bluuebunny/crossref_metadata_2025 huggingface dataset:
A Pilot Study of Transdiagnostic Group Cognitive-behavior Therapy for Anxiety: An Intensive Weekend Intervention
Authors: BAUTISTA CHANDRA , CHASE TANNAH , TENG ELLEN J.
Published: February 2021

Anxiety disorders are highly prevalent and can cause serious functional impairment. Cognitive-behavioral treatments are effective but they are not always readily available. One factor contributing to this problem is the large number of disorder-specific treatments that require a high level of clinician training and resources, despite the similarity in the mechanisms underlying the various anxiety disorders and their treatments. Group-based, transdiagnostic cognitive-behavioral therapy (TCBT) has been shown to reduce the burden on clinicians while maintaining strong positive treatment outcomes. Furthermore, long courses of treatment may limit some individuals’ ability to participate because of issues related to transportation, work, or childcare. Research has supported the efficacy of brief, intensive treatment for anxiety. The goal of the study presented here was to combine these 2 innovative treatment modalities by examining the feasibility and acceptability of TCBT provided in an intensive weekend format. The results of this pilot study indicated that this format was acceptable to a sample of Veterans (N=13) based on their feedback. This pilot study also demonstrated that the format was feasible, as all Veterans who initiated treatment completed the entire program (N=8). Preliminary outcome data suggested that TCBT delivered in an intensive weekend format may have positive effects for individuals with anxiety, including reduction in symptoms of anxiety and depression as well as improved overall functioning. Clinical implications and directions for future research are discussed.
The Role of Medical Comorbidity in the Rapid Psychiatric Readmission of Patients With Schizophrenia-spectrum Disorders
Authors: REEVES LAUREN E. , WEINSTOCK LAUREN , EPSTEIN-LUBOW GARY , METRIK JANE , GAUDIANO BRANDON A.
Published: February 2021

Objective:

Inpatient admissions are common for individuals with schizophrenia-spectrum disorders, and difficulty transitioning from the hospital to the community results in these individuals being at high risk for hospital readmissions. Thus, psychotic disorders account for high rates of rapid readmission within 30 days of discharge. Increasing evidence highlights the role of comorbid medical conditions, such as circulatory and metabolic problems, in contributing to early readmission rates for these patients. This study examined the specific role of circulatory and metabolic problems in predicting psychiatric rehospitalizations while accounting for other medical conditions, psychiatric comorbidities, and preadmission medications.

Methods:

The electronic medical records of 752 patients admitted to a psychiatric hospital were examined, with patients classified as having readmission within 30 days of their index hospitalization (n=79) or no readmission within 30 days (n=673). The 2 groups were compared on multiple variables in univariate and multivariate analyses.

Results:

Male sex [odds ratio (OR)=2.02, P=0.019)], disability status (OR=1.96, P=0.027), and presence of a circulatory (but not a metabolic) condition (OR=3.43, P=0.003) were associated with significantly increased odds of being rehospitalized within 30 days, even when accounting for additional predictors, including age, substance use disorder, race, and other medical conditions.

Conclusions:

These findings highlight the importance of considering circulatory, in addition to metabolic disorders, during inpatient stays. This comorbidity pattern may signify a subset of individuals with schizophrenia-spectrum disorders requiring more comprehensive discharge planning and support after an inpatient hospitalization to prevent rapid rehospitalization.
Facilitating Successful Reentry Among Justice-involved Veterans: The Role of Veteran and Offender Identity
Authors: DESAI ALISHA , HOLLIDAY RYAN , BORGES LAUREN M. , BLUE-HOWELLS JESSICA , CLARK SEAN , STIMMEL MATTHEW , WORTZEL HAL S.
Published: February 2021

Reentry courts facilitate successful offender reintegration into the community following release from incarceration, and many justice-involved veterans may benefit from such services given their elevated risk for deleterious outcomes postrelease. However, effectively engaging court participants is a crucial foundation to achieve the goals of recidivism reduction and global psychosocial improvement. This conceptual article presents an overview of factors that may interfere with a veteran’s engagement in reentry court through the lens of both veteran and offender identity. Recommendations for reentry court personnel based on justice-involved veterans’ experiences, identity, and unique needs are presented. Careful consideration of these factors and associated practice adaptations may facilitate rapport between reentry court personnel and veteran participants, foster engagement, and ultimately improve outcomes among this unique, at-risk population.
Stress Reactivity to the Trier Social Stress Test in Traditional and Virtual Environments: A Meta-Analytic Comparison
Authors: Helminen Emily C. , Morton Melissa L. , Wang Qiu , Felver Joshua C.
Published: February 2021

Objective

The traditional Trier Social Stress Test (TSST) is a widely used standardized stress induction protocol and has recently been adapted in a variety of virtual reality environments (V-TSST). Research has demonstrated the ability of the V-TSST to induce a stress reactivity response measured via cortisol, heart rate, and self-report. However, research comparing stress reactivity induced via the V-TSST to the traditional TSST across neuroendocrine, cardiovascular, and self-report variables has not yet been systematically and quantitatively reviewed.

Methods

In this meta-analytic review, the existing studies that used V-TSST were gathered, and each was age and sex matched with samples using the traditional TSST. These studies were then meta-analytically synthesized to determine if there was a moderating effect of TSST type (traditional TSST or V-TSST) on multiple measures of stress reactivity (i.e., cortisol, heart rate, and self-report).

Results

Examining the pre-post stress induction, the V-TSST studies demonstrated comparable effect sizes (ESs) for stress reactivity (cortisol ES = 0.61, heart rate ES = 0.98, self-reported stress ES = 0.94) to traditional TSST study ESs (cortisol ES = 0.79, heart rate ES = 0.85, self-reported stress ES = 0.85).

Conclusions

The TSST type differences between ESs were not statistically significant, indicating that the V-TSST is as effective as the traditional TSST at eliciting a physiological and self-reported stress reactivity response. Implications and limitations of this meta-analysis are discussed, and recommendations for future research are provided.
Time spent with HIV-RNA ≤ 200 copies/ml in a cohort of people with HIV during the U=U era
Authors: Madeddu Giordano , De Vito Andrea , Cozzi-Lepri Alessandro , Cingolani Antonella , Maggiolo Franco , Perno Carlo Federico , Gagliardini Roberta , Marchetti Giulia , Saracino Annalisa , Monforte Antonella d’Arminio , Antinori Andrea , Girardi Enrico
Published: February 2021

Objective:

Zero risk of linked HIV transmission in serodiscordant couples when the HIV-infected partner had viral load less than 200 copies/ml (‘U status’) was found in observational studies. We aimed at estimating the proportion of time in which ‘U status’ was maintained and identifying factors associated with the risk of losing it.

Design:

Observational cohort study.

Methods:

We included participants in the ICONA cohort who had reached an established ‘U status’ (viral load ≤200 copies/ml for >6 months) as of December 2010. The outcome was the number of person-days of follow-up (PDFU) above a viral load greater than 200 copies/ml, relative to the total number of PDFU observed. A logistic regression model was used to identify factors independently associated with the risk of losing ‘U status’.

Results:

Eight thousand, two hundred and forty-one persons living with HIV were included in the analysis who contributed 2 670 888 PDFU. Of these, 1648 (20%) were women, 768 (9%) were people who inject drugs (PWID), and 2066 (25%) were foreign-born. The median of viral load measurements was 9 (IQR: 4–15). Overall, only 3.1% of PDFU were observed when viral load was above 200 copies/ml. The proportion of PDFU with viral load more than 200 copies/ml was higher than average in women (5.3%), unemployed (5.4%), PWID (4.7%), and in people with more than three previous virologic failures (6.3%). These variables were significant predictors of losing ‘U status’ in the multivariable logistic regression.

Conclusion:

Our results reinforce the validity of the U=U message in real-world setting. However, we identified subsets of our study population at higher risk of losing the ‘U status’ for whom additional efforts are needed.
Mathematical modelling of the influence of serosorting on the population-level HIV transmission impact of pre-exposure prophylaxis
Authors: Wang Linwei , Moqueet Nasheed , Simkin Anna , Knight Jesse , Ma Huiting , Lachowsky Nathan J. , Armstrong Heather L. , Tan Darrell H.S. , Burchell Ann N. , Hart Trevor A. , Moore David M. , Adam Barry D. , Macfadden Derek R. , Baral Stefan , Mishra Sharmistha
Published: February 2021

Objectives:

HIV pre-exposure prophylaxis (PrEP) may change serosorting patterns. We examined the influence of serosorting on the population-level HIV transmission impact of PrEP, and how impact could change if PrEP users stopped serosorting.

Design:

We developed a compartmental HIV transmission model parameterized with bio-behavioural and HIV surveillance data among MSM in Canada.

Methods:

We separately fit the model with serosorting and without serosorting [counterfactual; sero-proportionate mixing (random partner-selection proportional to availability by HIV status)], and reproduced stable HIV epidemics with HIV-prevalence 10.3–24.8%, undiagnosed fraction 4.9–15.8% and treatment coverage 82.5–88.4%. We simulated PrEP-intervention reaching stable pre-specified coverage by year-one and compared absolute difference in relative HIV-incidence reduction 10 years post-intervention (PrEP-impact) between models with serosorting vs. sero-proportionate mixing; and counterfactual scenarios when PrEP users immediately stopped vs. continued serosorting. We examined sensitivity of results to PrEP-effectiveness (44–99%; reflecting varying dosing or adherence levels) and coverage (10–50%).

Results:

Models with serosorting predicted a larger PrEP-impact than models with sero-proportionate mixing under all PrEP-effectiveness and coverage assumptions [median (interquartile range): 8.1% (5.5–11.6%)]. PrEP users’ stopping serosorting reduced PrEP-impact compared with when PrEP users continued serosorting: reductions in PrEP-impact were minimal [2.1% (1.4–3.4%)] under high PrEP-effectiveness (86–99%); however, could be considerable [10.9% (8.2–14.1%)] under low PrEP effectiveness (44%) and high coverage (30–50%).

Conclusion:

Models assuming sero-proportionate mixing may underestimate population-level HIV-incidence reductions due to PrEP. PrEP-mediated changes in serosorting could lead to programmatically important reductions in PrEP-impact under low PrEP-effectiveness. Our findings suggest the need to monitor sexual mixing patterns to inform PrEP implementation and evaluation.
Agreement Between 18F-FDG PET/CT and Whole-Body Magnetic Resonance Compared With Skeletal Survey for Initial Staging and Response at End-of-Treatment Evaluation of Patients With Multiple Myeloma
Authors: Gómez León Nieves , Aguado Bueno Beatriz , Herreros Pérez María , León Ramírez Luisa F. , Alegre Adrián , Colletti Patrick M. , Rubello Domenico , Carreras José L. , Delgado Bolton Roberto C.
Published: February 2021

Purpose

To compare the agreement between whole-body (WB) magnetic resonance (MR) imaging, 18F-FDG PET/CT, and skeletal survey (SS) in patients with multiple myeloma (MM) for diagnosis, initial staging, response evaluation, and early detection of complications.

Methods

This is a retrospective cohort study including MM patients who were diagnosed, treated, and followed in 2 institutions. These patients were studied with SS, WB-MR, and/or 18F-FDG PET/CT. We studied bone lesions by anatomical locations and analyzed the concordance between SS and a tomographic technique (WB-MR or 18F-FDG PET/CT) and between both tomographic techniques (WB-MR and PET/CT).

Results

Forty-four MM patients with a mean age of 62.6 years (range, 38–85 years) were included from January 2012 to February 2016. Whole-body MR and 18F-FDG PET/CT found more lesions than SS in every location except in the skull. Concordance between WB-MR and 18F-FDG PET/CT was either good or excellent in most of the locations and in plasmacytoma studies. However, WB-MR was better than 18F-FDG PET/CT in the study of complications (medullar compression and vascular necrosis).

Conclusions

Our results suggest the study of MM patients should include WB-MR and/or 18F-FDG PET/CT, whereas SS is only useful for the skull. Whole-body MR and 18F-FDG PET/CT are complementary techniques, because both of them show good concordance in almost every location. It is still necessary to individualize the indication of each technique according to patient characteristics.
State of the Art MR Enterography Technique
Authors: Chatterji Manjil , Fidler Jeff L. , Taylor Stuart A. , Anupindi Sudha A. , Yeh Benjamin M. , Guglielmo Flavius F.
Published: February 2021

Magnetic resonance enterography (MRE) is a well-established imaging technique that is commonly used for evaluating a variety of bowel diseases, most commonly inflammatory bowel disease which is increasing in prevalence. Inflammatory bowel disease is composed of 2 related, but distinct disease entities: Crohn disease (CD) and ulcerative colitis. In ulcerative colitis, inflammation is generally limited to the mucosa and invariably involves the rectum, and often the more proximal colon. CD is typified by transmural inflammation with skip lesions occurring anywhere from the mouth to anus, but characteristically involves the terminal ileum. The transmural involvement of CD may lead to debilitating ulceration and, ultimately, development of sinus tracts, which can be associated with abscesses and fistulae as extraenteric manifestations of the disease. Because much of the small bowel and extraenteric disease cannot be adequately assessed with conventional endoscopy, imaging plays a crucial role in initial diagnosis and follow-up. MRE does not use ionizing radiation which is important for these patients, many of which present earlier in life and may require multiple imaging examinations. In this article, we review the clinical indications, patient preparation, and optimal technique for MRE. We also discuss the role and proper selection of intravenous gadolinium-based contrast material, oral contrast material, and antiperistaltic agents, including pediatric considerations. Finally, we review the recommended and optional pulse sequence selection, including discussion of a “time-efficient” protocol, reviewing their utility, advantages, and limitations. Our hope is to aid the radiologist seeking to develop a robust MRE imaging program for the evaluation of bowel disease.
The Complication of Tension Pneumocephalus After Septoplasty
Authors: Çiçek Mehmet Turan , Tan Mehmet
Published: February 2021

This paper presents a case of tension pneumocephalus with severe headache 2 days after septoplasty surgery. In such cases, endoscopic sinus surgery (ESS) or open approach can be used for repair of the defect. However, pneumocephalus, especially caused by minor defects, improves spontaneously with conservative treatment. In our case, the pneumocephalus was responsive to conservative treatment with bed rest, head elevation. His examinations in the 3rd and 8th months after discharge were uneventful and CT scan revealed no signs of pneumocephalus. In severe headaches developing after septoplasty, the possibility of intracranial complications should be evaluated. Simple conservative treatment should be tried before surgery, but then the patient should be examined at regular intervals.
Anatomical and Morphological Assessment of Nasopalatine Canal in Pediatric and Adolescent Population via Cone Beam Computed Tomography
Authors: Aydin Kader Cesur , Gaş Selin
Published: February 2021

Introduction:

Anatomical and morphological structure of nasopalatine canal (NPC) is important for surgical techniques carried out on the maxilla. The aim of the present study was to analyze the anatomical and morphological characteristics of the NPC among pediatric and adolescent population using cone beam computed tomography (CBCT).

Materials and Methods:

A total of 437 cases were analyzed using CBCT images in this retrospective, cross-sectional study. Shape was analyzed as hourglass, cone, funnel, banana, cylindrical, and tree branch like. Number of foramina Stenson (FS) was evaluated through coronal, axial, and sagittal views. Landmark evaluation involved; diameter of FS, diameter of incisive foramen, diameter at the mid-canal length, NPC length, and narrowest buccal bone thickness. Pathology presence near NPC was evaluated to determine alterations on the landmark metrics.

Results:

Nasopalatine canal shape distribution revealed 32% hourglass, 9.6% conic, 10.8% funnel, 11.9% banana, 29.5% cylindrical and 6.2% tree branch. Number of FS (P = 0.021;P < 0.05), diameter of FS (P = 0.041; p < 0.05), NPC length (P: 0.020;P < 0.05), and narrowest buccal bone thickness from the mid-canal length was significantly higher in males (P: 0.000;P < 0.05). Diameter of incisive foramen and diameter at the mid-canal length revealed no significance among genders (P1 = 0.318,P2 = 0.105;P > 0.05). Incidence of pathology near NPC is 20.8% and was not affected by gender (P = 0,192;P > 0.05).

Conclusions:

The current study demonstrates significant variations of NPC morphology among patients. Therefore, CBCT analysis is highly recommended for clinicians to reduce the complications in oral and maxillofacial surgery practices and to provide better surgical outcomes.
Application of the Digital Articulator in Surgery-First Approach
Authors: Biao Yan , Jung Jin-An , Kook Min-Suk , Lee Kyungmin Clara
Published: February 2021

Orthognathic surgery with surgery-first concept inevitably leads to an increase in posterior vertical dimension and anterior mandibular movement, causing a relapse. This case report introduces a digital technique for predictable surgical outcome in mandibular setback with the surgery-first orthognathic concept using digital articulator. Intraoral scans and a digital articulator were used to simulate the mandibular position after surgery and to predict postoperative increase in vertical dimension and its expecting forward movement of mandibile. This was incorporated in surgical planning. Sequential cone-beam computed tomography evaluation showed stable condylar position at 3 and 6 months after surgery. Thus, a digital articulator can be used to simulate the surgical outcome and to predict postsurgical increase in vertical dimension for better treatment planning.
Correction of Prominent Ears: Postauricular Muscle Relocation and Fibrofatty Tissue Excision
Authors: Mehmet Gunay Murat , Baklaci Deniz
Published: February 2021

In this study, we modified the combined Mustarde and Furnas type otoplasty technique and evaluated the postoperative results of the patients for symmetry and complications. Eighty prominent ears in 42 patients who underwent otoplasty between January 2017 and April 2019 were included in this study. The authors determined the amount of postauricular subcutaneous tissue to be removed according to the shape of skin incision and relocated the postauricular muscle as an adjunct to the Mustarde and Furnas otoplasty technique. All patients were followed-up at least 12 months postoperatively. The patients were also evaluated for early postoperative complications (bleeding, hematoma, perichondritis, wound infection, and skin necrosis), late postoperative complications (asymmetry, hypertrophic scars, suture extrusion, and recurrence), and patient satisfaction using objective and subjective methods.

Considering all the patients, early complications consisted of minimal low-flow bleeding (n = 4 ears/4 patients), hematoma (n = 1), and perichondritis (n = 1). Late complications consisted of suture extrusion (n = 2 ears/2 patients), hypertrophic scars (n = 2 ears/2 patients), and asymmetry (n = 1). None of the patients presented with wound infection or skin necrosis. Revision otoplasty was unilaterally performed in only 1 patient with the complaint of asymmetry. A natural-looking, adequate correction, and symmetric ear shape were achieved in all patients except 1. In terms of patient satisfaction, 38 of 42 patients evaluated the outcome as “very good,” 3 as “good,” and only 1 as “poor.” Our modified technique produced very satisfactory results and reduced the postoperative complication and asymmetry rates, as well as eliminating recurrence. The authors recommend this simple and safe procedure with excellent outcomes.
Effect of Nonradical Intravelar Veloplasty in Patients With Unilateral Cleft Lip and Palate: A Comparative Study and Systematic Review
Authors: Rossell-Perry Percy , Romero-Narvaez Carolina , Olivencia-Flores Claudia , Marca-Ticona Renato , Herencia Anaya Melissa , Pumamango Cordova Jimmy , Luque-Tipula Margot
Published: February 2021

Background:

The purpose of this study was to compare 2 techniques used for primary muscular repair and perform a systematic review of the literature to evaluate the effects of radical intravelar veloplasty (IVV) on nonsyndromic unilateral cleft lip and palate.

Methods:

This is an ambispective study between 2 groups of patients with unilateral cleft lip and palate who were operated using a radical and conservative form of IVV in Lima Peru. Data collection was accomplished by evaluation of speech development and middle ear function of the patients. A systematic review of the literature for studies published until June 2020 to evaluate the effect using the radical IVV in patients with cleft lip and palate.

Results:

Our comparative study did not find statistically significant differences in speech development between the studied techniques for unilateral cleft palate repair. Increased number of ear tube placements have been observed in the group treated with radical form of IVV. After systematic literature searching, 10 identified studies were qualified for the final analysis, which included 1367 patients. The overall study quality according to Oxford CEBM and GRADE scale was low.

Conclusions:

The results arising from this study provides statistical evidence that one technique let us obtain better speech outcomes. A technique with conservative IVV has statistical significant fewer rate of middle ear disorders after primary cleft palate repair. Based on available scientific evidence, definitive conclusions about the effectiveness of radical IVV on velopharyngeal and middle ear function cannot be drawn.
Evaluation of the use of Different Spreader Techniques in Primary Open Septorinoplasty in Terms of Nasal and Olfactory Functions
Authors: Bilgin Ergin , Kaya Celik Elif , Baklaci Deniz , Say Mehmet Ali , Dalgic Mustafa
Published: February 2021

Background:

In this study, the authors aimed to investigate the use of spreader and determine the efficacy and superiority of different spreader techniques in septorhinoplasty in terms of nasal and olfactory functions.

Methods:

A total of 60 patients who had undergone septorhinoplasty with the open technique were included in the study. In addition to open septorhinoplasty, 20 patients also underwent bilateral spreader graft placement and 20 bilateral spreader flap placement. For the remaining 20 patients, open septorhinoplasty was performed without spreader grafts or flaps. The patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale consisting of five questions, and the Brief Smell Identification Test was used to detect olfactory dysfunction.

Results:

The preoperative mean NOSE score of all patients was 10.87 (1–18), while the postoperative mean value was 1.83 (0–10). The preoperative mean olfactory score was 6.23 ± 2.20 in all patients while it was 7.33 ± 1.75 postoperatively. There was a statistically significant difference between the preoperative and postoperative NOSE and olfactory scores in all patients, but no statistically significant difference was observed between the three groups.

Conclusion:

Spreader graft or flap techniques used in septorhinoplasty are safe in terms of nasal obstruction and olfactory function, and there is no statistically significant difference between them.
Endoscopic Endonasal and Transmaxillary Approach for Resection of Juvenile Nasopharyngeal Angiofibroma With Preoperative Embolization in a Child
Authors: Bandoh Nobuyuki , Katada Akihiro , Kono Michihisa
Published: February 2021

A 13-year-old Japanese boy with a 6-month history of bilateral nasal obstruction and a 3-week history of recurrent epistaxis from the right nose was admitted to our department. Nasal endoscopy revealed a reddish, smooth-walled tumor occupying the right nasal cavity. Computed tomography scan revealed a 3.5 × 4.5 × 7.0-cm heterogeneously enhancing mass involving the right nasal cavity and extending posteriorly to the nasopharynx, and laterally to the pterygopalatine fossa and the medial part of the infratemporal fossa. We diagnosed as juvenile nasopharyngeal angiofibroma with Radkowski classification stage IIC. The internal maxillary and ascending pharyngeal arteries were embolized with polyvinyl alcohol followed by Embosphere using a conventional Seldinger technique. En bloc resection was performed with an endoscopic ipsilateral endonasal and sublabial Caldwell–Luc transmaxillary approach under general anesthesia. As of 3 years postoperatively, no recurrence has been found. We report a child case of juvenile nasopharyngeal angiofibroma successfully treated with less invasive surgery with preoperative embolization.
Psychology Behind Aesthetic Rhinoplasty – Introducing the term “SIFON”
Authors: Saeed Komal , Khan Farid Ahmad , Khan Izza , Farid Aimen
Published: February 2021

Background:

Rhinoplasty is considered one of the challenging aesthetic procedures. Psychosocial concerns motivate the urge for aesthetic procedures especially rhinoplasty. Males who fall in this category are designated as single, immature, male, over expectant and narcissistic (SIMON) in literature. As of yet, no term depicts females showing similar characteristics.

Aims and Objectives:

The purpose of this study is to evaluate the incidence of body dysmorphic disorder (BDD) in females seeking rhinoplasty and to introduce a new term.

Materials and Methods:

A prospective, questionnaire based, qualitative study was conducted in the Department Of Plastic Surgery, Services Institute Of Medical Sciences and Surgimed Hospital, Lahore between March 2018 and March 2020. 110 female candidates seeking aesthetic rhinoplasty were included in the study. BDD was evaluated using the Dysmorphic Concerns Questionnaire, DCQ (Table 1). Data were analyzed using SPSS version 25 software and correlation between the groups was evaluated.

Results:

Out of 110 female subjects, 77.3% (n = 85) were single, 16.4% (n = 18) were married and 6.4% (n = 7) were divorced. BDD was found in 41.8% (n = 46) of the candidates, majority being single (n = 41, 89.1%) and having educational status above diploma (n = 39, 84.8%). There was a statistically higher percentage of young adults between 24 and 28 years (n = 33, 71.7%) having BDD (P = 0.0001).

Conclusion:

Considering the high frequency of BDD among females seeking rhinoplasty, a standardized term ‘SIFON’ is introduced to describe such individuals who are S; single, I; immature, F; female, O; over expectant, N; narcissistic as apposed to SIMON in males.
An Extraordinary Complication of Chronic Tonsillitis: Perforation of Posterior Plica
Authors: Çiçek Mehmet Turan , Aslan Mehmet
Published: February 2021

Tonsillitis is a very common condition. It is usually of viral origin, is self-limiting, is generally treated conservatively in practice. Complications can be divided into non-suppurative and suppurative. According to the literature search, there is no reported case of posterior plica perforation caused by recurrent tonsil infections. The authors aimed to present the first case of posterior plica perforation caused by recurrent tonsillitis in the literature.
Functional Network Development in Sagittal Craniosynostosis Treated With Whole Vault Cranioplasty
Authors: Cabrejo Raysa , Lacadie Cheryl , Sun Alexander , Chuang Carolyn , Yang Jenny , Brooks Eric , Beckett Joel , Eilbott Jeffrey , Gabrick Kyle , Steinbacher Derek , Duncan Charles , DiLuna Michael , Alperovich Michael , Pelphrey Kevin , Ventola Pamela , Constable Todd , Persing John A.
Published: February 2021

Introduction:

In this study, the authors seek to clarify the neurological changes before and after whole vault cranioplasty (WVC) in patients born with sagittal craniosynostosis.

Methods:

A case control study design was performed that included thirty functional MRI scans, from 25 individual patients. Functional MRI and diffusion tension imaging data were analyzed with BioImageSuite (Yale University, USA). 9 functional brain networks were analyzed, with appropriate correlated functional regions of the brain and utilized for analysis.

Results:

Comparing functional MRI the infants after WVC versus infants before WVC group, the after WVC group demonstrated an increased connectivity in the left frontoparietal, secondary (V2), and third (V3) visual networks (P < 0.001). The right frontoparietal (RFPN) had decreased connectivity (P < 0.001). There is also a decrease and increase in anisotropy in the cingulum and precuneus despite surgery, respectively (P < 0.05). Adolescents treated with WVC compared to controls, demonstrated an increased connectivity in the salience and decreased connectivity in the RFPN relative to adolescent controls.

Conclusions:

Patients born with sagittal craniosynostosis have different connections in infancy in most of the defined cerebral networks compared to controls. After surgery, there are specific connectivity changes that occur in the RFPN, left frontoparietal, V2, and V3 networks, which are areas associated with executive function and emotional control. Changes identified in white matter tract microstructure connections could be influential in changes in functional connectivity. Although, as a child with sagittal craniosynostosis develops, much of the abnormal network connections, seen in infancy preoperatively, corrects to some degree after surgery. However, some aberrancies in the salience and RFPN networks remain potentially affecting executive functioning.
The Radiological Evaluation of the Crista Galli and Its Clinical Implications for Anterior Skull Base Surgery
Authors: Uçar Hadice , Bahşi Ilhan , Orhan Mustafa , Yalçin Eda Didem
Published: February 2021

Introduction:

Crista galli is extremely important in the endoscopic transcribriform approaches and some extradural approaches. Because of its clinical significance, the morphometric properties of crista galli should be well known. In this study, it was aimed to examine the morphometry and the pneumatization incidence of the crista galli in cone beam computed tomography (CBCT) images.

Material and Methods:

In this retrospective study, the length and width of the crista galli were measured in CBCT images of 300 healthy individuals. Besides, the presence of crista galli pneumatization was examined.

Results:

The length and width of the crista galli were determined to be as 14.03 ± 2.93 mm and 3.73 ± 1.48 mm, respectively. Pneumatized crista galli was detected in 53 out of 300 individuals (17.67%). There was no statistical difference between the presence of pneumatization and both length and width values of the crista galli (P = 0.876 and P = 0.478, respectively). In addition, no relationship was determined between age and the presence of pneumatization (P = 0.167).

Conclusion:

In this study, it is seen that the length (range: 6.00–23.40 mm) and width (range: 1.40–8.00 mm) of crista galli are in a very wide range. Besides, it is seen in the literature that the incidence of crista galli pneumatization is in a very wide range (2.4% to 66.6%). Based on the available data, it will not be possible to determine a specific range of values for crista galli morphometry. Therefore, the authors think that CT imaging is extremely important in preoperative evaluation.
MUC1 Mitigates Renal Injury and Inflammation in Endotoxin-Induced Acute Kidney Injury by Inhibiting the TLR4-MD2 Axis and Reducing Pro-inflammatory Macrophages Infiltration
Authors: Gibier Jean-Baptiste , Swierczewski Thomas , Csanyi Marie , Hemon Brigitte , Glowacki Francois , Maboudou Patrice , Van Seuningen Isabelle , Cauffiez Christelle , Pottier Nicolas , Aubert Sebastien , Perrais Michael , Gnemmi Viviane
Published: February 2021

Sepsis is the leading cause of acute kidney injury (AKI) in critical care patients. A cornerstone of sepsis-associated AKI is dysregulated inflammation driven by excessive activation of Toll-like receptor 4 (TLR4) pathway. MUC1, a membrane-bound mucin expressed in both epithelial tubular cells and renal macrophages, has been shown to be involved in the regulation of TLRs. Therefore, we hypothesized that MUC1 could mitigate the renal inflammatory response to TLR4 activation. To test this hypothesis, we used a murine model of endotoxin-induced AKI by intraperitoneal injection of LPS. We showed that Muc1−/− mice have a more severe renal dysfunction, an increased activation of the tissular NF-kB pathway and secreted more pro inflammatory cytokines compare to Muc1+/+ mice. By flow cytometry, we observed that the proportion of M1 (pro-inflammatory) macrophages in the kidneys of Muc1−/− mice was significantly increased. In human and murine primary macrophages, we showed that MUC1 is only induced in M1 type macrophages and that macrophages derived from Muc1−/− mice secreted more pro-inflammatory cytokines. Eventually, in HEK293 cells, we showed that MUC1 cytosolic domain (CT) seems necessary for the negative regulation of TLR4 by proximity ligation assay, MUC1-CT is in close relationship with TLR4 and acts as a competitive inhibitor of the recruitment of MYD88. Overall our results support that in the context of endotoxin-induced AKI, MUC1 plays a significant role in controlling disease severity by regulating negatively the TLR4-MD2 axis.
Thermal Stress Induces Long-Term Remodeling of Adipose Tissue and Is Associated with Systemic Dysfunction
Authors: Knuth Carly M. , Auger Christopher , Chi Leon , Barayan Dalia , Abdullahi Abdikarim , Jeschke Marc G.
Published: February 2021

Severe burns are characterized by the magnitude and duration of the hypermetabolic response thereafter, and demarcated by the loss of lean body mass and catabolism of fat stores. The aim of the present study was to delineate the temporal and location-specific physiological changes to adipose depots and downstream consequences post-burn in a murine model of thermal injury. C57BL/6 mice were subjected to a 30% total body surface area burn and body mass, food intake, and tissue mass were monitored for various time points up until 60 days postinjury. Mitochondrial respirometry was performed using a Seahorse XF96 analyzer. Lipolytic markers and browning markers were analyzed via Western blotting and histology. A severe burn results in a futile cycle of lipolysis and white adipose tissue (WAT) browning, the sequelae of which include fat catabolism, hepatomegaly, and loss of body mass despite increased food intake. A dynamic remodeling of epididymal WAT was observed with acute and chronic increases in lipolysis. Moreover, we demonstrate that pathological browning of inguinal WAT persists up to 60 days post-burn, highlighting the magnitude of the β-adrenergic response to thermal injury. Our data suggests that adipose depots have a heterogeneous response to burns and that therapeutic interventions targeting these physiological changes can improve outcomes. These data may also have implications for treating catabolic conditions such as cancer cachexia as well as developing treatments for obesity and type II diabetes.
Medical Student Ultrasound-Guided Intravenous Catheter Education
Authors: Kule Amy , Richards Rasheed A. , Vazquez Helen M. , Adams William H. , Reed Trent
Published: February 2021

Introduction

Simulation-based mastery learning (SBML) improves skill transfer to humans. However, limited data exist to support the practice of performing additional training attempts once mastery has been achieved. We explored whether implementing this concept in an SBML model improves skill transfer in ultrasound-guided peripheral intravenous (USGPIV) catheter placement from simulator to humans.

Methods

Forty-eight first- and second-year medical students underwent SBML for USGPIV placement to mastery standards on a simulator once to achieve minimum passing standard based on a 19-item checklist. Next, they completed either 0, 4, or 8 additional mastery level simulated performances in nonconsecutive order before attempting USGPIV placement on a human. An unplanned post hoc retention phase occurred 6 months later where participants' USGPIV skills were reassessed on a second human volunteer using the same checklist.

Results

In this sample, the success rate among the 3 training cohorts did not improve as the number of additional training sessions increased (exact P = 0.60) and were comparable among the 3 cohorts (exact P = 0.82). The overall checklist performance was also comparable among the 3 cohorts (exact P = 0.57). In an unplanned (small) sample of returning participants, the USGPIV retention rate exceeded 80% for those originally assigned to 4 or 8 sessions, whereas the retention rate fell less than 50% for those originally assigned to control. Among these returning participants, the overall success rate was 58% on the initial assessment and was 68% on retention.

Conclusions

In this sample of novices, we were unable to show that up to 8 additional mastery level performances of USGPIV placement on a simulator following SBML training improve skill transfer for both USGPIV placement success and total checklist performance.
Gender Parity Does Not Equal Gender Equity: Continued Sexism in Medical Literature
Authors: Kattapuram Taj M. , Patel Tirath Y. , Solberg Agnieszka O.
Published: February 2021

A recently retracted article discussing professionalism and young surgeons incites a social media storm on continued sexism in medical literature in 2020.
Early Locoregional Breast Surgery and Survival in de novo Metastatic Breast Cancer in the Multicenter National ESME Cohort
Authors: Hotton Judicaël , Lusque Amélie , Leufflen Léa , Campone Mario , Levy Christelle , Honart Jean-Francois , Mailliez Audrey , Debled Marc , Gutowski Marian , Leheurteur Marianne , Goncalves Anthony , Jankowski Clementine , Guillermet Sophie , Bachelot Thomas , Ferrero Jean-Marc , Eymard Jean-Christophe , Petit Thierry , Pouget Nicolas , de La Lande Brigitte , Frenel Jean-Sébastien , Villacroux Olivier , Simon Gaëtane , Pons-Tostivint Elvire , Marchai Frédéric
Published: February 2021

Objective:

The aim was to evaluate the impact of local surgery performed during the year after MBC diagnosis on patients' outcomes from a large reallife cohort.

Summary Background Data:

Locoregional treatment for patients with MBC at the time of diagnosis remains debated.

Methods:

Women with newly diagnosed, de novo stage IV MBC and who started MBC treatment between January 2008 and December 2014 in one of the 18 French Comprehensive Cancer Centers were included (NCT03275311). The impact of local surgery performed during the first year on overall survival (OS) and progression-free survival (PFS) was evaluated by the Cox proportional hazards model in a 12 month-landmark analysis.

Results:

Out of 16,703 patients in the ESME database, 1977 had stage IV MBC at diagnosis, were alive and progression-free at 12 months and eligible for this study. Among them, 530 (26.8%) had received primary breast cancer surgery within 12 months. A greater proportion of patients who received surgery had less than 3 metastatic sites than the no-surgery group (90.8% vs 78.2%, P < 0.0001). Surgery within 12 months was associated with treatment with chemotherapy, HER2-targeted therapy (89.1% vs 69.6%, P < 0.0001) and locoregional radiotherapy (81.7% vs 32.5%, P < 0.0001). Multivariable analyses showed that surgery performed within 12 months was associated with longer OS and PFS (adjusted HR [95%CI] = 0.75 [0.61–0.92] and 0.72 [0.63–0.83], respectively), which were also affected by pattern and number of metastatic sites, histological subtype, and age.

Conclusions:

In the large ESME cohort, surgery within 1 year after de novo MBC diagnosis was associated with a significantly better OS and PFS.
Preoperative Heart Failure Treatment Prevents Postoperative Cardiac Complications in Patients With Lower Risk
Authors: Shay Denys , Ng Pauline Y. , Dudzinski David M. , Grabitz Stephanie D. , Mitchell John D. , Xu Xinling , Houle Timothy T. , Bhatt Deepak L. , Eikermann Matthias
Published: February 2021

Objective:

The objective of this study was to identify undertreated subgroups of patients with heart failure who would benefit from better perioperative optimization.

Summary of Background Data:

Patients with heart failure have increased risks of postoperative cardiac complications after noncardiac surgery.

Methods:

In this analysis of hospital registry data of 130,677 patients undergoing noncardiac surgery, the exposure was preoperative history of heart failure. The outcome, cardiac complications, was defined as a composite of myocardial infarction, cardiac arrest, acute heart failure, and mortality within 30 postoperative days.

Results:

History of heart failure (n = 10,256; 7.9%) was associated with increased risk of cardiac complications [8.1% vs 1.1%; adjusted odds ratio, 2.28 (95% CI, 2.02–2.56); P < 0.001). Patients with heart failure and who carried a lower risk profile had increased risks of postoperative cardiac complications secondary to heart failure [adjusted absolute risk difference, 1.7% (95% CI, 1.4%–2.0%, lower risk); P < 0.001 vs 0.5% (95% CI, –0.6% to 1.6%, higher risk); P = 0.38]. Patients with heart failure and lower risk received a lower level of health care utilization preoperatively, and less frequently received anti-heart failure medications (59% vs 72% and 61% vs 82%; both P < 0.001). These preventive therapies significantly decreased the risk of cardiac complications in patients with heart failure.

Conclusions:

In patients with heart failure who have a lower preoperative risk profile, clinicians often make insufficient attempts to optimize their clinical condition preoperatively. Preoperative preventive treatment reduces the risk of postoperative cardiac complications in these lower-risk patients with heart failure.
Financial Evaluation of Kidney Transplant With Hepatitis C Viremic Donors to Uninfected Recipients
Authors: Axelrod David A. , Lentine Krista L. , Balakrishnan Ramji , Chang Su-Hsin , Alhamad Terek , Xiao Huiling , Kasiske Bertran L. , Bloom Roy D. , Schnitzler Mark A.
Published: February 2021

Background.

Kidney transplantation with hepatitis C viremic (dHCV+) donors appears safe for recipients without HCV when accompanied by direct acting antiviral (DAA) treatment. However, US programs have been reluctant to embrace this approach due to concern about insurance coverage. While the cost of DAA treatment is currently offset by the reduction in waiting time, increased competition for dHCV+ organs may reduce this advantage. This analysis sought to demonstrate the financial benefit of dHCV+ transplant for third-party health insurers to expand coverage availability.

Methods.

An economic analysis was developed using a Markov model for 2 decisions: first, to accept a dHCV+ organ versus wait for a dHCV uninfected organ; or second, accept a high kidney donor profile index (KDPI) (>85) organ versus wait for a better quality dHCV+ organ. The analysis used Medicare payments, historical survival data, cost report data, and an estimated cost of DAA of $29 874.

Results.

In the first analysis, using dHCV+ kidneys reduced the cost of end-stage kidney disease care if the wait for a dHCV uninfected organ exceeded 11.5 months. The financial breakeven point differed according to the cost of DAA treatment. In the second analysis, declining a high-KDPI organ in favor of a waiting dHCV+ organ was marginally clinically beneficial if waiting times were <12 months but not cost effective.

Conclusions.

dHCV+ transplant appears to be economically and clinically advantageous compared with waiting for dHCV-uninfected transplant but should not replace high-KDPI transplant when appropriate. Despite the high cost of DAA therapy, health insurers benefit financially from dHCV+ transplant within 1 year.
New-Onset Gout as an Independent Risk Factor for Returning to Dialysis After Kidney Transplantation
Authors: Li Justin W. , Yin David , Wang Zheng , Brigham Mark D. , LaMoreaux Brian D. , Kent Jeffrey D. , Francis-Sedlak Megan , Johnson Richard J. , Hadker Nandini , Francis Kevin M. , Sanchez Herman A. , Miyasato Gavin
Published: February 2021

Background.

The causal relationship between gout and renal transplant outcomes is difficult to assess due to multiple interacting covariates. This study sought to estimate the independent effect of new-onset gout on renal transplant outcomes using a methodology that accounted for these interactions.

Methods.

This study analyzed data on patients in the US Renal Data System (USRDS) who received a primary kidney transplant between 2008 and 2015. The exposure was new-onset gout, and the primary endpoint was returning to dialysis >12 months postindex date (transplant date). A marginal structural model (MSM) was fitted to determine the relative risk of new-onset gout on return to dialysis.

Results.

18 525 kidney transplant recipients in the USRDS met study eligibility. One thousand three hundred ninety-nine (7.6%) patients developed new-onset gout, and 1420 (7.7%) returned to dialysis >12 months postindex. Adjusting for baseline and time-varying confounders via the MSM showed new-onset gout was associated with a 51% increased risk of return to (RR, 1.51; 95% CI, 1.03-2.20).

Conclusions.

This finding suggests that new onset gout after kidney transplantation could be a harbinger for poor renal outcomes, and to our knowledge is the first study of kidney transplant outcomes using a technique that accounted for the dynamic relationship between renal dysfunction and gout.
Liver-only Transplantation in a Patient With Complex Congenital Heart Disease: Case Report and Review of the Literature
Authors: Perquy David , Pirenne Jacques , Van De Bruaene Alexander , Rex Steffen , van Malenstein Hannah
Published: February 2021

Background.

Patients with liver failure due to or in addition to congenital heart disease (CHD) represent a growing population in need of organ transplantation. Traditionally, these patients received a combined heart and liver transplantation carrying a high risk of perioperative morbidity and mortality.

Methods.

We discuss a patient with complex cyanotic CHD and biliary atresia undergoing liver-only transplantation. Furthermore, a literature study was performed on combined congenital heart and liver disease in the setting of transplantation.

Results.

We describe a unique case of a patient with severe CHD undergoing orthotopic liver transplantation for biliary atresia. In the literature, congenital malformations affecting different organs seems not that infrequent. Liver-only transplantation has been described in mild CHD, although data in adult patients are scarce. In severe CHD, the liver usually suffers from congestion. The severity of liver disease and reversibility should be estimated to decide on combined heart-liver transplantation.

Conclusions.

Our case and a review of the literature demonstrate that a patient-tailored approach with liver-only transplantation may be an appropriate alternative to combined heart and liver transplantation in selected cases.