bluuebunny/crossref_metadata_2025 huggingface dataset:
“The Use of Endonasal Spreader Grafts in Preservation Rhinoplasty”
Authors: Go Beatrice C , Frost Ariel S , Friedman Oren
Published: February 2023

Rhinoplasty is a complicated procedure that requires surgical finesse and precision to sculpt a framework that suits each patient’s unique anatomical needs. Extensive resection may lead to nasal valve incompetence, causing obstructive symptoms associated with reduced quality of life. Numerous techniques have been described to help preserve and open the nasal airway, thereby mitigating valvular obstructive problems. In particular, the endonasal spreader graft is a common technique used to widen the internal nasal valve cross-sectional area while limiting external incisions and preserving local nasal structures. Preservation rhinoplasty is a variation of the traditional rhinoplasty that can lower the nasal dorsum without causing major disruption to the nasal keystone area, the junction between the middle and upper thirds of the nose. This study describes the successful and safe combination of these two surgical operations, demonstrating 3 case examples, who all reported improved post-operative nasal obstruction symptoms. Using endonasal spreader grafts in preservation rhinoplasty allows providers to manage the nasal valve and nasal dorsum similarly to the external approach without extensive deconstruction and reconstruction.
“Natural History of Metacarpal Subsidence Following Trapeziectomy with Ligament Reconstruction and Tendon Interposition and Its Relationship to Clinical Outcomes”
Authors: Meyers Abigail , Krebs Jillian P , Rampazzo Antonio , Bassiri Gharb Bahar
Published: February 2023

Purpose:

Trapeziectomy is commonly performed for treatment of symptomatic trapeziometacarpal osteoarthritis. Proximal migration of the first metacarpal (subsidence) can occur following trapeziectomy. The aim of this study was to investigate the natural history of subsidence and its correlation with clinical outcomes.

Methods:

An IRB-approved retrospective review of patients who underwent trapeziectomy and ligament reconstruction and tendon interposition (LRTI) was conducted. Patient demographics, pain scores (VASp), grip strength, pinch strengths, and radial and palmar abduction were collected. The trapezial space ratio (TSR) was measured by the scaphometacarpal distance divided by the length of the capitate. Subsidence [(postoperative TSR-preoperative TSR)/preoperative TSR] was measured and classified as severe (≥70%) or mild-moderate (<70%). Median rate of subsidence increase was calculated. Conolly-Rath scores were used to evaluate the proportion of “good” outcomes in each group.

Results:

One hundred forty-one trapeziectomies-LRTI were included. Subsidence increased 6.7% [5.4-23.0%] per week, before 16 weeks, and 0.3% [0.1-0.8%] per week, thereafter. VASp was not significantly different between patients with severe and mild-moderate subsidence (p=0.25), 16 weeks after thumb mobilization.

The proportion of “good” outcomes was comparable among the two groups (p=0.12). There was no correlation between subsidence and pain (ρ=-0.20, p=0.24), grip (ρ=-0.02, p=0.93), key (ρ=-0.13, p=0.62), tripod (ρ=0.16, p=0.71), or index tip pinch strengths (ρ=-0.28, p=0.43), or radial (ρ=-0.03, p=0.92) or palmar (ρ=-0.15, p=0.61) abduction.

Conclusions:

Subsidence occurs in all patients following trapeziectomy and LRTI, stabilizing 16 weeks after mobilization. Degree of subsidence does not correlate with postoperative outcomes.
Transpalpebral “Eyelid” Approach for Supraorbital Frontal Craniotomy and Access to the Anterior Cranial Fossa
Authors: Morrison Kerry A. , Farber Scott J. , Riina Howard A. , Staffenberg David A.
Published: February 2023

The transpalpebral “eyelid” approach is an innovative alternative to the traditional incisions for exposure of the anterior cranial fossa for neurosurgery. Yet, there is a paucity of data on such a surgical technique in the plastic surgery literature for accessing the anterior cranial fossa. A retrospective review was performed of patients who underwent supraorbital frontal craniotomy using an anterior skull base approach with transpalpebral exposure over eight years by a single plastic surgeon (D.A.S.). Surgical techniques, medical co-morbidities, intra-operative complications, and long-term complications were assessed. Twenty patients (mean age 52±12 years, 55% male, 45% female) underwent supraorbital frontal craniotomy using an anterior skull base approach with upper transpalpebral exposure. Operative indications included: 75% had anterior communicating aneurysms with a mean aneurysm size of 5.36±1.91 mm, 10% had meningiomas, 10% had dural fistulas, and 5% had an orbital hemangioma. Notably, 60% had a smoking history. No intra-operative complications were encountered, and no cases required conversion to a traditional open approach. Mean length of hospital stay was 3.2±1.5 days. Post-operative imaging revealed no residual or recurrent pathology. Mean follow up time was 62.2±30.6 months. No long-term neurological or ophthalmologic complications or infections occurred. No forehead paresthesias, and no brow ptosis or brow paralysis were noted. The transpalpebral technique is an excellent, minimally invasive alternative to approach lesions of the anterior cranial fossa. Successful application may require appropriate management of the frontal sinus and supraorbital nerve. As described, this approach does not limit neurosurgical access or results, and led to no neurosurgical complications.
Y-Columellar Strut Graft: A Method for Reconstructing the Nasal Tip in Primary and Revision Rhinoplasty
Authors: Martino Carmine , Salzano Francesco Antonio , Martino Diletta , Ralli Massimo , Salzano Giovanni , De Vincentiis Marco , Brenner Michael J , Di Stadio Arianna
Published: February 2023

Background:

Several techniques have been proposed to modify tip shape and projection, both in congenital and acquired nasal tip deformities. We describe a novel technique, the Y-columellar strut graft (“Y-strut”), which uses auricular cartilage to increase tip projection and restore contour in primary or revision rhinoplasty.

Methods:

Thirty-seven patients with congenital, acquired, or iatrogenic nasal tip malformation were reconstructed with Y-strut using short or long upper limbs (“wings”). The short wings variant was employed to increase tip projection in primary rhinoplasty, and the long wings variant was used to corrected iatrogenic deformities of alar cartilages in revision rhinoplasty, improving contour and projection. Frontal, oblique, and lateral views before and after surgery were analyzed in blinded fashion at 1 year for tip shape and projection. Statistical analyses compared demographic characteristics, deformity type, and nasolabial angle before and after surgery to evaluate aesthetic outcome.

Results:

All patients demonstrated improved nasal tip position. The Y-strut increased the nasolabial angle, reflecting tip rotation, and findings were independent of type or location of deformity (p<0.00001). No statistically significant differences were observed in comparisons of the short versus long-wings techniques. Three patients with congenital nasal tip malformations showed mild tip deviation at 1-year follow-up, and one had mild dorsal irregularity unrelated to grafting; no negative outcomes were observed in revision rhinoplasty patients.

Conclusions:

The Y-columellar strut graft is a reliable and versatile rhinoplasty technique using paired, symmetrical grafts fashioned from auricular cartilage to correct tip deformities.

Level of evidence:IV
Abductor Digiti Minimi and Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer: The “Super-Turbocharge End to Side (STETS)” Transfer For Severe Ulnar Neuropathy
Authors: Peters Blair R. , Jacobson Lauren , Pripotnev Stahs , Mackinnon Susan E.
Published: February 2023

Anterior interosseous nerve (AIN) to ulnar motor nerve (UMN) supercharge end to side (SETS) nerve transfer to restore intrinsic function is a recently adopted nerve transfer in severe ulnar neuropathy. However, its success is predicated on the critical threshold number of axons innervating the intrinsic muscles. Given the relative expendability of the abductor digiti minimi (ADM) and the critical function of the other intrinsic muscles, we have modified our SETS transfer to redirect axons from the ADM to turbocharge the UMN to innervate the more critical intrinsic muscles, referring to this procedure as a super-turbocharge end to side (STETS) procedure. The ADM has been used previously as a muscle/tendon transfer for thumb opposition and more recently as a nerve transfer to reinnervate the thenar branch of the median nerve. While current methods of assessment of reinnervation are likely unable to differentiate between contributions from the AIN SETS versus ADM STETS transfer, this technique follows fundamentals of modern nerve surgery where directing the maximum number of nerve fibers in a timely fashion to the most critical target is paramount for the best functional recovery. Thus, we suggest the STETS technique may optimize outcomes in ulnar neuropathy without additional patient morbidity.
Gluteal Shape Framework for Augmentation Surgery: A Systematic Review of the Literature and Proposed Classification System
Authors: Dorfman Robert , Gupta Nisha , Saadat Sean , Delong Michael , Roostaeian Jason
Published: February 2023

Purpose:

Gluteal augmentation is used to improve the size and shape of the buttocks. Unlike other anatomic areas, such as the breasts, where there are classification systems for size and projection, no standardized methods for classifying gluteal size and shape exists. Patients seeking augmentation rely on pictures to communicate their desired result to surgeons. Our study objectively reviews this topic and proposes a novel classification system for the buttocks that can provide an organized framework for patients and providers.

Methods:

A systematic of the literature was conducted on March 17, 2021, using various combinations of the following terms: “gluteal augmentation”, “classification”, “size”, “gluteoplasty”, and “Brazilian butt lift”. All eligible articles were included for analysis.

Results:

The PubMed/MEDLINE searches yielded 49 articles and abstracts. After review, 8 publications were chosen for analysis. All publications were found in plastic surgery journals, with the most common journals as follows: Aesthetic Surgery Journal (n=4), Clinics in Plastic Surgery (n=2), Annals of Plastic Surgery (n=1), and Plastic and Reconstructive Surgery (n=1). There are no articles in the plastic surgery literature that provide a standardized classification system for gluteal size determination.

Conclusion:

Our study revealed the need for a standardized classification system for gluteal size and shape. While the publications analyzed discussed various techniques for related procedures and provided ways to improve aesthetic outcomes, none presented a system for reproducibly classifying size and shape. By introducing a classification system, we hope to enable plastic surgeons to more accurately and efficiently discuss their patient’s goals.
Dermal Sensory Regenerative Peripheral Nerve Interface (DS-RPNI) for Re-establishing Sensory Nerve Feedback in Peripheral Afferents in the Rat
Authors: Sando Ian C. , Adidharma Widya , Nedic Andrej` , Ursu Daniel C. , Mays Elizabeth A , Hu Yaxi , Kubiak Carrie A. , Sugg Kristoffer B. , Kung Theodore A. , Cederna Paul S. , Gerling Gregory J. , Kemp Stephen W. P. , Urbanchek Melanie G.
Published: February 2023

Background:

Without meaningful, intuitive sensory feedback, even the most advanced myoelectric devices require significant cognitive demand to control. The Dermal Sensory Regenerative Peripheral Nerve Interface (DS-RPNI) is a biologic interface designed to establish high-fidelity sensory feedback from prosthetic limbs.

Methods:

DS-RPNIs are constructed in rats by securing fascicles of residual sensory peripheral nerves into autologous dermal grafts. Our objectives are to confirm regeneration of sensory afferents within DS-RPNIs, and to establish the reliability of afferent neural response generation with either mechanical or electrical stimulation.

Results:

Two months after implantation, DS-RPNIs were healthy and displayed well-vascularized dermis with organized axonal collaterals throughout and no evidence of neuroma. Electrophysiological signals were recorded proximal from DS-RPNI’s sural nerve in response to both mechanical and electrical stimuli and compared to a) full-thickness skin, b) de-epithelialized skin, and c) transected sural nerves without DS-RPNI. Mechanical indentation of DS-RPNI’s evoked compound sensory nerve action potentials (CSNAPs) that were like those evoked during indentation of full-thickness skin. CSNAP firing rates and waveform amplitudes increased in a graded fashion with increased mechanical indentation. Electrical stimuli delivered to DS-RPNI’s reliably elicited CSNAPs at low current thresholds and CSNAPs gradually increased in amplitude with increasing stimulation current.

Conclusions:

These findings suggest that afferent nerve fibers successfully reinnervate DS-RPNI’s, and that graded stimuli applied to DS-RPNI’s produce proximal sensory afferent responses similar to those evoked from normal skin. This confirmation of graded afferent signal transduction through DS-RPNI neural interfaces validate DS-RPNI’s potential role of facilitating sensation in human-machine interfacing.
A Systematic Review and Meta-Analysis of Nerve Gap Repair: Comparative Effectiveness of Allografts, Autografts, and Conduits
Authors: Lans Jonathan , Eberlin Kyle , Evans Peter J. , Mercer Deana , Greenberg Jeffrey A. , Styron Joseph F.
Published: February 2023

Background:

Ideal nerve repair involves tensionless direct repair, which may not be possible after resection. Bridging materials include nerve autograft, allograft, or conduit. This study aimed to perform a systematic literature review and meta-analysis to compare the Meaningful Recovery (MR) rates and post-operative complications following autograft, allograft and conduit repairs in nerve gaps >5mm and <70mm. A secondary aim was to perform a comparison of procedure costs.

Methods:

The search was conducted in MEDLINE from January 1980 to March 2020, following PRISMA guidelines. Studies were included if they reported nerve injury type, repair type, gap length, and outcomes for MR rates. Thirty-five studies with 1,559 nerve repairs were identified.

Results:

Overall MR for sensory and motor function was not significantly different between autograft (n=670) and allograft (n=711) across both short and long gaps. However, MR rates for autograft (81.6%) and allograft (87.1%) repairs were significantly higher compared to conduits (62.2%) (p<0.05) in sensory short gap repairs. Complication rates were comparable for autograft and allograft but higher for conduit with regard to pain. Analysis of costs showed that total costs for allograft repair were less than autograft in the inpatient setting and were comparable in the outpatient setting.

Conclusion:

Literature showed comparable rates of MR between autograft and allograft, regardless of gap length or nerve type. Furthermore, the rates of MR were lower conduit repairs. In addition, the economic analysis performed demonstrates that allograft does not represent an increased economic burden compared to autograft.
The Key to a Straight Nose is a Straight Septum – 10 Essential Steps
Authors: Jalalabadi Faryan , Bellamy Justin L. , Rohrich Rod J.
Published: February 2023

The deviated nose derives from underlying skeletal and soft-tissue deformities in the upper, middle, and/or lower third of the nose. Although deviation may stem from several intrinsic and extrinsic elements, the septum is most often the primary contributor. Attempts to straighten the nose without properly addressing the septum invariably result in a persistently deviated nose. The goal of this article is to review the 10 key steps for a reliable, methodical approach to correcting the deviated septum in primary rhinoplasty.
“Maxillo-mandibular reconstruction with vascularized bone flaps using insourced virtual surgical planning and home-made CAD-CAM: A 5-year single-center evolution in 75 patients.”
Authors: Vranckx Jan Jeroen , Desmet Odille , Bila Michel , Wittesaele Winston , Wilssens Nicholas , Vander Poorten Vincent
Published: February 2023

Background:

Virtual surgical planning (VSP) and computer-aided design (CAD) and manufacturing (CAM) of surgical guides and jigs have dramatically changed the predictability of bony reconstruction of the jaw. VSP craftmanship can lead to precision and enables the surgeon to complement the donor bone osteotomies with bony resection of the jaw. In recent years, immediate dental rehabilitation has become an integral part of VSP. However, outsourced CAD-CAM technology is expensive and may not be an option for many institutions worldwide.

Methods:

We present here a consecutive series of 75 maxillofacial reconstructions from 2015 till 2020. We established an insourced ‘in-house’ protocol for VSP and ‘home-made’ CAD-CAM for the reconstruction of the maxilla-mandibular defects with fibula, iliac crest, and scapular angle flaps. All patient files were retrospectively analyzed and relevant parameters influencing the reconstructive outcome were determined.

Results:

We went from a fibula-based protocol towards the selection of optimal vascularized bone for immediate placement of osteo-integrated implants. Bone flap survival was 94.7% after four months. The three-year patient survival is 77.6%. We show the multiple steps required for the routine use of in-house CAD-CAM and report the related financial balance.

Conclusion:

Insourced VSP and CAD-CAM has evolved into a valuable strategy in maxillomandibular reconstruction that promotes accuracy and precision and allows for occlusion-based planning with quality of life and aesthetic outcomes as essential parts of the reconstruction even in high-level oral cancers. Further reductions in the hardware and software acquisition costs may lead to widespread implementation of this innovative technology.

Clinical Question/Level of Evidence:

Therapeutic, IV
Role of autologous fat transplantation combined with negative-pressure wound therapy in the treatment of diabetic wounds in a rat model
Authors: Zhang Hao , Zhou Min , Wang Yu , Zhang Dong , Qi Baiwen , Yu Aixi
Published: February 2023

Background:

Negative-pressure wound therapy (NPWT) and autologous fat transplantation (AFT) are two clinical modalities for plastic and reconstructive surgery. At present, there are few reports on the combination of these two methods in treating diabetic wounds. This study aimed to explore the effect of this combined therapy on diabetic wound healing.

Methods:

Full-thickness dorsal cutaneous wounds in rats with streptozotocin-induced diabetes were treated with either NPWT, AFT, or combined therapy. Rats covered with commercial dressings served as the control group. Macroscopic healing kinetics were examined. The levels of inflammation-related factors, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), Arginase-1, inducible NO synthase (iNOS) and angiogenesis related factors such as vascular endothelial growth factor (VEGF), were measured in the wound tissues on days 3, 7 and 14, and immunohistochemical staining for Arginase-1, iNOS, and CD-31 was performed on days 3, 7 and 14. The length of reepithelialization was investigated on day 14.

Results:

The combined therapy promoted faster wound healing than the other treatments. The expression levels of the proinflammatory factors IL-1β, IL-6, MCP-1, and iNOS were reduced, and Arginase-1 expression was increased compared with those in the other groups. The expression levels of VEGF and CD-31 in the NPWT combined with AFT group were significantly higher than those in the other groups. Reepithelialization was faster in the NPWT combined with AFT group (by day 14) than in the other groups.

Conclusion:

Combining NPWT and AFT can enhance diabetic wound healing by improving wound inflammation and increasing wound vascularization.
Shared Activities With Parents During Adolescence Predicts Health Risk Across Multiple Biological Systems 22 Years Later
Authors: Manczak Erika M.
Published: February 2023

Objective

Although affectively focused dimensions of social relationships are associated with differences in health risk, less research has considered nonaffective features of relationships, such as engaging in shared activities. This study sought to test whether adolescents who engaged in more shared activities with their parents had lower health risk in early midlife across multiple biological markers.

Methods

Using data from a nationally representative study (N = 4801), prospective associations between shared activities with parents during adolescence and health risk classifications for measures of inflammation, renal function, glucose homeostasis, and cholesterol 22 years later were examined, along with the potentially confounding roles of childhood socioeconomic status and parent-child relationship satisfaction. Exploratory analyses considered possible indirect effects of cigarette use, alcohol use, and body mass index in adulthood.

Results

Engaging in more shared activities with parents was associated with a reduced likelihood of being classified in a high-risk health category for markers of inflammation (B = −0.02, standard error [SE] = 0.01, p = .040), renal function (B = −0.08, SE = 002, p = .001), glucose (B = −0.06, SE = 0.23, p = .011), and high-density lipoprotein (B = −0.03, SE = 0.01, p = .021), and overall allostatic load (B = −0.02, SE = 0.02, p = .001), beyond demographic and health covariates. Controlling for parental income and relationship satisfaction largely did not affect observed associations. Exploratory tests of indirect effects imply that health behaviors in adulthood may partially account for observed associations.

Conclusions

Engaging in more shared activities predicted more optimal health classifications 22 years later, suggesting that the amount of contact between parents and teenagers may have long-lasting beneficial health effects. Furthermore, consideration of nonaffective dimensions of family relationships may provide additional insight into associations between social relationships and health.
Early Life Stress, Coping, and Cardiovascular Reactivity to Acute Social Stress
Authors: Mrug Sylvie , Pollock Jennifer , Pollock David , Seifert Michael , Johnson Kim A. , Knight David C.
Published: February 2023

Objective

Early life stress (ELS) occurring during childhood and adolescence is an established risk factor for later cardiovascular disease and dysregulated reactivity to acute social stress. This study examined whether ELS associations with baseline cardiovascular functioning, cardiovascular stress reactivity and recovery, and emotional stress reactivity vary across levels of emotion-oriented, task-oriented, and avoidant coping styles.

Methods

The sample included 1,027 adolescents and young adults (Mean age 19.29 years; 50% females; 64% Black, 34% Non-Hispanic White) who reported on their ELS exposure and coping styles. Participants completed a standardized acute social stress test (the Trier Social Stress Test; TSST), with heart rate (HR) and blood pressure (BP) measured before, during, and after the TSST. Self-reports of negative emotions during the TSST indexed emotional stress reactivity.

Results

Multiple regression models adjusting for demographic factors and body mass index (BMI) showed that ELS was associated with lower HR stress reactivity; avoidant coping was related to lower SBP and DBP during stress and lower SBP during recovery; and higher emotion-oriented coping and lower task-oriented coping predicted greater emotional stress reactivity. A consistent pattern emerged where emotion-oriented coping amplified the associations between ELS and maladaptive stress responses (blunted cardiovascular stress reactivity and recovery; enhanced emotional stress reactivity), whereas lower levels of emotion-oriented coping were associated with resilient profiles among those who experienced ELS (lower resting HR; lower emotional stress reactivity; average HR and BP stress reactivity and recovery). However, low levels of emotion-oriented coping also conferred a risk of higher BP during recovery for those with high levels of ELS.

Conclusions

These results suggest that low to moderate levels of emotion-oriented coping promote optimal cardiovascular and emotional reactivity to acute stress among individuals exposed to ELS.
Single-center experience evaluating and initiating people with HIV on long-acting cabotegravir/rilpivirine
Authors: Hill Lucas A. , Abulhosn Kari K. , Yin Jeffrey F. , Bamford Laura P.
Published: February 2023

Objective:

To describe our experience evaluating and initiating individuals on long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) and evaluate factors associated with starting LAI CAB/RPV and reasons for not starting.

Design:

We conducted a retrospective single-center study at the UC San Diego Owen Clinic.

Methods:

We included all individuals who expressed interest in treatment with LAI CAB/RPV between April 2021 and June 2022 who had a definitive decision made on starting LAI CAB/RPV.

Results:

In total, 383 individuals were included with 201 (52.5%) initiating LAI CAB/RPV. Those who initiated LAI CAB/RPV were younger (P = 0.02) and were more likely to be on a two-drug regimen or first-generation integrase inhibitor regimen and less likely to be on a protease inhibitor or multiclass regimen. The most common reasons for not starting LAI CAB/RPV were inconsistent clinic attendance or difficulty being contacted and patient choice not to start. Of those who had a proviral DNA resistance test as workup for LAI CAB/RPV (n = 135), 18.5% had a resistance mutation identified that may have impacted the activity of LAI CAB/RPV.

Conclusion:

Despite novel challenges over half of our cohort initiated LAI CAB/RPV. Evaluating for potential non-nucleoside reverse transcriptase inhibitor resistance is an important part of the workup for LAI CAB/RPV and proviral DNA resistance testing can be an additional tool to identify potential resistance.
The role of social support on cognitive function among midlife and older adult MSM
Authors: Henderson Emmett R. , Haberlen Sabina A. , Coulter Robert W.S. , Weinstein Andrea M. , Meanley Steven , Brennan-Ing Mark , Mimiaga Matthew J. , Turan Janet M. , Turan Bulent , Teplin Linda A. , Egan James E. , Plankey Michael W. , Friedman M. Reuel
Published: February 2023

Objective:

This study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV.

Design:

We analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study.

Methods:

We conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support.

Results:

Social support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effect on set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support.

Conclusion:

Social support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.
Lower anti-Müllerian hormone levels are associated with HIV in reproductive age women and shorter leukocyte telomere length among late reproductive age women
Authors: Van Ommen Clara E. , Hsieh Anthony Y.Y. , Albert Arianne Y. , Kimmel Elana R. , Cote Helene C.F. , Maan Evelyn J. , Prior Jerilynn C. , Pick Neora , Murray Melanie C.M.
Published: February 2023

Objectives:

We sought to better understand factors associated with ovarian aging in women with HIV (WWH).

Design:

HIV has been associated with diminished fertility, younger age at menopause, and shorter leukocyte telomere length (LTL), a marker of cellular aging. We herein examine cross-sectional and longitudinal associations between LTL, anti-Müllerian hormone (AMH), and HIV.

Methods:

We included WWH and HIV-negative women 12–50 years of age in the CARMA cohort with one or more study visit(s). LTL and AMH were measured by qPCR and ELISA, respectively. Women were analyzed in peak reproductive (<35 years) vs. late reproductive (≥35 years) life phases. Using multivariable mixed-effect linear or logistic regressions, we assessed factors associated with AMH and ΔAMH/year while adjusting for relevant confounders.

Results:

WWH had shorter LTL and lower AMH levels compared to HIV-negative controls despite being of similar age. After adjusting for relevant factors, HIV was associated with 20% lower AMH levels in women under 35 years of age and shorter LTL was associated with AMH levels below 2 ng/ml among women aged 35 years or older. Longitudinally, ΔAMH/year was largely related to initial AMH level among older women, and to age in younger women.

Conclusions:

Factors associated with AMH change across women's reproductive lifespan. Lower AMH among peak reproductive aged WWH suggests that HIV may have an initial detrimental effect on ovarian reserve, an observation that may warrant counseling around pregnancy planning. In women aged 35 years or older, the association between shorter LTL and lower AMH suggests that the immune and reproductive aging connections are more important in this age group.
Estimation of HIV-1 Incidence Using a Testing History-Based Method; Analysis From the Population-Based HIV Impact Assessment Survey Data in 12 African Countries
Authors: Gurley Stephen A. , Stupp Paul W. , Fellows Ian E. , Parekh Bharat S. , Young Peter W. , Shiraishi Ray W. , Sullivan Patrick S. , Voetsch Andrew C.
Published: February 2023

Background:

Estimating HIV incidence is essential to monitoring progress in sub-Saharan African nations toward global epidemic control. One method for incidence estimation is to test nationally representative samples using laboratory-based incidence assays. An alternative method based on reported HIV testing history and the proportion of undiagnosed infections has recently been described.

Methods:

We applied an HIV incidence estimation method which uses history of testing to nationally representative cross-sectional survey data from 12 sub-Saharan African nations with varying country-specific HIV prevalence. We compared these estimates with those derived from laboratory-based incidence assays. Participants were tested for HIV using the national rapid test algorithm and asked about prior HIV testing, date and result of their most recent test, and date of antiretroviral therapy initiation.

Results:

The testing history-based method consistently produced results that are comparable and strongly correlated with estimates produced using a laboratory-based HIV incidence assay (ρ = 0.85). The testing history-based method produced incidence estimates that were more precise compared with the biomarker-based method. The testing history-based method identified sex-, age-, and geographic location-specific differences in incidence that were not detected using the biomarker-based method.

Conclusions:

The testing history-based method estimates are more precise and can produce age-specific and sex-specific incidence estimates that are informative for programmatic decisions. The method also allows for comparisons of the HIV transmission rate and other components of HIV incidence among and within countries. The testing history-based method is a useful tool for estimating and validating HIV incidence from cross-sectional survey data.
Evaluation of Statin Prescribing Practices and Predictors of Statin Underutilization in Persons With HIV
Authors: Cottino Michelle C. , Kulig Caitlin E. , Suh Jin S. , Jimenez Humberto R.
Published: February 2023

Background:

Persons with HIV (PWH) have an increased risk of cardiovascular disease (CVD) compared with those without HIV. Despite the increased risk, PWH are less likely to be prescribed statin therapy compared with the general population. The purpose of this study is to describe the statin prescribing practices of an outpatient HIV clinic and identify potential predictors of statin underutilization.

Methods:

This study was a retrospective, single-center chart review of PWH ages 40–79 years receiving care at an HIV clinic. Statin eligibility, statin prescribing practices, and appropriateness of statin therapy were evaluated. Logistical regression analyses were conducted to assess for predictors of underutilization of statin therapy.

Results:

Of the 606 patients, statin therapy was indicated in 362 patients (60%). Among those with a statin indication, 60.2% were prescribed appropriate statin therapy, 11.6% were prescribed statin therapy but not at the indicated intensity, and 28.2% were not prescribed statin therapy. Tobacco use (P = 0.0023) was identified as a predictor of statin underutilization. The odds of statin prescribing were higher for those with clinical atherosclerotic CVD (P = 0.004) and hypertension (P = 0.017).

Conclusion:

Statin underutilization was significantly higher in PWH smoking tobacco and PWH without atherosclerotic CVD or low-density lipoprotein–cholesterol 190 mg/dL or higher. In addition, this study highlights the need for more robust CVD prevention efforts in PWH. Identifying predictors of statin underutilization may aid in elucidating where gaps in cardiovascular prevention care may exist.
Epidemiology of Tuberculosis Among People Living With HIV in the African Cohort Study From 2013 to 2021
Authors: Ganesan Kavitha , Mwesigwa Ronald , Dear Nicole , Esber Allahna L. , Reed Domonique , Kibuuka Hannah , Iroezindu Michael , Bahemana Emmanuel , Owuoth John , Singoei Valentine , Maswai Jonah , Parikh Ajay P. , Crowell Trevor A. , Ake Julie A. , Polyak Christina S. , Shah Neha , Cavanaugh Joseph S.
Published: February 2023

Background:

The prevalence and incidence of tuberculosis (TB) is high among people living with HIV (PLWH) but is often underdiagnosed in HIV programmatic settings.

Setting:

President's Emergency Plan for AIDS Relief (PEPFAR)–supported research sites in Uganda, Kenya, Tanzania, and Nigeria.

Methods:

All patients underwent molecular testing at entry into a longitudinal cohort of PLWH and annually thereafter. We assessed the prevalence and incidence of TB and identified clinical and demographic factors associated with prevalent and incident TB using logistic regression and Cox proportional hazard models.

Results:

From 21 January, 2013, to 1 December 2021, 3171 PLWH were enrolled with a TB prevalence of 3% (n = 93). Of the cases with prevalent TB, 66% (n = 61) were bacteriologically confirmed. The adjusted odds of prevalent TB were significantly higher among those with higher educational attainment, PLWH for 1–5 years since their HIV diagnosis, those who were underweight, and those with CD4 counts <200 cells/mm3. The overall TB incidence rate was 600 per 100,000 person-years (95% CI: 481–748). We found that shorter time since HIV diagnosis, being underweight, taking antiretroviral therapy <6 months, and having a CD4 count <200 cells/mm3 were significantly associated with incident TB. PLWH on dolutegravir/lamivudine/tenofovir had a 78% lower risk of incident TB compared with those on tenofovir/lamivudine/efavirenz (hazard ratio: 0.22; 95% CI: 0.08–0.63).

Conclusion:

The prevalence and incidence of TB was notably high in this cohort sourced from PEPFAR clinics. Aggressive efforts to enhance HIV diagnosis and optimize treatment in programmatic settings are warranted to reduce the risk of HIV-TB co-occurrence in this cohort.
HIV prevention in individuals engaged in sex work
Authors: Busza Joanna , Matambanadzo Primrose , Phiri Lawrence , Meki Bee , Cowan Frances M.
Published: February 2023

Purpose of review

People who sell sex remain at disproportionate risk of acquiring HIV and should be prioritized for evidence-based HIV prevention programmes delivered at sufficient scale and intensity for effectiveness. Although new biomedical tools are becoming available, many basic lessons learned early in the HIV pandemic remain salient today and need renewed attention.

Recent findings

New preexposure prophylaxis formulations, distribution systems, and delivery mechanisms are being successfully trialled and implemented, adding to well established prevention tools such as male and female condoms and lubricants. The importance of social support networks and community ownership of programmes has been consistently reaffirmed. Serious challenges remain in optimizing HIV prevention for sex workers, including providing services at the scale and intensity necessary for population level impact, addressing culturally sensitive issues of gender identity and sexual orientation, and protecting adolescents and young people who may sell sex. Pervasive social stigma, often reinforced by criminalization and police harassment, further constrain sex workers’ access to available services and prevention tools.

Meaningful community engagement and addressing the multiple social determinants of vulnerability at individual, community, and structural levels remain at the core of preventing HIV among people involved in selling sex.
Estimating the global impact of coronavirus disease 2019 on people living with HIV
Authors: Thornhill John , Orkin Chloe , Cevik Muge
Published: February 2023

Purpose of review

The COVID-19 pandemic and public health response have directly and indirectly affected broader health outcomes, especially for those with existing chronic conditions, including HIV. We examine our current understanding of the global impact of COVID-19 on people with HIV (PWH).

Recent findings

The interaction between COVID-19 and HIV is complex, making it challenging to estimate its true impact on PWH. Evidence to date does not suggest that HIV confers a higher risk of acquiring SARS-CoV-2. However, once acquired, HIV increases the risk of severe COVID-19 and mortality, particularly in immunosuppressed viraemic individuals and in the context of traditional COVID-19 risk factors, including disparities in social determinants of health. In addition, COVID-19 vaccines may be less effective in the context of HIV infection with additional doses needed. The consequences of disruption of access to essential prevention and treatment services because of the pandemic are becoming evident and will likely adversely affect outcomes, risking decades of progress.

Given the increased mortality risk and reduced vaccine effectiveness seen in PWH, specific prevention and support measures are needed, including prioritization of vaccination and boosters, funding to mitigate the impact of pandemic and enabling integrated healthcare delivery during pandemics will be critical.
Rapid diagnostics for skin and soft tissue infections: the current landscape and future potential
Authors: Barbier François , Woerther Paul-Louis , Timsit Jean-François
Published: January 2023

Purpose of review

Managing antimicrobial therapy in patients with complicated skin and soft tissue infections (SSTI) constitutes a growing challenge due to the wide spectrum of potential pathogens and resistance phenotypes. Today, microbiological documentation relies on cultural methods. This review summarizes the available evidence regarding the clinical input of rapid microbiological diagnostic tools (RMDT) and their impact on the management of antimicrobial therapy in SSTI.

Recent findings

Accurate tools are already available for the early detection of methicillin-resistant Staphylococcus aureus (MRSA) in SSTI samples and may help avoiding or shortening empirical anti-MRSA coverage. Further research is necessary to develop and evaluate RMDT detecting group A streptococci (e.g., antigenic test) and Gram-negative pathogens (e.g., multiplex PCR assays), including through point-of-care utilization. Next-generation sequencing (NGS) methods could provide pivotal information for the stewardship of antimicrobial therapy, especially in case of polymicrobial or fungal SSTI and in the immunocompromised host; however, a shortening in the turnaround time and prospective data regarding their therapeutic input are needed to better appraise the clinical positioning of these promising approaches.

The clinical input of RMDT in SSTI is currently limited due to the scarcity of available dedicated assays and the polymicrobial feature of certain cases. NGS appears as a relevant tool but requires further developments before its implementation in routine clinical practice.
Iterative Reconstruction: State-of-the-Art and Future Perspectives
Authors: Guido Gisella , Polici Michela , Nacci Ilaria , Bozzi Fernando , De Santis Domenico , Ubaldi Nicolò , Polidori Tiziano , Zerunian Marta , Bracci Benedetta , Laghi Andrea , Caruso Damiano
Published: February 2023

Image reconstruction processing in computed tomography (CT) has evolved tremendously since its creation, succeeding at optimizing radiation dose while maintaining adequate image quality. Computed tomography vendors have developed and implemented various technical advances, such as automatic noise reduction filters, automatic exposure control, and refined imaging reconstruction algorithms.

Focusing on imaging reconstruction, filtered back-projection has represented the standard reconstruction algorithm for over 3 decades, obtaining adequate image quality at standard radiation dose exposures. To overcome filtered back-projection reconstruction flaws in low-dose CT data sets, advanced iterative reconstruction algorithms consisting of either backward projection or both backward and forward projections have been developed, with the goal to enable low-dose CT acquisitions with high image quality. Iterative reconstruction techniques play a key role in routine workflow implementation (eg, screening protocols, vascular and pediatric applications), in quantitative CT imaging applications, and in dose exposure limitation in oncologic patients.

Therefore, this review aims to provide an overview of the technical principles and the main clinical application of iterative reconstruction algorithms, focusing on the strengths and weaknesses, in addition to integrating future perspectives in the new era of artificial intelligence.
Electrocardiographic Gating and Cerebral Perfusion Computed Tomography Option-Set Prevalence and Utilization Data From 62 Institutions in the United States
Authors: Rose Sean D. , Lubner Meghan G. , Heil John , Greenwood Gina M. , Szczykutowicz Timothy P.
Published: February 2023

Objectives

To provide the radiology community with data to address the question: “Compared with peer institutions, is my institution efficiently using its electrocardiographic (ECG) gating and cerebral perfusion-capable computed tomography (CT) scanners?”

Methods

In this retrospective study, we analyze 6 months of scanner utilization data from 62 institutions (299 locations, 507 scanners) to identify scanners capable of performing ECG gating and perfusion CT studies. We report the number of ECG gating/perfusion–capable scanners and locations as a function of the total number of locations and scanners in each institution. We additionally regress the number of ECG-gated and perfusion examinations on (1) the number of locations/scanners capable of performing these examinations and (2) the fraction of the institution's CT examination volume that requires ECG gating or perfusion. We provide look-up tables so an institution can compare its ECG-gated/perfusion examination volume to other institutions with similar ECG-gated/perfusion examination fractions and capable scanners.

Results

We detected an effect of both ECG-gating examination fraction and the number of ECG gating–capable scanners on ECG-gated examination volume (χ
2
1 = 77.5 [P < 0.001] and χ
2
1 = 64.2 [P < 0.001], respectively). Similar results were obtained for perfusion examination fraction and perfusion-capable scanners as they relate to perfusion examination volume (χ
2
1 = 51.6 [P < 0.001] and χ
2
1 = 45.2 [P < 0.001], respectively). The number of ECG gating/perfusion–capable scanners and locations within an institution were found to positively correlate with both the total number of locations and scanners within an institution (P < 0.001 for all hypothesis tests).

Conclusions

The study provides multi-institutional data on ECG gating and perfusion examination volumes that can be used to inform CT purchasing decisions.
Does the Thymus Index Predict COVID-19 Severity?
Authors: Berkan Ocal , Kiziloğlu Ilker , Keles Ercan , Duman Lale , Bozkurt Mehmet , Adıbelli Zehra , Oncel Guray , Berkan Nevsin , Ekemen Keles Yildiz , Jones Jeremy H. , Inan Abdurrahman Hamdi , Solak Cihan , Emiroğlu Mustafa , Yildirim Mehmet , Dursun Ayberk , Ilhan Enver , Camyar Asuman , Inceer Ozge , Nart Ahmet , Yilmaz Mehmet Birhan
Published: February 2023

Background

The COVID-19 (coronavirus disease 2019) pandemic is a global health emergency that is straining health care resources. Identifying patients likely to experience severe illness would allow more targeted use of resources. This study aimed to investigate the association between the thymus index (TI) on thorax computed tomography (CT) and prognosis in patients with COVID-19.

Methods

A multicenter, cross-sectional, retrospective study was conducted between March 17 and June 30, 2020, in patients with confirmed COVID-19. The patients' clinical history and laboratory data were collected after receiving a signed consent form. Four experienced radiologists who were blinded to each other and patient data performed image evaluation. The appearance of the thymus was assessed in each patient using 2 published systems, including the TI and thymic morphology. Exclusion criteria were lack of initial diagnostic thoracic CT, previous sternotomy, pregnancy, and inappropriate images for thymic evaluation. A total of 2588 patients with confirmed COVID-19 and 1231 of these with appropriate thoracic CT imaging were included. Multivariable analysis was performed to predict the risk of severe disease and mortality.

Results

The median age was 45 (interquartile range, 33–58) years; 52.2% were male. Two hundred forty-nine (20.2%) patients had severe disease, and 60 (4.9%) patients died. Thymus index was significantly associated with mortality and severe disease (odds ratios, 0.289 [95% confidence interval, 0.141–0.588; P = 0.001]; and 0.266 [95% confidence interval, 0.075–0.932; P = 0.038]), respectively. Perithymic lymphadenopathy on CT imaging had a significantly strong association with grades of TI in patients with severe disease and death (V = 0.413 P = 0.017; and V = 0.261 P = 0.002, respectively). A morphologically assessable thymus increased the probability of survival by 17-fold and the absence of severe disease by 12-fold.

Conclusion

Assessment of the thymus in patients with COVID-19 may provide useful prognostic data for both disease severity and mortality.