bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of Life and Symptoms Before and After Nasal Septoplasty With or Without Turbinoplasty Compared With Control Individuals in Saudi Arabia
Authors: Alanazy Sultan , AlQuniabut Ibrahim , Alenezi Mazyad M. , Almutairi Homood , Almutairi Abdulrahman , Altheyab Fatemah , Al-Wutayd Osama
Published: February 2023

Objectives:

Nasal septal deviation is a common health issue that can significantly impact the quality of life. Although nasal septoplasty is commonly performed in Otolaryngology practice, its effectiveness has been questioned. This was the first study to assess disease-specific quality of life in patients undergoing nasal septoplasty with or without turbinoplasty in Saudi Arabia.

Methods:

This was a prospective observational study of patients undergoing nasal septoplasty with or without turbinoplasty for nasal obstruction due to septal deviation with or without inferior turbinate hypertrophy. Nasal Obstruction Symptom Evaluation (NOSE) scores were collected preoperatively and 3 months postoperatively and were compared with controls.

Results:

This study involved 200 subjects, including 40 patients in the case group and 160 individuals in the control group. The mean preoperative and 3-month postoperative NOSE scores of the case group were (58.4±23.7 and 15.0±18.6, P<0.001), respectively. However, the postoperatively NOSE score did not reach NOSE score in control group (13.28±8.13, P=0.377). All nasal symptoms statistically and clinically improved postoperatively. There were no significant differences in NOSE score changes among cases preoperatively and postoperatively according to age, sex, or the presence of allergic rhinitis or asthma.

Conclusions:

Nasal septoplasty with or without turbinoplasty leads to improvements in disease-specific quality of life as assessed by NOSE scores and significantly improved nasal symptoms 3 months after surgery.
Anterior Dental Implant in Grafted Cleft Alveolus: A Clinical Comparison Between Intramembranous and Endochondral Bone Graft
Authors: Sodnom-Ish Buyanbileg , Eo Mi Young , Park Min Woo , Lee Ju Young , Seo Mi Hyun , Yang Hoon Joo , Kim Soung Min
Published: February 2023

Background:

Alveolar bone graft is usually performed during the early mixed dentition phase, at the chronological age of 6 to 8 years old, to reconstruct the cleft alveolus. As the appropriate time for implant placement is after completion of full growth, it can result in a likelihood of resorption. The aim of this study is to compare the clinical outcomes of anterior dental implants with delayed bone grafting using iliac crest (endochondral) and mandibular ramus or symphysis (intramembranous) bone in adolescents to adulthood patients with cleft alveolus.

Materials and Methods:

This study included 10 patients with cleft alveolus who underwent delayed bone grafting with autogenous block bone and particulate cancellous bone and marrow (PCBM) from the mandibular ramus and symphysis with dental implant placement, and iliac crest. The success of the treatment was evaluated through clinical and radiographic examination including marginal bone loss measurement of the implants.

Results:

All patients underwent delayed bone grafting between the ages of 11 and 21.1 years (mean age: 15.1±4.3 y). The implant diameters ranged from 3.8 to 4.5 mm and the lengths ranged from 8.0 to 11.5 mm. All of the implants were integrated successfully and survived during the 3-year follow-up period.

Conclusions:

Delayed bone grafting followed by implant placement showed long-term stability with satisfactory esthetic and functional rehabilitation. One of the main advantages of delayed bone grafting is to achieve adequate bone support for future dental implant placements with less bone resorption compared with those of primary, early secondary, and secondary bone grafting.
Evaluation of the Effects of Dual Antiplatelet Therapy on Guided Bone Regeneration in Peri-Implant Bone Defect
Authors: Kobat Mehmet Ali , Dundar Serkan , Bozoglan Alihan , Gelen Mehmet Ali , Artas Gokhan , Kirtay Mustafa , Tasdemir İsmail , Karasu Mehdi , Habek Osman
Published: February 2023

In this study, the authors aim to investigate the effect of dual antiplatelet agents on peri-implant–guided bone regeneraation by studying a sample of rats with titanium implants in their tibias. The rats were randomly divided into 5 groups: acetylsalicylic acid (ASA) (n=10), treated with 20 mg/kg of ASA; ASA+CLPD (Clopidogrel): (n=10), treated with 20 mg/kg of ASA and 30 mg/kg of clopidogrel; ASA+PRSG (Prasugrel): (n=10), treated with 20 mg/kg of ASA and 15 mg/kg of prasugrel; ASA+TCGR (Ticagrelor): (n=10), treated with 20 mg/kg of ASA and 300 mg/kg of ticagrelor; and a control group (n=10) received no further treatment after implant surgery. Bone defects created half of the implant length circumferencial after implant insertion and defects filled with bone grafts. After 8 weeks experimental period, the rats sacrified and implants with surrounding bone tissues were collected to histologic analysis; bone filling ratios of defects (%) and blood samples collected to biochemical analysis (urea, creatinine, aspartate aminotransferase, alanine aminotransferase, phosphorus, magnesium, alkaline phosphatase, calcium, and parathormone). A statistically significant difference was not detected between the groups for all parameters (P>0.05). When the percentage of new bone formation was examined, it was found that there was no statistically significant difference between the groups (P>0.05). Antiplatelet therapy may not adversely affect guided bone regeneration in peri-implant bone defects.
Utilizing Computer-Assisted Design and Virtual Surgical Planning for Correction of Unilateral Lambdoid Synostosis
Authors: Long Aaron S. , Gudbranson Emily , Almeida Mariana N. , Chong Lauren , Mozaffari Mohammad Ali , Alper David P. , Rivera Jean Carlo , Persing John A. , Alperovich Michael
Published: February 2023

Unilateral lambdoid synostosis is the rarest form of single-suture craniosynostosis. Although various surgical approaches have been described, cranial vault remodeling remains the predominant approach. To aid in surgical planning, preoperative virtual surgical modeling using a patient’s presenting computed tomography scan can be used to increase reconstructive precision and to reduce operative time. Presented is a 7-month-old male with unilateral lambdoid synostosis who underwent medically modeled cranial vault reconstruction.
Prediction of Enophthalmos in Medial Orbital Wall Fracture: Suggested Coordinate Plane for Making Surgical Decisions
Authors: Mo Young Woong , Ryu Da Hye , Shin Hea Kyeong , Lee Won Jai
Published: February 2023

Background:

Enophthalmos is one of the most distressing complications of blowout orbital fractures. Although several studies have been conducted on the topic of indications of early surgical correction, none have been performed using a set of measurable parameters.

Methods:

The study quantitatively examined orbital fracture areas (OFA) and volumes (OFV) retrospectively of 242 patients with isolated medial orbital wall fractures that were treated conservatively during a 12-year period (from 2009 to 2021). Three plastic surgeons measured enophthalmos >6 months after trauma. The correlations between parameters and enophthalmos in the study cohort were analyzed. In addition, patients treated operatively, and nonoperatively were compared with assess the suitability of the predictive model.

Results:

Significant correlations were observed between several parameters and late enophthalmos. Total 2.59 cm2 of OFA (ie, OFA >2.59 cm2) or 1.45 cm3 of OFV (ie, OFV >1.45 cm3) corresponds to 2 mm of enophthalmos. Multiple regression analysis revealed the following coefficients: −0.208 is a constant (P<0.001), with 0.695 and 0.372 for OFA and OFV, respectively (P<0.001 for both OFA and OFV).

Conclusions:

The study shows that enophthalmos can be more accurately predicted when OFA and OFV are simultaneously considered in patients with isolated medial wall fractures. Finally, an algorithm and a “blowout fracture coordinate plane” was proposed to aid treatment decision-making in isolated medial wall fractures.
Artificial Intelligence Splint in Orthognathic Surgery for Skeletal Class III Malocclusion: Design and Application
Authors: Liu Zhikai , Xu Chunwei , Zhu Zhaokun , Tai Yue , Liu Yao , Luo En
Published: February 2023

Background:

Digital splints are indispensable in orthognathic surgery. However, the present design process of splints is time-consuming and has low reproducibility. To solve these problems, an algorithm for artificial intelligent splints has been developed in this study, making the automatic design of splints accessible.

Methods:

Firstly, the algorithm and program of the artificial intelligence splint were created. Then a total of 54 patients with skeletal class III malocclusion were included in this study from 2018 to 2020. Pre and postoperative radiographic examinations were performed. The cephalometric measurements were recorded and the difference between virtual simulation and postoperative images was measured. The time cost and differences between artificial intelligent splints and digital splints were analyzed through both model surgery and radiographic images.

Results:

The results showed that the efficiency of designing splints is significantly improved. And the mean difference between artificial intelligent splints and digital splints was <0.15 mm in model surgery. Meanwhile, there was no significant difference between the artificial intelligent splints and digital splints in radiological image analysis.

Conclusions:

In conclusion, compared with digital splints, artificial intelligent splints could save time for preoperative design while ensuring accuracy. The authors believed that it is conducive to the presurgical design of orthognathic surgery.
Influence of Lip Revision Surgery on Facial Growth in Patients With A Cleft Lip
Authors: Kamata Masafumi , Sakamoto Yoshiaki , Ogata Hisao , Sakamoto Teruo , Ishii Takenobu , Kishi Kazuo
Published: February 2023

Although patients with cleft lip and palate often present with poor maxillary growth because of intrinsic and iatrogenic factors, the surgical influence of lip revision surgery, palatal fistula repair, and pharyngeal flap procedures remains uncertain in contrast to that of primary cleft lip repair and palatoplasty. Therefore, this study aimed to reveal factors inhibiting maxillary growth and inducing later orthognathic surgery. A retrospective analysis was conducted on the data of patients with cleft lip and palate who underwent a series of treatments at Keio University Hospital from 1990 to 2000. We collected data on patient sex, cleft type, number and timing of lip revision surgery, the incidence of palatal fistulae, history of pharyngeal flap procedures, and timing of a repeat bone graft, and reviewed whether these patients underwent orthognathic surgery later in life. Multivariate analysis was conducted using binary logistic regression to extract factors affecting later orthognathic surgery. A total of 52 patients were included in this study. Results showed that revision surgery conducted more than twice was the highest statistically significant predictor of later orthognathic surgery in patients with a cleft lip and palate (P<0.05, odds ratio=43.3), followed by palatal fistula occurrence after cleft palate repair (P<0.05, odds ratio=22.3). Therefore, primary surgical procedure is most important for these patients.
Antihypertensive Teach-Back to Reduce Delays, Cancellations, and Interventions in a Freestanding Gastroenterology Clinic
Authors: McKerrocher Paul R. , Hines Cheryl B.
Published: February 2023

The purpose of this study was improving patient compliance with the 2014 American College of Cardiologists/American Heart Association Joint Task Force Clinical Practice Guidelines recommendation regarding continuation of antihypertensive medications throughout the perioperative period. A patient education initiative, using the teach-back method of instruction, was implemented and evaluated. Effectiveness of instruction was measured by tracking hypertension requiring pharmacological intervention, procedure delay, and procedure cancellation. Pre- and postintervention data were collected from electronic health records using a retrospective cohort design. A χ2 analysis compared pre- and postintervention groups. The p value was calculated using the χ2 analysis, (χ2 [1, N = 1,044] = 7.71, p = .00548). No incidence of case delay or cancellation was experienced in either test group. Incidence of patients requiring preprocedural pharmacological intervention decreased by 70.5%. Statistically significant decreases in pharmacological treatment of hypertension supported permanent inclusion of the antihypertensive patient teaching method at the project gastroenterology clinic.
Natural Antibodies Are Associated With Rejection and Long-term Renal Allograft Loss in a Multicenter International Cohort
Authors: See Sarah B. , Yang Xue , Burger Carole , Lamarthée Baptiste , Snanoudj Renaud , Shihab Ronzon , Tsapepas Demetra S. , Roy Poulomi , Larivière-Beaudoin Stéphanie , Hamelin Katia , Mendoza Rojas Aleixandra , van Besouw Nicole M. , Bartosic Amanda , Daniel Nikita , Rodica Vasilescu E. , Mohan Sumit , Cohen David , Ratner Lloyd , Baan Carla C. , Bromberg Jonathan S. , Cardinal Héloïse , Anglicheau Dany , Sun Yifei , Zorn Emmanuel
Published: February 2023

Background.

Potentially harmful nonhuman leukocyte antigen antibodies have been identified in renal transplantation, including natural immunoglobulin G antibodies (Nabs) reactive to varied antigenic structures, including apoptotic cells.

Methods.

In this retrospective, multicenter study, we assessed Nabs by reactivity to apoptotic cells in sera collected from 980 kidney transplant recipients across 4 centers to determine their association with graft outcomes.

Results.

Elevated pretransplant Nabs were associated with graft loss (hazard ratio [HR] 2.71; 95% confidence interval [CI], 1.15-6.39; P  =  0.0232), the composite endpoint of graft loss or severe graft dysfunction (HR 2.40; 95% CI, 1.13-5.10; P = 0.0232), and T cell–mediated rejection (odds ratio [OR] 1.77; 95% CI, 1.07-3.02; P = 0.0310). High pretransplant Nabs together with donor-specific antibodies (DSAs) were associated with increased risk of composite outcomes (HR 6.31; 95% CI, 1.81-22.0; P = 0.0039). In patients with high pretransplant Nabs, the subsequent development of posttransplant Nabs was associated with both T cell–mediated rejection (OR 3.64; 95% CI, 1.61-8.36; P = 0.0021) and mixed rejection (OR 3.10; 95% CI, 1.02-9.75; P = 0.0473). Finally, elevated pre- and posttransplant Nabs combined with DSAs were associated with increased risk of composite outcomes (HR 3.97; 95% CI, 1.51-10.43; P = 0.0052) and T cell–mediated rejection (OR 7.28; 95% CI, 2.16-25.96; P = 0.0016).

Conclusions.

The presence of pre- and posttransplant Nabs, together with DSAs, was associated with increased risk of poor graft outcomes and rejection after renal transplantation.
Centripetal Nystagmus, Slow Saccades, Cerebellar Ataxia, and Parkinsonism in a Patient With Anti-GAD65-Associated Stiff Person Syndrome Spectrum Disorder
Authors: Hac Nicholas E. F. , Murphy Olwen C. , Butala Ankur A. , Newsome Scott D. , Gold Daniel R.
Published: February 2023

A 68-year-old woman with positional dizziness and progressive imbalance presented for vestibular evaluation. Examination was notable for spontaneous downbeat nystagmus (DBN), horizontal and vertical gaze-evoked nystagmus (GEN) with centripetal and rebound nystagmus, and positional apogeotropic nystagmus. There was also mild–moderate slowing of saccades horizontally and vertically and poor fast phases with an optokinetic stimulus. Further consultation by a movement disorder specialist uncovered asymmetric decrementing bradykinesia and rigidity, masked facies, and a wide-based stance without camptocormia. Screening serum laboratory results for metabolic, rheumatologic, infectious, heavy metal, endocrine, or vitamin abnormalities was normal. Surveillance imaging for neoplasms was unremarkable, and cerebrospinal fluid (CSF) analysis was negative for 14-3-3 and real-time quaking-induced conversion (RT-QuIC). However, her anti-glutamic acid decarboxylase-65 (GAD65) immunoglobulin G (IgG) level was markedly elevated in serum to 426,202 IU/mL (reference range 0–5 IU/mL) and in CSF to 18.1 nmol/L (reference range <0.03 nmol/L). No other autoantibodies were identified on the expanded paraneoplastic panel. The patient was referred to neuroimmunology, where torso rigidity, spasticity, and significant paravertebral muscle spasms were noted. Overall, the clinical presentation, examination findings, and extensive workup were consistent with a diagnosis of anti-GAD65-associated stiff person syndrome-plus (musculoskeletal plus cerebellar and/or brainstem involvement). She was subsequently treated with intravenous immunoglobulin (IVIg) and has been stable since commencing this therapy. In patients with centripetal nystagmus, especially in association with other cerebellar findings, an autoimmune cerebellar workup should be considered.
Sympathetic Skin Response in Ulnar Neuropathy at the Elbow
Authors: Mondelli Mauro , Aretini Alessandro
Published: February 2023

Introduction:

The sympathetic skin response (SSR) reflects the function of sudomotor sympathetic unmyelinated fibers. This study evaluates SSR abnormalities in ulnar neuropathy at the elbow (UNE).

Methods:

Sympathetic skin response was obtained after electrical stimulation of the glabella recording simultaneously from the hand palm (P), third digit (M3) and fifth digit ipsilateral (U5) and contralateral (cU5) to the side of UNE. Ten consecutive SSRs were recorded from each recording side of all participants.

Results:

The authors enrolled 31 patients (mean age 54.3 ± 11.4 years) and 25 subjects of a control group (mean age 52.6 ± 11.3 years). The mean of the areas and the area of the largest response of U5-SSR were significantly lower in the patients (106.9 ± 68.9 and 127.8 ± 79.7 μV/s, respectively) than in control group (161.8 ± 116.6 and 197.2 ± 143.3 μV/s, respectively) and in the affected than in the unaffected sides of the patients (155.3 ± 84.8 and 197.7 ± 103.3 μV/s, respectively); there were no differences in U5-SSR latencies and P-SSR and M3-SSR parameters. U5-SSR mean areas and U5-SSR largest area were reduced in 29% and 26% of patients, respectively. The differences between patients and control group and the number of patients with U5-SSR abnormalities increased when the ratios of M3/U5-SSR and U5/cU5-SSR areas were considered. U5-SSR area was related to UNE clinical severity and to some parameters of the ulnar nerve conduction velocity and cutaneous silent period.

Conclusions:

Sympathetic skin response is useful to demonstrate abnormalities of sympathetic fibers even if UNE patients do not complain for sympathetic symptoms. The SSR abnormalities were evident only if electrophysiological damage of myelinated fibers was moderate or severe.
A Stable EEG Epilepsy Network Spans From Infraslow to Ripple and From Interictal to Ictus
Authors: Ghimire Sushma , Dhamala Mukesh , Epstein Charles M.
Published: February 2023

Purpose:

To characterize the epilepsy network as reflected in intracranial electroencephalography (iEEG) across the full spectrum of iEEG frequencies and different phases of epilepsy, using a single, conceptually straightforward mathematical measure.

Methods:

The authors applied the spectral Granger causality techniques to intracranial electroencephalography recordings and computed contact-by-contact inward, outward, and total causal flow across frequencies and seizure phases in a selected group of three patients with well-defined, nonlesional seizure foci and prolonged responses to invasive procedures. One seizure and one interictal sample were analyzed per subject.

Results:

A prominent intracranial electroencephalography network was identified by Granger causality at both high and low frequencies. This network persists during the preictal and interictal phases of epilepsy and closely matches the visible seizure onset. The causal inflow network corresponded to seizure onset electrode contacts in 8 of 12 conditions, including ripple, infraslow, preictal, and interictal phases of epilepsy. Its most striking feature is the consistent dominance of causal inflow rather than outflow in the vicinity of the seizure onset zone.

Conclusions:

Findings of this study indicate that a stable intracranial electroencephalography epilepsy network persists, and it can be characterized by a single Granger causality measure from infraslow to ripple frequencies and from the interictal to the immediate preictal phases of epilepsy.
Technique for Robotic Pancreaticojejunostomy
Authors: Erstad Derek J , Hatanaka Yuji , Cass Samuel , Maxwell Jessica , Tran Cao Hop , Kim Michael , Tzeng Ching-Wei , Lee Jeffrey E , Katz Matthew , Ikoma Naruhiko
Published: February 2023

Background:

Minimally invasive, robotic techniques for hepatobiliary procedures offer the potential for accelerated recovery and reduced opioid usage. Robotic pancreaticoduodenectomy is a technically challenging procedure with a complex reconstruction. In this regard, standardization of the pancreaticojejunostomy technique is critical for safe adoption of robotic technology in pancreatic surgery.

Study Design:

We demonstrate the primary steps and associated principles to perform a robotic pancreaticojejunostomy using a modified Blumgart/Nagakawa technique.

Results:

Key steps to this procedure include: 1) exposure and positioning of the pancreatic remnant and jejunal limb; 2) transpancreatic suture placement using augmented sutures with bulldog clamps for organization; 3) duct-to-mucosa anastomosis with well-defined order of suture placement and knot-tying for optimal exposure, tissue handling, and technical ease; 4) completion of the anterior row of transpancreatic sutures using Lapra-TY clips for gentle, but firm tissue apposition; and 5) placement of omental flap and surgical drains in proximity to the reconstruction.

Conclusion:

We described our technique for performing a robotic pancreaticojejunostomy, which compensates for the technical limitations of the robotic approach. These adjustments in combination with the magnified surgical vision and augmented skill associated with the robotic platform allow for safe and reliable performance of the pancreaticojejunostomy technique.
Use of Thromboelastography with Platelet Mapping to Identify Prothrombotic Coagulation Profiles in Patients with History of Cardiac Intervention Undergoing Lower Extremity Revascularization
Authors: Hall Ryan , Majumdar Monica , Cassidy Ryan , Feldman Zachary , Suarez Sasha , Goudot Guillaume , Bellomo Tiffany , Jessula Samuel , Kirshkaln Amanda , Dua Anahita
Published: February 2023

Background:

Patients with concomitant peripheral and coronary artery disease (CAD and PAD) are at significant risk for major adverse limb events (MALE). Prevention of thrombosis in this population is of paramount importance. Identifying prothrombotic coagulation profiles in this cohort may facilitate targeted thromboprophylaxis. We compared coagulation profiles of those with CAD and PAD to those with PAD alone during the perioperative period of lower extremity revascularization.

Study Design:

Patients undergoing lower extremity revascularization underwent thromboelastography-platelet mapping (TEG-PM) analysis preoperatively and at serial intervals for up to 6 months. Coagulation profiles of patients with significant CAD (defined as history of coronary artery bypass graft or percutaneous coronary intervention) and PAD were compared to those with PAD alone. MALE in the post-operative period was recorded.

Results:

477 TEG-PM samples from 114 patients were analyzed. 28.1% had a history of significant CAD. The incidence of atrial fibrillation was higher in this group. The significant CAD group had lower ADP-platelet inhibition, higher ADP-platelet aggregation and greater maximum clot strength compared to patients with PAD alone. Patients with significant CAD were more frequently on full dose anticoagulation, but less frequently on dual-antiplatelet therapy. 28.1% of patients with significant CAD developed post-operative MALE compared to 22.9% of patients with PAD alone (p=.40). For both groups, patients who developed post-operative MALE demonstrated greater ADP-platelet aggregation and lower ADP-platelet inhibition.

Conclusion:

Patients with a history of significant CAD undergoing lower extremity revascularization demonstrated prothrombotic TEG-PM profiles, less frequent use of DAPT, and greater rates of full dose anticoagulation. Decreased platelet inhibition was also associated with postoperative MALE. This study underscores the potential utility of viscoelastic assays for coagulation profiling in complex cardiovascular patients.
Does Access to Point-of-Care Medical Information Improve Trauma and General Surgeons’ Clinical Knowledge in a Middle-Income Country? A Mixed-Methods Study with Random Assignment
Authors: Noble Helen , Neumann Ordoñez Willy Jesús , Wong Gabriela Zavala , Rodríguez Manuel J , Checa David Ortega , Warne Maria , Senturia Kirsten , Jin Ying , Peterson Ryan , LaGrone Lacey Nicole
Published: February 2023

Background:

Investing in continued medical education (CME) strengthens surgical systems. This study assessed the effectiveness of an evidence-based practice (EBP) tutorial and access to UpToDate (UTD) to improve EBP, and understand how and why providers practice using evidence.

Study Design:

A mixed-methods, implementation study at nine public hospitals in Peru consisting of didactic session for surgeons on EBP and Google Translate (GT), and support of applications for UTD access. Change in clinical knowledge scores (CKS), access and use of UTD and impact of language pre- and post-intervention were measured. Qualitative interviews uncovered reasons for these changes.

Results:

Intervention participants had lower CKS at follow-up compared to baseline (odds ratio (OR) of higher score: 0.41 [0.18,0.98]; p=0.044), and this effect was modified (p=0.003) to the extent that the reverse was true for control participants (OR: 2.30 [1.13,4.71]; p=0.022). Participants with 1-20 years’ experience had significantly improved CKS compared to students/residents (1-10 years: OR 4.5 [1.1,18]; 11-20 years: OR 4.9 [1.4,17]); there was no evidence of a different CKS between providers with >20 years’ experience compared to students/residents (OR 1.3 [0.5,3.7]). Administrative disconnect, usability, motivation, education, time, resources, and age influenced POCMIS impact on knowledge and EBP. Participants reporting low English proficiency translated medical literature mostly used GT. Those with low/no English reading proficiency had higher odds of reporting a negative impact on research compared to those with working (p=0.007) or professional (p<0.001) proficiency.

Conclusion:

Providing education on EBP, free UTD access and translation solutions did not correlate with increased CKS due to complex barriers to using POCMIS.
Low Muscle Mass and Radiodensity Associate with Impaired Pulmonary Function and Respiratory Complications in Patients with Esophageal Cancer
Authors: Cameron Miles E , Ayzengart Alexander L , Oduntan Olusola , Judge Sarah M , Judge Andrew R , Awad Ziad T
Published: February 2023

Background:

60% of patients with esophageal cancer display signs of cachexia at diagnosis. Changes in body composition are common, and muscle mass and quality are measurable through imaging studies. Cachexia leads to functional impairments that complicate treatments, including surgery. We hypothesize that low muscle mass and quality associate with pulmonary function testing parameters, highlighting ventilatory deficits and postoperative complications in patients receiving esophagectomy.

Study Design:

We performed a retrospective review of patients receiving esophagectomy between 2012 and 2021 at our facility. PET/CT scans were used to quantify skeletal muscle at the L3 and T4 levels. Patient characteristics were recorded, including pulmonary function testing parameters. Regression models were created to characterize predictive associations.

Results:

108 patients were identified. All were included in the final analysis. In linear regression adjusted for sex, age and COPD status, low L3 muscle mass independently associated with low FVC (p<0.005, β 0.354) and FEV1 (p<0.001, β 0.392). Similarly, T4 muscle mass independently predicted FVC (p<0.005, β 0.524) and FEV1 (p<0.01, β 0.480). L3 muscle quality correlated with TLC (R 0.2463, p<0.05). 26 patients had pleural effusions postoperatively, associated with low muscle quality on L3 images (p<0.05). Similarly, patients with hospitalization over two weeks presented with lower muscle quality (p<0.005).

Conclusion:

Cachexia and low muscle mass are common. Reduced muscle mass and quality independently associate with impaired FVC, FEV1 and TLC. We propose that respiratory muscle atrophy occurs with weight loss. Body composition analyses may aid in stratifying patients. Pulmonary function testing may also serve as a functional endpoint for clinical trials. These findings highlight the need to study mechanisms that lead to respiratory muscle pathology and dysfunction in tumor bearing hosts.
Role of Endovascular Stenting in Patients with Traumatic Iliac Artery Injury
Authors: Zambetti Benjamin R , Patel Devanshi D , Stuber Jacqueline D , Zickler William P , Hosseinpour Hamidreza , Anand Tanya , Nelson Adam C , Stewart Collin , Joseph Bellal , Magnotti Louis J
Published: February 2023

Background:

Common and external iliac artery injuries (IAI) portend significant morbidity and mortality. The goal of this study was to examine the impact of mechanism of injury and type of repair on outcomes and identify the optimal repair for patients with traumatic IAI using a large, national dataset.

Study Design:

Patients undergoing operative repair for IAI were identified from the Trauma Quality Improvement Program (TQIP) database over 5 years, ending in 2019. Age, gender, race, severity of injury, severity of shock, type of iliac repair (open and endovascular), mechanism, morbidity and mortality were recorded. Patients with IAI were stratified by both type of repair and mechanism and compared. Multivariable logistic regression (MLR) analysis was used to identify independent predictors of mortality.

Results:

Operative IAI was identified in 507 patients. Of these, 309 (61%) were penetrating and 346 (68.2%) involved the external iliac artery. The majority was male (82%) with a median age and ISS of 31 and 20, respectively. Endovascular repair was performed in 31% of cases. For patients with penetrating injuries, type of repair impacted neither morbidity nor mortality. For blunt-injured patients, endovascular repair was associated with lower morbidity (29.3 vs. 41.3%, p=0.082) and significantly reduced mortality (14.6 vs 26.7%, p=0.037) compared to open approach. MLR identified endovascular repair as the only modifiable risk factor associated with decreased mortality (OR 0.34, 95%CI 0.15-0.79, p=0.0116).

Conclusions:

Traumatic IAI causes significant morbidity and mortality. Endovascular repair was identified as the only modifiable predictor of decreased mortality in blunt-injured patients with traumatic IAI. Thus, for select patients with blunt iliac artery injuries, an endovascular repair should be the preferred approach.
Chromatin-Accessible miRNA Regulons Driving Thyroid Tumorigenesis and Progression
Authors: Toraih Eman A , Ruiz Emmanuelle , Ning Bo , Tortelote Giovane G , Hilliard Sylvia , Moroz Krzysztof , Hu Tony , Fawzy Manal S , Kandil Emad
Published: February 2023

Background:

While papillary thyroid cancer (PTC) can remain indolent, associated lymph node metastases (LNM) and recurrence rates are approximately 50% and 20%, respectively. Omics-based medicine has led to the discovery of predictive biomarkers that can be used to predict tumor progression and clinical outcomes. We aimed to develop a non-invasive omics-driven blood test to allow accurate risk stratification and help tailor individual patient treatment plans.

Study design:

RNA-seq and miRNA-seq analysis of TCGA and GEO datasets were employed to identify an epigenetic prognostic panel. Integrated bulk ATAC-seq and RNA-seq experiments confirmed the results. Sixty-two paired tumor and adjacent control thyroid tissues and 67 blood samples (62 PTC and 5 controls) were analyzed for validation using sequencing and RT-PCR and correlated to clinical outcomes. Liposome-exosome fusion CRISPR-FDS miRNA assay was developed. A predictive risk nomogram was generated and tested for performance.

Results:

Our miRNA panel (miR-146b-5p and miR-221-3p) from tissue and blood was associated with aggressive features and was located within accessible chromatin regions. The miRNA risk score and prognostic nomogram showed higher accuracy in predicting LNM (miR-146b: AUC=0.816, sensitivity=76.9%; miR-221: AUC=0.740, sensitivity=79.5%) and recurrence (miR-146b: AUC=0.921, sensitivity=75.0%; miR-221: AUC=0.756, sensitivity=70.0%) (p<0.001) than staging and ATA risk stratification. CRISPR-based miRNA assays showed upregulation in the blood of cancer cohorts.

Conclusion:

CRISPR-based detection of miR-146b and miR-221 in the blood of TC patients is a reliable and non-invasive tool for real-time assessment and prognostication that has great potential to provide a direct impact on the care of these patients.
Multilevel Intervention to Improve Racial Equity in Access to Kidney Transplant
Authors: Taber David J , Su Zemin , Gebregziabher Mulugeta , Mauldin Patrick D , Morinelli Thomas A , Mahmood Ammar O , Magwood Gayenell S , Casey Michael J , Scalea Joseph R , Kavarana Sam M , Baliga Prabhakar K , Rodrigue James R , DuBay Derek A
Published: February 2023

Background:

African Americans (AAs) have reduced access to kidney transplant (KTX). Our center undertook a multilevel quality improvement endeavor to address KTX access barriers, focused on vulnerable populations. This program included dialysis center patient/staff education, embedding telehealth services across South Carolina, partnering with community providers to facilitate testing/procedures, and increased use of high-risk donors.

Methods:

This was a time series analysis from 2017 to 2021 using autoregression to assess trends in equitable access to KTX for AAs. Equity was measured using a modified version of the Kidney Transplant Equity Index (KTEI), defined as the proportion of AAs in South Carolina with end-stage kidney disease (ESKD) versus the proportion of AAs initiating evaluation, completing evaluation, waitlisting, and undergoing KTX. A KTEI of 1.00 is considered complete equity; KTEI < 1.00 is indicative of disparity.

Results:

From January 2017 to September 2021, 11,487 ESKD patients (64.7% AA) were referred, 6,748 initiated an evaluation (62.8% AA), 4,109 completed evaluation (59.7% AA), 2,762 were waitlisted (60.0% AA), and 1,229 underwent KTX (55.3% AA). The KTEI for KTX demonstrated significant improvements in equity. The KTEI for initiated evaluations was 0.89 in 2017, improving to 1.00 in 2021 (p=0.0045). Completed evaluations KTEI improved from 0.85 to 0.95 (p=0.0230), while waitlist additions KTEI improved from 0.83 to 0.96 (p=0.0072). The KTEI for KTX also improved from 0.76 to 0.91, which did not reach statistical significance (p=0.0657).

Conclusion:

A multilevel intervention focused on improving access to vulnerable populations was significantly associated with reduced disparities in AAs.
Recipient Survival after Orthotopic Liver Transplantation: Interpretable Machine Learning Survival Tree Algorithm for Patient Specific Outcomes
Authors: Rogers Michael P , Janjua Haroon M , Read Meagan , Cios Konrad , Kundu Madan G , Pietrobon Ricardo , Kuo Paul C
Published: February 2023

Background:

Elucidating contributors affecting liver transplant survival is paramount. Current methods offer crude global group outcomes. To refine patient-specific mortality probability estimation and determine covariate interaction using recipient and donor data, we generated a survival tree algorithm (ReSOLT) using UNOS transplant data.

Study Design:

The UNOS database was queried for liver transplants in patients ≥18 years old between 2000-2021. Pre-operative factors were evaluated with stepwise logistic regression; 43 significant factors were used in survival tree modeling. Graft survival <7 days was excluded. Data were split into training and testing sets and further validated with ten-fold cross validation. Survival tree pruning and model selection was achieved based on AIC and log-likelihood values. Log-rank pairwise comparisons between subgroups and estimated survival probabilities were calculated.

Results:

A total of 122,134 liver transplant patients were included for modeling. Multivariable logistic regression (AUC = 0.742, F1 = 0.822) and survival tree modeling returned 8 significant recipient survival factors: recipient age, donor age, recipient primary payment, recipient Hepatitis C status, recipient diabetes, recipient functional status at registration and at transplantation, and deceased donor pulmonary infection. Twenty subgroups consisting of combinations of these factors were identified with distinct Kaplan-Meier survival curves (p<0.001 among all by log rank test) with five-year and ten-year survival probabilities.

Conclusions:

Survival trees are a flexible and effective approach to understand the effects and interactions of covariates on survival. Individualized survival probability following liver transplant is possible with ReSOLT, allowing for more coherent patient and family counseling and prediction of patient outcome using both recipient and donor factors.
Normothermic Machine Perfusion for Declined Livers: A Strategy to Rescue Marginal Livers for Transplantation
Authors: Olumba Franklin C , Zhou Fangyu , Park Yikyung , Chapman William C ,   and the RESTORE Investigators Group
Published: February 2023

Background:

Organ waste is a major cause of the donor liver shortage. Roughly 67% of recovered organ donors have liver utilization annually. A new technology called Normothermic Machine Perfusion (NMP) offers a way to recover marginal and declined livers for transplant. We report interim results of the RESTORE trial (FDA-IDE trial, NCT04483102) that aims to transplant NMP-treated livers that would otherwise be discarded.

Study Design:

Declined livers were screened for NMP eligibility (e.g., DCD grafts with warm ischemic time <40 minutes, DBD grafts with cold ischemic time <8 hours). Livers meeting pre-NMP eligibility criteria received NMP using the OrganOx® metra device for minimum 4 hours. All NMP-treated livers meeting viability criteria were transplanted to consented recipients.

Results:

Over 22 months, 60 declined livers from three OPOs (40 DCD and 20 DBD donor livers) were offered, and 22 livers (10 DCD and 12 DBD livers) met the pre-NMP eligibility. After NMP, 16 of 22 livers passed viability testing and were transplanted into needy recipients (median MELD 8, range 6-24), resulting in 72.7% rescue rate (50% DCD, 91.7% DBD). The rate of early allograft dysfunction was 31.3% but there were no graft related deaths, primary non-function or instances of non-anastomotic biliary strictures.

Conclusion:

Interim results of the RESTORE trial suggest that a sizable number of declined livers can be reclaimed. They are safe for transplantation and can enable lower MELD patients at high risk of morbidity and mortality to receive lifesaving grafts while offering OPOs a way to allocate more livers and reduce organ waste.
Financial Toxicity in Emergency General Surgery: Novel Propensity-Matched Outcome Comparison
Authors: Parreco Joshua P , Avila Azalia , Pruett Rachel , Romero Dino C , Solomon Rachele , Buicko Jessica L , Rosenthal Andrew , Carrillo Eddy H
Published: February 2023

Background:

Financial toxicity describes the harmful effect of individual treatment costs and fiscal burdens that have a compounding negative impact on outcomes in surgery. While this phenomenon has been widely studied in surgical oncology, the purpose of this study was to perform a novel exploration of the impact of financial toxicity in emergency general surgery (EGS) patients throughout the US.

Study Design:

The Nationwide Readmissions Database for January and February 2018 was queried for all EGS patients aged 18-65 years. One-to-one propensity matching was performed with and out risk for financial toxicity. The primary outcome was mortality, the secondary outcomes were venous thromboembolism (VTE), prolonged length of stay (LOS), and readmission within 30-days.

Results:

There were 24,154 EGS patients propensity matched. The mortality rate was 0.2% (n=39) and the rate of VTE was 0.5% (n=113). With financial toxicity there was no statistically significant difference for mortality (p=0.08) or VTE (p=0.30). The rate of prolonged LOS was 6.2% (n=824) and the risk was increased with financial toxicity (RR 1.24 [1.12-1.37] p<0.001). The readmission rate was 7.0% (n=926) and the risk with financial toxicity was increased (RR 1.21 [1.10-1.33] p<0.001). The mean count of comorbidities per patient per admission during readmission within 1 year with financial toxicity was 2.1 ± 1.9 versus 1.8 ± 1.7 without (p<0.001).

Conclusions:

Despite little difference in the rate of mortality or VTE, EGS patients at risk for financial toxicity have an increased risk of readmission and longer LOS. Fewer comorbidities were identified at index admission than during readmission in patients at risk for financial toxicity. Future studies aimed at reducing this compounding effect of financial toxicity and identifying missed comorbidities have the potential to improve EGS outcomes.
Machine Learning Models for Predicting the Outcomes of Surgical Treatment of Colorectal Liver Metastases
Authors: Moaven Omeed , Tavolara Thomas E , Valenzuela Cristian D , Cheung Tan to , Corvera Carlos U , Cha Charles H , Stauffer John A , Niazi Muhammad Khalid Khan , Gurcan Metin N , Shen Perry
Published: February 2023

Background:

Surgical intervention remains the cornerstone of a multidisciplinary approach in the treatment of colorectal liver metastases (CLM). Nevertheless, patient outcomes vary greatly. While predictive tools can assist decision-making and patient counseling, decades of efforts have yet to result in generating a universally adopted tool in clinical practice.

Study Design:

An international collaborative database of CLM patients who underwent surgical therapy between 2000 and 2018 was used to select 1004 operations for this study. Two different machine learning methods were applied to construct two predictive models for recurrence and death, using 128 clinicopathologic variables: gradient-boosted trees (GBTs) and logistic regression with bootstrapping (LRB) – in a leave-one-out cross-validation.

Results:

Median survival after resection was 47.2 months, and disease-free survival was 19.0 months, with a median follow-up of 32.0 months in the cohort. Both models had good predictive power, with GBT demonstrating a superior performance in predicting overall survival (area under the receiver operating curve [AUC]: 0.773, 95%CI: 0.743-0.801 vs. LRB with AUC: 0.648, 95%CI: 0.614-0.682), and recurrence (AUC: 0.635, 95% CI: 0.599-0.669 vs. LRB with AUC: 0.570, 95%CI: 0.535-0.601). Similarly, better performances were observed predicting 3-year and 5-year survival, as well as 3-year and 5-year recurrence with GBT methods generating a higher AUC.

Conclusion:

Machine learning provides powerful tools to create predictive models of survival and recurrence after surgery for CLM. The effectiveness of both machine learning models varies, but on most occasions, GBT outperforms LRB. Prospective validation of these models lays the groundwork to adopt them in clinical practice.
Differences in Cognitive Adverse Effects and Seizure Parameters Between Thiopental and Propofol Anesthesia for Electroconvulsive Therapy
Authors: Kavakbasi Erhan , Stoelck Alexandra , Wagner Nana-Maria , Baune Bernhard T.
Published: February 2023

Introduction

Electroconvulsive therapy (ECT) is a well-established treatment option in case of severe and treatment-resistant psychiatric conditions. In this retrospective study, we compared the 2 anesthetics propofol and thiopental in terms of seizure quality, cognitive adverse effects, and clinical outcome.

Methods

Data collection was performed retrospectively by a chart review, including patient files and medical records. A total of 64 patients (female = 60.9%) treated with ECT within the period of February 2019 to March 2020 were included. Of these, 35 (54.7%) received thiopental for ECT narcosis and 29 (45.3%) were treated with propofol.

Results

Six hundred sixteen ECT treatments (mean number per case, 9.6) were performed in total. The mean electroencephalogram seizure duration (38.3 vs 28.1 seconds, t = 3.534, degrees of freedom [df] = 62, P < 0.001) and motor seizure duration (21.5 vs 12.0, t = 4.336, df = 62, P < 0.001) as well as postictal suppression index and heart rate increase were significantly higher in the thiopental group. Mean stimulation energy needed per session was higher in the propofol group (88.6% vs 73.0%, Mann-Whitney U test, P = 0.042). The ECT series was more likely to be interrupted due to cognitive adverse effects in the thiopental group (P = 0.001, Pearson χ2 = 10.514, df = 1). Number of patients achieving remission was significantly higher in the thiopental group (31.4% vs 6.9%, P = 0.015, χ2 = 5.897, df = 1).

Conclusions

Thiopental led to better seizure duration and quality and was associated with a higher rate of remission. As a downside, thiopental was also associated with a greater risk of cognitive adverse effects.
Characteristics and outcomes of cases with methylphenidate abuse, dependence or withdrawal: an analysis of spontaneous reports in EudraVigilance
Authors: Hartmayer Lara T. , Hoffmann Falk , Bachmann Christian J. , Jobski Kathrin
Published: February 2023

Methylphenidate (MPH) is a central nervous stimulant, which is mainly used in attention deficit hyperactivity disorder (ADHD) and narcolepsy. In recent years, rising MPH prescription volumes have drawn attention to possible misuse. We analyzed data on suspected MPH abuse, dependence or withdrawal reported to the EudraVigilance database (1996–2019), comparing case characteristics (e.g. age, indications and outcome). In 1531 cases from 35 countries (median: 29 years, 57.6% male), 42.3% had been diagnosed with ADHD and 8.0% with narcolepsy. Narcolepsy cases were older than ADHD cases (mean age: 47 vs. 22 years), and used co-medications more frequently (79.4 vs. 47.8%). Intravenous MPH administration was most common among individuals not diagnosed with ADHD or narcolepsy. A history of abuse, dependence or withdrawal of any substance was more often documented in fatal than in nonfatal cases (49.0 vs. 22.5%), whereas differences regarding the route of administration were less pronounced. Minors, who presumably received MPH for ADHD treatment, presented less frequently with serious outcomes than older cases or those without an approved indication. Prescribers should exercise caution in adult MPH users and should make a thorough co-medication assessment. Finally, more research on substance abuse in narcolepsy patients is required, which should include comorbidities and co-medication.