bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiologic Evidence on the Role of Lactobacillus iners in Sexually Transmitted Infections and Bacterial Vaginosis: A Series of Systematic Reviews and Meta-Analyses
Authors: Carter Kayla A. , Fischer Molly D. , Petrova Mariya I. , Balkus Jennifer E.
Published: February 2023

Although Lactobacillus crispatus–dominated vaginal microbiotas are thought to protect against bacterial vaginosis (BV) and sexually transmitted infections, the role of Lactobacillus iners–dominated microbiotas is less clear. To better understand the impact of L. iners on common cervicovaginal infections, we conducted systematic reviews of the associations between L. iners compared with L. crispatus and 8 outcomes: Chlamydia trachomatis (Ct), BV, human papillomavirus, cervical dysplasia, human immunodeficiency virus, genital herpes, Trichomonas vaginalis, and Neisseria gonorrhoeae. On April 30, 2021, we searched PubMed, Embase, Cochrane Library, and Web of Science for epidemiologic studies of reproductive-age, nonpregnant, cisgender women that used marker gene sequencing to characterize vaginal microbiota composition and presented an effect estimate for the association between L. iners, compared with L. crispatus, and outcomes of interest. For outcomes with ≥3 eligible results presenting the same form of effect estimate, we conducted random-effects meta-analysis. The review protocol was registered prospectively (PROSPERO CRD42020214775). Six Ct studies were included in meta-analysis, which showed L. iners–dominated microbiotas were associated with 3.4-fold higher odds of Ct compared with L. crispatus–dominated microbiotas (95% confidence interval, 2.1–5.4). Three BV studies were included in meta-analysis, which indicated L. iners–dominated microbiotas were associated with 2.1-fold higher prevalence of BV compared with L. crispatus–dominated microbiotas (95% confidence interval, 0.9–4.9). Evidence was too sparse to perform meta-analysis for the remaining outcomes. L. iners–dominated vaginal microbiotas may be suboptimal compared with L. crispatus–dominated microbiotas for BV and Ct. These reviews highlight evidence gaps regarding the remaining outcomes and opportunities to improve epidemiologic rigor in vaginal microbiome science.
ROAR ED-SANE: A Retrospective Observational Assessment Review of an Emergency Department Sexual Assault Nurse Examiner Program's Adherence to Centers for Disease Control and Prevention Guidelines for Sexually Transmitted Infections
Authors: Nelson Jennifer M. , Woolever Nathan , Meyer Lisa , Hall Scott , Stakston Jaclyn , Dababneh Ala , Roush Kathleen , Van Sistine Michael , Tempelis Jennifer , Dierkhising Ross A. , Lessard Sarah
Published: February 2023

Background

Sexual assault survivors are at increased risk for sexually transmitted infections. Sexual Assault Nurse Examiner programs guide sexually transmitted infection treatment, monitoring, and follow-up scheduling according to guidelines by the Centers for Disease Control and Prevention (CDC). Reported low rates of provider adherence to CDC treatment guidelines and patient adherence to follow-up necessitate a review of medication prescribing and follow-up scheduling practices, especially at smaller community hospitals in the United States.

Methods

A retrospective medical record review was conducted to assess adherence rates to CDC guidelines for prescribing practices, scheduling, and follow-up of sexual assault survivors. We included pediatric and adult patients presenting to the emergency department (ED) and participating in the ED Sexual Assault Nurse Examiner program at a rural, community-based teaching hospital in La Crosse, WI, from January 2018 to December 2021. Descriptive statistics were used to evaluate results.

Results

Analysis included 103 patients. Prescribing adherence to CDC guidelines was >80% for all except human immunodeficiency virus (53.4%), trichomoniasis (68.1%), and hepatitis B (69%). Of the 38 patients who had a follow-up scheduled during their ED encounter, 78.9% attended their scheduled follow-up and 94.7% of those appointments were scheduled within the CDC-recommended time frame, leading to an overall adherence of 40%.

Conclusions

Adherence rates were high for most prescribing practices, and attendance of scheduled follow-up was higher than expected. Opportunities to improved adherence to CDC guidelines were identified in prescribing for 3 disease states (human immunodeficiency virus, trichomoniasis, and hepatitis B) and in scheduling of follow-up.
Knowledge on Chlamydia trachomatis and acceptance to testing for it among young students in China
Authors: Jiang Ting-Ting , Han Yan , Cao Ning-Xiao , Yin Yue-Ping , Chen Xiang-Sheng
Published: February 2023

Background

Actively screening for Chlamydia trachomatis (CT) is important for young people because of a high prevalence of asymptomatic infection in this population. This study aimed to investigate knowledge on CT and preference to the screening services for CT among young students in China.

Methods

From June to July 2022, a web-based questionnaire survey was conducted to collect information on socio-demographic characteristics, sexual behaviors, knowledge of CT, previous testing for CT, and preference to platform of testing for CT among Chinese young students. An online Home-Based Self-Sampling Test (HBSST) service was offered free of charge if the participant was willing to be tested for CT. Statistical analyses included descriptive analysis, chi-squared test, and multivariable logistic regression.

Results

Of 520 participants, 419 (80.6%) were aged between 16 and 24 years, 235 (45.2%) reported having sexual experience in the past, and 27 (5.2%) being tested before for CT. Slightly higher than 10% (57/520) of students were knowledgeable about CT. About one-third (36.9%) expressed their willingness to have a testing for CT but majority of them (63.1%) preferred to a free testing. Having sexual experience was significantly associated with the willingness to take the HBSST service (AOR 2.96, 95% CI 1.92-4.58). A total of 139 (26.7%) participants requested the HBSST service online and 43.2% (60/139) returned the specimen for testing, in which 2 positives (3.3%) were found.

Conclusions

The knowledge on CT and the previous uptake or current willingness to have a testing for CT was low among Chinese young students.
Meningococcus B Vaccination Effectiveness against Neisseria gonorrhoeae Infection in People Living with HIV: a Case-control Study
Authors: Raccagni Angelo Roberto , Galli Laura , Spagnuolo Vincenzo , Bruzzesi Elena , Muccini Camilla , Bossolasco Simona , Ranzenigo Martina , Gianotti Nicola , Lolatto Riccardo , Castagna Antonella , Nozza Silvia
Published: February 2023

Background

We assessed the vaccination effectiveness (VE) of multicomponent meningococcal serogroup B (4CMenB) vaccine against gonorrhoea among people living with HIV (PLWH) with a previous diagnosis of sexually transmitted infection (STI).

Methods

Unmatched case-control study on men who have sex with men (MSM) living with HIV, in care at San Raffaele Scientific Institute, Milan, Italy, with gonorrhoea, syphilis, chlamydia or anal HPV between July 2016 (beginning of 4CMenB vaccination) and February 2021 (date of freezing). For the analysis, cases were people with ≥1 gonorrhoea infection since July 2016 and controls were people with ≥1 syphilis, chlamydia, or anal HPV infection since July 2016. Logistic regression was used to provide the estimate of 4CMenB VE against gonorrhoea.

Results

Included PLWH were 1051 (103 cases, 948 controls); 349/1051 (33%) received two doses of 4CMenB vaccination. The median follow-up was 3.8 years (2.1-4.3). The unadjusted estimate for VE against gonorrhoea was 42% (95%CI 6-64; p = 0.027). Logistic regression showed that VE against gonorrhoea remained significant (44%, 95%CI 9-65; p = 0.020) after adjusting for some factors that might have a potential influence on VE or those with significant unbalanced distributions between cases and controls at univariable analysis.

Conclusions

4CMenB vaccination is associated with lower risk of gonorrhoea in the setting of MSM living with HIV with a previous STI.
Topical Review: Teaching Serious News Delivery in Eye Care
Authors: Spafford Marlee M. , Lawton Andrew J. , Flom Roanne E.
Published: February 2023

SIGNIFICANCE

Eye doctors regularly convey serious illness news to their patients. There is an evolving understanding of how medical educators can effectively teach this vital communication skill during real-time patient care. This article proposes teaching strategies to improve clinical optometric education related to serious illness conversations.

Effectively conveying serious illness news is an essential skill in optometry practice. Established protocols can help optometrists navigate these nuanced, emotional, and complex conversations with patients, yet protocols for teaching this skill in eye care settings have not been described. Clinical educators need discrete strategies for making such pivotal communication skills learnable in an environment where patient care, teaching priorities, and limited resources are regularly juggled. Despite the importance of this competency, limited study has focused on teaching optometry learners to deliver serious eye news. In this article, we explore the importance of optometry talk, serious news delivery tools, and considerations for optometric educators teaching serious news delivery. We then adapt specific strategies from medical education to help optometry educators teach serious news delivery in clinical settings.
Effect of Cognitive Mental Load on Attended and Nonattended Visual Stimuli
Authors: Mahjoob Monireh , Anderson Andrew J.
Published: February 2023

SIGNIFICANCE

In the real word, visual tasks may be concurrent with other activity that imposes mental load. Although the brain's capacity to process information is limited, attention can improve visual performance by selectively allocating processing resources. Therefore, measuring visual performance under such circumstances can reflect patients' vision more accurately.

PURPOSE

The aim of this study was to evaluate the effect of nonvisual task-induced mental load on visual performance at both attended and unattended locations in stimulus-driven captured attention.

METHODS

Visual function was measured with an orientation discrimination task for Gabor patches with contrasts of 10, 15, 30, 50, and 80%. Three attentional conditions (valid-cue, invalid-cue, and neutral-cue) were randomly interleaved within runs. To modulate mental load, the visual task was performed either with or without a simultaneous auditory n-back task (two-back for maximum mental load and zero-back to control for the effect of having to perform a simultaneous task).

RESULTS

Our result showed that the effect of mental load on correct responses was significant (P = .02). Correct responses decreased significantly during the two-back task when compared with the baseline condition (P = .03), but there was no significant difference between baseline and zero-back conditions (P = .06). The effect of attention and spatial frequencies on the percentage of correct responses was significant (P < .001). There was no significant interaction between mental load and spatial frequency, contrast level, or attention (P > .05).

CONCLUSIONS

Mental load had a similar decreasing effect on attended and unattended visual stimuli. This may be due to a generalized effect on processing resources upstream to where spatial attention is allocated.
Evaluation of Sirtuin1 Overexpression by Immunohistochemistry in Cervical Intraepithelial Lesions and Invasive Squamous Cell Carcinoma
Authors: Saffar Hana , Nili Fatemeh , Sarmadi Soheila , Barazandeh Elahe , Saffar Hiva
Published: February 2023

Cervical cancer is one of the most common genital cancers in the woman with approximately half a million new cases per year. Development of invasive squamous cell carcinoma (SCC) is the result of persistent and frequent human papilloma virus infection in premalignant lesions of cervix. Thereby identification of biomarkers that could predict progression of dysplastic mucosa to invasive cancer is of great clinical significance. Overexpression of SIRT1 has been reported to induce tumorogenesis in several organs. We evaluated SIRT1 expression in normal squamous epithelium of cervix, low-grade and high-grade cervical intraepithelial lesions and invasive SCC. A total of 104 cases were selected including 34 low-grade cervical intraepithelial lesions (CINs), 37 high-grade CINs, and 35 cases of invasive SCC. The normal cervical epithelium showed negative or weak SIRT1 positivity only in basal layers. SIRT1 cytoplasmic expression was found in 13 of 34 (38.2%) of low-grade CINs, 31 of 37 (83.8%) of high-grade CINs and all 35 (100%) cases of invasive SCC. Expression between 2 groups of CIN was statistically significant (P=0.001). Thus, SIRT1 appears to be a promising biomarker for predicting the progression of CIN to invasive SCC.
The Distinctive Nature of Thyroid MALT Lymphomas Including IRTA1 Expression
Authors: Carlsen Eric D. , Davis Adam R. , Cook James R. , Swerdlow Steven H.
Published: February 2023

Mucosa-associated lymphoid tissue (MALT) lymphomas often express IgM and IRTA1 with only a minority demonstrating plasmacytic differentiation. However, like primary cutaneous marginal zone lymphoproliferative disorders (PCMZLPD), thyroid MALT lymphomas (T-MALT-L) frequently show plasmacytic differentiation and IgG positivity. Whether T-MALT-L share other features with PCMZLPD, including frequent IgG4 positivity and infrequent IRTA1 expression, and how IRTA1 staining compares to that in Hashimoto thyroiditis (HT) are unknown. Therefore, the clinicopathologic features of 18 T-MALT-L were assessed, and their IRTA1 expression compared with that in 5 HT cases. All T-MALT-L cases included a B-lymphoid component. Plasmacytic differentiation was present in 15 cases and was extensive in 12. Fourteen cases were IgG+ including 2 IgG4+ (12 κ+, 2 κ−/λ−). One case was IgAλ+. Plasmacytic cells were uniformly CD19+/CD56− but CD138− in 7/15 cases. IRTA1+ cells were present in 16/16 cases, ranging from scattered cells to >50%. They were often concentrated in “MALT ball”-type lymphoepithelial lesions, perifollicular regions, and sometimes in germinal centers. IRTA1 positivity was also present in all HT cases, although it was never very extensive and often had a perifollicular distribution, occasionally with sparse aggregates and positive cells within rare thyroid follicles. Thus, T-MALT-L share some features with PCMZLPD but are more similar to noncutaneous MALT lymphomas, with prominent lymphoepithelial lesions, ubiquitous although variable IRTA1 positivity, and infrequent IgG4 positivity. Plasmacytic differentiation is also common although CD138 loss is frequent and light chain staining may be absent. IRTA1 staining may help in the differential diagnosis with HT, although there is some overlap in staining patterns.
Predictive Factors for Delayed Surgical Intervention in Children With Epidural Hematomas
Authors: Abe Naomi , Gardiner Michael , Dory Christopher , Gonda David , Harvey Helen , Hilfiker Mary , Hollenbach Kathryn , Kanegaye John T.
Published: February 2023

Background

Optimal treatment of children with traumatic intracranial epidural hematomas (EDHs) is unknown. We sought to identify clinical and radiographic predictors of delayed surgical intervention among children with EDH admitted for observation.

Methods

We retrospectively identified patients younger than 15 years with acute traumatic EDHs evaluated at our level 1 pediatric trauma center. We excluded patients with penetrating head injuries, recent surgical evacuation of EDH, or depressed skull fracture requiring surgical repair and assigned the remaining subjects to the immediate surgery group if they underwent immediate surgical evacuation, to the supportive-therapy-only group if they underwent observation only, and to the delayed surgery group if they underwent surgery after observation. We abstracted clinical and laboratory findings, surgical interventions, and neurological outcome and measured EDH dimensions and volumes, adjusting for cranial size. We compared clinical and radiographic characteristics among groups and performed receiver-operator characteristic analyses of predictors of delayed surgery.

Results

Of 172 patients with EDH, 103 patients met the inclusion criteria, with 6 (6%) in the immediate surgery group, 87 (84%) in the supportive-therapy-only group, and 10 (10%) in the delayed surgery group. Headache, prothrombin time of >14 seconds, EDH maximal thickness of ≥1.1 cm, volume of ≥14 mL, EDH thickness/cranial width index of ≥0.08 and EDH volume/cranial volume index of ≥0.18, and mass effect were associated with delayed surgical intervention. There was no difference in length of stay or functional impairment between the immediate and delayed surgery groups. However, patients in delayed surgery group were more likely to have subjective symptoms at discharge than those in immediate surgery group.

Conclusions

Among patients with EDH admitted for observation, larger EDH, mass effect, headaches, and prothrombin time of >14 seconds were associated with delayed surgical intervention. A larger-scale study is warranted to identify independent predictors of delayed surgery in children under observation for EDH.
Point-of-Care Ultrasound for the Diagnosis of Pediatric Testicular Torsion
Authors: Koppel Jordanna H. , Patt Yonatan Shneor , Berant Ron
Published: February 2023

Objectives

Acute testicular torsion is a surgical emergency that warrants prompt treatment. The diagnosis is typically confirmed by ultrasonography interpreted by a radiologist (RADUS); however, in this study, we describe the clinical course of 23 patients for whom point-of-care ultrasound (POCUS) was performed by pediatric emergency medicine physicians during the initial assessment for testicular torsion in the pediatric emergency department (PED).

Methods

A retrospective case series analysis of patients aged 0 to 18 years who were diagnosed with acute testicular torsion after undergoing scrotal POCUS through our PED.

Results

Between June 2015 and December 2020, 155 boys received an International Classification of Diseases-9 code of Torsion of Testis after presenting to our PED. Seventy-three patients were imaged preoperatively, of which 50 (68.5%) were diagnosed via RADUS alone. Twenty-three patients (31.5%) underwent POCUS (median age 14.1 years [interquartile range {IQR}: 11.4–15.9 years]), of which 14 (60.9%) were imaged by POCUS alone, whereas the remaining 9 patients (39.1%) underwent POCUS before RADUS. Thirteen of the 23 patients (56.5%) who underwent POCUS had intraoperative findings consistent with acute testicular torsion, whereas another 3 patients (13.0%) required manual detorsion in the PED before orchiopexy. Six patients required orchiectomy. All patients for which POCUS findings were suggestive of acute testicular torsion were correctly classified.

The median length of stay from time to admission to orchiopexy for those who received RADUS only versus POCUS only was 184 minutes (IQR: 136–255), and 121 minutes (IQR: 80–202), respectively (P = 0.036). Among the patients who experienced POCUS, the median length of stay for those who underwent RADUS in addition to POCUS compared with those who underwent POCUS alone was 202 minutes (IQR: 136–338.4) (P = 0.031).

Conclusions

Point-of-care ultrasound performed by pediatric emergency medicine physicians can be used to expedite surgical management and streamline the management of pediatric patients suspected of acute testicular torsion.
A Novel CASC15-ALK and TFG-ROS1 Fusion Observed in Uterine Inflammatory Myofibroblastic Tumor
Authors: Chang Bin , Wang Zhe , Ren Min , Yao Qianlan , Zhao Lu , Zhou Xiaoyan
Published: February 2023

The majority of inflammatory myofibroblastic tumors (IMTs) in the gynecologic tract occur in the uterine corpus and harbor anaplastic lymphoma kinase (ALK) rearrangement. Herein, we report 1 uterine IMT case with a novel fusion involving ALK and 1 uterine IMT case with ROS1 rearrangement. The ages of the patients were 56 and 57 yr, respectively. The tumor size was 10.0 and 8.0 cm, respectively. Both patients had stage IB disease. Histologically, the 2 IMT cases had classic morphologic features and predominantly comprised bland spindle cells with hypercellular (fascicular/storiform) and hypocellular (myxoid rich) areas admixed with variably prominent lymphoplasmacytic infiltration. Immunohistochemically, the ALK-rearranged case was positive for ALK, and the ROS1-rearranged case was positive for ROS1. Both cases were diffusely positive for desmin. The tumor cells were variably positive for estrogen receptor (1/2 cases, 50.0%) and progesterone receptor (1/2 cases, 50.0%). Targeted RNA sequencing revealed one case each with either a novel CASC15-ALK or TFG-ROS1 fusion. We identified a novel ALK fusion partner CASC15 in IMT and described the first uterine IMT with a TFG-ROS1 fusion. This study improves our understanding of molecular events in IMT.
Application of Current Pathologic Criteria for Atypical Placental Site Nodule Suggests That Refined Criteria Are Needed
Authors: Perez Catherine E. , Chapel David B. , Skala Stephanie L.
Published: February 2023

Atypical placental site nodules (APSNs) are histologically intermediate between placental site nodules (PSNs) and epithelioid trophoblastic tumors (ETTs). Little data exists to characterize these lesions and the risk of transformation from PSN to ETT. Recent World Health Organization (WHO) criteria for distinction of APSN are vague and not objectively defined. We identified cases signed out as PSN (n=33) and APSN (n=11) and aimed to characterize, statistically compare, and assess the risk of transformation in PSNs using data including size, location, mitotic rate, Ki-67 proliferation index, trophoblastic cells per high-power field, presence of severe cytologic atypia, beta-human chorionic gonadotropin levels, time since last pregnancy, presence of calcification, necrosis, or apoptosis, and follow-up results. All cases were confirmed to be positive for p63, and a Ki-67/AE1/AE3 dual stain was used to evaluate the Ki-67 proliferation index in the trophoblastic cells. In our cohort, slight changes in the interpretation of WHO criteria for PSN and APSN led to marked differences in the proportion of PSNs flagged as “atypical.” There was no statistically significant difference in the persistence of APSN versus non-APSN. None of the PSNs transformed to ETT. Current criteria for distinction between PSN and APSN are largely subjective. More objective, clearly defined, and clinically meaningful criteria are needed to distinguish between PSN and APSN, thus aiding in assessing the rare risk of transformation to ETT.
Grouping Public Health Skills to Facilitate Workforce Development: A Factor Analysis of PH WINS
Authors: Petrovskis Anna , Bekemeier Betty , van Draanen Jenna , Heitkemper Elizabeth
Published: February 2023

Objectives:

This study examined whether distinct factors exist among public health skills, measured through the Public Health Workforce Interests and Needs Survey (PH WINS). Understanding how workforce training needs group is important for developing targeted and appropriate public health workforce training sessions.

Design:

Exploratory factor analysis was used to examine public health skills among tier 1 staff (nonmanagers) and a combined group of tier 2 and 3 staff (managers and executives).

Setting:

Data for this study come from the 2017 PH WINS, which assessed public health workforce perceptions of training needs, workplace environment, job satisfaction, perceptions about national trends, and demographics. The analysis included 22 items.

Participants:

All public health staff in participating agencies were eligible to complete the survey. The national data set included participants from 47 state health agencies, 26 large local health departments (LHDs), and 71 mid-sized LHDs across all 10 Health and Human Services regions in the United States (including LHDs from all states). The analytic sample was n = 9630 in tier 1, n = 4829 in tier 2, and n = 714 in tier 3 staff.

Main Outcome Measure:

Three factors were identified within the skills portion of PH WINS, using exploratory factor analysis. To interpret retained factors, the following parameters were used: factor loadings greater than 0.4, factor cross-loadings less than 0.4 or higher than loadings on other factors, and communalities greater than 0.5.

Results:

Factors included (1) data and systems thinking, (2) planning and management, and (3) community collaboration, with slight variation in item loadings between tier 1 and tier 2 and 3 staff analyses.

Conclusion:

This study was the first known factor analysis of the training needs and workforce skills portion of PH WINS in the published literature. This study advances our conceptualization of public health workforce skills and has the potential to shape future critical workforce training development.
Pandemic Response Officers: Integration Between Medical, Public Health, and Higher Education Systems to Expedite Prevention and Response
Authors: Jones Anne C. , Meredith Genevive R. , Leong Donna , Jamal Sabine , Buckwalter Rachel , Clarke John D. , Clarkberg Marin , Bishop Allan , Cantone Frank , Espey Claire , Kruppa Frank , Opperman Mary George , Koretzky Gary A.
Published: February 2023

Context:

Research and policy studies alike have enumerated population and community health benefits of system integration between medical, public health, and social entities. The emergence of the COVID-19 pandemic revealed the necessity of a well-trained and adequately staffed public health and medical workforce in order to process SARS-CoV-2 cases and prevent subsequent transmission. Higher education systems, in particular, represented defined populations of exposure and transmission. Opportunities existed for collaboration and task sharing between institutions of higher education and local public health departments to limit spread and impacts.

Program:

This article describes the Pandemic Response Officer (PRO) program at Cornell University, a team of staff and students created during the intensity of the pandemic to benefit the Tompkins County and Cornell University communities.

Implementation:

The PRO program was formed in January 2021, with an original team of 8 individuals, working iteratively to investigate and support employee cases and exposures. Implementation was motivated by Cornell University's dual responsibility as a large employer that also possessed SARS-CoV-2 test results of employees. PROs loaded case information into a shared HIPPA-compliant electronic record that collected information for case notification, case investigation, isolation support, contact tracing, contact notification, and quarantine support. Over time, the PROs grew to a team of 25, gaining responsibilities as university and public health systems shared roles to maximize resources.

Evaluation:

From January 1 to December 31, 2021, PROs managed 773 employee and 2943 student cases. During the Omicron surge (November 28-December 31, 2021), PROs saved the public health department an estimated 2797 hours of effort, equating to more than 10 professionals working full-time, evenings and weekends, to process cases and contacts during this interval.

Discussion:

By integrating efforts between a university and public health agency, this intervention minimized SARS-CoV-2 transmission via expedient case support and alleviated strain on public health systems by expanding the public health workforce.
Longitudinal Ultrasound-Guided Injection Curriculum for Physical Medicine and Rehabilitation Residents
Authors: Eventov Michelle , Bean Allison C. , D’Amico Ella , Fultz Connor , Cerana Kerry , Helkowski Wendy , Schroeder Allison N.
Published: February 2023

Physiatrists are increasingly utilizing musculoskeletal ultrasound for both diagnostic and therapeutic purposes. However, a standardized longitudinal curriculum for instructing physical medicine and rehabilitation (PM&R) residents in performing ultrasound-guided interventional procedures has yet to be established. The purpose of this study was to develop and assess the effectiveness of a longitudinal curriculum in training residents to perform common ultrasound-guided musculoskeletal injections using fresh-frozen cadaveric specimens. The course included six weekly hands-on educational sessions, divided by anatomical region, integrated into an established anatomy and physical exam curriculum. Following completion of the curriculum, residents reported improved comfort and confidence, and displayed improved competence in performing these injections. Other physiatry residency programs should consider implementing longitudinal, hands-on cadaveric training courses to better prepare trainees to perform ultrasound-guided injections as part of their future clinical practice.
Virtual Reality-Based Rehabilitation to Restore Motor Function in People with Amputation: A Systemic Literature Review
Authors: Hao Jie , Chen Ziyan , Remis Andréas , He Zhengting
Published: February 2023

Virtual reality is an emerging technology with accumulating research and clinical evidence in the field of physical rehabilitation. This study aimed to systematically identify and examine the effects of virtual reality on motor function outcomes in patients with amputation to inform clinical decision-making on amputation rehabilitation and inform further research endeavors. Five databases were searched, including PubMed, CINAHL, PsycINFO, Embase, and Scopus. After screening for 1052 records, ten clinical studies were included in this review: four randomized controlled trials, three pre-post single-arm studies, and three case studies; all studies had fair to good methodological quality. Seven studies were for lower extremity amputation, and three were for upper extremity amputation. Results reveal the positive effects of virtual reality on improving motor function in prosthesis training, including balance, gait, and upper extremity outcomes. Participants also report enjoyment during virtual reality intervention as measured by subjective experience. However, it is unclear whether virtual reality can induce better therapeutic outcomes than conventional rehabilitation, given the limited number of controlled studies and conflicting results reported in the included studies. More properly designed randomized controlled trials with adequately powered sample sizes are warranted to elucidate the benefits of virtual reality-based rehabilitation in the amputation population.
A scoping review: carpal tunnel syndrome in athletes who compete in wheelchair sport
Authors: Marriott Catherine , Montgomery Kate , Whelan Alexander
Published: February 2023

ABTRACT

The purpose of this review was to understand the research on carpal tunnel syndrome (CTS) in athletes who compete in wheelchair sport. Eight articles were identified using the search strategy. The most common sport evaluated was wheelchair basketball (N = 4). Most athletes were male and were diagnosed with a spinal cord injury. Different clinical and electrodiagnostic criteria have been used to diagnose CTS. Two studies incorporated ultrasound into the clinical evaluation of median nerve pathology. The duration of disability and wheelchair use were associated with increased risk of CTS in four studies. There was no association between training load and the prevalence of CTS. No study has explored the functional implications of CTS on sports participation and performance. No study has assessed the prevention and treatment of CTS in individuals who compete in wheelchair sport. This review provides an understanding of the important diagnostic tools, and demographic and training risk factors to consider when evaluating para-athletes for CTS and highlights areas for future research.
Outcomes of Third-attempt Breast Reconstruction Following Infection-Associated Failure of Secondary Implant-Based Reconstruction
Authors: Hassan Abbas M. , Tran Jacquelynn , Asaad Malke , Slovacek Cedar , Liu Jun , Butler Charles E.
Published: February 2023

Background:

Implant-based reconstruction is the most common method of breast reconstruction in the United States. Despite ongoing advancements, periprosthetic infection is a serious problem that often results in device explantation. The objective of this study was to evaluate the outcomes of third-attempt reconstruction in patients in whom secondary implant-based reconstruction failed owing to infection.

Methods:

The authors performed a retrospective review of patients who underwent mastectomy followed by implant-based reconstruction from 2000 to 2019. The outcomes of patients who had failed secondary implant-based reconstruction due to infection and ultimately underwent third-attempt breast reconstruction were analyzed.

Results:

Of 6,093 patients who underwent primary implant-based reconstruction, 13 patients had third-attempt breast reconstruction following infection-related explantation (median age, 52 [51-56] years; median body mass index, 23 [22-31] kg/m2; median follow-up of 46 [16-62] months). Nine patients (70%) had implant-based reconstruction, two (15%) had implant-based reconstruction combined with pedicled latissimus dorsi flap, and two (15%) had abdominal-based free tissue transfer. Third-attempt breast reconstruction was immediate in 46% of patients and delayed in 54%. The success rate was 78% in the implant-based reconstruction group, with a 23% complication rate. The success rate for autologous breast reconstruction was 100%, with one patient developing venous congestion necessitating return to the operating room.

Conclusion:

Third-attempt breast reconstruction following infection-associated failed secondary implant-based reconstruction is a safe and feasible option. Although the risk of failure is higher than that for primary implant-based reconstruction, a third attempt after secondary IBR infection had a surprisingly high 78% success rate.
Otoplasty: The Belfast Experience - A Ten Year Review of 2333 Ear Outcomes.
Authors: McGarry Kevin M. , Khadim Muhammad F. , McBride Michael , Martin Serena , Moorehead Andrew , Rashid Abid , Hill Chris , Fogarty Brendan
Published: February 2023

Introduction:

“Prominent ear,” remains one of the most common referrals to pediatric plastic surgery. Correction of the perceived deformity has been carried out via a multitude of techniques for over a century and significant variation in practice still exists. Recent studies suggesting cartilage scoring techniques are associated with more major complications than suture techniques may have led to an adverse international perception of the technique. Thus, waning use of anterior scoring prominent ear correction appears to be occurring. In our center, for appropriate cases, we have used anterior scoring for over twenty years with high patient satisfaction and low complication rates. We thus present a review of all cases and outcomes from 2005-2015. We believe this is the largest case series of anterior scoring otoplasty published to date.

Methods:

All pediatric cases undergoing prominent ear correction from 2005 – 2015 were included in this retrospective case note analysis and follow up study. Patient demographics, operative details including early and late complications along with postoperative results were analyzed.

Results:

Over a 10 year period 1199 otoplasties were performed, of which 1134 were bilateral and 65 unilateral. This equates to a total of 2333 ear corrections. 1575 ears were corrected using the anterior scoring technique. The remaining cases underwent correction via suture only, cartilage reduction or combination techniques. There was a significantly lower all cause reoperation rate for anterior scoring compared to suture only techniques (p-value .0039. Significant at p < .025). There were no reported cases of cartilage necrosis in our series.

Conclusion:

This study demonstrates that in appropriately selected patients, anterior scoring otoplasty is a low morbidity procedure. In our institution, when compared to suture techniques, it was associated with a lower rate of complications and reoperation rate than suture only techniques.
Centralizing the Umbilicus in an Abdominoplasty: Eccentric Versus Concentric Fascial Plication in Addition to Medializing at the Skin
Authors: Vavra Jessica M. , Kachare Swapnil D. , Vivace Bradley J. , Choo Joshua , Wilhelmi Bradon J.
Published: February 2023

Background:

The umbilicus is often not a midline structure. Centralization of the umbilicus during an abdominoplasty is routinely performed at the level of the skin; however, this is associated with a high rate of postoperative reversion. We propose using an eccentric fascial plication centered on the true midline in order to maintain postoperative centralization of the umbilicus in addition to correction at the skin level.

Methods:

A retrospective study was conducted of all patients between 2015-2019 who underwent abdominoplasty with either skin only (concentric plication) versus fascial (eccentric plication) umbilical centralization. Fisher’s exact test and Student’s t test were used to compare the two groups and assess differences in rates of umbilical reversion.

Results:

71 patients were included in the study; the majority was female (n=69, 97%) and Caucasian (n=50, 70%). There were 28 (39%) patients who underwent concentric plication and 43 (61%) had eccentric plication. Mean BMI in the concentric and eccentric groups were 32 kg/m2 and 28.5 kg/m2, respectively. Average follow up was 51.6 months for concentric plication and 27.8 months for eccentric plication. Of those who received concentric plication, ten patients (36%), had their umbilicus revert to the preoperative position, while none in the eccentric plication group reverted, (p<0.0001).

Conclusion:

Midline placement of the umbilicus during an abdominoplasty is important in providing symmetry to optimize aesthetics. Eccentric fascial plication maintains the centralization of the umbilicus when compared to concentric fascial plication with skin-only centralization.
Effectiveness of high intensity micro-focused ultrasound (HIFU) therapy for non- surgical facial and body contouring: A systematic review of Prospective and Experimental Studies.
Authors: Kumar Vaibhav , Jain Anuj , Vadera Sapna , Shome Debraj , Kapoor Rinky
Published: February 2023

Introduction:

The most common body sculpting surgical procedure known today is liposuction. Its use is however associated with the risk of numerous complications. Hence, the choice has shifted to more safer and non-invasive type of modalities. One amongst them is the use of high-intensity focused ultrasonography (HIFU) lasers which work on the principle of selectively damaging fat tissue through apoptosis or necrosis induction of fat cells. The present systematic review is designed to identify the effectiveness of HIFU for non-surgical facial and body contouring.

Methodology:

An exhaustive literature search was conducted over electronic databases like PubMed/Medline, Cochrane Central, Scopus and EBSCO from a period of November 2005 to July 2020. Full text of the selected articles was reviewed for possible inclusion in the study and the articles fulfilling the inclusion criteria were recruited in the study. The characteristics of the included studies were noted and the outcomes were assessed. Quality assessment and Risk of Bias was done for all the studies using the RevMan tool and MINORS methodological index.

Results:

The initial search revealed a total of 4584 citations, out of which only 11 were included in the present review. Out of them, 9 studies used HIFU for recontouring of abdomen and only two studies used HIFU over face and neck. Studies either evaluated the efficacy of HIFU or the safety with its use. The average total energy ranged from 140 J/cm2 to 248 J/cm2 for abdominal region and 0.3 J/cm2 to 1.2 J/cm2 for face and neck. The focal depth ranged from 1.1 – 1.8 cm among the included studies. All the studies showed promising results with the use of HIFU.

Conclusion:

The HIFU therapy is safe, effective and minimally invasive with predictable results when used for body and facial recontouring.
Hairline correction by hair transplantation for reducing apparent face length in long face females
Authors: Park Jae Hyun , Suh Bum Sin
Published: February 2023

Background:

The long face morphology is associated with esthetic concerns, and surgery is often necessary to correct excess length in the frontal plane, in upper, middle, and lower thirds of the face. However, correcting midline facial length in the frontal plane, alone, does not provide facial harmony. This study introduces a novel approach to correcting long face morphology using measurements in the frontal, oblique, and lateral views, and reducing hairline measurements using hair transplants.

Methods:

83 patients were enrolled in the study. We measured the midline facial length in the frontal plane and the lengths of the upper, middle, and lower thirds of the face. We also measured four additional measurements in the oblique and lateral views, including the distance from the infratemporal hairline to the chin and from the sideburn to the chin. The patients’ midfrontal hairlines were lowered, and the measurements from the infratemporal hairline to the chin and from the sideburn to the chin were also shortened. The results were evaluated by patients and the surgeon using a 5-point Likert scale.

Results:

The mean patient Likert score was 4.5(range: 3-5), and the mean surgeon Likert score was 4.9(range: 3-5). No patients experienced adverse events. Three patients required touch-up surgery at the recipient sites to increase the hair density.

Conclusions:

This novel approach to correcting long face morphology using hair transplants to decrease hairline measurements provided excellent facial harmony and symmetry.

Level of Evidence:

Level IV
Evaluation of Prepectoral Breast Tissue Expander Reconstruction Intraoperative Fill: Air or Saline
Authors: Bamba Ravinder , Christopher Laura , Mailey Brian A. , Mercho Raphael , Dawson Steven E. , Hadad Ivan , Lester Mary E. , Hassanein Aladdin H.
Published: February 2023

Introduction:

Staged implant-based breast reconstruction with immediate tissue expanders is the most common method of breast reconstruction after mastectomy. Tissue expanders traditionally are filled with saline for expansion. Some surgeons have advocated initial intraoperative fill of the tissue expander with air to avoid excess pressure on ischemic mastectomy skin flaps. The purpose of the study was to compare intraoperative air versus saline tissue fills.

Methods:

All patients who underwent prepectoral tissue expander reconstruction after mastectomy from 2017-2019 were reviewed. The primary predictive variable was whether saline or air used for initial tissue expansion. Outcome variables included mastectomy skin necrosis, nipple necrosis, infection, number of expansions, hematoma, and explant.

Results:

A total of 53 patients(88 tissue expanders) were included in the study: 28 patients(44 tissue expanders) who underwent initial intraoperative fill with air and 25 patients(44 tissue expanders) who underwent an initial saline fill were assessed. There were no significant differences in complication rates between initial TE fill with saline versus air including nipple necrosis, wound dehiscence, cellulitis, abscess, or TE removal(p=1.0). The number of postoperative tissue expander fills in the initial air fill group was 3.2 compared to 2.7 in the initial saline fill(p=0.27).

Conclusions:

Prepectoral tissue expander initial fill with air has similar postoperative outcomes compared to initial saline fill. We found no benefit to initially filling prepectoral tissue expanders with air intraoperatively. Given the additional effort of exchanging air for saline during the first postoperative fill, there was no clinical advantage of filling prepectoral tissue expanders with air.
Top 100 Highly Cited Articles on Rhinoplasty Between 2001 and 2020: A Bibliometric and Visualized Analysis
Authors: Zhou Yu C. , Zhu Yuan L. , Cai Zhen , Chen Zai H. , Cui Wei , You Xiao B. , Wang Jian X.
Published: February 2023

Background:

We performed a bibliometric and visualized analysis of the top 100 highly cited articles in rhinoplasty published between 2001 and 2020, to provide researchers with the present research status and the potential directions.

Methods:

We obtained data from the Web of Science (WoS) Core Collection on April 7, 2021. Quantitative and qualitative analyses were performed using the WoS. Collaboration and keyword analyses were performed using VOSviewer software.

Results:

The top 100 highly cited articles included 86 original research and 14 reviews. The average total citations was 77 (ranging 50-202). The article with 202 citations was published by Toriumi DM in 2006 and the most influential reference. The most common level of evidence was the level IV (n =24). Only five articles had a level of evidence of I. The top 100 articles were published in 24 journals. The Plastic and Reconstructive Surgery (PRS) published 49 papers with 4,013 citations. The USA published most highly cited articles. The University of Texas System published 16 articles with 1,166 citations. Rohrich RJ published 14 papers with 1,025 total citations. Cleft lip and palate, FACE-Q, FROI-17, NOSE scale, quality of life, questionnaire, and RHINO scale were the most common keywords.

Conclusions:

PRS was the most influential journal, and most research was reported from the USA, and the University of Texas System published the most highly cited article. Rohrich RJ, Daniel RK, and Guyuron B were the most prolific and influential authors. Global cooperation in rhinoplasty requires further strengthening.
Terminal Schwann cells are essential for neuromuscular junction function and recovery after nerve injury
Authors: Jablonka-Shariff Albina , Balta Eric , Santosa Katherine , Lu Chuieng-Yi , Snyder-Warwick Alison K.
Published: February 2023

Background–

Terminal Schwann cells (tSCs), non-myelinating glial cells at the neuromuscular junction (NMJ), are integral to NMJ development, function, remodeling, and response to injury. It is essential to understand their requirement for NMJ function. In this study, we assessed consequences of immune-mediated tSC ablation in adult S100-GFP mice of both sexes in homeostasis and after nerve injury.

Methods–

We examined NMJ morphology and function in the extensor digitorum longus (EDL) muscle during homeostasis at post-tSC ablation days (PAD) 3, 14 and 42, and after peroneal nerve transection and immediate repair at 3 and 6 weeks post-nerve injury and tSC ablation (post-injury and ablation, PIA).

Results–

Terminal Schwann cell ablation resulted in significant decreases (p<0.05) in tSC numbers per NMJ and endplate fragmentation. NMJ innervation and EDL tetanic force significantly decreased at PAD14 (p<0.05), and tSCs re-established their NMJ coverage at PAD42. After nerve injury, motor endplate fragmentation increased (p<0.01) with tSC ablation compared with injured control mice. NMJ reinnervation and EDL tetanic force were significantly reduced (p<0.001), even at 6 weeks PIA, compared to control mice.

Conclusions–

These results add to the understanding that tSCs, with their pro-regenerative potential, help maintain NMJ integrity in homeostasis and are necessary for NMJ reinnervation following peripheral nerve injury.

Clinical Relevance Statement–

Terminal Schwann cells are integral for efficient NMJ recovery after nerve injury. This cell population may provide a novel therapeutic target to improve outcomes for patients with nerve injuries; additional investigation is warranted.