bluuebunny/crossref_metadata_2025 huggingface dataset:
Age-associated sleep spindle characteristics in Duchenne muscular dystrophy
Authors: Simon Katharine C , Cadle Chelsea , Nakra Neal , Nagel Marni C , Malerba Paola
Published: March 2024

Brain oscillations of non-rapid eye movement sleep, including slow oscillations (SO, 0.5–1.5 Hz) and spindles (10–16 Hz), mirror underlying brain maturation across development and are associated with cognition. Hence, age-associated emergence and changes in the electrophysiological properties of these rhythms can lend insight into cortical development, specifically in comparisons between pediatric populations and typically developing peers. We previously evaluated age-associated changes in SOs in male patients with Duchenne muscular dystrophy (DMD), finding a significant age-related decline between 4 and 18 years. While primarily a muscle disorder, male patients with DMD can also have sleep, cognitive, and cortical abnormalities, thought to be driven by altered dystrophin expression in the brain. In this follow-up study, we characterized the age-associated changes in sleep spindles. We found that age-dependent spindle characteristics in patients with DMD, including density, frequency, amplitude, and duration, were consistent with age-associated trends reported in the literature for typically developing controls. Combined with our prior finding of age-associated decline in SOs, our results suggest that SOs, but not spindles, are a candidate intervention target to enhance sleep in patients with DMD.
Distinguishing Cophylogenetic Signal from Phylogenetic Congruence Clarifies the Interplay Between Evolutionary History and Species Interactions
Authors: Perez-Lamarque Benoît , Morlon Hélène
Published: March 2024

Interspecific interactions, including host–symbiont associations, can profoundly affect the evolution of the interacting species. Given the phylogenies of host and symbiont clades and knowledge of which host species interact with which symbiont, two questions are often asked: “Do closely related hosts interact with closely related symbionts?” and “Do host and symbiont phylogenies mirror one another?.” These questions are intertwined and can even collapse under specific situations, such that they are often confused one with the other. However, in most situations, a positive answer to the first question, hereafter referred to as “cophylogenetic signal,” does not imply a close match between the host and symbiont phylogenies. It suggests only that past evolutionary history has contributed to shaping present-day interactions, which can arise, for example, through present-day trait matching, or from a single ancient vicariance event that increases the probability that closely related species overlap geographically. A positive answer to the second, referred to as “phylogenetic congruence,” is more restrictive as it suggests a close match between the two phylogenies, which may happen, for example, if symbiont diversification tracks host diversification or if the diversifications of the two clades were subject to the same succession of vicariance events. Here we apply a set of methods (ParaFit, PACo, and eMPRess), whose significance is often interpreted as evidence for phylogenetic congruence, to simulations under 3 biologically realistic scenarios of trait matching, a single ancient vicariance event, and phylogenetic tracking with frequent cospeciation events. The latter is the only scenario that generates phylogenetic congruence, whereas the first 2 generate a cophylogenetic signal in the absence of phylogenetic congruence. We find that tests of global-fit methods (ParaFit and PACo) are significant under the 3 scenarios, whereas tests of event-based methods (eMPRess) are only significant under the scenario of phylogenetic tracking. Therefore, significant results from global-fit methods should be interpreted in terms of cophylogenetic signal and not phylogenetic congruence; such significant results can arise under scenarios when hosts and symbionts had independent evolutionary histories. Conversely, significant results from event-based methods suggest a strong form of dependency between hosts and symbionts evolutionary histories. Clarifying the patterns detected by different cophylogenetic methods is key to understanding how interspecific interactions shape and are shaped by evolution.
Synchronizing Automatic Gain Control in Bilateral Cochlear Implants Mitigates Dynamic Localization Deficits Introduced by Independent Bilateral Compression
Authors: Pastore M. Torben , Pulling Kathryn R. , Chen Chen , Yost William A. , Dorman Michael F.
Published: March 2024

Objectives:

The independence of left and right automatic gain controls (AGCs) used in cochlear implants can distort interaural level differences and thereby compromise dynamic sound source localization. We assessed the degree to which synchronizing left and right AGCs mitigates those difficulties as indicated by listeners’ ability to use the changes in interaural level differences that come with head movements to avoid front-back reversals (FBRs).

Design:

Broadband noise stimuli were presented from one of six equally spaced loudspeakers surrounding the listener. Sound source identification was tested for stimuli presented at 70 dBA (above AGC threshold) for 10 bilateral cochlear implant patients, under conditions where (1) patients remained stationary and (2) free head movements within ±30° were encouraged. These conditions were repeated for both synchronized and independent AGCs. The same conditions were run at 50 dBA, below the AGC threshold, to assess listeners’ baseline performance when AGCs were not engaged. In this way, the expected high variability in listener performance could be separated from effects of independent AGCs to reveal the degree to which synchronizing AGCs could restore localization performance to what it was without AGC compression.

Results:

The mean rate of FBRs was higher for sound stimuli presented at 70 dBA with independent AGCs, both with and without head movements, than at 50 dBA, suggesting that when AGCs were independently engaged they contributed to poorer front-back localization. When listeners remained stationary, synchronizing AGCs did not significantly reduce the rate of FBRs. When AGCs were independent at 70 dBA, head movements did not have a significant effect on the rate of FBRs. Head movements did have a significant group effect on the rate of FBRs at 50 dBA when AGCs were not engaged and at 70 dBA when AGCs were synchronized. Synchronization of AGCs, together with head movements, reduced the rate of FBRs to approximately what it was in the 50-dBA baseline condition. Synchronizing AGCs also had a significant group effect on listeners’ overall percent correct localization.

Conclusions:

Synchronizing AGCs allowed for listeners to mitigate front-back confusions introduced by unsynchronized AGCs when head motion was permitted, returning individual listener performance to roughly what it was in the 50-dBA baseline condition when AGCs were not engaged. Synchronization of AGCs did not overcome localization deficiencies which were observed when AGCs were not engaged, and which are therefore unrelated to AGC compression.
Fixation techniques for periprosthetic femur fractures around total knee arthroplasty: a systematic review
Authors: Chan Peter Y.W. , Hinkle Andrew , Huo Michael H.
Published: March 2024

There is no consensus regarding the treatment algorithm for the fixation of periprosthetic femur fractures (PFFs) around a total knee arthroplasty (TKA). Established methods of fracture fixation include locking plate (LP) or retrograde intramedullary nail (RIN) techniques. Newer fixation methods include the dual plate (DP) and the nail-plate combination (NPC) techniques. The purpose of this study is to review the literature on the outcomes of PFF fixation following TKAs over the past two decades. A systematic review was undertaken in the MEDLINE, Embase, and Cochrane databases in accordance with the PRISMA standards. Selection criteria included: patient cohort > 5 cases and minimum follow-up of 12 mo. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklists for Cohort Studies and Case Series. Combined data analysis was performed with linear models and linear mixed effect models to compare the post-operative outcomes of the LP, RIN, and DP techniques. Our search identified 1086 studies and 31 were selected for final analysis. The number of the studies for the LP, RIN, DP, and NPC techniques were 23, 15, 4, and 1, respectively. There were no differences in the time to union, Knee Society Knee Score, or range of motion among the LP, RIN, and DP techniques. Although analysis did not demonstrate significant differences, it is limited by the lack of the available studies using the DP technique. Additionally, only one study for the NPC technique was retained after screening and data analysis was therefore not possible.
Is Immobilization Technique Associated With Postoperative Pubic Rami Diastasis Following Bladder Exstrophy Closure?
Authors: Annabell Lucas , Lee Ted , Barnett Samuel , Ralston Katelyn , Lee Richard , Borer Joseph G. , Kim Young-jo
Published: March 2024

Objective:

Pelvic osteotomies relieve tension of the bladder and fascial closures during bladder exstrophy repair. Multiple techniques for postoperative immobilization of the pelvis and lower extremities have been described. The primary aim of this study was to assess differences in short and long-term changes in pubic rami diastasis when comparing Bryant traction to spica cast immobilization. Secondary aims included a comparison of length of stay, skin-related complications, and urologic outcomes.

Methods:

We performed a single-institutional retrospective review of bladder exstrophy patients younger than 18 months of age who underwent posterior pelvic osteotomy and bladder exstrophy closure from April 2005 to April 2020. Short-term and long-term pubic rami diastasis were defined as postoperative measurements ≤6 months and ≥12 months, respectively. Secondary outcomes included length of stay, pressure ulcer, skin rash/abrasion, urethrocutaneous fistula, and bladder or fascial dehiscence rates. Multivariable logistic regression assessed for an association between immobilization type and degree of diastasis while controlling for age at the time of diastasis measurement and sex.

Results:

Fifteen patients underwent Bryant traction and 36 patients underwent spica cast immobilization. In both the short-term and long-term, there was a greater reduction in pubic diastasis in the spica cast group (P= 0.002 and P= 0.05, respectively). After adjustments, there were higher odds of having a greater reduction in pubic rami diastasis in both the short-term (odds ratio: 2.71, 95% CI: 1.52-4.86, P= 0.001) and long-term (odds ratio: 2.41, 95% CI: 1.00-5.80, P= 0.05). Length of stay was significantly higher in Bryant’s traction group (26 vs 19 d, P< 0.001). Rates of pressure ulcers were higher in the Bryant traction group (26.7% vs 0%, P= 0.005). Rates of skin rash/abrasions, urethrocutaneous fistula, and bladder/fascial dehiscence did not differ.

Conclusions:

Spica cast immobilization is a safe and effective immobilization method. Compared with Bryant traction, spica cast immobilization was associated with a greater reduction in postoperative pubic diastasis both short and long-term, along with a shorter length of hospitalization and reduced rate of pressure ulcers.

Level of Evidence:

Level III—therapeutic study.
Treatment of Hip Displacement in Children With Cerebral Palsy: A 5-year Comparison of Proximal Femoral Osteotomy and Combined Femoral-Pelvic Osteotomy in 163 Children
Authors: Kiapekos Nikolaos , von Heideken Johan , Broström Eva , Hägglund Gunnar , Åstrand Per
Published: March 2024

Background:

This study compared the 5-year outcomes of isolated proximal femoral varus osteotomy (FO) and combined proximal femoral varus and pelvic osteotomy (FPO) for the treatment of hip displacement in children with cerebral palsy (CP) in Sweden, focusing on the number of reoperations and residual hip displacement.

Methods:

The study included 163 children with a 5-year follow-up after FO or FPO in the national Swedish CP surveillance program, CPUP. Descriptive statistics and univariate and multivariate Cox regression analyses were used to identify whether the age at surgery, sex, Gross Motor Function Classification System level, CP dominant symptom, hip migration percentage (MP), type of surgery (unilateral/bilateral), and history of soft tissue hip surgery were related to the 5-year outcomes after surgery. Failure after hip surgery was defined as a skeletal reoperation involving the hip and/or MP >50%.

Results:

During the period 2001 to 2017, 163 children (65 girls) underwent 246 femoral and/or pelvic osteotomies (154 FO, 47 bilaterally; 92 FPO, 16 bilaterally) and had a 5-year follow-up; 95 and 74 children had ≥1 FO or FPO as the primary skeletal surgery, respectively. The mean preoperative MP (51%±18% for FO and 59%±17% for FPO, P=0.001) and age at surgery (6.2±2.5 years for FO and 7.3±2.8 years for FPO, P=0.014) differed between procedures. At the 5-year follow-up, 5 hips (5%) had reoperations and 5 hips (5%) had radiological failure among the 92 FPOs, and 33 (21%) had reoperations and 14 (9%) radiological failure among the 154 FOs. The difference in outcome failure rate was significant (P<0.001). Multivariate Cox regression analysis showed a lower risk for failure with FPO [hazard ratio (HR)=0.32, 95% CI: 0.15-0.68] compared with FO. A higher preoperative MP increased the risk for outcome failure (HR=1.21, 95% CI: 1.15-1.36 for each 5% increment).

Conclusions:

FPO had a higher mean preoperative MP but a lower 5-year outcome failure rate compared with FO. A higher preoperative MP was associated with an increased risk of failure.

Level of Evidence:

Level II—prospective comparative study.
Predicting Skeletal-related Events Using SINS
Authors: Nakanishi Kazuo , Hijikata Yasukazu , Uchino Kazuya , Sugimoto Yoshihisa , Iba Hideaki , Watanabe Seiya , Mitani Shigeru
Published: March 2024

Study Design.

Predictive study utilized retrospectively collected data.

Objective.

The primary objective was to evaluate the predictive association between the Spine Instability Neoplastic Score (SINS) and Skeletal-related events (SREs). Secondary objectives included examining characteristics of cases with SINS ≤ 6 among those who developed SRE and evaluating the impact of additional predictors on prediction accuracy.

Summary of Background Data.

Advances in cancer treatment have prolonged the lives of cancer patients, emphasizing the importance of maintaining quality of life. SREs from metastatic spinal tumors significantly impact the quality of life. However, currently, there is no scientifically established method to predict the occurrence of SRE. SINS, developed by the Spine Oncology Study Group, assesses spinal instability using six categories. Therefore, the predictive performance of SINS for SRE occurrence is of considerable interest to clinicians.

Methods.

This predictive study utilized retrospectively collected data from a single-center registry comprising over 1000 patients with metastatic spinal tumors. SINS and clinical data were collected. Logistic regression was used to create a prediction equation for SRE using SINS. Additional analyses explored factors associated with SRE in patients with SINS ≤ 6.

Results.

The study included 1041 patients with metastatic spinal tumors. SRE occurred in 121 cases (12%). The prediction model for SRE using SINS demonstrated an area under the curve (AUC) of 0.832. Characteristics associated with SRE included lower female prevalence, surgeries to primary sites, bone metastases to nonspinal sites, and metastases to other organs. A post hoc analysis incorporating additional predictors improved the AUC to 0.865.

Conclusions.

The SINS demonstrated reasonable predictive performance for SRE within one month of the initial visit. Incorporating additional factors improved prediction accuracy. The study emphasizes the need for a comprehensive clinical prediction model for SRE in metastatic spinal tumors.
HOXA1 silencing inhibits cisplatin resistance of oral squamous cell carcinoma cells via IκB/NF-κB signaling pathway
Authors: Zhu Ruifeng , Mao Yiting , Xu Xianzhi , Li Yingying , Zheng Jiwei
Published: March 2024

The resistance of oral squamous cell carcinoma (OSCC) cells to cisplatin remains a tough nut to crack in OSCC therapy. Homeobox A1 (HOXA1) overexpression has been detected in head and neck squamous carcinoma (HNSC). Accordingly, this study aims to explore the potential role and mechanism of HOXA1 on cisplatin resistance in OSCC. The expression of HOXA1 in HNSC and its role in overall survival (OS) rate of OSCC patients were analyzed by bioinformatic analysis. Following transfection as needed, OSCC cells were induced by different concentrations of cisplatin, and the cell viability and apoptosis were evaluated by cell counting kit-8 and flow cytometry assays. The mRNA and protein expression levels of HOXA1 and the phosphorylation of IκBα and p65 were determined by real-time quantitative PCR and western blot. HOXA1 expression level was upregulated in HNSC tissues and OSCC cells. Overexpressed HOXA1 was correlated with a low OS rate of OSCC patients. Cisplatin exerted an anti-cancer effect on OSCC cells. HOXA1 silencing or cisplatin suppressed OSCC cell viability, boosted the apoptosis, and repressed the phosphorylation of IκBα and p65. Intriguingly, the combination of HOXA1 silencing and cisplatin generated a stronger anti-cancer effect on OSCC cells than their single use. HOXA1 silencing attenuates cisplatin resistance of OSCC cells via IκB/NF-κB signaling pathway, hinting that HOXA1 is a biomarker associated with OSCC and HOXA1 silencing can enhance the sensitivity of OSCC cells to cisplatin.
Exploring the Effectiveness of Nurses' Usage of a Wound-Photography System
Authors: Hsin Pin-Hsien , Lee Ting-Ting , Liu Chieh-Yu , Chou Shin-Shang , Mills Mary Etta
Published: March 2024

As a result of rapid advancements in health information technology, uploading health-related information and records onto an electronic health record system has become a common practice. Photographs of patients' wounds have been uploaded electronically, but widespread acceptance by nurses has been prevented owing to issues such as file size and equipment. This research explores the attitude and satisfaction toward using an electronic health record for uploading wound photos. Through the integration of the Technology Acceptance Model, Information System Success Model, and other study results, this research aims to explore the impact of the following variables: system quality, information quality, perceived usefulness, perceived ease of use, user attitude, user satisfaction, and net benefits. We also tested nurses' understanding regarding the process of taking photographs and explored the photograph quality and the photography uploading rates. The results revealed that users were satisfied with the wound-photography system, but some believed that the system stability, processing time, and image resolution should be improved. In addition, more than 80% of the nurses correctly answered photo-taking questions, the study photos reached 70% of the quality standards, and the average uploading rate was 74%. The results could serve as guidelines for system design in the future.
The Effect of QR Code–Supported Patient Training on Total Knee Arthroplasty–Related Problems and Emergency Department Admission Rate
Authors: Özbaş Nilgün , Acar Ahmet , Karadağ Mevlüde
Published: March 2024

Knee arthroplasty surgery, which is increasingly performed due to increased life expectancy, has positive outcomes, although it can also cause serious health problems following surgery. This study was conducted to evaluate the impact of patient-related education via a QR code on total knee arthroplasty problems and emergency department referral rates. Participants were randomly assigned to intervention (n = 51) and control (n = 51) groups. The intervention group received QR code–supported training. The outcomes were assessed at baseline (preoperative), discharge, and postoperative sixth week. In the intervention group, significantly fewer problems related to total knee arthroplasty occurred at discharge and in week 6, and a higher level of functionality was noted (P < .05). In week 6, the rate of emergency department admissions was lower, and mean scores for satisfaction with patient training were higher in the intervention group (P < .05). In conclusion, QR code–supported patient training was effective in reducing the physiological and psychosocial problems related to total knee arthroplasty and the emergency department referral rates. In addition, it provided functional improvement and increased satisfaction with patient training.
Epicardial Adipose Tissue: A Precise Biomarker for Cardiovascular Risk, Metabolic Diseases, and Target for Therapeutic Interventions
Authors: Bogdański Aleksander , Niziołek Piotr , Kopeć Stanisław , Moszak Małgorzata
Published: March 2024

Epicardial adipose tissue (EAT) is located between the heart muscle and visceral pericardium, where it has direct contact with coronary blood vessels. Elevated thickness of this tissue can induce local inflammation affecting the myocardium and the underlying coronary arteries, contributing to various cardiovascular diseases such as coronary artery disease, atrial fibrillation, or heart failure with preserved ejection fraction. Recent studies have identified EAT thickness as a simple and reliable biomarker for certain cardiovascular outcomes. Examples include the presence of atherosclerosis, incident cardiovascular disease (CVD) in individuals with type 2 diabetes mellitus (T2DM), and the prevalence of atrial fibrillation. Furthermore, EAT measurements can help to identify patients with a higher risk of developing metabolic syndrome. Since the EAT thickness can be easily measured using echocardiography, such examinations could serve as a useful and cost-effective preventive tool for assessing cardiovascular health. This review also summarizes therapeutical interventions aimed at reducing EAT. Reducing EAT thickness has been shown to be possible through pharmacological, surgical, or lifestyle-change interventions. Pharmaceutical therapies, including thiazolidinediones, glucagon-like peptide 1-receptor agonists, sodium-glucose cotransporter 2 inhibitors, dipeptidyl peptidase-4 inhibitors, and statins, have been shown to influence EAT thickness. Additionally, EAT thickness can also be managed more invasively through bariatric surgery, or noninvasively through lifestyle changes to diet and exercise routines.
Combinatorial Inhibition of Complement Factor D and BCL2 for Early-Onset Colorectal Cancer
Authors: Rahman Shahrose , Affleck IV Arthur , Ruhl Rebecca , Patel Ranish K. , Gao Lina , Brinkerhoff Brian , Tsikitis V. Liana , Anand Sudarshan
Published: March 2024

BACKGROUND:

The tumor immune microenvironment is distinct between early-onset and late-onset colorectal cancer which facilitates tumor progression. We previously identified several genes, including complement factor D, as having increased expression in patients with early-onset colorectal cancer.

OBJECTIVE:

This study aimed to assess and validate differential expression of immune genes in early and late-onset colorectal cancer. We also aimed to test known drugs targeting genes increased in early-onset colorectal cancer in preclinical mouse models.

DESIGN:

Retrospective cohort study with analysis performed using tumor RNA from formalin-fixed paraffin-embedded, cell culture and immunohistochemistry to validate gene expression and gene function. In vivo preclinical tumor study to assess drug efficacy.

SETTINGS:

Oregon Colorectal Cancer Registry was queried to find patients with colorectal cancer.

SUBJECTS:

Study included 67 patients with early and 54 patients with late-onset colorectal cancer.

INTERVENTIONS:

Preclinical animal models using the HCT-116 colon cancer cell line were treated with complement factor D inhibitor danicopan and BCL2 inhibitor venetoclax, or with vehicle controls.

MAIN OUTCOME MEASURES:

Elevated RNA signatures using NanoString data was evaluated from the retrospective cohort. When inhibiting these markers in the mouse preclinical model, tumor volume and weight were the main outcome measures.

RESULTS:

After updating our sample size from our previously published data, we found that complement factor D and BCL2, genes with known function and small molecule inhibitors, are elevated in patients with early-onset colorectal cancer. When inhibiting these markers with drugs danicopan and venetoclax in a mouse model, we found that the combination of these drugs decreased tumor burden but also resulted in toxicity.

LIMITATIONS:

This study is limited by small sample size and a subcutaneous tumor model.

CONCLUSIONS:

Combinatorial inhibition of early-onset associated genes complement factor D and BCL2 slows growth of early-onset colorectal cancer in a mouse preclinical model. See Video Abstract.
Systematic Review of Neoadjuvant Immunotherapy for Mismatch Repair Deficient Locally Advanced Colon Cancer: An Emerging Strategy
Authors: Loria Anthony , Ammann Allison M. , Olowokure Olugbenga O. , Paquette Ian M. , Justiniano Carla F.
Published: March 2024

BACKGROUND:

In April 2023, the National Comprehensive Cancer Network endorsed neoadjuvant immunotherapy for select patients with non-metastatic mismatch repair deficient colon cancer. Approximately 15% of incident colon cancers are mismatch repair deficient, resulting in a distinct molecular subtype with high microsatellite instability that is responsive to immune checkpoint inhibition.

OBJECTIVE:

To describe the existing evidence supporting neoadjuvant immunotherapy for mismatch repair deficient, microsatellite unstable non-metastatic colon cancer.

DATA SOURCES:

A medical librarian performed PubMed, Embase, and Web of Science searches most recently on April 24, 2023. The PubMed search was re-run on September 26, 2023, to identify any additional studies published during the interim from April to September 2023.

STUDY SELECTION:

Two authors screened titles and abstracts in the published studies. The inclusion criteria were (1) English-language; (2) adults with primary cancer of the colon; (3) non-metastatic disease; (4) neoadjuvant immunotherapy; (5) reporting on 10 or more cases.

INTERVENTION:

Neoadjuvant immunotherapy.

MAIN OUTCOME MEASUREs:

Safety (Grade 3+ treatment related adverse events) and efficacy (complete pathologic responses).

RESULTS:

From 7,691 studies identified, 6,370 were screened, and 8 included. Various agents, dosing regimens, and treatment durations were employed, with durations of immunotherapy ranging from 1-16 cycles. Complete R0 resections were consistently achieved in 98%-100% of resections. Of patients who received neoadjuvant immunotherapy and underwent resection, 50%-91% had ypT0N0 pathology. The safety profiles were generally favorable, with Grade 1-2 treatment-related adverse events (mostly immune-related) during immunotherapy reported in 22.2%-70% of patients. Postoperative complications following neoadjuvant immunotherapy were reassuring, with no severe complications reported.

LIMITATIONS:

Small number of heterogeneous and uncontrolled studies precluding a meta-analysis.

CONCLUSIONS:

Neoadjuvant immune checkpoint inhibition is associated with high rates of pathologic complete responses in locally advanced colon cancer. The literature is limited, particularly for postoperative outcomes, and more studies are needed to understand the safety and positioning of these regimens in the neoadjuvant context.
Case-matched Comparison of Implant-based Breast Reconstruction with and without Acellular Dermal Matrix
Authors: Kilmer Lee H. , Challa Sanjana , Stranix John T. , Campbell Christopher A.
Published: March 2024

Background:

Acellular dermal matrix (ADM) is commonly used in implant-based breast reconstruction due to improved soft-tissue support and control of the implant pocket and decreased capsular contracture. However, concerns about complications have prompted the FDA to request more clinical data. This large-scale study aims to examine perioperative outcomes of ADM use in breast reconstruction.

Methods:

This study utilized a national insurance-based database to identify patients who underwent mastectomy between 2011 and 2019, with and without ADM. The groups were matched for age, region, and comorbidities. Complications within 90 days were compared using univariate and multivariate analyses.

Results:

A total of 49,366 patients were identified with 26,266 patients in the ADM group and 23,100 in the non-ADM group. Infection rates (4.7% ADM versus 4.4% no ADM) and seroma rates (3.9% ADM versus 4% no ADM) were similar. However, the ADM group had a 1% higher rate of implant removal (4.9% ADM versus 3.9% no ADM, P < 0.001). In direct-to-implant procedures, ADM use was associated with higher explantation rates (8.2% versus 6.3%, P = 0.002). Multivariate analysis identified tobacco use, hypertension, depression, obesity, ADM usage, and direct-to-implant surgery as risk factors for implant removal.

Conclusions:

This study found comparable infection and seroma rates in implant-based breast reconstruction with and without ADM. ADM use was associated with a 1% higher risk of implant removal, with risk factors including tobacco use, obesity, hypertension, depression, and direct-to-implant procedures. Multicenter studies and registry data on prepectoral breast reconstruction are warranted to help interpret these findings.
Innovative Application of GalaFLEX Poly-4-Hydroxybutyrate Scaffold in Breast Reduction/Mastopexy with Inferiorly Based Dermo-adipose Flap
Authors: Cagli Barbara , Gratteri Marco , Cimmino Andrea A. , Sofo Francesco , Mirra Carlo , Savani Luca , Vignapiano Iside , Cogliandro Annalisa , Marangi Giovanni F. , Persichetti Paolo
Published: March 2024

Breast reduction is one of the most required plastic surgery procedures worldwide, improving significantly the quality of life for patients with macromastia and gigantomachia. Despite various proposed approaches aiming to yield more stable results postreduction, no single technique has demonstrated unequivocal superiority. Recurrence ptosis at 6–12 months postoperative remains a challenging concern. To improve this issue, the authors propose a novel application of the poly-4-hydroxybutyrate (P4HB) scaffold on the anterior surface of the Ribeiro dermo-adipose flap. The primary aim was to establish a durable and resilient biological connection between the mammary gland and the flap, thereby promoting long-lasting outcomes in breast reduction procedures. The P4HB scaffold is a monofilament, single-layer, biologically derived, fully resorbable, rapidly integrating within breast tissue; this biological process stimulates the formation of freshly vascularized connective tissue up to a thickness of 2–3 mm. Within 18–24 months, the scaffold undergoes gradual resorption through hydrolysis-based mechanism, providing enhanced strength and resistance to the native tissue, as shown in animal model. A key innovation proposed by the authors involves the division of a 15 × 20 cm rectangular sheet of the P4HB scaffold along its diagonal, resulting in two right triangles. This modification ensures increased height of the device if compared with the traditional splitting technique of the scaffold. The strategic establishment of a biological bridge between the mammary gland and flap through the implementation of the P4HB scaffold could potentially enhance the longevity and aesthetics of breast reduction outcomes.
EPIRETINAL MACROPHAGE-LIKE CELLS ON OPTICAL COHERENCE TOMOGRAPHY
Authors: Zeng Yunkao , Wen Feng , Zhuang Xuenan , He Guiqin , Zhang Xiongze
Published: March 2024

Purpose:

To investigate the clinical value of epiretinal macrophage-like cells (eMLCs) in different stages of diabetic retinopathy (DR), including diabetic macular edema (DME).

Methods:

One hundred and seventy-six eyes of 176 patients, including 31 diabetes eyes without retinopathy, 24 with mild nonproliferative DR (NPDR), 37 with moderate NPDR, 32 with severe NPDR, and 52 with proliferative DR, were compared with 30 healthy controls. The optic nerve head and macular region were examined using en face optical coherence tomography and optical coherence tomography angiography. A previously described technique was employed to measure the eMLCs on the inner limiting membrane.

Results:

The optic nerve head and macular eMLC densities increased with worsening DR stage and were higher in moderate, severe NPDR, and proliferative DR, especially in eyes with DME (all adjusted P < 0.01). The optic nerve head and macular eMLC densities in the DME groups were higher than those in their corresponding non-DME groups at the same DR stage (all P < 0.05). The average macular thickness was correlated with macular eMLC density (standardized β = 0.661, P < 0.001) in patients with diabetes. The proportion of eyes with larger and plumper eMLCs increased with worsening DR and was higher in moderate, severe NPDR, proliferative DR, and eyes with DME (P = 0.018, P < 0.001, P < 0.001, and P < 0.001, respectively).

Conclusion:

Increased density along with morphological changes of eMLCs is observed beginning with moderate NPDR and correlates with the progression of DR, including DME.
Correlations of Corneal Endothelial Morphology and Corneal Thickness With Anterior Segment Parameters in Healthy Individuals
Authors: Karmiris Efthymios , Tsiogka Anastasia , Tsiripidis Konstantinos , Papakonstantinou Evangelia , Georgalas Ilias , Chalkiadaki Evangelia
Published: March 2024

Purpose:

The purpose of this study was to investigate the associations between central corneal endothelial cell density (ECD), endothelial morphology, and corneal thickness (central corneal thickness) with the anterior chamber depth, corneal volume (CV), white-to-white (WTW) distance, mean anterior chamber angle (CAmean), and gender in healthy individuals.

Methods:

This observational study included 136 healthy volunteers. The ECD, coefficient of variation of cell area, and hexagonal cell appearance ratio (%Hex) were measured by means of specular microscopy. The central corneal thickness, anterior chamber depth, CV, WTW distance, and the angle width of 12 points were taken by the Pentacam HR Scheimpflug anterior segment imaging. The arithmetical mean of the 12 points was considered as the CAmean. We used mixed effect linear regression model for the statistical analysis of the data.

Results:

ECD was positively correlated with CV (P = 0.028), while after adjusting for age, it was negatively correlated with age (P < 0.001). Coefficient of variation of cell area was positively correlated with CAmean (P = 0.036), while after adjusting for age, it was positively correlated with age (P < 0.001) and CAmean (P = 0.005). Hex was negatively correlated with WTW (P = 0.023) and CAmean (P = 0.025), and after adjusting for age, this correlation remained the same (P = 0.029 when correlated with WTW and P = 0.035 with CAmean).

Conclusions:

There were significant changes in the morphology of the corneal endothelial cells in eyes with wider anterior chamber angle. Greater pleomorphism and polymegethism of the corneal endothelium was observed in healthy patients with wider CAmean. Deepening of the anterior chamber as myopia progresses could render the corneal endothelium more fragile and susceptible to mechanical stress, which is an area worthy of further study.
Outcomes of Simple Limbal Epithelial Transplantation Without Amniotic Membrane Grafting in Unilateral Limbal Stem Cell Deficiency: A Case Series of 6 Patients
Authors: Jain Neha , Mittal Vikas , Sanandiya Dharma
Published: March 2024

Purpose:

This study describes the technique of simple limbal epithelial transplantation (SLET) without amniotic membrane grafting (AMG) in limbal stem cell deficiency (LSCD).

Methods:

Retrospective, interventional case series of 6 patients who underwent SLET without AMG were included. The procedure followed the standard technique, involving limbal biopsy from the healthy eye, resection of symblephera, and pannus dissection in the affected eye. Following host bed preparation, limbal explants were placed on the bare cornea and secured with fibrin glue. A large-diameter bandage contact lens was applied post surgery. No amniotic membrane was used. Preoperative data, including age, gender, cause of LSCD, best-corrected visual acuity, and previous ocular surgeries, were recorded. Postoperative clinical information, such as the duration of follow-up and recurrence of LSCD, best-corrected visual acuity, and other ocular examination findings, was recorded in an excel sheet.

Results:

Preoperatively, 2 patients had total LSCD (secondary to a firecracker injury and excision biopsy for ocular surface squamous neoplasia). 4 patients had partial LSCD (3 chemical injuries, 1 firecracker injury). The mean age of participants was 30.67 ± 15.91 years, with a mean follow-up duration of 9.33 ± 8.04 months. Intraoperatively, all patients exhibited a smooth corneal surface after pannus removal. Postoperatively, all limbal explants remained securely attached, with complete corneal epithelialization achieved within 2 to 3 weeks. The ocular surface remained stable throughout, and no recurrence of LSCD was observed in any patient. No loss of explants was seen.

Conclusions:

The present series suggests that AMG may not be a necessary step for performing SLET.
Descemet Membrane Endothelial Keratoplasty as Treatment for Late-Onset Interface Fluid Syndrome After Laser In Situ Keratomileusis
Authors: Huertas-Bello Marcela , Sem Karen , Alba Diego E. , Donaldson Kendall E. , Koo Ellen H.
Published: March 2024

Purpose:

We herein present Descemet membrane endothelial keratoplasty (DMEK) as an effective surgical means of treatment for the management of interface fluid syndrome (IFS) in a series of cases with distant history of laser in situ keratomileusis (LASIK).

Methods:

Three cases from a single institution were included. All patients had documented IFS in the setting of history of LASIK. All 3 patients underwent DMEK for the treatment of IFS. Visual acuity, clinical findings, pachymetry, endothelial cell count, and anterior segment optical coherence tomography were recorded.

Results:

We describe 3 cases of late-onset IFS that developed in eyes many years after LASIK (ranging from 15 to 31 years). All 3 patients had clinically significant corneal edema and evidence of poor endothelial function at the time of IFS diagnosis. DMEK was subsequently performed in each case. All 3 eyes showed resolution of corneal edema and improvement in best-corrected visual acuity after DMEK.

Conclusions:

DMEK can provide successful visual and anatomical recovery in patients who have had previous LASIK and experience late-onset IFS due to endothelial cell dysfunction.
Feasibility estimation of injected hydrodissection before definitive radiotherapy of pancreatic adenocarcinoma
Authors: Wu Yuan-Hung , Shen Shu-Huei , Wang Yen-Po , Chang Nai-Wen , Lee Pei-Chang , Li Chung-Pin , Lan Keng-Li , Shiau Cheng-Yin , Hu Yu-Wen , Huang Pin-I. , Hsu Chen-Xiong , Yen Sang-Hue , Hsu Shih-Ming
Published: March 2024

Background:

Pancreatic adenocarcinoma is often not diagnosed until an advanced stage, and so most patients are not eligible for resection. For patients who are inoperable, definitive radiotherapy is crucial for local disease control. However, the pancreas is located close to other vulnerable gastrointestinal organs, making it challenging to deliver an adequate radiation dose. The surgical insertion of spacers or injection of fluids such as hydrogel before radiotherapy has been proposed, however, no study has discussed which patients are suitable for the procedure.

Methods:

In this study, we reviewed 50 consecutive patients who received definitive radiotherapy at our institute to determine how many could have benefitted from hydrodissection to separate the pancreatic tumor from the adjacent gastrointestinal tract. By hypothetically injecting a substance using either computed tomography (CT)-guided or endoscopic methods, we aimed to increase the distance between the pancreatic tumor and surrounding hollow organs, as this would reduce the radiation dose delivered to the organs at risk.

Results:

An interventional radiologist considered that hydrodissection was feasible in 23 (46%) patients with a CT-guided injection, while a gastroenterologist considered that hydrodissection was feasible in 31 (62%) patients with an endoscopic injection. Overall, we found 14 (28%) discrepancies among the 50 patients reviewed. Except for 1 patient who had no available trajectory with a CT-guided approach but in whom hydrodissection was considered feasible with an endoscopic injection, the other 13 patients had different interpretations of whether direct invasion was present in the CT images.

Conclusion:

Our results suggested that about half of the patients could have benefited from hydrodissection before radiotherapy. This finding could allow for a higher radiation dose and potentially better disease control.
Criteria for selecting living liver donors to optimize recipient outcomes in pure laparoscopic donor right hepatectomy: a cohort study
Authors: Hong Suk Kyun , Hong Su young , Lee Jeong-Moo , Choi YoungRok , Yi Nam-Joon , Lee Kwang-Woong , Suh Kyung-Suk
Published: March 2024

Background:

Although the adoption of pure laparoscopic donor hepatectomy has expanded driven by considerations of donor cosmesis and function, the criteria for selecting candidates for pure laparoscopic donor right hepatectomy (PLDRH) continue to be debated. This study aimed to delineate the distinctive characteristics of donors and recipients who underwent conventional open-donor right hepatectomy (CDRH) during the era of PLDRH.

Materials and methods:

The authors conducted a retrospective review of a prospectively collected single-centre database encompassing all right hepatectomies at Seoul National University Hospital from April 2016 to December 2021, a period during which there were no absolute contraindications for PLDRH.

Results:

During the exclusive PLDRH period, there were still 63 cases of CDRH alongside 362 cases of PLDRH. The CDRH donors were older, had a lower estimated remnant liver volume, and a higher incidence of expected multiple openings in the portal vein and bile duct based on preoperative imaging compared with PLDRH donors. In the subgroup analysis, including only donors meeting two or more criteria (age ≥40 years, estimated remnant liver volume ≥35%, or multiple anticipated vessel openings), recipients in the PLDRH group exhibited significantly more early major complications (P=0.029) compared with those in the CDRH group.

Conclusion:

As PLDRH gains traction in practice, it is essential to acknowledge that specific donor conditions, such as advanced age, limited remnant liver volume, and anticipation of multiple portal or bile duct openings, may merit contemplating CDRH as a means of optimizing recipient outcomes.
Challenges in the Management of Symptomatic Fallopian Canal Meningoceles: A Multicenter Case Series and Literature Review
Authors: Filip Peter , Chiang Harry , Goldberg Allison , Khorsandi Azita S. , Moonis Gul , Moody Antonio Stephanie A. , Wanna George , Cosetti Maura
Published: March 2024

Objective

To describe the presentations, the diagnosis, our treatment approaches, and the outcomes for 11 patients with fallopian canal meningocele (FCM).

Study Design: Multicenter

Retrospective case series.

Setting

Tertiary referral centers.

Patients

Patients (N = 11) with radiographically or intraoperatively identified, symptomatic FCM.

Interventions

Surgical repair of cerebrospinal fluid (CSF) leak and meningocele versus observation.

Main Outcome Measures

Presentation (including symptoms, radiographic imaging, and comorbidities), management (including surgical approach, technique for packing, use of lumbar drain), clinical outcomes (control of CSF leak, meningitis, facial nerve function), and revision surgery.

Results

Patients presented with spontaneous CSF leak (n = 7), conductive (N = 11) and sensorineural hearing loss (n = 3), nonpositional intermittent vertigo (n = 3), headaches (n = 4), and recurrent meningitis (n = 1). Risk factors in our series included obesity (n = 4), Chiari 1 malformation (n = 1), and head trauma (n = 2). Noncontrast computed tomography of the temporal bone and magnetic resonance imaging were positive for FCM in 10 patients. Eight patients were managed surgically via a transmastoid approach (n = 4), combined transmastoid and middle fossa (N = 3), or middle fossa alone (n = 1); three were managed conservatively with observation. Postoperative complications included worsened facial nerve palsy (n = 1), recurrent meningitis (n = 1), and persistent CSF leak that necessitated revision (n = 1).

Conclusions

Facial nerve meningoceles are rare with variable presentation, often including CSF otorrhea. Management can be challenging and guided by symptomatology and comorbidities. Risk factors for FCM include obesity and head trauma, and Chiari 1 malformation may present with nonspecific otologic symptoms, in some cases, meningitis and facial palsy. Layered surgical repair leads to high rates of success; however, this may be complicated by worsening facial palsy.
Characteristics of factor V and protein C based on results from Korean testing centers
Authors: Na Min Ji , Kim Jae Kyung
Published: March 2024

Objective

The global incidence of thrombosis is increasing. However, research on thrombosis in the context of Korea is scarce. We aimed to analyze the relationship between factor V and protein C test results and thrombosis in Koreans through a domestic commissioned testing institution conducting mass examinations.

Methods

Results of factor V and protein C tests of 1386 individuals referred simultaneously to EONE Laboratories (Incheon, Republic of Korea) from January 2017 to July 2023 were analyzed retrospectively to identify the association with thrombotic disease. The tests were performed using a STAR MAX (Diagnostica Stago, Asnieres, France) automatic blood coagulation analyzer. The results were analyzed by age and sex.

Results

The inspection rate increased gradually from 2017 to 2022. Women (70.0%) demonstrated a higher test rate than did men (30.0%). Young women reported high test rates; the test rate and age distribution differed by sex. Women aged between 20 and 49 years reported lower factor V and higher protein C concentrations than did men between 20 and 49 years of age.

Conclusions

The tests were more commonly performed in women than in men. Women aged between 20 and 49 years reported lower factor V concentrations and higher protein C concentrations than men between 20 and 49 years of age. This study will facilitate recognizing and preventing thrombotic diseases in women.