bluuebunny/crossref_metadata_2025 huggingface dataset:
Posttraumatic Lip Replantation in a Pregnant Woman
Authors: Caragher Seamus P. , Hwang Charles D. , Gardenier Jason C. , Khouri Kimberly S. , Buta Martin R. , McCarty Justin C. , Ford Olivia A. , Ehret Ashley , Cetrulo Curtis L.
Published: March 2023

Traumatic lip amputation is a devastating injury. No other tissue replicates its unique histology, often limiting the reconstructive outcome. Replantation is a technically challenging procedure, requiring extensive postoperative optimization, including systemic anticoagulation, leech therapy, significant blood loss, and antibiosis. Given the rarity of replantation in the context of pregnancy, there are no documented accounts of lip replantation in pregnant patients. We report a case of a 25-year-old pregnant woman who sustained an avulsion injury of the right upper lip from a dog bite. The patient presented with the amputated lip and emergent microvascular replantation was performed. Postoperative course consisted of management of controlled yet significant blood loss through leech therapy and close collaboration with obstetric colleagues. The patient was ultimately discharged with successful cosmetic and functional outcome and, importantly, with maintenance of a healthy pregnancy.
Management of Free Fillet Flap Transfers in Large Oncologic Resections
Authors: Movtchan Nellie V. , Kandi Lyndsay A. , Teven Chad M. , Reece Edward M. , Rebecca Alanna M.
Published: March 2023

Background:

The fillet flap is a reliable flap for reconstruction of large deformities following oncologic resection. It provides healthy, nonradiated tissue for coverage with the secondary benefit of preserving other potential donor sites for reconstruction.

Methods:

A retrospective review of the medical records of eight patients who underwent fillet flap reconstruction from 2013 to 2021 at Mayo Clinic, Arizona, were analyzed.

Results:

Eight patients who underwent four hemipelvectomies, three forequarter amputations, and one below the knee amputation were identified. Patients’ ages ranged between 24 and 66 years. All indications for oncologic ablation were curative. Defect sizes ranged from 16 × 20 to 30 × 60 cm. Four pedicled flaps and four free fillet flaps were performed. Indication for free fillet flap was tumor invasion of local vascular structures. There was no flap loss in the pedicled group (follow-up ranged from 1 to 9 years), and one of four free fillet flaps had a successful long-term outcome (follow-up 36 months).

Conclusions:

Successful free fillet flap reconstruction in the setting of oncologic resection is a difficult task to achieve. Changes to the management of case 3F allowed for a successful transfer. Immediate elevation and anastomosis of the flap before oncologic resection, large caliber recipient vessels and isolation from the zone of injury, protection of the anastomosis, and delay in flap inset all contributed to flap survival. It is our belief that applying these general considerations in large oncologic resections with free fillet flap transfer may aid in successful flap transfer and improve its survival odds.
Morphometric Analysis of Gender-affirming Breast Augmentation
Authors: Song Siyou , Parmeshwar Nisha , Steiner Gabriela , Kim Esther A.
Published: March 2023

Background:

According to cisgender respondents, the “preferred” feminine breast has a 45:55 upper-to-lower pole ratio. Preferred breast ratios have not been evaluated for transgender women undergoing breast augmentation. Therefore, this study aimed to determine the preferred breast ratio according to the transgender population and, thus, better inform surgeon planning.

Methods:

Patients diagnosed with gender dysphoria were sent a survey with morphed breast images of four different upper-to-lower pole ratios: 35:65, 45:55, 50:50, and 55:45. Respondents ranked the images according to aesthetic preference. Rankings were analyzed by the Condorcet method.

Results:

298 survey responses were analyzed: 197 (66.1%) respondents identified as transgender women and 31 (10.4%) as transgender men. Most respondents were younger than 40 (64.8%). Eighty-one (27.2%) had undergone breast augmentation, 136 (45.6%) had not and were not considering it, and 81 (27.2%) had not but were considering it. Across all subgroups, the most preferred ratio was 45:55 (P = 0.046). Those with more masculine genders and assigned female at birth preferred the 45:55 and 50:50 ratios equally. Those in their 30's and younger preferred the 45:55 and 50:50 ratios equally.

Conclusions:

The 45:55 ratio, established as the most preferred morphometrics for breast augmentation by cisgender respondents, is also the most aesthetically preferred proportion among transgender patients. Interestingly, the 50:50 ratio, which projects a larger upper bust compared to the 45:55 ratio, may be equally or more appealing to younger patients and those with more masculine genders. We hope these results improve patient-physician shared decision-making and postoperative expectations.
Avive Soft Tissue Membrane Improves Outcomes of Revision Upper-extremity Nerve Decompression Surgery
Authors: Cox Cameron T. , Douthit Christian R. , McKee Desirae M. , Kharbat Abdurrahman F. , Suryavanshi Joash R. , Maveddat Ashley V. , Bashrum Bryan S. , MacKay Brendan J.
Published: March 2023

Background:

Revision nerve decompression remains a challenge for surgeons. Avive Soft Tissue Membrane is processed human umbilical cord membrane that may reduce inflammation and scarring, thereby improving tissue gliding. Although synthetic conduits have been reported in revision nerve decompression, the use of Avive has not.

Methods:

Prospective study of revision nerve decompression with Avive application. VAS pain, two-point discrimination, Semmes-Weinstein, pinch and grip strength, range of motion, Quick Disability of Arm, Shoulder & Hand (QuickDASH), and satisfaction were recorded. Using a propensity-matched cohort, VAS pain and satisfaction were retrospectively collected to compare with cohort outcomes.

Results:

In the Avive cohort, 77 patients (97 nerves) were included. Mean follow-up was 9.0 months. Avive was applied to the median nerve in 47.4%, ulnar nerve in 39.2%, and radial nerve in 13.4%. VAS pain was 4.5 preoperatively and 1.3 postoperatively. S4 sensory recovery was achieved in 58% of patients, S3+ in 33%, S3 in 7%, S0 in 2%, and improvement from baseline in 87%. Strength improved in 92%. Mean total active motion was 94.8%. Mean QuickDASH score was 36.1, and 96% reported improved or resolved symptoms. Preoperative pain was not significantly different between Avive cohort and controls (P = 0.618). Postoperative pain was significantly lower in cohort patients (1.3 ± 2.2 versus 2.7 ± 3.0, P = 0.001). In the Avive cohort, more had improved or resolved symptoms (P < 0.0001). Clinically important improvement in pain was reported in 64.9% of Avive group patients versus 40.8% of controls (P = 0.002).

Conclusion:

Avive contributes to improved outcomes in revision nerve decompression.
Wound Complication and Surgical Site Infection in Sarcoma Patients Undergoing Internal Hemipelvectomy
Authors: Katzman Ju Hee , Sun Steven , Patel Raj H. , Joyce David , Greene John N.
Published: March 2023

Background

Hemipelvectomy is associated with a significant risk of wound complications, including infections, bleeding, and injuries to nearby neurovascular structures as well as the gastrointestinal and genitourinary tract. This study aimed to determine the patient characteristics and approach to treatment that could affect the occurrence of surgical site infection or wound complications in sarcoma patients who have undergone hemipelvectomy.

Methods

We conducted a retrospective analysis of 33 adult patients who underwent hemipelvectomy at a large tertiary academic cancer center from 2008 to 2016. We used χ
2 (exact Fisher) test to investigate the association between wound complication and categorical variables. We used a t test to evaluate the difference in numerical variables for outcomes.

Results

Among 33 patients, 12 patients (36.4%) experienced wound complications after hemipelvectomy. The average age of patients with wound complications was 63.3 years (57.1 ± 15.4 years), significantly higher than that of patients without wound complications (P = 0.004). Without adjustment, the use of computer navigation had a lower wound complication rate (P = 0.027). Patients with wound complications had longer hospital length of stay (14.8 vs 7.0 days, P = 0.016). Patient and surgical characteristics were not associated with surgical site infection. Five patients (15%) developed surgical site infection, and they had longer hospital stay (19.4 vs 8.1 days, P = 0.001).

Conclusion

Older patients undergoing hemipelvectomy are at an increased risk of developing wound complications with a prolonged hospital stay. Initial antimicrobial therapy for suspected surgical site infection should include broad-spectrum coverage to include skin and gastrointestinal flora.
A retrospective cohort study on the cardiotoxicity incidence rates of immune checkpoint inhibitors for oncology patients
Authors: Ho Chin-Chin , Wu Shang-Liang , Tsai Han-Yi , Hu Yu-Wen , Chang Yuh-Lih
Published: March 2023

Background:

This present study investigated the incidence rates of cardiotoxicity among cancer patients treated with immune checkpoint inhibitors (ICIs) plus other anticancer drugs.

Methods:

This was a retrospective hospital-based cohort study using the medical records and the Cancer Registry records from the Taipei Veterans General Hospital. We enrolled patients diagnosed with cancer between 2011 and 2017, who were over 20 years old and had received ICI therapy, including pembrolizumab, nivolumab, atezolizumab, and ipilimumab. Cardiotoxicity was defined by the diagnosis of myocarditis, pericarditis, arrhythmia, heart failure, and Takotsubo syndrome.

Results:

We identified 407 patients who were eligible to participate in this study. We defined the three treatment groups as follows: ICI therapy, ICI combined with chemotherapy, and ICI combined with targeted therapy. Using ICI therapy as a reference group, the cardiotoxicity risk was not significantly higher compared to the ICI combined with chemotherapy group (adjusted hazard ratio 2.1, 95% confidence interval 0.2–21.1, p = 0.528] or to the ICI combined with targeted therapy group (adjusted hazard ratio 1.2, 95% confidence interval 0.1–9.2, p = 0.883). The total incidence rate of cardiotoxicity was 3.6 of 100 person-years, indicating an average incidence time of 1.0 ± 1.3 years (median: 0.5 years; range: 0.1–4.7 years) for 18 cardiotoxicity patients.

Conclusion:

The incidence rate of ICI-related cardiotoxicity is low. Combination of ICI with either chemotherapy or targeted therapy might not significantly increase the risk of cardiotoxicities among cancer patients. Nevertheless, it is recommend being careful in patients treated high-risk cardiotoxicity medications to avoid drug-related cardiotoxicity with a combination of ICI therapy.
Stimulation of angiotensin II type 2 receptor attenuates organ injury in rats with polymicrobial sepsis
Authors: Shih Chih-Chin , Chen Shiu-Jen , Chang Wen-Kuei , Tsai Hsin-Jung , Huang Hsieh-Chou , Wu Chin-Chen , Tsao Cheng-Ming
Published: March 2023

Background:

Both inflammation and oxidative stress contribute to the pathogenesis of sepsis and its associated organ damage. Angiotensin-(1–7), acting through the Mas receptor and angiotensin II-type 2 receptors (AT2R), could attenuate organ dysfunction and improve survival in rats with sepsis. However, the role of AT2R in inflammation and oxidative stress in rats with sepsis is unclear. Therefore, this study examined the modulatory effects and molecular mechanism of AT2R stimulation in rats with polymicrobial sepsis.

Methods:

Male Wistar rats underwent cecal ligation and puncture (CLP) or sham surgery followed by the administration of saline or CGP42112 (a selective, high-affinity agonist of AT2R, 50 μg/kg intravenously) at 3 hours after sham surgery or CLP. The changes in hemodynamics, biochemical variables, and plasma levels of chemokines and nitric oxide were detected during the 24-hour observation. Organ injury was evaluated by histological examination.

Results:

We found that CLP evoked delayed hypotension, hypoglycemia, and multiple organ injuries, characterized by elevated plasma biochemical parameters and histopathological changes. These effects were attenuated by treatment with CGP42112. CGP42112 significantly attenuated plasma chemokines and nitric oxide production and reduced liver inducible nitric oxide synthase and nuclear factor kappa-B expression. More importantly, CGP42112 significantly improved the survival of rats with sepsis (50% vs. 20% at 24 h after CLP, p < 0.05).

Conclusion:

The protective effects of CGP42112 may be related to anti-inflammatory responses, suggesting that the stimulation of AT2R is a promising therapeutic candidate for the treatment of sepsis.
Glucocorticoid withdrawal syndrome: what to expect and how to manage
Authors: Theiler-Schwetz Verena , Prete Alessandro
Published: March 2023

Purpose of review

Glucocorticoid withdrawal syndrome (GWS) can develop after withdrawing exposure to supraphysiological levels of endogenous or exogenous glucocorticoids due to an established physical dependence. It is characterised by symptoms similar to adrenal insufficiency but needs to be regarded as a separate entity. GWS is often under-recognised in clinical practice and affected patients can experience significant impairment in their quality of life.

Recent Findings

A cornerstone in GWS management is adequate patient education and reassurance that symptoms are expected and typically temporary. Patients with endogenous Cushing's syndrome need to be aware that psychopathology may persist into the postoperative period. GWS is more likely to develop in severe Cushing's syndrome and in patients with very low levels of cortisol after surgery. Postoperatively, glucocorticoid replacement should be initiated and tapered in an individualised approach but there is currently no consensus on the best tapering strategy. If symptoms of GWS develop, glucocorticoid replacement ought to be temporarily increased to the previous, well tolerated dose. No randomised studies have thus far compared regimens for withdrawing glucocorticoids after treatment for anti-inflammatory or immunosuppressive causes to determine the best and safest tapering strategy. One open-label, single-arm trial in patients with asthma has recently proposed a personalised glucocorticoid tapering regimen which included the systematic assessment of adrenal function.

Awareness of GWS by treating physicians and patient education are essential. Evidence on optimal GWS management after Cushing's syndrome treatment is scarce, but new data are emerging for tapering after long-term glucocorticoid treatment.
Update on nonpolio enterovirus and parechovirus infections in neonates and young infants
Authors: Tomatis Souverbielle Cristina , Erdem Guliz , Sánchez Pablo J.
Published: March 2023

Purpose of review

To review the epidemiology, clinical manifestations, and treatment strategies of nonpolio enterovirus and parechovirus (PeV) infections, and identify research gaps.

Recent findings

There is currently no approved antiviral agent for enterovirus or PeV infections, although pocapavir may be provided on a compassionate basis. Elucidation of the structure and functional features of enterovirus and PeV may lead to novel therapeutic strategies, including vaccine development.

Nonpolio human enterovirus and PeV are common childhood infections that are most severe among neonates and young infants. Although most infections are asymptomatic, severe disease resulting in substantial morbidity and mortality occurs worldwide and has been associated with local outbreaks. Long-term sequelae are not well understood but have been reported following neonatal infection of the central nervous system. The lack of antiviral treatment and effective vaccines highlight important knowledge gaps. Active surveillance ultimately may inform preventive strategies.
Choosing a Nursing Career During a Global Health Event
Authors: Avraham Rinat , Wacht Oren , Yaffe Eli , Grinstein-Cohen Orli
Published: March 2023

Background:

Although in the past, the decision to enter the nursing profession was mainly due to intrinsic motives, more recent generations present additional extrinsic career choice motives. The motivation of choosing a nursing career may be affected by global health events, such as COVID-19.

Purpose:

To examine the motivation for choosing a nursing career during COVID-19.

Methods:

A repeated cross-sectional study was conducted among 211 first-year nursing students at a university in Israel. A questionnaire was distributed during 2020 and 2021. Linear regression evaluated the motives that predict choosing a nursing career during COVID-19.

Results:

Intrinsic motives were the leading motives for choosing a nursing career in a univariate analysis. A multivariate linear model revealed that choosing a nursing career during the pandemic was associated with extrinsic motives (β= .265, P < .001). Intrinsic motives did not predict choosing a nursing career during COVID-19.

Conclusion:

Reassessment of motives among candidates may help the efforts of faculty and nursing to recruit and retain nurses in the profession.
Ten Years of Disseminated Gonococcal Infections in North Carolina: A Review of Cases From a Large Tertiary Care Hospital
Authors: Sciaudone Michael , Cope Anna , Mobley Victoria , Samoff Erika , Seña Arlene C.
Published: March 2023

Background

The detection and reporting of disseminated gonococcal infection (DGI) has been increasing across the United States.

Methods

We conducted a retrospective chart review of DGI case-patients diagnosed between 2010 and 2019 at a large tertiary care hospital in North Carolina.

Results

We identified 12 DGI case-patients (7 men and 5 women, aged 20 to 44 years), of whom 5 had Neisseria gonorrheae isolated from a sterile site (confirmed), 2 had N. gonorrheae detected at a nonsterile mucosal site and had clinical manifestations consistent with DGI (probable), and 5 did not have N. gonorrheae isolated from any site, but DGI was the most likely diagnosis (suspect). Among the 12 DGI case-patients, the most common manifestation was arthritis or tenosynovitis (n = 11); 1 patient had endocarditis. Half of the patients had significant underlying comorbidities or predisposing factors, including complement deficiency. Eleven of the 12 case-patients were hospitalized, and 4 required surgical intervention.

Conclusions

This case series highlights the difficulty of making a definitive diagnosis of DGI, which could negatively affect reporting to public health authorities and hinder surveillance efforts to determine the true prevalence of DGI. A high index of suspicion is required, and a full diagnostic workup should be pursued in all cases of suspected DGI.
Derivation and Internal Validation of a Risk Score for Predicting Chlamydia trachomatis Infection in Kenyan Women Planning Conception
Authors: Pulei Anne N. , Lokken Erica M. , Kinuthia John , Richardson Barbra A. , Mandaliya Kishorchandra , Jaoko Walter , McClelland R. Scott
Published: March 2023

Background

Availability of laboratory confirmation of sexually transmitted infections (STIs) is increasing in low- and middle-income countries, but costs continue to limit their access.Chlamydia trachomatis(CT) is an STI of significant clinical importance, particularly among women. This study aimed to develop a risk score to identify women with a higher likelihood of CT infection, who could then be prioritized for laboratory testing, in a population of Kenyan women planning pregnancies.

Methods

Women with fertility intentions were included in this cross-sectional analysis. Logistic regression was used to estimate odds ratios for the association between demographic, medical, reproductive, and behavioral characteristics and the prevalence of CT infection. A risk score was developed and validated internally based on the regression coefficients in the final multivariable model.

Results

The prevalence of CT was 7.4% (51/691). A risk score for predicting CT infection, with scores 0-6, was derived from participants' age, alcohol use, and presence of bacterial vaginosis. The prediction model yielded an area under the receiver operating curve (AUROC) of 0.78 (95%Cl: 0.72-0.84). A cutoff of ≤2 versus >2, identified 31.8% of women as higher risk with moderate sensitivity (70.6%, 95%Cl: 56.2-71.3) and specificity (71.3%, 95%Cl: 67.7-74.5). The bootstrap corrected AUROC was 0.77 (95%Cl: 0.72-0.83).

Conclusion

In similar populations of women planning pregnancies, this type of risk score could be useful for prioritizing women for laboratory testing, and would capture most women with CT infections while performing more costly testing in less than half of the population.
Patient-Reported Barriers to Treatment Initiation and Completion for Latent Tuberculosis Infection Among Patients Within a Large Integrated Health Care System in Southern California
Authors: Spence Brigitte C. , Bruxvoort Katia , Munoz-Plaza Corrine , Shaw Sally , Navarro Maria , Chen Henry , Skarbinski Jacek , Tartof Sara
Published: March 2023

Objective:

More than 80% of active tuberculosis in the United States is due to reactivation of latent tuberculosis infection (LTBI), which can be prevented via screening and treatment. Treatment initiation and completion rates are low for patients with LTBI in the United States, and the barriers to successful treatment are poorly understood.

Design:

We conducted semistructured qualitative interviews with 38 patients who were prescribed LTBI treatment (9 months isoniazid, 6 months rifampin, or 3 months rifamycin-isoniazid short-course combinations). We used purposeful sampling employing a maximum variation approach to obtain diverse perspectives of patients who did not initiate treatment, who did not complete treatment, and who completed treatment (n = 14, n = 16, and n = 8, respectively). Patients were asked about LTBI knowledge, experience regarding treatment, interactions with providers, and barriers they faced. Using a team coding model (2 coders/analysts), we developed deductively derived (a priori) codes based on our central research questions and inductively derived codes that emerged directly from the data. Analysis of our coding categories and relationships generated a hierarchy of key themes and subthemes.

Setting:

Kaiser Permanente Southern California.

Participants:

Individuals 18 years or older who received a diagnosis of LTBI and prescribed treatment.

Main Outcome Measures:

LTBI knowledge, attitudes toward LTBI, attitudes toward LTBI treatment, attitudes toward providers, and explanation of barriers.

Results:

Most patients reported having limited knowledge of LTBI. In addition to the duration of treatment, barriers to initiation and completion included perceived lack of support, uncomfortable side effects, and pervasive minimization of the positive impact of treatment on their health. Many patients felt there was little incentive to overcome barriers.

Conclusions:

Overall, patient experience with LTBI treatment initiation and completion could be improved with patient-centered treatment and more frequent follow-ups.
Aesthetic Genioplasty Based on Strategic Categorization
Authors: Hwang Chang Heon , Na Young Su , Lee Myung Chul
Published: March 2023

Background:

Genioplasty is a popular procedure used for lower facial contour correction. Various osteotomy techniques enable us to perform advancement, setback, reduction, or narrowing procedures. Computed tomography (CT) images facilitate preoperative planning in detail. The authors used a novel planning method based on strategic categorization. The analytic results are described.

Methods:

This retrospective study reviewed 208 patients who underwent genioplasty procedures for facial contouring from October 2015 to April 2020. During preoperative evaluation of the mandible, the operative procedure selected was among one of three types: 1) horizontal segment osteotomy, 2) vertical and horizontal segment osteotomy, and 3) bone graft after repositioning. Adequate osteotomies were followed by rigid fixation using a titanium plate and screws. The follow-up period ranged from 8 to 24 months (average, 17 months). The results were assessed based on medical records, photographs, and facial bone CT images.

Results:

Overall, the patients were satisfied with the outcomes and had responder-based improvement in lower facial contour and balance. Chin point deviations were noted in 176 cases; left side deviation (n=135) was more frequent than right side deviation (n=41). Strategic osteotomies based on precise measurements led to correction of asymmetries. Temporary partial sensory losses reported in twelve cases resolved within an average of 6 months after surgery.

Conclusion:

Each patient’s chief complaint and bony structures should be carefully evaluated before genioplasty procedures are performed. During the operation, meticulous osteotomy, precise movement, and rigid fixation are necessary. The strategic process used for genioplasty resulted in aesthetic balance and predictable outcomes.
Systematic Review of Capsular Contracture Management Following Breast Augmentation: An Update
Authors: Boyd Carter J. , Chiodo Michael V. , Lisiecki Jeffrey L. , Wagner Ryan D. , Rohrich Rod J.
Published: March 2023

Background:

Capsular contracture is one of the most frequent indications for revision following breast augmentation. Management goals focus on restoring breast aesthetics while minimizing subsequent recurrence of capsular contracture. As new data emerges, close review of the data is merited to build evidence-based clinical guidelines to inform surgical practice and management of capsular contracture.

Methods:

A systematic review of the MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews was conducted to characterize the surgical management of capsular contracture in revision breast augmentations. The primary endpoint was capsular contracture recurrence rate.

Results:

The review was conducted in November 2021. Primary search revealed 14,163 results. Initial screening by title left 1,223 manuscripts. Abstract review left 90 articles for full-text review, of which 34 were ultimately included which were all observational in nature.

Conclusions:

Capsular contracture management remains an important topic with limited high-level evidence for establishing clear evidence-based treatment guidelines. While more evidence is required to assess the effects of capsulectomy, implant exchange and plane change, these appear to be useful mechanisms for reducing recurrent capsular contracture. There is more evidence regarding the use of ADM, though this still requires long-term follow-up studies. New developments regarding textured implants limit the revision breast augmentation surgeon to smooth devices.
Safety of Outpatient Plastic Surgery: A Comparative Analysis of Patient, Procedure, and Facility Characteristics Using the TOPS Registry with 286,826 Procedures.
Authors: Chopan Mustafa , Lee Jimmy , Nichols D. Spencer , Mast Bruce A. , Neal Dan , Covey Sarah , Satteson Ellen
Published: March 2023

Background:

Outpatient plastic surgery at office-based surgery facilities (OBSFs) and ambulatory surgery centers (ASCs) has become increasingly prevalent over the past 30 years. Importantly, historical data are inconsistent regarding the safety outcomes of these venues, with advocates for both citing supporting studies. This investigation's purpose is to provide a more definitive comparative evaluation of outcomes and safety for outpatient surgery done in these facilities.

Methods:

The most common outpatient procedures were identified using the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) Database between 2008 and 2016. Outcomes were analyzed for OBSFs and ASCs. Patient and perioperative information was also analyzed using regression analysis to identify risk factors for complications.

Results:

A total of 286,826 procedures were evaluated, of which 43.8% were performed at ASCs and 56.2% at OBSFs. Most patients were healthy, middle-aged women categorized as ASA class I. The incidence of adverse events was 5.7%, and most commonly included antibiotic requirement (1.4%), dehiscence (1.3%), or seroma requiring drainage (1.1%). Overall, there was no significant difference in adverse events between ASCs or OBSFs. Age, ASA class, BMI, diabetes, smoking history, general anesthesia, CRNA involvement, operative duration, non-cosmetic indications, and body region were associated with adverse events.

Conclusions:

This study provides an extensive analysis of common plastic surgery procedures performed in an outpatient setting in a representative population. With appropriate patient selection, procedures are safely performed by board-certified plastic surgeons in ambulatory surgery centers and office-based settings, as evidenced by the low incidence of complications in both environments.
Intra-arterial thrombolytic treatment for visual deficits caused by hyaluronic acid filler: efficacy, safety, and prognostic factors
Authors: Wang Yingliang , Li Qian , Ye Yongsheng , Zhang Jie , Shen Haiyang , Zhou Yu , Zhou Chen , Yu Youtao , Xiong Bin
Published: March 2023

Background:

The benefits of intra-arterial thrombolytic treatment (IATT) in reversing hyaluronic acid (HA)-related visual deficits remain unclear. This study aimed to report a 5-year experience in the treatment of visual deficits resulting from HA embolization by IATT in a tertiary medical center.

Methods:

From December 2015 to June 2021, the medical records of consecutive patients with HA-related visual deficits who underwent IATT were retrospectively reviewed. The demographics, clinical features, imaging data, treatment details, and follow-up results of the patients were analyzed.

Results:

Totally 72 consecutive patients were analyzed, including 5 (5/72, 6.9%) men and 67 (67/72, 93.1%) women, aged 29.3 ± 7.6 years (range 24-73 years). Thirty-two patients (32/72, 44.4%) showed preserved visual acuity and forty (40/72, 55.6%) exhibited no light perception on admission. Ocular motility disorders were detected in 63 patients (63/72, 87.5%), ptosis in 61 patients (61/72, 84.7%), and facial skin changes in 54 patients (54/72, 75%). The technical success rate of IATT was 100% with successful recanalization of the occlusive artery. No procedure-related complications were detected, and all skin injuries, ptosis, and ocular motility disorders were healed. Improved visual acuity was detected in 26 cases (26/72, 36.1%). In the binary logistic regression model, only preoperative preserved visual acuity was independently associated with a good outcome.

Conclusion:

The IATT for selective patients with HA-related visual deficits is efficient and safe. Preoperative preserved visual acuity was independently associated with a good outcome after IATT.
The “Crossing Collection Sign”: A Diagnostic Tool on Spine Magnetic Resonance Imaging For Localizing Cerebrospinal Fluid Leak
Authors: Hill Daniel , Buchbinder Bradley , Pomerantz Stuart , Mehan William A. , Buch Karen
Published: March 2023

Objective

The aim of the study is to determine whether the site of “cross” between ventral and dorsal spinal longitudinal extradural CSF collections (SLECs) seen on magnetic resonance imaging during initial workup of patients with suspected CSF leaks can predict the subsequently confirmed leakage site on computed tomography myelography or surgical repair.

Methods

This was an institutional review board–approved, retrospective study performed from 2006 to 2021. Patients with SLECs who underwent total spine magnetic resonance imaging at our institution, followed by myelography and/or surgical repair for CSF leak, were included. Patients with incomplete workup including lack of computed tomography myelography and/or surgical repair and patients severely motion degraded imaging were excluded from our study. The site of cross between ventral and dorsal SLECs was defined as the “crossing collection sign” and was compared with the anatomically confirmed site of leak on myelography and/or at surgical repair.

Results

Thirthy-eight patients met inclusion criteria with 18 females and 11 males ranging in age from 27 to 60 years (median, 40 years; interquartile range, 14 years). The crossing collection sign was seen in 76% of patients (n = 29). The distributions of confirmed CSF leak were as follows: cervical (n = 9), thoracic (n = 17), and lumbar spine (n = 3). The crossing collection sign predicted the site of CSF leak in 14 of 29 patients (48%) and was within 3-vertebral segments in 26 of 29 cases (90%).

Conclusions

The crossing collection sign can help prospectively identify spinal regions with highest likelihood for CSF leak in patients with SLECs. This can potentially help optimize the more invasive subsequent steps in the workup for these patients, including dynamic myelography and surgical exploration for repair.
Can Sublingual Nitrate Improve Visualization of Lower Limb Arteries on Computed Tomography Angiography?
Authors: Gupta Sanchita , Dixit Rashmi , Prakash Anjali , Daga Mradul Kumar , Mishra Anurag
Published: March 2023

Objective

The aim of the study is to evaluate the role of sublingual nitrate in improving vessel visualization on peripheral computed tomography angiography (CTA).

Methods

Fifty patients clinically diagnosed with peripheral arterial disease of the lower limb were prospectively included in this study: Twenty-five underwent CTA after sublingual nitrate administration (nitrate group) and 25 without (non-nitrate group). Two blinded observers qualitatively and quantitatively assessed the data thus generated. The mean luminal diameter, intraluminal attenuation, site, and percentage of stenosis were evaluated in all segments. Assessment of collateral visualization at sites of significant stenosis was also done.

Results

Patients in the nitrate and non-nitrate groups were similar in age and sex characteristics (P > 0.05).

On subjective evaluation, there was significantly improved visualization of the femoropopliteal and tibioperoneal vasculature of the lower limb in the nitrate group compared with the non-nitrate group (P < 0.05). Quantitative evaluation showed a statistically significant difference in the measured arterial diameters for all evaluated segments in the nitrate group versus the non-nitrate group (P < 0.05). Intra-arterial attenuation was significantly greater for all segments in the nitrate group resulting in better contrast opacification in these studies. Collateral visualization around segments with more than 50% stenosis/occlusion was also better in the nitrate group.

Conclusions

Our study suggests that nitrate administration before peripheral vascular CTA can improve visualization, especially in the distal segments by increasing the vessel diameter and intraluminal attenuation along with better delineation of the collateral circulation around stenotic areas. It may also improve the number of evaluable segments of vasculature in these angiographic studies.
Diffusion-Weighted Imaging as a Quantitative Imaging Biomarker for Predicting Proliferation Rate in Hepatocellular Carcinoma: Developing a Radiomics Nomogram
Authors: Yan Chuan , Han Zewen , Chen Xiaojie , Gao Lanmei , Ye Rongping , Li Yueming
Published: March 2023

Purpose

This study aimed to explore the predictive performance of diffusion-weighted imaging with apparent diffusion coefficient map in predicting the proliferation rate of hepatocellular carcinoma and to develop a radiomics-based nomogram.

Methods

This was a single-center retrospective study. A total of 110 patients were enrolled. The sample included 38 patients with low Ki67 expression (Ki67 ≤10%) and 72 with high Ki67 expression (Ki67 >10%) as demonstrated by surgical pathology. Patients were randomly divided into either a training (n = 77) or validation (n = 33) cohort. Diffusion-weighted imaging with apparent diffusion coefficient maps was used to extract radiomic features and the signal intensity values of tumor (SItumor), normal liver (SIliver), and background noise (SIbackground) from all samples. Subsequently, the clinical model, radiomic model, and fusion model (with clinical data and radiomic signature) were developed and validated.

Results

The area under the curve (AUC) of the clinical model for predicting the Ki67 expression including serum α-fetoprotein level (P = 0.010), age (P = 0.015), and signal noise ratio (P = 0.026) was 0.799 and 0.715 in training and validation cohorts, respectively. The AUC of the radiomic model constructed by 9 selected radiomic features was 0.833 and 0.772 in training and validation cohorts, respectively. The AUC of the fusion model containing serum α-fetoprotein level (P = 0.011), age (P = 0.019), and rad score (P < 0.001) was 0.901 and 0.781 in training and validation cohorts, respectively.

Conclusions

Diffusion-weighted imaging as a quantitative imaging biomarker can predict Ki67 expression level in hepatocellular carcinoma across various models.
Evaluation of fetoplacental oxygenation in a rat model of gestational diabetes mellitus using BOLD-MRI at 7.0-T
Authors: Wang Ying-Fang , Chen Chang-An , Li Ming-Qing , Tao Xiang , Zhao Xian-Ce , Wang Cheng-Jie , Zhang Guo-Fu , Zhang He
Published: March 2023

Objective:

To compare the differences in blood oxygen level-dependent (BOLD) parameters following maternal hyperoxia between normal pregnancy and pregnancy in the rat model of gestational diabetes mellitus (GDM).

Methods:

GDM was induced by high-fat and sucrose diet (HFS) combined with an intraperitoneal injection of streptozotocin (STZ). On embryonic day 19 (E19), the two groups of pregnant rats were imaged using a 7.0-T animal MRI scanner. TurboRARE was initially used to localize the fetoplacental units (FPUs). Next, multiple gradient echo BOLD was performed during the air and oxygen inhalation periods. T2* map was then generated, and the baseline T2* and absolute changes in T2* value (ΔT2*, difference between T2*oxy and T2*air) were calculated. Following the MRI scan, the placentas and fetuses were aseptically stripped, weighed, and immunostained.

Results:

Nine rats were used in this study. After maternal oxygen inhalation, T2* increased significantly in all subjects in both groups. The ΔT2* for the placenta (5.97 msec vs. 7.81 msec; P = 0.007) and fetal brain (2.23 msec vs. 3.97 msec; P = 0.005) differed significantly between the GDM and control groups. Histochemical detection of placental glycogen content and inflammatory cytokines (IL-6 and TNF-α) showed significantly higher levels in the GDM than in the normal placenta.

Conclusions:

BOLD MRI revealed abnormalities in the fetoplacental response to maternal hyperoxygenation in rats with GDM. We believe that this approach can potentially be used to evaluate placental dysfunction and assess the state of the fetus during pregnancy with GDM.
The Lived Experience of Serious Stroke Survival: A Hermeneutic Phenomenological Case Study
Authors: Champlin Barbara E. , Hunt Roberta J.
Published: March 2023

Purpose

The aim of this study was to describe the lived experiences of a serious stroke survivor.

Design

This is a hermeneutic phenomenological case study.

Methods

Data were collected via observations and conversations during 75 visits, 14 brief audiotaped interviews, field notes, and conversations with family members, close friends, and care providers.

Findings

Seven themes emerged that form the general structure of the lived experience of surviving a serious stroke. These themes were organized around four fundamental existential themes including space, time, body, and relationships.

Clinical Relevance to the Practice of Rehabilitation Nursing

Spend intentional time with patients beyond the initial stroke rehabilitation period to better understand the experience, individualize care, identify meaningful activities previously engaged in, and identify people who may be willing to partner with them to continue participation in the meaningful activities.

Conclusion

Hermeneutic phenomenology allows the essence of the stroke survival experience to be revealed and contributes to better understanding of the phenomenon.
Sinusitis Following Reduction Malarplasty
Authors: Hwang Kun , Park Chan Yong
Published: March 2023

The aim of this paper was to search for reported cases of sinus infection following reduction malarplasty and present guidelines for the prevention of sinusitis. Two cases of maxillary sinusitis that developed after reduction malarplasty has been reported, which were treated with endoscopic sinus surgery. Histologically, thickness of the mucosal lining of the maxillary sinus (Schneiderian membrane) was 0.41 mm at sinus floor, and 0.38 mm at 2 mm above the floor. In functional endoscopic sinus surgery (FESS), the uncinate process is removed, exposing the hiatus semilunaris. The anterior ethmoid air cells are opened, allowing better ventilation but leaving the bone covered with mucosa. FESS improves the function of the osteomeatal complex and therefore provides better ventilation of the sinuses. In odontogenic maxillary sinusitis, regeneration of the mucosal lining (ciliated epithelium regeneration and bone healing) was achieved in 1.4±1.2 years after modified endoscopic sinus surgery. In in zygomatic implant surgery, 12.3% patients presented maxillary sinusitis, and the most common treatment was antibiotics alone or combined with FESS. To prevent sinusitis after reduction malarplasty, accurate osteotomy and fixation are needed, especially when using only an intraoral incision. After surgery, radiological examinations (Water’s view, computed tomography if needed) should be performed as part of follow-up. Prophylactic antibiotics (macrolides) are recommended for 1 week if the sinus wall is opened. If swelling or air-fluid level persists, re-exploration and drainage should be performed. In patients with risk factors such as age, comorbidities, smoking, nasal septal deviation, or other anatomical variants, simultaneous FESS is suggested.
BIOMARKERS: CAN THEY REALLY GUIDE OUR DAILY PRACTICE?
Authors: Tsangaris Iraklis , Antonakos Nikolaos , Fantoni Massimo , Kaplanski Gilles , Kyriazopoulou Evdoxia , Veas Francisco , Clemens Mark
Published: March 2023

Optimal management of septic patients requires accurate assessment of both current severity status and prognosis. Since the 1990s, substantial advances have been made in the use of circulating biomarkers for such assessments. This summary of the session on “Biomarkers: can they really use guide our daily practice?” presented at the 2021 WEB-CONFERENCE OF THE EUROPEAN SHOCK SOCIETY, 6 November 2021. These biomarkers include ultrasensitive detection of bacteremia, circulating soluble urokina-type plasminogen activator receptor (suPAR), C-reactive protein (CRP) and ferritin and procalcitonin. In addition, the potential application of novel multiwavelength optical biosensor technology allows noninvasive monitoring of multiple metabolites that can be used to assess severity and prognosis in septic patients. The application these biomarkers and improved technologies provide the potential for improved personalized management of septic patients.
Development of a Novel Infant Volumetric Capnography Simulator
Authors: Campos Marcelo D. , Bonardi Ariel , Palazzi Lucio H. , Madorno Matías , Böhm Stephan H. , Tusman Gerardo
Published: March 2023

Introduction

Volumetric capnography depicts volumetric capnograms [ie, the plot of expired carbon dioxide (CO2) over the tidal volume]. This bench study aimed to determine the reliability, accuracy, and precision of a novel infant simulator for volumetric capnography. This simulator would be clinically valuable for teaching purposes because it reflects the entire cardiopulmonary physiology within 1 breath.

Methods

An infant lung simulator was fed with CO2 supplied by a mass flow controller (VCO2-IN) and ventilated using standard settings. A volumetric capnograph was placed between the endotracheal tube and the ventilatory circuit. We simulated ventilated babies of different body weights (2, 2.5, 3, and 5 kg) with a VCO2 ranging from 12 to 30 mL/min. The correlation coefficient (r
2), bias, coefficient of variation (CV = SD/x × 100), and precision (2 × CV) between the VCO2-IN and the elimination of CO2 recorded by the capnograph (VCO2-OUT) were calculated. The quality of the capnogram's waveforms was compared with real ones belonging to anesthetized infants using an 8-point scoring system, where 6 points or greater meant that the simulated capnogram showed good, 5 to 3 points acceptable, and less than 3 points an unacceptable shape.

Results

The correlation between VCO2-IN and VCO2-OUT was r
2 = 0.9953 (P < 0.001), with a bias of 0.16 (95% confidence intervals from 0.12 to 0.20) mL/min. The CV was 5% or less and the precision was 10% or less. All simulated capnograms showed similar shapes compared with real babies, scoring 6 points for 3 kg and 6.5 points for 2-, 2.5-, and 5-kg babies.

Conclusions

The simulator of volumetric capnograms was reliable, accurate, and precise for simulating the CO2 kinetics of ventilated infants.
Pectin based biologic Velcro effectively seals traumatic solid organ and small bowel injuries
Authors: Williams James , Prey Beau , Francis Andrew , Weykamp Michael , Liu Betty , Parsons Michael , Vu Michael , Franko Jace , Roedel Erik , Lallemand Michael , Bingham Jason , Mentzer Steven , Kuckelman John
Published: March 2023

INTRODUCTION

Injuries to the liver and small bowel are common in multiple injuries. While there are currently a variety of accepted damage-control techniques to expeditiously manage such injuries, morbidity and mortality remain high. Pectin polymers have previously been shown to effectively seal visceral organ injuries ex vivo through physiochemical entanglement with the glycocalyx. We sought to compare the standard of care for the management of penetrating liver and small bowel injuries with a pectin-based bioadhesive patch in a live animal model.

METHODS

Fifteen adult male swine underwent a laparotomy with standardized laceration to the liver. Animals were randomized to one of three treatment arms: packing with laparotomy pads (n = 5), suture repair (n = 5), or pectin patch repair (n = 5). Following 2 hours of observation, fluid was evacuated from the abdominal cavity and weighed. Next, a full-thickness small bowel injury was created, and animals were randomized to either a sutured repair (n = 7) or pectin patch repair (n = 8). The segment of bowel was then pressurized with saline, and the burst pressure was recorded.

RESULTS

All animals survived the protocol to completion. There were no clinically significant differences between groups regarding baseline vitals or laboratory studies. On one-way analysis of variance, there was a statistically significant difference between groups regarding blood loss after liver repair (26 mL suture vs. 33 mL pectin vs. 142 mL packing, p < 0.01). On post hoc analysis, there was no statistically significant difference between suture and pectin (p = 0.9). After repair, small bowel burst pressures were similar between pectin and suture repair (234 vs. 224 mm Hg, p = 0.7).

CONCLUSION

Pectin-based bioadhesive patches performed similarly to the standard of care for the management of liver lacerations and full-thickness bowel injuries. Further testing is warranted to assess the biodurability of a pectin patch repair, as it may offer a simple option to effectively temporize traumatic intra-abdominal injuries.