bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct antiviral drugs in the treatment of hepatitis C-infected rheumatoid arthritis Egyptian cohort: safety and clinical impact
Authors: Lashen Sameh A. , Metawea Marwa I. , Shaaban Ahmed
Published: November 2020

Background and aim

Data about the safety and efficacy of direct-acting antivirals (DAAs) in the treatment of hepatitis C virus (HCV) patients with concomitant rheumatoid arthritis (RA) are scarce. We assessed the impact and safety of DAAs treatment of hepatitis C on rheumatoid arthritis disease activity.

Patients and methods

Prospectively, we enrolled 65 patients with RA and HCV. A clinico-laboratory evaluation was done at baseline, including liver assessment and RA disease activity score-28 (DAS28). At 12 weeks of post-DAAs treatment, sustained virologic response (SVR12) and DAS28 were reevaluated.

Results

The SVR12 was achieved in 59 (90.8%) patients. RA control was achieved in 47 (79.9%) patients. The post SVR12 DAS28 score was significantly lower than the baseline (3.32 ± 0.93 vs. 4.37 ± 0.90; P < 0.001). There was a significant decline in the mean values of serum anticyclic citrullinated peptide, rheumatoid factor, erythrocyte sedimentation rate and C-reactive protein after achieving an SVR12 (30.47 ± 12.37 vs. 57.61 ± 15.91 U/ml; 29.78 ± 19.58 vs. 55.14 ± 16.89 IU/ml; 17.13 ± 10.84 vs. 29.68 ± 14.32 mm/h and 5.76 ± 1.57 vs. 11.44 ± 4.13 mg/l, respectively; P < 0.05). RA activity and antirheumatic drugs were stepped-down [12 (20.3%) and 35 (59.3%) patients showed good and moderate RA response, respectively]. The baseline viral load, absence of cirrhosis and SVR12 were the only predictors of disease control (P 
< 0.05). No drug-related adverse events or drug-related discontinuation.

Conclusions

Unlike interferon, HCV elimination by DAAs significantly improves RA activity and treatment outcome with high safety and efficacy.
Initial results of the use of a novel semiquantitative parameter in three-phase bone scan to predict 99mTc-HMPAO-labeled leukocyte scintigraphy in patients with unilateral total knee replacement
Authors: Quartuccio Natale , Panareo Stefano , Urso Luca , Sturiale Letterio , Siracusa Massimiliano , Arnone Annachiara , Alongi Pierpaolo , Baldari Sergio , Bartolomei Mirco , Arnone Gaspare
Published: November 2020

Objectives

The aim of the study was to predict the results of 99mTc-hexamethylpropyleneamine oxime (HMPAO)-labeled autologous leukocytes scintigraphy assessing count ratios in the perfusion (Pr) and blood-pool (BPr) phase images in three-phase bone scan (3PBSr) between the prosthetic knee and the ‘healthy’ knee and a novel semiquantitative parameter (P/BP ratio) in patients with unilateral knee arthroplasty.

Methods

Patients with unilateral knee arthroplasty and available 3PBS and 99mTc-HMPAO-labeled autologous leukocytes scintigraphic images were searched in two hospitals (A and B). In center A, the perfusion phase was not available. Regions of interest (ROI) were delineated in the perfusion (P) and blood-pool (BP) phase images, incorporating the prosthetic region and applying an isocontour (40% of the maximum pixel activity); corresponding mirror ROIs were placed on the healthy knee. The P/BP ratio was calculated as {[(Pr/BPr) × 100] – 100}. Receiver operator curves (ROCs) were generated for each semiquantitative parameter to identify the optimal cutoff for predicting the results of the autologous leukocytes scintigraphy.

Results

In the whole group (79 patients), BPr demonstrated an area under the curve (AUC) of 0.722 (optimal cutoff = 1.43). In center A (52 patients), BPr demonstrated an AUC of 0.737 (cutoff = 1.43), whereas, in center B (27 patients), AUC for BPr was 0.718 (cutoff = 1.6). A better diagnostic performance was obtained selecting Pr (AUC = 0.918; cutoff = 2.34) and P/BP ratio (AUC = 0.947; cutoff = 26.5%) for the discrimination between septic and aseptic loosening.

Conclusions

The novel P/BP ratio seems to be a promising semiquantitative parameter to predict septic loosening. These findings warrant confirmation in larger patient samples.
Prognostic value of left ventricular mechanical dyssynchrony in hypertrophic cardiomyopathy patients with low risk of sudden cardiac death
Authors: Jiang Wanying , Liu Yanyun , He Zhuo , Zhou Yanli , Wang Cheng , Jiang Zhixin , Zhou Weihua
Published: November 2020

Purposes

This study aims to explore the prognostic value of left ventricular mechanical dyssynchrony (LVMD) in hypertrophic cardiomyopathy (HCM) patients with low risk of sudden cardiac death (SCD).

Methods

This retrospective study was performed in 50 patients with HCM who underwent Tc-99m sestamibi GSPECT-MPI. All patients were at low risk of SCD, defined as HCM risk-SCD scores <6%. Phase SD (PSD) and phase histogram bandwidth (PBW) were measured for assessment of LVMD. The primary endpoint was the composite major adverse cardiovascular events (MACE), including all-cause mortality, rehospitalization of heart failure symptoms, new-onset stroke, and new-onset syncope. Variables with significant difference between MACE group and non-MACE group were further assessed by Cox regression analysis.

Results

During follow-up, MACE occurred in 20 patients. Systolic-PSD, systolic-PBW, diastolic-PSD, and diastolic-PBW were all significantly greater in the MACE group. Multivariate analysis revealed that history of syncope, history of atrial fibrillation, and all the four LVMD parameters were independent predictors of MACE. All LVMD parameters showed similar accuracy to predict MACE. Sequential models indicated that both systolic and diastolic LVMD parameters added incremental value beyond atrial fibrillation and syncope.

Conclusion

LVMD parameters are independent predictors of MACE, which add incremental prognostic information in patients with HCM risk-SCD scores <6%.
Positron emission tomography for radiotherapy planning in head and neck cancer: What impact?
Authors: Flaus Anthime , Nevesny Stéphane , Guy Jean-Baptiste , Sotton Sandrine , Magné Nicolas , Prévot Nathalie
Published: November 2020

PET-computed tomography (CT) plays a growing role to guide target volume delineation for head and neck cancer in radiation oncology. Pretherapeutic [18F]FDG PET-CT adds information to morphological imaging. First, as a whole-body imaging modality, it reveals regional or distant metastases that induce major therapeutic changes in more than 10% of the cases. Moreover, it allows better pathological lymph node selection which improves overall regional control and overall survival. Second, locally, it allows us to define the metabolic tumoral volume, which is a reliable prognostic feature for survival outcome. [18F]FDG PET-CT-based gross tumor volume (GTV) is on average significantly smaller than GTV based on CT. Nevertheless, the overlap is incomplete and more evaluation of composite GTV based on PET and GTV based on CT are needed. However, in clinical practice, the study showed that using GTV PET alone for treatment planning was similar to using GTVCT for local control and dose distribution was better as a dose to organs at risk significantly decreased. In addition to FDG, pretherapeutic PET could give access to different biological tumoral volumes – thanks to different tracers – guiding heterogeneous dose delivery (dose painting concept) to resistant subvolumes. During radiotherapy treatment, follow-up [18F]FDG PET-CT revealed an earlier and more important diminution of GTV than other imaging modality. It may be a valuable support for adaptative radiotherapy as a new treatment plan with a significant impact on dose distribution became possible. Finally, additional studies are required to prospectively validate long-term outcomes and lower toxicity resulting from the use of PET-CT in treatment planning.
A Motivational Interviewing Intervention to Promote CRC Screening
Authors: Adegboyega Adebola , Aleshire Mollie , Wiggins Amanda T. , Palmer Kelly , Hatcher Jennifer
Published: November 2020

Background

Appalachian Kentuckians suffer a disproportionate incidence and mortality from colorectal cancer (CRC) and are screened at lower rates (35%) compared with 47% of Kentuckians.

Objective

The aim of this study was to evaluate the efficacy of a motivational interviewing intervention delivered by trained Lay Health Advisors on CRC screening.

Method

Eligible participants recruited from an emergency department (ED) completed a baseline survey and were randomized to either the control or the motivational interviewing intervention provided by Lay Health Advisors. Follow-up surveys were administered 3 and 6 months after baseline. To evaluate potential differences in treatment and control groups, t tests, χ
2, and Mann-Whitney U tests were used.

Results

At either the 3- or 6-month assessment, there was no difference in the CRC screening by group (χ
2 = 0.13, P = .72). There was a significant main effect for the study group in the susceptibility to CRC model; regardless of time, those in the intervention group reported approximately 1-point higher perceived susceptibility to CRC, compared with controls (est. b = 0.68, P = .038). Age and financial adequacy had a significant effect related to CRC screening. Older participants (est. b = 0.09, P = .014) and those who reported financial inadequacy (est. b = 2.34, P = .002) reported more screening barriers.

Conclusion

This pilot study elucidated important factors influencing the uptake of CRC for an ED transient population and this may be useful in the design of future interventions using motivational interviewing in EDs.

Implications for Practice

Nurses can provide information about CRC screening guidelines and provide referrals to appropriate screening resources in the community.
The Experiences and Support Needs of Women With Gestational Breast Cancer in Singapore
Authors: Liow Kelly Hui Fang , Ng Teresa Ruey Pyng , Choo Chih Huei , Koh Serena Siew Lin , Shorey Shefaly
Published: November 2020

Background

Gestational breast cancer is diagnosed during pregnancy or within the first postpartum year. There is a lack of studies on the experiences of ethnically diverse Asian women with gestational breast cancer.

Objective

The aim of this study was to explore the experiences of Asian women with gestational breast cancer so necessary support can be rendered.

Methods

This qualitative descriptive study used purposive sampling to recruit 7 women with gestational breast cancer who were following up at the breast center of a tertiary women's hospital in Singapore. Semistructured, individual, face-to-face, audio-recorded interviews were used to explore the in-depth experiences of these women. Data were transcribed verbatim and analyzed using thematic analysis.

Results

Three main themes emerged from the thematic analysis: (1) being a sick woman, (2) juggling between being a mother and a patient, and (3) seeking normalcy. Women had to contend with disruptive changes from gestational breast cancer, both emotionally and physically. They were constantly distressed by their altered body images, and family support was vital to help these women cope with their treatments. Alternative support sources included healthcare professionals and the Internet.

Conclusion

Gestational breast cancer experiences varied based on the women's encounter perceptions and existing support. Their experiences may be improved through further support to mediate their coping efforts. Future quantitative and qualitative research should explore and evaluate the various aspects of the long-term disease and psychosocial effects of gestational breast cancer.

Implications for Practice

Hospitals should include support strategies in antenatal classes and postnatal workshops to lessen disruptions of the motherhood experiences.
Accuracy of self-reported HIV-testing history and awareness of HIV-positive status in four sub-Saharan African countries
Authors: Xia Yiqing , Milwid Rachael M. , Godin Arnaud , Boily Marie-Claude , Johnson Leigh F. , Marsh Kimberly , Eaton Jeffrey W. , Maheu-Giroux Mathieu
Published: November 2020

Background:

In many countries in sub-Saharan Africa, self-reported HIV testing history and awareness of HIV-positive status from household surveys are used to estimate the percentage of people living with HIV (PLHIV) who know their HIV status. Despite widespread use, there is limited empirical information on the sensitivity of those self-reports, which can be affected by nondisclosure.

Methods:

Bayesian latent class models were used to estimate the sensitivity of self-reported HIV-testing history and awareness of HIV-positive status in four Population-based HIV Impact Assessment surveys in Eswatini, Malawi, Tanzania, and Zambia. Antiretroviral (ARV) metabolite biomarkers were used to identify persons on treatment who did not accurately report their status. For those without ARV biomarkers, we used a pooled estimate of nondisclosure among untreated persons that was 1.48 higher than those on treatment.

Results:

Among PLHIV, the model-estimated sensitivity of self-reported HIV-testing history ranged from 96% to 99% across surveys. The model-estimated sensitivity of self-reported awareness of HIV status varied from 91% to 97%. Nondisclosure was generally higher among men and those aged 15–24 years. Adjustments for imperfect sensitivity did not substantially influence estimates of PLHIV ever tested (difference <4%) but the proportion of PLHIV aware of their HIV-positive status was higher than the unadjusted proportion (difference <8%).

Conclusion:

Self-reported HIV-testing histories in four Eastern and Southern African countries are generally robust although adjustment for nondisclosure increases estimated awareness of status. These findings can contribute to further refinements in methods for monitoring progress along the HIV testing and treatment cascade.
Age-specific mortality rate ratios in adolescents and youth aged 10–24 years living with perinatally versus nonperinatally acquired HIV
Authors: Desmonde Sophie , Ciaranello Andrea L. , Malateste Karen , Musick Beverly , Patten Gabriela , Vu An Thien , Edmonds Andrew , Neilan Anne M. , Duda Stephany N. , Wools-Kaloustian Kara , Davies Mary-Ann , Leroy Valériane
Published: November 2020

Objective:

To measure mortality incidence rates and incidence rate ratios (IRR) in adolescents and youth living with perinatally acquired HIV (YPHIV) compared with those living with nonperinatally acquired HIV (YNPHIV), by region, by sex, and during the ages of 10–14, 15–19, and 20–24 years in IeDEA.

Design and methods:

All those with a confirmed HIV diagnosis, antiretroviral therapy (ART)-naive at enrollment, and who have post-ART follow-up while aged 10–24 years between 2004 and 2016 were included. We estimated post-ART mortality incidence rates and 95% confidence intervals (95% CI) per 100 person-years for YPHIV (enrolled into care <10 years of age) and YNPHIV (enrolled ≥10 years and <25 years). We estimate mortality IRRs in a negative binomial regression model, adjusted for sex, region time-varying age, CD4+ cell count at ART initiation (<350 cells/μl, ≥350 cells/μl, unknown), and time on ART (<12 and ≥12 months).

Results:

Overall, 104 846 adolescents and youth were included: 21 340 (20%) YPHIV (50% women) and 83 506 YNPHIV (80% women). Overall mortality incidence ratios were higher among YNPHIV (incidence ratio: 2.3/100 person-years; 95% CI: 2.2–2.4) compared with YPHIV (incidence ratio: 0.7/100 person-years; 95% CI: 0.7–0.8). Among adolescents aged 10–19 years, mortality was lower among YPHIV compared with YNPHIV (all IRRs <1, ranging from 0.26, 95% CI: 0.13–0.49 in 10–14-year-old boys in the Asia-Pacific to 0.51, 95% CI: 0.30–0.87 in 15–19-year-old boys in West Africa).

Conclusion:

We report substantial amount of deaths occurring during adolescence. Mortality was significantly higher among YNPHIV compared to YPHIV. Specific interventions including HIV testing and early engagement in care are urgently needed to improve survival among YNPHIV.
Monocyte activation in persons living with HIV and tuberculosis coinfection
Authors: Huaman Moises A. , Juchnowski Steven M. , Zidar David A. , Kityo Cissy M. , Nalukwago Sophie , Nazzinda Rashidah , Fichtenbaum Carl J. , Longenecker Chris T.
Published: November 2020

Objectives:

To characterize monocyte subsets and activation in persons living with HIV (PLWH) with tuberculosis coinfection.

Design:

Cross-sectional study within a cohort of PLWH and HIV-uninfected participants at the Joint Clinical Research Centre in Kampala, Uganda.

Methods:

Participants were at least 45 years old with at least one cardiovascular risk factor. PLWH had an HIV viral load 1000 copies/ml or less on stable antiretroviral therapy prior to cohort entry. QuantiFERON-TB testing was performed to define latent tuberculosis infection (LTBI). Prior active TB was defined by self-report and verified by medical records. Blood was stained with monocyte subset markers (CD14+, CD16), CD62p, CD69, CX3CR1, HLA-DR, and tissue factor, and examined with flow cytometry.

Results:

One hundred and twenty-five participants (83 PLWH and 42 without HIV) were included. Median CD4+ count was 582 cells/μl in PLWH. PLWH had a higher frequency of total monocytes (4.3% vs. 3.2%; P < 0.001) and inflammatory monocyte subset (15.5% vs. 11.7%; P = 0.016) compared with HIV-uninfected individuals. No differences in the frequency of monocyte subsets were observed by TB status. Among PLWH, prior active TB was associated with increased frequency of total monocytes compared with LTBI (5.1% vs. 3.7%; P = 0.013). HLA-DR density on monocytes was three-fold higher in PLWH with LTBI or prior TB compared with PLWH without LTBI (P = 0.002). In multivariate analysis, a higher monocyte HLA-DR density remained associated with LTBI or prior TB in PLWH (log-MFI; b = 1.17; P < 0.001).

Conclusion:

Our findings indicate enhanced monocyte activation in PLWH with LTBI or prior active TB, which may contribute to the pathogenesis of noncommunicable diseases in HIV.
Effects of anticholinergic medication use on brain integrity in persons living with HIV and persons without HIV
Authors: Cooley Sarah A. , Paul Robert H. , Strain Jeremy F. , Boerwinkle Anna , Kilgore Collin , Ances Beau M.
Published: November 2020

Objective:

This study examined relationships between anticholinergic medication burden and brain integrity in people living with HIV (PLWH) and people without HIV (HIV−).

Methods:

Neuropsychological performance z-scores (learning, retention, executive function, motor/psychomotor speed, language domains, and global cognition), and neuroimaging measures (brain volumetrics and white matter fractional anisotropy) were analyzed in PLWH (n = 209) and HIV− (n = 95) grouped according to the Anticholinergic Cognitive Burden (ACB) scale (0 = no burden, 1–3 = low burden, >3 = high burden). Neuropsychological performance and neuroimaging outcomes were compared between HIV− and PLWH with high anticholinergic burden. Within a cohort of PLWH (n = 90), longitudinal change in ACB score over ∼2 years was correlated to the rate of change per month of study interval in neuropsychological performance and neuroimaging measures.

Results:

A higher number of anticholinergic medications and ACB was observed in PLWH compared with HIV− (P < 0.05). A higher ACB was associated with worse motor/psychomotor performance, smaller occipital lobe, putamen, subcortical gray matter and total gray matter volumes in HIV−; and poorer executive function, retention and global cognition, smaller brain volumes (frontal, parietal and temporal lobes, hippocampus, amygdala, cortex, subcortical gray matter and total gray matter), and reduced fractional anisotropy (posterior corpus callosum, perforant pathway) in PLWH. PLWH with high anticholinergic burden performed worse on tests of learning and executive function compared with HIV− with high anticholinergic burden. Longitudinally, PLWH who reduced their ACB over time had better neuropsychological performance and neuroimaging measures.

Conclusion:

Anticholinergic medications were associated with worse neuropsychological performance and reduced structural brain integrity, and these effects were more widespread in PLWH. Use of anticholinergic medications should be carefully monitored in older adults with deprescription considered whenever possible.
Maintenance of statin therapy among people living with HIV
Authors: Boettiger David C. , Kerr Stephen , Chattranukulchai Pairoj , Siwamogsatham Sarawut , Avihingsanon Anchalee
Published: November 2020

Objective:

Statins play a critical role in reducing the elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLHIV). However, maintaining statin therapy is difficult and may be impeded further in PLHIV due to the risk of antiretroviral therapy (ART)/statin interactions. We estimated rates of statin discontinuation and reinitiation, and the percentage of days covered by statin use among PLHIV on ART, and investigated factors associated with these outcomes.

Design:

Observational cohort study.

Methods:

Clinical data from individuals attending the HIV-NAT Centre in Bangkok, Thailand between 2001 and 2020 were analyzed using Kaplan–Meier curves, competing-risk regression, and generalized estimating equations. Discontinuation was defined as statin cessation lasting 90 days.

Results:

Data on 318 PLHIV were included. After 1, 3, and 5 years, 22.3, 50.8, and 61.1% had discontinued statin use, respectively. Among those who discontinued (n = 178), 52.0% reinitiated statin use within 5 years. Factors associated with statin discontinuation were low education level, fewer concomitant medications, and lack of ASCVD. Factors associated with statin reinitiation were older age, diabetes, and high levels of LDL cholesterol. The adjusted mean percentage of days covered by a statin was 86.7, 61.1, and 58.1% in the 6 months prior to 1, 3, and 5 years of follow-up, respectively.

Conclusion:

Maintenance of statin therapy is poor among PLHIV on ART but is not associated with using contraindicated antiretroviral/statin combinations. A better understanding of statin use in PLHIV will aid clinicians treating individuals and policy makers designing interventions for population-level ASCVD risk reduction.
Maternal HIV and child anthropometric outcomes over time: an analysis of Zimbabwe demographic health surveys
Authors: Groene Emily A. , Valeris-Chacin Robert J. , Stadelman Anna M. , Safo Sandra E. , Cusick Sarah E.
Published: November 2020

Objective(s):

To understand the association between children's anthropometric measures and maternal HIV status in Zimbabwe and to determine whether these relationships changed over time.

Design:

Data from Demographic Health Surveys in Zimbabwe rounds 2005, 2010, and 2015 were used to conduct cross-sectional analyses of child anthropometric measures (stunting, underweight, and wasting).

Methods:

Using separate logistic regression models for each of the anthropometric measures, we estimated the adjusted prevalence odds ratio (OR) of stunting, underweight, and wasting in children according to maternal HIV status. Moreover, we evaluated an interaction by survey year to evaluate change over time.

Results:

Children of mothers with HIV had 32% greater odds [OR = 1.32, 95% confidence interval (CI) 1.16–1.5] of stunting, 27% greater odds (OR = 1.27, 95% CI 1.1–1.48) of underweight status and 7% greater odds (OR = 1.07, 95% CI 0.81–1.42) of wasting status, than children of mothers without HIV. These associations between maternal HIV status and child undernutrition did not differ by year (P > 0.05 for all interaction terms).

Conclusion:

In Zimbabwe, having a mother who tested positive for HIV at the time of the survey has been associated with greater child undernutrition over the last two decades with no significant change by survey round. This emphasizes the need for continued programming to address nutritional deficiencies, sanitation, and infectious disease prevention in this high-risk population. The greatest impact of maternal HIV status has been on child stunting and underweight, associated with poor long-term child development.
Depressive symptoms and use of HIV care and medication-assisted treatment among people with HIV who inject drugs
Authors: Zeziulin Oleksandr , Mollan Katie R. , Shook-Sa Bonnie E. , Hanscom Brett , Lancaster Kathryn E. , Dumchev Kostyantyn , Go Vivian F. , Chu Viet A. , Kiriazova Tetiana , Syarif Zulvia , Dvoryak Sergii , Reifeis Sarah A. , Hamilton Erica , Sarasvita Riza , Rose Scott , Richardson Paul , Clarke William , Latkin Carl A. , Metzger David S. , Hoffman Irving F. , Miller William C.
Published: November 2020

Objective:

Vietnam, Indonesia, and Ukraine have major burdens of IDU and HIV. We estimated the prevalence of depressive symptoms at baseline among people living with HIV who inject drugs, evaluated associations between depression at baseline and 12-month HIV care outcomes and medication-assisted treatment (MAT), and evaluated the study intervention effect by baseline depression subgroups.

Design:

HPTN 074 was a randomized study. The study intervention included psychosocial counseling, systems navigation, and antiretroviral treatment (ART) at any CD4+ cell count.

Methods:

Moderate-to-severe depression was defined as a Patient Health Questionnaire-9 score of 10 or above. ART and MAT were self-reported. Eligibility criteria were: 18–60 years of age, active IDU, and viral load of at least 1000 copies/ml. Adjusted probability differences (aPD) were estimated using inverse-probability weighting.

Results:

A total of 502 participants enrolled from April 2015 to June 2016. Median age was 35 years; 85% identified as men. Prevalence of baseline moderate-to-severe depression was 14% in Vietnam, 14% in Indonesia, and 56% in Ukraine. No evident associations were detected between baseline depression and ART, viral suppression, or MAT at 12-month follow-up. The study intervention improved the proportions of people who inject drugs achieving 12-month viral suppression in both the depressed [intervention 44%; standard of care 24%; estimated aPD = 25% (95% confidence interval: 4.0%, 45%)] and nondepressed subgroups [intervention 38%; standard of care 24%; aPD = 13% (95% confidence interval: 2.0%, 25%)].

Conclusion:

High levels of depressive symptoms were common among people living with HIV who inject drugs in Ukraine but were less common in Vietnam and Indonesia. The study intervention was effective among participants with or without baseline depression symptoms.
Reconstruction of Lagophthalmos of Upper Eyelid With a Subcutaneous Pedicled Propeller Flap
Authors: Ding Jin-Ping , Chen Bo , Yao Jian-Min
Published: November 2020

An 11-year-old boy presented with lagophthalmos of the left upper eyelid after traumatic scar contracture. Chronic eyelid hypophasis could produce dryness, foreign body sensation, cornea exposure. To reconstruct the upper eyelid defects after scar release represented a significant challenge in terms of recreating functional eyelids. The authors applied the orbital subcutaneous pedicled propeller flap for one-stage reconstruction of the lagophthalmos. Four weeks after surgery, the patient had functional eyelid with no ectropion, cornea exposure or conjunctivitis and the appearance of eyelid was improved. And the final result was found to be acceptable at 6 months follow-up. The authors consider that to repair the lagophthalmos of upper eyelid, the use of orbital subcutaneous propeller flap can achieve both functional and appearance improvement, it is an effective method with flexibility and personalization.
Quantitative Assessment of the Pupil: An Underrecognized Yet Important Factor Related to Orbital Blowout Fracture Repair
Authors: Li Chenglin , Li Zhengri , Jin Hua , Deng Wenqing , Cui Hong , Jin Haiyan , Ru Xinyu , Zhao Jinghua , Jia Yujie , Lin Shuhua , Li Yingjun
Published: November 2020

Purpose:

To investigate dynamic pupil changes after orbital blowout fracture repair. To compare postoperative changes in under photopic and mesopic pupil size and center position after orbital blowout fracture repair surgery.

Methods:

The study evaluated 19 eyes. Pupils were imaged for pupil size and center position before and 3 months after orbital blowout fracture repair surgery. Pupil size changes were measured, and the correlation between preoperative and postoperative pupil centroid shift was evaluated.

Results:

After repair, operative eyes exhibited a growth of 9.3% ± 8.6% in pupil size, and contralateral eyes showed a growth of 8.6% ± 8.2% (P = 0.011, P = 0.007). Similar findings were noted in mesopic conditions. Under mesopic conditions, the pupil of operative eyes in medial orbital wall fracture deviated 0.030 ± 0.019 mm towards the nasal side along the X-axis (P = 0.031). The postoperative orbital floor fracture group demonstrated statistical significance at a spatial frequency of 5 (P = 0.041).

Conclusions:

Orbital blowout fracture repair surgery affects pupil size and center position.
Anatomic Approximation Approach to Bilateral Macrostomia Repair
Authors: Ueno Kazuki , Miyazaki Hidetaka , Oshima Toshiyuki , Wada Yoshitaka , Asamura Shinichi
Published: November 2020

In principle, reconstruction in macrostomia requires symmetry and accurate positioning of the newly reconstructed commissure. The proper position of the new commissure can be determined by several methods. In the determination of the new commissure of bilateral cases, generally the average length of the lips or the distance from anatomical landmarks other than the lips, such as the pupils or tragi, has been used. A new approach was reported by Tse et al in 2018: the anatomic approximation approach. Macrostomia repair refers to anatomical landmarks in the lips to determine the new commissure. The authors performed surgery using this anatomic approximation approach for bilateral macrostomia and achieved the good results.
Neurological Functional Connectivity in Unilateral Coronal Synostosis: A Side-Based Comparison
Authors: Park Kitae E. , Singh Anusha , Lacadie Cheryl , Allam Omar , Smetona John , Alperovich Michael , Persing John A.
Published: November 2020

Purpose:

Unicoronal synostosis (UCS) has been associated with reading, language, and social dysfunction. Limited brain function connectivity studies exist for UCS with none devoted to comparing outcomes by side of synostosis (left versus right-sided UCS).

Methods:

Twelve patients with surgically treated UCS, 7 right-sided and 5 left-sided, were age matched to healthy controls. Resting state functional MRI was acquired in a 3T Siemens TIM Trio scanner (Erlangen, Germany). Data was collected with intrinsic connectivity distribution and seed-connectivity analysis using BioImage Suite (Yale School of Medicine). Region of interest analysis was performed based on Brodmann areas related to emotional, executive, language, motor, and visuo-spatial function. Significance was set at P < 0.05.

Results:

Compared to controls, all UCS patients demonstrated decreased connectivity in areas of the parietal and temporal cortices responsible for visuo-motor coordination and language function. Right UCS patients demonstrated decreased intrinsic connectivity in regions related to complex motor movement and proprioception relative to control subjects. Left UCS patients demonstrated decreased seed connectivity between regions of the parietal lobe and occipital lobe related to motor coordination, visual function, and language compared to right UCS patients.

Conclusion:

Unicoronal synostosis had decreased functional connectivity in regions associated with memory, visual information processing, and motor function. Moreover, left-sided UCS had decreased connectivity in circuits for motor coordination and language when compared to right-sided UCS. This study provides data suggestive of long-term sequelae of UCS that varies by sidedness, which may be responsible for neurocognitive impairments found in previous cognitive analyses.
A Pilot Study of Identification Genetic Background of Craniosynostosis Cases
Authors: Atli Emine Ikbal , Yalcintepe Sinem , Atli Engin , Demir Selma , Mail Cisem , Eker Damla , Kalkan Rasime , Gurkan Hakan
Published: November 2020

The early fusion of the cranial sutures was described as a craniosynostosis. The early diagnosis and management of craniosynostosis is very important. Environmental factors and genetic abnormalities plays a key role during the development of craniosynostosis. Syndromic craniosynostosis cases are related with autosomal dominant disorders but nearly half of the affected cases carry a new mutation. In this study, in order to identify the genetic etiology of craniosynostosis the authors analyzed 20 craniosynostosis patients by using conventional karyotype, aCGH, sanger sequencing, next generation sequencing (NGS) and Multiplex ligation-dependent probe amplification (MLPA) techniques. The authors identified mutations on FGFR2 and FGFR3 genes which were associated with Muenke syndrome, Crouzon syndrome and skeletal dysplasia syndromes. NGS applied all of the cases and 7 clinical variations in 5 different gene were detected in %20 of cases. In addition to these abnormalities; del(11)(q14.1q22.2), del(17)(q21.31), dup(22)(q13.31) and t(2;16)(q37;p13) have been identified in our cohort which are not previously detected in craniosynostosis cases. Our study demonstrates the importance of detailed genetic analysis for the diagnosis, progression and management of the craniosynostosis.
A Modified Design of the Pectoralis Major Myocutaneous Flap for Reconstruction of Head and Neck Defect
Authors: Lyu Xiaoming , Liu Shuming , Zheng Lei , Huang Mingwei , Zhang Jianguo , Zhang Jie
Published: November 2020

Even though the pectoralis major myocutaneous flap (PMMF) still has an important role in the free flaps ear, it is reported to have drawbacks such as the limited cephalad extension and high incidence of total or partial flap necrosis. Various modifications have been attempted to augment the limited cephalad extension and a stable blood supply.

The aim of this study is to describe a modified design of the skin paddle and preparation of the PMMF, to achieve stable blood circulation and sufficient pedicle length. The priority skin paddle is the medial part for its stable blood supply, and the lateral margin should be adjusted as needed. During the harvesting, the lateral thoracic artery (LTA) is preserved to protect the perforating branches, and the anterior sheath of the rectus abdominis muscle is used as a suture margin to prevent damage of the thin muscle of the PMMF. The skin paddles in this study are larger than those previously reported. All of the 21 patients in our study, the skin paddles show complete survival with no partial necrosis of skin paddle, fistula, or wound dehiscence.

It is worthwhile to consider and preserve the LTA as a major contributor to a lateral and distal PMMF. This study would be useful in future and preparation of the PMMF in head and neck reconstruction.
Chiasmatic Ridge: Incidence, Classification, and Clinical Implications
Authors: Beger Orhan , Bahşi Ilhan
Published: November 2020

Objective:

The study aimed to identify the chiasmatic ridge (CR) morphology and to discuss its surgical significance.

Methods:

The suprasellar region of 90 adult dry skulls with unknown ages, sexes, or nationalities was examined to record the shape and incidence of the CR.

Results:

The CR was found in 14 (15.56%) of 90 dry skulls. The ridge was classified into 3 types, taking into account its shape, incidence (presence/absence), and the risk of residual tumor formation. The absence of the CR was named as Type 1 (76 cases, 84.44%). The bony extension without a hidden area was identified as Type 2 (8 cases, 8.89%), while the bony extension with a hidden area as Type 3 (6 cases, 6.67%).

Conclusion:

Type 3 CR (which has an evident hidden area beneath the ridge) should be taken into account by neurosurgeons to eliminate possible residual tumor risk during removal of tumors (eg, meningioma) with subfrontal or supraorbital approaches.
Epidemiological Research of Microtia Combined With Congenital Heart Disease
Authors: Cao Tongyu , Chen Qi , Wang Bingqing , Hu Jintian , Zou Mengxuan , Zhang Qingguo
Published: November 2020

Congenital heart disease (CHD) is one of the most common combined malformations of microtia. There is currently no specific study that investigates the relationship between microtia and CHD.

Methods:

This study collected microtia inpatients admitted from May 1, 2015 to July 31, 2016. The diagnosis of CHD was based on patient's symptoms, past history, and echocardiography. Pearson χ
2 test was used to analyze the correlation between CHD and microtia.

Results:

A total of 30 cases (3.35%) were documented with CHD, including atrial septal defect (12/40.00%), ventricular septal defect (7/23.30%), patent ductus arteriosus (2/6.70%), complex congenital heart disease (3/10.00%), combined CHD (2/6.70%) and other malformations (4/13.30%). Analysis showed no statistically significant relation between CHD and the side of affected ear or gender.

Conclusions:

The occurrence of CHD in microtia patients was higher than that in the general population. The relationship between them was explored mainly from the etiological perspective. Microtia and CHD were often combined in syndromes such as Goldenhar syndrome, 22q11 deletion syndrome, and CHARGE syndrome. Absence of genes or abnormal embryo development associated with these syndromes leads to the occurrence of both.
Surgical Management of Sinus Pericranii With Crouzon Syndrome
Authors: Han Tao , Ji Yi , Cui Jie , Shen Weimin
Published: November 2020

Background:

Sinus pericranii (SP) is a rare vascular malformation which connects the intracranial dural sinuses to the extracranial venous drainage system. Although the majority of SP cases are caused by trauma, some of them are congenital. Furthermore, a few SP cases have been reported in association with craniosynostosis. The authors’ objective is to discuss the surgical management of SP with Crouzon's syndrome in children.

Methods:

Three-Dimensional reconstruction with enhanced CT scan was used for evaluate the condition of SP with Crouzon's syndrome in all 4 cases. Two cases with small single-hole defect on skull were only treated by cranioplasty with distraction osteogenesis. In the management of the other 2 SP patients with large skull defect, titanium mesh was used for compression of dilated venous sinus to inhabit filling and promote shrinking.

Result:

Four cases of SP with Crouzon's syndrome were treated in the authors’ department. With cranioplasty with distraction osteogenesis only, 2 patients with single-hole skull defect experienced SP spontaneous involution at 4 to 6 months postoperatively. With titanium mesh compression, SP with large skull defect shrank significantly without clinical recurrence, but long-term follow-up was still in need.

Conclusion:

For small single-hole skull defect in SP patient with Crouzon's syndrome, the only application of cranioplasty for decreasing intracranial pressure can promote SP spontaneous involution. 3D printed titanium mesh compression renders a safe and efficient approach for SP with large skull defect. Long-time follow up and further accumulation of cases may establish the efficacy of the authors’ management.
Laparoscopic Versus Open Roux-en-Y Choledochojejunostomy: A Single-institute Experience With Literature Review
Authors: Li Tao , Tuerxun Kahaer , Keyoumu Yimingjiang , Apaer Shadike , Zeng Qi , Aierken Amina , Payiziwula Jiangduosi , Ainiwaerjiang Nuerzhati , Wu Jing , Tuxun Tuerhongjiang
Published: November 2020

Objectives:

The current clinical study aims to compare the clinical efficacy of open choledochojejunostomy (OCJ) and laparoscopic choledochojejunostomy (LCJ) in patients with benign and malignant biliary tract disorders.

Patients and Methods:

The clinical data of 40 consecutive patients who underwent either OCJ or LCJ from January 2015 to February 2017 were retrospectively analyzed. The clinical parameters analyzed include baseline information, intraoperative characteristics, and postoperative clinical outcomes. The patients were divided into OCJ group and LCJ group based on the surgical approach performed.

Results:

Of 40 patients during the study period, 15 underwent LCJ and the remaining 25 patients underwent OCJ. The mean operative time was slightly longer in the LCJ group (323.53±150.30 min) than the OCJ group (295.38±130.34 min) (P=0.945); intraoperative blood loss in 2 groups were similar (179.17 vs. 164.67 mL, P=0.839). Although hospital stay was significantly shorter in the LCJ group (8.33±2.1 d) compared with the OCJ group (19.24±4.2 d) (P<0.001). Biliary leakage is the most common complication after OCJ; no complication was experienced in the LCJ group.

Conclusions:

LCJ is a feasible and safe option for patients undergoing choledochojejunostomy.
Pros and Cons of Transoral Endoscopic Thyroidectomy Via Vestibular Approach: A Comparative Study
Authors: Zhang Guoliang , Li Bing , Zhang Guolie , Lin Yuanmei , Chen Yijun , Gao Jian
Published: November 2020

Objective:

The objective of this study was to explore the feasibility and safety of transoral endoscopic thyroidectomy via vestibular approach (TOETVA) compared with endoscopic thyroidectomy via bilateral areola approach (ETBAA) in the treatment of patients with benign thyroid nodules.

Materials and Methods:

From January 2017 to December 2018, 60 patients who received TOETVA were enrolled as the research group; 65 patients who underwent ETBAA were included as the control group. A retrospective study was performed using the clinical data for these cases. All patients were diagnosed with benign nodules by preoperative examinations. Parameters including surgical trauma, complications, cosmetic satisfaction, and postoperative discomfort were compared between the 2 groups.

Results:

All operations were completed without incident. There were significant differences in operation time (137.8±18.7 vs. 95.7±17.2 min), intraoperative blood loss (16.8±9.1 vs. 24.6±16.6 mL), drainage volume (123.1±20.9 vs. 153.6±40.2 mL), C-reactive protein level (7.2±5.2 vs. 9.0±4.7 mg/L), drainage time (3.2±0.6 vs. 3.9±1.3 d), postoperative hospital stay (3.3±0.8 vs. 4.1±1.5 d), and sense of skin tension on the neck (0% vs. 10.8%) between the TOETVA and ETBAA groups (P<0.05). There were no significant differences in pain score, incidence of recurrent laryngeal nerve injury, transient hypoparathyroidism, infection, inadvertent parathyroidectomy, or swallow discomfort between the 2 groups. The cosmetic satisfaction score in the TOETVA group was significantly higher than that in the ETBAA group at 1 month after surgery (9.8±0.5 vs. 9.4±0.9, P<0.05), but at 3 months after the operation, the difference was not statistically significant.

Conclusions:

TOETVA was accompanied by less surgical trauma and skin tension on the neck than ETBAA, and the cosmetic effect of this approach was better than that of ETBAA in the early postoperative period. TOETVA for benign thyroid nodules is safe and feasible. However, there are disadvantages with TOETVA, such as a long surgical period. More cases and further research are needed to delve further into this approach.
Retroperitoneoscopic Drainage of Psoas Abscess: A Systematic Review
Authors: Froiio Caterina , Bernardi Daniele , Lovece Andrea , Bonavina Giulia , Manzo Carlo Alberto , Asti Emanuele , Bonavina Luigi
Published: November 2020

Background:

Psoas abscess is a relatively rare clinical condition that can occur worldwide, is difficult to diagnose, and has a severe clinical course. Conventional treatment ranges from antibiotic therapy alone to computed tomography (CT)-guided and/or open surgical drainage. Retroperitoneoscopic drainage represents a minimally invasive and potentially definitive therapeutic option.

Materials and Methods:

A systematic review of the literature on minimally invasive extraperitoneal access for drainage of psoas abscess was conducted through PUBMED, EMBASE, and COCHRANE databases, according to the PRISMA statement guidelines. We considered only studies in English and with a full text. The quality of all selected articles was assessed for the risk of methodological bias. Additional literature sources were used to put into context the indications and limits of retroperitoneoscopic drainage.

Results:

Seven papers published between 2004 and 2020, including a total of 56 patients, met the eligibility criteria and were included in the qualitative analysis. Causative agents of psoas abscess included Mycobacterium tuberculosis, Klebsiella pneumoniae, Enterobacter aerogenes, Staphylococcus aureus, and Streptococcus spp. Tuberculous abscess was more common than pyogenic abscess (92.8% vs. 7.2%). Main clinical findings were back pain (76.8%) and fever (53.6%). All patients were preoperatively evaluated by CT or magnetic resonance imaging. Only 4 patients (7.1%) had previously undergone CT-guided percutaneous drainage. Retroperitoneoscopic drainage was combined with antibiotic therapy in all cases. No Clavien-Dindo grade >3 complications occurred, and there was no 30-day postoperative mortality. The recurrence rate was 1.8% at a mean follow-up of 21 months.

Conclusion:

Retroperitoneoscopic surgical drainage is a safe and effective approach for the treatment of psoas abscess.
Covid-19 vaccination intentions among Canadian parents of 9-12 year old children: results from the All Our Families longitudinal cohort
Authors: Hetherington Erin , Edwards Sarah A , MacDonald Shannon E , Racine Nicole , Madigan Sheri , McDonald Sheila , Tough Suzanne
Published: November 2020

Background

Acceptance of a COVID-19 vaccine is critical to achieving high levels of immunization. The objective of this study is to understand factors associated with COVID-19 vaccine intentions among parents and explore reasons underlying decision making.

Methods

Participants from a longitudinal cohort were invited to participate in a COVID-19 impact survey in May-June 2020 (n=1321). Parents were asked about the impact of the pandemic and their intention to vaccinate their child against COVID-19 should a vaccine be approved. Past infant vaccination status was validated against public health records. Multinomial regression models were run to estimate associations between demographic factors, past vaccination status, and vaccine intention. Qualitative responses regarding factors impacting decision making were analyzed thematically.

Results

Sixty percent of parents (n=798) intended to vaccinate their children, but 9% (n=113) said they did not intend to vaccinate and 31% (n=410) were unsure. Lower education and income were inversely associated with intention to vaccinate. Incomplete vaccination history was associated with intention not to vaccinate but not uncertainty. Qualitative responses revealed concerns over vaccine safety and efficacy, long term effects and a rushed vaccination process.

Interpretation

Almost a third of parents remain unsure about vaccinating their children against COVID-19, even within a group with historically high uptake of infant vaccines. Given the many uncertainties about future COVID-19 vaccines, clear communication regarding safety will be critical to ensuring vaccine uptake.