bluuebunny/crossref_metadata_2025 huggingface dataset:
Mesothelioma In Situ Mimicking Well-differentiated Papillary Mesothelial Tumor
Authors: Galateau-Salle Francoise , Hamilton Trevor , MacNeill Andrea , Hofman Véronique , Sequeiros Ruth , Sagan Christine , Le Stang Nolwenn , Churg Andrew
Published: March 2023

We have previously hypothesized that well-differentiated papillary mesothelial tumor (WDPMT) consists of 2 morphologically identical lesions, one of which is true WDPMT, while the other is a form of mesothelioma in situ. Here, we report 8 examples of the latter phenomenon, 3 with pleural disease (2 men/1 woman, ages 66 to 78 y); and 5 with peritoneal disease (all women, ages 31 to 81 y). At presentation the pleural cases all had effusions but no evidence of pleural tumor on imaging. Four of the 5 peritoneal cases had ascites as the initial finding and all 4 had nodular lesions that by imaging and/or direct inspection were thought to represent a diffuse peritoneal malignancy. The fifth peritoneal case presented with an umbilical mass. Microscopically, the pleural and peritoneal lesions looked like diffuse WDPMT, but all had lost BAP1. Occasional microscopic foci of superficial invasion were present in 3/3 pleural cases, while single nodules of invasive mesothelioma and/or occasional foci of superficial microscopic invasion were found in all of the peritoneal cases. The pleural tumor patients developed what clinically appeared to be invasive mesothelioma at 45, 69, and 94 months. Four/five peritoneal tumor patients underwent cytoreductive surgery and heated intraperitoneal chemotherapy. Three with follow-up data are alive without recurrence at 6, 24, and 36 months; 1 patient refused treatment but is alive at 24 months. We conclude that mesothelioma in situ morphologically mimicking WDPMT is strongly associated with the synchronous or metachronous development of invasive mesothelioma, but that these lesions appear to progress very slowly.
Nipple projection change in immediate breast reconstruction after nipple-sparing mastectomy and use of an acellular dermal matrix strut for maintaining nipple projection
Authors: Kim Jong-Ho , Kang Jiwon , Najmiddinov Bakhtiyor , Kim Eun-Kyu , Myung Yujin , Heo Chan Yeong
Published: March 2023

Introduction:

Nipple-sparing mastectomy (NSM) has gained popularity as more studies have supported its oncological safety. Although there have been some studies reporting complications including mastectomy flap and nipple necrosis, there have been few reports discussing the change in nipple projection following NSM. This study aimed to analyze the change in nipple projection after NSM and identify risk factors for nipple depression. In addition, we present a new method for maintaining nipple projection.

Methods:

Patients who underwent NSM between March 2017 and December 2020 at our institute were included in this study. We measured the pre- and postoperative nipple projection height and used a nipple projection ratio (NPR) to compare the change in height. Univariate and multivariate analyses were performed to examine the correlation of variables with the NPR.

Results:

A total of 307 patients and 330 breasts were included in this study. There were 13 cases of nipple necrosis. The postoperative nipple height was decreased by 32.8%, which was statistically significant. In multiple linear regression analysis, the use of an ADM strut was positively correlated with the NPR and implant-based reconstruction and post-mastectomy radiation therapy were negatively correlated with the NPR.

Conclusions:

The results of this study demonstrated that the reduction in nipple height after NSM was statistically significant. Surgeons need to be aware of these changes following NSM and explain this possibility to patients who have risk factors. The application of an ADM strut should be considered for the prevention of nipple reduction.
The Ninth and Tenth Costal Cartilages are Available and Safe Options for Rhinoplasty: A Cadaveric Anatomical Study
Authors: Yeo Hyeonjung , Lee Dongkyu , Paik Daehyang , Son Daegu
Published: March 2023

Some authors prefer the ninth costal cartilage for autogenous rhinoplasty, but few anatomical studies focus on tapering shape and harvesting safety regarding pneumothorax risk. Therefore, we studied the size and related anatomy of the ninth and tenth costal cartilages.

Twelve fresh cadavers (24 ribs) were studied. We measured the length, width, and thickness of the ninth and tenth costal cartilages at the osteochondral junction (OCJ), midpoint and tip. To evaluate safety during harvesting, we measured the thickness of the transversus abdominis muscle beneath the costal cartilage.

The mean lengths of the ninth and tenth cartilages were 99.1±25.0 and 60.6±22.5 mm, respectively. The ninth cartilage was 11.8±2.6, 9.0±2.4, and 2.5±0.5 mm wide, and the tenth cartilage was 9.9±2.0, 7.1±2.0, and 2.7±0.5 mm wide at the OCJ, midpoint and tip, respectively. The ninth cartilage was 8.4±2.0, 6.4±1.5, and 2.4±0.6 mm thick, and the tenth cartilage was 7.0±2.2, 5.1±1.7, and 2.3±0.5 mm thick at each point. For the transversus abdominis muscle, the thickness was 2.1±0.9, 3.7±1.0, and 4.5±1.3 mm at the ninth cartilage and 1.9±0.5, 2.9±1.1, and 3.7±1.4 mm at the tenth cartilage at each point.

The size of the cartilage was sufficient for autogenous rhinoplasty. The transversus abdominis muscle provides thickness for safe harvesting. Furthermore, if this muscle is breached during cartilage harvest, the abdominal cavity is exposed but not the pleural cavity. Consequently, there is a very low risk of pneumothorax at this level.
A Novel, Minimally Invasive Festoon Surgery: Mini Incision Direct Festoon Access, Cauterization, and Excision (MIDFACE): A 12 Year Analysis
Authors: Gupta Lopa Y. , Gupta Sarina S. , Bamberger Jacob N. , Gupta Kasmira R.
Published: March 2023

Background:

Surgical festoon management often entails aggressive dissection, flaps, unsightly scars, prolonged recovery, and high recurrence rates. The author presents outcomes with subjective and objective evaluation of an office-based novel, minimally invasive (1 cm incision) festoon repair: MIDFACE (Mini-Incision Direct Festoon Access, Cauterization and Excision).

Methods:

Charts of 75 consecutive patients from 2007 to 2019 were evaluated. Photographs of 39 who met inclusionary criteria were evaluated by 3 expert physician graders for festoon and incision visibility (339 randomly scrambled preoperative and postoperative photographs taken with and without flash and from 4 different views–close-up, profile, full-frontal, and worm’s eye) using paired student t-tests and Kruskal-Wallis tests for statistical evaluation. Surveys returned by 37 of 75 patients were evaluated for patient satisfaction and possible contributing factors to festoon formation or exacerbation.

Results:

There were no major complications in the 75 patients who underwent MIDFACE. Physician grading of 39 patients (78 eyes, 35 women; 4 men; mean 58±7.7 years) demonstrated statistically significant sustained improvement in festoon score postoperatively up to 12 years regardless of view or flash. Incision scores were the same pre- and post-op, indicating incisions could not be detected by photography. Average patient satisfaction was 9.5 on a Likert scale of 0-10. Possible factors for festoon formation or exacerbation included genetic (51%), pets (51%), prior hyaluronic acid fillers (54%), neurotoxin (62%), facial surgery (40%), alcohol (49%), allergies (46%), and sun exposure (59%).

Conclusions:

MIDFACE repair results in sustained improvement of festoons with an office-based, minimally invasive procedure with high patient satisfaction, rapid recovery, and low recurrence.
Active Heating Following Cryolipolysis Reduces Efficacy as well as Side Effects – A Prospective Randomized Split-Body Trial
Authors: Dahmann Sonja , Sanders Agnes , Saarbeck Christina , Batsilas Ioannis , Meyer-Marcotty Max
Published: March 2023

Background:

Cryolipolysis – a popular noninvasive technique for body contouring – has less side effects compared to liposuction, however, its effectiveness in terms of reducing local adipose tissue is also lower. This study is, to our knowledge, the first prospective controlled, investigator-blinded split body trial to evaluate whether post cryolipolytic heating can increase the efficacy.

Methods:

25 subjects were treated with one session of cryolipolysis on the lower abdomen and a subsequent heating with a mud pack of a randomized side of the treated region (left or right). Epidemiological data, temperature, edema, erythema, hypesthesia and pain level were obtained. Photographs, fat layer thickness (on ultrasound, caliper and abdominal girth), satisfaction and side effects were documented over a follow-up period of 12 weeks.

Results:

The side effects - edema, erythema and hypesthesia – faded almost completely with heating, whereas they remained on the non-heated site. However, the mean sonographic reduction of local adipose tissue after 12 weeks was significantly lower on the heated than on the control sites (9.6% vs. 14.1%; p=0.0003). The overall satisfaction was high (9.2 out of 10 points), even though only 44% of participants had a subjective recognition of fat loss without difference between the sites.

Conclusions:

Active heating following cryolipolysis increases bodily wellbeing by reducing common side effects. However, it reduces the effectiveness of cryolipolysis significantly and should therefore be avoided. Further improvements are necessary to enhance the efficacy of cryolipolysis.
“Extended Frontalis Muscle Advancement Technique for Severe Congenital Blepharoptosis”
Authors: Cang Zheng-Qiang , Liu Chao-Hua , Cui Jiang-Bo , Fan Xiao , Chen Yong-Jun , Song Bao-Qiang , Hao Dong-Yue , Peng Pai , Cao Jiao
Published: March 2023

Background:

The conventional frontalis muscle advancement technique still has some disadvantages, such as residual lagophthalmos, eyebrow ptosis, eyelid contour abnormality, and under-correction. This article describes the authors’ extended frontalis muscle advancement technique that takes extensive subcutaneous separation through the eyelid crease incision for the treatment of severe congenital blepharoptosis.

Methods:

A retrospective review was performed that included patients with severe congenital ptosis who underwent extended frontalis muscle advancement technique from April of 2019 to April of 2021. Preoperative evaluation included age, sex, and margin reflex distance 1 (MRD1), levator function, and lagophthalmos. Postoperative evaluation including correction result, closure function of eyelid, cosmetic result was performed at the last follow-up.

Results:

From April of 2019 to April of 2021, a total of 102 patients (137 eyes) who underwent extended frontalis muscle advancement technique were included in the study. The mean postoperative MRD1 in unilateral and bilateral ptosis patients was 3.84 ± 0.60 mm and 3.86 ± 0.56, respectively, and 126 eyes (92.0 percent) showed successful correction. Postoperatively, the mean residual lagophthalmos was 0.88 ± 1.40 mm, and 127 eyes (92.7 percent) showed excellent or good eyelid closure function. The average score of cosmetic results was 8.29 ± 1.34, and 94 patients (92.2 percent) had an excellent or good cosmetic result.

Conclusions:

Extensive subcutaneous separation relieves the mutual restriction between the forehead skin and frontalis muscle. The extended frontalis muscle advancement technique is effective in correcting severe congenital ptosis, while minimizing under-correction, residual lagophthalmos, eyelid contour abnormality and eyebrow ptosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Defining the Cervical Line in Face Lift Surgery: A Three-Dimensional Study of the Cervical and Marginal Mandibular Branches of the Facial Nerve
Authors: Lindsey John T. , Lee James J. , Phan Ho Tan Phat , Lindsey John T.
Published: March 2023

Background:

Continuous subSMAS dissection in the cheek with subplatysmal dissection in the neck is an important feature of many face lift techniques, yet the neural anatomy in this area remains unclear, and recommendations regarding continuous dissection of these adjacent areas vary widely. The purpose of this study is to define the vulnerability of the facial nerve branches in this transitional area from the face lift surgeon’s perspective and to specifically identify the location of the cervical branch penetration through the deep cervical fascia.

Methods:

Ten fresh and 5 preserved cadaveric facial halves were dissected under 4X loupe magnification. The skin was reflected followed by elevation of a SMAS-platysma flap with identification of the location of cervical branch penetration through the deep cervical fascia. The cervical and marginal mandibular branches were then dissected retrograde through the deep cervical fascia to the cervicofacial trunk to confirm identifications.

Results:

The anatomy of the cervical and marginal mandibular branches were found to be similar to the other facial nerve branches, all of which initially course deep to the deep fascia in their post-parotid course. The location of emergence of the terminal branch or branches of the cervical branch through the deep cervical fascia was consistently at or distal to a line from a point 5 cm below the mandibular angle on the anterior border of the sternocleidomastoid muscle to the point where the facial vessels course over the mandibular border (Cervical Line).

Conclusion:

Continuous dissection of the SMAS in the cheek with subplatysmal dissection in the neck crossing over the mandibular border is possible without jeopardizing the marginal mandibular or the cervical branches if done proximal to the Cervical Line. This study serves as the anatomic justification of continuous SMAS-platysma dissection and has implications for all types of SMAS flap manipulations.
“Defining the Ideal Male Buttocks”
Authors: Kollu Tejas , Giutashvili Tinatini , Bhat Deepa , Fournier Craig , Patel Ashit
Published: March 2023

Background:

There is no well-defined male buttock aesthetic. The authors performed a crowdsourced analysis in order to define the ideal male buttocks.

Methods:

A survey was deployed using the Amazon MTurk platform. Respondents rated a panel of digitally altered male buttocks from most to least attractive using three views. Respondents were asked questions pertaining to their own interest in gluteal augmentation, self-reported body type, and other demographics.

Results:

A total of 2,095 responses were recorded; 61% were male, 52% were between the ages of 25-34, and 49% were Caucasian. The preferred lateral ratio in the AP dimension was 1.18, the oblique angle between the sacrum, lateral gluteal depression, and point of maximal projection of the gluteal sulcus was 60 degrees, and posterior ratio between the waist and maximal width of the hips was .66. This corresponds to moderate gluteal projection in the lateral and oblique views, with a narrower gluteal width and defined trochanteric depression in the posterior view. Loss of the trochanteric depression was associated with lower scores. Subgroup analysis revealed differences when stratified by region, race, sexual orientation, employment industry, and athletic interest. No appreciable difference was found based on respondent gender.

Conclusions:

Our results demonstrate that there is a preferred male gluteal aesthetic. This study suggests that males and females favor a more projected male buttock with a more pronounced contour, but preferred a narrow width with defined lateral depression. These findings have the potential to guide future aesthetic gluteal contouring techniques in males.
A Four-Year Institutional Experience of Immediate Lymphatic Reconstruction
Authors: Granoff Melisa D. , Fleishman Aaron , Shillue Kathy , Johnson Anna Rose , Ross JoEllen , Lee Bernard T. , Teller Paige , James Ted A. , Singhal Dhruv
Published: March 2023

Introduction:

Up to 1 in 3 patients may go on to develop breast cancer-related lymphedema (BCRL) after treatment. Immediate Lymphatic Reconstruction (ILR) is a surgical procedure that has been shown in early studies to reduce the risk of BCRL. However, long-term outcomes are limited due to its recent introduction and different institutions’ eligibility requirements. This study evaluates the incidence of BCRL in a cohort that underwent ILR over the long-term.

Methods:

A retrospective review of all patients referred for ILR at our institution from September 2016 through September 2020 was performed. Patients with preoperative measurements, a minimum 6-months follow-up data and at least one completed lymphovenous bypass were identified. Medical records were reviewed for demographics, cancer treatment data, intra-operative management and lymphedema incidence.

Results: A total of 186 patients with unilateral node-positive breast cancer underwent axillary nodal surgery and attempt at ILR over the study period. Ninety patients underwent successful ILR and met all eligibility criteria, with a mean patient age of 54 (sd: 12.1) years and median BMI of 26.6 (q1-q3: 24.0-30.7) kg/m2. Median number of lymph nodes removed was 14 (q1-q3: 8-19). Median follow-up was 17 months (range: 6-49). 87% of patients underwent adjuvant radiotherapy of which 97% received regional lymph node radiation. At the end of the study period, we found an overall 9% rate of LE.

Conclusion:

Utilizing strict follow-up guidelines over the long-term, our findings support ILR at time of axillary lymph node dissection is an effective procedure that reduces the risk of BCRL in a high-risk patient population.
Long-term Maintenance of Projection of Nipples Reconstructed Using 3D-printed Poly-4-Hydroxybutyrate (P4HB) Bioabsorbable Scaffolds
Authors: Dong Xue , Shih Sabrina , Premaratne Ishani D. , Sariibrahimoglu Kemal , Ginter Paula , Scott Jeffrey , Limem Skander , Spector Jason A.
Published: March 2023

Background:

For patients who are unable to undergo nipple-sparing mastectomy, reconstruction of the nipple-areolar complex (NAC) has been shown to promote greater satisfaction in cosmetic outcome, body image and sexual relationships. Although there have been a variety of techniques developed to optimize the shape, size, and mechanical properties of the reconstructed NAC, maintenance of sustained nipple projection over time remains a challenge for plastic surgeons.

Methods:

3D-printed Poly-4-Hydroxybutyrate (P4HB) scaffolds were designed and fabricated then 1) filled with either mechanically minced or zested patient-derived costal cartilage (CC) 2) designed with an internal P4HB lattice (rebar) to provide interior structure to foster tissue ingrowth or 3) left unfilled. All scaffolds were wrapped within a CV flap on the dorsa of a nude rat.

Results:

One year after implantation, neo-nipple projection and diameter was well preserved in all scaffolded groups compared to non-scaffolded neo-nipples (p<0.05). Histologic analysis showed significant vascularized connective tissue ingrowth at 12 months in both empty and rebar scaffolded neo-nipples and fibrovascular cartilaginous tissue formation in mechanically processed CC-filled neo-nipples. The internal lattice promoted to more rapid tissue infiltration and scaffold degradation, and best mimicked the elastic modulus of the native human nipple after one year in vivo. No scaffolds extruded or caused any other mechanical complications.

Conclusion:

3D printed biodegradable P4HB scaffolds maintain diameter and projection while approximating the histologic appearance and mechanical properties of native human nipples after one year with a minimal complication profile. These long term pre-clinical data suggest that P4HB scaffolds may be readily translated for clinical application.
Dermal Nipple-Areola Complex perfusion through full thickness circumareolar scars: a porcine model for safe delay in two-stage nipple sparing mastectomy.
Authors: TONDU Thierry , JACOBS Christel , VANDEVIVERE Yzabel , VERHOEVEN Veronique , TJALMA Wiebren , HUBENS Guy , BLONDEEL Phillip , DE GREEF Kathleen , Ysebaert Dirk
Published: March 2023

Introduction:

Nipple sparing mastectomy (NSM) has evolved to a standard surgical option. NSM complication rate remains high in large breasts. To reduce the risk of necrosis several authors propose delayed procedures to enhance blood supply to nipple-areola complex (NAC). The purpose of this study in a porcine model is to show adequate redirection of NAC perfusion by neoangiogenesis through circumareolar scars.

Methods:

Delayed two-staged NSM is simulated in 52 nipples (6 pigs) with a 60-days interval. The nipples undergo a full thickness circumareolar incision onto the muscular fascia with preservation of underlying glandular perforators. After 60 days NSM is performed through a radial incision. A silicone sheet is introduced in the mastectomy plane to prevent NAC revascularization by wound bed imbibition. Digital colour imaging is used to assess necrosis. Near-infrared fluorescence with indocyanine green (ICG) is used to assess perfusion patterns as well as perfusion in real time.

Results:

No NAC necrosis is seen after 60 days delay in all nipples. In all nipples ICG-angiography shows complete alteration of NAC vascular perfusion pattern from subjacent gland to a capillary fill following devascularization exhibiting a predominant arteriolar capillary blush without distinct larger vessels.

Conclusion: NAC delay reverses glandular perfusion to adequate dermal neovascularization. Neovascularization through full thickness scars provides sufficient dermal perfusion after 60 days delay. Identical staged delay in humans may be a surgically safe NSM option and could broaden therapeutic NSM indications in difficult breasts. Large clinical trials are necessary to provide identical results in human breasts.
Extracellular vesicles from adipose-derived stem cells relieve extremity lymphedema in mouse models.
Authors: Tashiro Kensuke , Yoshioka Yusuke , Ochiya Takahiro
Published: March 2023

Introduction:

Transplantation of adipose-derived mesenchymal stem cells (ADSCs) has been reported to improve the severity of chronic lymphedema. Extracellular vesicles (EVs) derived from mesenchymal stem cells have been reported to exert effects such as the promotion of angiogenesis, suppression of inflammation, and regeneration of damaged organs. In this study, we showed that lymphangiogenesis was induced by EVs derived from ADSCs and revealed the therapeutic potential of these EVs for the treatment of lymphedema.

Methods:

We examined in vitro effects of ADSC-EVs to lymphatic endothelial cells (LECs). Next, we conducted in vivo analysis of ADSC-EVs to mouse lymphedema models. Furthermore, Bioinformatics analysis was also performed to evaluate the implications of the altered miRNA expression.

Results:

We showed that ADSC-EVs promoted the proliferation, migration, and tube formation of LECs, and the gene expression of lymphatic markers was elevated in the ADSC-EV-treated group. Notably, a mouse lymphedema model revealed that legs treated with ADSC-EVs had markedly improved edema with increased numbers of capillary vessels and lymphatic channels. Bioinformatics analysis revealed that ADSC-EV-associated microRNAs, such as miR-199a-3p, miR-145-5p, miR-143-3p, miR-377-3p, miR-100-3p, miR-29a-3p, miR-495-3p, and miR-29c-3p, targeted MDM2, which contributed to the stability of HIF1 and resulted in angiogenesis and lymphangiogenesis in LECs.

Conclusion:

The present study showed lymphangiogenic effects of ADSC-EVs, which will lead to new treatment options for chronic lymphedema. Cell-free therapy with EVs has fewer potential risks, such as poor engraftment efficiency and potential tumor formation, than stem cell transplantation and could be a promising tool for patients suffering from lymphedema.
Radiomics Analysis of Multiphasic Computed Tomography Images for Distinguishing High-Risk Thymic Epithelial Tumors From Low-Risk Thymic Epithelial Tumors
Authors: Liufu Yuling , Wen Yanhua , Wu Wensheng , Su Ruihua , Liu Shuya , Li Jingxu , Pan Xiaohuan , Chen Kai , Guan Yubao
Published: March 2023

Objectives

The objective of this study is to preoperatively investigate the value of multiphasic contrast-enhanced computed tomography (CT)-based radiomics signatures for distinguishing high-risk thymic epithelial tumors (HTET) from low-risk thymic epithelial tumors (LTET) compared with conventional CT signatures.

Materials and Methods

Pathologically confirmed 305 thymic epithelial tumors (TETs), including 147 LTET (Type A/AB/B1) and 158 HTET (Type B2/B3/C), were retrospectively analyzed, and were randomly divided into training (n = 214) and validation cohorts (n = 91). All patients underwent nonenhanced, arterial contrast-enhanced, and venous contrast-enhanced CT analysis. The least absolute shrinkage and selection operator regression with 10-fold cross-validation was performed for radiomic models building, and multivariate logistic regression analysis was performed for radiological and combined models building. The performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC of ROC), and the AUCs were compared using the Delong test. Decision curve analysis was used to evaluate the clinical value of each model. Nomogram and calibration curves were plotted for the combined model.

Results

The AUCs for radiological model in the training and validation cohorts were 0.756 and 0.733, respectively. For nonenhanced, arterial contrast-enhanced, venous contrast-enhanced CT and 3-phase images combined radiomics models, the AUCs were 0.940, 0.946, 0.960, and 0.986, respectively, in the training cohort, whereas 0.859, 0.876, 0.930, and 0.923, respectively, in the validation cohort. The combined model, including CT morphology and radiomics signature, showed AUCs of 0.990 and 0.943 in the training and validation cohorts, respectively. Delong test and decision curve analysis showed that the predictive performance and clinical value of the 4 radiomics models and combined model were greater than the radiological model (P < 0.05).

Conclusions

The combined model, including CT morphology and radiomics signature, greatly improved the predictive performance for distinguishing HTET from LTET. Radiomics texture analysis can be used as a noninvasive method for preoperative prediction of the pathological subtypes of TET.
Osseous-Tissue Tumor Reporting and Data System With Diffusion-Weighted Imaging of Bone Tumors—An Interreader Analysis and Whether It Adds Incremental Value on Tumor Grading Over Conventional Magnetic Resonance Imaging
Authors: Guirguis Mina , Gupta Anurag , Thakur Uma , Pezeshk Parham , Weatherall Paul , Sharan Gaurav , Xi Yin , Chhabra Avneesh
Published: March 2023

Objective

The aim of the study is to determine whether the use of diffusion-weighted imaging (DWI) provides incremental increase in performance in the osseous-tissue tumor reporting and data system (OT-RADS) with the hypothesis that use of DWI improves interreader agreement and diagnostic accuracy.

Methods

In this multireader cross-sectional validation study, multiple musculoskeletal radiologists reviewed osseous tumors with DW images and apparent diffusion coefficient maps. Four blinded readers categorized each lesion using the OT-RADS categorizations. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. These measures were then compared with the previously published work that validated OT-RADS but did not include incremental value assessment of DWI.

Results

One hundred thirty-three osseous tumors of the upper and lower extremities (76 benign, 57 malignant) were tested. Interreader agreement for OT-RADS with DWI (ICC = 0.69) was slightly lower (not statistically different) from the previously published work that did not incorporate DWI (ICC = 0.78, P > 0.05). The mean sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve including DWI of the 4 readers were 0.80, 0.95, 0.96, 0.79, and 0.91, respectively. In the previously published work without DWI, the mean values of the readers were 0.96, 0.79, 0.78, 0.96, and 0.94, respectively.

Conclusions

The addition of DWI to the OT-RADS system does not allow significantly improved area under the curve diagnostic performance measure. Conventional magnetic resonance imaging can be prudently used for OT-RADS for reliable and accurate characterization of bone tumors.
The Computed Tomography Findings and Follow-up Course of Pulmonary Nocardiosis
Authors: Su Ruihua , Wen Yanhua , Liufu Yuling , Pan Xiaohuan , Guan Yubao
Published: March 2023

Objective

Our study aimed to elucidate the computed tomography (CT) features and follow-up course of pulmonary nocardiosis patients to improve the understanding and diagnostic accuracy of this disease.

Methods

The chest CT findings and clinical data of patients diagnosed with pulmonary nocardiosis by culture or histopathological examination in our hospital between 2010 and 2019 were retrospectively analyzed.

Results

A total of 34 cases of pulmonary nocardiosis were included in our study. Thirteen patients were on long-term immunosuppressant therapy, among whom 6 had disseminated nocardiosis. Among the immunocompetent patients, 16 had chronic lung diseases or a history of trauma. Multiple or solitary nodules represented the most common CT feature (n = 32, 94.12%), followed by ground-glass opacities (n = 26, 76.47%), patchy consolidations (n = 25, 73.53%), cavitations (n = 18, 52.94%), and masses (n = 11, 32.35%). There were 20 cases (61.76%) with mediastinal and hilar lymphadenopathy, 18 (52.94%) with pleural thickening, 15 (44.12%) with bronchiectasis, and 13 (38.24%) with pleural effusion. Significantly higher rates of cavitations were observed among immunosuppressed patients (85% vs 29%, P = 0.005). At follow-up, 28 patients (82.35%) clinically improved with treatment, while 5 (14.71%) had disease progression, and 1 (2.94%) died.

Conclusions

Chronic structural lung diseases and long-term immunosuppressant use were found as risk factors for pulmonary nocardiosis. While the CT manifestations were highly heterogeneous, clinical suspicion should be raised upon findings of coexisting nodules, patchy consolidations, and cavitations, particularly in the presence of extrapulmonary infections such as those of the brain and subcutaneous tissues. A significant incidence of cavitations may be observed among immunosuppressed patients.
Comparison of Deep-Learning Image Reconstruction With Hybrid Iterative Reconstruction for Evaluating Lung Nodules With High-Resolution Computed Tomography
Authors: Hamada Akiyoshi , Yasaka Koichiro , Inui Shohei , Okimoto Naomasa , Abe Osamu
Published: March 2023

Objective

This study aimed to investigate the impact of deep-learning reconstruction (DLR) on the detailed evaluation of solitary lung nodule using high-resolution computed tomography (HRCT) compared with hybrid iterative reconstruction (hybrid IR).

Methods

This retrospective study was approved by our institutional review board and included 68 consecutive patients (mean ± SD age, 70.1 ± 12.0 years; 37 men and 31 women) who underwent computed tomography between November 2021 and February 2022. High-resolution computed tomography images with a targeted field of view of the unilateral lung were reconstructed using filtered back projection, hybrid IR, and DLR, which is commercially available. Objective image noise was measured by placing the regions of interest on the skeletal muscle and recording the SD of the computed tomography attenuation. Subjective image analyses were performed by 2 blinded radiologists taking into consideration the subjective noise, artifacts, depictions of small structures and nodule rims, and the overall image quality. In subjective analyses, filtered back projection images were used as controls. Data were compared between DLR and hybrid IR using the paired t test and Wilcoxon signed-rank sum test.

Results

Objective image noise in DLR (32.7 ± 4.2) was significantly reduced compared with hybrid IR (35.3 ± 4.4) (P < 0.0001). According to both readers, significant improvements in subjective image noise, artifacts, depictions of small structures and nodule rims, and overall image quality were observed in images derived from DLR compared with those from hybrid IR (P < 0.0001 for all).

Conclusions

Deep-learning reconstruction provides a better high-resolution computed tomography image with improved quality compared with hybrid IR.
Sternocleidomastoid Muscle in Fetuses: Classification, Morphometric Analysis, and Clinical Significance
Authors: Özdemir Ayşe , Beger Orhan , Bahşi İlhan
Published: March 2023

Purpose:

This study aimed to examine variations and morphometric properties of the sternocleidomastoid muscle (SCM) in fetuses in terms of infancy and early childhood surgeries.

Materials and Methods:

Neck regions of 27 fetuses (mean age: 23.30±3.40 wk, sex: 11 boys and 16 girls) fixed with 10% formalin were dissected bilaterally. Photographs of the dissected fetuses were taken in the standard position. Morphometric measurements, such as length, width, and angle, were performed on the photographs using the ImageJ software. In addition, the origin and insertion of SCM were detected. Taking into account the studies in the literature, a classification consisting of 10 types associated with the origin of SCM was carried out.

Results:

No statistically significant difference was observed in the parameters in terms of side and sex (P>0.05), except from the linear distance between the clavicle and motor point where the accessory nerve enters SCM (20.10±3.76 for male, 17.53±4.05 for female, P=0.022). Two-headed SCM (Type 1) was detected in 42 out of 54 sides. Two-headed clavicular head (Type 2a) was detected on 9 sides, and 3-headed (Type 2b) on 1 side. A 2-headed sternal head (Type 3) was detected on 1 side. A single-headed SCM (Type 5) was also detected on 1 side.

Conclusion:

Knowledge related to variations of the origin and insertion of fetal SCM may be helpful in preventing complications during treatments of pathologies such as congenital muscular torticollis in early period of life. Moreover, the calculated formulas may be useful to estimate the size of SCM in newborns.
Changes in Subspecialty Interest of Plastic Surgery Residents With Progression of Training: Impact on Academic Attrition
Authors: Stoehr Jenna R. , Vaca Elbert E. , Bacos Jonathan T. , Applebaum Sarah A. , Lopez Joseph , Chu Yuyang ,   ASPSRC Subspecialty Career Pathways Study Group, Gosain Arun K.
Published: March 2023

Background:

Plastic surgery residency applicants often express interest in academic subspecialties, but only a small percentage of graduating residents pursue academic careers. Identifying reasons for academic attrition may help training programs address this discrepancy.

Methods:

A survey was sent to plastic surgery residents through the American Society of Plastic Surgeons Resident Council to assess interest in 6 plastic surgery subspecialties during junior and senior years of training. If a resident changed their subspecialty interest, the reasons for change were recorded. The importance of different career incentives over time were analyzed with paired t tests.

Results:

Two hundred seventy-six plastic surgery residents of 593 potential respondents (46.5% response rate) completed the survey. Of 150 senior residents, 60 residents reported changing interests from their junior to senior years. Craniofacial and microsurgery were identified as the specialties with the highest attrition of interest, while interest in esthetic, gender-affirmation, and hand surgery increased. For residents who left craniofacial and microsurgery, the desire for higher compensation, to work in private practice, and the desire for improved job opportunities significantly increased. The desire for improved work/life balance was a prominent reason for subspecialty change among senior residents who changed to esthetic surgery.

Conclusions:

Plastic surgery subspecialties associated with academia, such as craniofacial surgery, suffer from resident attrition due to a variety of factors. Increased retention of trainees in craniofacial surgery, microsurgery, and academia could be improved through dedicated mentorship, improved job opportunities, and advocacy for fair reimbursement.
A Case Report of Delusions in a Patient Receiving Cabergoline Therapy for Prolactinoma: Pathophysiology and Proposed Treatment With Aripiprazole
Authors: Springer Charles , Rodgers Robert , Vivino Gina , Attanagoda Saritha , Miks Charles Dylan
Published: March 2023

Cabergoline is a dopamine 2 receptor agonist used as first-line treatment of pituitary prolactinomas. Here, we describe the case of a 32-year-old woman with a pituitary prolactinoma who was treated with cabergoline for 1 year, during which time she developed delusions. We also discuss the use of aripiprazole to mitigate the psychotic symptoms, while maintaining the efficacy of cabergoline treatment.
Out of the Laboratory and into the Home: Home Testing for Sleep Apnea and Other Sleep Disorders
Authors: Dredla Brynn K. , Castillo Pablo R.
Published: March 2023

Home sleep testing has emerged over the past decade and become an intriguing option for patients and providers because it can be conducted in the home environment. However, appropriate application of this technology is key to ensure accurate and validated results to provide appropriate patient care. In this review, we will cover the current guidelines for the use of home sleep apnea tests, the types of testing available, and future directions of home testing.
Restless Legs Syndrome and Periodic Limb Movements of Sleep: From Neurophysiology to Clinical Practice
Authors: Kouri Ioanna , Junna Mithri R. , Lipford Melissa C.
Published: March 2023

This article summarizes restless legs syndrome (RLS), periodic limb movements of sleep, and periodic limb movement disorder. RLS is a common sleep disorder with a prevalence of 5% to 15% in the general population. RLS can present in childhood, and incidence increases with age. RLS can be idiopathic or secondary to iron deficiency, chronic renal failure, peripheral neuropathy, and medications such as antidepressants (with higher rates for mirtazapine and venlafaxine, while bupropion may reduce symptoms at least in the short term), dopamine antagonists (neuroleptic antipsychotic agents and antinausea medications), and possibly antihistamines. Management includes pharmacologic agents (dopaminergic agents, alpha-2 delta calcium channel ligands, opioids, benzodiazepines) and nonpharmacologic therapies (iron supplementation, behavioral management). Periodic limb movements of sleep are an electrophysiologic finding commonly accompanying RLS. On the other hand, most individuals with periodic limb movements of sleep do not have RLS. The clinical significance of the movements has been argued. Periodic limb movement disorder is a distinct sleep disorder that arises in individuals without RLS and is a diagnosis of exclusion.
Neural mechanisms for emotional contagion and spontaneous mimicry of live facial expressions
Authors: Hirsch Joy , Zhang Xian , Noah J. Adam , Bhattacharya Aishwarya
Published: March 2023

Viewing a live facial expression typically elicits a similar expression by the observer (facial mimicry) that is associated with a concordant emotional experience (emotional contagion). The model of embodied emotion proposes that emotional contagion and facial mimicry are functionally linked although the neural underpinnings are not known. To address this knowledge gap, we employed a live two-person paradigm (
n
= 20 dyads) using functional near-infrared spectroscopy during live emotive face-processing while also measuring eye-tracking, facial classifications and ratings of emotion. One dyadic partner, ‘Movie Watcher’, was instructed to emote natural facial expressions while viewing evocative short movie clips. The other dyadic partner, ‘Face Watcher’, viewed the Movie Watcher's face. Task and rest blocks were implemented by timed epochs of clear and opaque glass that separated partners. Dyadic roles were alternated during the experiment. Mean cross-partner correlations of facial expressions (
r
= 0.36 ± 0.11 s.e.m.) and mean cross-partner affect ratings (
r
= 0.67 ± 0.04) were consistent with facial mimicry and emotional contagion, respectively. Neural correlates of emotional contagion based on covariates of partner affect ratings included angular and supramarginal gyri, whereas neural correlates of the live facial action units included motor cortex and ventral face-processing areas. Findings suggest distinct neural components for facial mimicry and emotional contagion.

This article is part of a discussion meeting issue ‘Face2face: advancing the science of social interaction’.
The promise and peril of interactive embodied agents for studying non-verbal communication: a machine learning perspective
Authors: Gratch Jonathan
Published: March 2023

In face-to-face interactions, parties rapidly react and adapt to each other's words, movements and expressions. Any science of face-to-face interaction must develop approaches to hypothesize and rigorously test mechanisms that explain such interdependent behaviour. Yet conventional experimental designs often sacrifice interactivity to establish experimental control. Interactive virtual and robotic agents have been offered as a way to study true interactivity while enforcing a measure of experimental control by allowing participants to interact with realistic but carefully controlled partners. But as researchers increasingly turn to machine learning to add realism to such agents, they may unintentionally distort the very interactivity they seek to illuminate, particularly when investigating the role of non-verbal signals such as emotion or active-listening behaviours. Here I discuss some of the methodological challenges that may arise when machine learning is used to model the behaviour of interaction partners. By articulating and explicitly considering these commitments, researchers can transform ‘unintentional distortions’ into valuable methodological tools that yield new insights and better contextualize existing experimental findings that rely on learning technology.

This article is part of a discussion meeting issue ‘Face2face: advancing the science of social interaction’.
Cardiomyocyte transcriptomic signatures in response toTrypanosoma cruziinfection underpin Chagas cardiomyopathy progression
Authors: Candray-Medina Katherine-Sofia , Nakagama Yu , Ito Masamichi , Nakagama Shun , Tshibangu-Kabamba Evariste , Takeda Norihiko , Sugiura Yuki , Nitahara Yuko , Michimuko-Nagahara Yu , Kaku Natsuko , Onizuka Yoko , Arias Carmen-Elena , Mejia Maricela , Alas Karla , Peña Susana , Maejima Yasuhiro , Komuro Issei , Nakajima-Shimada Junko , Kido Yasutoshi
Published: March 2023

Chagas disease can lead to life-threatening cardiac manifestations that occur more frequently in geographic areas more prevalent with the TcI/II circulating genetic strains. To elucidate the differential transcriptomic signatures of the cardiomyocyte resulting from infection with TcI/II or TcVIT. cruzistrains and explore their relationships with pathogenesis, HL-1 rodent cardiomyocytes were infected with TcI/II or TcVIT. cruzitrypomastigotes. RNA was isolated serially post-infection for microarray analysis. Enrichment analyses of differentially expressed genes (fold-change ≥2 or ≤ 0.5) highlighted the over-represented biological pathways. We found that Oxidative stress-related GO terms, ‘Hypertrophy model’, ‘Apoptosis’, and ‘MAPK signaling’ pathways (all with p<0.01) were upregulated. ‘Glutathione and one-carbon metabolism’ pathway, and ‘Cellular nitrogen compound metabolic process’ GO term (all with p <0.001) were upregulated exclusively in the cardiomyocytes infected with the TcI/II strains. Upregulation in the oxidative stress-related and hypertrophic responses are shared hallmarks with viral myocarditis, another inflammatory cardiac pathology. Nitrogen metabolism upregulation and Glutathione metabolism imbalance may implicate the relation of nitrosative stress and poor oxygen radicals scavenging in the unique pathophysiology of chagasic cardiomyopathy development.

Importance

Chagas disease affects more than 6 million people worldwide. One-third of those chronically infected will develop the life-threatening condition Chagas Cardiomyopathy (CCM).Trypanosoma cruzi (T. cruzi), grouped based on their genetic variability into six discrete typing units (DTU), are associated with DTU-specific clinical phenotypes. The diverse genetic make-up of parasite virulence factors shall evoke unique host defense responses of variable magnitude, collectively affecting the phenotypic expression of CCM. To address this, we performed a transcriptome analysis of cardiomyocytes infected with three differentT. cruzistrains each belonging to a different DTU. As a result, we were able to point out dysregulation in nitrogen metabolic processes, Glutathione, and one-carbon metabolism pathways as main features in the host response against cardiomyopathy-proneT. cruzistrains. Further research on these pathways could serve not only in the lookout for progression biomarkers but also in the lead toward the discovery of new therapeutic targets.
Brain age prediction improves the early detection of Alzheimer’s disease in East Asian elderly
Authors: Choi Uk-Su , Park Jun Young , Lee Jang Jae , Choi Kyu Yeong , Won Sungho , Lee Kun Ho
Published: March 2023

Introduction

Brain age prediction is used to quantify the pathological and cognitive changes associated with brain aging. However, the predicted age derived from certain models can result in biased estimation and the concealment of inherent aged brain function.

Methods

We constructed a brain age prediction model for the East Asian elderly brain using the brain volume and cortical thickness features from cognitively normal (CN) brains. Furthermore, our model was used to estimate different diagnoses and to construct a classification model of mild cognitive impairment (MCI) conversion and Alzheimer’s disease (AD) conversion.

Results

Our model showed a strong association of the brain age difference (BAD) with three diagnosis groups. In addition, the classification models of MCI conversion and AD conversion showed acceptable and robust performances, respectively (area under the curve [AUC] = 0.66, AUC = 0.76).

Discussion

We believe that our model can be used to estimate the predicted status of an East Asian elderly brain. Moreover, the MCI conversion model has the potential to prevent severe cognitive impairment and can be used for the early detection of AD.
Preterm Preeclampsia Risk Modelling: Examining Hemodynamic, Biochemical, and Biophysical Markers Prior to Pregnancy
Authors: Loftness Bryn C. , Bernstein Ira , McBride Carole A. , Cheney Nick , McGinnis Ellen W. , McGinnis Ryan S.
Published: March 2023

Preeclampsia (PE) is a leading cause of maternal and perinatal death globally and can lead to unplanned preterm birth. Predicting risk for preterm or early-onset PE, has been investigated primarily after conception, and particularly in the early and mid-gestational periods. However, there is a distinct clinical advantage in identifying individuals at risk for PE prior to conception, when a wider array of preventive interventions are available. In this work, we leverage machine learning techniques to identify potential pre-pregnancy biomarkers of PE in a sample of 80 women, 10 of whom were diagnosed with preterm preeclampsia during their subsequent pregnancy. We explore biomarkers derived from hemodynamic, biophysical, and biochemical measurements and several modeling approaches. A support vector machine (SVM) optimized with stochastic gradient descent yields the highest overall performance with ROC AUC and detection rates up to .88 and .70, respectively on subject-wise cross validation. The best performing models leverage biophysical and hemodynamic biomarkers. While preliminary, these results indicate the promise of a machine learning based approach for detecting individuals who are at risk for developing preterm PE before they become pregnant. These efforts may inform gestational planning and care, reducing risk for adverse PE-related outcomes.

Clinical Relevance

This work considers the development and optimization of pre-pregnancy biomarkers for improving the identification of preterm (early-onset) preeclampsia risk prior to conception.