bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in Hearing Protection Use With Occupational Noise Exposure in the United States 1999 to 2016
Authors: Pan Dorothy W. , Choi Janet S. , Hokan Albert , Doherty Joni K.
Published: September 2021

Objective:

Determine hearing protection use in relation to occupational noise exposure, tinnitus, and audiometry-measured hearing loss in the United States from 1999 to 2016.

Study Design:

Cross-sectional study utilizing US National Health and Nutritional Examination Survey (NHANES) 1999 to 2016 with occupation, reported occupational noise exposure, hearing protection use, tinnitus, and audiometry-measured hearing loss data. Subgroup analysis divided data into two cohorts early 2000s and 2010s.

Setting:

Population-based study using NHANES database capturing representative sample of US population.

Participants:

Individuals with complete data 1999 to 2004 (n = 10,347) and 2011 to 2012 with 2015 to 2016 (n = 9,383).

Interventions:

Participants self-reported occupational noise exposure lasting more than 4 h/d for more than 3 months. Self-reported hearing protective device uses and tinnitus frequency. Audiometric hearing loss objectively measured.

Main Outcome Measures:

Hearing protection use. Secondary measures included self-reported bothersome tinnitus and audiometrically measured hearing loss.

Results:

Across occupations, reported occupational noise exposure was higher in 2010s [32%, 95% CI: 29.6–34.6%] than 2000s [12.5%, 95% CI: 11.2–13.9%], while hearing protection use remained low in 2000s [41.3%, 95% CI: 37.8–44.8%] and 2010s [32.8%, 95% CI: 29.8–35.8%]. Less hearing protection use was associated with absence of bothersome tinnitus. Factors associated with increased hearing protection use were younger age, male sex, college education or higher, and white race in a multivariate model.

Conclusions:

Reported occupational noise exposure appeared to increase from 2000s to 2010s yet hearing protection use remained stable at low use rate. As noise exposure is a major risk factor for hearing loss, significant education and reinforcement of appropriate hearing protection use for workplace noise exposures is necessary to preserve workers’ hearing.
Radiological and Audiological Prediction for Ossicular Fixation in Chronic Otitis Media and Tympanic Membrane Perforation
Authors: Motegi Masaomi , Yamamoto Yutaka , Akutsu Taisuke , Tada Takeshi , Kurihara Sho , Takahashi Masahiro , Sampei Sayaka , Morino Tsunetaro , Yamamoto Kazuhisa , Sakurai Yuika , Kojima Hiromi
Published: September 2021

Objectives:

Recurrent middle-ear infection can lead to ossicular fixation, adversely affecting post-tympanoplasty hearing outcomes. Preoperative prediction of ossicular fixation remains challenging. We aimed to investigate potential predictors of ossicular fixation in patients with chronic otitis media.

Study Design:

Retrospective.

Setting:

Tertiary academic medical center.

Patients:

Patients with noncholesteatomatous chronic otitis media and tympanic membrane perforation, without ossicular discontinuities.

Interventions:

Diagnostic.

Main Outcome Measures:

The fixation of each ossicle was assessed during tympanoplasty. The impact of preoperative otoscopic findings, computed tomography (CT) features, and hearing levels on the prediction of ossicular fixation was evaluated using uni- and multivariable logistic regression analyses.

Results:

One hundred thirty-five patients were included. Soft-tissue density between the malleus head and the anterior wall (odds ratio, 3.789 [95% confidence interval, 1.177–12.196]; p = 0.0255) and poor development of mastoid cells (16.826 [2.015–134.520]; p = 0.0078) were independent predictors of malleus fixation. In addition, ≥50% tympanic membrane perforation (5.412 [1.908–15.353]; p = 0.0015), poor development of mastoid cells (3.386 [1.039–11.034]; p = 0.0431), and a ≥40-dB preoperative air-bone gap (ABG) at 500 Hz (4.970 [1.732–14.261]; p = 0.0029) were independent predictors of incus fixation. Soft-tissue density surrounding the stapes (18.833 [1.856–191.104]; p = 0.0119) and a ≥40-dB preoperative ABG at 500 Hz (13.452 [1.640–∞]; p = 0.0138) were correlated with stapes fixation.

Conclusions:

The accurate prediction of ossicular fixation in patients with chronic otitis media based on CT features and the ABG may facilitate decision-making regarding the need for ossiculoplasty, possibly avoiding unnecessary manipulation or overlooking of fixation.
The Role of Endoscopy in the Resection of Sporadic Vestibular Schwannomas: A Systematic Review of Surgical Outcomes
Authors: Raza-Knight Saba , Chiuta Sacha , Golash Aprajay , Gurusinghe Nihal , Roberts Gareth , Alalade Andrew F.
Published: September 2021

Background:

Vestibular schwannomas (VS) are benign intracranial tumors originating from the vestibular division of the eighth cranial nerve. Treatment options include microsurgery, radiotherapy, and surveillance. Endoscopy is becoming more widely used as an adjunct in skull base surgery and may influence outcomes in surgically managed VS.

Methods:

A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies involving endoscope-assisted and fully endoscopic procedures for sporadic VS resection were identified. Facial nerve function, hearing preservation, extent of resection, and complications were analyzed.

Results:

Thirty-one studies were included (27 endoscope-assisted, four fully endoscopic). Subgroup analyses were performed to assess outcomes according to tumor size and surgical approach. Overall, endoscopic facial nerve preservation rates were comparable to microsurgical treatment. A subgroup analysis suggested that functional facial nerve preservation rates may be higher when endoscopic assistance is used for smaller (Koos I–II) tumors using the retrosigmoid or translabyrinthine approach. The gross total resection rate for small tumors was higher in retrosigmoid ES-assisted microsurgery (96.2%) compared to rates in the literature for the standard, open retrosigmoid approach. Hearing outcomes were more variable and were under-reported.

Conclusions:

Current data suggest that ES-assisted resection of sporadic VS is not inferior to microsurgical resection with respect to facial nerve outcomes and extent of resection. However, some ES series report poor hearing outcomes, which are under-reported in the literature. Further prospective studies are required to ascertain if endoscopic assistance can improve outcomes for VS resection, particularly for smaller (Koos I–II) tumors.
Short-term outcomes of different modalities of pyloromyotomy versus gastric electrical stimulation in the treatment of gastroparesis
Authors: Shiu Sz-Iuan , Shen Shih-Hsiung , Luo Hua-Nong
Published: September 2021

Background:

The aim of this meta-analysis was to compare the short-term outcomes surrounding the efficacy and complication rate between different modalities of pyloromyotomy and gastric electrical stimulation (GES) in the treatment of gastroparesis.

Methods:

Comprehensive, computerized research was performed on PubMed, Embase, and the Cochrane Central Register of Controlled Trials. We additionally reviewed relevant articles, without any language limitations, published prior to April 15, 2020. Meta-analysis was conducted using RevMan 5.3 software.

Results:

Three studies totaling 196 participants who had received 4 interventions, including single per-oral pyloromyotomy (POP), double POP, laparoscopic pyloromyotomy, and GES, were eligible for analysis. Compared to single POP, double POP achieved a better clinical response with a pooled relative risk (RR) of 1.27 (95% confidence interval [CI], 1.01–1.60, P = .04), while laparoscopic pyloromyotomy and GES showed no difference with a pooled RR of 0.89 (95% CI, 0.74–1.08, P = .23) and 0.87 (95% CI, 0.73–1.04, P = .13), respectively. As for the recurrence and complication rates, only GES showed a borderline significance of recurrence in comparison to single POP (RR 2.17, 95% CI, 1.00–4.71, P = .05), while there were no differences in the remainder of the comparisons.

Conclusions:

We conducted a detailed comparison of 3 modalities of pyloromyotomy and GES in the treatment of gastroparesis, with the results suggesting that double POP demonstrated better clinical success with similar recurrence and complication rates. In addition, GES may result in more recurrence amongst these interventions.
Disparities in Audio-only Telemedicine Use Among Medicare Beneficiaries During the Coronavirus Disease 2019 Pandemic
Authors: Benjenk Ivy , Franzini Luisa , Roby Dylan , Chen Jie
Published: September 2021

Background:

Under emergency coronavirus disease 2019 pandemic regulations, Medicare granted temporary payment parity with in-person visits for audio-only (telephone) telemedicine visits. This policy was designed to expand telemedicine to patients without camera-equipped devices and broadband internet. However, audio-only telemedicine use has been substantial.

Objective:

The aim of this study was to explore whether the rate of audio-only telemedicine during the pandemic is related to patient access to technology or provider behavior.

Design:

Cross-sectional analysis of the Summer and Fall 2020 Medicare Current Beneficiary Survey coronavirus disease 2019 supplements, using multivariable logistic models and accounting for complex survey design.

Subjects:

A total of 3375 participants in the summer survey and 2633 participants in the fall 2020 were offered a telemedicine visit to replace a scheduled in-person visit by their usual care provider.

Measures:

We compared beneficiaries who were exclusively offered audio-only telemedicine to beneficiaries who were offered video telemedicine or both audio and video.

Results:

We found that among Medicare beneficiaries who were offered telemedicine to replace a scheduled in-person appointment, ~35% were exclusively offered audio-only. 65.8% of beneficiaries exclusively offered audio-only reported having a smartphone/tablet and home internet. After controlling for personal access to technology, Hispanic [adjusted odds ratio (AOR)=2.09, P<0.001], dually eligible (AOR=1.63, P=0.002), nonprimary English speaking (AOR=1.64, P<0.001), and nonmetro beneficiaries (AOR=1.71, P=0.003) were more likely to be offered audio-only during July−November 2020.

Conclusions:

These findings suggest audio-only telemedicine use during the pandemic is only partially related to patient access to technology. Policymakers must work to both expand programs that provide smartphones and broadband internet to disparity communities and telemedicine infrastructure to providers.
Exploring Factors Associated With Depressive Symptoms Among Patients With Chronic Pain
Authors: Al Shukaili Mohamed , Al Alawi Mohammed , Al Huseini Salim , Al Shukaili Ahmed , Al Muharrami Maya , Al Abdali Marwa , Al Harthi Hiba , Al Saadi AlKhatib , Al Balushi Rasheeda , Al Kasbi Fatma , Al-Fahdi Amal , Panchatcharam Sathiya Murthi , Cucchi Angie , Al-Adawi Samir
Published: September 2021

This cross-sectional study examined the factors associated with depression among people with chronic pain (PwCP) attending specialized pain clinics in Muscat, Oman. Two-hundred eighty-seven participants were recruited for the study, and univariate analyses were used to investigate the difference between individuals who scored above/below the cutoff points for depressive symptoms. A multiple regression analysis was used to detect the independent predictors. Twenty-six percent of participants scored above the cutoff point. Further analysis indicated that unstable family relationships pre-existing depressive symptoms (odds ratio [OR], 2.86; p = 0.044), a family history of depression (OR, 4.75; p = 0.019), severe pain (OR, 4.21; p < 0.006), having fibromyalgia (OR, 28.29; p = 0.005), and lumbago/truck (OR, 2.41; p = 0.039) were independent predictors of depressive symptoms. This study indicates that one in four patients with chronic pain also presents with depressive symptoms. However, the role of culture needs to be taken into consideration when interpreting these findings and when building on these data.
Bridging the Gap Between Corporate Sustainability Commitments and Consumer Action: Nutrition Communications Help Consumers Contribute to a More Sustainable Food Value Chain
Authors: Smith Edge Marianne , Hermann Mindy
Published: September 2021

The complexity of finding sustainable solutions to produce more food with less environmental impact to feed more people has been at the forefront of stakeholders across the food value chain over the past decade. The recent pandemic has provided the opportunity to assess and evaluate current practices for optimal sustainable practices. The goal to feed the world in a way that promotes healthy people, healthy planet, and healthy communities is reflected in the missions and actions of suppliers and companies along the food value chain. Progress has been made with continued opportunities for goal attainment. Decision-making by consumers, however, often does not align with where companies are prioritizing their actions and communications. The most important role of nutrition professionals, then, may be to help consumers better understand the nuances around sustainability, including how and where consumers can have the greatest impact in creating a more sustainable food system. It is only when all stakeholders across the food chain continuum gain alignment in understanding sustainability and where they make a difference that we can create our desired future.
Facial Asymmetry in Unilateral Congenital Superior Oblique Muscle Palsy
Authors: Akbari Mohamad Reza , Khorrami-Nejad Masoud , Kangari Haleh , Akbarzadeh Baghban Alireza , Ranjbar Pazouki Mehdi
Published: September 2021

SIGNIFICANCE

This study was conducted to evaluate facial asymmetry in unilateral congenital superior oblique muscle palsy (SOP). The results showed that all facial asymmetry parameters had a higher frequency in SOP patients compared with orthotropic individuals.

PURPOSE

This study aimed to evaluate the characteristics of facial asymmetry in unilateral congenital SOP and compare with orthotropic individuals.

METHODS

This cross-sectional comparative case series was conducted in 58 patients with ocular torticollis caused by SOP (mean ± standard deviation age, 18 ± 12 years) and 58 orthotropic individuals (mean ± standard deviation age, 19 ± 13 years). The exact form of torticollis was determined by direct observation from yaw, roll, and pitch axes. Four photographs were taken from patients: (1) with torticollis to calculate the amount of head tilt; (2) with the head in the straight position to calculate the facial angle and relative facial size (RFS); and (3 and 4) with the head positioned downward (to compare the cheek size) and upward (to assess columella deviation and nostril asymmetry).

RESULTS

Twenty-nine patients (50%) had a head tilt, 23 (39.66%) had combined head tilt and a face turn, and 6 (10.44%) had a pure face turn. The mean ± standard deviation of head tilt, facial angle, and RFS was 10.11 ± 6.31°, 1.11 ± 1.67°, and 1.003 ± 0.126 in SOP patients, respectively, and the mean RFS and facial angle were significantly higher in SOP patients compared with orthotropic individuals (both P < .001). Facial hemihypoplasia, unilateral cheek compression, nostril asymmetry, and columella deviation were observed in 43 (74.1%), 31 (53.4%), 39 (67.2%), and 38 patients (65.5%), respectively, which were all significantly more common compared orthotropic individuals (P < .001). Facial asymmetry was seen in 52 patients (91.2%) and 17 orthotropic subjects (29.3%), respectively (P < .001).

CONCLUSIONS

All quantitative and qualitative facial asymmetry parameters had a higher frequency in SOP patients compared with orthotropic subjects.
Impact of Low Humidity on Damage-associated Molecular Patterns at the Ocular Surface during Dry Eye Disease
Authors: Alven Alyce , Lema Carolina , Redfern Rachel L.
Published: September 2021

SIGNIFICANCE

Dry eye is one of the leading causes for individuals to seek eye care, whereas the pathogenesis is poorly understood. One mechanism in which dry eye inflammation may ensue is by the release of damage-associated molecular patterns (DAMPs) by damaged cells to stimulate the production of cytokines and matrix metalloproteinases. Examining DAMP levels on the ocular surface during dry eye disease (DED) will increase our understanding of their potential involvement in the pathogenesis of DED.

PURPOSE

This study aimed to quantitate DAMPs, high-mobility group box 1 (HMGB1), and heat shock proteins on the ocular surface of normal and dry eye subjects and to examine the impact of low-humidity environment (LHE) on DAMPs and inflammation in dry eye subjects.

METHODS

Basal tears (10 to 20 μL) and conjunctival impression cytology samples were analyzed for HMGB1, HSP-27, HSP-60, HSP-70, and HSP-90α by ELISA or Luminex assays in normal (n = 15) and DED (n = 15) subjects. In addition, a subset of DED subjects were exposed to LHE for 2 hours. The level of DAMPs in the tear film was evaluated by ELISA or Luminex assay. Interleukin 6, interleukin 8, or metalloproteinase (MMP) 9 mRNA were quantitated by real-time polymerase chain reaction from conjunctival impression cytology samples.

RESULTS

Compared with age-matched normal subjects, HMGB1 was significantly elevated in the tear film of DED subjects (P = .03), whereas there was no significant difference in heat shock proteins. Conjunctival impression cytology samples revealed no significant difference in intracellular DAMP levels between both groups. After exposure to an LHE, there was an increase in corneal staining (P = .005), HSP-60 levels in the tear film (P = .01), and MMP-9 mRNA in the conjunctiva (P = .001).

CONCLUSIONS

Dry eye subjects had higher levels of HMGB1 in their tear film. Exposure to an LHE worsened corneal staining, increased conjunctival MMP-9 mRNA expression, and increased tear film HSP-60 levels. Larger studies are needed to understand the involvement of DAMPs in stimulating dry eye inflammation.
Validity and Reliability of the Student Refractive Error and Eyeglasses Questionnaire—Revised Version in Myopic Children
Authors: Marupuru Srujitha , Dahlmann-Noor Annegret , Crescioni Mabel , Slack Marion , Barnard Simon , Amerat Imran , Loveday Adam , Chauhan Dharshana , Adler Paul , Walker Rosemary , Warholak Terri L.
Published: September 2021

SIGNIFICANCE

Multiple vision-related quality of life (VRQol) instruments exist, but questionnaires designed specifically for myopic children that are appropriate for assessing the impact of refractive error are rare.

PURPOSE

This study aimed to assess the validity and reliability of the Student Refractive Error and Eyeglasses Questionnaire – Revised (SREEQ-R) in school-aged children with myopia in the United Kingdom.

METHODS

Community optometrists in the United Kingdom invited children up to the age of 18 years presenting for an eye examination with current or previous reported use of eyeglasses for myopia to complete the SREEQ-R, which consists of 20 specific items divided into two sections each with three response categories. The “without glasses” section relates to perceptions of uncorrected vision/not wearing glasses, and the “with glasses” relates to corrected vision/wearing glasses. Rasch analysis was used to explore the psychometric performance (content, construct validity, and reliability) of the questionnaire items and scale using Winsteps software (Winsteps.com. Portland, OR).

RESULTS

A total of 125 eligible children with a mean ± standard deviation age of 12.7 ± 2.9 years completed the SREEQ-R. All items fit the Rasch model and were retained, and the scale was found to be unidimensional. All children and item infit and outfit mean square statistics fell within the recommended fit criteria. As per the Rasch analysis, the person reliability coefficients were 0.84 and 0.91, whereas item reliabilities were 0.99 and 0.80 for the without glasses and with glasses sections, respectively. The internal consistency for the SREEQ-R was good; Cronbach α values were 0.84 for without glasses and 0.91 for with glasses.

CONCLUSIONS

The SREEQ-R had satisfactory validity and reliability evidence. Construct validity of the scale was supported to measure the impact of uncorrected and corrected refractive error on vision-related quality of life in myopic school-aged children in the United Kingdom. The SREEQ-R could be used in future studies to evaluate vision-related quality of life in children with myopia.
Assessment and Correlation of Corneal Endothelial Cell Changes in Different Stages of Keratoconus in Non–contact Lens Wearers
Authors: Shah Zalak , Shilpy Neha , Purohit Dipali , Singh Shwetambari
Published: September 2021

SIGNIFICANCE

The endothelial changes in keratoconus are of interest because these can affect the surgical plan in management. Previously, many studies have evaluated the endothelium in eyes with keratoconus, but there is no common consensus on change in endothelial cell density (ECD) with studies showing variable results.

PURPOSE

This study aimed to compare and correlate endothelial cell parameters in different stages of keratoconus using specular microscope.

METHODS

This cross-sectional, cohort, comparative study included 162 eyes of 96 patients with keratoconus in one or both eyes. Corneal endothelial cell parameters were assessed with SP-1P specular microscope (Topcon Co., Tokyo, Japan). Corneal topography and thickness data were obtained from Sirius tomographer (Costruzione Strumenti Oftalmici, Florence, Italy). Eyes were divided into keratoconus stage 0 to 4 according to ABCD classification. Comparison and correlation of endothelial cell parameters in different stages were done.

RESULTS

There were 21.6% eyes (35) in stage 0, 29.6% eyes (48) in stage 1, 29.0% eyes (47) in stage 2, and 19.8% eyes (32) in stage 3 of keratoconus. Measurement was not possible in stage 4 keratoconus. Among the stages 0, 1, 2, and 3, the ECD was 3024, 3051, 3025, and 3043 cells/mm2; coefficient of variation was 27.2, 27.6, 26.8, and 27.4; and frequency of hexagon cells was 61.5, 63.7, 63.3, and 62.3, respectively (P > .05). The number of analyzed cells was 232, 209, 185, and 169 in stages 0, 1, 2, and 3, respectively (P < .001). No significant difference was found in minimum, maximum, and average cell area between the stages (P > .05). A weak Spearman rank correlation of ECD, coefficient of variation, and frequency of hexagon cells was found between eyes with keratoconus stages 0 and 1 and stages 2 and 3 (r = −0.05, P = .65; r = −0.11, P = .37; r = 0.05, P = .67, respectively). No significant correlation was found in the number of cells analyzed and minimum, maximum, and average cell area between the stages (P > .05).

CONCLUSIONS

Endothelial cell parameters do not show any significant changes and correlation up to stage 3 of keratoconus in non–contact lens wearers.
Analysis of Pedestrian Fractures in Collisions Between Small Cars and Pedestrians Based on Surveillance Videos
Authors: Miao Qi , Zhang Yan-Lin , Yang Xing-An , Miao Qi-Feng , Zhao Wei-Dong , Tong Fang , Lan Feng-Chong , Li Dong-Ri
Published: September 2021

Objective

To discuss the collision relationship and the cause of the fracture caused by traffic accidents in which the front of a small car collides with the side of a pedestrian while braking.

Methods

The surveillance videos of 42 traffic accidents involving the front of a small car colliding with the side of a pedestrian while braking were collected. By analyzing the surveillance videos and the paths, the speed of the collision, the relationship between the vehicle and the pedestrian upon collision, and the movement trajectory of the human body were clearly identified. The type and severity of the injuries were also determined through autopsy. The characteristics of the human injuries and vehicle paths were analyzed according to the collision speed (<40 km/h, 40–60 km/h, 60–90 km/h), and the correlations between the fracture and the height of the pedestrian, the height of the hood and the length of the hood were discussed.

Results

When a small car hits the side of a pedestrian, the front bumper first hits the lower limbs of the pedestrian, and then, the human body falls to the side of the vehicle, causing a secondary collision with the hood and front windshield; thus, the pedestrian is thrown at a speed similar to the speed of the vehicle, finally falling to the ground and sliding forward a certain distance. (1) When V is less than 40 km/h (n = 10), the pedestrian's head did not collide with the windshield, and the fatal injuries were caused by the individual striking the ground. (2) When V is greater than 40 km/h (n = 32), the majority (97%) of cases showed collision with the windshield. (3) When 40 to 60 km/h (n = 16), the pedestrian's head collided with the windshield, which can cause fatal injuries, and pelvic fractures and rib fractures occurred in 56.25% of patients. (4) When V is less than 60 km/h (n = 26), the ratio of the height of the pedestrian to the height of the hood was significantly smaller in the pelvic fracture group than in the nonpelvic fracture group (P < 0.01). (5) When 60 to 90 km/h (n = 16), there were holes in the windshield, and the pedestrians experienced severe head injuries, with cervical spine fracture occurring in 37.5% of patients, pelvic fractures occurring in 43.75% of patients, and rib fractures occurring in 31.25% of patients.

Conclusions

When V is less than 40 km/h, the vehicle does not cause severe injuries in pedestrians; when V is greater than 40 km/h, the collisions of the pedestrian's head with the windshield lead to severe head injuries and the accident can cause severe pelvic and rib fractures; when V is greater than 60 km/h, the collisions of the pedestrian's head with the windshield can cause cervical spine fracture in addition to head injuries. The occurrence of human injuries is related to not only the vehicle speed but also factors such as the height of the pedestrian, the height of the hood and the length of the hood.
Ruptured Splenic Artery Pseudoaneurysm Causing Hemorrhage Into a Pancreatic Pseudocyst
Authors: Overton-Hennessy Zo C. , Devane A. Michael , Fiester Steve , Schammel Noah , Schammel Christine , Fulcher James W.
Published: September 2021

This case report describes fatal exsanguination due to splenic artery hemorrhage into a pancreatic pseudocyst with cystogastrostomy in a 46-year-old woman. The decedent had a complicated medical history including necrotizing pancreatitis, giant pseudocyst formation after cystogastrostomy procedure, and coiling of a hemorrhagic splenic artery. While hospitalized, she underwent embolization of a ruptured splenic artery pseudoaneurysm. Weeks later, she went into hemorrhagic shock and was ultimately pronounced at the hospital. Doctors suspected an upper gastrointestinal (GI) bleed as the cause of death; however, the patient was too unstable to undergo interventional radiology at the time.

At autopsy, the pancreas was hemorrhagic and included a 15 × 15 × 15-cm pseudocyst, which contained a metallic stent from a cystogastrostomy. This case describes a unique co-occurrence of numerous common complications of chronic pancreatitis. There are multiple ways by which pancreatitis can cause upper and lower GI bleeds. In this case, the presence of a cystogastrostomy stent allowed for a ruptured pseudoaneurysm to hemorrhage through the pancreatic pseudocyst and into the stomach and duodenum, mimicking the presentation of a more common upper GI bleed. The pseudocyst then ruptured causing abdominal hemorrhage. The passage of hemorrhage through a cystogastrostomy stent is not described in other literature.
Systemic AA Amyloidosis Associated With Intravenous Injection of Oral Prescription Opioids—An Autopsy Case Report
Authors: Zabel Kenneth M. , Lin Grace Y. , Sell Rebecca E. , Aisagbonhi Omonigho
Published: September 2021

There are reports of AA amyloidosis associated with intravenous and/or subcutaneous injection of street drugs, such as heroin and cocaine. Most reports describe patients with substance use disorder, renal amyloidosis and concurrent viral infections, such as hepatitis and/or human immunodeficiency virus. Herein, we present a case of systemic AA amyloidosis and sepsis in a 34-year-old woman with a history of intravenous injection of oral prescription medications (as evidenced by excipient lung disease) who had no known history of human immunodeficiency virus nor of hepatitis B or C. Our case shows the broader spectrum of pathology that can occur with the misuse of prescription medications.
Suicide Screening in a Large Pediatric Emergency Department
Authors: Rufino Katrina A. , Kerr Tarra , Beyene Hayate , Hill Ryan M. , Saxena Johanna , Kurian Sherin , Saxena Kirti , Williams Laurel
Published: September 2021

Suicide is a leading cause of death among children and adolescents, and research has shown a significant increase in the rates of emergency department (ED) visits because of suicide ideation and attempts for children younger than 18 years.

Objective

This study examined the feasibility of screening all patients entering the ED using the Columbia–Suicide Severity Rating Scale as well as examining the rates of suicide ideation and attempts endorsed by adolescents who present at the ED.

Methods

This study used a sample of 12,113 patients between the ages of 11 and 19 years.

Results

Results revealed that 13.5% of the participants endorsed passive suicide ideation in the month leading up to their ED visit and 11.3% of the participants reported active ideation in the prior month. Results also revealed that patients whose chief complaints were coded as psychiatric or medical trauma were more likely to endorse either active or passive suicidal ideation than other presenting problems. Patients with a psychiatric or medical trauma chief complaint were also more likely to report lifetime suicidal behavior and suicidal behavior 3 months before the ED visit.

Conclusions

In addition to findings, implications, feasibility, and lessons learned are discussed for other institutions or departments considering implementation of a widespread screening.

Highlights:

• Suicide screenings were implemented in a large pediatric emergency department.

• One in 5 endorsed suicidal ideation or behavior regardless of presenting problem.

• Feasibility and lessons learned are discussed for others hoping to implement a widespread screening.
Inductively Coupled Intraoral Flexible Coil for Increased Visibility of Dental Root Canals in Magnetic Resonance Imaging
Authors: Tesfai Agazi Samuel , Vollmer Andreas , Özen Ali Caglar , Braig Moritz , Semper-Hogg Wiebke , Altenburger Markus Jörg , Ludwig Ute , Bock Michael
Published: September 2021

Objectives

Accurate visualization of dental root canals is vital for the correct diagnosis and subsequent treatment. This work assesses the improvement of a dedicated new coil for dental magnetic resonance imaging (MRI) in comparison to conventional ones in terms of signal-to-noise ratio (SNR) and visibility.

Materials and Methods

A newly developed intraoral flexible coil was used to display dental roots with MRI, and it provides improved sensitivity with a loop design and size adjusted to a single tooth anatomy. Ex vivo and in vivo measurements were performed on a 3 T clinical MR system, and results were compared with conventional head and surface coil images. Additional comparison was performed with a modified fast spin echo sequence and a constructive interference in steady-state sequence.

Results

Ex vivo, an SNR gain of 6.3 could be achieved with the intraoral flexible coil setup, and higher visibility down to 200 μm was possible, whereas the external loop coil is limited to 400 μm. In vivo measurements in a volunteer resulted in an SNR gain of up to 4.5 with an improved delineation of the root canals, especially for the branch tissue splitting of the mesial root canal into mesial-buccal and mesial-lingual.

Conclusions

In summary, we showed the feasibility of implementing a wireless coil approach with readily available dental practice materials for sealing and placement. Highly improved MRI scans can be acquired within clinically feasible scan times, and this might provide additional medical findings to supplement available x-ray images.
The Role of Measurement of Pedicle Length for DIEP Flap Transferring in Breast Reconstruction
Authors: Song Dajiang , Pafitanis Georgios , Li Juanjuan , Li Zan
Published: September 2021

Background

Intraoperative venous congestion is a main complication in deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction. We present a pedicle measuring technique to precisely predict the length of pedicle needed in DIEP free flap, to improve the outcome, and to reduce the risk of donor site morbidity and complications.

Materials and Methods

A single-center, open-label, prospective, randomized study was carried out to access efficacy and safety of a pedicle measuring technique in 389 patients. Each patient received a delayed breast reconstruction using free unipedicled DIEP flap, and internal mammary vessels were chosen as recipient vessels. During the surgery, the conventional DIEP flap technique was used in the control group, in which the course of the pedicle was fully dissected. In the measuring group, the flap in setting way was decided preoperatively, the distance (A) between the internal mammary vessels (a) and the point of DIEP perforator into the subcutaneous tissue (b) was measured, and then the length (B) of the perforator (c) and the main trunk (d) is measured and dissected to achieve 1 cm longer than A.

Results

There are 180 and 209 patients enrolled in the control and measuring group, respectively. Venous congestion occurred in 15 patients (8.3%) in the control group, and 1 patient (0.5%) in the measuring group (P < 0.001). All the 16 patients were found venous thrombosis. Then successful free flap salvage surgeries were performed in 10 patients. Six patients (3.3%) had total flap necrosis due to recurrent venous thromboembolisms. Fat necrosis occurred in 16 patients (8.9%) in the control group, and 5 patients (2.4%) in the measuring group (P = 0.006). Partial flap necrosis was found in 12 patients (6.7%) in the control group, and in 3 patients (1.4%) in the measuring group (P = 0.008). Total flap necrosis occurred in 6 patients (3.3%) in the control group, but no (0%) patient in the measuring group (P = 0.009).

Conclusions

Measurement of pedicle length for DIEP flap transferring in breast reconstruction is a reliable technique that could secure the DIEP free flap, reduce operative invasiveness, and lower the risk of complications considerably.
Change in Eyelid Closure in Spontaneous Blinking After Static Eyelid Reconstruction Surgery for Patients With Facial Paralysis
Authors: Hidaka Takeaki , Ogawa Kazuya , Tomioka Yoko , Yoshii Kengo , Tomio Jun , Okazaki Mutsumi
Published: September 2021

Background

Static eyelid reconstruction surgery, such as ptosis repair or brow lift, is widely performed for patients with facial paralysis. Complications include exposure keratitis and possible vision loss mainly due to eyelid closure impairment in spontaneous blinking. However, no quantitative evaluation data has been available regarding postoperative closure deterioration.

Methods

To elucidate factors associated with postoperative eyelid closure impairment, a retrospective study was performed for 51 patients who underwent an initial static eyelid reconstruction surgery from October 2017 to August 2020. A static eyelid reconstruction surgery consisted of either 1 or more of the following: (1) levator advancement, (2) brow lift, and (3) orbicularis oculi myectomy. Eyelid closure ratios (0% for complete closure impairment and 100% for perfect closure) at spontaneous blinks were measured on 6 occasions: before operation and at postoperative 1, 3, 6, 9, and 12 months. Comparison was made between preoperative and postoperative values by using mixed-effects model.

Results

Overall, average closure ratio was significantly increased. However, 10 patients had >10% closure ratio decreases at at least 1 postoperative measurement point, and all those patients had undergone brow lift procedures.

Conclusions

Although eyelid closure at spontaneous blinks may, contrary to assumptions, generally be improved after static eyelid reconstruction surgery, brow lift was suggested to be associated with eyelid closure impairment.
Perineal Reconstruction With the Profunda Artery Perforator Flap
Authors: Arquette Connor , Wan Derrick , Momeni Arash
Published: September 2021

Background

Abdominoperineal resection is used to treat a variety of colorectal pathologies. Traditionally, the vertical rectus abdominis myocutaneous flap has been most commonly used for reconstruction. Here, we explore the role of the profunda artery perforator (PAP) flap for perineal reconstruction.

Methods

A prospectively maintained database was retrospectively analyzed to identify patients who had undergone perineal reconstruction with a pedicled PAP flap. Parameters of interest included age, sex, body mass index, primary diagnosis, comorbidities, and history of radiation, and postoperative complications.

Results

Fifteen patients (5 men and 10 women) with a median age of 52 years (interquartile range, 48.5–61.5 years) were included in the study. Median body mass index was 26.3 kg/m2 (interquartile range, 24.0–29.3 kg/m2). Patients underwent abdominoperineal resection for treatment of rectal cancer (n = 9, 60.0%), recurrent anal squamous cell carcinoma (n = 3, 20.0%), and Crohn’s disease (n = 3, 20.0%). Twelve patients (80.0%) underwent neoadjuvant radiotherapy. Eight patients (53.3%) experienced a total of 10 complications (2 major and 8 minor). The most common complication was donor (n = 3, 20.0%)/recipient (n = 3, 20.0%) site wound dehiscence. Stable soft tissue coverage was achieved in all patients.

Conclusions

The PAP flap provides stable soft tissue coverage of perineal defects with a low donor-site morbidity. This flap should be strongly considered in the reconstructive algorithm when approaching perineal defects.
Decreasing Medicare Utilization, Reimbursement, and Reimbursement-to-Charge Ratio of Reconstructive Plastic Surgery Procedures: 2010 to 2019
Authors: Gong Jung Ho , Bai Ge , Vervoort Dominique , Eltorai Adam E.M. , Giladi Aviram M. , Long Chao
Published: September 2021

Background

This study aimed to evaluate recent trends in utilization, reimbursement, and charges for reconstructive plastic surgery procedures billed to Medicare.

Methods

We queried the Physician/Supplier Procedure Summary from the Centers for Medicare and Medicaid Services for procedures billed by plastic surgeons to Medicare Part B between 2010 and 2019. We collected service counts, charges, and reimbursements. We adjusted utilization by Medicare enrollment and adjusted monetary values for inflation. We calculated the weighted mean charge and reimbursement, which were used to calculate the reimbursement-to-charge ratio (RCR). We examined trends over time by calculating differences and performing correlation analyses of utilization, charges, reimbursement, and RCR for all procedures and for different procedural categories.

Results

From 2010 to 2019, the overall enrollment-adjusted utilization for 912 reconstructive procedures decreased by 6.6% (r
2 = 0.46). Utilization increased in certain procedural categories such as skin debridement (+36.9%, r
2 = 0.48) and procedures of the breast (+114.9%, r
2 = 0.48). Charges increased by 32.9% (r
2 = 0.99), reimbursement decreased by 5.3% (r
2 = 0.84), and RCR decreased by 28.7% (r
2 = 0.99). Skin replacement/flaps/grafts procedures underwent the greatest relative decrease in reimbursement (−26.8%, r
2 = 0.87). Reimbursement-to-charge ratio decreased for all procedural categories except for procedures of the auditory system.

Conclusions

In the past decade, Medicare utilization and reimbursement for reconstructive plastic surgery procedures decreased, whereas charges increased. This resulted in decreasing reimbursement relative to charged amounts. These findings raise concerns regarding the economic viability of providing plastic surgery services to an aging population and may impact patients' ability to access affordable plastic surgical care.
Autologous Fat Grafting in Velopharyngeal Insufficiency Gives Complete and Stable Speech Recovery in Patient Under 7 years.
Authors: Suzzi Chiara , Baylon Helene , Tramini Paul , Captier Guillaume
Published: September 2021

The authorspresent a retrospective observational cohort study of 47 French speaking consecutive patients treated with retropharyngeal wall filling with autologous fat graft from 2006 to 2019 in a single tertiary center, to assess with a long-term follow-up, the best tailored treatment to recovery speech for velopharyngeal insufficiency, and to stress the importance of early treatment with minimally invasive procedure with retropharyngeal wall fat grafting. In preoperative setting, a clinical and instrumental evaluation with aerophonoscope is completed by a palatal closure assessment with nasal endoscopy. All patients were classified according with Borel Maisonny score pre- and post-operatively. Sixty three fat injections were performed. In 4 cases a pharyngeal flap was performed after fat graft for an insufficient speech result. The authors had no complications. Patients with less than 7 years of age obtained a complete recovery of their velopharyngeal incompetence (P = 0.03) compared to older patients. In conclusion, the authors can state that this tailored surgical technique needs a multidisciplinary approach. Many variables can affect postoperative results: fat reabsorption, concurrently performed surgery, pattern of pharyngeal closure, hearing impairment. None of these factors affected our result. Early treatment plays a crucial role to achieve better results. Patients with less of 7 years showed a better result in this functional treatment.
Comprehensive Review of the Submental Flap in Head and Neck and Facial Reconstruction: What Plastic Surgeons Need to Know
Authors: Hamidian Jahromi Alireza , McClure Logan J. , Horen Sydney R. , Konofaos Petros
Published: September 2021

Since its first introduction by Martin and colleagues (1993) and with further revisions by Sterne et al (1996), the submental artery flap (SMAF) has proven to be an effective, reliable, safe, and valuable option in head, neck, and facial reconstructive surgeries. The SMAF utilizes a long pedicle based on the submental artery, a branch of the facial artery, which provides good reach to the lower two-thirds of the face with excellent cosmetic outcomes. It also maintains a good skin color match for facial and cervical defects with a mostly hidden donor site scar (in the majority of cases the donor site can be primarily closed after raising the flap). Although the use of the SMAF is associated with high patient and surgeon satisfaction along with low rates of complications, disadvantages including flap thickness and the hair-bearing nature of the submental skin, which may be problematic for coverage of orofacial defects, especially in male patients. Although it has been almost 30 years since its introduction, and the SMAF has been successfully used in over 500 reported cases of pediatric and adult patients, a comprehensive review of the different aspects of the SMAF is lacking in the medical literature.
A Comprehensive Single-Center Analysis of Postoperative Nausea and Vomiting Following Orthognathic Surgery
Authors: Pourtaheri Navid , Peck Connor J. , Maniskas Seija , Park Kitae E. , Allam Omar , Chandler Ludmila , Smetona John , Yang Jenny , Wilson Alexander , Dinis Jacob , Lopez Joseph , Steinbacher Derek M.
Published: September 2021

Background:

Postoperative nausea and vomiting (PONV) remains a major clinical end-point for directing enhanced recovery after surgery (ERAS) protocols in facial plastic surgery. This study aimed to identify risk factors for PONV and evaluate strategies for PONV reduction in orthognathic surgery patients.

Methods:

A retrospective cohort study was performed among patients receiving orthognathic surgery at our institution from 2011 to 2018. Patient demographics, surgical operative and anesthesia notes, medications, and nausea/vomiting were assessed for each patient. The amount of opioid analgesia given both perioperatively and postoperatively was recorded and converted into morphine equivalents (MEQ). Stepwise regression analysis was used to identify significant risk factors for PONV. Post hoc analyses were employed to compare PONV among patients based on MEQ dosage and antiemetic prophylaxis regimes.

Results:

A total of 492 patients were included; mean age was 23.0 years (range: 13–60); 54.4% were female. The majority of patients received concurrent Le Fort I osteotomy, BSSO, and genioplasty (70.1%). During hospitalization, 59.4% of patients experienced nausea requiring antiemetic medications and 28.4% experienced emesis. Stepwise regression yielded Apfel scores (P = 0.003) and postoperative opioids (P = 0.013) as the strongest predictors of PONV. Post hoc analyses showed that undertreatment with prophylactic antiemetics (based on Apfel) predicted increased PONV (+12.9%, P = 0.020), and that lower postoperative MEQs (<28.0) predicted decreased PONV (−11.8%, P = 0.01).

Conclusions:

The study findings confirm the high incidence of PONV among orthognathic surgical patients and stratify previously reported PONV risk factors. More aggressive utilization of antiemetic medications and decreased dependence on opioid analgesia may decrease nausea/vomiting following orthognathic surgery.
New Bone Formation in the Whole Decellularized Cortical Bone Scaffold Using the Model of Revitalizing a Haversian System
Authors: Kim Chan Woo , Ha Hyun Jeong , Yang Jun Young , Hwang Euna
Published: September 2021

Decellularized allogeneic bone chips act as scaffolds for bone tissue regeneration. Owing to their lack of osteogenic potentials compared to autologous bone graft, decellularized bone scaffolds (DBSs) have applied only to small partial bone defects in clinical settings. Furthermore, only decellularized cancellous bone chips have been limitedly used for the purpose of bone regeneration. The cortical bone has less porosity and less osteogenic materials such as bone morphogenetic proteins in comparison with cancellous bone. In this study, we tried to accelerate new bone formation within the decellularized cortical bone scaffold using a vascular pedicle as an in vivo bioreactor.

Forty DBSs were divided into 4 groups with different conditionings (DBS+ demineralized bone matrix [DBM], DBS+DBM+me+mesenchymal stem cells, DBS+DBM+vascular pedicle, and DBS+DBM+vascular pedicle+mesenchymal stem cells) and implanted into the back of 5 rabbits. Half of the DBSs were examined at 8 weeks and the other half at 16 weeks to determine vascularization level and osteogenesis within each group. New bone formation and bone-forming cells related to osteogenesis were observed via histological staining. Inclusion of the vascular pedicle resulted in larger areas of bone regeneration. With time, osteon structures became more prominent in groups containing the vascular pedicle.

In summary, vascularized DBSs combined with a vascular pedicle have shown promising results for bone regeneration, thereby representing potential therapeutic alternatives for autologous bone grafts or bone tissue free transfer in large or segmental bone defects. In addition, demineralized whole cortical bone matrix along with vascular pedicle and various bone inductive materials, such as DBM and recombinant human bone morphogenetic protein-2, may be an additional new option of an ideal osteoinductive system.