bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness and safety of electroacupuncture and its cotreatment with electronic moxibustion in the treatment of patients with moderate benign prostatic hyperplasia using alpha blocker
Authors: Kim Hyo Bin , Kim Young Il , Jeon Ju Hyun , Kim Eunseok , Kim Jin Youp , Kwon Ojin , Choi Young Eun , Yang Changsop , Han Chang-Hyun
Published: April 2020

Background:

Benign prostatic hyperplasia (BPH) is a medical condition that affects the quality of life by causing lower urinary tract symptoms (LUTS) in 40% to 70% of men aged ≥60 years. Medication treatment is primarily recommended for patients with BPH if their symptom score based on the International Prostate Symptom score (IPSS) is above the moderate level. However, electroacupuncture (EA) and electronic moxibustion (EM), one of the most recent complementary and alternative treatments, are suggested as adjuvant treatments in the improvement of LUTS caused by BPH with respect to the limitations of medication treatments, such as side effects or no improvement in LUTS despite treatment. Therefore, this study aimed to evaluate the effectiveness and safety of EA and its cotreatment with EM for the improvement of LUTS in patients diagnosed with BPH using an alpha blocker but with moderate symptoms on the basis of IPSS.

Methods/design:

This protocol is a 2-arm parallel-design, randomized, controlled assessor-blinded clinical trial. Seventy-eight patients diagnosed with BPH are randomized to one of the following groups: [EA and its cotreatment with EM + alpha blocker group] and [alpha blocker group]. [EA and its cotreatment with EM + alpha blocker group] continues to use the previously prescribed alpha blocker and visits the study institution 3 times a week for 6 weeks to receive the cotreatment of EA and EM. [Alpha blocker group] continues to use the previously prescribed alpha blocker for 6 weeks. To evaluate the effectiveness of the EA and its cotreatment with EM, the followings are measured: total score of the IPSS, IPSS quality of life assessment, EuroQol-Five dimension, maximum and average urinary flow rate (Qmax and Qave), and prostate size at the baseline, 3rd, 6th, and 12th weeks. The primary effectiveness endpoint measures the average change in the total score of the IPSS at the 6th week. Side effects are recorded at each visit.

Discussion:

The results of this study are expected to provide useful information on the effectiveness and safety of the EA and its cotreatment with EM for patients with BPH with regard to the improvements in LUTS.

Trial registration:

Clinical Research Information Service of Republic of Korea (CRIS-KCT0004411), October 31, 2019.
Celecoxib vs diclofenac sodium in patients with knee osteoarthritis
Authors: Huang Hetao , Pan Jianke , Yang Weiyi , Chen Hongyun , Liang Guihong , Zeng Lingfeng , Liu Jun , Pan Biqi
Published: April 2020

Background:

Knee osteoarthritis (KOA) is one of the most common chronic muscular diseases in old people. The purpose of this meta-analysis was to compare celecoxib and diclofenac sodium in patients with knee osteoarthritis (KOA).

Methods:

Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing the use of celecoxib and diclofenac sodium in KOA patients were retrieved from each database from the date of database inception to September 2019. The outcome measurements were the treatment effect, visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and complication rate. The pooled data were evaluated with Review Manager 5.3.5.

Results:

The literature will provide a high-quality analysis of the current evidence supporting celecoxib for KOA based on various comprehensive assessments including the treatment effect, visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and complication rate.

Conclusion:

This proposed systematic review will provide up-to-date evidence to assess the effect of celecoxib in the treatment for patients with KOA.

Research Registry registration number:

reviewregistry827.
Acupuncture for erectile dysfunction in post-stroke patients
Authors: Li Yanfeng , Yu Xudong , Liu Ruijia , Wang Jisheng , Deng Sheng , Liu Bowen , Zhang Chongyang , Li Haisong
Published: April 2020

Introduction:

Erectile dysfunction refers to the continued inability of the penis to reach and maintain sufficient erections to achieve a satisfactory sex life and last at least 6 months. As part of traditional Chinese medicine, acupuncture has been widely used in clinical practice. In order to evaluate, the exact effect of acupuncture on the clinical efficacy of patients with Post-stroke Erectile dysfunction (PSED), this experiment uses randomized controlled experiments.

Methods/design:

This pragmatic randomized controlled trial will recruit 103 patients who are diagnosed with PSED. Simple randomization to conventional treatment with a 1:1 allocation ratio will be used. Ten 30-min acupuncture sessions will be provided to patients assigned to the Intervention group. All participants will continue to receive conventional treatment. The selection of outcomes will be evaluated by International Erectile Function Index-5 (IIEF-5) score at week 8.

Discussion:

This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of acupuncture for patients with PSED.

Trial registration:

ClinicalTrials.gov, ChiCTR2000030231, Registered on February 25, 2020.
Case report of an unusual presentation of Staphylococcus aureus induced toxic shock syndrome/hyperimmunoglobulinemia E syndrome
Authors: Jacob Harry S. , Vercellotti Gregory M. , Leung Donald Y.M. , Schlievert Patrick M.
Published: April 2020

Rationale:

Toxic shock syndrome (TSS) typically is an acute onset multi-organ infection caused by TSS toxin-1 producing Staphylococcus aureus. Herein we describe a highly unusual case report.

Patient concerns:

A male patient self-referred to the University of Minnesota Hospital with a chronic history of S aureus infection with accompanying fever, hypotension, and nonhealing, football-sized lesion on his leg.

Diagnosis:

An unusual case presentation of TSS/hyperimmunoglobulin E syndrome is described. The patient had a leg wound from which TSS toxin-1 S aureus was isolated. The patient exhibited characteristic skewing of T cells to those with variable region, β-chain T cell receptor-2. Other patients have been seen with related presentations.

Interventions:

The following therapeutic regimen was instituted: vigorous antibacterial scrubs several times daily plus intravenous Ancef 3 days each month; intravenous infusions of immunoglobulin G infusions (28 gm) every 3 weeks; and weekly subcutaneous injections of recombinant granulocyte colony-stimulating factor.

Outcome:

Improvement was obvious within 3 months: no further cellulitic episodes occurred; the patient regained 95 pounds in 9 months; blanching and cyanosis of fingers disappeared within 3 months as did intractable pain although mild hypesthesias continued for 2 years; erythroderma resolved, and repeat skin biopsies performed after 2 years no longer demonstrated T cell receptor skewing. Although IgE levels have not completely returned to normal, the patient remains in excellent health.

Lessons:

We propose that staphylococcal TSST-1 was responsible for the serious problems suffered by this patient as suggested by the following features: rapid onset of chronic, life-threatening, disorder that began with an episode of staphylococcal sepsis; the extraordinary elevation of IgE levels in this previously non-atopic individual; the acquired severe granulocyte chemotactic defect that accompanied this hyperimmunoglobulinemia (“Job Syndrome”) with its accompanying wound-healing defect; and the striking diffuse erythroderma, including palmar erythema (“Red Man Syndrome”) with hypotension and fever that also characterizes TSS.
Intraductal Tubulopapillary Neoplasm of the Pancreas and Bile Duct
Authors: Kuan Li Lian , Dennison Ashley R. , Garcea Giuseppe
Published: April 2020

Intraductal tubulopapillary neoplasms (ITPNs) of the pancreas and bile duct are contemporary entities. It is unclear on how to best manage patients with this diagnosis because little is known about its progression to cancer. This review provides an update on the current knowledge of ITPN of the pancreas and bile duct with an overview of clinical, radiological, histopathological, and molecular features, as well as the prognosis and management. Embase and Medline databases search were performed to identify studies that evaluated ITPN of the pancreas and bile duct. The infrequent exposure to this variant poses a diagnostic challenge. The diagnosis of ITPN is almost always made postoperatively because there are no characteristics on radiological studies to distinguish it from other cystic neoplasms of the pancreas. As ITPN has a favorable prognosis, it is crucial to establish an accurate diagnosis and differentiate it from other pancreatic and biliary variants. These neoplasms are considered to be precursor lesions to carcinomas, hence, surgery and close clinical surveillance are recommended. Further studies are essential to elucidate the natural history of ITPN, guide best treatment strategy and determine disease recurrence and survival.
Roles of Autophagy and Pancreatic Secretory Trypsin Inhibitor in Trypsinogen Activation in Acute Pancreatitis
Authors: Hirota Masahiko , Ohmuraya Masaki , Hashimoto Daisuke , Suyama Koichi , Sugita Hiroki , Ogawa Michio
Published: April 2020

The focus of the review is on roles of autophagy and pancreatic secretory trypsin inhibitor (PSTI), an endogenous trypsin inhibitor, in trypsinogen activation in acute pancreatitis. Acute pancreatitis is a disease in which tissues in and around the pancreas are autodigested by pancreatic digestive enzymes. This reaction is triggered by the intrapancreatic activation of trypsinogen. Autophagy causes trypsinogen and cathepsin B, a trypsinogen activator, to colocalize within the autolysosomes. Consequently, if the resultant trypsin activity exceeds the inhibitory activity of PSTI, the pancreatic digestive enzymes are activated, and they cause autodigestion of the acinar cells. Thus, autophagy and PSTI play important roles in the development and suppression of acute pancreatitis, respectively.
Alteration of Transforming Growth Factor β Signaling Pathway Predicts Worse Prognosis in Pancreatic Ductal Adenocarcinoma
Authors: Li Mao , Li Ang , Zhao Xiaochen , Hou Shengzhong , Lu Shan , Mou Yu , Liu Xubao , Cai Shangli , Cao Dan , Tian Bole
Published: April 2020

Objectives

Transforming growth factor β (TGF-β) signaling pathway is one of the core pathways in pancreatic ductal adenocarcinoma (PDAC). Prognostic value of TGF-β pathway genes as a functionally related group in PDAC is rarely studied.

Methods

Seventy-two PDAC patients who underwent surgery between November 30, 2015, and September 13, 2017, in West China Hospital, Sichuan University, were identified and included in this study. Whole-exome sequencing or targeted next-generation sequencing was performed with tumor tissue. Clinicopathologic characteristics and survival data were retrospectively collected and analyzed.

Results

Genetic alterations were detected in 71 patients (98.6%). Although 1 patient (1.4%) had one genetic alteration, 33 patients (45.8%) had 2 to 4 alterations and 37 patients (51.4%) had 5 or more alterations. Twenty-five patients with TGF-β pathway alteration were identified as TGF-βm+ group. Other 47 patients were TGF-βm− group. Mutation of TGF-β pathway was independently associated with inferior survival (hazard ratio, 2.22, 95% confidence interval, 1.05–4.70, P = 0.04), especially in patients accepting radical surgery (hazard ratio, 3.25, 95% confidence interval, 1.01–10.49, P = 0.04).

Conclusions

Inferior prognosis was observed in PDACs with mutations of TGF-β pathway. Genomic information could help screen out patients at risk after surgery, and adjuvant therapy might benefit this subgroup of PDACs.
Endoscopic Ultrasound Criteria for Arterial Invasion in Pancreatic Cancer of the Body and Tail
Authors: Yamato Mutsumi , Mikata Rintaro , Yasui Shin , Iino Yotaro , Shingyoji Ayako , Kusakabe Yuko , Ohyama Hiroshi , Sugiyama Harutoshi , Sakai Yuji , Tsuyuguchi Toshio , Yoshitomi Hideyuki , Ohtsuka Masayuki , Kishimoto Takashi , Kato Naoya
Published: April 2020

Objectives

We aimed to determine the difference in endoscopic ultrasonography (EUS) images between portal vein (PV) and arterial invasion of pancreatic cancer and to develop criteria for arterial involvement.

Methods

We reviewed EUS data of consecutive patients who underwent distal pancreatectomy from December 2010 to May 2017. We categorized the tumor-vessel relationship into 4 and 5 types, respectively, for the PV and arteries: (a) clear separation between tumor and vessel; (b) tumor border at vessel, echo-rich vessel wall uninterrupted; (c) echo-rich vessel wall interrupted; (d) vessel contour irregularity; and (e) arterial wall thickening or echogenic band surrounding the artery. We compared EUS outcomes with surgical and pathological results.

Results

Overall, 56 patients underwent distal pancreatectomy, of whom 22 received en bloc celiac axis resection. The pathological invasion rates of PVs and arteries were 46.2% and 0% in (c), and 72.5% and 42.4% in (d) (P = 0.046, P = 0.016), respectively. The overall sensitivity and specificity were 92.1% and 83.2%, respectively, for diagnosing venous invasion and 70.0% and 84.4%, respectively, for arterial invasion.

Conclusions

Different EUS criteria may be necessary for diagnosing arterial and portal venous invasions. Criterion (d) might be appropriate for diagnosing arterial invasion.
Nonaggressive Versus Aggressive Intravenous Fluid Therapy in Acute Pancreatitis With More Than 24 Hours From Disease Onset
Authors: Cuéllar-Monterrubio Jesús Eduardo , Monreal-Robles Roberto , González-Moreno Emmanuel I. , Borjas-Almaguer Omar D. , Herrera-Elizondo José Luis , García-Compean Diego , Maldonado-Garza Héctor J. , González-González José Alberto
Published: April 2020

Objective

This study aimed to compare a “nonaggressive” hydration versus an “aggressive” hydration using Hartmann's solution in patients with acute pancreatitis (AP) with more than 24 hours from disease onset.

Methods

We included 88 patients with AP with more than 24 hours from disease onset, and were randomized into 2 groups. Group I (n = 45) received a nonaggressive hydration (Hartmann's solution at 1.5 mL kg−1h−1for the first 24 hours and 30 mL kg during the next 24 hours), and group II (n = 43) received an aggressive hydration (bolus of Hartmann's solution 20 mL kg, followed by an infusion of 3 mL kg−1h−1for the first 24 hours and then 30 mL kg for the next 24 hours).

Results

The mean volume of fluid administered was greater in group II (P< 0.001). We did not find differences when comparing both groups in reference to persistent systemic inflammatory response syndrome (P= 0.528), pancreatic necrosis (P= 0.710), respiratory complications (P= 0.999), acute kidney injury (P= 0.714), or length of hospital stay (P= 0.892).

Conclusions

Our study suggests that the clinical evolution of patients with AP with more than 24 hours from disease onset is similar using an aggressive or nonaggressive hydration.
FOLFIRINOX for Advanced Pancreatic Cancer Patients After Nab-Paclitaxel Plus Gemcitabine Failure
Authors: Matsumoto Toshihiko , Kurioka Yusuke , Okazaki Ukyo , Matsuo Yu , Kimura Shogo , Miura Kou , Tsuduki Takao , Takagi Shinjiro , Takatani Masahiro , Morishita Hirofumi
Published: April 2020

Objectives

There is no standard chemotherapy for advanced pancreatic cancer (APC) after gemcitabine plus nab-paclitaxel (GP) failure. The aim of this study was to evaluate the efficacy and safety of FOLFIRINOX (5-Fluorouracil, leucovorin, irinotecan, and oxaliplatin) (5-Fluorouracil, leucovorin, irinotecan, and oxaliplatin) (FFX) and modified FFX (mFFX) for APC patients after GP failure.

Methods

We retrospectively evaluated the efficacy and safety of FFX in APC patients who were refractory or intolerant of GP.

Results

Between July 2014 and October 2018, 23 patients received FFX after failure of GP. The overall response rate (RR) was 23%, and the disease control rate (DCR) was 68%. The median progression-free survival (PFS) was 5.3 months (95% confidence interval, 2.5–8.9), and the median overall survival (OS) was 12.1 months (95% confidence interval, 4.0–14.2). Twelve patients received FFX, and 11 patients received mFFX. In the FFX group, the RR was 9%, the DCR was 73%, the PFS was 5.3 months, and the OS was 6.9 months. In the mFFX group, the RR was 23%, the DCR was 64%, the PFS was 4.3 months, and the OS was 12.8 months. There was no significant difference between the groups.

Conclusions

FOLFIRINOX has potential activity for patients with APC in whom GP failed.
Aberration of ARID1A Is Associated With the Tumorigenesis and Prognosis of Sporadic Nonfunctional Pancreatic Neuroendocrine Tumors
Authors: Han Xu , Chen Wenqi , Chen Pingping , Zhou Wentao , Rong Yefei , Lv Yang , Li Jian-ang , Ji Yuan , Chen Wei , Lou Wenhui , Xu Xuefeng
Published: April 2020

Objective

The genetic aberrations that underlie chromatin remodeling in sporadic nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) remain largely unknown. Here, we investigated the dysregulation of the switch/sucrose nonfermentable (SWI/SNF) component ARID1A and its correlation with clinicopathological features and prognosis.

Methods

We sequenced the exomes of sporadic NF-pNETs. Quantitative real-time polymerase chain reaction and immunohistochemistry were used to determine messenger RNA level and protein expression.

Results

The sporadic NF-pNETs harbored 264 somatic mutations in 228 different genes, most commonly affecting the SWI/SNF components ARID1B (57.1%) and ARID1A (42.9%). The expression of ARID1A was remarkably downregulated in NF-pNETs and corresponding liver metastases compared with that in normal pancreatic islet tissue. Reduced expression of ARID1A was associated with malignant clinicopathological features (P < 0.05). The loss of ARID1A was related to a high Ki-67 index (P < 0.05). Patients with ARID1A-negative expression had a significantly worse overall survival rate than those with ARID1A-positive expression (P < 0.05). The ARID1A status was an independent predictor of overall survival, and a nomogram integrating ARID1A with clinicopathological features was proposed.

Conclusions

The loss of SWI/SNF components ARID1A may be associated with malignant behaviors and an unfavorable prognosis. Aberrations of ARID1A may contribute to tumorigenesis and metastasis in sporadic NF-pNETs.
Including Family Members in Rounds to Improve Communication in Intensive Care
Authors: Simon Kay , Sankara Ishwara R. , Gioe Christina , Newcomb Patricia
Published: April 2020

Background:

Family members frequently function as surrogate decision-makers in critical care settings. This role requires family to establish satisfactory communication with clinicians.

Local Problem:

Posthospital patient satisfaction with communication scores were lower than desired. Investigators assumed family member satisfaction with communication could influence patient satisfaction scores.

Methods/Interventions:

Including family members in multidisciplinary daily clinical rounds was implemented in a 22-bed neurointensive care unit (ICU). Family members who attended rounds were compared with those who did not. Changes in clinician time devoted to rounding were measured.

Results:

The intervention increased time devoted to clinical rounds by 4 minutes per patient on average. Rounding dose correlated positively while depression correlated negatively with family satisfaction with communication. No harm, such as family member agitation, anxiety, or complaints, was found.

Conclusions:

Including family in rounding in the ICU appears safe and can improve family satisfaction with communication, but whether it influences patient satisfaction remains an open question.
Kernohan-Woltman Notch Phenomenon in Two Patients with Subdural Hematoma and Ipsilateral Hemiparesis
Authors: Gimarc Kayli , Massagli Teresa L.
Published: April 2020

Case 1

A 9-yr-old boy presents with right subdural hematoma and ipsilateral hemiparesis. Clinical presentation and imaging are consistent with Kernohan-Woltman notch phenomenon.

Case 2

A 19-yr-old man presents with right subdural hematoma and ipsilateral hemiparesis. Clinical presentation is consistent with Kernohan-Woltman notch phenomenon.

Clinical Pearl

Kernohan-Woltman notch phenomenon is a false-localizing neurologic sign that presents with hemiparesis ipsilateral to the primary lesion. It occurs in the setting of transtentorial herniation, during which the contralateral cerebral peduncle is compressed against the free edge of the tentorium, causing compression of descending corticospinal tract fibers.
Parathyroid Carcinoma Shown on 99mTc-Sestamibi Parathyroid SPECT/CT Scan in a Pediatric Patient
Authors: Wang Wei , Liu Jun , Liu Jie , Yang Jigang
Published: April 2020

A 10-year-old boy presented with back pain. 99mTc-methylene diphosphonate bone scan demonstrated the sign of metabolic bone disease, suspected due to hyperparathyroidism. 99mTc-sestamibi parathyroid SPECT/CT demonstrated focal lesion in the lower pole of the right lobe. The pathological examination demonstrated parathyroid carcinoma, which is very rare in pediatric population.
Clinical Follow-up Study of the Reconstruction of the Femoral Head With Transferred Vascularized Greater Trochanter Bone Graft for Association Research Circulation Osseous III–IV Osteonecrosis of the Femoral Head
Authors: Zhao Dewei , Fan Dechao , Liu Baoyi , Tian Simiao
Published: April 2020

Purpose

The aim of the study was to investigate the curative efficacy of osteonecrosis of the femoral head (ONFH) in a hip-preserving operative approach, by transferring a vascularized greater trochanter graft combined with osteotomy of the upper third of femoral head, in an attempt to seek an innovative approach for patients who experienced middle- to late-stage ONFH with femoral head's weight-bearing area severely collapsed.

Method

Our research included a total of 23 patients (23 hips) who accepted hip-preserving surgery by reconstructing the femoral head with transferred vascularized greater trochanter bone graft for ONFH from January 2013 to December 2017. The definition of reconstructing the femoral head is that we do the osteotomy on the upper third of the femoral head with weight-bearing area severely collapsed, and the remnant femoral head requires a hemispherical bone graft to recover the shape. A vascularized greater trochanter bone graft was next transferred and fixed at the upper portion of the remnant femoral head, and then, the shape and vascular supply of the femoral head are successfully reconstructed. The clinical assessment was performed with Harris Hip Score system. Kaplan-Meier survival curves with femoral head collapse as the end point showing the probability of progression in collapsed femoral head based on the gender, age and body mass index.

Results

Twenty-three patients (23 hips) were eventually contacted by telephone for an outpatient clinic follow-up, with a mean follow-up time of 41.35 months (varied from 16 to 72 months), no patients lost contact. Seven patients (7 hips) had radiographic stage progress. One patient (1 hip) had conversion to total hip arthroplasty at 24 months postoperatively because of progressive femoral head collapse and severely pain. The image success rate was 69.6%, clinical success rate was 65.2%, and the clinical survival rate was 96%. The average Harris Hip Score was 82.5 ± 5.5 points at the last follow-up, representing a great improvement compared with the 51.9 ± 7.2 points obtained preoperatively (P<0.05). Kaplan-Meier survival curves with femoral head collapsed as the end point showing the probability of progression in collapsed femoral head based on the sex, age, and body mass index.

Conclusions

Reconstructing the femoral head with transferred vascularized greater trochanter bone graft provides a new method for the treatment of the young Association Research Circulation Osseous stage III–IV ONFH patients with severely femoral head collapsed, which can better improve the patient's symptoms, the quality of life, and delay the age of undergoing arthroplasty in young patients.
Reconstruction of Soft Tissue Defects and Bone Loss in the Tibia by Flap Transfer and Bone Transport by Distraction Osteogenesis: A Case Series and Our Experience
Authors: Abula Abulaiti , Yushan Maimaiaili , Ren Peng , Abulaiti Alimujiang , Ma Chuang , Yusufu Aihemaitijiang
Published: April 2020

Objective

The aim of this study is to evaluate the clinical outcome of flap transfer followed by delayed bone transport using external fixator on the soft tissue defect with segmental tibial loss.

Methods

A total of 14 patients with soft tissue defects and bone loss were treated with flap transfer combined followed by delayed bone transport using external fixator from January 2010 to January 2017 and, successfully, follow-up were included. Demographic data and data on clinical outcomes and complications were obtained from hospital record. The mean age was 35.5 years, and the average time from injury to reconstructive surgery was 4.14 months. The average soft tissue and bone defect sizes were 33.57 cm2 and 7.04 cm, respectively. Local or free flap was created to reconstruct the soft tissue defects. The Ilizarov external fixator or Orthofix limb reconstruction system (OLRS) was used to reconstruct bony defects by bifocal or trifocal bone transport using delayed distraction osteogenesis. The functional results were evaluated by Association for the Study and Application of the Method of Ilizarov scoring system, and all postoperative complications were recorded.

Results

The mean duration of follow-up after removal of fixator was 29.49 ± 4.34 months (range, 24–38 months). All wounds healed after 1-stage operation, and all transferred flaps were survived. The average interval between flap coverage and bone transportation was 13.4 weeks (range, 8–24 weeks). Eight patients used bifocal, and 6 patients used trifocal approach for bone transportation. An average external fixation time was 208.5 days (range, 168–235 days) and external fixation index was 33.6 days/cm (range, 18.8–46.5 days/cm). Superficial necrosis of the flap edge was noted in 4 cases, after debridement and regular dressing, the flap healed successfully. Bone union was achieved in all patients except 4 cases that occurred with docking site nonunion which achieved satisfactory union after application of accordion maneuver and autografting of iliac bone. All patients achieved satisfactory functional recovery and were able to walk normally.

Conclusions

The flap transfer followed by delayed distraction osteogenesis using external fixator which can be used for successful reconstruction of bone and soft tissue defects in lower leg.
Flow-Through Free Anterolateral Thigh Flap in Reconstruction of Severe Limb Injury
Authors: Yang Zhao , Xu Chao , Zhu Yonggang , Li Jun , Zou Jiwei , Xue Baobao , Yang Xiaojiang , Zhao Guangyue
Published: April 2020

Objective

This study aimed to present the use of flow-through free anterolateral thigh (ALT) flap for the reconstruction of severe limb injury.

Patients and Methods

Four patients (2 male and 2 female subjects), with an average age of 26 (9–39) years, were included. These injuries referred to upper and lower limbs, including bone, soft tissue, nerve, and arterial segments. Two patients experienced large soft tissue defects in the lower limb and were repaired by double flow-through ALT flaps. The sizes of damaged soft tissues in the remaining 2 patients were 14 × 10 cm2 and 21 × 13 cm2, respectively. Three patients had bone fractures, in which one of them experienced bone shortening during operation. The arterial injury was observed in 2 patients and the lengths of defects were 5 and 12 cm, respectively. Flow-through free ALT flap was applied for all 4 patients.

Results

Patients were followed up for 18 months. All the flaps have survived successfully without any vascular crisis or infection. All incision wounds were under primary healing stage, without any severe complications. The flaps showed better appearance, color, texture, and satisfactory sensation. All patients had satisfactory functional recovery of their injured limbs.

Conclusions

The flow-through free ALT flap assists in overcoming complex traumatic injuries with severe soft tissue and arterial defects in the limbs. This flow-through ALT flap can be an effective alternative for reconstruction of severe limb injury.
Endoscopic Endonasal Dacryocystorhinostomy With a Novel Lacrimal Ostium Stent in Chronic Dacryocystitis Cases With Small Lacrimal Sac
Authors: Yu Bo , Qian Zhenbin , Han Xuemei , Tu Yunhai , Wu Wencan
Published: April 2020

Purpose:

To investigate feasibility of endoscopic endonasal dacryocystorhinostomy (EE-DCR) with an novel lacrimal ostium stent (LOS) intubation for patients with chronic dacryocystitis with small lacrimal sac.

Methods:

Patients diagnosed as chronic dacryocystitis with small lacrimal sac who preferred to surgery treatment between March 1st, 2012 and May 1st, 2015. All included subjects were randomly divided into 2 groups (Group A and Group B). Cases in group A were performed EE-DCR with LOS intubation while cases in group B were underwent EE-DCR without LOS intubation. Demographic data of each cases were collected. The success rate and the surgical outcomes of 2 groups were compared.

Results:

The success rate was much higher in group A than group B. At 3 months follow up, 61.6% of patients in group A exhibited scarring and/or granulation tissues around the ostium, which was significantly higher than the 36.4% of patients in group B. Of these patients with scars and/or granulation tissues, no statistical difference was found between 2 groups. Granuloma alone and scars with granuloma were observed in 10 patients and 2 patients, in group A and group B, respectively, resulting in a statistical significant difference for this outcome between the groups. At 9 months follow up and 12 months follow up, no significant statistical difference were found in the rate of scarring and/or granulation tissues, scars alone, granuloma alone and scars with granuloma between 2 groups.

Conclusions:

EE-DCR with novel LOS may be an effective procedure to manage chronic dacryocystitis with small lacrimal sac.
Diagnosis and Treatment of Oral Venous Malformation in a Child
Authors: Valente Vitor Bonetti , Kayahara Giseli Mitsuy , Miyahara Glauco Issamu , Biasoli Éder Ricardo , Bernabé Daniel Galera
Published: April 2020

Venous malformations (VMs) are congenital disorders that constitute about 40% of all vascular anomalies. These lesions do not regress spontaneously and may increase in size during childhood. The case of a 10-year-old girl with an extensive oral VM is reported. Intraoral examination revealed the presence of purplish nodules in the alveolar mucosa and gingiva from anterior maxilla. Doppler ultrasound showed a well-defined hypoechoic image and increased vascularization with low blood flow for the alveolar mucosa lesion. The patient was submitted to intralesional injections of the ethanolamine oleate/mepivacaine sclerosing solution. After four sessions, there was a significant reduction of the lesions. However, the patient abandoned the treatment and the oral VM grew progressively. After 1 year, sclerotherapy was resumed and performed weekly. After 10 session of sclerotherapy, the oral VM totally regressed. The childhood is a critical period for oral VM growth. Doppler ultrasound and sclerotherapy can be effective for the management of extensive lesions in children.
The Influence of Lip Repair on the Growth of Craniofacial Structures in Bilateral Cleft Lip and Palate Patients With Unoperated Palate From Childhood to Adulthood
Authors: Liu Yingmeng , Huang Hanyao , Shi Bing , Wang Yan
Published: April 2020

Purpose:

Surgical treatment of complete bilateral cleft lip and palate (BCLP) is the most difficult procedure among common cleft lip and palate. This study was to research the long-term effect of lip surgery by localizing the craniofacial growth pattern of BCLP patients in the Han people in western China compared with normal healthy people from childhood to adulthood.

Patients and Methods:

A cross-sectional study included a sample of 43 BCLP patients who have received lip repair and a control group of 55 normal healthy people with Angle Class I occlusion at the similar age, gender and ethnicity, and all participants were obtained from the Department of Oral and Maxillofacial Surgery, Sichuan University. Sixteen linear and 14 angular bony landmarks were identified on lateral cephalometric radiographs at the average age of 5.6-year-old, 10.7-year-old, and 24.2-year-old. The measurements were used to represent the growth changes of cranial base, bony nasopharynx, maxillary, mandibular and maxilla-mandibular relationship. Between-group differences were assessed by using the Independent-Sample t test.

Result:

Lip repair has a slow and long-term effect on the craniofacial morphology. The tension from repaired orbicularis oris muscle would cause a decrease in maxillary sagittal length and the retroposition of maxilla combined with the mandibular functional displacement, which would cause a positive change in the postoperative facial morphology of BCLP patients in the long run.

Conclusion:

BCLP patients who have undergone lip repair at an early age have the potential to develop better facial convexity.
Outcomes Following Orbital Floor Fractures in the Elderly
Authors: Patel Alap U. , Haas Jacqueline A. , Skibba Kathryn E. , Morrison Clinton S.
Published: April 2020

Background:

Orbital floor fractures in the elderly are controversial, with varying guidelines on indications for operative and nonoperative management. Morbidity includes changes to ocular position, inferior rectus muscle injury, and damage to the neurovascular bundle as it traverses the orbital floor. Across all facial fractures, the elderly are less frequently operated on, albeit longer hospital stays and more probably ICU admission. This study's purpose is to describe our experience with orbital floor fractures and the role of operative versus nonoperative management in the context of patient age.

Methods:

Retrospective review of orbital floor fracture coronal and sagittal CT images between 2015 and 2018 in those aged 20 to 40 (controls) or over 65 (cases). Patients were excluded if imaging revealed additional complex fractures of the upper third of the face or the midface.

Results:

Twenty-five subjects met inclusion criteria for the elderly cohort (mean age of 79.4 years) compared to 48 subjects included in the control cohort (mean age 29.9). In the elderly population the most common mechanisms of injury were mechanical fall (72%) and syncope (8%), compared to assault (69%) and MVC (13%) in the controls. Two elderly patients (8%) required operative repair of their injury, whereas fourteen had surgery (29%) in the control cohort. Overall, the mean elderly fracture size was 3.19 cm2 (SD 1.18) and the mean control fracture size was 2.83 cm2 (SD 1.67) (P 
= 0.37). Within the elderly group, the mean fracture size for those who underwent surgery was 3.5 cm2 compared to 3.2 cm2 in those treated non-operatively (P 
= 0.27). Within the control group, the mean fracture size for those who underwent surgery was 2.9 cm2 compared to 2.8 cm2 in those treated non-operatively (P 
= 0.25).

Conclusions:

Orbital floor fractures in the elderly do not require operative intervention in most instances for management.
Late Primary Palatoplasty in Skeletally Mature Patients: Obstacles and Outcomes
Authors: Vieira Pedro Henrique , Denadai Rafael , Raposo-Amaral Cesar Augusto , Sabbag Anelise , Monte Thais Miguel do , Raposo-Amaral Cassio Eduardo
Published: April 2020

Background:

As the performance of late primary palatoplasty for skeletally mature patients remains controversial, there is little data available regarding speech outcomes for this patient population. The purpose of this study therefore is to identify and evaluate the impact of speech outcomes following late palate repair on skeletally mature patients.

Methods:

A retrospective study was performed on 19 consecutive skeletally mature patients who underwent late primary palate repair between 2010 and 2018. Speech assessment was performed preoperatively, between 3 and 6 months postoperatively, and then after 6 months postoperatively. Levels for hypernasality, oral pressure, and audible nasal air emission were scored and recorded.

Patients were stratified by age, gender, presence of postoperative fistula, and Veau cleft type, in order to determine the impact of each variable on final speech outcomes. The Kruskal-Wallis test was used to compare the preoperative speech assessment with the postoperative speech outcomes, and the Mann–Whitney test was used to analyze the impact of the above variables on final speech outcomes.

Results:

Our data showed overall postoperative speech improvement for all tested variables. Patients without postoperative fistula presented better results in oral pressure than those patients with postoperative fistula (P < 0.05). None of the other tested variables presented a significant negative impact on speech outcomes.

Conclusion:

Late primary palatoplasty significantly improves speech outcomes for skeletally mature patients. Fistula has a negative impact on oral pressure.
Floating Bone Phenomenon in Pierre Robin Sequence
Authors: Fontanari Marco , Vellone Valentino , Maffia Francesco , Papoff Paola , Cascone Piero
Published: April 2020

After a failed mandibular osteodistraction, the wrong positioned mandible of a few patients with Pierre Robin sequence returned in the most functional position and regained a proper symmetry, without external intervention. The study aims to explain this self-adjustment and introduce the floating bone phenomenon.

The inclusion criteria were severe micrognathia, Fast and Early Mandibular Distraction Osteogenesis protocol, postoperative mandibular wrong positioning, presurgery, immediate postsurgery, and long-term computed tomography scan. Five patients were included. The considered parameters were the distance between mandibular dental centerline and midsagittal facial axis, the rotation of the mandibular body, the magnitude of elongation, and the lowering of the mandibular body.

Three patients went from a decentralization >4 mm in the activation phase to a normalization of the said value in the follow-up. In the same period, the interincisal point of 2 patients moved respectively from 0.5 mm on the left and 0.8 mm on the right to 1.2 mm and 1.6 mm on the right, respectively. The rotation of the mandibular body was meanly 25.6° among all patients. The mean value of the distraction was 14.1 mm. A difference of about 4.4 mm between the left and the right side was measured. The lowering of the mandible varied between 2.8 and 12.6 mm.

All patients improved their symmetry. Four of them improved in all the measured parameters, while 1 patient presented a worsening in the decentralization of the interincisal point.

The floating bone phenomenon could break new grounds in the management of patients with Pierre Robin sequence.
Anthropometric Analysis of Nasolabial Region and Age-Related Changes in Adult Women
Authors: Doğru Semahat , Deniz Mustafa , Uslu Ayşe Imge
Published: April 2020

Purpose:

The nasal and labial characteristics along with the other facial characteristics are different between races. The purpose of this study is to identify nasal and labial features of Turkish women by anthropometric measurements and indices besides to detect variances with aging.

Methods:

The study was conducted with total 302 women volunteers whose ages were between 19 and 85. The women included were divided into 3 groups according to their ages; respectively young (ages between 19 and 44), middle-aged (45–59) and senior (>60). By using camera footages with the IT version 3.00 software program, anthropometric measurements of the nasolabial region was performed.

Results:

The mean nasal length of the included participants was measured as 38.56 ± 8.32 mm while mean nasal height was 50.05 ± 8.36 mm. Mean nasal root width was 13.24 ± 2.70 mm, mean morphological nasal width was 32.16 ± 5.80 mm and mean anatomical nasal width was 27.85 ± 4.92 mm. In addition, mean nasal depth was 19.55 ± 5.25 mm.

In the middle-aged group of participants, the nasal length was more than senior group (P < 0.05). Nasal root width was increased with aging (P < 0.05). Morphological and anatomical widths of the nose were increased with aging but increase rate was lower in the senior group (P < 0.05). The nasal depth was lower in the young group in comparison with middle-aged and senior groups (P < 0.05). When nostril types were analyzed; ratios of ‘teardrop’, ‘heart-shaped’, ‘annular’ and ‘triangular’ types were 51.65%, 0.99%, 6.95%, and 40.39%, respectively.

Conclusions:

To be acquainted with facial anthropometric features and measurements of nasolabial region which varies with races and aging; would have a significant importance in view of conserving the facial ratio and esthetics in the plastic and reconstructive surgery field.
Value-Based Analysis of Virtual Versus Traditional Surgical Planning for Orthognathic Surgery
Authors: Lin Lawrence O. , Kalmar Christopher L. , Vu Giap H. , Zimmerman Carrie E. , Humphries Laura S. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A.
Published: April 2020

Background:

In orthognathic surgery, virtual surgical planning (VSP) is gaining popularity over traditional surgical planning (TSP); however, concerns about cost of VSP have slowed adoption of this technology. This study investigates the clinical value of VSP versus TSP over the entire clinical care continuum.

Methods:

Retrospective cohort study was conducted for patients undergoing maxillomandibular surgery between 2005 and 2016 at a tertiary pediatric hospital. Clinical value, defined as patient outcomes per unit cost, was analyzed between the 2 groups with appropriate statistics.

Results:

The VSP (n = 19) and TSP (n = 10) cohorts had statistically similar hospital lengths of stay, rates of complications, readmissions, and duration of postoperative orthodontic treatment (P = 0.518, P > 0.999, P > 0.999, P = 0.812, respectively). VSP maxillomandibular procedures trended towards shorter operative times (P = 0.052). Total hospital charges were statistically similar between the TSP and VSP cohorts (P = 0.160). Medication, laboratory and testing, and room charges were also statistically similar between the TSP and VSP cohorts (P = 0.169, P = 0.953, and P = 0.196 respectively).

Conclusions:

Indexed patient outcomes and costs incurred for maxillomandibular procedures were statistically similar between those utilizing TSP or VSP leading us to conclude that these 2 methods are associated with similar clinical value. This retrospective analysis should be followed with prospective data to give patients and insurers the best estimate of clinical value utilizing TSP and VSP.
Life on the battlefield: Valproic acid for combat applications
Authors: Russo Rachel , Kemp Michael , Bhatti Umar F. , Pai Manjunath , Wakam Glenn , Biesterveld Ben , Alam Hasan B.
Published: April 2020

The leading causes of death in military conflicts continue to be hemorrhagic shock (HS) and traumatic brain injury (TBI). Most of the mortality is a result of patients not surviving long enough to obtain surgical care. As a result, there is a significant unmet need for a therapy that stimulates a “prosurvival phenotype” that counteracts the cellular pathophysiology of HS and TBI to prolong survival. Valproic acid (VPA), a well-established antiepileptic therapy for more than 50 years, has shown potential as one such prosurvival therapy. This review details how VPA's role as a nonselective histone deacetylase inhibitor induces cellular changes that promote survival and decrease cellular pathways that lead to cell death. The review comprehensively covers more than two decades worth of studies ranging from preclinical (mice, swine) to recent human clinical trials of the use of VPA in HS and TBI. Furthermore, it details the different mechanisms in which VPA alters gene expression, induces cytoprotective changes, attenuates platelet dysfunction, provides neuroprotection, and enhances survival in HS and TBI. Valproic acid shows real promise as a therapy that can induce the prosurvival phenotype in those injured during military conflict.
A Review on the Function and Regulation of ARHGDIB/RhoGDI2 Expression Including the Hypothetical Role of ARHGDIB/RhoGDI2 Autoantibodies in Kidney Transplantation
Authors: Kardol-Hoefnagel Tineke , van Logtestijn Sofie A.L.M. , Otten Henny G.
Published: April 2020

Challenging and still unsolved problems in kidney transplantation are risk stratification and the treatment of humoral rejection. Antibody-mediated rejection is an important cause of early and chronic rejection. The impact of donor-specific HLA antibodies on antibody-mediated rejection–causing graft damage is well known, but the clinical relevance of non-HLA antibodies remains unclear. Recently, in 2 independent studies, a new correlation was found between the presence of non-HLA anti-Rho guanosine diphosphate dissociation inhibitor 2 (ARHGDIB) antibodies and increased graft failure. RhoGDI2, another name for ARHGDIB, is a negative regulator of the Rho guanosine triphosphate (RhoGTP)ases RhoA, Rac1m, and Cdc42, whose main function is regulating the actin network in a variety of cells. RhoGDI2 is mainly expressed intracellularly, and some expression is observed on the cell surface. Currently, there is no mechanism known to explain this correlation. Additionally, the reason why the antibodies are produced is unknown. In this review, we will address these questions, provide an overview of other diseases in which these antibodies are prevalent, and describe the physiological role of RhoGDI2 itself. If the mechanism and impact of RhoGDI2 antibodies in kidney graft failure are known, improved risk stratification can be provided to decrease the rate of donor kidney graft failure.
The early stage of processing emotional faces in patients with major depressive disorder: an event-related potential study
Authors: Xin Wei , Yu Ran , Zhao Lun
Published: April 2020

In order to investigate the early stage of processing emotional faces in patients with major depressive disorder (MDD), we recorded and analyzed the N170 elicited by happy, angry and neutral faces. It was found that the N170 was significantly lower in patients with depressive disorder than that in the control group, especially at the left occipital-temporal area. The N170 was significantly modulated by facial expression, but this emotional effect was similar between patients with MDD and controls. These data provide further electrophysiological evidence for processing emotional faces in patients with MDD.