bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Ethical Challenges in Medical Education Research
Authors: Klitzman Robert L.
Published: July 2021

Rapidly advancing biomedical and electronic technologies, ongoing health disparities, and new online educational modalities are all changing medicine and medical education. As medical training continues to evolve, research is increasingly critical to help improve it, but medical education research can pose unique ethical challenges.

As research participants, medical trainees may face several risks and in many ways constitute a vulnerable group. In this commentary, the author examines several of the ethical challenges involved in medical education research, including confidentiality and the risk of stigma; the need for equity, diversity, and inclusion; genetic testing of students; clustered randomized trials of training programs; and questions about quality improvement activities. The author offers guidance for navigating these ethical challenges, including the importance of engaging with institutional review boards. Academic medical institutions should educate and work closely with faculty to ensure that all research adheres to appropriate ethical guidelines and regulations and should provide instruction about the ethics of medical education research to establish a strong foundation for the future of the field.

Research on medical education will become increasingly important. Given the potential sensitivity of the data collected in such research, investigators must understand and address potential ethical challenges as carefully as possible.
A Comparative Study of a Novel Postural Garment Versus Exercise for Women with Nonspecific Cervical Pain
Authors: Avellanet Merce , Boada-Pladellorens Anna , Pages Esther , Dorca Aleix , Sabria Betlem , Pfeifer Michael , Gea Elvira
Published: July 2021

Study Design.

Randomized cross-over study.

Objective.

The aim of this study was to compare exercise, the criterion standard, to the postural garment PosturePlusForce in the management of nonspecific cervical pain in women. We also analyzed both interventions with regards to baseline posture, use of pharmacological pain relievers, compliance, and comfort.

Summary of Background Data.

The prevalence of neck pain has increased during the last decade, preferentially affecting women. Those suffering from this condition may manifest a decrease in quality of life and inability to work. Consistent recommendations highlight the importance of exercise and posture for neck pain improvement.

Methods.

A total of 32 female health care professionals with cervical pain (≥3 on the visual analogue scale) entered the trial. Participants were allocated to either performing exercises or wearing the postural garment. The cross-over between interventions was separated by a 3-month washout period. Primary outcomes included pain intensity and posture. Secondary outcomes comprised cervical pain-related disability, psychological factors, physical activity, global perceived effect of treatment, and garment comfort. Treatment compliance, medication use, and adverse events were also recorded.

Results.

Both interventions showed a significant improvement in pain in subjects with an adherence >60%. However, in participants with dorsal hyperkyphosis (>45°), the garment demonstrated a greater reduction in pain than exercise (P = 0.019). Additionally, those wearing the garment needed fewer pain relievers than those performing exercises (P = 0.007). Compliance was >50% for both interventions and comfort was contingent on season.

Conclusion.

In our study, PosturePlusForce showed, at least, a similar effect on pain to exercise, although those with dorsal hyperkyphosis exhibited a greater reduction in pain and related variables with the garment. Pain relievers were less required by those wearing PosturePlusForce than by those performing the exercises.

Level of Evidence: 1
Primary Idiopathic Cutaneous Intestinal Metaplasia: First Case
Authors: Fernandez-Flores Angel , Cassarino David
Published: July 2021

Cutaneous intestinal either metaplasia or ectopia has mostly been described around intestinal stomas or in patients with Crohn disease. In this study, we described a unique case of cutaneous metaplasia on the elbow of a 25-year-old man who had a clinical history of epidermolysis bullosa simplex, but had no history of any gastrointestinal disease. The lesion had been clinically stable for 5 years. Histopathologically, the epithelium showed many columnar cells with mucinous cytoplasm, with no atypia or mitoses. The proliferation rate was low (7% by Ki67). The metaplastic areas expressed epithelial membrane antigen, carcinoembryonic antigen, cytokeratin 7, MUC5AC, MUC2, and Cyclin-D1.
Disparities in Elevated Body Mass Index in Youth Receiving Care at Community Health Centers
Authors: Mohanty Nivedita , Padilla Roxane , Leo Michael C. , Tilmon Sandra , Akhabue Ehimare , Rittner Sarah S. , Crawford Phillip , Okihiro May , Persell Stephen D.
Published: July 2021

Childhood obesity has increased significantly in the United States. Racial subgroups are often grouped into categories in research, limiting our understanding of disparities. This study describes the prevalence of obesity among youth of diverse racial and ethnic backgrounds receiving care at community health centers (CHCs). This cross-sectional study describes the prevalence of elevated body mass index (BMI) (≥85th percentile) and obesity (≥95th percentile) in youth aged 9 to 19 years receiving care in CHCs in 2014. Multilevel logistic regression estimated the prevalence of elevated BMI and obesity by age, race/ethnicity, and sex. Among 64 925 youth, 40% had elevated BMI and 22% were obese. By race, obesity was lowest in the combined Asian/Pacific Islander category (13%); however, when subgroups were separated, the highest prevalence was among Native Hawaiians (33%) and Other Pacific Islanders (42%) and the lowest in Asians. By sex, Black females and Hispanic and Asian males were more likely to be obese. By age, the highest prevalence of obesity was among those aged 9 to 10 years (25%). Youth served by CHCs have a high prevalence of obesity, with significant differences observed by race, sex, and age. Combining race categories obscures disparities. The heterogeneity of communities warrants research that describes different populations to address obesity.
Community-Driven Prioritization of Primary Health Care Access Issues by Bangladeshi-Canadians to Guide Program of Research and Practice
Authors: Turin Tanvir C. , Haque Sarika , Chowdhury Nashit , Yeasmin Fahmida , Ferdous Mahzabin , Rashid Ruksana , Rumana Nahid , Rahman Nafiza , Rahman Afsana , Lasker Mohammad , Chowdhury Mohammad
Published: July 2021

Research around probable solutions to immigrants accessing health care in Canada is not extensive, and the perspective of immigrant communities on priorities and potential solutions has not been captured effectively. The purpose of this article is to describe a research initiative that involved grassroots community members as producers of research priorities on primary care access issues. This study aimed to seek input from an immigrant community in Calgary, Canada. Members of the Bangladeshi community of Calgary were asked through a survey to rank 10 predefined primary care access topics as to what they felt constituted priorities for solution-oriented research (1, highest; 10, lowest). We used frequencies and percentages to describe the participant demographics. Ratings of preferred research themes were analyzed on the basis of relative weighted priority rank. We received 432 responses: 51.2% female; 58.9% aged 36 to 55 years; 90.5% had university-level education; 46.2% immigrated to Canada between 10 and 19 years ago; 82.5% employed full/part-time or self-employed. Lack of resources, lack of knowledge, health care cost, and workplace-related barriers were among the top-ranked topics identified as solution-oriented research priorities. Through partnerships and reciprocal learning, public input can increase insider perspectives to help develop interventions that align with the needs of community members.
Transgender Medicine and Hormone Therapy: What the Gynecologist Needs to Know
Authors: Wilde Melyssa , Huguelet Patricia , Alaniz Veronica I.
Published: July 2021

The transgender community comprises individuals with diverse identities in both gender and sexual orientation. Unfortunately, many face discrimination and harassment within our society—including within the medical system. There is an overall lack of provider training in transgender specific health which has led to health disparities and inequities within this population. This chapter aims to elucidate the medical needs unique to transgender and gender nonconforming individuals and thus enable medical providers to meet those needs with competency and compassion.
Environmental Correlates of Physical Activity, Sedentary Behavior, and Self-Rated Health in Chronic Obstructive Pulmonary Disease
Authors: Stevens Daniel , Andreou Pantelis , Rainham Daniel
Published: July 2021

Purpose:

Physical activity (PA) predicts important health outcomes in chronic obstructive pulmonary disease (COPD). In the general population, environmental factors have the potential to influence PA; however, data are limited in this clinical population. Therefore, we sought to investigate associations between the environment and PA, sedentary behavior, and self-rated health in COPD.

Methods:

Sociodemographic, PA, sedentary behavior, and self-rated health data were collected from a prospective cohort of 418 individuals with COPD (65% female; 58 ± 8 yr), while environmental data were drawn from a national environmental data repository and individually matched to participant postal code. Environmental variables included social and material deprivation, urban form index, surrounding greenness, and air quality (concentrations of air pollution for fine particles, nitrogen dioxide, ozone, and sulphur dioxide). Logistic and multivariate linear regression models were used to investigate the strongest environmental predictors.

Results:

The models showed a statistically significant negative correlation between PA level and ozone pollution (P = .023; adjusted OR = 0.85: 95% CI, 0.74-0.98). Urban form index was also significantly associated with sedentary behavior (β = 0.113; t value = 1.71; P = .011). Self-rated health was significantly positively correlated with PA level (P = .006; adjusted OR = 2.22: 95% CI, 1.25-3.94), and significantly inversely correlated with sedentary behavior (β = −0.159; t value =−2.42; P = .016).

Conclusion:

These new data may identify barriers to PA and assist clinicians in the prescription of exercise for individuals living with COPD.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS OF CLASSIC CHOROIDAL NEOVASCULARIZATION IN POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Izumi Takahiko , Koizumi Hideki , Maruko Ichiro , Hasegawa Taiji , Iida Tomohiro
Published: July 2021

Purpose:

To evaluate the flow signals in subretinal hyperreflective material (SHRM) that represents classic choroidal neovascularization (CNV) on fluorescein angiography in eyes with polypoidal choroidal vasculopathy.

Methods:

We retrospectively reviewed 20 eyes with polypoidal choroidal vasculopathy that appeared to have classic CNV on fluorescein angiography, accompanied by SHRM on optical coherence tomography (OCT) at the same location. Using OCT angiography (OCTA), we analyzed intrinsic flow signals in the SHRM (cross-sectional B-scans and en face). The possible association between pretreatment OCT angiography findings and fibrotic scar formation after antivascular endothelial growth factor (VEGF) treatment was evaluated.

Results:

Six of 20 eyes (30%) showed vascular SHRM; the remaining 14 eyes (70%) showed avascular SHRM at the classic CNV site at baseline. The SHRM corresponded with polypoidal lesions seen on indocyanine green angiography in 5 of 6 eyes with vascular SHRM and in all 14 eyes with avascular SHRM. After anti-VEGF treatment, all 6 eyes with vascular SHRM left a fibrotic scar, whereas all 14 eyes with avascular SHRM showed no scar formation (P < 0.001).

Conclusion:

Using OCT angiography, we evaluated the flow signals in SHRM that represented classic CNV in eyes with polypoidal choroidal vasculopathy and successfully differentiated true Type 2 macular neovascularization from pseudo classic CNV.
SALIVARY ALPHA-AMYLASE LEVELS MAY CORRELATE WITH CENTRAL SEROUS CHORIORETINOPATHY ACTIVITY
Authors: Scholz Paula , Altay Lebriz , Sitnilska Vasilena , van Dijk Elon H. C. , Pereira Alberto M. , van Haalen Femke M. , Akhtar Isha , Boon Camiel J. F. , Fauser Sascha
Published: July 2021

Purpose:

To investigate and compare the salivary alpha-amylase (sAA) activity as an indicator of the sympathetic activity and stress response in patients with central serous chorioretinopathy (CSC) and healthy control subjects.

Methods:

Prospective multicenter case series, including 80 CSC patients and 88 healthy control subjects. Central serous chorioretinopathy status was classified as either active or inactive, depending on the presence of subretinal fluid on optical coherence tomography. Salivary samples were collected in the morning from patients and control subjects of the main cohort and at midnight for the additional cohort. Salivary alpha-amylase activity was determined in all patients and control subjects.

Results:

Morning sAA activity was significantly higher in patients with active CSC compared with inactive CSC (P = 0.049) and to healthy control subjects (P = 0.012). There was no significant difference in sAA activity between patients with inactive CSC and control subjects (P = 1.0). Nocturnal sAA activity did not show any significant difference between patients with active CSC and either inactive CSC or control subjects (P = 0.139).

Conclusion:

Morning sAA activity is increased in patients with active CSC, although diurnal rhythmicity is preserved. Measurement of sAA is easy to perform and might be an eligible tool to further investigate the relation between stress and CSC.
THE IMPACT OF DISEASE ACTIVITY ON 5-YEAR OUTCOMES IN PATIENTS UNDERGOING TREATMENT FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Chong Teo Kelvin Yi , Nguyen Vuong , Gemmy Cheung Chui Ming , Arnold Jennifer J. , Chen Fred K. , Barthelmes Daniel , Gillies Mark C.
Published: July 2021

Purpose:

To assess the impact of disease activity on clinical outcomes in a “real-world” cohort with neovascular age-related macular degeneration over 5 years.

Methods:

Data were obtained from the prospectively defined Fight Retinal Blindness! registry. Eyes were divided into tertiles based on the proportion of visits where choroidal neovascular lesion was active (low, moderate, and high) up until 5 years.

Results:

Data from 2,109 eyes were included. The adjusted mean (95% confidence interval) visual acuity change was −0.5 letters (−1.8 to 1.1), 1.8 letters (0.2 to 3.4), and −2.5 letters (−4.2 to −1.3) in the low, moderate, and high activity groups respectively, P < 0.001. Eyes in the low activity group were more likely to develop macular atrophy (56, 47 and 26% in the low, moderate, and high activity groups respectively, P < 0.001) but less likely to develop subretinal fibrosis (27, 35 and 42% in the low, moderate, and high activity groups respectively, P < 0.001).

Conclusion:

Eyes with higher and lower levels of disease activity had poorer outcomes than eyes with moderate activity over 5 years, apparently because of the development of subretinal fibrosis or macular atrophy.
Lateral Wall Implant as an Adjunct to Lateral Wall Orbital Decompression in Severe Thyroid Eye Disease
Authors: Men Clara J. , Gur Zvi , Ko Audrey C. , Liu Catherine Y. , Korn Bobby S. , Kikkawa Don O.
Published: July 2021

Purpose:

To describe the use of a lateral wall implant as an adjunct in lateral orbital wall decompression in severe thyroid eye disease.

Methods:

This study is a retrospective review of 6 patients who underwent prior orbital decompression but had persistent proptosis. These patients underwent lateral wall decompression with adjunct lateral wall implant placement with a manually vaulted 0.6-mm polyethylene-coated titanium mesh implant. Data collection included: visual acuity, intraocular pressure, exophthalmometry, ocular motility, eyelid position, and complication rates.

Results:

Eight orbits in 6 patients underwent maximal lateral wall decompression and reconstruction using the polyethylene-coated titanium implant. Four males and 2 females were included with ages ranging from 25 to 73 years. Visual acuity improved an average of 2.4 lines (range 0–5 lines). Intraocular pressure improved an average of 7.5 mm Hg (2–13 mm Hg). There was reduction of proptosis by 3.4 mm on average (1–7 mm). Upper eyelid retraction improved on average by 1.8 mm (0–5 mm). Horizontal eye movements improved by 11% on average (−3.1% to +25%). Excellent cosmesis was achieved with no visible temple deformity, trismus, conjunctival scarring, orbital hemorrhage, or vision loss.

Conclusions:

The amount of volume created in lateral wall decompression is limited by the amount of native bone present and the temporalis muscle. In severe or recalcitrant cases, the authors propose the placement of a lateral wall implant as an adjunct to laterally displace the temporalis muscle and create additional volume. This technique accomplishes further reduction of proptosis in patients who have undergone prior orbital decompression.
Periocular Presentation of Solitary Plasmacytomas and Multiple Myeloma
Authors: Zloto Ofira , Vahdani Kaveh , Stack Rebecca , Verity David H. , Rose Geoffrey E.
Published: July 2021

Aims:

To describe patients with periocular solitary extramedullary plasmacytoma (SEMP) and multiple myeloma (MM), together with an estimate of the risk of progression from SEMP to MM.

Patients and methods:

A retrospective case-note review for patients seen between 1978 and 2020, examining demographics, presentation, imaging, pathology, management, and outcome.

Results:

Twenty patients (10 male; 50%) presented at a mean age of 60.9 years, with an average symptom duration of 4.5 months. Ten (50%) patients had known systemic myeloma at ophthalmic presentation (the MM group) and, on average, they presented one decade earlier than those with occult MM discovered after orbital biopsy (p = 0.06); the majority (9/15; 60%) of patients with MM were female, whereas there was a male bias (4/5; 80%) with SEMP (p = 0.30). Most tumors (15/20; 75%) were within the anterior part of the orbit, especially superolaterally (16 patients; 80%), and the soft-tissue mass often appeared to “explode” from the frontal bone or greater wing of the sphenoid (16/20; 80%). Full treatment details were known for 19 patients: 6 (32%) had solely orbital radiotherapy, 4 (21%) chemotherapy, 6 (32%) combined chemoradiation, and 3 (16%) had combined chemoradiation with stem-cell transplant (Table 3). After an average follow up of 58 months, 1/5 (20%) patients with SEMP and 11/15 (73%) with MM had tumor-related death. The overall survival probability for all 20 patients with periocular plasmacytoma was 34% at 5 and 10 years, with MM patients having a worse outlook (27% 5-year, and 18% 10-year survival) compared with SEMP (53% survival at 5 and 10 years) (p = 0.18). None of the 5 patients with SEMP progressed to systemic MM over an average follow up of 9.1 years.

Conclusions:

Although 50% patients with periocular plasmacytoma appear to have a SEMP at ophthalmic presentation, a half of these patients were found to have occult MM within 6 months of biopsy. Of those without systemic disease around the time of biopsy, none developed MM over an average follow up of more than 9 years.
Effects of atorvastatin doses on serum level of procalcitonin and predictors for major adverse cardiovascular events in patients with acute myocardial infarction: a pilot study and post hoc analysis
Authors: Hu Jing , Yang Changchun , Yang Guirong , Du Huashuang , Zhao Haibin , Liu Huiliang
Published: July 2021

Background

Inflammation plays an important role in acute myocardial infarction (AMI). Procalcitonin levels rise in response to proinflammatory stimuli. This study aimed to investigate the effects of different doses of atorvastatin on the serum inflammatory profiles, especially procalcitonin and major adverse cardiovascular events (MACEs) in patients with AMI during hospitalization.

Methods

The patients who were admitted to the Coronary Care Unit of The Third Medical Center of PLA General Hospital (Beijing, China) between January 2015 and December 2015 with a diagnosis of AMI were enrolled, and randomized to atorvastatin 20 mg/day postoperatively (20-mg group), 40 mg/day postoperatively (40-mg group) and 80 mg preoperatively+40 mg/day postoperatively (80/40-mg group). Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) were evaluated before and at 1 and 3 days after percutaneous coronary intervention (PCI).

Results

A total of 112 patients with AMI (23 women and 89 men) were prospectively eligible for the study. There were no significant differences in most clinical data among the three groups. The 80/40-mg group showed significantly reduced serum procalcitonin levels at 1 and 3 days after PCI (P < 0.001) and reduced hs-CRP levels at 3 days P = 0.001) compared with 20-mg and 40-mg groups. Serum procalcitonin (OR, 4.593; 95% CI, 1.476–8.387; P = 0.005), hs-CRP (OR, 1.149; 95% CI, 1.012–1.338; P = 0.018), highly sensitive cardiac troponin T (OR, 1.255; 95% CI, 1.004–1.569, P = 0.009) and Gensini score (OR, 1.022; 95% CI, 1.045–1.062; P = 0.013) were independently associated with MACEs during hospitalization.

Conclusion

The use of atorvastatin 80 mg before and 40 mg/day after PCI in patients with AMI can effectively reduce serum inflammatory factors. procalcitonin and hs-CRP were independently associated with in-hospital MACEs.
Sepsis in patients hospitalized with coronavirus disease 2019: how often and how severe?
Authors: da Silva Ramos Fernando Jose , de Freitas Flávio Geraldo Rezende , Machado Flavia Ribeiro
Published: July 2021

Purpose of review

To discuss why severe COVID-19 should be considered sepsis and how co-infection and secondary infection can aggravate this condition and perpetuate organ dysfunction leading to high mortality rates.

Recent findings

In severe COVID-19, there is both direct viral toxicity and dysregulated host response to infection. Although both coinfection and/or secondary infection are present, the latest is of greater concern mainly in resource-poor settings. Patients with severe COVID-19 present a phenotype of multiorgan dysfunction that leads to death in an unacceptable high percentage of the patients, with wide variability around the world. Similarly to endemic sepsis, the mortality of COVID-19 critically ill patients is higher in low-income and middle-income countries as compared with high-income countries. Disparities, including hospital strain, resources limitations, higher incidence of healthcare-associated infections (HAI), and staffing issues could in part explain this variability.

The high mortality rates of critically ill patients with severe COVID-19 disease are not only related to the severity of patient disease but also to modifiable factors, such as the ICU strain, HAI incidence, and organizational aspects. Therefore, HAI prevention and the delivery of best evidence-based care for these patients to avoid additional damage is important. Quality improvement interventions might help in improving outcomes mainly in resource-limited settings.
Systematic Review of Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes
Authors: Chircop James , Sheffield David , Kotera Yasuhiro
Published: July 2021

Background

The benefit of self-monitoring of blood glucose in reducing HbA1c in non-insulin-treated participants remains unclear. HbA1c may be improved in this population with said self-monitoring.

Objective

The aim of this study was to conduct meta-analyses of glycemic control in non-insulin-treated participants with Type 2 diabetes: self-monitoring of blood glucose versus usual care, structured versus unstructured self-monitoring of blood glucose, and use of self-monitoring of blood glucose readings by clinicians to adjust (or modify) therapy versus usual care.

Methods

MEDLINE, Embase, and Cochrane Central were electronically searched to identify articles published from January 1, 2000, to June 30, 2020. Trials investigating changes in HbA1c were selected. Screening was performed independently by two investigators. Two investigators extracted HbA1c at baseline and follow-up for each trial.

Results

Nineteen trials involving 4,965 participants were included. Overall, self-monitoring of blood glucose reduced HbA1c. Preplanned subgroup analysis showed that using self-monitoring of blood glucose readings to adjust therapy contributed significantly to the reduction. No significant improvement in HbA1c was shown in self-monitoring of blood glucose without therapy adjustment. The same difference was observed in structured versus unstructured self-monitoring of blood glucose.

Discussion

HbA1c is improved with clinician therapy modification based on structured self-monitoring of blood glucose readings. Implications are for clinicians to prescribe structured self-monitoring of blood glucose to modify therapy based on the readings and not prescribe unstructured self-monitoring of blood glucose. Participants with suboptimal glycemic control may benefit most. A self-monitoring of blood glucose regimen that improves clinical and cost-effectiveness is presented. Future studies can investigate this regimen specifically.
Return to Work and Associated Costs after Treatment for Dupuytren’s Disease
Authors: Blake Shacara N. , Poelstra Ralph , Andrinopoulou Eleni-Rosalina , Obdeijn Miryam C. , van de Oest Mark J. W. , Feitz Reinier , Burdorf Alex , Selles Ruud W.
Published: July 2021

Background:

Return to work is potentially an important factor in assessing the success of treatment. However, little is known about the return to work after treatment for Dupuytren’s contracture. Therefore, the primary aim of this study was to assess return to work after limited fasciectomy and percutaneous needle fasciotomy.

Methods:

Patients who underwent either a limited fasciectomy or percutaneous needle fasciotomy were invited to complete a return-to-work questionnaire at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Median time to return to work was assessed using inverted Kaplan-Meier curves, and hazard ratios were calculated with Cox regression models. Finally, a cost analysis was carried out using the human capital method to determine indirect costs associated with loss of productivity.

Results:

The authors included 2698 patients in the study, of which 53 percent were employed at intake and included in the follow-up. After 1 year of follow-up, 90 percent of the patients had returned to work. Median time to return to work was 2 weeks after limited fasciectomy and within days after percutaneous needle fasciotomy. Furthermore, physically strenuous work, female sex, and higher age were associated with a longer time to return to work. Lost productivity per patient was estimated at €2614.43.

Conclusions:

The majority of patients returned to work after treatment for Dupuytren’s disease. Return to work is much faster after percutaneous needle fasciotomy compared to limited fasciectomy. These findings can be used for more evidence-based preoperative counseling with patients with Dupuytren’s disease.
Induced Beige Adipocytes Improved Fat Graft Retention by Promoting Adipogenesis and Angiogenesis
Authors: Xia Jing , Zhu Huidong , Zhu Shengqian , Ge Jinbo , Wang Zijue , Lu Feng , Liao Yunjun , Cai Junrong
Published: July 2021

Background:

Fat grafting is commonly used in treating soft-tissue defects. However, the basic biology behind fat grafting is still not fully understood. Evidence of adipose browning into beige adipose tissue after fat grafting was revealed, but its role in fat grafting remains unclear.

Methods:

Induced beige adipocytes and adipose-derived stem cells were obtained from human lipoaspirates and labeled with green fluorescent protein. Nude mice were each injected with 300 mg of human lipoaspirate containing green fluorescent protein–labeled adipose-derived stem cells, green fluorescent protein–labeled induced beige adipocytes, or phosphate-buffered saline. Grafted fat was harvested after 1, 4, 8, and 12 weeks for immunohistochemistry and histologic examination. Graft retention, vascularization, and adipogenic gene expression were compared.

Results:

After 7 days’ induction, adipocytes achieved browning with multilocular lipid droplets, increased mitochondria, and up-regulated browning gene expression. Fat graft retention rates at week 12 were significantly higher after injection of induced beige adipocytes than after injection of phosphate-buffered saline (46.0 ± 4.9 percent versus 31.0 ± 3.6 percent; p = 0.01), but were similar after injection of induced beige adipocytes and adipose-derived stem cells (p > 0.05). Induced beige adipocytes underwent rewhitening into white adipocytes and showed up-regulation of peroxisome proliferator-activated receptor-γ expression. Induced beige adipocytes enhanced angiogenesis, but were not active in forming vessel structures.

Conclusions:

Induced beige adipocytes and adipose-derived stem cells were comparable in improving fat graft retention rates. Induced beige adipocytes promote angiogenesis in a paracrine manner and are prone to rewhitening after fat grafting.
Chronic Stress Burden, Visceral Adipose Tissue, and Adiposity-Related Inflammation: The Multi-Ethnic Study of Atherosclerosis
Authors: Delker Erin , AlYami Bandar , Gallo Linda C. , Ruiz John M. , Szklo Moyses , Allison Matthew A.
Published: July 2021

Objective

We investigated the role of chronic stress burden on adiposity and adiposity-related inflammation with two hypotheses: a) greater chronic stress is associated with higher central adiposity and selective accumulation of visceral adipose tissue (VAT) compared with subcutaneous adipose tissue (SAT), and b) associations between VAT and inflammatory biomarkers are exacerbated when chronic stress is high.

Methods

Data come from 1809 participants included in a Multi-Ethnic Study of Atherosclerosis ancillary study of body composition and adiposity-related inflammation. Chronic psychosocial stress was measured with a five-item version of the Chronic Stress Burden Scale. First, we tested associations between chronic stress (three-level categorical variable) and VAT, SAT, and VAT/SAT ratio. Second, we tested whether associations between VAT and inflammatory biomarkers varied by level of chronic stress.

Results

Participants were approximately 65 years, 50% female, and 40.5% White, 25.6% Hispanic, 21.2% African American, and 12.8% Chinese American. About half of the sample reported little to no stress, and a quarter and a fifth of the sample reported medium and high levels of stress. Higher levels of chronic stress were associated with greater VAT and SAT, but not VAT/SAT ratio. Greater levels of VAT were associated with increased levels of adiposity-related inflammation in a graded pattern. These associations did not vary by stress level.

Conclusions

Greater chronic stress burden is associated with both central and subcutaneous adiposity. We found no evidence that the associations between VAT and inflammatory biomarkers are exacerbated by chronic stress. Findings contribute to ongoing literature untangling pathways in which psychosocial stress contributes to adiposity-related inflammation.
Modulatory Effects of Actual and Imagined Acupuncture on the Functional Connectivity of the Periaqueductal Gray and Ventral Tegmental Area
Authors: Cao Jin , Tu Yiheng , Orr Scott P. , Wilson Georgia , Kong Jian
Published: July 2021

Objective

Both acupuncture and guided imagery hold promise for treating pain. The mechanisms underlying these alternative interventions remain unclear. The reported study aimed to comparatively investigate the modulation effect of actual and imagined acupuncture on the functional connectivity of descending pain modulation system and reward network.

Methods

Twenty-four healthy participants (mean [standard error], 25.21 [0.77] years of age; 66.67% female) completed a crossover study that included five sessions, a training session and four intervention sessions administered in randomized order. We investigated the modulation effect of real acupuncture, sham acupuncture, video-guided acupuncture imagery treatment (VGAIT) and VGAIT control on the resting-state functional connectivity (rsFC) of periaqueductal gray (PAG) and ventral tegmental area (VTA). These are key regions of the descending pain modulatory system and dopaminergic reward system, respectively.

Results

Compared with sham acupuncture, real acupuncture produced decreased PAG-precuneus (Pcu) rsFC and increased VTA-amygdala/hippocampus rsFC. Heat pain threshold changes applied on the contralateral forearm were significantly associated with the decreased PAG-Pcu (r = 0.49, p = .016) and increased VTA-hippocampus rsFC (r = −0.77, p < .001). Compared with VGAIT control, VGAIT produced decreased PAG–paracentral lobule/posterior cingulate cortex/Pcu, middle cingulate cortex (MCC), and medial prefrontal cortex rsFC, and decreased VTA-caudate and MCC rsFC. Direct comparison between real acupuncture and VGAIT showed that VGAIT decreased rsFC in PAG–paracentral lobule/MCC, VTA-caudate/anterior cingulate cortex/nucleus accumbens, and VTA-MCC.

Conclusions

Results suggest that both actual and imagined acupuncture can modulate key regions in the descending pain modulatory system and reward networks, but through different pathways. Identification of different pain relief mechanisms may facilitate the development of new pain management methods.
Relationships Between Early Maternal Warmth and Social Connection: A Randomized Clinical Trial With Naltrexone
Authors: Ross Lauren P. , Andreescu Carmen , Inagaki Tristen K.
Published: July 2021

Objective

Early experiences of having received maternal warmth predict responses to opportunities to connect with others later in life. However, the understanding of neurochemical mechanisms by which such relationships emerge remains incomplete. Endogenous opioids, involved in social connection in both animals and humans, may contribute to this link. Therefore, the current study examined a) relationships between early maternal warmth and brain and self-report responses to novel social targets (i.e., outcomes that may promote social connection) and b) the effect of the opioid antagonist, naltrexone, on such relationships.

Methods

Eighty-two adult participants completed a retrospective report of early maternal warmth. On a second visit, participants were randomized to 50 mg of oral naltrexone (n = 42) or placebo (n = 40), followed by a magnetic resonance imaging scan where functional brain activity in response to images of novel social targets (strangers) was assessed. Approximately 24 hours later, participants reported on their feelings of social connection since leaving the scanner.

Results

In the placebo condition, greater early maternal warmth was associated with less dorsal anterior cingulate cortex, anterior insula, ventral striatum, and amygdala activity in response to images of novel social targets (r values ≥ −0.360, p values ≤ .031), and greater feelings of social connection (r = 0.524, p < .001) outside of the laboratory. The same relationships, however, were not present in the naltrexone condition.

Conclusions

Results highlight relationships between early maternal warmth and responses to the social world at large and suggest that opioids might contribute to social connection by supporting the buffering effects of warm early life experiences on social connection later in life.

Trial Registration: Clinical Trials NCT02818036.
Using Deep Learning Segmentation for Endotracheal Tube Position Assessment
Authors: Schultheis William G. , Lakhani Paras
Published: July 2021

Purpose:

The purpose of this study was to determine the efficacy of using deep learning segmentation for endotracheal tube (ETT) position on frontal chest x-rays (CXRs).

Materials and Methods:

This was a retrospective trial involving 936 deidentified frontal CXRs divided into sets for training (676), validation (50), and 2 for testing (210). This included an “internal test” set of 100 CXRs from the same institution, and an “external test” set of 110 CXRs from a different institution. Each image was labeled by 2 radiologists with the ETT-carina distance. On the training images, 1 radiologist manually segmented the ETT tip and inferior wall of the carina. A U-NET architecture was constructed to label each pixel of the CXR as belonging to either the ETT, carina, or neither. This labeling allowed the distance between the ETT and carina to be compared with the average of 2 radiologists. The interclass correlation coefficients, mean, and SDs of the absolute differences between the U-NET and radiologists were calculated.

Results:

The mean absolute differences between the U-NET and average of radiologist measurements were 0.60±0.61 and 0.48±0.47 cm on the internal and external datasets, respectively. The interclass correlation coefficients were 0.87 (0.82, 0.91) and 0.92 (0.88, 0.94) on the internal and external datasets, respectively.

Conclusion:

The U-NET model had excellent reliability and performance similar to radiologists in assessing ETT-carina distance.
Estimation of Sex From Dental Arch Dimensions: An Odontometric Analysis
Authors: Kanchan Tanuj , Chugh Vinay , Chugh Ankita , Setia Puneet , Shedge Rutwik , Krishan Kewal
Published: July 2021

Sex estimation is one of the “big three” of human identification and is a vital aspect of the process of generating biological profile of unknown deceased. Anthropometric and odontometric methods that utilize measurement of distances between certain landmarks are commonly employed to differentiate between the 2 sexes. Teeth are the most robust and well-preserved parts of the human body, and studies have shown that the sex of an unknown individual can be estimated using their measurements. The present study was carried out to analyze the sex differences based on the dental arch dimensions of both the jaws in an Indian population. A proper understanding of dental arch dimensions not only help forensic odontologists in human identification, but also help dental practitioners in teeth restoration, and to quantify selection of anterior teeth in bonding of dentures. The dental arch dimensions of the canines, premolars, and the molars of both the jaws were recorded in dental casts of 307 participants. Comparison of the dental arch dimensions of males and females was done and logistic regression models were generated to estimate sex. Receiver Operating Characteristic analysis was done to find out the potential to estimate sex for all the dental arch dimensions in both the sexes. It was observed that maxillary intermolar II distance gave the best results in estimating the sex. The sexing accuracy is seen to increase as we go distally from canines to molars in each jaw; minimum for intercanine distance and maximum for distance between the 2nd molars. The sexing accuracy from dental arch dimensions was found to be between 72.7% and 86.5%. The models derived for estimation of sex from dental arch dimensions can be used in cases of skeletal remains.
Anthropometric Analysis of the Growth Proportions of the Head and Face in Koreans
Authors: Yeo In-Seung , Park Jung-Ah , Lee Hye-In , Koh Ki-Seok , Song Wu-Chul
Published: July 2021

The present study is to identify primarily the morphological characteristics in the growth proportion of the head and face for young Korean (8–24 years) and compare the magnitude of growth changes to the sex-related differences. Total 1255 were divided into 3 age groups: childhood (8–10 years), adolescence (14–16 years), and young adult (20–24 years). The anthropometric assessments were performed with 11 landmarks on the head and facial dimensions. The standardized frontal and lateral head and face photographs were analyzed the craniofacial growth proportions and morphological features for the comparison of both sexes. The noteworthy differences of anthropometric measurements between sexes with growing were noted on the lower head height (22.6%, 17.8%), midface height (22.0%, 19.6%), lower face height (23.5%, 14.7%), and face length (21.1%, 14.9%), face breadth (14.8%, 11.3%) of males and females, respectively. Whereas the upper head height (7.9%, 6.0%) and upper face height (4.2%, 0%, respectively) were less growing features. The most remarkable changes are the dimension of midface height and lower face height in both sexes. The present study could demonstrate a fundamental example to elucidate the sex-related dimensional differences for the analysis of the growth proportion of both sexes in Koreans.
Comparison of Conduits Fabricated by Fresh and Predegenerated Skeletal Muscles for Peripheral Nerve Repairing
Authors: Chen Zi-Xiang , Yi Zhen , Lu Hai-Bin , Chen Lu-Lu , Yang Xiao-Nan , Qi Zuo-Liang
Published: July 2021

Reconstruction of peripheral nerve injury remains a challenge for clinical medicine. Previous reports have confirmed that external oblique muscle-fabricated nerve conduit (EMC) could effectively be used to promote peripheral nerve regeneration. In this study, we compared between conduits fabricated from fresh muscle and conduits fabricated from predegenerated muscle for the repair of peripheral nerve defects in a mouse sciatic nerve transection model. We found that the number, diameter, and myelin sheath thickness of the myelinated nerve fibers of the regenerative nerve in the EMC group were larger than those of the predegenerated-EMC (P-EMC) group eight weeks after surgery. The sciatic function index and gastrocnemius wet-weight mass ratio in the EMC group were higher than those in the P-EMC group. The Bcl-2/Bax ratio and the number of Schwann cell nucleus in the proximal nerve stumps in the EMC group were greater than those in the P-EMC group. In conclusion, our results confirmed that the use of fresh skeletal muscle nerve conduit increased the Bcl-2/Bax ratio and promoted the survival of Schwann cells of the proximal nerve stump compared with that of predegenerated skeletal muscle nerve conduits, thus achieving better functional recovery after sciatic nerve defect.
Distichiasis: An Unusual Complication of the Preseptal Transconjunctival Approach and Its Management
Authors: John Centina Rose , Ganesh Praveen , Rao Venkata Mahipathy Surya Rao
Published: July 2021

Distichiasis is a rare condition where the accessory row of eyelashes exit from the posterior lid margin apparently from the opening of the meibomian glands, causing corneal irritation and ulceration. The authors report a rare clinical presentation of acquired distichiasis, as a complication of a preseptal transconjunctival approach. The patient presented with complaints of discomfort over the right eyelid after the management of zygomaticomaxillary complex fracture. On evaluation, the diagnosis of acquired distichiasis was made and was surgically managed by direct tarsal strip excision. During the follow up the complete resolution of symptoms without lid margin deformity was noted. Acquired distichiasis as a complication of the preseptal transconjunctival approach was rarely reported. Hence the understanding of the condition and its management is necessary to avoid the sequela.
The Development of Frontal and Sphenoid Sinuses After Full-House Endoscopic Sinus Surgery in a Child
Authors: Nomura Kazuhiro , Numano Yuki , Sugawara Mitsuru
Published: July 2021

Although endoscopic sinus surgery (ESS) is a standard procedure for adults and is considered a safe and effective procedure in children as well, some uncertainty remains when it comes to children, especially with regard to the future facial and sinus development. Overall, limited ESS does not affect sinus development, and extended ESS does not affect facial features. However, whether or not full-house ESS affects the sinus development, especially the frontal and sphenoid sinuses, remains unclear. The authors herein report a 15-year-old child who received full-house ESS and later re-examined the paranasal sinuses at 24 years old, at which point the frontal and sphenoid sinuses had developed. This is the first report showing the development of the frontal and sphenoid sinuses after such a procedure.
Versatility of Superficial Temporal Artery Pedicle for Postburn Facial Reconstruction: Our Center experience
Authors: Bhandari Padam Singh , Singh Sukhbir
Published: July 2021

Objectives:

Superficial temporal artery (STA) is the one of the terminal branches of external carotid artery. Superficial temporal artery divides into frontal and parietal terminal branches. Various types of locoregional flaps can be based on the STA as a pedicle to provide effective and robust cover. In this article, we shall discuss the various applications of STA and its terminal branches as a pedicle for postburn facial reconstruction in our clinical experience of more than 20 years.

Methods:

This is a retrospective review of 531 cases of postburn facial reconstruction using STA and one its terminal branches as a pedicle done at Department of Plastic and Reconstructive Surgery, Lok Nayak Hospital, which is tertiary care government hospital in New Delhi for burn care from March 2000 to March 2020. We started use of this flap initially for postburn ear reconstruction cases and slowly expanded our indications over the period of time due to its high vascularity and versatile nature. There were 269 females and 262 males included in this review.

Results:

We have used STA and one its terminal branches as a pedicle to our advantage with varied indications and excellent results. We had minor complications which were easily manageable with 7 cases of partial flap loss and zero case of total flap loss. We shall discuss all the details in our review.

Conclusions:

We wish to conclude that STA and one its terminal branches as a pedicle offers excellent versality and vascularity for postburn facial reconstruction with good long-standing results.