bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comprehensive Clinicopathologic and Molecular Study of 19 Primary Effusion Lymphomas in HIV-infected Patients
Authors: Calvani Julien , Gérard Laurence , Fadlallah Jehane , Poullot Elsa , Galicier Lionel , Robe Cyrielle , Garzaro Margaux , Bertinchamp Remi , Boutboul David , Cuccuini Wendy , Cayuela Jean-Michel , Gaulard Philippe , Oksenhendler Éric , Meignin Véronique
Published: September 2021

Primary effusion lymphoma (PEL) is associated with human herpesvirus 8 and frequently with Epstein-Barr virus (EBV). We report here a single-center series of 19 human immunodeficiency virus–associated PELs, including 14 EBV+ and 5 EBV− PELs. The objectives were to describe the clinicopathologic features of PELs, with a focus on programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) expression, to search for genetic alterations by targeted deep sequencing analysis, and to compare the features between EBV+ and EBV− cases. All the patients were male, and the median age at diagnosis was 47 years old (interquartile range: 40 to 56 y). Reflecting the terminal B-cell differentiation, immunophenotypic profiles showed low expression levels of B-cell markers, including CD19 (0/19), CD20 (1/19), CD79a (0/19), PAX5 (1/19), BOB1 (3/19), and OCT2 (4/19), contrasting with a common expression of CD38 (10/19), CD138 (7/19), and IRF4/MUM1 (18/19). We observed a frequent aberrant expression of T-cell markers, especially CD3 (10/19), and less frequently CD2 (2/19), CD4 (3/19), CD5 (1/19), and CD8 (0/19). Only 2 cases were PD-L1 positive on tumor cells and none PD-1 positive. With respect to immune cells, 3 samples tested positive for PD-L1 and 5 for PD-1. Our 36-gene lymphopanel revealed 7 distinct variants in 5/10 PELs, with either a single or 2 mutations per sample: B2M (n=2), CD58 (n=1), EP300 (n=1), TNFAIP3 (n=1), ARID1A (n=1), and TP53 (n=1). Finally, we did not observe any major clinical, pathologic, or immunohistochemical differences between EBV+ and EBV− PELs and the outcome was similar (2-y overall survival probability of 61.9% [95% confidence interval, 31.2-82.1] vs. 60.0% [95% confidence interval, 12.6-88.2], respectively, P=0.62).
Association Between Hyperoxemia and Increased Cell-Free Plasma Hemoglobin During Cardiopulmonary Bypass in Infants and Children*
Authors: Gretchen Catherine , Bayir Hϋlya , Kochanek Patrick M. , Ruppert Kristine , Viegas Melita , Palmer David , Kim-Campbell Nahmah
Published: September 2021

OBJECTIVES:

To determine potential risk factors for severe hemolysis during pediatric cardiopulmonary bypass and examine whether supraphysiologic levels of oxygen and cardiopulmonary bypass duration are associated with hemolysis.

DESIGN:

Prospective observational study.

SETTING:

Cardiac ICU in a university-affiliated children’s hospital.

PATIENTS:

Greater than 1 month to less than 18 years old patients undergoing cardiopulmonary bypass for cardiac surgery.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Plasma samples from 100 patients to assess cell-free plasma hemoglobin levels were obtained at start cardiopulmonary bypass, at the end of cardiopulmonary bypass, and 2 and 24 hours after reperfusion. Arterial blood gas samples were obtained before and every 30 minutes during cardiopulmonary bypass. Patient demographics and laboratory data were collected from the electronic medical record. Plasma hemoglobin levels peaked at the end of cardiopulmonary bypass and haptoglobin levels continued to fall throughout all time points. There were 44 patients with severe hemolysis (change in cell-free plasma hemoglobin > 50 mg/dL). Younger age (odds ratio/sd 0.45 [95% CI, 0.25–0.81]) and higher mean Pao
2 × cardiopulmonary bypass duration (31.11 [1.46–664.64]) were identified as risk factors for severe hemolysis in multivariable analysis. Severe hemolysis was associated with longer hospital and ICU lengths of stay as well as acute kidney injury.

CONCLUSIONS:

We observed younger age and the exposure to both oxygen and duration of cardiopulmonary bypass as risk factors for hemolysis. Oxygen delivery through the cardiopulmonary bypass circuit is an easily modifiable risk factor. Its role in the production of reactive oxygen species that could alter the erythrocyte membrane deserves further examination in larger prospective studies.
Antimicrobial Stewardship in Bronchiolitis: A Retrospective Cohort Study of Three PICUs in Canada
Authors: Aljassim Nada A. , Noël Kim C. , Maratta Christina , Tam Ingrid , Almadani Ahmed , Papenburg Jesse , Quach Caroline , Thampi Nisha , McNally James D. , Dendukuri Nandini , Lefebvre Marie-Astrid , Zavalkoff Samara , O’Donnell Shauna , Jouvet Philippe , Fontela Patricia S.
Published: September 2021

OBJECTIVES:

To determine the association between the implementation of an antimicrobial stewardship program at a local PICU and to determine the association between the presence of an antimicrobial stewardship programs and antimicrobial use across three Canadian PICUs, among critically ill children with bronchiolitis.

DESIGN:

A multicenter retrospective cohort study.

SETTING:

Three Canadian PICUs over two winter seasons.

INTERVENTIONS:

An antimicrobial stewardship program was implemented at PICU 1 at the end of season 1.

PATIENTS:

Patients less than or equal to 2 years old admitted with bronchiolitis.

MEASUREMENTS AND MAIN RESULTS:

We used regression models with an interaction term between site (PICU 1 and PICU 2) and season (1 and 2) as the primary analysis to determine the association between implementation of an antimicrobial stewardship program at PICU 1 and 1) the proportion of antimicrobials discontinued 72 hours after hospital admission (logistic regression), 2) antimicrobial treatment duration (negative binomial regression), and 3) antimicrobial prescriptions within 48 hours of hospital admission (logistic regression). As a secondary analysis, we determined the association between having an antimicrobial stewardship program present and the aforementioned outcomes across the three PICUs. A total of 372 patients were included. During seasons 1 and 2, median age was 2.2 months (interquartile range, 1.2–6.2 mo) and 2.1 months (interquartile range, 1.3–6.8 mo), respectively. Among patients with viral bronchiolitis, implementation of an antimicrobial stewardship program at PICU 1 was associated with increased odds of discontinuing antimicrobials (odds ratio, 25.63; 95% CI, 2.86–326.29), but not with antimicrobial duration (odds ratio, 0.56; 95% CI, 0.31–1.02) or antimicrobial prescriptions (odds ratio, 0.33; 95% CI, 0.10–1.04). The presence of an antimicrobial stewardship program was similarly associated with antimicrobial discontinuation among patients with viral bronchiolitis (odds ratio, 20.79; 95% CI, 2.46–244.92), but not with antimicrobial duration (odds ratio, 0.57; 95% CI, 0.32–1.03) or antimicrobial prescriptions (odds ratio, 0.37; 95% CI, 0.12–1.11).

CONCLUSIONS:

Antimicrobial stewardship programs were associated with increased likelihood of discontinuing antimicrobial treatments in the PICU patients with viral bronchiolitis. However, larger studies are needed to further determine the role of an antimicrobial stewardship programs in reducing unnecessary antimicrobial use in this patient population.
Influencing kinetic energy using ankle-foot orthoses to help improve walking after stroke: a pilot study
Authors: Kimura Nodoka , Ohata Koji , Kawasaki Shihomi , Nogi Shiori , Tsuruda Akihiro , Yamada Shigehito
Published: September 2021

Background:

An ankle-foot orthosis with an oil damper (AFO-OD) may improve kinetics and kinematics for efficient walking after stroke. Yet it is unknown whether hemiplegic walking behaves like “inverted-pendulum” gait and how it is modulated by using AFO-ODs for efficiency.

Objectives:

This study examined whether the use of AFO-ODs improves the kinetics of total vertical ground reaction force (vGRF) and kinematics of vertical pelvic displacement (vPD) in different walking phases, and gait speed following stroke. Also, the relationship between those gait parameters was examined to assess efficient walking.

Study design:

Observational study within subject.

Methods:

Eight participants with hemiplegia walked at self-selected speed without and with AFO-ODs over the walkway and gait speed was measured. Force plates were used to measure total vGRF during the double-limb support phase with the paretic leading limb and with the paretic trailing limb (DSPT). The vPD in the paretic and nonparetic stance phases was measured by a three-dimensional motion analysis system.

Results:

Without AFO-ODs, reduced total vGRF during DSPT was related to greater vPD in the subsequent nonparetic stance. Using AFO-ODs significantly increased gait speed and total vGRF during double-limb support phase with the paretic leading limb and during DSPT, which were significantly correlated. Vertical pelvic displacement in the nonparetic stance was higher than the paretic stance in both conditions.

Conclusions:

Decreased total vGRF during DSPT was compensated by excessive vPD in the nonparetic stance phase without AFO-ODs, indicating inefficient walking. However, the use of AFO-ODs improved the kinetic energy of total vGRF during the double-limb support phase, contributing to efficient walking.

Clinical relevance statement:

The AFO-ODs can be used to improve kinetic energy and to modulate functions in the weight transition during the double-limb support phase, with faster walking speed. Thus, AFO-ODs can be considered to be therapeutic AFOs to acquire efficient walking performance in poststroke rehabilitation.
Effects of Ankle-Foot Orthoses on acceleration and energy cost of walking in children and adolescents with cerebral palsy
Authors: Goihl Tobias , Ihlen Espen Alexander F. , Bardal Ellen Marie , Roeleveld Karin , Ustad Astrid , Brændvik Siri Merete
Published: September 2021

Background:

Impaired postural control is a key feature of cerebral palsy that affects daily living. Measures of trunk movement and acceleration have been used to assess dynamic postural control previously. In many children with cerebral palsy, ankle-foot orthoses are used to provide a stable base of support, but their effect on postural control is not yet understood.

Objectives:

The objectives of the current study were to investigate the effects of ankle-foot orthoses on postural control and energy cost of walking in children with cerebral palsy.

Study design:

Clinical study with controls.

Methods:

Trunk accelerometry (amplitude and structure) and energy cost of walking (J/kg/m) were recorded from five-minute walking trials with and without ankle-foot orthoses for children with cerebral palsy and without orthoses for the reference group.

Results:

Nineteen children with unilateral spastic cerebral palsy and fourteen typically developed children participated. The use of ankle-foot orthoses increased structure complexity of trunk acceleration in mediolateral and anterior–posterior directions. The use of ankle-foot orthoses changed mediolateral-structure toward values found in typically developed children. This change was not associated with a change in energy cost during walking.

Conclusions:

The use of ankle-foot orthoses does affect trunk acceleration that may indicate a beneficial effect on postural control. Using measures of trunk acceleration may contribute to clinical understanding on how the use of orthoses affect postural control.
Predictors of Transition to Frailty in Middle-Aged and Older People With HIV: A Prospective Cohort Study
Authors: Lorenz David R. , Mukerji Shibani S. , Misra Vikas , Uno Hajime , Gelman Benjamin B. , Moore David J. , Singer Elyse J. , Morgello Susan , Gabuzda Dana
Published: September 2021

Background:

People with HIV (PWH) have increased frailty risk at younger ages compared with the general population. Multimorbidity is associated with frailty, yet effects of specific comorbidities on transition to frailty in PWH are unknown.

Setting:

Prospective study of 219 PWH age 45 years or older in the National NeuroAIDS Tissue Consortium.

Methods:

Frailty status was categorized using Fried frailty phenotype criteria. Comorbidities [bone disease, cardiovascular disease, cerebrovascular disease, liver disease, renal disease, diabetes, chronic obstructive pulmonary disease (COPD), hypertension, obesity, cancers, neuropsychiatric conditions] were assessed from longitudinal data. Associations between baseline comorbidities and transition to frailty within 30 months were analyzed using Kaplan–Meier and Cox regression models. Grip strength was assessed using mixed-effects models.

Results:

At baseline, the median age was 61 years, 73% were male 98% were on antiretroviral therapy, 29% had ≥3 comorbidities, 27% were robust, and 73% were pre-frail. Cerebrovascular disease, diabetes, and COPD were independent predictors of transition to frailty within 30 months in models adjusted for age, sex, and multimorbidity (≥3 additional comorbidities) [hazard ratios (95% confidence intervals) 2.52 (1.29 to 4.93), 2.31 (1.12 to 4.76), and 1.82 (0.95 to 3.48), respectively]. Furthermore, cerebrovascular disease, diabetes, COPD, or liver disease co-occurring with multimorbidity was associated with substantially increased frailty hazards compared with multimorbidity alone (hazard ratios 4.75–7.46). Cerebrovascular disease was associated with decreased baseline grip strength (P =0.0001), whereas multimorbidity, diabetes, and COPD were associated with declining grip strength (P< 0.10).

Conclusions:

In older PWH, cerebrovascular disease, diabetes, COPD, or liver disease co-occurring with multimorbidity is associated with substantially increased risk of becoming frail within 30 months. Interventions targeting these comorbidities may ameliorate frailty and age-related functional decline in PWH.
Impact of the COVID-19 Pandemic on Use of HIV Care, Antiretroviral Therapy Adherence, and Viral Suppression: An Observational Cohort Study From Uganda
Authors: Wagner Zachary , Mukasa Barbara , Nakakande Josephine , Stecher Chad , Saya Uzaib , Linnemayr Sebastian
Published: September 2021

Introduction:

Recent studies project thousands of additional AIDS-related deaths because of COVID-19–related disruptions in HIV care. However, the extent to which disruptions in care have materialized since the start of the pandemic is not well understood.

Methods:

We use electronic health records to investigate how the pandemic has affected clinic visits, patients' antiretroviral therapy (ART) supply, and viral suppression for a cohort of 14,632 HIV clients from a large HIV clinic in Kampala, Uganda. We complement this with an analysis of electronically measured longitudinal ART adherence data from a subcohort of 324 clients.

Results:

Clinic visits decreased by more than 50% after a national lockdown started. The risk of patients running out of ART on a given day increased from 5% before the lockdown to 25% 3 months later (Relative Risk Ratio of 5.11, 95% confidence interval: 4.99 to 5.24) and remained higher than prelockdown 6 months later at 13% (Relative Risk Ratio of 2.60; 95% confidence interval: 2.52 to 2.70). There was no statistically significant change in electronically measured adherence or viral suppression.

Conclusion:

We document substantial gaps in HIV care after the start of the COVID-19 pandemic in Uganda. This suggests that measures to improve access should be explored as the pandemic persists. However, ART adherence was unaffected for the subcohort for whom we measured electronic adherence. This suggests that some clients may have stockpiles of ART tablets from previous prescriptions that allowed them to keep taking their medication even when they could not visit the clinic for ART refills.
18F-FDG-Detected Brown Tumor Confined to the Maxillary Bone With Parathyroid Adenoma
Authors: Yamaga Emi , Fujioka Tomoyuki , Asakage Takahiro , Miura Keiko , Tateishi Ukihide
Published: September 2021

Brown tumor is a reactive osteolytic lesion associated with hyperparathyroidism and an extremely rare form of a single lesion in the maxilla. We report the case of a 57-year-old woman with renal dysfunction, nasal obstruction, and hypercalcemia. MRI and CT revealed a huge osteolytic lesion in the maxilla. 18F-FDG PET/CT demonstrated marked FDG uptake within the mass and the lower-left lobe of the thyroid gland. 99mTc-methoxy-isobutyl-isonitrile scintigraphy suggested that this accumulation was a parathyroid adenoma. Parathyroid adenoma resection was performed, and the maxillary tumor was diagnosed as brown tumor. FDG PET/CT was helpful in evaluating brown tumor and detecting parathyroid adenoma.
CheXED
Authors: Irvin Jeremy A. , Pareek Anuj , Long Jin , Rajpurkar Pranav , Eng David Ken-Ming , Khandwala Nishith , Haug Peter J. , Jephson Al , Conner Karen E. , Gordon Benjamin H. , Rodriguez Fernando , Ng Andrew Y. , Lungren Matthew P. , Dean Nathan C.
Published: September 2021

Purpose:

Patients with pneumonia often present to the emergency department (ED) and require prompt diagnosis and treatment. Clinical decision support systems for the diagnosis and management of pneumonia are commonly utilized in EDs to improve patient care. The purpose of this study is to investigate whether a deep learning model for detecting radiographic pneumonia and pleural effusions can improve functionality of a clinical decision support system (CDSS) for pneumonia management (ePNa) operating in 20 EDs.

Materials and Methods:

In this retrospective cohort study, a dataset of 7434 prior chest radiographic studies from 6551 ED patients was used to develop and validate a deep learning model to identify radiographic pneumonia, pleural effusions, and evidence of multilobar pneumonia. Model performance was evaluated against 3 radiologists’ adjudicated interpretation and compared with performance of the natural language processing of radiology reports used by ePNa.

Results:

The deep learning model achieved an area under the receiver operating characteristic curve of 0.833 (95% confidence interval [CI]: 0.795, 0.868) for detecting radiographic pneumonia, 0.939 (95% CI: 0.911, 0.962) for detecting pleural effusions and 0.847 (95% CI: 0.800, 0.890) for identifying multilobar pneumonia. On all 3 tasks, the model achieved higher agreement with the adjudicated radiologist interpretation compared with ePNa.

Conclusions:

A deep learning model demonstrated higher agreement with radiologists than the ePNa CDSS in detecting radiographic pneumonia and related findings. Incorporating deep learning models into pneumonia CDSS could enhance diagnostic performance and improve pneumonia management.
A Novel Approach to Virtual Surgical Planning for Mandibular and Midfacial Reconstruction With a Fibula Free Flap
Authors: Kalachi Kourosh , Highstein Mallory J. , Shikara Meryam , Hirsch Jeffrey , Vakharia Kalpesh T.
Published: September 2021

Background:

The fibula free flap is a major workhorse in facial reconstruction. To decrease operative times, virtual surgical planning (VSP) has been implemented. Traditional VSP is costly and may delay operative planning. in this study, the authors present a novel algorithm using readily accessible software packages to perform VSP in a manner that is quick and cost-effective.

Methods:

A 6-part survey was administered to physicians with prior training in facial reconstruction. Fourteen physicians participated regarding outcomes on 10 patients who underwent mandibular or midfacial fibula free flap reconstruction. Participants were asked to match the true postoperative and VSP models and rate the similarity of the models using the Likert scale (0–10). The goal was to determine whether the VSP models accurately depicted the actual reconstruction, and whether they would use VSP in future clinical practice.

Results:

The physicians surveyed were able to match the models correctly 93.6% of the time. The mean score for the similarity between virtual and actual models ranged between 7.60 and 8.80. Most participants (90.9%) who answered stated they would use our VSP algorithm if they were trained in the protocol.

Conclusions and Relevance:

Virtual surgical planning models were created utilizing our novel algorithm. Participants matched the preoperative VSP plan with the postoperative model most of the time and rated the similarity well. Participants in our study are interested in learning more about physician performed VSP. The authors believe this model may be financially and clinically relevant and serve as an excellent educational tool.
Repair Sequence and Management of the Premaxilla in Patients With Bilateral Cleft Lip and Palate: A Systematic Review of the Literature
Authors: Chang Irene A. , Bassiri Gharb Bahar , Papay Francis A. , Rampazzo Antonio
Published: September 2021

Background:

Bilateral cleft lip and palate (BCLP) remains a difficult surgical problem due to the severely protruding premaxillary segment, with no consensus of optimal treatment sequence in older patients. A systematic review of the literature was performed to assess the current status of BCLP repair based on age.

Methods:

A PRISMA systematic review of the PubMed, Web of Science, and Embase databases was performed using a series of search terms related to BCLP. Studies were categorized based on the age of presentation, repair sequence, and technique.

Results:

The database search identified 381 articles. Of these, 72 manuscripts were ultimately included. The lip was repaired first in 1077 patients (86.0%), palate first in 161 patients (12.9%), and simultaneous lip and palate in 14 patients (1.1%). Patients less than 6 months old received lip repair first (n = 959, 98.6%), with complications of unaesthetic appearance (n = 86, 62.3%) and midface retrusion (n = 41, 34.1%) in younger patients and wound dehiscence (n = 8, 40%) in older patients. Primary lip repair was preceded by presurgical orthopedics (n = 760) or lip adhesion (n = 272) to reduce lip tension with nasoalveolar molding (n = 452, 62.9%) or the Latham device (n = 282, 37.1%). In older patients, the palate was repaired first or premaxillary setback (n = 222) was indicated in protruded premaxillae greater than 10 mm, but carried the risk of premaxilla mobility (n = 20, 37.7%) and midface retrusion (n = 10, 18.9%).

Conclusion:

In younger patients, lip repair is performed first with preoperative orthopedics or lip adhesion. In older patients, the palate is more commonly repaired first compared with the lip; however, there is no difference in complication rate.
Stepwise Reconstruction of a Large, Self-Inflicted Calvarial Defect
Authors: Junn Alexandra , Dinis Jacob , Kahle Kristopher T. , Alperovich Michael
Published: September 2021

Background and Importance:

Scalp expansion ensures that tissue similar in color, texture, thickness, and most importantly, hairbearing quality, is available to resurface the scalp. It is a critical option for reconstruction of large calvarial defects.

Clinical Presentation:

Over 6months, a 55-year-old male patient excoriated his scalp into a full-thickness scalp and calvarial wound resulting in dural violation and meningitis. The patient presented with altered mental status and methicillin-susceptible staphylococcus aureus (MSSA) bacteremia, cranial osteomyelitis, and an intracranial abscess secondary to the large scalp defect. The patient underwent immediate debridement and dural coverage with a scalp rotational flap. Several months later he began delayed stepwise cranioplasty with multiple scalp tissue expanders given the deficiency of soft tissue.

Conclusions:

This case is presented to highlight the unusual mechanism of injury and the complex reconstructive approach in surgical management.
A Rare Case of Craniocervical Penetrating Injury by a Steel Bar
Authors: Liu Yuan-qin , Zhang Qing-lu , Fan Xiao-yong , Zhang Ming-kun , Liu Guang-cun
Published: September 2021

Rationale:

Non-missile penetrating injuries caused by foreign bodies, such as knives or sharp wood, are infrequent. We report a 49-year-old male suffering from severe craniocervical penetrating injury by a steel bar was successfully treated by surgery.

Chief Complaint:

The male patient was a 49-year-old builder. Although working on the construction site, an approximately 60 cm steel bar penetrated the patient's brain vertically through the left top of the head presenting with unconsciousness and intermittent irritability.

Diagnosis:

Computed tomography of the head showed the entrance and exit of the skull damaged by the steel bar. Three-dimensional reconstruction showed that the steel bar entered the skull from the posterior left coronal suture and penetrated the ipsilateral occipital bone, about 5 cm into the neck soft tissue.

Intervention:

We successfully performed the operation and removed the steel bar.

Outcomes:

The patient was followed up for 5 years; muscle strength returned to normal.

Lessons:

Penetrating injuries caused by steel bars are rare, which always cause severe intracranial injury combined with peripheral tissue injury, by sharing our experience in the treatment of this rare case, we hope to provide a reference for similar injuries in the future.
Deep Learning-Based CT Radiomics for Feature Representation and Analysis of Aging Characteristics of Asian Bony Orbit
Authors: Li Zhu , Chen Kunjian , Yang Jiayu , Pan Lei , Wang Zhen , Yang Panfeng , Wu Sufan , Li Jingyu
Published: September 2021

Objective:

This paper puts forward a new method for automatic segmentation of bony orbit as well as automatic extraction and classification of aging features of segmented orbit contour based on depth learning, with which the aging mode of bony orbit contour is preliminarily validated.

Method:

Three-dimensional reconstruction was carried out by using the craniofacial Computed Tomography scanning data of 595 adult Mongolians at different ages (119 young males, 78 young females, 109 middle-aged males, 89 middle-aged females, 95 elderly males, and 105 elderly females), the craniofacial images were exported, orbit contour images were obtained with U-Net segmentation network, and then the orbit contour features of young group, the middle-aged group and the elderly group were classified with the classification network. Next, contour area, height, and other features put forward in existing research were automatically calculated by using the connected component shape description method; and it was validated whether the aging features of the bony orbit only occur to partial or the whole orbit.

Results:

With the method put forward in this paper, high-precision identification (97.94% and 99.18%) of 3 categories in the male and female group experiments. In the meanwhile, it was found in the comparison experiment with other features that bony orbit contour definitely has features relating to aging, but these features only occur to partial areas of the orbit, which enables the convolutional neural network to achieve good identification effects. And, bone resorption of the superior orbital rim of males is more obvious than that of the inferior orbital rim, but the overall shape features like the bony orbit area and height do not change significantly along with the increase of the age.

Conclusions:

U-Net can realize high-precision segmentation of the orbit contour, and with the Convolutional Neural Network-based orbit contour sorting algorithm, the aging degree of the bony orbit can be identified precisely. It is preliminarily validated that the aging mode of Mongolian bony orbit contour is that the bone resorption of the superior orbital rim is more obvious than that of the inferior orbital rim, and the change of the orbit area, perimeter, height and circularity is not obvious in the aging process.
Pediatric Odontogenic and Maxillofacial Bone Pathology: A Global Analysis
Authors: Garg Ravi K. , O’Connor Michaela K. , Sterling David A. , Jacob Laya , Hammoudeh Jeffrey A. , Andrews Brian T.
Published: September 2021

Background:

Although pathology in the maxillary and mandibular bones is rare in young patients, the differential diagnosis is broad. The World Health Organization (WHO) updated its classification of maxillofacial bone pathology in 2017. Using these updated guidelines, a systematic review of common maxillofacial bone lesions in the pediatric population was performed.

Methods:

A PubMed search was conducted capturing English language articles from inception to July 2020. Thirty-one articles were identified that described the frequency of maxillofacial bone pathology. Data were extracted and organized using the WHO 2017 classification of odontogenic and maxillofacial bone tumors. Prevalence data were analyzed among diagnostic categories and geographical regions. The SAS version 9.4 was used to complete statistical analyses.

Results:

The articles included patients from birth to a maximum age of 14 to 19 years. The most common odontogenic cysts included radicular cyst (42.7%) and dentigerous cyst (39.0%) followed by odontogenic keratocyst (15.0%). Among odontogenic bone tumors, odontoma (49.3%) was most common followed by ameloblastoma (29.1%). The most common nonodontogenic bone tumor was fibrous dysplasia (42.4%), and the most common malignant bone tumor was osteosarcoma (75.0%). Significant variations were found by geographic region, with dentigerous cyst more common than radicular cyst, and ameloblastoma more common than odontoma in African and Asian countries (P < 0.0001).

Conclusions:

This systematic review uses the WHO 2017 guidelines to classify common odontogenic and nonodontogenic maxillofacial bone lesions around the world. Pathogenesis, presentation, and available treatment options for the most common maxillofacial bone lesions are reviewed.
Reconstruction of Large Acquired Palatal Defects Using Facial-Submental Artery Island Flap
Authors: Huang Zhuo-Shan , Wang You-Yuan , Chen Wei-Liang , Liao Juan-Kun , Yu Yan-Song
Published: September 2021

Objective:

To evaluate the feasibility and clinical effect of facial-submental artery island flap (FSAIF) in the repair of palatal defects, and to provide reference for the clinical application of submental artery island flap.

Methods:

Nine patients with palatal defects, the range of nasal palatal perforation defects were 3 cm × 4cm to 3 cm × 6 cm (median 3 cm × 5.4 cm), were repaired by FSAIF, and the sizes of FSAIF were 4 cm × 9cm to 4 cm × 12 cm (median 4 cm × 10.4 cm,). Postoperative clinical efficacy was evaluated, including infection and necrosis of mucosal flap and postoperative palatal fistula perforation. Patients were followed up to evaluate their chewing, swallowing, speech function, and satisfaction of appearance.

Results:

All patients were successfully repaired with FSAIF. Followed up 13∼35 months, there was no palatal fistula perforation in all patients. The speech, agitation, and swallowing function were not affected and the patients were satisfied with the appearance.

Conclusion:

FSAIF is a safe and reliable method for palatal defect repair.
Retrospective Study of the Epidemiological Profile of Facial Trauma Related to Violence
Authors: Caldeira Leticía , Borges Hully , Simonetti Taíse , Freddo Angelo Luiz , Corsetti Adriana
Published: September 2021

Facial trauma is now considered an epidemic due to its high incidence. This type of injury represents an impact on the social, psychological and professional life of the victim. It may be associated with poor protection and exposure of this region of the body, as well as with the attempt to disfigure the face of victims of aggression, to affect their identity and self-image. This study aims to carry out an epidemiological survey on the profile of facial trauma related to violence at the First Aid Hospital of Porto Alegre from November 2015 to July 2016. In this retrospective descriptive cross-sectional study, data such as age and sex of the patient, type of trauma, anatomical region, etiology, and reasons for the aggression of patients’ records were analyzed using the Chi-Square test in Paws Statistics 18 software, evaluatingP < 0.05. During the period evaluated, 1224 cases were recorded. The most prevalent sex was male. The age group with the most injuries varied from 21 to 40. The most affected type of lesion was soft tissue injury. Scalp regions (parietal, occipital, temporal) and multiple regions were the most affected in males, differing from females, where the frontal and nasal regions were the most predominant. Violence is a major risk factor for facial trauma in adult patients and it is from epidemiological studies like this that we have the possibility to know the magnitude and severity of the results of violence, allowing the definition of public policies for coping.
Clinical T4b Squamous Cell Carcinoma Resection With Hemimandibulectomy and Temporomandibular Joint Reconstruction With Bridging Plate and Modified Dautrey Procedure
Authors: Shih Hao , Lee Jian-Jr , Lin Yu-Ting
Published: September 2021

Clinical T4b oral squamous cell carcinoma is traditionally considered nonoperable. We present a case of right mandibular squamous cell carcinoma (PT4bN0M0, stage IVB). The tumor had extended to the right mandibular condylar head and masticatory space. The patient received right modified radical neck dissection and radical operation with hemimandibulectomy to remove the right mandibular condyle. Then, we reconstructed the resected portion with an anterior lateral thigh free flap and bridging plate, which was bent to form an artificial condyle and fixed using the modified Dautrey procedure. The patient had stable postoperative occlusion and normal hinge movement of the temporomandibular joint. After postoperative concurrent chemotherapy and radiotherapy, the patient is under regular out patient department follow-up with satisfactory jaw function and oral intake.
Transposition Mucosal Flap Combined With Autologous Fat Transplantation to Repair Lip Defects Caused by Sclerotherapy of Hemangioma
Authors: Wang Yanyang , Wang Xingang , Zhao Jingjing , Ma Hengyuan , Yin Ningbei , Wang Yongqian , Song Tao , Li Haidong , Wu Di
Published: September 2021

Infantile hemangiomas are the most common benign childhood tumors and can occur on any part of the human body. Sclerosing agents are used in the early stage of treatment of infantile hemangioma. Sometimes a lip defect remains after sclerosing agent treatment. We developed a simple technique to repair lip defects. The authors performed transposition mucosal flap and autologous fat transplantation surgery on patients who had lip defects caused by sclerosing agents. The flap was transposed 90° from the intraoral labial mucosa to the vermilion defect. Autologous fat was transplanted to the white lip defect. If necessary, a secondary fat transplantation may be performed every half year. All patients were followed up to evaluate the effect of the operation. Patients were asked to rate their satisfaction with the surgery between 1 and 10. Digital three-dimensional evaluation was performed. Sixteen patients underwent the surgery successfully, and the flaps were all viable. No complications occurred after surgery (5 males, 11 females; age range, 5–27 years; 12 upper lip, 3 lower lip, and 1 median lip). The patients were satisfied with the aesthetic outcome of surgery (mean score, 9). Seven patients wanted to undergo a second fat transplantation, whereas 9 patients felt it was unnecessary to transplant fat again. Transposition mucosal flap combined with autologous fat transplantation is reliable and minimally invasive. It is an effective method for repairing moderate lip defects mainly involving vermilion caused by a sclerosing agent.
Effect of Primary Stabilisation on Osseointegration of Implants With Local and Systemic Zoledronic Acid Application
Authors: Sokmen Nurullah , Dundar Serkan , Bozoglan Alihan , Yildirim Tuba Talo , Sokmen Kevser , Sayeste Erjeng , Isayev Abulfaz , Kirtay Mustafa
Published: September 2021

Primary stabilization (PS) is defined as initial tight fit during the surgical placement of an implant. Tight implant placement is quite difficult in cases where bone quality and quantity are insufficient. Zoledronic acid (ZA) is a powerful bisphosphonate that prevents bone resorption. The aim of this study is to investigate the effect of local and systemic ZA application on osseointegration in titanium implants with and without PS. Male Sprague Dawley rats were divided into 2 main groups, with PS, PS + (n = 24), and without primary stabilisation, PS − (n = 24). These main groups were divided into control (n = 8), 2mg/1 mL local ZA (n = 8) and 0.1mg/kg systemic ZA (n = 8) groups. All of the subjects were sacrificed after a 4-week recovery period. Bone implant connection (BiC) and thread filling (TF) (%) of the samples was analyzed according to the non-decalcified histological analysis method. In terms of BiC percentages and TF, statistically significant differences were found between the groups with and without PS and between the ZA treatment groups (P < 0.05). The common effect of PS and ZA use on the percentage of BIC was found to be statistically significant (P < 0.05). The common effect of PS and acid type on TF was not statistically significant (P < 0.05). Within the limitations of this study, it may be concluded that systemic and local administration of ZA may increase implant osseointegration.
Closed Isolated Zygomatic Arch Fracture Management Made Easy
Authors: Estawrow Mina A. , Elbarbary Amir S.
Published: September 2021

Background:

Zygomatic arch fractures can occur either as isolated fractures or as a part of multiple facial fractures. There are several techniques available for reduction of zygomatic arch fractures, which include closed reduction and open reduction with fixation using metallic splints, closed reduction via Gillies or a gingivobuccal approach is preferred for minimal invasiveness, short operative time, and low complication rate. The aim of the present study is to present a simple, easy, and reliable method for closed reduction of isolated zygomatic arch fractures.

Patients and Methods:

This study included twenty patients presented with isolated zygomatic arch fractures between January of 2017 and December of 2018. All patients were evaluated based on the clinical and radiographic findings. Closed reduction of the zygomatic arches was carried on by a stainless steel wire. Surgical outcomes were subjected for objective assessment based on the postoperative alignment of the zygomatic arch in the computed tomography (CT scan) immediately after surgery and after 3 months. Subjective evaluation was carried out comparing preoperative, 1 and 3 months photographs assessing facial symmetry, as well as the patients’ satisfaction.

Results:

After a period of 3 to 6 months follow-up between January 2017 and December 2019, all patients were satisfied by the overall results, no major complications were recorded and no additional surgery needed for them.

Conclusions:

The suture wire method is quick, simple, easy, and effective for the reduction of isolated, depressed fractures of the zygomatic arch.
What is the Fate of the Pedicled Buccal Fat Pad Flap When Used During Primary Palatoplasty?
Authors: Kotlarek Katelyn J. , Perry Jamie L. , Jaskolka Michael S.
Published: September 2021

Pedicled buccal fat pad flaps have more recently been applied to primary cleft palate reconstruction, and yet the integrity of the flap and the long-term impact on the palate has not yet been studied. This case study uses magnetic resonance imaging to evaluate the composition of the soft palate 5 years after the interpositional placement of bilateral pedicled buccal fat pad flaps during primary palatoplasty. Anatomical measures are used to quantify the flap and surrounding velopharynx using magnetic resonance imaging and three-dimensional computer technology, indicating that this surgical technique may have a lasting impact for children with cleft palate.
A Modified Procedure for Anterior Maxillary Osteotomy
Authors: Chen Zheng-Hao , Wang Jian-Ning
Published: September 2021

Anterior maxillary osteotomy is a traditional operation in the treatment of maxillary protrusion. Varies fields about operation have been changed or improved in those years to avoid different kinds of complications. In our study, the authors would present 1 kind of improved anterior maxillary osteotomy surgical method. The study was conducted at the Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Guangzhou, Guangdong province. Patients are divided into improved group and general group. Patients after surgery were claimed to have regular return visits. Occlusion, tooth vitalities, postoperative complications would be well evaluated. The operative time, blood losses, complications showed no different at maxillary operation. Our procedure could give much better and direct sight of anterior maxillary bone, and the simplified osteotomy lines could help maxilla move, reduce the times spent on hard tissue cut off or grind. The modified procedure can meet clinical command, improve dentofacial deformities, and gives convenience to surgeon.
Effects of a Written Expression-Based Positive Psychological Intervention on the Psychological Status of Patients With Inflammatory Bowel Disease
Authors: Shang Xingchen , Gu Fangchen , Bian Qiugui , Wang Meifeng , Lin Zheng
Published: September 2021

This prospective parallel-group controlled trial explored the effects of a written expression-based positive psychological intervention on the psychological status of patients with inflammatory bowel disease. Primary outcomes were anxiety, depression, hope, optimism, and subjective well-being, assessed at 8 weeks. Secondary outcomes were coping mode, quality of life at 8 weeks, and patient feedback. Sixty-eight volunteer patients meeting inclusion criteria were recruited from a hospital in China and randomized into the intervention group (positive psychological intervention+care as usual = 33) and the control group (care as usual = 35). The intervention group showed significantly greater improvements in anxiety, depression, hope, and quality of life (p > .05). The intervention group scored the feasibility, simplicity, and applicability of the positive psychological intervention themes at more than 6.5 for all measures. The study concludes that written expression-based positive psychological interventions alleviate negative emotions in inflammatory bowel disease patients and enhance their positive psychological characteristics. This approach also promotes a positive coping mode in inflammatory bowel disease patients, and the intervention measures devised are convenient, feasible, and well-accepted by patients.
l-Menthol – a new treatment for breathlessness?
Authors: Kanezaki Masashi , Terada Kunihiko , Ebihara Satoru
Published: September 2021

Purpose of review

In patients with advanced chronic obstructive pulmonary disease (COPD), it is challenging to treat breathlessness. In addition, novel palliative interventions are required for multiple perspectives of breathlessness that may still be present after disease-specific therapies. This review provides an overview of the mechanisms and effects of l-menthol on breathlessness by covering the latest relevant papers.

Recent findings

A literature review identified one randomized controlled trial assessing the effect of l-menthol on relieving breathlessness in patients with COPD. It has been reported that the mechanism of relieving breathlessness partly involves stimulation of the trigeminal nerve by the cooling sensation of l-menthol, which gives a cognitive illusion of inspiratory flow perception. The effect of l-menthol on breathlessness caused by exertion has been reported in healthy subjects but not yet in patients with breathlessness.

The effect of l
-menthol on the sensory-emotional dimensions of laboratory-induced breathlessness in patients with COPD has been described in a clinical trial. Further studies are warranted to investigate its application to inspiratory muscle training and its effects in combination with exercise training.
Non-invasive ventilation support for people with amyotrophic lateral sclerosis: multidisciplinary team management
Authors: Barry Caroline , Larner Emma , Copsey Helen , Smith Matthew , Peryer Guy
Published: September 2021

Purpose of review

To summarise recent developments in the use of noninvasive ventilation (NIV) for people with amyotrophic lateral sclerosis (pwALS), with a specific focus on how multidisciplinary teams (MDT) can support best practice.

Recent findings

We included 13 papers, 12 with observational designs and one qualitative interview design. The review is structured using four content domains: prognosis, the effectiveness of NIV, NIV tolerance, and MDT structure and delivery. Findings suggest a modest survival benefit of NIV for pwALS. Further evidence is needed to consider the appropriate time of initiation in the context of respiratory status and the influence of NIV on cognitive function over the course of the disease. A key emerging determinant of tolerability of NIV is secretion load. Palliative care professionals within the MDT can play a key role in supporting pwALS to consider the potential benefits of NIV in the context of their preferences, prognosis, symptom burden, and ALS variant.

ALS MDTs allow timely information sharing about NIV between experts that is likely to improve outcomes. MDT practice must continually adapt to reflect pwALS's preferences for care and ensure those caring for them at home have access to support using digital innovations.
A scoping review of unmet needs of caregivers of patients with pulmonary fibrosis
Authors: Klein Sara , Logan Ayaba , Lindell Kathleen Oare
Published: September 2021

Purpose of review

Pulmonary fibrosis is an incurable lung disease that leads to significant morbidity. In many patients, pulmonary fibrosis is progressive causing debilitating dyspnea that impairs patients’ ability to perform everyday tasks and maintain independence. Informal caregivers provide invaluable support for patients with pulmonary fibrosis; however, support for the caregiver is inadequate. The purpose of this scoping review is to identify unmet needs for caregivers of pulmonary fibrosis patients.

Recent findings

During the past 18 months, there has been an increase in studies about the impact of pulmonary fibrosis on the caregiver or carer of the patient with pulmonary fibrosis. These carers experience caregiver burden which includes negative psychological and physical effects on caregiver health because of the challenge in caring for someone with pulmonary fibrosis. Caregivers describe the need for help navigating the healthcare system. This includes supportive and informational needs, lack of access to comprehensive patient-centred care, geographically accessible specialty centres and psychological support for both patient and caregiver.

Caregivers of pulmonary fibrosis patients have numerous unmet care needs that include education about the disease, symptom management, financial assistance, access to specialty centres, advanced care planning and psychological support. This resulting caregiver burden can be alleviated with comprehensive support tailored throughout the disease course.