bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Race and Sex on the Clinical Outcomes of Homeless Patients With Alcoholic Liver Disease
Authors: Lee David U. , Kwon Jean , Han John , Chang Kevin , Kolachana Sindhura , Bahadur Aneesh , Lee Ki Jung , Fan Gregory H. , Malik Raza
Published: November 2023

Background:

Among patients with alcoholic liver disease (ALD), homelessness poses significant medical and psychosocial risks; however, less is known about the effects of race and sex on the hospital outcomes of admitted homeless patients with ALD.

Methods:

The National Inpatient Sample database from 2012 to 2017 was used to isolate homeless patients with ALD, and the cohort was further stratified by race and sex for comparisons. Propensity score matching was utilized to minimize covariate confounding. The primary endpoints of this study include mortality, hospital length of stay, and hospital costs; secondary endpoints included the incidence of liver complications.

Results:

There were 3972 females/males postmatch, as well as 2224 Blacks/Whites and 4575 Hispanics/Whites postmatch. In multivariate, there were no significant differences observed in mortality rate, length of stay, and costs between sexes. Comparing liver outcomes, females had a higher incidence of hepatic encephalopathy [adjusted odds ratio (aOR) 1.02, 95% CI: 1.01-1.04, P<0.001]. In comparing Blacks versus Whites, Black patients had higher hospitalization costs (aOR 1.13, 95% CI: 1.03-1.24, P=0.01); however, there were no significant differences in mortality, length of stay, or liver complications. In comparing Hispanics versus Whites, Hispanic patients had longer length of hospital stay (aOR 1.12, 95% CI: 1.06-1.19, P<0.001), greater costs (aOR 1.15, 95% CI: 1.09-1.22, P<0.001), as well as higher prevalence of liver complications including varices (aOR 1.04, 95% CI: 1.02-1.06, P<0.001), hepatic encephalopathy (aOR 1.03, 95% CI: 1.02-1.04, P<0.001), and hepatorenal syndrome (aOR 1.01, 95% CI 1.00-1.01, P=0.03). However, there was no difference in mortality between White and Hispanic patients.

Conclusions:

Black and Hispanic ALD patients experiencing homelessness were found to incur higher hospital charges; furthermore, Hispanic patients also had greater length of stay and higher incidence of liver-related complications compared with White counterparts.
Trends and Variations in Pancreatic Cancer Mortality Among US Metro and Nonmetro Adults, 1999-2020
Authors: Ma Samuel , Sokale Itunu O. , Thrift Aaron P.
Published: November 2023

Background:

Pancreatic cancer is the third leading cause of cancer deaths in the United States. Despite decreasing cancer mortality rates as a whole, pancreatic cancer death rates in the United States remain steady and demonstrate racial/ethnic disparities. Divergent cancer mortality trends have also been observed between metro and nonmetro populations. We therefore aimed to compare metro and nonmetro trends in pancreatic cancer mortality rates in the United States from 1999 to 2020 and investigate potential sex and racial/ethnic differences.

Methods:

We analyzed National Center for Health Statistics data for all pancreatic cancer deaths among individuals aged 25 years or older in the United States. We estimated the average annual percent change (AAPC) in age-standardized pancreatic cancer mortality rates in metro versus nonmetro areas by sex and race/ethnicity.

Results:

Of the total 810,425 pancreatic cancer–related deaths identified from 1999 to 2020, 668,547 occurred in metro areas and 141,878 in nonmetro areas. Non-Hispanic Black individuals had the highest rates of pancreatic cancer mortality regardless of metropolitan status. In both metro and nonmetro areas, pancreatic cancer mortality rates among non-Hispanic White individuals increased over the study period (AAPC: metro, males, 0.32%; females, 0.27%; nonmetro, males, 0.77%; females, 0.62%). Non-Hispanic Black individuals in metro areas had a decrease in pancreatic cancer mortality (AAPC: males, −0.25%; females, −0.29%), but rates among non-Hispanic Black women in nonmetro areas increased (AAPC, 0.49%).

Conclusions:

There are variations not only in pancreatic cancer mortality by metro and nonmetro status but also by sex and race/ethnicity within these areas. Individuals who live in nonmetro areas have higher pancreatic cancer mortality rates and increasing death rates compared with their metro counterparts. These findings highlight the need for targeted cancer prevention strategies that are specific to metro or nonmetro populations.
Endoscopic Glue Injection Versus Endoscopic Human Thrombin Injection for Bleeding Gastric Varices—A Randomized Controlled Trial
Authors: Jhajharia Ashok , Ashdhir Prachis , Dhaked Gireesh , Sharma Hitesh
Published: November 2023

Background:

Acute gastric variceal bleeding (AGVB) is a potentially fatal consequence of portal hypertension, accounting for 10% to 30% of all variceal bleeding. Although endoscopic cyanoacrylate glue injection is a common treatment for acute hemostasis, it has been linked to significant side effects. In the treatment of AGVB, there is limited evidence of the efficacy and relative safety of endoscopic human thrombin injection over glue injection.

Materials and Methods:

A total of 52 AGVB patients were randomized to receive either thrombin injection (25 patients) or glue injection (27 patients). The primary outcome was the incidence of any glue or thrombin injection-related post-therapy complications. Initial hemostasis, rebleeding, and mortality were all secondary end goals.

Results:

Both groups had comparable baseline data. Hemostasis of active bleeding at endoscopy was 100.0% (10/10) in the thrombin group and 87.5% (7/8) in the glue group (P=0.44). Treatment failure after 5 days occurred in 2 patients (6.1%) in the glue group compared with none in the thrombin group (P=0.165). Between 6 and 42 days after index bleeding, rebleeding occurred in 4 patients in the thrombin group compared with 6 patients in the glue group (P=0.728). In the thrombin group, none of the patients had post-treatment ulcers on gastric varices compared with 14.81% (4/27) that occurred in the glue group (P=0.045), a statistically significant observation. Overall, complications occurred in 4 (20%) and 11 (40.7%) patients in the thrombin and glue groups, respectively (P=0.105). Two patients in the glue group died.

Conclusion:

To achieve successful AGVB hemostasis, endoscopic thrombin injection has been proven efficacious. However, glue injection may be linked to a higher rate of rebleeding and post-therapy gastric variceal ulceration compared with thrombin.
Tislelizumab with gemcitabine and cisplatin as a neoadjuvant regimen for muscle-invasive bladder cancer: case series
Authors: Wang Ze , Wang Yapeng , Wang Shuo , Ran Qiang , Peng Song , Zhang Yao , Zhang Jun , Zhang Dianzheng , Wang Luofu , Lan Weihua , Liu Qiuli , Jiang Jun
Published: November 2023

Introduction and importance:

The feasibility of combined tislelizumab with gemcitabine and cisplatin as a neoadjuvant regimen for muscle-invasive bladder cancer (MIBC) remains to be investigated.

Case presentation:

The neoadjuvant treatment not only shrunk tumours significantly but also lowered their stages from T4bN1M0, T3N0M0, and T3bN0M0 to pT1, pT0 and pTis, respectively. The treatment suppressed tumour cell proliferation and promoted luminal-to-basal transition.

Clinical discussion:

MIBC is an aggressive bladder cancer with poor prognosis. All three patients with MIBC benefited greatly from the neoadjuvant regimen (tislelizumab + gemcitabine + cisplatin). It appears that the effect of the treatment is independent of the levels of programmed death-ligand 1 nor the subtype of urothelial bladder cancer.

Conclusion:

Combination of tislelizumab with gemcitabine and cisplatin appeared to be a safe and efficacious neoadjuvant therapy for MIBC.
Unraveling the leptospirosis epidemic: tales from the Philippine outbreak – a short communication
Authors: Nazir Abubakar , Oduoye Malik Olatunde , Nazir Awais , Uzoamaka Chukwudile B. , Ali Muzammil Muhammad , Sakr Salma Mohsen , Scott Godfred Y. , Khan suheb Mahammed
Published: November 2023

Leptospirosis, also known as Weil’s disease, is an emerging zoonotic infection that occurs worldwide but is particularly common in the tropics. There has been an increasing trend of leptospirosis in the Philippines since the outbreak occurred in 2020. The number of reported cases was 182 in 2020, 1661 in 2021, and 2794 in 2022. This present article aimed to access previously published studies on the prevalence, implications, and efforts to combat leptospirosis worldwide, with a particular focus on the Philippines from 2001 to 2023. In writing this article, we conducted a thorough search of databases such as PubMed, Researchgate, Web of Science, Scopus, and Google Scholar within 20 years. This present article found that more than 810 cases were reported from 1 January to 4 March 2023. The Cagayan Valley Region has 103 cases, the Zamboanga Peninsula has 77 cases, and the Western Visayas Region has 176 cases, making them the worst-hit areas. The increase in leptospirosis cases in the Philippines is primarily attributed to several factors. Firstly, the country is prone to natural disasters such as typhoons, floods, and landslides, which increase the risk of water sources and the environment being contaminated with Leptospira bacteria. To address the menace of leptospirosis in the Philippines, we urge the Philippine government to focus on improving healthcare infrastructure, providing swift, reliable, and effective treatments, implementing safety regulations, supplying personal protective equipment to medical authorities, and taking strict actions to improve water sanitation.
Bowel Management Protocol
Authors: Shanholtz Gayle , Vergara Franz Henryk , Amba Katheryne Tifuh , Ramos Mary Dioise
Published: November 2023

Purpose of Study:

The project aimed to determine the impact of a standardized bowel regimen protocol for patients receiving opioids on the rate of stool softener prescription, occurrence of bowel movements of oncology patients, and improving the length of stay (LOS).

Primary Practice of Setting:

Oncology unit in a community hospital.

Methodology and Sample:

A posttest design was utilized, and a prospective medical record review of patients was completed after 8 weeks of the pilot study. The study sample (N = 164) included oncology patients admitted to a community hospital in the Southeast. The χ2 test was used to determine the impact of implementing a bowel panel order on the rate of stool softener prescriptions, the occurrence of bowel movements, and the LOS.

Results:

Only 43% (n = 40) of the patients from the comparison group were ordered laxatives, and more patients from the intervention group (68%; n = 49) received the bowel regimen protocol, whereas 26% (n = 19) of the patients used a laxative or stool softener using providers' preference and demonstrated statistical significance (p = .001). In the intervention group, 93% of the patients (n = 67) reported having bowel movements compared with the comparison group, whereas only 32% (n = 32) demonstrated statistical significance (p = .001). The average LOS in the intervention group is less than 9 days compared with the comparison group, which was at 9 days (p = .001).

Implications to Case Management Practice:

Case managers play a critical role in coordinating care, improving transitions of care, and reducing LOS. Case managers can have a significant impact by monitoring and reminding nurses to report the gastrointestinal movements of oncology patients and then escalate opioid-induced constipation with the providers immediately. Case managers can facilitate the implementation of bowel regimen protocols, which may reduce hospitalizations and enhance patient outcomes, by taking this action.
Experiences of Ambulatory Patients With Huntington's Disease With Case Management
Authors: Kruijthof Cindy , de Boer Marike E. , van Loon Anouk M. , Bredewold Jonieke , van Dusseldorp Loes
Published: November 2023

Purpose/Objectives:

Huntington's disease (HD) requires high-quality care to reduce disruption of the patient system, prevent crisis situations, and prevent early admission in a nursing home. In the Netherlands, case management has been available for the last to 9 years for people with HD. However, there is a notable gap in understanding experiences and beliefs of HD patients regarding case managers' care, guidance, and support for quality of life. To improve the international quality of care for people with HD, insight in experiences of ambulatory HD patients with the care, guidance, and support received from a case manager HD (CMHD) is crucial.

Primary Practice Setting:

Ambulatory care.

Findings/Conclusions:

Ambulatory patients with HD highly appreciate and value the role and support of the CMHD. This was reflected in four themes: (1) the CMHD as a person, with commitment, sympathy, and reliability as central concepts; (2) the CMHD as a professional, with the key roles of coordinator, point of contact, expert, and supporter; (3) impact of the CMHD on quality of life, with support of coping with decline and monitoring the home situation as important subthemes; and (4) support of the CMHD for family members, with providing help and giving attention as subthemes. This insight into patients' experiences of the CMHD's role adds value to the improvement of the international quality of care for people with HD.

Implications for Case Management Practice:

Commitment, expertise, support for both family members and patients, and bond of trust from the CMHD are experienced as very valuable. These qualitative findings from a patient's perspective add significantly to the body of knowledge on CMHD's role and practices as “spider at the center of the web.”
Healing the Heart of Healthcare
Authors: Hand Loren , Probst Nicole , Griffis Leigh
Published: November 2023

Healthcare workers continue to work without fully processing the stress of the pandemic on their overall health. Outcomes of stress include workplace burnout, low morale, and an increase in suicide rates. At Huntington Hospital, a need was identified to give caregivers an opportunity to grieve and process their experiences. Healing the Heart of Healthcare was a formal intervention that provided acknowledgment of trauma and reinstated a sense of hope to the profession. The activities in this program may be duplicated in other celebrations such as Nurses Day recognition.
Pulmonary Low Malignant Potential Adenocarcinoma
Authors: Pittaro Alessandra , Crivelli Filippo , Orlando Giulia , Napoli Francesca , Zambelli Vanessa , Guerrera Francesco , Sobrero Simona , Volante Marco , Righi Luisella , Papotti Mauro
Published: November 2023

Adenocarcinoma (ADC) is the most common histologic type of lung cancer, including in situ (lepidic), minimally invasive, and invasive forms. While the former 2 types are associated with a favorable outcome, the latter includes tumors with variable behavior, often tumor stage–related. A recent study proposed strict morphologic criteria defining a new subgroup of resected stage I invasive ADC (16% of cases) with favorable outcomes (100% disease-specific survival), named “ADC of low malignant potential (LMP-ADC).” The following criteria were met: ≤3 cm size, nonmucinous histotype, ≥15% lepidic growth, and the absence of the following: high-grade patterns, >1 mitosis/2 mm2, necrosis, and vascular/pleural invasion. The aim of the present study was to validate the performance of such criteria to identify LMP-ADC in a series of 274 stage IA resected lung ADCs from a single institution. Thirty-four tumors (12.4%) met the proposed criteria for LMP-ADC, as confirmed by additional stains for mitotic figures, Ki67 index, and elastic fibers (helpful to assess alveolar wall invasion). Minor differences between the lepidic and invasive components were observed regarding cell atypia and proliferation. p53 was normally expressed by invasive tumor cells. Mutations occurred in known lung cancer genes (mostly KRAS and EGFR). Five patients (14.7%) developed disease progression and 2 of them (5.9%) died of the disease. In our series, the disease-specific survival was 94.1%. In conclusion, in resected invasive lung ADC, a subgroup presenting low-grade morphologic features and associated with favorable prognosis does exist. Morphologic criteria for LMP-ADC supported by ancillary techniques represent a valid tool to better define this novel subgroup and to refine the stratification of invasive lung ADC, possibly suggesting modified follow-up protocols, based on the observed indolent behavior in most cases.
Extranodal NK/T-Cell Lymphoma Predominantly Composed of Anaplastic Cells
Authors: Zhong Yujia , Xie Jianlan , Chen Jierong , Ping Liqin , Zang Shengbing , Zhang Yingchun , Feng Yanfen , Huang Yuhua
Published: November 2023

Extranodal NK/T-cell lymphoma (ENKTL) is a non-Hodgkin lymphoma associated with the Epstein-Barr virus that primarily affects individuals in East Asia and indigenous populations in Central and South America. Morphologically, ENKTL typically consists of medium-sized cells or a combination of small and large cells. This report presents 10 cases characterized by predominantly anaplastic cells with diffuse expression of CD30, resembling anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (ALK-negative ALCL) and demonstrating highly aggressive behavior. The cohort included 9 males and 1 female, ranging in age from 29 to 65 years (median age: 47 y). Eight patients presented with nasal disease, while 2 had non-nasal disease. Five patients had stage I/II disease, and the remaining 5 had stage III/IV disease. Morphologically, necrosis was observed in 9 cases, angiocentric-angiodestructive growth in 3 cases, and pseudoepitheliomatous hyperplasia in 2 cases. Anaplastic cells predominated in all cases, with some displaying eccentric, horseshoe-shaped, or kidney-shaped nuclei (referred to as “Hallmark” cells). The morphology profile was monomorphic in 3 cases and polymorphic in 7 cases. Immunohistochemically, all cases tested positive for cytotoxic granule markers (TIA1 and granzymeB) and Epstein-Barr virus-encoded RNA. Cytoplasmic expression of CD3ε and CD56 was observed in 9 of 10 cases. Interestingly, most cases (7 of 8) exhibited variable expression of MuM1, ranging from 10% to 90%. All cases showed diffuse positivity for CD30 but were negative for ALK, resulting in 3 cases being initially misdiagnosed as ALK-negative ALCL. Compared with nonanaplastic cases, anaplastic cells predominant ENKTL had a significantly higher frequency of “B” symptoms, bone marrow involvement, hemophagocytic lymphohistiocytosis, and higher Ki67 proliferative index. These findings provide valuable information for pathologists, expanding their understanding of the cytologic spectrum of ENKTL. This rare variant of ENKTL, characterized by the predominance of anaplastic cells and diffuse CD30 expression, exhibits high aggressiveness and should be differentiated from ALK-negative ALCL. Awareness of this uncommon variant is crucial in preventing misdiagnosis and ensuring the timely initiation of therapy.
Frontalis Suspension through Infrabrow Skin Excision for Blepharoptosis in Asian Patients
Authors: Tomioka Yoko , Okazaki Mutsumi , Matsutani Hitomi
Published: November 2023

Frontalis suspension is the preferred approach for blepharoptosis with compromised levator function. Various studies have explored the use of different materials or material shapes for performing this procedure; however, a limited number discuss the specifics of skin incisions. Given that blepharoplasty demands not only functional but also aesthetic results, the authors applied an infrabrow incision, a technique commonly used in cosmetic surgery. This study, the first report involving a series of blepharoptosis cases treated using this technique, explores its viability as a promising alternative to traditional frontalis suspension. This technique was used in 7 consecutive patients exhibiting poor levator function who were treated at the University of Tokyo between September of 2019 and February of 2022. A retrospective analysis was conducted on clinical photographs and charts. In 1 representative case, visual field angle and frontal muscle tone were also measured. The average duration of postoperative follow-up was 9 months. In all cases, the frontalis muscle was adequately exposed to allow suspension through the infrabrow approach. Significant improvements were observed in the marginal reflex distances without effort from −1.9 to 2.1 mm (P = 0.0027) and marginal reflex distances with effort from 0.0 to 5.4 mm (P < 0.0001). Complications included a hematoma (n = 1), eyelash entropion (n = 1), transient sensory loss of the forehead (n = 1), and transient dry eye (n = 3). The infrabrow incision is a good alternative for frontalis suspension owing to its capacity to offer a broad surgical field, provide effective access to the frontalis muscle, and facilitate excess skin excisions without resulting in conspicuous scarring.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Treatment Effects on Psychophysiological Stress Responses in Youth With Obesity
Authors: Van Royen Annelies , Verbiest Ine , Goemaere Heleen , Debeuf Taaike , Michels Nathalie , Verbeken Sandra , Braet Caroline
Published: November 2023

Objective

Stress plays a central role in obesity development, but research on treatment options to tackle elevated stress levels in youth with obesity is scarce. The present study examined the impact of the Multidisciplinary Obesity Treatment (MOT; lifestyle intervention including physical exercise, healthy meals, and cognitive behavioral techniques) on physiological stress parameters in youth with obesity and assessed whether adding emotion regulation (ER) training on top of MOT is beneficial.

Methods

From an inpatient treatment center for obesity, 92 youngsters (mean [standard deviation] age = 12.50 [1.66] years, 43.5% boys) were randomly assigned to a control group (MOT) or experimental group (MOT + ER training). Before (T1) and after 12 weeks of treatment (T2), high-frequency heart rate variability (HF-HRV) and heart rate were measured at rest and during a stress induction (= psychophysiological reactivity).

Results

At T2, after MOT only, participants displayed a lower resting heart rate (M
T2/T1 = 74.7/78.6) and a reduced stress response (i.e., less decrease in HF-HRV [M
T2/T1 = −0.06/−0.01] and less increase in heart rate [M
T2/T1 = 0.03/0.06] after the stress induction). No further improvements were revealed after adding ER training. However, when considering the weight changes, the significant results in resting heart rate and HF-HRV and heart rate reactivity decreased in the control group, and additional improvements in psychophysiological parameters were discovered in the experimental group.

Conclusions

The results suggest that MOT may effectively reduce physiological stress responses and also provide preliminary evidence for a potential additional effect of ER training. Further research in a larger sample with extended follow-up measurements is needed.
The Role of Artificial Intelligence in Coronary Calcium Scoring in Standard Cardiac Computed Tomography and Chest Computed Tomography With Different Reconstruction Kernels
Authors: Lin Yenpo , Lin Gigin , Peng Meng-Ting , Kuo Chi-Tai , Wan Yung-Liang , Cherng Wen-Jin
Published: November 2023

Purpose:

To assess the correlation of coronary calcium score (CS) obtained by artificial intelligence (AI) with those obtained by electrocardiography gated standard cardiac computed tomography (CCT) and nongated chest computed tomography (ChCT) with different reconstruction kernels.

Patients and Methods:

Seventy-six patients received standard CCT and ChCT simultaneously. We compared CS obtained in 4 groups: CSCCT, by the traditional method from standard CCT, 25 cm field of view, 3 mm slice thickness, and kernel filter convolution 12 (FC12); CSAICCT, by AI from the standard CCT; CSChCTsoft, by AI from the non-gated CCT, 40 cm field of view, 3 mm slice thickness, and a soft kernel FC02; and CSChCTsharp, by AI from CCT image with same parameters for CSChCTsoft except for using a sharp kernel FC56. Statistical analyses included Spearman rank correlation coefficient (ρ), intraclass correlation (ICC), Bland–Altman plots, and weighted kappa analysis (κ).

Results:

The CSAICCT was consistent with CSCCT (ρ = 0.994 and ICC of 1.00, P < 0.001) with excellent agreement with respect to cardiovascular (CV) risk categories of the Agatston score (κ = 1.000). The correlation between CSChCTsoft and CSChCTsharp was good (ρ = 0.912, 0.963 and ICC = 0.929, 0.948, respectively, P < 0.001) with a tendency of underestimation (Bland–Altman mean difference and 95% upper and lower limits of agreements were 329.1 [–798.9 to 1457] and 335.3 [–651.9 to 1322], respectively). The CV risk category agreement between CSChCTsoft and CSChCTsharp was moderate (κ = 0.556 and 0.537, respectively).

Conclusions:

There was an excellent correlation between CSCCT and CSAICCT, with excellent agreement between CV risk categories. There was also a good correlation between CSCCT and CS obtained by ChCT albeit with a tendency for underestimation and moderate accuracy in terms of CV risk assessment.
Identification of Mitral Valve Prolapse on Non–electrocardiography-gated Enhanced Chest Computed Tomography
Authors: Son Min Ji , Chun Eun Ju , Yoo Seung Min , Lee Soo Jeong , White Charles S.
Published: November 2023

Purpose:

The primary imaging modality for the diagnosis of mitral valve prolapse (MVP) is echocardiography supplemented by electrocardiography (ECG)-gated cardiac computed tomography (CT) angiography. However, we have recently encountered patients with MVP who were initially identified on non–ECG-gated enhanced chest CT. The purpose of this study is to evaluate the diagnostic accuracy of non–ECG-gated enhanced chest CT to predict the presence of MVP.

Patients and Methods:

Of 92 patients (surgically confirmed MVP who underwent non–ECG-gated chest CT), 27 patients were excluded for motion artifact or insufficient surgical correlation, and 65 patients were ultimately included. As a control, 65 patients with dyspnea and without MVP (non–ECG-gated chest CT and echocardiography were performed within 1 month) were randomly selected. We retrospectively analyzed an asymmetric double line sign on axial CT images for the presence of MVP. The asymmetric double line sign was defined as the presence of a linear structure, not located in the plane traversing the mitral annulus.

Results:

Use of the asymmetric double line sign to predict MVP on non–ECG-gated CT showed modest sensitivity, high specificity, modest negative predictive value, and high positive predictive value of 59% (38/65), 99% (64/65), 70% (64/91), and 97% (38/39), respectively.

Conclusion:

The asymmetric double line sign on non–ECG-gated enhanced chest CT may be a valuable finding to predict the presence of MVP. Familiarity with this CT finding may lead to prompt diagnosis and proper management of MVP.
Cutaneous Layer and SMAS Suspension (CaSS) Lift as a Minimally Invasive Lateral Midface Lift
Authors: Byun Jin Suk , Kim Kenneth K.
Published: November 2023

Background:

In our prior study, the authors determined that pulling on the superficial adipose layer is more effective in lifting the skin than pulling on the superficial musculoaponeurotic system (SMAS). Applying this concept of using the superficial adipose layer to transmit the lifting force to the skin, this study examined improvements in patients who underwent lateral midface lifting using our minimally invasive multilayer lifting technique and measured the duration of those improvements.

Methods:

Along the hairline in front of the sideburns, a W-shaped zigzag incision of 3 to 8 mm in width and 3 to 4 cm in length was made. On the temporal scalp, 3 to 4 cm away from the first incision, a second incision was made more lateral/posterior to the first incision, and an elliptical excision of 3 to 5 mm in width and 3 to 4 cm in length was made. From the medial cut margin of the anterior first incision, the superficial temporal fascia/SMAS (the deep layer), and the superficial adipose layer (the superficial layer) were purchased with 3-0 polyester sutures, tunneled under the soft tissue, and fixed to the deep temporal fascia of the second posterior temporal incision. Prior to the excised temporal scalp closure, the dermis in the medial cut margin of the second incision was pulled to the rear as much as possible and fixed to the deep temporal fascia.

Results:

The effects of surgery were monitored for 6 to 42 months after surgery. The nasolabial folds were improved. Skin elasticity also showed significant improvements, which lasted throughout the follow-up period (up to 42 mo).

Conclusions:

Unlike traditional wide dissection SMAS facelift, our method requires minimal incisions and does not require skin undermining. Therefore, the operating time is shorter, and postoperative swelling is minimized. In our technique, the superficial adipose layer, the superficial temporal fascia/SMAS, and the dermis were pulled individually to lift all layers of the lateral midface soft tissues. This results in a significant and long-lasting lateral midface rejuvenation.
The Effect of Presurgical Nasoalveolar Molding on Oronasal Fistula Following Primary Palatoplasty
Authors: Siriwiroj Singto , Pisek Poonsak , Punyavong Pattama , Jenwitheesuk Kamonwan , Surakunprapha Palakorn , Winaikosol Kengkart
Published: November 2023

Objective:

Presurgical nasoalveolar molding (PNAM) is widely used in cleft care protocol. This study investigated the correlation between PNAM and oronasal fistula after primary palatoplasty.

Methods:

A case-controlled study of 80 unilateral and bilateral complete cleft palate patients who underwent cleft palate repair were enrolled. Patients were divided into 2 groups: (1) no PNAM use and (2) PNAM use. The incidence of oronasal fistula and postoperative complications were compared between groups.

Results:

Forty patients in each group demonstrated the same baseline characteristics. The PNAM group showed a significantly lower postoperative oronasal fistula rate (15% versus 50%, P=0.003). Palatal cleft width wider than 12.5 mm increases the odds ratio of fistula formation by 1.19-fold (P=0.037), and the PNAM protected against postoperative palatal fistula formation (odds ratio 0.20, P=0.003).

Conclusion:

Presurgical nasoalveolar molding can reduce postoperative oronasal fistula in wide-gap Veau type III and IV cleft palate.
Treatment of Severely Atrophic Maxilla by Using Zygomatic, Pterygoid, and Transnasal Implants
Authors: Şahin Onur
Published: November 2023

For many decades the success of dental implants has been considered to be dependent predominantly on the quality and quantity of the patient’s alveolar bone. Grafting procedures have been commonly used to rehabilitate severely atrophic jaws but these procedures have disadvantages such as long treatment duration, major surgery, the risk of morbidity in the donor area, and high treatment costs. Recently, the use of 4 zygomatic implants has become an important treatment option in the rehabilitation of extremely atrophic maxilla. The quad zygoma technique is a method applied in cases where conventional implants cannot be used in the anterior maxilla. However, the technique has some difficulties and requires surgical experience. An alternative to the use of quad zygomatic implants is the placement of transnasal with zygomatic implants and subperiosteal implants. The aim of this case report was to present the treatment of a patient with severely atrophic maxilla with zygomatic, pterygoid, and transnasal implants.
YiQiFuMai Injection Ameliorated Sepsis-induced Cardiomyopathy by Inhibition of Ferroptosis via xCT/GPX4 Axis
Authors: Guo Liying , Li Peng , Wang Yuming , Wang Jing , Lei Jinyan , Zhao Jie , Wu Xiliang , He Wenju , Jia Jianwei , Miao Jing , Wang Dongqiang , Cui Huantian
Published: November 2023

Sepsis-induced cardiomyopathy (SIC) is a distinct form of myocardial injury that disrupts tissue perfusion and stands as the significant cause of mortality among sepsis patients. Currently, effective preventive or treatment strategies for SIC are lacking. YiQiFuMai injection (YQFM), composed of Panax ginseng C.A. Mey., Ophiopogon japonicus (Thunb.) Ker Gawl., and Schisandra chinensis (Turcz.) Baill., is widely used in China to treat cardiovascular diseases, such as coronary heart disease, heart failure and SIC. Research has shown that YQFM can improve cardiac function and alleviate heart failure through multiple pathways. Nevertheless, the mechanisms through which YQFM exerts its effects on SIC remain to be fully elucidated. In this study, we firstly investigated the therapeutic effects of YQFM on a SIC rat model and explored its effects on myocardial ferroptosis in vivo. Then, LPS-induced myocardial cell death model was used to evaluate the effects of YQFM on ferroptosis and xCT/GPX4 axis in vitro. Furthermore, using GPX4 inhibitors, we aimed to verify whether YQFM improved cardiomyocyte ferroptosis through the xCT/GPX4 axis. The results showed that YQFM was effective in alleviating myocardial injury in septic model rats. Besides, the concentrations of iron and the levels of lipid peroxidation-related factors (ROS, MDA and 4-HNE) were significantly decreased and the expression of xCT/GPX4 axis was up-regulated in SIC rats after YQFM treatment. In vitro studies also showed that YQFM alleviated iron overload and lipid peroxidation and activated xCT/GPX4 axis in LPS-induced myocardial cell death model. Moreover, GPX4 inhibitor could abolish the effects above. In summary, the study highlights the regulatory effect of YQFM in mitigating myocardial injury. It probably achieves this ameliorative effect by enhancing xCT/GPX4 axis and further reducing ferroptosis.
Residential Redlining, Neighborhood Trajectory, and Equity of Breast and Colorectal Cancer Care
Authors: Loehrer Andrew P. , Weiss Julie E. , Chatoorgoon Kaveer K. , Bello Oluwaferanmi T. , Diaz Adrian , Carter Benjamin , Akré Ellesse-Roselee , Hasson Rian M. , Carlos Heather A.
Published: November 2023

Objective:

This study aimed to determine the influence of structural racism, vis-à-vis neighborhood socioeconomic trajectory, on colorectal and breast cancer diagnosis and treatment.

Summary Background Data:

Inequities in cancer care are well documented in the United States but less is understood about how historical policies like residential redlining and evolving neighborhood characteristics influence current gaps in care.

Methods:

This retrospective cohort study included adult patients diagnosed with colorectal or breast cancer between 2010 and 2015 in 7 Indiana cities with available historic redlining data. Current neighborhood socioeconomic status was determined by the Area Deprivation Index (ADI). Based on historic redlining maps and current ADI, we created four “Neighborhood Trajectory” categories: Advantage Stable, Advantage Reduced, Disadvantage Stable, Disadvantage Reduced. Modified Poisson regression models estimated the relative risks (RR) of Neighborhood Trajectory on cancer stage at diagnosis and receipt of cancer-directed surgery (CDS).

Results:

A final cohort derivation identified 4,862 cancer patients with colorectal or breast cancer. Compared to Advantage Stable neighborhoods, Disadvantage Stable neighborhood was associated with late-stage diagnosis for both colorectal and breast cancer (RR=1.30 [95% CI=1.05 – 1.59]; RR=1.41 [1.09 – 1.83], respectively). Black patients had lower likelihood of receiving CDS in Disadvantage Reduced neighborhoods (RR=0.92 [0.86 – 0.99]) than White patients.

Conclusions:

Disadvantage Stable neighborhoods were associated with late-stage diagnosis for breast and colorectal cancer. Disadvantage Reduced (gentrified) neighborhoods were associated with racial-inequity in CDS. Improved neighborhood socioeconomic conditions may improve timely diagnosis but could contribute to racial inequities in surgical treatment.
Early career acute care surgeons' priorities and perspectives: A mixed-methods analysis to better understand full-time employment
Authors: Murphy Patrick B. , Coleman Jamie , Maring Morgan , Pokrzywa Courtney , Deshpande David , Al Tannir Abdul Hafiz , Biesboer Elise A. , Morris Rachel S. , Figueroa Juan , de Moya Marc
Published: November 2023

BACKGROUND

Understanding the expectations of early career acute care surgeons will help clarify the practice and employment models that will attract and retain high-quality surgeons, thereby sustaining our workforce. This study aimed to outline the clinical and academic preferences and priorities of early career acute care surgeons and to better define full-time employment.

METHODS

A survey on clinical responsibilities, employment preferences, work priorities, and compensation was distributed to early career acute care surgeons in the first 5 years of practice. A subset of agreeable respondents underwent virtual semistructured interviews. Both quantitative and thematic analysis were used to describe current responsibilities, expectations, and perspectives.

RESULTS

Of 471 surgeons, 167 responded (35%), the majority of whom were assistant professors within the first 3 years of practice (80%). The median desired clinical volume was 24 clinical weeks and 48 call shifts per year, 4 weeks less than their median current clinical volume. Most respondents (61%) preferred a service-based model. The top priorities cited in choosing a job were geography, work schedule, and compensation. Qualitative interviews identified themes related to defining full-time employment, first job expectations and realities, and the often-misaligned system and surgeon.

CONCLUSION

Understanding the perspectives of early career surgeons entering the workforce is important particularly in the field of acute care surgery where no standard workload or practice model exists. The wide variety of expectations, practice models, and schedule preferences may lead to a mismatch between surgeon desires and employment expectation. Consistent employment standards across our specialty would provide a framework for sustainability.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
Evaluating the impact of timing to rib fixation in patients with traumatic brain injury: A nationwide analysis
Authors: Lagazzi Emanuele , Argandykov Dias , de Roulet Amory , Proaño-Zamudio Jefferson A. , Romijn Anne-Sophie C. , Abiad May , Rafaqat Wardah , Velmahos George C. , Hwabejire John O. , Paranjape Charudutt N.
Published: November 2023

BACKGROUND

Early surgical stabilization of rib fractures (SSRF) is associated with improved inpatient outcomes in patients with multiple rib fractures. However, there is still a paucity of data examining the optimal timing of SSRF in patients with concomitant traumatic brain injury (TBI). This study aimed to assess whether earlier SSRF was associated with improved outcomes in patients with multiple rib fractures and TBI.

METHODS

We performed a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program 2017–2020, including adult patients with TBI and multiple rib fractures who had undergone SSRF. The outcomes were post-procedural length of stay (LOS), hospital LOS, intensive care unit (ICU) LOS, in-hospital mortality, ventilator days, and tracheostomy rate. Multilevel mixed-effects regression analyses accounting for patient, injury, and hospital characteristics as well as institutional SSRF volume were used to assess the association between timing to SSRF and the outcomes of interest. As a sensitivity analysis, propensity-score matching was performed to compare patients who underwent early (<72 hours) versus late SSRF (≥72 hours).

RESULTS

Of 1,041 patients included in this analysis, 430 (41.3%) underwent SSRF within the first 72 hours from admission. Delay to SSRF was associated with an increase in post-procedural LOS (partial regression coefficient (β) = 0.011; p = 0.036; 95% confidence interval [CI], 0.001–0.023), longer hospital LOS (β = 0.053; p < 0.001; 95% CI, 0.042–0.064), prolonged ICU LOS (β = 0.032; p < 0.001; 95% CI, 0.025–0.038), and more ventilator days (β = 0.026, p < 0.001; 95% CI, 0.020–0.032).

CONCLUSION

In patients with concurrent multiple rib fractures and TBI, a delay in SSRF is associated with an increase in postprocedural LOS, hospital LOS, ICU LOS, and ventilator days. These findings suggest that the early patient selection and implementation of SSRF may play a beneficial role in patients presenting with concomitant TBI and multiple rib fractures.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Common postbariatric surgery emergencies for the acute care surgeon: What you need to know
Authors: Cheng Vincent , Samakar Kamran , Dobrowolsky Adrian B. , Nguyen James D. , Abel Stuart A. , Pakula Andrea , Bernard Andrew , Martin Matthew J.
Published: November 2023

The field of bariatric and metabolic surgery has changed rapidly over the past two decades, with an exponential increase in case volumes being performed because of its proven efficacy for morbid obesity and obesity-related comorbidities. Although this increased volume of procedures has been accompanied by significant decrease in postoperative complication rates, there are numerous potential complications after bariatric surgery that may require urgent or emergent surgical evaluation or interventions. Many of these risks extend well beyond the early postoperative period and can present months to years after the index procedure. Acute care surgeons are increasingly covering most or all of the emergency general surgery services at many centers and must be familiar with the numerous bariatric surgical procedures being performed and their individual complication profile to provide optimal care for these frequently challenging patients. This article provides a focused and concise review of the common bariatric procedures being performed, their early and late complication profiles, and a practical guide to the optimal diagnostic evaluations, surgical interventions, and perioperative management options. The author group includes both acute care surgeons and bariatric surgeons with significant experience in the emergency management of the complicated postbariatric surgical patient.

LEVEL OF EVIDENCE

Literature Synthesis and Expert Opinion; Level V.
Amide proton transfer imaging in rats after heatstroke
Authors: Han Mingxing , Li Qinglong , Yang Ting , Li Jun
Published: November 2023

Metabolic acidosis is the most common acid-base change following heatstroke. This study aimed to evaluate the internal environment changes caused by heatstroke using amide proton transfer (APT) imaging. Nineteen male Sprague–Dawley rats were randomly divided into the control group (CTRL, n = 7) and the heatstroke group (HS, n = 12). All the rats underwent a 7.0-T MRI, which included T2-weighted imaging (T2WI) and APT imaging. Subsequently, the surviving HS group rats repeated the same magnetic resonance scanning after 25 days and were designated as the follow-up group (FU, n = 7). APT values were measured in the hippocampus, thalamus, and corpus callosum. The APT values of the three groups were statistically analyzed and found in the hippocampus (CTRL vs. HS, P = 0.011; CTRL vs. FU, P = 0.078; HS vs. FU, P = 0.484; η² = 0.276), left thalamus (CTRL vs. HS, P = 0.004; CTRL vs. FU, P = 0.014; HS vs. FU, P = 0.822; η² = 0.331), right thalamus (CTRL vs. HS, P = 0.003; CTRL vs. FU, P = 0.015; HS vs. FU P = 0.769; η² = 0.336), and corpus callosum (CTRL vs. HS, P < 0.001; CTRL vs. FU, P = 0.005; HS vs. FU, P = 0.523; η² = 0.437). APT imaging can be a viable and practical tool for diagnosing heatstroke and monitoring its progression.
Impact of long-acting injectable aripiprazole on the concomitant medication and antipsychotic polypharmacy: a retrospective, observational study of 127 patients with psychosis
Authors: Lee Junhee , Oh Sanghoon , Moon Sun-Young , Loh Silvia Kyungjin , Kim Minah , Lee Tae Young , Kwon Jun Soo
Published: November 2023

Antipsychotic polypharmacy (APP) has become prevalent over the years, but several concerns have been raised over APP. Accumulating evidence suggests that aripiprazole long-acting injectable (LAI) may reduce the rate of APP, but the association remains speculative. This retrospective observational study included 127 patients with psychosis and observed them for 1.8 ± 1.3 years, up to 4 years. Prescription data of antipsychotics (APs), mood stabilisers, benzodiazepines, and anti-extrapyramidal side effect medications were obtained at baseline and the last observation. Daily chlorpromazine equivalent (CPZ) dose of APs decreased from 124.40 ± 235.35 mg to 77.95 ± 210.36 mg (P = 0.027). The daily dose of anticholinergics and beta-blockers also significantly decreased after introducing aripiprazole LAI. Among the patients having APP, the number of concurrent APs along with daily CPZ dose of APs decreased after initiation of aripiprazole LAI from 1.28 ± 0.62 to 0.85 ± 0.73 (P < 0.001) and 298.33 ± 308.70 mg to 155.43 ± 280.53 mg (P = 0.004), respectively. Treatment with aripiprazole LAI for up to 4 years in patients with psychosis was associated with a reduced number of prescribed APs in patients having an APP and a reduced dose of APs and concurrent psychotropic medications.
Adversarial Learning for MRI Reconstruction and Classification of Cognitively Impaired Individuals
Authors: Zhou Xiao , Balachandra Akshara R. , Romano Michael F. , Chin Sang P. , Au Rhoda , Kolachalama Vijaya B.
Published: November 2023

Game theory-inspired deep learning using a generative adversarial network provides an environment to competitively interact and accomplish a goal. In the context of medical imaging, most work has focused on achieving single tasks such as improving image resolution, segmenting images, and correcting motion artifacts. We present a dual-objective adversarial learning framework that simultaneously (1) reconstructs higher quality brain magnetic resonance images (MRIs) that (2) retain disease-specific imaging features critical for predicting progression from mild cognitive impairment (MCI) to Alzheimer’s disease (AD). We obtained 3-Tesla, T1-weighted brain MRIs of participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI, N=342) and the National Alzheimer’s Coordinating Center (NACC, N=190) datasets. We simulated MRIs with missing data by removing 50% of sagittal slices from the original scans (i.e., diced scans). The generator was trained to reconstruct brain MRIs using the diced scans as input. We introduced a classifier into the GAN architecture to discriminate between stable (i.e., sMCI) and progressive MCI (i.e., pMCI) based on the generated images to facilitate encoding of AD-related information during reconstruction. The framework was trained using ADNI data and externally validated on NACC data. In the NACC cohort, generated images had better image quality than the diced scans (SSIM: 0.553 ± 0.116 versus 0.348 ± 0.108). Furthermore, a classifier utilizing the generated images distinguished pMCI from sMCI more accurately than with the diced scans (F1-score: 0.634 ± 0.019 versus 0.573 ± 0.028). Competitive deep learning has potential to facilitate disease-oriented image reconstruction in those at risk of developing Alzheimer’s disease.