bluuebunny/crossref_metadata_2025 huggingface dataset:
Donor-specific antibodies, glomerulitis, and human leukocyte antigen B eplet mismatch are risk factors for peritubular capillary C4d deposition in renal allografts
Authors: Zheng Jin , Guo Hui , Gong Hui-Lin , Lan Ping , Ding Chen-Guang , Li Yang , Ding Xiao-Ming , Xue Wu-Jun
Published: October 2021

Background:

The complement system plays an important role in the immune response to transplantation, and the diagnostic significance of peritubular capillary (PTC) C4d deposition (C4d+) in grafts is controversial. The study aimed to fully investigate the risk factors for PTC C4d+ and analyze its significance in biopsy pathology of kidney transplantation.

Methods:

This retrospective study included 124 cases of kidney transplant with graft biopsy and donor-specific antibody (DSA) testing from January 2017 to December 2019 in a single center. The effects of recipient pathological indicators, eplet mismatch (MM), and DSAs on PTC C4d+ were examined using univariate and multivariate logistic regression analyses.

Results:

In total, 35/124 (28%) were PTC C4d+, including 21 with antibody-mediated rejection (AMR), eight with renal tubular injury, three with T cell-mediated rejection, one with glomerular disease, and two others. Univariate analysis revealed that DSAs (P < 0.001), glomerulitis (P < 0.001), peritubular capillaritis (P < 0.001), and human leukocyte antigen (HLA) B eplet MM (P = 0.010) were the influencing factors of PTC C4d+. According to multivariate analysis, DSAs (odds ratio [OR]: 9.608, 95% confidence interval [CI]: 2.742–33.668, P < 0.001), glomerulitis (OR: 3.581, 95%CI: 1.246–10.289, P = 0.018), and HLA B eplet MM (OR: 1.166, 95%CI: 1.005–1.353, P = 0.042) were the independent risk factors for PTC C4d+. In receiver operating characteristic curve analysis, the area under the curve was increased to 0.831 for predicting PTC C4d+ when considering glomerulitis, DSAs, and HLA B eplet MM. The proportions of HLA I DSAs and PTC C4d+ in active antibody-mediated rejection were 12/17 and 15/17, respectively; the proportions of HLA class II DSAs and PTC C4d+ in chronic AMR were 8/12 and 7/12, respectively. Furthermore, the higher the PTC C4d+ score was, the more serious the urinary occult blood and proteinuria of recipients at the time of biopsy.

Conclusions:

PTC C4d+ was mainly observed in AMR cases. DSAs, glomerulitis, and HLA B eplet MM are the independent risk factors for PTC C4d+.
Cytrellis: A Novel Microcoring Technology for Scarless Skin Removal: Summary of Three Prospective Clinical Trials
Authors: Pozner Jason N. , Kilmer Suzanne L. , Geronemus Roy G. , Jack Megan , Burns Jay A. , Kaminer Michael S.
Published: October 2021

Background:

We introduce an innovative and novel technology that achieves scarless skin removal without the use of thermal energy. Microcoring technology (MCT) uses a modified, hollow hypodermic needle to remove skin safely and without a scar. This method is advantageous compared to other fractional devices, given that it has the same benefits as energy-based devices (removal of skin cores without a scar), with the added value of immediate closure along the relaxed skin tension lines, with significantly less thermal energy.

Methods:

Three prospective clinical safety trials analyzing MCT treatment on abdominal and facial skin (short- and long-term) are described.

Results:

MCT treatment of human skin resulted in scarless skin removal that was well tolerated by patients. Healing occurred rapidly, with limited side effects. Skin area reduction (skin tightening) and increase in skin thickness were observed long term.

Conclusions:

MCT treatment of human skin is safe and well tolerated. Although further studies on efficacy are required to evaluate the full potential of MCT in skin rejuvenation, early findings such as skin tightening and increase in skin thickness are encouraging.
ALTMETRIC ANALYSIS OF THE MOST-CITED 100 ARTICLES ON THE RETINA PUBLISHED BETWEEN 2010 AND 2020
Authors: Sener Hidayet , Polat Osman Ahmet
Published: October 2021

Purpose:

Altmetric analysis is a way of assessing the social impact of scientific articles. In this study, we aimed to analyze the 100 most-cited articles on the topic of the retina published in ophthalmology journals in traditional metrics and altmetrics.

Methods:

The term “retina” was searched in the Web of Science database, and articles published in ophthalmology journals were filtered out. A total of 100 highly cited articles from 2010 to 2020 were evaluated for bibliographic data and altmetrics. First, descriptive statistics and then correlation analysis between traditional bibliographies and altmetrics were performed.

Results:

According to the Web of Science search, the number of citations of the articles listed in the top 100 list ranged from 809 to 137. The altmetric scores of the articles listed in the top 100 list ranged from 0 to 1,340. There was no statistically significant correlation between the altmetric scores and the number of citations, but there was a statistically weak correlation between the altmetric scores and the average citations per year, H index, impact factor, and number of years since publication.

Conclusion:

Altmetrics is not sufficient to determine the scientific value of articles and can be affected by many factors, unlike traditional bibliometrics. However, being a good communicator in social media can support scientific productivity and create social impact.
MACULAR SENSITIVITY AND CAPILLARY PERFUSION IN HIGHLY MYOPIC EYES WITH MYOPIC MACULAR DEGENERATION
Authors: Zheng Feihui , Chua Jacqueline , Sim Yin Ci , Tan Bingyao , Yu Marco , Wong Qiu Ying , Dan Yee Shan , Chong Rachel S. , Gemmy Cheung Chui Ming , Ang Marcus , Lee Shu Yen , Wong Tien Yin ,   SNEC Retina Group, Schmetterer Leopold , Wai Wong Chee , Hoang Quan V.
Published: October 2021

Purpose:

To evaluate the interrelationship between macular sensitivity and retinal perfusion density (PD) in eyes with myopic macular degeneration (MMD).

Methods:

One hundred and thirty-eight highly myopic eyes from 82 adult participants were recruited. Macular sensitivity was evaluated using the Microperimeter MP-3. Retinal PD was measured using the PLEX Elite 9000 swept source optical coherence tomography angiography. Macular sensitivity values between different categories of MMD and its relationship with optical coherence tomography angiography measurements were evaluated using multivariable linear mixed models, adjusting for age and axial length.

Results:

Macular sensitivity reduced with increasing severity of MMD (β ≤ −0.95, P < 0.001), whereas the best-corrected visual acuity was not associated with MMD severity (P > 0.04). Persons who were older (β = −0.08, P < 0.001), with longer axial length (β = −0.32, P = 0.005), presence of macular diffuse choroidal atrophy (β = −2.16, P < 0.001) or worse MMD (β = −5.70, P < 0.001), and presence of macular posterior staphyloma (β ≤ −2.98, P < 0.001) or Fuchs spot (β = −1.58, P = 0.04) were associated with reduced macular sensitivity. Macular sensitivity was significantly associated with deep retinal PD in MMD (β = 0.15, P = 0.004) but not with superficial retinal PD (P = 0.62).

Conclusion:

There was a strong correlation between reduced macular sensitivity and increasing MMD severity, even in mild MMD independent of the best-corrected visual acuity. Furthermore, macular sensitivity was correlated with deep retinal PD, suggesting a vasculature–function relationship in MMD.
Higher Hospitalization Rates in Children Born HIV-exposed Uninfected in British Columbia, Canada, Between 1990 and 2012
Authors: Li Shu Nan Jessica , Albert Arianne , Piske Micah , Janssen Patricia A. , Alimenti Ariane , Jesson Julie , Côté Hélène C. F. , Sauvé Laura
Published: October 2021

Background:

Compared with children who are HIV-unexposed and uninfected (CHUU), children who are HIV-exposed and uninfected (CHEU) experience more clinical complications. We investigated hospitalizations among CHEU by antenatal antiretroviral therapy (ART) exposure, in British Columbia, Canada.

Methods:

This retrospective controlled cohort study used administrative health data from 1990 to 2012. CHEU and CHUU were matched 1:3 for age, sex and maternal geographical area of residence. We determined adjusted odds ratios (aORs) via conditional logistic regression, adjusting for maternal risk factors.

Results:

A total of 446 CHEU and 1333 CHUU were included. Compared with CHUU, more CHEU experienced one or more lifetime hospitalization (47.3% vs. 29.8%), one or more neonatal hospitalization (40.4% vs. 27.6%), and any intensive care unit admission (28.5% vs. 9.2%). In adjusted analyses, CHEU experienced higher odds of any lifetime hospitalization (aOR 2.30, 95% confidence interval 1.81–2.91) and neonatal hospitalization (aOR 2.14, 95% confidence interval 1.68–2.73), compared with CHUU. There was, however, no difference in infection-related hospitalizations (9.0% vs. 7.5%), which were primarily respiratory tract infections among both CHEU and CHUU. CHEU whose mothers-initiated ART preconception showed lower odds of infection-related hospitalizations than children whose mothers initiated ART during pregnancy or received no ART.

Conclusions:

CHEU experienced increased odds of hospitalization relative to CHUU. A substantial number of CHEU hospitalizations occurred within the neonatal period and were ICU admissions. Initiating ART preconception may reduce the risk of infection-related hospitalizations. These findings reinforce the benefit of ART in pregnancy and the need for ongoing pediatric care to reduce hospitalizations.
Can perioperative psychological interventions decrease the risk of postsurgical pain and disability? A systematic review and meta-analysis of randomized controlled trials
Authors: Nadinda Putu G. , van Ryckeghem Dimitri M.L. , Peters Madelon L.
Published: October 2021

Many patients experience pain after surgery. Psychological factors such as emotion and cognition are shown to be associated with the development of acute and chronic postsurgical pain (CPSP). Therefore, the question arises whether targeting these psychological factors can reduce negative postsurgical outcomes. The aim of the current review was to investigate the efficacy of perioperative psychological interventions in reducing (sub)acute postsurgical pain and CPSP and disability in adults. Randomized controlled trials were identified through 4 databases (Web of Science, PsychINFO, PubMed, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]). The outcomes of interest were (sub)acute (ie, within 3 months after surgery) and chronic (>3 months after surgery) pain and disability. After screening, 21 studies were included in the final analyses. It was found that psychological interventions significantly reduced (sub)acute pain (d = −0.26, 95% confidence interval [CI] [−0.48 to −0.04]) and disability (d = −0.43, 95% CI [−0.84 to −0.03]) as well as CPSP (d = −0.33, 95% CI [−0.61 to −0.06]) and disability (d = −0.43, 95% CI [−0.68 to −0.18]). In addition, interventions delivered after surgery and interventions delivered by a psychologist tended to be more effective than interventions delivered before surgery and interventions delivered by another healthcare provider. Furthermore, the current review points to the need for more research to determine which specific type of intervention may be most beneficial for surgical patients. Finally, the current review identified that research in this domain has concerns regarding bias in missing outcome data due to withdrawal and drop out.
Prevalence and treatment of neuropathic pain diagnoses among U.S. nursing home residents
Authors: Mbrah Attah K. , Nunes Anthony P. , Hume Anne L. , Zhao Danni , Jesdale Bill M. , Bova Carol , Lapane Kate L.
Published: October 2021

Neuropathic pain is a common condition experienced by older adults. Prevalence estimates of neuropathic pain and descriptive data of pharmacologic management among nursing home residents are unavailable. We estimated the prevalence of neuropathic pain diagnoses and described the use of pain medications among nursing home residents with possible neuropathic pain. Using the Minimum Data Set 3.0 linked to Medicare claims for residents living in a nursing home on November 30, 2016, we included 473,815 residents. ICD-10 codes were used to identify neuropathic pain diagnoses. Identification of prescription analgesics/adjuvants was based on claims for the supply of medications that overlapped with the index date over a 3-month look-back period. The prevalence of neuropathic pain was 14.6%. Among those with neuropathic pain, 19.7% had diabetic neuropathy, 27.3% had back and neck pain with neuropathic involvement, and 25.1% had hereditary or idiopathic neuropathy. Among residents with neuropathic pain, 49.9% received anticonvulsants, 28.6% received antidepressants, 19.0% received opioids, and 28.2% had no claims for analgesics or adjuvants. Resident characteristics associated with lack of medications included advanced age, dependency in activities of daily living, cognitive impairment, and diagnoses of comorbid conditions. A diagnosis of neuropathic pain is common among nursing home residents, yet many lack pharmacologic treatment for their pain. Future epidemiologic studies can help develop a more standard approach to identifying and managing neuropathic pain among nursing home residents.
Exploration of the Impact of Coronavirus Disease 2019 on People Living With HIV in Kerman, Iran: A Qualitative Study
Authors: Jaafari Zahra , Eybpoosh Sana , Sharifi Hamid , Karamouzian Mohammad
Published: October 2021

We explored the impact of the coronavirus disease 2019 (COVID-19) pandemic on people living with HIV (PLWH) in Kerman, Iran. A convenience sample of 18 PLWH from a voluntary counseling and testing (VCT) center (August–October 2020) were invited to participate in face-to-face interviews. Inductive content analysis was performed with MAXQDA software. Six themes were identified: COVID-19–related knowledge and preventive practices, misconceptions about COVID-19, fear of seeking health care services, psychosocial effects, limited or inconvenient access to health care services, and the impact of COVID-19 on socioeconomic status. Although participants generally understood COVID-19 preventative measures, some held misconceptions. COVID-19 negatively affected PLWHs' mental health, financial stability, and use of and access to health care services. Our findings support expansion of services related to HIV care/treatment and mental health to promote health and well-being during the COVID-19 pandemic.
Tympanoplasty Before Tympanoplasty: Alea Jacta Erat!
Authors: Mudry Albert
Published: October 2021

Objectives:

Tympanoplasty is the most common ear surgery performed throughout the world. As its basic principles remain the same since its introduction, many publications usually explain, in the introduction, that tympanoplasty has been a successful technique since the 1950s. The aim of this historical notice is to go back to the origin of the word tympanoplasty, and its final introduction as a specific defined surgical concept.

Material and Method:

Historical study based solely on original publications in different languages.

Results:

The term tympanoplasty was first used by Hirch in 1912 for an operation for chronic adhesive catarrh of the middle ear. It was revived by Wullstein in 1952. One Polish, Miodonski, and three German otologists played an important role in the development of the actual concept and definition of tympanoplasty: Moritz, Zöllner and Wullstein, the two latter being recognized as worldwide dispensers of the technique.

Conclusion:

The history of the term tympanoplasty can be divided into two periods: the first being 1912 to 1913 with its first use for an operation to treat chronic adhesive catarrh of the middle ear, and the second 1952 to 1955, with its revival and definitive implementation in the surgery of the ear based on the concept of protection of the round window and construction of an effective sound-transmitter system through the oval window. Nevertheless, the concept of tympanoplasty was already established in 1950 but not surgically definitively implemented: alea jacta erat—the die was cast!
Translation and Validation of the Dizziness Handicap Inventory into Thai Language
Authors: Emasithi Alongkot , Pakdee Sirinthip , Isaradisaikul Suwicha Kaewsiri , Uthaikhup Sureeporn
Published: October 2021

Objective:

To translate and evaluate psychometric properties of Thai version of the Dizziness Handicap Inventory (DHI-TH).

Study Design:

A cross-sectional study.

Setting:

Ambulatory.

Patients:

Fifty patients with dizziness at a vestibular clinic.

Main Outcome Measures:

Translation and cross-cultural adaptation of the original English version of the DHI was performed according to published guidelines. Psychometric evaluation included internal consistency, content validity, test–retest reliability, convergent validity, discriminant ability, and responsiveness. Responsiveness was examined in 28 patients with vestibular dysfunction who received vestibular rehabilitation for 6 to 8 weeks.

Results:

There were no floor and ceiling effects. The Cronbach's alpha was good for the total score (0.87) and subscale scores (0.70 physical, 0.73 emotional, and 0.71 functional). Excellent test–retest reliability was demonstrated for the total and subscales (ICC ranged from 0.91 to 0.97, p < 0.001). The SEM was 3.50 and the MDC was 9.68. The total and subscales of DHI-TH were moderately correlated with the SF-36-TH scores (r ranged from −0.40 to −0.63). An optimal cut-off point for detection of dizziness was 21 points (98% sensitivity, 94% specificity). Responsiveness of the DHI-TH was excellent. The ES and SRM were large (1.25 and 1.59, respectively). The DHI-TH discriminated well between patients with self-perceived improved dizziness versus unchanged dizziness (AUC = 0.87). The MCID was 17 points (82.0% sensitivity, 82.0% specificity).

Conclusion:

The DHI-TH demonstrated good psychometric properties for patients with dizziness. The DHI-TH is a valid and reliable instrument recommended as a measure of disability and quality of life in Thai patients with dizziness.
Foreign body removal using flexible bronchoscopy in terminal cancer
Authors: Jeon So-Yeon , Choe Yeong-Hun , Song Eun-Kee , Yim Chang-Yeol , Lee Na-Ri
Published: October 2021

Rationale:

Pulmonary foreign body aspiration is a serious medical problem. The risk of foreign body aspiration into the airways increases considerably in patients with end stage cancer with reduced consciousness and impaired airway reflexes. However, few studies have reported on foreign body aspiration in the airways in patients with terminal cancer or receiving end-of-life care. Herein, we report the use of flexible bronchoscopy in patients with end-of-life cancer with pulmonary aspiration.

Patient concerns:

A 71-year-old man with neuroendocrine carcinoma was admitted to a palliative care unit for end-of-life care. He accidentally aspirated implant teeth into the airway with decreased consciousness and death rattle.

Diagnosis:

On chest x-ray, the foreign material was observed in the left main bronchus.

Interventions:

Despite concerns regarding the use of bronchoscopy given the deterioration of the overall organ function, flexible bronchoscopy was performed.

Outcomes:

Eventually, the foreign body was removed using a basket in the nasal cavity without major complications. The patient died comfortably after 7 days.

Lessons:

The possibility of patients in the palliative care unit with reduced consciousness and death rattle to aspirate foreign bodies into the airways must be carefully considered. Flexible bronchoscopy should be considered to carefully remove aspirated foreign bodies in the airway without any side effects, even in patients with terminal cancer or receiving end-of-life care.
Postoperative radioiodine therapy impact on survival in poorly differentiated thyroid carcinoma: a population-based study
Authors: Xu Lei , Zou Qiong , Jiao Ju , Zhang Yong
Published: October 2021

Purpose

The true impact of postoperative radioiodine therapy on survival has been controversial for patients with poorly differentiated thyroid carcinoma (PDTC). We aimed to determine the impact of postoperative radioiodine on survival in PDTC through a population-based study.

Methods

Data on patients with PDTC were collected from the US SEER database (2004 to 2015). Patients were divided into the radioiodine group and nonradioiodine group. Survival comparison between groups was evaluated by Kaplan–Meier curves, log-rank test and multivariate Cox regression analysis. Akaike information criterion was used to select variables in the nomogram. The performance of the nomogram was assessed by discrimination (C-index) and calibration plots.

Results

The radioiodine group had more aggressive features, such as advanced tumor node metastasis stage and radical surgery, compared to the nonradioiodine group. PDTC patients receiving radioiodine therapy had a significant survival advantage in terms of overall survival (OS) (P = 0.001) but not in terms of cancer-specific survival (P = 0.083). Multivariate analysis revealed radioiodine therapy was an independent favorable factor for OS in PDTC patients (hazard ratio = 0.57; 95% CI, 0.44–0.75, P < 0.001). Subgroup analysis identified patients’ characteristics favoring radioiodine therapy. The nomogram (age, tumor size, extension, neck lymph nodes metastasis and radioiodine therapy) of OS for predicting 3-, 5- and 10-year OS probability showed good discrimination (C-index, 0.797) and calibration power.

Conclusion

Postoperative radioiodine therapy can prolong the long-term OS in patients with PDTC, and is an independent favorable prognostic factor for those patients. Further prospective studies are warranted.
Expression and Prognostic Value of Small Mothers Against Decapentaplegic 7, Matrix Metalloproteinase 2, and Matrix Metalloproteinase 9 in Resectable Pancreatic Ductal Adenocarcinoma
Authors: Zhou Li , Lu Jun , Liang Zhi-Yong , Zhou Wei-Xun , Wang Yi-Zhi , Jiang Bo-Lun , You Lei , Guo Jun-Chao
Published: October 2021

Objective

Thus far, expression, clinicopathologic, and prognostic implication of small mothers against decapentaplegic 7 (Smad7), matrix metalloproteinase 2 (MMP2), and matrix metalloproteinase 9 (MMP9) in pancreatic ductal adenocarcinoma (PDAC) were rarely investigated or controversial.

Methods

Expression of Smad7, MMP2, and MMP9 was detected using immunohistochemistry in tissue microarrays based on 322 patients with curatively resected PDAC. Their expression pattern, clinicopathologic, and prognostic relevance were further evaluated.

Results

Smad7 expression was found to be lower in tumor than in adjacent nontumor tissues, whereas tumoral MMP2 and MMP9 staining scores were much higher than in adjacent nontumor ones. Furthermore, Smad7 was negatively associated with serum carbohydrate antigen 19-9 level. Univariate survival analyses showed that patients with high Smad7 tumors had significantly better disease-specific survival (P = 0.0007), whereas MMP2 and MMP9 predicted poor disease-specific survival (P = 0.0211 and 0.0404). In multivariate Cox regression test, Smad7 was an independent prognostic indicator (P = 0.021). In addition, these 3 proteins were also prognostic in many subgroups.

Conclusions

Smad7 and MMP2/9 significantly predict good or poor prognosis in resectable PDAC, respectively. Therefore, the genes might serve as a tool or targets for molecular therapy in PDAC.
A Comparative Study of Endoscopic Ultrasonography and Histopathology Images for the Diagnosis of Early Chronic Pancreatitis
Authors: Sekine Masanari , Tanaka Akira , Akimoto Maho , Miura Takaya , Fujiwara Junichi , Noda Hiroshi , Rikiyama Toshiki , Ohnishi Hirohide , Mashima Hirosato
Published: October 2021

Objective

The concept of early chronic pancreatitis (ECP) and its diagnostic criteria were first proposed by Japan, using endoscopic ultrasonography (EUS) findings for diagnosis. However, these findings have not been supported by pathological findings. We aimed to examine the association between the EUS and pathological findings of the same area of the pancreas.

Methods

In 12 patients who underwent pancreaticoduodenectomy for distal bile duct cancer without accompanying pancreatitis, a comparative analysis between preoperative EUS and pathological findings was performed. The part of the pancreas adjoining the portal vein was evaluated.

Results

In 7 cases, abnormal EUS findings included in the diagnostic criteria for ECP were seen; the correlation of the accuracy of lobularity seen on EUS compared with the pathological findings of the pancreatic parenchyma (inflammatory cell infiltration, atrophy of acinar cells, and fibrosis) was high (83.3%–91.7%). Pancreatic duct findings revealed that the accuracy of the hyperechoic margin of the pancreatic duct on EUS compared with pathological findings (wall thickness of pancreatic duct) was high (83.3%).

Conclusions

Endoscopic ultrasonography findings for ECP, according to Japan's 2019 revised criteria, lobularity, and the hyperechoic margin of the pancreatic duct may highly correspond to the pathological findings of chronic inflammation.
Quantifying the Risk of Drug-Induced Pancreatitis With Angiotensin-Converting Enzyme Inhibitors and Statins Using a Large Electronic Medical Record Database
Authors: Twohig Patrick A. , de-Madaria Enrique , Thakkar Shyam , Dulai Parambir , Gardner Timothy B. , Kochhar Gursimran , Sandhu Dalbir S.
Published: October 2021

Objectives

Quantify the risk of drug-induced pancreatitis (DIP) from angiotensin-converting enzyme inhibitors (ACEis) and 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins).

Methods

Retrospective cohort analysis using IBM Explorys (1999–2019), a pooled, deidentified clinical database of more than 63 million patients across the United States. Odds ratios were calculated to determine the risk of DIP from ACEi, statins, and both medications together. χ2 testing assessed the relationship between age, sex, ethnicity, insurance status, and mortality among patients with DIP from ACEi, statins, or both combined.

Results

Acute pancreatitis (AP) was found in 280,740 patients. Odds ratios for ACEi, statins, and both combined were 6.12, 4.97, and 5.72, respectively. Thirty-eight percent of all-cause AP occurs in adults older than 65 years. Acute pancreatitis from ACEi and statins occurs in 49% and 56% of patients older than 65 years, respectively. Men and patients older than 65 years are at higher risk of DIP from ACEi and statins. Patients on Medicaid are at higher risk of DIP from statins, and Asian patients are at highest risk of DIP from ACEi.

Conclusions

We found that ACEi and statins increase the odds of DIP. Although ACEis and statins are critical medications for many patients, clinicians should consider using alternatives in patients with AP of unclear etiology.
Phase I Study of Preoperative Chemoradiotherapy Using Gemcitabine Plus Nab-Paclitaxel for Patients Who Have Localized Pancreatic Ductal Adenocarcinoma With Contact or Invasion to Major Arteries
Authors: Hayasaki Aoi , Kishiwada Masashi , Murata Yasuhiro , Komatsubara Haruna , Nakagawa Yuki , Maeda Koki , Shinkai Toru , Noguchi Daisuke , Gyoten Kazuyuki , Fujii Takehiro , Iizawa Yusuke , Tanemura Akihiro , Kuriyama Naohisa , Sakurai Hiroyuki , Isaji Shuji , Mizuno Shugo
Published: October 2021

Objectives

This study aimed to assess the feasibility of preoperative chemoradiotherapy using gemcitabine plus nab-paclitaxel (GnP) and to determine the recommended dose (RD) of nab-paclitaxel for patients with localized pancreatic ductal adenocarcinoma (PDAC).

Methods

The participants had localized PDAC with contact or invasion to major arteries. They received GnP on days 1, 15, 29, and 43. The dose of gemcitabine was fixed at 600 mg/m2, whereas that of nab-paclitaxel was at 3 dose levels in accordance with a standard 3 + 3 dose escalation scheme. Three-dimensional radiotherapy was administered concurrently to a total dose of 50.4 Gy per 28 fractions.

Results

The study cohort comprised 15 patients. Grade 3 or 4 neutropenia was observed in 4 (26.7%), leukopenia in 1 (6.7%), biliary infection in 2 (13.3%), appetite loss and nausea in 1 (6.7%), and anaphylaxis in 1 (6.7%). The RD was determined as level 2 (gemcitabine, 600 mg/m2; nab-paclitaxel, 100 mg/m2). Three patients underwent pancreatectomy after additional chemotherapy and achieved R0 resection.

Conclusions

The RD of nab-paclitaxel in our chemoradiotherapy protocol using GnP was 100 mg/m2 with gemcitabine 600 mg/m2 and 3-dimensional conformal radiotherapy to a total dose of 50.4 Gy per 28 fractions for patients with localized PDAC.
Is the Combination of Rectal Diclofenac and Intravenous Ringer Lactate Superior to Individual Therapy for Prophylaxis of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis
Authors: Thanage Ravi , Jain Shubham , Chandnani Sanjay , Udgirkar Suhas , Nair Sujit , Debnath Prasanta , Jain Samit , Rathi Pravin
Published: October 2021

Objectives

Rectal diclofenac and hydration with Ringer lactate (RL) are proven therapies for prophylaxis of post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). This study was to analyze the effect of a combination of them for the prevention of PEP.

Methods

This was single-center, open-label, randomized trial. Patients who were undergoing ERCP and who were at high risk for the development of PEP were selected for the study. Patients were randomized into 3 treatment groups: diclofenac suppository group, RL group, and a combination group.

Results

Eight of 57 patients (14.03%) in the diclofenac group, 9 of 57 patients (15.78%) in the RL group, and 6 of 57 patients (10.52%) in the combination group developed PEP. The incidence of PEP between the three groups was not statistically significant (P = 0.70). Serum amylase level of >252 U/L had 91.3% sensitivity and 92.6% specificity for the diagnosis of PEP.

Conclusions

Post-ERCP pancreatitis is usually mild to moderate 95% times. Female sex, age younger than 50 years, a benign indication of ERCP, and low bilirubin levels have higher chances of PEP. A combination of rectal diclofenac and hydration with RL does not offer better protection for PEP, as compared with individual prophylaxis.
Systematic evaluation of the guidelines for rehabilitation in multiple sclerosis patients: an overview according to ICF functioning domains
Authors: Soler Bernardita , Raats Joke , Abasiyanik Zuhal , Lamers Ilse , Makshakov Gleb , Feys Peter
Published: October 2021

High-quality clinical practice guidelines (CPGs) can provide evidence-based recommendations for optimizing care on managing multiple sclerosis (MS). There is currently no review that compiles recommendations of high-quality CPGs to guide decision-making for MS rehabilitation. The aim was to identify evidence-based recommendations in high-quality multidisciplinary English CPGs for rehabilitation in MS. CPGs published in the last 10 years (2009–2019) that described recommendations on rehabilitation were searched in PubMed, Turning Research into Practice database, International Guideline databases, National Guideline databases and websites of MS organizations. Quality assessment of CPGs was conducted by two evaluators using the Appraisal of Guidelines for Research and Evaluation II instrument. Recommendations were classified according to the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Intervention (ICHI) and documented in terms of strength of recommendation and level of evidence. Five CPGs satisfied the inclusion criteria. Of 120 recommendations, 38 had a strong level with moderate to low level of evidence, 61 were of weak strength and 18 were formulated by the consensus of experts. Recommendations were categorized into 12 domains and 1 chapter on the body function level, 1 chapter on activity level and 2 domains on external factors. The existing CPGs demonstrated more than 100 evidence level recommendations to be followed at the clinical practice, most in body functions of the ICF. Developing up-to-date CPGs with more focus on activity and participation domains for countries with various healthcare backgrounds may be useful for a best clinical practice.
Normative Values of Pediatric Thoracic Aortic Diameters Indexed to Body Surface Area Using Computed Tomography
Authors: Kocher Madison R. , Waltz Jeffrey , Collins Heather , Schoepf U. Joseph , Tran Tri , Guruvadoo Kharina , Lehew Haley , Kabakus Ismail M. , Akkaya Selcuk , McBee Morgan P. , Gregg David , Zahergivar Aryan , Burt Jeremy R.
Published: October 2021

Purpose:

The purpose of this study was to establish normative values for the thoracic aorta diameter in pediatric patients from birth to 18 years of age using computed tomography (CT) measurements and to create nomograms related to body surface area (BSA).

Methods:

A total of 623 pediatric patients without cardiovascular disease (42.1% females; from 3 d to 18 y old) with high-quality, non–electrocardiogram-gated, contrast-enhanced CT imaging of the chest were retrospectively evaluated. Systematic measurements of the aortic diameter at predetermined levels were recorded, and demographic data including age, sex, ethnicity, and BSA were collected. Reference graphs plotting BSA over aortic diameter included the mean and Z−3 to Z+3, where Z represents SDs from the mean.

Results:

The study population was divided into 2 groups (below 2 and greater than or equal to 2 y old). There were no significant differences in average aortic measurements between males and females. Both age groups exhibited significant positive correlations among all size-related metrics (all P<0.001) with BSA having the highest correlation. For both groups, the average orthogonal thoracic aortic diameters at each level of the thoracic aorta were used to create nomograms.

Conclusion:

This study establishes clinically applicable, BSA-specific reference values of the normal thoracic aorta for the pediatric population from CT imaging.
Comparison of the Effects of Intratubal Injection of Adipose-Derived Mesenchymal Stem Cells in a Rat Sciatic Nerve Transection
Authors: Karakol Perçin , Kapi Emin , Karaöz Erdal , Tunik Selçuk , Bozkurt Mehmet
Published: October 2021

This study was designed to evaluate the efficacy of epineural tubulization (ENT) with or without intratubal application of adipose-derived mesenchymal stem cells (ASCs) in the rat model of sciatic nerve transection. After formation of 1-cm defect in the left sciatic nerve and ENT, 32 adults female Wistar albino rats were separated into 4 groups (n = 8 for each) including ENT per se (group 1; ENT group) and ENT plus intratubal ASC injection groups killed on day 21 (group 2; ENT-ASC-21-day group), 60 days (group 3; ENT-ASC-60-day group), and 120 days (group 4; ENT-ASC-120-day group). Functional (sciatic function index, hip circumference, withdrawal reflex latency, muscle weight ratio), electrophysiological, histomorphometric, and immunohistochemical analyses were performed in each group. Sciatic function index was significantly higher (−51.98 ± 5.94, P < 0.01) and withdrawal reflex latency was shorter (−6.21 ± 2.14, P < 0.01), in the group 4 as compared with all other groups on day 21. Amplitude of contraction was significantly lower in the group 4 as compared with all other groups (0.22 ± 0.05 vs 0.34 ± 0.07, 0.50 ± 0.11, and 0.61 ± 0.16, P < 0.01 for each). Immunohistochemical analysis revealed presence of green fluorescent protein, vimentin-stained cells, and single neural progenitor cells indicating that induction of neuronal differentiation by ASCs and direct involvement of ASCs within the axonal structure alongside extension of ASCs to the muscular layer of the group 4. In conclusion, our findings revealed that use of ENT plus intratubal ASC injection in a rat sciatic nerve transection model was associated with satisfactory functional outcome and improved peripheral axonal regeneration along with stem cell neural differentiation.
A Comparison of Applicant and Resident Physician Demographics Among Surgical Subspecialties From 2009 to 2019
Authors: Jain Abhishek , Nichols Georgina , Tarabishy Sami , Scomacao Isis , Herrera Fernando A.
Published: October 2021

Background

The purposes of this study were to compare applicant statistics to resident physician demographics among several surgical subspecialties (SSSs), to identify trends of gender and underrepresented minorities in medicine (UIM), and to evaluate current diversity among these specialties.

Methods

Graduate medical education reports from 2009 to 2019 were queried to determine trends among programs. Further identification of gender and UIM statistics was obtained in 4 several SSSs: integrated plastic surgery, orthopedic surgery (OS), otolaryngology surgery (ENT), and neurosurgery (NS). These were compared with Association of American Medical Colleges data of residency applicants for the respective years.

Results

Significant differences were seen among gender and UIM(s) of the applicant pool when compared with resident data. All specialties had significantly fewer American Indian and African American residents compared with applicants. Significant differences between applicants and residents were also found among Hispanic, Native Hawaiian, and female demographics. All SSSs had a significant positive trend for the percentage of female residents. Significant differences between specialties were identified among African American, Hispanic, and female residents. Orthopedic surgery and NS had significantly higher percentage of African American residents compared with ENT and integrated plastic surgery. Neurosurgery had significantly higher percentage of Hispanic residents compared with OS and ENT. Integrated plastic surgery and ENT had significantly higher percentage of female residents compared with OS and NS.

Conclusions

There has been significant increase in number of residency programs and resident positions since 2009. However, increase in female residents and UIM(s) among SSSs has not matched the pace of growth.
Mandibular Distraction Osteogenesis First for Children With Severe Unilateral Hemifacial Microsomia: Treatment Strategy and Outcomes
Authors: Liu Wei , Xu Xi , Zhao Shanbaga , Peng Qi-Li , Shu Kai-Yi , Liu Bing-Yang , Tang Xiao-Jun , Yin Lin , Feng Shi , Zhang Zhi-Yong
Published: October 2021

The treatment for severe hemifacial microsomia (HFM), especially type III case, is extremely difficult. Mandibular distraction osteogenesis (MDO) was rarely used as the primary choice in the treatment of severe type cases. The authors sought to observe the short-term therapeutic outcomes of patients with severe unilateral HFM who underwent MDO first.

A retrospective study of children underwent MDO or later received costochondral graft (CCG) for severe unilateral HFM from 2009 to 2019 was conducted. Cephalometric measurements and clinical variables were analyzed to evaluate the effectiveness of MDO first strategy for severe cases and compare disparity between Pruzansky–Kaban classification type IIb and type III groups.

Thirty-six patients (23 males and 13 females) underwent MDO first for severe HFM were included for analysis in the present study. The average age at MDO was 8.33 ± 2.03 years. At the last follow-up, MDO acquired significant improvement in mandibular height, maxillary cant, chin deviation, lip commissural line tilt, and clinical chin deviation (P < 0.05). Distraction results were stable during the short-term follow-up in terms of the mandibular height ratio and maxillary cant (P > 0.05).

MDO is a proper primary method for suitable type IIb and type III HFM cases. MDO can immediately and significantly improve the facial skeleton deficiency, extend the associated soft tissue at the same time, and lay foundation for secondary surgery. MDO can achieve the downgrade of HFM deficiency severity. MDO followed by costochondral graft can get satisfactory esthetic and structural consequence for type III patients.
A Novel Technique for Autologous Supratip Augmentation: Septal Gap Graft
Authors: Lee Wooyeon , Park Bumjin
Published: October 2021

Background:

Although it has been common to use artificial implant to augment nasal dorsum in Asian rhinoplasty, the demand for not using it is increasing due to the long-term complications of implants. However, if only the tip is raised without raising the dorsum with implant, it is difficult to avoid supratip depression, so it is difficult to obtain good cosmetic results. The authors would like to report good results, performing an augmentation rhinoplasty that raises the supratip area using the nasal septal cartilage without using an implant.

Methods:

Septal gap graft was used in 22 patients undergoing nasal tip surgery from January 2019 to April 2021. Septal gap graft refers to a graft that increases the height of the supratip area by using septal cartilage. Firstly, the authors perform a septal extension graft using the septal cartilage, then the authors fix the lower lateral cartilage in an ideal position, and lastly the authors heighten the nasal tip with onlay graft. The height difference between the nasal bone and the nasal tip, is solved by placing the septal cartilage. Before, during and after surgery, photometric analysis was done by taking clinical pictures.

Results:

Through the septal gap graft, the supratip depression index was decreased and the nasal tip projection was increased. It was confirmed that the septal gap graft was well maintained at long-term follow-up, and the patients’ postoperative satisfaction was also high.

Conclusions:

The authors presented a new technique for augmentation rhinoplasty in Asians. Septal gap graft can be used safely and effectively to raise supratip area without using implant.
Histomorphometric Comparison of New Bone Formed After Maxillary Sinus Lift With Lateral and Crestal Approaches Using Periostal Mesenchymal Stem Cells and Beta-Tricalcium Phosphate: A Controlled Clinical Trial
Authors: Fatale Valentina , Pagnoni Stefano , Pagnoni Albino Emidio , Passarelli Pier Carmine , Netti Andrea , Lajolo Carlo , Santacroce Luigi , D’Addona Antonio
Published: October 2021

The present study investigated clinical and histomorphometric data after sinus lift procedures performed with and without mesenchymal stem cells (MSCs) added to a graft. Twenty-four patients underwent maxillary sinus lift for implant placement. Twelve patients each were assigned to control (Group 1) and test (Group 2) groups. An MSC suspension was added to the graft used in patients of Group 2. Five of 12 patients in both groups underwent crestal-approach sinus lift with immediate implant placement, while seven patients received a lateral-approach sinus lift. The MSC suspension was obtained using the Rigenera protocol. Samples from the grafted site were evaluated, processed, and stained using three staining techniques 90 days after surgery. Histomorphometric analysis was performed using an imaging software (ImageJ). Two types of tissues were defined: Type 1 ‘mature bone’ and Type 2 ‘osteoid tissue’. The mean Type 1 tissue percentage was 27.24% in Group 1 and 44.45% in Group 2 (P < 0.05). The mean Type 2 tissue percentage was 10.86% and 7.04% in Groups 1 and 2, respectively. The mean Type 1 tissue percentages for the crestal approach were 24.52% for Group 1 and 50.78% for Group 2, while the mean Type 1 tissue percentages for the lateral approach were 29.18% for Group 1 and 39.92% for Group 2. Patients treated with grafts containing MSCs showed 63.18% increased bone formation compared to those treated with grafts not containing MSCs (P < 0.05). Although our data showed a positive trend in patients treated with MSCs, differences between subgroups were not significant (P > 0.05).
Pleomorphic Adenoma of the Eyebrow: An Unexpected Finding and Review of Unusual Periorbital Soft Tissue Lesions
Authors: Fajardo Manuel Alejandro , Glomski Krzystof , Castiglione Charles L. , Babigian Alan , Hughes Christopher D.
Published: October 2021

Soft tissue lesions of the eyebrow are common and are usually diagnosed as dermoid cysts, pilomatrixomas, inclusion cysts, or basal cell carcinomas. Pleomorphic adenomas are benign glandular lesions most commonly found in the parotid gland or salivary glands, and less commonly found in the lacrimal gland. Here the authors report the case of a 35-year-old male who presented with a prominent soft tissue lesion of his right upper brow. This had been present for several months and had not substantially changed in size. Operative excision was performed via a supratarsal crease incision. The mass was located in a deep, periosteal plane, similar to a dermoid cyst. Final pathology demonstrated a 1.1 × 1.0 × 0.9 cm pleomorphic adenoma without defining characteristics of either the lacrimal gland or the minor adnexal glands of the skin or subcutaneous tissue. The authors reviewed the current literature on unusual lesions of the periorbital and brow regions, and the authors present aggregate data regarding epidemiology, diagnosis, and management.
IMPACT OF DIFFERENT VENTILATION STRATEGIES ON GAS EXCHANGES AND CIRCULATION DURING PROLONGED MECHANICAL CARDIO-PULMONARY RESUSCITATION IN A PORCINE MODEL
Authors: Fritz Caroline , Jaeger Deborah , Luo Yun , Lardenois Emilie , Badat Bilal , Roquet Florian Eric , Rigollot Marceau , Kimmoun Antoine , Tran N.’Guyen , Richard Jean-Christophe M. , Chouihed Tahar , Levy Bruno
Published: October 2021

Background: Optimal ventilation during cardio-pulmonary resuscitation (CPR) is still controversial. Ventilation is expected to provide sufficient arterial oxygen content and adequate carbon dioxide removal, while minimizing the risk of circulatory impairment. The objective of the present study was to compare three ventilation strategies in a porcine model during mechanical continuous chest compressions (CCC) according to arterial oxygenation and hemodynamic impact. Method: Ventricular fibrillation was induced and followed by five no-flow minutes and thirty low-flow minutes resuscitation with mechanical-CCC without vasopressive drugs administration. Three groups of eight Landras pig were randomized according to the ventilation strategy: 1. Standard nonsynchronized volume-control mode (SD-group); 2. synchronized bilevel pressure-controlled ventilation (CPV-group); 3. continuous insufflation with Boussignac Cardiac-Arrest Device (BC-group). We assessed 1. arterial blood gases, 2. macro hemodynamics, 3. tissular cerebral macro and micro-circulation and 4. airway pressure, minute ventilation at baseline and every 5 minutes during the protocol. Results: Arterial PaO2 level was higher at each measurement time in SD-group (>200 mm Hg) compare to CPV-group and BC-group (P< 0.01). In BC-group, arterial PaCO2 level was significantly higher (>90mm Hg) than in SD and CPV groups (P< 0.01). There was no difference between groups concerning hemodynamic parameters, cerebral perfusion and microcirculation. Conclusion: Ventilation modalities in this porcine model of prolonged CPR influence oxygenation and decarboxylation without impairing circulation and cerebral perfusion. Synchronized bi-level pressure-controlled ventilation' use avoid hyperoxia and was as efficient as asynchronized volume ventilation to maintain alveolar ventilation and systemic perfusion during prolonged CPR.