bluuebunny/crossref_metadata_2025 huggingface dataset:
Lymphocyte blood levels that remain low can predict the death of patients with COVID-19
Authors: Zhang Hong-Jun , Qi Gang-Qiang , Gu Xing , Zhang Xiao-Yan , Fang Yan-Feng , Jiang Hong , Zhao Yan-Jun
Published: July 2021

The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been rapidly spreading on a global scale and poses a great threat to human health. However, efficient indicators for disease severity have not been fully investigated. Here, we aim to investigate whether dynamic changes of lymphocyte counts can predict the deterioration of patients with COVID-19.

We collected data from 2923 patients with laboratory-confirmed COVID-19. Patients were then screened, and we focused on 145 severe cases and 60 critical cases (29 recovered cases, 31 deaths). The length of hospitalization was divided into five time points, namely admission, 25%, 50%, 75% and discharge or death, according to the principle of interquartile distance. A series of laboratory findings and clinical data were collected and analyzed during hospitalization. The results showed that there were differences in levels of leukocytes, neutrophils and lymphocytes at almost every time point in the severe cases and 60 critical cases (29 recovered cases, 31 deaths). Further analysis showed that 70.2% of the COVID-19 cases had low circulating lymphocyte count, of which 64.1% were severe cases and 85.0% were critical cases (75.9% recovered cases and 93.5% died). Moreover, the lymphocyte count in dead cases was significantly lower than that of critical cases who recovered, at almost every time point in the critical groups. We also divided critical patients into group A (<1.1 × 109/L) and group B (>1.1 × 109/L) according to number of lymphocytes. Through survival analysis, we found that there was no significant difference in survival between group A and group B at admission (P = .3065). However, the survival rate according to lymphocyte levels in group A was significantly lower than that of group B at 25% hospital stay (on average day 6.5), 50% and 75% time points (P < .001).

Lymphocyte counts that remain lower after the first week following symptom onset are highly predictive of in-hospital death of adults with COVID-19. This predictor may help clinicians identify patients with a poor prognosis and may be useful for guiding clinical decision-making at an early stage.
Prognostic signature of ovarian cancer based on 14 tumor microenvironment-related genes
Authors: Nie Xiazi , Song Lina , Li Xiaohua , Wang Yirong , Qu Bo
Published: July 2021

Background:

Ovarian cancer is one of the lethal gynecological diseases in women. However, using tumor microenvironment related genes to identify prognostic signature of ovarian cancer has not been discussed in detail.

Methods:

The mRNA profiles of 386 ovarian cancer patients were retrieved from The Cancer Genome Atlas. Univariate Cox regression and LASSO Cox regression analyses were performed and 14 optimized prognostic genes related to tumor microenvironment were identified.

Results:

The multivariate Cox hazards regression showed risk score was an independent prognostic signature for ovarian cancer. Nomogram model could reliably predict the patients’ survival. Furthermore, M1 macrophages, M2 macrophages, and follicular helper T cells, differentially expressed between the high- and low-risk groups, were found to be associated with the risk score.

Conclusion:

CTL-associated antigen 4 (CTLA4) and indoleamine 2,3-Dioxygenase 1 (IDO1), which were previously shown to be important immune checkpoints, probably contribute to the immunosuppressive microenvironment aberration. This study may shed light on the prognosis of ovarian cancer.
Clinical significance of YAP1 and TAZ in esophageal squamous cell carcinoma
Authors: Liu Li , Lu Ziyang , Hu Xiayun , Su Tianyuan , Su Liping , Pu Hongwei
Published: July 2021

Background

Esophageal cancer is the eighth most frequent and sixth most fatal cancer worldwide. This study aimed to investigate the clinical characteristics and prognostic significance of yes related protein 1 (YAP1) and transcriptional co-activator with PDZ binding motif (TAZ) in patients with esophageal squamous cell carcinoma (ESCC).

Methods

A total of 306 ESCC pathological specimens and adjacent tissues (as control; tissues from the esophageal mucosa >5 cm from the edge of the tumor) were collected between January, 2008 and December, 2018. Immunohistochemical staining was used to assess the expression of YAP1 and TAZ proteins in the ESCC and adjacent tissues, and their relationship with clinicopathological parameters was evaluated using SPSS 21.0 software.

Results

YAP1 and TAZ proteins were highly expressed in ESCC, and their expression was closely related to TNM stage and lymph node metastasis. Expression of YAP1 was associated with tumor size (P = .029), differentiation (P = .000), depth of invasion (P = .001), and TNM stage (P = .000). Expression of TAZ was associated with tumor size (P = .034), differentiation (P = .000), depth of invasion (P = .029), lymph node metastasis (P = .006), and ethnicity (P < .001). The expression of YAP1 protein was positively correlated with the expression of TAZ protein (r = 0.257, P < .05). YAP1 and TAZ expression (P = .039 and .000, respectively), tumor size (P = .041), and lymph node metastasis (P = .001) significantly affected the overall survival of patients with ESCC, and represent independent factors for overall survival.

Conclusion

YAP1 and TAZ proteins are highly expressed in ESCC, and closely related to the clinical and pathological parameters such as the diameter of the tumor, degree of differentiation, and depth of invasion, indicating that YAP1 and TAZ may be involved in the development of ESCC. YAP1 and TAZ may be used as prognostic markers in ESCC.
Coexisting nutcracker phenomenon and superior mesenteric artery syndrome in a patient with IgA nephropathy
Authors: Wang Chenghua , Wang Fengmei , Zhao Bing , Xu Liang , Liu Bing , Guo Qi , Yang Xiaowei , Wang Rong
Published: July 2021

Rationale:

Nutcracker and superior mesenteric artery (SMA) syndrome share the same pathogenesis, but the simultaneous occurrence of both diseases is quite rare. A combination of the nutcracker syndrome and IgA nephropathy has previously been reported. Herein, we report what we believe is the first case of coexisting nutcracker and SMA syndrome in a patient with IgA nephropathy.

Patient concerns:

A 15-year-old Chinese boy who was diagnosed with IgA nephropathy at 8 years of age presented with gross hematuria, fatigue, anorexia, nausea, and recurrent abdominal distension for 1 week without any obvious evidence of preceding infection. Laboratory data showed macroscopic hematuria, heavy proteinuria, and relatively normal renal function. Doppler ultrasonography and upper gastrointestinal gastrografin study were performed, respectively. Since his renal function deteriorated after admission, repeated renal biopsy was performed.

Diagnoses:

IgA nephropathy with nutcracker phenomenon and SMA syndrome.

Intervention:

Immunosuppressive therapy combined with conservative therapy for superior mesenteric artery syndrome.

Outcomes:

One month later, his abdomen symptoms such as anorexia and abdominal distension eased a lot with body weight increase of about 3 kg. After 6 months of follow-up, his body weight increased to 57 kg, serum creatinine decreased to 63 μmol/L, and urine microscopy showed 75.5 RBC/high-power field with 0.3 g urine protein per day.

Lessons:

Although the association between vascular compression and IgA nephropathy (IgAN) has not been elucidated yet, combination of nutcracker syndrome and SMA syndrome should be considered in patients with IgAN. The combination may increase the complexity of the disease, and renal biopsy should not be hesitated for differential diagnosis.
Comparison of postprocedural new-onset atrial fibrillation between transcatheter and surgical aortic valve replacement
Authors: Ding Yongmin , Wan Minmin , Zhang Hemei , Wang Chunyu , Dai Zhuoyu
Published: July 2021

Background:

Presently, transcatheter aortic valve replacement (TAVR) as an effective and convenient intervention has been adopted extensively for patients with severe aortic disease. However, after surgical aortic valve replacement (SAVR) and TAVR, the incidence of new-onset atrial fibrillation (NOAF) is prevalently found. This meta-analysis was designed to comprehensively compare the incidence of NOAF at different times after TAVR and SAVR for patients with severe aortic disease.

Methods:

A systematic search of PubMed, Embase, Cochrane Library, and Web of Science up to October 1, 2020 was conducted for relevant studies that comparing TAVR and SAVR in the treatment of severe aortic disease. The primary outcomes were the incidence of NOAF with early, midterm and long term follow-up. The secondary outcomes included permanent pacemaker (PM) implantation, myocardial infarction (MI), cardiogenic shock, as well as mortality and other complications. Two reviewers assessed trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2.

Results:

A total of 16 studies including 13,310 patients were identified. The pooled results indicated that, compared with SAVR, TAVR experienced a significantly lower incidence of 30-day/in-hospital, 1-year, 2-year, and 5-year NOAF, with pooled risk ratios (RRs) of 0.31 (95% confidence interval [CI] 0.23–0.41; 5725 pts), 0.30 (95% CI 0.24–0.39; 6321 pts), 0.48 (95% CI 0.38–0.61; 3441 pts), and 0.45 (95% CI 0.37–0.55; 2268 pts) respectively. In addition, TAVR showed lower incidence of MI (RR 0.62; 95% CI 0.40–0.97) and cardiogenic shock (RR 0.34; 95% CI 0.19–0.59), but higher incidence of permanent PM (RR 3.16; 95% CI 1.61–6.21) and major vascular complications (RR 2.22; 95% CI 1.14–4.32) at 30-day/in-hospital. At 1- and 2-year after procedure, compared with SAVR, TAVR experienced a significantly higher incidence of neurological events, transient ischemic attacks (TIA), permanent PM, and major vascular complications, respectively. At 5-year after procedure, compared with SAVR, TAVR experienced a significantly higher incidence of TIA and re-intervention respectively. There was no difference in 30-day, 1-year, 2-year, and 5-year all-cause or cardiovascular mortality as well as stroke between TAVR and SAVR.

Conclusions:

Our analysis showed that TAVR was superior to SAVR in decreasing the both short and long term postprocedural NOAF. TAVR was equal to SAVR in early, midterm and long term mortality. In addition, TAVR showed lower incidence of 30-day/in-hospital MI and cardiogenic shock after procedure. However, pooled results showed that TAVR was inferior to SAVR in reducing permanent pacemaker implantation, neurological events, TIA, major vascular complications, and re-intervention.
Efficacy and safety of tacrolimus monotherapy versus cyclophosphamide–corticosteroid combination therapy for idiopathic membranous nephropathy
Authors: Gong Lifeng , Xu Min , Xu Wei , Tang Weigang , Lu Jingkui , Jiang Wei , Xie Fengyan , Ding Liping , Qian Xiaoli
Published: July 2021

Objective

The objective of this meta-analysis was to compare the efficacy and safety of tacrolimus (TAC) monotherapy versus cyclophosphamide (CTX)-corticosteroid combination therapy in idiopathic membranous nephropathy (IMN) patients.

Methods

Databases including the PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched from inception to October 20, 2020. Eligible studies comparing TAC monotherapy and CTX-corticosteroid combination therapy in IMN patients were included. Data were analyzed using Review Manager Version 5.3.

Results

Nine studies were included in the meta-analysis. One randomized controlled trial and eight cohort studies involving 442 patients were identified. Compared with CTX-corticosteroid combination therapy for IMN, TAC monotherapy had higher complete remission (CR) at month 6 (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.35–3.50, P < .01). The 2 therapeutic regimens had similar partial remission (OR 0.69, 95% CI 0.45–1.04, P = .08), total remission (OR 1.38, 95% CI 0.85–2.23, P = 0.19) at month 6, and similar CR (OR 1.64, 95% CI 0.84–3.19, P = .15), partial remission (OR 0.71, 95% CI 0.37–1.38, P = 0.31), and total remission (OR 1.29, 95% CI 0.55–3.01, P = .56) after 1 year. The relapse rate of the TAC group was higher than that of the CTX group, but the difference was not statistically significant (OR 1.85, 95% CI 0.75–4.53, P = .18). There was no difference between the 2 therapeutic regimens concerning glucose intolerance (OR 1.15, 95% CI 0.61–2.14, P = .67), acute renal failure (OR 1.14, 95% CI 0.39–3.33, P = .81), or tremors (OR 4.39, 95% CI 0.75–25.67, P = .10). Incidences of gastrointestinal symptoms (OR 0.29, 95% CI 0.10–0.79, P = .02), infection (OR 0.18, 95% CI 0.08–0.39, P < 0.01), leukopenia (OR 0.14, 95% CI 0.04–0.51, P < .01), and abnormal aminotransferase (OR 0.31, 95% CI 0.13–0.77, P = .01) in the TAC group were all lower than those in the CTX group. Subgroup analysis showed that there was no significant difference between the TAC group and the CTX combined with corticosteroid 0.8 to 1 mg/kg/day group concerning CR at month 6 (P > .05). There was no significant difference between the TAC group and the CTX combined with corticosteroid 0.5 mg/kg/day group concerning abnormal aminotransferase (P > .05).

Conclusion

TAC monotherapy is comparable to CTX-corticosteroid combination therapy for renal remission in IMN patients. TAC monotherapy had a higher CR in the early stage and had fewer drug-related adverse effects. The relapse rate of TAC monotherapy was higher than that of CTX-corticosteroid combination therapy, but the difference was not significant.
Effects of dynamic response to coronavirus disease outbreak in a regional emergency medical center
Authors: Oh Ye Jin , Kim Gyun Moo , Ko Seung Hyun , Seo Young Woo , Lee Suk Hee , Jang Tae Chang
Published: July 2021

Emergency departments (EDs) are on the frontline of the coronavirus disease (COVID-19) outbreak. To resolve the abrupt overloading of COVID-19–suspected patients in a community, each ED needs to respond in various ways. In our hospital, we increased the isolation beds through temporary remodeling and by performing in-hospital COVID-19 polymerase chain reaction testing rather than outsourcing them. The aim of this study was to verify the effects of our response to the newly developed viral outbreak.

The medical records of patients who presented to an ED were analyzed retrospectively. We divided the study period into 3: pre-COVID-19, transition period of response (the period before fully implementing the response measures), and post-response (the period after complete response). We compared the parameters of the National Emergency Department Information System and information about isolation and COVID-19.

The number of daily ED patients was 86.8 ± 15.4 in the pre-COVID-19, 36.3 ± 13.6 in the transition period, and 67.2 ± 10.0 in the post-response period (P < .001). The lengths of stay in the ED were significantly higher in transition period than in the other periods [pre-COVID-19 period, 219.0 (121.0–378.0) min; transition period, 301 (150.0–766.5) min; post-response period, 281.0 (114.0–575.0) min; P < .001]. The ratios of use of an isolation room and fever (≥37.5°C) were highest in the post-response period [use of isolation room: pre-COVID-19 period, 0.6 (0.7%); transition period, 1.2 (3.3%); post-response period, 16.1 (24.0%); P < .001; fever: pre-COVID-19 period, 14.8(17.3%); transition period, 6.8 (19.1%); post-response period, 14.5 (21.9%), P < .001].

During an outbreak of a novel infectious disease, increasing the number of isolation rooms in the ED and applying a rapid confirmation test would enable the accommodation of more suspected patients, which could help reduce the risk posed to the community and thus prevent strain on the local emergency medical system.
Self-efficacy remains a vital factor in reducing the risk of dialysis in type 2 diabetes care
Authors: Liao Kuomeng , Lin Kuan-Chia , Chiou Shang-Jyh
Published: July 2021

Studies have provided promising outcomes of the pay-for-performance (P4P) program or with good continuity of care levels in diabetes control.

We investigate the different exposures in continuity of care (COC) with their providers and those who participate in the P4P program and its effects on the risk of diabetes diabetic nephropathy in the future.

We obtained COC and P4P information from the annual database, to which we applied a hierarchical linear modeling (HLM) in 3 levels adjusted to account for other covariates as well as the effects of hospital clustering and accumulating time.

Newly diagnosed type 2 diabetes in 2003

At the individual level, those with a higher Diabetes Complications Severity Index (DCSI) score have a higher likelihood of diabetic nephropathy than those with a lower DCSI (OR, 1.46), whereas contrasting results were obtained for the Charlson Comorbidity Index (CCI) (odds ratio[OR], 0.88). Patients who visited family physicians, endocrinologists, and gastroenterologists showed a lower likelihood of diabetic nephropathy (OR, 0.664, 0.683, and 0.641, respectively), whereas those who continued to visit neurologists showed an increased risk of diabetic nephropathy by 4 folds. At the hospital level, patients with diabetes visiting primary care clinics had a lower risk of diabetic nephropathy with an OR of 0.584 than those visiting hospitals of other higher levels. Regarding the repeat time level, the patients who had a higher COC score and participated in the P4P program had a reduced diabetic nephropathy risk with an OR of 0.339 and 0.775, respectively.

Diabetes control necessitates long-term care involving the patients’ healthcare providers for the management of their conditions to reduce the risk of diabetic nephropathy. Indeed, most contributing factors are related to patients, but we cannot eliminate the optimal outcomes related to good relationships with healthcare providers and participation in the P4P program.
Acute HIV infection with presentations mimicking acalculous cholecystitis
Authors: Liu Wang-Da , Cheng Chih-Ning , Lin Ya-Ting , Kuo Ching-Hua , Ho Shu-Yuan , Hung Chien-Ching
Published: July 2021

Rationale:

Acute retroviral syndrome is the symptomatic presentation of acute human immunodeficiency virus (HIV) infection, which often manifests as a self-limited infectious mononucleosis-like syndrome and occurs 2 to 6 weeks after exposure to HIV. Atypical manifestations including hepatitis, meningitis, or hemophagocytic lymphohistiocytosis have been reported. However, manifestations of acute acalculous cholecystitis during acute HIV infection are rarely reported.

Patient concerns:

A 30-year-old man with nausea and loose stools, followed by fever and abdominal pain at the right upper quadrant for 10 days.

Diagnosis:

Acute retroviral syndrome, complicated with acute acalculous cholecystitis.

Interventions:

Percutaneous transhepatic gallbladder drainage was performed and treatment with co-formulated bictegravir/emtricitabine/tenofovir alafenamide was initiated upon HIV diagnosis.

Outcomes:

The patient's symptoms improved after the drainage. The levels of liver enzyme including aspartate transaminase alanine aminotransferase decreased to a level within normal limits 1 month after initiation of antiretroviral therapy.

Conclusion:

Acalculous cholecystitis in combination with acute hepatitis could be manifestations of acute HIV infection. For individuals at risk of acquiring HIV infection who present with manifestations of acute acalculous cholecystitis, HIV testing should be considered.
Laparoscopic ureterolithotomy and retrograde flexible ureteroscopy-assisted transperitoneal laparoscopic ureteroureterostomy for a huge ureteropelvic junction stone and multiple small renal stones
Authors: Chou Sheng-Feng , Hsieh Po-Fan , Lin Wei-Ching , Huang Chi-Ping
Published: July 2021

Rationale:

Concurrent kidney and ureteral stones are always complicated and a clinical challenge. Improvements in endoscopic equipment have led to the widespread adoption of retrograde intrarenal surgery, which has a good stone clearance rate. On the other hand, laparoscopic ureterolithotomy (LUL) has been reported to be non-inferior to retrograde flexible ureteroscopy in stone-free rate and the need for axillary procedures, and to have a significantly lower rate of post-operative sepsis compared to retrograde flexible ureteroscopy. We describe a case managed with LUL followed by laparoscope-assisted retrograde intrarenal surgery (LA-RIRS) in a single operation for a large upper ureteral stone and small renal stones, which is usually challenging and requires axillary procedures.

Patient concerns:

The patient was a 66-year-old male with underlying hypertension and diabetes mellitus. He reported severe flank pain after receiving endoscopic management of concurrent right ureteropelvic junction stone and multiple renal stones about 1 month previously.

Diagnosis:

The residual stones were reassessed using non-contrast computed tomography before surgery. A 2.8-cm residual ureteropelvic junction stone and multiple renal stones with a maximum length of 1 cm were found. A second operation was considered to be necessary due to the deterioration of his renal function and refractory flank pain.

Interventions:

We performed LUL followed by LA-RIRS. Two surgeries were completed in a single operation. The Jackson–Pratt drain was removed 3 days after the operation.

Outcomes:

After the surgery, no high-grade complications were recorded according to the Clavien Dindo classification. A follow-up kidney, ureter, and bladder radiograph performed 2 months after the operation revealed no residual stones. Renal echo revealed no obstructive nephropathy 1 month after double-J catheter removal.

Conclusion:

LUL with LA-RIRS with a stone basket for renal stone extraction is a safe and feasible technique, and no step surgery or axillary procedures were needed in our case. If clinical cases with a huge stone burden over the ureter are indicated for LUL with concurrent small renal stones, LUL with LA-RIRS can be an alternative option.
Image-guided, intensity-modulated radiotherapy for the treatment of diffuse-type tenosynovial giant cell tumor of the knee
Authors: Xiang Xiaoyong , Jiang Wei , Qiu Chunyan , Xiao Nanjie , Liang Jun
Published: July 2021

Rationale:

Tenosynovial giant cell tumor (TGCT) is a neoplastic, inflammatory disease with a benign but aggressive course that often presents as localized (TGCT-L) and diffuse (TGCT-D) forms based on the growth pattern and clinical behavior. For TGCT-L, simple excision of the diseased synovial tissue is the preferred treatment option, while for TGCT-D, adequate synovectomy is usually tricky but is essential. However, approximately 44% of TGCT-D cases will relapse after surgery alone. Thus, the optimal treatment strategy in patients with TGCT-D is evolving, and standalone surgical resection can no longer be regarded as the only treatment. The previous studies have shown that postoperative adjuvant radiotherapy can reduce recurrence in TGCT, especially in patients with incomplete synovectomy.

Patient concerns:

In the first case, a 54-year-old male presented with recurrent pain and swelling of the right knee with a protracted disease course (≥10 years). The other patient is a 64-year-old male who developed swelling, pain, abnormal bending, and limited movement of the left knee without obvious inducement.

Diagnoses:

Clinical and imaging examinations can provide a definitive diagnosis, and pathology is the gold standard. TGCT-D was confirmed by postoperative pathology. After the operation, the patients underwent an MRI re-examination and showed that the lesions of the knee were not completely resected.

Interventions:

Arthroscopic synovectomy was performed on the patients, and postoperative pathology was confirmed as TGCT-D. Because of incomplete synovectomy, the 2 cases received image-guided, intensity-modulated radiotherapy (IG-IMRT) after the operation.

Outcomes:

The follow-up time was 1 year, no evidence of disease progression was found in MRI. No obvious adverse effects associated with radiotherapy were detected during the follow-up period.

Lessons:

These cases and reviews illustrate the necessity of radiotherapy for TGCT-D and that IG-IMRT is a safe and effective method for treating TGCT-D of the knee.
Surgical Site Infection After Autologous Cranioplasty for Decompressive Craniectomy in Traumatic Brain Injury: A Retrospective Review of Two Level 1 Trauma Centers
Authors: Caruso James P. , Griffin Samuel , El Ahmadieh Tarek Y. , Bedros Nicole M. , Hoeft Jennifer , Urquiaga Jorge F. , Pernik Mark N. , Hoes Kathryn , Patel Ankur R. , Funk Robert H. , Davies Matthew T. , Vance Awais Z. , Adogwa Owoicho , Barnett Samuel L. , Bagley Carlos A. , Batjer Henry H. , Coppens Jeroen , El Tecle Najib , Aoun Salah G.
Published: July 2021

Object:

Surgical site infection (SSI) after cranioplasty can result in unnecessary morbidity. This analysis was designed to determine the risk factors of SSI after cranioplasty in patients who received a decompressive craniectomy with the autologous bone for traumatic brain injury (TBI).

Methods:

A retrospective review was performed at two level 1 academic trauma centers for adult patients who underwent autologous cranioplasty after prior decompressive craniectomy for TBI. Demographic and procedural variables were collected and analyzed for associations with an increased incidence of surgical site infection with two-sample independent t tests and Mann Whitney U tests, and with a Bonferroni correction applied in cases of multiple comparisons. Statistical significance was reported with a P value of < 0.05.

Results:

A total of 71 patients were identified. The mean interval from craniectomy to cranioplasty was 99 days (7–283), and 3 patients developed SSIs after cranioplasty (4.2%). Postoperative drain placement (P > 0.08) and administration of intrawound vancomycin powder (P = 0.99) were not predictive of infection risk. However, a trend was observed suggesting that administration of prophylactic preoperative IV vancomycin is associated with a reduced infection rate.

Conclusions:

The SSI rate after autologous cranioplasty in TBI patients is lower than previously reported for heterogeneous groups and indications, and the infection risk is comparable to other elective neurosurgical procedures. As such, the authors recommend attempting to preserve native skull and perform autologous cranioplasty in this population whenever possible.
Local Soft Tissue and Bone Displacements Following Midfacial Bipartition Distraction in Apert Syndrome – Quantification Using a Semi-Automated Method
Authors: van de Lande Lara S. , O'Sullivan Eimear , Knoops Paul G.M. , Papaioannou Athanasios , Ong Juling , James Greg , Jeelani N. Owase , Schievano Silvia , Dunaway David J.
Published: July 2021

Patients with Apert syndrome experience midfacial hypoplasia, hypertelorism, and downslanting palpebral fissures which can be corrected by midfacial bipartition distraction with rigid external distraction device. Quantitative studies typically focus on quantifying rigid advancement and rotation postdistraction, but intrinsic shape changes of bone and soft tissue remain unknown. This study presents a method to quantify these changes. Pre- and post-operative computed tomography scans from patients with Apert syndrome undergoing midfacial bipartition distraction with rigid external distraction device were collected. Digital Imaging and Communications in Medicine files were converted to three-dimensional bone and soft tissue reconstructions. Postoperative reconstructions were aligned on the preoperative maxilla, followed by nonrigid iterative closest point transformation to determine local shape changes. Anatomical point-to-point displacements were calculated and visualized using a heatmap and arrow map. Nine patients were included.

Zygomatic arches and frontal bone demonstrated the largest changes. Mid-lateral to supra-orbital rim showed an upward, inward motion. Mean bone displacements ranged from 3.3 to 12.8 mm. Soft tissue displacements were relatively smaller, with greatest changes at the lateral canthi. Midfacial bipartition distraction with rigid external distraction device results in upward, inward rotation of the orbits, upward rotation of the zygomatic arch, and relative posterior motion of the frontal bone. Local movements were successfully quantified using a novel method, which can be applied to other surgical techniques/syndromes.
A Rare Ocular Complication of Autologous Fat Injection: Subconjunctival Fat Infiltration
Authors: Vatansever Mustafa , Dursun Özer , Özer Ömer , Oktay Özgün , Dinç Erdem
Published: July 2021

The aim of this brief clinical study to describe and discuss the subconjunctival fat infiltration encountered in a patient with autologous fat injection. A 50-year-old female patient, who had an autologous fat injection 2 days ago, applied to our clinic with the complaint of redness and burning in the left eye. On anterior segment examination, a raised 20 × 15 mm adipose tissue was observed in the temporal region under the conjunctiva. Infiltrated fat tissue was surgically removed from the subconjunctival area. Subconjunctival fat infiltration is an extremely rare complication after autologous fat injection.
A Bibliometric Keyword and Term Analysis of the Articles Published in the Journal of Craniofacial Surgery Between 1995 and 2020
Authors: Bahşi Ayşe , Tekin Ahmet Mahmut , Bahşi Ilhan
Published: July 2021

The aim of this study is to analyze the terms in the abstract section and keywords of articles published in the Journal of Craniofacial Surgery (J Craniofac Surg) bibliometrically. Using the advanced search section in the Web of Science database on February 26, 2021, all articles published in the J Craniofac Surg from 1995 to 2020 were listed. All records of the detected 11,888 articles were exported and both terms in the abstract and keywords used in the articles were determined through the VOSviewer (version 1.6.16) software. It was found that the 10 most common terms in the abstract were patient (n: 6820), study (n: 4729), surgery (n: 3422), case (n: 3230), year (n: 2585), treatment (n: 2430), author (n: 2303) complication (n: 2150), month (n: 2061), and technique (n: 2002), respectively. It was found that the 10 most common keywords were craniosynostosis (n: 408), distraction osteogenesis (n: 257), orthognathic surgery (n: 243), mandible (n: 225), cleft palate (n: 214), reconstruction (n: 206), surgery (n: 157), cranioplasty (n: 150), cleft lip (n: 133), and computed tomography (n: 132), respectively. To the best of our knowledge, the current study is the first bibliometric keyword and term analysis in the field of craniofacial surgery. This study will enable us to have an idea about the past and current trends and the visibility of the articles published in the J Craniofac Surg.
Comparing Load-Sharing Miniplate and Load-Bearing Plate Fixation in Atrophic Edentulous Mandibular Fractures: A Systematic Review and Meta-Analysis
Authors: Seu Michelle , Jazayeri Hossein E. , Lopez Joseph , Khavanin Nima , Lake Isabel V. , Phillips Sarah , Reategui Alvaro , Shamliyan Tatyana , Peacock Zachary S. , Dorafshar Amir H.
Published: July 2021

Purpose:

To critically examine reported data to compare patient outcomes between load-sharing and load-bearing plate fixation for edentulous mandibular fractures.

Materials and Methods:

A systematic review and meta-analysis were designed to test the null hypothesis of no difference in postoperative outcomes between load-sharing and load-bearing plate fixation in atrophic, edentulous mandibular fractures. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried up until July 2016. The quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation method.

Results:

A total of 1212 studies were screened for inclusion of which we included 1 high-quality Cochrane review, 6 narrative reviews, and 21 publications of case reports and case series. Overall, the quality of evidence was low. No difference was found between load-bearing and load-sharing fixation in functional recovery, nonunion, or infection. An uncontrolled case series portrayed complete functional and morphological restoration in 96.9% of patients (83.2–99.5; 95% confidence interval) in load-bearing osteosynthesis while another demonstrated the same outcome in only 40.0% of patients (17.5–65.0; 95% confidence interval).

Conclusions:

The authors did not find a statistically significant difference between load-bearing and load-sharing plate fixation in edentulous atrophic mandibular fracture patients; although this finding may be influenced by type 2 statistical error. Surgeons should continue to use their best clinical judgment in deciding on treatment approach for these challenging fractures. Future studies with higher level evidence are necessary to guide optimal fracture management.
Velopharyngeal Insufficiency in Craniofacial Microsomia: Prevalence, Diagnosis, and Treatment
Authors: Chan Candace H. , Hu Allison C. , Jain Nirbhay S. , Dang Brian N. , Liu Mengyuan T. , Bertrand Anthony A. , Wilson Libby F. , Lee Justine C.
Published: July 2021

The purpose of this study was to analyze the prevalence, diagnosis, and management of velopharyngeal insufficiency (VPI) in patients with craniofacial microsomia (CFM).

Craniofacial microsomia patients 13 years of age and above treated at 2 centers from 1997 to 2019 were reviewed retrospectively for demographics, prevalence of VPI, and management of VPI. Patients with isolated microtia were excluded. Comparisons were made between patients with and without VPI using chi-square and independent samples t tests.

Among 68 patients with CFM (63.2% male, mean 20.7 years of age), VPI was diagnosed in 19 patients (27.9%) at an average age of 7.2 years old. Among the total cohort, 61 patients had isolated CFM, of which 12 (19.6%) were diagnosed with VPI. Of the patients with isolated CFM and VPI, 8 patients (66.7%) were recommended for nasoendoscopy, of which only 2 patients completed. Seven isolated CFM patients (58.3%) underwent speech therapy, whereas none received VPI surgery. In contrast, 7 patients were diagnosed with both CFM and cleft lip and/or palate (CL/P), all of whom had VPI and were recommended for nasoendoscopy, with 5 (71.4%) completing nasoendoscopy, 6 (85.7%) undergoing speech therapy, and 6 (85.7%) undergoing corrective VPI surgery. Overall, we demonstrated that VPI was present in 27.9% of all CFM patients. On subset analysis, VPI was diagnosed in 20% of patients with isolated CFM and 100% of patients with CFM and CL/P. In addition, despite clinical diagnosis of VPI, a sizeable proportion of isolated CFM patients did not undergo therapy or surgical interventions.
The Second Free Tissue Transfer After the First Free Flap Loss for a Complex Scalp Reconstruction: Our Strategy to Success With a Staged Approach
Authors: Song Ping , Jaiswal Rohit , Pu Lee L.Q.
Published: July 2021

Scalp reconstruction for a critical neurosurgical patient, as lifesaving efforts continued, can be challenging and a free tissue transfer is often needed to achieve reliable soft tissue coverage. However, the patient's labile perioperative condition may compromise successful reconstruction and perioperative hypotension is one of the major known factors for the failure of free tissue transfer. In this report, the authors encountered such an instance, and present our strategy in overcoming this hurdle toward obtaining successful scalp reconstruction with second free tissue transfer after the first free flap loss. After optimizing the patient's medical condition, the second free tissue transfer was performed in 2 stages with recipient vessel dissection during the first stage and the flap harvest and microvascular anastomoses during the second stage. Our staged approach is warranted to ensure the patient can tolerate the stressor of general anesthesia and to precondition the patient for ultimate successful second free tissue transfer.
Suturectomies Assisted by Cranial Orthosis Remodeling for the Treatment of Craniosynostosis Can Be Performed Without an Endoscope
Authors: Olshinka Asaf , Har-Shai Lior , Novitski Ivan , Lev Sapir , Ad-El Dean D. , Kershenovich Amir
Published: July 2021

Background:

Minimally-invasive endoscopic strip-craniectomy (or suturectomy) for the repair of craniosynostosis combined with postoperative cranial orthotic molding has been widely adopted in the past 2 decades, proving itself as a safe and effective procedure. Over time the authors transitioned from performing an endoscopic strip-craniectomy, to performing the same surgery without the endoscope. The authors here describe our technique and compare its results to those published in the literature for endoscopic suturectomies.

Methods:

A retrospective chart review was performed for patients with nonsyndromic craniosynostosis who underwent minimally-invasive nonendoscopic suturectomy between 2019 and 2020 at our institution.

Results:

Thirteen patients (11 males; 2 females) were operated including 5 Metopic, 5 Sagittal, 2 coronal, and 1 lambdoid craniosynostosis. The average age at surgery was 4.35 months. The average length of surgery was 71 minutes. Averaged intraoperative estimated blood loss was 31.54 mL. Eleven patients received a blood transfusion (most before performing the skin incision) with a mean amount of 94.62 mL of blood transfused during surgery. The mean hemoglobin at discharge was 10.38 mg/dL. There was only 1 intraoperative mild complication. The mean intrahospital length of stay was 1.77 days with no postoperative complications noted. All patients initiated remodeling orthotic treatment following surgery. Long-term follow-up scans were available for 8 patients (5 metopic, 2 sagittal, and 1 lambdoid) with an average follow-up of 9 months. In all cases, there was a significant improvement in the skull width at the synostosis location as well as in the skull proportions and symmetry. The above outcomes are similar to those published in the literature for endoscope-assisted strip-craniectomies.

Conclusions:

Suturectomies assisted with cranial orthosis remodeling for the treatment of all types of nonsyndromic craniosynostosis can be performed without an endoscope while maintaining minimal-invasiveness, good surgical results, and low complication rates.
#facialtraumasurgery: Educational Content of Instagram as a Social Media Source for Facial Trauma Surgery
Authors: Lentzen Max-Philipp , Trojtza Sonja , Zinser Max , Kreppel Matthias , Zoeller Joachim E. , Zirk Matthias
Published: July 2021

With an uprising influence of social media platforms like Instagram during the last decade, medical and healthcare related posts have accumulated majorly. In particular the head and face characterizes and signifies each individual's human character, which may be the reason why numerous posts are shared on social media platforms. The purpose of this investigation was to assess the content associated with facial trauma surgery and evaluate its educational quality.

The authors performed a retrospective investigation on 550 Instagram posts by #facialtraumasurgery due to number of “likes,” comments, type of post, language, its purpose, and source. Furthermore, posts were evaluated due to their educational quality by 3 examiners of different educational levels.

The majority of posts showed 0 to 50 “likes” and 0 to 5 comments in English language. The major post type were single photographs (289; 52.5%), multiple photographs (188; 34.2%), videos (73; 13.3%) and predominantly case reports (233; 42.4%). The source was 322 (58.5%) posts by surgeons, followed by 185 (33.6%) clinic posts. Only 10% to 18% of the posts were rated “excellent.” Interrater reliability between all 3 examiners presented a high concordance with 89% (P = 0.000).

Our study presents an analysis of quantity and quality of social media content according to facial trauma surgery. It supports the deduction that most of the content on Instagram is shared by patients and unclear sources and thus is limited informative. Nevertheless, influence of social media on medical information is increasing and practitioners have to face its effect on their patients.
Out of “Site”: Low Utilization of the American Urogynecologic Society’s Online Patient Resources in an Observational Study Using Website Analytics
Authors: Bennett Alaina T. , Gregory W. Thomas , Boniface Emily R. , Cichowski Sara B.
Published: July 2021

Objectives

The aims of the study were to estimate utilization of the American Urogynecologic Society’s patient education website, VoicesForPFD.org, by women with pelvic floor disorders (PFDs), to describe users over time and how they found the site, and to evaluate use of content areas of the site.

Methods

Website metrics were extracted from Google Analytics during 2013-2019 for VoicesForPFD.org. Data included number and geography of users, source of user arrival (for example search engine, social media, advertisement), and web pages viewed. Utilization was calculated by dividing the number of website users by the estimated number of women with symptomatic PFDs in the same year from previously published prevalence estimates and U.S. Census population data. The number of page views were extracted for each web page from 2017 to 2019 to describe content use. Descriptive analyses are presented.

Results

VoicesForPFD.org had 1,382,287 users during 2013–2019, predominantly in the United States. Nationally, there were 5.3 VoicesForPFD.org users for every 1,000 women with symptomatic PFDs in 2018. Users arrived primarily through organic search and advertisements; less than 1% of users arrived via social media. The pelvic organ prolapse section of VoicesForPFD.org was the most highly viewed content with 670,550 page views in 2017–2019. In the same years, the site’s pages on pelvic mesh had only 21,249 page views despite high media visibility on the subject.

Conclusions

Utilization of VoicesForPFD.org by U.S. women with symptomatic PFDs is very low. More research is needed on methods to engage women online and through social media to provide them with high-quality PFD treatment information.
Risk Factors for Urinary Retention After Colpocleisis
Authors: DiCarlo-Meacham Angela , Dengler Katherine , Welch Eva , Hamade Sara , Horbach Nicolette , Welgoss Jeffrey , Mazloomdoost Donna , Sheridan Michael , von Pechmann Walter
Published: July 2021

Objectives

Transient urinary retention occurs frequently after pelvic organ prolapse surgery. While the prevalence of postoperative urinary retention has been reported for reconstructive procedures, a paucity of data exists for colpocleisis. The objectives of this retrospective cohort study were to identify risk factors for transient urinary retention after colpocleisis and to determine the rate of its occurrence.

Methods

A retrospective chart review was performed for patients undergoing colpocleisis from January 2015 to December 2019 in a high-volume urogynecology practice. Patients were excluded if they required prolonged catheterization postoperatively because of a surgical complication or used a catheter before surgery, or if a suprapubic catheter was placed during surgery. Potential patient and procedural risk factors were analyzed. Transient urinary retention was diagnosed if patients failed their postoperative voiding trial and went home with a catheter.

Results

A total of 172 patients met the inclusion criteria. The incidence of transient postoperative urinary retention was 55%, with rates of 36.7% with LeFort colpocleisis, 51.5% with posthysterectomy colpocleisis, and 64.9% with colpocleisis with concomitant hysterectomy. Logistic regression revealed an increased risk of postoperative urinary retention if hysterectomy was performed at the time of colpocleisis (odds ratio, 2.9; confidence interval, 1.23–6.84; P = 0.015). Patient age, prolapse severity, preoperative postvoid residual volume, and concomitant anti-incontinence procedure were not associated with transient postoperative urinary retention.

Conclusions

Transient urinary retention occurs in more than half of patients after colpocleisis. Patients undergoing concomitant hysterectomy have the highest risk of postoperative urinary retention. Surgeons can use this information both for counseling and management decisions for individual patients.
How to Deal With Kidney Retransplantation—Second, Third, Fourth, and Beyond
Authors: Sageshima Junichiro , Chandar Jayanthi , Chen Linda J. , Shah Rushi , Al Nuss Ammar , Vincenzi Paolo , Morsi Mahmoud , Figueiro Jose , Vianna Rodrigo , Ciancio Gaetano , Burke George W.
Published: July 2021

Kidney transplantation is the best health option for patients with end-stage kidney disease. Ideally, a kidney transplant would last for the lifetime of each recipient. However, depending on the age of the recipient and details of the kidney transplant, there may be a need for a second, third, fourth, or even more kidney transplants. In this overview, the outcome of multiple kidney transplants for an individual is presented. Key issues include surgical approach and immunologic concerns. Included in the surgical approach is an analysis of transplant nephrectomy, with indications, timing, and immunologic impact. Allograft thrombosis, whether related to donor or recipient factors merits investigation to prevent it from happening again. Other posttransplant events such as rejection, viral illness (polyomavirus hominis type I), recurrent disease (focal segmental glomerulosclerosis), and posttransplant lymphoproliferative disease may lead to the need for retransplantation. The pediatric recipient is especially likely to need a subsequent kidney transplant. Finally, noncompliance/nonadherence can affect both adults and children. Innovative approaches may reduce the need for retransplantation in the future.
Humoral Response of Renal Transplant Recipients to the BNT162b2 SARS-CoV-2 mRNA Vaccine Using Both RBD IgG and Neutralizing Antibodies
Authors: Hod Tammy , Ben-David Aharon , Olmer Liraz , Levy Itzchak , Ghinea Ronen , Mor Eytan , Lustig Yaniv , Rahav Galia
Published: July 2021

Background.

Data about SARS-CoV-2 vaccines efficacy in renal transplant recipients (RTR) are lacking.

Methods.

To reveal predictors for humoral response to BNT162b2 vaccine among RTR, patients were divided into positive (N = 42) and negative (N = 78) response groups based on receptor-binding domain (RBD) immunoglobulin G (IgG) ≥1.1 and neutralizing antibodies (NA) ≥16 dilution versus RBD IgG <1.1 or NA <16, respectively. NA were detected using a SARS-CoV-2 pseudo-virus.

Results.

NA were detected in only 42 of 120 (35%) of RTR versus 197 of 202 (97.5%) immunocompetent controls (P < 0.001). NA geometric mean titers in RTR were significantly lower versus the control group {83.7 (95% confidence interval [CI], 50.5-138.8) versus 482 (95% CI, 411-566), P < 0.001}. In a multivariable analysis, mycophenolic acid (MPA) dose and hemoglobin level were found to be independent predictors for antibody response in RTR. A positive response rate of 27% versus 63% was observed in patients on and off MPA, respectively. An increase in MPA dose by 1 mg/kg weight reduced the odds for a positive response by 17% (odds ratio = 0.83; 95% CI, 0.75-0.92; P < 0.001). Geometric mean titers for RBD IgG were significantly reduced as MPA daily dose increased. Hemoglobin blood level <13 g/dL reduced the antibody response by 63% (P = 0.04). Pain at the injection site after the second vaccine dose was significantly higher in the responders versus nonresponders (20.5% versus 5.5%, P = 0.01).

Conclusions.

Only 35% of RTR develop NA to the BNT162b2 mRNA vaccine. MPA is a major suppressor of antibody response in RTR.