bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midface Multilayering Filler Injection Technique: Understanding of the Dynamic Facial Anatomy Through a “Smiling Cadavers” Anatomical Study
Authors: Trévidic Patrick , Trévidic Thibault , Imanilov Alexander , Criollo-Lamilla Gisella 
Published: April 2022

Background:
Understanding age-related changes in compartmentalized facial fat and their role in facial dynamics and aesthetics is essential to target filler injections for midface rejuvenation.

Methods:
A novel anatomical approach (“smiling cadavers”) was used to identify the main midface fat compartments involved during muscular contraction when smiling and their motion and behavior with and without filler injections. Based on these insights and the literature, a multilayering filler injection approach was developed to optimize midface rejuvenation by restoring fat volumes using rheologically different products injected into different fat compartments.

Results:
Twenty-four hemifacial dissections confirmed the presence of two fat compartment layers, separated by the orbicularis oculi muscle in the horizontal plane and by the septa in the vertical plane, and revealed the anatomical effects of facial movement. The midface is composed of deep static fat compartments and a superficial dynamic adipose layer that follows the facial movements, creating a natural dynamic appearance. A proof-of-concept study involved 130 White patients (36 to 56 years; 91 percent women). After the procedure, 95 percent of patients and 98 percent of practitioners rated facial appearance as “improved” or “much/very much improved.” No major complications were reported.

Conclusions:
The smiling cadavers method enhances understanding of dynamic facial anatomy by showing the superficial and deep fat compartments of the midface at rest and their motion during a procedure to represent a smile. The multilayered injection technique takes into account these anatomical findings to rejuvenate the midface, achieving a natural appearance at rest and during motion.
We Are Not There Yet: A Qualitative System Probing Study of a Hospital Rapid Response System
Authors: Olsen Siri Lerstøl , Søreide Eldar , Hansen Britt Sætre 
Published: April 2022

Objectives
The capability of a hospital’s rapid response system (RRS) depends on various factors to reduce in-hospital cardiac arrests and mortality. Through system probing, this qualitative study targeted a more comprehensive understanding of how healthcare professionals manage the complexities of RRS in daily practice as well as identifying its challenges.

Methods
We observed RRS through in situ simulations in 2 wards and conducted the debriefings as focus group interviews. By arranging a separate focus group interview, we included the perspectives of intensive care unit personnel.

Results
Healthcare professionals appreciated the standardized use of the National Early Warning Score, when combined with clinical knowledge and experience, structured communication, and interprofessional collaboration. However, we identified salient challenges in RRS, for example, unwanted variation in recognition competence, and inconsistent routines in education and documentation. Furthermore, we found that a lack of interprofessional trust, different understandings of RRS protocol, and signs of low psychological safety in the wards disrupted collaboration. To help remedy identified challenges, healthcare professionals requested shared arenas for learning, such as in situ simulation training.

Conclusions
Through system probing, we described the inner workings of RRS and revealed the challenges that require more attention. Healthcare professionals depend on structured RRS education, training, and resources to operate such a system. In this study, they request interventions like in situ simulation training as an interprofessional educational arena to improve patient care. This is a relevant field for further research. The Consolidated Criteria for Reporting Qualitative Studies Checklist was followed to ensure rigor in the study.
Ultra-High-Field 7 T Magnetic Resonance Imaging Including Dynamic and Static Contrast-Enhanced T1-Weighted Imaging Improves Detection of Secreting Pituitary Microadenomas
Authors: Eisenhut Felix , Schlaffer Sven-Martin , Hock Stefan , Heynold Elisabeth , Kremenevski Natalia , Bluemcke Ingmar , Buchfelder Michael , Doerfler Arnd , Schmidt Manuel A. 
Published: April 2022

Objective
A prospective preoperative evaluation of 7 T ultra-high-field magnetic resonance imaging (MRI) in patients with suspected pituitary microadenomas for both adenoma detection and intrasellar localization compared with 3 T MRI was carried out.

Materials and Methods
Patients underwent prospective preoperative standardized 3 and 7 T MRI. A distinct qualitative (lesion detection, intrasellar lesion location) and quantitative (lesion diameters, T1/T2 signal intensity ratio of the lesion to normal pituitary gland tissue) analysis was performed, along with an evaluation of image quality (IQ) regarding overall IQ, anatomical parameters, and artifacts; the findings of the qualitative analysis were compared with intraoperative findings and endocrinological outcomes.

Results
Sixteen patients (mean age, 43 ± 16 years; 13 women) with pituitary microadenomas were included. Using 7 T MRI allowed the detection of 15 microadenomas—3 more than 3 T MRI. In addition, 7 T MRI allowed more precise lesion localization with 93.75% (15/16) agreement with intraoperative findings, compared with 75% (12/16) agreement using 3 T MRI. Lesion diameters showed no significant difference between 3 and 7 T MRI. T1 and T2 signal intensity ratio between microadenomas and normal pituitary gland tissue were higher in 7 T MRI than in 3 T MRI. The overall IQ and the IQ of each anatomical parameter of 7 T MRI were rated higher than those of 3 T MRI. No significant differences in susceptibility or head motion artifacts were observed between 3 and 7 T MRI; however, 7 T MRI was more susceptible to pulsation artifacts.

Conclusion
Ultra-high-field MRI surpasses 3 T MRI in pituitary microadenoma detection and enables more precise delineation with higher correlation with intraoperative findings. Thus, 7 T sellar imaging is a promising option—especially in previously magnetic resonance–negative patients with endocrinologically confirmed hormone oversecretion—and helps reduce the need for invasive diagnostics.
“Occipital Pole” Sign on 18F-FDG PET for Dementia With Lewy Bodies and Posterior Cortical Atrophy
Authors: Gallucci Maurizio , Fiore Vittorio , Grassivaro Francesca , Da Ronch Chiara , Bonanni Laura 
Published: April 2022

Abstract
The 18F-FDG PET images of dementia with Lewy bodies and posterior cortical atrophy, a visual-cognitive phenotype described in patients with Alzheimer disease, show occipital lobe hypometabolism with relative sparing of the primary visual cortex (PVC) generating the “occipital tunnel” sign proposed by Sawyer and Kuo in 2017, which is viewable on the medial sagittal projection. We believe that the saving of PVC compared with the lateral occipital cortex can be better appreciated by capturing the posterior projection of the PVC in a 3D stereotactic surface projection map, and we propose the name of “occipital pole” sign for this evidence.
Iron Polymaltose Infusion Effects on Bone Scintigraphy and Remodeling
Authors: Kang Christine , Jiang James Y. , Wong Veronica , Man Jennifer , Mansberg Robert 
Published: April 2022

Abstract
A 73-year-old woman with metastatic breast cancer and known widespread skeletal metastases was referred for bone scintigraphy. Delayed images acquired at 2 and 5 hours postinjection of 30 mCi (1089 MBq) 99mTc-HDP demonstrated markedly reduced bony uptake, markedly increased renal activity, and significantly increased soft tissue accumulation. By contrast, appropriate skeletal uptake of 99mTc-HDP was seen in prior bone scans. The patient had been treated for iron deficiency anemia with an infusion of 1 g of iron polymaltose approximately 22 hours before injection of 99mTc-HDP. This phenomenon may be due to transient reduced bone resorption with increased FGF23 release secondary to IV iron supplementation.
68Ga-FAPI-04 PET/CT in Solitary Choroid Plexus Metastasis From Renal Cell Carcinoma
Authors: Yang Jian , Dong Aisheng , Zuo Changjing 
Published: April 2022

Abstract
Intraventricular metastasis from extracranial tumor is rare. We describe MRI and 68Ga-FAPI-04 PET/CT findings in a case of histologically proved solitary choroid plexus metastasis from clear cell renal cell carcinoma. The tumor showed remarkable enhancement on MRI and increased FAPI uptake with high tumor-to-background activity ratio on PET/CT. This case indicates FAPI PET may be useful for detection of intraventricular metastasis from renal cell carcinoma.
Impact of the Use of Simulated Patients in Basic First Aid Training on Laypeople Knowledge, Skills, and Self-efficacy
Authors: Avau Bert , Vanhove Anne-Catherine , Scheers Hans , Stroobants Stijn , Lauwers Karen , Vandekerckhove Philippe , De Buck Emmy 
Published: April 2022

Background
First aid training is a cost-effective way to improve public health, but the most effective methods to teach first aid are currently unclear. The aim of this research was to investigate the added value of simulated patients during first aid certification trainings.

Methods
Occupational first aid trainings organized by the Belgian Red Cross between September 2018 and August 2019 were allocated to either training with a simulated patient or regular training, for the topics “stroke” and “burns.” Participants' knowledge and self-efficacy related to these topics were assessed at baseline, directly after training and after 1 year. First aid skills for “stroke” and “burns” and participant satisfaction were assessed after training. Knowledge and self-efficacy were measured via a questionnaire, and skills were assessed during a practical skills test. Data were analyzed using generalized linear mixed model analyses.

Results
A total of 1113 participants were enrolled, 403 in the simulated patient group and 710 in the control group. First aid knowledge and self-efficacy increased strongly immediately after training. These increases did not differ between groups, nor did the level of practical skills. The simulated patient group had a significantly increased retention in first aid knowledge after 1 year, compared with control, while retention in self-efficacy did not differ. Participant satisfaction with training was similar between groups.

Conclusions
Using simulated patients during occupational first aid trainings for laypeople did not improve outcomes immediately after training but did improve retention of first aid knowledge after 1 year. These results support the use of simulated patients during first aid training.
Setting an Agenda
Authors: Gross Isabel T. , Clapper Timothy C. , Ramachandra Geethanjali , Thomas Anita , Ades Anne , Walsh Barbara , Kreuzer Florian , Elkin Rachel , Wagner Michael , Whitfill Travis , Chang Todd P. , Duff Jonathan P. , Deutsch Ellen S. , Loellgen Ruth M. , Palaganas Janice C. , Fayyaz Jabeen , Kessler David , Calhoun Aaron W. 
Published: April 2022

Background
The COVID-19 pandemic forced rapid implementation and refinement of distance simulation methodologies in which participants and/or facilitators are not physically colocated. A review of the distance simulation literature showed that heterogeneity in many areas (including nomenclature, methodology, and outcomes) limited the ability to identify best practice. In April 2020, the Healthcare Distance Simulation Collaboration was formed with the goal of addressing these issues. The aim of this study was to identify future research priorities in the field of distance simulation using data derived from this summit.

Methods
This study analyzed textual data gathered during the consensus process conducted at the inaugural Healthcare Distance Simulation Summit to explore participant perceptions of the most pressing research questions regarding distance simulation. Participants discussed education and patient safety standards, simulation facilitators and barriers, and research priorities. Data were qualitatively analyzed using an explicitly constructivist thematic analysis approach, resulting in the creation of a theoretical framework.

Results
Our sample included 302 participants who represented 29 countries. We identified 42 codes clustered within 4 themes concerning key areas in which further research into distance simulation is needed: (1) safety and acceptability, (2) educational/foundational considerations, (3) impact, and (4) areas of ongoing exploration. Within each theme, pertinent research questions were identified and categorized.

Conclusions
Distance simulation presents several challenges and opportunities. Research around best practices, including educational foundation and psychological safety, are especially important as is the need to determine outcomes and long-term effects of this emerging field.
Building a sustainable Mil-Civ partnership to ensure a ready medical force: A single partnership site's experience
Authors: Stinner Daniel J. , Jahangir A. Alex , Brown Christopher , Bickett Christopher R. , Smith Joshua P. , Dennis Bradley M. 
Published: April 2022

ABSTRACT
One of the challenges in military medicine is ensuring that the medical force deployed to the theater of combat operations is prepared to perform life, limb, and eyesight saving care at a level of care comparable to our top civilian Level I trauma centers. There is increasingly more evidence demonstrating that the majority of military physicians are not exposed to trauma or combat casualty care-relevant surgical cases on a consistent basis in their daily practice at their garrison military treatment facility (MTF). To prevent this widening skills and experience gap from become more of a reality, the 2017 National Defense Authorization Act called for the expansion of military and civilian (Mil-Civ) medical partnerships, working toward embedding military medical providers and surgical teams in busy civilian trauma centers. Vanderbilt University Medical Center is one of the busiest trauma centers in the country and being in close proximity to the local MTF at Fort Campbell, KY, it is primed to become one of the premier Mil-Civ partnerships. Creating a strategy that builds the partnership in a calculated and stepwise fashion through multiple avenues with centralized leadership has resulted in the early success of the program. However, Vanderbilt University Medical Center is not immune to challenges similar to those at other Mil-Civ partnerships, but only by sharing best practices can we continue to make progress.
Prognostic Value of Water-Soluble Contrast Challenge for Nonadhesive Small Bowel Obstruction
Authors: Hunter Lanier M , Ludwig Daniel R , Ilahi Obeid , Mellnick Vincent 
Published: April 2022

BACKGROUND:
There is little evidence supporting the use of a water-soluble contrast challenge (WSCC) for conservative management of nonadhesive small bowel obstruction (NASBO). Our objective was to evaluate the prognostic value of the WSCC in a diverse group of patients with NASBO in comparison with patients with adhesive small bowel obstruction (ASBO).

STUDY DESIGN:
Retrospective chart review of patients with ASBO or NASBO who underwent a WSCC during a 4-year time period was performed. The primary study endpoint was any intervention for small bowel obstruction during the initial admission or within 30 days of discharge.

RESULTS:
A total of 106 patients were included, 53 with ASBO (mean age 64 ± 13 years [SD]; 55% women) and 53 with NASBO (mean age 59 ± 13 years [SD]; 57% women). A higher rate of interventions during admission or within 30 days of discharge was seen in patients with NASBO compared with ASBO (24/53 [45%] vs 12/53 [23%]; p = 0.01), including those with colonic transit times of less than 36 hours (14/41 [34%] vs 5/43 [12%]; p = 0.01). Using multivariate analysis, transit time greater than 36 hours remained an independent predictor of an intervention during admission or within 30 days of discharge (p < 0.001, odds ratio 19.0), after controlling for the type of small bowel obstruction.

CONCLUSIONS:
A majority of patients with NASBO were successfully managed conservatively during a 30-day period, supporting the use of WSCC in patients with NASBO; however, patients with NASBO had a higher rate of interventions during admission or within 30 days of discharge.
Increasing Living Donor Liver Transplantation Using Liver Paired Exchange
Authors: Gunabushanam Vikraman , Ganesh Swaytha , Soltys Kyle , Mazariegos George , Ganoza Armando , Molinari Michele , Tevar Amit , Hughes Christopher , Humar Abhinav 
Published: April 2022

BACKGROUND:
Living donor liver transplantation (LDLT) continues to be the primary modality of liver transplantation in Asia, but it accounts for about 5% of all liver transplantations in the US. ABO incompatibility is the primary reason motivated donors are declined. Although kidney paired exchanges are common, liver paired exchange (LPE) is still evolving in the US.

STUDY DESIGN:
This is a retrospective review (between January 1, 2019, and July 31, 2021) of our initial experience with LPE.

RESULTS:
A total of 10 LPEs (20 LDLTs) were performed during the study period. Seven LPEs were initiated by a nondirected O donor. The other 3 pair sets involved 1 ABO compatible and 1 ABO incompatible pair. Transplantations in a pair set were completed within a mean of 4.8 (range 1–14) days of each other. All 20 donors are doing well with no major complications at 12.7 (range 1–20) months. Seventeen of 20 recipients are alive and have good allograft function. One recipient died in the early postoperative period. Two late deaths of patients with functioning allografts were due to COVID-19 (at 8 months) and peritoneal carcinomatosis and gram-negative sepsis (at 9 months).

CONCLUSIONS:
LPE is feasible in a high-volume LDLT center and is a useful option to increase LDLT by overcoming ABO incompatibility. Nondirected donors can be utilized to initiate an LPE.
Incidence and Clinical Impact of Bile Leakage after Laparoscopic and Open Liver Resection: An International Multicenter Propensity Score-Matched Study of 13,379 Patients
Authors: Görgec Burak , Cacciaguerra Andrea Benedetti , Aldrighetti Luca A , Ferrero Alessandro , Cillo Umberto , Edwin Bjørn , Vivarelli Marco , Lopez-Ben Santiago , Besselink Marc G , Abu Hilal Mohammed ,   for the International Study Group of Bile Leakage after Liver Surgery
Published: April 2022

BACKGROUND:
Despite many developments, postoperative bile leakage (POBL) remains a relatively common postoperative complication after laparoscopic liver resection (LLR) and open liver resection (OLR). This study aimed to assess the incidence and clinical impact of POBL in patients undergoing LLR and OLR in a large international multicenter cohort using a propensity score–matched analysis.

STUDY DESIGN:
Patients undergoing LLR or OLR for all indications between January 2000 and October 2019 were retrospectively analyzed using a large, international, multicenter liver database including data from 15 tertiary referral centers. Primary outcome was clinically relevant POBL (CR-POBL), defined as Grade B/C POBL.

RESULTS:
Overall, 13,379 patients met the inclusion criteria and were included in the analysis (6,369 LLR and 7,010 OLR), with 6.0% POBL. After propensity score matching, a total of 3,563 LLR patients were matched to 3,563 OLR patients. In both groups, propensity score matching accounted for similar extent and types of resections. The incidence of CR-POBL was significantly lower in patients after LLR as compared with patients after OLR (2.6% vs 6.0%; p < 0.001). Among the subgroup of patients with CR-POBL, patients after LLR experienced less severe (non-POBL) postoperative complications (10.1% vs 20.9%; p = 0.028), a shorter hospital stay (12.5 vs 17 days; p = 0.001), and a lower 90-day/in-hospital mortality (0% vs 5.4%; p = 0.027) as compared with patients after OLR with CR-POBL.

CONCLUSION:
Patients after LLR seem to experience a lower rate of CR-POBL as compared with the open approach. Our findings suggest that in patients after LLR, the clinical impact of CR-POBL is less than after OLR.
Impact of Pretransplantation CT on Liver Donation in Potential Deceased Organ Donors
Authors: Robb Caroline L , Fowler Kathryn J , Bierhals Andrew J , Raptis Demetrios A , Majella Doyle Maria B , Chapman William C , Raptis Constantine A 
Published: April 2022

BACKGROUND:
Computed tomography (CT) is routinely used to determine the suitability of potential living donor liver transplants, providing important information about liver size, vascular anatomy, and the presence of other diseases that would preclude it from safe donation. CT is not routinely used, however, when evaluating eligible deceased organ donors after brain death, a group which comprises most orthotopic liver transplants. After the installation of a CT scanner at a local procurement facility, CTs have been performed on potential deceased organ donors and used, in conjunction with other evaluative protocols, to help direct donation decisions and assist in procurement procedures.

STUDY DESIGN:
A retrospective analysis of data from 373 cases spanning 5 years was systematically collected and analyzed, including information pertaining to patient’s medical histories, biopsy results, operative findings, and CT results.

RESULTS:
CT findings directly impacted the directive decision-making process in 29% of cases in this patient cohort, likely an underestimate, and reliably evaluated important factors including variant vascular anatomy and the presence and severity of hepatic steatosis and cirrhosis.

CONCLUSION:
Overall, this study suggests that CT has the potential to play a significant role in procurement procedures and the directive decision-making process, thereby improving the efficiency and accuracy by which potential deceased organ donors are evaluated.
Long-Term Outcomes of Single-Incision Distal Gastrectomy Compared with Conventional Laparoscopic Distal Gastrectomy: A Propensity Score–Matched Analysis
Authors: Kang So Hyun , Lee Eunju , Lee Sangjun , Park Young Suk , Ahn Sang-Hoon , Park Do Joong , Kim Hyung-Ho 
Published: April 2022

BACKGROUND
Single-incision laparoscopic surgery is gaining more attention due to advancements in surgical devices and techniques. Ten years have passed since the first report of single-incision distal gastrectomy. This study aims to analyze the long-term oncological safety of single-incision distal gastrectomy by comparing it with multiport distal gastrectomy.

STUDY DESIGN
Patients diagnosed with gastric cancer who underwent laparoscopic distal gastrectomy from January 2010 to December 2017 were enrolled. Palliative surgery, history of other malignancy, preoperative chemotherapy, and distant metastasis were excluded. The 5-year overall survival and 5-year disease-free survival were set as coprimary endpoints. Operative time, blood loss, postoperative outcome, and risk factors for survival were secondary endpoints. Propensity score matching of 1:1 ratio was performed to adjust for age, sex, body mass index, comorbidities, tumor size, operation history, and clinical stage.

RESULTS
A total of 3,097 patients were enrolled. After propensity score matching, 378 patients were allocated to each group. There was no difference in patient demographics after matching. Operation time was faster (170.8 ± 65.3 minutes vs 147.2 ± 44.1 minutes, p < 0.001), with less blood loss in the single-port group (84.1 ± 87.6 mL vs 34.9 ± 49.9 mL, p < 0.001). Administration of additional intravenous analgesics was less frequent in the single-port group (p = 0.043). There was no difference in long-term survival (5-year overall survival: multiport 94.2%, single-port 95.8%, p = 0.43; 5-year disease-free survival: multiport 94.1%, single-port 95.8%, p = 0.32).

CONCLUSIONS
Single-incision distal gastrectomy is safe and feasible with good long-term outcomes and less use of additional analgesics for patients diagnosed with early gastric cancer.