bluuebunny/crossref_metadata_2025 huggingface dataset:
Disparities in Awareness of Hepatitis C Virus Among US Adults: An Analysis of the 2019 Health Information National Trends Survey
Authors: Islam Jessica Yasmine , Spees Lisa , Camacho-Rivera Marlene , Vidot Denise C. , Yarosh Rina , Wheldon Christopher W.
Published: May 2021

Background

The U.S. Preventive Services Task Force updated hepatitis C virus (HCV) screening 2020 guidelines to target adults aged 18 to 79 years: a major shift from the prior focus on high-risk populations (“baby boomers” aged ≥55 years as of 2019). To inform efforts to maximize HCV screening coverage, our objective was to identify demographic groups reporting a lack of HCV awareness, particularly by race/ethnicity and age, and sources of health information.

Methods

We used nationally representative data of adults (≥18 years) included in the 2019 Health Information National Trends Survey (n = 5438). Awareness of HCV was defined using the following question: “Have you ever heard of the hepatitis C virus (also known as Hep C or HCV)?” We estimated frequencies by demographic groups and computed risk differences (RDs) with 95% confidence intervals (CIs) to compare lack of HCV awareness by age (<55 and ≥55 years) and race/ethnicity.

Results

Overall, 17% of adults never heard of HCV. Younger adults (<55 years; 21%) were more likely to have never heard of HCV compared with older adults (≥55 years; 12%; χ2
P < 0.001). This observation was consistent across most demographic characteristics including, racial/ethnic categories, and residing in the Southern United States. More than one-third of adults with low English fluency had a lack of HCV awareness in both age groups (χ2
P = 0.537). Non-Hispanic (NH) Asian (RD, 25%; 95% CI, 6.9%–43.3%) and Hispanic (RD, 10%; 95% CI, 0.01%–19.6%) adults younger than 55 years were significantly more likely to have never heard of HCV compared with their NH White counterparts after adjustment for sex, educational level, household income, English fluency, and having a regular provider. Adults younger than 55 years with a lack of HCV awareness commonly obtained their health information from the Internet across most sociodemographic characteristics.

Conclusions

Hispanic and NH Asian young adults should be targeted for public health messaging regarding HCV screening, potentially through social media campaigns.
Availability of Sexually Transmitted Disease and HIV Clinical Services: Ending the HIV Epidemic Versus Non–Ending the HIV Epidemic Jurisdictions, 2018
Authors: Leichliter Jami S. , Cuffe Kendra M. , Kelley Kathleen R. , Gift Thomas L.
Published: May 2021

We assessed sexually transmitted disease/human immunodeficiency virus (HIV) service availability at the primary sexually transmitted disease safety net clinic by phase I Ending the HIV Epidemic jurisdiction status. HIV testing was >90%. In Ending the HIV Epidemic jurisdictions, 22% of primary safety net clinics initiated and/or provided preexposure prophylaxis (PrEP), 46.6% provided PrEP education or referral only, and 29.9% did not provide any PrEP services.
Community-Based Prevalence Estimates of Chlamydia trachomatis and Neisseria gonorrhoeae Infections Among Gay, Bisexual, and Other Men Who Have Sex With Men in Montréal, Canada
Authors: Harvey-Lavoie Simonne , Apelian Herak , Labbé Annie-Claude , Cox Joseph , Messier-Peet Marc , Moodie Erica E. M. , Fourmigue Alain , Moore David , Lachowsky Nathan J. , Grace Daniel , Hart Trevor A. , Jollimore Jody , Fortin Claude , Lambert Gilles
Published: May 2021

Background

Reported cases of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are increasing among Canadian men. Estimates of community-based CT/NG prevalence are lacking among gay, bisexual, and other men who have sex with men (GBM).

Methods

Respondent driven sampling was used to recruit GBM in Montréal, Canada between February 2017 and June 2018. Specimens provided from urogenital, rectal, and pharyngeal sites were analyzed using nucleic acid amplification test to detect CT/NG. Prevalence estimates of CT/NG, overall and by anatomical site were calculated. All estimates are respondent-driven sampling–adjusted.

Results

Among 1177 GBM, the prevalence of rectal, urogenital, pharyngeal and overall were respectively 2.4%, 0.4%, 0.4%, and 2.8% for CT infections, and 3.1%, 0.4%, 3.5%, and 5.6% for NG infections. If testing had been limited to the urogenital site, 80% and 94% of CT and NG infections, respectively, would have been missed.

Conclusions

This community-based study among GBM shows that the CT prevalence was about half of that observed for NG. A large part of CT/NG infections involves only the extragenital sites, highlighting the need for systematic multisite screening regardless of symptoms. In the mist of the COVID-19 pandemic and the limited CT/NG screening capacity due to test kits shortage, it might be considered to prioritize rectal and pharyngeal CT/NG testing over urogenital testing in asymptomatic GBM.
Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Black Americans With HIV-1: A Randomized Phase 3b, Multicenter, Open-Label Study
Authors: Hagins Debbie , Kumar Princy , Saag Michael , Wurapa Anson K. , Brar Indira , Berger Daniel , Osiyemi Olayemi , Hileman Corrilynn O. , Ramgopal Moti N. , McDonald Cheryl , Blair Christiana , Andreatta Kristen , Collins Sean E. , Brainard Diana M. , Martin Hal ,   on behalf of the BRAAVE2020 Investigators
Published: May 2021

Background:

With the highest rates of HIV/AIDS in the United States, Black Americans are still underrepresented in HIV medical research.

Setting:

BRAAVE (NCT03631732) is a randomized, phase 3b, multicenter, open-label US study.

Methods:

Adults identifying as Black or African American and virologically suppressed on 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus third agent were randomized (2:1) to switch to open-label bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) once daily or stay on baseline regimen (SBR) for 24 weeks, after which SBR had delayed switch to B/F/TAF. Resistance to non-NRTIs, protease inhibitors, and/or NRTIs was permitted; integrase strand transfer inhibitor resistance was exclusionary. Primary endpoint was proportion of participants with HIV-1 RNA ≥50 copies/mL at week 24 (snapshot algorithm; noninferiority margin of 6%).

Results:

Of 558 screened, 495 were randomized/treated (B/F/TAF n = 330; SBR n = 165). Overall, 32% were ciswomen, 2% transwomen, and 10% had an M184V/I mutation. At week 24, 0.6% on B/F/TAF vs 1.8% on SBR had HIV-1 RNA ≥50 copies/mL (difference −1.2%; 95% confidence interval −4.8% to 0.9%), demonstrating noninferiority of B/F/TAF vs SBR. Proportions with HIV-1 RNA <50 copies/mL at week 24 were 96% B/F/TAF and 95% SBR and remained high at week 48. No participant had treatment-emergent resistance to study drug. Treatments were well tolerated. Study drug-related adverse events, mostly grade 1, occurred in 10% of participants on B/F/TAF through week 48 and led to discontinuation in 9 participants through week 48.

Conclusions:

For Black Americans with HIV, switching to B/F/TAF was noninferior to continuing a variety of regimens, including those with pre-existing NRTI mutations.
Positive Somatostatin Receptor Expression Demonstrated on 68Ga-NODAGA-LM3 PET/CT in a Neuroendocrine Tumor Patient With Negative Immunohistochemical Staining
Authors: Zhu Wenjia , Liu Rongrui , Zhao Lin , Huo Li
Published: May 2021

We present a case with pulmonary atypical carcinoid and multiple hepatic metastases. Immunohistochemical staining of liver biopsy sample was negative for somatostatin receptor subtype 2, but 68Ga-NODAGA-LM3 PET/CT scan revealed multiple positive lesions. The mismatch was actually caused by heterogeneous expression of somatostatin receptor in liver lesions.
Prognostic Value of 18F-FDG PET in Neuroendocrine Neoplasm
Authors: Han Sangwon , Lee Hyo Sang , Woo Sungmin , Kim Tae-Hyung , Yoo Changhoon , Ryoo Baek-Yeol , Ryu Jin-Sook
Published: May 2021

Objectives

Accurate assessment of the prognosis is critical for the rational treatment of neuroendocrine neoplasms (NENs). We performed a systematic review and meta-analysis of the prognostic value of 18F-FDG PET for NENs.

Patients and Methods

PubMed and Embase databases were searched up to September 2020 for studies that evaluated 18F-FDG PET as prognostic factors in patients with NENs with overall survival (OS) and event-free survival (EFS) as outcomes. Hazards ratios (HRs) comparing high and low FDG uptakes were pooled using the DerSimonian-Laird method. Publication bias was assessed and adjusted for using the trim-and-fill method. Metaregression and subgroup analyses were performed to explore the cause of heterogeneity.

Results

Twenty-three studies (1799 patients) were included. The overall pooled HRs of high FDG uptake on EFS and OS were 2.84 (95% confidence interval [CI], 2.21–3.64) and 3.50 (95% CI, 2.42–4.12), respectively. Publication biases were present regarding both EFS and OS (P = 0.0342 and 0.0009, respectively). After adjustment, effect sizes remained significant for EFS and OS (adjusted HR, 2.26 [95% CI, 1.76–2.89]; 3.16 [95% CI, 2.42–4.12]). In metaregression analyses, the proportion of grade 3 tumors positively correlated with the HR of OS (adjusted P = 0.0422).

Conclusions

18F-FDG PET is a significant prognostic factor in patients with NENs. 18F-FDG PET might be a useful prognostic biomarker in conjunction with the histologic grade and can help select the optimal treatment.
Incidental Finding of Hibernoma in Prostate-Specific Membrane Antigen PET/CT
Authors: Moreau Aurélie , Cruel Thierry , Giraudet Anne Laure , Derolland Philippe , Kryza David
Published: May 2021

We reported the case of a 76-year-old man followed up since 2008 for a prostatic adenocarcinoma with pelvic and retroperitoneal nodes. He was initially treated by hormonotherapy with a good biological response. Twelve years after, he demonstrated an increased PSA level up to 10.2 ng/mL. He underwent a 68Ga-PSMA PET/CT, which shown an intense uptake by a left iliac extern mass, suspected of recurrence. The histology concluded in a hibernoma.
Constellation of Von Hippel–Lindau Disease–Related Findings on a 68Ga-DOTATATE PET/CT
Authors: Marcus Charles , John Priya Dayamani , Giles Monica , Sethi Ila
Published: May 2021

Von Hippel–Lindau (VHL) is a rare predominantly hereditary syndrome characterized by multiple benign and malignant tumors that can affect different organ systems. We present representative images of a 68Ga-DOTATATE PET/CT in a patient with confirmed VHL gene mutation, which demonstrates a constellation of findings commonly seen in these patients in one single imaging modality.
COVID-19 Lung Findings Detected by 68Ga-PSMA PET/CT for Staging Purposes in Patients With Prostate Cancer
Authors: Karasah Erkek Burcin , Ömür Özgür , Özkök Serdar , Turna Burak
Published: May 2021

We report 3 patients with COVID-19 findings in 68Ga-PSMA PET/CT taken for staging. The first patient, A 64-year-old man with prostate cancer, who had COVID-19 in November 2020 and whose treatment was completed, was observed to continue with COVID-19 findings in 68Ga-PSMA PET/CT in December 2020 before surgery. Other patients were asymptomatic for the disease. It was determined that a PSMA uptake in the lungs corresponding to the CT findings of COVID-19 had increased in 68Ga-PSMA PET/CT.
COVID Lessons Continue
Authors: Shah Hina J. , Halpern Jason I. , Watane Gaurav V. , Hyun Hyewon
Published: May 2021

COVID vaccination has begun in most of the countries. Older population and high-risk groups are prioritized for vaccination. Postvaccination imaging in cancer patients may show effects of the immune response to the vaccine. As such, it is important to know the timing and laterality of the vaccination as the reactive lymph nodes in the ipsilateral axilla can be seen on the imaging. We present a case of DOTATATE-avid nonpathologically enlarged lymph nodes in ipsilateral axilla and linear tracer uptake in the deltoid muscle on a patient imaged for a recent diagnosis of rectal neuroendocrine neoplasm.
The Effect of Topical Tacrolimus on Pedicled Flap Survival
Authors: Wald Gal , Van Y-Vu , Towne William , Otterburn David M.
Published: May 2021

Purpose

Our previous rodent study demonstrated significantly decreased full-thickness necrosis in pedicled dorsal skin flaps with topical tacrolimus as compared with petroleum jelly. The pathophysiology of tissue necrosis involves lymphatic congestion, followed by venous congestion and ultimately arterial insufficiency. Topical tacrolimus has been shown to increase growth of lymphatic collateral vessels and decrease lymphedema, potentially obviating one contributor to necrosis. The purpose of this study was to investigate the vascular and histological differences between these 2 groups to identify the etiology of our research findings.

Methods

A 3 × 10-cm cranially based dorsal skin flap was raised and reinset on 22 Sprague Dawley rats. They were randomized to receive 0.2 g of either topical petroleum jelly or topical 0.1% tacrolimus ointment daily to the flaps. The rats were killed 7 days postoperatively. Two blinded reviewers marked the total flap area as well as areas of viable tissue, reversible ischemia, and necrotic tissue. Full-thickness biopsies of each area were taken from 2 randomly chosen animals in each group. Paraffin-embedded tissue was sectioned to generate hematoxylin and eosin–stained slides. Representative images of each area of the flap were taken less than 40× magnification using light microscopy. Arteries, veins, and lymphatics in the dermal layer were quantified under blinded conditions by a trained pathologist and calculated per cross-sectional area using Fiji software.

Results

The average area of the dorsal flaps in the control and tacrolimus groups was 22.5 and 23.9 cm2, respectively. Total necrotic area was significantly lower in rats receiving topical tacrolimus as compared with controls (P = 0.015). In the control cohort, average total number of vessels was 12.5, 6, and 0, in the areas of viable tissue, reversible ischemia, and necrosis, respectively. In the tacrolimus cohort, average total number of vessels increased was 20, 11.5, and 5.4, in the areas of viable tissue, reversible ischemia, and necrosis, respectively.

Conclusions

On a histological level, topical tacrolimus is correlated with increased vascular growth in areas most susceptible for ischemic damage as compared with topical control. Future work is needed to investigate vascular biomarkers and increase the power of our study.
Does E-learning Improve Plastic Surgery Education?
Authors: Lin Ines C. , Lee Alfred , Mauch Jaclyn T.
Published: May 2021

Purpose

E-learning is rapidly growing in medical education, overcoming physical, geographic, and time-related barriers to students. This article critically evaluates the existing research on e-learning in plastic surgery.

Methods

A systematic review of e-learning in plastic surgery was conducted using the PubMed/MEDLINE, Scopus, and Embase databases. Studies were limited to those written in English and published after 1995 and excluded short communications, letters to the editor, and articles focused on in-person simulation.

Results

A total of 23 articles were identified. Represented subspecialties include breast, burns, craniofacial/pediatrics, hand, and microsurgery. Most e-learning resources target surgeons and trainees, but a small number are for patients, parents, and referring physicians. Users reported high levels of satisfaction with e-learning and significant gains in knowledge after completion, although there may be more variable satisfaction with teaching technical skills. Two studies showed no differences in knowledge gains from e-learning compared with traditional learning methods. Subgroup analysis showed greater benefit of e-learning for novice learners when evaluated. Surveys of plastic surgeons and trainees showed high interest in and growing utilization of e-learning.

Conclusions

Research in plastic surgery e-learning shows high user satisfaction and overall improvements in learning outcomes with knowledge gains equivalent to traditional teaching methods and greater benefit in novice learners. Thus, e-learning can serve an important role in plastic surgery education, especially in the current state of social distancing. Future work should aim to define learner preferences and educational needs and better establish how e-learning can augment plastic surgical education, particularly among other teaching methods.
Effects of Tissue-engineered Bone by Coculture of Adipose-derived Stem Cells and Vascular Endothelial Cells on Host Immune Status
Authors: Wang Fuke , Yang Guiran , Xiao Yu , He Chuan , Cai Guofeng , Song En , Li Yanlin
Published: May 2021

Aim

The study aimed to explore the effects of tissue-engineered bone constructed with partially deproteinized biologic bone (PDPBB) and coculture of adipose-derived stem cells (ADSCs) and vascular endothelial cells (VECs) on host immune status, providing a very useful clue for the future development of bone engineering.

Methods

Tissue-engineered bones constructed by PDPBB and ADSCs, VECs or coculture of them were implanted into the muscle bag of bilateral femurs of Sprague-Dawley rats. Partially deproteinized biologic bone alone and blank control were also implanted. After transplantation, the proliferation of implanted seed cells in tissue-engineered bones was labeled by bromodeoxyuridine staining. Moreover, the changes of T-lymphocyte subpopulations, including CD3 + CD4+ and CD3 + CD8+ in peripheral blood were then detected using flow cytometry to analyze the immune rejection of tissue-engineered bone implantation based on peripheral blood CD4/CD8 ratios.

Results

After transplantation, the proliferation of implanted seed cells was observed in tissue-engineered bones of different groups. At different time points after transplantation, the CD4+/CD8+ ratio in peripheral blood of PDPBB + ADSCs, PDPBB + coculture, and blank control groups did not exhibit significant change. Although the CD4+/CD8+ ratio in peripheral blood of PDPBB + VECs group was significantly higher than other group at 1 week after transplantation, that of PDPBB + VECs and PDPBB + coculture group was significantly decreased at 8 week after transplantation compared with that of blank control group.

Conclusions

Our results indicated that there was no significant immune rejection after transplantation of tissue-engineered bone constructed with PDPBB and coculture of ADSCs and VECs as seed cells.
Split Pectoralis Muscle Patch
Authors: Epps Mathew T. , Codner Mark A.
Published: May 2021

Prepectoral implant-based breast reconstruction after mastectomy is a safe and reliable surgical option to restore aesthetic contour. Perioperative radiation therapy lends a morbidity to the integrity of the thin-walled mastectomy construct. Wound complications may result in implant exposure, which is potentially devastating to the reconstructed breast. Salvage often leads to implant explantation with the subsequent need for autogenous tissue grafts. Such rotational and free flap procedures result in prolonged operative times and inpatient length of stay, as well as donor site morbidity. Here we present a technique that utilizes a pedicled split pectoralis muscle flap as an internally rotated breast envelope patch to buttress a mastectomy flap repair during salvage of the prepectoral breast envelope when full-thickness tissue defect is present.
The Content of US Plastic Surgery Private Practices' Websites
Authors: Ananthasekar Shivani , Patel Jason J. , Patel Neha J. , Awad Shadi K. , Boyd Carter J. , King Timothy W.
Published: May 2021

Introduction

Connecting patients with healthcare providers continues to grow as the digital era evolves. A successful website has the power to influence patients on choosing a practice and provider. The objectives of this study were to characterize information provided on private practice websites of plastics surgeons in the United States and to assess the relationship among the websites based on the number of years that the physicians have been in practice.

Methods

Newly board-certified plastic surgeons by the American Board of Plastic Surgery in 2005, 2010, and 2015 were identified. A Google search was conducted on all participants, and only those in private practice were included in this study. Each webpage was quantitatively and qualitatively assessed for the presence or absence of 23 criteria that were categorized as practice, physician, patient, or procedure information. χ2 was used for statistical analysis using Microsoft Excel (PSPP 1.2.0). A P value of less than 0.05 was considered statistically significant.

Results

Most plastic surgeons in each cohort were currently in private practice. A total of 532 plastic surgery private practice websites were analyzed. The data points found on 100% of the websites were directions to the facility and the contact for any billing questions. Most websites provided information on the practice and its surgeons. The most common web-based data points included online consultations and links to their social media. Information on expenses incurred by patients, such as cancellation policies and consultation fees, was least commonly listed.

Conclusions

Our study shows that the number of years in practice is not associated with comprehensiveness of their website's content. This study provides insight into the content of plastic surgery private practices' websites in the United States in relation to the practice, the physician, the patient, and the procedures. This information may be useful for expanding and optimizing their websites. This has the potential to increase patient satisfaction and visibility of the practice. The success of these businesses is vital as the private sector in plastic surgery continues to grow.
Flap Reconstruction for Treatment of Pediatric Linear Scleroderma
Authors: Yan Maria , Stans Anthony A. , Moran Steven L.
Published: May 2021

Background

Linear scleroderma is a rare connective tissue disease characterized by thickening of the skin due to excess collagen deposit. It is the most frequent type of localized scleroderma in the pediatric population (40%–70%), and it usually affects the extremities and head. Linear scleroderma can cause growth disturbances, extremity length discrepancy, and debilitating joint contractures. The aim of this study was to describe the surgical outcomes of microsurgical flap reconstruction of linear scleroderma in the pediatric population.

Methods

A retrospective review of all children with linear scleroderma was performed at our institution. Patients less than 18 years of age with clinical diagnosis of linear scleroderma and who underwent microsurgical flap reconstruction for correction of their scleroderma were included. Fat grafting procedures were excluded. Patient demographics and surgical outcomes were collected.

Results

A total 7 patients underwent microsurgical flap reconstruction for treatment of their linear scleroderma producing debilitating soft tissue contractures and preventing ambulation or elbow extension. Six patients had scleroderma involving the lower extremity and 1 involving the upper extremity. Three anterolateral thigh and 4 latissimus dorsi flaps were performed. The median age at surgery was 7 years (Q1–Q3, 5–11), and the median body mass index was 21.3 kg/m2 (Q1–Q3, 16.5–22.1). The median follow-up was 121.1 months (Q1–Q3, 43.2–187.4). All flaps survived, and no donor site complications were reported. Perioperative complications included wound infection that required debridement (n = 1), immediate postoperative bleeding requiring surgical intervention (n = 1), intraoperative venous congestion (n = 1), and scleroderma recurrence outside the flap (n = 2). When comparing anterolateral thigh and latissimus dorsi flaps, there was no statistically significant difference in the development of surgical complications, number of surgical revisions per patient [median, 4 (Q1–Q3, 4–7) vs 2.5 (Q1–Q3, 1.3, 3), P = 0.0916], or unplanned surgical interventions [median, 0 (Q1–Q3, 0–1) vs 1 (Q1–Q3, 0–1), P = 0.7228]. The reconstruction was successful in improving range of motion in 6 patients, 5 of which reached full weight-bearing. However, all patients had residual limb deformity, and 4 had remaining extremity length discrepancy.

Conclusions

Microsurgical flaps are a good option for functional improvement of severe pediatric linear scleroderma affecting the extremities. However, residual limb deformity is common, and patients are often required to undergo additional surgical revisions.
Lop Ear to Conchal Microtia
Authors: Lese Ioana , Aldabbas Mohammed , Mazeed Ahmed S. , Bulstrode Neil W.
Published: May 2021

Background

The lop ear deformity is defined by a deficient helix and scapha, underdeveloped anthelix, and downfolding of the helix. The terminology used is still confusing, and the treatment is not entirely structured. The aim of this study was to provide a new systematic surgical approach of this deformity based on our center's experience.

Materials and Methods

All patients undergoing surgical correction of lop ears between 2007 and 2019 at Great Ormond Street Hospital were included. Patients' data, surgical techniques, and postoperative complications were recorded.

Results

Based on our records, we identified 3 surgical techniques for the correction of lop ears, based on the degree of deformity encountered. In a mild lop ear, correction was achieved with a modified otoplasty technique by improving the definition of the antihelix and superior crus. In a moderate deformity, additional remodeling of the lidded helix was performed (extended otoplasty), whereas for the severe lop ear, the amount of cupping and the deficient cartilage required formal reconstruction using a carved rib cartilage framework. There were a total of 109 patients and 146 lop ears: 58 mild, 27 moderate, and 61 severe lop ears.

Conclusion

We feel that there is a point in the spectrum of congenital ear deformity when a severe lop ear becomes a conchal microtia and recommend this approach to simplify the management of these cases. This is intended to bring greater clarity to how to deal with lop ears, based on the severity of the deformity and the surgical techniques used.
Prominent Ear Correction Using Full-Thickness Cartilage Strip
Authors: Elmelegy Nader Gomaa
Published: May 2021

Background

Prominent ears are one of the most well-known facial disfigurements influencing youngsters. Approximately 5% of the population suffers from some degree of ear prominence. More than 200 techniques have been used for the surgical correction of prominent ears, referring that no single “best” method exists and that techniques and modifications will continue to appear.

Objectives

In this work, we are going to evaluate the results of using a full-thickness cartilage strip, an incomplete cutting technique for the correction of various degrees of the prominent ear.

Patients and Methods

This prospective controlled clinical trial was carried out on a sum of 63 patients, who presented with prominent ear deformity, in the period between March 2014 and January 2020 at the plastic and reconstructive surgery department, Tanta University Hospitals, and private clinic.

Results

Sixty-three patients were operated upon, 46 were males and 17 were females, their age ranged between 4 and 23 years, and their mean age was 9.7 years. Clinical results showed excellent results in 37 patients (58.7%), good results in 18 patients (28. 6%), fair results in 8 patients (12.7%), and no poor results. Patient satisfaction showed excellent results in 32 patients (50.8%), good results in 22 patients (34.9%), fair results in 9 patients (14.3%), and no poor results.

Conclusions

Prominent ear correction using full-thickness cartilage strip, an incomplete cutting technique, is a good technique. It can be used in the correction of different varieties of prominent ears. It has a very low incidence of complications. No hypertrophic or keloidal scars have been reported.
Lateral Nasal Artery Perforator Flap for Nasal Reconstruction
Authors: Abe Yoshiro , Ishida Soushi , Mineda Kazuhide , Yamashita Yutaro , Nagasaka Shinji , Yamasaki Hiroyuki , Hashimoto Ichiro
Published: May 2021

Background

Nasal reconstruction is challenging because of the difficulty in balancing superior aesthetic outcomes and less invasive surgery. The use of the lateral nasal artery (LNA) perforator flap has been reported for nasal reconstruction. However, few reports have described appropriate applications of nasal reconstruction and assessments of nasal deformity. This study aimed to quantify the aesthetic outcomes on using this flap and reveal the risk factors associated with nasal deformities.

Methods

Twenty patients underwent nasal reconstruction using the LNA flap with a cranial perforator adjacent to the nasal defect. Postoperative protuberant deformities were scored by 2 independent plastic surgeons using a 5-point Likert scale and classified as excellent, good, or poor. The risk factors of deformities were identified using univariate analyses. A nasal alar deviation index was developed to analyze correlations with flap harvesting. The sensory function was assessed by the Semmes-Weinstein test.

Results

Flaps survived in 19 patients (95%), and 1 flap showed distal necrosis. All arterial perforators used remained within 5 mm lateral to the boundary between the cheek and nasal ala. The flaps were most often used to cover 2 subunits, including the nasal sidewall defects. Protuberant deformities in 6 (30%), 8 (40%), and 6 (30%) patients were classified as excellent, good, and poor, respectively. Nasal defects involving more than 3 subunits caused severe protuberant deformity. Only 2 patients (5%) in the good and fair groups underwent additional debulking surgery. Nasal alar deviation was not significantly correlated with flap harvesting, when the nasal alar deviation index before and after surgery were compared. Sensory function was retained in all patients.

Conclusions

Aesthetic outcomes and sensory function were good on using the LNA perforator flap as a propeller flap having a wide arc of rotation. This flap is suitable for nasal reconstruction involving less than 2 nasal subunits without any severe nasal alar deviation deformity. In addition, this flap allows for better outcomes because it requires less invasive 1-stage surgery.
Clinical Effect of the Anterior Fascia of Tarsus Tightening Combined With Lower Eyelid Blepharoplasty for Senile Entropion
Authors: Tan Nian , Wang Zhiqiang , Ren Huanhuan , Ye Jian
Published: May 2021

Objective

A majority of patients with senile entropion have a lower eyelid pouch. This study aimed to explore a modified method to correct the entropion and enhance ophthalmic cosmetology.

Patients and Methods

Patients with senile entropion and lower eyelid pouches, who underwent anterior fascia of tarsus tightening combined with lower eyelid pouch plastic surgery from 2018 to 2019, were enrolled in the study. The data on operation time, postoperative effect, degree of eyelid swelling after surgery, patient satisfaction, and recurrence rate were recorded.

Results

The lower eyelid entropion was well corrected in all of the 46 patients after the surgery, and the lower eyelid pouch and saggy skin were satisfactorily repaired. After 1-year follow-up, no recurrence of lower eyelid eversion and ectropion was observed. The shape of the orbital areas was natural in all the patients, the incision scar was hidden, and the patient achieved a high degree of satisfaction.

Conclusions

In patients with senile entropion and lower eyelid pouch, anterior tarsal fascia tightening combined with lower eyelid blepharoplasty could not only increase the cure rate and reduce the recurrence rate but also achieve good appearance and improve patient satisfaction.
Routine Postsurgical Anesthesia Visit to Improve 30-day Morbidity and Mortality
Authors:   The TRACE Study Investigators
Published: May 2021

Objective:

To study the impact of a standardized postoperative anesthesia visit on 30-day mortality in medium to high-risk elective surgical patients.

Background:

Postoperative complications are the leading cause of perioperative morbidity and mortality. Although modified early warning scores (MEWS) were instituted to monitor vital functions and improve postoperative outcome, we hypothesized that complementary anesthesia expertise is needed to adequately identify early deterioration.

Methods:

In a prospective, multicenter, stepped-wedge cluster randomized interventional study in 9 academic and nonacademic hospitals in the Netherlands, we studied the impact of adding standardized postoperative anesthesia visits on day 1 and 3 to routine use of MEWS in 5473 patients undergoing elective noncardiac surgery. Primary outcome was 30-day mortality. Secondary outcomes included: incidence of postoperative complications, length of hospital stay, and intensive care unit admission.

Results:

Patients were enrolled between October 2016 and August 2018. Informed consent was obtained from 5473 patients of which 5190 were eligible for statistical analyses, 2490 in the control and 2700 in the intervention group. Thirty-day mortality was 0.56% (n = 14) in the control and 0.44% (n = 12) in the intervention group (odds ratio 0.74, 95% Confidence interval 0.34–1.62). Incidence of postoperative complications did not differ between groups except for renal complications which was higher in the control group (1.7% (n = 41) vs 1.0% (n = 27), P = 0.014). Median length of hospital stay did not differ significantly between groups. During the postanesthesia visits, for 16% (n = 437) and 11% (n = 293) of patients recommendations were given on day 1 and 3, respectively, of which 67% (n = 293) and 69% (n = 202) were followed up.

Conclusions:

The combination of MEWS and a postoperative anesthesia visit did not reduce 30-day mortality. Whether a postoperative anesthesia visit with strong adherence to the recommendations provided and in a high-risk population might have a stronger impact on postoperative mortality remains to be determined.

Trial Registration:

Netherlands Trial Registration, NTR5506/ NL5249, https://www.trialregister.nl/trial/5249.
Immunogenicity and Reactogenicity After SARS-CoV-2 mRNA Vaccination in Kidney Transplant Recipients Taking Belatacept
Authors: Ou Michael T. , Boyarsky Brian J. , Chiang Teresa P.Y. , Bae Sunjae , Werbel William A. , Avery Robin K. , Tobian Aaron A.R. , Massie Allan B. , Segev Dorry L. , Garonzik-Wang Jacqueline M.
Published: May 2021

Background.

Belatacept may impair humoral immunity, impacting the effectiveness of SARS-CoV-2 mRNA vaccines in transplant recipients. We investigated immunogenicity after SARS-CoV-2 mRNA vaccines in kidney transplant recipients who are and are not taking belatacept.

Methods.

Participants were recruited between December 9, 2020, and April 1, 2021. Blood samples were collected after dose 1 and dose 2 (D1, D2) and analyzed using either an anti-SARS-CoV-2 enzyme immunoassay against the S1 domain of the SARS-CoV-2 spike protein or immunoassay against the receptor-binding domain of the SARS-CoV-2 spike protein. Stabilized inverse probability of treatment weights was used to compare immunogenicity, and a weighted logistics regression was used to calculate fold change of positive response.

Results.

Among the 609 participants studied, 24 (4%) were taking belatacept. After dose 1, 0/24 (0%) belatacept patients had detectable antibodies, compared with 77 of 568 (14%) among the equivalent nonbelatacept population (P = 0.06). After dose 2, 1/19 (5%) belatacept patients had detectable antibodies, compared with 190/381 (50%) among the equivalent nonbelatacept population (P < 0.001). Belatacept use was associated with 16.7-fold lower odds of having a positive post-D2 titer result (P < 0.01).

Conclusions.

Additional measures need to be explored to protect kidney transplant recipients taking belatacept. Best safety practices should be continued despite vaccination among this population.
Topics in the mathematical design of materials
Authors: Chen Xian , Fonseca Irene , Ravnik Miha , Slastikov Valeriy , Zannoni Claudio , Zarnescu Arghir
Published: May 2021

We present a perspective on several current research directions relevant to the mathematical design of new materials. We discuss: (i) design problems for phase-transforming and shape-morphing materials, (ii) epitaxy as an approach of central importance in the design of advanced semiconductor materials, (iii) selected design problems in soft matter, (iv) mathematical problems in magnetic materials, (v) some open problems in liquid crystals and soft materials and (vi) mathematical problems on liquid crystal colloids. The presentation combines topics from soft and hard condensed matter, with specific focus on those design themes where mathematical approaches could possibly lead to exciting progress.

This article is part of the theme issue ‘Topics in mathematical design of complex materials’.
Quantitative analysis of compatible microstructure by electron backscatter diffraction
Authors: Chapman Michael , De Graef Marc , James Richard D. , Chen Xian
Published: May 2021

We propose a scheme for assigning the martensite variant using electron backscatter diffraction in a martensite material that undergoes a solid–solid phase transformation. Based on the solutions of the crystallographic equations of martensite, we provide an algorithm to assign martensite variants to a particular microscopic region, and to check the elastic compatibility of the microstructure corresponding to low hysteresis and high reversibility in shape memory alloys.

This article is part of the theme issue ‘Topics in mathematical design of complex materials’.
Leveraging Northern European population history; novel low frequency variants for polycystic ovary syndrome
Authors: Tyrmi Jaakko S. , Arffman Riikka K. , Pujol-Gualdo Natàlia , Kurra Venla , Morin-Papunen Laure , Sliz Eeva , FinnGen  ,   Estonian Biobank Research Team, Piltonen Terhi T. , Laisk Triin , Kettunen Johannes , Laivuori Hannele
Published: May 2021

Background

Polycystic ovary syndrome (PCOS) is a common, complex disorder, which should be recognized as a prominent health concern also outside the context of fertility. Although PCOS affects up to 18% of women worldwide, its etiology remains poorly understood. It is likely that a combination of genetic and environmental factors contributes to the risk of PCOS development. Whilst previous genome-wide association studies have mapped several loci associated with PCOS, analysis of populations with unique population history and genetic makeup has the potential to uncover new low frequency variants with larger effects. In this study, we leverage genetic information of two neighboring and well-characterized populations in Europe – Finnish and Estonian – to provide a basis for a new understanding of the genetic determinants of PCOS.

Methods and Findings

We conducted a three-stage case-control genome-wide association study (GWAS). In the discovery phase, we performed a GWAS comprising of a total of 797 cases and 140,558 controls from the FinnGen study. For validation, we used an independent dataset from the Estonian Biobank, including 2,812 cases and 89,230 controls. Finally, we conducted a joint meta-analysis of 3,609 cases and 229,788 controls from both cohorts.

In total, we identified three novel genome-wide significant variants associating with PCOS. Two of these novel variants, rs145598156 (p=3.6 × 10−8, OR=3.01 [2.02-4.50] MAF=0.005) and rs182075939 (p=1.9 × 10−16, OR= 1.69 [1.49-1.91], MAF=0.04), were found to be enriched in the Finnish and Estonian populations and are tightly linked to a deletion c.1100delC (r2= 0.95) and a missense I157T (r2=0.83) in CHEK2. The third novel association is a common variant near MYO10 (rs9312937, p= 1.7 × 10−8, OR=1.16 (1.10-1.23), MAF=0.44). We also replicated four previous reported associations near the genes ERBB4, DENND1A, FSHB and ZBTB16.

Conclusions

We identified three novel variants for PCOS in a Finnish-Estonian GWAS. Using isolated populations to perform genetic association studies provides a useful resource to identify rare variants contributing to the genetic landscape of complex diseases such as PCOS.
Lockdown babies- Birth and new parenting experiences during the 2020 Covid-19 lockdown in South Africa
Authors: Farley Elise , Edwards Amanda , Numanoglu Emma , Phillips Tamsin K.
Published: May 2021

Abstract

Background

Perceived birth experiences of parents can have a lasting impact on children. We explored the birth and new parenting experiences of South African parents during the Covid-19 lockdown.

Methods

We conducted an online cross-sectional survey with consenting parents of babies born in South Africa during 2020. Factors associated with negative birth emotions and probable depression were estimated using logistic regression.

Results

Most of the 520 respondents were females (n= 496, 95%) who gave birth at private hospitals (n=426, 86%). Mothers reported having overall positive birth emotions (n= 399, 80%). Multivariable analysis showed that having the baby during lockdown (adjusted odds ratio (aOR) 5.02; CI 1.28 – 19.66); being diagnosed with Covid-19 (aOR 3.17; CI 1.07 – 9.42); having negative new parenting emotions (aOR 6.07; CI 3.27 – 11.29); a preterm baby (aOR 3.02; CI 1.36 – 6.70) and lockdown related barring of preferred in hospital support (aOR 2.45; CI 1.35 – 4.43) were associated with mothers reporting predominately negative emotions about the birth. Having their chosen delivery method reduced the odds of negative birth emotions (aOR 0.4; CI 0.22 – 0.72). Multivariable analysis showed that having predominantly negative new parenting emotions (aOR 10.75; CI 5.41-21.37), breastfeeding struggles (aOR 2.16; CI 1.36 – 3.46); lockdown preventing health care access (aOR 2.06; CI 1.20 – 3.54) and creating financial strain (aOR 2.58; CI 1.08 – 6.18) were associated with probable minor depression

Conclusions

Lockdown exacerbated many birth and parenting challenges including mental health and health care access. However, overall experiences were positive and there was a strong sense of resilience amongst parents.
T Cell Positive B Cell Negative Flow Cytometry Crossmatch (FCXM): Frequency, HLA-Locus Specificity, and Mechanisms Among 3073 Clinical FCXM Tests
Authors: Putheti Prabhakar , Sharma Vijay K , Friedlander Rex , Menon Arvind , Dadhania Darshana , Muthukumar Thangamani , Suthanthiran Manikkam
Published: May 2021

Background

A T cell positive and B cell negative (T+B-) flow cytometry crossmatch (FCXM) result remains a conundrum since HLA-class I antigens are expressed on both T and B cells. We investigated the frequency, HLA specificity of the antibodies and mechanisms for the T+B- FCXM result.

Methods

We analyzed 3073 clinical FCXM tests performed in an American Society of Histocompatibility and Immunogenetics accredited histocompatibility laboratory. The sera associated with the T+B- FCXM were also tested for donor HLA IgG antibodies using LABScreen™ single antigen assays.

Results

Among the 3073 FCXM tests, 1963 were T-B-, 811 were T-B+, 274 were T+B+, and 25 were T+B-. IgG antibodies directed at donor HLA-A, B, or Cw locus determined antigens (DSA) were identified in all 25 sera and the summed mean fluorescence intensity (MFI) of DSA ranged from 212 to 53,187. Correlational analyses identified a significant association between the summed MFI of class I DSA, and the median channel fluorescence (MCF) of T cells treated with the recipient serum (Spearman rank correlation, rs=0.34, P=0.05) but not with the MCF of B cells (rs=0.23, P=0.24). We identified that differential binding of anti-HLA antibodies to T cells and B cells and the B cell channel shift threshold used to classify a B cell FCXM are potential contributors to a T+B- FCXM result.

Conclusions

Our analysis of 3073 FCXM, in addition to demonstrating that HLA antibodies directed at HLA-A, B or Cw locus are associated with a T+B- result, identified mechanisms for the surprising T+B- FCXM result.
The maladaptive vascular response in COVID-19 acute respiratory distress syndrome and recovery
Authors: Price David R. , Benedetti Elisa , Hoffman Katherine L. , Gomez-Escobar Luis , Alvarez-Mulett Sergio , Capili Allyson , Sarwath Hina , Parkhurst Christopher N. , Lafond Elyse , Weidman Karissa , Ravishankar Arjun , Cheong Jin Gyu , Batra Richa , Büyüközkan Mustafa , Chetnik Kelsey , Easthausen Imaani , Schenck Edward J. , Racanelli Alexandra C. , Reed Hasina Outtz , Laurence Jeffrey C. , Josefowicz Steven Zvi , Lief Lindsay , Choi Mary E. , Rafii Shahin , Schmidt Frank , Borczuk Alain C. , Krumsiek Jan , Choi Augustine M.K.
Published: May 2021

Vascular injury is a menacing element of acute respiratory distress syndrome (ARDS) pathogenesis. To better understand the role of vascular injury in COVID-19 ARDS, we used lung autopsy immunohistochemistry and blood proteomics from COVID-19 subjects at distinct timepoints in disease pathogenesis, including a hospitalized cohort at risk of ARDS development (“at risk”, N=59), an intensive care unit cohort with ARDS (“ARDS”, N=31), and a cohort recovering from ARDS (“recovery”, N=12). COVID-19 ARDS lung autopsy tissue revealed an association between vascular injury and platelet-rich microthrombi. This link guided the derivation of a protein signature in the at risk cohort characterized by lower expression of vascular proteins in subjects who died, an early signal of vascular limitation termed the maladaptive vascular response. These findings were replicated in COVID-19 ARDS subjects, as well as when bacterial and influenza ARDS patients (N=29) were considered, hinting at a common final pathway of vascular injury that is more disease (ARDS) then cause (COVID-19) specific, and may be related to vascular cell death. Among recovery subjects, our vascular signature identified patients with good functional recovery one year later. This vascular injury signature could be used to identify ARDS patients most likely to benefit from vascular targeted therapies.
Research priorities for lower limb amputation in patients with vascular disease
Authors: Bosanquet DC , Nandhra S , Wong KHF , Long J , Chetter I , Hinchliffe RJ
Published: May 2021

Introduction

Lower limb amputation is a life-changing event for patients and can be associated with high mortality and morbidity rates. Research into this critical part of vascular surgery is limited. The Vascular Society of Great Britain and Ireland (VSGBI) in partnership with the James Lind Alliance (JLA) process, aimed to identify and develop key research priorities for amputation.

Methods

A modified JLA Priority Setting Partnership was undertaken, encompassing all vascular practice. Two separate Delphi processes to identify research topics were undertaken with healthcare professionals, patients and carers, led by the VSGBI. The priorities were then ranked by the same participants and amalgamated to produce a list for final prioritisation. The final consensus meeting was attended by patients, carers and healthcare professionals from a variety of backgrounds involved in the care of people with amputation. Using a nominal group technique, the top ten research priorities were identified.

Results

A total of 481 clinicians submitted 1231 research questions relating to vascular surgery in general. 63 amputation-specific research questions were combined into 5 final clinical questions. 373 patients or carers submitted 582 research questions related to vascular surgery in general. Nine amputation-specific research questions were identified after combining similar questions. Amalgamating both the clinician and patient questions, 12 questions were discussed at the final prioritisation meeting and the top 10 identified. These related to amputation prevention, supporting rehabilitation, improving clinical outcomes following amputation (preventing/treating pain including phantom limb pain and improving wound healing) and research into information provision for patients undergoing amputation.

Conclusion

The top 10 research priority areas in vascular amputation provide guidance for researchers, clinicians, and funders on the direction of future research questions that are important to both healthcare professionals and patients.