bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Inverted Conchal Bowl Deformity: Proposed Technique
Authors: Dickey Ryan M. , Geisler Emily L. , Derderian Christopher A.
Published: August 2020

Congenital inverted conchal bowl is a rare deformity with unknown etiology. Its occurrence poses both functional and aesthetic difficulties for patients. We report 2 cases of congenital inverted conchal bowl deformity in an 8-year-old male and 17-year-old female. Both patients were first evaluated in a delayed fashion with concern for difficulty hearing, poor hygiene, and aesthetic concerns. Patient presentation, surgical management, and 6-month follow-up results are presented. Both patients had improved functional and aesthetic outcome after surgical correction.
Experience in Neurosurgery During the Prevalence of COVID-19
Authors: Sheng Liuqing , Chen Yingchun , Li Huanhuan , Wang Zhizhong , Bie Bizhou , You Huichao , Ye Jianfeng , Feng Juanjuan , Zhang Chun , Li Jun
Published: August 2020

In order to summarize the experience of neurosurgery in The Third People's Hospital of Hubei Province after the outbreak of COVID-19 in 2019, 28 patients were admitted from January 5, 2020 to February 17, 2020. A series of department formulates and constant improvements were made, including elective operation cancellation, altered conventional outpatient service into online outpatient service, strict control of inter department consultation prevention and entering the department, improvements in operation and treatment processes, and strict ward management. As a result, 1 patient with hypertensive cerebral hemorrhage and deep vein thrombosis of the right lower extremity died suddenly due to pulmonary embolism during anticoagulation treatment. Two patients with deep coma gave up treatment and died. No patient was confirmed to be infected with COVID-19 in hospital. One doctor had a low fever and cough in January, and CT showed a small nodule in the lower left lung. After 2 weeks isolation and oral anti-infective drugs, the chest nodule disappeared. One nurse was isolated as a close contact with infected parents. One nurse was confirmed to be infected with COVID-19 in a mild symptom. She was discharged after being cured in the infected department. In conclusion, measures like sufficient theoretical training and protection upgrading for medical staff, continuous improvement on the understanding of COVID-19 characteristics and transmission routes, formulation of strict department management system, monitoring of patients and their families, could effectively deal with the epidemic situation in the neurosurgery department.
The Role of Three-Dimensional Printing Technology as an Additional Tool in Unilateral Condylar Hyperplasia Surgical Planning
Authors: Cascone Piero , D’Alessandro Francesco , Gallo Emanuela , Cicero Giuseppe , Vellone Valentino
Published: August 2020

The purpose of this study is to evaluate whether additive manufactory technology through the use of 3D mandible and skull cast models can provide additional support to the virtual surgical planning for patients affected by unilateral condylar hyperplasia (UCH). This study describes 2 patients affected by active UCH. Cone beam computed tomography (CBCT) scans were converted in STL files and then sent to a 3D printer that provided 3D cast models of patient's mandible and skull. Surgical planning was conducted performing linear measurement both on 3D virtual images and on 3D cast models. Proportional condylectomy was then simulated with the virtual software and on the 3D cast models as well. After 18 months, new CBCT scans of the patients were acquired and new 3D cast models were printed. Measurements performed on the 3D cast models were close and reliable if compared to measurements obtained on 3D virtual images. None of the patients underwent further surgeries obtaining stable results in terms of symmetry. 3D printing technologies have a relevant support for a more accurate planning and surgical treatment in UCH.
Piezoelectric Cutting Devices for Osteotomy in Temporomandibular Joint Condylectomy
Authors: Pauwels-Tumiñan Andrés , Lozano-Morales Constanza , López Juan Pablo , Orjuela María Paula
Published: August 2020

Condylar hyperplasia is an alteration in mandibular growth that can cause facial asymmetry and occlusal changes that usually affect the aesthetics and function of patients. To date, condylectomy for its part remains a key part of the treatment. Although there are still controversies regarding the amount of bone to remove and the surgical approach, there are still other concerns, such as finding the benefit in terms of intraoperative safety and postoperative results with different cutting devices, including the use of piezoelectric, which is increasing its use in the maxillofacial field. This is why the main objective of this study is to compare the results found in medical records and databases of condylectomy procedures performed between 2017 and 2019 with different cutting devices.
A New and Different Lip Augmentation Material Containing Cartilagenous Tissues Harvested From Rhinoplasty
Authors: Emsen Ilteris Murat
Published: August 2020

Lips are an important unit of the lower face. In the literatures, not so many augmentation methods are seen except the fat graft, filler material, alloplastic prosthesis, fascia grafts. Each one has both advantages and disadvantages. The most valuable method for lip augmentation should be minimally invasive, low cost, and resistant to resorption. The authors are presenting different and novel graft material for lip augmentation. The method has some important advantages such as both long lasting result and no cost, and not any donor area morbidity.
Analysis of Clinical Pathway for Patients With Cleft Lip and Palate
Authors: Xu Kangxin , Lin Yan , Gao Yuan , Wang Yuqun
Published: August 2020

Aim:

To evaluate the implementation of a clinical pathway (CP) and identify clinical factors affecting the CP for cleft lip and palate (CLP) patients.

Methods:

A specific CP for CLP patients was developed at CLP Medical Center of Stomatological Hospital affiliated to Nanjing Medical University in 2008. The authors reviewed the collected data of 1810 consecutive patients using the CP for repairing cleft lip, cleft palatal, and alveolar cleft. The patients were treated between January 2008 and December 2019. The rate of completion and risk factors affecting dropout from the CP were analyzed.

Results:

The completion rates of the CP in cleft lip, cleft palate and alveolar cleft patients were 68.3% (n = 345), 82.4% (n = 785) and 76.1% (n = 268), respectively. The overall completion rate was 77.2% (n = 1398). The main reasons for dropping out were pre-operation events (n = 212, 11.7%) and post-operation events (n = 188, 10.4%). Among the factors of dropout of CP, laboratory test abnormalities accounted for the majority of pre- and post-operation events (n = 179, 9.9%). In statistical analysis, the combined abnormities and events associated with operations were significant risk factors affecting the dropout rate from CP.

Conclusion:

The use of CP for CLP patients was reliable but the completion rate was relatively low because of perioperative events. These results provided some evidence of risk factors which should be considered when modifying the protocol of CP for CLP patients in order to achieve higher completion rate.
Achieving the Optimal Aesthetic Benefit While Correcting Midface Deficiency: Utilizing A High Winged Le Fort I in Cleft and Craniofacial Patients
Authors: Strong Amy L. , Ulma Raquel M. , Duncan Anthony , Vercler Christian J. , Buchman Steven R.
Published: August 2020

Craniofacial anomalies are congenital disorders that affect the cranium and facial bones, with cleft lip and palate being the most common. These anomalies are often associated with abnormal development of pharyngeal arches and can result in the development of class III malocclusion and severe maxillary retrusion. Current treatment includes orthodontic decompensation and Le Fort I osteotomy to correct the maxillomandibular relationship. However, the traditional Le Fort I (LFI) advancement does not fully address the lack of skeletal volume in the midface. The high winged Le Fort I osteotomy (HWLFI) is an excellent surgical option for simultaneous correction of the midface deficiency and malocclusion while restoring optimal esthetic convexity. A retrospective chart review was conducted to include all cleft and craniofacial patients who underwent HWLFI advancement from 2002 to 2018. Patients had a minimum of 12 months of follow-up. Patient data and complications were reviewed. Standardized facial photographs were analyzed for esthetic improvement, occlusion, and beneficial salutary effects on the midface. Forty-three patients met the inclusion criteria. The mean age at surgery was 18.9 years. The mean follow-up was 32 months. Early complications included infection (9.3%) and temporary nerve paresthesia (2.3%). Late complications included infection (6.5%), wound dehiscence (4.3%), and painful hardware (2.3%). One patient (2.3 percent) had clinically significant relapse that required surgery. Postoperatively, patients demonstrated excellent midface projection and correction of the skeletal malocclusion. The HWLFI advancement significantly improves both the malocclusion and esthetic concerns of cleft and craniofacial patients by reestablishing maximal midfacial support. Important advantages of the HWLFI are avoidance of alloplastic implant use and extensive and potentially unstable surgical procedures that increase orbital volume.
Volumetric Investigation of Sphenoid Sinus in an Elderly Population
Authors: Andrianakis Alexandros , Kiss Peter , Wolf Axel , Pilsl Ulrike , Palackic Alen , Holzmeister Clemens , Moser Ulrich , Tomazic Peter Valentin
Published: August 2020

The aims of this study were to determine the sphenoid sinus volume in an Austrian population, evaluate the relationship between volume and different types of pneumatization and investigate possible age-related sphenoid sinus volume degeneration in the elderly. A total of 50 human cadaver including 25 male and 25 female samples (=100 sphenoid sinuses, age range 65–100, mean age 84.52 ± 9.50) were selected to obtain volume and anatomical variants of pneumatization by using sphenoid sinus casts, made of quadrofunctional hydrophilic addition reaction silicone. The mean sphenoid sinus volume was 4.79 ± 2.39 cm3. Males showed statistically significant larger sinus volumes than females (P = 0.048). The volume differed statistically significant for the different types of pneumatization (P < 0.001). The combined type of sphenoid sinus pneumatization presented the largest volume with 7.20 cm3, followed by lateral, clival, sphenoid body, presellar, and conchal sinus type with 5.72, 5.63, 4.25, 2.08, and 0.5 cm3, respectively. No significant correlation between age and sphenoid sinus volume was found (P = 0.707). This study highlights the close relationship between volume and morphology of sphenoid sinus and confirms ethnic variability. Moreover, our data shows no age-related volume degeneration.
VITOM 3D System in Parotid Gland Surgery: Our Experience
Authors: Mincione Antonio , Lepera Davide , Rizzi Lucio
Published: August 2020

In this report, we present our experience with the VITOM 3D system for parotid gland surgery. A retrospective review of 9 consecutive VITOM 3D-assisted parotidectomies was carried out. All of the cases included had benign pathology. Eight of the tumors were in the superficial lobe whereas one case arose in the deep lobe. Superficial parotidectomy type II, according to the ESGS classification, was performed in 5 cases (55.6%): type I–II in 2 cases (22.2%), type I and III in 1 case respectively (11.1%). The postoperative period was uneventful for all of the patients, and no cases of postoperative temporary or definite facial nerve palsy or other complications were reported. The mean operating time was 145 minutes (range 135–165 minutes). Asthenopia never occurred, and there were no cases in which the first surgeon, the assistants, or the nurses needed to interrupt the 3D vision. VITOM 3D has been demonstrated to be safe and effective for parotid gland surgery. The main advantages of VITOM 3D are improved visualization, ergonomics, versatility, training, and education. The drawbacks are related to asthenopia and the learning curve, even though, in our experience, the impact of these factors is minimal.
Lateral Approach With a Mouth Corner Incision for the Molar Part of Mandibulectomy
Authors: Enomoto Akifumi , Kinoshita Yuko , Matsunaga Kazuhide , Sukedai Miho , Shimoide Takeshi , Ehara Hiroki , Hamada Suguru
Published: August 2020

Objectives:

The aim of the present study was to evaluate the functional and esthetic results of marginal mandibulectomy for mandibular cancer using a lateral approach with a simple, straightforward mouth corner incision.

Study Design:

Six mandibular cancer patients (2 men, 4 women; age range: 65–80 years; mean age, 73.1 years; all stage I) were treated using this approach. With this approach, the surgical field was widely exposed, and mandibulectomy was performed with sufficient surgical margins. Intraoperative frozen specimens of remaining tissues showed no malignancy in all cases. In all 6 patients, follow-up imaging assessments were obtained, with no local recurrence after 12 to 78 months.

Results and Conclusions:

An overall functional, physical, and esthetic assessment of oral behavior and oral appearance was made of all patients by the FACT-H&N questionnaire, which showed that functional lip behavior and esthetic lip appearance were not much affected by the present surgical approach, and good quality of life was maintained. Thus, the lateral approach with the mouth corner incision is an effective and useful alternative for the molar part of mandibulectomy.
Soft Tissue Changes After Clockwise Rotation of Maxillo-Mandibular Complex in Class III Patients: Three-Dimensional Stereophotogrammetric Evaluation
Authors: Choi Tae-Hyun , Kim So-Hyun , Yun Pil-Young , Kim Young-Kyun , Lee Nam-Ki
Published: August 2020

Objectives:

To evaluate the linear, angular, and volumetric changes of soft tissue after clockwise repositioning of the maxillo-mandibular complex in skeletal class III patients using three-dimensional (3D) stereophotogrammetry and to determine the correlation between changes in the skeletal and soft tissue variables.

Methods:

This study included 18 skeletal class III patients who underwent two-jaw surgery; superior impaction and clockwise rotational movement of the maxilla with the rotation center at upper incisors, and setback of the mandible. Lateral cephalograms and 3D photographs taken before and 6 months after surgery were compared.

Results:

After maxillary impaction of anteriorly 1.7 mm and posteriorly 3.1 mm, and mandibular setback of 8.7 mm, the volume of lower lip and chin region decreased significantly by 33.6 cm3 (13% net change, P < 0.001), while paranasal and upper lip region volume increased by 3.2 cm3 (2%) and 7.2 cm3 (4%), respectively.

Conclusion:

The clockwise rotation of maxillo-mandibular complex in class III patients significantly reduced lower lip and chin volume with minimal increase in paranasal and upper lip volumes. 3D stereophotogrammetry can provide quantitative evaluation of facial soft tissue volumetric changes.
Large Congenital Facial Teratoma Associated With Neurological Migration Disorder (Polymicrogyria) and Absent Corpus Callosum
Authors: Kelemen Noemi , Mota Ashley , Bains Robert D. , Liddington Mark I.
Published: August 2020

Background:

Herein, the author report a severe case of large facial mixed germ line tumor associated with neuronal migration disorder, polymicrogyria, and corpus callosum agenesis. This specific association has not been reported as yet.

Method:

A 33-year-old primiparous woman at 38th week, delivered 3820 g male baby, via Cesarian section. Postpartum profuse bleeding was noticed from a large, ulcerative, 7 cm exophytic left facial mass, which was controlled nonoperatively. The treatment included surgical excision and 560 g of large facial tumor. Histology results revealed mixed germ line tumor with grade 3, immature teratoma.

Results:

Four months postoperatively the teratoma recurred in the buccal, tonsillar, and parapharyngeal areas. Fourteen months following the initial surgical excision the patient died from airway obstruction.

Conclusion:

Due to poor initial prognosis further treatment of the facial malignancy was not feasible. However, initial, early postnatal, excisional surgery provided a prolonged and better quality of life for the patient and family.
Endonasal Transpterygoid Surgery for Adult Mature Teratoma in the Sphenoid Bone
Authors: Zhou Yicui , Pan Chunchen , Guo Tao , Wang Yinfeng , Zhao Yi , Sun Jingwu
Published: August 2020

Teratomas are germline tumors commonly composed of multiple cell types derived from embryonic germ cell layers. Teratomas in head and neck region are exceptionally rare and present during the neonatal and infantile period. We describe a male adult with a mature teratoma originating from sphenoid body. A 24-year-old male patient presented with left-sided intermitted headache and facial numbness. Radiographic imaging showed a 3 cm × 2.3 cm mass with heterogeneous density in the sphenoid region. The endoscopic sphenoid sinus opening surgery was performed through endonasal transpterygoid approach. The final pathologic diagnosis was confirmed as mature teratoma. The patient has been followed-up for 18 months without recurrence. We suggest endonasal transpterygoid approach could be an effective and safe treatment for patients with mature teratoma in the sphenoid bone.
Traumatic Buccal and Inferior Alveolar Pseudoaneurysm Associated With Von Willebrand Disease: A Challenging Case Treated by Endovascular Approach
Authors: Vanzin José Ricardo , Sawazaki Renato , Manzato Luciano Bambini , Giacomelli Richard , Mileto Tiago Nascimento , Yépez Franklin David Gordillo , Santos Moema Nenê
Published: August 2020

Pseudoaneurysm resulting from the external carotid artery or its branches after trauma to the maxillofacial region is unlikely, even more so, in a patient with von Willebrand disease. This study aimed to report a challenging case of pseudoaneurysm of the buccal artery and inferior alveolar artery due to a mandible fracture in a traumatized patient with undiagnosed von Willebrand disease. This reported case was conducted by a multidisciplinary team, covering the departments of maxillofacial surgery, interventional neuroradiology, neurosurgery, and hematology. From a fracture of the lower jaw and the appropriate course of action, bleeding episodes followed until intervention with embolization therapy. To our knowledge, this is the first case reported in the literature of a patient with those conditions.
Neuroplastic Surgery Aboard USNS Comfort During the COVID-19 Pandemic in New York City
Authors: Santiago Gabriel F. , Anderson Danielle C. , Zuckerman Scott L.
Published: August 2020

In December of 2019, a novel virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) produced a cluster of viral pneumonia cases in Wuhan, China. In the United States (US), New York City was particularly devastated, with the volume and acuity of patients placing an unprecedented strain on the hospital system and health care workers. In response to this crisis, USNS Comfort (T-AH 20) was deployed to New York City with a 1100 member medical team to augment local hospitals. Comfort's mission to New York City was dynamic, and required special adaptation to care for both COVID positive and COVID negative patients. Neuroplastic surgery procedures were indicated in both COVID positive and COVID negative patients, and lessons learned with regard to performance of complex surgery in an unfamiliar environment consisted of developing a thorough understanding of ones capabilities, and working with a highly skilled team of Navy surgeons, anesthesiologists, and surgical support staff, in order to provide high quality care in a deployment platform.
Have We Achieved Optimal Skin Color Matching in Partial Facial Transplantation? A Survey Study of the General Public and Medical Professionals
Authors: Park Jenn J. , Diep Gustave K. , Alfonso Allyson R. , Berman Zoe P. , Hoffman Alexandra F. , Mills Emily C. , Wolfe Erin M. , Felsenheld Julia H. , Ramly Elie P. , Rodriguez Eduardo D.
Published: August 2020

Background:

Skin color matching is an essential factor in achieving optimal aesthetic outcome in partial facial transplantation. However, there is no published literature evaluating the success of color matching to date. Furthermore, a medical professional's perception of an optimal color match may not necessarily translate to that of the general public. The purpose of our study was to evaluate skin color matching between the donor allograft and recipient native tissue in partial facial transplantations to determine the level of success perceived by the general public and medical professionals.

Methods:

Published photographs of partial face transplant recipients were used to create a survey where recipient native and donor allograft skin samples were juxtaposed. Thirty-three members of the general public and 30 medical professionals were asked to rate skin color match on a scale from “excellent match” to “not a match.”

Results:

Overall, 47% of given ratings were positive, indicating an “excellent” or “good match,” and 53% of ratings were negative, indicating a “poor match” or “lack of match” between the skin sample pairings shown. Of the 19 partial face transplant patients who were rated, 9 patients received >50% positive ratings, and 10 patients received <50% positive ratings. Medical professionals consistently gave more positive ratings, with statistically significant differences in 7 of the 19 rated patients (P < 0.05).

Conclusion:

The results suggest that there is need for improvement in color matching in partial facial transplantation, and that the general public is more critical of skin color matching compared to medical professionals.
A Massive Right Hemisphere Infarction After Autologous Fat Grafting for Facial Filling
Authors: Miao Jinfeng , Sun Wenzhe , Zhu Zhou , Yang Zhaoxia , Xu Yi
Published: August 2020

Cerebral fat embolism following facial autologous fat injection is a rare and serious complication. There are limited long-term follow-up data on the motion, cognitive and mental outcomes of surviving patients with cerebral fat embolism following facial autologous fat injection. In this study, the authors reported a patient with a 22-year-old woman with a massive right hemisphere infarction following facial autologous fat injection had normal cognitive function, independent living ability, and social function at 5 years follow-up visit, even though computed tomography showed her entire right cerebral hemisphere had atrophied with softening lesions.
Cleft Lip and Palate Surgery Crowdfunding and Access to Care
Authors: Akiki Ronald K. , Jehle Charles , Crozier Joseph , Woo Albert S.
Published: August 2020

A total of 169 ACPA approved teams treat cleft deformities in the United States. These centers are unevenly distributed, and families may disproportionally pay extra travel costs to consult a multidisciplinary cleft team. Families experiencing hardships are able to create campaigns on GoFundMe to advertise their fundraiser publicly. The authors sought to establish whether a correlation exists between patients asking for support for cleft treatment and their geographic location in the US.

A total of 635 crowdfunding campaigns for cleft lip and/or palate were reviewed from GoFundMe. Google searches for cleft lip and palate were evaluated utilizing Google Trends, with values reported as Relative Search Volumes (RSV). Driving distances and travel time to the nearest approved ACPA center were calculated using Google Maps data.

There was a statistically significant difference in average driving distance and travel duration between the different subregions of the US (P 
= 
0.0059 and 0.026, respectively). The South subregion had the highest proportion of campaigns (n = 259, 40.9%), mean driving distance (105.75 km) and mean driving duration (1 hour 8 minutes). The number of approved teams per state was negatively correlated to both RSV scores (r = -0.38, P 
= 
0.048) and the number of campaigns (r = −0.34, P 
= 
0.014).

There is an uneven distribution of ACPA centers among the US subregions. The South seems to have the highest need for care, as identified by proportionate number of campaigns, adjusted driving distances and travel time. This data suggests that underserved areas for cleft care are correlated with greater numbers of hardship campaigns and more internet searches regarding cleft lip and palate.
Lacrimal Ductal Fistula After Lateral Canthoplasty
Authors: Kang Min Seung , Ahn Jung Hyo
Published: August 2020

We report a rare case of lacrimal ductal fistula in a patient who underwent esthetic lateral canthoplasty. A 37-year-old woman was referred to our hospital with tearing in right eye after cosmetic lateral canthoplasty of both eyes. The patient was treated with silicone tube intubation at a local medical center, but the symptoms were not resolved. Lacrimal sac irrigation tests and paranasal computed tomography (CT) were performed to analyze the possibility of lacrimal pathway obstruction. However, there was no evidence of acquired lacrimal duct stenosis. The teardrop leaked out through a small orifice in the right lateral canthal area and it increased in size over time. We identified lacrimal ductal fistula and performed lacrimal fistulectomy. The tearing at right lateral canthus area was resolved. There were no more recurrences nor any other complications 2 years after surgery.
Endoscopic Orbital Reconstruction With Temporalis Muscle Flap
Authors: Sibar Serhat , Karasu Oguzhan
Published: August 2020

Temporalis muscle flap is one of the most commonly used flaps in orbital reconstruction. Although multiple case series in the literature have reported elevation of the flap with an open incision and a retrograde approach from the periorbital region, to the best of the authors’ knowledge, no studies have reported the use of an endoscopic method. Therefore, the authors’ study presents endoscopy-assisted temporalis muscle reconstruction of a defect that occurred in the periorbital region following orbital exenteration. Minimal scarring and morbidity are some of the advantages of endoscopic methods, and healing without complications was achieved in our patient during the postoperative period. To the authors’ knowledge, their study is the first to report the use of temporalis muscle flap in endoscopy-assisted periorbital reconstruction, which is a preferred method for endoscopic surgery.
Management of Proximal Segment of the Anterior Cerebral Artery Aneurysms
Authors: Jin Ke , Jin Yichao , Lv Tao , Xiao Zhipeng , Zhang Xiaohua
Published: August 2020

The authors reported 2 cases with proximal anterior cerebral artery (A1) aneurysms, and one was treated with aneurysm clipping, whereas another was treated with coil embolization. The authors suggest both endovascular surgery and aneurysm clipping are good options for A1 aneurysms.
Bilateral Epibulbar Dermolipomas in a Patient With Goldenhar Syndrome
Authors: Ann L. Lee Patricia , Kakizaki Hirohiko , Takahashi Yasuhiro
Published: August 2020

A 19-year-old woman consulted for bilateral superotemporal conjunctival lesions that had been present since birth. Physical examination also revealed hemifacial microsomia and bilateral auricular appendages. Medical history included heart, hearing, and neurologic problems. Excision biopsy of these lesions showed nodular proliferations of adipose tissue, which corresponded to the diagnosis of dermolipomas in the setting of Goldenhar syndrome. Complete examination for other first and second branchial arch anomalies is warranted in patients presenting with such lesions.
Anterior Cartilage Rasping During Otoplasty Performed With an Adson Brown Cartilage Forceps
Authors: Rauso Raffaele , Lo Faro Carmelo , Rugge Luigi , Califano Luigi , Tartaro Gianpaolo
Published: August 2020

Protruding ears are a common occurrence and can affect the aesthetics and psychosocial aspects of patients. Hundreds of procedures have been described over the years to correct the 2 main deformities related to protruding ears: conchal hypertrophy and anti-helical fold absence.

For the rasping technique, the rasp is inserted posteriorly, from the side where the skin is excised;

The ending part of the forceps looks like a small rasp, it worked very well and the surgery was completed without problems

The authors think this tip could be a useful “tool” for all the surgeons used to perform cartilage rasping “in case of necessity” when rasp is not available.
Assesing Intraoperative Virtual Navigation on My Craniofacial Surgery Fellowship for Orbital Fractures Repair: Is it Useful?
Authors: García-Cano Eugenio , Malagón-Hidalgo Héctor Omar , Gónzalez-Magaña Fernando , Monroy-Cedillo Jose Luis.
Published: August 2020

Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory restoration of normal orbital volume and globe projection following traumatic injury, due to the inability of the surgeon to gain adequate visibility and to verify proper implant position and placement during the operation. Surgical navigation is a very helpful tool when dealing with the reconstruction of such orbital fractures. During the training of the craniofacial fellowship learning to recognize the orbital floor boundaries is essential for the correct implant placement for reconstruction, their identification is a critical step, which may be assisted by intraoperative virtual navigation. Six patients were surgically treated for orbital floor fracture with intraoperative virtual navigation. The clinical evaluation showed no complications such as enophtalmos, exophtalmos or dystopia in all the patients 2 months post operatively and a correct implant/graft position.

During surgery, navigation provides exact determination of transverse, cranio-caudal and postero-anterior dimensions within the orbit and precise control of the position of implants/bone grafts.

This tool aids consistently on the craniofacial surgery fellow's formation, as it facilitates the identification of the bony floor boundaries and verifies the correct placement of the implants/bone grafts. It is routinely use could help to avoid implants/bone grafts misplacement not only for craniofacial surgeon's fellow, but for all the orbital surgeons.
Review and update in the diagnosis of peripheral nerve sheath tumors
Authors: Meyer Anders
Published: August 2020

Purpose of review

Although tumors with nerve sheath differentiation are vast, the main clinically significant problems faced by the pathologist are the separation of malignant peripheral nerve sheath tumors (MPNSTs) from histologic mimics, the diagnosis of neurofibromatous neoplasms with atypical features, and the separation of cutaneous neurofibromatous neoplasms from melanoma. This review briefly discusses a variety of common nerve sheath tumors and summarizes recent advances on these diagnostic fronts.

Recent findings

Much of recent work has focused on abnormalities in polycomb repressive complex 2, and the ways in which these abnormalities may be exploited in the diagnosis of MPNSTs. Progress has been made in the diagnostic and clinical understanding of atypical neurofibromatous neoplasms and low-grade MPNSTs. A number of reports have explored the diagnostic distinction between cutaneous neurofibroma and melanoma.

New discoveries show promise in the diagnosis of peripheral nerve sheath tumors, but challenges – old and new – remain.
Cognitive and behavioural impairment in amyotrophic lateral sclerosis
Authors: Pender Niall , Pinto-Grau Marta , Hardiman Orla
Published: August 2020

Purpose of review

The current review provides an up to date overview of the nature and progression of the cognitive and behavioural impairment in amyotrophic lateral sclerosis (ALS). Understanding these symptoms has implications for the management of the disease and the design of clinical trials, in addition to the support of patient and caregiver regarding mental capacity and end of life decision-making.

Recent findings

Cognitive and behavioural change in ALS are best characterized as the consequence of extensive network dysfunction. 35–45% of ALS patients present with mild–moderate cognitive impairment and comorbid dementia occurs in approximately 14% of patients, the majority of these meeting diagnostic criteria for frontotemporal dementia (FTD). Cognitive change in ALS manifests most commonly as executive dysfunction and language impairment. Behavioural change in the form of apathy, disinhibition, loss of sympathy and empathy, stereotyped behaviours and dietary changes occur.

Cognitive and behavioural impairment is an important feature of ALS, and reflects broad network dysfunction of frontostriatal and frontotemporal systems. Cognition and behaviour should be assessed early in the diagnostic process, and data driven approaches should be developed to enable reliable quantitative outcome assessment suitable for clinical trials.
3D structure of three jumbo phage heads
Authors: Neumann Emmanuelle , Kawasaki Takeru , Effantin Grégory , Estrozi Leandro F. , Chatchawankanphanich Orawan , Yamada Takashi , Schoehn Guy
Published: August 2020

Jumbo phages are bacteriophages that carry more than 200 kbp of DNA. In this study we characterized two jumbo phages (ΦRSL2 and ΦXacN1) and one semi-jumbo phage (ΦRP13) at the structural level by cryo-electron microscopy. Focusing on their capsids, three-dimensional structures of the heads at resolutions ranging from 16 to 9 Å were calculated. Based on these structures we determined the geometrical basis on which the icosahedral capsids of these phages are constructed, which includes the accessory and decorative proteins that complement them. A triangulation number novel to Myoviridae (ΦRP13; T=21) was discovered as well as two others, which are more common for jumbo phages (T=27 and T=28). Based on one of the structures we also provide evidence that accessory or decorative proteins are not a prerequisite for maintaining the structural integrity of very large capsids.
3D Printed Snorkel Mask Adapter for Failed N95 Fit Tests and PPE Shortages
Authors: Dalla Shiv , Shinde Rohit , Ayres Jack , Waller Stephen , Nachtigal Jay
Published: August 2020

Introduction

The shortage of personal protective equipment (PPE) across the country has been widely discussed throughout the COVID-19 pandemic. Unfortunately, recent reports indicate that PPE shortages persist amidst continually increasing caseloads nationwide. Additionally, there have been reports of poor-fitting masks, a problem which is magnified by shortages. The lack of adequate access to conventional N95 masks pushed for some to pursue 3D printing and locally distributing their own manufactured masks as substitutes when PPE, including N95 masks, were not readily available. The design presented, the snorkel mask adapter, is one such design born from the local maker community in partnership with local physicians and hospitals. This article discusses the design, manufacturing, and validation of the snorkel mask adapter and its immediate use in the COVID-19 pandemic as well as future use as stopgap PPE.

Methods

The design presented is an adapter which can be used with a commercially available snorkel mask in order to serve as a full face respirator in either the case of a PPE shortage or more pertinently for those who are unable to pass fit testing with the available N95 respirators at their respective facilities. Mask components were 3D printed, assembled, and then fit tested by qualitative fit testing (QLFT) at The University of Kansas Health System (TUKHS) in Kansas City, KS as a proof of concept.

Results

At TUKHS, the mask was fit tested on 22 individuals who required an N95 mask but were not able to pass qualitative fit testing with the masks available to them at the time. Of the 22 tested, all 22 of them were able to pass QLFT with the snorkel mask, adapter, and viral/bacterial filter combination.

Conclusion

The results of the fit testing at TUKHS is promising for this N95 alternative. More extensive testing can and should be done, including quantitative fit testing. Persistently increasing caseloads and PPE shortages necessitates an urgent dissemination of these preliminary results. The authors do not advocate for this design as a replacement of traditional N95 masks or other PPE but do endorse this design as a stopgap measure, proven to be effective in situations of dire PPE shortage or for individuals who have failed fit testing with conventional PPE.
Genetically-predicted vitamin D status, ambient UVB during the pandemic and COVID-19 risk in UK Biobank: Mendelian Randomisation study
Authors: Li Xue , Geffen Jos van , Weele Michiel van , Zhang Xiaomeng , He Yazhou , Meng Xiangrui , Timofeeva Maria , Campbell Harry , Dunlop Malcolm , Zgaga Lina , Theodoratou Evropi
Published: August 2020

A growing body of evidence shows that poor vitamin D status has been associated with an increased susceptibility to viral and bacterial respiratory infections. In this study, we aimed to examine the association between vitamin D and COVID-19 risk and outcomes, and to explore potential causal effects. We used logistic regression to identify associations between different vitamin D variables (25-hydroxyvitamin D concentration (25-OHD), ambient UVB and genetically-predicted 25-OHD concentrations) and COVID-19 (risk of infection, hospitalisation and death) in 495,780 participants from UK Biobank. We subsequently performed a Mendelian Randomisation (MR) study to test if there was any causal effect. In total, 1,746 COVID-19 cases and 399 COVID-19 deaths occurred between March and June 2020. We found significant inverse associations between COVID-19 infection and 25-OHD in univariable models, but these associations were non-significant after adjustment for confounders. Ambient UVB was strongly and inversely associated with hospitalization and death. Although the main MR analysis showed that genetically-predicted vitamin D levels were not causally associated with COVID-19 risk, MR sensitivity analysis using weighted mode method indicated a potential causal effect (OR=0.72, 95% CI:0.53-0.98; P=0.041). In conclusion, our study found suggestive evidence of association between vitamin D and the risk or severity of COVID-19 but further studies are needed.
A delayed SEIQR epidemic model of COVID-19 in Tokyo
Authors: Maki Kazuo
Published: August 2020

The rapid expansion of COVID-19 has caused a global pandemic. In order to avoid excessive restriction to the social activity, a good strategy of quarantine is needed. Several epidemic models with a quarantine compartment such as susceptible-exposed-infectious-quarantined-removed (SEIQR) model have been applied. However, in the actual situation, the infection test and quarantine is often delayed from the beginning of the infectious stage. This article presents a delayed SEIQR model to analyze the effect of the delay of quarantine, and to suggest a guideline for the measure. The latency period (compartment E) was assumed to be 3 days, and the start of quarantine action was assumed to be delayed by 4 to 10 days from infection. The actual PCR test-positive number data from March 10th to July 18th in 2020 was analyzed to estimate a transmission rate and the reproduction number. The area where the infection expansion is restrained was displayed in the two parameter space (transmission rate and quarantine rate) for several possible lengths of the delay of quarantine. As a result, it was shown to be very hard to restrain the expansion of infection only by a simple quarantine action retaining the delay. As a short term measure, it was found to be necessary to reduce the transmission rate through some kind of restriction of social activity, but as a long term measure, it was found to be possible to maintain the social activity by shortening the delay of quarantine through expanding the infection test system to find earlier stage patients, including asymptomatic infectious patients. In order to shed light to this conclusion from a different viewpoint, this model was applied in another case that an additional quarantine was taken into account before the delay. The result was shown to have a similar effect as that of the shortening of the delay.
Whether Early Steroid dose is associated with lower mortality in COVID-19 critically ill Patients- An exploratory chart review
Authors: Goyal Abhishek , Saigal Saurabh , Joshi Ankur , Brahmam Dodda , Niwariya Yogesh , Khurana Alkesh , Singh Pooja , Kama Sunaina Tejpal , Sharma Jaiprakash , Khadanga Sagar , Pavan G Sai , Mitra Arun
Published: August 2020

Introduction

Steroids have shown its usefulness in critically ill COVID19 patients. However time of starting steroid and dose tailored to severity remains a matter of inquiry due to still emerging evidences and wide-ranging concerns of benefits and harms. We did a retrospective record analysis in an apex teaching hospital ICU setting to explore optimal doses and duration of steroid therapy which can decrease mortality.

Methodology

114 adults with COVID19-ARDS admitted to ICU between 20thMarch-15thAugust2020 were included in chart review. We did preliminary exploratory analysis(rooted in steroid therapy matrix categorized by dose and duration) to understand the effect of several covariates on survival. This was followed by univariate and multivariate Cox proportion hazard regression analysis and model diagnostics.

Results

Exploratory analysis and visualization indicated age, optimal steroid, severity (measured in P/F) of disease and infection status as potential covariates for survival. Univariate cox regression analysis showed significant positive association of age>60 years{2.6 (1.5-4.7)} and protective effect of optimum steroid{0.38(0.2-0.72)} on death (hazard) in critically ill patients. Multivariate cox regression analysis after adjusting effect of age showed protective effect of optimum steroid on hazard defined as death {0.46(0.23-0.87),LR=17.04,(p=2e- 04)}.The concordance was 0.70 and model diagnostics fulfilled the assumption criteria for proportional hazard model.

Conclusion

Optimal dose steroid as per defined ‘optimum’ (<24 hours and doses tailored to P/F at presentation) criteria can offer protective effect from mortality which persists after adjusting for age. This protective effect was not found to be negatively influenced by the risk of infection.

No funding was taken for this paper.
Development of Diagnostic Score for Acute Pericarditis in Patients Admitted for Chest Pain
Authors: Meireles André Costa , Oliveira João Vitor Miranda Porto , de Sá Barreto Pontes Bruna , Souza Alexandre Costa , Gomes Laila Caroline Oliveira Souza Barbo , Silva Thomaz Emanoel Azevedo , de Melo Milton Henrique Vitoria , Bagano Gabriela Oliveira , Rabelo Márcia Maria Noya , Correia Luis Claudio Lemos
Published: August 2020

Background

Despite the presence of clinical, laboratory and electrocardiographic characteristics suggestive of acute pericarditis, there is no multivariate diagnostic score developed for this condition.

Objective

To develop a clinical score for diagnosis of pericarditis as the cause of acute chest pain, using data from admission.

Methods

In a diagnostic case-control study, we compared consecutive 45 patients of the Chest Pain Registry diagnosed of pericarditis (confirmed by magnetic resonance imaging or the presence of pleural effusion in echocardiography) versus 90 patients with an alternative confirmed diagnosis, randomly selected from our registry. Six clinical characteristics, 16 chest pain characteristics and 4 additional tests were candidates as predictors. Logistic regression was used to derivate a model composed by independent predictors of pericarditis.

Results

Among 17 variables associated with pericarditis, 5 remained independent predictors: age; pain aggravation with thorax movement; positive troponin; diffuse ST-segment elevation and C-reactive protein. Each independent predictor was attributed points proportional to its regression coefficient. The final score presented discriminatory capacity represented by C-statistic of 0.97 (95% CI = 0.93 – 1.0). The best cutoff point was defined as > 6 points, with sensitivity of 96% (95% CI = 85 – 100), specificity of 87% (95% CI = 78 – 93), positive likelihood ratio of 7.2 (95% CI = 4.2 – 12) and negative likelihood ratio of 0.05 (95% CI = 0.01 – 0.2).

Conclusion

The proposed multivariate score seems to be accurate for the diagnosis of pericarditis and require further validation in an independent sample.
Evaluation of emotional arousal level and depression severity using the centripetal force derived from voice
Authors: Shinohara Shuji , Toda Hiroyuki , Nakamura Mitsuteru , Omiya Yasuhiro , Higuchi Masakazu , Takano Takeshi , Saito Taku , Tanichi Masaaki , Boku Shuken , Mitsuyoshi Shunji , So Mirai , Yoshino Aihide , Tokuno Shinich
Published: August 2020

In this research, we propose a new voice feature called centripetal force (CF) to investigate the relationship between emotional arousal level and depression severity. First, CFs were calculated from various speech recordings in the interactive emotional dyadic motion capture database, and the correlation with the arousal level of each voice was examined. The resulting correlation coefficient was 0.52. We collected a total of 178 datasets comprising 10 speech phrases and the Hamilton Rating Scale for Depression (HAM-D) score of outpatients with major depression at the Ginza Taimei Clinic (GTC) and the National Defense Medical College (NDMC) Hospital. The correlation coefficients between CF and HAM-D scores were –0.33 and –0.43 at the GTC and NDMC, respectively. Next, the dataset was divided into the no depression group (HAM-D< 8) and the depression group (HAM-D ≥8) according to the HAM-D score. There was a significant difference in the mean CF values between the two groups in both the GTC and NDMC data (p = 0.0089 and p = 0.0016, respectively). The AUC when discriminating both groups by CF was 0.76 in GTC data and 0.72 in NDMC data. Indirectly, using CF established a relationship between emotional arousal level and depression severity.