A Review of Craniofacial Training Programs in North America

FACE ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 11-20
Author(s):  
Stefanie Hush ◽  
Joseph K. Williams
Keyword(s):  
Craniofacial Surgery ◽  
Facial Trauma ◽  
Ear Reconstruction ◽  
Facial Skeleton ◽  
Skill Sets ◽  
Group 6 ◽  
Facial Reanimation ◽  
Fellowship Programs ◽  
Case Logs ◽  
Group 1

Introduction: The specialty of craniofacial surgery has expanded rapidly since the landmark surgeries of Dr. Paul Tessier. The expansion of fellowship programs over the last 50 years has been seen in both numbers and structure. This growth has been complemented by the continued expansion of skill sets that fellows are experiencing. However, the exposure to these skill sets are varied. The study had 2 objectives: (1) Create a clearer picture of the skill sets that fellows are exposed to during training and (2) provide some threshold of case numbers shared by programs that may be used to establish shared expectations for the fellow’s experience. Method: A comprehensive database was created and placed on the webpage for the American Society of Craniofacial Surgery (ASCFS). Fellows in the year 2017 to 2018 were asked to input their case logs. The cumulative data base was categorized into 9 groupings, capturing surgeries of the facial skeleton, cleft surgeries and specialty surgeries in the area of microsurgery, facial reanimation, and ear reconstruction. These 9 groupings were used to establish 3 tiers that provided an opportunity to discover thresholds of experience that captured consistent skill sets for the majority of the programs. Results: A total of 6018 cases were entered into the cumulative database of which 3469.5 cases were placed into 9 specified groups. Group 1 (craniosynostosis) had 578 cases (mean = 30.4, SD = 22.3). Sixteen of the 19 programs participating (84.2%) were found to be at or above the 20th percentile ranking for this procedure (20th percentile = 10 cases). Group 2 consisted of Mandibular distraction (144 cases), Group 3 midface skeletal surgeries (87), Group 4 facial trauma (641.5), Group 5 orthognathic surgery (506), Group 6 cleft surgeries (1303.5), Group 7 microsurgery (67), Group 8 facial reanimation (40.5), and Group 9 ear reconstruction (113). Percentile rankings were found for each group. Three tiers were created for comparison, Tier 1 (group 1), Tier 2 (groups 2-6), Tier 3 (groups 7-9). When a 20th percentile threshold for case numbers was created for groups 1 to 5, 77.9% of all programs met this criteria (95% CI: 63.7%-92.1%). When group 6 was included 78.9% of programs met the 20th percentile (95% CI: 67.9%-90.0%). Conclusion: Fellows are receiving consistent exposure to areas of training related to manipulation of the facial skeleton with the exception of midface surgeries. The study also demonstrates a significant volume of both cleft surgery and facial trauma. The majority of the participating programs meet a threshold of 20% for skill sets associated with our subspecialty. These thresholds could be used as guides by fellowship programs and the ASCFS to better monitor our training goals.

scholarly journals Association between serum oestradiol level on the hCG administration day and neonatal birthweight after IVF-ET among 3659 singleton live births

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu Liu ◽  
Jing Li ◽  
Wanyu Zhang ◽  
Yihong Guo
Keyword(s):  
Birth Weight ◽  
Ovarian Stimulation ◽  
Group 4 ◽  
Group 6 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
The Impact ◽  
Ivf Et ◽  
Group 1

AbstractOestradiol, an important hormone in follicular development and endometrial receptivity, is closely related to clinical outcomes of fresh in vitro fertilization-embryo transfer (IVF-ET) cycles. A supraphysiologic E2 level is inevitable during controlled ovarian hyper-stimulation (COH), and its effect on the outcome of IVF-ET is controversial. The aim of this retrospective study is to evaluate the association between elevated serum oestradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration and neonatal birthweight after IVF-ET cycles. The data of 3659 infertile patients with fresh IVF-ET cycles were analysed retrospectively between August 2009 and February 2017 in First Hospital of Zhengzhou University. Patients were categorized by serum E2 levels on the day of hCG administration into six groups: group 1 (serum E2 levels ≤ 1000 pg/mL, n = 230), group 2 (serum E2 levels between 1001 and 2000 pg/mL, n = 524), group 3 (serum E2 levels between 2001 and 3000 pg/mL, n = 783), group 4 (serum E2 levels between 3001 and 4000 pg/mL, n = 721), group 5 (serum E2 levels between 4001 and 5000 pg/mL, n = 548 ), and group 6 (serum E2 levels > 5000 pg/mL, n = 852). Univariate linear regression was used to evaluate the independent correlation between each factor and outcome index. Multiple logistic regression was used to adjust for confounding factors. The LBW rates were as follows: 3.0% (group 1), 2.9% (group 2), 1.9% (group 3), 2.9% (group 4), 2.9% (group 5), and 2.0% (group 6) (P = 0.629), respectively. There were no statistically significant differences in the incidences of neonatal LBW among the six groups. We did not detect an association between peak serum E2 level during ovarian stimulation and neonatal birthweight after IVF-ET. The results of this retrospective cohort study showed that serum E2 peak levels during ovarian stimulation were not associated with birth weight during IVF cycles. In addition, no association was found between higher E2 levels and increased LBW risk. Our observations suggest that the hyper-oestrogenic milieu during COS does not seem to have adverse effects on the birthweight of offspring after IVF. Although this study provides some reference, the obstetric-related factors were not included due to historical reasons. The impact of the high estrogen environment during COS on the birth weight of IVF offspring still needs future research.

scholarly journals Melatonin attenuates ovarian ischemia reperfusion injury in rats by decreasing oxidative stress index and peroxynitrite

2020 ◽  
Vol 50 (6) ◽  
pp. 1513-1522
Author(s):  
Şenol KALYONCU ◽  
Bülent YILMAZ ◽  
Mustafa DEMİR ◽  
Meltem TUNCER ◽  
Zehra BOZDAĞ ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Stress Index ◽  
Oxidative Stress Index ◽  
Group 6 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background/aim: To evaluate the protective effect of melatonin on ovarian ischemia reperfusion injury in a rat model. Materials and methods: Forty-eight rats were separated equally into 6 groups. Group 1: sham; Group 2: surgical control with 3-h bilateral ovarian torsion and detorsion; Group 3: intraperitoneal 5% ethanol (1 mL) just after detorsion (as melatonin was dissolved in ethanol); Group 4: 10 mg/kg intraperitoneal melatonin 30 min before 3-h torsion; Group 5:10 mg/kg intraperitoneal melatonin just after detorsion; Group 6:10 mg/kg intraperitoneal melatonin 30 min before torsion and just after detorsion. Both ovaries and blood samples were obtained 7 days after detorsion for histopathological and biochemical analysis.Results: In Group 1, serum levels of total oxidant status (TOS) (μmol H2O2 equivalent/g wet tissue)were significantly lower than in Group2 (P = 0.0023), while tissue TOS levels were lower than in Group 3 (P = 0.0030). Similarly, serum and tissue levels of peroxynitrite in Group 6were significantly lower than those ofGroup 2 (P = 0.0023 and P = 0.040, respectively). Moreover, serum oxidative stress index (OSI) (arbitrary unit) levels were significantly increased in Group 2 when compared to groups 1 and 6 (P = 0.0023 and P= 0.0016, respectively) and in Group 3 with respect to groups 1, 4, 5, and 6 (P = 0.0023, P = 0.0026, P = 0.0008, and P = 0.0011, respectively). Furthermore, there was a significant decrease in histopathological scores including follicular degeneration, vascular congestion, hemorrhage, and inflammation in the melatonin and sham groups in comparison with control groups. Additionally, primordial follicle count was significantly higher in Group 6 than in Group 2 (P = 0.0002).Conclusion: Melatonin attenuates ischemia reperfusion damage in a rat torsion/detorsion model by improving histopathological and biochemical findings including OSI and peroxynitrite.

A Survey of Craniofacial Fellowships in North America: The Craniofacial Fellowship Experience Outside of the Operating Room

FACE ◽  
2020 ◽  
Vol 1 (2) ◽  
pp. 114-123
Author(s):  
Jenny Lee Nguyen ◽  
Colin M. Brady ◽  
Joseph K. Williams
Keyword(s):  
Operating Room ◽  
Online Survey ◽  
International Experience ◽  
Craniofacial Surgery ◽  
Core Faculty ◽  
Multidisciplinary Clinic ◽  
Fellowship Programs ◽  
Program Characteristics ◽  
Similar Experience ◽  
Educational Meetings

Residencies are governed by the Accreditation Council for Graduate Medical Education’s (ACGME) common program requirements to help ensure that residents are adequately trained to practice medicine independently. Fellowships either rely on ACGME accreditation for standardization, have developed their own specialty accreditation councils, or have no governing body to monitor programs, such as in craniofacial surgery. This study was designed to capture the clinical, educational, and scholarly experiences of craniofacial fellows to better understand the current craniofacial fellowship landscape. An anonymous online survey was sent to all North American craniofacial surgery fellowship program directors via email. The first question group focused on program characteristics: ACGME accreditation, core faculty, and patient population. The second question group focused on the fellow’s scholarly experience: educational meetings and research requirements. The third question group focused on the fellow’s non-operative experience: clinic participation and call experience. The fourth question group focused on the fellow’s international experience. A total of 22 of 31 programs directors (71%) responded to the survey. The majority of fellowship programs (95.5%) had an educational program of meetings. The majority of programs (82.8%) mandated clinic time for the fellows. Five programs (22.7%) had a fellow’s clinic. The majority of fellowship programs (95.5%) had research expectations for the fellow. Call type and frequency varied widely between fellowship programs. Less than half (47.6%) of programs had an international experience for the fellow. Three-fourths of fellows only interacted with subspecialties of the cleft and craniofacial multidisciplinary clinic during clinic time. A total of 16 fellowship programs (72.7%) were non-ACGME accredited. Despite rapid growth in craniofacial fellowships and a lack of current oversight as to content, programs provide a similar experience for fellows outside of the operating room. Areas for further discussion regarding standardizing programs may include international experiences and formal exposure to other disciplines within the cleft and craniofacial clinic.

EFFECT OF TREATMENT WITH STREPTOKINASE AND HEPARIN ON FIBRINOGEN, FIBRIN AND RELATED PROTEINS IN ACUIE MYOCARDIAL INFARCTION (/ME) PATIENTS

1987 ◽  
Author(s):  
V Vila ◽  
E Reganon ◽  
J Aznar ◽  
V Lacueva ◽  
M Ruano
Keyword(s):  
Degradation Products ◽  
Heparin Therapy ◽  
Heparin Group ◽  
Normal Value ◽  
Group 4 ◽  
Group 6 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

The properties of fibrinogen and fibrin, the levels of fibrincpeptide A (FPA) and fibrin(ogen) degradation products (FDP) were studied in 34 patients with AMI who were undergoing thrombolytic and heparin therapy. They were classified into 6 groups accordingto their stage of treatment: group 1, before intravenous administration of 800.000 U streptokinase over 30 min; group 2, after a<Mnistraticn of SK but before adninistraticn of heparin; group 3, during 24 h ofthe 5 ng/h heparin continuous infusion; group 4, during 48-72 h of the 16.6 ng/h heparin continuous infhsion; group 5, after 1 week of administration of SK and with a bolus inyection of 50 rg heparin every 4 h; group 6, patients who were undergoing only heparin treatment. The Fg 1/ Fg II ratio varies during treatment with SK and heparin. In group 1 a sligjnt increase (2.5) is observed. Group 2 shows a significantdecrease (0.6) as a result of fibrinolysis. In group3 the ratio reaches normal value (1.8) while in the fourth group it is twice the normal value (4). The value for group 5 is nearly normal (2.1), and in group 6 it reaches values similar to those obtained in group 4, which implies that the rise in the Fgl/Fgll ratio is not a result of fibrinolytic treatment. TheFPA level shows and increase in patients with AMI (group 1,126 ng/ml). When SK treatment is applied (group 2), FPA decreases to 52 ng/ml. Later treatment with heparin (group-3, 82; group-4, 44 and group-5, 81ng/ml) does not neutralize thrcmbinic activity. Patients treated only with heparin (group 6) show an FPAvalue of 19 ng/ml, which is lower than in the other groups. All of this indicates that thrombin is activated after fibrinolytic treatment. FDP values show asignificant increase in the six groups (1, 53; 2, 430; 3, 128; 4, 270; 5, 139 and 6, 141 ug/ml), which indicates that during treatment with heparin the fibrinolytic activity persists. he formation of highly cross-linked fibrin is altered in groups 1,2,3 and 4,as a consequence of circulating FDP effect and fibrincgeno- lysis.The permeability of the fibrin clotdecreases in groups 1 (0.42), 2 (1.3), 4 (1.1) and 5(0.5 ml/s/ng) and increases in group 2 (23.2 ml/s/nig) with respect to the normal plasma value (3.2 ml/s/nrg). The decrease in permeability must be related to the existence of hypercoagulability resistant to heparinization. FPA values, tine Fgl/Fgll ratio, andfibrin permeability can be used to evaluate the degree of thrcmbin activity during thrombolytic treatmentinAMI.

Species groups of Oriental Ptecticus Loew including descriptions of ten new species with a revised identification key to the Oriental species (Diptera: Stratiomyidae)

Zootaxa ◽  
2009 ◽  
Vol 2034 (1) ◽  
pp. 1-30 ◽  
Author(s):  
RUDOLF ROZKOŠNÝ ◽  
MARTIN HAUSER
Keyword(s):  
New Species ◽  
Southern China ◽  
The Philippines ◽  
Junior Synonym ◽  
Identification Key ◽  
Group 4 ◽  
Group 6 ◽  
Group 3 ◽  
Species Groups ◽  
Group 1

The species of Oriental Ptecticus are reviewed and ten species are described: P. artocarpophilus sp. nov. from the Philippines; P. bannapensis sp. nov., P. kubani sp. nov. and P. subaurifer sp. nov. from Laos; P. elegans sp. nov. and P. semimetallicus sp. nov. from Nepal; P. fukienensis sp. nov. from southern China; P. indicus sp. nov. from India; and P. infuscatus sp. nov. and P. sarawakensis sp. nov. from Borneo. Five new synonymies are proposed: P. minimus Rozkošný & Kovac, 1997 is a junior synononym of P. shirakii Nagatomi, 1975; P okinawae James, 1950 is a junior synonym of P. aurifer (Walker, 1854); P. tenebrifer (Walker, 1849) is a junior synonym of P. japonicus (Thunberg, 1789); P. wulpii Brunetti, 1907 is a junior synonym of P. melanurus (Walker, 1848), and P. zhejiangensis D. Yang & C. Yang, 1995 is a junior synonym of P. kerteszi de Meijere, 1924. Eight species groups for the Oriental Ptecticus species are defined: aurifer group (6 spp.), australis group (9 spp.), cingulatus group (11 spp.), histrio group (7 spp.), longipennis group (6 spp.), shirakii group (1 sp.), japonicus group (4 spp.), tricolor group (3 spp.) and 5 species remain unplaced. A new identification key to the Oriental Ptecticus species, including references to the published figures of distinguishing characters and basic distributional data, is given.

Estudo de fraturas nos taludes de corte, em rocha vulcânica, ao longo da BR 158, Santa Maria, RS

1999 ◽  
Vol 21 (21) ◽  
pp. 97
Author(s):  
Andrea V. Nummer ◽  
Luis Eduardo S. Robaina ◽  
Marcos Geovane Berger
Keyword(s):  
Conditioning Factors ◽  
Weathering Processes ◽  
Group 4 ◽  
Group 6 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Road Data ◽  
Santa Maria ◽  
Group 1

Weathering processes and jointing degree are the conditioning factors for rock falI.The fractured volcanic lithologies from Santa Maria, RS, Brazil, were studied along the BR 158 road. Data was gathered through the Scanline method from BRADY & BROWN (1985) and analyzed by vector statistics.Six main jointing groups were defined, associated to rock cooling and shrinking. Main attitudes are: Group 1: 348;83; Group 2: 174;82; Group 3: 85;76; Group 4: 265;75; Group 5: 300;42 and Group 6: 121 ;53.

scholarly journals Replacement of vitamin-mineral premix by Spirulina and its effect on the performance of broiler

2018 ◽  
Vol 2 ◽  
pp. 39
Author(s):  
Shahinur Nahar Moury ◽  
Md. Touhiduzzaman Sarker ◽  
Adhita Sri Prabakusuma ◽  
Md. Imrul Hasan Russel ◽  
Md. Shahidul Islam
Keyword(s):  
Negative Control Group ◽  
Negative Control ◽  
Control Group ◽  
Feed Conversion ◽  
Final Body Weight ◽  
Group 4 ◽  
Group 6 ◽  
Group 5 ◽  
And Control ◽  
Group 1

The main purpose of this study was to explore the effects of Spirulina (Spirulina platensis) as a feed supplement by replacing Vitamin-Mineral Premix on the performance of broiler. The study explored that final body weight was 1039, 1070, 1044, 1065, 1117 and 893 g/bird in group 1, 2, 3, 4, 5 and 6 where significantly (p<0.5) higher weight observed in Spirulina group (5) but lower in negative control group (6). Feed intake observed more or less similar in all groups (1483±24g; p>0.5). Feed conversion ratio (kg FI/kg LWG) observed significantly different like 1.72, 1.65, 1.69, 1.62, 1.61 and 1.99 in group 1, 2, 3, 4, 5 and 6 respectively (p<0.5) where higher in negative group (6) and control group (1), but is lowest and similar in 75% Spirulina group (4) and highest (100%) Spirulina group (5). %Ash of different dietary groups were 46.35, 46.54, 48.93, 49.93, 55.07 and 46.92 of group 1, 2, 3, 4, 5 and 6 respectively. The %ash of bone was gradually increased among dietary groups and the best result was obtained in 100% Spirulina group 5 (55.07). It also revealed that diets containing no vitamin-mineral premix with 100% Spirulina improve the performance of broiler. The findings suggest that poultry farmer can use spirulina as a feed item for broiler for more yield.

scholarly journals Effect of Aqueous Extract of Tribulus terrestris orally administration on some Biochemical Parameters in Castrated Male Rabbits

2012 ◽  
Vol 36 (2) ◽  
pp. 217-221
Author(s):  
Abeer Uthman Moosa
Keyword(s):  
Aqueous Extract ◽  
Biochemical Parameters ◽  
Iron Concentration ◽  
Iron Phosphate ◽  
Tribulus Terrestris ◽  
Biochemical Tests ◽  
Group 6 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

The present study is aimed to investigate the influence of an aqueous extract of Tribulus terrestris on some biochemical parameters namely, alkaline phosphatase (ALP), Iron, phosphate (PO4), sodium (Na+), potassium (K+), aldosterone, and cortico steroid in unilateral and bilateral castrated male rabbits. Thirty mature male rabbits which are divided randomly in to six groups. group 1: is control, group2: orally administrated 150 mg / kg / day of an aqueous extract of T. terrestris, group3: is bilateral castrated rabbits received D. W., group4: is bilateral castrated rabbits received (150 mg / kg / day) of the extract, group 5: unilateral castrated rabbits received D. W., group 6 is unilateral castrated rabbits received 150 mg / kg / day of the extract, all doses were given orally every day for 30 days. At the end of the experiment, sera were collected and biochemical tests measured. The results showed a significant (P<0.05) increased in ALP level in group 2 and in PO4 level in group 5 in comparison with group1, while PO4 level tended to be decreased significantly (P<0.05) in group 6 when it compared with group 5. The results also showed a significant(P<0.05) increased in (K+) and (Na+) in group 2 and group 6 in comparison with group1 while there was a significant(P<0.05) decreased in (K+) and (Na+) in group 4 when it compared with group 2. In addition there was a significant (P<0.05) increased in aldosterone concentration in group 6 compared with group 1 and group 2. While there was a significant decreased in cortico steroid concentration in group 3 , 5 and 2 compared with group 1 but the cortico steroid showed a significant (P<0.05) increased in group 6 compared with group 1. There were no significant differences between groups concerning the iron concentration.

scholarly journals Orbital abscess after facial trauma

2009 ◽  
Vol 20 (4) ◽  
pp. 341-346 ◽  
Author(s):  
Elis Cristina Sousa Serra ◽  
Cassio Edvard Sverzut ◽  
Alexandre Elias Trivellato
Keyword(s):  
Hospital Admission ◽  
Clinical Findings ◽  
Facial Trauma ◽  
Ocular Motility ◽  
Facial Skeleton ◽  
Rapid Improvement ◽  
Orbital Abscess ◽  
Ocular Movements ◽  
Normal Ranges ◽  
The Right

This paper reports a rare case of acute severe orbital abscess manifested 2 days after a facial trauma without bone fracture in a 20-year-old Afro-American female. The symptoms worsened within the 24 h prior to hospital admission resulting in visual disturbances such as diplopia and photophobia. The clinical findings at the first consultation included fever, periorbital swelling and redness, ptosis, proptosis and limitation of ocular movements upwards, downwards, to the right and to the left. Computed tomography scan showed proptosis with considerable soft tissue swelling on the left side and no fracture was evidenced in the facial skeleton, including the zygomatic-orbital complex. After hospital admission and antibiotic therapy intravenously the patient was conducted to the operation room and submitted to incision and drainage under general anesthesia. The orbit was approached thorough both eyelids and the maxillary sinus was reached only through the Caldwell-Luc approach. The postoperative period was uneventful and the rapid improvement of symptoms was remarkable. Visual acuity and ocular motility returned to the normal ranges within 2 days after the surgical intervention. After 12 postoperative days, the patient presented with significative improvement in the ptosis and proptosis, and acceptable scars.

scholarly journals Sports-Related Pediatric Facial Trauma: Analysis of Facial Fracture Pattern and Concomitant Injuries

2019 ◽  
Vol 05 (04) ◽  
pp. e146-e149 ◽  
Author(s):  
Andrew A. Dobitsch ◽  
Nicholas C. Oleck ◽  
Farrah C. Liu ◽  
Jordan N. Halsey ◽  
Ian C. Hoppe ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Skull Fracture ◽  
Management Strategies ◽  
Nasal Bone ◽  
Fracture Pattern ◽  
University Hospital ◽  
Facial Trauma ◽  
Facial Fractures ◽  
Facial Skeleton ◽  
Concomitant Injuries

Abstract Objective Sports-related injuries, such as facial fractures, are potentially debilitating and may lead to long-term functional and aesthetic deficits in a pediatric patient. In this study, we analyze sports-related facial fractures in the urban pediatric population in an effort to characterize patterns of injury and improve management strategies and outcomes. Methods Retrospective chart review was performed for all facial fractures resulting from sports injuries in the pediatric population at a level-1 trauma center (University Hospital, Newark, NJ). Results Seventeen pediatric patients were identified as having sustained a fracture of the facial skeleton due to sports injury. Mean age was 13.9 years old. A total of 29 fractures were identified. Most common fracture sites included the orbit (n = 12), mandible (n = 5), nasal bone (n = 5), and zygomaticomaxillary complex (n = 3). The most common concomitant injuries included skull fracture (n = 3), intracranial hemorrhage (n = 4), and traumatic brain injury (n = 4). One patient was intubated upon arrival to the emergency department. Hospital admission was required in 13 patients, 4 of which were admitted to an intensive care setting. Nine patients required operative intervention. Mean length of hospital stay was 2.4 days. No patients were expired. Conclusions Sports-related facial fractures are potentially debilitating injuries in the pediatric population. Analysis of fracture pattern and concomitant injuries is imperative to develop effective management strategies and prevention techniques.

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