bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association of Modifiable Postresuscitation Management and Annual Case Volume With Survival After Extracorporeal Cardiopulmonary Resuscitation
Authors: Tonna Joseph E. , Selzman Craig H. , Bartos Jason A. , Presson Angela P. , Ou Zhining , Jo Yeonjung , Becker Lance , Youngquist Scott T. , Thiagarajan Ravi R. , Johnson M. Austin , Rycus Peter , Keenan Heather T.
Published: July 2022

IMPORTANCE:

It is not know if hospital-level extracorporeal cardiopulmonary resuscitation (ECPR) case volume, or postcannulation clinical management associate with survival outcomes.

OBJECTIVES:

To describe variation in postresuscitation management practices, and annual hospital-level case volume, for patients who receive ECPR and to determine associations between these management practices and hospital survival.

DESIGN:

Observational cohort study using case-mix adjusted survival analysis.

SETTING AND PARTICIPANTS:

Adult patients greater than or equal to 18 years old who received ECPR from the Extracorporeal Life Support Organization Registry from 2008 to 2019.

MAIN OUTCOMES AND MEASURES:

Generalized estimating equation logistic regression was used to determine factors associated with hospital survival, accounting for clustering by center. Factors analyzed included specific clinical management interventions after starting extracorporeal membrane oxygenation (ECMO) including coronary angiography, mechanical unloading of the left ventricle on ECMO (with additional placement of a peripheral ventricular assist device, intra-aortic balloon pump, or surgical vent), placement of an arterial perfusion catheter distal to the arterial return cannula (to mitigate leg ischemia); potentially modifiable on-ECMO hemodynamics (arterial pulsatility, mean arterial pressure, ECMO flow); plus hospital-level annual case volume for adult ECPR.

RESULTS:

Case-mix adjusted patient-level management practices varied widely across individual hospitals. We analyzed 7,488 adults (29% survival); median age 55 (interquartile range, 44–64), 68% of whom were male. Adjusted hospital survival on ECMO was associated with mechanical unloading of the left ventricle (odds ratio [OR], 1.3; 95% CI, 1.08–1.55; p = 0.005), performance of coronary angiography (OR, 1.34; 95% CI, 1.11– 1.61; p = 0.002), and placement of an arterial perfusion catheter distal to the return cannula (OR, 1.39; 95% CI, 1.05–1.84; p = 0.022). Survival varied by 44% across hospitals after case-mix adjustment and was higher at centers that perform more than 12 ECPR cases/yr (OR, 1.23; 95% CI, 1.04–1.45; p = 0.015) versus medium- and low-volume centers.

CONCLUSIONS AND RELEVANCE:

Modifiable ECMO management strategies and annual case volume vary across hospitals, appear to be associated with survival and should be the focus of future research to test if these hypothesis-generating associations are causal in nature.
A Retrospective Study of Ipilimumab Plus Nivolumab in Anti-PD-L1/PD-1 Refractory Merkel Cell Carcinoma
Authors: Shalhout Sophia Z. , Emerick Kevin S. , Kaufman Howard L. , Silk Ann W. , Thakuria Manisha , Miller David M.
Published: July 2022

Merkel cell carcinoma (MCC) is a very rare but highly aggressive cutaneous neuroendocrine carcinoma and is associated with chronic exposure to ultraviolet light and the Merkel cell polyoma virus. The incidence rate of MCC is increasing and MCC is associated with high rates of recurrence and mortality. Immune checkpoint inhibitors (ICIs) offer durable responses and significant clinical benefit with 2 agents-avelumab (anti-PD-L1) and pembrolizumab (anti-PD-1)—currently approved by the U.S. Food and Drug Administration for the treatment of advanced MCC. Despite the advances in systemic therapy options for MCC, ~50% of patients with advanced MCC treated with ICI progress on therapy. There is a paucity of studies assessing second-line systemic therapy following primary/acquired resistance to ICIs. Current management in this setting remains a clinical challenge especially in trial ineligible patients. We evaluated objective response to ipilimumab plus nivolumab in metastatic MCC refractory to anti-PD-(L)1 therapy. Thirty-one percent of patients experienced a grade III or grade IV immune-related adverse event (irAE) due to ipilimumab plus nivolumab. No patients (0/13) achieved a complete or partial response via RECISTv1.1/irRECIST. Twenty-three percent (3/13) of patients achieved stable disease as the best overall response but progressed shortly thereafter. The median progression-free survival was 1.3 months (90% CI 1.1–1.5) from the initiation of ipi-nivo. The median overall survival was 4.7 months (95% CI 3–17). This study suggests limited, if any, clinical benefit of ipi-nivo in patients with advanced anti-PD-L1/anti-PD-1 refractory MCC.
Conversion of Breast Implants into Natural Breast Reconstruction: Evaluating Lipofilled Mini Dorsi Flap
Authors: Piat Jean-Marc , Giovinazzo Vincenzo , Talha Aurore , Dinnebier Tomazzoni Gabriela , Maiato Anna Paula , Roskamp Budel Lucas , Ho Quoc Christophe
Published: July 2022

Background:

Autologous reconstruction techniques can provide a long-lasting natural breast reconstruction for patients. This study aimed to further investigate outcomes in the conversion of breast implant reconstruction into a lipofilled mini dorsi flap, focusing on reviewing its techniques, efficiency, and final results.

Methods:

Over 3 years, we performed a number of breast implant replacements via the lipofilled mini dorsi flap technique. The artificial implants were replaced to a deepithelized flap. The efficiency and tolerance of the technique were evaluated by the whole surgical team, and the achieved results were also analyzed by the patients in terms of postoperative pain, functional impact, and the softness of the reconstructed breast by comparing their prior condition to the lipofilled mini dorsi flap condition at least 9 months after operation.

Results:

Forty-seven consecutive operations were prospectively studied. The mean ± standard deviation volume of the removed implants was 348.66 ± 86.54 mL. The mean volume of fat injected was 284.13 ± 62.94 mL. The procedure’s average duration was 108.93 ± 17.65 minutes. The surgical team evaluated the results as very satisfactory in 32 cases (68.1%), satisfactory in 15 cases (31.9%), and moderately satisfactory or unsatisfactory in zero cases (0.0%). Eighteen patients (38.3%) evaluated their reconstruction as very good, while 20 patients (42.6%) considered their reconstruction as good, four (8.5%) as average, and zero (0.0%) as insufficient.

Conclusion:

According to our experience, the lipofilled mini dorsi flap is a simple, less invasive, and quick procedure to convert breast implants into natural breast reconstruction.
Harnessing the Power of Artificial Intelligence to Teach Cleft Lip Surgery
Authors: Sayadi Lohrasb Ross , Hamdan Usama S. , Zhangli Qilong , Vyas Raj M.
Published: July 2022

Background:

Artificial intelligence (AI) leverages today’s exceptional computational powers and algorithmic abilities to learn from large data sets and solve complex problems. The aim of this study was to construct an AI model that can intelligently and reliably recognize the anatomy of cleft lip and nasal deformity and automate placement of nasolabial markings that can guide surgical design.

Methods:

We adopted the high-resolution net architecture, a recent family of convolutional neural networks–based deep learning architecture specialized in computer-vision tasks to train an AI model, which can detect and place the 21 cleft anthropometric points on cleft lip photographs and videos. The model was tested by calculating the Euclidean distance between hand-marked anthropometric points placed by an expert cleft surgeon to ones generated by our cleft AI model. A normalized mean error (NME) was calculated for each point.

Results:

All NME values were between 0.029 and 0.055. The largest NME was for cleft-side cphi. The smallest NME value was for cleft-side alare. These errors were well within standard AI benchmarks.

Conclusions:

We successfully developed an AI algorithm that can identify the 21 surgically important anatomic landmarks of the unilateral cleft lip. This model can be used alone or integrated with surface projection to guide various cleft lip/nose repairs. Having demonstrated the feasibility of creating such a model on the complex three-dimensional surface of the lip and nose, it is easy to envision expanding the use of AI models to understand all of human surface anatomy—the full territory and playground of plastic surgeons.
Residual Cholesteatoma After Endoscopic-Assisted Canal Wall-Up Tympanomastoidectomy: A Randomized Controlled Trial
Authors: Noschang Lopes da Silva Maurício , Selaimen da Costa Sady , André Selaimen Fábio , da Costa Huve Felipe , Lang Silva Alice , Dias Toshiaki Koga Fernanda , Martins-Costa Luciana Lima , Bernard Rosa Nery Marcel , Zanardini Marcos , Sperling Neil
Published: July 2022

Objective

This study aimed to determine the effectiveness of using endoscopes in reducing recidivism secondary to residual cholesteatoma after canal wall-up tympanomastoidectomy.

Study Design

Randomized clinical trial.

Setting

Tertiary referral center.

Patients

Patients with cholesteatoma, aged 7 to 70 years.

Interventions

Subjects were randomly allocated into two groups: endoscopic-assisted canal wall-up (EACWU; group 1) and conventional canal wall-up (CWU; group 2) techniques. Pars flaccida and pars tensa subgroups were analyzed according to the anatomic location of cholesteatoma origin.

Main Outcome Measures

Presence or absence of residual cholesteatoma, based on second look surgery, diffusion-weighted magnetic resonance imaging, or video-otoscopy at 12 and 18 months after surgery.

Results

In total, 57 ears were analyzed: 29 in group 1 and 28 in group 2. Group 1 revealed residual disease in 17.2% of ears, whereas group 2 had residual disease in 35.7% (p > 0.05) of the ears. In the pars tensa cholesteatoma subgroup, the incidence of residual disease was 13.3% for EACWU and 47.1% for the CWU technique (p < 0.05). A tendency of reduced incidence was observed for cholesteatoma due to residual disease using EACWU. In addition, a statistically significant reduction in the residual disease was observed in the subgroup of pars tensa cholesteatomas. In this subgroup, the relative risk was 0.28, and the number needed to treat was 4.6.

Conclusion

The use of the endoscope reduces the incidence of recidivism secondary to residual disease in pars tensa cholesteatomas. Endoscopic-assisted surgery may be useful in cases with an indication for canal wall-up tympanomastoidectomy.

Level of Evidence

1b.
Benefits of High-Dose Corticosteroid and Antiviral Agent Combination Therapy in the Treatment of House-Brackman Grade VI Ramsay Hunt Syndrome
Authors: Furukawa Takatoshi , Abe Yasuhiro , Ito Tsukasa , Kubota Toshinori , Hull Melinda , Goto Takanari , Sugiyama Motoyasu , Kakehata Seiji
Published: July 2022

Objective

Few large-scale investigations have been conducted on treatment of House-Brackmann grade VI (HB grade VI) Ramsay Hunt syndrome (RHS) patients. We compared recovery rates among patients receiving a normal-dose corticosteroid (prednisolone [PSL] 60 mg/d) or high-dose corticosteroid (PSL 200 mg/d), both with or without an antiviral agents. Recovery rates were also examined based on the order of presentation of herpetic vesicles versus facial palsy.

Study Design

Retrospective case review.

Setting

Tertiary referral center.

Patients

A total of 128 patients with HB grade VI RHS were treated in our department between 1995 and 2017. These patients were divided into four treatment groups based on corticosteroid dosage and use of an antiviral agent.

Methods

We assessed treatment outcomes for HB grade VI patients together with logistic regression analysis to investigate factors that can impact treatment outcomes, that is, sex, age, days to start of treatment, PSL dosage, and antiviral agent administration.

Results

Recovery rates were best in the high-dose corticosteroid group with an antiviral agent (71.1%) in comparison with the normal-dose corticosteroid group with an antiviral agent (60.0%) or high-dose corticosteroid alone (57.1%). Significant factors for treatment outcomes were high-dose corticosteroid administration and early initiation of treatment. A better recovery rate was also found when the herpetic vesicles appeared before facial palsy.

Conclusion

We showed that a combination of a high-dose corticosteroid and antiviral agent produced the best outcomes for patients with HB grade VI RHS. However, our results were not statistically significant because of small sample size.
Expansion of the Foramen Ovale in Patients With Cerebrospinal Fluid Leak or Encephalocele
Authors: Curry Steven D. , Granger Kleve W. , Richman Evan H. , Liu Collin , Moore Gary F. , Barnes Christie A. , Surdell Daniel L. , Hatch Jonathan L.
Published: July 2022

Objective

Spontaneous cerebrospinal fluid (CSF) leaks are associated with elevated intracranial pressure and idiopathic intracranial hypertension (IIH). Skull base erosion and widening of the foramen ovale have been reported in patients with IIH. This study sought to investigate changes in the size of the foramen ovale and foramen spinosum in patients with IIH, spontaneous CSF leak, and encephalocele.

Study Design

Retrospective cohort study.

Setting

Tertiary care academic medical center.

Patients

Adult patients treated from 2014 to 2018 with computed tomographic imaging of the head and who were diagnosed with IIH, encephalocele, or CSF leak.

Intervention

Two blinded observers measured the long and short axes of the foramen ovale and foramen spinosum on axial computed tomographic images. Measurements were used to calculate the approximate elliptical cross-sectional area of the foramina.

Main Outcome Measures

Length, width, and area of the foramen ovale and foramen spinosum.

Results

A total of 264 patients were identified meeting the inclusion criteria and were placed into three groups. There were 170 patients with IIH, 48 with spontaneous CSF leak or encephalocele (CSF/E group), and 46 with traumatic or iatrogenic CSF leak (control group). Mean foramen ovale short axis (4.85 ± 1.00 mm) and cross-sectional area (30.17 ± 9.25 mm2) in the CSF/E group were significantly increased compared with measurements in patients with IIH or the control groups. Foramen ovale size was positively correlated with age in the CSF/E group. No significant difference in foramen spinosum size was found.

Conclusion

Skull base defect resulting in spontaneous CSF leak or encephalocele is associated with enlargement of the foramen ovale on axial computed tomography.
Vestibular Migraine Confounds Management of Superior Canal Dehiscence Syndrome
Authors: Smetak Miriam R. , Cass Nathan D. , Manzoor Nauman F. , Hatton Kelsey , Perkins Elizabeth L. , Rivas Alejandro , O'Malley Matthew R. , Bennett Marc L. , Haynes David S.
Published: July 2022

Objective

To investigate the prevalence of vestibular migraine (VM) in a cohort of patients with radiologic confirmation of superior canal dehiscence (SCD) and to compare management of superior canal dehiscence syndrome (SCDS) in patients with and without comorbid VM.

Study Design

Retrospective review of a SCD database.

Setting

University-based tertiary medical center.

Patients

Ninety-one patients identified with SCD from 2009 to 2017.

Interventions

None.

Main Outcome Measures

Coincidence of VM and SCD, and resolution of symptoms.

Results

Ninety-one patients with SCD met the inclusion and exclusion criteria. VM was diagnosed in 36 (39.6%) patients. Of those receiving medical therapy for VM alone, five (45.5%) reported symptom resolution, five (45.5%) reported partial improvement, one (9.1%) had no change, and none worsened. Fifteen patients (41.7%) were treated with both surgery (for SCD) and medical therapy (for VM). Seven (46.7%) reported symptom resolution, seven (46.7%) reported partial improvement, and one (6.7%) worsened. There was no statistically significant difference in symptom resolution between SCD + VM patients who were treated medically compared with those treated with medical therapy and surgery (p = 0.951). There was no significant difference in symptom resolution after surgery between SCD + VM and SCD-only cohorts (p = 0.286).

Conclusions

This is the first study describing the incidence of VM in a cohort of patients with SCDS. The symptoms of VM confound those of SCDS and unrecognized or undertreated VM may contribute to surgical failure in SCDS. Therefore, we recommend a high index of suspicion for VM in patients with SCDS and a trial of medical therapy in the setting of suspected VM.
Stapedotomy Versus Hearing Aids in the Management of Conductive Hearing Loss Caused by Otosclerosis: A Prospective Comparative Study
Authors: Molinier Charles-Edouard , Gallois Yohan , Deguine Olivier , Iversenc Gaetan , Vales Olivier , Taoui Soumia , Lepage Benoit , Fraysse Bernard , Marx Mathieu
Published: July 2022

Objective

To compare the outcomes of patients with unilateral otosclerosis treated consecutively by a hearing aid then stapedotomy.

Study Design

Monocentric, nonrandomized, prospective, longitudinal, cohort study.

Setting

Tertiary university hospital.

Patients

Adult patients with a unilateral conductive hearing loss of at least 30 dB caused by otosclerosis.

Interventions

Consecutive treatment by an external hearing aid followed by stapedotomy.

Main Outcome Measures

Differences between hearing aids and stapedotomy in quality of life, pure-tone audiometry, binaural hearing, tinnitus severity, and patient satisfaction.

Results

Twenty-two patients were included, of which 20 (91%) underwent stapedotomy. Stapedotomy demonstrated increased quality of life according to Glasgow Health Status Inventory scores versus hearing aids (+10.4 ± 9.4 [p = 0.0001]). Stapedotomy versus hearing aids showed improved pure-tone averages (−11.1 ± 11.0 dB [p = 0.002]) and air-bone gaps (−11.8 ± 10.7 dB [p = 0.0006]). Stapedotomy was superior to hearing aids for speech-in-noise recognition in the reverse dichotic condition (−8.4 ± 26.9 dB [p = 0.004]) and showed improved sound localization accuracy in root mean square error (−14.5 ± 24.5 degrees [p = 0.02]). Stapedotomy, but not hearing aids, showed improved patient self-evaluated tinnitus after baseline adjustment according to the Tinnitus Handicap Inventory (−8.0 ± 13.4 [p = 0.02]) and visual analog scale for tinnitus intensity (−28.7 ± 34.1 [p = 0.006]). Overall, patients were more satisfied with surgery versus hearing aids.

Conclusions

Stapedotomy remains more effective compared with hearing aids with greater improvements in quality of life, patient satisfaction, hearing outcomes, and self-evaluated tinnitus.
Dural Venous Sinus Arachnoid Granulations in Patients with Pulsatile Tinnitus
Authors: Bauschard Michael J. , Reichl Kaitlyn , Socolovsky Leandro D. , Sismanis Aristides A. , Coelho Daniel H.
Published: July 2022

Objective

To determine the relationship, if any, between dural venous sinus arachnoid granulations (AGs) and pulsatile tinnitus.

Study Design

Retrospective case-control study.

Methods

Between October 1999 and March 2020, magnetic resonance imaging of patients with tinnitus (pulsatile [PT] and nonpulsatile [NPT]) were assessed for the presence of dural venous sinuses AG. During the same interval, patients with AGs found incidentally on all magnetic resonance imagings ordered without an indication of tinnitus were reviewed. Demographic variables recorded included patient age, sex, race, body mass index, and a history of idiopathic intracranial hypertension (IIH) or obstructive sleep apnea. Location of AGs, when present, were recorded.

Results

A total of 651 (PT 250, NPT 401) were found to have AGs. AGs had a higher prevalence in PT patients (10.4% [n = 26]) versus NPT patients (0.3% [n = 1]; odds ratio, 31.0; confidence interval 4.1–234; p < 0.001). Of the 77,607 patients who had an indication for imaging other than tinnitus, 230 patients (0.30%) were found to have incidental AGs, suggesting that the NPT cohort was an adequate control. Patients with PT were more likely to have a higher body mass index, be female, be non-White, and have an existing diagnosis of IIH. For all patients with AGs, AGs were more likely to be found in the lateral sinuses (i.e., sigmoid, transverse) in the PT group (odds ratio, 8.1; confidence interval, 1.1–61.1; p = 0.0218).

Conclusions

This study evaluates the association between AG and PT, finding higher rates of AG in patients with PT than in NPT. However, despite the increased prevalence of AG in patients with IIH, these data combined with existing literature would suggest that AGs are not necessarily the missing link to explain PT pathophysiology in IIH.
Normative Cochlear Implant Quality of Life (CIQOL)-35 Profile and CIQOL-10 Global Scores for Experienced Cochlear Implant Users from a Multi-Institutional Study
Authors: McRackan Theodore R. , Hand Brittany N. , Chidarala Shreya , Velozo Craig A. , Dubno Judy R.
Published: July 2022

Objective

Although adult cochlear implant (CI) outcomes have primarily focused on speech recognition scores, the rigorous development of a CI-specific patient-reported outcome measure provides an opportunity for a more comprehensive and ecologically valid approach to measure the real-world functional abilities of adult CI users. Here, we report for the first time normative Cochlear Implant Quality of Life (CIQOL)-35 Profile and global scores and variance for a large, multi-institutional sample of adult CI users.

Study Design

Cross-sectional study design.

Setting

CI centers in the United States.

Patients

Seven hundred five adults with bilateral moderate to profound hearing loss with at least 1 year of CI use.

Intervention(s)

Cochlear implantation.

Main Outcome Measure(s)

CIQOL-35 Profile and CIQOL-10 Global scores.

Results

During the development of the CIQOL instruments, 1,000 CI users from all regions of the United States were invited to participate in studies. Of these, 705 (70.5%) completed all portions of the study, and their data are reported here. Mean CIQOL domain scores were highest (indicating better function) for the emotional and social domains and lowest for listening effort. The entertainment and social domains demonstrated the widest distribution of scores and largest standard deviations, indicating greatest variability in function. Overall, there were minimal ceiling and floor effects for all domains.

Conclusion

Normative scores from a large sample of experienced adult CI users are consistent with clinical observations, showing large differences in functional abilities and large variability. Normative CIQOL data for adult CI users have the potential to enhance preoperative discussions with CI candidates, improve post-CI activation monitoring, and establish standards for CI centers.
HiRes Ultra Series Recall: Failure Rates and Revision Speech Recognition Outcomes
Authors: Lindquist Nathan R. , Cass Nathan D. , Patro Ankita , Perkins Elizabeth L. , Gifford René H. , Haynes David S. , Holder Jourdan T.
Published: July 2022

Objective

To report Advanced Bionics (AB) Ultra (V1) and Ultra 3D (V1) cochlear implant (CI) electrode failures and revision speech recognition outcomes for patients at a large CI program.

Study Design

Retrospective case series.

Setting

Tertiary referral center.

Patients

Patients receiving Ultra (V1) or Ultra 3D (V1) devices as of September 21, 2021.

Main Outcome Measures

Failure rate, revision surgery, speech recognition scores.

Results

To data, 65 (21.1%) of the 308 implanted devices are known failures, with 63 (20.5%) associated with the recent voluntary field corrective action (FCA). Average time to failure was 2.2 ± 1.1 years. Fifty-two patients (82.5%) elected for revision surgery. Among adults, immediate prerevision scores demonstrated a significant decrease from best-achieved scores with the faulty implant, with mean difference of −15.2% (p = 0.0115) for consonant-nucleus-consonant (CNC) and −27.3% (p < 0.0001) for AzBio in quiet. By 3 months postactivation of the revised device, CNC (p = 0.9766) and AzBio in quiet (p = 0.9501) scores were not significantly different than best prerevision scores. Overall, 15 of 19 patients regained or improved their best prerevision CNC score. The current trajectory for FCA device failures is approximately 6% per year.

Conclusion

Compared to manufacturer reporting, a high number of patients experienced hard failures of the Ultra (V1) and Ultra 3D (V1) devices. Early identification of failures is possibly because of the diligent use of electrical field imaging testing. Most patients affected by the FCA regain or exceed their prefailure speech recognition score as soon as 3 months after revision surgery.
Comprehensive Molecular Profiling of Oncocytic Salivary Gland Malignancies
Authors: Zaccarini Daniel J. , Sivapiragasam Abirami , Sokol Ethan , Huang Richard S.P. , Pavlick Dean C. , Janovitz Tyler , Nasr Michele R. , Ross Jeffrey S.
Published: July 2022

Oncocytic histologic features can be seen in a variety of salivary gland carcinomas. We performed a comprehensive molecular profiling of 15 salivary gland malignancies with oncocytic features (diagnosed as oncocytic carcinoma, carcinoma NOS with oncocytic features, or salivary duct carcinoma with oncocytic features). We reveal multiple novel molecular alterations that have not been previously described in other salivary gland malignancies, including, but not limited to, KEL amplification (13.3%, 2/15), PARP1 amplification (13.3%, 2/15), and EPHB4 amplification (13.3%, 2/15). Alterations in KMT2C (13.3%, 2/15), ERBB3 (13.3%, 2/15), CTNNA1 (13.3%, 2/15), and SMAD4 (20%, 3/15) were also found in this series and have been reported in other salivary gland malignancies. Alterations that have been reported in salivary duct carcinoma were also identified, including TP53 (40%, 6/15), ERBB2 mutations (13.3%, 2/15), ERBB2 amplification (13.3%, 2/15), PIK3CA (26.7%, 4/15), PTEN (20%, 3/15), BRCA2 (20%, 3/15), BRAF (20%, 3/15), CDKN2A/B (20%, 3/15), CDH1 (13.3%, 2/15), and HRAS (13.3%, 2/15). Oncocytic salivary gland malignancies are a molecularly heterogenous group of tumors with partial overlap with salivary duct carcinoma subtypes.
Personal Evolution in Rhinoplasty Tip Shaping: Beyond the Tri-pod Concept
Authors: Rohrich Rod J. , Bellamy Justin L. , Chamata Edward S. , Alleyne Brendan
Published: July 2022

Introduced over fifty years ago, the “tripod concept” has long been the foundation of our understanding of tip dynamics in rhinoplasty. Modern approaches to rhinoplasty have built upon these principles and seen the evolution of several operative techniques to address tip aesthetics. The following manuscript and accompanying case video details our algorithmic approach to tip shaping, based upon the utilization of complete lower lateral cartilage reshaping & tensioning; clarified use of medial crural transection & overlap; with stabilization on a fixed-floating septal extension graft and deliberate management of the soft-tissue envelope. The intra-operative sequencing, key technical considerations, relevant classification schemes, and global decision-making processes are reviewed.
Zones for Fat Grafting in Hybrid Breast Augmentation Revisited: Standardization for Intraoperative Planning of Fat Grafting Based on Breast Cleavage Units
Authors: Munhoz Alexandre Mendonça , Maximiliano João , Neto Ary de Azevedo Marques , Duarte Daniele Walter , de Oliveira Antonio Carlos Pinto , Portinho Ciro Paz , Zanin Eduardo , Collares Marcos Vinicius Martins
Published: July 2022

Background:

Autologous fat grafting (AFG) is a procedure indicated for breast augmentation (BA) to improve coverage of silicone implants and redesign breast shape. Different techniques are based on parameters such as intermammary distance and implant volume/projection, none of which have been systematically standardized according to the main areas for AFG placement. This study presents a method utilizing breast zone standardization based on breast anatomy and implant location to promote natural superior/medial breast poles and achieve an anatomical composite breast.

Material/Methods:

The authors performed this zone standardization in 76 breasts (38 patients) undergoing primary/secondary hybrid BA. An upper/medial pole area between the implant and the clavicle region and parasternal area was marked to receive subsequent AFG and divided into three zones. A mathematical formula (VAFG= (π. r2.p)/4.8) was used to estimate the volume of fat grafts according to implant volume in the respective zones.

Results:

Implant volumes ranged from 205 to 375 cc (mean: 265 cc), and patients received an average AFG volume of 105.3 cc per breast (range: 36–135 cc); the average fat graft volume in zones I-II and III was 78.28 (range: 0–100 cc) and 27.03 (15–60 cc), respectively. Three cases of minor complications were observed in 2 patients (5.2%) during a mean follow-up of 12.8 months (6–19 months). A high correlation was observed between the AFG performed in the cohort and predictions obtained from the formula (p<0.001).

Conclusion:

Recognizing risky cleavage breast zones between the implant pocket and upper and medial quadrants remains essential to attain satisfactory outcomes and minimize adverse results. Although experience and proper judgment are still important in the AFG technique, the data presented here offer plastic surgeons an additional standardized framework to help deliver predictable HBA.
Longitudinal HIV care outcomes by gender identity in the United States
Authors: Lesko Catherine R. , Edwards Jessie K. , Hanna David B. , Mayor Angel M. , Silverberg Michael J. , Horberg Michael , Rebeiro Peter F. , Moore Richard D. , Rich Ashleigh J. , McGinnis Kathleen A. , Buchacz Kate , Crane Heidi M. , Rabkin Charles S. , Althoff Keri N. , Poteat Tonia C.
Published: July 2022

Objective:

Describe engagement in HIV care over time after initial engagement in HIV care, by gender identity.

Design:

Observational, clinical cohort study of people with HIV engaged in routine HIV care across the United States.

Methods:

We followed people with HIV who linked to and engaged in clinical care (attending ≥2 visits in 12 months) in cohorts in the North American Transgender Cohort Collaboration, 2000–2018. Within strata of gender identity, we estimated the 7-year (84-month) restricted mean time spent: lost-to-clinic (stratified by pre/postantiretroviral therapy (ART) initiation); in care prior to ART initiation; on ART but not virally suppressed; virally suppressed (≤200 copies/ml); or dead (pre/post-ART initiation).

Results:

Transgender women (N = 482/101 841) spent an average of 35.5 out of 84 months virally suppressed (this was 30.5 months for cisgender women and 34.4 months for cisgender men). After adjustment for age, race, ethnicity, history of injection drug use, cohort, and calendar year, transgender women were significantly less likely to die than cisgender people. Cisgender women spent more time in care not yet on ART, and less time on ART and virally suppressed, but were less likely to die compared with cisgender men. Other differences were not clinically meaningful.

Conclusions:

In this sample, transgender women and cisgender people spent similar amounts of time in care and virally suppressed. Additional efforts to improve retention in care and viral suppression are needed for all people with HIV, regardless of gender identity.
The Ideal Nasion in Chinese: A Preference Analysis of the General Population
Authors: Liang Xuebing , Sun Sijie , Ma Hengyuan , Gu Tianyi , Guo Haoyue , Zhao Zhao , Wang Keming
Published: July 2022

Augmentation rhinoplasty has gained popularity in China in the past decades and nasion profile is a key variable in aesthetic outcomes. The nasion is the deepest portion of the nasofrontal groove and its aesthetic preferences vary between different ethnic groups. At the time of this writing, there is limited research about ideal nasion measurements in the Chinese population. Therefore, we conducted an online survey of plastic surgeons and the public through social media. Participants were asked to rank nasion images according to their preferences. Images were created from a 3-dimensional scan of a Chinese Han female and modified to show various dimensions of nasion height, position, and forehead height. Nasion preferences were compared by age, sex, ethnicity, occupation, and whether had a history of plastic surgery. There were 777 respondents, including 461 (59.3%) women and 74 (9.5%) plastic surgeons. Nasion height of 8 and 10 mm ranked highest among all demographic groups. All respondents preferred nasion position to be level with the center of the pupil and forehead height of 4 mm above the nasion. Our study showed that the ideal Chinese nasion is in line with baseline ethnic characteristics. Therefore, plastic surgeons must be aware of these nasion preferences to guide preoperative discussions and achieve satisfactory outcomes.
A Novel Tumor Staging System Incorporating Tumor Regression Grade (TRG) With Lymph Node Status (ypN-Category) Results in Better Prognostication Than ypTNM Stage Groups After Neoadjuvant Therapy for Esophageal Squamous Cell Carcinoma
Authors: Wong Ian Y.H. , Chung Jason C.Y. , Zhang Rui Qi , Gao X. , Lam K.O. , Kwong Dora L.W. , Chao Y.K. , Law Simon Y.K.
Published: July 2022

Objective:

This study aims at constructing a staging system incorporating tumor regression grade and ypN-category (TRG-N) in patients with neoadjuvant therapy before esophagectomy. It is hypothesized that this would prognosticate better than the current American Joint Committee on Cancer (AJCC) postneoadjuvant therapy (ypTNM) stage groups.

Background:

Conventional pathological T-category is defined by the depth of invasion, and may lose prognostic relevance after neoadjuvant therapy. TRG defines treatment response by the degree of tumor regression, and when combined with ypN-category may be more prognostic than AJCC postneoadjuvant therapy (ypTNM) stage groups.

Methods:

A training cohort of 210 patients with esophageal squamous cell carcinoma and who had had neoadjuvant therapy before esophagectomy were studied. A validation cohort comprised 107 patients from another hospital. Resected esophagi were assessed by ypT-category and TRG, the latter assigned according to the Becker 4-tier system. These categories were grouped with ypN-category into a TRG-N system. Patients’ survival was compared between the current AJCC postneoadjuvant therapy (ypTNM) stage groups and this TRG-N system.

Results:

In the training cohort, 5-year survival rates according to ypTNM stage I, II, IIIA, IIIB, and IVA were 53%, 39.4%, 47%, 18.3%, and 0%, respectively. For TRG-N stages I, II, III, and IV, the respective figures were 59.6%, 43.5%, 23.8%, and 15.6%. TRG-N stage showed better fit in survival than ypTNM stage groups, indicated by lower Akaike Information Criteria (AIC) and Bayesian Information Criterion values. Similar results were found in the validation cohort. Multivariate analysis showed that TRG-N stage (P=0.02), age (P=0.006), and sex (P=0.005) were independent prognostic factors.

Conclusion:

TRG-N stage shows better prognostication than the AJCC postneoadjuvant therapy (ypTNM) stage groups.
The Value of Single-cell Technologies in Solid Organ Transplantation Studies
Authors: Peereboom Emma T.M. , Matern Benedict M. , Spierings Eric , Geneugelijk Kirsten
Published: July 2022

Single-cell technologies open up new opportunities to explore the behavior of cells at the individual level. For solid organ transplantation, single-cell technologies can provide in-depth insights into the underlying mechanisms of the immunological processes involved in alloimmune responses after transplantation by investigating the role of individual cells in tolerance and rejection. Here, we review the value of single-cell technologies, including cytometry by time-of-flight and single-cell RNA sequencing, in the context of solid organ transplantation research. Various applications of single-cell technologies are addressed, such as the characterization and identification of immune cell subsets involved in rejection or tolerance. In addition, we explore the opportunities for analyzing specific alloreactive T- or B-cell clones by linking phenotype data to T- or B-cell receptor data, and for distinguishing donor- from recipient-derived immune cells. Moreover, we discuss the use of single-cell technologies in biomarker identification and risk stratification, as well as the remaining challenges. Together, this review highlights that single-cell approaches contribute to a better understanding of underlying immunological mechanisms of rejection and tolerance, thereby potentially accelerating the development of new or improved therapies to avoid allograft rejection.
“#LongCOVID affects children too”: A Twitter analysis of healthcare workers’ sentiment and discourse about Long COVID in children and young people in the UK
Authors: Martin Sam , Chepo Macarena , Déom Noémie , Khalid Ahmad Firas , Vindrola-Padros Cecilia
Published: July 2022

Aims

With a social media analysis of the discourse surrounding the prevalence of Long COVID in children and young people (CYP), this study aims to explore healthcare workers’ perceptions concerning Long COVID in CYP in the UK between January 2021 and January 2022. This will allow to contribute to the emerging knowledge on Long COVID and identify critical areas and future directions for researchers and policymakers.

Design

A mixed methods approach with a discourse, keywords, sentiment, and image analysis, using Pulsar™ and Infranodus.

Setting

A discussion of the experience of Long COVID in CYP in the UK shared on Twitter between 1 January 2021 and 31 January 2022.

Participants

A sample of health workers with Twitter accounts whose bio has them identifying themselves as HCWs.

Results

We obtained 2588 tweets. HCW were responsive to announcements issued by authorities regarding the management of COVID-19 in the UK. The most frequent feelings were negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing COVID-19 and Long COVID in CYP, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences.

Conclusions

The perceptions described on Twitter by HCW concerning the presence of Long COVID in CYP appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of Long COVID in CYP.

Strengths and limitations of this study

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Our online analysis of Long COVID contributes towards an emerging understanding of reported experiential, emotional and practical dimensions of Long COVID in CYP specifically, as well as questions of vaccine hesitancy in CYP with Long COVID.

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We identify key policy areas that need considered attention and focus, such as: a) the provision of psychosocial support with access to quality mental health resources to alleviate the impact that Long COVID can have on the mental health of CYP; and b) the development of clear Long COVID pandemic recovery policies that are informed from a health equity perspective and how this affects CYP living with Long COVID.

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This is one of few studies to collect healthcare workers’ perceptions regarding Long COVID in CYP in the UK, using information from Twitter.

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This study is limited to the perception of those who identified as healthcare workers via their online biographies, and so is not representative of the general UK or the global population.
Intracardiac echocardiography guidance for percutaneous transcatheter closure of atrial septal defects: A nationwide registry data analysis
Authors: Tanabe Yasuhiro , Takahara Mitsuyoshi , Kohsaka Shun , Shinke Toshiro , Takamisawa Itaru , Amano Tetsuya , Kanazawa Hideaki , Suzuki Tomomi , Kuwata Shingo , Ishibashi Yuki , Akashi Yoshihiro J , Ikari Yuji
Published: July 2022

The authors have withdrawn their manuscript because they decided to modify their analysis because of how the imaging devices are employed in the real-world practice in Japan. Instead of simply comparing ICE vs. TEE patients, they decided that 3-way comparison comparing patients that underwent ASD closure with ICE alone vs. TEE alone vs Both Modalities is more practical and send clinically useful messages to the practicing physicians. Since it is highly likely that the above analysis will alter subsequent conclusions, the authors decided to withdraw the present version of their manuscript. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
The expression levels of NOS2, HMOX1 and VEGFC in cumulus cells are markers of oocyte maturation and fertilization rate
Authors: Barragán Montserrat , Cornet-Bartolomé David , Molina Natalia , Vassena Rita
Published: July 2022

Purpose

We aim to study whether the expression of genes related to hypoxia and ageing in cumulus cells (CC) is associated to reproductive results in in vitro fertilization cycles.

Methods

Cumulus cells (CC) were collected after ovum pick-up (OPU) from 94 women recruited undergoing controlled ovarian stimulation from 2018 to 2021; total RNA was extracted and reverse transcribed to cDNA using random hexamers. 14 genes affected by ageing in humans, and expressed in CC, were selected for testing. Expression levels of these genes were detected by qPCR and normalized against TATA-box binding protein (TBP) in CC. Expression levels were plotted against woman age, AFC, MII rate at OPU (MR), and fertilization rates (FR) and non-parametric Spearman’s correlation was applied.

Results

From the initial list of 423 candidate genes, we tested 14 genes related to hypoxia response via HIF1alpha activation, oxidative stress response, and angiogenic response. The expression of CLU, NOS2 and TXNIP had a positive correlation with age (rs=0.25, p=0.014; rs=0.31, p=0.0027; and rs=0.24, p=0.03; respectively). Additionally, NOS2 and HMOX1 expression correlated positively with the retrieval of immature oocytes (rs = 0.23228, p = 0.03242; rs = 0.38827, p = 0.01212; respectively). Moreover, VEGFC levels decreased overall with increasing fertilization rate, independently of age (rs=-0.29, p=0.026).

Conclusion

We found that the fertilization potential of a cohort of oocytes is related to the ability of CC to respond to oxidative stress and hypoxia, pointing at NOS2, HMOX1 and VEGFC expression as markers for oocyte maturation and fertilization success.
TIST: Transcriptome and Histopathological Image Integrative Analysis for Spatial Transcriptomics
Authors: Shan Yiran , Zhang Qian , Guo Wenbo , Wu Yanhong , Miao Yuxin , Xin Hongyi , Lian Qiuyu , Gu Jin
Published: July 2022

Sequencing-based spatial transcriptomics (ST) is an emerging technique to study in situ gene expression patterns at the whole-genome scale. In addition to transcriptomic data, the technique usually generates matched histopathological images for the same tissue sample. ST data analysis is complicated by severe technical noise; matched histopathological images with high spatial continuity and resolution introduce complementary cellular phenotypical information and provide a chance to mitigate the noise in ST data. Hence, we propose a novel ST data analysis method called transcriptome and histopathological image integrative analysis for spatial transcriptomics (TIST), which integrates the information from sequencing-based ST data and histopathological images. TIST uses a Markov random field (MRF) model to learn the macroscopic cellular features from histopathological images and devises a random-walk-based strategy to integrate the extracted image features, the transcriptomic features and the location information for spatial cluster (SC) identification and gene expression enhancement. We tested TIST both on simulated datasets and on 33 real datasets; we found that TIST achieved superior performance on multiple tasks, which illustrates the utility of this method in facilitating the discovery of biological insights from sequencing-based ST data.
Top-Down Ion Mobility Separations of Isomeric Proteoforms
Authors: Berthias Francis , Thurman Hayden A. , Wijegunawardena Gayani , Wu Haifan , Shvartsburg Alexandre A. , Jensen Ole N.
Published: July 2022

Continuing advances in proteomics highlight the ubiquity and biological importance of proteoforms - the proteins with varied sequence, splicing, or distribution of post-translational modifications (PTMs). The preeminent example is histones, where the PTM pattern encodes the combinatorial language controlling the DNA transcription central to life. While the proteoforms with distinct PTM compositions are distinguishable by mass, the isomers with permuted PTMs (“localization variants”) commonly coexisting in cells generally require separation before mass-spectrometric (MS) analyses. That was accomplished on the bottom-up and middle-down levels using chromatography or ion mobility spectrometry (IMS), but proteolytic digestion obliterates the crucial PTM connectivity information. Here we demonstrate baseline IMS resolution of intact isomeric proteoforms, specifically the acetylated H4 histones (11.3 kDa). The variants with a single acetyl moiety on five alternative lysine residues (K5, K8, K12, K16, K20) known for distinct functionalities in vivo were constructed by two-step native chemical ligation and separated using trapped IMS at the resolving power up to 350 on the Bruker TIMS/ToF platform. Full resolution for several pairs was confirmed using binary mixtures and by unique fragments in tandem MS employing collision-induced dissociation. This novel capability for top-down proteoform characterization is poised to open major new avenues in proteomics and epigenetics.