bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autologous Fat Grafting as Treatment of Postmastectomy Pain Syndrome: A Randomized Controlled Trial
Authors: Sollie Martin , Toyserkani Navid M. , Bille Camilla , Thomsen Jørn Bo , Sørensen Jens Ahm 
Published: January 2022

Background:
Postmastectomy pain syndrome is a common and disabling side effect of breast cancer treatment. Medical treatment seems to be insufficient for a considerable proportion of patients. Fat grafting has shown promise in relieving pain from postmastectomy pain syndrome, but no randomized clinical trial comparing fat grafting to a sham operation has been performed to date. The authors’ objective was to compare the effect of fat grafting compared to a sham operation for treating postmastectomy pain syndrome.

Methods:
The authors conducted a single-center, double-blind, randomized clinical trial with two arms between October of 2017 and September of 2020. The authors assessed four patients suffering from postmastectomy pain syndrome for inclusion. The intervention group received scar-releasing rigottomy and fat grafting to the area of pain. The control group received scar-releasing rigottomy and a placebo of saline solution. The primary outcome was the degree of pain measured using the Numerical Rating Scale. The secondary outcomes were the degree and quality of neuropathic pain (Neuropathic Pain Symptom Inventory) and quality of life (36-Item Short-Form Health Survey). Follow-up was 6 months.

Results:
Thirty-five participants completed follow-up: 18 participants in the intervention group and 17 in the control group. The authors detected no statistically significant changes in average and maximum pain or neuropathic pain. Regarding quality of life, the control group reported a statistically significant improvement in emotional problem parameters, whereas the intervention group reported a deterioration. The authors observed no serious adverse effects.

Conclusion:
The authors did not find evidence to support that fat grafting is superior to a placebo when treating postmastectomy pain syndrome.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, I.
Microvascular Breast Reconstruction in the Era of Value-Based Care: Use of a Cosurgeon Is Associated with Reduced Costs, Improved Outcomes, and Added Value
Authors: Mericli Alexander F. , Chu Carrie K. , Sisk Geoffroy C. , Largo Rene D. , Schaverien Mark V. , Liu Jun , Villa Mark T. , Garvey Patrick B. 
Published: January 2022

Background:
Reducing complications while controlling costs is a central tenet of value-based health care. Bilateral microvascular breast reconstruction is a long operation with a relatively high complication rate. Using a two-surgeon team has been shown to improve safety in bilateral microvascular breast reconstruction; however, its impact on cost and efficiency has not been robustly studied. The authors hypothesized that a cosurgeon for bilateral microvascular breast reconstruction is safe, effective, and associated with reduced costs.

Methods:
The authors retrospectively reviewed all patients who underwent bilateral microvascular breast reconstruction with either a single surgeon or surgeon/cosurgeon team over an 18-month period. Charges were converted to costs using the authors’ institutional cost-to-charge ratio. Surgeon opportunity costs were estimated using time-driven activity-based costing. Propensity scoring controlled for baseline characteristics between the two groups. A locally weighted logistic regression model analyzed the cosurgeon’s impact on outcomes and costs.

Results:
The authors included 150 bilateral microvascular breast reconstructions (60 single-surgeon and 90 surgeon/cosurgeon reconstructions) with a median follow-up of 15 months. After matching, the presence of a cosurgeon was associated with a significantly reduced mean operative duration (change in operative duration, −107 minutes; p < 0.001) and cost (change in total cost, −$1101.50; p < 0.001), which was even more pronounced when surgeon/cosurgeon teams worked together frequently (change in operative duration, −132 minutes; change in total cost, −$1389; p = 0.007). The weighted logistic regression models identified that a cosurgeon was protective against breast-site complications and trended toward reduced overall and major complication rates.

Conclusion:
The practice of using a of cosurgeon appears to be associated with reduced costs and improved outcomes, thereby potentially adding value to bilateral microvascular breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Is the Mirroring Technology Reliable in the Use of Computer-Aided Design for Orbital Reconstruction? Three-Dimensional Analysis of Asymmetry in the Orbits
Authors: Kang Hee Yong , Shin Ho Seong 
Published: January 2022

Background:
Reconstruction of the orbital area remains a challenge in many cases. The recently introduced mirroring technology provides surgeons with patient-specific information for accurate orbital reconstruction; its premise is that the three-dimensional anatomy of craniofacial bone is symmetric. The purpose of this study was to verify this premise of the mirroring technology by assessing three-dimensional asymmetry.

Methods:
Facial computed tomographic data of 104 patients were imported into iPlan software. Four reference points (i.e., zygomaticofrontal suture, frontomaxillary suture, infraorbital foramen, and optic canal) were set, and the three-dimensional distances from these points to the anterior nasal spine on the mirroring plane were calculated. In addition, the orbital cavity volume and the three-dimensional distances from point optic canal to the other reference points were calculated for the assessment of the orbit anatomy. Three plastic surgeons performed these processes independently.

Results:
No statistically significant difference was found in the three-dimensional distances between anterior nasal spine and the four reference points bilaterally. Also, no statistically significant difference in the three-dimensional distances between the point representing the optic canal and other reference points was detected bilaterally. Orbital cavity volume showed a mild asymmetry, but the discrepancy was acceptable for computer-aided design applications. For all reference points, the maximum value of the 95 percent CI was less than 1.4 mm.

Conclusions:
The three-dimensional location of the orbits and the three-dimensional anatomy of the orbit were symmetric. Thus, the mirroring technology could be a reliable first step in computer-aided design, computer-assisted surgery, and navigation-assisted surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Two-Layer Palatal Reconstruction Reduces Postoperative Intraoral Complications in Head and Neck Surgery
Authors: Nemoto Hitoshi , Cheong David Chon-Fok , Hung Shao-Yu , Tsao Chung-Kan 
Published: January 2022

Background:
Although microvascular free flaps are commonly performed and have high success rates, postoperative oronasal fistulas or infections do occur. The authors hypothesized that a two-layer closure is effective for prevention of intraoral complications.

Methods:
Patients who underwent palatal reconstruction with a microvascular free flap were evaluated retrospectively. The cases were divided into two groups (palatal reconstruction with or without a two-layer closure). A two-layer closure involves unilateral reconstruction with a free flap, then reconstruction of the nasal lining with a local flap or folding free flap. The postoperative complication rates between these two groups were compared.

Results:
One hundred fifty-five cases were evaluated. A two-layer closure was performed in 65 cases (41.9 percent). The incidence of infections, dehiscence of the recipient site, and oronasal fistula were significantly higher in the single-layer closure group than in the two-layer closure group [10.0 percent versus 0 percent (p = 0.011); 15.6 percent versus 4.6 percent (p = 0.036); and 17.8 percent versus 4.6 percent (p = 0.013), respectively].

Conclusions:
A two-layer closure in palatal reconstruction was shown to reduce the rate of infection, intraoral wound dehiscence, and oronasal fistula in the current study. A two-layer closure provides greater support and stability and reduces the risk of failure in reconstruction of the palate with a microvascular free flap.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Long-Term Resorption Rate of Autogenous Onlay Graft in East Asian Rhinoplasty: A Retrospective Study
Authors: Lee Tae-Yul , Lee Kyu-Il , Dhong Eun-Sang , Jeong Seong-Ho , Kim Deok-Woo , Han Seung-Kyu 
Published: January 2022

Background:
Autologous material remains the preferred graft material for use in rhinoplasty. However, resorption rates of autografts remain controversial. In addition, long-term follow-up studies on autografts are rare. Thus, the objective of the present study was to access long-term resorption rates of various autologous grafts on the upper nasal third.

Methods:
Medical records of patients who had undergone septorhinoplasty with dorsal augmentation using autologous tissues between 2009 and 2018 were retrospectively reviewed. Autogenous grafts applied on the nasal dorsum were categorized into three groups: rolled superficial mastoid fascia, diced cartilage wrapped with superficial mastoid fascia, and rolled sacral dermis. Preoperative and postoperative photographs were used to evaluate resorption rates and projection.

Results:
The rolled sacral dermis group showed a steep increase in postoperative projection but a sharp decrease in long-term follow-up projection compared to the other two groups. Among these three groups, there were statistically significant trend differences in rhinion (p < 0.001) and ½ nasion-rhinion point (p < 0.001), but not in nasion. Of these three groups, the rolled sacral dermis group showed the most projection, followed by the diced cartilage wrapped with superficial mastoid fascia group. The resorption rate was the highest in the rolled superficial mastoid fascia group (p < 0.001). Regarding resorption rates in the other two groups, the rolled sacral dermis group had a higher rate than the diced cartilage wrapped with superficial mastoid fascia group.

Conclusions:
At least 50 percent of resorption was observed in almost all groups in the long term. The choice of graft material and proper decision-making could determine success or failure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Perforator and Perforator Flap Spinoffs: A Historical Journey
Authors: Hallock Geoffrey G. 
Published: January 2022

Summary:
The concept of the perforator has now become a fundamental topic well known in every training program. However, that has not always been so. The mere definition of the word has historically been argued relentlessly; nevertheless, its major derivative, the perforator flap, has become accepted as a basic consideration whenever flaps need be selected. However, this has not been the only spinoff derived from the author’s investigations of the perforator, a point that should be stressed in addition to some reiterations of pertinent and perhaps confusing nomenclature that deserve to be reemphasized. Truly, it has been amazing to see how our ideas and innovations arise simultaneously and independently throughout the world of reconstructive surgery. A final plea is made to sustain the future—each of us must continue to contribute our passion and our knowledge to all others by means of that technology now globally so instantaneously available.
Application of the Buccal Fat Pad in Oral Reconstruction: Covered With Collagen Membrane or Not?
Authors: Huang Wei , Ye Hui-Sheng , Tan Jie-Wen , Huang Shan 
Published: January 2022

Objective:
To evaluate the clinical effectiveness of collagen membrane as biological dressing in protecting the covered buccal fat pad (BFP) from physical damage during postoperative healing phase in the reconstruction of oral soft tissue defect.

Methods:
A retrospective cohort study was performed in patients undergoing oral defects reconstruction using BFP. The predictor variable was the application of collagen membrane or not. The primary outcome variable was the wound healing. Other variables considered included age, gender, pain score, time taken for epithe-lialization, defect size and site. Postoperative follow-up was done at 1 week, 3 weeks, 6 months, and 1 year.

Results:
Thirty patients in Zhuhai People’s Hospital were selected and randomly divided in 2 groups. Group i patients were reconstructed using BFP alone, whereas collagen membrane was used as a covering over BFP in group II patients. In group I, 4 patients developed dehiscence 1-week postoperative, and underwent infection with food lodgment along with another 1 patient at 3-week follow-up, whereas none of the group II patients developed dehiscence or infection. Pain score was lesser in group II patients as compared to group I. Time taken for epithelialization was about 3 weeks in both groups.

Conclusions:
Combined application of collagen membrane protects the covered BFP from masticatory physical damage and food lodgment, which reduces infection and graft loss. It is worthy of consideration as an effective method for the reconstruction of selected moderate-sized oral defects, especially in larger size or at distant location.
Celiac Axis Stenosis is an Underestimated Risk Factor for Increased Morbidity After Pancreatoduodenectomy
Authors: Al-Saeedi Mohammed , Sauer Hendrik B. , Ramouz Ali , Koch Julian M. , Frank-Moldzio Leonie , Bruckner Tom , Loos Martin , Mayer Philipp , Klauss Miriam , Kulu Yakup , Berchtold Christoph , Hoffmann Katrin , Mehrabi Arianeb , Schneider Martin , Müller-Stich Beat , Hackert Thilo , Büchler Markus W. , Strobel Oliver 
Published: January 2022

Objective:
To assesses the prevalence and severity of CAS in patients undergoing PD/total pancreatectomy and its association with major postoperative complications after PD.

Summary of background data:
CAS may increase the risk of ischemic complications after PD. However, the prevalence of CAS and its relevance to major morbidity remain unknown.

Methods:
All patients with a preoperative computed tomography with arterial phase undergoing partial PD or TP between 2014 and 2017 were identified from a prospective database. CAS was assessed based on computed tomography and graded according to its severity: no stenosis (<30%), grade A (30%–<50%), grade B (50%–≤80%), and grade C (>80%). Postoperative complications were assessed and uni- and multivariable risk analyses were performed.

Results:
Of 989 patients, 273 (27.5%) had CAS: 177 (17.9%) with grade A, 83 (8.4%) with grade B, and 13 (1.3%) with grade C. Postoperative morbidity and 90-day mortality occurred in 278 (28.1%) patients and 41 (4.1%) patients, respectively. CAS was associated with clinically relevant pancreatic fistula (P=0.019), liver perfusion failure (P=0.003), gastric ischemia (P=0.001), clinically relevant biliary leakage (P=0.006), and intensive care unit (P=0.016) and hospital stay (P=0.001). Multivariable analyses confirmed grade B and C CAS as independent risk factors for liver perfusion failure; in addition, grade C CAS was an independent risk factor for clinically relevant pancreatic fistula and gastric complications.

Conclusions:
CAS is common in patients undergoing PD. Higher grade of CAS is associated with an increased risk for clinically relevant complications, including liver perfusion failure and postoperative pancreatic fistula. Precise radiological assessment may help to identify CAS. Future studies should investigate measures to mitigate CAS-associated risks.
A qualitative process analysis of DCT as an alternative to self-isolation following close contact with a confirmed case of COVID-19
Authors: Denford Sarah , Martin Alex F , Towler Lauren , Mowbray Fiona , Essery Rosie , Bloomer Rachael , Ready Derren , Love Nicola , Amlôt Richard , Oliver Isabel , Rubin G James , Yardley Lucy 
Published: January 2022

AbstractBackgroundIn July 2021, a randomised controlled trial was conducted to compare the effect on SARS-CoV-2 transmission of seven days of daily contact testing (DCT) using lateral flow devise (LFT) and 2 PCR tests as an alternative to 10 days of standard self-isolation with 1 PCR, following close contact with a confirmed case of COVID-19. DCT appeared equivalent to self-isolation in terms of transmission in the trial, however it was not clear how tests were viewed and used in practice. In this qualitative study, we used a nested process to aid interpretation of the trial and provide insight into factors influencing use of tests, understanding of test results, and how tests were used to inform behavioural decisions.MethodsInterviews were conducted with 60 participants (42 randomised to DCT and 18 randomised to self-isolation) who had been in close contact with a confirmed positive case of COVID-19 and had consented to take part in the trial.ResultsSub-themes emerging from the data were organised into three overarching themes: (1) assessing the risks and benefits of DCT; (2) use of testing during the study period and (3) future use of testing. Attitudes toward DCT as an alternative to self-isolation, and behaviour during the testing period appeared to be informed by an assessment of the associated risks and benefits. Participants reported how important it was for them to avoid isolation, how necessary self-isolation was considered to be, and the ability of LFTs to detect infection. Behaviour during the testing period was modified to reduce risks and harms as much as possible. Testing was considered a potential compromise, reducing both risk of transmission and the negative impact of self-isolation and was highly regarded as a way to ‘return to new normal’.ConclusionParticipants in this study viewed DCT as a sensible, feasible and welcome means of avoiding unnecessary self-isolation. Although negative LFTs provided reassurance, most people still restricted their activity as recommended. DCT was also highly valued by those in vulnerable households as a means of providing reassurance of the absence of infection, and as an important means of detecting infection and prompting self-isolation when necessary.
Hierarchical true prevalence, risk factors and clinical symptoms of tuberculosis among suspects in Bangladesh
Authors: Khan Mohammad Kamruzzaman , Islam Md. Nazimul , Hassan Jayedul , Paul Shaymal Kumar , Islam M. Ariful , Pateras Konstantinos , Kostoulas Polychronis , Ward Michael P. , Anisur Rahman A. K. M. , Alam Md. Mahbub 
Published: January 2022

AbstractBackgroundThe study was aimed to estimate the true prevalence of human tuberculosis (TB); identify risk factors and clinical symptoms of TB; and detect rifampicin (RIF) sensitivity in Bangladesh.MethodsThe cross-sectional study was conducted in three Bangladesh districts during 2018. Potential risk factors, clinical symptoms, and comorbidities were collected from 684 TB suspects. Sputum specimens were examined by LED microscopy. TB hierarchical true prevalence, risk factors and clinical symptoms were estimated and identified using a Bayesian analysis framework. Rifampicin sensitivity of M. tuberculosis (MTB) was detected by GeneXpert MTB/RIF assay.ResultsThe median TB true prevalence was 14.2% (3.8; 34.5). Although overall clustering of prevalence was not found, several DOTS centers were identified with high prevalence (22.3% to 43.7%). Risk factors for TB identified (odds ratio) were age (> 25 to 45 years 2.67 (1.09; 6.99), > 45 to 60 years 3.43 (1.38; 9.19) and individuals in families/neighborhoods where a TB patient(s) has (ve) already been present (12.31 (6.79; 22.60)). Fatigue, night sweat, fever and hemoptysis were identified as important clinical symptoms. Seven of the GeneXpert MTB/RIF positive sputum specimens (65) were resistant to rifampicin.ConclusionsAbout one in every seven TB suspects was affected with TB. Around 11% of the TB patients carry multi drug resistant MTB. Hierarchical true prevalence estimation allowed identifying DOTS centers with high TB burden. Insights from this study will enable more efficient use DOTS centers-based TB surveillance to end the TB epidemic in Bangladesh by 2035.
The Effect of Ethanolic Extract of Acacia Seyal Bark on Induced Diabetic rats
Authors: Elamin Elhasan LM , Elhkotam Basmat , Abdelgadir Tomader Salah , Allah Ibraheim Smaher Greeb , Eldin Othman Omar Musa Izz 
Published: January 2022

AbstractBackgroundDiabetes mellitus Type 2 is a chronic metabolic disorder characterized by insulin insensitivity that leads to a decrease in glucose transport into the other cells. Many drugs are being developed, while no cure is available regarding to this disease although, there are limitations due to high cost and certain side effects. The Traditional Medicines are preferred due to lesser side effects and low cost. Acacia species have wide traditional medicinal using as anti-diabetic, antimicrobial, and anti-inflammatory activities.ObjectiveThe study aimed to examine the effect of ethanolic extract of Acacia Seyal bark in induced diabetic rats.Materials and methodsAcacia Seyal bark was extracted in ethanol 80%. The Ethanolic extract was analyzed for phytochemicals screening tests using standard methods. To investigate the effect of the extract thirty induced diabetic albino rats introduced by injection of glucose 2g\kg were divided to 5 groups equally; Group 1 was treated with 10mg\kg of glibenclamide, group 2 left as control treated with distilled water 10mg\kg, Group 3 was treated with 200mg of plant extract, Group 4 was treated with 400mg of plant extract, and Group 5 was treated with 800mg of plant extract. The Glucose Tolerant Test were done after 1 hour, 2 hour and 4 hour to determine blood glucose level of rats. Estimation of in vitro glucose uptake by rat diaphragm experiment was done to evaluate the glucose utilization capacity of extract.ResultsThe effect of different concentration of ethanolic extract of Acacia Seyal bark on the blood glucose level of diabetic induced rats is significantly different (0.05 p 0.01 <p). The phytochemical screening of extract indicated the presence of Saponin, Tannins Steroids, Triterpens, and Anthraquinone, While the absence of flavonoids. In vitro glucose consumption by diaphragm study the level of utilized glucose from the media is 69.4% in the presence of extract compared to control group.ConclusionStudy concluded that the ethanolic bark extract of A. seyal showed significant anti-diabetic activity. This results might have a great potential for translation to humans and the obtained data might set the stage for clinical trials investigating the effects of anti-diabetic effect in patients with diabetes mellitus type2. In the best of our knowledge, this is the first study that has conducted to study the anti-diabetics effect of ethanolic extract of Acacia Seyal bark in diabetic rats.