bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Stepwise Guide to Freehand Bending of Orbital Floor Mesh
Authors: Rajendiran Saravanan , Krishnan B. 
Published: March 2022

Summary:
Orbital fractures can often result in enophthalmos or diplopia. Orbital reconstruction with titanium meshes is the current treatment modality. Adapting the titanium orbital floor mesh is often challenging due to the complex anatomy of the orbital floor. Here, a stepwise free hand bending technique of a titanium orbital floor mesh is described. The bending can be done preoperatively, and mesh fit can be checked against a dry anatomical skull before sterilization. The methodical approach to free hand bending of titanium orbital floor mesh minimizes the intraoperative adjustments and permits quick orbital reconstruction. Trainees and less-experienced surgeons can benefit from the methodical approach to free hand bending of titanium orbital floor mesh.
A Photosealed Cap Prevents Disorganized Axonal Regeneration and Neuroma following Nerve Transection in Rats
Authors: Scott Benjamin B. , Wu Ruby C. , Nietlispach Viviane , Randolph Mark A. , Redmond Robert W. 
Published: March 2022

Background:
Neuroma is a common sequela of traumatic peripheral nerve injury that can result in pain and decreased quality of life for patients. Neuromas result from axonal outgrowth in an attempt to reestablish continuity with the disrupted distal nerve end. Photosealing is a light-activated technique whereby tissues can be securely isolated in a strong and secure manner. This study investigated whether photosealing of autologous vein and crosslinked human amniotic membrane (xHAM) to cap the proximal stump of transected sciatic nerve would prevent disorganized axonal regeneration and neuroma in a rat model.

Methods:
The right sciatic nerve of Lewis rats (n = 27, 300–350 g) was transected 1 cm proximal to the trifurcation. Animals were randomized to one of three groups (n = 9): no further intervention (Group 1), photosealing with xHAM (Group 2), or photosealing with vein (Group 3). After 60 days, rats were euthanized and their right hindlimbs were re-explored for evidence of disorganized axonal regeneration and/or bulbous neuroma.

Results:
All untreated control animals were found to have protruding nerve fibers, often invading the adjacent muscle, and 33% of these control animals exhibited a bulbous neuroma. Photosealing with xHAM successfully capped 100% of nerves, with no observable axonal outgrowth. Photosealing with vein prevented axonal outgrowth in eight of nine nerves. No bulbous neuroma was found in any photosealed nerves.

Conclusion:
Nerve capping with photosealed xHAM or autologous vein can prevent axonal outgrowth in transected nerves, therefore decreasing the likelihood of symptomatic neuroma formation following nerve transection injury or surgical intervention.
A Practical Approach to the Diagnosis and Treatment of Palmar Hyperhidrosis
Authors: Solish Max J. , Savinova Iryna , Weinberg Michael J. 
Published: March 2022

Background:
Palmar hyperhidrosis (PH), a condition characterized by excess sweating of the palms, is a common concern that presents to the plastic surgeon, which can have major impacts on patient confidence and quality of life. While several studies summarize treatment options for hyperhidrosis in general, few outline the therapeutic options available specifically for PH.

Method:
The authors reviewed the current literature specific to the diagnostic workup and treatment of PH.

Results:
In this article, we show a practical approach to managing patients presenting with PH, summarize its main nonsurgical and surgical treatment options, provide a suggested treatment ladder, and outline emerging therapeutic approaches. We suggest that, after diagnosing PH and classifying its severity, nonsurgical treatments (ie, topical antiperspirants, iontophoresis, botulinum toxin A injection, and topical/oral anticholinergics) should be utilized in a stepwise manner. In patients with severe palmar hyperhidrosis who do not respond to nonsurgical treatments, surgical intervention may be warranted, generally in the form of sympathetic denervation.

Conclusion:
This article provides a clear overview of PH treatment options, stepwise guidelines for physicians, and educational video resources demonstrating botulinum toxin A injections with cryotherapy and nerve blocks.
The Development and Application of a Quasi-dynamic Food Chain Model in Chinese Agricultural Conditions
Authors: Cui Hui-ling , Yao Ren-tai , Zhang Jun-fang , Huang Sha , Lv Ming-hua , Zhao Duo-xing , Wu Qiang 
Published: March 2022

Abstract
A quasi-dynamic food chain model (Chi-FDMT) was developed to predict the consequences of nuclear accidents on the food chain through the ingestion pathway in Chinese agricultural conditions. The Chi-FDMT structure is based on ECOSYS-87, with some revised calculation processes and the adoption of new parameters; herein, it was applied to two regions in China. The model was used to estimate the spatial and temporal patterns of crop plant activity and ingestion dose in the Chinese agricultural environment at the scale of the Fukushima nuclear disaster. A comparative study between Chi-FDMT and an equilibrium model demonstrated good agreement for depositions occurring during the growth season. The parameter sensitivity analysis of Chi-FDMT indicated that the parameters of food intake and processing factor are sensitive, and the sensitivity of the transfer factors within plant and soil-plant systems are dependent on the deposition scenario.
RETINAL HYPOPERFUSION DETECTED BY WIDE-FIELD OPTICAL COHERENCE TOMOGRAPHIC ANGIOGRAPHY IN A CASE OF RETINAL RACEMOSE HEMANGIOMA
Authors: Mitamura Mizuho , Noda Kousuke , Kase Satoru , Hirooka Kiriko , Ishida Susumu 
Published: March 2022

Purpose:
Retinal racemose hemangioma is a rare, unilateral, nonhereditary, arteriovenous malformation characterized by the appearance of dilated and tortuous retinal vessels. Retinal racemose hemangioma can develop complications associated with retinal ischemia, such as vitreous hemorrhage, retinal vein occlusion, and neovascular glaucoma. Here, a case of retinal racemose hemangioma with retinal hypoperfusion detected by wide-field swept-source optical coherence tomographic angiography was reported, which was not unambiguously illustrated by fluorescein angiography.

Methods:
Case report.

Results:
A 57-year-old woman was referred to our hospital for the evaluation of severe retinal vascular tortuosity, dilation, and retinal hemorrhages in the left eye. Fundus examination revealed arteriovenous communications temporal to the fovea and multiple microaneurysms surrounded by retinal hemorrhages at the midperipheral temporal fundus. In fluorescein angiography, multiple hyperfluorescent lesions with leakage corresponding to microaneurysms were observed in the temporal and lower midperipheral areas; however, nonperfused areas were apparently absent. By contrast, wide-field optical coherence tomographic angiography clearly showed low-density retinal capillaries in the superotemporal quadrant in comparison with those in the inferotemporal quadrant.

Conclusion:
Wide-field optical coherence tomographic angiography detected sparse retinal capillaries, which were not well illustrated by fluorescein angiography, in a patient with retinal racemose hemangioma. This indicates the presence of low-grade retinal hypoperfusion caused by altered retinal hemodynamics, potentially leading to ischemia-related retinal disorders during a prolonged course, in patients with clinically quiescent retinal racemose hemangioma.
Safety-Net Suture for Aphakic Descemet Membrane Endothelial Keratoplasty
Authors: Berger Osvaldo , Kriman Jaime , Vasquez-Perez Alfonso , Allan Bruce D. 
Published: March 2022

Purpose:
The purpose of this research was to describe a low-cost, accessible method for reducing the risk of posterior donor dislocation in Descemet membrane endothelial keratoplasty (DMEK) performed in eyes with aphakia and a large iris defect (unicameral eyes)—the “safety-net suture.”

Methods:
We review 3 cases of aphakic bullous keratopathy in unicameral eyes treated successfully using DMEK aided by a simple technique to create a temporary, partial barrier between the anterior and posterior chambers. The safety-net suture technique is based on a continuous 10-0 polypropylene suture placed across the anterior chamber in a cat's-cradle pattern anterior to the trabecular meshwork. At the end of surgery, after air tamponade of the DMEK donor, the 10-0 polypropylene suture is removed.

Results:
All 3 cases were completed with no intraoperative posterior dislocation. A partial postoperative detachment in 1 case was successfully treated with repeat air tamponade. The corneas remain clear in early follow-up, 1 to 10 months after surgery.

Conclusions:
The safety-net suture is a simple, low-cost method of reducing the risk of intraoperative posterior dislocation for DMEK in unicameral, aphakic eyes.
Long-Standing Corneal Edema and Endothelial Decompensation due to Ecballium elaterium
Authors: Roditi Eduardo , Weill Yishay , Wasser Lauren M. , Zadok David , Assayag Elishai 
Published: March 2022

Purpose:
The purpose of this study was to report the most severe documented ocular injury caused by Ecballium elaterium, an invasive and toxic herb characterized by an explosive seed dispersal.

Methods:
A 55-year-old man presented to the emergency department several hours after direct exposure to the contents of E. elaterium to his left eye. Clinical examinations, investigations, and imaging findings are reported.

Results:
Medical and ocular histories were unremarkable. On presentation, the patient exhibited markedly decreased visual acuity, severe periorbital edema, conjunctival chemosis, and corneal edema. Although other signs gradually improved, corneal edema worsened despite rapid initiation of systemic and topical steroids and normal intraocular pressure. After 4 months of follow-up, the cornea cleared and visual acuity returned to normal; however, a significant decrease in endothelial cell count was observed.

Conclusions:

Ecballium elaterium may cause a severe corneal chemical burn, with subsequent long-standing corneal edema and endothelial decompensation. Specular microscopy is a modality of great importance in these cases.
Implementation of the Corneal Sweep Test in the Diagnosis of Recurrent Corneal Erosion: A 2-Year Retrospective Study
Authors: Kim Madeleine Eun-Ji , Kim Dooho Brian 
Published: March 2022

Purpose:
The purpose of this study was to evaluate the incidence and epidemiology of recurrent corneal erosion within a clinical population using standard diagnostic techniques and a new technique called the corneal sweep test (CST).

Methods:
A retrospective chart review was conducted on 58 eyes of 51 patients with the diagnosis of recurrent corneal erosion from July 2018 to June 2020. All underwent a thorough history and physical examination. The CST was performed as a confirmatory test and on any patient who lacked visible corneal pathology.

Results:
The CST was necessary on 49 of the 58 eyes to help confirm the diagnosis of a corneal erosion. Among them, 34 had an occult corneal erosion, which is defined as having a normal-appearing cornea on slitlamp examination but found to have loose corneal epithelium with the CST. Clear corneal cataract surgery (28 eyes, 48.2%) was the most common presumed mechanism of injury, with 20 (71.4%) developing symptoms only after cataract surgery. All 20 eyes had an erosion located directly over a clear corneal cataract incision.

Conclusions:
The CST is a new and effective technique to help diagnose corneal erosions in the absence of visible corneal findings. Clear corneal cataract surgery is an under-recognized but important risk factor to consider because the incision can be the source for an erosion. Using the CST could lead to a paradigm shift in the way clinicians approach RCEs and patients with a persistent ocular pain syndrome.
Possible Synergistic Role of Cryo-Alcohol Therapy in Infectious Scleritis—Scope and Rationale for Expanding Indications and Review of the Literature
Authors: Agarwal Shweta , Pandey Sunita , Srinivasan Bhaskar , Anand Appakkudal R. , Iyer Geetha 
Published: March 2022

Purpose:
The purpose of this study was to highlight the use of topical ethanol as an adjunct to cryotherapy, termed cryo-alcohol therapy, in the management of fungal/acanthamoeba scleritis along with a review of the literature.

Method:
Retrospective interventional case reports of fungal and acanthamoeba scleritis along with a review of the literature.

Results:
The patient with circumferential necrotic fungal scleritis resolved in 6 weeks achieving a best-corrected visual acuity (BCVA) of 20/20, and the patient with acanthamoeba scleritis is awaiting optical keratoplasty after complete resolution in 8 weeks. The literature review from January 1990 to December 2020 revealed BCVA >20/200 in 50% of the eyes with a mean time to resolution being 4.16 ± 2.13 months in fungal scleritis, with 27.02% and 75% of the eyes requiring evisceration in fungal and acanthamoeba scleritis, respectively.

Conclusions:
Cryotherapy is a useful adjunct in managing refractory infectious scleritis, and its efficacy can be enhanced by combining the use of topical ethanol to aid in faster recovery and reduce visual morbidity.
Updates in hypertension: new trials, targets and ways of measuring blood pressure
Authors: Abu Salman Liann , Cohen Jordana B. 
Published: March 2022

Purpose of review
Several recent trials and observational studies have identified critical areas that can help to improve the management and measurement of blood pressure in patients with hypertension.

Recent findings
High-quality trial evidence supports intensive SBP lowering to 110–130 mmHg in older patients, potassium- based salt substitution in patients without chronic kidney disease, and chlorthalidone for the management of hypertension in patients with chronic kidney disease. In addition, population-based studies indicate enormous underdiagnosis of primary aldosteronism as well as greater sustained intensification of antihypertensive therapy in older patients by maximizing medication dosage rather than adding new agents. The prevalence of hypertension is stable worldwide, though is generally improving in high-income countries and worsening in low-income countries. Furthermore, although cuffless blood pressure devices have the potential to improve access to blood pressure measurement, they have not yet demonstrated sufficient accuracy for clinical use.

Summary
Growing evidence supports intensive blood pressure lowering, sodium reduction, targeted antihypertensive treatment and appropriate screening for secondary hypertension to optimize blood pressure control and reduce the risk of target organ damage from hypertension. Future studies are needed to identify ways to improve our ability to implement these findings in routine clinical practice.
Small varices in chronic liver diseases
Authors: Zhu Ying , Cheng Hui , Chen Jianyong , Huang Yifei , Liu Hao , Qi Xiaolong 
Published: March 2022

Purpose of review
Gastroesophageal varices are common complications of chronic liver diseases (CLDs) and portal hypertension. Small varices have the risk of progressing to larger varices, causing bleeding or even death. Thus, early detection and appropriate management of small varices are necessary. The purpose of this review is to summarize the advance in the recent 5years about diagnosing and managing the small varices in CLDs.

Recent findings
The diagnosing methods of small varices in recent studies include improved endoscopic examinations, such as capsule endoscopy, and many noninvasive methods, including blood tests, ultrasound, computed tomography and magnetic resonance. For the management of small varices, though it is controversial, prevention using nonselective beta-blockers is still an essential part.

Summary
In this review, we summarize the classification of varices, the invasive and noninvasive diagnostic methods, their performances, and the emerging progression in the management of small varices in the recent 5 years. We hope that this review provides relevant information to understand better and appropriately manage small varices.
Reimbursement of surgical procedures for benign prostatic hyperplasia: are we disincentivizing complex care?
Authors: Narang Gopal , Kellner Daniel , Krambeck Amy , Humphreys Mitchell 
Published: March 2022

Purpose of review
To provide an overview of how surgical benign prostatic hyperplasia (BPH) procedures are compensated in the United States and the implications of the current reimbursement system on the care of patients.

Recent findings
The resource-based relative value care system is Medicare's current reimbursement model. There is strong evidence that the current system does not adequately account for complex care. Consequently, for BPH surgical procedures, treatment options best suited for complex patients are not adequately reimbursed which may have implications on healthcare delivery and outcomes.

Summary
Inadequate reimbursement for certain BPH procedures may disincentivize the care of complex patients. Procedures such a holmium laser enucleation of the prostate are well suited for complex patients but have a steep learning curve. The incentive to learn and offer such procedures to complex patients may be unfairly influenced by reimbursement levels, which in the end penalizes patients and the treatments available to them.
Robotic Harvest of the Deep Inferior Epigastric Perforator Flap for Breast Reconstruction: A Case Series
Authors: Bishop Sarah N. , Asaad Malke , Liu Jun , Chu Carrie K. , Clemens Mark W. , Kapur Sahil S. , Largo Rene D. , Selber Jesse C. 
Published: March 2022

Background:
Robotic surgery is emerging as a viable tool in reconstructive surgery. Harvesting of the deep inferior epigastric perforator flap is typically performed through an anterior approach, which involves a long fascial incision. A robotic approach allows the deep inferior epigastric pedicle to be harvested from the posterior surface. This approach reduces the length of the fascial incision and should decrease the abdominal morbidity associated with large fascial dissections.

Methods:
A case series study of 21 patients who underwent a robotic deep inferior epigastric perforator or during a 12-month period for breast reconstruction was performed. Patient demographics, surgical characteristics, and complications were assessed.

Results:
Mean patient age was 54.6 ± 7.6 years, and mean body mass index was 30.4 ± 3.9 kg/m2. Mean fascial incision and pedicle length were 3.6 ± 1.6 cm and 13.3 ± 1 cm, respectively. None of the patients required conversion to open harvest. Mean length of hospital stay was 3.8 ± 0.9 days. Surgical site occurrences were identified in five patients (31.3 percent). One patient had delayed wound healing at the donor site. None of the patients developed hernia or bulge. The mean benefit (B = C − A), defined as length of fascial incision spared and measured as the difference between pedicle length and intramuscular course, was 9.83 ± 2.28 cm. The precision of computed tomography angiography in identifying the intraoperative fascial incision was 86 percent.

Conclusion:
The robotic deep inferior epigastric perforator flap is a safe and reliable technique that decreases the length of fascial incision and short-term complications associated with the open approach.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Assessment of acute postoperative pain management and associated factors after elective surgery among adult surgical patients: a prospective cross-sectional study
Authors: Kasahun Habtamu G. , Agizew Tesfaye B. , Temesgen Mamaru M. , Ashagrie Henos E. 
Published: March 2022

Background:
Appropriate and effective management of acute postoperative pain has been one of the major challenges worldwide and the majority of patients admitted to hospitals still suffer from uncontrolled postoperative pain.

Objective:
To assess acute postoperative pain management and associated factors after elective surgery among adult patients.

Methods:
A prospective cross-sectional study was conducted on 198 adult surgical patients from February 25/2020 to May 25/2020 with response rate of 96%. Descriptive statistics performed to determine incidence of postoperative pain. Multivariable binary logistics regression was held to identify the associated factors and a P-value <0.05 was considered as significant.

Result:
Among 190 patients, 100 (52.6%) of patients were inadequately treated at 24 hours of postsurgery. The overall incidence of moderate to severe postoperative pain after elective surgery with in the first 24 postoperative hours was 69.5% [95% confidence interval (CI): 63%–76%]. History of previous surgery [adjusted odds ratio (AOR): 3.46, CI: 1.19–10.05], length of incision ≥10 cm (AOR: 5.46, CI: 2.01–14.80), use of nerve block (AOR: 3.00, CI: 1.206–7.46), duration of surgery ≥3 hours (AOR: 3.39, CI: 1.26–9.09), type of surgery (AOR: 3.55, CI: 1.09–11.53) and preoperative anxiety (AOR: 5.40, CI: 2.241–13.05) were significantly associated with moderate to severe postoperative pain. Therefore, the surgical team need to prepare and distribute a standard pain assessment scale as other vital sign sheets and need to take a plan of action to reduce the magnitude of the problem by addressing the risk factors.
In situ-produced10Be and26Al indirect dating of Elarmékora Earlier Stone Age artefacts: first attempt in a savannah forest mosaic in the middle Ogooué valley, Gabon
Authors: Braucher R. , Oslisly R. , Mesfin I. , Ntoutoume P. P. ,   ASTER Team
Published: March 2022

Discovered in 1988 by R. Oslisly and B. Peyrot, Elarmékora is a high terrace that, today, is situated 175 m above the Ogooué River in the historical complex of Elarmékora, attached to the Lopé National Park in Gabon, a World Heritage site since 2007. The site yielded a small lithic assemblage, including mainly cobble artefacts embedded within the 1 m thick alluvial material. Based on geomorphological and palaeoclimatological criteria, the preliminary dating suggested an age of 400 ka. However, Elarmékora could be a key site for Atlantic Central Africa if this lithic industry can be dated absolutely. In 2018 and 2019, two field trips were organized to collect surface samples as well as samples in vertical depth profiles with the aim of measuring theirin situ-produced cosmogenic nuclide (10Be and26Al) content. Results suggest a surface abandonment between 730 and 620 ka ago representing a minimum age for the cobble artefacts. Concurrently, technological reappraisal of the artefacts suggests an atypical lithic industry that should, for the moment, be considered as ‘undiagnostic’ Earlier Stone Age. This age bracketing may be compared with a similar age range obtained for prehistoric occupations in Angola using the same approach. This age will place Elarmékora among the oldest evidence for the presence of hominins in western Central Africa and raises the question of a ‘West Side Story’ to early human dispersals in Africa.This article is part of the theme issue ‘Tropical forests in the deep human past’.