bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiological characteristics of hepatic echinococcosis, concurrent cerebral echinococcosis, and pulmonary echinococcosis in Ganzi County, Sichuan Province, China
Authors: Ma Li , Chen De-Cai , Zou Shi-Yue , Liu Yan-Yi , Zhou Lin-Yong , Xiu Zhi-Gang
Published: April 2020

Human echinococcosis has become a major public health problem in most parts of the world. The objective of this article was to study the demographics of patients with hepatic echinococcosis in Ganzi County to elucidate the main risk factors, as well as to report the concurrent prevalence of cerebral echinococcosis and pulmonary echinococcosis.

We recruited 195 patients with hepatic echinococcosis from the Datongma area of Ganzi County from January 2018 to November 2018. The patients’ demographics, living environments, supported medical resources, knowledge of echinococcosis prevention and control, and hygienic practices were investigated and analyzed. The prevalence of cerebral echinococcosis and pulmonary echinococcosis were also investigated.

The data were analyzed to identify risk factors for human echinococcosis. Our analysis showed that the herding Tibetan population within the 20 to 60 age group, and females, in particular, were at the highest risk of human echinococcosis infection. Having stray dogs around habitations and intimate activities with dogs and livestock were also behavioral risk factors. People with poor health literacy and low educational qualifications had possible risks of infection. In terms of hygiene, not using tap water as the drinking water source and lack of medical staff were significantly correlated with echinococcosis prevalence. Four patients were diagnosed with cerebral echinococcosis. Among them, 1 patient had both cerebral echinococcosis and pulmonary echinococcosis.

Possible high-risk factors for echinococcosis were being female, herding population, in the 20 to 60 age group, having stray dogs around habitations, having activities with dogs and livestock, having poor health literacy, having low educational qualifications, and not using tap water as a drinking water source. The detection rate for brain echinococcosis in patients with hepatic echinococcosis was high (2.05%). Effective preventive strategies should be implemented in epidemic areas. Head CT scans should be applied for early detection of cerebral echinococcosis to carry out the treatment.
Metastatic castration-resistant prostate cancer: Academic insights and perspectives through bibliometric analysis
Authors: He Lugeng , Fang Hui , Chen Chao , Wu Yanqi , Wang Yuyong , Ge Hongwei , Wang Lili , Wan Yuehua , He Huadong
Published: April 2020

Background:

In recent years, metastatic castration-resistant prostate cancer (MCRPC) and studies related to MCRPC have drawn global attention. The main objective of this bibliometric study was to provide an overview of MCRPC, explore clusters and trends in research and investigate the future direction of MCRPC research.

Methods:

A total of 4089 publications published between 1979 and 2018 were retrieved from the Web of Science (WoS) Core Collection database. Different aspects of MCRPC research, including the countries/territories, institutions, journals, authors, research areas, funding agencies and author keywords, were analyzed.

Results:

The number of annual MCRPC publications increased rapidly after 2010. American researchers played a vital role in this increase, as they published the most publications. The most productive institution was Memorial Sloan Kettering Cancer Center. De Bono, JS (the United Kingdom [UK]) and Scher, HI (the United States of America [USA]) were the two most productive authors. The National Institutes of Health (NIH) funded the largest number of published papers. Analyses of keywords suggested that therapies (abiraterone, enzalutamide, etc.) would attract global attention after US Food and Drug Administration (FDA) approval.

Conclusions:

Developed countries, especially the USA, were the leading nations for MCRPC research because of their abundant funding and frequent international collaborations. Therapy was one of the most vital aspects of MCRPC research. Therapies targeting DNA repair or the androgen receptor (AR) signing pathway and new therapies especially prostate-specific membrane antigen (PSMA)-based radioligand therapy (RLT) would be the next focus of MCRPC research.
Application of multiple injections of contrast agent in head and neck CT arteriovenous angiography in children
Authors: Tang Shilong , Zhang Guanping , Chen Zhuo , Liu Xianfan , Fan Xiao , Liu Daisong , He Ling
Published: April 2020

Objective:

To investigate the application value of multiple injections of contrast agent in head and neck CT arteriovenous angiography in children.

Methods:

A total of 100 children aged 6 to 7 years who needed head and neck CT arteriovenous angiography were prospectively selected. They were randomly divided into a control group and a research group, with 50 children in each group. The same scanning parameters and reconstruction methods were used. The right median cubital vein was injected intravenously with the contrast agent Omnipaque (350 mg I/ml). For children in the control group, a bolus of undiluted contrast agent (dose was 2 ml/kg, upper limit was 50 ml) was injected 1 time. The arterial phase and vein phase of the head and neck vessels were scanned. For children in the research group, a contrast agent bolus diluted with saline to a concentration of 20% was first injected (dose was 1 ml/kg, upper limit was 25 ml), and then an undiluted contrast agent bolus (dose was 1 ml/kg, upper limit was 25 ml) was injected. Thresholds were used to trigger the scanning of the head and neck arterial phases. The CT image quality of the head and neck arteries and veins, radiation dose and contrast agent dose were compared between the 2 groups.

Results:

Subjective evaluation of CT image quality of arteries: there were 47 cases of 4 points and 3 cases of 3 points in the control group and 34 cases of 4 points and 16 cases of 3 points in the research group. Subjective evaluation of CT image quality of veins: there were 47 cases of 4 points and 3 cases of 3 points in the control group and 5 cases of 4 points, 42 cases of 3 points and 3 cases of 2 points in the research group. The CT value of brain arterial vessel enhancement was higher in the control group than the research group, and the difference was statistically significant (P < .05). The CT value of vein enhancement was higher in the control group than the research group, and the difference was statistically significant (P < .05). The X-ray dose in the research group was 51% lower than that in the control group; the contrast agent dose in the research group was 44% lower than that in the control group.

Conclusion:

For the head and neck enhanced CT examination of children, the method of first bolus injection of 20% diluted contrast agent and later bolus injection of undiluted contrast agent can clearly demonstrate the head and neck arteries and veins one time, reducing the X-ray dose and contrast agent dose, which has clinical practical value in the enhanced CT examination of children with head and neck disease.
Cardiac tamponade complicating thoracentesis in a patient after left pneumonectomy
Authors: Zheng Mingxia , Kang Yu , Wang Tong , Wei Jiafu
Published: April 2020

Rationale:

Therapeutic or diagnostic thoracentesis is widely used in different clinical settings. Cardiac injury, a rare complication, could lead to fatal consequences. We describe a case of cardiac tamponade complicating thoracentesis that was recognized and rescued in a timely manner.

Patient concerns:

A 42-year-old woman underwent blind thoracentesis due to excessive left pleural effusion after left pneumonectomy surgery. She suddenly lost consciousness and was in a state of shock a few minutes after needle insertion and fluid drainage.

Diagnosis:

Bedside transthoracic echocardiography revealed pericardial effusion at a depth of 20 mm, and cardiac tamponade complicating thoracentesis was diagnosed.

Interventions:

After draining 250 mL of non-coagulated blood by pericardiocentesis under transthoracic echocardiography guidance, a tube was placed for continuous drainage over the subsequent 36 hours.

Outcomes:

The patient's hemodynamic condition was stabilized hours after pericardiocentesis. The patient was discharged in good condition a few days later.

Lessons:

Imaging assessment and guidance in the process of thoracentesis was indispensable, especially in a patient with altered intra-thoracic anatomy. Cardiac damage, as a life-threatening complication, should be considered once hemodynamic instability occurs during the procedure.
Femoral pseudotumor secondary to injury in a patient with idiopathic thrombocytopenic purpura
Authors: Sun Tao , Han Shu-Man , Wu Wen-Juan , Gao Bu-Lang
Published: April 2020

Rationale:

Idiopathic thrombocytopenic purpura (ITP) is the condition of having a low platelet count of unknown causes and is a poorly understood acquired hemorrhagic disease involving destruction of platelets in the reticuloendothelial system induced by antiplatelet antibodies. Patients with ITP can have traumatic intra-articular, intraosseous or soft tissue hemorrhage which may present as a rare intraosseous pseudotumor on medical imaging.

Patient concerns:

A 30-year old male patient had complaint of pain in the right leg for 1 year. Laboratory test revealed a much lower platelet count (3–12 × 109/L).

Diagnoses:

Radiography and computed tomography showed expansive bone destruction in the distal segment of the right femur, and magnetic resonance imaging revealed heterogeneous signal intensity in the lesion. Lesion curettage and pathology showed an expansion cyst with a really thin cortical bone shell containing serum-like red liquid and some sediment-like deposit. Consequently, the diagnosis of a pseudotumor was confirmed.

Interventions:

Lesion curettage and bone graft surgery were performed, and 8 units of platelet were transfused to the patient. Giant cell reaction was found on the shell of the lesion, but no tumor cell was found on pathological examination.

Outcomes:

The platelet count was 308 × 109/L 5 days after operation, and the clotting time was normal. At 6 month follow-up after lesion curettage, the patient remained normal with no deterioration in the lesion site.

Conclusion:

The diagnosis of a pseudotumor of ITP relies mainly on imaging findings of the lesion and, in particular, knowledge of the underlying bleeding disorders. Radiologist and pathologist should be aware of the characteristics of this rare complication of ITP and other bleeding disorders like hemophilia in order to avoid misinterpretation of the lesion as a tumor or infection disease.
Fecal calprotectin: current and future perspectives for inflammatory bowel disease treatment
Authors: Bertani Lorenzo , Mumolo Maria Gloria , Tapete Gherardo , Albano Eleonora , Baiano Svizzero Giovanni , Zanzi Federico , Ceccarelli Linda , Bellini Massimo , Marchi Santino , Costa Francesco
Published: April 2020

Fecal calprotectin has been widely studied in inflammatory bowel disease (IBD) under clinical and therapeutic settings. It showed a good correlation with clinical, endoscopic, and histologic findings. For these reasons, fecal calprotectin is currently one of the most useful tools in IBD care, both in diagnosis and in clinical management. The development of biologic drugs allowed a deeper control of disease, which sometimes reaches histological healing; this is associated with a reduced risk of relapses and complications. The management of IBD treatment is currently carried out with a treat-to-target approach, and mucosal healing is considered at present to be the optimal therapeutic target, but the future is going through histologic remission. Fecal calprotectin is probably the best marker of mucosal healing, but it is correlated also with histologic remission: moreover, it has been recently studied as a possible therapeutic target in the CALM study. We carried out a comprehensive literature review in order to evaluate the role of fecal calprotectin at present and in the future in the management of IBD therapies.
Sepsis prevalence among patients with suspected infection in emergency department: a multicenter prospective cohort study
Authors: Oberlin Mathieu , Balen Frederic , Bertrand Lionel , Chapeau Noellie , San Cirilo Bastien , Ruols Emmanuelle , Vandercamere Thomas , Souchaud Clement , Guedj Jean François , Konan Bertille , Duval Alice , Mur Sebastien , Specia-Fajolles Anne Sophie , Salles Marie , Boullenger Eric , Vuillot Olivier , Bobbia Xavier
Published: April 2020

Objective

In the emergency department (ED), the early identification of patients suspected of infection is a challenge for emergency physicians. Sepsis prevalence among patients with suspected infection in the ED remains uncertain. Our objective was to determine how many cases of sepsis occurred among patients with suspected infections in the ED.

Methods

This multi-center, prospective, observational study was conducted in 19 EDs in France. For 1 week, all consecutive ED patients with suspected infection (according to the emergency physician) were included. The primary endpoint was the prevalence of sepsis in the ED according to the ‘sepsis-3’ definition. Secondary endpoints involved comparisons among patients with and without sepsis.

Results

During the study period, 13 904 patients were screened; 494 (3.6%) consulted for suspected infection and were included in the study. Among them, 172 patients [39%, 95% confidence interval (CI) (34–44)] were diagnosed with sepsis. The total hospital mortality for patients with a suspected infection was 4.7% and the hospital mortality for sepsis patients was 9.9%.

Conclusion

In the ED, among patients with a suspected infection, the prevalence of sepsis as per the ‘sepsis-3’ definition was 39% [95% CI (34–44)].
Endoscopic Ultrasound–Guided Fine-Needle Aspiration Microhistology in Asymptomatic and Symptomatic Pancreatic Cystic Lesions
Authors: Vaiciunas Spencer , Taglieri Eloy , Micelli-Neto Otávio , Brunaldi Mariângela Ottoboni , Venco Filadélfio , Goldman Suzan Menasce , Kemp Rafael , dos Santos José Sebastião , Ardengh José Celso
Published: April 2020

Objective

This study aimed to analyze the usefulness of endoscopic ultrasound–guided fine-needle aspiration (EUS-FNA) microhistology to detect malignancy in pancreatic cystic lesions (PCLs).

Methods

Patients with PCLs were identified and submitted to EUS-FNA from January 2010 to January 2017. The percentage of samples suitable for diagnostic classification by microhistology and the positive and negative likelihood ratios to detect malignancy in asymptomatic (APC) and symptomatic (SPC) PCLs were determined.

Results

Endoscopic ultrasound–guided fine-needle aspiration was performed in 510 patients. The resulting material was processed by microhistology and useful for diagnosis in 432 (84.2%). Clinical characteristics of APC (341) and SPC (169) revealed that APC patients were younger (P = 0.004) and had smaller PCLs (23 vs 35 mm; P < 0.001). In APC, we found more preneoplastic (38.7% vs 30.2%; P = 0.0016) and a lower number of malignant PCLs (8.2% vs 24.3%; P < 0.001). In APC and SPC, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of microhistology to detect malignancy were 71.4%, 99.7%, 95.2%, 97.5%, and 97.4% (k = 0.80) and 58.5%, 96.9%, 85.7%, 87.9%, and 87.6%, respectively.

Conclusions

Endoscopic ultrasound–guided fine-needle aspiration was technically feasible. Microhistology was especially useful to detect neoplastic or malignant PCLs in APC patients.
A Predictive Nomogram for Small Intestine Neuroendocrine Tumors
Authors: Kelly Susheian , Aalberg Jeffrey , Kim Michelle Kang , Divino Celia M.
Published: April 2020

Objective

There is a scarcity of prognostic tools for small intestine neuroendocrine tumors (SI-NETs) and inconsistencies in currently available grading and staging systems. Nomograms are being proposed to address these limitations. However, none is specific to the US population. This study proposed a concise nomogram for SI-NETs using US population-based data.

Methods

Patients with SI-NETs (2004–2015) were selected from the Surveillance, Epidemiology, and End Results database. Variables selected were age, sex, race, tumor grade, primary tumor size, and TNM staging. Cox regression parameter estimates were used to generate nomogram scores.

Results

A total of 2734 patients were selected: 2050 for nomogram development and 684 for internal validation. Prognosticators, age (P < 0.0001), primary tumor size >3 cm (P < 0.0022), tumor grade (P < 0.0001), depth of invasion ≥T3 (P < 0.0280), and distant metastasis (P < 0.0001) were used to develop the nomogram. Nomogram scores ranges from 10 to 80 points with an area under the curve of 0.76, which remained consistently high during internal validation (area under the curve, 0.75).

Conclusions

This Surveillance, Epidemiology, and End Results database nomorgram is a concise prognostic tool that demonstrated high predictive accuracy.
Development of a Standardized System to Detect and Treat Early Patient Deterioration
Authors: Ashbeck Rebecca , Stellpflug Courtney , Ihrke Eriana , Marsh Scott , Fraune Marit , Brummel Ashley , Holst Chelsea
Published: April 2020

Background:

Inpatient nurses identified the need to recognize clinical deterioration earlier, including rapid response team (RRT) activations and transfers to the intensive care unit. Surveys identified the need for better interdisciplinary communication.

Local Problem:

A system was needed to detect early clinical deterioration with structured responses promoting multidisciplinary collaboration.

Methods:

An early warning score (EWS) identified patients at risk. The system ensured timely and accurate actions were taken when scores reached 3 or above.

Interventions:

Collaborative, graded responses to EWSs and nurse-led rounds promoted communication and timely interventions.

Results:

Mortality decreased (−27%) as did multiple RRT activations on a single patient (−15%). Nurses are aware of early vital sign changes (+45%) and resident responsiveness has improved. There has been an increase in nurse/resident communication satisfaction (+31%).

Conclusions:

The system implemented reinforces the importance of patient assessment, collaboration among the multidisciplinary team, and promotes early interventions.
A 2-Year Experience With Enhanced Recovery After Surgery
Authors: Baimas-George Maria , Cochran Allyson , Tezber Kendra , Kirks Russell C. , Addor Valerie , Baker Erin , Martinie John , Iannitti David , Vrochides Dionisios
Published: April 2020

Background:

Enhanced Recovery After Surgery (ERAS) programs reduce recovery time, length of stay (LOS), and complications after major surgical procedures.

Purpose:

We evaluated our 2-year experience with a newly implemented comprehensive ERAS program at a high-volume center after pancreatic surgery.

Methods:

Outcomes, cost, and compliance metrics were assessed in 215 patients who underwent elective pancreatic surgery (pre-ERAS; n = 99; post-ERAS: n = 116). Mann-Whitney U and χ2 tests were used to evaluate continuous and categorical variables.

Results:

There were significant decreases in LOS and cost in the post-ERAS cohorts. There were significant increases in compliance with ERAS implementation. Postoperative complication, readmission, and survival rates did not increase.

Conclusions:

Implementation of ERAS at a large-volume hospital may improve compliance and reduce costs and LOS without increasing adverse outcomes.
Impact of a Telephonic Outreach Program on Patient Outcomes Within the Heart Failure Community
Authors: Hall Esscence T. , Maduro Ralitsa S. , Morgan Merri K. , McGee Genemarie W. , Zimbro Kathie S.
Published: April 2020

Background:

Telephonic outreach programs (TOPs) can be an effective measure to improve 30-day readmissions and self-management behaviors.

Local Problem:

Our health care providers identified that patients admitted with heart failure (HF) were among those with the highest readmission rate, so we implemented a TOP specific to HF.

Methods:

This project evaluated retrospective data from a convenience sample of adult patients admitted to our hospitals between January 2015 and June 2017, with a primary diagnosis of HF, and discharged home (N = 6271). Of those, 1708 patients also had at least partial TOP data, and a subset had timestamped TOP data (n = 1524).

Interventions:

The TOP program included patient education and personal follow-up via an automatic voice calling system that employed a series of 4 phone calls over a 27-day period.

Results:

Results showed that the TOP enhanced our hospital discharge process and contributed to program outcomes when the patients completed all 4 of the calls, with those patients having 11 times lower odds of having a 30-day readmission.

Conclusions:

The proportion of patients who completed the program reported more use of self-management behaviors compared with those who answered fewer than 4 calls. Our findings related to the lower frequency of self-management behaviors of patients who did not complete all vendor calls stress the important issue of vendor management.
Pediatric Concurrent Hospice Care
Authors: Lindley Lisa C. , Keim-Malpass Jessica , Svynarenko Radion , Cozad Melanie J. , Mack Jennifer W. , Hinds Pamela S.
Published: April 2020

In 2010, forgoing curative therapies were removed as a hospice eligibility criterion for children through section 2302 of the Patient Protection and Affordable Care Act called Concurrent Care for Children. Given that concurrent care is a federally mandated option for children and their families, no review of the science has been conducted. The purpose of this study was to systematically collect the evidence on concurrent hospice care, critically appraise the evidence, and identify areas for future nursing research. Of the 186 articles identified for review, 14 met the inclusion and exclusion criteria. Studies in this review described concurrent hospice care from a variety of perspectives: policy, legal, and ethics. However, only 1 article evaluated the impact of concurrent hospice care on outcomes, whereas several studies explained clinical and state-level implementation. There is a need for further studies that move beyond conceptualization and generate baseline and outcomes data. Understanding the effectiveness of concurrent hospice care might provide important information for future nursing research. The approaches used to disseminate and implement concurrent hospice care at state, provider, and family levels should be explored.
The Effect of Autologous Alveolar Bone Grafting on Nasolabial Asymmetry in Unilateral Cleft Lip and Palate
Authors: Thierens Laurent A.M. , Kerckhof Eveline , De Roo Noëmi M.C. , Temmerman Liesbeth , Nadjmi Nasser , Swennen Gwen , Ortega-Castrillon Alejandra , Claes Peter , De Pauw Guy A.M.
Published: April 2020

The objective of this study was to examine whether an autologous alveolar bone graft has an effect on the nasolabial asymmetry in unilateral cleft lip, alveolus, and palate. Fifteen children (mean age 7.5 ± 2.4 years) with non-syndromic unilateral cleft lip and palate (CLP) were included. Non-ionizing three-dimensional images were acquired prior to and three months after the alveolar bone grafting procedure. A 2D and a landmark-independent 3D asymmetry assessment were used to detect changes of asymmetry in the nasolabial area. For the 2D assessment, a cleft and non-cleft side ratio for 4 linear nasal and 2 linear labial distances was expressed as a Coefficient of Asymmetry (CA). The 3D asymmetry assessment comprised a robust superimposition of the face with its mirror image, expressed as a root-mean-square-error (RSME) in mm. A significant decrease in the CA for the labial distance from the facial midline to the labial commissure was observed (P = 0.036). Also, the CA for the labial distance from the facial midline to the highest point of Cupid's bow increased significantly (P = 0.028). Non-significant changes were observed for the CA for the 2 nasal distances and the 2 other labial distances. No significant changes in 3D nasal asymmetry were detected (P = 0.820). Alveolar bone grafting completes the alveolar ridge but has only little to no clinical effect on the asymmetry of the secondary cleft lip nasal deformity.
The Effect of Orthognathic Surgery on Soft-Tissue Facial Asymmetry: A Longitudinal Three-Dimensional Analysis
Authors: Da Pozzo Filippo , Gibelli Daniele , Beltramini Giada A. , Dolci Claudia , Giannì Aldo Bruno , Sforza Chiarella
Published: April 2020

In modern orthognathic surgery, the functional results cannot disregard a good aesthetic outcome. In this study, a stereophotogrammetric longitudinal analysis of the symmetry of facial thirds was performed in 18 patients affected by Class III skeletal malocclusion, with clinical asymmetry, treated with a bimaxillary osteotomy. Their 3-dimensional facial images were acquired in the preoperative phase and 6, 12, and 24 months after surgery, and compared to those obtained in a control group of 23 subjects with Class I skeletal occlusion, without clinical asymmetry and no history of traumas or alterations at the maxillo-facial area. Images of the hemi-faces of the subjects were divided into thirds (upper, middle, lower), mirrored and superimposed to their contralateral ones; soft-tissue facial symmetry was obtained as the root mean square distance between the hemi-faces in the three thirds.

In patients, no significant differences in facial symmetry (root mean square distance) were found among the study time points (analysis of variance, P > 0.05); the lower facial third was more asymmetric than the upper one (Tukey honestly significant difference P < 0.05). Patients were significantly more asymmetric than the control subjects (Student t, P < 0.05). In conclusion, patients with Class III malocclusion exhibited a higher level of facial asymmetry than control subjects; their asymmetry did not change significantly in the different phases of the surgical and orthodontic treatment and throughout a 24-month follow-up. In skeletal Class III patients, bimaxillary osteotomy did not modify the level of asymmetry in any facial third.
Small-Incision Sutureless Surgical Technique for Subconjunctival Orbital Fat Prolapse
Authors: Kim Woojin , Yang Sungwon , Park Jinhwan , Lee Hwa , Baek Sehyun
Published: April 2020

Surgical outcomes of 20 patients treated by one surgeon between March 2014 and August 2019 were reviewed retrospectively. The authors included 20 patients with subconjunctival orbital fat prolapse (SOFP) treated by a small-incision, sutureless surgical technique using local anesthesia. All patients were followed for at least 3 months postoperatively. Medical information such as patient's age, number of eyes involved, location of fat, surgical time and whether or not the prolapse recurred was reviewed. Twenty patients (16 men and 4 women) were included and had a mean age of 67.1 years. There were 7 bilateral and 13 unilateral SOFP cases. There were no intra-operative or postoperative complications and no cases of recurrence within a mean follow-up of 3 months. All surgeries were successful from both cosmetic and symptomatic perspectives. Our small-incision, sutureless surgical technique is an effective method to manage SOFP. This technique, performed with local anesthesia, is both cost- and time-effective.
Algorithm for Temple Reconstruction With Consideration of Anatomic and Defect Characteristics
Authors: Olshinka Asaf , Maricevich Renata , Shay Tamir , Cohen Avi A. , Ad-El Dean , Ali Kausar
Published: April 2020

The temple is an intriguing region of the face with unique anatomic features, such as the temporal hairline, concave contour, and close proximity to vital structures like the frontal branch of the facial nerve. However, cancerous skin lesions can plague this sun-exposed region and, when excised, it can result in large and significant defects. Reconstruction in this area is a formidable challenge for surgeons, as it requires comprehensive knowledge of temple morphology and the use of creative techniques in order to minimize disruption of surrounding functional and aesthetic structures. In this study, we describe our experience with temple reconstruction in patients of varying defect size and depth. Based on these defect characteristics, anatomic and aesthetic principles of the temple, we propose a surgical algorithm for temple reconstruction to aid surgeons in achieving optimal results.
Occult Scaphocephaly: A Forme Fruste Phenotype of Sagittal Craniosynostosis
Authors: Mantilla-Rivas Esperanza , Tu Liyun , Goldrich Agnes , Manrique Monica , Porras Antonio R. , Keating Robert F. , Oh Albert K. , Linguraru Marius George , Rogers Gary F.
Published: April 2020

Introduction:

Latent cranial suture fusions may present with mild or absent phenotypic changes that make the clinical diagnosis challenging. Recent reports describe patients with sagittal synostosis and a normal cranial index (CI), a condition termed normocephalic sagittal craniosynostosis (NSC). The goal of this study is to evaluate the shape and intracranial volume (ICV) in a cohort of NSC patients using quantitative cranial shape analysis (CSA).

Methods:

We identified 19 patients (7.5 ± 2.28 years) between 2011 and 2016, who presented to our hospital with NSC. Cranial index and CSA were measured from the computed tomography image. Cranial shape analysis calculates the distances between the patient's cranial shape and its closest normal shape. Intracranial volume was measured and compared to an established age-matched normative database.

Results:

Cranial index revealed 15 (78.9%) patients within the mesocephalic range and 4 patients (21.1%) in the brachycephalic range. Detailed CSA identified 15 (78.9%) patients with subtle phenotypic changes along the scaphocephalic spectrum (ie, subtle anterior and posterior elongation with inter-parietal narrowing) and 1 patient (5.3%) with isolated overdevelopment on the posterior part of the right parietal bone. Three patients (15.8%) had a CSA close to normal. Mean ICV was 1410.5 ± 192.77cc; most patients (78.9%) fell within ±2 standard deviations.

Conclusion:

Quantitative CSA revealed that most of the patients with NSC had cranial shape abnormalities, consistent with a forme fruste scaphocephaly that could not be otherwise recognized by clinical observation or CI. Given these findings, we propose the termoccult scaphocephalyto describe this condition. The associated incidence of intracranial hypertension is unknown.
Surgeon Perspectives on Benefits and Downsides of Overlapping Surgery
Authors: Perez Andrew W. , Brelsford Kathleen M. , Diehl Carolyn J. , Langerman Alexander J.
Published: April 2020

Objective:

The aim of the study was to characterize surgeon perspectives regarding the benefits and downsides of conducting overlapping surgery.

Background:

Although surgeons are key stakeholders in current discussions surrounding overlapping surgery, little has been published regarding their opinions on the practice. Further characterization of surgeon perspectives is needed to guide future studies and policy development regarding overlapping surgery.

Methods:

Study information was sent to all members of 3 professional surgical societies. Interested individuals were eligible to participate if they identified as attending surgeons in an academic setting who work with trainees. Purposive selection was used to diversify surgeons interviewed across multiple dimensions, including subspecialty and opinion regarding appropriateness of overlapping surgery. In-depth, qualitative interviews were conducted with participants regarding their opinions on overlapping surgery.

Results:

The 51 surgeons interviewed identified a wide array of potential benefits and disadvantages of overlapping surgery, some of which have not previously been measured, including downsides to surgeon wellness and patient experience, less surgeon control over procedures, and difficulty in scheduling cases. Interviewees often disagreed as to whether overlapping surgery negatively or positively affects each dimension discussed, particularly regarding the impact on resident training.

Conclusions:

The utilization of the novel perspectives presented here will allow for targeted assessment of physician perspectives in future quantitative studies and increase the likelihood that variables measured encompass the range of factors that surgeons find meaningful and relevant. Priority areas of future research should include examining effects of overlapping surgery on surgical training and surgeon wellness.
Complications and outcome after rib fracture fixation: A systematic review
Authors: Peek Jesse , Beks Reinier B. , Hietbrink Falco , Heng Marilyn , De Jong Mirjam B. , Beeres Frank J.P. , Leenen Loek P.H. , Groenwold Rolf H.H. , Houwert R. Marijn
Published: April 2020

BACKGROUND

In recent years, there has been a growing interest in operative treatment for multiple rib fractures and flail chest. However, to date, there is no comprehensive study that extensively focused on the incidence of complications associated with rib fracture fixation. Furthermore, there is insufficient knowledge about the short- and long-term outcomes after rib fracture fixation.

METHODS

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The MEDLINE, EMBASE, and Cochrane databases were searched to identify studies reporting on complications and/or outcome of surgical treatment after rib fractures. Complications were subdivided into (1) surgery- and implant-related complications, (2) bone-healing complications, (3) pulmonary complications, and (4) mortality.

RESULTS

Forty-eight studies were included, with information about 1,952 patients who received rib fracture fixation because of flail chest or multiple rib fractures. The overall risk of surgery- and implant-related complications was 10.3%, with wound infection in 2.2% and fracture-related infection in 1.3% of patients. Symptomatic nonunion was a relatively uncommon complication after rib fixation (1.3%). Pulmonary complications were found in 30.9% of patients, and the overall mortality was 2.9%, of which one third appeared to be the result of the thoracic injuries and none directly related to the surgical procedure. The most frequently used questionnaire to assess patient quality of life was the EuroQol-5D (EQ-5D) (n = 4). Four studies reporting on the EQ-5D had a weighted mean EQ-5D index of 0.80 indicating good quality of life after rib fracture fixation.

CONCLUSION

Surgical fixation can be considered as a safe procedure with a considerably low complication risk and satisfactory long-term outcomes, with surgery- and implant-related complications in approximately 10% of the patients. However, the clinically most relevant complications such as infections occur infrequently, and the number of complications requiring immediate (surgical) treatment is low.

LEVEL OF EVIDENCE

Systematic Review, level III.
Validation of a novel partial resuscitative endovascular balloon occlusion of the aorta device in a swine hemorrhagic shock model: Fine tuning flow to optimize bleeding control and reperfusion injury
Authors: Forte Dominic M. , Do Woo S. , Weiss Jessica B. , Sheldon Rowan R. , Kuckelman John P. , Cook Benjamin A. , Levine Tiffany C. , Eckert Matthew J. , Martin Matthew J.
Published: April 2020

OBJECTIVES

Partial restoration of aortic flow during resuscitative endovascular balloon occlusion of the aorta (REBOA) is advocated by some to mitigate distal ischemia. Our laboratory has validated the mechanics and optimal partial REBOA (pREBOA) flow rates using a prototype device. We hypothesize that pREBOA will increase survival when compared with full REBOA (fREBOA) in prolonged nonoperative management of hemorrhagic shock.

METHODS

Twenty swine underwent placement of aortic flow probes, zone 1 REBOA placement, and 20% blood volume hemorrhage. They were randomized to either solid organ or abdominal vascular injury. The pREBOA arm (10 swine) underwent full inflation for 10 minutes and then deflation to a flow rate of 0.5 L/min for 2 hours. The fREBOA arm (10 swine) underwent full inflation for 60 minutes, followed by deflation/resuscitation. The primary outcome is survival, and secondary outcomes are serologic/pathologic signs of ischemia-reperfusion injury and quantity of hemorrhage.

RESULTS

Two of 10 swine survived in the fREBOA group (2/5 solid organ injury; 0/5 abdominal vascular injury), whereas 7 of 10 swine survived in the pREBOA group (3/5 solid organ injury, 4/5 abdominal vascular injury). Survival was increased (p = 0.03) and hemorrhage was higher in the pREBOA group (solid organ injury, 1.36 ± 0.25 kg vs. 0.70 ± 0.33 kg, p = 0.007; 0.86 ± 0.22 kg vs. 0.71 ± 0.28 kg, not significant). Serum evidence of ischemia was greater with fREBOA, but this was not significant (e.g., lactate, 16.91 ± 3.87 mg/dL vs. 12.96 ± 2.48 mg/dL at 120 minutes, not significant). Swine treated with pREBOA that survived demonstrated trends toward lower alanine aminotransferase, lower potassium, and higher calcium. The potassium was significantly lower in survivors at 60 minutes and 90 minutes time points (5.97 ± 0.60 vs. 7.53 ± 0.90, p = 0.011; 6.67 ± 0.66 vs. 8.15 ± 0.78, p = 0.029). Calcium was significantly higher at 30 minutes, 60 minutes, and 90 minutes (8.56 ± 0.66 vs. 7.50 ± 0.40, p = 0.034; 8.63 ± 0.62 vs. 7.15 ± 0.49, p = 0.019; 8.96 ± 0.64 vs. 7.00, p = 0.028).

CONCLUSION

Prolonged pREBOA at a moderate distal flow rate provided adequate hemorrhage control, improved survival, and had evidence of decreased ischemic injury versus fREBOA. Prophylactic aggressive calcium supplementation may have utility before and during the reperfusion phase.
Splenial Restricted Diffusion as MRI Correlate of Diaschisis in a Blind Infant With Unilateral Posterior Cerebral Artery Stroke
Authors: Eton Emily A. , Patel Tapan P. , Srinivasan Ashok , Moritani Toshio , Trobe Jonathan D.
Published: April 2020

A 3-month-old male infant appeared on multiple clinical examinations to have acutely developed bilateral retrogeniculate blindness. Electroencephalography showed focal status epilepticus confined to the left posterior cerebral hemisphere. MRI demonstrated restricted diffusion in the domain of the left posterior cerebral artery consistent with acute stroke. Notably, the restricted diffusion extended across the midline in the splenium of the corpus callosum. This splenial sign may be the imaging correlate of cerebral diaschisis, a well-described phenomenon in which patients with new brain lesions develop acutely impaired neurologic function in related but nonlesioned brain regions. Diaschisis has been posited as the explanation for the temporary bilateral blindness in adult patients suffering from unilateral occipital infarctions.
Exosomes derived from differentiated Schwann cells inhibit Schwann cell migration via microRNAs
Authors: Sohn Eun Jung , Park Hwan Tae , Shin Yoon Kyung
Published: April 2020

Exosomes derived from Schwann cells have been known to have a variety of functions in the development and repair of the peripheral nervous system, and cyclic AMP (cAMP) is a key inducer of Schwann cell differentiation. In the present study, we aimed to study the effect of exosomes derived from differentiated Schwann cells on the expression of microRNAs (miRNAs). To show that miRNAs were altered from exosomes derived from Schwann cells, we conducted next-generation sequencing (NGS) arrays with exosomes derived from cAMP-induced differentiated Schwann cells and control. NGS arrays revealed that 22 miRNAs, 33 small nucleolar RNAs, one antisense RNA, and two mRNAs were upregulated, while 37 mRNAs, one tRNA, and 35 antisense RNAs were downregulated. We also confirmed that miRNA211 and miR92a-3p were upregulated, while the expression levels of hypoxia-inducible factor, rat cyclin-dependent kinase 2, and rat platelet-derived growth factor C were reduced in exosomes derived from cAMP-induced differentiated Schwann cells. Venn diagrams were used to identify overlapping miRNA targets from highly expressed miRNAs (miR211-5p, miR211-3p, and miR92a-3p). The pathways identified via Kyoto Encyclopedia of Genes and Genomes analysis of the target genes are associated with nerve regeneration and Schwann cell proliferation such as the tumor necrosis factor signaling pathway, dopaminergic synapse, and neurotrophin signaling, and cAMP-dependent signaling pathways. Additionally, we observed that exosomes derived from differentiated Schwann cells suppressed Schwann cell migration, while control exosomes obtained from undifferentiated Schwann cells did not. Together, the results suggested that exosomes released from differentiated Schwann cells regulated Schwann cell migration through changes in miRNA expression.
Eosinophilic pneumonia during treatment with clozapine: reports from a retrospective case series
Authors: Nakamura Masaru , Nagamine Takahiko
Published: April 2020

Clozapine is an atypical antipsychotic known to cause multiple hematologic abnormalities, most seriously agranulocytosis, but also notably eosinophilia. It is considered as an allergic reaction with a spontaneous remission, however, sometimes, it may predict subsequent major inflammatory complications. The aim of this study was to investigate the relationship between clozapine usage and drug-induced pneumonia based on characteristic respiratory symptoms and radiological findings, retrospectively in 69 Japanese treatment-resistant schizophrenia patients. Comparisons of the 26 weeks consecutive levels: white blood cell count with neutrophil and eosinophil, relative to their baseline levels were performed within total subjects and two groups divided by the findings of pneumonia. The crude odds ratios with 95% confidence intervals for developing pneumonia and potential confounders were calculated. The levels of eosinophils significantly increased at 1 month in each group. The introduction season between October and January and higher eosinophil level at first month were correlated with the risk of pneumonia, which occurred independent of clozapine dosage and term and relapsed in subjects when developed within initial 1 month. Clozapine-induced eosinophilic pneumonia was considered transient and reversible, however, the risks and benefits must be considered and close monitoring should be done to avoid life-threatening conditions during clozapine treatment.
Decoding the lethal effect ofSARS-CoV-2(novel coronavirus) strains from global perspective: molecular pathogenesis and evolutionary divergence
Authors: Banerjee Shuvam , Dhar Shrinjana , Bhattacharjee Sandip , Bhattacharjee Pritha
Published: April 2020

Background

COVID-19 is a disease with global public health emergency that have shook the world since its’ first detection in China in December, 2019. Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is the pathogen responsible behind this pandemic. The lethality of different viral strains is found to vary in different geographical locations but the molecular mechanism is yet to be known.

Methods

Available data of whole genome sequencing of different viral strains published by different countries were retrieved and then analysed using Multiple Sequence Alignment and Pair-wise Sequence Alignment leading to Phylogenetic tree construction. Each location and the corresponding genetic variations were screened in depth. Then the variations are analysed at protein level giving special emphasis on Non Synonymous amino acid substitutions. The fatality rates in different countries were matched against the mutation number, rarity of the nucleotide alterations and functional impact of the Non Synonymous changes at protein level, separately and in combination.

Findings

All the viral strains have been found to evolve from the viral strain of Taiwan (MT192759) which is 100% identical with the ancestorSARS-CoV-2sequences of Wuhan (NC 045512.2; submitted on 5thJan, 2020). Transition from C to T (C>T) is the most frequent mutation in this viral genome and mutations A>T, G>A, T>A are the rarest ones, found in countries with maximum fatality rate i.e Italy, Spain and Sweden. 20 Non Synonymous mutations are located in viral genome spanning Orf1ab polyprotein, Surface glycoprotein, Nucleocapsid protein etc. The functional effect on the structure and function of the protein can favourably or unfavourably interact with the host body.

Interpretation

The fatality outcome depends on three important factors (a) number of mutation (b) rarity of the allelic variation and (c) functional consequence of the mutation at protein level. The molecular divergence, evolved from the ancestral strain (S) lead to extremely lethal (E), lethal(L) and non lethal (N) strains with the involvement of an Intermediate strain(I).
Biomass of a trophic level increases with maximum body size, but less than proportionally
Authors: Giacomini Henrique C.
Published: April 2020

A recent paper by Enquist and colleagues1took a very important step in predicting the ecosystemic effects of species losses on a global scale. Using Metabolic Scaling Theory (MST), they concluded that large-sized species contribute disproportionately to several ecosystem functions. One of their key predictions is that total biomass of animals in a trophic level (MTot, using their notation) should increase more than proportionally with its maximum body size (mmax), following the relationshipMTot∝mmax5/4. Here I argue that this superlinear scaling results from an incorrect representation of the individual size distribution and that the exponent should be 1/4, implying a sublinear scaling. The same reasoning applies to total energy flux or metabolismBTot, which should be invariant to maximum size according to the energetic equivalence and perfect compensatory responses entailed by MST.
Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans
Authors: Fox Sharon E. , Akmatbekov Aibek , Harbert Jack L. , Li Guang , Brown J. Quincy , Heide Richard S. Vander
Published: April 2020

SARS-CoV-2 has rapidly spread across the United States, causing extensive morbidity and mortality, though the histopathologic basis of severe disease cases has yet to be studied in detail. Over the past century, autopsy has contributed significantly to our understanding of numerous disease processes, but for several reasons, autopsy reports following deaths related to SARS- CoV-2 have thus far been limited across the globe. We report on the relevant cardiopulmonary findings in the first series of autopsies in the United States, with the cause of death being due to SARS-CoV-2 infection. These cases identify key pathologic states potentially contributing to severe disease and decompensation in these patients.