bluuebunny/crossref_metadata_2025 huggingface dataset:
#6688 HEMODIALYSIS CATHETER-RELATED RIGHT ATRIAL THROMBOSIS AND PULMONARY EMBOLISM: ANTICOAGULANT THERAPY MAY NOT BE REQUIRED
Authors: Cui Tian-Lei , Li Qiu , Zhao Yan
Published: June 2023

Background and Aims

Though tunneled cuffed catheters (TCCs) are frequently inserted for treating thrombotic malfunction, it is unclear whether such exchanges are associated with an increased risk of pulmonary embolism (PE). This study sought to investigate the incidence of PE among patients with hemodialysis catheter- related right atrial thrombosis (CRAT).

Method

We conducted a retrospective cohort study on 180 hemodialysis (HD) patients treated in the West China Hospital with a diagnosis of CRAT between May 2018 and March 2020. All cases with CRAT were treated with catheter replacements (guidewire exchange or insertion at new sites) and the tip of new catheters were adjusted to be away from the original position and close to the right atrial. Antiplatelet therapy was started after the surgery with dipyridamole. All patients maintained routine hemodialysis without any thrombolysis or thrombectomy.We investigated the PE incidence and mortality among them.

Results

Of the 180 patients undergoing catheter replacement and with CART, 10 patients had asymptomatic PEs pre-operation and 3 additional patients developed PE post-operation. During follow-up, two patients died of pneumonia and acute myocardial infarction, respectively, but no patients died due to PE or other thrombosis complications.

Conclusion

The incidence of PE among HD patients with CRAT is low (5.6%), and there does not appear to exist an elevated risk of fatal PE. Combined catheter.
#3813 EFFECT OF ORAL FLAVONOIDS ON ARTERIAL STIFFNESS IN CKD: A PILOT PROSPECTIVE STUDY
Authors: Vagkopoulou Anastasia , Haddad Nasra , Kontogiorgos Ioannis , Papatolios Thomas , Papadopoulou Evaggelia , Makridis Dimitrios , Tsimikas Stergios , Kalaitzidis Rigas , Karasavvidou Despina
Published: June 2023

Background and Aims

Flavonoids, the main category of polyphenols possess antioxidative and antihypertensive properties mediated through endothelial protection, renin-angiotensin-aldosterone and sympathetic system suppression. The aim of the study was to evaluate the effect of oral flavonoids administration in arterial stiffness indices and of oxidative stress markers in patients with Chronic Kidney Disease (CKD).

Method

The enrolled patients received chocolate bars rich in polyphenols (200 mg) daily for a period of 3 months The patients underwent clinical examination and laboratory test arterial stiffness measurements with Sphygmocor. Markers of oxidative stress (total phenols, total plasma antioxidant capacity, protein carbonyls) were also measured

Results

Sixteen patients were enrolled in the study, [median age 62.5 years (± 8,2), 14 patients (87,5%) were male]. Clinical characteristics, blood pressure measurements, arterial stiffness indices and markers of oxidative stress are summarized in table 1,2 and 3. Peripheral systolic Blood Pressure (PSBP) was decreased by 13,56 mmHg (± 2,57), (p< 0,001). Pulse wave velocity (PWV) and central pulse pressure (CPP) were significantly decreased (8,2 m/sec (5,1-9,22), vs 8,85 m/sec (6,7-11,75), (p<0,001) and 47,63 (36,5-60) versus [59,13 mmHg (43,5-69 respectively) at the end of the study], (p=0,003). Markers of oxidative stress were also improved. A decreased in plasma proteinic carbonyls 52,54 nmol/ml ± 25,04 versus (73,50 nmol/ml ± 18,65, (p<0,001) was observed while antioxidative capacity was increased 3,55% (1,15-6,38) versus 12,51% (6,26-17,66) (p= 0,013). Importantly no side effects were observed during the study period.

Conclusion

In this pilot study, oral flavonoid supplementation in the dose of 200 mg may improve arterial stiffness indices and systolic blood pressure measurements and contribute to the improvement of antioxidative capacity in CKD patients.
#4059 MICROBIOLOGICAL ANALYSIS OF HEMODIALYSIS WATER AT THE DOUALA GENERAL HOSPITAL, CAMEROON
Authors: Gueguim Cedric , Ragon Alain , Patrice Halle Marie , Folefack Francois Jerome Kaze , Kamga Hortense Gonsu
Published: June 2023

Background and Aims

Rigorous control of the microbiological quality of water in hemodialysis services is important because the immune system of patients with chronic renal failure is weakened. The aims of this study was to determine the microbiological quality of water for hemodialysis in Nephrology Unit of the Douala Général Hospital in order to improve the disinfection strategy.

Method

Twelve water samples were collected each month at different sites of the hemodialysis circuits A (inlet of filters), B (Outlet of filters / inlet of Reverse Osmosis (RO) device) and C (outlet of the RO device / close to the generator) between November 2015 and February 2016 to be analyzed. The bacteria were isolated after filtration of 100 ml of water at each site through nitrocellulose membrane with 0.45 µm microporosity deposited on the surface of the Tryptone Glucose Extract Agar (TGEA) and then incubated at room temperature (20 to 22°C) for 7 days. After transplanting to different environments, pure bacterial isolates were identified by their cultural characters and marketed biochemical galleries.

Results

The colony count was well above the required international standards (˃100 CFU / ml), for the hemodialysis water with a percentage of 50% of non-compliance. Among the bacteria identified, seven (07) were Gram-negative bacilli including Pseudomonas fluorescens, and Klebsiella pneumoniae subsp ozaenae, three (03) Gram-positive bacilli all Bacillus sp and three (03) Gram-positive cocci all of coagulase-negative staphylococci. The most frequently isolated bacterial genera were Pseudomonas sp (38,5%), Staphylococcus sp (23%), Bacillus sp (23%) and Klebsiella sp (15,5%).

Conclusion

The high bacteriological contamination of the hemodialysis water with the detection of a variety of bacteria shows that the disinfection procedure of the distribution loop is not efficient and cannot prevent the development of a biofilm. A higher frequency of disinfection (almost every week), an increase of the concentration and time of contact of the chlorine disinfection product or the use of peracetic acid and a regular monitoring can contribute to improve the quality of the hemodialysis water at the Douala General Hospital to ensure a better quality of life for patients undergoing this treatment.
#5395 ASSOCIATION BETWEEN PARABEN EXPOSURE AND EARLY RENAL INJURY IN A MIDDLE-AGED ADULT IN TAIWAN
Authors: Chang Jung-Wei , Huang Yen-Hsuan , Chen Hsin-Chang , Chang Wan-Ting , Huang Po-Chin
Published: June 2023

Background and Aims

Parabens are a class of preservatives used in the cosmetics industry and are widely used in people's daily lives, including personal care products (PCPs), pharmaceuticals and food. Epidemiological studies concerning the relations of exposure to parabens with renal function were limited. We aimed to investigate the potential sources of paraben exposure, estimate the daily intake (DI) of four parabens based on their urinary levels and the association between urinary paraben and renal function in a middle-aged adult population in Taiwan.

Method

We recruited 591 subjects aged from ≥40 to <65 years old (yrs) who have participated in Taiwan Environmental Survey for Toxicants (TEST) study from 2013-2016. Urinary parabens including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP) are measured by liquid chromatography/ tandem mass spectrometry. The cross-sectional analysis of the association between urinary paraben and biomarkers of renal function have also been established.

Results

The urinary MeP, EtP, PrP and BuP (median) levels were measured at 442, 42.9, 107 and 5.92 μg/L, respectively, which were also 10 times higher than those in other countries. Subjects aged from ≥55 to <65 yrs had higher urinary MeP and EtP levels and DI than those aged from ≥40 to <55 yrs (Fig. 1 & Fig. 2). The median of DI was higher in lotion, perfume and nail polish users than those seldom used (Fig. 3). However, there was no significant difference between DI and PCPs usage, or the cumulative usage of PCPs by gender. The median of creatinine, microalbumin, urinary protein and uric acid were significantly higher in men than in women, the albumin to creatinine ratio was significantly higher in women (3.73 mg/g) than in men (3.05 mg/g).

Conclusion

The urinary paraben concentration of middle-aged adults in Taiwan was significantly higher than those in US, Canada, and Korea. There was no significant difference among paraben levels, age and gender. PCPs usage was a source of paraben exposure.
#5657 FRAILTY AND VASCULAR ACCESS IN HEMODIALYSIS PATIENTS
Authors: Intzevidou Eleni , Loutradis Charalampos , Kougioumtzidou Ourania , Pitoulias Georgios
Published: June 2023

Background and Aims

Frailty is a geriatric syndrome characterized by increased vulnerability to stressors. The elderly become vulnerable and susceptible to adverse outcomes for their health and to functional restrictions. Previous guidelines suggested fistula creation as first choice for vascular access. Current guidelines suggest a more tailored approach to the patient's needs. Despite the high prevalence of frailty in hemodialysis patients, there is paucity of work investigating the relationship between frailty and vascular access failure. The aim of the study was the estimation of frailty with different scores and relationship with the choice of first vascular access, the current vascular access and vascular failures.

Method

67 patients in hemodialysis participated to the study (observational cross-sectional study). Frailty was assessed with 6 different scores,Clinical Frailty Scale (CFS), Frailty Phenotype (FP), Edmonton Frailty Scale (EFS), Groningen Frailty Index GFI), Short Physical Performance Battery (SPPB), Prisma-7 and ankle-brachial index (ABI) and hand grip were also estimated. The current vascular access, the first vascular access, the vascular access failures and the mean duration of the vascular accesses were also recorded. Finally, the levels of the hemoglobin, serum albumin, C reactive protein, cholesterol were measured for all patients and the hemodialysis adequacy (URR, sp Kt/V) was calculated from the levels of urea before and after the hemodialysis session. Finally, the levels of the hemoglobin, albumin, C reactive protein, cholesterol were measured for all patients and the hemodialysis adequacy was calculated from the levels of urea before and after the hemodialysis session.

Results

The first vascular access of hemodialysis presents statistically significant relation between frail and robust patients that start hemodialysis with central venus catheter and AVF-AVG respectively. (SPPB- tunneled CVC 85, 7%, non tunneled CVC 46,2% ρ=0,032, Prisma-7- frail tunneled CVC 100%, non tunneled CVC 76,9% ρ=0,018, Groningen FI -frail tunneled CVC 100%, non tunneled CVC 65,7% ρ=0,011, Εdmonton FS -AVF-AVG not frail 64,7%, vulnerable 20,6% ρ=0,042) (Table 1-4). ABI presented a statistically significant relationship with the current vascular access. 68,18% of the patients with normal ABI have AVF-AVG and 60,87% of patients with abnormal ABI have tunneled CVC (p=0,022). In addition, the number of vascular accesses per patient, the mean duration of the accesses and the premature failures (3 months after creation) don't present statistically significant relation with frailty.

Conclusion

The frailty score could be used as a tool for the choice of vascular access in hemodialysis patients. Further studies, in a larger number of patients, are required to define a reliable and easy to use frailty tool, which is best suited to dialysis access selection.
Passively Acquired Constant Region 5–Specific Antibodies Associated With Improved Survival in Infants Who Acquire Human Immunodeficiency Virus
Authors: Yaffe Zak A , Sung Kevin , Bosire Rose , Farquhar Carey , Ngacha Dorothy Mbori , Lohman-Payne Barbara , Nduati Ruth , John-Stewart Grace , Matsen Frederick A , Overbaugh Julie
Published: June 2023

Studying vertical human immunodeficiency virus (HIV) transmission enables the impact of passively transferred antibodies on HIV transmission and pathogenesis to be examined. Using phage display of HIV envelope peptides and peptide enzyme-linked immunosorbent assay (ELISA), we found that, in infants who acquired HIV, passive antibody responses to constant region 5 (C5) were associated with improved survival in 2 cohorts. In a combined analysis, C5 peptide ELISA activity was correlated directly with survival and estimated infection time and inversely with set point viral load. These results suggest that preexisting C5-specific antibodies may be correlated with the survival of infants living with HIV, motivating additional research into their protective potential.
Impaired Sleep Mediates the Relationship Between Interpersonal Trauma and Subtypes of Delusional Ideation
Authors: Herms Emma N , Bolbecker Amanda R , Wisner Krista M
Published: June 2023

Background and Hypothesis

Trauma is a robust risk factor for delusional ideation. However, the specificity and processes underlying this relationship are unclear. Qualitatively, interpersonal traumas (i.e., trauma caused by another person) appear to have a specific relationship with delusional ideation, particularly paranoia, given the commonality of social threat. However, this has not been empirically tested and the processes by which interpersonal trauma contributes to delusional ideation remain poorly understood. Given the role of impaired sleep in both trauma and delusional ideation, it may be a critical mediator between these variables. We hypothesized that interpersonal trauma, but not non-interpersonal trauma, would be positively related to subtypes of delusional ideation, especially paranoia, and that impaired sleep would mediate these relationships.

Study Design

In a large, transdiagnostic community sample (N = 478), an exploratory factor analysis of the Peter’s Delusion Inventory identified three subtypes of delusional ideation, namely magical thinking, grandiosity, and paranoia. Three path models, one for each subtype of delusional ideation, tested whether interpersonal trauma and non-interpersonal trauma were related to subtypes of delusional ideation, and impaired sleep as a mediating variable of interpersonal trauma.

Study Results

Paranoia and grandiosity were positively related to interpersonal trauma and unrelated to non-interpersonal trauma. Furthermore, these relationships were significantly mediated by impaired sleep, which appeared strongest for paranoia. In contrast, magical thinking was unrelated to traumatic experiences.

Conclusions

These findings support a specific relationship between interpersonal trauma and paranoia as well as grandiosity, with impaired sleep appearing as an important process by which interpersonal trauma contributes to both.
Hanging on and digging deep: comparative forelimb myology of the koala (Phascolarctos cinereus) and common wombat (Vombatus ursinus)
Authors: Richards Hazel L , Adams Justin W , Evans Alistair R
Published: June 2023

Establishing relationships between soft tissues and bones in living species can inform our understanding of functional adaptations in their extinct kin in the absence of direct data on habitual behaviours. The koala and the wombats are the only surviving species of the vombatiform suborder, and represent the extant phylogenetic bracket for dozens of fossil marsupial species across nine families. Here we present the first quantitative architectural data on the forelimb myology of the koala and common wombat, alongside redescriptions based on physical and digital dissections. Despite obvious contrasts in how their forelimbs are used in arboreal (koala) and fossorial (wombat) functional contexts, overall they showed only minor differences in qualitative and quantitative measures of myology. When the architectural properties of antagonistic pairs of muscle groups crossing each joint were compared, the greatest contrasts were seen in muscles crossing the elbow, where the wombat exhibited greater relative emphasis on forceful elbow extension than the koala, indicative of adaptations for digging. Our findings reinforce the importance of the elbow as a useful system to explore when seeking discrimination between habitual patterns of forelimb use in extinct vombatiform species.
Inhibitory Effect of Tea Saponin on Major Apple-Disease-Inducing Fungi
Authors: Li Zhao-Yang , Sun Qian , Ma Ning , Zhang Fu-Jun , Zhang Shuai , Zhang Zheng-Qun , Wang Xiao-Fei , Sun Ping , You Chun-Xiang , Zhang Zhenlu
Published: June 2023

Plant secondary metabolites are well known for their biological functions in defending against pathogenic microorganisms. Tea saponin (TS), one type of secondary metabolite of the tea plant ( Camellia sinensis), has been shown to be a valuable botanical pesticide. However, its antifungal activity in controlling the fungi Valsa mali, Botryosphaeria dothidea, and Alternaria alternata, which induce major diseases in apple ( Malus domestica), has not been determined. In this study, we first determined that TS has higher inhibitory activity than catechins against the three types of fungi. We further utilized in vitro and in vivo assays to confirm that TS showed high antifungal activity against the three types of fungi, especially for V. mali and B. dothidea. In the in vivo assay, application of a 0.5% TS solution was able to restrain the fungus-induced necrotic area in detached apple leaves efficiently. Moreover, a greenhouse infection assay also confirmed that TS treatment significantly inhibited V. mali infection in leaves of apple seedlings. In addition, TS treatment activated plant immune responses by decreasing accumulation of reactive oxygen species and promoting the activity of pathogenesis-related proteins, including chitinase and β-1,3-glucanase. This indicated that TS might serve as a plant defense inducer to activate innate immunity to fight against fungal pathogen invasion. Therefore, our data indicated that TS might restrain fungal infection in two ways, by directly inhibiting the growth of fungi and by activating plant innate defense responses as a plant defense inducer.
Local anaesthetic adjuncts for peripheral nerve blockade
Authors: Desai Neel , Albrecht Eric
Published: June 2023

Purpose of review

Moderate-to-severe pain is common and remains a significant problem. Compared with opioid analgesia alone, single-shot peripheral nerve blockade has been associated with improved pain relief and the potential of decreased side effects. Single-shot nerve blockade, however, is limited by its relatively short duration of action. In this review, we aim to summarize the evidence related to local anaesthetic adjuncts for peripheral nerve blockade.

Recent findings

Dexamethasone and dexmedetomidine exhibit characteristics that most closely resemble the ideal local anaesthetic adjunct. In upper limb block, dexamethasone has been demonstrated to be superior to dexmedetomidine regardless of administration route for the duration of sensory and motor blockade as well as the duration of analgesia. No clinically significant differences between intravenous and perineural dexamethasone were found. Perineural and intravenous dexamethasone have the potential to prolong sensory blockade to a greater extent than motor blockade. The evidence indicates that the mechanism of action of perineural dexamethasone in upper limb block is systemic in nature. Unlike perineural dexmedetomidine, intravenous dexmedetomidine has not been shown to result in differences in the characteristics of regional blockade compared with local anaesthetic alone.

Intravenous dexamethasone is the local anaesthetic adjunct of choice, increasing the duration of sensory and motor blockade as well as the duration of analgesia by 477, 289 and 478 min, respectively. In view of this, we recommend consideration of the intravenous administration of dexamethasone at a dose of 0.1–0.2 mg/kg for all patients undergoing surgery whatever the level of postoperative pain, mild, moderate or severe. Further research should focus on the potential synergism of action between intravenous dexamethasone and perineural dexmedetomidine.
Clarifying the grey space of sugammadex induced bradycardia
Authors: Johnson Ken B. , Chacin Rebeca
Published: June 2023

Purpose of review

This review describes recent prospective and retrospective work exploring the incidence and clinical consequence of sugammadex-induced bradycardia and an update of recent evidence and adverse event reports to the United States Food and Drug Administration regarding the incidence of sugammadex induced bradycardia.

Recent findings

This work suggests that the incidence of sugammadex-induced bradycardia can range from 1 to 7% depending on the definition to reverse moderate to deep neuromuscular blockade. For most instances, the bradycardia is inconsequential. For those instances that have hemodynamic instability, the adverse physiology is easily treated with appropriate vasoactive agents. One study demonstrated that the incidence of bradycardia from sugammadex is less than with neostigmine. There are several case reports that describe marked bradycardia with cardiac arrest from reversal with sugammadex. The incidence of this type of reaction to sugammadex appears to be very rare. Data from the United States Food and Drug Administration's Adverse Event Reporting System public dashboard corroborates this presence of this rare finding.

Sugammadex-induced bradycardia is common and, in most instances, of minimal clinical consequence. Nevertheless, anesthesia providers should maintain proper monitoring and vigilance to treat hemodynamical instability with each administration of sugammadex.
Flow-Sizing Critical Care Resources*
Authors: Nates Joseph L. , Oropello John M. , Badjatia Neeraj , Beilman Gregory , Coopersmith Craig M. , Halpern Neil A. , Herr Daniel L. , Jacobi Judith , Kahn Roozehra , Leung Sharon , Puri Nitin , Sen Ayan , Pastores Stephen M. ,   for the Academic Leaders in Critical Care Task Force (ALCCM) of the Society of Critical Care Medicine
Published: June 2023

OBJECTIVES:

To describe the factors affecting critical care capacity and how critical care organizations (CCOs) within academic centers in the U.S. flow-size critical care resources under normal operations, strain, and surge conditions.

DATA SOURCES:

PubMed, federal agency and American Hospital Association reports, and previous CCO survey results were reviewed.

STUDY SELECTION:

Studies and reports of critical care bed capacity and utilization within CCOs and in the United States were selected.

DATA EXTRACTION:

The Academic Leaders in the Critical Care Medicine Task Force established regular conference calls to reach a consensus on the approach of CCOs to “flow-sizing” critical care services.

DATA SYNTHESIS:

The approach of CCOs to “flow-sizing” critical care is outlined. The vertical (relation to institutional resources, e.g., space allocation, equipment, personnel redistribution) and horizontal (interdepartmental, e.g., emergency department, operating room, inpatient floors) integration of critical care delivery (ICUs, rapid response) for healthcare organizations and the methods by which CCOs flow-size critical care during normal operations, strain, and surge conditions are described. The advantages, barriers, and recommendations for the rapid and efficient scaling of critical care operations via a CCO structure are explained. Comprehensive guidance and resources for the development of “flow-sizing” capability by a CCO within a healthcare organization are provided.

CONCLUSIONS:

We identified and summarized the fundamental principles affecting critical care capacity. The taskforce highlighted the advantages of the CCO governance model to achieve rapid and cost-effective “flow-sizing” of critical care services and provide recommendations and resources to facilitate this capability. The relevance of a comprehensive approach to “flow-sizing” has become particularly relevant in the wake of the latest COVID-19 pandemic. In light of the growing risks of another extreme epidemic, planning for adequate capacity to confront the next critical care crisis is urgent.
PARP Inhibitors in Newly Diagnosed and Recurrent Ovarian Cancer
Authors: Giannini Andrea , Di Dio Camilla , Di Donato Violante , D’oria Ottavia , Salerno Maria Giovanna , Capalbo Giuseppe , Cuccu Ilaria , Perniola Giorgia , Muzii Ludovico , Bogani Giorgio
Published: June 2023

Ovarian cancer is the most lethal gynecologic malignancy, characterized by a high death-to-incidence ratio. Platinum-based chemotherapy is the mainstay of treatment for newly diagnosed and platinum-sensitive recurrent ovarian cancer. Poly (ADP-ribose) polymerase inhibitors (PARP inhibitors) have been incorporated into the treatment strategy for ovarian cancer. PARP inhibitors showed particular benefit for patients harboring defects in DNA repair pathways. Accumulating evidence showed that PARP inhibitors provide a benefit in newly diagnosed advanced ovarian cancer, even in the absence of BRCA mutation, as reported in the PRIMA, PRIME, and ATHENA-mono trials. Interestingly, the PAOLA-1 study provides another important finding, supporting the adoption of olaparib plus bevacizumab in patients with homologous recombination deficiency. Although those results are exciting, several patients develop resistance to PARP inhibitors. Hence, new combinations are under investigation to identify new treatment strategies to overcome this resistance. Currently, researchers are focused on the possibility to adopt PARP inhibitors even in the setting of platinum-resistant disease. The present critical review aims to report the current landscape and further perspective for strengthening PARP inhibitors' effectiveness in newly diagnosed and recurrent ovarian cancer.
Early MDO with a Virtually Planned Distractor in a Neonate with Pierre Robin Sequence
Authors: Lutz Rainer , Olmos Manuel , Schmidt Joachim , Morhart Patrick , Nobis Christopher , Möst Tobias , Kesting Marco , Weber Manuel
Published: June 2023

Pierre Robin sequence (PRS) is characterized by mandibular micrognathia, glossoptosis, and airway obstruction. We report a case of a female infant with PRS in combination with deletion of chromosome 4q and cardiac insufficiency due to an atrioventricular septum defect. The child was transferred to our center from a peripheral hospital with respiratory insufficiency. Initially, respiration was ensured using a continuous positive airway pressure (CPAP) device because a Tuebingen plate was not tolerated. After a pediatric cardiac surgery intervention, CPAP ventilation proved to be insufficient, and the young patient had to be resuscitated and endotracheal intubation was required for recurrent severe respiratory failure. To avoid tracheostomy, an interdisciplinary decision was made to perform an early mandibular distraction. In the fifth week of life, two patient-specific internal distractors were implanted after prior virtual surgery planning. This approach allows for shorter surgical time through preoperative vector planning and fabrication of a patient-specific distractor, in combination with reduced morbidity through maximum protection of adjacent structures such as the tooth follicles and inferior alveolar nerves. An advancement of the mandible by 15 mm could be achieved within 2 weeks. Thereafter, the small patient could be extubated successfully, and there was no further episode of major respiratory insufficiency. We demonstrate that mandibular early distraction with a patient-specific distractor is a successful method to treat severe respiratory insufficiency in PRS, and it can prevent the necessity for tracheostomy with the resulting disadvantages. We provide details concerning our therapeutic algorithm, metric analyses, and a discussion of relevant literature.
External Ear Melanoma Treated with Auricular Reconstruction Using Four Different Tissues in a 16-Year-Old Patient
Authors: Takasu Hiroyuki , Yagi Sasagu , Taguchi Sawa , Furukawa Soichi , Ono Nao , Nakahama Miyako , Shimomura Yutaka
Published: June 2023

The auricular region is a common site of cutaneous malignancies, most of which are nonmelanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma, in older patients. They are often treated with limited surgery that can be performed under local anesthesia. We report the case of a young patient with external ear melanoma who underwent reconstruction for defects of more than one-half of the helix and concha using four types of tissues: a rib cartilage graft, temporoparietal fascia flap, full-thickness skin graft, and retroauricular flap. Extending the retroauricular flap posteriorly to the entire hairless area allowed us to cover the anterior surface of the rib cartilage framework, which helped effectively achieve aesthetics. In auricle reconstruction, it is crucial to determine how well the anterior surface of the auricle is created.
Breast Implant-associated Squamous Cell Carcinoma: Initial Review and Early Recommendations
Authors: Glasberg Scot B. , Sommers Catherine A. , McClure Gina T.
Published: June 2023

Background:

The purpose of this study is to identify and describe all published cases of breast implant-associated squamous cell carcinoma (BIA-SCC) to gain a greater understanding of the incidence, presentation, diagnosis, treatment, and prognosis and to support development of recommendations that promote prompt diagnosis and management in clinical practice.

Methods:

A scoping review of PubMed and social media sites was performed in August and September 2022 to identify published cases of SCC arising in the breast capsule. No limits were set on search results. Additional data review was begun on deidentified cases reported directly to American Society of Plastic Surgeons.

Results:

Twelve articles met inclusion criteria and reported data on 16 total cases. Mean age of patients was 55.56 years (range, 40–81 years). Mean duration from initial implant placement to presentation was 23.56 years (range, 11–40 years). Cases occurred with silicone, saline, textured, and smooth implants. At the time of case publication or reporting, seven patients were alive, five were deceased and/or presumed deceased, and four were unreported.

Conclusions:

BIA‐SCC seems to be a rare complication of breast implantation that can result in significant morbidity and mortality. Physicians should be aware of the presentation of BIA-SCC to promote prompt diagnosis and treatment. BIA-SCC should be discussed with all patients considering breast implantation as part of the informed-consent process.
Impact of gas/air tamponade on refractive outcomes after flanged intrascleral intraocular lens fixation
Authors: Tanaka Yui , Inoue Tatsuya , Mohamed Shaheeda , Yamaguchi Takefumi , Iwashita Yume , Hirono Kazushi , Nakamura Kentaro , Asaoka Ryo , Kobayashi Shinobu , Yamane Shin , Yanagi Yasuo , Maruyama-Inoue Maiko , Kadonosono Kazuaki
Published: June 2023

Purpose:

The current study aims to investigate the postoperative refractive outcomes in eyes that underwent the flanged intrascleral IOL fixation combined with vitrectomy with or without gas/air tamponade.

Methods:

We divided the eyes into two groups (Group A; eyes that underwent flanged intrascleral IOL fixation with gas/air tamponade, Group B; eyes that underwent flanged intrascleral IOL fixation without gas/air tamponade). The predicted spherical equivalent (SE) refraction values were calculated using the SRK/T formula. Then, the prediction error (PE) was calculated by subtracting the predicted SE refraction from the postoperative objective SE refraction and the absolute prediction error (AE) was calculated as the absolute value of the PE for each eye.

Results:

A total of 68 eyes were included in the current study. There was a significant correlation between the predicted and postoperative SE refraction in both groups (Group A, r = 0.968, p<0.0001, Group B, r = 0.943, p<0.0001, linear regression analysis). The PE demonstrated a mild myopic shift after the flanged intrascleral IOL fixation in both groups (Group A, -0.40 ± 0.96 D, Group B, -0.59 ± 0.95 D). There was no significant difference in PE and AE between the two groups (p=0.44, p=0.70, Wilcoxon rank sum test).

Conclusion:

The postoperative SE refraction after flanged intrascleral IOL fixation was not influenced by gas/air tamponade.
Quality Control for Spine Registries: Development and Application of a New Protocol
Authors: Baroncini Alice , Langella Francesco , Barletta Paolo , Cecchinato Riccardo , Vanni Daniele , Giudici Fabrizio , Scaramuzzo Laura , Bassani Roberto , Morselli Carlotta , Brayda-Bruno Marco , Luca Andrea , Lamartina Claudio , Berjano Pedro
Published: June 2023

Registries are gaining importance both in clinical practice and for research purposes. However, quality control is paramount to ensure that data are consistent and reliable. Quality control protocols have been proposed for arthroplasty registries, but these are not directly applicable to the spine setting. This study aims to develop a new quality control protocol for spine registries. Based on the available protocols for arthroplasty registries, a new protocol for spine registries was developed. The items included in the protocol were completeness (yearly enrollment rate and rate of assessment completion), consistency, and internal validity (coherence between registry data and medical records for blood loss, body mass index, and treated levels). All aspects were then applied to the spine registry of the Institution to verify its quality for each of the 5 years in which the registry has been used (2016–2020). Regarding completeness, the yearly enrollment rate ranged from 78 to 86%; the completion of preoperative assessment from 79% to 100%. The yearly consistency rate varied from 83% to 86%. Considering internal validity, the interclass correlation coefficient ranged from 0.1 to 0.8 for blood loss and from 0.3 to 0.9 for body mass index. The coherency for treated levels ranged from 25% to 82%. Overall, all 3 items showed an improvement over time. All 3 analyzed domains showed good to excellent results. The overall quality of the registered data improved over time.
Influence of CX3CR1 Deletion on Cochlear Hair Cell Survival and Macrophage Expression in Chronic Suppurative Otitis Media
Authors: Schiel Viktoria , Xia Anping , Santa Maria Peter L.
Published: June 2023

Objective

Our objective was to determine whether the receptor CX3CR1 is necessary for the recruitment of macrophages to the cochlea in chronic suppurative otitis media (CSOM) and if its deletion can prevent hair cell loss in CSOM.

Background

CSOM is a neglected disease that afflicts 330 million people worldwide and is the most common cause of permanent hearing loss among children in the developing world. It is characterized by a chronically discharging infected middle ear. We have previously demonstrated that CSOM causes macrophage associated sensory hearing loss. The receptor CX3CR1 is expressed on macrophages, which have been shown to be increased at the time point of outer hair cell (OHC) loss in CSOM.

Methods

In this report, we examine the influence of CX3CR1 deletion (CX3CR1−/−) in a validated model of Pseudomonas aeruginosa (PA) CSOM.

Results

The data show no difference in OHC loss between the CX3CR1−/− CSOM group and CX3CR1+/+ CSOM group (p = 0.28). We observed partial OHC loss in the cochlear basal turn, no OHC loss in the middle and apical turns in both CX3CR1−/− and CX3CR1+/+ CSOM mice at 14 days after bacterial inoculation. No inner hair cell (IHC) loss was found in all cochlear turns in all groups. We also counted F4/80 labeled macrophages in the spiral ganglion, spiral ligament, stria vascularis and spiral limbus of the basal, middle, and apical turn in cryosections. We did not find a significant difference in the total number of cochlear macrophages between CX3CR1−/− mice and CX3CR1+/+ mice (p = 0.97).

Conclusion

The data did not support a role for CX3CR1 macrophage associated HC loss in CSOM.
Quantification of Fat Graft Retention in the Translabyrinthine Approach Using Magnetic Resonance Imaging Volumetric Analysis
Authors: Vesole Adam S. , Shapiro Scott B. , Samy Ravi N. , Pensak Myles L. , Breen Joseph T.
Published: June 2023

Objective

To characterize the viability and volume of autologous free fat grafts over time, determine clinical/patient factors that may affect free fat graft survival and assess the clinical impact of free fat graft survival on patient outcomes in the translabyrinthine approach for lateral skull base tumor resection.

Study Design

Retrospective chart review.

Setting

Tertiary neurotologic referral center.

Patients

Forty-two adult patients who underwent translabyrinthine craniotomy for resection of a lateral skull base tumor with the mastoid defect filled by autologous abdominal fat graft and subsequently underwent more than one postoperative magnetic resonance imaging (MRI) scans of the brain.

Intervention(s)

Mastoid obliteration with abdominal fat after craniotomy, postoperative MRI

Main Outcome Measure(s)

Rate of fat graft volume loss, fraction retention of original fat graft volume, initial fat graft volume, time to steady-state fat graft retention, rate of postoperative cerebrospinal fluid (CSF) leak, and/or pseudomeningocele formation.

Results

Patients were followed postoperatively with MRI for a mean of 31.6 months with a mean of 3.2 postoperative MRIs per patient. Initial graft size was a mean of 18.7 cm3 with a steady-state fat graft retention of 35.5%. Steady-state graft retention (<5% loss per year) was achieved at a mean of 24.96 months postoperatively. No significant association was found in multivariate regression analysis of clinical factors impact on fat graft retention and CSF leak/pseudomeningocele formation.

Conclusions

In the use of autologous abdominal free fat graft for filling mastoid defects after translabyrinthine craniotomy, there is a logarithmic decline in fat graft volume over time, reaching steady state in 2 years. Rates of CSF leak or pseudomeningocele formation were not significantly affected by initial volume of the fat graft, rate of fat graft resorption, nor the fraction of original fat graft volume at steady state. In addition, no analyzed clinical factors significantly influenced fat graft retention over time.
COVID-19 in Pediatric Cancer Patients and Hematopoietic Stem Cell Transplant Recipients in a Tertiary Care Hospital in Argentina
Authors: Latella Antonio , Gómez Sandra , Palladino Marcela , Navia Marcelo , Mangano Andrea , Borgnia Daniela , Rino Pedro , González Claudia , Felice María S. , Rose Adriana , Alderete Daniel , Staciuk Raquel , Roizen Mariana , Fraquelli Lidia
Published: June 2023

The outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in cancer pediatric patients was initially uncertain. The objective of this study was to describe the characteristics and outcome of cancer patients and hematopoietic stem cell transplant recipients from 0 to 19 years with detectable SARS-CoV-2 from April 23, 2020, to April 30, 2022, treated in a tertiary-level hospital in Argentina. A total of 348 cases were registered in 339 patients. The median age was 89.5 (3 to 224) months. The sex was predominantly male: 193 (55.5%). The most common malignant disease was leukemia (42.8%). One hundred four cases (29.9%) had comorbidities. Of the 346 cases with an available blood count, 17.6% had a lymphocyte count <300/mm3. Fever was the most common symptom. In most cases (93.1%) presented asymptomatic or mild disease. Twenty-one cases (6%) presented severe or critical status. Eleven of 24 admissions to the intensive care unit were due to COVID-19 (coronavirus disease 2019). Eight patients (2.3%) died. Two deaths were attributable to SARS-CoV-2 (0.6%). Being older, having fever, lymphopenia at diagnosis, and having received hematopoietic stem cell transplant were associated with a more severe disease. Around 90% of the children continued their cancer treatment without any change.
Acute Disorders of Consciousness in Pediatric Severe Sepsis and Organ Failure: Secondary Analysis of the Multicenter Phenotyping Sepsis-Induced Multiple Organ Failure Study*
Authors: Cheung Christina , Kernan Kate F. , Berg Robert A. , Zuppa Athena F. , Notterman Daniel A. , Pollack Murray M. , Wessel David , Meert Kathleen L. , Hall Mark W. , Newth Christopher , Lin John C. , Doctor Allan , Shanley Tom , Cornell Tim , Harrison Rick E. , Banks Russell K. , Reeder Ron W. , Holubkov Richard , Carcillo Joseph A. , Fink Ericka L. ,   on behalf of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
Published: June 2023

OBJECTIVES:

Acute disorders of consciousness (DoC) in pediatric severe sepsis are associated with increased risk of morbidity and mortality. We sought to examine the frequency of and factors associated with DoC in children with sepsis-induced organ failure.

DESIGN:

Secondary analysis of the multicenter Phenotyping Sepsis-Induced Multiple Organ Failure Study (PHENOMS).

SETTING:

Nine tertiary care PICUs in the United States.

PATIENTS:

Children less than 18 years old admitted to a PICU with severe sepsis and at least one organ failure during a PICU stay.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome was frequency of DoC, defined as Glasgow Coma Scale (GCS) less than 12 in the absence of sedatives during an ICU stay, among children with severe sepsis and the following: single organ failure, nonphenotypeable multiple organ failure (MOF), MOF with one of the PHENOMS phenotypes (immunoparalysis-associated MOF [IPMOF], sequential liver failure-associated MOF, thrombocytopenia-associated MOF), or MOF with multiple phenotypes. A multivariable logistic regression analysis was performed to evaluate the association between clinical variables and organ failure groups with DoC. Of 401 children studied, 71 (18%) presented with DoC. Children presenting with DoC were older (median 8 vs 5 yr; p = 0.023), had increased hospital mortality (21% vs 10%; p = 0.011), and more frequently presented with both any MOF (93% vs 71%; p < 0.001) and macrophage activation syndrome (14% vs 4%; p = 0.004). Among children with any MOF, those presenting with DoC most frequently had nonphenotypeable MOF and IPMOF (52% and 34%, respectively). In the multivariable analysis, older age (odds ratio, 1.07; 95% CI, 1.01–1.12) and any MOF (3.22 [1.19–8.70]) were associated with DoC.

CONCLUSIONS:

One of every five children with severe sepsis and organ failure experienced acute DoC during their PICU stay. Preliminary findings suggest the need for prospective evaluation of DoC in children with sepsis and MOF.
A quantitative analysis of optimum design for rigid ankle foot orthoses: The effect of thickness and reinforcement design on stiffness
Authors: Chatzistergos Panagiotis E. , Eddison Nicola , Ganniari-Papageorgiou Evangelia , Chockalingam Nachiappan
Published: June 2023

Background:

An ankle foot orthosis (AFO) which is prescribed to be rigid should only deform a small amount to achieve its clinical goals. Material thickness and the design of reinforcing features can significantly affect AFO rigidity, but their selection remains based on anecdotal evidence.

Objectives:

To quantify the effect of these parameters on AFO stiffness and to set the basis for quantitative guidelines for the design optimisation of rigid AFOs.

Study design:

Experimental and computational study.

Methods:

A polypropylene AFO was produced according to UK standard practice and its stiffness was experimentally measured for 30Nm of dorsiflexion. Its geometry and mechanical characteristics were utilised to create a finite element (FE) model of a typical AFO prescribed to be rigid. Following validation, the model was used to quantify the effect of material thickness and reinforcement design (i.e., reinforcement placement, length) on stiffness. A final set of AFO samples was produced to experimentally confirm key findings.

Results and conclusions:

For a specific AFO geometry and loading magnitude, there is a thickness threshold below which the AFO cannot effectively resist flexion and buckles. FE modelling showed that stiffness is maximised when reinforcements are placed at the anterior-most position possible. This key finding was also experimentally confirmed. The stiffness of an AFO reinforced according to standard practice with lateral and medial ribbing was 4.4 ± 0.1 Nm/degree. Instructing the orthotic technician to move the ribbings anteriorly increased stiffness by 22%. Further stiffening is achieved by ensuring the reinforcements extend from the footplate to at least two-thirds of the AFO's total height.
Adenoma Detection Rate Benchmarks: An Updated Analysis
Authors: Morrow Linda , Greenwald Beverly
Published: June 2023

Early-onset colorectal cancer prompted organizations to reduce the recommended screening initiation age from 50 to 45 years. The American Society for Gastrointestinal Endoscopy Quality Assurance in Endoscopy Committee recommends 3 priority quality indicators for colonoscopy services. The adenoma detection rate is considered the most important measure with the established benchmark based upon studies of patients 50 years or older. The incidence of polyps increases with age, so this change has an as-yet-unknown effect on the new benchmark. Five studies were reviewed. Based upon the results, 45- to 50-year-old patients should be included in facilities' adenoma detection rate calculations using the currently recommended benchmarks of 25% for women and men combined, or 20% for women and 30% for men when the genders are calculated separately. Males consistently had more adenomas than females in each of the 3 studies that separated genders, a detail that might merit gender-based adenoma detection rate determinations in some practices. One study indicated caution is advised; it recommends males and females be calculated separately and different benchmarks be used for each gender. The adenoma detection rate has been shown to increase over time. More studies are needed to guide screening quality metrics.