injuries respectively.

Conclusions:
All described chin augmentation techniques achieved good outcomes with high patient satisfaction. Perfect knowledge of each technique is essential to minimize each procedure’s specific complications. Caution is generally needed to avoid nerve injuries and potential over- or under-correction.
Exosomes of adipose-tissue-derived stem cells over-expressing Neat1 promote wound healing by sponging miR-17-5p and inducing autophagy protein Ulk1
Authors: An Yang , Huang Fei , Tan Xiaojie , Zhu Shiou , Zhen Yonghuan , Shang Yujia , Ding Pengbing , Li Dong , Wu Junhao 
Published: February 2023

Background:
Wound healing undergoes intricate phases: hemostasis, inflammation, proliferation and remodeling. Stem cell therapy based on adipose-tissue-derived stem cells (ADSCs) exosomes is considered as potential effective treatment for accelerating wound healing. While the molecular mechanisms of wound healing using ADSCs-exo remain largely unknown.

Methods:
Circular wounds of 1 × 1 cm were generated on C57BL/6 mice, followed by oricell C57BL/6 mouse adipose-derived mesenchymal stem cell suspension treatment, and wound area was measured and recorded at day 0, day 7 and day 21 respectively. A comprehensive transcriptome profiling of skin wounds was conducted in the mouse model. Importantly, we also examined autophagy and cell migration in mouse keratinocytes treated with ADSCs exosomes. Further competing endogenous RNA (ceRNA) networks were also used to reveal the relationship between Neat1 and Ulk1.

Results:
Mouse keratinocytes treated with ADSCs exosomes showed significant up-regulation of pathways related to wound-healing, including response to virus, bacterium, immune system and wounding. Activated autophagy was detected, which significantly promote the wounds repair of mice. ceRNA networks uncovered that Neat1 induces the expression of Ulk1 and thus up-regulates autophagic activity to promote wound repair through sponging miR-17-5p.

Conclusions:
Collectively, these results reveal a novel molecular mechanism that the autophagy pathway enhanced by Neat1/miR-17-5p/Ulk1 axis can promote the wound-healing and suggest that lncRNA Neat1 loaded by ADSCs-exo might be a potential therapeutic target for skin no-healing wounds.
Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis
Authors: Escandón Joseph M. , Ciudad Pedro , Poore Samuel O. , Mayer Horacio F. , Saha Shivangi , Morrison Clinton S. , Langstein Howard N. , Manrique Oscar J. 
Published: February 2023

Background:
Supermicrosurgical simulators and experimental models promote test viability, a faster learning curve, technical innovations, and improvements of the surgical dexterities. We aimed to present a systematic review and meta-analysis of preclinical experimental models and simulation platforms used for supermicrosurgery.

Methods:
An electronic search was conducted across PubMed MEDLINE, Embase, Web of Science, and Scopus in accordance with the PRISMA statement. Data collection included the types of experimental models and outcomes. Pooled estimates were calculated with a random-effect meta-analysis using the DerSimonian-Laird model.

Results:
Thirty-eight articles were incorporated in the qualitative synthesis. Twenty-three articles reported the use of in vivo models (60.5%), twelve used ex vivo models (31.5%), and three used synthetic models (7.9%). The superficial inferior epigastric system of rats was the most common in vivo model, while the chicken wings and hindlimbs were the most common methods used in ex vivo models. The most common methods to evaluate patency of anastomoses were gross inspection, passage of nylon thread into the lumen, and intravascular flow of an injected dye. Nineteen studies were incorporated in the meta-analysis. The overall rate of a successful anastomosis was 94.9% (95%CI 92.3%-97.5%). The success rate in in vivo models using rats was 92.5% (95%CI 88.8%-96.3%). The success rate in ex vivo models was 97.7% (95%CI 94.6%->99%).

Conclusion:
Simulators that have a high fidelity concerning the dissection of the vascular pedicle, flap elevation, supermicro-vascular anastomosis, and adequate assessment of a successful anastomosis possess adequate predictive validation to evaluate and simulate the supermicrosurgical technique.
Upper and lower limb anomalies in craniofacial microsomia and its relation to the O.M.E.N.S.+ classification: A multicentre study of 688 patients.
Authors: Houwen Thymen , Renkema Ruben W. , van Nieuwenhoven Christianne A. , Padwa Bonnie L. , Forrest Christopher R. , Dunaway David J. , Koudstaal Maarten J. , Caron Cornelia J.J.M. 
Published: February 2023

Background:
Craniofacial microsomia (CFM) is characterized by several malformations related to the first and second pharyngeal arch. Patients typically present with facial asymmetry, but extracraniofacial organ systems might be involved, including limb anomalies. The purpose of this study is to analyze the occurrence of upper and lower limb anomalies in CFM patients. Furthermore, the relation between limb-anomalies and the O.M.E.N.S.+ classification was examined.

Methods:
A retrospective study was conducted including patients with craniofacial microsomia from craniofacial units in three different countries. Patients were included when clinical and/or radiographic images were available. Demographic, radiographic and clinical information was obtained.

Results:
A cohort of 688 patients was available and selected for analysis. In total, 18.2% of the patients were diagnosed with at least one upper and/or lower limb anomaly. Upper and lower limb anomalies were seen in respectively 13.4% and 7.8% patients. Patients with other extracraniofacial anomalies had a significantly higher risk for limb anomalies (odd ratio 27.98, p=0.005). Laterality of CFM and a higher O.M.E.N.S. score were not associated with limb anomalies.

Conclusions:
More than 1 in 6 patients with CFM have limb anomalies. Therefore, clinical awareness for these anomalies is warranted. Examination and, if present, follow up on limb abnormalities in patients with CFM should be implemented in the standard assessment of CFM patients.