bluuebunny/crossref_metadata_2025 huggingface dataset:
Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis
Authors: Sernandez Haley , Riehl John
Published: March 2019

Objectives:

This meta-analysis was performed to answer the following questions: (1) What is the expected outcome of sternoclavicular (SC) dislocations left untreated? (2) What are the indications for closed reduction of SC dislocations? (3) What are the indications for open reduction of SC dislocations? and (4) Does the evidence support the need for a cardiothoracic surgeon to be available for the open reduction of a SC dislocation?

Data Sources:

Articles were obtained from the database EBSCOhost and supplemented by hand searching of bibliographies of included references. A search using the following terms: SC joint AND (dislocation OR injuries OR vascular injury OR cardiovascular surgeon) of the English-language literature from 1970 to 2018 on the topic of SC joint dislocations was performed.

Study Selection:

Studies were included if they contained clinical data on one or more of our study objectives. Articles were included if they contained participants presenting with an acute (<3 week old) SC joint dislocation who were 16 years of age or above. A total of 92 cases fit this participant criteria.

Data Extraction:

Studies chosen based on the inclusion and exclusion criteria were assessed for level of evidence and were then carefully reviewed for data pertaining to the current study questions. Data from individual articles were recorded in a spreadsheet program and grouped appropriately.

Data Synthesis:

Individual cases of acute SC joint dislocations reported in the literature were noted by the authors. The cases were organized into a spreadsheet, which allowed for the calculation of total patients treated and with what treatment option. Complications that followed treatment were also noted, allowing for a quantitative analysis of patient outcome.

Conclusions:

Based on the current body of literature, closed reduction should be attempted in the acute setting and open treatment performed in cases of failed closed reduction in posterior SC dislocations.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
New approaches in salivary gland carcinoma
Authors: Even Caroline , Baste Neus , Classe Marion
Published: March 2019

Purpose of review

Salivary gland carcinomas (SGCs) are rare tumors of the head and neck with a wide diversity of histologic subtypes characterized by specific morphological, immunohistochemical, and genetic features as well as particular clinical behavior. Chemotherapy is employed almost exclusively with a palliative aim in patients with metastatic and/or recurrent disease and has demonstrated poor activity.

Recent findings

Important advances have been made in the understanding of the molecular pathogenesis of SGCs. Recent studies using next-generation sequencing and genomic and expression profiling methods have identified several genomic alterations of potential clinical significance. We discuss here the recent and most important advances in SGCs biomarkers and their clinical implication. Last years, immune checkpoint inhibitors (ICIs) have changed the landscape of oncology. We report here the few available data in SGCs.

A strategy based on molecular screening and targeted therapy seems to be the best approach for treating patients with SGCs, in the future. More data on ICI's efficacy and biomarkers of response are required to define the place of immunotherapy in the management of SGCs.
Targeting advanced urothelial carcinoma-developing strategies
Authors: Alhalabi Omar , Rafei Hind , Shah Amishi , Siefker-Radtke Arlene , Campbell Matthew , Gao Jianjun
Published: March 2019

Purpose of review

Advanced urothelial carcinoma is a heterogeneous disease with high burden of morbidity, mortality, and cost. Significant progress has been made in understanding the biology of the disease and the development of immunotherapies and targeted therapies. In this review, we summarize the current and future therapeutic approaches in the management of urothelial carcinoma.

Recent findings

Advances in immune checkpoint inhibitors resulted in the Food and Drug Administration (FDA) approvals of atezolizumab in 2016, and pembrolizumab, avelumab, durvalumab, and nivolumab in 2017 for the treatment of advanced urothelial carcinoma. More recently, development of inhibitors targeting the fibroblast growth factor receptor genetic alterations and antibody–drug conjugates targeting specific cell surface antigens (trop2, nectin4, and SLITRK6) resulted in several FDA breakthrough designations for urothelial carcinoma.

Conclusion

The development of novel therapies targeting the immune and molecular pathways of advanced urothelial carcinoma is promising for the improvement of outcomes in this lethal disease. Ongoing efforts are poised to optimize therapeutic options in the post-chemotherapy arena. In the era of precision medicine, the future of urothelial carcinoma lies in using less cytotoxic chemotherapy, more targeted therapy and immunotherapy, and possibly a combination of these therapeutic approaches.
Six Principles for Remaining Positive in a Negative Work Environment
Authors: Johanson Linda S.
Published: March 2019

Nurses employed in a caustic work environment can find their ability to give quality patient care impeded. Situations in which there is incivility, high stress, jealousy, or harassment, exemplify work environments that can be discouraging, especially for Christian nurses who may have pursued the profession in response to a spiritual calling. There are biblical passages that nurses may use to help them cope, including six focus points to guide and encourage nurses in caustic work situations.
No Additional Benefit of Combining Fractional Carbon Dioxide Laser With Narrow-Band Ultraviolet B Phototherapy for Vitiligo: A Randomized Prospective Study With Half-Body Side Comparison
Authors: Eşme Pelin , Gür Aksoy Güneş , Elçin Gonca
Published: March 2019

BACKGROUND

Narrow-band ultraviolet B (nb-UVB) phototherapy constitutes the gold standard treatment for vitiligo. Whether carbon dioxide (CO2) laser might increase the efficacy of nb-UVB is still a topic of debate.

OBJECTIVE

To test the hypothesis that the addition of fractional CO2 laser to nb-UVB may enhance repigmentation.

PATIENTS AND METHODS

Fractional CO2 laser was applied with an interval of 2 weeks for 7 sessions, only to 1 of the 2 symmetrical vitiligo patches located on 2 different half-body sides. Patients received whole-body nb-UVB phototherapy 3 times a week, for at least 4 months. Repigmentation was scored with a quartile grading scale, with the help of a computer program using the photographs taken by the digital dermatoscope.

RESULTS

Fifty-one symmetrical vitiligo patches of 30 patients were included. No statistically significant difference was found between the mean repigmentation scores for the laser and nonlaser sides (p = .11).

CONCLUSION

Results of this study suggest that combining fractional CO2 laser with nb-UVB phototherapy with the regimen used in this study does not increase the repigmentation scores for vitiligo.
Efficacy and Safety of Botulinum Toxin A in Axillary Bromhidrosis and Associated Histological Changes in Sweat Glands: A Prospective Randomized Double-Blind Side-by-Side Comparison Clinical Study
Authors: Wu Chien-Ju , Chang Chun-Kai , Wang Chi-Yu , Liao Yi-Shu , Chen Shyi-Gen
Published: March 2019

BACKGROUND

The efficacy of botulinum toxin A (BTX-A) therapy in axillary hyperhidrosis has been documented; however, there are a few studies reporting the efficacy of BTX-A in treating axillary bromhidrosis. The histological changes occurring in sweat glands after BTX-A treatment are also unknown.

OBJECTIVE

The authors report on the efficacy and safety of BTX-A in the treatment of axillary bromhidrosis and on the histological changes in sweat glands after BTX-A treatment.

MATERIALS AND METHODS

Nineteen patients were included in this study. The patients were administered BTX-A injection in one axilla and sterile normal saline as placebo in the other axilla. The degree of malodor was evaluated subjectively by the patients before and 3 months after treatment. Sweat secretion was quantified by the gravimetric method. All patients underwent standard apocrinectomy in both axillary regions.

RESULTS

The mean degree of malodor and mean sweat production in the BTX-A–treated axilla were significantly lower than those in the control axilla (2.42 vs 8.00; p < .0001 and 13.33 vs 33.75 mg/min; p = .0028, respectively) at 3 months after therapy. The histological studies showed apocrine sweat glands with atrophic changes and hypoplasia in treated axilla.

CONCLUSION

BTX-A injection is an easy, fast, noninvasive method of treating axillary bromhidrosis.
A Simple Method to Screen for Radiostrontium in Water by Ion Exchange Chromatography
Authors: Nguyen Dao M. , Moody W. Allen , Williamson John A.
Published: March 2019

Radiostrontium isotopes (85Sr, 89Sr, and 90Sr) are major fission by-products in nuclear reactors, in radiological events, and in environmental radioactive contamination. A method to analyze 89Sr and 90Sr in water has been developed using gradient elution with dilute hydrochloric acid and cation exchange resin, followed by carbonate precipitation. Counting was done on a gas proportional counter. The sample was recounted a second time after 2 to 3 wk to permit 90Y, a progeny of 90Sr, to achieve secular equilibrium and to allow 89Sr and 90Sr to be determined. This method was found to be simple, exhibiting high recovery, reduced use of hazardous chemicals, and lower cost compared to other current methods. An extensive comparison of the performance of the cation exchange method vs. a method using strong nitric acid (US Environmental Protection Agency Method 905.0) and a method using a specific strontium resin was conducted on performance test samples containing 90Sr (in a number of matrices) from the US Department of Energy’s Mixed Analyte Performance Evaluation Program and mixed 89Sr- and 90Sr-containing water samples from the Environmental Resource Associates quality assurance program. The method described here is shown to yield comparable results to others.
Risk Communication Strategies for Possible Health Risks From Radio-Frequency Electromagnetic Fields (RF-EMF) Emission by Telecommunication Structures
Authors: Fernandez Prasana Rosaline , Ng Kwan-Hoong , Kaur Surinderpal
Published: March 2019

There is widespread anxiety and speculation about RF-EMF emissions by telecommunication base stations and structures, as it is perceived by some to be unsafe and a threat to public health. Scientists, medical experts, politicians, journalists, and mobile telecommunication company specialists are involved in an active debate on whether people are immune to RF or if we are gambling with our future. Interviews with 31 individuals from 7 stakeholder groups in Malaysia reveal that the residents’ main concerns are that the telecommunication companies do not follow guidelines and as a result the telecommunication structures are constructed close to their homes, which they perceive as a threat to public health. Some residents also do not want these structures because of cultural reasons, while some are jealous over rental income received by the landlords. Meanwhile, the authorities entrusted with safe-guarding public health are involved in a blame game as there is no agency that is clearly in charge. The interviews also highlight that the current risk communication initiatives are more reactive rather than proactive, and that the authorities do not speak in one voice. Based on the outcome of the interviews, eleven recommendations are formulated to improve risk communication initiatives in Malaysia. The recommendations stress on repairing, building, and strengthening trust, because trust in agencies, along with credibility, determines risk communication initiatives’ effectiveness. These strategies can also be effectively replicated across regions to deal with contestations over RF-EMF emissions and the impact on health.
Dimensions and Morphologic Variability of the Retro-Orbicularis Oculi and Frontalis Muscle Fat Pad
Authors: Blandford Alexander D. , Bachour Salam P. , Chen Rachel , Xu Lucy T. , Hwang Catherine J. , Perry Julian D.
Published: March 2019

Purpose:

To quantify the complete dimensions of the retro-orbicularis oculi fat (ROOF) pad and to determine its relationship to other fat compartments of the forehead.

Methods:

The entire forehead of 14 hemifaces of seven fresh frozen human cadavers (four female, three male) was dissected in the subcutaneous and submuscular planes. For each plane, a ruler was placed at the facial midline, and images of the dissection plane were taken at 90° and 45°. Images were analyzed for vertical height, horizontal length, the distance to midline from the point of maximal height, and area for each hemiface of the ROOF and for the entire fat compartment contiguous with the ROOF. A two-tailed t test was conducted between ROOF and ROOF plus the extended fat plane across all measurements. A Wilcoxon nonparametric signed rank test was performed to determine equivalent fat distribution of the extended fat plane over each cadaver’s respective eye.

Results:

The deep fat originating from the ROOF consistently extended laterally and superiorly in each specimen, distinctly separated via septae from the deep central, deep lateral, and the deep temporal fat compartments. The color, composition, and distribution of this contiguous deep fat did not differ phenotypically from the traditional ROOF. The extended deep fat plane possessed an average vertical height of 3.09 ± 0.68 cm, average distance to midline from point of maximal height of 3.56 ± 0.53 cm, an average horizontal length of 5.37 ± 0.82 cm, and an average area of 13.40 ± 2.69 cm2. The extended deep fat demonstrated a statistically significant increase in maximal height, length, and total area compared with the ROOF. A Wilcoxon nonparametric signed rank test was nonsignificant (α = 0.01) across all measurements, demonstrating that the extended fat plane was similarly distributed over each eye.

Conclusions:

A layer of deep fat originating from the traditionally defined ROOF extends superiorly and laterally beneath the frontalis muscle, separate from the deep lateral, deep central, and deep temporal fat pads. This is the first study to clearly demonstrate a contiguous superficial musculoaponeurotic system layer of fat extending under both the orbicularis oculi and frontalis muscles. This plane of fat is more appropriately described as the retro-orbicularis oculi and frontalis fat.
Orbital Septum Fibrosis in Congenital Ptosis Correlates With Eyelid Function: A Clinicopathologic Study
Authors: Heisel Curtis J. , Heider Amer , Stewart Krista J. , Andrews Christopher A. , Kahana Alon
Published: March 2019

Purpose:

Congenital ptosis can threaten visual function and is usually treated with surgical correction. This study tests the hypothesis that congenital ptosis involves not only the levator muscle but also the orbital septum, which may tether the eyelid in the primary position.

Methods:

A retrospective chart review was performed on 30 patients (41 eyelids) with congenital ptosis who underwent surgical correction that included partial septum excision. Histologic analysis was performed by a masked pediatric pathologist, with grading of septal tissue disorganization and fibrosis based on standard histologic criteria. An independent comparison of histologic grading with clinical ptosis measures was then performed.

Results:

Fifteen eyelids demonstrated significant septal fibrosis, 19 were mild, and 7 were not fibrotic. Thirty-six eyelids demonstrated histologic disorganization. Mildly fibrotic eyelids were found to have reduced preoperative levator function than those that were not fibrotic (2.84 ± 1.92 vs. 9.57 ± 4.76 mm; p < 0.0001). Samples that demonstrated significant fibrosis were also found to have reduced preoperative levator function (4.67 ± 2.12 vs. 9.57 ± 4.76 mm; p = 0.0007). Histologically disorganized samples were also found to have a lower preoperative levator function (9.50 ± 6.04 vs. 3.99 ± 2.49; p = 0.0052).

Conclusions:

Orbital septae in patients with congenital ptosis demonstrate histologic disorganization and fibrosis. When decreased levator function is observed clinically, septal fibrosis and/or disorganization is likely present. These observations suggest that debulking the fibrotic septum during congenital ptosis surgery may improve outcomes by releasing the eyelid from its congenitally tethered position, improving eyelid elasticity.
Clinical and Ultrasonographic Evaluation of Infantile Periocular Hemangioma Treated With Oral Propranolol
Authors: Jamshidian-Tehrani Mansooreh , Nabavi Amin , Taghavi Mostafa , Sharif-Kashani Shervin , Kasaee Abolfazl , Sadeghi-Tari Ali , Mirhosseini Mohammad , Nowroozzadeh M. Hossein
Published: March 2019

Purpose:

To evaluate the clinical and ultrasonographic response of periocular infantile capillary hemangioma during treatment with oral propranolol.

Methods:

Patients with infantile periocular hemangioma and visual or cosmetic concerns were enrolled in this prospective interventional case series. Propranolol was given at a dose of 2 mg/kg per day for at least 6 months. Evaluation of treatment response was performed at month 3 (time point 1) and month 6 (time point 2). Gray scale ultrasonography and color Doppler imaging were performed at baseline and month 3.

Results:

Thirty-one patients with mean age of 4.1 ± 2.3 months were eligible for analysis. Complete or near complete clinical resolution was observed in 4 patients (12.9%) at time point 1 and 21 patients (67.7%) at time point 2. Longitudinal diameter, transverse diameter, thickness, arterial peak systolic velocity, and end diastolic velocity reduced significantly from baseline to 3-month follow up. Complete clinical response at time point 2 was significantly higher in patients with peak systolic velocity reduction >50% from baseline to month 3 than patients with peak systolic velocity reduction of 10% to 50% and <10%.

Conclusions:

Propranolol is safe and effective for infantile periocular hemangioma. Ultrasonography and color Doppler imaging are useful modalities to monitor and predict the treatment response.
Intraorbital Arteriovenous Fistula From the Superficial Temporal Artery
Authors: Zhou Elaine J. , Sweeney Adam R. , Chen Stephen R. , Yen Michael T.
Published: March 2019

Intraorbital arteriovenous fistula is a rare vascular disease characterized by an acquired arteriovenous communication without direct cavernous sinus involvement. Intraorbital arteriovenous fistula may develop slowly and present similarly to other insidious orbitopathies, such as carotid-cavernous fistula. The authors present a case of a superficial temporal artery to superior ophthalmic vein fistula arising in the absence of trauma or prior surgery. This is the first report of a spontaneous intraorbital arteriovenous fistula arising between these vessels and further describes the rare occurrence of intraorbital arteriovenous fistula.
Bilateral Silent Sinus (Imploding Antrum) Syndrome
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: March 2019

Silent sinus syndrome, also termed imploding antrum syndrome, describes spontaneous enophthalmos arising from contracture of the maxillary sinus in the complete absence of any symptomatic sinonasal disease. The unusual nasal structure that probably causes the condition renders its occurrence almost exclusively unilateral. The authors describe a patient with left silent sinus syndrome, who presented 4 years later with right silent sinus syndrome; to the authors’ knowledge, this is only the second case of bilateral sequential silent sinus syndrome. Each side was successfully managed with endoscopic antrostomy and secondary orbital floor repair.
Demographics, Psychological Distress, and Pain From Pressure Injury
Authors: Kim Junglyun , Lyon Debra , Weaver Michael T. , Keenan Gail , Stechmiller Joyce
Published: March 2019

Background

There is a knowledge gap regarding factors that influence the intensity of pain associated with pressure injuries.

Objectives

We examined the influence of age, gender, race, and comorbidity on the relationships between pressure injuries, psychological distress, and pain intensity in hospitalized adults.

Methods

This study was a cross-sectional, retrospective secondary analysis using data from a regional acute hospital’s electronic health records from 2013 to 2016. A sample of 454 cases met the inclusion criteria and were analyzed using path analysis.

Results

The hypothesized model (Model A) and two alternative models (Models B and C) were tested and demonstrated adequate model fit. All tested models demonstrated statistically significant independent direct effects of age on the severity of pressure injury (p < .001) and pain intensity (p = .001), as well as independent direct effects of gender (p ≤ .005), race (p < .001), and comorbidity (p = .001) on psychological distress.

Discussion

Pain management for individuals with pressure injuries should include not only the treatment of wounds but also the individual characteristics of the patient such as demographics, comorbidity, and psychological status that may affect pain. Given the limitations of secondary analyses, further studies are suggested to validate these findings.
Impact of Adoption of Smart Pump System With Continuous Capnography Monitoring on Opioid-Related Adverse Event Rates: Experience From a Tertiary Care Hospital
Authors: Steele Terry , Eidem Leslie , Bond Jack
Published: March 2019

Objectives

The use of opioid analgesics for pain management in hospitalized patients is associated with a high risk of adverse events, including respiratory depression which may lead to respiratory arrest and death. Patients who experience opioid-related adverse drug reactions (ADRs) have been shown to experience longer and more costly hospital stays and have a higher risk of requiring a readmission after discharge. In this study, we report on the impact of the introduction of Wesley Medical Center's Safe Medication Practice Protocol on opioid-related ADRs.

Methods

A retrospective, pre-post cohort study using electronic health records combined with manual chart review was undertaken at the Wesley Medical Center, a 760-bed tertiary care facility. The Safe Medication Practice Protocol incorporating a smart infusion pump system with capnography monitoring was implemented in May 2010 hospital-wide. The number and severity of ADRs and the duration of opioid treatment were compared between the pre (2007-April 2010) and post (May 2010–2014) periods.

Results

A total of 139,734 (pre-period) versus 267,573 (post-period) patients received opioid treatment during the hospital stay. Compared with the pre-period, the post-period resulted in a 79.2% reduction in the number of severe adverse reactions (3.08 vs 0.64 per 10,000 patients treated with opioid, P < 0.0001) as well as a shorter duration of opioid treatment (average 2.05 vs 1.37 days, P < 0.0001).

Conclusions

Implementing education, revisions to patient-controlled analgesia policies and procedures, and capnography monitoring with patient-controlled analgesia pause is associated with significantly lower rates of severe ADRs and shorter opioid treatment duration.
Factors Associated With Sex-Related Pre-exposure Prophylaxis Adherence Among Men Who Have Sex With Men in New York City in HPTN 067
Authors: Mannheimer Sharon , Hirsch-Moverman Yael , Franks Julie , Loquere Avelino , Hughes James P. , Li Maoji , Amico K. Rivet , Grant Robert M.
Published: March 2019

Background:

HPTN 067 assessed the feasibility of daily and non-daily dosing of open-label emtricitabine/tenofovir disoproxil fumarate (FTC/TDF)-based pre-exposure prophylaxis (PrEP).

Methods:

Factors associated with sex-related PrEP adherence were assessed among men who have sex with men (MSM) randomized to one of 3 PrEP dosing arms in HPTN 067 in New York City. Sex-related PrEP adherence was defined per protocol as at least 1 PrEP tablet taken within 4 days pre-sex and at least 1 additional PrEP tablet taken within 24 hours post-sex, assessed via electronic drug monitoring and weekly interviews. Demographic data and behavioral measures were evaluated for association with sex-related PrEP adherence. Logistic regression for clustered data was used to estimate the unadjusted and adjusted odds ratios.

Results:

Of 176 randomized MSM participants, 59% were Black, 10% White, 25% Hispanic, and 6% other; median age was 31 years. In the multivariable analyses, higher sex-related PrEP adherence was significantly associated with daily dosing arm, older age, employment, and higher PrEP adherence behavioral skills. Lower sex-related PrEP adherence was significantly associated with identifying as Black or Hispanic (compared with White), opiate use, and reporting “I forgot” as an adherence barrier.

Conclusions:

This analysis identified populations of MSM who might benefit from additional support to optimize PrEP adherence, including those who are younger, unemployed, or opiate users. MSM with lower PrEP behavioral skills may benefit from targeted interventions. Further study is needed to assess racial and ethnic disparities in PrEP adherence, which may reflect broader social and economic inequalities not captured in this study.
Do Cleft Lip and Palate Types Affect Health-Related Quality of Life of Adolescents?
Authors: Crepaldi Thainara Alves , Vitor Luciana Lourenço Ribeiro , Carrara Cleide Felicio Carvalho , Rios Daniela , Cruvinel Thiago , Almeida Ana Lúcia Pompéia Fraga , Soares Simone , Machado Maria Aparecida Andrade Moreira , Oliveira Thais Marchini
Published: March 2019

The adolescent with oral cleft must deal with the process of body changing and the psychological implications caused by morphological, functional, and esthetic impairments of the cleft itself. This study aimed to evaluate whether the cleft lip and palate types affects health-related quality of life of adolescents through Short-form Health Survey (SF-36) questionnaire. Fifty-seven adolescents (29 males and 28 females; mean age 15 years and 11 months ± 1 year and 2 months) were divided into 2 groups: Group 1—single cleft—unilateral or bilateral CL or CP; Group 2—complex cleft—unilateral or bilateral cleft lip and palate. The participants filled in SF-36 questionnaire to verify their functional, physical, and mental well-being profile. Spearman test assessed SF-36 scores correlation with age. Mann–Whitney U test verified the differences between genders and cleft types. Linear regression models were used to analyze confounding factors (age and gender). P was set at <0.05. The different SF-36 domains weakly correlated with age, ranging from −0.07 (P = 0.60) for the social aspects and 0.31 (P = 0.02) for general health. Females had statistically lower SF-36 scores than males in the domains Bodily pain (P = 0.02), Vitality (P < 0.001), and Mental Health (P < 0.001). G1 showed lower scores in the domains Limitations due to Emotional Problems (P = 0.008) and Mental Health (P = 0.036). However, when the confounding factors (age and gender) were analyzed, the oral cleft type did not affect health-related quality of life (P > 0.05). Considering the age and gender, the cleft lip and palate types did not affect the health-related quality of life of adolescents.
Arteriovenous Fistula Occurring After Alveolar Arch Repair With Free Medial Femoral Condyle Flap
Authors: Akdag Osman , Guray Evin Seyda , Sutcu Mustafa
Published: March 2019

The occurrence of an arteriovenous fistula (AVF) after microvascular tissue transfer is extremely rare. This paper presents the development of an AVF in a patient who underwent a free-flap procedure for alveolar arch reconstruction and discusses the mechanisms of AVF formation and its current treatments.
Autologous Free Fat Graft for Repair of Concave Deformity After Total Parotidectomy
Authors: Wang Kuan-Yu , Yang Zhi , Wang Wen-Long , Xu Hui , Liu Fa-Yu
Published: March 2019

Objective:

Resectioning of giant maxillofacial tumors has been shown to cause facial depression deformity, representing a persistent challenge for surgeons. Here, the authors review their experience using autologous free fat grafts to repair total parotidectomy defects. This review aims to encourage the surgical field to pay more attention to this century-old treatment technique.

Methods:

Patients were included who underwent free fat transfer for tissue reconstruction after total parotidectomy at the Affiliated Stomatology Hospital of China Medical University between 2012 and 2018. Patients with bleeding disease or postoperative follow-up less than 6 months were excluded.

Results:

Twenty-three patients between the ages of 35 and 68 were included in this analysis. Ten patients (6 males, 4 females) underwent fat grafting at the time of total parotidectomy, and a control group of 13 patients (9 males, 4 females) underwent total parotidectomy without correction of concave deformities. There were significant differences between fat graft group and control group in terms of age (44.9 ± 9.0117 years versus 56.385 ± 8.9586 years; P = 0.006), Frey syndrome questionnaire score (1 ± 0 versus 2.385 ± 1.0439; P = 0.00), blood loss (195.7 ± 54.8777 mL versus 107.769 ± 22.8916 mL; P = 0.001), postoperative drainage (319.8 ± 103.1803 mL versus 230.385 ± 53.5701 mL; P = 0.027), duration of postoperative drainage (122.4 ± 23.8663 hours versus 90.462 ± 22.2434 hours; P = 0.003), and satisfaction questionnaire score (8.5 ± 0.8498 versus 3 ± 1.1547; P = 0.00). The difference in operation time between the fat graft group and control group was not significant (417 ± 108.0062 min versus 351.538 ± 91.7475 min; P = 0.131).

Conclusion:

Autologous free fat grafting resulted in more blood loss as well as an increased volume and duration of postoperative drainage. Remarkably, however, patients had superior satisfaction, lower Frey syndrome scores, and similar operation times with use of free fat grafting after parotidectomy. The authors recommend such grafting be utilized to repair concave deformities secondary to total parotidectomy.
Facial Injuries in Handball: A Survey of Handball Coaches
Authors: Hwang Kun , Kim Hun
Published: March 2019

The aim of this study was to investigate the occurrence of facial trauma in handball players in South Korea.

Forty-one handball coaches responded to an 11-item standardized questionnaire. Twenty-three coaches (56.1%) stated that their players had experienced a facial injury and reported 56 patients.

The nose was the most common site of the injuries (51.7%), followed by the eye (19.6%) and cheek (12.5%). The most common causes of nose injuries were being hit by a hand (26.8%), elbow (12.5%), and ball (8.9%). Most of the nose injuries were fractures (41.1%). The most common causes of the injuries were being hit by a hand (37.5%), elbow (30.3%), and ball (16.1%). The most common type of facial injury was fracture (41.1%), followed by contusion (26.8%), and laceration (21.4%). The most common position of the player was pivot (25.0%), followed by center back (21.4%), and right back (19.6%). Among the facial injuries experienced by pivots, the nose (12.5%) was the most common site, followed by the eye (8.9%). The most common causes of the injuries in pivots were being hit by a hand (12.5%) and an elbow (12.5%). The mean convalescence period after the facial injuries was 3.2 ± 1.6 weeks. No respondents stated that their players wore a mouthguard.

Team doctors should be aware of the high frequency of nasal bone fractures and prepare for them. A suture set should be prepared for lacerations. If a player is hit in the eye by a ball, the possibility of retinal injury should be considered.
Bone Marrow Aspirate in Cystic Maxillofacial Bony Defects
Authors: U Vignesh , Mehrotra Divya , Howlader Debraj , Kumar Sumit , Anand Vaibhav
Published: March 2019

Autogenous or alloplastic bone grafts are routinely applied for reconstruction of cystic bone defects. Addition of mesenchymal bone marrow stem cell in osteoconductive alloplastic bone makes it osteoinductive and osteogenic. The purpose of this study was to evaluate the role of bone marrow aspirate in regenerating new bone with hydroxyapatite collagen scaffold in patients with large cystic maxillofacial defects. This prospective randomized study had random allocation of 15 patients with large cystic maxillofacial bony defects in each of the 2 groups. Group I patients received hydroxyapatite granules and bone marrow aspirate in collagen sponge and group II received hydroxyapatite granules only. Clinical and radiologic assessment showed the time taken in bone healing. In group I, the bone defect volume reduction was statistically significant at 3 and 6 months, the postoperative pain and swelling was less, and there was no tooth mobility at 3 months. The authors concluded that use of hydroxyapatite granules with bone marrow aspirate in collagen sponge in maxillofacial bone defects provided early bone regeneration, and faster wound healing. However, to arrive at a definitive conclusion a long-term study with a larger sample size is required.
Endoscopic Transcaruncular Medial Orbitotomy as an Alternative Approach to Anterior Ethmoidal Artery Coagulation
Authors: Matoušek Petr , Čábalová Lenka , Masárová Michaela , Komínek Pavel
Published: March 2019

Background:

The authors present a series of 5 patients with anterior epistaxis in which a transcaruncular endoscopic approach was used for the anterior ethmoidal artery coagulation (AEA).

Methods:

Six AEA coagulations (5 unilateral, 1 bilateral) using the transcaruncular endoscopic approach were performed in 5 patients with anterior epistaxis resistant to conservative measures. An incision was made between the plica semilunaris of conjunctiva and the lacrimal caruncle. Using a rigid endoscope, tissues were dissected lateral to the lacrimal sac, to the posterior lacrimal crest. The periorbit was incised and pulled aside. Hereafter, the technique was the same as that involving a frontoethmoidal incision. After bipolar coagulation of the AEA, the conjunctiva was sutured.

Results:

Bleeding was resolved in all patients. One patient experienced early postoperative temporary diplopia.

Conclusions:

The transcaruncular endoscopic approach is a promising technique with no outer scarring. It is convenient in patients with difficult orientation in the nasal cavity, relatively safe, and faster than the transnasal endoscopic approach
Impact of Regional Organ Sharing and Allocation in the UK Northern Liver Alliance on Waiting Time to Liver Transplantation and Waitlist Survival
Authors: Malik Abdullah K. , Masson Steven , Allen Elisa , Akyol Murat , Bathgate Andrew , Davies Mervyn , Hidalgo Ernest , Hudson Mark , Powell James , Taylor Rhiannon , Zarankaite Agne , Manas Derek M.
Published: March 2019

Background.

In the United Kingdom, liver transplantation (LT) is undertaken in 7 supraregional centers. Until March 2018, liver grafts were offered to a center and allocated to a patient on their elective waiting list (WL) based on unit prioritization. Patients in Newcastle, Leeds, and Edinburgh with a United Kingdom Model for End-Stage Liver Disease (UKELD) score ≥62 were registered on a common WL and prioritized for deceased-donor liver allocation. This was known as the Northern Liver Alliance (NLA) “top-band scheme.” Organs were shared between the 3 centers, with a “payback” scheme ensuring no patient in any center was disadvantaged. We investigated whether the NLA had improved WL survival and waiting time (WT) to transplantation.

Methods.

Data for this study were obtained from the UK Transplant Registry maintained by National Health Service Blood and Transplant. This study was based on adult patients registered for first elective liver transplant between April 2013 and December 2016. Non-NLA centers were controls. The Kaplan-Meier method was used to estimate WL survival and median WT to transplant, with the log-rank test used to make comparisons; a Bonferroni correction was applied post hoc to determine pairwise differences.

Results.

WT was significantly lower at NLA centers compared with non-NLA centers for top-band patients (23 versus 99 days, P < 0.001). However, WL survival was not significantly different for top-band patients (P > 0.999) comparing NLA with non-NLA centers. WL survival for nontop-band patients was no different (P > 0.999) comparing NLA with non-NLA centers.

Conclusions.

The NLA achieved its aim, providing earlier transplantation to patients with the greatest need. Nontop-band patients did not experience inferior survival.
The influence of lifestyle and gender on cluster headache
Authors: Lund Nunu L.T. , Snoer Agneta H. , Jensen Rigmor H.
Published: March 2019

Purpose of review

Cluster headache is by many regarded as a males’ disorder that is often accompanied by an unhealthy lifestyle. We aimed to study the influence of sex and lifestyle factors on clinical presentation, the diagnostic process and management.

Recent findings

Overall, the clinical presentation of cluster headache in both sexes was similar; however, chronic cluster headache may occur more frequently in women than in men. Misdiagnosis was most prevalent in women and more women than men were not correctly diagnosed until seen in a highly specialized center. In relation to lifestyle, smoking prevalence remains very high and some studies suggest that obesity and use of illegal drugs may be pronounced as well. In contrast to previous beliefs, recent findings on alcohol consumption report a lower use in patients than in controls. Overall, men and to some extent chronic patients were more prone to some unhealthy lifestyle factors than women and episodic patients.

Despite an overall similar clinical presentation in men and women, the diagnostic process was more problematic for women in the form of more frequent misdiagnosis and failure to diagnose women in the primary and secondary sectors. Unhealthy lifestyle factors are prevalent in cluster headache and may ultimately have consequences for the management of the disease.
Gabapentin-Associated Urinary Incontinence: A Case Verified by Rechallenge
Authors: Rissardo Jamir Pitton , Caprara Ana Letícia Fornari
Published: March 2019

Introduction

Gabapentin (GBP) is an analog of γ-aminobutyric acid and was originally designed as an anticonvulsant. Because its mechanism of action is unclear, assumed to have no abuse potential, and apparent lack of toxicity, GBP is used widely off-label to treat an array of disorders, including essential tremor.

Case Report

We present a case of an elderly woman diagnosed with essential tremor, in which GBP was initiated. In the following day, she complained of urinary incontinence with the absence of dysuria and urgency. It was not worse with movement, coughing, sneezing, or laughing. The vaginal parity of the patient was one. Laboratory tests and urinalysis were within normal limits. Assuming that the urinary symptom was an adverse drug reaction, the GBP was withdrawn and the patient's incontinence completely resolved within 2 days. Several weeks later, a rechallenge with GBP was tried. In the day 1 of GBP use, the subject reported intermittent urinary incontinence. Medication was discontinued and her continence returned. One year later, in the follow-up, the subject remained continent.

Conclusions

Only a few cases with GBP-associated urinary incontinence have been reported in the literature. To the authors' knowledge, these cases described individuals with only 1 attempt of the use of GBP. In this way, the present case was the first to describe a subject with the recurrence of urinary incontinence with the GBP rechallenge. This adverse effect, although not potentially fatal, can be very embarrassing to patients and lead to poor compliance with therapy.
Type 1 diabetes mellitus and coronary revascularization
Authors: Mamet Helene , Petrie Mark C. , Rocchiccioli Paul
Published: March 2019

Over the last three decades, trials of coronary revascularization have taken into account whether populations did or did not have diabetes. What has not been considered is whether or not patients with diabetes in these studies have type 1 or type 2 diabetes. ‘Diabetes’ appears to be largely used as a synonym for type 2 diabetes. The number of patients with type 1 diabetes has not been reported in most trials. Many questions remain unanswered. Do patients with type 1 diabetes have the same response to various modes of revascularization as those with type 2 diabetes? We know type 2 diabetes affects coronary endothelial function and the coronary artery wall but to what extent does type 1 diabetes affect these? Any response to revascularization does not just depend on the coronary artery but also on the myocardium. How does type 1 diabetes affect the myocardium? To what extent do patients with type 1 diabetes have viable or ischaemic myocardium or scar? What does ‘diabetic cardiomyopathy’ refer to in the context of type 1 diabetes? This manuscript reviews the evidence for revascularization in type 1 diabetes. We conclude that there has been a near absence of investigation of the pros and cons of revascularization in this population. Investigations to establish both the nature and extent of coronary and myocardial disease in these populations are necessary. Clinical trials of the pros and cons of revascularization in type 1 diabetes are necessary; many will declare that these will be too challenging to perform.
The early detection of atherosclerosis in type 1 diabetes: why, how and what to do about it
Authors: Jenkins Alicia , Januszewski Andrzej , O’Neal David
Published: March 2019

The major cause of morbidity and often premature mortality in people with type I diabetes (T1D) is cardiovascular disease owing to accelerated atherosclerosis. We review publications relating to the rationale behind, and clinical tests for, detecting and treating early atherosclerosis in people with T1D. Currently available tools for atherosclerosis assessment include risk equations using vascular risk factors, arterial intima–media thickness, the ankle–brachial index, coronary artery calcification and angiography, and for more advanced lesions, intravascular ultrasound and optical coherence tomography. Evolving research tools include risk equations incorporating novel clinical, biochemical and molecular tests; vascular MRI and molecular imaging. As yet there is little information available to quantify early atherosclerosis. With better means to control the vascular risk factors, such as hypertension, dyslipidaemia and glycaemic control, and emerging therapies to control novel risk factors, further epidemiologic and clinical trials are merited to facilitate the translation into clinical practice of robust means to detect, monitor and treat early atherosclerosis in those with T1D.
Within-population variability in a moth sex pheromone blend, part 2: selection towards fixation
Authors: Groot Astrid T. , van Wijk Michiel , Villacis-Perez Ernesto , Kuperus Peter , Schöfl Gerhard , van Veldhuizen Dennis , Heckel David G.
Published: March 2019

To understand how variation in sexual communication systems evolves, the genetic architecture underlying sexual signals and responses needs to be identified. Especially in animals where mating signals are important for mate recognition, and signals and responses are governed by independently assorting genes, it is difficult to envision how signals and preferences can (co)evolve. Moths are a prime example of such animals. In the noctuid moth
Heliothis virescens
, we found within-population variation in the female pheromone. In previous selection experiments followed by quantitative trait locus (QTL) analysis and expression analysis of candidate desaturase genes, we developed a model involving a
trans
-acting repressor of the delta-11-desaturase. In our current study with new selection lines, we fixed the most extreme phenotype and found a single underlying mutation: a premature stop codon in the first coding exon of delta-11-desaturase, which we could trace back to its origin in the laboratory. Interestingly, we found no pleiotropic effects of this knock-out mutation on the male physiological or behavioural response, or on growth or fertility. This finding is in contrast to
Drosophila melanogaster
, where a single desaturase gene affects both female pheromone production and male behavioural response, but similar to other Lepidoptera where these traits are under independent genetic control. To our knowledge, this is the first time that a single point mutation has been identified that underlies the phenotypic variation in the pheromone signal of a moth.
Analysis of tangential contact boundary value problems using potential functions
Authors: Taylor Adam G. , Chung Jae H.
Published: March 2019

This paper presents an analysis technique of high-order contact potential problems and its application to an elastic settlement analysis of a shallow foundation system subjected to a combined traction boundary condition. Closed-form solutions of potential functions are derived for an elastic half-space subjected to bilinear tangential traction boundary conditions over rectangular surface regions. Using the principle of superposition, the present solutions provide a means to form an approximate and continuous solution of elastic contact problems with higher-order tangential boundary conditions. As an application example, an elastic settlement analysis of a rigid footing founded on a dense granular soil is performed under a tangential traction boundary condition prescribed in an analogy with the stress equilibrium states of static sandpiles. A generalized solution approach to combined normal and tangential traction boundary value problems is discussed in the context of foundation engineering.
Inter-ecosystem variation in the food-collection behaviour in climbing perch Anabas testudineus, a freshwater fish
Authors: Binoy V. V. , Rakesh V. B. , Sinha Anindya
Published: March 2019

A unique piscine behaviour—collection and temporary storage of food materials inside the mouth during times of availability and particularly in response to starvation—has been reported in a single species, the climbing perch Anabas testudineus. In this study, we documented a significant variation in the amount of food collected by populations of climbing perch inhabiting different ecological regimes, kole paddy fields, canals and water channels in coconut plantations, after experiencing starvation for two different periods of 24 and 48 h. Our results revealed a significant flexibility in this unique behaviour, depending on the ecological conditions and hunger experienced by the individuals.
Uncovering mechanisms of global ocean change effects on the Dungeness crab (Cancer magister) through metabolomics analysis
Authors: Trigg Shelly A. , McElhany Paul , Maher Michael , Perez Danielle , Busch D. Shallin , Nichols Krista M.
Published: March 2019

The Dungeness crab is an economically and ecologically important species distributed along the North American Pacific coast. To predict how Dungeness crab may physiologically respond to future global ocean change on a molecular level, we performed untargeted metabolomic approaches on individual Dungeness crab juveniles reared in treatments that mimicked current and projected future pH and dissolved oxygen conditions. We found 94 metabolites and 127 lipids responded in a condition-specific manner, with a greater number of known compounds more strongly responding to low oxygen than low pH exposure. Pathway analysis of these compounds revealed that juveniles may respond to low oxygen through evolutionarily conserved processes including downregulating glutathione biosynthesis and upregulating glycogen storage, and may respond to low pH by increasing ATP production. Most interestingly, we found that the response of juveniles to combined low pH and low oxygen exposure was most similar to the low oxygen exposure response, indicating low oxygen may drive the physiology of juvenile crabs more than pH. Our study elucidates metabolic dynamics that expand our overall understanding of how the species might respond to future ocean conditions and provides a comprehensive dataset that could be used in future ocean acidification response studies.