bluuebunny/crossref_metadata_2025 huggingface dataset:
A case report of a young patient with both Brugada and long QT3 syndrome: between the hammer and the anvil
Authors: Abu Dogoshh Ala , Konstantino Yuval , Haim Moti
Published: March 2021

Background

Brugada syndrome (BrS) is an inherited disorder associated with increased risk of ventricular arrhythmias and sudden cardiac death. The most common genetic alteration is a loss of function mutation of SCN5A gene. Several mutations in SCN5A gene were found to be associated with an overlap phenotype of both BrS and long QT3 (LQT3) syndrome.

Case summary

We report of a 29-year-old man with familial LQT3 syndrome that was diagnosed at age 6 during evaluation of syncope. He has been treated for several years with Flecainide. Now presented with recurrent episodes of syncope. Electrocardiogram (ECG) upon admission was notable for Brugada type 1 pattern that was attenuated after Flecainide was discontinued. Genetic analysis revealed SCN5A 1790D>G mutation that is associated with overlap of LQT3 and BrS. Due to recurrent syncope and difficult management of both LQT3 and BrS, an implantable cardioverter-defibrillator was implanted together with beta-blockers treatment. The patient was discharged home with no evidence of Brugada type 1 pattern on his ECG. He had no further syncope or arrhythmias during 6 months of follow-up.

Discussion

There are few reports describing the phenotypic overlap between LQT3 and BrS. Despite the confirmed genetic link between both syndromes, their management strategy is controversial. In particularly, the treatment with sodium channel blockers for LQT3 syndrome may increase the risk for arrhythmias in patients with coexisting BrS. The present case demonstrates the link between LQT3 and BrS and the difficult dilemma in the management of these patients.
The endoplasmic reticulum unfolded protein response – homeostasis, cell death and evolution in virus infections
Authors: Prasad Vibhu , Greber Urs F
Published: March 2021

Viruses elicit cell and organismic stress, and offset homeostasis. They trigger intrinsic, innate and adaptive immune responses, which limit infection. Viruses restore homeostasis by harnessing evolutionary conserved stress responses, such as the endoplasmic reticulum (ER) unfolded protein response (UPRER). The canonical UPRER restores homeostasis based on a cell-autonomous signalling network modulating transcriptional and translational output. The UPRER remedies cell damage, but upon severe and chronic stress leads to cell death. Signals from the UPRER flow along three branches with distinct stress sensors, the inositol requiring enzyme (Ire) 1, protein kinase R (PKR)-like ER kinase (PERK), and the activating transcription factor 6 (ATF6). This review shows how both enveloped and non-enveloped viruses use the UPRER to control cell stress and metabolic pathways, and thereby enhance infection and progeny formation, or undergo cell death. We highlight how the Ire1 axis bypasses apoptosis, boosts viral transcription and maintains dormant viral genomes during latency and persistence periods concurrent with long term survival of infected cells. These considerations open new options for oncolytic virus therapies against cancer cells where the UPRER is frequently upregulated. We conclude with a discussion of the evolutionary impact that viruses, in particular retroviruses, and anti-viral defense has on the UPRER.
Validation of a Commercial Reagent for the Depletion of Biotin from Serum/Plasma: A Rapid and Simple Tool to Detect Biotin Interference with Immunoassay Testing
Authors: Katzman Brooke M , Hain Erin A , Donato Leslie J , Baumann Nikola A
Published: March 2021

Background

It is important for clinical laboratories to have protocols for investigating suspected biotin interference in patient samples. VeraPrep Biotin™ is a commercial product used to rapidly deplete biotin from serum/plasma samples. The objectives of this study were to verify that VeraPrep Biotin™: (a) does not impact immunoassay analyte recovery in control samples and (b) can effectively deplete biotin from samples (both biotin-spiked and samples from donors who ingested biotin supplements).

Methods

De-identified residual waste serum/plasma samples were combined to create 9 pools for each immunoassay. Plasma/serum samples (n = 23) were obtained from 6 healthy donors at varying times following ingestion of biotin (20 mg, 100 mg, or 200 mg). Nine Elecsys immunoassays were evaluated using the e 602 (Roche Diagnostics Inc.). Control, biotin-spiked (n = 10, ∼400 ng/mL), and donor samples were assayed pre- and post-VeraPrep treatment. Percentage analyte recovery [(posttreatment/pretreatment) × 100] was calculated for control samples. A laboratory-developed LC–MS/MS method was used to quantify biotin.

Results

In control samples (n = 81), 90–110% analyte recovery was observed post-VeraPrep treatment in over 95% of samples (77/81). The pre- and post-VeraPrep treatment biotin concentration [mean ± standard deviation (SD)] for specimens spiked with up to 500 ng/mL biotin was 357 ± 47 ng/mL and 1.0 ± 0.6 ng/mL, respectively. The mean (range) biotin concentration for the donor samples pre- and post-treatment was 166 (15–1029)  ng/mL and 0.2 (<0.1–3)  ng/mL, respectively (P = 0.004).

Conclusions

These data demonstrate that treatment with VeraPrep Biotin™ does not affect analyte recovery in biotin-negative samples and effectively depletes both spiked and endogenous biotin in serum/plasma.
Ubiquitination-mediated degradation of TRDMT1 regulates homologous recombination and therapeutic response
Authors: Zhu Xiaolan , Wang Xiangyu , Yan Wei , Yang Haibo , Xiang Yufei , Lv Fengping , Shi Yi , Li Hong-yu , Lan Li
Published: March 2021

The RNA methyltransferase TRDMT1 has recently emerged as a key regulator of homologous recombination (HR) in the transcribed regions of the genome, but how it is regulated and its relevance in cancer remain unknown. Here, we identified that TRDMT1 is poly-ubiquitinated at K251 by the E3 ligase TRIM28, removing TRDMT1 from DNA damage sites and allowing completion of HR. Interestingly, K251 is adjacent to G155 in the 3D structure, and the G155V mutation leads to hyper ubiquitination of TRDMT1, reduced TRDMT1 levels and impaired HR. Accordingly, a TRDMT1 G155V mutation in an ovarian cancer super responder to platinum treatment. Cells expressing TRDMT1-G155V are sensitive to cisplatin in vitro and in vivo. In contrast, high expression of TRDMT1 in patients with ovarian cancer correlates with platinum resistance. A potent TRDMT1 inhibitor resensitizes TRDMT1-high tumor cells to cisplatin. These results suggest that TRDMT1 is a promising therapeutic target to sensitize ovarian tumors to platinum therapy.
Muscle-fiber array inspired, multiple-mode, pneumatic artificial muscles through planar design and one-step rolling fabrication
Authors: Zou Jiang , Feng Miao , Ding Ningyuan , Yan Peinan , Xu Haipeng , Yang Dezhi , Fang Nicholas X , Gu Guoying , Zhu Xiangyang
Published: March 2021

Advances in development of artificial muscles have enabled creation of soft robots with biological dexterity and self-adaption in unstructured environments; however, production of scalable artificial muscles with multiple-mode actuations remains elusive. Inspired by muscle-fiber arrays in muscular hydrostats, we present a class of versatile artificial muscles called MAIPAMs (muscle-fiber array inspired pneumatic artificial muscles), capable of multiple-mode actuations (such as parallel elongation-bending-spiraling actuations, 10 parallel bending actuations and cascaded elongation-bending-spiraling actuations). Our MAIPAMs consist of active 3D elastomer-balloon arrays reinforced by a passive elastomer membrane, achieved through a planar design and one-step rolling fabrication approach. We introduce prototypical designs for the MAIPAMs and demonstrate their muscle-mimic structures and versatility, as well as their scalable ability to integrate flexible but non-stretchable layers for contraction and twisting actuation modes and compliant electrodes for self-sensing. We further demonstrate that this class of artificial muscles shows potential for versatile robotic applications, such as carrying a camera for recording videos, gripping or manipulating objects, and climbing a pipe-line.
Chronic kidney disease unawareness and determinants using 1999–2014 National Health and Nutrition Examination Survey Data
Authors: Florea Ana , Jacobs Elizabeth T , Harris Robin B , Klimentidis Yann C , Thajudeen Bijin , Kohler Lindsay N
Published: March 2021

Background

Although chronic kidney disease (CKD) affects 15% of the United States (US) population, <10% of the US CKD population is aware of their disease. This is significant as untreated CKD can progress to end-stage renal disease which would require dialysis or transplantation. This study aimed to provide updated information regarding US CKD unawareness.

Methods

Data from the 1999–2014 National Health and Nutrition Examination Survey (NHANES) were used (n = 38 474); response rate > 70%. CKD self-report and lab-confirmed CKD were used to assess CKD unawareness. Adjusted logistic regression models examined association between unawareness and patient characteristics.

Results

In individuals with lab-confirmed CKD (n = 7137, 14.3%), 91.5% answered ‘no’ to self-report question; in those without CKD, 1.1% answered ‘yes’ to self-report question. In those with lab-confirmed CKD, in the adjusted models, increased age [odds ratio (ORs), 1.03 (95%CI, 1.02–1.04)] and female sex [OR, 1.37 (95%CI, 1.08–1.72)] were statistically significantly associated with greater odds of being unaware of CKD.

Conclusion

These findings demonstrated high unawareness of disease status as there was a discrepancy between respondents’ self-reported CKD diagnosis and lab-confirmed CKD. Older individuals and women may be more unaware of their CKD; these groups should be queried about reasons for increased unawareness.
SHOULD WE BEGIN REGULATING THE RADIATION SAFETY OF CABINET X-RAY SYSTEMS?
Authors: Zhai Shuguang , Tian Qingxiang , Wang Hongfang , Kong Yuxia , Bai Bin , Cui Limeng
Published: March 2021

Radiation measurements were conducted at 22 cabinet X-ray systems in Beijing, China, between 2015 and 2019. The median dose rates in the closed-drapes position were 0.11, 0.14, 0.12, 0.14, 0.34 and 0.17 μGy h−1 at the operator position and 5 cm from the surface of the left side, right side, top, entrance and exit, respectively. When a scattering object was passed through the entrance/exit (open-drapes position), the dose rates of eight systems ranged from 1.19 to 6.72 μGy h−1 (median: 3.75 μGy h−1). From 2015 to 2019, we monitored the personal dose equivalent Hp (10) 589 times. The personal dose equivalent of three workers exceeded 1 mSv year−1. However, the integrity of equipment shielding needs to be checked regularly to ensure safe operation. The regulation of radiation protection by employers, technician support institutes or government departments is thus warranted to limit the radiation exposure of workers and the public.
Bisphenol F Exposure in Adolescent Heterogeneous Stock Rats Affects Growth and Adiposity
Authors: Wagner Valerie A , Clark Karen C , Carrillo-Sáenz Leslie , Holl Katie A , Velez-Bermudez Miriam , Simonsen Derek , Grobe Justin L , Wang Kai , Thurman Andrew , Solberg Woods Leah C , Lehmler Hans-Joachim , Kwitek Anne E
Published: March 2021

Bisphenol F (BPF) is increasingly substituting bisphenol A in manufacturing polycarbonates and consumer products. The cardiometabolic effects of BPF in either humans or model organisms are not clear, and no studies to date have investigated the role of genetic background on susceptibility to BPF-induced cardiometabolic traits. The primary goal of this project was to determine if BPF exposure influences growth and adiposity in male N:NIH heterogeneous stock (HS) rats, a genetically heterogeneous population. Littermate pairs of male HS rats were randomly exposed to either vehicle (0.1% ethanol) or 1.125 µg/ml BPF in 0.1% ethanol for 5 weeks in drinking water starting at 3 weeks-of-age. Water consumption and body weight was measured weekly, body composition was determined using nuclear magnetic resonance, urine and feces were collected in metabolic cages, and blood and tissues were collected at the end of the study. BPF-exposed rats showed significantly increased body growth and abdominal adiposity, risk factors for cardiometabolic disease. Urine output was increased in BPF-exposed rats, driving a trend in increased creatinine clearance. We also report the first relationship between a bisphenol metabolizing enzyme and a bisphenol-induced phenotype. Preliminary heritability estimates of significant phenotypes suggest that BPF exposure may alter trait variation. These findings support BPF exposure as a cardiometabolic disease risk factor and indicate that the HS rat will be a useful model for dissecting gene by BPF interactions on metabolic health.
Does the Approach of the Lateral Platysmal Bands Widen the Gap between the Medial Bands?
Authors: Charles-de-Sá Luiz , Gontijo-de-Amorim Natale F. , Loureiro Claro Valéria , Vieira Diogo Maciel Lobão , de Andrade Gustavo Maltez , Dantas-Rocha Lucas , da Silva Cláudio Gonçalves Ramos , Abboudib José Horácio , de Castro Cláudio Cardoso
Published: March 2021

Background:

The first visible change in an aging face and neck is the loss of neck contour, which can be corrected by treating the platysmal bands; however, it remains unclear as to which is the best strategy to approach these bands. The aim of the present study is to verify whether the lateral platysmal bands approaches, before the medial ones, cause widening of the gap between them.

Methods:

This is a prospective, randomized, comparative study involving 30 individuals presenting various stages of neck and facial flaccidity and sagging. The patients were split into 2 groups according to the lateral platysmal approach (group A: lateral platysmal traction/plication; group B: lateral platysmal undermined/traction). A protocol was established to measure the gap between the medial bands, 3 and 5 cm away from the chin, before and after superficial musculoaponeurotic system/platysma lateral suspension. Measurements were taken using a compass and a ruler. The endpoint was to determine whether the gap between the medial platysmal bands widens after the lateral procedure.

Results:

Group A, first measure (1-M): the gap ranged between 1.0 and 1.6 cm in point M3 (3 cm away from chin) and between 1.8 and 3.0 cm in point M5 (5 cm away from chin) (mean in M3 = 1.2; SD, 0.22 and mean in M5 =2.3; SD, 0.52). Group A, second measure (2-M): the measure ranged between 1.0 and 1.7 cm in point M3 and between 1.8 and 3.2 cm in point M5 (mean = 1.28; SD, 0.25 and mean = 2.42; SD, 0.63, respectively). Group B, first measure (1-M): the gap ranged between 1.1 and 1.7 cm in M3 (mean = 1.32; SD, 0.21) and between 1.8 and 3.2 cm in M5 (mean = 2.38; SD, 0.57). Group B, second measure (2-M): the measure ranged between 1.2 and 1.7 cm in M3 (mean = 1.4; SD, 0.18) and between 2.0 and 3.2 cm in M5 (mean = 2.5; SD, 0.55). Group A: P = 0.07 (M3) and 0.10 (M5); Group B: P = 0.09 (M3) and 0.07 (M5).

Conclusion:

The lateral platysmal approach, plication or undermined, does not lead to a widening of the gap between the medial platysmal bands.
Effect of Platelet Rich Plasma versus Saline Solution as a Preservation Solution for Hair Transplantation
Authors: Abdelkader Rasha , Abdalbary Sahar , Naguib Ibrahim , Makarem Kyrillos
Published: March 2021

Background:

Hair transplantation is the only method available to regrow new hairs; hence, enhancing the results of this procedure using state-of-the-art methods has become mandatory in clinical practice. Recent studies have suggested that significant improvements in hair density and stimulation of hair growth occur when follicular units are pretreated with platelet plasma growth factors before implantation. This study aimed to investigate and compare the outcomes of this procedure using platelet-rich plasma (PRP)–preserved hair grafts and saline-preserved hair grafts.

Methods:

This is a randomized controlled study. The study included 27 men and 3 women aged 22–51 years. Clinical examination (general and local) and preoperative marking were performed in these patients. The surgical technique involved graft extraction, PRP preparation, and hair implantation. Postsurgical patient satisfaction and clinical improvement were evaluated.

Results:

There were significant differences between the groups in hair uptake and hair thickness after 1 year follow-up, withPvalue <0.05. Using PRP therapy with follicular unit extraction increases the success of follicular unit extraction hair transplantation. All participants in the PRP group had >75% hair regrowth after 6 months. They had more rapid improvements in hair density and skin recovery than those in the non-PRP group.

Conclusion:

Preserving hair grafts in PRP before implantation increases the hair density, the graft uptake, and the hair thickness compared with pretreatment preservation of hair grafts in saline.
Layered Closure of Lumbosacral Myelomeningocele Defects with Bilateral Paraspinous Muscle and Composite Fasciocutaneous Flaps
Authors: Holoyda Kathleen A. , Kim Erinn N. , Tuncer Fatma B. , Maglic Dino , Hosein Ray C. , Kestle John R. , Siddiqi Faizi A. , Gociman Barbu R.
Published: March 2021

Robust, reliable, and reproducible closure of lumbosacral myelomeningocele defects remains a challenge. In infants with lumbosacral myelomeningocele defects, multiple methods of soft tissue coverage have been described. These include various cutaneous, fascial, and muscle flaps and grafts. This is done with relative ease when ample soft tissue is present but becomes extremely difficult for large and distally located defects. We present here our closure technique of lumbosacral myelomeningocele defects in newborns, with associated short- and medium-term outcomes. We demonstrate the anatomy of this technique with fresh cadaver dissection and present a review of demographic and outcome data of 12 consecutive patients treated with this method from June 2014 to August 2019. No major intra- or postoperative complications have been encountered, with a mean follow-up of 22.2 months and median follow up of 18 months. After the neurosurgical repair of lumbosacral myelomeningocele, bilateral composite fascial flaps composed of thoracolumbar and gluteus maximus fascia are elevated in continuity. The paraspinous muscle flaps are then elevated, disinserted distally, and medialized to provide complete muscular coverage of the dural repair. The bilateral composite fascial flaps are medialized and closed over the deep paraspinous muscle flap repair. Two patients experienced areas of small, superficial skin necrosis, one of which healed by secondary intention and the other by debridement and full-thickness skin grafting. Use of bilateral paraspinous muscle flaps and bilateral composite fascial flaps composed of thoracolumbar and gluteus maximus fascia provides robust coverage of lumbosacral defects following myelomeningocele repair in infants.
Precaution Costs: The Presumption of Breast Cancer Seeding and Its Impact on Surgical Expenditure
Authors: Caudill Antonina R. , Newman Ashley , Davison Steven P.
Published: March 2021

As healthcare costs continue to rise at unsustainable rates (at an average rate of 5.5% a year), expenses without measurable outcomes need review.
1
In reconstructive surgery, empiric change of instruments between oncologic and reconstructive segments of surgery is one such practice. Breast surgery for ductal carcinoma in situ (DCIS), prophylaxis, and partial extirpation has little possible increase in seeding or implantation risk based on the literature. With undue extrapolation from higher risk cancers (such as ovarian), preventative practices of changing out trays, re-gloving, re-gowning, re-preparing, and re-draping between phases persist in operating rooms across the country. From real case costs, the additional expense of 2 surgical setups in the United States is conservatively estimated at $1232 per case, or over $125 million per year for this theoretical risk. Using implantation risk for core breast biopsies as a denominator, this cost is $1.65–$5.8 million per potential recurrence. This is an unacceptably high cost for hypothetical recurrence risk reduction, especially one that does not impact survival outcomes.
Bilateral Lower Limb Salvage after Fourth-degree Burns: Subscapular Axis Free and Chimeric Flaps Effectiveness in Complex Reconstruction
Authors: Brito Íris M. , Vaz Miguel , Brandão Carla , Sanches Fernanda , Diogo Carla
Published: March 2021

Microsurgery is usually required for reconstruction of complex lower limb defects, preserving otherwise unsalvageable injuries. Fourth-degree burns are severe traumatic injuries. A case of bilateral lower limb salvage through a resourceful use of subscapular axis free and chimeric flaps for acute burn reconstruction of extensive lower leg injuries is reported. A 48-year-old man sustained a 40% surface area flame burn, circumferential and full-thickness at the lower limbs. Debridement of fourth-degree burns of the anterior lower legs resulted in bone exposure of the left and right tibias, right medial malleolus, and Achilles tendon. A latissimus dorsi (LD) flap plus a chimeric subscapular axis free flap with 3 components (LD, serratus anterior (SA), and parascapular) were designed for reconstruction. LD insetting for left tibia coverage with anastomoses to anterior tibial vessels was performed. Right side flap insetting provided tibia coverage with LD; medial malleolus with SA; and Achilles tendon with parascapular flap. An anatomical variation required anastomoses to proximal (chimeric LD + SA) and distal (parascapular) ends of posterior tibial vessels because of an independent origin of the pedicles. At 10-months follow-up after intensive rehabilitation, the patient showed proper functional outcomes at daily-life and work activities with autonomous walking using a single crutch. This case highlights the importance of microsurgery and chimeric flaps for limb salvage in extreme situations. The authors review and discuss the surgical options, emphasizing specific considerations of microsurgical reconstruction in burn patients.
Treatment of Post-mastectomy Lymphedema with Herbal Medicine: An Innovative Pilot Study
Authors: Chiu Tor-Wo , Kong Shun-Ling , Cheng King-Fai , Leung Ping-Chung
Published: March 2021

Background:

Lymphedema of the arms or legs is a difficult clinical problem yet devoid of effective treatment. Lymphedema is the result of obstructed lymphatic flow secondary to chronic infection, parasitic infestation, or postsurgical obstruction (eg, after axillary dissections). We arranged this clinical trial to investigate whether patients with limb lymphedema can benefit from a standard dose of Astragalus plus Paeoniae rubra to improve the symptomatology, functional capacity, and quality of life (QOL).

Method:

The pilot study was designed as a self-control clinical trial. Patients with post-mastectomy lymphedema were recruited. A double-herb formulation (Astragalus, Paeoniae rubra) with standard dosage was administered orally in a powdered form, 6 times per week for 6 months. Outcome measurements included standard limb volume changes measured by water displacement method; handgrip strength; and QOL for limb lymphedema questionnaire (LYMQOL).

Results:

There were no reported adverse effects or complications; there were no episodes of infection during the period of study. There was a tendency of limb volume reduction by 6 months, which, however, did not reach statistical significance. There was a significant improvement in appearance and symptom scores as was assessed with the LYMQOL questionnaire.

Conclusions:

The oral herbal formula improved the symptomatology and QOL among the pilot group of patients with post-mastectomy lymphedema. Side effects were absent, and there was a trend of lymphedema reduction.
Severe Skin Ulcer on the Hand Caused by Hemodialysis Shunt-related Venous Hypertension That Required a Skin Graft
Authors: Kuwahara Masamitsu , Yoneda Tatsuo
Published: March 2021

In dialysis patients, peripheral venous hypertension–induced hand ulcers are rare. We report a case in which a severe hand ulcer was treated with skin grafting after shunt ligation. The patient was a 60-year-old woman who been undergoing dialysis for 13 years. Twelve years ago, a shunt was created in her right wrist via a side-to-side anastomosis. Swelling and congestion occurred in the right hand, and skin ulcers developed on the dorsal proximal portions of the index, middle, ring, and little fingers. No central vein obstruction was apparent. The right wrist shunt was explored, and the distal vein was ligated. A new shunt was created at the right elbow, but the proximal end of the vein that was used for the wrist shunt had to be used, resulting in complete cephalic vein occlusion from the wrist to the elbow. The swelling extended to the entire forearm. Four weeks after the wrist and elbow shunts were ligated, conservative treatment had resulted in granulation tissue formation in the ulcers. Debridement and full-thickness skin grafting from the abdomen were performed. Overall, skin graft survival was 75%. In conclusion, in this patient, side-to-end anastomosis of the proximal vein might be appropriate for shunt creation. When venous hypertension is suspected, ensuring an appropriate alternative shunt, promptly detecting the cause of the problem, and appropriate treatment are important. Venous hypertension must be completely resolved before surgery for ulcers.
Digital Image Analyses of Preoperative Simulation and Postoperative Outcome following Blepharoptosis Surgery
Authors: Zheng Xiaodong , Yamada Hiroko , Kamao Tomoyuki , Goto Tomoko , Shiraishi Atsushi
Published: March 2021

Background:

Before blepharoptosis surgery, simulation of eyelid features, including lid height and crease position, is often performed. However, discrepancies of the simulation and outcome can occur. The purpose of this study was to analyze the pre- and postoperative images and to evaluate factors contributing to the discrepancies.

Methods:

Forty-one involutional blepharoptosis patients (68.2 ± 7.1 years) underwent levator aponeurosis advancement. A semicircular bent wire was used to push the preoperative ptotic eyelid up to simulate the postoperative appearance of the eyelid. Digital images of the simulation were compared with the appearance at 3 months after the surgery. The ImageJ software was used to analyze the pre- and postoperative margin reflex distance-1 (MRD-1), pretarsal show (PTS), fissure height (FH), and ocular surface area (OSA). Factors with a potential of affecting the predictability of simulation were determined.

Results:

During simulation, the MRD-1 was 3.6 ± 0.4 mm, the PTS was 3.48 ± 1.2 mm, the FH was 8.5 ± 0.9 mm, and the OSA was 120.7 ± 22.3 mm2. After the surgery, the corresponding values were 3.3 ± 1.2 mm, 3.3 ± 1.5 mm, 8.6 ± 1.4 mm, and 119.1 ± 25.1 mm2, respectively. The postoperative MRD-1 was significantly smaller than that of the simulation (P = 0.005, paired t test). The MRD-1 simulation error was positively correlated with the length and width of the skin resection (all P < 0.05), and the PTS error was positively correlated with the length of the skin resection (r = 0.332, P = 0.031) and negatively correlated with the preoperative OSA (r = −0.588, P = 0.007).

Conclusions:

The postoperative appearance of the eyelid can be simulated fairly accurately by pushing up the upper eyelid with a curved wire. However, the MRD-1 tended to be overestimated, especially for cases requiring a large skin resection.
A Simple and Scarless Method for Inframammary Fold Correction Using a Barbed Suture
Authors: Tomita Koichi , Taminato Mifue , Nomori Michiko , Maeda Daisuke , Seike Shien , Tashima Hiroki , Yano Kenji , Kubo Tateki
Published: March 2021

Background:

In the typical procedure for secondary correction of the inframammary fold (IMF) following breast reconstruction, a large incision is often required, and this increases surgical invasiveness. The “drawstring method” is a simple procedure for recreating a smooth IMF. We modified the drawstring method and developed an essentially scarless method for IMF correction from small stab incisions.

Methods:

Patients at our hospital who presented with IMF ptosis or loss of definition after breast reconstruction and required IMF correction, as well as those who requested IMF recreation for the contralateral breast, during the period spanning May 2016 to June 2019 were considered for this study. We collected and analyzed demographic data, as well as complications and postoperative outcomes.

Results:

The new method was performed on 20 patients, with the following breakdown: IMF recreation after breast reconstruction with a deep inferior epigastric artery perforator flap (11 patients), IMF recreation after breast reconstruction with a breast implant (2 patients), IMF recreation after breast reconstruction with fat graft (5 patients), and IMF recreation for the contralateral breast (2 patients). Overcorrection of the IMF stabilized by 2–3 months postoperatively, resulting in a smooth and well-defined IMF. For non–breast implant cases, the implant volume increased at the lower pole. Slack in the suture was observed in only 2 patients of the deep inferior epigastric artery perforator group and in 1 patient of the breast implant group after 6 months postoperatively.

Conclusions:

Our new method allows for the recreation of an essentially scarless, smooth, and well-defined IMF. IMF definition can be adjusted by altering the depth of the barbed suture. Since this method can be performed under local anesthesia, it offers the benefits of reducing medical costs and physical burden on patients.
Targeted Muscle Reinnervation for Partial Hand Amputation
Authors: Chepla Kyle J. , Wu-Fienberg Yuewei
Published: March 2021

Background:

Targeted muscle reinnervation for the treatment of symptomatic neuromas after upper limb amputation has been described for shoulder disarticulation and for transhumeral and transradial amputations. Early clinical outcomes are promising and demonstrate a statistically significant reduction in phantom limb pain and a decrease in residual limb pain.

Methods:

We performed a cadaver dissection of the motor branches arising from the median and ulnar nerves to assess whether this technique could be applied to symptomatic neuromas after partial hand and finger amputations.

Results:

After identification of all branches under 4.5x loupe magnification, we performed simulated transfers of digital nerves to lumbrical motor branches, common digital nerves to lumbrical motor branches or the recurrent motor branch, and the common sensory portion of the ulnar nerve to a hypothenar motor branch.

Conclusions:

The proximity of all sensory nerves to motor branches and the numerous redundant motor nerve targets available support our hypothesis that targeted muscle reinnervation is possible after partial hand or finger amputation. Further studies will be required to refine clinical indications and evaluate outcomes.
Cannula Size Effect on Stromal Vascular Fraction Content of Fat Grafts
Authors: Becker Hilton , Vazquez Oscar Adrian , Rosen Tans
Published: March 2021

Background:

Fat is an active and dynamic tissue composed of adipocytes supported by a structural framework known as the stromal vascular fraction (SVF). SVF is traditionally isolated by enzymatic processing, but new methods are being investigated to isolate it mechanically. Recent studies propose that fat harvested with larger cannulas has a higher survival rate, most likely due to a higher concentration of SVF.

Methods:

Lipoaspirates were obtained from 10 patients who underwent elective liposuction using a 5-mm and a 1-mm cannula attached to a syringe using standard pressure. The fat was aspirated from the same area at adjacent sites. An estimated 5-mm fat particles were also cut down to 1-mm using a micronizer (Marina Medical). A 5-cm3 volume of each sample was compressed through a 0.5-mm opening strainer and rinsed with normal saline to extrude the oil. The resultant SVF left on the strainer was then measured in a 1-cm3 syringe.

Results:

The volume extracted from a 5-mm cannula (mean, 0.23 cm3; SD, 0.10) versus a 1-mm cannula (mean, 0.11 cm3; SD, 0.06) was statistically significant (P = 0.009). An H&E-stained slide from the SVF was obtained for confirmation. Finally, 5-mm fat particles cut down to 1-mm particles using the micronizer resulted in an average volume of 0.20 cm3, which was higher than the average volume harvested with a 1-mm cannula.

Conclusions:

Harvesting with a 5-mm cannula resulted in significantly more SVF than harvesting with a 1-mm cannula. Resizing fat particles harvested with a larger cannula down to 1-mm resulted in higher SVF than SVF obtained with a 1-mm cannula directly.
Comparison of Various Kinds of Probes for Lymphedematous Limbs
Authors: Hara Hisako , Mihara Makoto
Published: March 2021

Recently, there has been a growing interest in the use of lymphatic ultrasound in the preoperative investigation of lymphaticovenous anastomosis. The device used for the performance of lymphatic ultrasound varies among surgeons. In this case report, we compared several probes (18 MHz, 24 MHz, and 33 MHz linear probes) in 2 cases, to detect the lymphatic vessels in the lymphedematous limbs. In the upper limb lymphedema case, the lymphatic vessels were located at a depth of <5 mm. They could be better observed with the 33 MHz probe than with the 18 MHz probe. The probe with a high frequency (33 MHz) and high resolution seemed to be suitable for superficial layers <5 mm in depth. On the other hand, the probe of 33 MHz was not appropriate for the lymphedematous lower limb because the lymphatic vessels are usually located at around a depth of 1 cm. When comparing the 18 MHz and 24 MHz probes in observing the lymphatic vessels in the lower limb, the 24 MHz probe seemed more suitable because of its higher resolution. Among these options, the 33 MHz probe was suitable for lymphedematous upper limbs, and the 24 MHz probe was suitable for lymphedematous lower limbs.
Three-dimensional Printed Customized Adjustable Mallet Finger Splint: A Cheap, Effective, and Comfortable Alternative
Authors: Papavasiliou Theodora , Shah Rushabh K. , Chatzimichail Stelios , Uppal Lauren , Chan Jeffrey C.Y.
Published: March 2021

Mallet finger deformity is a common and debilitating injury of the fingertip, accounting for 10% of all tendon and ligament injuries. It involves a disruption of the terminal extensor mechanism of the distal phalanx. Patients can experience significant pain and swelling of the fingertip and have significant morbidity without treatment. Nonoperative treatment using joint immobilization with splints is the mainstay of management. Traditionally, prefabricated and thermoplastic splints have been utilized; however, issues with comfort and skin complications such as maceration can lead to patient noncompliance and eventually, poor outcomes. To address this, we demonstrate our experience with the design, manufacture, and application of individualized 3D printed mallet finger splints. The splints were found to provide advantages akin to traditional thermoplastic splints, with the addition of being low cost, easy to manufacture, and environmentally friendly.
Complications and Patient-reported Outcomes in Transfemale Vaginoplasty: An Updated Systematic Review and Meta-analysis
Authors: Bustos Samyd S. , Bustos Valeria P. , Mascaro Andres , Ciudad Pedro , Forte Antonio J. , Del Corral Gabriel , Manrique Oscar Javier
Published: March 2021

Background:

Vaginoplasty aims to create a functional feminine vagina, sensate clitoris, and labia minora and majora with acceptable cosmesis. The upward trend in the number of transfemale vaginoplasties has impacted the number of published articles on this topic. Herein, we conducted an updated systematic review on complications and patient-reported outcomes.

Methods:

A update on our previous systematic review was conducted. Several databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were assessed. Random effects meta-analysis and subgroup analyses were performed.

Results:

After compiling the results of the update with the previous systematic review, a total of 57 studies pooling 4680 cases were included in the systematic review, and 52 studies were used in the meta-analysis. Overall pooled data including any surgical technique showed rates of 1% [95% confidence interval (CI) <0.1%–2%] of fistula, 11% (95% CI 8%–14%) of stenosis and/or strictures, 4% (95% CI 1%–9%) of tissue necrosis, and 3% (95% CI 1%–4%) of prolapse. Overall satisfaction was 91% (81%–98%). Regret rate was 2% (95% CI <1%–3%). Average neovaginal depth was 9.4 cm (7.9–10.9 cm) for the penile skin inversion and 15.3 cm (13.8–16.7 cm) for the intestinal vaginoplasty.

Conclusions:

Transfemale vaginoplasty is a key component of the comprehensive surgical treatment of transfemale patients with gender dysphoria. Over time, we will see an increased demand for these procedures, so adequate surgical training, clinical/surgical experience, and research outcomes are required, as we continue to strive to provide the best care possible for a population in need.
Effect of Le Fort I Maxillary Repositioning on Three-Dimensional Nasal Tip Rotation: A Comparative Study with Implication for the Asian Nose
Authors: Denadai Rafael , Chou Pang-Yun , Yao Chuan-Fong , Chen Ying-An , Lin Yi-Yu , Huang Chiung-Shing , Lo Lun-Jou , Chen Yu-Ray
Published: March 2021

Background:

Le Fort I maxillary repositioning influences nasal morphology. In Asian cultures, upward nasal tip rotation with increased nostril exposure is considered aesthetically unpleasant and can have psychosocial consequences. This three-dimensional imaging–based study evaluated the effect of different Le Fort I maxillary movements on nasal tip rotation.

Methods:

Consecutive patients who underwent two-jaw orthognathic surgery (n = 107) were enrolled. To achieve a standard head orientation, preoperative and 1-week and 12-month postoperative cone-beam computed tomography–derived three-dimensional craniofacial models were superimposed. Tip rotation angle was calculated according to the Frankfort horizontal plane for all three-dimensional digital models. The final tip rotation angle change was defined as 12-month postoperative value minus preoperative value. Translational maxillary movement types (advancement versus setback and intrusion versus extrusion), postoperative maxillary segment locations (anterosuperior, anteroinferior, posterosuperior, or posteroinferior), and actual linear maxillary changes were noted.

Results:

Advancement (1.79 ± 5.20 degrees) and intrusion (2.23 ± 4.96 degrees) movements demonstrated significantly larger final tip rotation angle changes than setback (−0.88 ± 5.15 degrees) and extrusion (0.09 ± 5.44 degrees) movements (all p < 0.05). Postoperative anterosuperior location (2.95 ± 4.52 degrees) of the maxillary segment demonstrated a significantly larger final tip rotation angle change than anteroinferior (0.48 ± 5.65 degrees), posterosuperior (−1.08 ± 4.77 degrees), and posteroinferior (−0.64 ± 5.80 degrees) locations (all p < 0.05). Translational maxillary movement and actual linear maxillary change were not correlated with final tip rotation angle change.

Conclusion:

Effects of Le Fort I maxillary repositioning on nasal tip rotation depend on movement types and maxillary segment location.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Pretransplant Hepatitis C Virus Treatment Decreases Access to High-quality Livers
Authors: Strauss Alexandra T. , Ishaque Tanveen , Weeks Sharon , Hamilton James P. , Simsek Cem , Durand Christine M. , Massie Allan B. , Segev Dorry L. , Gurakar Ahmet , Garonzik-Wang Jacqueline M.
Published: March 2021

Background.

Despite the revolutionary role of direct-acting antivirals for hepatitis C virus (HCV), the treatment timing for liver transplant candidates remains controversial. We hypothesize that deferring treatment until after liver transplantation improves access to a larger and higher-quality donor pool without a detrimental impact on post-liver transplantation outcomes.

Methods.

This single-center study includes recipients that underwent deceased-donor liver transplant with HCV as the primary indication January 1, 2014, to December 31, 2018. For recipients that were untreated (n = 87) versus treated (n = 42) pre-LT, we compared post-LT mortality using Cox regression with inverse probability of treatment-weighted data.

Results.

Among pre-LT untreated recipients, 95% were willing to accept an HCV+ donor, and 44.8% received a positive HCV antibody and nucleic acid amplification test (NAT) liver. Among pre-LT treated recipients, 5% were willing to accept an HCV+ donor, and 100% received a negative HCV antibody and NAT liver. The median calculated model for end-stage liver disease at transplant was similar between pre-LT untreated (13, IQR = 9–22) and treated recipients (11, IQR = 8–14) (P = 0.1). Pre-LT treated recipients received livers from older (47 y old versus 37, P < 0.01) and higher body mass index donors (30.2 versus 26.6; P = 0.04) and spent longer on the waiting list (319 d 180, P < 0.001). Unadjusted post-LT mortality at 1 year was higher in the pre-LT treated recipients (14.6% versus 3.5%, P = 0.02). After adjusting for recipient factors, pre-LT treated recipients trended toward a 3.9 times higher risk of mortality compared with the pre-LT untreated recipients (adjusted hazard ratio = 0.973.8615.4) (P = 0.06).

Conclusions.

Deferring HCV treatment improves access to higher-quality donors and may improve post-LT survival.
Dissemination of novel Tn7 family transposons carrying genes for synthesis and uptake of fimsbactin siderophores among Acinetobacter baumannii isolates
Authors: Hamidian Mohammad , Hall Ruth M.
Published: March 2021

Acinetobacter baumannii

is a successful opportunistic pathogen that can compete for iron under iron-limiting conditions. Here, large novel transposons that carry genes for synthesis and transport of the fimsbactin siderophores present in some

A. baumannii

strains were examined. Tn6171, originally found in the

A. baumannii

global clone 1 (GC1) lineage 2 isolate D36, includes tns genes encoding proteins related to the TnsA, TnsB, TnsC transposition proteins (50–59 % identity), TnsD targeting protein (43 % identity) and TnsE (31 % identity) of Tn7, and is found in the chromosome downstream of the glmS gene, the preferred location for Tn7, flanked by a 5 bp target site duplication. Tn6171 is bounded by 29 bp inverted repeats and, like Tn7, includes additional TnsB binding sites at each end. Tn6171 or minor variants were detected in the equivalent location in complete or draft genomes of several further

A. baumannii

isolates belonging to GC1 [sequence type (ST) 1, ST81, ST94, ST328, ST623, ST717], GC2 (ST2) and ST10. However, in some of these isolates the surrounding glmS region was clearly derived from a different

A. baumannii

lineage, indicating that the transposon may have been acquired by replacement of a segment of the chromosome. A recombination-free phylogeny revealed that there were several transposon acquisition events in GC1. The GC1 isolates were mainly lineage 2, but a potential third lineage was also detected. A related transposon, designated Tn6552, was detected in ATCC 17978 (ST437) and other ST437 isolates. However, the Tn6552 tnsD targeting gene was interrupted by an ISAba12, and Tn6552 is not downstream of glmS.
COVID-19 Vaccine Perceptions in New York State’s Intellectual and Developmental Disabilities Community
Authors: Iadarola Suzannah , Siegel Joanne F. , Gao Qi , McGrath Kathleen , Bonuck Karen A.
Published: March 2021

Background

People with intellectual and developmental disabilities (IDD) are at disproportionate risk for severe COVID-19 outcomes, particularly those living in congregate care settings. Yet, there is limited data on vaccine perceptions in the disability community.

Objective

To explore COVID-19 vaccine perceptions in individuals with IDD, their family members, and those who work with them, to inform a statewide vaccine information and messaging project.

Methods

A national survey, adapted for the IDD community, was distributed to a convenience sample of IDD organizations throughout New York State, in five languages. Constructs included vaccine intention, reasons for vaccine hesitancy, and trusted sources of vaccine information. Zip code data were used to map respondent location and vaccine preferences.

Results

Of n= 825 respondents, approximately 75% intended to or had received the vaccine, across roles (i.e., people with disabilities, family members, direct care workers) and racial/ethnic groups. Greater vaccine hesitancy was reported in younger individuals and those making decisions on behalf of a person with IDD. Concerns included side effects and the swiftness of vaccine development. Black and Hispanic participants had heightened concerns about being an “experiment” for the vaccine. Trusted sources of information included healthcare providers and family members. Respondents who intended/got the vaccine were distributed throughout the state.

Conclusions

Vaccine preferences in this New York State disability community sample align with national data. Identified concerns suggest the need for community education that addresses misperceptions. Age and race differences in perspectives highlight the need for tailored education, delivered by trusted messengers.
Unilateral corneal insult in Zebrafish results in a bilateral cell shape and identity modification, supporting wound closure
Authors: Ikkala Kaisa , Stratoulias Vassilis , Michon Frederic
Published: March 2021

Most of terrestrial and aquatic vertebrates are equipped with camera-type eyes, offering a focused and clear sight. This apparatus is rendered inefficient if its most superficial and transparent element, the cornea, is opaque. This structure, prone to environmental aggressions, bears excellent wound healing capabilities to preserve vision. Up to date, most of the corneal wound healing studies are made on mammals. Here, for the first time, zebrafish is used as model to study wound closure of corneal epithelium after abrasion. Our study demonstrates a swift wound closure after corneal insult. Interestingly, a unilateral wound induces a bilateral response. While cell proliferation is increased during wound closure, this parameter is not crucial, and cell rearrangements seems to be the driving force. Furthermore, we discovered a profound change in epithelial cell transcriptomic signature after abrasion, reflecting a modulation of cell identity and increase of phenotypic plasticity. The latter seems to unlock terminally differentiated cell capacities for wound healing, which could be the key for a speed up organ regeneration. Our results prove that zebrafish cornea is a powerful model to investigate, not only corneal wound healing, but ectodermal organ pathophysiology.