bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Tape Sealing Face Masks on Visual Field Scores in the Era of COVID-19: A Randomized Cross-over Study
Authors: Heidinger Astrid , Falb Thomas , Werkl Peter , List Wolfgang , Hoeflechner Lukas , Riedl Regina , Ivastinovic Domagoj , Hommer Anton , Lindner Ewald
Published: August 2021

Precis:

Tape sealing of the face mask can prevent fogging artifacts of visual field testing. Here, we demonstrate that tape sealing can improve visual field scores even when fogging artifacts are not obvious.

Purpose:

The purpose of this study was to demonstrate that visual field scores improve when the face masks are taped to prevent fogging artifacts.

Methods:

A Single-center, randomized 2×2 cross-over study. Twenty-six visual fields of 13 patients of the glaucoma outpatient clinic were included. Patients were randomized in either sequence 1 (Octopus visual field examination without tape sealing, followed by examination with tape sealing) or sequence 2 (examination with, followed by without tape sealing).

Results:

The results for mean defect and square root of loss variance differ significantly in the examination with and without tape sealing [mean difference (without−with) 0.39 dB, 95% confidence interval: 0.07-0.70 dB, P=0.018 and 0.49 dB, 95% confidence interval: 0.19-0.79 dB, P=0.003, respectively]. There was no sequence effect (P=0.967) for mean defect nor the square root of loss variance (P=0.779). A significant effect for period (P=0.023) for mean defect was yielded.

Conclusion:

Tape sealing of face masks during visual field testing prevented fogging artifacts and improved visual field scores even when fogging artifacts were not obvious and should be considered in clinical practice.
Comparison of the 24-2 and 24-2C Visual Field Grids in Determining the Macular Structure-Function Relationship in Glaucoma
Authors: Hong Ji Wook , Baek Min Su , Lee Jin Yeong , Song Min Kyung , Shin Joong Won , Kook Michael S.
Published: August 2021

Precis:

The 24-2C grid showed significantly greater structure-function (S-F) associations in the global and regional sectors than the 24-2 visual field (VF) grid in open-angle glaucoma eyes.

Purpose:

The aim was to compare a Humphrey Field Analyzer (HFA) Swedish Interactive Threshold Algorithm-Faster (SITA-faster) 24-2C grid to a conventional HFA 24-2 grid regarding macular S-F relationships.

Methods:

The macular ganglion cell-inner plexiform layer thickness (mGCIPLT) was measured at different parafoveal sectors using spectral-domain optical coherence tomography in 150 eyes from 150 healthy, preperimetric, and perimetric glaucoma subjects. The central visual field mean sensitivity (VFMS) on the decibel and 1/L scales and the parafoveal mGCIPLT were matched topographically in 4 sectors and the strengths of the S-F relationships were assessed using “weighted” correlation coefficients and compared between 24-2C and 24-2 VF test grids.

Results:

There were significant global and sectoral correlations between the mGCIPLT and VFMS using both VF grids. The S-F correlations between the average/hemimacular mGCIPLT and the corresponding VFMS using a 24-2C grid were however significantly greater in both the entire and perimetric glaucoma groups (P<0.05), except for the average mGCIPLT of the perimetric glaucoma group in the 1/L scale (P=0.065). The 24-2C grid showed significantly greater S-F associations in the superotemporal and inferotemporal parafoveal sectors than the 24-2 VF grid (both P<0.05).

Conclusions:

A 24-2C grid may offer an advantage over the conventional 24-2 VF grid in assessing macular S-F relationships.
Concurrence of Merkel Cell Carcinoma and Squamous Cell Carcinoma in A Patient with Generalized Actinic Keratosis: A Case Report
Authors: Yue Zhang-Hui , Wang Yan , Fang Fang , Sun Jian-Fang
Published: August 2021

Introduction:

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy, and its pathogenesis might relate to ultraviolet light and Merkel cell polyomavirus infection. MCC in the Chinese population is uncommon. Here, we present a case of MCC that occurred based on widespread actinic keratosis (AK) in a Chinese female.

Case report:

An 82-year-old woman presented with two rapidly enlarging and rupture lesions on the face for 1 year. Biopsy was suggestive of squamous cell carcinoma (SCC) on the forehead and MCC on the left cheek. The patient had a history of generalized AK for 3years. The lesion on the left cheek was also revealed as an AK by histopathological examination 1 year ago. Complete surgical resection was performed to remove the two malignancies.

Discussion:

The co-occurrence of AK, SCC, and MCC in a Chinese woman is unusual. Immunohistopathological examination is vital for correct diagnosis. The three tumors, in this case, may originate from two different precursor cells and are affected by the same carcinogen. Alternatively, they may come from the same pluripotent epidermal stem cells, and chronic exposure to ultraviolet light and Merkel cell polyomavirus lead to the formation of different types of tumors. The coexist of MCC with other cutaneous tumors provided a train of thought for exploring the origin of MCC.

Conclusion:

We reported a rare co-existence phenomenon of MCC associated with AK and SCC. Hence, long-term follow-up and early treatment are imperative for patients with premalignant lesions, such as widespread AK.
Multiple thrombotic sources and embolic events at arterial sites in a patient with protein-C deficiency
Authors: Kulahcioglu Seyhmus , Ayturk Mehmet , Sari Munevver
Published: August 2021

Protein-C deficiency causes a thrombophilic environment in circulation. Although venous thromboembolism is the most common presentation, arterial events are rare. A 45 year-old woman with protein-C deficiency presented with multiple thromboembolic events including bilateral renal infarct and inferior ST-elevation myocardial infarction 3-days after coronary angiography via femoral approach which were normal coronary arteries. Computed tomographic angiography and transesophageal echocardioraphy displayed multiple thrombi sources including left atrium, left subclavian artery, sinus valsalva and descending aorta. Unfractionated-heparin and tissue plasminogen activator infusion were given. Although regression in ST-segment elevation and chest pain, no reduction in sizes of left atrial and aortic thrombus was observed by imaging modality. The patient refused surgical removal of thrombi, then warfarin therapy was planned. In patients with congenital thrombophilia and history of thromboembolism, anticoagulant treatment should be carefully managed during percutaneous diagnostic and interventional treatments and they should be performed by radial approach without interruption of anticoagulants.
Retrospective Application of Sinusoidal Obstruction Syndrome/Veno-occlusive Disease Diagnostic Criteria in a Pediatric Hematopoietic Stem Cell Transplant Cohort
Authors: Dhir Aditi , Wadhwa Aman , Haines Hilary , Chewning Joseph , Murthy Susmita , Kim Justin , Beatty Lisa , Mixon Emily , Fowler Karen B. , Gage Jarrod , Meadows Teresa , Goldman Frederick
Published: August 2021

Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) posthematopoietic stem cell transplantation (HSCT) is often diagnosed using the modified Seattle (MS) or European Society for Blood and Marrow Transplantation (EBMT) criteria. We hypothesized that strict application of these criteria could affect the timing of diagnosis and incidence of SOS/VOD. We collected data on 215 transplants performed in 184 patients at a single pediatric hematopoietic stem cell transplantation center, which were divided into 3 cohorts. Clinical diagnosis and treatment of SOS/VOD was documented in 13% of transplants (cohort 1). On retrospective review, 49% of transplant events met either MS and/or EBMT criteria, however, were not diagnosed with SOS/VOD (cohort 2); remaining 38% of transplant events did not meet MS or EBMT criteria and were not diagnosed with SOS/VOD (cohort 3). Day+100 overall survival was significantly inferior for cohort 1 (78%) compared with cohorts 2 or 3 (92% and 95%, P=0.01) with no difference between cohorts 2 and 3 (P=0.5). Patients diagnosed with SOS/VOD >day+13 had worse day+100 overall survival when compared with those diagnosed ≤day13 (64.3% and 100%, respectively, P=0.02). This study highlights the value of careful clinical assessment to guide diagnosis and the need to refine diagnostic criteria for SOS/VOD in children.
Hepatitis-Associated Aplastic Anemia: Etiology, Clinical Characteristics and Outcome
Authors: Tüfekçi Özlem , Özdemir Hamiyet H. , Malbora Bariş , Özbek Namik Y. , Yarali Neşe , Erdem Arzu , Evim Melike , Baytan Birol , Güneş Adalet M. , Karapinar Tuba , Oymak Yeşim , Töret Ersin , Bör Özcan , Yilmaz Şebnem , Ören Hale , Özdemir Gül N. , Karapinar Deniz Y.
Published: August 2021

Hepatitis-associated aplastic anemia (HAA) is a form of acquired aplastic anemia (AA) in which bone marrow failure develops after an acute attack of hepatitis. Bone marrow failure leading to AA is generally severe in cases of HAA and fatal if left untreated. This retrospective multicenter study investigated clinical and laboratory characteristics, possible causes, treatment, and outcome of HAA in children. Twenty patients from 8 centers were included in the study. Aspartate aminotransferase and alanine aminotransferase were <3 to 5×upper limit of normal (ULN) in 2 patients, <5 to 10×ULN in 2 patients, and >10×ULN in 16 patients. Acute liver failure developed in 5 (29%) patients. Pancytopenia was simultaneously present in 6 of 20 (30%) patients. Eleven of the 20 patients (55%) were alive, in remission and transfusion free. Those who were alive either had undergone hematopoietic stem cell transplantation and/or immunosuppressive treatment, except 1 patient who had received no treatment. Patients with the diagnosis of acute hepatitis should be evaluated and followed up carefully for presence of cytopenia, so that definitive treatment of AA can be initiated in a timely and appropriate manner when needed.
Abdominal Complications During Treatment for Pediatric Acute Myeloid Leukemia
Authors: Borgstedt-Bendixen Sofie E. , Abrahamsson Jonas , Ha Shau-Yin , Koskenvuo Minna , Lausen Birgitte , Palle Josefine , Zeller Bernward , Hasle Henrik , Løhmann Ditte J.A.
Published: August 2021

Acute myeloid leukemia (AML) accounts for 15% to 20% of childhood leukemias. Because of high-intensive therapy, up to 5% of patients suffer from treatment-related mortality (TRM). Abdominal complications are frequent, however, literature on this subject is sparse. We aimed to characterize severe abdominal pain (AP) and hyperbilirubinemia experienced by pediatric AML patients treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO)-AML 2004 protocol (n=313). Patients were censored at hematopoietic stem cell transplantation and relapse. Toxicity information was collected prospectively. Additional information was requested retrospectively from the treating centers. Sixteen episodes of hyperbilirubinemia and 107 episodes of AP were reported. The treating centers deemed infection (30%) and typhlitis (18%) as the most frequent causes of AP. Six patients developed appendicitis (2%). Patients experiencing concurrent AP and sepsis had a high risk of TRM (36%, n=4). Eighty percent of episodes with hyperbilirubinemia fulfilled the European Society for Bone and Marrow Transplantation criteria for sinusoidal obstruction syndrome. In conclusion, abdominal complications were frequent with infection considered the predominate cause. Most patients with hyperbilirubinemia fulfilled the criteria for sinusoidal obstruction syndrome. AML treatment might be associated with appendicitis. Patients suffering from concurrent AP and sepsis had a high risk of TRM indicating that high awareness of abdominal complications is essential to reduce mortality, especially during sepsis.
Endothelium-derived Microparticles Are Increased in Teenagers With Cobalamin Deficiency
Authors: Dundar Mehmet A. , Torun Yasemin A. , Cetin Feyza , Oz Hatice T.
Published: August 2021

Introduction:

Vitamin B12 (cobalamin) deficiency may be a significant cause of hyperhomocysteinemia, and high homocysteine (Hcy) levels are associated with an increased risk of cardiovascular disease. Endothelium-derived microparticles (EMPs) are a new marker in endothelial dysfunction and atherosclerosis, which play a role in cardiovascular diseases’ pathogenesis. This study aimed to evaluate the EMPs, the markers of endothelial dysfunction and atherosclerosis, and lipid profile in teenagers with cobalamin deficiency.

Materials and Methods:

This prospective study included 143 teenagers, 75 vitamin B12 deficient patients and 68 healthy controls between 11 and 18 years of age. Routine laboratory tests, hemogram, vitamin B12, folic acid, ferritin, Hcy, lipid profile and EMPs were examined and compared. EMP subgroups were analyzed by flow cytometry method according to the expression of membrane-specific antigens. The microparticles released from the endothelium studied were VE-cadherin (CD144), S-endo1 (CD146), and Endoglin (CD105).

Results:

The present study demonstrates that circulating CD105+ EMP, CD144+ EMP, CD146+ EMPs, and Hcy were increased, and high-density lipoprotein (HDL) cholesterol was reduced in teenagers with cobalamin deficiency. Vitamin B12 showed a negative correlation with EMPs and Hcy, positive correlation with folate and HDL. All EMPs showed a significant positive correlation with triglyceride, vitamin B12, and HDL.

Conclusion:

Vitamin B12 deficiency may predispose to endothelial damage and atherosclerosis by increasing EMPs and harms lipid metabolism in the long term.
Validation of the German Version of the Second Victim Experience and Support Tool—Revised
Authors: Strametz Reinhard , Siebold Bianka , Heistermann Peter , Haller Susanne , Bushuven Stefan
Published: August 2021

Introduction

The second victim phenomenon that occurs after critical events poses a serious factor for patient and workplace safety. These experiences can be evaluated using the Second Victim Experience and Support Tool (SVEST), originally in English, or the translated and validated Korean or Chinese versions. In 2020, a revised version was published (SVESTR) with the addition of resilience items. The aim of this study is the validation of the German version, the G-SVESTR, in a multiprofessional setting.

Methods

The G-SVESTR questionnaire was designed according to World Health Organization recommendations. This entails translation, test for face validity, back translation, pretest, expert panel evaluation, and a test in a large population for validity and reliability. We provided an anonymous online questionnaire to physicians, nurses, paramedics, medical assistants, and physician assistants to test our developed tool. Statistics were accomplished using XL-Stats.

Results

Altogether, 72% (306 of 428) of the participants completed the survey. The mean time for completion was 9.4 minutes. Physician assistants and medical assistants were significantly younger than other respondents. The analysis revealed satisfactory reliability (Cronbach α = 0.844). A principal component analysis showed 11 factors with eigenvalues greater than 1. Factor loading on distinct dimensions was satisfactory with one exception, the absenteeism item (item 31), which showed cross-loadings and poor factor loading on the absenteeism dimension. The results of the G-SVESTR revealed only some differences between the professional subgroups.

Conclusion

The G-SVESTR is a valid and reliable testing instrument for the evaluation of second victim experiences in different medical professions.
Mucosal AIDS virus transmission is enhanced by antiviral IgG isolated early in infection
Authors: Marasini Bishal , Vyas Hemant K. , Lakhashe Samir K. , Hariraju Dinesh , Akhtar Akil , Ratcliffe Sarah J. , Ruprecht Ruth M.
Published: August 2021

Objective:

Antibody-dependent enhancement (ADE) affects host-virus dynamics in fundamentally different ways: i) enhancement of initial virus acquisition, and/or ii) increased disease progression/severity. Here we address the question whether anti-HIV-1 antibodies can enhance initial infection. While cell-culture experiments hinted at this possibility, in-vivo proof remained elusive.

Design:

We used passive immunization in nonhuman primates challenged with simian-human immunodeficiency virus (SHIV), a chimera expressing HIV-1 envelope. We purified IgG from rhesus monkeys with early-stage SHIV infection – before cross-neutralizing anti-HIV-1 antibodies had developed – and screened for maximal complement-mediated antibody-dependent enhancement (C’-ADE) of viral replication with a SHIV strain phylogenetically distinct from that harbored by IgG donor macaques. IgG fractions with maximal C’-ADE but lacking neutralization were combined to yield enhancing anti-SHIV IgG (enSHIVIG).

Results:

We serially enrolled naive macaques (Group 1) to determine the minimal and 50% animal infectious doses required to establish persistent infection after intrarectal SHIV challenge. The first animal was inoculated with a 1 : 10 virus-stock dilution; after this animal's viral RNA load was >104copies/ml, the next macaque was challenged with 10x less virus, a process repeated until viremia no longer ensued. Group 2 was pretreated intravenously with enSHIVIG 24 h before SHIV challenge. Overall, Group 2 macaques required 3.4-fold less virus compared to controls (P = 0.002). This finding is consistent with enhanced susceptibility of the passively immunized animals to mucosal SHIV challenge.

Conclusion:

These passive immunization data give proof of IgG-mediated enhanced virus acquisition after mucosal exposure – a potential concern for antibody-based AIDS vaccine development.
Opioid use disorder: a neglected human immunodeficiency virus risk in American adolescents
Authors: Lloyd Audrey R. , Savage Rebekah , Eaton Ellen F.
Published: August 2021

In 2017 alone, 783 000 children aged 12–17 years misused opioids with 14 000 using heroin. Opioid misuse and opioid use disorder (OUD) in adolescents and young adults are significant barriers to ending the HIV epidemic. To address these synergistic scourges requires dedicated practitioners and improved access to life-saving evidence-based treatment. Adolescents and young adults make up over one in five new HIV diagnoses even though they are less likely to be tested or know they are infected. Adolescents and young adults living with HIV are less likely to be retained in care or achieve virological suppression. OUD further leads to increased rates of risky behaviours (like sex without condoms), deceased retention in HIV care and decreased rates of viral suppression in this vulnerable population. Medications for opioid use disorder (MOUD) are recommended for adolescents and young adults with severe OUD and help retain youth in HIV treatment and decrease risk of death. However, due to stigma and lack of experience prescribing MOUD in adolescents, MOUD is often perceived as a last line option. MOUD remains difficult to access for adolescents with a shortage of providers and decreased options for treatment as compared to adults. Addiction treatment is infection prevention, and integrated addiction and HIV services are recommended to improve health outcomes. A multipronged approach including patient education, provider training and policy changes to improve access to treatment and harm reduction are urgently needed confront the drug use epidemic in youth.
Diagnostic and Management Considerations in Pediatric Dermatofibrosarcoma Protuberans
Authors: Reilly Daniel J. , Loo Yew Loong , Alexander William M. , Wilks Daniel J. , MacGregor Duncan , Coombs Christopher J.
Published: August 2021

Background

Dermatofibrosarcoma protuberans (DFSP) is a rare fibrohistiocytic tumor of dermal origin. Six percent of all cases present in children, with a childhood incidence of 1 per million.

Methods

This is a retrospective review of all cases of pediatric DFSP managed at a single institution over a 23-year period.

Results

Seventeen patients (10 male; mean age, 9.9 years) were managed during the study period. The median follow-up was 29 months. All patients had surgical excision. Three patients required further excision to achieve uninvolved final margins. There were no recurrences observed.

Conclusions

Pediatric DFSP should be managed by a soft tissue tumor multidisciplinary team, with experienced pathologists and reconstructive surgeons. Where R0 resections are obtained, patients can experience recurrence-free survival.
Sensory Reinnervation With Subcutaneously Embedded Innervated Flaps
Authors: Otani Naoya , Tomita Koichi , Taminato Mifue , Kuroda Kazuya , Yano Kenji , Kubo Tateki
Published: August 2021

Background

In breast reconstruction, both aesthetic outcomes and sensory function are important for postoperative quality of life. Innervated flaps are useful in reconstruction after conventional mastectomy (CM), which leaves a large portion of the skin paddle exposed on the body surface. However, whether they are also useful in skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) remains unclear. This study aimed to examine the usefulness of innervated flaps in restoring sensation after SSM and NSM using a rat model.

Methods

Dorsal cutaneous nerves of rats were entirely eliminated except for the medial branch of the dorsal cutaneous nerve of thoracic segment 13, resulting in an innervated field surrounded by a denervated field. The innervated field was elevated as an innervated island flap and then subcutaneously embedded, with the skin paddle deepithelialized entirely (NSM group, n = 5) or except at the center (SSM group, n = 6). In the control model (CM group, n = 5), the flap was sutured back into its original position. Postoperative changes in the mechanonociceptive field were evaluated using the cutaneous trunci muscle reflex test. Immunohistochemical evaluation of regenerated nerves in the new mechanonociceptive field was performed at postoperative week 12.

Results

In the SSM and CM groups, the mechanonociceptive field expanded around the skin paddle. In the NSM group, a new mechanonociceptive field appeared at postoperative week 4 and expanded thereafter. Areas of the mechanonociceptive field at postoperative week 12 did not differ significantly between the SSM and NSM groups, but were significantly smaller compared with the CM group and comparable to original flap areas. Histologically, S100- and PGP9.5-positive nerve fibers were observed in the dermis of the new mechanonociceptive field and subcutaneous flap tissue.

Conclusions

Subcutaneously embedded innervated island flaps induced nerve regeneration and sensory reinnervation of the denervated skin, suggesting that innervated flaps may also be useful in reconstruction post-SSM/NSM.
Ocular Outcomes of Maxillofacial Trauma – A Decennary Descriptive Study
Authors: Singh Ishan , Shetty Premalatha , Fernandes Trishala Bhadauria , Singh Amoli
Published: August 2021

Maxillofacial trauma is amongst the most frequently encountered trauma seen in the hospital emergency setting. It may be life-threatening on rare occasions, and with concomitant injuries, it is often severely debilitating.

Objective:

The present study was conducted to determine the occurrence of concomitant orbital and ocular injuries amongst patients with maxillofacial trauma, and also helps in deriving a correlation between different patterns of maxillofacial fractures.

Methods:

All the records of the patients with maxillofacial trauma who were admitted to our institution over a 10-year period were analyzed. The files were screened to isolate the patients with concomitant ocular and orbital injuries.

Results:

Out of a total of 686 patients, 370 had associated ocular injuries. A total of 566 (82.5%) patients were males and 120 (17.5%) females. A total of 236 patients (34.4%) were in the 3rd decade. A total of 351 cases of orbital fracture (isolated + concomitant) were reported. About 44 (12.5%) cases of isolated orbital floor fractures were seen.

Subconjunctival hemorrhage accounted for the maximum number of cases amounting to 59.19%. The least associated ocular injuries seen were of traumatic mydriasis (0.28%). Out of 370 cases of ocular injuries, 249 (67.3%) were associated with fractures of the zygomaticomaxillary complex.

Conclusions:

The present study draws attention to the concomitant orbital and ocular injuries in maxillofacial trauma patients. This study is strongly suggestive of a very high probability of concomitant ocular injury in maxillofacial trauma patients which necessitates strong interdepartmental coordination for holistic management of the maxillofacial trauma patients.
Nasal Obstruction Evaluation After LeFort I Osteotomy: A Pilot Study
Authors: Kosyk Mychajlo S. , Zapatero Zachary D. , Kalmar Christopher L. , Carlson Anna R. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A.
Published: August 2021

Previous literature has documented changes in nasal obstruction after acute LeFort I osteotomy. However, there is a paucity of studies that evaluate distraction-mediated LeFort I (DO-LFI) without concomitant intranasal interventions using the nasal obstruction symptom evaluation (NOSE) scale in Class III patients. The purpose of this study is to objectively evaluate nasal obstruction quality of life through the NOSE scale in patients undergoing DO-LFI. Inclusion into the study required both a preoperative (1 year ≤ date of service) and postoperative (≥6 months and ≤2 years) NOSE scale administration. Nasal obstruction symptom evaluation scales were compared using Wilcoxon signed rank test. There was a significant difference in composite NOSE scales, x̃ = 8.0 (interquartile range: 4.0–11.0), x̃ = 1.0 (interquartile range: 1.0–3.0), P < 0.017, preoperatively and postoperatively respectfully. Additionally, when looking at individual components of the NOSE scale, nasal congestion or stuffiness, and trouble breathing through nose were significantly improved after DO-LFI (P < 0.017). Nasal blockage or obstruction (P > 0.084) and trouble breathing when exercising (P > 0.076) trended towards significant improvement, as well. Trouble sleeping did not differ, P > 0.611. We elucidate, in this pilot study, that there is an association between DO-LFI and patient reported nasal obstructive symptoms. Future prospective studies utilizing the NOSE scale are needed to determine causality.
Frontotemporal Lipofilling for Plagiocephaly Sequelae
Authors: Mendes Margarida Sofia Soares , Oliveira Ricardo José Moreira Horta , da Silva Álvaro Manuel Catarino Pereira
Published: August 2021

Plagiocephaly patients generally undergo corrective surgery in the first years of life, but during their growth malformative sequelae become apparent and can have a negative psychological and social impact. Volumetric filling techniques have been used to improve social balance and minimize such negative effects.

We present a case of a 25 years old male with a history of plagiocephaly corrected by 8 months of age. He kept a bilateral frontotemporal defect and we performed a lipofilling of the affected areas. The aesthetic results were very satisfactory and 6 months and 1 year after the procedure he maintained a good volumetric filling. There were no complications during or after the procedure.

Lipofilling provides good contouring results and has low complication rates. Its major inconvenient is adipose tissue resorption.

As illustrated by this case, this type of treatment significantly improves facial appearance, raising patients’ self-esteem and quality of life.
Modified Burr-Hole Craniostomy for the Treatment of Chronic Subdural Hematoma in Adults
Authors: Zhao Zhiyong , Zhang Jinglong , Zhang Guojin , Cao Yuntai , Wang Gang , Yin Hang , Zhang Jing , Zhu Miaojuan , Pan Yawen , Zhou Junlin
Published: August 2021

Background:

Burr-hole craniostomy (BHC) is considered to be the most effective method for the treatment of chronic subdural hematoma (CSDH), and middle meningeal artery embolization is a new therapy used in clinical practice in recent years to treat CSDH. However, the optimal therapeutic effect of these 2 procedures is still controversial. This study prospectively designed a modified burr-hole craniostomy (mBHC) with drainage to treat CSDH.

Methods:

A total of 101 patients diagnosed with CSDH from January 2019 to April 2020 were prospectively included in this study. They were divided into BHC and mBHC groups. Among them, 40 selected CSDH patients received mBHC treatment. For comparison, 61 CSDH patients who received BHC treatment were used as the control group. Primary outcomes were hematoma recurrence and postoperative complications. Secondary outcomes included midline recovery, hematoma clearance, operation time, and hospital stay. The Chi-square test was used to compare the 6-month follow-up results between the 2 groups.

Results:

Among patients treated with mBHC, 39 patients had a good prognosis, and one 87-year-old patient with bilateral hematoma died of postoperative heart failure. Of the patients treated with BHC, 52 patients had good prognoses, and one 53-year-old patient with unilateral hematoma died of postoperative acute intracranial bleeding. During the 6-month follow-up period, no relapse occurred in the patients treated with mBHC, whereas 8 (13%) of the patients treated with BHC relapsed. There was a significant difference in the recurrence rate between the 2 groups (P < 0.05). In addition, midline recovery, hematoma clearance rate, operation time, and complications were found to be significantly different statistically (P < 0.05), and other characteristics of operation and outcome were not significantly different (P > 0.05) between the 2 groups.

Conclusions:

Modified burr-hole craniostomy has a positive therapeutic effect on patients with CSDH and is more effective than conventional BHC therapy.
Endoscopic-Assisted Fronto-Orbital Distraction Osteogenesis: Initial Patient Report
Authors: Kalmar Christopher L. , Carlson Anna R. , Kosyk Mychajlo S. , Zapatero Zachary D. , Heuer Gregory G. , Taylor Jesse A.
Published: August 2021

Background:

The purpose of this manuscript is to introduce a novel endoscopic-assisted approach for creation of osteotomies and distractor hardware placement for unicoronal craniosynostosis.

Methods:

Only three small incisions are performed, one at the anterior fontanelle, pterional region, and upper lateral blepharoplasty location. Unicoronal strip craniectomy and osteotomies in temporal bone, nasofrontal junction, lateral orbital rim, sphenoid wing, orbital roof, and contralateral frontal bone are performed through these incisions with the assistance of a 30° 5-mm endoscope. One linear cranial distractor is inserted through the pterional incision and fixated across the unicoronal suturectomy.

Results:

Endoscopic-assisted fronto-orbital distraction osteogenesis has been performed on 3 patients with unicoronal craniosynostosis. Median age at surgery was 5.4 months (95%CI 5.0–6.1). Median operative duration was 98 minutes (95%CI 91–112), and estimated blood loss was 25 mL (95%CI 15–150). Median length of distraction achieved was 25.7 mm (95%CI 21.9–28.0), based on lateral skull x-rays obtained on the last day of activation. Distractors were removed 2.3 months postoperatively (95%CI 2.1–3.1), and operative duration of distractor removal was 20 minutes (95%CI 19–29). There was 1 complication, a transient cerebrospinal fluid leak thought to have been caused by a pinpoint injury to the dura at the nasofrontal junction, which was managed expectantly and resolved spontaneously by the fourth postoperative day.

Conclusions:

Endoscopic-assisted fronto-orbital distraction osteogenesis is a promising treatment modality for children with unicoronal craniosynostosis combining the benefits of distraction osteogenesis with a minimally invasive approach. Additional experience and follow-up are needed to determine its utility, safety, and longevity.
Pediatric Aggressive Benign Mandibular Tumors: Clinical Features and Management
Authors: Koraitim Mohamed , Medra Ahmed Mohamed , Salloum Ahmed M. , Shehata Ehab A.
Published: August 2021

Introduction:

Aggressive benign mandibular tumors are uncommon in the pediatric population, and there is few publishing in the literature specifically dealing with them. Aggressive tumors can be defined based on known biologic behavior and/or histologic type and/or clinical characteristics.

Aim of the Study:

To review the clinical features and management of lower jaw pediatric aggressive benign tumor.

Patients and Methods:

Medical records review of pediatric patients presented with aggressive benign mandibular tumors to the Maxillofacial and Plastic Surgery Department, University of Alexandria, Egypt between 2011 and 2019.

Results:

Fifty-eight patients were included in this study, aged between 2 and 16 years (average = 11.8). Ameloblastoma was the commonest pathological diagnosis (n = 18) followed by central giant cell granuloma (n = 11) and juvenile ossifying fibroma (n = 10). Patients with central giant cell granuloma were treated by en-block resection (n = 4) or curettage after interferon alfa injection (n = 7). All other benign tumors were treated by en-block resection. The length of follow-up ranged from 1 to 8 years. Successful reconstruction was accomplished in 45 patients (88.2%).

Conclusions:

Aggressive lesion should be treated in an aggressive manner and immediate reconstruction is advocated. However, pharmacotherapy combined with enucleation is a more conservative approach for management of aggressive central giant cell tumors.
Destructive Frontonasal Mucocele Following Facial Trauma and Surgery
Authors: Moore Warner , Cohn Jason E. , Bundrick Paige
Published: August 2021

Mucoceles are fluid filled cysts with numerous etiologies that can erode bone and if left untreated, can lead to infraorbital and intracranial complications. With limited cases published in the medical literature, our patient with a frontonasal mucocele expanding from the frontal sinus to the nasal dorsum with erosion of the nasal bones and upper lateral cartilages, provides an opportunity for evidence-based diagnosis and treatment. We present a 24-year-old female with a nasal mass destroying numerous nasal structures. Three surgical approaches were considered: open rhinoplasty, bicoronal approach, and Lynch excision; the latter executed with subsequent total nasal reconstruction. Bone, septal cartilage, and temporalis fascia were utilized to provide structural support and a posterior nasal septal flap was incorporated to maintain a blood supply. integrity of nasal structure and cosmesis as well as recurrence of disease were monitored during postoperative visits.
Efficacy and Safety of Low Molecular Weight Heparin Versus Unfractionated Heparin for Prevention of Venous Thromboembolism in Trauma Patients
Authors: Tran Alexandre , Fernando Shannon M. , Carrier Marc , Siegal Deborah M. , Inaba Kenji , Vogt Kelly , Engels Paul T. , English Shane W. , Kanji Salmaan , Kyeremanteng Kwadwo , Lampron Jacinthe , Kim Dennis , Rochwerg Bram
Published: August 2021

Purpose:

Trauma patients are at high risk of VTE. We summarize the efficacy and safety of LMWH versus UFH for the prevention of VTE in trauma patients.

Methods:

We searched 6 databases from inception through March 12, 2021. We included randomized controlled trials (RCTs) or observational studies comparing LMWH versus UFH for thromboprophylaxis in adult trauma patients. We pooled effect estimates across RCTs and observational studies separately, using random-effects model and inverse variance weighting. We assessed risk of bias using the Cochrane tool for RCTs and the Risk of Bias in Non-Randomized Studies (ROBINS)-I tool for observational studies and assessed certainty of findings using Grading of Recommendations, Assessment, Development and Evaluations methodology.

Results:

We included 4 RCTs (879 patients) and 8 observational studies (306,747 patients). Based on pooled RCT data, compared to UFH, LMWH reduces deep vein thrombosis (RR 0.67, 95% CI 0.50 to 0.88, moderate certainty) and VTE (RR 0.68, 95% CI 0.51 to 0.90, moderate certainty). As compared to UFH, LMWH may reduce pulmonary embolism [adjusted odds ratio from pooled observational studies 0.56 (95% CI 0.50 to 0.62)] and mortality (adjusted odds ratio from pooled observational studies 0.54, 95% CI 0.45 to 0.65), though based on low certainty evidence. There was an uncertain effect on adverse events (RR from pooled RCTs 0.80, 95% CI 0.48 to 1.33, very low certainty) and heparin induced thrombocytopenia [RR from pooled RCTs 0.26 (95% CI 0.03 to 2.38, very low certainty)].

Conclusions:

Among adult trauma patients, LMWH is superior to UFH for deep vein thrombosis and VTE prevention and may additionally reduce pulmonary embolism and mortality. The impact on adverse events and heparin induced thrombocytopenia is uncertain.
Long-term Mental Health Trajectories of Injured Military Servicemembers
Authors: Dalton Michael K. , Manful Adoma , Jarman Molly P. , Koehlmoos Tracey P. , Weissman Joel S. , Cooper Zara , Schoenfeld Andrew J.
Published: August 2021

Objective:

We sought to quantify the impact of injury characteristics and setting on the development of mental health conditions, comparing combat to noncombat injury mechanisms.

Background:

Due to advances in combat casualty care, military service-members are surviving traumatic injuries at substantial rates. The nature and setting of traumatic injury may influence the development of subsequent mental health disorders more than clinical injury characteristics.

Methods:

TRICARE claims data was used to identify servicemembers injured in combat between 2007 and 2011. Controls were servicemembers injured in a noncombat setting matched by age, sex, and injury severity. The rate of development, and time to diagnosis [in days (d)], of 3 common mental health conditions (post-traumatic stress disorder, depression, and anxiety) among combat-injured servicemembers were compared to controls. Risk factors for developing a new mental health condition after traumatic injury were evaluated using multivariable logistic regression that controlled for confounders.

Results:

There were 3979 combat-injured servicemember and 3979 matched controls. The majority of combat injured servicemembers (n = 2524, 63%) were diagnosed with a new mental health condition during the course of follow-up, compared to 36% (n = 1415) of controls (P < 0.001). In the adjusted model, those with combat-related injury were significantly more likely to be diagnosed with a new mental health condition [odds ratio (OR): 3.18, [95% confidence interval (CI): 2.88–3.50]]. Junior (OR: 3.33, 95%CI: 2.66–4.17) and senior enlisted (OR: 2.56, 95%CI: 2.07–3.17) servicemem-bers were also at significantly greater risk.

Conclusions:

We found significantly higher rates of new mental health conditions among servicemembers injured in combat compared to service-members sustaining injuries in noncombat settings. This indicates that injury mechanism and environment are important drivers of mental health sequelae after trauma.
The Impact of COVID-19 on Electroconvulsive Therapy
Authors: Kwan Elaine , Le Brandon , Loo Colleen K. , Dong Vanessa , Tor Phern-Chern , Davidson Don , Mohan Titus , Waite Susan , Branjerdporn Grace , Sarma Shanthi , Hussain Salam , Martin Donel M.
Published: August 2021

Objectives

The coronavirus disease 2019 (COVID-19) pandemic has led to reported change in electroconvulsive therapy (ECT) services worldwide. However, minimal data have been published demonstrating tangible changes across multiple ECT centers. This article aimed to examine changes in ECT patients and ECT service delivery during the pandemic.

Methods

We retrospectively assessed data collected on ECT patients within the Clinical Alliance and Research in Electroconvulsive Therapy and Related Treatments (CARE) Network during a 3-month period starting at the first COVID-19 restrictions in 2020 and compared data with predicted values based on the corresponding 3-month period in 2019. Mixed-effects repeated-measures analyses examined differences in the predicted and actual number of acute ECT courses started and the total number of acute ECT treatments given in 2020. Sociodemographic, clinical, treatment factors, and ECT service delivery factors were compared for 2020 and 2019.

Results

Four Australian and 1 Singaporean site participated in the study. There were no significant differences between the predicted and actual number of acute ECT courses and total number of acute ECT treatments administered in 2020. During 2020, there were statistically significant increases in the proportion of patients requiring ECT under substitute consent and receiving ECT for urgent reasons compared with 2019.

Conclusions

This multisite empirical study is among the first that supports anecdotal reports of changes in the triaging and delivery of ECT during COVID-19. Results suggest that ECT was prioritized for the most severely ill patients. Further data assessing the impacts of COVID-19 on ECT are needed.
Anthroengineering: an independent interdisciplinary field
Authors: Berthaume Michael A. , Kramer Patricia Ann
Published: August 2021

In recent decades, funding agencies, institutes and professional bodies have recognized the profound benefits of transdisciplinarity in tackling targeted research questions. However, once questions are answered, the previously abundant support often dissolves. As such, the long-term benefits of these transdisciplinary approaches are never fully achieved. Over the last several decades, the integration of anthropology and engineering through inter- and multidisciplinary work has led to advances in fields such as design, human evolution and medical technologies. The lack of formal recognition, however, of this transdisciplinary approach as a unique entity rather than a useful tool or a subfield makes it difficult for researchers to establish laboratories, secure permanent jobs, fund long-term research programmes and train students in this approach. To facilitate the growth and development and witness the long-term benefits of this approach, we propose the integration of anthropology and engineering be recognized as a new, independent field known as
anthroengineering
. We present a working definition for anthroengineering and examples of how anthroengineering has been used. We discuss the necessity of recognizing anthroengineering as a unique field and explore potential novel applications. Finally, we discuss the future of anthroengineering, highlighting avenues for moving the field forward.
A review of musculoskeletal modelling of human locomotion
Authors: Sylvester Adam D. , Lautzenheiser Steven G. , Kramer Patricia Ann
Published: August 2021

Locomotion through the environment is important because movement provides access to key resources, including food, shelter and mates. Central to many locomotion-focused questions is the need to understand internal forces, particularly muscle forces and joint reactions. Musculoskeletal modelling, which typically harnesses the power of inverse dynamics, unites experimental data that are collected on living subjects with virtual models of their morphology. The inputs required for producing good musculoskeletal models include body geometry, muscle parameters, motion variables and ground reaction forces. This methodological approach is critically informed by both biological anthropology, with its focus on variation in human form and function, and mechanical engineering, with a focus on the application of Newtonian mechanics to current problems. Here, we demonstrate the application of a musculoskeletal modelling approach to human walking using the data of a single male subject. Furthermore, we discuss the decisions required to build the model, including how to customize the musculoskeletal model, and suggest cautions that both biological anthropologists and engineers who are interested in this topic should consider.
The effects of femoral metaphyseal morphology on growth plate biomechanics in juvenile chimpanzees and humans
Authors: Stamos Peter A. , Berthaume Michael A.
Published: August 2021

The distal femoral metaphyseal surface presents dramatically different morphologies in juvenile extant hominoids—humans have relatively flat metaphyseal surfaces when compared with the more complex metaphyseal surfaces of apes. It has long been speculated that these different morphologies reflect different biomechanical demands placed on the growth plate during locomotor behaviour, with the more complex metaphyseal surfaces of apes acting to protect the growth plate during flexed-knee behaviours like squatting and climbing. To test this hypothesis, we built subject-specific parametric finite-element models from the surface scans of the femora of fivePanand sixHomojuveniles. We then simulated the loading conditions of either a straight-leg or flexed-knee gait and measured the resulting stresses at the growth plate. When subjected to the simulated flexed-knee loading conditions, both the maximum and mean von Mises stresses were significantly lower in thePanmodels than in theHomomodels. Further, during these loading conditions, von Mises stresses were strongly negatively correlated with ariaDNE, a measure of complexity of the metaphyseal surface. These results indicate that metaphyseal surface morphology has a robust effect on growth plate mechanics.
Comparative biomechanics of thePanandMacacamandibles during mastication: finite element modelling of loading, deformation and strain regimes
Authors: Smith Amanda L. , Robinson Chris , Taylor Andrea B. , Panagiotopoulou Olga , Davis Julian , Ward Carol V. , Kimbel William H. , Alemseged Zeresenay , Ross Callum F.
Published: August 2021

The mechanical behaviour of the mandibles ofPanandMacacaduring mastication was compared using finite element modelling. Muscle forces were calculated using species-specific measures of physiological cross-sectional area and scaled using electromyographic estimates of muscle recruitment inMacaca. Loading regimes were compared using moments acting on the mandible and strain regimes were qualitatively compared using maps of principal, shear and axial strains. The enlarged and more vertically oriented temporalis and superficial masseter muscles ofPanresult in larger sagittal and transverse bending moments on both working and balancing sides, and larger anteroposterior twisting moments on the working side. The mandible ofPanexperiences higher principal strain magnitudes in the ramus and mandibular prominence, higher transverse shear strains in the top of the symphyseal region and working-side corpus, and a predominance of sagittal bending-related strains in the balancing-side mandible. This study lays the foundation for a broader comparative study of Hominidae mandibular mechanics in extant and fossil hominids using finite element modelling.Pan's larger and more vertical masseter and temporalis may make it a more suitable model for hominid mandibular biomechanics thanMacaca.