bluuebunny/crossref_metadata_2025 huggingface dataset:
Sexual Dissatisfaction after Hand Surgery
Authors: Rompala Alexander , Dar Qurratul-Ain , Avoricani Alba , Levy Kenneth H. , Kurtzman Joey S. , Koehler Steven M.
Published: February 2023

Background:

Using the hand questionnaire (HAND-Q) patient-reported outcome measure, the effects of upper extremity surgery on patients’ perception of their sex life were explored. The hand is a uniquely sexual organ, and we hypothesized that self-reported measures of disease severity, quality of life, and emotional impact would correlate with sexual dissatisfaction among patients receiving treatment for hand/upper extremity conditions.

Methods:

Patients were prospectively enrolled for hand questionnaire participation. Patients with valid responses to the following questions were included: functionality, hand appearance satisfaction, symptom severity, emotional dissatisfaction, sexual dissatisfaction, and treatment satisfaction. Composite scores were created and scored. Sexual dissatisfaction composite scores were compared through Spearman correlation coefficient analysis to quality of life, emotional dissatisfaction, hand appearance, symptom severity, and hand functionality.

Results:

High levels of diminished quality of life correlated with sexual dissatisfaction (rs = 0.748, P < 0.001). Increased emotional dissatisfaction correlated with sexual dissatisfaction (rs = 0.827, P < 0.001). Increased satisfaction with hand appearance negatively correlated with sexual dissatisfaction (rs = –0.648, P = 0.001). Increased levels of dissatisfaction with hand functionality correlated with sexual dissatisfaction (rs = 0.526, P = 0.005).

Conclusions:

The correlation between sex life and quality of life may allow surgeons to improve patient satisfaction when treating hand/upper extremity issues. The relationship between sex life and emotional dissatisfaction emphasizes the impact that sexual dissatisfaction has on patients’ lives. Evaluating the relationship between hand appearance and sexual dissatisfaction may indicate that patient self-perception of hand attractiveness plays a role in sex life.
BRAF V600E Immunohistochemistry Predicts Prognosis of Patients with Cutaneous Melanoma in Thai population
Authors: Meevassana Jiraroch , Anothaisatapon Kullawit , Subbalekha Surawish , Kamolratanakul Supitcha , Siritientong Tippawan , Ruangritchankul Komkrit , Pungrasami Pornthep , Hamill Kevin J , Angsapatt Apichai , Kitkumthorn Nakarin
Published: February 2023

Background:

The BRAF V600E mutation in the Thai population has been identified in a considerable percentage of people with cutaneous melanoma. The objectives of this study were to determine the prevalence of this mutation in cutaneous melanomas, conduct a clinicopathological association analysis with the BRAF V600E mutation, and develop a treatment strategy for patients with this mutation that would take advantage of the medications currently available to treat them.

Methods:

Anti-BRAF V600E (clone VE1) immunohistochemistry was performed on 50 pathological samples of cutaneous melanoma after excluding the samples with a low amount of pathologic tissue, a lack of clinical data‚ and poor follow-up. BRAF V600E expression DNA sequencing was performed to confirm the results of several cases.

Results:

Anti-BRAF V600E antibody positivity was noted in 56% (28/50) of cutaneous melanoma cases. DNA sequencing results were consistent with immunohistochemistry results. In cutaneous melanoma, the BRAF V600E mutation was significantly associated with adverse prognosis of patients, including reduced overall survival and disease-free survival.

Conclusions:

An increased prevalence of the BRAF V600E mutation was determined in a collection of cutaneous melanomas in the Thai population, implying that BRAF-targeted therapy may be a promising strategy for patients with BRAF-mutated cutaneous melanoma. This study revealed an association between the clinicopathological aspects of cutaneous melanoma and overall survival, disease-free survival, and overall mortality. A treatment with anti-BRAF-targeted therapy, which incorporates the already available medications‚ is being researched and developed.
Alternative Nerve Transfer for Shoulder Function: Thoracodorsal and Medial Triceps to Anterior Axillary Nerve
Authors: Janes Lindsay Ellen , Crowe Christopher , Shah Nikhil , Sasson Daniel , Ko Jason H.
Published: February 2023

Introduction:

We describe a reliable approach for double nerve transfer of the medial triceps branch and thoracodorsal nerve to the axillary nerve to increase axonal input. We present a review of outcomes for both end-to-end and reverse end-to-side nerve transfer.

Methods:

A retrospective review of patients who underwent nerve transfer for improvement of shoulder abduction at Harborview Medical Center and Northwestern Memorial Hospital between 2012 and 2021 was conducted. Patients were prospectively contacted to fill out a 30 item Disabilities of the Arm, Shoulder and Hand questionnaire, with an option to upload a video demonstrating active range of motion.

Results:

Twenty-one patients with 23 affected extremities were included in the final analysis. Fifteen patients completed the prospective arm of the study (71% response rate). Seventy-nine percent of patient limbs achieved a Medical Research Council Motor Scale (MRC-MS) of 4 or greater, and measured shoulder abduction active range of motion (AROM) was 139.2 degrees (range, 29–174 degrees) and 140.9 degrees (range, 60–180 degrees) (P = 0.95) for end-to-end and reverse end-to-side, respectively. Comparing end-to-end with reverse end-to-side neurorrhaphy, outcomes, including follow-up, mean postoperative MRC-MS, mean change in MRC-MS, Disabilities of the Arm, Shoulder and Hand, abduction AROM, and flexion AROM, were not statistically different.

Conclusions:

We showed improvements in shoulder abduction with the thoracodorsal nerve, in addition to the medial triceps branch, to increase axonal donation and power the axillary nerve without sacrificing the spinal accessory nerve. Furthermore, we demonstrated improvements with reverse end-to-side coaptation when intraoperative stimulation of the axillary nerve revealed residual function.
The UQ Flap: A Novel Modification of the Keystone Flap
Authors: Hassani Mohammadreza , Hertess Isolde , Tucker Simon , Coetzer-Botha Martelle , Kittler Harald , Rosendahl Cliff
Published: February 2023

Wound closure following excisions on the leg (between the knee and ankle), including the distal leg, is challenged by limited skin laxity. The keystone flap, first described by Behan in 2003, was proposed as one solution, but with a significant complication rate on the distal leg. This pilot study introduces a novel modification of the keystone flap, named the UQ flap, differing from other modifications, with an un-incised portion on one flap border and a unique curved leading-edge to absorb tension and distribute shearing forces in different directions, providing improved flap security and vascularization. The UQ flap was performed on 10 patients in two formats of “U” and “Q” also with two different orientations as base-proximal and base-distal. Other variations including minor deviation from the longitudinal axis, and double flap, were also performed. Except for one case with minor infection, there were no complications, and the results were favorable. No fasciotomy or undermining was required. The UQ flap proved to be a safe and convenient method of wound closure on the leg, including the distal leg. Compared with the keystone flap, there were reduced incisions leading to improved vascularity and less healthy tissue trimming. Its unique shape provided flap flexibility facilitating easy adjustment to the defects. The order and direction of wound closure after the excision of the lesion and incision of the flap are critical.
Sickle Cell Disease Association with Premature Suture Fusion in Young Children
Authors: Manrique Monica , Toro-Tobon Sara , Bade Yusuf , Paredes-Gutierrez Juliana , Mantilla-Rivas Esperanza , Rana Md Sohel , Oh Albert K. , Rogers Gary F.
Published: February 2023

Background:

Sickle cell disease (SCD) leads to the formation of an atypical hemoglobin tetramer with reduced capacity to carry oxygen. Although correlation between SCD and craniosynostosis (CS) has been mentioned, these are mostly small series or case reports. This article aimed to study any correlation between these entities in a large pediatric population.

Methods:

We retrospectively reviewed head CT scans of SCD patients from 0 to 8 years of age who required a CT for issues unrelated to their head shape between 2012 and 2020. We excluded patients with known history of CS or any CS-related syndrome, hydrocephalus, shunt placement, history of cranial surgery, or any reported cerebral or cranial shape abnormality.

Results:

Ninety-four CT scans were analyzed. The mean age at imaging was 4.48 ± 2.30 years. CS prevalence in this cohort was 19.1%. Analysis between independent variables and patients with +CS showed that SCD-associated vasculopathy, first-degree relatives with SCD, and the use of folic acid had a statistically significant association with CS development.

Conclusions:

Approximately 20% of pediatric patients with SCD developed CS. This association was higher in those patients who had a family history of SCD, used folic acid, and had SCD-associated vasculopathy. While the clinical impact of these findings needs more extensive study, centers that manage patients with SCD should be aware of the relatively high concordance of these diagnoses, vigilantly monitor head shape and growth parameters, and understand the potential risks associated with unidentified or untreated CS.
The Potential of Transexamic Acid Use for Wide Awake Local Anesthesia No Tourniquet
Authors: Economou George , Kunda Nicholas , Eberlin Kyle R. , Valerio Ian L. , Agrawal Nikhil A.
Published: February 2023

Tranexamic acid (TXA) is a drug commonly used to decrease intraoperative bleeding. Its use in various types of surgery is well defined; however, its use in plastic surgery and even more so, hand surgery is not as well researched. Concurrently, the use of wide-awake local anesthesia no tourniquet (WALANT) procedures has increased in popularity. As the use of WALANT increases, it comes to question whether TXA could be used as an alternative to epinephrine during WALANT procedures. This case involves a 33-year-old woman status-post motor vehicle collision. On examination, the patient sustained transection of the flexor digitorum profundus on both her left middle and ring fingers along with absent sensation to her left middle finger. Due to the surgical preference for vascular monitoring, TXA was used alternatively to epinephrine to control intraoperative bleeding during the tendon repairs. It was observed that TXA allowed for controlled bleeding, preservation of the surgical visual field, successful tendon repair, and postoperative success. The successful use of TXA in this case prompts further investigation as to whether TXA could be used as an alternative to epinephrine in WALANT procedures.
Accuracy and Reliability of 3D Imaging for Facial Movement Evaluation: Validation of the VECTRA H1
Authors: Kelly Brendan C. , Pyne Justin M. , Rosvall Brandon R. , Song Jin Soo , Côté David W. J.
Published: February 2023

Background:

Three-dimensional imaging can be used to obtain objective assessments of facial morphology that is useful in a variety of clinical settings. The VECTRA H1 is unique in that it is relatively inexpensive, handheld, and does not require standardized environmental conditions for image capture. Although it provides accurate measurements when imaging relaxed facial expressions, the clinical evaluation of many disorders involves the assessment of facial morphology when performing facial movements. The aim of this study was to assess the accuracy and reliability of the VECTRA H1, specifically when imaging facial movement.

Methods:

The accuracy, intrarater, and interrater reliability of the VECTRA H1 were assessed when imaging four facial expressions: eyebrow lift, smile, snarl, and lip pucker. Fourteen healthy adult subjects had the distances between 13 fiducial facial landmarks measured at rest and the terminal point of each of the four movements by digital caliper and by the VECTRA H1. Intraclass correlation and Bland–Altman limits of agreement were used to determine agreement between measures. The agreement between measurements obtained by five different reviewers was evaluated by intraclass correlation to determine interrater reliability.

Results:

Median correlation between digital caliper and VECTRA H1 measurements ranged from 0.907 (snarl) to 0.921 (smile). Median correlation was very good for both intrarater (0.960–0.975) and interrater reliability (0.997–0.999). The mean absolute error between modalities, and both within and between raters was less than 2 mm for all movements tested.

Conclusion:

The VECTRA H1 met acceptable standards for the assessment of facial morphology when imaging facial movements.
The Medicare IPPS 40 Years Later
Authors: Averill Richard F. , Mills Ronald E.
Published: February 2023

The 1983 implementation of the Medicare Inpatient Prospective Payment System (IPPS) was successful in controlling Medicare inpatient costs because it was designed as a clinically credible management tool that facilitated real behavior change and performance improvement. The next phase of IPPS should expand the inpatient payment bundle to a hospital episode-of-care performance bundle that explicitly links episode cost and quality. A uniform, comparable, and transparent episode performance bundle that highlights the tradeoffs between episode cost and quality can expand the incentives to control costs and provide hospitals the management information to improve performance.
Harnessing the Collective Expertise of Patients, Care Partners, Clinical Teams, and Researchers Through a Coproduction Learning Health System
Authors: Tosteson Anna N. A. , Kirkland Kathryn B. , Holthoff Megan M. , Van Citters Aricca D. , Brooks Gabriel A. , Cullinan Amelia M. , Dowling-Schmitt Miriam C. , Holmes Anne B. , Meehan Kenneth R. , Oliver Brant J. , Wasp Garrett T. , Wilson Matthew M. , Nelson Eugene C.
Published: February 2023

The coproduction learning health system (CLHS) model extends the definition of a learning health system to explicitly bring together patients and care partners, health care teams, administrators, and scientists to share the work of optimizing health outcomes, improving care value, and generating new knowledge. The CLHS model highlights a partnership for coproduction that is supported by data that can be used to support individual patient care, quality improvement, and research. We provide a case study that describes the application of this model to transform care within an oncology program at an academic medical center.
Cervical High-Grade Squamous Intraepithelial Lesion Burden and Standard of Care Treatment Effectiveness and Safety in the United States, 2008–2018: The EACH-WOMAN Project
Authors: Hughes Katherine C. , Herring Timothy A. , Song Jennifer N. , Gately Robert V. , Przybyl Lindsey M. , Ogilvie Rachel P. , Simon Keiko , Bhuyan Prakash K. , Kyrgiou Maria , Seeger John D.
Published: February 2023

Objective

Management of cervical high-grade squamous intraepithelial lesions (HSILs), the immediate precursor of cervical cancer, consists largely of surgical treatment for women at higher risk for progression to cancer. The authors’ objective was to describe the occurrence of cervical HSIL in the United States and various outcomes for women who received surgical treatment.

Methods

From a US commercial health insurer, a cohort of adult women with cervical HSIL diagnoses receiving surgical treatment within 3 months of diagnosis between January 2008 and September 2018 was identified. This cohort was followed for several outcomes, including cervical HSIL recurrence, human papillomavirus clearance, preterm birth, infection, and bleeding.

Results

The incidence rate of cervical HSIL declined from 2.34 (95% CI = 2.30–2.39) cases per 1,000 person-years in 2008 to 1.39 (95% CI = 1.35–1.43) cases per 1,000 person-years in 2014, remaining near that level through 2018. Among 65,527 women with cervical HSIL, 47,067 (72%) received surgical treatment within 3 months of diagnosis. Among the women receiving surgical treatment, cervical HSIL recurred in 6% of surgically treated women, whereas 45% of surgically treated women underwent subsequent virological testing that indicated human papillomavirus clearance. Preterm birth was observed in 5.9% by 5 years follow-up and bleeding and infection each at 2.2% by 7 days follow-up.

Conclusions

From 2008 through 2018, the incidence of diagnosed cervical HSIL decreased for several years before stabilizing. Surgical treatment of HSIL may be beneficial in removing the precancerous lesion, but cervical HSIL may recur, and the surgery is associated with complications including preterm birth, infection, and bleeding.
Comorbidity of Urogynecological and Gastrointestinal Disorders in Female Patients With Lichen Sclerosus
Authors: Söderlund Jenni M. , Hieta Niina K. , Kurki Samu H. , Orte Katri J. , Polo-Kantola Päivi , Hietanen Sakari H. , Haataja Marjut A.M.
Published: February 2023

Objective

Lichen sclerosus (LS) is a chronic inflammatory disease with a significant impact on quality of life. The aim of this cross-sectional case-control study was to characterize concomitant urogynecological and gastrointestinal disorders in female patients with LS.

Methods

A medical records search between 2004 and 2012 yielded 455 women and girls (mean age 64 years) with LS. The study cohort was compared with a 10-fold age- and sex-matched control cohort. Gynecological cancers and their precursors; gynecological, urinary, and gastrointestinal disorders; and pain syndromes were evaluated.

Results

The well-known association between LS and increased risk of vulvar cancer and its precursors was also found in our study (relative risk [RR] = 100.0; p < .001 and high-grade squamous intraepithelial lesions RR = 110.0; p < .001, respectively), but we also found an increased risk for cervical cancer (RR = 6.0; p = .005) and endometrial cancer (RR = 2.9; p < .001). Gynecological pain syndromes such as dyspareunia (RR = 20.0; p < .001) and interstitial cystitis (RR = 5.0; p < .001) and urinary incontinence (RR = 4.8; p < .001) were also increased. Among gastrointestinal disorders, we found increased risk for celiac disease (RR = 6.8; p < .001), diverticular intestine diseases (RR = 1.9; p < .001), functional intestinal disorders (RR = 2.3; p = .003), and anal and rectal fissures (RR = 2.4; p = .046).

Conclusions

We found that female patients with LS have an increased risk for gynecological cancers as well as for several urogynecological and gastrointestinal disorders. Increased awareness is required to identify and treat these concomitant disorders.
Noninvasive evaluation of fibrosis in adult biliary diseases
Authors: Helgadottir Holmfridur , Vesterhus Mette
Published: February 2023

Purpose of review

Liver fibrosis is highly associated with disease progression and clinical outcome in primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), the major chronic biliary diseases in adults. Establishment of validated tools for the noninvasive evaluation of liver fibrosis in PBC and PSC for use in patient follow-up, and effect evaluation in clinical trials, has been a top research priority over recent years.

Recent findings

Two studies in large PBC patient panels investigated liver stiffness measurement by vibration-controlled transient elastography (VCTE) and two studies in PSC demonstrated enhanced liver fibrosis (ELF) variation over time, confirming VCTE and ELF as good prognostic markers. Currently, magnetic resonance elastography (MRE), quantitative MRI mapping and novel serum extracellular matrix and extracellular vesicle markers show promising results for fibrosis and prognostic assessment in biliary diseases.

In this article, we will briefly review recent studies supporting recommendations to assess liver fibrosis and prognosis using the ELF test and VCTE during clinical follow-up in both PBC and PSC. We will discuss emerging evidence for MRE and other imaging techniques, and novel serum fibrosis markers, for which sufficient data or availability is currently limited precluding recommendations for clinical use.
Intestinal microbiota in biliary diseases
Authors: Xia Qiyun , Liu Qiaoyan , Ma Xiong
Published: February 2023

Purpose of review

Biliary diseases are a group of disease affecting biliary tract, including immune-mediated primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). With limited treatment options, PBC and PSC may lead to liver cirrhosis.

Recent findings

Emerging evidence has shown the participation of gut microbiota in the etiology of PBC and PSC. Patients with PBC and PSC exhibit alterations in gut microbiota composition. Dysfunctional gut barrier facilitates the translocation of possible pathogenic bacteria and derived metabolites. Along with molecular mimicry between host and bacterial antigen, these factors result in aberrant auto-immune activation, and subsequently lead to liver injury. Though the precise mechanism has not been fully elucidated, studies investigating the role of gut microbiota in pathogenesis of PBC and PSC have inspired novel biomarkers and therapeutic strategies.

In this review, recent evidence on the alteration of intestinal microbiota and possible mechanistic and therapeutic applications are discussed, predominantly focusing on PSC and PBC.
Prognostic modeling in biliary diseases
Authors: Ciobanu Camelia , Russo Mark W.
Published: February 2023

Purpose of review

To discuss the prognostic models for the cholestatic diseases focusing on primary sclerosing cholangitis and primary biliary cholangitis.

Recent findings

Noninvasive prognostic models that outperform alkaline phosphatase and Mayo Risk Score have been developed to predict clinically significant events, such as transplant free survival or hepatic decompensation. Models for primary sclerosing cholangitis (PSC) include UK-PSC, Primary Sclerosing Cholangitis Risk Estimate Tool, and Amsterdam Oxford models. Models for primary biliary cirrhosis (PBC) include UK-PBC, Global primary biliary cholangitis group score (GLOBE) and Paris II scores. Other models have incorporated elastography with or without findings on magnetic resonance imaging.

Noninvasive prognostic models can inform patients about their risk for clinical outcomes and serve as surrogate intermediate outcomes to determine efficacy of novel agents in clinical trials.
Practice Survey: Depression Screening in Pediatric Inflammatory Bowel Disease
Authors: Maddux Michele H. , Drovetta Megan , Mackner Laura M. , Plevinsky Jill , Whitaker Brandi N.
Published: February 2023

Background:

Little is known about depression screening practices in pediatric inflammatory bowel disease (IBD) care. This study summarizes depression screening within IBD centers in the ImproveCareNow Collaborative Network.

Methods:

Pediatric IBD providers across 79 IBD centers completed an online survey on current practices surrounding depression screening.

Results:

Half of centers report doing annual depression screening, largely for patients 12–14 years. The Patient Health Questionnaire (PHQ-9) is most often used. For positive depression screens, most centers refer for evidence-based psychotherapy and/or a psychosocial provider meets with the patient during that visit. Suicidal ideation is addressed by calling a psychosocial provider to clinic or sending a patient to the emergency department. Barriers to routine screening include lack of personnel/resources, billing, and lack of clinic time.

Conclusions:

Pediatric IBD centers conducting depression screening provide targeted intervention based on screening and include psychosocial providers in the process. Greater understanding of screening efforts can inform future clinical efforts.
Using a Harm Reduction Approach to Treat Inpatients With Substance Use Disorders
Authors: Shields Lisa B. E. , LaRocco Matthew , Young Matt W. , Flanders Kimberly
Published: February 2023

OBJECTIVE

This study investigated harm reduction (HR) strategies at our institution to decrease the number of patients with a substance use disorder (SUD) who left against medical advice (AMA).

BACKGROUND

HR is a public health strategy used for adult substance use problems for whom abstinence is not feasible.

METHODS

An HR program was established at 1 institution to enhance the care of hospitalized patients with a SUD.

RESULTS

Of the 1780 unique visits for patients with a diagnosis of SUD, 311 patients (17.5%) left our hospital AMA or eloped. The average length of stay for all patients evaluated by the HR team was 6.6 days compared with 4.0 days for those who left AMA. Patients with >1 hospital stay accounted for 22% of our population but represented 34% of the patients who left AMA.

CONCLUSIONS

This study reports the approaches implemented to reduce the AMA rate of patients with a SUD and to promote patient-enhanced care.
Current Controversies in Melanoma Treatment
Authors: Temple-Oberle Claire , Nicholas Christine , Rojas-Garcia Priscila
Published: February 2023

Learning Objectives:

After reading this article and viewing the videos, the participant should be able to: 1. Discuss margins for in situ and invasive disease and describe reconstructive options for wide excision defects, including the keystone flap. 2. Describe a digit-sparing alternative for subungual melanoma. 3. Calculate personalized risk estimates for sentinel node biopsy using predictive nomograms. 4. Describe the indications for lymphadenectomy and describe a technique intended to reduce the risk of lymphedema following lymphadenectomy. 5. Offer options for in-transit melanoma management.

Melanoma management continues to evolve, and plastic surgeons need to stay at the forefront of advances and controversies. Appropriate margins for in situ and invasive disease require consideration of the trials on which they are based. A workhorse reconstruction option for wide excision defects, particularly in extremities, is the keystone flap. There are alternative surgical approaches to subungual tumors besides amputation. It is now possible to personalize a risk estimate for sentinel node positivity beyond what is available for groups of patients with a given stage of disease. Sentinel node biopsy can be made more accurate and less morbid with novel adjuncts. Positive sentinel node biopsies are now rarely managed with completion lymphadenectomy. Should a patient require lymphadenectomy, immediate lymphatic reconstruction may mitigate the lymphedema risk. Finally, there are minimally invasive modalities for effective control of in-transit recurrences.
An Anatomical Dissection Method for Observation of Fibrous Facial Structures
Authors: Hashiguchi Shin-ichiro , Hayakawa Koji , Inoue Eiko , Han Aya , Iwanaga Joe , Tabira Yoko , Yamashita Akihiro , Rikimaru Hideaki , Kiyokawa Kensuke , Watanabe Koichi
Published: February 2023

Background:

In recent years, structures including the superficial musculoaponeurotic system and retaining ligaments that support the facial soft tissue have been clarified. However, these structures are very difficult to observe in their entirety by the standard gross anatomical procedure (ie, dissection from superficial to deep layers). Furthermore, accurate descriptions of these structures are rare in both anatomical and plastic surgery textbooks. The aim of this study was to clarify the facial fibrous structures in a gross anatomical view.

Methods:

The authors’ novel method used soft facial tissue and bone. The tissue was fixed in gelatin and sectioned at a thickness of 5 to 10 mm. Each section was placed on a wooden board; the bone was then pinned, and the skin was pulled outward with sutures to hyperextend the soft tissue. Subsequently, the loose connective tissue was torn and fat tissue was removed under a surgical microscope. After the removal of fat tissue, the fibrous facial structures (eg, the superficial musculoaponeurotic system and retaining ligaments) could be observed clearly.

Results:

The thickness of the sections allowed three-dimensional observation, such that a structure located deep within a section could be clearly observed. The expansion of soft tissue facilitated observation of the facial layer and fibrous structures, and the locations of nerves and vessels. Therefore, the facial layer structure was readily discerned.

Conclusion:

This method is likely to be very useful in the field of plastic surgery because it enabled intuitive identification of facial layers and their characteristics.

Clinical Relevance Statement:

The dissection method developed by the authors reveals the connected morphology of each tissue of the face, thus providing basic data for analyzing soft tissue changes due to aging and gravity. This will be useful for the development of anti-aging medicine.
Factors of Affecting the Success of Intragastric Balloon
Authors: Turan Umut Firat , Katar Mehmet Kağan , Ersoy Pamir Eren
Published: February 2023

Background:

Our aim was to determine the efficacy and safety of intragastric balloon (IGB) application and the factors affecting its success by evaluating the results of patients who underwent IGB.

Materials and Methods:

A total of 277 consecutive patients that underwent IGB between January 2019-September 2020 in our clinic were evaluated. Patients’ demographic data, height and weight before the IGB procedure, weight at 6 and 12 months after the procedure, follow-up period, complication status, and whether they received dietician’s assistance during the follow-up were recorded.

Results:

In 5 (1.8%) patients, IGB was removed for various reasons before the standard period of 6 months. The mean age of the patients was 35.6±9.5 years, the mean baseline weight and body mass index (BMI) was 92.6±14 kg and 33.5±5.4 kg/m 2 respectively. The mean follow-up time was 13±4.9 months, whereas in 146(53.6%) patients the follow-up was≥12 months. In the 6-month follow-up, the mean %excess weight loss and %body weight loss were 65.65±25.19% and 14.69±6.96%, respectively, whereas at the 12-month follow-up they were 32.38±24.79% and 6.56±5.31%, respectively. High BMI (odds ratio=1.2, 95% CI=1.0-1.2) and not receiving dietitian’s assistance (odds ratio=8.5, 95% CI=3.1-23.7) were independent risk factors for unsuccessful IGB application at both 6-month and 12-month follow-ups.

Conclusion:

IGB application is a relatively effective and safe weight loss treatment for overweight and obese individuals. High BMI and not getting help from a dietician are risk factors for failure of IGB. To increase compliance with dieticians and therefore success of IGB application, patients should undergo psychiatric evaluation before IGB procedure, and receive psychiatric support, if necessary.
Estimation of Sensitization Status in Renal Transplant Recipients by Assessing Indirect Pathway CD4+ T Cell Response to Donor Cell-pulsed Dendritic Cell
Authors: Kenta Iwasaki , Toshihide Tomosugi , Takashi Sekiya , Shintaro Sakamoto , Yuko Miwa , Manabu Okada , Takahisa Hiramitsu , Norihiko Goto , Shunji Narumi , Yoshihiko Watarai , Mai Okumura , Satoshi Ashimine , Kohei Ishiyama , Ezzelarab Mohamed B. , Takaaki Kobayashi
Published: February 2023

Background.

Generation of donor-specific human leukocyte antigen antibody (DSA) via indirect allorecognition is detrimental to long-term survival of transplant organs. The detection of such immune responses would make it possible to define patients with high risk of sensitization. In this study, we established a novel method for evaluating indirect allorecognition to assess sensitization in kidney transplant recipients.

Methods.

Recipient CD14+ monocytes were mixed with donor peripheral blood mononuclear cells; cultured in the presence of IL-4, GM-CSF, IL-1β, and TNFα; and used as pulsed dendritic cells (DCs). Cell proliferation and cytokine production were evaluated by carboxyfluorescein diacetate succinimidyl ester–based T cell proliferation assay and Enzyme-Linked ImmunoSpot assay, respectively.

Results.

CD4+ T cell proliferation was strongly observed in following coculture with allogeneic antigen-pulsed DC leading to interferon-γ and IL-21 production. About 1% of CD4+ T cells exhibited Tfh-like phenotype (PD-1highCXCR5+ICOS+CD40L+). Recipient DC pulsed with donor peripheral blood mononuclear cells was cocultured with recipient CD45RA+CD4+ and CD45RA-CD4+ (generally defined as naive and memory in humans, respectively) T cells. Irrespective of preformed or de novo DSA status, CD45RA+CD4+ T cells constantly produced IL-21. In contrast, IL-21–produced CD45RA−CD4+ T cells were significantly higher in preformed DSA-positive patients than those in negative patients (80.8 ± 51.2 versus 14.8 ± 20.4, P < 0.001). In de novo DSA-positive patients, IL-21–produced CD45RA−CD4+ T cells were significantly increased after transplantation compared with before transplantation (9.23 ± 9.08 versus 43.9 ± 29.1, P < 0.001).

Conclusions.

Assessment of indirect pathway CD4+ T cell response could provide new insights into the underlying mechanism of de novo DSA production, leading to the development of effective strategies against antibody-mediated rejection.
Ex Vivo Heart Perfusion for Cardiac Transplantation Allowing for Prolonged Perfusion Time and Extension of Distance Traveled for Procurement of Donor Hearts: An Initial Experience in the United States
Authors: Isath Ameesh , Ohira Suguru , Levine Avi , Pan Stephen , Aggarwal-Gupta Chhaya , Lanier Gregg M. , Wolfe Kevin , Spielvogel David , Gass Alan , Kai Masashi
Published: February 2023

Background.

Scarcity of donor hearts continues to be a challenge for heart transplantation (HT). The recently Food and Drug Administration–approved Organ Care System (OCS; Heart, TransMedics) for ex vivo organ perfusion enables extension of ex situ intervals and thus may expand the donor pool. Because postapproval real-world outcomes of OCS in HT are lacking, we report our initial experience.

Methods.

We retrospectively reviewed consecutive patients who received HT at our institution in the post–Food and Drug Administration approval period from May 1 to October 15, 2022. Patients were divided into 2 groups: OCS versus conventional technique. Baseline characteristics and outcomes were compared.

Results.

A total of 21 patients received HT during this period, 8 using OCS and 13 conventional techniques. All hearts were from donation after brain death donors. The indication for OCS was an expected ischemic time of >4 h. Baseline characteristics in the 2 groups were comparable. The mean distance traveled for heart recovery was significantly higher in the OCS group (OCS, 845 ± 337, versus conventional, 186 ± 188 mi; P < 0.001), as was the mean total preservation time (6.5 ± 0.7 versus 2.5 ± 0.7 h; P < 0.001). The mean OCS time was 5.1 ± 0.7 h. In-hospital survival in the OCS group was 100% compared with 92.3% in the conventional group (P = 0.32). Primary graft dysfunction was similar in both groups (OCS 12.5% versus conventional 15.4%; P = 0.85). No patient in the OCS group required venoarterial extracorporeal membrane oxygenation support after transplant compared with 1 in the conventional group (0% versus 7.7%; P = 0.32). The mean intensive care unit length of stay after transplant was comparable.

Conclusions.

OCS allowed utilization of donors from extended distances that otherwise would not be considered because ischemic time would be prohibitive by conventional technique.
Physical Exercise as a Nonpharmacological Intervention for the Treatment of Neuropsychiatric Symptoms in Persons With Dementia
Authors: Kouloutbani Komanthi , Venetsanou Fotini , Karteroliotis Konstantinos E. , Politis Antonios
Published: February 2023

Background:

Neuropsychiatric symptoms (NPS) are prevalent in dementia and affect both patients and caregivers in multiple ways. Because of the complications of drug treatments, nonpharmacological interventions, such as exercise, are of particular value. This study aimed to investigate the effect of exercise on the NPS of dementia and draw recommendations for the disease management.

Methods:

Meta-analyses were conducted on the findings of randomized controlled trials identified during an initial systematic review of the literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies examined the effect of exercise interventions on patients with dementia or mild cognitive impairment using valid assessment tools. The quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation analysis.

Results:

The meta-analyses revealed that exercise significantly limits NPS [mean difference: −5.28, (95% CI, −9.46, −1.11), P = 0.01] and symptoms of depression [standardized mean difference: −0.16, (95% CI, −0.29, −0.02), P = 0.02], and has a beneficial effect on agitation symptoms. The Grading of Recommendations, Assessment, Development, and Evaluation analysis results showed that exercise has a moderate and high confidence positive effect on NPS and depression, respectively.

Conclusions:

Exercise could be an alternative approach for nonpharmacological treatment of NPS in dementia. Therefore, exercise could be utilized as a treatment of choice or to support existing treatment regimens.
Research Priorities of Individuals and Caregivers With Lewy Body Dementia
Authors: Holden Samantha K. , Bedenfield Noheli , Taylor Angela S. , Bayram Ece , Schwilk Chris , Fleisher Jori , Duda John , Shill Holly , Paulson Henry L. , Stacy Kelly , Wood Julia , Corsentino Pamela , Sha Sharon J. , Litvan Irene , Irwin David J. , Quinn Joseph F. , Goldman Jennifer G. , Amodeo Katherine , Taylor John-Paul , Boeve Bradley F. , Armstrong Melissa J.
Published: February 2023

Introduction:

Lewy body dementia (LBD) is common, yet under-recognized and under-researched. To plan studies with the highest impact, engagement of the community personally affected by these conditions is essential.

Methods:

A web-based survey of people living with LBD and current and former caregivers of people with LBD queried research priorities through forced ranking and exploration of burden of LBD symptoms. Specific caregiving needs in LBD and perceptions of research participation were also investigated.

Results:

Between April 7, 2021 and July 1, 2021, 984 responses were recorded. Top research priorities included disease-modifying therapies and improved disease detection and staging. People with LBD were interested in pathophysiology and more bothered by motor symptoms; caregivers were interested in risk factors and symptomatic therapies and more bothered by neuropsychiatric symptoms. Few available LBD treatments and resources were rated as helpful, and many valuable services were never received. Previous participation in LBD research was infrequent, but interest was high.

Discussion:

People with LBD and caregivers highlighted the need for research across all aspects of LBD, from pathophysiology and disease modification to prognosis, education, symptomatic treatments, and caregiver support. Funders should increase support for all aspects of LBD research to target the many needs identified by individuals and families living with LBD.
Unlocking the Power of EHRs: Harnessing Unstructured Data for Machine Learning-based Outcome Predictions
Authors: Noaeen Mohammad , Amini Somayeh , Bhasker Shveta , Ghezelsefli Zohreh , Ahmed Aisha , Jafarinezhad Omid , Hossein Abad Zahra Shakeri
Published: February 2023

The integration of Electronic Health Records (EHRs) with Machine Learning (ML) models has become imperative in examining patient outcomes due to the vast amounts of clinical data they provide. However, critical information regarding social and behavioral factors that affect health, such as social isolation, stress, and mental health complexities, is often recorded in unstructured clinical notes, hindering its accessibility. This has resulted in an over-reliance on clinical data in current EHR-based research, potentially leading to disparities in health outcomes. This study aims to evaluate the impact of incorporating patient-specific context from unstructured EHR data on the accuracy and stability of ML algorithms for predicting mortality, using the MIMIC III database. Results from the study confirmed the significance of incorporating patient-specific information into prediction models, leading to a notable improvement in the discriminatory power and robustness of the ML algorithms. Furthermore, the findings underline the importance of considering non-clinical factors related to a patient’s daily life, in addition to clinical factors, when making predictions about patient outcomes. These results have significant ramifications for improving ML in clinical decision support and patient outcome predictions.
Rapid emergence of transmissible SARS-CoV-2 variants in mild community cases
Authors: Crone Michael A , Hakki Seran , Zhou Jie , de Oliveira Carolina Rosadas , Madon Kieran J , Koycheva Aleksandra , Badhan Anjna , Jonnerby Jakob , Fenn Joe , Kundu Rhia , Barnett Jack L , Nevin Sean , Conibear Emily , Derqui-Fernandez Nieves , Pillay Timesh D , Varro Robert , Luca Constanta , Quinn Valerie , Ahmad Shazaad , Zambon Maria , Barclay Wendy S , Dunning Jake , Freemont Paul S , Taylor Graham P , Lalvani Ajit
Published: February 2023

SARS-CoV-2 immune-escape variants have only been observed to arise in immunosuppressed COVID-19 cases, during prolonged viral shedding. Through daily longitudinal RT-qPCR, quantitative viral culture and sequencing, we observe for the first time the evolution of transmissible variants harbouring mutations consistent with immune-escape in mild community cases within 2 weeks of infection.
Classification performance bias between training and test sets in a limited mammography dataset
Authors: Hou Rui , Lo Joseph Y. , Marks Jeffrey R. , Hwang E. Shelley , Grimm Lars J.
Published: February 2023

Objectives

To assess the performance bias caused by sampling data into training and test sets in a mammography radiomics study.

Methods

Mammograms from 700 women were used to study upstaging of ductal carcinoma in situ. The dataset was repeatedly shuffled and split into training (n=400) and test cases (n=300) forty times. For each split, cross-validation was used for training, followed by an assessment of the test set. Logistic regression with regularization and support vector machine were used as the machine learning classifiers. For each split and classifier type, multiple models were created based on radiomics and/or clinical features.

Results

Area under the curve (AUC) performances varied considerably across the different data splits (e.g., radiomics regression model: train 0.58-0.70, test 0.59–0.73). Performances for regression models showed a tradeoff where better training led to worse testing and vice versa. Cross-validation over all cases reduced this variability, but required samples of 500+ cases to yield representative estimates of performance.

Conclusions

In medical imaging, clinical datasets are often limited to relatively small size. Models built from different training sets may not be representative of the whole dataset. Depending on the selected data split and model, performance bias could lead to inappropriate conclusions that might influence the clinical significance of the findings. Optimal strategies for test set selection should be developed to ensure study conclusions are appropriate.
Underlying Pressures that Black Mothers and Their Children Face: A Qualitative Assessment on the Effects of Racism/Discrimination and the COVID 19 Pandemic
Authors: Thomas Denisia N. , Rizzieri Ashley , Rodriguez Mayra
Published: February 2023

Background

Poverty, racism, discrimination, inadequate access to healthcare, and personal, everyday stressors lead to poor health outcomes, especially in African American families in the south. There is limited data on how these stressors are absorbed between the mother and child dyad.

Objective

To assess the effects of racism, everyday stressors (i.e. motherhood), and the COVID pandemic on African American/Black mothers and their children.

Methods

Utilizing the Health Belief Model, a survey was developed to assess mother-child stressors relating to three different constructs: racism/discrimination, pandemic/covid-19, and parenting. We interviewed seven black mothers and their children (aged 4-10yo). The families were recruited from a pediatric office in the rural city of Alexander City, Alabama. Interviews took place in an intimate setting and lasted for 1.5-2 hours. Medical students conducted, recorded, and transcribed each interview. The interview assessed the association between the COVID-19 pandemic, personal traumatic events, and racism and discrimination in their everyday lives.

Results

Through qualitative analysis; racism, daily activities, and the COVID-19 pandemic were demonstrated to be significant stressors for the mothers. Knowledge, school/work, actions, emotions, and seriousness/susceptibility displayed stressors not only in the mom as one would expect, but in the children as well. Using the resilience model, we assessed adversity, coping strategies, and self-efficacy. As one might expect, each situation caused a different level of anxiety; however, the coping strategies varied. Some moms took to smoking to cope with it while others chose suppression. The children’s coping ranged from inconsolable crying and using outlets such as phones to cope.

Conclusion

Ultimately, our qualitative approach saw an association between the pandemic and discrimination. Mothers often felt the need to shield children from the emotions attached to discrimination, and ultimately were unable to. There is a need to explore resilience and assess these stressors and changes in perception over time.