bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival of total knee arthroplasty after high tibial osteotomy versus primary total knee arthroplasty
Authors: Seo Seung-Suk , Nha Kyung-Wook , Kim Tae-Yeong , Shin Young-Soo
Published: July 2019

Background:

Theoretical considerations suggest that total knee arthroplasty (TKA) is technically more challenging after high tibial osteotomy (HTO), resulting in inferior results compared to primary TKA. However, several studies on this issue have shown contradictory results. The purpose of this meta-analysis to compare survivorship and clinical outcomes between TKA with and without previous HTO.

Methods:

We reviewed studies that evaluated pain and function scores, range of motion (ROM), operation time, Insall-Salvati (IS) ratio, complications, and survival rates in patients treated with TKA with previous HTO or with primary TKA with short- to midterm (<10 years) or long-term (>10 years) follow-up.

Results:

Fifteen studies were included in the meta-analysis. There were no significant differences between TKA with and without previous HTO in pain score (95% CI: −0.27 to 0.29; P = .94), function score (95% CI: −0.08 to 0.24; P = .32), operation time (95% CI: −5.43 to 26.85; P = .19), IS ratio (95% CI: −0.03 to 0.08; P = .40), complication rates (TKA with previous HTO, 62/1717; primary TKA, 610/31386; OR 1.31, 95% CI: 0.97–1.77; P = .08), and short- to midterm survival rates (TKA with previous HTO, 1860/2009; primary TKA, 37848/38765; OR 0.55, 95% CI: 0.28–1.10; P = .09). Conversely, ROM (95% CI: −7.40 to −1.26; P = .006) and long-term survival rates (TKA with previous HTO, 1426/1523; primary TKA, 29810/31201; OR 0.71, 95% CI: 0.57–0.89; P = .003) were significantly different between the two groups. In addition, both groups had substantial proportions of knees exhibiting short- to midterm survivorship (92.6% by TKA with previous HTO and 97.6% by primary TKA) and long-term survivorship (93.6% by TKA with previous HTO and 95.5% by primary TKA).

Conclusions:

This meta-analysis suggests that a previous HTO affected ROM or survival of TKA in the long-term even though both groups have equivalent clinical outcomes and complications. Thus, orthopedic surgeons should offer useful information regarding the advantages and disadvantages of both procedures to patients, and should provide advice on the generally higher risk of revision after TKA with previous HTO at long-term follow-up when counseling patients.
General anesthesia combined with epidural anesthesia maintaining appropriate anesthesia depth may protect excessive production of inflammatory cytokines and stress hormones in colon cancer patients during and after surgery
Authors: Hou Bao-Jun , Du Ying , Gu Shu-Xin , Fan Jie , Wang Ran , Deng Hong , Guo Dan-Xia , Wang Li , Wang Yan-Ying
Published: July 2019

The purpose of this study was to investigate the influences of varied anesthetic methods and depths on inflammatory cytokines and stress hormone levels in radical operation among colon cancer patients during perioperative period.

A total of 120 patients were collected in the study and randomly divided into 4 groups, A: general anesthesia + Narcotrend D1, B: general anesthesia + Narcotrend D2, C: general anesthesia + epidural anesthesia + Narcotrend D1, D: general anesthesia + epidural anesthesia + Narcotrend D2. The levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, cortisol (Cor), adrenocorticotropic hormone (ACTH), and endothelin-1 (ET-1) were measured adopting commercial kits before anesthesia (T0), 4 hours after surgery (T1), 24 hours after surgery (T2), and 72 hours after surgery (T3).

There was no significant difference in basic clinical characteristics among the groups. In comparison with group A, B and C, group D showed significantly lower levels of TNF-α, IL-6, IL-10, Cor, ACTH, and ET-1 at T1 and T2 (all, P < .05). Significantly higher levels of TNF-α, IL-6, IL-10, Cor, and ACTH were detected at T1 and T2 than those at T0 (all, P < .05), whereas, at T3, the levels of inflammatory cytokines and stress hormones were all decreased near to preoperation ones.

General anesthesia combined with epidural anesthesia at Narcotrend D2 depth plays an important role in reducing immune and stress response in patients with colon cancer from surgery to 24 hours after surgery.
Medical emergencies in dental hygienists’ practice
Authors: Smereka Jacek , Aluchna Marcin , Aluchna Alicja , Puchalski Marcin , Wroblewski Pawel , Checinski Igor , Leskiewicz Marcin , Szarpak Lukasz
Published: July 2019

Dental hygienists in Poland work in various settings, including public health care institutions, private dental practices, dental clinics, kindergartens, and schools. They can often face medical emergencies, whose rate is increasing owing to comorbidities and aging of dental patients’ populations. The aim of the study was to assess the prevalence of medical emergencies in dental hygienists’ practice in Poland and the hygienists’ preparedness and attitudes toward emergencies.

A 10-question authors’ own questionnaire was filled in by 613 dental hygienist. It referred to their cardiopulmonary resuscitation training, availability of emergency medical equipment in the workplace, the prevalence of medical emergencies including the need for an emergency medical service (EMS) call, and the management of cardiac arrest.

Overall, 613 dental hygienists working in Poland participated in the study; 38.99% had taken part in basic life support (BLS) training within the previous 12 months and 35.89% within 2 to 5 years; 15.17% had experienced at least 1 emergency situation requiring an EMS call within the previous 12 months. Vasovagal syncope was the most common medical emergency (15.97%), followed by moderate anaphylactic reaction (13.87%), seizures (8.81%), hyperventilation crisis (7.50%), and hypoglycemia (7.34%).

The most common medical emergency in dental hygienists’ practice in Poland is syncope followed by mild anaphylactic reaction. Most of the dental hygienist had participated in a BLS course within the previous 5 years; however, 20% of them have never participated since graduation. Dental hygienists should participate in BLS courses every 2 years to keep the cardiopulmonary resuscitation skills and stay up-to-date with current guidelines. An important part of the study participants declare the lack of availability in their workplaces of life-saving equipment, including self-expanding bag resuscitator, oropharyngeal, and supraglottic airway device and oxygen source. Medical emergency equipment as recommended in the international guidelines should be available in every practice.
The Qigong Wuqinxi for chronic obstructive pulmonary disease
Authors: Yu Feng , Xin Mengxue , Liu Nan , Huang Na , Lu Jianhui
Published: July 2019

Background:

Chronic obstructive pulmonary disease (COPD) is a chronic and progressive disease that represents an important public health challenge nowadays. Despite the growing number of studies assessing the rehabilitation outcome of Wuqinxi for COPD, their many variables and observations are often explored with a relatively small sample size, accordingly maybe lead to potential false-positive results. The aim of this systematic review and meta-analysis is to evaluate the rehabilitation efficacy of Wuqinxi for COPD.

Methods:

A detailed search for articles up to June 2019 will be performed to identify randomized controlled trials for Wuqinxi in COPD. The following database will be used: PUBMED, Embase, Scopus, Web of Science, Google Scholar, Cochrane Library, Sino Med, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodicals Database, and Wanfang Database. Grey literature will be explored and the selection of studies, data extraction and validation will performed independently by 2 reviewers using predefined selection criteria and quality indicators. Stata V.13.0 and Review manager 5.3 software will be used for data synthesis, sensitivity analysis, subgroup analysis, and risk of bias assessment. We will use the grading of recommendations assessment, development, and evaluation system to assess the quality of evidence.

Results:

This research will update previous evidence summaries and provide a quantitative and standardized assessment of the rehabilitation efficacy of Wuqinxi for COPD.

Conclusion:

This systematic review will generate the latest evidence for determining whether Wuqinxi has a positive rehabilitation effect for COPD.

PROSPERO registration number: PROSPERO CRD 42019120960.
Clinical characteristics of early neuroendocrine carcinoma in stomach
Authors: Zhu Xiaolong , Jing Haiyan , Yao Takashi
Published: July 2019

Introduction:

Gastric neuroendocrine carcinoma (NEC) is rare. It is considered to be aggressive and has a poor prognosis since the diagnosis is usually made at its advanced stage. However, the survival rate is increased in some early gastric NECs. This study showed a case and reviewed the clinical characteristics of early NECs in stomach.

Patient concerns:

A 38-year-old man displayed no symptoms and underwent the gastric endoscopy test for his health examination, which showed a red slightly depressed lesion 1.0 cm in size on the lesser curvature of gastric cardia. Magnifying endoscopy with narrow-band imaging (NBI) revealed a clear demarcation and an irregular mesh in vessels within the depressed area. The background mucosa was negative for atrophic gastritis and Helicobacter Pylori infection. A contrast-enhanced computed tomography (CT) scan disclosed no obvious thickening of stomach and lymphadenopathy. Blood tests and physical examination were unremarkable. He had not received any surgical treatment and denied a family history of cancer and any genetic disorders. The pathologic result of biopsy from the lesion was suspicious of superficial carcinoma. Then endoscopic submucosal dissection (ESD) was performed.

Diagnosis:

Gastric NEC G3 in the early stage (T1aN0M0).

Interventions:

Concerning this patient's situation, we considered the ESD as a curable treatment. And no radical surgery or adjuvant chemotherapy was arranged.

Outcomes:

The patient is doing well and displays no recurrence for 11 months, who is still in follow-up.

Lessons subsections as per style:

The early diagnosis and effective treatment by endoscopy would contribute to improve the prognosis of gastric NECs.
Organs by design: can bioprinting meet self-organization?
Authors: Martin Ivan , Malda Jos , Rivron Nicolas C.
Published: July 2019

Purpose of review

Engineering functional organs starting from stem or progenitor cells holds promise to address the urgent need for organ transplants. However, to date, the development of complex organ structures remains an open challenge.

Recent findings

Among multiple approaches to organ regeneration that are being investigated, two main directions can be identified, namely the patterned deposition of cells to impose specific structures, using bioprinting technologies, and (ii) the spontaneous development of organoids, according to principles of self-organization. In this review, we shortly describe the advantages and limitations of these paradigms and we discuss how they can synergize their positive features to better control and robustly develop organs from stem cells, toward organogenesis by design.

The outlined possibilities to bring together tools and concepts of bioprinting and self-organization will be relevant not only to generate implantable organs, but also to dissect fundamental mechanisms of organogenesis and to test therapeutic strategies in modeled pathological settings.
Algorithm for selection of balance assessment tools in post-stroke patients
Authors: Goljar Nika , Rudolf Marko , Bizovičar Nataša
Published: July 2019

The aim of the study was to design an algorithm of selecting the balance assessment tool in patients after stroke, which could be used in a subacute rehabilitation setting. A retrospective study was carried out to analyse results of standardized balance measurements in three groups of stroke patients classified by Functional Ambulation Category (FAC) (FAC 1 or 2, non-functional ambulation; FAC 3 or 4, ambulatory dependent; FAC 5 or 6, ambulatory independent). Balance functions were evaluated in 62 out of 70 patients (88.6%) at admission and discharge with at least with one standardized assessment tool. In 21 patients (30%), two or more assessment tools were used. From admission to discharge significant changes in balance functions in the non-functional ambulatory group were detected by Postural Assessment Scale for Stroke (PASS) (P = 0.003), in the ambulatory dependent group with PASS (P = 0.025) and Berg Balance Scale (BBS) (P = 0.009) and in the ambulatory independent group with the Timed Up and Go Test (P = 0.002) and Functional Gait Assessment (P = 0.029). In a post-stroke rehabilitation most commonly used BBS and PASS are sensitive enough in non-functional ambulatory and ambulatory dependent patients, though they do not reflect the overall balance function. In ambulatory independent patients, significant changes in balance functions can be detected only with the assessment tools that include the measurements of dynamic balance. Based on the findings, the algorithm for the selection of balance assessment tools in post-stroke rehabilitation setting was formulated according to FAC.
Measuring the Burden on Family Caregivers of People With Cancer
Authors: Kristanti Martina Sinta , Vernooij-Dassen Myrra , Utarini Adi , Effendy Christantie , Engels Yvonne
Published: July 2019

Background

The Caregiver Reaction Assessment (CRA) is considered one of the well-developed instruments for measuring the multidimensional burden of family caregivers. To date, there is no available validated instrument to assist healthcare professionals in measuring the caregiver’s burden in Indonesia.

Objective

To translate the CRA from English into Indonesian and to conduct psychometric testing of this CRA–Indonesian version (CRA-ID) with family caregivers of patients with cancer.

Methods

Cross-cultural translation and psychometric testing were conducted. Confirmatory factor analysis and exploratory factor analysis were performed to check, explore, and confirm the best model for the CRA-ID; internal consistency was also measured.

Results

A total of 451 respondents participated, of whom 40 were involved in the feasibility testing. Confirmatory factor analysis with the original factors of the CRA revealed that the fit was not satisfactory, and adaptation was needed. Through exploratory factor analysis, the best model fit was developed, and confirmatory factor analysis was performed again. Five factors from the original instrument were confirmed with an explained variance of 54.89%. Almost all items in the CRA-ID appeared to have a similar structure as the original version. Cronbach's α's ranged between .64 and .81.

Conclusions

The CRA-ID appeared to be feasible, valid, and reliable for measuring the burden of family caregivers of patients with cancer in Indonesia.

Implications for Practice

Nurses can use the CRA-ID to measure family caregivers’ burden. Its availability in the Indonesian language enhances the opportunity to conduct international comparisons of family caregiver burden using the same instrument.
Capturing the Use of Dietary Supplements in Electronic Medical Records
Authors: Costello Rebecca B. , Deuster Patricia A. , Michael Madeline , Utech Anne
Published: July 2019

Of importance to federal agencies that administer healthcare facilities is capturing patient use of dietary supplements (DSs) to avoid potential drug-supplement interactions. Digital technologies, such as use of the electronic medical record and the electronic health record (EHR), are key to monitoring healthcare. The particular electronic software package and the healthcare professional using this software influence how this documentation is recorded. A survey was conducted to determine how information on DSs is being collected, recorded, and processed in EHRs across federal agencies. Four federal agencies providing direct healthcare services to large numbers of men and women in the United States were surveyed on current practices regarding the recording and processing of information on DS use on either an outpatient or inpatient basis. A point of contact for each of the following federal agencies was identified, and a 13-question survey was sent to each for completion: National Institutes of Health Clinical Center, Department of Defense Military Nutrition Committee, Veterans Health Administration Office of Specialty Care Services, and Indian Health Service, Office of Information Technology. All 4 agency representatives completed the survey. No agency used the same EHR software reporting system. Most EHRs have searchable fields that are in a structured format, but some information is free text and allowed entry by multiple members of the healthcare team. Three different medication formulary or drug knowledge databases were used across the agencies. Most agencies using EHR management systems have adequately described procedures for entering and charting information on DSs. The responsibility for charting, however, varies across agencies whether captured by the admitting doctor, nurse, dietitian, or pharmacist. Direct linkage between the pharmacy system and the drug knowledge database is a feature of the EHR for several but not all federal agencies. An unmet need still exists in the EHR to implement DS/drug interaction checks as many DS products have multiple active ingredients and, when taken with other DSs or prescription drugs, increase the likelihood of an adverse event. Establishing common EHR practices could facilitate monitoring the use and potential interactions of DSs with prescribed drugs.
History and Perspectives on the Dannon Institute Early-Career Nutrition Leadership Institute
Authors: Heimburger Douglas C. , Hermann Mindy , McClung James P. , McGuire Michelle K. , Rasmussen Kathleen M. , Troy Lisa M. , Young Sera L.
Published: July 2019

Graduate nutrition training in the United States prepares graduates for careers in academia, industry, and government and nongovernment sectors by enhancing critical thinking skills and providing specific technical skills necessary for doctoral-level employment. However, it is often not designed to develop skills in leadership that are key to fully successful careers. The Dannon Institute’s Nutrition Leadership Institute was initiated in 1998 to provide leadership training to fill this gap and to enable early-career nutrition scientists to achieve their career goals. After 20 years of experience with the Nutrition Leadership Institute, this article describes the program’s genesis and evolution, captures its key features and principal outcomes as expressed by alumni, and highlights its value to its participants and the larger nutrition community.
Creating and Disseminating a Resource for State Policy Makers About Injury and Violence Prevention: A Case Example of Translating Research to Policy
Authors: Frattaroli Shannon , Pollack Porter Keshia , Omaki Elise , Vernick Jon S. , Gielen Andrea C.
Published: July 2019

The gap between evidence and policy is a challenge that can be bridged through strategic outreach and translation efforts. We developed and disseminated the Resource for State Policy Makers (the Resource) to lessen the information gap between state policy makers and injury prevention researchers in Maryland. Our goal was to produce and disseminate a resource for policy makers that could be replicated by public health professionals in other states and regions. The Maryland Department of Health assumed production of the Resource in 2017, with assistance from our team. Several states and regions have replicated the Resource for their own jurisdictions. This experience provides an informative case example of one approach to increasing the role of evidence in policy making.
A Spatial Evaluation of Healthy Food Access: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participants
Authors: Davis Jonathan , Jossefides Mindy , Lane Travis , Pijawka David , Phelps Mallory , Ritchey Jamie
Published: July 2019

Context:

It is well known in public health practice that vulnerable populations in rural and inner-city areas may not be able to access healthy foods due to cost, availability, access to transport, and other factors.

Program:

The Inter Tribal Council of Arizona, Inc (ITCA), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides moderate- and lower-income families with increased access to nutritional information, health care, and healthy foods.

Implementation:

ITCA WIC authorizes and enters into contracts with stores that carry a baseline of healthy foods. To use WIC benefits, participants must go to authorized WIC stores where approved healthy foods are available.

Evaluation:

ITCA Tribal Epidemiology Center developed a methodological framework using Geographic Information Systems to examine WIC authorized stores in 2014 and 2016 to determine whether there were gaps in the store network. To be considered served by the store network, urban WIC participants were required to be within 1 mile and nonurban WIC participants were required to be within 5 miles of a store. We examined whether additional stores could be added to the network to decrease travel distance and travel time in order to further improve access to healthy foods.

Discussion:

Between 2014 and 2016, 700 stores were examined and WIC authorized 8 new stores to increase the network; all remote and most rural stores were WIC authorized. In 2014, about 50% of participants met the criteria to be considered served. In 2016, 54% met the criteria, indicating a modest increase in store access for WIC participants. Store network access increased in urban areas from 39% to 41% and from 66% to 74% in nonurban areas between 2014 and 2016. By evaluating the ITCA WIC authorized stores, we note that ITCA increased access to WIC approved healthy foods for WIC participants.
Reducing Expansion Visits in Immediate Implant-Based Breast Reconstruction: A Comparative Study of Prepectoral and Subpectoral Expander Placement
Authors: Wormer Blair A. , Valmadrid Al C. , Ganesh Kumar Nishant , Al Kassis Salam , Rankin Timothy M. , Kaoutzanis Christodoulos , Higdon Kent K.
Published: July 2019

Background:

The numerous office visits required to complete expansion in implant-based breast reconstruction impact patient satisfaction, office resources, and time to complete reconstruction. This study aimed to determine whether prepectoral compared to subpectoral immediate implant-based breast reconstruction offers expedited tissue expansion without affecting complication rates.

Methods:

Consecutive patients who underwent immediate implant-based breast reconstruction with tissue expanders from January of 2016 to July of 2017 by a single surgeon were grouped into subpectoral (partial submuscular/partial acellular dermal matrix) or prepectoral (complete acellular dermal matrix coverage), and reviewed. The primary outcomes were total days and number of visits to complete expansion. Groups were compared by univariate analysis with significance set at p < 0.05.

Results:

In total, 101 patients (subpectoral, n = 69; prepectoral, n = 32) underwent 184 immediate implant-based breast reconstructions (subpectoral, n = 124; prepectoral, n = 60). There was no difference in age, body mass index, smoking, or diabetes between the groups (all p > 0.05). Follow-up was similar between groups (179.3 ± 98.2 days versus 218.3 ± 119.8 days; p = 0.115). Prepectoral patients took fewer days to complete expansion (40.4 ± 37.8 days versus 62.5 ± 50.2 days; p < 0.001) and fewer office visits to complete expansion (2.3 ± 1 .7 versus 3.9 ± 1.8; p < 0.001), and were expanded to greater final volumes than subpectoral patients (543.7 ± 122.9 ml versus 477.5 ± 159.6 ml; p = 0.017). Between prepectoral and subpectoral reconstructions, there were similar rates of minor complications (25 percent versus 18.5 percent; p = 0.311), readmissions (5 percent versus 2.4 percent; p = 0.393), seromas (8.3 percent versus 5.6 percent; p = 0.489), reoperations for hematoma (3.3 percent versus 1.6 percent; p = 0.597), and explantations (5 percent versus 2.4 percent; p = 0.393).

Conclusion:

This novel analysis demonstrates that prepectoral immediate implant-based breast reconstruction can facilitate expansion to higher total volumes in nearly half the office visits compared to subpectoral placement in similar populations without increasing complication rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Cross-Sectional Soft-Tissue Composition and the Distribution of Blue Cutaneous Discoloration in the Lower Eyelid after Hyaluronic Acid Injection
Authors: Essilfie Juliet O. , Kattan Jaffer , Demer Joseph L. , Rootman Daniel B.
Published: July 2019

The soft-tissue composition of the eyelid varies from lateral to medial, in that the orbicularis area (in square millimeters) is greatest medially and least laterally, whereas the reverse is true for the preauricularis and postorbicularis fat. The purpose of this study was to describe the relative contribution of tissue types to the volume of the lower eyelid-midface junction. This is an observational cohort study of 11 subjects (20 eyes) without a history of orbital or periorbital surgery or abnormality. Quasi-sagittal surface coil magnetic resonance imaging scans in planes parallel to the long axis of each orbit were obtained during central gaze fixation. Measurements of the tissue area (in square millimeters) of the skin, preorbicularis fat, orbicularis, and postorbicularis fat were obtained in the center, medial, and lateral eyelid regions. Differences in tissue area across the eyelid were assessed. The segmental cross-sectional area and percentage of total segment represented by the orbicularis muscle increased from the lateral (9.4 mm2; 21.8 percent) to the central (14.1 mm2; 35.0 percent) and to the medial (18.5 mm2; 47.0 percent) eyelid (p < 0.01). The inverse pattern was noted for both preorbicularis and postorbicularis fat, each occupying less area (in square millimeters) from lateral to medial (p < 0.01). Skin thickness did not vary significantly across the eyelid. The soft-tissue composition of the eyelid varies from lateral to medial in that the orbicularis increases in area, whereas the reverse is true for the preorbicularis and postorbicularis fat. This anatomical progression may help to explain the stereotypical location of blue discoloration in some patients after hyaluronic acid filler injection.
Protective Effect of Botulinum Toxin against Ultraviolet-Induced Skin Pigmentation
Authors: Jung Jae-A , Kim Beom-Jun , Kim Min-Sook , You Hi-Jin , Yoon Eul-Sik , Dhong Eun-Sang , Park Seung-Ha , Kim Deok-Woo
Published: July 2019

Background:

Hyperpigmentation following ultraviolet irradiation has cosmetic concerns. Botulinum toxin type A can favorably affect skin pigmentation. However, the mechanism of skin pigmentation is unclear.

Methods:

In vitro, human epidermal melanocytes were co-cultured with human keratinocytes. After cells were treated with botulinum toxin type A, cell morphology, proliferation, and dendricity were analyzed, and immunofluorescence, tyrosinase activity, and melanin contents were determined. To evaluate the effect of botulinum toxin type A on ultraviolet B–irradiated mouse skin, ultraviolet B alone was applied to one side of the back of each mouse as a control, whereas ultraviolet B plus injection of botulinum toxin type A was applied to the contralateral side. Skin pigmentation, histology, and the number of dihydroxyphenylalanine-positive melanocytes were evaluated. The L* colorimeter value was measured. Enzyme-linked immunosorbent assay determinations of basic fibroblast growth factor, interleukin-1 alpha, and prostaglandin E2 were performed.

Results:

Immunohistochemical staining revealed botulinum toxin type A in the cytoplasm of melanocytes and in the positive control. In vitro, melanocyte dendricity and melanin contents were decreased slightly but significantly (p < 0.05) after botulinum toxin type A treatment. In vivo, botulinum toxin type A suppressed skin pigmentation. The number of dihydroxyphenylalanine-positive melanocytes was also significantly lower than in the control side. Tyrosinase activity and melanin content were also significantly reduced (p < 0.05). Botulinum toxin type A also significantly reduced the amounts of basic fibroblast growth factor, interleukin-1 alpha, and prostaglandin E2 (all p < 0.05).

Conclusion:

Botulinum toxin type A can suppress epidermal melanogenesis through both direct and indirect mechanisms.
Lower Eyelid Reconstruction: A New Classification Incorporating the Vertical Dimension
Authors: Alghoul Mohammed S. , Bricker Jonathan T. , Vaca Elbert E. , Purnell Chad A.
Published: July 2019

Background:

Lower eyelid defects are traditionally classified based on depth and 25 percent increments in defect width. The authors propose a new classification system that includes the vertical defect component to predict functional and aesthetic outcomes.

Methods:

A retrospective review of patients who underwent lower lid reconstruction performed by a single surgeon was performed. Defects were classified into four categories based on the vertical component: (1) pretarsal; (2) preseptal; (3) eyelid-cheek junction; and (4) complex pretarsal/preseptal. Preoperative and postoperative central and lateral marginal reflex distance-2 values were obtained. Aesthetic outcomes were evaluated by three blinded reviewers. Outcomes were compared using one-way analysis of variance and analysis of covariance with Bonferroni corrected post hoc comparisons to control for defect area and width.

Results:

Thirty-four patients underwent reconstruction of lower eyelid defects. There were 12 pretarsal defects (type I), nine preseptal defects (type II), nine eyelid-cheek defects (type III), and four complex pretarsal/preseptal defects (type IV). Postoperative retraction was highest in the complex pretarsal/preseptal group at 75 percent, with a significantly greater change from preoperative to postoperative central and lateral marginal reflex distance-2 compared with the other groups (p < 0.01) and worse postoperative mean aesthetic scores (p < 0.001). Type IV patients had significantly more revision operations (mean, 5.5) compared with the other groups (p < 0.001).

Conclusions:

The vertical dimension of lower eyelid defects is an important variable. A new classification system is proposed that supplements width-based methods for improved surgical planning and prediction of postoperative outcomes in lower eyelid reconstruction.

CLINICAL QUESTION/LEEVL OF EVIDENCE:

Therapeutic, IV.
Facial Transplantation for an Irreparable Central and Lower Face Injury: A Modernized Approach to a Classic Challenge
Authors: Kantar Rami S. , Ceradini Daniel J. , Gelb Bruce E. , Levine Jamie P. , Staffenberg David A. , Saadeh Pierre B. , Flores Roberto L. , Sweeney Nicole G. , Bernstein G. Leslie , Rodriguez Eduardo D.
Published: July 2019

Background:

Facial transplantation introduced a paradigm shift in the reconstruction of extensive facial defects. Although the feasibility of the procedure is well established, new challenges face the field in its second decade.

Methods:

The authors’ team has successfully treated patients with extensive thermal and ballistic facial injuries with allotransplantation. The authors further validate facial transplantation as a reconstructive solution for irreparable facial injuries. Following informed consent and institutional review board approval, a partial face and double jaw transplantation was performed in a 25-year-old man who sustained ballistic facial trauma. Extensive team preparations, thorough patient evaluation, preoperative diagnostic imaging, three-dimensional printing technology, intraoperative surgical navigation, and the use of dual induction immunosuppression contributed to the success of the procedure.

Results:

The procedure was performed on January 5 and 6, 2018, and lasted nearly 25 hours. The patient underwent hyoid and genioglossus advancement for floor-of-mouth dehiscence, and palate wound dehiscence repair on postoperative day 11. Open reduction and internal fixation of left mandibular nonunion were performed on postoperative day 108. Nearly 1 year postoperatively, the patient demonstrates excellent aesthetic outcomes, intelligible speech, and is tolerating an oral diet. He remains free from acute rejection.

Conclusions:

The authors validate facial transplantation as the modern answer to the classic reconstructive challenge imposed by extensive facial defects resulting from ballistic injury. Relying on a multidisciplinary collaborative approach, coupled with innovative emerging technologies and immunosuppression protocols, can overcome significant challenges in facial transplantation and reinforce its position as the highest rung on the reconstructive ladder.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Appropriate Timing of Early Postoperative Botulinum Toxin Type A Injection for Thyroidectomy Scar Management: A Split-Scar Study
Authors: An Min Kyun , Cho Eun Byul , Park Eun Joo , Kim Kwang Ho , Kim Lee Su , Kim Kwang Joong
Published: July 2019

Background:

Botulinum toxin type A (BTxA) injection is effective for surgical scar prevention. Although some studies have aimed to confirm the efficacy of BTxA injection at different time points, none has been conducted to determine the most appropriate timing of injection for scar management. The authors predicted that the injection of BTxA at different times during the wound healing process would cause differing scar quality improvement and clarify unknown molecular mechanisms.

Methods:

The study included adults who underwent thyroidectomy. All patients received paralesional BTxA injections on the day of the surgery on either the right or left side of the operative site. The same dose was injected on the noninjected side by means of the same method after 2 weeks. At 2, 4, 12, and 24 weeks postoperatively, the modified Stony Brook Scar Evaluation Scale, visual analogue scale, and erythema index were used for objective, subjective, and quantitative evaluations of the scar. At week 24 postoperatively, a quantitative scar assessment was performed with respect to the erythema index, skin elasticity, melanin index, and friction.

Results:

On objective evaluation of the scar and patient satisfaction at 24 weeks postoperatively, the operation-day injection side showed better outcomes than the 2-week-postoperative injection side. These differences were significant from postoperative week 4. In the final quantitative scar assessment at postoperative week 24, significant improvements were observed in the erythema index and skin elasticity.

Conclusion:

These results suggest that immediate postoperative BTxA injection is more effective for thyroidectomy scar management in terms of erythema, skin elasticity, and patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
18F-FDG PET/CT in Metastatic Extramammary Paget’s Disease
Authors: Khoo Alex Cheen Hoe , Yeoh Kheng Wei
Published: July 2019

Extramammary Paget's disease (EMPD) is a rare disease with an estimated prevalence of 0.1 to 2.4 per 1,000,000 person-years. Metastatic EMPD has a poor prognosis with a 5-year survival of approximately 7%. Local therapy is the only curative option with surgery being recommended for resectable disease. It is therefore crucial to be able to stage such patients appropriately. The utility of 18F-FDG PET/CT for this disease is not well established. We share a case on how 18F-FDG PET/CT was used to stage metastatic EMPD.
Clinical Utility of 68Ga–Prostate-Specific Membrane Antigen PET/CT Scan on Postoperative Assessment of Juvenile Nasal Angiofibroma
Authors: Thakar Alok , Sakthivel Pirabu , Prashanth Arun , Kumar Rakesh , Sharma Suresh Chandra , Kumar Rakesh
Published: July 2019

Prostate-specific membrane antigen (PSMA) is expressed on the endothelial cells of tumor-associated neovasculature of various nonprostatic benign and malignant neoplasms. Positive uptake on PET/CT imaging with 68Ga-labeled PSMA is noted in a patient with juvenile nasal angiofibroma, and the same is noted to be absent following complete surgical excision. 68Ga-PSMA PET/CT may be a useful tool for juvenile nasal angiofibroma recurrence identification and in differentiating recurrence from surgical site reparative tissue.
18F-THK5351 PET Can Identify Astrogliosis in Multiple Sclerosis Plaques
Authors: Ishibashi Kenji , Miura Yoshiharu , Hirata Kosei , Toyohara Jun , Ishii Kenji
Published: July 2019

A 26-year-old woman with relapsing-remitting multiple sclerosis (MS) underwent 18F-THK5351 PET during a remission period. PET imaging showed that small regions with elevated uptake of 18F-THK5351 were scattered in the brain and that the foci of 18F-THK5351 accumulations corresponded anatomically to MS plaques identified by MRI. Because 18F-THK5351 binds to monoamine oxidase B highly expressed in astrocytes, 18F-THK5351 accumulates in lesions undergoing astrogliosis. Hence, elevated uptake of 18F-THK5351 in the present case can represent ongoing astrogliosis in inactive MS lesions (plaques).
Demographics, Treatments, and Outcomes of Acute Respiratory Distress Syndrome: the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) Study
Authors: Fujishima Seitaro , Gando Satoshi , Saitoh Daizoh , Kushimoto Shigeki , Ogura Hiroshi , Abe Toshikazu , Shiraishi Atsushi , Mayumi Toshihiko , Sasaki Junichi , Kotani Joji , Takeyama Naoshi , Tsuruta Ryosuke , Takuma Kiyotsugu , Yamashita Norio , Shiraishi Shin-ichiro , Ikeda Hiroto , Shiino Yasukazu , Tarui Takehiko , Nakada Taka-aki , Hifumi Toru , Otomo Yasuhiro , Okamoto Kohji , Sakamoto Yuichiro , Hagiwara Akiyoshi , Masuno Tomohiko , Ueyama Masashi , Fujimi Satoshi , Yamakawa Kazuma , Umemura Yutaka
Published: July 2019

Purpose:

Acute respiratory distress syndrome (ARDS) remains a major cause of death. Epidemiology should be continually examined to refine therapeutic strategies for ARDS. We aimed to elucidate demographics, treatments, and outcomes of ARDS in Japan.

Methods:

This is a prospective cohort study for ARDS. We included adult patients admitted to intensive care units through emergency and critical care departments who satisfied the American–European Consensus Conference (AECC) acute lung injury (ALI) criteria. In addition, the fulfillment of the Berlin definition was assessed. Logistic regression analyses were used to examine the association of independent variables with outcomes.

Results:

Our study included 166 patients with AECC ALI from 34 hospitals in Japan; among them, 157 (94.6%) fulfilled the Berlin definition. The proportion of patients with PaO2/FIO2 ≤ 100, patients under invasive positive pressure ventilation (IPPV), and in-hospital mortality was 39.2%, 92.2%, and 38.0% for patients with AECC ALI and 38.9%, 96.8%, and 37.6% for patients with Berlin ARDS, respectively. The area of lung infiltration was independently associated with outcomes of ARDS. Low–mid-tidal volume ventilation was performed in 75% of patients under IPPV. Glucocorticoid use was observed in 54% patients, and it was positively associated with mortality.

Conclusions:

Our study included a greater percentage of patients with ARDS with high severity and found that the overall mortality was 38%. The management of ARDS in Japan was characterized by high the utilization rate of glucocorticoids, which was positively associated with mortality.
Morphologic Factors Predict Pain Relief Following Pancreatic Head Resection in Chronic Pancreatitis Description of the Chronic Pancreatitis Pain Relief (CPPR) Score
Authors: Bachmann Kai , Melling Nathaniel , Groteluschen Rainer , Fleischauer Anne , Reeh Matthias , Ghadban Tarik , Bockhorn Max , Izbicki Jakob R.
Published: July 2019

Objective:

This study analyzes the clinicopathologic findings and their impact on outcome of patients so as to identify which patients benefit most from surgical treatment in chronic pancreatitis, especially in regard to pain relief.

Summary Background Data:

The predominant symptom of chronic pancreatitis is chronic pain resulting in reduced quality of life. It is well known that the main reason for development of the disease is abuse of alcohol and nicotine, but only little data on factors influencing outcome are available.

Methods:

One thousand one hundred forty-six consecutive patients who underwent surgery for chronic pancreatitis were included. Clinicopathologic data, including morphology of the pancreas in preoperative diagnostics and the histopathologic results, were evaluated. A long-term follow-up including Quality of Life and pain scores was performed. Additionally, we describe the novel Chronic Pancreatitis Pain Relief Score (CPPR-Score) as a tool for prediction of pain relief.

Results:

Overall the rate of pain relief was 79.8% after surgery. The presence of an inflammatory mass in the pancreatic head larger than 4 cm (P< 0.001), presence of a dilated main pancreatic duct of over 4 mm (P< 0.001), histopathologically detected severe calcifications (P= 0.001) and severe fibrosis (P< 0.001) as well as ethanol induced disease (P< 0.001) found to be strong independent prognostic factors for pain relief. The CPPR-Score (0–5 points) proved to be a very good predictive score for pain-relief (P< 0.001).

Conclusions:

The rate of pain relief after surgical treatment in chronic pancreatitis is high and the commonly used procedures can be performed with acceptable morbidity and mortality. The Chronic Pancreatitis Pain Relief Score allows identifying patients who will benefit most from surgery.
Association of Overlapping, Nonconcurrent, Surgery With Patient Outcomes at a Large Academic Medical Center
Authors: Glauser Gregory , Osiemo Benjamin , Goodrich Stephen , McClintock Scott D. , Vollmer Charles , DeMatteo Ronald , Malhotra Neil R.
Published: July 2019

Objective:

Assess the safety of overlapping surgery before implementation of new recommendations and regulations.

Background:

Overlapping surgery is a longstanding practice that has not been well studied. There remains a need to analyze data across institutions and specialties to draw well-informed conclusions regarding appropriate application of this practice.

Methods:

Coarsened exact matching was used to assess the impact of overlap on outcomes amongst all surgical interventions (n = 61,524) over 1 year (2014) at 1 health system. Overlap was categorized as: any, beginning, or end overlap. Study subjects were matched 1:1 on 11 variables. Serious unanticipated events were studied including unplanned return to operating room, readmission, and mortality.

Results:

In all, 8391 patients (13.6%) had any overlap and underwent coarsened exact matching. For beginning/end overlap, matched groups were created (total matched population N = 4534/3616 patients, respectively). Any overlap did not predict unanticipated return to surgery (9.8% any overlap vs 10.1% no overlap; P = 0.45). Further, any overlap did not predict an increase in reoperation, readmission, or emergency room (ER) visits at 30 or 90 days (30D reoperation 3.6% vs 3.7%; P = 0.83, 90D reoperation 3.8% vs 3.9%; P = 0.84) (30D readmission 9.9% vs 10.2%; P = 0.45, 90D readmissions 6.9% vs 7.0%; P = 0.90) (30D ER 5.4% vs 5.6%; P = 0.60, 90D ER 4.8% vs 4.7%; P = 0.71). In addition, any overlap was not associated with mortality over the surgical follow-up period (90D mortality 1.7% vs 2.1%; P = 0.06). Beginning/end overlap had results similar to any overlap.

Conclusion:

Overlapping, nonconcurrent surgery is not associated with an increase in reoperation, readmission, ER visits, or unanticipated return to surgery.
Patient Preferences in Cases of Inter-system Medical Error Discovery (IMED)
Authors: Antunez Alexis G. , Saari Annaka , Miller Jacquelyn , Dossett Lesly A.
Published: July 2019

Objective:

This study analyzes patients’ preferences around disclosure in cases of IMED.

Background:

Patients prefer that physicians disclose their self-discovered medical errors, and disclosure expectations and practices have changed accordingly. Patient preferences about disclosure when physicians discover another provider's error are unknown.

Methods:

We conducted telephone interviews beyond thematic saturation (N = 30) from January to March 2018 with patient volunteers in Michigan. Participants responded to 2 medical error vignettes, the first involving a single physician discovering their own error, and the second involving an IMED scenario. Interviews were conducted concurrently with thematic coding, coded independently by 2 investigators, and discussed until consensus was reached. Analysis proceeded after the inductive and comparative approach of interpretive description.

Results:

Patients considered IMED essentially equivalent to self-discovered errors, and strongly preferred disclosure in both scenarios. Patients preferred disclosure for a variety of reasons, most commonly describing an inherent value in knowing about their own health, a belief that physicians should practice honesty and transparency, and a desire to participate in future care in an informed manner. Patients said they would likely take certain actions after disclosure of another physician's error, ranging from confronting the responsible physician to changing providers to pursuing legal action, with the latter being only in cases of irreversible and debilitating errors.

Conclusions:

This study explores a new domain within the field of error disclosure, concluding that patients preferred disclosure of errors in cases of IMED. Overall, these findings provide motivation to devise systems-level solutions to enable and facilitate IMED disclosure.
Interventions for myofascial pain syndrome in cancer pain: recent advances: why, when, where and how
Authors: Thottungal Athmaja , Kumar Pranab , Bhaskar Arun
Published: July 2019

Purpose of review

Pain is one of the most feared and most common symptoms of cancer, experienced by 38–85% of patients. Pain in terminally ill cancer patients is a multidimensional experience caused by a diverse array of factors – cancer itself, its treatment or other causes. Studies have shown a high incidence of myofascial pain syndrome (MPS) in patients with cancer and the knowledge of myofascial trigger points (MTrPs) is important to address and manage existing pain, and to prevent the recurrence of pain. This review aims to summarize recent advances in interventions for managing MPS in patients with cancer.

Recent findings

Database searches were conducted on MEDLINE, CINAHL, and Google Scholar to locate all studies published from inception until April 2019 using the keywords cancer pain, myofascial pain, TrPs with emphasis of any methodological quality that included interventions for MPS. MPS in advanced cancer patients are more commonly observed along with other cancer pains rather than independently with a prevalence of 11.9–48% in those patients diagnosed with cancer of head and neck and breast cancer.

Interventional therapies employing ultrasound guided injection of the MTrPs is gaining popularity in the management of MPS in cancer pain and may be a better alternative than the use of opioid analgesics in the multidisciplinary management.