bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in serum interferon-γ-inducible protein-10 levels and liver stiffness among chronic hepatitis C Egyptian patients in response to directly acting antiviral agents
Authors: El-Nahaas Saeed M. , Rady Normeen Hany , Malek Shimaa , Serag Khaled
Published: January 2021

Background

Interferon-γ inducible protein-10 (IP-10) is chemokine biomarker of liver inflammation, elevated in patients with chronic hepatitis C infection.

Aims

Investigating if changes in serum IP-10 levels in response to directly acting antiviral agents (DAAs) treatment for chronic HCV patients are paralleled by changes in liver stiffness measurements (LSM), and assessing role of using serum IP-10 as a noninvasive accurate method to predict changes in hepatic necro-inflammation and fibrosis.

Material and methods

A prospective observational study included 92 Egyptian chronic HCV patients, who received treatment with sofosbuvir with daclatasvir regimen. Patients were classified into two groups; group I (53 patients) with non to mild significant liver fibrosis (F0–F1), and group II (39 patients) with significant to advanced liver fibrosis (F2–F4). Fibroscan and serum IP-10 were assessed pretreatment and 3 months after end of treatment.

Results

All patients achieved SVR. Both IP-10 and LSM showed significant decline after treatment in both groups. No significant correlation was found between changes in LSM and IP-10. IP-10 detected liver cirrhosis at cut off level of 17.8 pg/ml, with 75% sensitivity and 73.86% specificity, with area under the curve = 0.66, however, IP-10 had no statistical significance in detecting advanced fibrosis.

Conclusion

IP-10 might be of significance as a noninvasive predictor of liver cirrhosis. IP-10 significant decline post-DAAs treatment in chronic HCV genotype IV infected patients reflects significant improvement in fibrosis stage and hepatic necro-inflammation in response to treatment. No significant correlation was detected in the changes of both IP-10 and LSM.
The prevalence of sessile serrated lesion in the colorectum and its relationship to synchronous colorectal advanced neoplasia: a systemic review and meta-analysis
Authors: Shiu Sz-Iuan , Kashida Hiroshi , Komeda Yoriaki
Published: January 2021

Background

The aim of this systemic review and meta-analysis was to evaluate the prevalence of sessile serrated lesion (SSL) and its relationship to synchronous colorectal advanced neoplasia.

Materials and methods

Comprehensive, computerized research was performed on PubMed and published from 1 January 2010 to 6 July 2018 which searched relevant articles without any language limitations. Clinical trials were included in the narrative systemic review if they matched the following inclusion criteria: (1) published as a case-controlled study, cohort study or cross-sectional study; (2) defined objectively for diagnosis of SSL within the studies; (3) addressed the prevalence and characteristics of SSL. Within these trials, if they met additional criteria involving the reported outcome of risk regarding advanced neoplasia in relation to SSL, they were enrolled into meta-analysis.

Results

Forty-one trials were enrolled for the systematic review, with a total of eight analyzed for the meta-analysis. The prevalence of all SSL ranged from 0.038 to 20.23% and the prevalence by pooled analysis was 2.7%. In a subgroup analysis, the overall prevalence of SSL during the periods of 2010–2014 and 2015–2018 was shown to be 2.7 and 2.8%, respectively. We calculated the pooled data on the cancer risk of SSL and the risk of synchronous advanced neoplasia in patients with SSL made available from the eight trials, which resulted in a pooled odds ratio of 3.53 (95% confidence interval 2.39–5.20, I
2 = 4%, P = 0.40).

Conclusion

In this systemic review, SSL was found to be associated with an increased risk of synchronous advanced neoplasia in the colorectum.
Innovations in urolithiasis management
Authors: Veser Julian , Jahrreiss Victoria , Seitz Christian
Published: January 2021

Purpose of review

This review provides a forecast about ongoing developments in the management of urolithiasis with a potential to challenge the current standard of care. We therefore emphasized innovative technology, which might be considered still experimental in the daily clinic or needs further clinical validation, but harbors the great potential to become a game changer for future stone management.

Recent findings

Especially in the endoscopic stone treatment, we observed a multitude of groundbreaking technical innovations, which changed our treatment algorithms over the last decades. Some of this technology already found its way into daily practice. Others like artificial intelligence, burst wave lithotripsy, smart laser systems or gene therapy may not be standardized yet, but have the potential to further revolutionize current practice. Besides those technical features, we included innovations in prevention and diagnostics, as well as patient expectations and patient satisfaction into the analysis. A proper metaphylaxis and patient communication seems to be essential for a long-lasting treatment success.

The combination of technical innovations, improved stone metaphylaxis and proper patient communication presents the cornerstone of future kidney stone management.
Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood
Authors: Mubarak Amani , Benninga Marc A. , Broekaert Ilse , Dolinsek Jernej , Homan Matjaž , Mas Emmanuel , Miele Erasmo , Pienar Corina , Thapar Nikhil , Thomson Mike , Tzivinikos Christos , de Ridder Lissy
Published: January 2021

Button batteries (BB) remain a health hazard to children as ingestion might lead to life‐threatening complications, especially if the battery is impacted in the esophagus. Worldwide initiatives have been set up in order to prevent and also timely diagnose and manage BB ingestions. A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) task force for BB ingestions has been founded, which aimed to contribute to reducing the health risks related to this event. It is important to focus on the European setting, next to other worldwide initiatives, to develop and implement effective management strategies. As one of the first initiatives of the ESPGHAN task force, this ESPGHAN position paper has been written. The literature is summarized, and prevention strategies are discussed focusing on some controversial topics. An algorithm for the diagnosis and management of BB ingestions is presented and compared to previous guidelines (NASPGHAN, National Poison Center). In agreement with earlier guidelines, immediate localization of the BB is important and in case of esophageal impaction, the BB should be removed instantly (preferably <2 hours). Honey and sucralfate can be considered in ingestions ⩽12 hours while waiting for endoscopic removal but should not delay it. In case of delayed diagnosis (first confirmation of the BB on X‐ray >12 hours after ingestion or time point of removal >12 hours after ingestion) and esophageal impaction the guideline suggests to perform a CT scan in order to evaluate for vascular injury before removing the battery. In delayed diagnosis, even if the battery has passed the esophagus, endoscopy to screen for esophageal damage and a CT scan to rule out vascular injury should be considered even in asymptomatic children. In asymptomatic patients with early diagnosis (⩽12 hours after ingestion) and position of the BB beyond the esophagus, one can monitor with repeat X‐ray (if not already evacuated in stool) in 7 to 14 days, which is different from previous guidelines where repeat X‐ray and removal is recommended after 2–4 days and is also based on age. Finally, prevention strategies are discussed in this paper.
Genetic Enteropathies Linked to Epithelial Structural Abnormalities and Enteroendocrine Deficiency
Authors: Caralli Morgane , Roman Celine , Coste Marie‐Edith , Roquelaure Bertrand , Buffat Christophe , Bourgeois Patrice , Badens Catherine , Fabre Alexandre
Published: January 2021

Objectives:

Congenital diarrhea and enteropathies linked to epithelial structural abnormalities constitute 3 different rare diseases: the tufting enteropathies (TE; EPCAM and SPINT2 mutations), microvillous inclusion disease (MVID; MYO5B and STX3 mutations), and tricho‐hepato‐enteric syndrome (THE; TTC37 and SKIV2L mutations). Moreover, enteroendocrine deficiencies (ED; PCSK1 and NEUROG3 mutations) share common clinical characteristics with TE, THE, and MVID in that the treatment requires, in most cases, long‐term parenteral nutrition. Although numerous cases have been reported in the literature, aggregated data on morbidity and mortality are missing owing to the rarity of the diseases.

Methods:

We performed a systematic review of all published cases and retrieved 86 articles describing 323 patients (164 boys and 135 girls).

Results:

The mortality rate was 20.28%, with a median age at death of 13.5 months (range 0–228 months); the mortality risk was 30.8/1000 person‐year; in half of the cases, death was caused by infections. Parenteral nutrition was required in 95.4% of patients and weaning off from parenteral nutrition was achieved in 29.35% at a median age of 23 months (range 3.3–276 months). The patients with ED linked to PCSK1 were nearly all weaned at a median age of 14 months, but most of the patients became overweight. MVID patients with MYO5B mutations were most often born preterm. ED linked to NEUROG3 mutation and THE patients usually presented with intrauterine growth retardation.

Conclusions:

This review presents data from 323 patients with congenital diarrhea linked to EPCAM TE, SPINT2 TE, TTC37 THE, SKIV2L THE, MYO5B MVID, STX3 MVID, NEUROG3 ED, and PCSK1 ED mutations.
Microbiology and histological study of gallbladder among acute and chronic cholecystitis in Babylon City, Iraq
Authors: Ali Rawaa Adday , Khudhur Hasan R. , Hasan Ahmed Abbas
Published: January 2021

The current study aimed to identify the bacteria from the gallbladder taken during cholecystectomy of patients with acute and chronic cholecystitis of calculus and acalculus type. The study included 100 patients taken randomly (85 women and 15 men) undergoing cholecystectomy at the general teaching Hilla Hospital from September 2016 to June 2017. For each patient, two samples were taken, which included tissue and stone (if present). All samples were cultured on different media for full bacteriological identification. The infection appears in both sexes, but the rate of infection in women (85%) was higher than men (15%). The most affected age group in both sexes was between 35 and 45 years (30%). Clinically, chronic cholecystitis was the most common (84%) compared with acute cholecystitis (16%). The results of bacterial isolation appeared to be 75% for gallbladder tissue samples and 25% for stones culture. The total number of isolated bacterial samples were 80. Gram-negative bacteria were predominant and represented 86% whereas the Gram-positive group was 13%. The most common bacterial isolates were Salmonella typhi (20%) as Gram-negative bacteria and Enterococcus faecalis (45%) as Gram-positive bacteria. Cholesterol stones were the most common types of gallstones (60%) followed by pigment stone (40%) and mixed type (32%). Also, the study showed changes in the histological structure of the gallbladder, which were characterized by the expansion of the cavity and congestion of the blood vessels in the follicular layer and an increase in the amount of lymphatic tissue diffused in the layers of the gallbladder wall.
The current advances and future perspectives of lateral flow immunoassay for infectious diseases
Authors: Shi Xiaoqiang , Wang Zhe
Published: January 2021

Although much progresses have been made, preventing and curing infectious diseases have proven increasingly unable to keep pace with the spread of these pandemics. Therefore, there is fueled demanding for accurate, speed, affordable, and convenient diagnostic assays. Recent years, tremendous efforts to develop the point-of-care (POC) testing have provided plenty of solutions to meet above requirements, their application will be especially useful in resource-limited countries and areas. In this perspective, we discuss the recent advances and emerging potentials of POC diagnostic, mainly focusing on lateral flow immunoassay (LFA), to overview how this powerful and portable platform facilitates to fighting diverse pathogens in our real world. We hope this review can be helpful for interested infectious disease researchers and physicians.
Distribution of clinical Candida species and their susceptibility to antifungal agents
Authors: Tumer Seray , Bayraktar Mehmet , Öztürk Ali
Published: January 2021

Background:

The incidence of fungal infections, especially by Candida species, has increased in recent years. This study was designed to isolate and identify Candida species from various clinical samples, and to examine their susceptibility to antifungal agents.

Methods:

A total of 175 Candida species were isolated from different clinical samples, and were identified using germ tube test, Cornmeal agar, and API C 20 AUX and VITEK 2 Compact Systems. Antifungal susceptibility of these isolates was determined using ATB Fungus 3 strip and VITEK 2 antifungal susceptibility cards. The results of these two methods were comparatively assessed.

Results:

A total of 175 Candida strains were isolated from 114 (65.1%) urine, 42 (24%) blood, eight (4.6%) sputum, seven (4%) endotracheal, and four (2.3%) wound samples. Of isolated Candida species, 102 (58.2%) were Candida albicans, 31 (17.6%) Candida tropicalis, 17 (9.6%) Candida parapsilosis, 13 (7.4%) Candida glabrata, three (1.8%) Candida kefyr, three (1.8%) Candida krusei, two (1.2%) Candida lusitaniae, and one (0.6%) Candida famata. By VITEK 2 antifungal susceptibility cards, the overall resistance rates were 0.6% to each of amphotericin B and 5-flucytosine, and 1.8% to fluconazole. In ATB Fungus 3 strip, the resistance (1.8%) was observed only to fulconazole. All isolates were uniformly susceptible to voriconazole in both methods.

Conclusion:

Valuable information and data on distribution and susceptibility of Candida strains were obtained. These data may be valuable from epidemiological point of view as well as for proper and optimal therapy of Candida infections in our region (Şanliurfa, Turkey).
The Risk of Congenital Anomalies by Fertility Treatment Modality
Authors: Chung Esther H. , Harris Benjamin S. , Muasher Suheil J. , Kuller Jeffrey A.
Published: January 2021

Importance

Up to 4% of all births in developed nations involve assisted reproductive technology (ART), along with other fertility treatment modalities. Thus, ART pregnancies constitute an important epidemiologic population with a known increased risk of congenital anomalies. In this review, we summarize current fertility treatment modalities and their associated risk of congenital anomalies.

Objective

To review the risk of birth defects among pregnancies conceived with ART and other fertility treatments.

Evidence Acquisition

Articles were obtained from PubMed and the American College of Obstetricians and Gynecologists and American Society of Reproductive Medicine committee opinions.

Results

In vitro fertilization has been associated with a 25% to 50% increased risk of birth defects, including abnormalities of these organ systems: cardiovascular (25%–40% of anomalies), genitourinary (10%–60%), gastrointestinal (10%–20%), and musculoskeletal (10%–35%). Although the data are mixed, intracytoplasmic sperm injection has also been found to be associated with an increased risk of defects, particularly hypospadias, when compared with conventional in vitro fertilization. The risk among fresh versus frozen cycles and cleavage stage versus blastocyst transfers remains uncertain. There appears to be no significant added risk with preimplantation genetic testing, although more studies are needed. Ovulation induction with oral agents appears safe and not associated with an increased risk of anomalies. Oocyte cryopreservation also appears safe, but the data are still limited, requiring future investigation.

Conclusions and Relevance

While the relative risk of birth defects among ART pregnancies is increased when compared with spontaneous conceptions, the absolute risk remains low. There are no standard screening recommendations for ART pregnancies. Per the American College of Obstetricians and Gynecologists, patients who have undergone ART should be counseled regarding the risk of birth defects and available antenatal evaluation, including fetal echocardiogram and detailed ultrasound evaluation.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

Following completion of this CME article, readers should be better able to assess risk factors for birth defects among individuals undergoing fertility treatment; explain available antenatal screening modalities for detection of common birth defects associated with ART; and identify available resources and recommendations on risk factors for birth defects associated with infertility treatment.
Report of a Rare Case of Spindle Cell Ameloblastic Carcinoma and the Diagnostic Utility of Immunohistochemistry
Authors: Behtaj Mohadese , Alawi Faizan , Shanti Rabie Mamdoh , Cannady Steven , Zhang Paul Jun , Modi Mitul , Lamzabi Ihab
Published: January 2021

Ameloblastic carcinoma is a rare aggressive malignant epithelial odontogenic tumor. The spindle cell variant of ameloblastic carcinoma (SCAC) is exceedingly rare with 15 cases of SCAC having been reported. Therefore, because of the paucity of cases in literature related to SCAC, the biological behavior of the entity has not been well evaluated. Herein the authors report a case of incidentally diagnosed SCAC in a 20-year-old woman identified on imaging as part of the evaluation of a work-related facial injury. Histologically, the tumor had background of cystic ameloblastoma with areas of dense hypercellular spindle cells with short-to-long intersecting fascicles and occasional herringbone pattern intermixed with solid epithelial nests. Both the epithelial and spindle cells were positive for cytokeratin including cytokeratin 19, D2-40, and transducin-like enhancer of split proteins-1 immunohistochemical stains. The patient was followed for 18 months with no evidence of recurrence or metastasis. To the knowledge this is a first case of reporting D2-40 positivity in spindle ameloblastic carcinoma and this immunostain could be used as helpful marker to diagnose this entity.
The Usefulness of 4 Immunoperoxidase Stains Applied to Urinary Cytology Samples in the Pathologic Stage of Urothelial Carcinoma: A Study With Histologic Correlation
Authors: Alabiad Mohamed Ali , Elderey Mohamed S. , Shalaby Amany Mohamed , Nosery Yousef , Gobran Mai Ahmed
Published: January 2021

Background:

Currently, the golden rule for the diagnosis of urothelial carcinoma is biopsy and cystoscopy, unfortionally both are costly, invasive, and uncomfortable. While most urothelial cancers are noninvasive at presentation, it is necessary to find a highly sensitive, noninvasive way to diagnose in its earlier stages, Cytology with immunostaining is a noninvasive, reliable method that might play a role in detecting the earlier stages before its progression and accurate correlation with different stages of these tumors.

Aim:

This study aimed to reach an accurate level in the staging of urothelial carcinoma using CD44, ProExC, Laminin, and Fascin on urinary cytology.

Design:

We include a total of 180 urinary cytology specimens with their surgical biopsies’ counterparts, the staging of the surgical specimens were done according to AJCC2017TNM classification, while their counterpart urinary samples were centrifuged and the sediment was used for H&E and immunocytochemical staining with CD44, ProExC, Laminin, and Fascin.

Results:

The diagnosis of Ta-stage tumors was done according to the following immunohistochemical (IHC) profile [positive (+ve) CD44, negative (−ve) proExC, −ve Laminin, and −ve Fascin] with 100% sensitivity, 100% specificity. The diagnosis of Tis stage tumors was done according to IHC profile [−ve CD44, +ve proExC, −ve Laminin, and −ve Fascin] with 100% sensitivity, 93% specificity. The diagnosis of T1 stage tumors according to IHC profile [−ve CD44, +ve proExC, +ve Laminin, and −ve Fascin] with 100% sensitivity, 97% specificity, The diagnosis of T2 and T3 stage tumors was done according to IHC profile [−ve CD44, +ve proExC, +ve Laminin and weak to moderate +ve Fascin] with 100% sensitivity, 92% specificity, while the diagnosis of T4 stage tumors according to the IHC profile [−ve CD44, +ve proExC, +ve Laminin, and intense +ve Fascin] with 100% sensitivity, 100% specificity.

Conclusion:

Using (CD44, ProExC, Laminin, and Fascin) on urinary cytology is a simple, reliable, and noninvasive method for the staging of urothelial carcinoma with 99% total accuracy.
“Holding the City's Feet to the Fire”: Lessons Learned From Oakland's Implementation of Measure HH Sugar-Sweetened Beverage Tax
Authors: Asada Yuka , Chriqui Jamie F. , Pipito Andrea A. , Taher Sabira , Powell Lisa M.
Published: January 2021

Context:

Sugar-sweetened beverage (SSB) taxes offer a promising public health strategy to decrease consumption of sugary beverages. To date, 7 US cities have successfully implemented SSB taxes; however, only a few studies have examined adoption and implementation processes.

Objectives:

To describe public health and policy lessons learned during the first 2.5 years of implementation of the Oakland, California, penny-per-ounce SSB tax, Measure HH.

Design:

A mixed-methods, longitudinal, qualitative case study was conducted using a combination of key informant interviews with implementation stakeholders as well as analyses of archival documents and media documents from 2016 to 2019. Interviews were digitally recorded and professionally transcribed. Interview transcripts, archival documents, and media documents were analyzed by 3 coders using Atlas.ti v8. Analyses employed principles of constant comparative analysis to identify themes related to lessons learned.

Setting:

Oakland, California.

Participants:

Key informants (n = 15), archival documents (n = 43), and media documents (n = 90).

Intervention:

Oakland, California's SSB tax (Measure HH).

Results:

Implementation lessons included both success stories and challenges. Successes included contracting a third-party tax administrator to support tax collection and education; leveraging a pro-tax coalition to counteract industry attacks and to protect tax revenue; and offering “quick win” funding to support local needs. Challenges were associated with implementing a “general” tax versus a “special” tax; the lack of explicit revenue allocation in the ordinance to support city-level implementation and oversight; and, the original ordinance language for tax application to distributors.

Conclusions:

The study offers a range of recommendations—derived from lessons learned over several years of implementation—to policy makers and advocates engaged in SSB tax adoption and implementation efforts in their jurisdictions. SSB tax implementation requires sufficient agency administrative capacity and a strong pro-tax coalition that engages local community organizations to respond to public health needs.
Epidemiology of Triple-Negative Breast Cancer
Authors: Howard Frederick M. , Olopade Olufunmilayo I.
Published: January 2021

Triple-negative breast cancer accounted for 12% of breast cancers diagnosed in the United States from 2012 to 2016, with a 5-year survival 8% to 16% lower than hormone receptor–positive disease. However, preventive and screening strategies remain tailored to the demographics of less lethal luminal cancers. This review examines the ethnic, genetic, and modifiable risk factors associated with triple-negative breast cancer, which providers must recognize to address the societal disparities of this deadly disease. Most notable is that triple-negative cancers disproportionately affect African American women and carriers of germline BRCA and PALB2 mutations. Even controlling for treatment delays, stage, and socioeconomic factors, African Americans with triple-negative breast cancer remain nearly twice as likely to die of their disease. To level the playing field, we must integrate genomic predictors of disease and epidemiologic characteristics of molecular breast cancer subtypes to provide personalized risk assessment, screening, and treatment for each patient.
Obesity and Energy Balance Considerations in Triple-Negative Breast Cancer
Authors: Berger Elizabeth R. , Iyengar Neil M.
Published: January 2021

Obesity is an increasingly prevalent state of energy imbalance that contributes to breast cancer risk and outcomes. The effects of obesity differ by breast cancer subtype and menopause. While most studies have focused on postmenopausal hormone receptor–positive disease, less is known about the relationship between obesity and triple-negative breast cancer (TNBC). Here we will review the observations linking obesity to TNBC, the socioeconomic disparities that contribute to obesity-related TNBC, and putative biologic mechanisms. Finally, we will consider the impact of obesity on surgical and medical treatment of TNBC and novel strategies to improve energy balance after cancer diagnosis.
Worldwide relative smoking prevalence among people living with and without HIV
Authors: Johnston Peter I. , Wright Shanie W. , Orr Martin , Pearce Fiona A. , Stevens John W. , Hubbard Richard B. , Collini Paul J.
Published: January 2021

Objective and design:

People living with HIV (PLH) suffer disproportionately from the chronic diseases exacerbated by smoking tobacco. We performed a systematic review and meta-analysis to establish the relative prevalence of smoking among PLH.

Methods:

We included observational studies reporting current smoking rates among PLH and comparators without HIV. We searched Medline, EMBASE, LILACS and SciELO from inception to 31 August 2019. We excluded studies that recruited participants with smoking related illness. We used a random effects model to estimate the odds ratio for current smoking in PLH and people without HIV. We used the Newcastle--Ottawa scale to assess methodological bias. We performed subgroup analysis based on sex and WHO region. We quantified heterogeneity with meta-regression and predictive distributions. PROSPERO registration:CRD42016052608.

Results:

We identified 6116 studies and included 37. Of 111 258 PLH compared with 10 961 217 HIV-negative participants pooled odds of smoking were 1.64 [(95% confidence interval, 95% CI: 1.45–1.85) (95% prediction interval: 0.66–4.10, I
2 = 98.1%)]. Odds for men and women living with HIV were 1.68 [(95% CI: 1.44–1.95) (95% prediction interval: 0.71–3.98, I
2 = 91.1%)] and 2.16 [(95% CI: 1.77–2.63) (95% prediction interval: 0.92–5.07, I
2 = 81.7%)] respectively.

Conclusion:

PLH are more likely to be smokers than people without HIV. This finding was true in subgroup analyses of men, women and in four of five WHO regions from which data were available. Meta-regression did not explain heterogeneity, which we attribute to the diversity of PLH populations worldwide. Smoking is a barrier to PLH achieving parity in life expectancy and an important covariate in studies of HIV-associated multimorbidity.
Epstein-Barr Virus-associated Diffuse Large B-cell Lymphoma Identified in a Breast Implant Capsule
Authors: Malata Charles M. , Madada-Nyakauru Rudo N. , Follows George , Wright Penny
Published: January 2021

Background

Breast implant-associated anaplastic large cell lymphoma is a relatively uncommon T-cell lymphoma with about 900 reported cases worldwide to April 2020 according to the American Society of Plastic Surgeons Breast Implant-Associated Anaplastic Large Cell Lymphoma Physician Resources information.

Case presentation

A 51-year old woman was found to have an Epstein-Barr virus–related diffuse large B-cell lymphoma (EBV-DLCBCL) in her left breast periimplant capsule at the time of a second revision breast implant surgery for recurrent severe capsular contractures following cosmetic breast augmentation 21 years previously. The first revision operation, 15 years earlier, had comprised simple implant exchange from smooth-saline to textured-silicone gel prostheses.

Results

Histopathological and immunohistochemical analyses of the periimplant capsulectomy specimen confirmed a B cell lymphoma which was, in addition, positive for EBV-encoded RNA on in-situ hybridization. Staging investigations including positron emission tomography-computed tomography did not reveal any metastatic disease.

Discussion and Conclusion

Despite recommendations to the contrary (by 2 independent hematological malignancy multidisciplinary teams), the patient has declined explantation of her new breast implants choosing instead to be observed under a watch-and-wait protocol. She remains disease-free 2 years postdiagnosis. To date, a diffuse B-cell lymphoma has never been documented as arising in a breast implant capsule or in association with breast augmentation whether associated with EBV or not. This is the first such report in the world.
Reconstruction of Congenital Alar Rim Defects (Tessier Number 1 Cleft) Using Laterally Based Alar Subunit Rotation Advancement Flap
Authors: Aldabaany Waleed
Published: January 2021

Background

Alar rim defects develop in most cases as a result of burns, trauma, or tumor excision. Congenital alar rim defects are rare, with an incidence of 1 in 20,000 to 40,000 live births. Tessier classification is the most commonly used classification system for craniofacial defects. Facial clefts involving the nose are categorized as types 0, 1, 2, and 3, whereas cranial clefts with nose lesions are categorized as types 11, 12, 13, and 14. The patterns of nasal clefts are extremely variable, ranging from a simple notch of alar margin to complex craniofacial cleft involving the lip, nose, eyelid, brow, forehead, and underlying bone.

Patients and Methods

This study was conducted at Fayoum University Hospital on 8 male patients who present with congenital alar rim defects (Tessier number 1 cleft). Surgeries were performed under general anesthesia with orotracheal intubation. A full-thickness incision was created along the whole alar subunit, keeping the ala attached only laterally (laterally based alar full-thickness flap). The alar flap was advanced and rotated medially and inferiorly and sutured to the anatomical place in 2 layers, skin and mucosa. Follow-up was done at least 1.5 years postoperatively.

Results

The study was conducted on 8 male patients presenting with congenital alar rim defects (Tessier number 1 cleft). The mean age of patients was 14.2 years, and the cleft was unilateral in 4 patients (50%) and bilateral in 4 patients (50%). The patients were assessed both aesthetically and functionally and followed at 1.5 years postoperatively. The aesthetic outcome was assessed according to both patients' and author's evaluations of the scar appearance, alar symmetry, nostril symmetry, and general satisfaction.

Conclusions

Laterally based alar subunit rotation advancement flap is a reliable option for reconstruction of congenital alar rim defects (Tessier number 1 cleft) with the advantages of being an easy single-stage procedure with good tissue matching and nostril symmetry and only limitation of extremely wide defects with deficient tissues between the ala and tip.
Plastic Surgery Across Continents
Authors: Stoehr Jenna R. , Chappell Ava G. , Hassan Abbas , Nthumba Peter , Salyapongse A. Neil
Published: January 2021

There is a demonstrated need for access to plastic surgical care in low- and middle-income countries worldwide. Recently, there is increasing interest in promoting transcontinental partnerships between academic institutions to improve training opportunities for local surgeons while increasing access to care for patients. Before such programs can be established, it is crucial for US-based surgeons and educators to understand the existing training models in different countries. The aim of this study is to identify the current plastic surgery training model in the College of Surgeons of East, Central, and Southern Africa (COSECSA) group of African nations and compare this to training in the United States. The curricula of 2 accrediting bodies of plastic surgery, COSECSA and the Accreditation Council for Graduate Medical Education of the United States, were compared. Similarities included the length of dedicated plastic surgery training, curriculum content, and final evaluation structure. Differences include training pathways, assessment methodology, and regulation regarding specific competencies, program requirements, and resident benefits. These findings establish a baseline understanding of how plastic surgical training is organized, delivered, and evaluated in Africa, highlight opportunities for educational initiatives, and serve as a foundation for future efforts to develop collaborative partnerships in these communities. Future research will include a survey sent to program directors and plastic surgery attendings in the COSECSA regions to gather additional information.
Staged Approach to Autologous Reconstruction in the Ptotic Breast
Authors: Deptula Peter , Yesantharao Pooja , Wapnir Irene , Nguyen Dung
Published: January 2021

Background

Nipple-sparing mastectomy (NSM) and autologous breast reconstruction are associated with higher patient satisfaction, quality of life, and aesthetic outcome. For patients with naturally ptotic breasts, this ideal reconstructive treatment of NSM and autologous breast reconstruction poses a challenge. We describe our experience in treating patients with ptotic natural breasts using a 2-staged approach: oncoplastic breast reduction in the first stage followed by nipple-sparing mastectomy and immediate autologous reconstruction in a second stage.

Methods

We reviewed cases of patients with grade III ptosis who underwent a staged reconstruction approach with reduction mammaplasty followed by NSM and immediate reconstruction with an abdominally based free flap (2014–2019). We compared this group of patients to a second group who underwent staging with a technique of nipple-areola complex (NAC) devascularization. A survey was administered to assess for patient satisfaction and aesthetic outcome 1 year after the second stage procedure.

Results

Eight patients were identified in our reduction group, and 9 patients were identified in our devascularization group. No cases of total NAC necrosis were noted in either group (0%). Two cases of partial NAC necrosis were noted in the devascularization group (11%), whereas none were observed in the reduction group. All patients were satisfied with final outcome (100%, P = 1.0). Aesthetic scores across all factors were higher in the reduction group. Scores for overall outcome (4.6 vs 3.7, P = 0.04), natural appearance (4.8 vs 3.8, P = 0.01), breast contour (4.8 vs 3.2, P = 0.002), and position of breasts (5.0 vs 3.9, P = 0.03) were significantly higher in the reduction group.

Conclusions

Breast ptosis no longer represents a contraindication for patients desiring nipple-sparing mastectomy and immediate autologous reconstruction. This series supports the use of a 2-staged approach with reduction mammaplasty in patients with naturally ptotic breasts. A staged reduction approach may offer fewer NAC complications while also allowing for superior aesthetic outcomes.
Modeling Performance of Open Surgical Cases
Authors: Azari David P. , Frasier Lane L. , Miller Brady L. , Pavuluri Quamme Sudha R. , Le Brian V. , Greenberg Caprice C. , Radwin Robert G.
Published: January 2021

Introduction

Previous efforts used digital video to develop computer-generated assessments of surgical hand motion economy and fluidity of motion. This study tests how well previously trained assessment models match expert ratings of suturing and tying video clips recorded in a new operating room (OR) setting

Methods

Enabled through computer vision of the hands, this study tests the applicability of assessments born out of benchtop simulations to in vivo suturing and tying tasks recorded in the OR.

Results

Compared with expert ratings, computer-generated assessments for fluidity of motion (slope = 0.83, intercept = 1.77, R
2 = 0.55) performed better than motion economy (slope = 0.73, intercept = 2.04, R
2 = 0.49), although 85% of ratings for both models were within ±2 of the expert response. Neither assessment performed as well in the OR as they did on the training data. Assessments were sensitive to changing hand postures, dropped ligatures, and poor tissue contact—features typically missing from training data. Computer-generated assessment of OR tasks was contingent on a clear, consistent view of both surgeon's hands.

Conclusions

Computer-generated assessment may help provide formative feedback during deliberate practice, albeit with greater variability in the OR compared with benchtop simulations. Future work will benefit from expanded available bimanual video records.
Measuring quality of life in older people with cancer
Authors: Fitch Margaret I. , Strohschein Fay J. , Nyrop Kirsten
Published: January 2021

Purpose of review

The number of individuals aged 65+ with cancer will double in the next decade. Attention to quality of life (QOL) is imperative to identify relevant endpoints/outcomes in research and provide care that matches individual needs. This review summarizes recent publications regarding QOL measurement in older adults with cancer, considering implications for research and practice.

Recent findings

QOL is a complex concept and its measurement can be challenging. A variety of measurement tools exist, but only one specific to older adults with cancer. QOL is frequently measured as functional health, adverse symptoms, and global QOL, thus only capturing a portion of this concept. Yet successful QOL intervention for older adults requires drawing from behavioral and social dimensions.

Growing interest in comprehensive geriatric assessment (CGA) and patient-reported outcomes (PROs) provides important opportunities for measuring QOL. Recommendations for use of CGAs and PROs in clinical practice have been made but widespread uptake has not occurred.

QOL is important to older adults and must be central in planning and discussing their care. It is modifiable but presents measurement challenges in this population. Various domains are associated with decline, survival, satisfaction with life, coping, and different interventions. Measurement approaches must fit with intention and capacity to act within given contexts.
Direct admission versus transfer to a tertiary hospital for definitive management of lower extremity injuries: Systematic review and meta-analysis
Authors: Klifto Kevin M. , Azoury Saïd C. , Othman Sammy , Klifto Christopher S. , Levin L. Scott , Kovach Stephen J.
Published: January 2021

BACKGROUND

Delays in definitive management for traumatic lower extremity injuries may result in morbidity. We compared patients with lower extremity injuries directly admitted to a tertiary hospital for definitive care with patients transferred to that hospital following initial treatment elsewhere.

METHODS

PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were searched. Participants sustained lower extremity injuries, definitively treated at a tertiary hospital. Interventions were direct admission to a tertiary hospital for definitive care and patients transferred to that hospital for definitive care after initial management at another location. PRISMA, Cochrane, and grading of recommendations assessment, development and evaluation certainty-evidence guidelines were implemented.

RESULTS

Nineteen studies published from 1991 to 2020 compared 3,367 patients directly admitted with 1,046 patients transferred to a hospital for definitive management of lower extremity injuries. Direct admission to a tertiary center, compared with transfer, decreased time to first definitive surgical procedure (standard mean difference, −0.36; 95% confidence interval [CI], −0.57 to −0.16; p = 0.0006; participants, 788; studies, 6; I
2 = 34%; high-certainty evidence) and wound infections (risk ratio [RR], 0.38; 95% CI, 0.19–0.77; p = 0.007; participants, 475; studies, 7; I
2 = 27%; high-certainty evidence). Risks for diabetic patients (RR, 0.87; 95%CI, 0.77–0.98; p = 0.03; participants, 2,973; studies, 4; I
2 = 0%; moderate-certainty evidence), total number of surgeries (standard mean difference, −0.69; 95% CI, −1.02 to −0.36; p < 0.0001; participants, 259; studies, 4; I
2 = 35%; moderate-certainty evidence), osteomyelitis (RR, 0.47; 95% CI, 0.28–0.80; p = 0.006; participants, 212; studies, 2; I
2 = 0%; moderate-certainty evidence), and total complications (RR, 0.47; 95% CI, 0.32–0.67; p < 0.0001; participants, 729; studies, 5; I
2 = 32%; moderate-certainty evidence) are likely lower for direct admits compared with transfers. Direct admission may reduce risks for systemic infections (RR, 0.08; 95% CI, 0.01–0.51; p = 0.007; participants, 198; studies, 2; I
2 = 0%; low-certainty evidence), venous thromboembolism (RR, 0.09; 95% CI, 0.01–0.73; p = 0.02; participants, 94; studies, 1; low-certainty evidence), and postoperative bleeding (RR, 0.74; 95% CI, 0.59–0.93; p = 0.01; participants, 2,725; studies, 3; I
2 = 0%; low-certainty evidence), compared with transfer.

CONCLUSION

Earlier admission to a definitive tertiary center avoids morbidity associated with transfer delays.

LEVEL OF EVIDENCE

Systematic Review/meta-analysis, level III.
Poststroke Effects on Power Production in Older Adults
Authors: Hood Ethan , Klima Dennis W.
Published: January 2021

Muscular power is an important performance component to emphasize in older adults following stroke. Aging affects neuromuscular function reducing strength and power; in turn, this loss is exacerbated in clients with stroke. Stroke can impact both ipsilateral and contralateral extremity power production, which correlates with reduced function in gait, transfers, and impaired hand use. A variety of objective clinical tests assess lower extremity power production. Studies demonstrate that exercise regimens that improve muscular power improve function poststroke. Future research should focus on best practice interventions to maximize extremity power in this population of older adults.
Power Training for Improvement of Postural Stability and Reduction of Falls in Individuals With Parkinson Disease
Authors: Malin Kimberly
Published: January 2021

Recurrent falls are common in persons with Parkinson disease (PD), and a decrease in lower extremity (LE) power is predictive of falls in the general population of older adults. To date, we are unaware of a synthesis of the literature pertaining to power training, postural stability, and falls in persons with PD. This narrative review synthesizes current literature related to the effect of LE power training on postural stability and falls in older adults with PD. There is limited yet compelling evidence to support an association between LE power and the performance of balance and mobility tasks in persons with PD. A need for further research is indicated to determine the strength of the relationship between improved power output, LE power symmetry, and falls reduction in individuals with PD.
Power Training in Older Adults With Knee Osteoarthritis
Authors: Corkery Marie B. , Hensley Craig P. , Danilovich Margaret K. , Davila Victoria S. , Chui Kevin K.
Published: January 2021

Knee osteoarthritis (OA) is the leading cause of chronic pain and disability in older adults. It impacts both muscle strength and power, contributing to decreased functional mobility. Exercise interventions such as power training are recommended for persons with knee OA. The aim of this literature review was to investigate outcomes following power training as a rehabilitation approach for knee OA. Power training resulted in improved outcomes for persons with knee OA. Power training may be a safe and useful addition to exercise programs for older adults with knee OA. Additional research is needed to determine optimal exercises, dosage, and intensity.
Impact of Physiotherapy Absence in COVID-19 Pandemic on Neurological State of Patients With Parkinson Disease
Authors: Kapel Alen , Serdoner Domen , Fabiani Ester , Velnar Tomaz
Published: January 2021

The purpose of this study was to demonstrate the impact of COVID-19 pandemic restrictions on patients with Parkinson disease in the absence of physiotherapy interventions. We analyzed 42 patient surveys on motor and mental aspects in the neurological state. The survey was conducted in 3 primary care–level clinics specialized in neurological rehabilitation in the seventh week of COVID-19 restrictions, which started on March 13, 2020. A number of deteriorations, worsening of disorder, and emerging conditions were found. The absence of physiotherapy interventions in COVID-19 restrictions had a significant multidimensional impact on the neurological state of patients with Parkinson disease.
A reappraisal of injuries and accidents in people with epilepsy
Authors: Asadi-Pooya Ali A. , Tomson Torbjörn
Published: January 2021

Purpose of review

We review data on injuries and traffic accidents affecting people with epilepsy with emphasis on the overall risk of injuries, specific types of injuries, and risk factors.

Recent findings

Population-based studies of incident epilepsy cohorts indicate that the risk of physical injuries in people with epilepsy in general is increased only modestly. The risk is higher in selected populations that attend epilepsy clinics or referral centers. Soft tissue injuries, dislocations, and fractures are the most common injures, whereas the greatest increase in risk is reported for more uncommon injuries such as drowning. People with epilepsy are at a two-fold to four-fold increased risk for fatal injuries. Comorbidities contribute to fatal as well as nonfatal injuries. The other major risk factor is poorly controlled major convulsive seizures (generalized as well as focal to bilateral tonic-clonic seizures). Serious transport accidents associated with increased risks for people with epilepsy include pedestrian, bicycle, as well as car accidents.

Individualized information on the risk of physical injuries and accidents should be part of counseling of patients with epilepsy. Improved seizure control is likely the most effective way to reduce risks, but work place and home adjustments should also be considered.
Serotonergic therapy in epilepsy
Authors: Gilliam Frank G. , Hecimovic Hrvoje , Gentry Matthew S.
Published: January 2021

Purpose of review

The serotonergic system is implicated in multiple aspects of epilepsy, including seizure susceptibility, sudden unexpected death in epilepsy (SUDEP), and comorbid depression. Despite the complexity of serotonin's effects on various neuronal networks, ongoing research provides considerable insight into the role of serotonin in human epilepsy. This review explores the potential roles of serotonergic therapies to improve clinical outcomes in epilepsy.

Recent findings

In recent decades, research has markedly increased our knowledge of the diverse effects of serotonin on brain function. Animal models of epilepsy have identified the influence of serotonin on seizure threshold in specific brain regions, serotoninergic augmentation's protective effects on terminal apnea and mortality in SUDEP, and mechanisms underlying behavioral improvement in some models of comorbid depression. Human clinical studies are largely consistent with animal data but the translation into definitive treatment decisions has moved less rapidly.

Evidence for serotonergic therapy is promising for improvement in seizure control and prevention of SUDEP. For some epilepsies, such as Dravet syndrome, basic research on serotonin receptor agonists has translated into a positive clinical trial for fenfluramine. The cumulative results of safety and efficacy studies support the routine use of SSRIs for comorbid depression in epilepsy.