bluuebunny/crossref_metadata_2025 huggingface dataset:
Mass gathering events and transmission of respiratory tract infections: updates pre and post COVID-19 lockdown
Authors: Hui David S.C. , Zumla Alimuddin
Published: March 2023

Purpose of review

This article reviews the epidemiology and transmission of respiratory tract infections (RTIs) during mass gathering events (MGEs) before and during the COVID-19 pandemic.

Recent findings

RTIs of viral cause such as influenza, rhinovirus and coronaviruses (229E, HKU1, OC43) are common in MGEs. No cases of MERS-CoV have yet been identified in pilgrims during Hajj, despite the fact that MERS-CoV continues to circulate in the Middle East. Due to the COVID-19 pandemic, organizers of mass gathering religious and sporting events have implemented risk-based infection control measures and lockdowns that limited transmission of RTIs.

Large-scale RTI outbreaks at MGEs are uncommon due to more robust public health planning, prevention, risk assessment and improved health infrastructures in host countries during the COVID-19 pandemic.
Evolving threat of pediatric ingestions: a discussion of cannabis and button batteries and their implications for children
Authors: Lorenzo Melissa , Beno Suzanne
Published: March 2023

Purpose of Review

Pediatric button battery and cannabis ingestions are rising in incidence and have the potential for significant harm. This review will focus on the clinical presentation and complications of these two common inadvertent ingestions in children, as well as recent regulatory efforts and advocacy opportunities.

Recent Findings

The rising incidence of cannabis toxicity in children has corresponded with its legalization across several countries in the last decade. Inadvertent pediatric cannabis intoxication is most commonly due to the ingestion of edible forms discovered by children in their own home. The clinical presentation can be nonspecific, therefore clinicians should have a low threshold for including it on their differential diagnosis. Button battery ingestions are also increasing in incidence. While many children are asymptomatic at presentation, button battery ingestions can quickly cause esophageal injury and lead to several serious and potentially life-threatening complications. Prompt recognition and removal of esophageal button batteries is essential for reducing harm.

Cannabis and button battery ingestions are important for physicians who take care of children to recognize and manage appropriately. Given their rising incidence, there are many opportunities for policy improvements and advocacy efforts to make a difference in preventing these ingestions altogether.
Impressions of the Nursing Profession Among Nursing Students and New Graduates During the First Wave of COVID-19
Authors: Bongiorno Anne Watson , Armstrong Normadeane , Moore Geraldine A. , Mannino Jennifer Emilie , Watters Pamela , Cotter Elizabeth , Kelley Randy
Published: March 2023

Background:

The COVID-19 pandemic has been a defining event for the next generation of the nursing workforce. Complex pandemic practice environments have raised concerns for the preparation and support of novice nurses, even as a multitude of nurses leave the profession.

Purpose:

Researchers sought to examine nursing students' and new graduate nurses' impressions of the nursing profession in contrasting regions of New York State during the first wave of the COVID-19 pandemic.

Methods:

Inductive content analysis was performed on narrative text responses (n = 295) drawn from a larger multisite mixed-methods survey.

Results:

Five subconcepts were abstracted, leading to the main concept of shocked moral distress.

Conclusion:

Nursing students and new graduate nurses have experienced high levels of moral distress but remain committed to the profession. Building moral resilience, fostering ethical decision making, and implementing protective policies can reduce the incidence of moral distress.
Supporting family members requested to donate hematopoietic stem cells to a relative: development and pilot testing of a psycho-educational resource
Authors: Zomerdijk Nienke , Turner Jane , Gottlieb David , Barnes Annette , Butler Jason P. , Markey Kate A. , Hill Geoffrey R.
Published: March 2023

Background:

In light of the increased demand for related donors in allogeneic stem cell transplantation, recognition of the psychosocial issues has also emerged. While resources supporting unrelated volunteer donors exist, none address the emotional issues specific to being a related donor. Providing related donors with preparatory information could help improve the overall donation experience and donor's outcomes.

Objective:

The objectives of this study were to develop and pilot test a print-based psycho-educational resource to support donors in coping with the physical and emotional aspects of donating to a relative. This article describes the development and pilot testing of the resource.

Methods:

Seventeen related donors and eight transplant nurses and physicians (transplant professionals) completed a survey and provided quantitative and qualitative feedback on the acceptability of the resource and preferences regarding the ideal distribution time.

Results:

Respondents endorsed the resource and found it useful and appropriate for the information needs at different stages of the donation and transplant process. The most useful reported components of the resource were testimonials from previous donors and explanations of blood cancers and the stem cell donation process. Most donor respondents indicated that the resource should be distributed as soon as possible while transplant professionals felt this should be after tissue typing, once the donor is confirmed as suitable. Respondents requested additional information on the side effects of donating and the possibility of being asked to repeat donation if the recipient relapses. More donor testimonials were also desired.

Conclusion:

The resource appears to be acceptable to donors and transplant professionals and helpful for developing confidence about coping with the physical and emotional aspects of donation. Findings from this study are currently being used to further refine and deliver the resource in additional formats.
Hemodynamic Effects of a High-Frequency Oscillatory Ventilation Open-Lung Strategy in Critically Ill Children With Acquired or Congenital Cardiac Disease
Authors: de Jager Pauline , Curley Martha A. Q. , Cheifetz Ira M. , Kneyber Martin C. J.
Published: March 2023

OBJECTIVES:

To study the hemodynamic consequences of an open-lung high-frequency oscillatory ventilation (HFOV) strategy in patients with an underlying cardiac anomaly with or without intracardiac shunt or primary pulmonary hypertension with severe lung injury.

DESIGN:

Secondary analysis of prospectively collected data.

SETTING:

Medical-surgical PICU.

PATIENTS:

Children less than 18 years old with cardiac anomalies (± intracardiac shunt) or primary pulmonary hypertension.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Data from 52 subjects were analyzed, of whom 39 of 52 with cardiac anomaly (23/39 with intracardiac shunt) and 13 of 52 with primary pulmonary hypertension. Fourteen patients were admitted postoperatively, and 26 patients were admitted with acute respiratory failure. Five subjects (9.6%) were canulated for ECMO (of whom four for worsening respiratory status). Ten patients (19.2%) died during PICU stay. Median conventional mechanical ventilation settings prior to HFOV were peak inspiratory pressure 30 cm H2O (27–33 cm H2O), positive end-expiratory pressure 8 cm H2O (6–10 cm H2O), and Fio
2 0.72 (0.56–0.94). After transitioning to HFOV, there was no negative effect on mean arterial blood pressure, central venous pressure, or arterial lactate. Heart rate decreased significantly over time (p < 0.0001), without group differences. The percentage of subjects receiving a fluid bolus decreased over time (p = 0.003), especially in those with primary pulmonary hypertension (p = 0.0155) and without intracardiac shunt (p = 0.0328). There were no significant differences in the cumulative number of daily boluses over time. Vasoactive Infusion Score did not increase over time. Paco
2 decreased (p < 0.0002) and arterial pH significantly improved (p < 0.0001) over time in the whole cohort. Neuromuscular blocking agents were used in all subjects switched to HFOV. Daily cumulative sedative doses were unchanged, and no clinically apparent barotrauma was found.

CONCLUSIONS:

No negative hemodynamic consequences occurred with an individualized, physiology-based open-lung HFOV approach in patients with cardiac anomalies or primary pulmonary hypertension suffering from severe lung injury.
LIP SHORTENING SURGERY
Authors: Gatti John E.
Published: March 2023

Many changes are associated with the aging face. Upper lip lengthening with atrophy, lip thinning, and diminution of the lip margin are commonly seen.

Methods:

Lip shortening surgery over a 32-year period by a single surgeon is reviewed. A direct surgical excision of the upper lip skin at the base of the nose with an irregular or curvilinear incision was employed.

Results:

Facial aesthetics were improved with this direct surgical approach. A more youthful vermillion border and an increased lip projection were achieved. Lip asymmetry and an improvement in lip dynamics were also observed. A high rate of revisional surgery (approximately one-fourth) was found in this series. The highly visible, delicate, central facial landmarks involved in lip shortening magnify small scar irregularities and revision, while relatively minor, is often necessary. Patient satisfaction is high as a subjective improvement in lip aesthetics is readily appreciated. Patients frequently request further shortening.

Discussion:

Surgeons need to review the exigent nature of this surgery with their patients and be willing to perform the associated revisions inherent in the procedure. Lip shortening surgery reliably improves facial aesthetics and should be utilized by plastic surgeons when treating the aging face.
Laser combined with radiotherapy for keloid treatment: a novel and efficient comprehensive therapy with a lower recurrence rate
Authors: Ma Qian-Yu , Yang Ya-Ting , Chen Zong-An , Xie Chun-Hui , Wang Wen-Bo , Lin Xiang , Xia Ling-Ling , Zhao Qiong , Gao Zhen , Wu Xiao-Li
Published: March 2023

Background:

Keloid is a fibroproliferative skin disorder with a high recurrence rate. Combined therapies are most used in clinical treatments but relatively high risk of relapse remains a question, the various side effects, and the complexity of the treatment process therapies remain unknown for the current combination therapies.

Methods:

Totally 99 patients with keloids in 131 positions were included in this retrospective study. Fractional CO2 laser therapy was first applied (Alma Laser, Israel) with energy ranging from 360-1008mJ. Then the 6 Mev, 900 cGy electron beam irradiation was applied twice. The first pass was initiated within 24 hours after the laser therapy, and the second pass was performed on the 7th day after laser therapy. The patient and observer scar scale (POSAS) evaluated the lesions before the treatment and at 6-, 12-, 18-month post-treatment. At each follow-up visit, all the patients filled up a questionnaire of recurrence, side effects, and satisfaction.

Results:

We found a significant decrease in the total POSAS score (29[23, 39] versus 61.2±13.4, P＜0.001) at the 18-month follow-up compared to the baseline value (before the therapy). A total of 12.1% of the patients have recurrences during the 18-month follow-up period (11.1% for partial recurrence and 1.0% for complete recurrence). The total satisfaction rate was 97.0%. No severe adverse effects were observed during the follow-up period.

Conclusions:

CHN·Wu LCR is a new comprehensive therapy composed of ablative lasers and radiotherapy for keloids with excellent clinical efficacy, low recurrence rate and no serious adverse effects.
Surgical and Patient-Reported Outcomes of 694 Two-Stage Prepectoral vs. Subpectoral Breast Reconstructions
Authors: Asaad Malke , Yu Jessie Z. , Tran Jacquelynn P. , Liu Jun , O’Grady Brittney , Clemens Mark W. , Largo Rene D. , Mericli Alexander F. , Schaverien Mark , Shuck John , Mitchell Melissa P. , Butler Charles E. , Selber Jesse C.
Published: March 2023

Introduction:

Opinion regarding the optimal plane for prosthetic device placement in breast reconstruction patients has evolved. The purpose of this study was to assess the differences in complication rates and patient satisfaction between patients who underwent prepectoral and subpectoral implant-based breast reconstruction (IBR).

Methods:

We conducted a retrospective cohort study of patients who underwent two-stage IBR at our institution in 2018-2019. Surgical and patient-reported outcomes were compared between patients who received a prepectoral versus a subpectoral tissue expander.

Results:

A total of 694 reconstructions in 481 patients were identified (83% prepectoral, 17% subpectoral). The mean body mass index was higher in the prepectoral group (27 vs. 25 kg/m 2, p=0.001), while postoperative radiotherapy was more common in the subpectoral group (26% vs 14%, p=0.001). The overall complication rate was very similar at 29.3% in the prepectoral and 28.9% in the subpectoral group (p=0.887). Rates of individual complications were also similar between the two groups. A multiple frailty model showed that device location was not associated with overall complications, infection, major complications, or device explantation. Mean scores for satisfaction with the breast, psychosocial well-being, and sexual well-being were similar between the two groups. Median time to permanent implant exchange was significantly longer in the subpectoral group(200 vs. 150 days, p<0.001).

Conclusion:

Prepectoral breast reconstruction results in similar surgical outcomes and patient satisfaction compared to subpectoral IBR.
Short Fasciotomy-Deep Inferior Epigastric Perforator Flap Harvest for Breast Reconstruction
Authors: Kim Jisu , Lee Kyeong-Tae , Mun Goo-Hyun
Published: March 2023

Background:

Despite several technical modifications to further reduce donor invasiveness in harvesting deep inferior epigastric perforator (DIEP) flaps, techniques with general applicability and demonstrating clinical benefits are scarce. The present study aimed to introduce a short-fasciotomy technique and evaluate its reliability, efficacy, and applicability by comparing with those of conventional methods.

Methods:

A retrospective study was conducted with 304 consecutive patients who underwent DIEP flap-based breast reconstruction, consisting of 180 using the conventional technique between October 2015 and December 2018 (cohort 1) and 124 implementing short-fasciotomy technique between January 2019 and September 2021 (cohort 2). In the short-fasciotomy technique, the rectus fascia was incised as much as that overlay the intramuscular course of targeted perforators. After intramuscular dissection, pedicle dissection proceeded without additional fasciotomy. Postoperative complications and fasciotomy-saving benefit were compared.

Results:

The short-fasciotomy technique was successfully adapted for all patients in cohort 2 regardless of length of intramuscular course and number of harvested perforators, with no case requiring conversion to the conventional technique. The mean length of fasciotomy in cohort 2 was 6.6 cm, significantly shorter than that in cohort 1 (11.1cm). The mean length of the harvested pedicle in cohort 2 was 12.6cm. No flap loss occurred in either group. The rate of other perfusion-related complications did not differ between two groups. The rate of abdominal bulge/hernia was significantly lower in cohort 2.

Conclusions:

The short-fasciotomy technique allows for less invasive DIEP flap harvest regardless of anatomical variability and provides reliable outcomes with minimal functional donor morbidity.
Comparison of 3 CT Perfusion Software Packages in Estimation of Ischemic Lesions in Acute Ischemic Stroke Patients
Authors: Li Xiang , Zeng Chen , Li Yige , Liu Huan , Liu Ling , Zeng Wenbing , Yang Ran
Published: March 2023

Objective

The aim of this study was to compare 3 computed tomography perfusion (CTP) software packages in the estimation of infarct core volumes, hypoperfusion volumes, and mismatch volumes.

Methods

Forty-three patients with large vessel occlusion in the anterior circulation who underwent CTP imaging were postprocessed by 3 software packages: RAPID, advantage workstation (AW), and NovoStroke Kit (NSK). Infarct core volumes and hypoperfusion volumes were generated by RAPID with default settings. The AW and NSK threshold settings were the following: infarct core (cerebral blood flow [CBF] <8 mL/min/100 g, CBF <10 mL/min/100 g, CBF <12 mL/min/100 g, and cerebral blood volume [CBV] <1 mL/100 g) and hypoperfusion (Tmax >6 seconds). Mismatch volumes were then obtained for all the combinations of the settings. Bland-Altman, intraclass correlation coefficient (ICC), and Spearman ρ or Pearson correlation coefficient were applied for statistical analysis.

Results

In the estimation of infarct core volumes, good agreement was observed between AW and RAPID when CBV <1 mL/100 g (ICC, 0.767; P < 0.001). For hypoperfusion volumes, good agreement (ICC, 0.811; P < 0.001) and strong correlation (r = 0.856; P < 0.001) were observed between NSK and RAPID. For mismatch volumes, the setting of CBF <10 mL/min/100 g combined with hypoperfusion with NSK resulted in moderate agreement (ICC, 0.699; P < 0.001) with RAPID, which was the best among all other settings.

Conclusions

The estimation results varied among different software packages. Advantage workstation had the best agreement with RAPID in the estimation of infarct core volumes when CBV <1 mL/100 g. NovoStroke Kit had better agreement and correlation with RAPID in the estimation of hypoperfusion volumes. NovoStroke Kit also had moderate agreement with RAPID in estimating mismatch volumes.
Effect of 320-Row Computed Tomography Acquisition Technology on Coronary Computed Tomography Angiography–Derived Fractional Flow Reserve Based on Machine Learning: Systolic and Diastolic Scan Acquisition
Authors: Yang Fengfeng , Shi Ke , Chen Yuhuan , Yin Youbing , Zhao Yang , Zhang Tong
Published: March 2023

Background

The aim of the study is to investigate the performance of coronary computed tomography angiography (CCTA)–derived fractional flow reserve (CT-FFR) in the same patient evaluated by different systolic and diastolic scans, aiming to explore whether 320-slice CT scanning acquisition protocol has an impact on CT-FFR value.

Methods

One hundred forty-six patients with suspected coronary artery stenosis who underwent CCTA examination were included into the study. The prospective electrocardiogram gated trigger sequence scan was performed and electrocardiogram editors selected 2 optimal phases of systolic phase (preset collection trigger at 25% of R-R interval) and diastolic phase (preset collection trigger at 75% of R-R interval) for reconstruction. The lowest CT-FFR value (the CT-FFR value at the distal end of each vessel) and the lesion CT-FFR value (at 2 cm distal to the stenosis) after coronary artery stenosis were calculated for each vessel. The difference of CT-FFR values between the 2 scanning techniques was compared using paired Wilcoxon signed-rank test. Pearson correlation value and Bland-Altman were performed to evaluate the consistency of CT-FFR values.

Results

A total of 366 coronary arteries from the remaining 122 patients were analyzed. There was no significant difference regarding the lowest CT-FFR values between systole phase and diastole phase across all vessels. In addition, there was no significant difference in the lesion CT-FFR value after coronary artery stenosis between systole phase and diastole phase across all vessels. The CT-FFR value between the 2 reconstruction techniques had excellent correlation and minimal bias in all groups. The correlation coefficient of the lesion CT-FFR values for left anterior descending branch, left circumflex branch, and right coronary artery were 0.86, 0.84, and 0.76, respectively.

Conclusions

Coronary computed tomography angiography–derived fractional flow reserve based on artificial intelligence deep learning neural network has stable performance, is not affected by the acquisition phase technology of 320-slice CT scan, and has high consistency with the evaluation of hemodynamics after coronary artery stenosis.
Myeloid Sarcoma: A Primer for Radiologists
Authors: Chiu Austin M. , Yoon Justin G. , Tirumani Sree H. , Ramaiya Nikhil H. , Smith Daniel A.
Published: March 2023

Myeloid sarcoma (MS) is a rare extramedullary neoplasm that can present in association with acute myeloid leukemia, most commonly in children younger than 15 years. This unique extramedullary malignancy may involve a variety of different organ systems and can present following, preceding, simultaneous with, or in insolation to acute myeloid leukemia. Common areas of extramedullary involvement include soft tissues, bones, lymph nodes, and the peritoneum. Imaging plays a critical role in the diagnosis and management of MS, with commonly used modalities including positron emission tomography-computed tomography, magnetic resonance imaging, computerized tomography, and ultrasound. The purpose of this review article is to provide radiologists with a comprehensive guide summarizing the relevant imaging and clinical features of MS, with emphasis on the role of imaging in the diagnosis, treatment, and follow-up of patients with MS. The relevant pathophysiology, epidemiology, clinical presentations, and differential diagnosis of MS will be reviewed. The relevance of different imaging modalities in diagnosis, monitoring of treatment response, and assessment of treatment-related complications will also be outlined. Through summarizing these topics, this review article aims to provide radiologists with a guide for understanding the existing knowledge of MS in the literature and the current role of imaging in the management of this unique malignancy.
How Do Cancer-Specific Computed Tomography Protocols Compare With the American College of Radiology Dose Index Registry? An Analysis of Computed Tomography Dose at 2 Cancer Centers
Authors: Szczykutowicz Timothy P. , Ahmad Moiz , Liu Xinming , Pozniak Myron A. , Lubner Meghan G. , Jensen Corey T.
Published: March 2023

Background

Little guidance exists on how to stratify radiation dose according to diagnostic task. Changing dose for different cancer types is currently not informed by the American College of Radiology Dose Index Registry dose survey.

Methods

A total of 9602 patient examinations were pulled from 2 National Cancer Institute designated cancer centers. Computed tomography dose (CTDIvol) was extracted, and patient water equivalent diameter was calculated. N-way analysis of variance was used to compare the dose levels between 2 protocols used at site 1, and three protocols used at site 2.

Results

Sites 1 and 2 both independently stratified their doses according to cancer indications in similar ways. For example, both sites used lower doses (P < 0.001) for follow-up of testicular cancer, leukemia, and lymphoma. Median dose at median patient size from lowest to highest dose level for site 1 were 17.9 (17.7–18.0) mGy (mean [95% confidence interval]) and 26.8 (26.2–27.4) mGy. For site 2, they were 12.1 (10.6–13.7) mGy, 25.5 (25.2–25.7) mGy, and 34.2 (33.8–34.5) mGy. Both sites had higher doses (P < 0.001) between their routine and high-image-quality protocols, with an increase of 48% between these doses for site 1 and 25% for site 2. High-image-quality protocols were largely applied for detection of low-contrast liver lesions or subtle pelvic pathology.

Conclusions

We demonstrated that 2 cancer centers independently choose to stratify their cancer doses in similar ways. Sites 1 and 2 dose data were higher than the American College of Radiology Dose Index Registry dose survey data. We thus propose including a cancer-specific subset for the dose registry.
Computer-Aided Detection of Subsolid Nodules on Chest Computed Tomography: Assessment of Visualization on Vessel-Suppressed Images
Authors: Yoshida Kotaro , Takamatsu Atsushi , Toshima Fumihito , Kozaka Kazuto , Kitagawa Taichi , Kobayashi Takeshi , Gabata Toshifumi
Published: March 2023

Objectives

This study aimed to clarify the performance of automatic detection of subsolid nodules by commercially available software on computed tomography (CT) images of various slice thicknesses and compare it with visualization on the accompanying vessel-suppression CT (VS-CT) images.

Methods

A total of 95 subsolid nodules from 84 CT examinations of 84 patients were included. The reconstructed CT image series of each case with 3-, 2-, and 1-mm slice thicknesses were loaded into a commercially available software application (ClearRead CT) for automatic detection of subsolid nodules and generation of VS-CT images. Automatic nodule detection sensitivity was assessed for 95 nodules on each series of images acquired at 3 slice thicknesses. Four radiologists subjectively evaluated visual assessment of the nodules on VS-CT.

Results

ClearRead CT automatically detected 69.5% (66/95 nodules), 68.4% (65/95 nodules), and 70.5% (67/95 nodules) of all subsolid nodules in 3-, 2-, and 1-mm slices, respectively. The detection rate was higher for part-solid nodules than for pure ground-glass nodules at all slice thicknesses. In the visualization assessment on VS-CT, 3 nodules at each slice thickness (3.2%) were judged as invisible, while 26 of 29 (89.7%), 27 of 30 (90.0%), and 25 of 28 (89.3%) nodules, which were missed by computer-aided detection, were judged as visible in 3-, 2-, and 1-mm slices, respectively.

Conclusions

The automatic detection rate of subsolid nodules by ClearRead CT was approximately 70% at all slice thicknesses. More than 95% of subsolid nodules were visualized on VS-CT, including nodules undetected by the automated software. Computed tomography acquisition at slices thinner than 3 mm did not confer any benefits.
Correlation Between Computed Tomography Findings and the Laboratory Test-Derived Severity Score in Patients With Severe Acute Alcoholic Hepatitis
Authors: Kim Hye Ri , Kim Seung Ho , Lee Yedaun , Son Jung Hee , Park Eun Joo , Ryu Ji Hwa
Published: March 2023

Objective

This study aimed to compare computed tomography (CT) findings between patients with severe and nonsevere acute alcoholic hepatitis (AAH).

Methods

We included 96 patients diagnosed with AAH between January 2011 and October 2021 who underwent 4-phase liver CT and laboratory blood tests. Two radiologists reviewed the initial CT images with respect to distribution and grade of hepatic steatosis; transient parenchymal arterial enhancement (TPAE); and presence of cirrhosis, ascites, and hepatosplenomegaly. A Maddrey discriminant function score (4.6 × [patient's prothrombin time − control] + total bilirubin [mg/mL]) was used as cutoff indicator for severity, with a score of 32 or higher indicating severe disease. The image findings were compared between the severe (n = 24) and nonsevere (n = 72) groups using the χ2 test or Fisher exact test. After univariate analysis, the most significant factor was identified using a logistic regression analysis.

Results

In the univariate analysis, there were significant between-group differences in the TPAE, liver cirrhosis, splenomegaly, and ascites (P < 0.0001, P < 0.0001, P = 0.0002, and P = 0.0163, respectively). Among them, TPAE was the only significant factor for severe AAH (P < 0.0001; odds ratio, 48.1; 95% confidence interval, 8.3–280.6). Using this single indicator, the estimated accuracy, positive predictive, and negative predictive values were 86%, 67%, and 97%, respectively.

Conclusions

Transient parenchymal arterial enhancement was the only significant CT finding in severe AAH.
Real value of the oocytes with smooth endoplasmic reticulum aggregates in IVF/ICSI cycle: a retrospective cohort study
Authors: Zhang Zheng , Liu Xiao-Na , Wang Ying , Bai Xue-Yao , Tao Shang-Guan , Li Hong-Mei , Zhu Lin , Li Yu-Yan , He Wei
Published: March 2023

Objective:

The management of oocytes affected by smooth endoplasmic reticulum aggregates (SERa) remains debatable. To understand how to manage SERa+ oocytes and cycles, we performed a retrospective cohort study and analyzed the impact of SERa+ cycles and oocytes on clinical and neonatal outcomes.

Methods:

We included 4856 cycles (149 SERa+ and 4707 SERa−) from 4201 women (age: 21–42 years) who received in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments at the Center of Reproductive Medicine, First Affiliated Hospital of Army Military University, from 2016 to 2019. SERa+ cycles had at least one SERa oocyte in the oocyte cohort. All 1722 oocytes in the SERa+ cycle were divided into SERa+ (405) and SERa− (1317) oocytes.

Results:

The rates of two pronuclei (2PN) and high-quality embryos were lower in SERa+ cycles than in SERa− cycles, regardless of IVF or ICSI (P<0.05). As the proportion of SERa+ oocytes increased in the SERa+ cycles, the rate of high-quality embryos declined gradually (P<0.05). Furthermore, the rate of 2PN in SERa+ oocytes was significantly lower than that in SERa− oocytes (P<0.05). Regardless of whether IVF or ICSI insemination was performed, no significant differences in terms of clinical pregnancy rate and spontaneous abortion rate were observed between SERa+ and SERa− cycles or between SERa+ and SERa− oocytes (P>0.05).

Conclusion:

Normal fertilization with SERa+ cycles and oocytes was substantially reduced, regardless of the insemination method. Embryos originating from SERa+ oocytes can be transferred when there are no other options, but fully informed consent and strict follow-up of fetal development are mandatory.
Squamous Cell Carcinoma Arising From Odontogenic Cyst Epithelium or Oral Mucosa Epithelium After Marsupialization of Odontogenic Radicular Cyst in Posterior Mandible?
Authors: Han Xiaodong , Shao Xiaojun , Lin Xiaozhen , Du Zhaojie , Wang Yanyi
Published: March 2023

Squamous cell carcinomas (SCCs) are common malignant tumors in the oral and maxillofacial region. However, SCCs secondary to marsupialization of odontogenic radicular cysts are extremely rare. The authors report an unusual case of a 43-year-old male presented with dull pain in the right molar region of the mandible without numbness of lower lips, who had a long history of smoking, alcohol consumption, and betel nut chewing. Computerized tomography revealed a round well-defined unilocular radiolucent at the apex of lower right premolars, 2 nonvital teeth. The clinical diagnosis was the radicular cyst of the right mandible. The patient was initially treated with root canal therapy of the teeth followed by marsupialization with a mandibular vestibular groove incision. While the patient did not follow the instruction of irrigation of the cyst and had no regular follow-up. The reexamination of computerized tomography indicated a round well-defined unilocular radiolucent at the apex of lower right premolars and filled with a soft tissue without clear boundary with buccal muscles at 31 months follow-up. There were no masses or ulcer around the mandibular vestibular groove incision and the patient had no sign of numbness of lower lips. The clinical diagnosis was the radicular cyst of right mandible with infection. A curettage was performed. However, the pathologic diagnosis was well-differentiated SCC. An extended radical surgical resection including segmental resection of the right mandible was performed. The histopathology was well-differentiated SCC without the cyst epithelium and invasion of bone, which can be distinguished from primary intraosseous SCC. The case indicates that marsupialization performed in patients with a history of smoking, alcohol consumption, and betel nut chewing, has a risk of suffering from oral SCC.
Effectiveness of An Intraoperative Lagophthalmos Formula for Levator Resection in Patients With Congenital Ptosis
Authors: Han Ye Eun , Kim Gye Jung , Kim Hwa Jung , Kang Julia Y. , Sa Ho-Seok
Published: March 2023

Purpose:

To evaluate the effectiveness of an intraoperative lagophthalmos formula (IOLF) for levator resection in congenital ptosis and investigate the optimal preoperative conditions for IOLF application.

Methods:

This retrospective interventional cohort study evaluated 30 eyelids of 22 patients with congenital ptosis who underwent levator resection using the IOLF to calculate the extent of surgical correction under general anesthesia. Surgical success was defined as margin reflex distance-1 (MRD1)≥3 mm in each eye and a difference of MRD1

1 mm between the eyes at 6 months postoperatively. Logistic regression was performed to investigate the preoperative conditions associated with surgical success.

Results:

Among 30 eyelids, 19 had good-to-fair levator function (LF) (≥5 mm) and 11 had poor LF (

4 mm). The overall success rate was 90.0% (n=27/30), whereas the under-correction rate was 10.0% (n=3/30). The surgical success rate was 100% (n=19/19) in eyelids with LF ≥5 mm and 72.7% (n=8/11) in eyelids with LF

4 mm. Patients with preoperative MRD1≥0 mm (versus MRD1<0 mm, odds ratio=34.5, P=0.0098) or a combination of preoperative MRD1≥0 mm and LF≥5 mm (versus MRD1<0 mm and LF

4 mm, odds ratio=48.0, P=0.0124) more likely had successful surgical outcomes.

Conclusions:

Levator resection using the IOLF can provide satisfactory results for congenital ptosis regardless of LF. Preoperative MRD1≥0 mm may be suitable for IOLF application, and the combination of preoperative MRD≥0 mm and LF≥5 mm may be the optimal preoperative condition for IOLF application.
Reviewing the External Jugular to Internal Jugular Vein Bypass for Circumventing Venous Congestion: Technique Description And Case Correlates
Authors: Thomas Michaella C. , Viaud-Murat Estelle M. , Bahra Luka , Kadakia Sameep P.
Published: March 2023

This study reviews the operative technique of external jugular vein to the internal jugular vein (IJV) bypass and discusses its advantages of decreasing postoperative complications in bilateral neck dissection patients. A retrospective chart review was performed on 2 patients at a single institution with prior bilateral neck dissection and jugular vein bypass. The tumor resection, reconstruction, bypass, and postoperative management were led by the listed senior author (S.P.K). An 80-year-old (case 1) and a 69-year-old (case 2) underwent bilateral neck dissection with the creation of a micro-venous anastomosis. This bypass allowed for improved venous drainage without adding significant time or difficulty to the procedure. Both patients recovered well in the initial postoperative period with maintained venous drainage. This study describes an additional technique that the trained microsurgeon can consider during the index procedure and reconstruction that can benefit the patient without adding significant time or technical challenges to the remaining portion of the procedure.
Infantile Cranial Fasciitis: A Clinicopathologic Evaluation
Authors: Cao Juan , Yang Guocheng , Chen Yongxian , Wang Yue , Shan Yingying , Xu Shoujun , Liu Yuecheng , Feng Xia , Liu Shuguang
Published: March 2023

Objective:

To investigate the clinicopathologic features, immunophenotype, molecular genetic changes, and differential diagnosis of cranial fasciitis (CF).

Methods:

The clinical manifestations, imaging, surgical technique, pathologic characteristics, special staining, and immunophenotype, as well as break-apart fluorescence in situ hybridization assay for USP6 of 19 CF cases were analyzed, retrospectively.

Results:

The patients were 11 boys and 8 girls, aged 5 to 144 months, with a median age of 29 months. There were 5 cases (26.31%) in the temporal bone, 4 cases (21.05%) in the parietal bone, 3 cases (15.78%) in the occipital bone, 3 cases (15.78%) in the frontotemporal bone, 2 cases (10.52%) in the frontal bone, 1 case (5.26%) in the mastoid of middle ear, and 1 case (5.26%) in the external auditory canal. The main clinical manifestations were painless, with the presentation of masses that grew rapidly and frequently eroded the skull. There was no recurrence and no metastasis after the operation. Histologically, the lesion consists of spindle fibroblasts/myofibroblasts arranged in bundles, braided or atypical spokes. Mitotic figures could be seen, but not atypical forms. Immunohistochemical studies showed diffuse strong positive SMA and Vimentin in all CFs. These cells were negative for Calponin, Desmin, β-catenin, S-100, and CD34. The ki-67 proliferation index was 5% to 10%. Ocin blue-PH2.5 staining showed blue-stained mucinous features in the stroma. The positive rate of USP6 gene rearrangement detected by fluorescence in situ hybridization assay was about 10.52%, and the positive rate was not related to age. All patients were observed for 2 to 124 months and showed no signs of recurrence or metastasis.

Conclusions:

In summary, CF was a benign pseudosarcomatous fasciitis that occurs in the skull of infants. Preoperative diagnosis and differential diagnosis were difficult. Computed tomography typing might be beneficial for imaging diagnosis, and pathologic examination might be the most reliable way to diagnose CF.
Free Flap Reconstruction of Recalcitrant Defects in Cleft Palate Patients
Authors: Gur Ersin , Tiftikcioglu Yigit Ozer
Published: March 2023

Introduction:

Defects of the palate can be as a result of oronasal fistula of cleft patients and the ablative surgery of tumors. There are many studies about reconstruction of the defects of plate in the literature and most of them are related to tumor surgery. Despite the use of free flaps in cleft patients being not a new approach, the articles in the literature are very few. The authors describe the experience of oronasal fistula reconstructions with free flaps with a new modification of tensionless inset of the free flap’s pedicle.

Patients and Methods:

Between 2019 and 2022, 2 males and 1 female, 3 consecutive cleft patients underwent free flap surgery because of recalcitrant palatal defects. One patient had 5 and each of remain had 3 unsuccessful reconstructive attempts previously. The age of patients was ranged from 20 to 23 years old. Radial forearm flap was the option of oral lining reconstruction for all patients. In 2 patients, the flap was modified as a skin tail was linked to the flap for covering the pedicle as tensionless closure.

Results:

There was a mucosal swelling in first patient who underwent classical pedicle inset as mucosal tunneling. In 1 patient there was a spontaneous bleeding from the anterior side of the flap and it stopped without medical interventions, spontaneously. There was no additional complication. All flaps survived without anastomosis problems.

Conclusion:

Incision of the mucosa rather than tunneling provides good surgical exposure and bleeding control and modified flap design may be beneficial and reliable for tensionless pedicle inset and covering.
Understanding the burden of traumatic injuries at the United States–Mexico border: A scoping review of the literature
Authors: Keller Benjamin A. , Skubic Jeffrey , Betancourt-Garcia Monica , Ignacio Romeo C. , Radowsky Jason S. , Tyroch Alan H. , Lascano Carlos Palacio , Joseph Bellal , Stewart Collin , Moore Forrest O. , Costantini Todd W. , Rizzo Julie A. , Paul Jasmeet S. , Galindo Roger M. , Silva Aaron , Coimbra Raul , Berndtson Allison E.
Published: March 2023

The US-Mexico border is the busiest land crossing in the world and faces continuously increasing numbers of undocumented border crossers. Significant barriers to crossing are present in many regions of the border, including walls, bridges, rivers, canals, and the desert, each with unique features that can cause traumatic injury. The number of patients injured attempting to cross the border is also increasing, but significant knowledge gaps regarding these injuries and their impacts remain. The purpose of this scoping literature review is to describe the current state of trauma related to the US-Mexico border to draw attention to the problem, identify knowledge gaps in the existing literature, and introduce the creation of a consortium made up of representatives from border trauma centers in the Southwestern United States, the Border Region Doing Research on Trauma Consortium. Consortium members will collaborate to produce multicenter up-to-date data on the medical impact of the US-Mexico border, helping to elucidate the true magnitude of the problem and shed light on the impact cross-border trauma has on migrants, their families, and the US health care system. Only once the problem is fully described can meaningful solutions be provided.
Electroencephalography Findings in Wrong Way Eyes: Unilateral Hemispheric Dysfunction Supporting Smooth Pursuit Asymmetry Hypothesis
Authors: Gilani Kia , Tyndel Felix J. , Wennberg Richard A.
Published: March 2023

Background:

Conjugate horizontal eye deviation away from the side of the lesion, termed Wrong Way Eyes (WWE), is a rare manifestation of supratentorial lesions. The proposed etiologic hypotheses include seizure activity, compression of contralateral horizontal gaze pathways from mass effect or midline shift, and asymmetry of hemispheric smooth pursuit mechanisms. We present neurophysiological evidence that favors the asymmetry of hemispheric smooth pursuit hypothesis.

Methods:

Electroencephalography (EEG) was performed in 2 patients with large left hemispheric supratentorial lesions, capturing fluctuating periods of (a) unresponsiveness with WWE and (b) relative alertness without WWE. One patient had 5 days of continuous EEG, and the other routine EEG.

Results:

Neither patient had seizures. EEG showed normal right hemispheric activity during both unresponsiveness with WWE and alertness without WWE states. By contrast, more severe left hemispheric dysfunction was evident in the WWE state compared with the non-WWE state in both patients. In one patient, during the relatively alert state, right-beating nystagmus was observed, and drift of the eyes away from the side of the lesion was reliably seen to occur on eyelid closure and after ipsiversive volitional saccades.

Conclusions:

Seizure activity does not account for WWE. Compression of contralateral horizontal gaze pathways is also unlikely to account for WWE as that hypothetical mechanism should produce EEG abnormalities over the nonlesioned hemisphere, which were not seen. The findings suggest instead that a single dysfunctional hemisphere is sufficient to produce WWE. The repeated rightward drift of the eyes and nystagmus seen in one patient during relative alertness, and the observation of unilateral hemispheric dysfunction on EEG during unresponsiveness with WWE in both patients supports the idea that an imbalance of smooth pursuit mechanisms is most likely to account for this rare phenomenon.
MRI Signal Intensity Varies Along the Course of the Normal Optic Nerve
Authors: Prairie Michael L. , Gencturk Mehmet , Lindgren Bruce R. , McClelland Collin M. , Lee Michael S.
Published: March 2023

Background:

MRI can help distinguish various causes of optic neuropathy including optic neuritis. Importantly, neuromyelitis optica spectrum disorder (NMOSD) has a propensity to cause enhancement of the prechiasmatic optic nerves. To determine whether the prechiasmatic optic nerve (PC-ON) demonstrates a different intensity from the midorbital optic nerve (MO-ON) on MRI among patients without optic neuropathy.

Methods:

Data were retrospectively obtained from 75 patients who underwent brain MRI for an ocular motor nerve palsy between January 2005 and April 2021. Inclusion criteria were patients aged 18 years or older with visual acuities of at least 20/25 and no evidence of optic neuropathy on neuro-ophthalmic examination. A total of 67 right eyes and 68 left eyes were assessed. A neuroradiologist performed quantitative intensity measurements of the MO-ON and PC-ON on precontrast and postcontrast T1 axial images. Normal-appearing temporalis muscle intensity was also measured and used as a reference to calculate an intensity ratio to calibrate across images.

Results:

The mean PC-ON intensity ratio was significantly higher than the MO-ON intensity ratio on both precontrast (19.6%, P < 0.01) and postcontrast images (14.2%, P < 0.01). Age, gender, and laterality did not independently affect measurements.

Conclusions:

The prechiasmatic optic nerve shows brighter intensity ratios on both precontrast and postcontrast T1 images than the midorbital optic nerve among normal optic nerves. Clinicians should recognize this subtle signal discrepancy when assessing patients with presumed optic neuropathy.
Objective Diagnosis of Circadian Rhythm Disorders
Authors: Giordano Alessandra , Duffy Jeanne , Epstein Lawrence J. , Pavlova Milena K.
Published: March 2023

Circadian sleep–wake disorders are common. Because they represent conflict between the timing of the patient's endogenous rhythms and desired timing of sleep, the presenting complaints may include both difficulty of sleep initiation or maintenance and undesired or unplanned daytime or early evening sleepiness. Therefore, circadian disorders may be misdiagnosed as either a primary insomnia or a hypersomnia disorder, depending on which complaint is more troublesome for the patient. Objective information about sleep and wake patterns over long periods is crucial for accurate diagnosis. Actigraphy provides long-term information about the rest/activity pattern about an individual. However, caution should be applied in interpretation of the results because the information provided only includes information of movements, and activity is only an indirect circadian phase marker. Timing of light and melatonin therapy is critical for successful treatment of circadian rhythm disorders. Therefore, results of actigraphy are useful and should be used in conjunction with additional measurements, including 24 hours sleep–wake history, sleep log, and melatonin measurements.
Turn-taking in human face-to-face interaction is multimodal: gaze direction and manual gestures aid the coordination of turn transitions
Authors: Kendrick Kobin H. , Holler Judith , Levinson Stephen C.
Published: March 2023

Human communicative interaction is characterized by rapid and precise turn-taking. This is achieved by an intricate system that has been elucidated in the field of conversation analysis, based largely on the study of the auditory signal. This model suggests that transitions occur at points of possible completion identified in terms of linguistic units. Despite this, considerable evidence exists that visible bodily actions including gaze and gestures also play a role. To reconcile disparate models and observations in the literature, we combine qualitative and quantitative methods to analyse turn-taking in a corpus of multimodal interaction using eye-trackers and multiple cameras. We show that transitions seem to be inhibited when a speaker averts their gaze at a point of possible turn completion, or when a speaker produces gestures which are beginning or unfinished at such points. We further show that while the direction of a speaker's gaze does not affect the speed of transitions, the production of manual gestures does: turns with gestures have faster transitions. Our findings suggest that the coordination of transitions involves not only linguistic resources but also visual gestural ones and that the transition-relevance places in turns are multimodal in nature.

This article is part of a discussion meeting issue ‘Face2face: advancing the science of social interaction’.