bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-time Navigation for Vascularized Lymph-node Transplantation Using Projection Mapping with Indocyanine Green Fluorescence
Authors: Tsuge Itaru , Sowa Yoshihiro , Yamanaka Hiroki , Katsube Motoki , Sakamoto Michiharu , Morimoto Naoki
Published: February 2023

The medical imaging projection system (MIPS) is a real-time surgical navigation device using indocyanine green (ICG) emission signals and active projection mapping. The difference between the object and the projected image is within 1 mm, and the time lag is within 0.1 seconds. We herein report the application of the MIPS to vascularized lymph-node transplantation (VLNT) surgery for lower extremity lymphedema to detect inguinal lymph nodes and perform color-coded navigation surgery for lymph-node resection. A left superficial inguinal lymph node was planned to be used as a donor for VLNT to the right lower leg in a 73-year-old woman with lower extremity lymphedema. Under general anesthesia, multiple intradermal injections of 0.1 ml of ICG were administered around the left inguinal donor site. The MIPS showed a clear linear projection image from a lateral injected point connecting to a lateral superficial inguinal lymph node. The left superficial circumflex iliac artery and vein were dissected for vascularized VLNT. Intraoperative real-time MIPS navigation continuously guided the transection plane colored by ICG fluorescence signals without shifting the visual focus from the surgical field. This is the first report of the intraoperative use of ICG projection mapping for VLNT donor-site surgery. The MIPS was able to visualize functional lymph nodes to facilitate minimally invasive donor-site surgery.
Multistage Reconstruction of Large Arm Defect Using Keystone Type I Flap and Temporary Synthetic Skin Substitute
Authors: Viscardi Juan A. , Eseme Ebai A. , Gohritz Andreas , Tremp Mathias , Merat Rastine , Kalbermatten Daniel F. , Oranges Carlo M.
Published: February 2023

Large arm defects remain a challenge to the reconstructive surgeon, as local and regional flaps are limited regarding size and free flaps have disadvantages such as poor color match, technical complexity, prolonged operative time, and the risk of total flap loss. Keystone flaps are fascia-based flaps and combine perforator-based vascularity with relative simplicity of nonmicrosurgical techniques and do not distort local anatomy in cases of malignant excision with wide defects. This article highlights the approach of a multistaged procedure to reconstruct a large arm defect using a keystone type I flap and a temporary synthetic skin substitute for closure in a patient referred to our department for wide resection of a large melanoma in situ on the posterior aspect of the left arm. The defect, measuring 14 cm × 8 cm, was initially reconstructed with a keystone type I flap. Part of the wound was temporarily covered with EpiGARD (Biovision GmbH, Ilmenau, Germany) to avoid excessive wound tension. One week later, the wound was partially narrowed, and a smaller EpiGARD was placed in office under local anesthesia. The multistaged approach was completed with direct closure 1 week later after removal of the smaller EpiGARD. No complications occurred and the result was satisfactory with a pleasing cosmetic result after an 8-month follow-up. In conclusion, the keystone flap allows reconstruction of large arm defects. Temporary synthetic skin substitute coverage can serve as a good addition for those cases where tension on the margins is observed at the price of a small in-office procedure.
Reconstructing Skin Defects of the Neck with Subfascial Expanded Anterolateral Thigh Flap: Report of Two Cases
Authors: Sơn Trần Thiết , Việt Dung Phạm Thị , Nghĩa Phan Tuấn
Published: February 2023

Reconstruction of functional and aesthetic deformities of the neck after severe burn contracture is challenging. A free anterolateral thigh (ALT) perforator flap may be required, especially if local tissue is affected. To enlarge the surface area of this flap, donor site pre-expansion can be combined with flap transfer. Two patients with large neck defects were treated using pre-expanded free ALT perforator flaps. A rectangular expander was placed under the deep fascia after dissection of the perforator of the descending branch of the lateral circumflex femoral artery. The expansion time was from 3 to 4 months and the final expanded volume was 900–1500 ml. Defect sizes ranged from 14 × 18 to 18 × 27 cm and the expanded ALT flap was measured from 12 × 18 to 27 × 18 cm with one perforator in the flap. After immediate thinning, flap thickness was reduced, ranging from 5 to 11 mm. All flaps survived completely. Two patients were followed for 40 months. The skin color and textures of the flap were good. There was also a clear improvement in appearance and function. In summary, the subfascial expanded ALT perforator flap can be an excellent option for repairing severe neck defects due to its safe harvesting even with the large flaps. The donor area is closed primarily, and the thinned expanded skin is more aesthetically pleasing. The drawbacks are that it is a two-stage procedure, and the expander may be displaced during the expansion period.
Expanding Candidacy for Nipple-sparing Mastectomy in Women with Large or Ptotic Breasts: Staged Reconstruction Outcomes
Authors: Barnes Laura L. , Foster Rob , Mukhtar Rita A. , Esserman Laura J. , Ewing Cheryl , Alvarado Michael , Wong Jasmine , Piper Merisa
Published: February 2023

Background:

Development of the nipple-sparing mastectomy (NSM) technique has dramatically improved breast reconstruction, and preservation of the nipple–areolar complex (NAC) positively influences patient satisfaction. However, women with large, ptotic breasts have historically not been candidates for NAC preservation due to impaired perfusion of the NAC leading to NAC loss. Although reduction mammoplasty has been reported as a strategy to increase candidacy for NSM, success rates and surgical outcomes for this staged approach are not well described in heterogeneous clinical scenarios.

Methods:

We performed a retrospective chart review of all patients who underwent reduction mammoplasty followed by NSM at our institution between January 2014 and September 2020. Clinical and surgical characteristics were collected. All surgical complications, including NAC loss rates, were analyzed.

Results:

Forty-one patients (74 breasts) underwent staged NSM during the defined time period. The average time between breast reduction mammoplasty and NSM was 213 days. Overall, 94.6% of NSM resulted in successful nipple preservation. There was no significant difference in the time interval from breast reduction mammoplasty to NSM between patients who had NAC loss (208 days) and those who did not (213 days, P = 0.87). Increasing age was significantly associated with risk of NAC loss (P = 0.002) in our cohort.

Conclusions:

In women with breast ptosis (which precludes safe NSM), it is possible to first offer reduction mammoplasty to preserve the NAC for future NSM. Our data suggest that 3 months between staged procedures is a safe time frame.
Limitations of Computed Tomography Angiography in Preoperative Planning of Peroneus Brevis Rotational Flap
Authors: Halverson Sky , Fadell Nicholas , Boyer Martin , Brogan David
Published: February 2023

Background:

The distally based peroneus brevis (PB) rotational flap has been shown to be a reliable method of coverage of distal third tibial wounds. The flap is perfused via retrograde flow from distal PB perforators located within 8 cm of the lateral malleolus. The ability to assess patency of these vessels preoperatively facilitates surgical planning, and computed tomography angiography (CTA) has been used for perforator assessment of other lower extremity flaps. The purpose of the present study is to establish the potential utility of standard CTA for locating distal PB perforators by examining uninjured lower extremities.

Methods:

Twenty-five patients who underwent bilateral lower extremity CTAs using standard lower extremity protocol were retrospectively identified. Axial two-dimensional images were scanned craniocaudally using our institution’s standard CT image viewing software, Merge Radsuite (Merge Healthcare, Hartland, Wis.).

Results:

The average location of distal-most PB perforators identified on CT angiogram was 13.1 ± 5.1 cm proximal to the distal fibula, or 34.5% ± 13.5% of total fibular length. Standard CTA was only able to locate a pedicle within 8 cm of the lateral malleolus (20.9% of fibular length) in three of 25 patients (12%).

Conclusions:

Previous studies have described a reliable pedicle within 8 cm of the distal fibular tip upon which to design a distally based PB rotational flap. The absence of such perforators in the CT angiogram suggests that standard CT angiogram is not a reliable technique for identifying the patency of such perforators when evaluating the utility of a distally based PB flap.
Resource Utilization and the Use of Bone Stimulators among Operatively and Nonoperatively Managed Scaphoid Nonunion Patients
Authors: Hooper Rachel C. , Zeng Yuan , Wang Lu , Chung Kevin C.
Published: February 2023

Background:

The prevalence of bone stimulator use among nonoperatively and operatively managed scaphoid nonunion patients is unknown. We hypothesize that bone stimulators are a relatively underutilized treatment for scaphoid nonunion patients.

Methods:

We used the 2009–2017 Truven Marketscan Research Databases to identify patients with closed scaphoid fractures and performed an analysis of variance test to determine resource utilization and bone stimulator use among these patients.

Results:

A total of 36,611 patients with scaphoid fractures were identified: 30,143 were managed nonoperatively and 6468 were managed operatively. Nonunion was diagnosed in 500 (1.66%) nonoperatively and in 1211 (19%) operatively managed patients. Bone stimulators were used in less than 2% of nonoperatively and operatively managed scaphoid nonunion patients.

Conclusion:

Lack of trust in the technology and heterogenous (and occasionally burdensome) requirements for insurance approval are barriers to bone stimulator use; however, surgeons should examine how this technology may fit into the treatment algorithm for these difficult cases.
Assessing the effects of aging on the liver endothelial cell landscape using single-cell RNA sequencing
Authors: Wang Dongliang , Li Mengke , Ling Jie , Chen Shuxia , Zhang Qikai , Liu Zhong , Huang Yanjing , Pan Caineng , Lin Yuheng , Shi Zhuoxing , Zhang Ping , Zheng Yingfeng
Published: February 2023

Endothelial cell (EC) function declines with age and contributes to the development of many vascular-related disease processes. Currently, the effects of aging on the molecular regulatory mechanisms of liver ECs have not been fully elucidated. Here, we employed single-cell RNA sequencing to map the transcriptome of ECs and analyzed their relationship with aging. We identified 8 different EC subtypes, interestingly, 2 of which were specially expressed in aged mice ECs namely aged capillary ECs (Aged ECs) and pro-inflammation capillary ECs (Proinfla.ECs). Double immunostaining for an EC marker (Cd31) and a marker of these specialized EC phenotypes confirmed the single-cell RNA sequencing data. Gene ontology analysis revealed that Aged ECs and Proinfla.ECs were associated with inflammatory response. Then we found that liver proliferating capillary ECs (Prolife.ECs) were most affected by senescence. Single-cell transcript analysis suggests that Prolife.ECs and angiogenic capillary ECs may form a poor microenvironment that promotes angiogenesis and tumorigenesis. Pseudo-temporal trajectories revealed that Prolife.ECs have different differentiation pathways in young and aged mice. In aged mice, Prolife.ECs could specifically differentiate into an unstable state, which was mainly composed of angiogenic capillary ECs. Intercellular communication revealed inflammatory activation in old group. Overall, this work compared the single-cell RNA profiles of liver ECs in young and aged mice. These findings provide a new insight into liver aging and its molecular mechanisms, and further exploration of Aged ECs and Proinfla.ECs may help to elucidate the molecular mechanisms associated with senescence.
Challenges in the evaluation of endothelial cell dysfunction: a statement from the European Society of Hypertension Working Group on Endothelin and Endothelial Factors
Authors: Rossi Gian Paolo , Barton Matthias , Dhaun Neeraj , Rizzoni Damiano , Seccia Teresa M.
Published: February 2023

Endothelial cell function is mediated by different mechanisms in different vascular beds. Moreover, in humans, endothelial cell dysfunction triggers and accelerates the progression of cardiovascular and chronic kidney diseases. Progression of such diseases can be in part mitigated by the control of cardiovascular risk factors and drugs targeting different systems, including endothelin receptor antagonists (ERAs), renin-angiotensin aldosterone antagonists and glucose metabolism, all of which were shown to improve endothelial cell function. In recent years, the microRNAs, which are endogenous regulators of gene expression, have been identified as transmitters of information from endothelial cells to vascular smooth muscle cells, suggesting that they can entail tools to assess the endothelial cell dysfunction in arterial hypertension and target for pharmacologic intervention. This article critically reviews current challenges and limitations of available techniques for the invasive and noninvasive assessment of endothelial function, and also discusses therapeutic aspects as well as directions for future research in the areas of endothelial cell biology and pathophysiology in humans.
Orthostatic hypotension, falls and in-hospital mortality among elderly patients with and without type 2 diabetes
Authors: Beretta Mileni V. , Milan Victoria B. , Hoffmeister Mariana C. , Rodrigues Ticiana C.
Published: February 2023

Objectives:

To evaluate the association of falls and in-hospital mortality with the presence of orthostatic hypotension and type 2 diabetes mellitus (T2D). The study also aims to identify whether the orthostatic hypotension assessed at 1 min or at 3 min can predict falls and mortality, as a secondary objective to identify the predictors of fall during hospitalization.

Methods:

We performed a prospective study with patients admitted to a university hospital. The risk of falls was assessed using the Morse questionnaire and the presence of falls was verified by the patient's medical records during hospitalization. The orthostatic hypotension was determined by measuring blood pressure at three times, considering as orthostatic hypotension the reduction of at least 20 mmHg in SBP or 10 mmHg in DBP. In-hospital mortality was consulted in the medical records.

Results:

Patients with orthostatic hypotension were slower on Timed Up and Go test (TUG) (12.26 ± 3.16 vs. 16.08 ± 5.96 s, P = 20 s) and presence of orthostatic hypotension. After adjustments, patients with T2D and orthostatic hypotension had a 2.7 times greater risk of in-hospital falls and 1.54 times greater odds of in-hospital mortality when compared with patients without T2D and orthostatic hypotension.

Conclusion:

In this sample, sedentary patients and those with lower TUG had a higher risk of falls. The prevalence of falls was higher in patients with T2D. The association of T2D with orthostatic hypotension significantly increased both the risk of falls and the risk of in-hospital mortality
Saturated fatty acid promotes calcification via suppressing SIRT6 expression in vascular smooth muscle cells
Authors: Tao Yafen , Wu Yue , Jiang Chuanyue , Wang Qianghua , Geng Xu , Chen Lei , Zhou Sihui , Wang Xuegu , Han Mingliang , Du Danli , Ding Biao , Li Xiang
Published: February 2023

Background:

This study aims to investigate the effects of saturated free fatty acid on calcification and SIRT6 expression in vascular smooth muscle cells (VSMCs) and the role of SIRT6 in regulating VSMC calcification.

Methods:

Sprague–Dawley rats were randomly allocated to two groups: rats with normal diet (ND) and high-fat diet (HFD) from 4 to 12 weeks. At 12 weeks, part rats randomly selected from ND and HFD were administrated with vitamin D3 and nicotine to establish a model of vascular calcification. Thoracic aortas were collected from treatment rats at 16 weeks for assaying vascular calcification and related protein expression. Primary VSMCs isolated from Sprague–Dawley rats were used for investigating the effects of palmitic acid on VSMCs’ calcification, apoptosis and target protein expression.

Results:

HFD-facilitated calcification in medial aorta, with decreased SIRT6 expression in VSMCs of aortas. Palmitic acid decreased SIRT6 expression while increased calcification, apoptosis and protein expression of BMP2 and RUNX2 in primary VSMCs. Overexpression of SIRT6 could, partially or completely, rescue the palmitic acid-induced elevation of calcification, apoptosis and expression of BMP2 and RUNX2.

Conclusion:

This study demonstrated that vascular calcification induced by HFD was linked to the palmitic acid-induced downregulation of SIRT6. Overexpression of SIRT6 could decrease palmitic acid-induced calcification and apoptosis in VSMCs.
Adolescent blood pressure classification curves and cardiometabolic risk factors: a comparison of the Brazilian and American references
Authors: Medeiros Brenda M. , Da Silva Thiago L.N. , Bloch Katia V. , Kuschnir Maria C.C. , Sbaraini Mariana , Schaan Beatriz D. , Cureau Felipe V.
Published: February 2023

Background:

The American Academy of Pediatrics (AAP) adolescent blood pressure (BP) percentiles were updated in 2017, and have been used as reference in Brazil since then. However, specific BP percentiles for Brazilian adolescents were recently proposed based on data from the Study of Cardiovascular Risk in Adolescents (ERICA).

Objectives:

To compare the prevalence of arterial hypertension according to each reference, as well as to assess the cardiometabolic risk associated with the reclassification by Brazilian BP percentiles.

Methods:

Data from 73 399 adolescents aged 12–17 years who participated in the ERICA study were analyzed. To assess cardiometabolic risk, 6185 adolescents who were reclassified upwards by the Brazilian reference were 1 : 1 matched with adolescents that were normotensive by both references and were of the same age, sex and height percentile. The parameters evaluated were: overweight/obesity, waist circumference, total cholesterol, triglycerides, LDL-c, HDL-c, fasting glucose, HbA1c and HOMA-ir.

Results:

The classification according to Brazilian BP percentiles resulted in a higher prevalence of arterial hypertension (14%, 95% CI 13.2–14.8), when compared with the AAP percentiles (10.6%, 95% CI 10.0–11.2). The use of the Brazilian reference also resulted in higher prevalence of arterial hypertension in girls, teenagers ranging from 12 to 14 years, and those classified with adequate weight, overweight or obesity. In the case–control analysis, cardiometabolic risk factors were present more often in adolescents reclassified with arterial hypertension by the ERICA reference.

Discussion:

The use of the BP percentiles proposed by ERICA is a sensitive method for tracking Brazilian adolescents with hypertension and higher cardiometabolic risk.
Combined effects of blood pressure and glycemic status on risk of heart failure: a population-based study
Authors: Kobayashi Ayako , Fujihara Kazuya , Yamada Mayuko Harada , Sato Takaaki , Yaguchi Yuta , Kitazawa Masaru , Matsubayashi Yasuhiro , Iwanaga Midori , Yamada Takaho , Kodama Satoru , Sone Hirohito
Published: February 2023

Aims:

To investigate the combined effects of blood pressure (BP) and glycemic status on the risk of heart failure.

Methods:

Examined was a Japanese claims database from 2008 to 2019 on 589 621 individuals. Cox proportional hazards model identified the incidence of heart failure among five levels of SBP/DBP according to glucose status.

Results:

Mean follow-up period was 5.6 years. The incidence of heart failure per 1000 person-years in the normoglycemia, borderline glycemia, and diabetes groups were 0.10, 0.18, and 0.80, respectively. In normoglycemia, a linear trend was observed between both SBP and DBP categories and hazard ratios for heart failure (P for linearity <0.001). In borderline glycemia, J-shaped association was observed between DBP categories and hazard ratios, although the liner trend was significant (P < 0.001). In diabetes, the linear trend for the relationship between DBP categories and hazard ratios was not significant (P = 0.09) and the J-shaped association in relation to the hazard ratios was observed between SBP categories and heart failure risk. In the lowest SBP category (i.e. SBP < 120 mmHg), patients with diabetes had more than five-fold heart failure risk [hazard ratio (95% confidence interval), 5.10 (3.19–8.15)], compared with those with normoglycemia and SBP less than 120 mmHg.

Conclusion:

The association between SBP/DBP and heart failure risk weakened with worsening of glucose metabolism, suggesting strict BP control accompanied by excessively lowered DBP should be cautious in prevent heart failure in abnormal glycemic status. Particularly in diabetes, comprehensive management of risk factors other than BP may be essential to prevent heart failure. Further trials are needed to support these suggestions and apply them to clinical practice.
Methods of arterial stiffness calculation and cardiovascular disease events: the multiethnic study of atherosclerosis
Authors: Pewowaruk Ryan J. , Korcarz Claudia , Stein James H. , Bluemke David , Tedla Yacob , Gepner Adam D.
Published: February 2023

Background:

A wide variety of different formulae have been used to calculate local arterial stiffness with little external validation in relationship to cardiovascular events. We compared the associations of several arterial stiffness calculations in a large, multiethnic cohort.

Methods:

The multi-ethnic study of atherosclerosis (MESA) is a longitudinal study of 6814 adults without clinical cardiovascular disease (CVD) at enrollment. MESA participants with CVD surveillance through year 2018 and carotid ultrasound (n = 5873) or aorta MRI (n = 3175) at the baseline exam (2000–2002) were included. We analyzed 21 different calculations of local arterial stiffness. Cross-sectional and longitudinal statistical analyses were performed in addition to Cox hazard modeling for associations with CVD events (myocardial infarction, resuscitated cardiac arrest, stroke, adjudicated angina, and cardiovascular death).

Results:

Carotid artery stiffness calculations had variable correlations with each other (r = 0.56–0.99); aortic stiffness measures were similar (r = 0.66–0.99). Nevertheless, for CVD events, the hazard ratio (HR) per standard deviation change were similar for all carotid stiffness calculations with HRs in the range of 1.00–1.10 (equivalence P < 0.001). For the aorta, aortic distensibility coefficient had a stronger association with CVD events (HR 1.18 [1.02–1.37]) compared to aorta Peterson's elastic modulus (HR 0.98 [0.89–1.07]) and aorta pulse wave velocity (HR 1.00 [0.90–1.11]). HRs between all other aortic stiffness calculations were equivalent (P < 0.01).

Conclusion:

Different methods of calculating local arterial stiffness largely gave equivalent results, indicating that the variety of different arterial stiffness calculations in use do not cause inconsistent findings.
CircRNA_06354 might promote early-onset preeclampsia in humans via hsa-miR-92a-3p/vascular endothelial growth factor-A
Authors: Zhang Yueming , Zhao Yuanyuan , Yu Fangfang , Li Xiang , Chen Xionghui , Zhu Dan , Sun Jie , Huang Qin , Li Min , Sun Miao , Zhang Pengjie
Published: February 2023

Background:

Early-onset preeclampsia (EOPE) is a serious pregnancy disorder with multisystem complications. Recently, circRNA was reported to participate in the progression of EOPE. However, the role and mechanism of circRNA_06354 in the pathophysiological development of EOPE remain unclear.

Methods:

Blood samples from patients with EOPE and healthy pregnant controls (CTRL) were analyzed by RNA-seq. functions and mechanisms of circRNA_06354 in EOPE were investigated by a series of experiments. An EOPE rat model was constructed to detect the expression levels of circRNA_06354.

Results:

The level of circRNA_06354 was altered in EOPE and CTRL individuals, as well as EOPE and CTRL rats. CircRNA_06354 had a sensitivity of 88.9% and a specificity of 100% in predicting EOPE. Subcellular localization indicated that circRNA_06354 was primarily detected in the cytoplasm of HTR8-/SV-neo cells and the cytotrophoblast of EOPE placentas. In addition, circRNA_06354 transcription was markedly higher than that of its linear counterpart. RNA pull-down assays implied that hsa-miR-92a-3p might sponge circRNA_06354. Vascular endothelial growth factor-A (VEGF-A) levels were found to be increased in EOPE patients. Moreover, overexpression of circRNA_06354 suppressed the migration, invasion and tube formation of trophoblastic cells invading spiral arteries or the endometrium.

Conclusion:

CircRNA_06354 inhibits trophoblastic cell invasion, migration and tube formation toward the endometrium in the initiation of EOPE. The circRNA_06354/hsa-miR-92a-3p/VEGF-A axis might be a therapeutic target in the prevention and treatment of EOPE.
Sex-specific associations of reservoir–excess pressure parameters with age and subclinical vascular remodelling
Authors: Gimblet Colin J. , Armstrong Matthew K. , Nuckols Virginia R. , DuBose Lyndsey E. , Holwerda Seth W. , Luehrs Rachel E. , Lane Abbi D. , Voss Michelle W. , Pierce Gary L.
Published: February 2023

Objective:

Central artery reservoir pressure and excess pressure (XSP) are associated with cardiovascular disease (CVD) events and mortality. However, sex differences in the trajectory of central reservoir pressure and XSP with advancing age and their relations with vascular markers of subclinical CVD risk are incompletely understood. Therefore, we tested the hypothesis that central reservoir pressure and XSP would be positively associated with advancing age and vascular markers of subclinical CVD risk in men and women.

Method:

Healthy adults (n = 398; aged 18–80 years, 60% female individuals) had central (carotid) artery pressure waveforms acquired by applanation tonometry. Reservoir pressure and XSP peaks and integrals were derived retrospectively from carotid pressure waveforms using custom written software. Carotid artery intimal–medial thickness (IMT) was measured by ultrasonography, and aortic stiffness was determined from carotid–femoral pulse wave velocity (cfPWV).

Results:

Reservoir pressure peak, reservoir pressure integral and XSP integral were higher with age in both men and women (P < 0.05), whereas XSP peak was lower with age in men (P < 0.05). In women, both reservoir pressure peak (β = 0.231, P < 0.01) and reservoir pressure integral (β = 0.254, P < 0.01) were associated with carotid artery IMT, and reservoir pressure peak was associated with cfPWV (β = 0.120, P = 0.02) after adjusting for CVD risk factors.

Conclusion:

Central artery reservoir pressure and XSP were higher with advancing age in men and women, and reservoir pressure peak was associated with both carotid artery wall thickness and aortic stiffness in women but not men. Central reservoir pressure peak may provide some insight into sex differences in vascular remodeling and subclinical CVD risk with advancing age in healthy adults.
Estimating mean population salt intake using spot urine samples in Nepal: a cross-sectional study
Authors: Ghimire Kamal , McLachlan Craig S. , Mishra Shiva R. , Kallestrup Per , Neupane Dinesh
Published: February 2023

Introduction:

Little is known about the usefulness of spot urine testing compared with 24-h urine samples to estimate salt intake in low-income settings. This is given 24-h urinary collection can be costly, burdensome, and impractical in population surveys. The primary objective of the study was to compare urinary sodium levels (as an estimate of salt intake) of Nepalese population between 24-h urine and spot urine using previously established spot urine-based equations. Additionally, this study explored the 24-h prediction of creatinine and potassium excretion from spot urine samples using available prediction equations.

Methods:

The sample population was derived from the community-based survey conducted in Nepal in 2018. Mean salt intake was estimated from spot urine samples comparing previously published equations, and this was then contrasted with mean salt intake estimations from 24-h urine samples, using paired t test, Pearson correlation coefficient, intraclass correlation coefficient, and Bland–Altman plots.

Results:

A total of 451 participants provided both complete 24-h and morning spot urine samples. Unweighted mean (±SD) salt intake based on 24-h urine collection was 13.28 ± 4.72 g/day. The corresponding estimates were 15.44 ± 5.92 g/day for the Kawasaki, 11.06 ± 3.17 g/day for the Tanaka, 15.22 ± 16.72 g/day for the Mage, 10.66 ± 3.35 g/day for the Toft, 8.57 ± 1.72 g/day for the INTERSALT with potassium, 8.51 ± 1.73 g/day for the INTERSALT without potassium, 7.88 ± 1.94 g/day for the Whitton, 18.13 ± 19.92 g/day for the Uechi simple-mean and 12.07 ± 1.77 g/day using the Uechi regression. As compared with 24-h urine estimates, all equations showed significant mean differences (biases); the Uechi regression had the least difference with 9% underestimation (−1.21 g/day, P < 0.001).

Proportional biases were evident for all equations depending on the level of salt intake in the Bland–Altman plots.

Conclusion:

None of the included spot urine-based equations accurately corresponded to 24-h salt intake in the present study. These equations may be useful for longitudinal monitoring of population salt intake in Nepal, our study highlights that there are limitations on using existing equations for estimating mean salt intake in Nepali population. Further studies are warranted for accuracy and validation.
Relative prognostic importance of aortic and brachial blood pressures for cardiovascular and mortality outcomes in patients with resistant hypertension and diabetes: a two cohorts prospective study
Authors: Cardoso Claudia R.L. , Leite Nathalie C. , Salles Gil F.
Published: February 2023

Objective:

The prognostic importance of derived central/aortic blood pressures (BPs) in relation to brachial office and ambulatory BPs has never been investigated in patients with resistant hypertension (RHT) or type 2 diabetes (T2D). We aimed to evaluate it in two cohorts with 532 individuals with RHT and 467 with T2D (median follow-ups 4.4 and 7.3 years, respectively).

Methods:

Central/aortic pressure waveforms were estimated by radial tonometry by a type 1 device (SphygmoCor device/software), and other parameters of central hemodynamics (augmentation index and Buckberg indices) were calculated. Multivariate Cox regressions examined the associations between central and peripheral BPs with cardiovascular events incidence and mortality, and C-statistics and the integrated discrimination improvement index evaluated the improvement in risk discrimination.

Results:

During follow-up, there were 52 cardiovascular events and 51 all-cause deaths in the RHT and 104 and 137 in the T2D cohort. No aortic BP was better than its brachial counterpart in predicting risk or improving discrimination for any outcome in either cohort. In the RHT cohort, ambulatory BPs were superior to central and office-brachial BPs. Otherwise, the augmentation index in RHT (hazard ratios: 1.5, for 1-SD increment) and the Buckberg index in T2D (hazard ratios: 0.7–0.8) were independent predictors of cardiovascular/mortality outcomes, and improved risk discrimination (integrated discrimination improvement up to 25% in RHT and 15% in T2D).

Conclusion:

Derived aortic BPs by a type 1 device did not improve cardiovascular/mortality risk prediction over brachial BPs in our cohorts of patients with RHT and T2D, but additional parameters of central hemodynamics may be useful.

Graphical Abstract:

http://links.lww.com/HJH/C137
The Impact of Virtual Laboratories on Student Clinical Education Preparedness: A Mixed-Method Analysis
Authors: Kothe Caitlin , Reynolds Breanna , Eaton Kareaion , Harrison Sarah , Kozsalinski Alex , Krogmann Monica , Norton Hannah , Pharr Ann , Sabbahi Ahmad , Volansky Kerry
Published: February 2023

Introduction:

The COVID-19 pandemic saw physical therapist (PT) education programs in 2020 add virtual options to prepare students for hands-on clinical skills. The purpose of this research was to investigate student confidence, preparation, and clinical performance based on their choice of virtual or in-person laboratory immersion. Secondary analysis compared 2020 cohort outcomes with the previous cohort in 2019 (prepandemic).

Review of literature:

Virtual skill acquisition has been studied with support for effectiveness in didactic and psychomotor skill acquisition. The impact on clinical education performance is unknown.

Subjects:

Student records from an accelerated hybrid, PT education program in 2020 (n = 91) and 2019 (n = 86).

Methods:

In this mixed-method observational study, researchers analyzed a Qualtrics survey and the PT Clinical Performance Instrument (CPI) to compare student outcomes. Statistical analyses included chi-square, two-way multivariate analysis of variance (MANOVA), and Mann–Whitney U test. MAXQDA software was used to code student and clinical instructor narrative responses from the CPI related to strengths and areas for further development.

Results:

All students in 2020 attended laboratory virtually for 9 full days, and 24% of students chose virtual laboratory for the remaining 8.5 days; 97% of students reported feeling confident going into their clinical experience (66% inpatient). No statistically significant differences were found based on instructional method (virtual or in-person) or clinical practice setting (inpatient or outpatient) for confidence, preparation, or CPI performance. Themes of wanting more time to prepare and more confidence in clinical decision making emerged from the qualitative analysis.

Discussion and Conclusion:

Results indicate no statistically significant difference for virtual versus in-person laboratory and no difference compared with the 2019 cohort. Virtual instruction effectively prepared students for their clinical experiences across all settings. Although an in-person laboratory experience may be preferred, it is possible to deliver effective experiences in a virtual setting without compromising student performance. Further research is needed to confirm findings.
Acute-on-chronic liver failure before liver transplantation does not impact post-transplant survival in children with biliary atresia
Authors: Banc-Husu Anna M. , Hall Matt , Thurm Cary , Whitehead Bridget A. , Godown Justin A. , Alonso Estella M.
Published: February 2023

Acute-on-chronic liver failure (ACLF) occurs in children with biliary atresia (BA) awaiting liver transplantation (LT). However, data on transplant outcomes in ACLF are limited. Our aim was to characterize ACLF and determine its effect on transplant outcome and resource utilization. Using a linkage of the Scientific Registry of Transplant Recipients and Pediatric Health Information System, we identified children with BA between 3 months and 18 years at the time of listing who received a transplant from 2003 to 2018 and were hospitalized while waiting. ACLF was defined by the presence of at least 1 extra-hepatic organ failure during a pre-LT hospitalization. In all, 1044 patients (58% female, median age at listing 7.0 months IQR 5.0–14.0) were included. Thirty-four percent (351/1044) of the patients had at least 1 ACLF hospitalization. Patients with ACLF had longer waitlist times (114 [54–231] vs. 81 [35–181] days, p < 0.001), and were more likely to be listed as Status 1 (8% vs. 4%, p = 0.02). Pre-LT resource utilization was significantly higher in ACLF patients. There were no differences in mortality at 30 days (ACLF 3% vs. No ACLF 2%, p = 0.17), 90 days (ACLF 3% vs. No ACLF 2%, p = 0.24), 1 year (ACLF 3% vs. No ACLF 2%, p=0.23), 3 years (ACLF 4% vs. No ACLF 3%, p = 0.58), or 5 years (ACLF 5% vs. No ACLF 4%, p = 0.38) after LT. ACLF status was not associated with increased post-transplant mortality (adjusted HR 1.51, 95% CI 0.76–3.0, p=0.25). ACLF is an important morbidity in children with BA awaiting LT as it is associated with higher resource utilization and longer waitlist times. Further studies are needed to help understand the spectrum of ACLF and better prioritize critically ill children awaiting LT, as our study shows successful post-LT outcomes in children with BA and ACLF.
Setmelanotide: a promising advancement for pediatric patients with rare forms of genetic obesity
Authors: Trapp Christine M. , Censani Marisa
Published: February 2023

Purpose of review

Examine Setmelanotide use in patients with rare genetic variants that disrupt the melanocortin pathway.

Recent findings

Between February 2017 and September 2018, 10 participants with pro-opiomelanocortin (POMC)/ proprotein convertase subtilisin/kexin type 1 (PCSK1) deficiency and 11 participants with leptin receptor (LEPR) deficiency were enrolled in open-label, phase 3 trials at 10 centers in the United States and internationally to assess the efficacy and safety of the melanocortin-4 receptor (MC4R) agonist Setmelanotide. 80% of POMC participants and 45% of LEPR participants achieved at least 10% weight loss at 1 year. Significant changes in hunger scores were seen for both cohorts as well. Setmelanotide was well tolerated with injection site reactions and hyperpigmentation being the most common adverse events reported. As a result, Setmelanotide was approved by the U.S. FDA in 2020 for chronic weight management in adult and pediatric patients ≥6 years of age with POMC, LEPR, or PCSK1 deficiency. In 2022, its approval was extended to include patients with Bardet–Biedel syndrome (BBS) after phase 3 trial data showed that, on average, Setmelanotide treatment resulted in a BMI loss of 7.9% for the 44 BBS participants.

Rare genetic variants such as POMC, LEPR, and PCSK1 deficiency disrupt MC4R pathway signaling, resulting in severe early-onset obesity, hyperphagia, and increased risk for metabolic co-morbidities. Patients with BBS also demonstrate severe early-onset obesity and hyperphagia, due in part to defective MC4R signaling. Setmelanotide has shown promising benefits in improving satiety scores and weight-related outcomes in patients with these early-life genetic obesity conditions, although longer-term studies are needed.
Ligaments’ preservation in Open Rhinoplasty: Prospective analysis
Authors: Ali Yasser Helmy , Elbadawy Yasser A. , El-dsoky Ibrahim , Autifi Mohamed A. , Elbanooby Tarek , Taha Ahmed , Eleowa Samy , Farahat Ayman , Mohamed Sayed A. , Hamza Fawzy A
Published: February 2023

Background:

In open rhinoplasty technique, the soft tissue and ligaments are vulnerable to injury. Routine reconstruction of the ligaments usually has little attention by the surgeons.

Purpose:

to assess the effect of preservation of nasal ligaments; Scroll ligament, Septo-columellar ligament and Pitanguy's ligament in open approach rhinoplasty.

Methods:

Prospective Cohort study on 32 patients underwent open rhinoplasty with ligaments' preservation after precise meticulous training on 5 Cadavers.

Results:

All patients have better aesthetic and functional outcome with long lasting preservation of tip projection as well as the same results in early postoperative period. No patient needed secondary revision surgery due to tip dropping or malrotation. The objective findings and subjective assessments were satisfying for the patients and surgeons.

Conclusion:

Refinements of nasal surgery have no limits. Study Suggests that nasal ligaments reconstruction; Scroll ligament, Septo-columellar ligament and Pitanguy's ligament could maintain nasal tip projection and rotation for long time.
Current Surgical Outcomes of Nasal Tip Grafts in Rhinoplasty: A Systematic Review
Authors: Skochdopole Anna , Bay Caroline , Grome Luke , Vorstenbosch Joshua , Yu Jessie , Winocour Sebastian , Reece Edward M.
Published: February 2023

Background:

Refinement of the nasal tip plays an important role in rhinoplasty surgery outcomes and may be considered the most technically challenging aspect of the procedure. Numerous techniques have been described for nasal tip augmentation utilizing grafts. The aim of this study was to systematically review the existing literature on nasal tip grafts and critically appraise it.

Methods:

A PubMed search was performed to identify journal articles related to nasal tip grafts from the last decade. A total of 44 studies met inclusion criteria. The Newcastle-Ottawa Quality Assessment Scale (NOQAS) and Jadad Scale were used to appraise 38 observational studies and six randomized trials, respectively, to determine the quality of the studies.

Results:

Critical assessment revealed that the studies were highly variable in focus and encompassed autologous, homologous, and alloplastic grafts. The quality of the data included an average NOQAS score of 6.5 (out of 9) and Jadad score of 2.5 (out of 5). A majority (86.4%) of studies included objective outcomes via anthropometric measurements and a portion (27.3%) of studies also included patient-reported outcomes.

Conclusions:

The results of this systematic review suggest that more than one type of nasal tip graft may result in satisfactory outcomes. This review provides an expansive collection of studies on nasal tip grafts which serves as an invaluable tool to the plastic surgeon engaging in rhinoplasty.
Brain volumetrics differ by Fiebig stage in acute HIV infection
Authors: Bolzenius Jacob , Sacdalan Carlo , Ndhlovu Lishomwa C. , Sailasuta Napapon , Trautmann Lydie , Tipsuk Somporn , Crowell Trevor A. , Suttichom Duanghathai , Colby Donn J. , Phanuphak Nittaya , Chan Phillip , Premeaux Thomas , Kroon Eugène , Vasan Sandhya , Hsu Denise C. , Valcour Victor , Ananworanich Jintanat , Robb Merlin L. , Ake Julie A. , Pohl Kilian M. , Sriplienchan Somchai , Spudich Serena , Paul Robert
Published: February 2023

Objective:

People with chronic HIV exhibit lower regional brain volumes compared to people without HIV (PWOH). Whether imaging alterations observed in chronic infection occur in acute HIV infection (AHI) remains unknown.

Design:

Cross-sectional study of Thai participants with AHI.

Methods:

One hundred and twelve Thai males with AHI (age 20–46) and 18 male Thai PWOH (age 18–40) were included. Individuals with AHI were stratified into early (Fiebig I–II; n = 32) and late (Fiebig III–V; n = 80) stages of acute infection using validated assays. T1-weighted scans were acquired using a 3 T MRI performed within five days of antiretroviral therapy (ART) initiation. Volumes for the amygdala, caudate nucleus, hippocampus, nucleus accumbens, pallidum, putamen, and thalamus were compared across groups.

Results:

Participants in late Fiebig stages exhibited larger volumes in the nucleus accumbens (8% larger; P = 0.049) and putamen (19%; P < 0.001) when compared to participants in the early Fiebig. Compared to PWOH, participants in late Fiebig exhibited larger volumes of the amygdala (9% larger; P = 0.002), caudate nucleus (11%; P = 0.005), nucleus accumbens (15%; P = 0.004), pallidum (19%; P = 0.001), and putamen (31%; P < 0.001). Brain volumes in the nucleus accumbens, pallidum, and putamen correlated modestly with stimulant use over the past four months among late Fiebig individuals (Ps < 0.05).

Conclusions:

Findings indicate that brain volume alterations occur in acute infection, with the most prominent differences evident in the later stages of AHI. Additional studies are needed to evaluate mechanisms for possible brain disruption following ART, including viral factors and markers of neuroinflammation.
Predictors of intact HIV DNA levels among children in Kenya
Authors: Neary Jillian , Fish Carolyn S. , Cassidy Noah A.J. , Wamalwa Dalton , Langat Agnes , Ngugi Evelyn , Benki-Nugent Sarah , Moraa Hellen , Richardson Barbra A. , Njuguna Irene , Slyker Jennifer A. , Lehman Dara A. , John-Stewart Grace
Published: February 2023

Objective:

We determined predictors of both intact (estimate of replication-competent) and total (intact and defective) HIV DNA in the reservoir among children with HIV.

Design:

HIV DNA in the reservoir was quantified longitudinally in children who initiated antiretroviral therapy (ART) at less than 1 year of age using a novel cross-subtype intact proviral DNA assay that measures both intact and total proviruses. Quantitative PCR was used to measure pre-ART cytomegalovirus (CMV) viral load. Linear mixed effects models were used to determine predictors of intact and total HIV DNA levels (log10copies/million).

Results:

Among 65 children, median age at ART initiation was 5 months and median follow-up was 5.2 years; 86% of children had CMV viremia pre-ART. Lower pre-ART CD4+ percentage [adjusted relative risk (aRR): 0.87, 95% confidence intervals (95% CI): 0.79–0.97; P = 0.009] and higher HIV RNA (aRR: 1.21, 95% CI: 1.06–1.39; P = 0.004) predicted higher levels of total HIV DNA during ART. Pre-ART CD4+ percentage (aRR: 0.76, 95% CI: 0.65–0.89; P < 0.001), CMV viral load (aRR: 1.16, 95% CI: 1.01–1.34; P = 0.041), and first-line protease inhibitor-based regimens compared with nonnucleoside reverse transcriptase-based regimens (aRR: 1.36, 95% CI: 1.04–1.77; P = 0.025) predicted higher levels of intact HIV DNA.

Conclusion:

Pre-ART immunosuppression, first-line ART regimen, and CMV viral load may influence establishment and sustainment of intact HIV DNA in the reservoir.
Longitudinal patterns of initiation, persistence, and cycling on preexposure prophylaxis among female sex workers and adolescent girls and young women in South Africa
Authors: Rao Amrita , Lesko Catherine , Mhlophe Hlengiwe , Rucinski Katherine , Mcingana Mfezi , Pretorius Anje , Mcloughlin Jennifer , Baral Stefan , Beyrer Chris , Hausler Harry , Schwartz Sheree
Published: February 2023

Objective:

Female sex workers (FSW) and adolescent girls and young women (AGYW) face a disproportionately high risk of HIV in South Africa. Oral preexposure prophylaxis (PrEP) can avert new infections, but its effectiveness is linked to consistent use. Early discontinuation of PrEP in this population is high, but less is known about longitudinal patterns of PrEP use, including patterns of re-initiation and cycling.

Design:

Longitudinal descriptive analysis of routine program data.

Methods:

Between 2016 and 2021, 40 681 FSW and AGYW initiated PrEP at TB HIV Care, the largest PrEP provider to this population in South Africa and were included. Using survival analyses and group-based trajectory modeling, we described patterns of initiation, discontinuation, re-initiation, and cycling.

Results:

Total initiations increased over the life of the program for both FSW and AGYW. About 40% of FSW [0.41, 95% confidence interval (CI) [0.40–0.42]] and AGYW (0.38, 95% CI [0.37–0.38]) remained on PrEP at one month. FSW were more likely to restart PrEP, however <10% restarted PrEP within a year of initiation. Three latent trajectory groups of PrEP use were identified for FSW (low use, early cycling, and ongoing cycling) and two for AGYW (low use and ongoing cycling). Persistence was negatively associated with initiation among AGYW, but there was no clear relationship among FSW. Those initiating later in the program and older women had a reduced risk of discontinuation.

Conclusions:

Persistence on PrEP was low, but cycling on and off PrEP was common, with early missed visits and inconsistent, but ongoing use. A push to increase PrEP initiations needs to factor in readiness and persistence support, to achieve public health impact.