bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the Efficacy of Endoscopic Radial Incision and Cutting Procedure and Endoscopic Balloon Dilatation for Benign Anastomotic Stricture after Low Anterior Resection Combined with Preventive Loop Ileostomy in Rectal Cancer
Authors: Wang Shijie , Wan Jinliang , Li Zhiming , Long Chenyan , Zhang Renyi , Luo Yaxin , Han Zelong , Yan Jun
Published: June 2023

BACKGROUND:

Endoscopic radical incision and cutting procedure is a notable technique in the treatment of benign anastomotic strictures after low anterior resection in rectal cancer. However, the efficacy and safety of endoscopic radical incision and cutting procedure and traditional endoscopic balloon dilatation remain unknown.

OBJECTIVE:

To compare the efficacy and safety of endoscopic radical incision and cutting procedure and endoscopic balloon dilatation in patients with anastomotic stricture after low anterior resection.

DESIGN:

Rectal cancer patients with anastomotic stricture after low anterior resection combined with synchronous preventive loop ileostomy between January 2014 and June 2021 were retrospectively collected. These patients underwent endoscopic radical incision and cutting procedure or endoscopic balloon dilatation as an initial treatment. The clinicopathological baseline data of the patients, endoscopic surgery success rate, complications and restricture rate were analyzed.

SETTINGS:

This study was conducted at Nanfang Hospital in China.

PATIENTS:

A total of 30 patients were eligible after reviewing the medical records. Twenty patients underwent endoscopic balloon dilatation and ten patients underwent endoscopic radical incision and cutting procedure.

MAIN OUTCOME MEASURES:

The adverse event rate and stricture recurrence rate.

RESULTS:

There were no significant differences in patient demographics or clinical features. No adverse events occurred in either of the two groups. The mean operation time was 18.9±3.6 minutes in the endoscopic balloon dilatation group and 10.2±3.3 minutes in the endoscopic radical incision and cutting procedure group (p < 0.001). The stricture recurrence rates between the endoscopic balloon dilatation group and the endoscopic radical incision and cutting procedure group were significantly different (44.4% vs. 0%, p = 0.025).

LIMITATIONS:

This was a retrospective study.

CONCLUSIONS:

The endoscopic radical incision and cutting procedure is a safe procedure and is more efficacious than endoscopic balloon dilatation for anastomotic stricture after low anterior resection combined with synchronous preventive loop ileostomy in rectal cancer.
The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia
Authors: Schubert Ann-Kristin , Seneviratne Vera , Stolz Jessica , Wiesmann Thomas , Wulf Hinnerk , Eberhart Leopold , Dinges Hanns-Christian
Published: June 2023

BACKGROUND

Peripheral regional anaesthesia is frequently used for upper extremity surgery. To prolong the duration of analgesia, adjuvants can be added to single-injection local anaesthetics. Despite attempts to compare several adjuvants in pairwise meta-analyses, a comprehensive comparison is still missing.

OBJECTIVE

The objective of this network meta-analysis was to determine the effectiveness of adjuvants in upper extremity peripheral nerve blocks.

DESIGN

A systematic review of randomised controlled trials with network meta-analyses.

DATA SOURCES

A literature search in Embase, CENTRAL, MEDLINE and Web of Science was performed up to March 2023.

ELIGIBILITY CRITERIA

Randomised trials comparing different adjuvants injected perineurally in peripheral upper extremity nerve blocks were eligible. Frequentist network meta-analysis was conducted using a random effects model with physiological saline as the comparator. The primary endpoint was the ratio of means (ROM) of the duration of analgesia.

RESULTS

The review included 242 randomised controlled trials with a total of 17 391 patients. Twenty-eight adjuvants were compared in the largest networks. Most network estimations consisted of a high proportion of direct evidence. Fourteen adjuvants increased the duration of analgesia significantly by the following factors, ROM [95% confidence interval (CI)]: dexamethasone 1.95 (1.79 to 2.13), buprenorphine 1.83 (1.51 to 2.24), butorphanol 1.84 (1.41 to 2.39), potassium chloride 1.89 (1.15 to 3.11), dexmedetomidine 1.70 (1.59 to 1.81), sufentanil 1.70 (1.27 to 2.29), ketorolac 1.68 (1.24 to 2.27), midazolam 1.55 (1.24 to 1.94), tramadol 1.52 (1.32 to 1.75), nalbuphine 1.50 (1.30 to 1.72), morphine 1.43 (1.09 to 1.88), magnesium sulfate 1.42 (1.20 to 1.67), clonidine 1.36 (1.24 to 1.50) and fentanyl 1.23 (1.08 to 1.40). Inconsistency in network meta-analysis was substantial. Overall side effect rates were low with all adjuvants.

CONCLUSION

The best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam. There are general concerns about the quality of underlying studies and the risk of publication bias.

TRIAL REGISTRATION

PROSPERO 2018 CRD42018115722
Correlates of serum estradiol concentration among postmenopausal women in Ilorin, North-Central Nigeria
Authors: Odeigah Louis Okebunor , Obalowu Ismaila Aberi , Alabi Anthonia Nkechi , Mohammed Abdulkadir , Ademola Christy Olanike , Oyeleke Oyeronke Adekemi
Published: June 2023

Objectives

There are limited data on the associated factors of circulating endogenous estradiol among Nigerian postmenopausal women. The main objective of this study is to assess the relationship between serum estradiol levels and some menstrual, clinical, and sociodemographic factors in postmenopausal women attending a family medicine clinic in Nigeria.

Methods

This was a hospital-based cross-sectional study involving 372 postmenopausal women. Sociodemographic, menstrual, and clinical data of the participants were collected, and their serum estradiol concentrations were assayed. The collected data were analyzed using IBM SPSS version 21 statistical software. A χ
2 test of association and logistic regression analysis were done to identify significant correlates of serum estradiol concentration among the participants.

Results

The mean ages at menarche and menopause among the participants were 15.6 and 48.1 years respectively. Approximately half of them (51.1%) were receiving chronic medical care for systemic hypertension and/or diabetes. The mean estradiol concentration of the participants in the study was 20.69 pg/mL. The participants' marital status and clinical presentation pattern (chronic vs others) were found to have statistically significant associations with their serum estradiol concentration; P = 0.048 and P = 0.001, respectively. Logistic regression analysis revealed that only the clinical presentation pattern had a significant relationship with serum estradiol concentration among the participants (P = 0.002).

Conclusion

Of all the studied factors, the only significant correlate of low serum estradiol concentration found in this study was chronic medical care presentation for hypertension and/or diabetes.
Efficacy and safety of lemborexant in midlife women with insomnia disorder
Authors: Terauchi Masakazu , Cheng Jocelyn Y. , Yardley Jane , Pinner Kate , Moline Margaret , Malhotra Manoj , Inabe Kanako , Nishida Maika , Pappadopulos Elizabeth
Published: June 2023

Objective

Insomnia is common in midlife women. The efficacy and safety of lemborexant (LEM), a competitive dual orexin receptor antagonist, was assessed for 12 months in a subgroup of midlife women (age, 40-58 y) from Study E2006-G000-303 (Study 303; SUNRISE-2).

Methods

This was a randomized, double-blind, placebo (PBO)-controlled (first 6 mo) study of adults with insomnia disorder (N = 949). During treatment period 1 (TP1), participants received PBO or LEM 5 mg (LEM5) or 10 mg (LEM10). During TP2 (second 6 mo), LEM participants continued their assigned dose; PBO participants were rerandomized to LEM5 or LEM10. Assessments included patient-reported sleep- and fatigue-related measures and treatment-emergent adverse events.

Results

The midlife female subgroup comprised 280 of 949 participants (TP1: PBO, n = 90 of 318 [28.3%]; LEM5, n = 82 of 316 [25.9%]; LEM10, n = 108 of 315 [34.3%]). At 6 months, median changes from baseline in subjective sleep-onset latency (in minutes) were −17.9, −20.7, and − 30.4 for PBO, LEM5, and LEM10 (vs PBO: LEM5, P = not significant; LEM10, P = 0.0310). At 6 months, mean changes from baseline in subjective wake after sleep onset (in minutes) were −37.0 (59.6), −50.1 (74.5), and −54.5 (65.4) for PBO, LEM5, and LEM10 (vs PBO: LEM5 and LEM10, P = not significant), with benefits sustained through 12 months. Greater decreases from baseline (improvement) in Insomnia Severity Index total score and Fatigue Severity Scale total score were seen with LEM versus PBO at 6 months; benefits continued through 12 months. Most treatment-emergent adverse events were mild to moderate in severity.

Conclusions

Consistent with the total population, subjective sleep parameters improved, and improvement was sustained over time in midlife women. LEM was well tolerated, suggesting that LEM may be a potential treatment option for midlife women with insomnia.
Factors Affecting C5 Viability and Demographic Variability in Two Brachial Plexus Centers
Authors: Zelenski Nicole A. , Joslyn Nichole A. , Lee Ying Hsuan , Chuang David Chwei-Chin , Lu Johnny Chuieng-Yi , Chang Tommy Nai-Jen , Spinner Robert J. , Bishop Allen T. , Shin Alexander Y.
Published: June 2023

Background:

Complete brachial plexus injuries are devastating injuries. A viable C5 spinal nerve can offer additional sources of axons and alter surgical treatment. We aimed to determine factors that portend C5 nerve root avulsion.

Methods:

A retrospective study of 200 consecutive patients with complete brachial plexus injuries at two international centers (Mayo Clinic in the United States and Chang Gung Memorial Hospital in Taiwan) was performed. Demographic information, concomitant injuries, mechanism, and details of the injury were determined, and kinetic energy (KE) and Injury Severity Score were calculated. C5 nerve root was evaluated by preoperative imaging, intraoperative exploration, and/or intraoperative neuromonitoring. A spinal nerve was considered viable if it was grafted during surgery.

Results:

Complete five-nerve root avulsions of the brachial plexus were present in 62% of US and 43% of Taiwanese patients, which was significantly different. Increasing age, the time from injury to surgery, weight, body mass index of patient, motor vehicle accident, KE, Injury Severity Score, and presence of vascular injury significantly increased the risk of C5 avulsion. Motorcycle (≤150cc) or bicycle accident decreased the risk of avulsion. Significant differences were found between demographic variables between the two institutions: age of injury, body mass index, time to surgery, vehicle type, speed of injury, KE, Injury Severity Score, and presence of vascular injury.

Conclusions:

The rate of complete avulsion injury was high in both centers. Although there are a number of demographic differences between the United States and Taiwan, overall the KE of the accident increased the risk of C5 avulsion.
Assessment and role of artery-vein complex in myopic choroidal neovascularization using Optical Coherence Tomography Angiography.
Authors: Ruiz-Medrano Jorge , Almazán-Alonso Elena , Puertas Mariluz , Flores-Moreno Ignacio , García-Zamora María , Kudsieh Bachar , Ruiz-Moreno José M
Published: June 2023

Objective:

To analyze the presence of an artery-vein complex (AVC) underneath myopic choroidal neovascularization (mCNV) and to determine its relationship with neovascular activity.

Patients and methods:

Retrospective analysis of 681 eyes from 362 patients with high myopia defined by an axial length (AL) of >26mm using optical coherence tomography (OCT) and OCT angiography (OCTa) imaging. Patients with clinical diagnosis of mCNV and good quality OCTa images were then selected. An AVC was defined by the identification of both perforating scleral vessels (PSV) and dilated choroidal veins (DCV) under or in contact with the mCNV in the same case. Swept-source OCT (SS-OCT) and SS-OCT angiography images (TRITON; Topcon Corporation, Japan) were reviewed to detect AVC in the mCNV area.

Results:

Results: 50 eyes of 49 highly myopic patients with mCNV were analyzed. Eyes with AVC were statistically older (69.95±13.53 vs. 60.83±10.47 years-old; p<0.01), needed less intravitreal injections/year along the follow-up period (0.80±0.62 vs. 1.92±0.17; p<0.01) and showed less relapses/year (0.58±0.75 vs. 0.46±0.42; p<0.05) when compared to eyes without AVC. Moreover, eyes with AVC were less likely to relapse during the first year from mCNV activation (n=5/14 vs. n=14/16; p<0.01; p<0.01). No significant differences were found regarding either AL (30.55±2.31 vs. 29.65±2.24, p>0.05) or BCVA (0.4±0.5 vs. 0.4±0.5 logMAR, p>0.05) between groups.

Conclusions:

AVC complex has an influence over myopic choroidal neovascularization activity resulting in less aggressive neovascular lesions than those with PSVs only.
Drug Repurposing for the Treatment of Mycobacterium abscessus Infections
Authors: Baker Emily J. , Molloy Antonia , Cox Jonathan A. G.
Published: June 2023

With the ever-increasing burden of antimicrobial resistance, the demand to introduce countermeasures becomes increasingly critical. The urgency of this need is intensified by the void in antibiotic discovery, with the identification of novel compounds declining with time. Of increasing concern is Mycobacterium abscessus, which displays high levels of intrinsic resistance that lead to poor success rates, even after lengthy drug regimens. Research tackling these issues is now focused on the repurposing of preexisting drugs for antimycobacterial use, facilitating the discovery of antimicrobial compounds amidst a crisis where novel antibiotics are sparse. Part of this includes the use of combination treatments, whereby coadministration of synergistic compounds can reduce dose requirements and slow the progression of antimicrobial resistance in the long term. In this review, we will introduce the current therapeutic options for M. abscessus and provide insight into why treatment is so burdensome. We will also compile the current updates within drug repurposing for this pathogen, including the use of unconventional agents such as antimalarial drugs, the repositioning of antituberculosis candidates and the repurposing of preexisting antibiotics, including the application of combination regimens. In addition, the in vitro drug screening platforms used in their discovery will be appraised, with the view of highlighting potential future perspectives that may help increase physiological relevance. This review provides a timely appraisal of the future of M. abscessus treatment.
Miniature Palpebral Plexiform Neurofibroma in Neurofibromatosis Type 2
Authors: Charles Norman C. , Kim Eleanore T.
Published: June 2023

A 27-year-old woman with well-documented neurofibromatosis 2 developed a soft, painless, nodular lesion on the skin surface of the left upper eyelid over 2 years. Following excision, histopathology revealed a plexiform neurofibroma with intradermal nodules comprised of benign round and spindle cells that reacted diffusely with immunohistochemical stains SOX-10 and S100. A subset showed focal reactivity for neurofilament and CD34. A perineurium surrounded each nodule with cells staining positively for markers EMA (epithelial membrane antigen) and GLUT1 (glucose transporter 1). Plexiform neurofibromas are rare tumors that occur in 5%–15% of patients with neurofibromatosis 1. Cutaneous abnormalities in neurofibromatosis 2 have not been widely studied although reports have described schwannomas, plexiform schwannomas, and occasional neurofibromas. Plexiform neurofibromas in neurofibromatosis 2 have rarely been illustrated and the current case represents a unique bona fide eyelid example to date.
Endoscopic-assisted Orbitotomy for Obliteration of Orbital Arteriovenous Fistula Refractory to Endovascular Techniques
Authors: Ghahvehchian Hossein , Karimi Nasser , Kashkouli Mohsen Bahmani , Ramadan Mohammad , Ghamari Kiandokht , Aghili SeyyedSaeed
Published: June 2023

Orbital arteriovenous fistula is a rare acquired disorder. The coincidence of arteriovenous fistula with lymphaticovenous malformation is even rarer. The optimal treatment, thus, is controversial. Surgical approaches vary widely, with associated pros and cons. The purpose of this case report is to describe an orbital arteriovenous fistula in a 25-year-old man with congenital fronto-orbital lymphaticovenous malformation, refractory to endovascular techniques, which was later successfully ablated by a direct endoscopic-assisted orbital approach.
Buffered Versus Nonbuffered Local Anesthetics and Local Pain Scores in Upper Eyelid Blepharoplasty: Randomized Controlled Trial
Authors: Vasović Dolika D. , Karamarković Miodrag , Stojičić Milan , Jovanović Milan , Savić Vujović Katarina , Rašić Dejan , Colić Milan , Musić Nikola
Published: June 2023

Purpose:

This split-face study aimed to see whether different types of local anesthetics or their buffered/nonbuffered combinations produce lower pain scores in upper eyelid blepharoplasty.

Methods:

The study involved 288 patients, randomly divided into 9 groups: 1) 2% lidocaine with epinephrine—Lid + Epi; 2) 2% lidocaine with epinephrine and 0.5% bupivacaine (1:1)—Lid + Epi + Bupi; 3) 2% lidocaine with 0.5% bupivacaine (1:1)—Lid + Bupi; 4) 0.5% bupivacaine—Bupi; 5) 2% lidocaine—Lid; 6) 4% articaine hydrochloride with epinephrine—Art + Epi; 7) buffered 2% lidocaine/epinephrine with sodium bicarbonate (SB) in a 3:1 ratio—Lid + Epi + SB; 8) buffered 2% lidocaine with SB in a 3:1 ratio—Lid + SB; 9) buffered 4% articaine hydrochloride/epinephrine with SB in a 3:1 ratio—Art + Epi + SB. Following the injection of the first eyelid and a 5-minute period of soft pressure on the injection site, patients were asked to rate their pain level on the Wong-Baker Face Pain Rating Visual Analogue Scale. Rating of the pain level was repeated 15 and 30 minutes following anesthetic administration.

Results:

The lowest pain scores at the first time point were observed in Lid + SB when compared with all of the other groups (p < 0.05). At the final time point, significantly lower scores were also observed in Lid + SB, Lid + Epi + SB, and Art + Epi + SB when compared with the Lid + Epi group (p < 0.05).

Conclusion:

These findings could help surgeons select an appropriate combination of local anesthetics, particularly in patients with lower pain threshold and tolerance because buffered combinations of local anesthetics produce significantly lower pain scores compared with nonbuffered solutions.
Cardiogenic shock: a major challenge for the clinical trialist
Authors: Sarma Dhruv , Jentzer Jacob C. , Soussi Sabri
Published: June 2023

Purpose of review

Cardiogenic shock (CS) results in persistently high short-term mortality and a lack of evidence-based therapies. Several trials of novel interventions have failed to show an improvement in clinical outcomes despite promising preclinical and physiologic principles. In this review, we highlight the challenges of CS trials and provide suggestions for the optimization and harmonization of their design.

Recent findings

CS clinical trials have been plagued by slow or incomplete enrolment, heterogeneous or nonrepresentative patient cohorts, and neutral results. To achieve meaningful, practice-changing results in CS clinical trials, an accurate CS definition, a pragmatic staging of its severity for appropriate patient selection, an improvement in informed consent process, and the use of patient-centered outcomes are required. Future optimizations include the use of predictive enrichment using host response biomarkers to unravel the biological heterogeneity of the CS syndrome and identify subphenotypes most likely to benefit from individualized treatment to allow a personalized medicine approach.

Accurate characterization of CS severity and its pathophysiology are crucial to unravel heterogeneity and identify the patients most likely to benefit from a tested treatment. Implementation of biomarker-stratified adaptive clinical trial designs (i.e., biomarker or subphenotype-based therapy) might provide important insights into treatment effects.
Increasing Antibiotic-Resistant Infections With Inpatient Endoscopic Retrograde Cholangioscopies (ERCP) Is Associated With Higher Mortality in the United States
Authors: Chang Patrick W. , Bui Aileen , Zhou Selena , Sahakian Ara B. , Buxbaum James L. , Phan Jennifer
Published: June 2023

Goals:

This study aims to investigate associated mortality with inpatient endoscopic retrograde cholangiopancreatography (ERCP) with and without resistant infections. The co-primary objective compares frequencies of inpatient ERCP with resistant infections to overall hospitalizations with resistant infections.

Background:

The risks of inpatient antibiotic-resistant organisms are known, but the associated mortality for inpatient ERCP is unknown. We aim to use a national database of hospitalizations and procedures to understand trends and mortality for patients with antibiotic-resistant infections during inpatient ERCP.

Study:

The largest publicly available all-payer inpatient database in the United States (National Inpatient Sample) was used to identify hospitalizations associated with ERCPs and antibiotic-resistant infections for MRSA, VRE, ESBL, and MDRO. National estimates were generated, frequencies were compared across years, and multivariate regression for mortality was performed.

Results:

From 2017 to 2020, national weighted estimates of 835,540 inpatient ERCPs were generated, and 11,440 ERCPs had coincident resistant infections. Overall resistant infection, MRSA, VRE, and MDRO identified at the same hospitalization of inpatient ERCPs were associated with higher mortality (OR CI(95%): Overall: 2.2(1.77–2.88), MRSA: 1.90 (1.34–2.69), VRE: 3.53 (2.16–5.76), and MDRO: 2.52 (1.39–4.55)). While overall hospitalizations with resistant infections have been decreasing annually, there has been a yearly increase in admissions requiring ERCPs with simultaneous resistant infections (P=0.001–0.013), as well as infections with VRE, ESBL, and MDRO (P=0.001–0.016). Required Research Practices for Studies Using the NIS scoring was 0, or the most optimal.

Conclusions:

Inpatient ERCPs have increasing coincident resistant infections and are associated with higher mortality. These rising infections during ERCP highlight the importance of endoscopy suite protocols and endoscopic infection control devices.
Equity in liver transplantation: are we any closer?
Authors: Ogundolie Moronke , Chan Norine , McElroy Lisa M.
Published: June 2023

Purpose of review

As policies governing liver transplantation (LT) continue to change and influence clinical practice, it is important to monitor trends in equitable access and outcomes amongst patients. The purpose of this review is to closely examine recent advances and findings in health equity research in LT over the last 2 years; specifically evaluating inequities at the different stages of LT (referral, evaluation, listing, waitlist outcomes and post-LT outcomes).

Recent findings

Advancements in geospatial analysis have enabled investigators to identify and begin to study the role of community level factors (such as neighborhood poverty, increased community capital/urbanicity score) in driving LT disparities. There has also been a shift in investigating center specific characteristics that contributes to disparities in waitlist access. Modification to the current model for end stage liver disease (MELD) score policy accounting for height differences is also crucial to eradicating the disparity in LT amongst sexes. Lastly, Black pediatric patients have been shown to have higher rates of death and worse posttransplant outcome after transitioning to adult healthcare.

Although, there have been some advances in methodology and policies, inequities in waitlist access, waitlist outcomes and posttransplant outcomes continue to be pervasive in the field of LT. Future directions include expansion of social determinants of health measures, inclusion of multicenter designs, MELD score modification and investigation into drivers of worse posttransplant outcomes in Black patients.
Efficacy of vestibular rehabilitation in vestibular neuritis: a systematic review and meta-analysis
Authors: Huang Hsiao-Han , Chen Chih-Chung , Lee Hsun-Hua , Chen Hung-Chou , Lee Ting-yi , Tam Ka-Wai , Kuan Yi-Chun
Published: June 2023

Objective

This study aimed to evaluate the efficacy of vestibular rehabilitation in vestibular neuritis (VN).

Design

RCTs was collected from MEDLINE, EMBASE, Cochrane Library, PEDro, LILACS, and Google Scholar before May 2023.

Results

This study included 12 RCTs involving 536 patients with VN. Vestibular rehabilitation was comparable to steroids in dizziness handicap inventory (DHI) score at the 1st, 6th, and 12th months (pooled mean differences [MDs]: −4.00, −0.21, and − 0.31, respectively); caloric lateralization at the 3rd, 6th, and 12th months (pooled MD: 1.10, 4.76, and − 0.31, respectively); and abnormal numbers of vestibular-evoked myogenic potentials (VEMPs) at the 1st, 6th and 12th months. Patients receiving a combination of rehabilitation and steroid exhibited significant improvement in DHI score at the 1st, 3rd, and 12th months (MD: −14.86, pooled MD: −4.63, MD: −9.50, respectively); caloric lateralization at the 1st and 3rd months (pooled MD: −10.28, pooled MD: −8.12, respectively); and numbers of VEMPs at the 1st and 3rd months (risk ratios: 0.66 and 0.60, respectively) than did those receiving steroids alone.

Conclusion

Vestibular rehabilitation is recommended for patients with VN. A combination of vestibular rehabilitation and steroids is more effective than steroids alone in the treatment of patients with VN.
Refinements in Extended Alar Contour Grafts: Retrograde Approach in Conjunction with Alar Base Surgery
Authors: Rohrich Rod J. , Sherif Rami D. , Cason Roger W. , Novak Matthew , Trost Jeffrey G.
Published: June 2023

Alar contour grafts are an excellent adjunct in both primary and revision rhinoplasty for correction and prevention of alar rim irregularities. They are traditionally placed at the conclusion of a rhinoplasty through a vestibular incision along the underside of the alar rim. Alternatively, alar base resection provides an opportunity for precise retrograde placement of alar contour grafts. The purpose of this article is to describe an efficient, five-step technique for retrograde placement of alar contour grafts in the setting of concomitant alar base surgery.
The Blocking Points: The Keys to Consistent Success in Preservation Rhinoplasty
Authors: Goksel Abdulkadir , Cason Roger W. , Tran Khanh Ngoc , Rohrich Rod J.
Published: June 2023

Preservation rhinoplasty is a growing area of interest amongst rhinoplasty surgeons. Dorsal preservation—a tenet of preservation rhinoplasty—is predicated on maintaining the integrity of the nasal midvault and effecting aesthetic change through alterations to the bony nasal pyramid and underlying septum. A challenge that is unique to dorsal preservation is the phenomenon of hump recurrence, owing to the existence of anatomical blocking points. Blocking points are resistant tensile forces that either impede dorsal lowering intraoperatively or push the dorsum back to its native convexity over time. Five anatomical blocking points have previously been described, which the authors expand upon and include an additional two. The seven anatomical blocking points are: the cartilaginous septum, perpendicular plate of the ethmoid, lateral osteotomy site, Webster’s triangle, internal mucoperiosteum of the maxillary bone, medial canthal ligament, and the lateral keystone area. It is critical that the surgeon be aware of the particular blocking points relevant to his or her chosen technique, and to appropriately and methodically address them to ensure consistent long-term results.
Effective Correction of Columellar Base Deviation in Primary Unilateral Cleft Lip Repair: A Muscle-Driven Method
Authors: Saito Takafumi , Hattori Yoshitsugu , Tu Junior Chun-Yu , Lo Lun-Jou
Published: June 2023

Columellar base deviation is a common and challenging deformity in patients with unilateral cleft lip. Debate continues on its surgical correction without sufficient studies to establish effective management. This article presents the authors’ experience in correcting the columellar base deviation with the muscle-driven method in primary lip repair. The key is to perform extensive muscle dissection and reconstruction. In the medial lip segment, muscle dissection is performed subcutaneously up to the contralateral nostril floor for effective lengthening and rotation. In the lateral lip segment, muscle dissection is executed in both submucosal and subcutaneous planes, and muscle component is extensively separated from the lip skin and buccal mucosa. The lateral muscle flap is advanced and reattached to the contralateral nostril floor and columellar base using a subcutaneous sustaining suture. Cinching suture between columellar base and alar base is performed. These 2 sutures help centralize and overcorrect the columellar base. Bilateral muscle components are reoriented and approximated in a Z-plasty format for lengthening of the lip. The patients were followed up for at least 3 years. Quantitative measurements of deviation in columellar base angulation were taken and revealed 55.8 ± 2.6 degrees (before nasoalveolar molding), 29.6 ± 1.7 degrees (after nasoalveolar molding), and 2.8 ± 0.4 degrees (postoperative follow-up), respectively. The muscle-driven method represents a safe and effective technique to correct columellar base deviation in patients with unilateral cleft lip.
Masseteric Nerve Ultrasound Identification for Dynamic Facial Reanimation Purposes
Authors: Blasi Marc , Ribera Àngels , de la Fuente Javier , Ayté Tomás , Malagón Paloma , Carrasco Lopez Cristian , Higueras Carmen
Published: June 2023

Background:

The masseteric nerve is one of the main options to neurotize free muscle flaps in irreversible long-term facial paralysis. Several preoperative skin-marking techniques for the masseteric nerve have been proposed to limit the surgical dissection area, shorten the surgical time, and enable a safer dissection. However, these have shown variability among them, and cannot visualize the nerve preoperatively. The authors designed an observational study to validate a high-frequency ultrasound (HFUS) nerve identification technique.

Methods:

A systematic HFUS examination was designed and performed to visualize the masseteric nerve in 64 hemifaces of healthy volunteers. One-third were randomly selected to undergo an additional HFUS-guided needle electrostimulation to validate the HFUS image.

Results:

The masseteric nerve was identified by HFUS in 96.9% of hemifaces (95% CI, 0.89 to >0.99) and showed almost perfect agreement with direct needle stimulation as calculated with Cohen kappa coefficient (0.95; 95% CI, 0.85 to 1.00). The masseteric nerve was found within the masseter muscle, in between the deeper muscle bellies, at 18.3 mm (SD ±2.2) from the skin. Only in 12.9% of cases (95% CI, 0.06 to 0.24) did its course become adjacent to the mandible periosteum. Other important features, such as disposition in relation to the parotid gland, or if the nerve was covered directly by a thick intramuscular aponeurosis, could be well observed by HFUS.

Conclusion:

HFUS enables masseteric nerve identification and can provide the surgeon with specific information on anatomical relations for each examined individual before surgery.
The Role of 68Ga-FAPI PET/CT in Breast Cancer Response Assessment and Follow-Up
Authors: Eshet Yael , Tau Noam , Levanon Keren , Bernstein-Molho Rinat , Globus Ofer , Itay Amit , Shapira Tal , Oedegaard Cecilie , Eifer Michal , Davidson Tima , Nidam Meital , Gal-Yam Einav , Domachevsky Liran
Published: June 2023

Purpose

68Ga–fibroblast activation protein inhibitor (FAPI), a new PET/CT radiotracer targeting cancer-associated fibroblasts in tumor microenvironment, can detect many types of cancer. We aimed to assess whether it can also be used for response assessment and follow-up.

Methods

We followed up patients with FAPI-avid invasive lobular breast cancer (ILC) before and after treatment changes and correlated qualitative maximal intensity projection images and quantitative tumor volume with CT results and blood tumor biomarkers.

Results

Six consenting ILC breast cancer patients (53 ± 8 years old) underwent a total of 24 scans (baseline for each patient and 2–4 follow-up scans). We found a strong correlation between 68Ga-FAPI tumor volume and blood biomarkers (r = 0.7, P < 0.01), but weak correlation between CT and 68Ga-FAPI maximal intensity projection–based qualitative response assessment.

Conclusions

We found a strong correlation between ILC progression and regression (as assessed by blood biomarkers) and 68Ga-FAPI tumor volume. 68Ga-FAPI PET/CT could possibly be used for disease response assessment and follow-up.
Giant Malignant Meningioma Penetrates the Skull
Authors: Zhang Zheng , Li Aijun , Liu Jingyi , Cheng Yingxin , Ma Jinyuan , Xing Hongshun
Published: June 2023

Meningioma is a primary tumor of the central nervous system, most commonly found in the middle-aged and elderly. Most meningiomas are benign, whereas malignant meningiomas account for only 1% of all meningiomas. Meningiomas usually grow slowly, and patients often have headaches and epilepsy as the first symptoms. According to the location of the tumor, there can also be vision, visual field, olfactory, hearing impairment, and so on. Surgery is the main treatment. A case of giant malignant meningioma penetrating the skull is reported. The patient was a 67-year-old male with a left parietal scalp mass about 1 year ago, which gradually enlarged to the size of 6×6 cm and had no other symptoms. Imaging examination showed that the tumor eroded the skull, and the density was uneven. After surgical resection (Simpson grade I), poorly differentiated meningioma (World Health Organization Grade Ⅲ) was returned pathologically. After operation, the patient recovered well.
Endovascular Stent Implantation in the Treatment of Vertebrobasilar Dolichoectasia
Authors: Cao Xuemin , Chen Xiaoshuai , Qu Bingkun , Wang Zengwu , Fan Danjie , Li Sen
Published: June 2023

Vertebrobasilar dolichoectasia (VBD) is a rare disease in clinic, with an incidence of 0.06% and 5.8%. It is a progressive vascular disease caused by the dilatation, tortuosity, and prolongation of vertebral and basilar arteries caused by a variety of factors. VBD can lead to hemodynamic changes, ischemic stroke, compression symptoms due to vasodilation, neurological dysfunction, hydrocephalus, subarachnoid hemorrhage, and other clinical manifestations. However, because the condition of VBD is complex and changeable, the treatment of VBD is not uniform. With the development of vascular intervention, especially the development of stent technology, it may become an effective method for the treatment of VBD. Two patients with VBD were treated with endovascular stent implantation.
The Necessity of Dural Resection for Nasal Dermal Sinus Cyst With Intracranial Extension
Authors: Shimizu Rieko , Sakamoto Yoshiaki , Miwa Tomoru
Published: June 2023

Nasal dermal sinus cysts are characterized by an intracranial-extradural extension. Complete extirpation of nasofrontal dermoid sinus cysts is essential for effective treatment to minimize recurrence. The authors revealed the pathologic findings of the cranial end connected to the dura. In our case, the cranial end and dura were fibrous connective tissues that were difficult to separate. For complete extirpation of the nasal dermal sinus cyst with intracranial extension, the cranial ends of the nasofrontal dermoid sinus cyst and dura should be resected en bloc.
An assessment of the safety, hemostatic efficacy, and clinical impact of low-titer group O whole blood in children and adolescents
Authors: Gerard Justin , Mueck Krislynn , Lubkin David , Hatton Gabrielle , Brill Jason , Boukas Konstantinos , Cox Charles , Wade Charles , Cotton Bryan
Published: June 2023

BACKGROUND

Low-titer group O whole blood (LTOWB) use has been associated with improved survival and less blood transfusions in adult trauma patients. Its use in pediatric trauma has been shown to be safe when using leukoreduced, LTOWB with anti-A, anti-B antibody titers of <1:50. We set out to evaluate the safety, hemostatic potential, and impact on pediatric outcomes at a center using non-leukoreduced, LTOWB with anti-A, anti-B antibody titers of <1:200.

METHODS

Patients younger than 18 years, who received emergency-release, uncrossed matched blood, and presented to our trauma center from November 2017 to April 2021 were included. Patients were divided into those receiving any LTOWB and those receiving only RBC and or plasma (COMP). Primary outcome was 30-day survival.

RESULTS

One hundred sixty-four patients received emergency release blood products. Of these, 73 received at least one unit of LTOWB. The LTOWB group were younger (14 years vs. 13 years), more likely to be male (87% vs. 49%), and to have sustained penetrating trauma (44% vs. 23%); all p < 0.05. Low-titer group O whole blood patients received more blood than their COMP counterparts prior to arrival. Serial hemolysis panels (K+, bilirubin, LDH, haptoglobin) obtained at 24 hours, 48 hours, and 72 hours were similar between groups; all p > 0.05. There was no difference in survival by univariate analysis but after adjusting for inverse probability of treatment weights there was an observed association between WB administration and improved survival, with an odds ratio of 2.48 (1.15–5.47).

CONCLUSION

Non-leukoreduced, LTOWB in anti-A/anti-B antibody titers of <1:200 appear safe in children and adolescents. While patients receiving LTOWB had more evidence of shock, higher torso injury severity, and received more prehospital blood products, there may be a mortality benefit with whole blood. Larger, multicenter studies are needed.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Susceptibility and disease modifier genes in amyotrophic lateral sclerosis: from genetic associations to therapeutic implications
Authors: Willemse Sean W. , van Es Michael A.
Published: June 2023

Purpose of review

Amyotrophic lateral sclerosis (ALS) is a severe disease characterized by the degeneration of motor neurons. Large-scale genetic studies have now identified over 60 genes that are associated with ALS, which in large part have also been functionally characterized. The purpose of this review is to outline how these advances are being translated into novel therapeutic strategies.

Recent findings

The emergence of techniques that allow the specific therapeutic targeting of a (mutant) gene, in particular antisense oligonucleotide therapy (ASOs), have led to the first successful gene therapy for SOD1-ALS and multiple other gene-targeted trials are underway. This includes genetic variants that modify the disease phenotype as well as causal mutations.

Technological and methodological advances are enabling researchers to unravel the genetics of ALS. Both causal mutations and genetic modifiers are viable therapeutic targets. By performing natural history studies, the phenotype-genotype correlations can be characterized. In conjunction with biomarkers for target engagement and international collaboration, this makes performing gene-targeted trials ALS feasible. The first effective treatment has now been developed for SOD1-ALS and, with multiple studies underway, it seems realistic that more therapies will follow.
Ageing of juvenile coral grouper (
Plectropomus maculatus
) reveals year-round spawning and recruitment: implications for seasonal closures
Authors: Harrison H. B. , Drane L. , Berumen M. L. , Cresswell B. J. , Evans R. D. , Galbraith G. F. , Srinivasan M. , Taylor B. M. , Williamson D. H. , Jones G. P.
Published: June 2023

Temporal patterns in spawning and juvenile recruitment can have major effects on population size and the demographic structure of coral reef fishes. For harvested species, these patterns are crucial in determining stock size and optimizing management strategies such as seasonal closures. For the commercially important coral grouper (
Plectropomus
spp.) on the Great Barrier Reef, histological studies indicate peak spawning around the summer new moons. Here we examine the timing of spawning activity for
P. maculatus
in the southern Great Barrier Reef by deriving age in days for 761 juvenile fish collected between 2007 and 2022, and back-calculating settlement and spawning dates. Age-length relationships were used to estimate spawning and settlement times for a further 1002 juveniles collected over this period. Unexpectedly, our findings indicate year-round spawning activity generates distinct recruitment cohorts that span several weeks to months. Peak spawning varied between years with no clear association with environmental cues, and little to no alignment with existing seasonal fisheries closures around the new moon. Given the variability and uncertainty in peak spawning times, this fishery may benefit from additional and longer seasonal closures, or alternative fisheries management strategies, to maximize the recruitment contribution from periods of greatest reproductive success.
Evidence of cospeciation between termites and their gut bacteria on a geological time scale
Authors: Arora Jigyasa , Buček Aleš , Hellemans Simon , Beránková Tereza , Romero Arias Johanna , Fisher Brian L. , Clitheroe Crystal , Brune Andreas , Kinjo Yukihiro , Šobotník Jan , Bourguignon Thomas
Published: June 2023

Termites host diverse communities of gut microbes, including many bacterial lineages only found in this habitat. The bacteria endemic to termite guts are transmitted via two routes: a vertical route from parent colonies to daughter colonies and a horizontal route between colonies sometimes belonging to different termite species. The relative importance of both transmission routes in shaping the gut microbiota of termites remains unknown. Using bacterial marker genes derived from the gut metagenomes of 197 termites and one
Cryptocercus
cockroach, we show that bacteria endemic to termite guts are mostly transferred vertically. We identified 18 lineages of gut bacteria showing cophylogenetic patterns with termites over tens of millions of years. Horizontal transfer rates estimated for 16 bacterial lineages were within the range of those estimated for 15 mitochondrial genes, suggesting that horizontal transfers are uncommon and vertical transfers are the dominant transmission route in these lineages. Some of these associations probably date back more than 150 million years and are an order of magnitude older than the cophylogenetic patterns between mammalian hosts and their gut bacteria. Our results suggest that termites have cospeciated with their gut bacteria since first appearing in the geological record.
Harmonizing spatial scales and ecological theories to predict avian richness and functional diversity within forest ecosystems
Authors: Cooper W. Justin , McShea William J. , Songer Melissa , Huang Qiongyu , Luther David A.
Published: June 2023

Classic ecological theory has proven that temperature, precipitation and productivity organize ecosystems at broad scales and are generalized drivers of biodiversity within different biomes. At local scales, the strength of these predictors is not consistent across different biomes. To better translate these theories to localized scales, it is essential to determine the links between drivers of biodiversity. Here we harmonize existing ecological theories to increase the predictive power for species richness and functional diversity. We test the relative importance of three-dimensional habitat structure as a link between local and broad-scale patterns of avian richness and functional diversity. Our results indicate that habitat structure is more important than precipitation, temperature and elevation gradients for predicting avian species richness and functional diversity across different forest ecosystems in North America. We conclude that forest structure, influenced by climatic drivers, is essential for predicting the response of biodiversity with future shifts in climatic regimes.
Partial protection from fluctuating selection leads to evolution towards wider population size fluctuation and a novel mechanism of balancing selection
Authors: Kim Yuseob
Published: June 2023

When a population is partially protected from fluctuating selection, as when a seed bank is present, variance in fitness will be reduced and reproductive success of the population will be promoted. This study further investigates the effect of such a ‘refuge’ from fluctuating selection using a mathematical model that couples demographic and evolutionary dynamics. While alleles that cause smaller fluctuations in population density should be positively selected according to classical theoretic predictions, this study finds the opposite: alleles that increase the amplitude of population size fluctuation are positively selected if population density is weakly regulated. Under strong density regulation with a constant carrying capacity, long-term maintenance of polymorphism caused by the storage effect emerges. However, if the carrying capacity of the population is oscillating, mutant alleles whose fitness fluctuates in the same direction as population size are positively selected, eventually reaching fixation or intermediate frequencies that oscillate over time. This oscillatory polymorphism, which requires fitness fluctuations that can arise with simple trade-offs in life-history traits, is a novel form of balancing selection. These results highlight the importance of allowing joint demographic and population genetic changes in models, the failure of which prevents the discovery of novel eco-evolutionary dynamics.
Polymorphisms in Intron 1 of HLA-DRA Differentially Associate with Type 1 Diabetes and Celiac Disease and Implicate Involvement of Complement System Genes C4A and C4B
Authors: Aydemir Özkan , Bailey Jeffrey A. , Agardh Daniel , Lernmark Åke , Noble Janelle A. , Svärd Agnes Andersson , Blankenhorn Elizabeth P. , Parikh Hemang , Ziegler Anette-G. , Toppari Jorma , Akolkar Beena , Hagopian William A. , Rewers Marian J. , Mordes John P. ,   TEDDY Study Group
Published: June 2023

Polymorphisms in genes in the human leukocyte antigen (HLA) class II region comprise the most important inherited risk factors for many autoimmune diseases including type 1 diabetes (T1D) and celiac disease (CD): both diseases are positively associated with the HLA-DR3 haplotype (DRB1*03:01-DQA1*05:01-DQB1*02:01). Studies of two different populations have recently documented that T1D susceptibility in HLA-DR3 homozygous individuals is stratified by a haplotype consisting of three single nucleotide polymorphisms (“tri-SNP”) in intron 1 of theHLA-DRAgene. In this study, we use a large cohort from the longitudinal “The Environmental Determinants of Diabetes in the Young” (TEDDY) study to further refine the tri-SNP association with T1D and with autoantibody-defined T1D endotypes. We found that the tri-SNP association is primarily in subjects whose first-appearing T1D autoantibody is to insulin. In addition, we discovered that the tri-SNP is also associated with celiac disease (CD), and that the particular tri-SNP haplotype (“101”) that is negatively associated with T1D risk is positively associated with risk for CD. The opposite effect of the tri-SNP haplotype on two DR3-associated diseases can enhance and refine current models of disease prediction based on genetic risk. Finally, we investigated possible functional differences between the individuals carrying high and low-risk tri-SNP haplotypes, and found that differences in complement system genes C4A and C4B may underlie the observed divergence in disease risk.