bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic excision of inflammatory pseudotumors: A case report
Authors: Rispoli Corrado , Marra Ester , Tufo Andrea , Marte Gianpaolo , D’Avino Raffaele , Quassone Pasquale , Tamburrini Stefania , Armellino Mariano F.
Published: November 2023

Inflammatory pseudotumors (IPs) are rare incidental benign lesions which can occur in any anatomical site. They have been reported by a variety of names, including inflammatory myofibroblastic tumor, histiocytoma, xanthoma, and plasma cell granuloma. Their knowledge is important because of the differential diagnosis with others true malignancies. Only 30 case reports are reported in the literature. Surgical resection is the mainstay of treatment with excellent outcomes and low recurrence rates. When anatomical site is suitable, a laparoscopic approach should be performed to minimize morbidity and expedite recovery. Here, we present a case report of IPs of antimesenteric bowel treated with a laparoscopic surgical approach.
Renal packing for management of transplanted kidney blunt trauma: a case report and a review of literature
Authors: Di Lauro Katia , Mottola Arianna , Dumani Xheseda , Ciccarelli Maria Carmela , Esposito Alessandro , Maietta Paola , Tammaro Nicola , Zamboli Anna Ginevra Immacolata , Festa Patrizio
Published: November 2023

The kidney is injured in up to 10% of patients who experience significant abdominal trauma and approximately 65% of genitourinary tract injuries involve the kidney. Less is known about the management of this kind of trauma in the case of a transplanted kidney, and for this reason, we performed a review of the current literature. A systematic search was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses in all electronic databases; the inclusion criteria regarded all studies reporting on blunt trauma of a transplanted kidney, and the main outcome was the surgical or conservative management strategy of the trauma. A total of eight studies were included in the review and they were all case reports. We also reported our experience of a case of a 51-year-old patient with blunt trauma to his 18-year-old transplanted kidney, who underwent temporary packing of the renal fossa for kidney salvage. Trauma to a transplanted organ is rare, but clinicians will increasingly confront this scenario with the rise in transplantations. Although the management of renal trauma is well established, we are still far from identifying a gold standard for the treatment of transplanted kidney blunt trauma. It has been demonstrated that outcomes for trauma patients with previous organ transplants are not worse than nontransplanted patients; from this point of view, damage control surgery is considered an adequate approach and is applicable to unstable patients unfit for conservative or radiological intervention, and also in the case of a previous transplant. Data from this review and our experience demonstrate that accurate diagnostic profiling and the correct surgical management can allow the transplanted organ to be saved through a damage control approach; compliance with the most up-to-date therapeutic protocols must always guide surgical choices and, in our case, has allowed us to preserve the graft improving the patient’s quality of life.
Robotic resection of Todani’s cyst type Ic
Authors: Conticchio Maria , Delvecchio Antonella , Ferraro Valentina , Stasi Matteo , Casella Annachiara , Filippo Rosalinda , Tedeschi Michele , Memeo Riccardo
Published: November 2023

Choledochal malformation is a rare congenital disease. The current standard of treatment is complete excision of the choledocal cyst followed by reconstruction of the biliointestinal continuity. We report the case of a 45-year-old woman with repeated pancreatitis for Todani’s cyst type Ic. We decided to perform a robotic resection of the common bile duct and a hepatic-jejunal anastomosis. The robotic resection of the common bile duct followed by a hepaticojejunal anastomosis was a safe and feasible procedure.
Same-day discharge bariatric surgery: A pilot experience from an Italian center
Authors: Beomonte Zobel Lorenza , Dhimolea Sirvjo , Billeci Federica , Magrini Andrea , Dauri Mario , Sbraccia Paolo , Sica Giuseppe S.
Published: November 2023

Ambulatory bariatric surgery (BS) is a novel model of clinical care for patients with morbid obesity. The American College of Surgeons and the American Society for Metabolic and BS published clinical standards in BS that included ambulatory surgery in centers for low-acuity patients. Although ambulatory BS has been demonstrated to be safe and feasible, it has not yet been reported in Italy. It is hereby reported that this is the first experience of ambulatory BS in the Italian healthcare system. Two patients with morbid obesity underwent, respectively, a sleeve gastrectomy and an anastomosis gastric bypass. This pivotal experience was undertaken solely to evaluate the availability of logistics and the feasibility. Both patients were sent home within 10 hours of surgery. Admission, discharge protocol, and initial considerations are herein reported. The reduction of unnecessary hospital stays is clearly important and Same-day-discharge BS seems to have the potential to become one of the new models of offering this surgery.
Electrochemotherapy in plastic surgery: New perspectives from the pandemic experience in the treatment of advanced skin cancers in elderly and frail patients
Authors: Bonadies Antonio , Marcasciano Marco , Nanni Jacopo , Tedesco Marinella , Pallara Tiziano , Govoni Flavio Andrea , Grippaudo Francesca Romana , Greco Manfredi , Migliano Emilia
Published: November 2023

Background:

During the COVID-19 pandemic, most of the surgical units involved in the treatment of skin cancers could continue their activities, but the reevaluation of cases and the adaptation of the surgical approach, to limit access and hospital stays, proved to be mandatory. The study aims to demonstrate how the electrochemotherapy (ECT) approach guarantees a chance to keep on delivering comprehensive oncologic surgical treatment in a difficult and high-risk cohort of patients.

Methods:

We collected 35 elderly and frail patients affected by advanced and metastatic skin cancer who were unsuitable for a standard surgical approach. They were submitted to an ECT protocol, while evaluating the impact of ECT on health-related quality of life, using the EuroQol–five dimensions–three levels (EQ-5D-3L) instrument at baseline and after treatment.

Results:

A general improvement in health status was reported from the preoperative (mean 56.9) to the postoperative period (mean 63.7), according to the EuroQol–visual analog scale measure. The EuroQol–five dimensions descriptive system showed a reduction of the “patients reporting problems” from the baseline, in the domains for self-care (−27%), usual activities (−24%), pain/discomfort (−43%), and anxiety/depression (−11%).

Conclusions:

Rapid intervention, minimum hospitalization, palliation in selected cases, and postoperative management with telemedicine may represent the only option in the hands of a surgeon to treat advanced oncologic lesions in fragile patients, especially in a pandemic scenario. ECT can be considered a safe and effective procedure, well tolerated by most elderly and “high-risk” patients.
Mucosa layer obtruding the oesophagojejunostomy: A rare complication after total laparoscopic gastrectomy for gastric cancer
Authors: Carannante Filippo , Miacci Valentina , Bianco Gianfranco , D’Agostino Fausto , Caricato Marco , Capolupo Gabriella Teresa
Published: November 2023

The linear-stapled method of esophagojejunostomy is one of the most commonly used techniques to perform laparoscopic intracorporeal anastomosis after gastrectomy. We describe a case of total laparoscopic gastrectomy for gastric cancer. On the first postoperative day, our patient had vomited, so we decided to perform an endoscopy that showed a mucosa layer obtruding the esophagojejunostomy. The only way to solve the situation endoscopically was to perform endoscopic ultrasonography to find the right side to cut the layer, avoiding drilling the esophagus. After the procedure, gastroscopy and barium x-ray demonstrated a perfect resolution of the problem. An endoscopic control 30 months later showed a wide, easily transitable, and scarred esophagojejunostomy, and the patient had no discomfort or problems. We think that this type of anastomosis is safe and feasible. After the complication we described, we usually use a gastric tube to be sure that the mucosa layer was cut making the linear stapler anastomosis.
Comparison of Efficacy of Micropulse and Continuous Wave Cyclophotocoagulation in Patients With Pediatric Glaucoma
Authors: Vega-Garces Maria , Uppuluri Siri , Oydanich Marko , Khouri Albert S.
Published: November 2023

Précis:

Both micropulse (MP-CPC) and continuous wave (CW-CPC) cyclophotocoagulation exhibited short-term effectiveness in lowering IOP, followed by reversion to near baseline levels 12 months after laser treatment.

Objective:

To determine and compare the effectiveness and safety of MP-CPC and CW-CPC in patients diagnosed with pediatric glaucoma.

Methods:

A retrospective cohort study was conducted on a total of 28 patients (81 eyes) diagnosed with pediatric glaucoma either undergoing MP-CPC or CW-CPC. Intraocular pressure (IOP) measurements, number of glaucoma medications, and the onset of complications were collected at baseline, 1-month, 3-month, 6-month, and 12-month intervals. Success rate (SR) was defined as eyes achieving IOP ≤21 mm Hg and ≥5 mm Hg and a 20% reduction in IOP at the last follow-up visit.

Results:

All patients either undergoing MP-CPC or CW-CPC were matched for age (mean ± SD; 1.76 ± 1.69 vs 1.56 ± 2.49 y). Patients undergoing MP-CPC had significant decreases in IOP from baseline IOP at 1, 3, and 6 months with a 22% SR at 12 months. CW-CPC had a significant decrease in IOP from baseline IOP at all follow-ups, with a 27% SR at 12 months. At the 12-month follow-up, the CW-CPC cohort exhibited a significantly larger overall drop in IOP when compared with the MP-CPC cohort, (7.99 ± 7.95 vs 1.78 ± 6.89, P < 0.05); however, the difference in SR between treatment groups (27% vs 22%) at 12 months was not significant (P > 0.05). Complications were minimal for both groups.

Conclusion:

Both MP-CPC and CW-CPC exhibited short-term effectiveness in lowering IOP, followed by reversion to near baseline levels 12 months after laser treatment. Both MP-CPC and CW-CPC exhibited similar SR at 12 months, 22% and 27% respectively.
Nerve–myeloid cell interactions in persistent human pain: a reappraisal using updated cell subset classifications
Authors: O'Brien Jayden A. , Karrasch Jackson F. , Huang Yun , Vine Erica E. , Cunningham Anthony L. , Harman Andrew N. , Austin Paul J.
Published: November 2023

The past 20 years have seen a dramatic shift in our understanding of the role of the immune system in initiating and maintaining pain. Myeloid cells, including macrophages, dendritic cells, Langerhans cells, and mast cells, are increasingly implicated in bidirectional interactions with nerve fibres in rodent pain models. However, our understanding of the human setting is still poor. High-dimensional functional analyses have substantially changed myeloid cell classifications, with recently described subsets such as epidermal dendritic cells and DC3s unveiling new insight into how myeloid cells interact with nerve fibres. However, it is unclear whether this new understanding has informed the study of human chronic pain. In this article, we perform a scoping review investigating neuroimmune interactions between myeloid cells and peripheral nerve fibres in human chronic pain conditions. We found 37 papers from multiple pain states addressing this aim in skin, cornea, peripheral nerve, endometrium, and tumour, with macrophages, Langerhans cells, and mast cells the most investigated. The directionality of results between studies was inconsistent, although the clearest pattern was an increase in macrophage frequency across conditions, phases, and tissues. Myeloid cell definitions were often outdated and lacked correspondence with the stated cell types of interest; overreliance on morphology and traditional structural markers gave limited insight into the functional characteristics of investigated cells. We therefore critically reappraise the existing literature considering contemporary myeloid cell biology and advocate for the application of established and emerging high-dimensional proteomic and transcriptomic single-cell technologies to clarify the role of specific neuroimmune interactions in chronic pain.
Allogenic Umbilical Cord Tissue for Rotator Cuff Injuries
Authors: Aratikatla Adarsh , Sidhu Justin , Maffulli Nicola , Gupta Manu , Potty Anish G. , Gupta Ashim
Published: November 2023

Highly prone to injury, the rotator cuff greatly contributes to the stability and mobility of the shoulder. Clinicians prioritize conservative treatment, resorting to surgery only when necessary, although they are hindered by inherent limitations. Biological therapies, including perinatal tissue, such as umbilical cord (UC) tissue, hold promise for treating rotator cuff injuries (RCIs) in the field of regenerative medicine. This article qualitatively presents the in vitro, preclinical, clinical, and ongoing scientific literature exploring the application of UC tissue and associated mesenchymal stem cells in the context of RCIs. Employing the “Preferred Reporting Items for Systematic Reviews and Meta-analyses” guidelines, a systematic review was conducted. These studies have presented substantial evidence indicating that UC tissue and UC-derived mesenchymal stem cells are safe and potentially efficacious for managing RCIs, though more adequately powered randomized controlled trials are warranted to further establish efficacy and justify clinical use.
The effects of empathic communication skills training on nurse practitioner students
Authors: Beckstrom Kimberly M. , Farrow Stacy L.
Published: November 2023

Evidence regarding the impact of empathic communication training on nurse practitioner (NP) students is lacking. Despite increasing emphasis within practice settings in the United States, formal communication training for NP students has been modestly integrated into curriculum, based on limited data supporting its efficacy. As such, we sought to evaluate the impact of empathic communication training on NP students' self-efficacy with empathic communication. This is a quasi-experimental study of a single group of NP students (n = 49) who participated in empathic communication training with pretraining/posttraining measurements using the Self-Efficacy-12 instrument. There were statistically significant improvements in students' comfort and confidence with nine of the 17 items surveyed. Several other domains also showed improvement approaching statistical significance. Based on our results, empathic communication training increases NP students' self-efficacy with empathic communication.
Defining Optimal Settings for Lung Cryobiopsy in End-Stage Pulmonary Disease. A Human, Ex Vivo, Diseased Lung Clinical Trial
Authors: Menezes Vanessa , Pollock Clare , Ferraro Pasquale , Nasir Basil , Leduc Charles , Morisset Julie , Liberman Moishe
Published: November 2023

Background:

To evaluate optimal settings of probe size, freezing time, and distance to the pleura that influence the size and quality of biopsy specimens during transbronchial lung cryobiopsies in ESPD.

Methods:

We prospectively recruited 17 patients undergoing lung transplantation. We created a nonperfused ex vivo bronchoscopy setting to perform multiple cryobiopsies with different probe sizes (1.7, 1.9, and 2.4 mm), freezing times (3, 5, 7, 10, 20, 30 seconds), and probe distance from pleura (5, 10, and 20 mm). Alveolated pulmonary parenchyma area≥50% in histology was considered a good quality biopsy, with a minimum procedural artifact. We used logistic regression to identify independent parameters as risk factors for histologic adequacy.

Results:

A total of 545 cryobiopsies were obtained from 34 explanted lungs after pneumonectomy for lung transplantation. The mean maximum diameter of the specimen achieved with the 1.7 probe was larger (13.5 mm) than those obtained with 1.9 and 2.4 mm probes (11.3 and 10.7 mm, P=0.07). More pleural macroscopic damage and pleural tissue in histology occurred with the 2.4 mm probe (P<0.001). There was no difference in the quality of specimens between the different freezing times and the distance from the pleura.

Conclusions:

Freezing time and distance from the pleura did not affect the histologic quality for diagnosing ESPD in severely damaged lungs. Smaller cryoprobe size did not negatively affect sample adequacy.
Central Extracorporeal Membrane Oxygenation Support Following Calcium Channel Blocker Overdose in Children
Authors: Sorabella Robert A. , Gray William H. , Dabal Robert J. , Padilla Luz A. , Hock Kristal , Clark Matthew G. , O’Meara Carlisle , Hawkins Jeremy , Richter Robert P. , Borasino Santiago , Byrnes Jonathan W.
Published: November 2023

Refractory vasodilatory shock (RVS) following massive calcium channel blocker (CCB) overdose remains a challenging clinical entity. Peripheral venoarterial extracorporeal membrane oxygenation (ECMO) has proven useful in several cases of CCB intoxication, however, its use in the pediatric population poses unique challenges given the generally small size of pediatric peripheral vasculature in comparison to the high flow rates necessary for adequate mechanical circulatory support. As a result of these challenges, our group has adopted a “primary” central ECMO cannulation approach to the treatment of children and adolescents admitted to our center with profound RVS after CCB ingestion. We present four cases within the last year using this approach. All patients were successfully discharged from the hospital with no late morbidity at most recent follow-up. Central ECMO support in cases of massive vasodilatory shock following CCB overdose is safe and effective and should be considered early in the clinical course of these critically ill patients.
School-based health: an area of opportunity to address challenges in management of pediatric obesity and type 2 diabetes
Authors: Wood Aurelia C.H. , Pratt Keeley
Published: November 2023

Purpose of review

Obesity and type 2 diabetes (T2D) are increasingly common, chronic, and complex and disproportionally affect systemically under-resourced communities negatively impacted by social determinants of health. The primary goals of management for both conditions are improvement of medical and psychosocial well being and prevention of secondary complications. The advent of pediatric specific multidisciplinary weight management programs, bariatric surgery, and recent FDA approved medications have provided clinicians with tools to improve patient outcomes. However, implementation remains a challenge.

Recent findings

The Chronic Care Model proposes utilization of community-based interventions to support children and families in managing chronic disease The CDC's Whole School, Whole Community, Whole Child Model provides a framework for schools to engage in this role. School-Based Health Centers (SBHCs) utilize a child-focused, multidisciplinary approach to support the medical home and overcome barriers to routine primary care, medical screenings and successful care plans for management of chronic disease. SBHCs and school-based programs have proven sustainable and effective in addressing obesity and T2D in youth, however recent studies are limited and more research evaluating impact are needed.

School-based health offers an evidence-based solution to ensuring equitable and comprehensive care for obesity and T2D, particularly among at-risk communities.
Incidence of incisional hernias and cosmetic outcome after laparoscopic single-incision cholecystectomy: a long-term follow-up cohort study of 125 patients
Authors: Krollmann Niklas , Hunger Richard , Paasch Christoph , Mantke René
Published: November 2023

Background:

Studies have evaluated long-term occurrence of incisional hernia, cosmesis, and postoperative pain after single-incision laparoscopic cholecystectomy (SILC). However, the follow-up periods were rarely defined longer than 12 months. The authors performed a cohort study to evaluate hernia rate and cosmesis in a prolonged follow-up period.

Methods:

All patients that underwent SILC at the University Hospital Brandenburg an der Havel Hospital between December 2008 and November 2014 were evaluated in terms of postoperative complications, and a follow-up telephone interview including the existence of hernias and chronic pain was performed. Cosmesis and the overall satisfaction of the scar was measured by POSAS (Patient and Observer Scar Assessment Scale).

Results:

In total 125 patients underwent SILC. The single-incision approach was completed in 94.4%, an additional trocar was necessary in 3.2% (n=4) and a conversion to 4 trocar cholecystectomy was required in 2.4% (n=3). Intraoperative complications occurred in 0.8% and postoperative complication in 12.8% of all patients. Follow-up telephone interview was performed in 49.6% of 125 patients. The mean follow-up period was 138.9 months (11.6 years). Overall, in 3.6%, an incisional hernia was diagnosed. A total of 3.6% reported pain in the region of the umbilicus with a mean VAS (visual analog scale) of 2/10. The mean POSAS score was 7.8. Overall, 82.3% of this cohort rate their satisfaction of the scar with a 1/7, resembling the best possible result of the scar.

Conclusion:

The present study demonstrates that SILC is a safe alternative in terms of incisional hernia rate and complications with a high satisfaction of the scar even after one decade after surgery. In comparison to shorter follow-up period and multiport laparoscopic cholecystectomy, our result is comparable.
Factors influencing bacterial colonization of double J ureteral stents: a prospective study
Authors: Bouassida Khaireddine , Marzouk Manel , Ben Saad Hamda , Khalfaoui Najd , Jaidane Mehdi , Boukadida Jalel , Zairi Amira
Published: November 2023

Background:

To investigate the microorganisms responsible for double J stent (DJS) colonization, bacteriuria, and the drug susceptibility of the isolates. We also tried to determine factors associated with stent colonization, such as indwelling time, sex, age, and comorbidities.

Materials and methods:

This study is a prospective analysis of patients following DJS ablation. A total of 155 patients from our institution were enrolled in this study between January 2023 and May 2023. Bladder urine was collected in a sterile container prior to stent removal for bacteriological exam. The removed stents were divided into three parts: top (Renal), middle (Ureteral), and bottom (Bladder); 3 cm pieces from each part were taken and placed in a sterile test tube for bacteriological investigation.

Results:

The mean age of patients with positive stent culture was 61.17±12.82 versus 55.94±10.32 when stent culture is negative, which is statistically significant P=0.016. Diabetes and bacteriuria are both correlated with DJS contamination with P<0.001 in the two cases. The mean duration of the use of DJS in patients with colonized stent culture is 6.45±2.98 months versus 4.06±2.20 months for the other patients; the difference is statistically significant P<0.001. The most commonly isolated pathogens on stents were Gram-negative bacilli (53.2%), dominated by Enterobacteriaceae in 19 cases (55.2%).

Conclusion:

Indwelling time is the only unanimous factor of stent colonization in literature, so we recommend using DJS only if necessary and to remove it as soon as possible.
Management and Interventions in Previable and Periviable Preterm Premature Rupture of Membranes: A Review
Authors: Phillips Amy , Pagan Megan , Smith Alex , Whitham Megan , Magann Everett F.
Published: November 2023

Importance

Periviable and previable premature rupture of membranes (pPPROM) occurs in <1% of pregnancies but can have devastating consequences for the mother and the fetus. Understanding risk factors, possible interventions, and both maternal and neonatal outcomes will improve the counseling and care provided for these patients.

Objective

The aim of this review is to describe the etiology, risk factors, management strategies, neonatal and maternal outcomes, and recurrence risk for patients experiencing pPPROM.

Evidence Acquisition

A PubMed, Web of Science, and CINAHL search was undertaken with unlimited years searched. The search terms used included “previable” OR “periviable” AND “fetal membranes” OR “premature rupture” OR “PROM” OR “PPROM.” The search was limited to English language.

Results

There were 181 articles identified, with 41 being the basis of review. Multiple risk factors for pPPROM have been identified, but their predictive value remains low. Interventions that are typically used once the fetus reaches 23 to 24 weeks of gestation have not been shown to improve outcomes when used in the previable and periviable stage. Neonatal outcomes have improved over time, but survival without severe morbidity remains low. Later gestational age at the time of pPPROM and longer latency period have been shown to be associated with improved outcomes.

Conclusions and Relevance

Periviable and previable premature rupture of membranes are uncommon pregnancy events, but neonatal outcomes remain poor, and routine interventions for PPROM >24 weeks of gestation have not proven beneficial. The 2 most reliable prognostic indicators are gestational age at time of pPPROM and length of the latency period.

Target Audience

Obstetricians and gynecologist, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to identify risk factors for previable and periviable preterm premature rupture of membranes; interpret the risks and benefits of possible interventions for patients experiencing previable or periviable preterm premature rupture of membranes; and describe the neonatal and maternal outcomes when a pregnancy is complicated by previable or periviable preterm premature rupture of membranes.
Complete Response to 177Lu-DOTATATE PRRT in a 9-Year-Old Child With Metastatic Carotid Body Paraganglioma
Authors: Yadav Madhav Prasad , Raju Shobhana , Ballal Sanjana , Bal Chandrasekhar
Published: November 2023

We present a case involving a 9-year-old boy diagnosed with metastatic carotid body paraganglioma. The metastases were detected in cervical lymph nodes and lungs using 68Ga-DOTANOC PET/CT imaging. The patient received peptide receptor radionuclide therapy with 177Lu-DOTATATE. Following 3 treatment cycles, a significant improvement was observed in the metastatic lesions. After 4 cycles, the patient achieved a complete response, with a cumulative administered activity of 16.65 GBq during the therapy. This case underscores the effectiveness of using 177Lu-DOTATATE in managing metastatic carotid body paraganglioma, offering promising results in terms of tumor regression and overall therapeutic response.
FDG PET/CT Demonstrated Unilateral Striatum Hypometabolism in a Case of Advanced Nasopharyngeal Cancer
Authors: Lu Xuan-Ping , Chen An-Chih , Wu Ming-Chi , Tseng Hsien-Chun , Kao Pan-Fu
Published: November 2023

A 79-year-old man with nasopharyngeal cancer (NPC) presented with diplopia symptom and a history of diabetes mellitus was referred for an FDG PET/CT scan to determine the pretreatment staging. The FDG PET/CT scan revealed NPC with skull base invasion and decreased FDG uptake at the left striatum. A review of his clinical history and a brain MRI conducted 5 months ago confirmed a previous diagnosis of left hyperglycemic hemichorea. In this NPC patient with inadequate blood sugar control, unilateral striatum hypometabolism may persist for up to 5 months after the initial clinical symptoms.
The Outcomes of Endoscopic Suturectomy in Syndromic Craniosynostosis
Authors: Shim Youngbo , Kim Seung-Ki , Ko Jung Min , Jeon Sungmi , Kim Byung Jun , Jung Jee Hyeok , Lee Seunghoon , Kim Kyung Hyun , Lee Ji Yeoun , Phi Ji Hoon
Published: November 2023

Objective:

Endoscopic suturectomy is a widely practiced surgical option for infants with craniosynostosis. But the efficacy and safety of the procedure remain unclear in syndromic patients. This study aims to evaluate the efficacy and safety of endoscopic suturectomy for patients with syndromic craniosynostosis.

Methods:

From January 2013 to December 2020, 242 patients underwent endoscopic suturectomy at our institution. The surgical outcome was determined to be favorable or unfavorable based upon the necessity of an additional cranial surgery upon the last follow-up. First, we analyzed the outcomes of 26 syndromic craniosynostosis patients who have followed up for over a year. Second, we compared the outcomes between the syndromic (N=12) and nonsyndromic (N=11) patients with bilateral coronal synostosis who have followed up for over a year.

Results:

Twenty-three out of 26 syndromic craniosynostosis patients (88%) showed favorable outcomes without significant complications. In the analysis for bilateral coronal synostosis patients, 11 of 12 syndromic patients (92%) presented favorable outcomes, and all nonsyndromic patients showed favorable outcomes. No significant differences were observed in various anthropometric indices (cranial index, intracranial volume, anterior cranial height, anterior cranial base length, and cranial height–length index) and surgical outcomes between syndromic and nonsyndromic groups.

Conclusions:

Endoscopic suturectomy has the potential to be a surgical option for syndromic craniosynostosis. Even for patients with unfavorable outcomes, endoscopic suturectomy could serve as a bridge treatment for infants to counter cranial deformation before additional extensive surgery.
Five-Segment Mandibular Osteotomy: A Novel Approach to the Correction of Complex Post-Traumatic Mandibular Deformities
Authors: Al-Shaqsi Sultan Z. , Antonyshyn Oleh M.
Published: November 2023

Background:

Post-traumatic mandibular malocclusion is a complex condition that poses a significant challenge to reconstructive surgeons. The malocclusion that ensues from bilateral condylar and parasymphseal fractures presents a particular challenge as it leads to bilateral posterior shortening and lingual tilting of dental arch leading to a combination of open anterior bite, crossbite, overbite, underbite, and/or facial asymmetry. The complexity of such malocclusion requires intricate freedom of movement of the mandibular arch that can be achieved by performing a 5-segment mandibular osteotomy.

Method:

This is a case series of 9 adult patients with significant post-traumatic mandibular malocclusion who were treated with 5-segment mandibular osteotomy technique. This article details the demographics, surgical technique and outcomes in this cohort of patients.

Results:

All 9 patients in this series had condylar fracture as part of the index mandibular trauma. They have a common post-traumatic deformity of the mandibular arch due to shortening of the vertical mandibular height in the fracture site and variable degrees of lingual tilting leading to crossbite. The 5-segment mandibular osteotomy provided an adequate correction of dental and facial deformities in all 9 patients. One patient had a relapse of the dental malocclusion that required postoperative rescue orthodontics. Furthermore, one patient had a significant postoperative hemorrhage that required a facial artery ligation.

Conclusion:

Post-traumatic mandibular malocclusion is a complex deformity that poses a great challenge to practicing surgeons. Five-segment mandibular osteotomy is a technique that provides ample degrees of movement of mandibular segments that is necessary to correct such deformity.
Cleft Maxillary Hypoplasia: Comparison of Techniques and Proposal of a Novel Treatment Protocol for Management
Authors: Richardson Sunil , Sinai Khandeparker Rakshit Vijay , Krishna Shreya , Diwaker Meghali
Published: November 2023

This study was designed to compare different techniques of managing cleft maxillary hypoplasia and to propose a treatment protocol taking patient’s age of presentation, amount of maxillary hypoplasia, and presence/absence of velopharyngeal insufficiency (VPI) into consideration. Five treatment modalities, viz. facemask therapy (Group I), anterior maxillary distraction (Group II), total maxillary distraction osteogenesis using rigid external distraction devices (Group III) and internal distraction devices (Group IV), and conventional orthognathic surgery (Group V), were assessed retrospectively using lateral cephalograms (taken at 3 intervals) and speech records (studied pre- and post-operatively). The results were subjected to statistical analysis. A P value of less than 0.05 was considered statistically significant. The mean advancement achieved in groups I, II, III, IV, and V was 4.2±1.54, 9.03±2.62, 11.82±1.18, 10.41±1.42, and 7.24±2.44 mm, respectively. The mean horizontal relapse noted in Groups I, II, III, IV, and V was 2.3 mm (n=8), 2.1 mm (n=14), 3.4 mm (n=10), 1.4 mm (n=5), and 2.4 mm (n=24), respectively. Compared to other groups, group II had fewer patients exhibiting relapse, a statistically significant observation. Similarly, statistically significant improvement in speech outcomes was found only in group II compared to other groups. Based on the results, a treatment protocol was proposed. The authors conclude that the proposed protocol would enable surgeons to decide the most appropriate treatment modality paying attention to not only the age of presentation and amount of advancement but also presence/absence of VPI which is instrumental in deciding upon the most appropriate treatment.
The Influence of the Hourglass Form of the Neck on Perceptions of Frontal Esthetics
Authors: Gulsever Serap , Suzen Muazzez , Tuncer Mehmet Koray , Uckan Sina
Published: November 2023

The purpose of this investigation was to evaluate the effect of the neck concavity angle (NCA) on different occupational groups’ perceptions of frontal esthetics. An online survey was developed using Google Forms and sent to the observers through WhatsApp. Male and female frontal silhouettes were created, and NCAs that comprise the hourglass form of the neck were altered in 5 degrees increments from 120 degrees to 170 degrees. Observers were asked to score the images using 0 to 10 numerical rating scale. In all, 279 observers (97 orthodontists, 92 oral-maxillofacial surgeons, and 90 laypeople) participated in this study. For the male and female silhouettes, an NCA of 145 degrees was perceived as the most esthetic, while an NCA of 170 degrees was perceived as the least esthetic by all groups. Generally, an NCA greater than 145 degrees was perceived as less esthetic than an NCA smaller than 145 degrees. There was no significant difference between the scores of the observer groups for the silhouettes except for the female silhouettes with an NCA of 125 degrees or 150 degrees and the male silhouettes with an NCA of 145 degrees or 150 degrees. For both the female and male silhouettes, the further the NCA increased or decreased from 145 degrees, the less esthetic it was perceived to be. A significant increase in NCA was perceived as less esthetic than a significant decrease. The range of NCAs perceived as esthetic varied between 120 degrees and 145 degrees for women and between 130 degrees and 150 degrees for men. These ranges of variability of NCA may provide clinicians with useful information for orthognathic surgical planning.
A Novel Technique for Septal Perforation Repair: Fascia Lata Graft
Authors: Hanci Deniz , Onaran Öykü İzel , Altun Hüseyin , Uyar Yavuz
Published: November 2023

Background:

Nasal septal perforation (NSP) is an anatomical defect involving the mucosa, cartilage/bone of the nasal septum, most commonly caused by septoplasty. Spontaneous healing of a perforated septum is rare; instead, it tends to worsen over time. Several surgical approaches have been described for NSP repair. In this study, the authors present a novel technique using only fascia lata graft for repairing NSP of various sizes.

Methods:

The authors conducted a retrospective study, including 23 patients who underwent NSP repair between January 2020 and January 2022. Grafts were harvested, and the perforation was accessed through an open rhinoplasty approach, followed by insertion and suturing of the graft.

Results:

The mean size of the septal perforations was 2.13 mm horizontally and 2.14 mm vertically. The mean follow-up period was 12 months. Complete closure of NSP was achieved in 21 out of 23 patients (91.30%). Among the cases, 17 were males (11.76%), and the age ranged from 20 to 43 years with a mean of 36.5. Eight cases (50%) were smokers. At 12 months postoperatively, 3 medium-sized NSPs were closed successfully, whereas 2 large NSPs did not achieve closure due to smoking.

Conclusion:

The fascia lata technique for NSP closure is a safe and reliable approach with a high success rate, which should be considered for patients with NSP.
Older Patient Receptivity to the Integration of Patient Portals and Telehealth in Urogynecology: Promoters and Deterrents
Authors: Zoorob Dani , Hasbini Yasmin
Published: November 2023

Importance

Limited studies focus on the integration of online portals, including telehealth services, in urogynecology while identifying promoters and deterrents of utilization, especially for the older population.

Objective

This study aimed to identify facilitators, concerns, technical or personal issues encountered, and the desired features of the online patient portals among older urogynecology patients.

Study Design

This is a secondary analysis of a cross-sectional study of older patients (≥65 years). The survey was devised using 2 focus groups with questions addressing older patient practicality and comfort with virtual visits for menopause and urogynecology-specific conditions.

Results

A total of 205 patients completed the study. Promoters of use included health care professional encouragement, enrollment on site with concurrent education, and clarification of relevance of the virtual care to one's care. Patients who were uncomfortable with portal use reported anxiety and technical issues as deterrents for using such technology. More than half of the patients were comfortable having online visits for preoperative (51.7%), postoperative (66.3%), and medical management (73.7%). Up to 60.5% of the patients believed that virtual visits were equally stressful as in-person visits, whereas 24.4% believed that the logistics of in-person visits were the cause of stress.

Conclusions

To improve access to care, augment the utilization of online patient portals, and combat ageism, enhancing the older urogynecologic patient's portal experience is vital. Investment in this population's needs includes education of patients, active enrollment, and engagement by health care systems, and addressing technical concerns.
Neuroscience and oncology: state-of-the-art and new perspectives
Authors: Winkler Frank
Published: November 2023

Purpose of review

Emerging discoveries suggest that both the central (CNS) and peripheral (PNS) nervous system are an important driver of cancer initiation, promotion, dissemination, and therapy resistance, not only in the brain but also in multiple cancer types throughout the body. This article highlights the most recent developments in this emerging field of research over the last year and provides a roadmap for the future, emphasizing its translational potential.

Recent findings

Excitatory synapses between neurons and cancer cells that drive growth and invasion have been detected and characterized. In addition, a plethora of paracrine, mostly tumor-promoting neuro-cancer interactions are reported, and a neuro-immuno-cancer axis emerges. Cancer cell-intrinsic neural properties, and cancer (therapy) effects on the nervous system that cause morbidity in patients and can establish harmful feedback loops receive increasing attention. Despite the relative novelty of these findings, ther

apies that inhibit key mechanisms of this neuro-cancer crosstalk are developed, and already tested in clinical trials, largely by repurposing of approved drugs.

Neuro-cancer interactions are manyfold, have multiple clinical implications, and can lead to novel neuroscience-instructed cancer therapies and improved therapies of neurological dysfunctions and cancer pain. The development of biomarkers and identification of most promising therapeutic targets is crucial.
Artificial intelligence in neuroimaging of brain tumors: reality or still promise?
Authors: Pan Ian , Huang Raymond Y.
Published: November 2023

Purpose of review

To provide an updated overview of artificial intelligence (AI) applications in neuro-oncologic imaging and discuss current barriers to wider clinical adoption.

Recent findings

A wide variety of AI applications in neuro-oncologic imaging have been developed and researched, spanning tasks from pretreatment brain tumor classification and segmentation, preoperative planning, radiogenomics, prognostication and survival prediction, posttreatment surveillance, and differentiating between pseudoprogression and true disease progression. While earlier studies were largely based on data from a single institution, more recent studies have demonstrated that the performance of these algorithms are also effective on external data from other institutions. Nevertheless, most of these algorithms have yet to see widespread clinical adoption, given the lack of prospective studies demonstrating their efficacy and the logistical difficulties involved in clinical implementation.

While there has been significant progress in AI and neuro-oncologic imaging, clinical utility remains to be demonstrated. The next wave of progress in this area will be driven by prospective studies measuring outcomes relevant to clinical practice and go beyond retrospective studies which primarily aim to demonstrate high performance.
Optic Disc Drusen Prevalence in Patients With Retinitis Pigmentosa: A Cross-Sectional Study
Authors: Steensberg Alvilda H. , Schmidt Diana C. , Malmqvist Lasse , Kessel Line , Bertelsen Mette , Grønskov Karen , Hamann Steffen
Published: November 2023

Background:

Studies of patients with retinitis pigmentosa (RP) have reported an increased prevalence of optic disc drusen (ODD) compared with the ODD prevalence in the general population. The diagnostic gold standard method for identifying ODD is enhanced depth imaging optical coherence tomography (EDI-OCT), but this modality has not previously been used systematically for identifying ODD in patients with RP. This study aimed to estimate the prevalence of ODD in patients with RP using EDI-OCT.

Methods:

In this cross-sectional study, 40 patients with clinically diagnosed RP aged 18 years or older were included. All patients underwent an ophthalmic examination, including kinetic perimetry, EDI-OCT of the optic nerve head, and fundus photography. Genetic testing with a next-generation sequencing panel of retinal dystrophy genes was performed on the RP patients without a prior genetic diagnosis.

Results:

Twelve patients (30.0%) had at least one ODD. Six patients had bilateral ODD. No significant differences between patients with and without ODD were found according to age, refraction, best-corrected visual acuity, Bruch membrane opening, or visual field. The genetic variation causing RP was found in 11 of 12 cases in the ODD group and in 17 of 28 cases in the group without ODD.

Conclusions:

We found the prevalence of ODD in patients with RP to be 30.0%. This is 15 times higher than in the general population and much higher than previously estimated in most studies, potentially indicating that the 2 conditions might be pathogenically related.
Facilitation in evidence implementation – experiences, challenges, and determinants of perceived effectiveness: a qualitative systematic review
Authors: Lizarondo Lucylynn , McArthur Alexa , Porche Demetrius , Corremans Marleen , Perrenoud Beatrice , Rodrigues Rogério , Lockwood Craig
Published: November 2023

Introduction:

Facilitation is a key element of evidence implementation. Although quantitative systematic reviews have been undertaken to examine its components and effectiveness, no attempt has been made to synthesize qualitative evidence examining the experiences of facilitators on how facilitation is operationalized, the challenges associated with it, and the factors that can influence its perceived effectiveness.

Methods:

A systematic review of qualitative studies was conducted using the JBI methodology.

Results:

A total of 36 qualitative studies was included in the systematic review, with the majority being assessed as high quality following critical appraisal. The findings were extracted and further synthesized, highlighting that facilitation involves providing technical and non-technical support to health professionals, as well as high-intensity collaborations and relationship building. Determinants of perceived effectiveness of facilitation include facilitators’ access to resources and learning support; their skills, traits/attitudes, and approach to facilitation; and the context of the organization where the implementation occurs. Work demands, emotional stress, and lack of clarity in roles and career development can pose challenges for facilitators.

Conclusion:

To maximize the outcomes of facilitation in evidence implementation, the team of facilitators should be carefully selected to ensure they have the right skills, traits/attitudes, and approach to facilitation. They should also be provided with dedicated time to conduct the facilitation and have access to resources, training, and mentoring support. Future research should aim to examine the perspectives of the “implementers” who received support from facilitators to gain a better understanding of which facilitation strategies have an impact on clinical practice behavior.

Review registration number:

PROSPERO CRD42023402496
Anxiety and mood disorders in forcibly displaced people across the world
Authors: Schouler-Ocak Meryam , Moran James Kennth
Published: November 2023

Purpose of review

Displaced persons around the world have intensified in the previous decade and are predicted to rise further with greater global instability. The mental health issues involved with fleeing one's home, and attempting to make a new life in a host country need to be understood and addressed-

Recent findings

Prevalence of anxiety and mood disorders, including posttraumatic stress disorder appear to be higher for displaced peoples than for the population in the host country. This is consistent across different methods. Traumatic life events in the country of origin as well as during flight contribute to symptom severity. Factors in the host country increasing severity including isolation, discrimination, low social support. There are successfully implemented intercultural interventions at the individual level of the practitioner, as well as at the institutional level.

There are many possibilities for successful interventions in displaced people, realizing this at a scale appropriate to the size of the problem remains a challenge.