bluuebunny/crossref_metadata_2025 huggingface dataset:
Thoracodorsal Artery Perforator Flap in Partial Breast Reconstruction: A Systematic Review
Authors: Mangialardi Maria Lucia , Baldelli Ilaria , Salgarello Marzia , Raposio Edoardo
Published: April 2021

Introduction:

Breast conserving surgery followed by radiation therapy represents the standard of care for early stage breast cancer. Oncoplastic breast surgery includes several reconstructive techniques essentially summarized in 2 categories: volume displacement and volume replacement procedures. These latest procedures have evolved over time from the use of the entire latissimus dorsi muscle to the use of pedicled perforator flaps, namely the thoracodorsal artery perforator (TDAP) flap. The aim of this article is to provide a comprehensive review of the literature regarding the use of the TDAP flap in partial breast defects.

Methods:

A literature search was performed via PubMed, Medline, and Cochrane. Studies reporting the use of the TDAP flap after breast conserving surgery were included. Patient characteristics, topography and size of breast defect, flap size and design, number of perforators, and operative time were analyzed. Moreover, aesthetic and functional (shoulder morbidity) results, patient satisfaction, postoperative complications, and donor site morbidity were registered.

Results:

Twelve articles fulfilled inclusion criteria, and 337 patients were included. All articles except 1 described the use of the TDAP flap for defects in every breast quadrant. The mean weight of resected breast tissue was 97.28 g, and patients with over 20% of volume deficiency were considered eligible for TDAP flap volume replacement. The ellipse-shaped skin paddle (oriented oblique downward, transversal or oblique upward in most cases) was extended over the anterior border of the latissimus dorsi muscle to include possible septocutaneous perforator vessels. Most authors began the dissection from the anterior and caudal border of the flap to reserve the possibility to convert the TDAP to a musculocutaneous flap and check for septocutaneous perforators. Flap size ranged from 4 × 12 to 21 × 9 cm. The mean procedure time was 192.21 minutes. Mean follow-up was 17.42 months. Evaluation by way of a 5-point Likert scale reported overall mean values of over 4 points. Satisfactory outcomes were reported in 92.85%–100% of cases. Patient satisfaction ranged from 80% to 94% of cases. The incidence of seroma (1 case) and “shoulder-related” donor site morbidity was very low.

Conclusions:

Despite the heterogeneity of the evaluation methods, our review suggested that the use of the TDAP flap in oncoplastic surgery allows for satisfactory aesthetic outcomes and quite high levels of patient satisfaction. The TDAP flap represents an effective and versatile tool that amplifies the oncoplastic surgeon’s arsenal, which allows for satisfactory outcomes.
Complications and Patient-reported Outcomes after TRAM and DIEP Flaps: A Systematic Review and Meta-analysis
Authors: He Waverley Y. , El Eter Leen , Yesantharao Pooja , Hung Bethany , Owens Haley , Persing Sarah , Sacks Justin M.
Published: April 2021

Introduction:

Transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric artery perforator (DIEP) flaps are the most common abdominally based breast reconstruction procedures. Each technique has its advantages and disadvantages; however, how morbidity relates to satisfaction is not well-understood. Our aim was to compare complications and patient-reported outcomes following pedicled TRAM (pTRAM), free TRAM (fTRAM), and DIEP flaps to guide flap selection.

Methods:

A systematic literature search was conducted, and 2 independent reviewers identified comparative studies of abdominally based flaps. Data were extracted on patient characteristics, complications, and patient-reported outcomes. Meta-analyses were conducted using random effects modeling with the DerSimonian and Laird method.

Results:

The search retrieved 5090 articles, of which 18 were included in this review. pTRAM flaps trended toward a higher risk of abdominal bulge/hernia compared with DIEP flaps, particularly in low-volume hospitals. While fTRAM flaps had a higher risk of abdominal morbidity compared with DIEP flaps, relative risk decreased when obese patients were excluded and when only muscle-sparing fTRAM flaps were compared. Muscle-sparing flaps had a higher risk of flap loss than fTRAM flaps. Compared with DIEP flaps, pTRAM flaps were associated with lower general satisfaction but comparable emotional well-being.

Conclusions:

Our findings indicate that safety and satisfaction following abdominally based breast reconstruction depend on flap type and patient characteristics. When possible, DIEP or muscle-sparing fTRAM flaps should be performed for obese patients to decrease the risk of abdominal bulge/hernia. Although pTRAM flaps are associated with a greater risk of flap loss, they are still an appropriate option when microsurgery is not available.
Use of dCELL (Decellularized Human Dermis) in Repair of Urethrocutaneous Fistulas or Glans Dehiscence
Authors: Naderi Naghmeh , Joji Nikita , Venantius Kang Norbert
Published: April 2021

Background:

In hypospadias repairs, there is some evidence to suggest that a “waterproofing” layer can be helpful in reducing the risk of urethrocutaneous fistula formation. The most likely role of this layer is to prevent the creation of overlapping suture lines. Many hypospadias surgeons use a dartos fascia interposition flap for this purpose. However, raising a dartos fascia flap adds time to the procedure, can result in devascularization of the overlying skin, and can create unsightly torsion of the penis, which may be hard to correct. To avoid these problems, the senior author has started to use dCELL (decellularized human dermis) as an alternative to dartos fascia to separate the suture lines.

Methods:

Between March and July 2018, a pilot study was performed in 8 patients undergoing closure of a urethrocutaneous fistula or glans dehiscence combined with dCELL. Data on infections, wound breakdown, length of stay and catheterization, surgical time, and hospital stay were collected.

Results:

All patients had a successful reconstruction. One patient developed a urinary tract infection, possibly related to prolonged catheterization following his repair.

Conclusion:

Our results suggest that dCELL may be useful in the repair of urethrocutaneous fistulas and glans dehiscence after hypospadias surgery.
Incidental Findings in CT and MR Angiography for Preoperative Planning in DIEP Flap Breast Reconstruction
Authors: Wagner Ryan D. , Doval Andres F. , Mehra Nikhilesh V. , Le Hung B. , Niziol Paul A. , Ellsworth Warren A. , Spiegel Aldona J.
Published: April 2021

Background:

Autologous breast reconstruction with deep inferior epigastric perforator flaps is considered a standard of care in the treatment after mastectomy, yet vascular anatomy is highly variable and perforator selection remains challenging. The use of preoperative imaging can influence surgical planning and assist intraoperative decision-making. However, this imaging can inevitably uncover incidental findings. The purpose of this study was to analyze incidental findings, evaluate correlation with patient factors, and examine effects on overall care.

Methods:

A retrospective review was performed on 350 consecutive patients who received magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) as a preoperative evaluation for deep inferior epigastric perforator flap breast reconstructions done between August 2015 and June 2019. Radiology reports were analyzed for incidental findings. Patient charts were reviewed for patient history, genetic history, cancer treatment, and type of reconstruction.

Results:

Of the 350 patients meeting the criteria, 56.9% were noted to have incidental findings on preoperative imaging, 12.9% received additional imaging, and 4.0% underwent additional interventions. There was no difference in the percentage of patients with incidental findings between immediate and delayed reconstructions or between CTA and MRA. Five patients were found to have malignancies.

Conclusions:

Preoperative CTA and MRA is a valuable tool to optimize outcomes and efficiency in breast reconstruction with abdominal perforator flaps. However, this imaging can also be beneficial to the overall wellness of the patient. With the high prevalence of incidental findings on preoperative imaging, it is important to counsel patients and adjust surgical plans, if necessary.
An Aesthetic Factor Priority List of the Female Breast in Scandinavian Subjects
Authors: Sandberg Lars Johan , Tønseth Kim A. , Kloster-Jensen Kristine , Liu Jun , Robe Charee , Reece Gregory , Hansen Elisabeth H. , Berntsen Karin , Halle Martin , Edsander-Nord Åsa , Höckerstedt Anna , Kauhanen Susanna , Sneistrup Christian , Tindholdt Tyge , Petter Gullestad Hans , Gunnarsson Gudjon Leifur , Berg Erik , Selber Jesse Creed
Published: April 2021

Background:

There is little consensus about the relative determinative value of each individual factor in female breast aesthetics. When performing breast surgery with an aesthetic goal, certain factors will be more important than others. The purpose of this study was to make an aesthetic factor rank list to determine the relative contributions to overall breast aesthetics.

Method:

Volunteers were scanned using the 3-dimensional Vectra system. Ten Scandinavian plastic surgeons rated 37 subjects, using a validated scoring system with 49 scoring items. The correlation between specific aesthetic factors and overall breast aesthetic scores of the subjects were calculated using Pearson’s r, Spearman’s ρ, and Kendall’s τ.

Results:

A very strong correlation was found between overall breast aesthetic score and lower pole shape (0.876, P < 0.0001). This was also true for upper pole shape (0.826, P < 0.0001) and breast height (0.821, P < 0.0001). A strong correlation was found between overall breast aesthetic score and nipple position (0.733, P < 0.0001), breast size (0.644, P < 0.0001), and breast width (0.632, P < 0.0001). Factors that were only moderately correlated with aesthetic score were intermammary distance (0.496, P = 0.002), nipple size and projection (0.588, P < 0.0001), areolar diameter (0.484, P < 0.0001), and areolar shape (0.403, P < 0.0001). Perceived symmetry was a weak factor (0.363, P = 0.027).

Conclusions:

Aesthetic factors of the female breast can be ranked in a priority list. Shape of the lower pole and upper pole and breast height are primary factors of female breast aesthetics. These should be prioritized in any aesthetic breast surgery. Vertical dimensional factors seem to be more determinative than horizontal factors.
Efficacy of Silicone Gel versus Silicone Gel Sheet in Hypertrophic Scar Prevention of Deep Hand Burn Patients with Skin Graft: A Prospective Randomized Controlled Trial and Systematic Review
Authors: Pruksapong Chatchai , Burusapat Chairat , Hongkarnjanakul Natthawoot
Published: April 2021

Background:

Burn injuries are burdensome to the public health system. Hypertrophic scars are the most common undesirable sequelae associated with burn scar contracture, resulting in reduced hand function. This study compared 2 different forms of silicone combined with pressure garment (PG) to determine the efficacy in hypertrophic scar prevention in hand burns.

Methods:

A systematic review was also performed, including only randomized control trials with silicone materials in burned patients. A prospective intraindividual randomized controlled trial was conducted to compare the efficacy of 3 treatment groups: silicone gel and silicone gel sheet combined with PG versus PG alone.

Results:

There were no significant differences in all Vancouver Scar Scale parameters. Three of 6 Patient and Observer Scar Assessment Score parameters showed significant differences among the 3 groups (P < 0.05). Scar stiffness improved at 8- and 12-weeks follow-up in both silicone gel and silicone gel sheet combined with PG; however, there was no significant difference between silicone groups. Scar thickness significantly improved at 2, 4, and 8 weeks in the silicone gel group compared with PG. Scar irregularity significantly improved at 2, 4, 8, 16, and 20 weeks in both silicone combined PG groups compared with PG alone.

Conclusions:

Silicone gel and silicone gel sheet combined with PG were more effective than PG alone in some aspects of the Patient and Observer Scar Assessment Score. However, there was no significant difference between the silicone gel and silicone gel sheet on the Vancouver Scar Scale.
Aesthetic Applications of Radiofrequency: Lymphatic and Perfusion Assessment
Authors: Dayan Erez , Theodorou Spero , Rohrich Rod J. , Jay Burns A.
Published: April 2021

Background:

The use of radiofrequency in aesthetics has increased in popularity since the early 2000s. To date, there have been limited studies investigating the effect of thermal energy secondary to radiofrequency treatment. The purpose of this study was to evaluate perfusion and lymphatic assessment tools pre and post bipolar and fractional radiofrequency treatment.

Methods:

A retrospective IRB-approved study was conducted between January 2019 and April 2019. Patients who were independently deemed appropriate candidates for radiofrequency soft tissue remodeling were evaluated. Diagnostic perfusion and lymphatic imaging obtained were reviewed using indocyanine green (SPY, Stryker) and optical coherence tomography (Vivosight OCT).

Results:

A total of 63 patients were treated during the study period, of which 37 had diagnostic perfusion and lymphatic imaging. Average patient age was 47 (STD 12), 95% (35/37) of patients were women, and no patients were active smokers. In total, 27% (10/37) of patients were post-surgical patients with recurrent laxity, 32% (12/37) did not have enough skin laxity to justify traditional excisions procedures, and 41% (15/37) may have been candidates for excisional procedures but were willing to accept more moderate results to avoid excisions surgery. Indocyanine green perfusion and lymphatic assessment for bipolar and fractional radiofrequency, as well as optical coherence tomography pre and post radiofrequency, did not show compromise from thermal injury.

Conclusions:

This study supports safety of radiofrequency in terms of preservation of tissue perfusion and lymphatic drainage. This correlated to our low clinical incidence of burns, prolonged swelling, or tissue ischemia.
No Longer a Pain in the Neck: Use of Operating Microscope for Palatoplasty
Authors: Tanaka Shoichiro A. , Patel Nilesh M. , Murthy Ananth S.
Published: April 2021

For craniofacial surgeons, cleft palate repair is an intricate and difficult operation positionally. Historically, use of loupe magnification and a headlight can cause significant strain to the surgeon’s neck and, at times, subpar optics for both the operator and the assistant. The use of an operating microscope was first advocated by Sommerlad in 2003. By using the operating microscope for cleft palate closure, there are improved ergonomics for the surgeon and assistant by allowing for straight in-line back and neck posture with excellent visualization of the surgical field for the entire surgical team. The available zoom and focus improve the ability to isolate and repair the levator veli palatini muscle. Proper posture with a neutral cervical spine will help prolong a surgeon’s career and ability to care for their patients.
Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay
Authors: Knackstedt Rebecca , Patel Niyant
Published: April 2021

Background:

Enhanced recovery after surgery (ERAS) protocols utilize multi-modal approaches to decrease morbidity, narcotic usage, and length of stay. In 2013, we made several changes to our perioperative approach to children undergoing complex craniofacial procedures. The goal of this study was to analyze our protocol for children undergoing fronto-orbital advancement (FOA) for craniosynostosis.

Methods:

A retrospective chart review was performed after IRB approval, for children who underwent fronto-orbital advancement for craniosynostosis from 2010 to 2018. The ERAS protocol, initiated in December 2013, involves hemoglobin optimization, cell-saver technology, tranexamic acid, specific postoperative fluid titration, and a transfusion algorithm. The analgesic regimen focuses on narcotic reduction through the utilization of scheduled acetaminophen, ibuprofen, or ketorolac, and a dexmedetomidine infusion with opioids only for breakthrough pain.

Results:

Fifty-five ERAS protocol children and 23 control children were analyzed. ERAS children had a decreased rate (13/53 versus 23/23, P < 0.0001) and volume of intraoperative transfusion (183.4 mL versus 339.8 mL, P = 0.05). Fewer ERAS children required morphine/dilaudid (12/55 versus 22/23 P < 0.0001) and for children who required morphine, fewer doses were required (2.8 versus 11, P = 0.02). For ERAS protocol children who required PO narcotics, fewer doses were required (3.2 versus 5.3, P = 0.02). ERAS children had a decreased length of stay (2.3 versus 3.6 nights, P < 0.0001). No patients were re-admitted due to poor oral intake, pain, hemodynamic, or pulmonary concerns.

Conclusions:

Our ERAS protocol demonstrated a reduction in the overall and intraoperative allogenic blood transfusion rate, narcotic use, and hospital length of stay. This is a safe and effective multimodal approach to managing complex craniofacial surgical recovery.
Extensive Facial Reconstruction Using Thickness-controlled Perforator Free Flaps
Authors: Choi Jong-Woo , Park Joo-Seok , Kim Ji-Hee
Published: April 2021

Background:

Although small and medium facial defects can be reconstructed with local flaps to ensure skin color and texture matching, extensive facial defects require the application of free flaps, including perforator free flaps. We hereby propose a personalized strategy for facial reconstruction to overcome these limitations, based on the use of free flaps accompanied by local flaps and thickness-controlled perforator flap concept, for extensive facial defects.

Methods:

A series of consecutive facial reconstructions were performed from 2006 to 2016 in the Plastic and Reconstructive Surgery Department of our institution. Only extensive facial defects greater than 40 cm2 were included in this study.

Results:

A total of 323 patients underwent reconstruction using free flaps with or without local flaps, from November 2005 to March 2019. Of these, 79 extensive facial surface reconstruction cases were analyzed retrospectively. The size of the defects, their areas (upper, middle, or lower third of the face), and the method of reconstruction were analyzed. This led to the development of a personalized reconstruction procedure for extensive facial defects. These extensive facial reconstruction cases included 24 defects of the upper third of the face, 43 cases of the middle third, and 12 of the lower third. Four cases addressed the middle and lower thirds simultaneously.

Conclusions:

The facial surface reconstruction strategy I suggest in this study is based on the flap selection, thickness-controlled perforator flap elevation, and combination of local and free flaps. We expect this procedure will improve the treatment and resolution of extensive facial defects.
The Triple Unilimb Z Plasty Technique for Severe Forms of Unilateral Cleft Lip Repair
Authors: Rossell-Perry Percy
Published: April 2021

Background:

A wide spectrum of variation of the unilateral cleft lip deformity requires an individualized management. Current classifications for unilateral cleft lip are limited to incomplete or complete, and these descriptions do not address well this deformity. The soft tissue deficiency is not considered, which plays an important role in the surgical correction of the unilateral cleft lip. The author developed an innovative technique for surgical correction of unilateral cleft lip with severe soft tissue deficiency.

Methods:

Since 2007, 168 patients with severe unilateral cleft lip have been operated on by the author, using the proposed surgical technique. The author’s classification of severity considers a severe unilateral cleft lip as a discrepancy between the non-cleft and cleft vertical height greater than 6 mm. The technique uses 2 Z plasties for the upper lip and 1 Z plasty for vermillion repair.

Results:

This method lets the surgeon to achieve an adequate symmetry of the upper lip. A low rate of revision (14.88%) has been observed for 13 years, using the proposed surgical technique, by the author.

Conclusions:

An innovative technique to address severe forms of unilateral cleft lip is presented in this article. This method represents a good alternative for cleft lips with increased lateral segment tissue deficiency, providing adequate lip symmetry.
Webinar during COVID-19 Improves Knowledge of Changes to the Plastic Surgery Residency Application Process
Authors: Serebrakian Arman T. , Amador Ricardo O. , Christensen Joani M. , Pickrell Brent B. , Irwin Timothy J. , Karinja Sarah J. , Broyles Justin M. , Liao Eric C. , Eberlin Kyle R. , Helliwell Lydia A.
Published: April 2021

Background:

The COVID-19 pandemic has significantly impacted residency application process for all specialties, including plastic surgery residency. Almost all plastic surgery residency programs have suspended visiting sub-internship rotations. This study quantifies the impact of a webinar through an analysis of poll questions and a post-webinar survey sent to all registered participants.

Methods:

A dedicated webinar was organized and held by the Harvard Plastic Surgery Residency Training Program. All attendees were asked several poll questions during the webinar. The 192 participants were also sent a post-webinar survey.

Results:

The response rate was 68.2% (n = 131). Respondents were more confident about matching into a plastic surgery residency program at the end of the webinar compared with before the webinar (P < 0.001). Respondents who did not have a plastic surgery residency program at their home institution were less confident at the start of the webinar (P = 0.009). In addition, respondents who had not taken time off for research or for other endeavors during or after medical school were less confident about their chances to match at the start of the webinar (P = 0.034).

Conclusions:

An online webinar program increased confidence levels of medical students interested in applying for residency positions in plastic surgery. Residency programs should consider webinars as a method to inform and assist medical students during the upcoming application season.
Level of Evidence on Platelet-rich Plasma in Plastic Surgery
Authors: Cho Min-Jeong , Rohrich Rod J.
Published: April 2021

Background:

Despite the increased popularity of platelet-rich plasma (PRP) in plastic surgery, there is no detailed analysis on the level of evidence on PRP use in plastic surgery. As the number of applications of PRP in plastic surgery increases, it is important for plastic surgeons to understand the scientific and validated evidence behind its use. Therefore, we performed a literature review to identify current level of evidence on platelet-rich plasma in plastic surgery.

Methods:

We performed a computerized search of platelet-rich plasma in plastic surgery using the MEDLINE, Cochran Library, and EMBASE databases. Data regarding the type of study, PRP application, and outcomes were collected. Then, the level of evidence was assigned using the American Society of Plastic Surgeons Level of Evidence Rating.

Results:

Our search identified 105 articles, and about 78.1% of studies were lower-quality studies: 37 level-III articles (35.2%), 32 level-IV articles (30.5%), and 13 level-V articles (12.4%). There were only 6 level-I articles and 17 level-II studies. Level-I studies were on facial rejuvenation using a laser, carpal tunnel release, cleft lip repair, trauma wounds, breast reconstruction using latissimus dorsi, and hair regrowth.

Conclusions:

Our review of the literature shows that the level of evidence on PRP use in plastic surgery is low (21.9%). Nevertheless, we believe level-III to level-V studies are still valuable, as performing high-level quality studies in plastic surgery is difficult due to variability in surgical techniques, experiences, and materials.
Tip Droop Prevention in Rhinoplasty: Dynamic Effect of Strut Graft on Smiling versus Depressor Muscle Release
Authors: Brady Chevonne , Berwick Daniele , Uppal Rajan
Published: April 2021

Background:

Aesthetic rhinoplasty is one of the most challenging procedures performed by aesthetic surgeons. Tip droop, especially on smiling, may not be noted by the surgeon postoperatively but can be concerning to patients. Our aim was to determine if the division of the depressor septi nasi or its combination with a columellar strut graft during rhinoplasty produce a measurable reduction in nasal tip droop on smiling.

Methods:

A retrospective casenote and photograph review was conducted on patients who had undergone aesthetic endonasal rhinoplasty, performed by a single surgeon between 2015 and 2019. In total, 29 patients had release of the depressor septi nasi muscle, whilst 11 had release of the muscle along with a strut graft. Lateral smiling photographs were taken postoperatively. Tip droop was measured as a variation of the nasolabial angle from rest to smiling using the Frankfurt line.

Results:

Photographs were taken at a mean of 14 months postoperatively. In the group who had muscle release only, a mean increase in nasolabial angle of 3.66 degrees was seen when smiling when compared with rest. In the group who had muscle release combined with strut graft, a mean increase of 2.27 degrees was seen. When using a columellar strut along with muscle release, tip droop on smiling was reduced.

Conclusions:

This study demonstrates that columellar strut grafting in combination with muscle release can alleviate drooping of the tip better than muscle division alone after rhinoplasty. The columellar strut graft provides tip stability and can therefore be used to enhance dynamic outcomes after rhinoplasty.
Evaluation of the Use of Nerve Allograft Preserved in Glycerol
Authors: Nakamoto João Carlos , Wataya Erick Yoshio , Nakamoto Hugo Alberto , Santos Gustavo Bispo , Ribaric Ivan , Herrera Ana K.A. , Faria José C.M.
Published: April 2021

Background:

We aimed to evaluate the use of nerve allograft preserved in glycerol. We compared the efficiency of glycerol-preserved allografts with autogenous nerve grafting, cryopreserved grafts, and detergent-processed grafts in the axonal regeneration. Secondarily, we evaluated the effectiveness of each preservation method in maintaining the extracellular matrix free of cellular components.

Methods:

This was a prospective experimental, longitudinal, unblinded, nonrandomized, controlled animal model study. Three different allograft preservation techniques for the repair of sciatic nerve injuries were compared, including cold preservation, glycerol preservation, and detergent preservation. Functional assessment was performed, and histomorphometric analyses were further performed, which enabled the allograft structure evaluation and an estimation of the nerve regeneration efficacy based on the myelinated axons count and on their diameters.

Results:

After the 14th week, all groups were already balanced and similar (P = 0.265): all groups present near-zero SFIs, thus confirming their efficiency in promoting nerve regeneration. In the histomorphometric evaluations, all groups were equivalent, presenting a similar efficiency in nerve regeneration (P = 0.716 and P = 0.577, respectively). Similarly, histomorphometric evaluations showed a reduction in the number of axons and in their diameters, but none of them effectively eliminated all cellular debris. Comparing the groups with each other, the groups preserved in glycerol and detergent solution were similar, both presenting better results than the cooled group.

Conclusion:

By evaluating the presence of cell debris after the treatment using glycerol, it was found to be similar to the treatment using detergent and significantly better than the cold-preservation treatment.
Breast Reconstruction in Inflammatory Breast Cancer: An Analysis of Predictors, Trends, and Survival from the National Cancer Database
Authors: Karadsheh Murad J. , Katsnelson Jacob Y. , Ruth Karen J. , Weiss Eric S. , Krupp James C. , Sigurdson Elin R. , Bleicher Richard J. , Ng Marilyn , Shafqat M. Shuja , Patel Sameer A.
Published: April 2021

Introduction:

Survival for women diagnosed with inflammatory breast cancer (IBC) has improved with advances in multimodal therapy. This study was performed to evaluate trends, predictors, and survival for reconstruction in IBC patients in the United States.

Methods:

Women who underwent mastectomy with or without reconstruction for IBC between 2004 and 2016 were included from the National Cancer Database. Predictors for undergoing reconstruction and association with overall survival were determined.

Results:

Of 12,544 patients with IBC who underwent mastectomy, 1307 underwent reconstruction. Predictors of reconstruction included younger age, private insurance, higher income, performance of contralateral prophylactic mastectomy, and location within a metropolitan area (P < 0.001). The proportion of women having reconstruction for IBC increased from 7.3% to 12.3% from 2004 to 2016. Median unadjusted overall survival was higher in the reconstructive group l [93.7 months, 95% confidence interval (CI) 75.2–117.5] than the nonreconstructive group (68.1 months, 95% CI 65.5–71.7, hazard ratio = 0.79 95% CI 0.72–0.88, P < 0.001). With adjustment for covariates, differences in overall mortality were not significant, with hazard ratio of 0.95 (95% CI 0.85–1.06, P = 0.37).

Conclusions:

Reconstruction rates for IBC are increasing. Women with IBC who undergo reconstruction tend to be younger and are not at the increased risk of all-cause mortality compared to those not having reconstruction. The National Cancer Database does not differentiate immediate from delayed reconstruction. However, the outcomes of immediate reconstruction in carefully selected patients with IBC should be further studied to evaluate its safety. This could impact current guidelines, which are based largely on an expert opinion.
Urinary Incontinence and Pelvic Organ Prolapse
Authors: Wong Jennifer W.H. , Ramm Olga
Published: April 2021

The multifactorial pathophysiology of pelvic floor disorder accounts for the coexistence of several pelvic floor disorders in many women. Up to 54% of women with pelvic organ prolapse (POP) report concurrent stress urinary incontinence (SUI). While POP is a risk factor for coexistent SUI, apical and anterior prolapse can also conceal SUI symptoms that are unmasked by POP repair, resulting in de novo SUI postoperatively. It is important for pelvic reconstructive surgeons to consider the relationship between POP and urinary incontinence in presurgical planning and to discuss with patients the risks and advantages of concurrent versus staged anti-incontinence procedures.
Genetically determined hypertensive phenotype affects gut microbiota composition, but not vice versa
Authors: Konopelski Piotr , Konop Marek , Perlejewski Karol , Bukowska-Osko Iwona , Radkowski Marek , Onyszkiewicz Maksymilian , Jaworska Kinga , Mogilnicka Izabella , Samborowska Emilia , Ufnal Marcin
Published: April 2021

Objectives:

Research suggests reciprocal crosstalk between the host and gut bacteria. This study evaluated the interaction between gut microbiota and arterial blood pressure (BP) in rats.

Methods:

Continuous telemetry recordings of BP were started in 7-week-old normotensive Wistar--Kyoto rats (WKY) and spontaneously hypertensive rats (SHR). Two weeks later, half of the WKY and SHR were subjected to cross-transplantation of fecal matter, with stools harvested from either WKY or SHR and BP measurements until the age of 14 weeks. The composition of gut bacteria was assessed through analysis of the bacterial 16S ribosomal RNA gene sequence. The concentration of microbiota-derived metabolites was evaluated using HPLC-MS.

Results:

There was a significant difference between WKY and SHR in the composition of gut bacteria at the start and end of the study. This was accompanied by significant histological differences in the colon. SHR, but not WKY, showed a gradual increase in BP throughout the experiment. For both WKY and SHR, there was no significant difference in BP or metabolic parameters between animals receiving fecal transplantation from either SHR or WKY.

Conclusion:

Genetically induced hypertension in SHR is associated with alterations in the composition of gut bacteria and histological morphology of the colon. An inter-strain fecal transplant does not affect BP and does not produce long-term changes in gut bacteria composition. We propose that the impact of the host genotype and/or phenotype on the gut bacteria may be greater than the impact of the gut bacteria on the host BP.
Childhood vascular phenotypes have differing associations with prenatal and postnatal growth
Authors: Sletner Line , Crozier Sarah R. , Inskip Hazel M. , Godfrey Keith M. , Mahon Pamela , Chiesa Scott T. , Charakida Marietta , Cooper Cyrus , Hanson Mark
Published: April 2021

Objective:

In children aged 8--9 years, we examined the associations of linear and abdominal circumference growth during critical stages of prenatal and postnatal development with six vascular measurements commonly used as early markers of atherosclerosis and later cardiovascular disease (CVD) risk.

Methods:

In 724 children from the UK Southampton Women's Survey mother--offspring cohort, offspring length/height and abdominal circumference measurements were collected at 10 ages between 11 weeks’ gestation and age 8--9 years. Using residual growth modelling and linear regression, we examined the independent associations between growth and detailed vascular measures made at 8--9 years.

Results:

Postnatal linear and abdominal circumference growth were associated with higher childhood SBP and carotid--femoral pulse wave velocity, whereas prenatal growth was not. For example, 1SD faster abdominal circumference gain between ages 3 and 6 years was associated with 2.27 [95% confidence interval (CI): 1.56--2.98] mmHg higher SBP. In contrast, faster abdominal circumference gain before 19 weeks’ gestation was associated with greater carotid intima--media thickness [0.009 mm (0.004--0.015) per 1SD larger 19-week abdominal circumference), whereas later growth was not. We found no strong associations between prenatal or postnatal growth and DBP or measures of endothelial function.

Conclusion:

Higher postnatal linear growth and adiposity gain are related to higher SBP and carotid--femoral pulse wave velocity in childhood. In contrast, faster growth in early gestation is associated with greater childhood carotid intima--media thickness, perhaps resulting from subtle changes in vascular structure that reflect physiological adaptations rather than subclinical atherosclerosis.
Relation between elevated first SBP from baseline (delta SBP) and postoperative outcome
Authors: Zhou Yan , Liu Lin , Fan Fangfang , Hong-Yun Yang
Published: April 2021

Background:

Hypertension is associated with increased postoperative risk. However, no consensus was accepted whether elevated blood pressure in the operating room with normal blood pressure at rest related to additional cardiovascular risk.

Methods:

This was a single-center retrospective cohort study based on patients who underwent elective noncardiac surgery from 1 January 2012, to 31 December 2018. We evaluated the relationship between the delta SBP (the difference between first operating room blood pressure and baseline blood pressure) and the development of postoperative major adverse cardiac events (MACEs) in patients with normal baseline blood pressure. Multivariate logistic regression before and after propensity score weighting was performed to adjust for perioperative variables, and the minimum P value approach was used to identify the possible threshold of delta SBP that independently indicated the risk of MACE.

Results:

Of the 55 563 surgeries, in 4.1%, postoperative MACE occurred. The threshold for the delta SBP was 49 mmHg. The adjusted odds ratio for MACE before and after propensity score weighting for the delta SBP threshold was 1.35 (95% CI, 1.11--1.59); P less than 0.001 and 1.28 (1.03–1.60); P = 0.028, respectively.

Conclusion:

Delta SBP contributed to the elevated risk over and beyond the SBP at rest in patients who underwent elective noncardiac surgery. A rise of SBP of more than 49 mmHg from baseline in the operating room was significantly associated with an increased risk of postoperative MACE.
Effect of Music on Fatigue, Comfort, and Vital Signs in Patients After Liver Transplant Surgery
Authors: Demir Bilsev , Kapιkιran Gürkan , Özkan Meral
Published: April 2021

This randomized controlled clinical trial was conducted to determine the effect of music therapy on fatigue, comfort and vital signs of the liver transplant patients. The study sample comprised 120 adult patients (60 in the experimental and 60 in the control group) who met the inclusion criteria and agreed to participate in the study. In the experimental group, the researcher performed music therapy. After applying music therapy once to patients for 30 minutes, their fatigue, comfort, and vital signs were evaluated. No treatment was performed in the control group. According to music therapy follow-ups after liver transplantation, mean scores of fatigue levels were lower, comfort levels were higher, and vital signs were normal, with a statistical significance in the experimental group compared with the control group in all measurements before and after music therapy (P < .001). The study should be repeated using different parameters.
Investigation and Analysis of Perceived Stress Levels in Pediatric Nurses During the 2019-20 SARS-CoV-2 Outbreak
Authors: Yan Mengwei , Xie Anwei , Cheng Fangfang , Zhou Weifang , Tian Jianmei , Xu Yunqiu
Published: April 2021

This study investigated perceived stress levels of pediatric nurses during the 2019-20 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak. From February 9 to 13, 2020, 250 pediatric nurses were selected from 4 grade III children's hospitals and 5 grade III general hospitals in Jiangsu Province, China. A general information questionnaire and a stress perception scale were used to investigate and analyze the influencing factors of perceived stress among participants. Perceived stress was at the intermediate level or above for 54.1% (133) of the sample. Multiple linear regression analysis showed that hospital department, living styles, physical conditions, and the proportion of negative (eg, increased deaths and infections) information received about the epidemic (eg, via media and/or face-to-face) influenced perceived stress. Thus, the overall level of perceived stress among clinical pediatric nurses was medium. Nursing managers should pay more attention to and conduct timely assessment interventions for staff to reduce stress levels and promote physical and mental health.
Association Between Dry Eye Disease and Newly Diagnosed Obsessive-Compulsive Disorder
Authors: Eroglu Fatma Corak , Gediz Berrak Sekeryapan , Ozturk Mehmet , Kazancı Burcu
Published: April 2021

Purpose:

The purpose of this study was to evaluate the association between dry eye disease and patients with newly diagnosed obsessive-compulsive disorder (OCD).

Methods:

Thirty treatment-naive patients with OCD and 30 healthy controls were included in this prospective study. The Ocular Surface Disease Index, tear breakup time, Schirmer I test, corneal and conjunctival staining grade (Oxford scale), and neutrophil-to-leucocyte ratio values were obtained for all participants.

Results:

The comparison of the patients with OCD and healthy controls showed significantly higher values in Ocular Surface Disease Index (34.8 vs. 20.8, P = 0.001), corneal Oxford scoring (0.9 vs. 0.6, P = 0.02), and conjunctival Oxford scoring (0.8 vs. 0.5, P = 0.04), with consistently lower values in the Schirmer I test (15.7 vs. 18.8, P = 0.043) and tear breakup time (9.1 vs. 12.9, P = 0.001). The mean neutrophil-to-leucocyte ratio values were significantly higher in the OCD group compared with the controls (2.4 ± 0.9 vs. 1.6 ± 0.4, respectively; P = 0.001).

Conclusions:

Our study showed a relation between dry eye disease and patients with newly diagnosed OCD who were not using any psychiatric drug. Our findings suggest that inflammation, which plays an important role in the pathogenesis of both diseases, may be responsible for this relationship.
Outcomes After Corneal Crosslinking for Keratoconus in Children and Young Adults
Authors: Saleh Solin , Koo Euna B. , Lambert Scott R. , Manche Edward E.
Published: April 2021

Purpose:

The aim of this study was to assess the effect of corneal crosslinking on vision and keratometry in children and young adults with progressive keratoconus.

Methods:

A retrospective medical records review of patients aged 22 years or younger with keratoconus who underwent corneal crosslinking between January 2013 and November 2019 at Byers Eye Institute at Stanford University was conducted. Outcome measures included logarithm of the Minimum Angle of Resolution corrected distance visual acuity (CDVA); keratometry, including maximum keratometry (Kmax); pachymetry; and total wavefront aberration. Measurements were taken at baseline and at 12 and 24 months postoperatively.

Results:

Fifty-seven eyes of 49 patients aged 12 to 22 years were assessed. The mean preoperative CDVA was logarithm of the Minimum Angle of Resolution 0.38 ± 0.32 (20/48), with a mean postoperative CDVA of 0.29 ± 0.31 (20/39) and 0.31 ± 0.31 (20/41) at 12 and 24 months postoperatively, respectively. Compared with preoperative mean Kmax, there was an improvement of −0.8 diopters (D) to a mean postoperative Kmax of 59.1 ± 9.1 D at 12 months and −1.3 D to 59.7 ± 8.8 D at 24 months. Subanalysis excluding the second eye of patients who underwent bilateral crosslinking showed similar results. Linear mixed modeling showed significant improvement in Kmax at both 12 and 24 months postoperatively. Minimum central corneal thickness initially decreased but stabilized at 24 months after crosslinking. Total wavefront aberration remained stable.

Conclusions:

Corneal crosslinking stabilizes, and in some cases improves, visual and corneal parameters in pediatric and young adult patients with keratoconus. The procedure is safe and well-tolerated and may prevent keratoconus progression in young patients.
Subpalpebral Antibiotic Lavage as Safe, Emergent, and Cost-Effective Management of Acute Infectious Keratitis Related to Contact Lens Overwear: Case Report and Literature Review
Authors: Yang Lucy Y. , Huang Jessica J. M. , Toohey Thomas P. , Wong Elizabeth L. S. , Khan Muhammad A. , Jiang Ivy W. , Ting Eugene L. , Jiang James , Ruan Claire W. , Agar Ashish , Coroneo Minas T. , Maloof Anthony J. , Francis Ian C.
Published: April 2021

Purpose:

The aim of this study is to describe the technique of subpalpebral antibiotic lavage (SAL), which is a highly therapeutic, efficient, and cost-effective method for managing severe bacterial keratitis.

Methods:

This case report describes a 26-year-old woman with severe bacterial keratitis in the right eye due to contact lens overwear, with progressive corneal thinning, a hypopyon, impending perforation, and marked visual loss to perception of light despite treatment with intensive topical antibiotics. This was managed with SAL that involves the insertion of a cannula transcutaneously into the upper conjunctival fornix to provide continuous antibiotic irrigation of the ocular surface.

Results:

By 11 weeks after presentation, the cornea and anterior chamber appeared clinically quiescent, and visual acuity improved to 20/40 corrected in the right eye.

Conclusions:

Bacterial keratitis is a potentially blinding condition for which contact lens wear is an important risk factor. Most cases are successfully managed with topical medications; however, in cases of treatment failure, a second-line approach such as SAL can be sight-saving. SAL uses readily available equipment for the delivery of high concentrations of antibiotics to the ocular surface, thus increasing therapeutic efficacy and reducing nursing staff workload. Despite its advantages, the literature reveals apparent underutilization of this technique.
Parent-Collected Nasal Swab for Severe Acute Respiratory Syndrome Coronavirus 2 Testing in Children
Authors: Lodi Lorenzo , Rubino Chiara , Moriondo Maria , Pisano Laura , Astorino Valeria , Citera Francesco , Giovannini Mattia , Trapani Sandra , Resti Massimo , Ricci Silvia , Indolfi Giuseppe , Azzari Chiara
Published: April 2021

This cross-sectional study, including children hospitalized for severe acute respiratory syndrome coronavirus 2 infection, demonstrates for the first time that nonhealthcare worker parents perform similarly to healthcare workers in the administration to their children of an unsupervised nasal swab for severe acute respiratory syndrome coronavirus 2 detection by following written instructions and video tutorials.
Pulmonary Embolism as the Initial Presentation of Coronavirus Disease 2019 in Adolescents
Authors: Panjabi Anurag L. , Foster Rachel C. , McCarthy Amanda M. , Shah Satish K. , Al-Wahab Haitham , Greenleaf Christopher , Su Erik
Published: April 2021

The current coronavirus disease 2019 pandemic has been particularly challenging for the clinician because of the unclear nature of the underlying disease mechanisms. One of the hallmarks of the disease involves an increased risk of thrombosis and hypercoagulable state. Here, we describe 2 cases of patients admitted with submassive pulmonary embolism in the setting of positive tests for severe acute respiratory syndrome coronavirus 2.
Comorbid Communicable Diseases of Substance Abuse in Thailand: A 5-Year Retrospective Study
Authors: Wongtongkam Nualnong , Lampoo Seearoon , Nilaban Sumnao , Lukanapichonchut Lumsum
Published: April 2021

Substance abuse is a major threat to health and safety of not only drug users themselves but also communities more widely because of the increased risk of spreading communicable diseases that coexist with drug misuse. Retrospective data from 2013 to 2017 drawn from a Thai rehabilitation center showed 14 cases of hepatitis, 36 of HIV, and 102 of tuberculosis (TB). Demographic data and International Classification of Disease, Tenth Revision, codes related to comorbidity of these communicable diseases were obtained. Most hepatitis comorbidity was found in patients with alcohol dependence who were infected with hepatitis B or C. Comorbidities with TB and HIV were found only in persons with other stimulant use. With a 5-year prevalence, there was statistically significant difference in TB comorbidities among substance abusers (P = 0.028). Interestingly, any substance misuse could contribute to co-occurring HIV infection, but there were no statistically significant differences. Nowadays, a tradition of sharing unsterilized injection equipment might not be the leading cause of coexisting communicable diseases among illegal drug users. Instead, sharing personal possessions and unprotected sexual activity might the major actions increasing risk of contracting comorbid communicable diseases, particularly TB and HIV.