bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid resolution of reversible bronchiectasis after Mycoplasma pneumoniae pneumonia in an adult
Authors: Guo Qi , Li Hai-yan
Published: March 2019

Rationale:

Bronchiectasis results when inflammatory and infectious damage to the bronchial and bronchiolar walls leads to a vicious cycle of airway injury. On the basis of the classic characteristic, that is, permanent bronchial dilatation, bronchiectasis is generally considered irreversible in the adult population.

Patient concerns:

A 21-year-old woman presented to our hospital with a 9-day history of productive cough and fever.

Diagnosis:

Bronchiectasis after Mycoplasma pneumoniae pneumonia.

Interventions:

The patient was treated with azithromycin for 7 days.

Outcomes:

The bronchial dilatation resolved as evidenced by sequential chest high-resolution computed tomography 7 days and 1 month later, respectively.

Lessons:

Although complete disappearance is quite rare in adult, this case demonstrated that bronchial dilatation might resolve completely in such a fascinating short period of time if receiving adequate and timely regimens.
Primary antiphospholipid syndrome during aromatase inhibitors therapy
Authors: Tenti Sara , Giordano Nicola , Cutolo Maurizio , Giannini Fabio , Fioravanti Antonella
Published: March 2019

Rationale:

Aromatase inhibitors (AIs) are a class of drugs widely used in the treatment of estrogen sensitive breast and ovarian cancer which convert testosterone to estradiol and androstenedione to estrogen. The AIs of third generation, including anastrazole, letrozole and exemestane, have actually become the standard of care of estrogen-receptor-positive breast cancer in menopausal women and are recommended as adjuvant treatment after surgery in place of/or following tamoxifen. Their main side-effects include reduction in bone mineral density, occurrence of menopausal manifestations and development of musculoskeletal symptoms which are, usually, transient, but sometimes evolve into a typical form of arthritis, such as rheumatoid arthritis (RA). Recently, a pathogenic linkage with other autoimmunity diseases, such as Sjogren syndrome (SjS), anti-synthetase antibody syndrome (ASAS), systemic sclerosis (SS) and subacute cutaneous lupus erythematosus (SCLE), was also described.

Patient concerns:

Here, we report the first case of a patient with primary antiphospholipid syndrome (APS) developed during treatment with anastrazole.

Diagnosis:

The patient developed a sudden onset of speech disturbance and disorientation, due to ischemic lesions, after 6 months of AIs therapy and the laboratory examination showed the positivity of anti-Cardiolipin antibodies, anti-β2 Glycoprotein 1 antibodies and Lupus Anticoagulant, so a certain diagnosis of APS was achieved.

Interventions:

The patient was treated with warfarin associated to hydroxychloroquine and monthly cycles of low doses intravenous immunoglobulins.

Outcomes:

A good control of the disease was obtained despite the continuation of anastrazole; the patient's clinical and laboratory situation remained not modified after AIs withdrawal.

Lessons:

We discussed the possible role of anastrazole treatment in inducing APS in our patient, reporting the available literature data about the association between AIs treatment and autoimmune diseases. Furthermore, we analyzed the mechanism of action of estrogens in the pathophysiology of autoimmune rheumatic disorders.
Dietary ginger as a traditional therapy for blood sugar control in patients with type 2 diabetes mellitus
Authors: Huang Fang-yan , Deng Ting , Meng Lian-xin , Ma Xin-ling
Published: March 2019

Background:

Ancient medical practitioners used to encourage dietary supplements and herbal medicine for the treatment of type 2 diabetes mellitus (T2DM). Ginger (Zingiber officinale), is a nontoxic spice with negligible side effects, and is considered safe by the food and drug administration. In this analysis, we aimed to systematically compare fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) at baseline versus at follow-up in T2DM patients who consumed and who did not consume ginger.

Methods:

A literature search was carried out through MEDLINE, Embase, the Cochrane Central, and www.ClinicalTrials.gov for English-published trials comparing glucose parameters in T2DM patients who were assigned to ginger consumption versus a control group. All the participants were patients with T2DM who were either assigned to ginger therapy (1600– 4000 mg daily) or to a control group. FBS and HbA1c were assessed in the ginger and control groups, respectively, from baseline to follow-up to observe any significant change. Weight mean difference (WMD) with 95% confidence intervals (CI) was calculated to represent the analysis which was carried out by the RevMan 5.3 software.

Results:

Eight randomized trials consisting of a total number of 454 participants with T2DM were included in this analysis. At first, FBS was compared in patients with T2DM from baseline prior to ginger consumption until follow-up after ginger consumption. The results showed no significant difference in FBS (WMD: 1.38, 95% CI: [−0.53–3.30]; P = .16). For the T2DM patients who did not consume ginger, no significant difference in FBS was observed (WMD: −0.27, 95% CI: [−5.09–4.54]; P = .91). However, a significantly improved HbA1c from baseline to follow-up was observed in those participants with ginger consumption (WMD: 0.46, 95% CI: [0.09–0.84]; P = .02) whereas in the control group, no significant difference in HbA1c was observed (WMD: −0.23, 95% CI: [−0.60–0.14]; P = .22).

Conclusion:

This analysis involving patients with T2DM showed no significant difference in FBS with ginger consumption. However, dietary ginger significantly improved HbA1c from baseline to follow-up showing that this natural medicine might have an impact on glucose control over a longer period of time in patients with T2DM.
The prognostic value of left ventricular systolic function and cardiac biomarkers in pediatric severe sepsis
Authors: Li Juanzhen , Ning Botao , Wang Ying , Li Biru , Qian Juan , Ren Hong , Zhang Jian , Hu Xiaowei
Published: March 2019

Echocardiography and cardiac biomarkers, such as cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are useful tools to evaluate cardiac dysfunction. Left ventricular systolic dysfunction (LVSD) is common in pediatric severe sepsis. The aim of this study is to evaluate the prognostic value of LVSD, cTnI, and NT-pro BNP for pediatric severe sepsis.

A prospective, single center, observational study was conducted. Severe sepsis children were enrolled in the study from December 2015 to December 2016 in pediatric intensive care unit of Shanghai Children's Medical Center. Recorded general information, transthoracic echocardiography were performed at day 1, 2, 3, 7, and 10, using Simpson to measure left ventricular end-diastolic dimension and left ventricular end-systolic dimension, obtained echocardiography parameters: left ventricular ejection fraction (LVEF), left ventricular fractional shortening, left ventricular end-diastolic volume, left ventricular end- systolic volume, stroke volume, cardiac output. At the same time collecting the blood sample to measure cTnI, NT-pro BNP. The definition of LVSD was LVEF <50%. According to the prognosis of 28 days, children with severe sepsis were divided into survived group and nonsurvived group.

Total of 50 pediatric patients who were diagnosed with severe sepsis (including septic shock) were enrolled, the incidence of LVSD was 52%. The 28-day mortality rate of severe sepsis was 34%. Multivariate logistic regression analyses for predictors of death in pediatric severe sepsis revealed that the 28-day mortality of severe sepsis was associated with mechanical ventilation (MV) within the first 6 hours of admission (odds ratio [OR], 0.01; 95% confidence interval [CI], 0.00–0.07) and total MV time (OR, 0.81; 95% CI, 0.68–0.97). The receiver operating characteristic curves LVEF (area under curve = 0.526), cTnI (area under curve = 0.480), and NT-pro BNP (area under curve = 0.624) were used to predict the 28-day mortality in pediatric severe sepsis. Follow-up echocardiography parameters for survived group and nonsurvived group showed no significant changes in LVEF, LVFS, stroke volume index, cardiac index (CI), left ventricular end-diastolic volume index and left ventricular end-systolic volume index at day 1, 2, 3, 7, and 10, except for CI at day 1 and 2. Kaplan–Meier plot of 28-day mortality and LVSD in pediatric severe sepsis showed there were no statistical differences (χ
2 = 0.042, P = .837).

LVSD occurs frequently in pediatric with severe sepsis. The 28-day mortality rate of severe sepsis was also high. In this study, none of LVSD, cTnI, and NT-proBNP was associated with the prognosis of pediatric severe sepsis.
Robotic radical lymphadenectomy without touching the pancreas during gastrectomy for gastric cancer
Authors: Ojima Toshiyasu , Nakamura Masaki , Nakamori Mikihito , Hayata Keiji , Katsuda Masahiro , Maruoka Shimpei , Yamaue Hiroki
Published: March 2019

Laparoscopic lymph node dissection around the peripancreatic area for gastric cancer (GC) remains challenging because of drawbacks in laparoscopic surgery including the limited range of movement, amplification of hand tremors, and inconvenient surgical positioning. In some cases of laparoscopic gastrectomy (LG), therefore, postoperative pancreatic fistula (POPF) occurs. Robotic surgery, on the other hand, plays an essential role in ergonomics and offers advantages, such as motion scaling, less fatigue, tremor filtering, 7 degrees of motion in the robotic instruments assisted by the wrist-like instruments tips, and three-dimensional vision. Robotic gastrectomy (RG) may enable surgeons to overcome the drawbacks associated with laparoscopic surgery. This study compares the safety and feasibility of short-term surgical outcomes of RG and LG for patients with GC.

This was a single-center retrospective study of 659 consecutive patients with GC who received minimally invasive surgery. LG (n = 639) was performed between 2013 and 2017 and RG (n = 20) was performed in 2017. Lymphadenectomy without touching the pancreas was basically performed during RG using assisting articulating forceps.

Overall incidence of postoperative complications higher than Clavien–Dindo grade 2 was not significantly different (LG group 5.9%, RG group 5.0%). In RG group, POPF, intra-abdominal abscess, and anastomotic leakage were not found, but postoperative bleeding requiring interventional catheter embolization occurred in 1 patient. In LG, POPF was found in 4.7%. Amylase levels in drainage fluid on postoperative day 1 were significantly lower in the RG group (238.5 IU/L) than in the LG group (884.5 IU/L) (P = .028).

Regarding short-term surgical outcomes, RG is feasible, safe, and ideal treatment procedure for GC. Our robotic procedure without touching the pancreas may be associated with decreased incidence of POPF.
Incontinence in Phelan‐McDermid Syndrome
Authors: Witmer Claire , Mattingly Aviva , D'Souza Precilla , Thurm Audrey , Hadigan Colleen
Published: March 2019

Objective:

The aim of the study was to evaluate gastrointestinal symptoms and continence in the context of Phelan‐McDermid Syndrome (PMS).

Methods:

A prospective evaluation of children with PMS (n = 17) at the National Institutes of Health.

Results:

Parent‐reported history of symptoms were common: constipation (65%), reflux (59%), choking/gagging (41%), and more than half received gastrointestinal specialty care. No aspiration was noted in 11/11 participants who completed modified barium swallows. Four participants met criteria for functional constipation, 2 of whom had abnormal colonic transit studies. Stool incontinence was highly prevalent (13/17) with nonretentive features present in 12/17. Participants who were continent had significantly smaller genetic deletions (P = 0.01) and higher nonverbal mental age (P = 0.03) compared with incontinent participants.

Conclusions:

Incontinence is common in PMS and associated with intellectual functioning and gene deletion size. Management strategies may differ based on the presence of nonretentive fecal incontinence, functional constipation, and degree of intellectual disability for children with PMS.
Pediatric Celiac Disease and Eosinophilic Esophagitis
Authors: Patton Tiffany , Chugh Ankur , Padhye Leena , DeGeeter Catherine , Guandalini Stefano
Published: March 2019

Objective:

The coexistence of celiac disease (CeD) and eosinophilic esophagitis (EoE) in pediatric patients has been increasingly recognized. In the current study, we have aimed to assess the outcomes of therapeutic dietary interventions in a cohort of pediatric patients with CeD and EoE.

Methods:

Pediatric patient records obtained from the University of Chicago Celiac Center Database from August 2008 to July 2013 were reviewed. Information was collected on patients with concomitant CeD and EoE regarding age, sex, dates of diagnoses, presenting symptoms, length of symptoms before diagnosis, familial and personal atopic history, dietary therapy, and esophageal histologic response to dietary therapy.

Results:

A total of 350 records of patients with CeD were reviewed. Twenty‐two (6.3%) had a confirmed diagnosis of CeD and EoE, 17 had repeat biopsies. Four of 17 (23.5%) had resolution of esophageal eosinophilia on an exclusive gluten‐free diet, 10 of 17 (59%) required additional eliminations to show histologic resolution, 1 of 17 (6%) had not reached histological remission, and 2 of 17 (12%) were lost to follow‐up. Success rates of single food reintroductions were: soy 5 of 5 (100%), eggs 3 of 5 (60%), dairy 3 of 7 (43%), nuts 2 of 4 (50%), and fish 2 of 4 (50%).

Conclusions:

To our knowledge, this is the largest pediatric study to assess the histologic outcome of EoE‐associated esophageal eosinophilia in response to dietary management of pediatric patients with concomitant CeD and EoE. We demonstrate that soy is well tolerated in this cohort, and suggest that reintroducing this food first, or trialing a soy‐inclusive elimination diet is a viable strategy.
Neurocognitive Impairment Risk Among Individuals With Multiple Drug–Resistant Tuberculosis and Human Immunodeficiency Virus Coinfection
Authors: Tomita Andrew , Ramlall Suvira , Naidu Thirusha , Mthembu Sbusisiwe Sandra , Padayatchi Nesri , Burns Jonathan K.
Published: March 2019

Although neurocognitive impairment (NCI) is a well-recognized challenge in human immunodeficiency virus (HIV), there is little evidence regarding it among individuals with multiple drug–resistant tuberculosis (MDR-TB) within HIV endemic sub-Saharan Africa. The extent of NCI risk, particularly HIV-associated neurocognitive disorders (HAND) risk, was investigated in 200 microbiologically confirmed inpatients with MDR-TB at a TB-specialist hospital in KwaZulu-Natal Province, South Africa. Within this population, the prevalence of HIV coinfection, major depressive episode, and substance use disorder was 89.50%, 10.50%, and 7.00%, respectively. After excluding individuals with major depressive episode/substance use disorder and monoinfection (i.e., MDR-TB without HIV), the prevalence of HAND risk was 43.5%. Older and low-income individuals had significantly greater odds of HAND risk, whereas those with family members/relatives who work(ed) in the health services had lower odds. The role of timely linkage to and retention of care in TB/HIV treatment to offset cognitive decline in MDR-TB/HIV coinfected individuals needs to be investigated further.
Shared Obsessive-Compulsive Disorder
Authors: Benatti Beatrice , Arici Chiara , Altamura A. Carlo , Dell'Osso Bernardo
Published: March 2019

Shared obsessive-compulsive disorder (S-OCD) has seldom been reported in the literature, whereas shared psychotic disorder has been described since the end of 19th century. The aim of this report was to describe a case of S-OCD in a married couple. A 38-year-old OCD patient, after several pharmacological trials, eventually improved when a combination of escitalopram and risperidone was prescribed. During his symptoms' remission, his wife started developing the same OCD symptoms. She was prescribed escitalopram, but, given her inconsistent compliance, it was difficult to obtain full effectiveness of the pharmacological treatment. The case showed several common features with S-OCD. Obsessions and delusions could be considered as extremes of the same spectrum—an option recognized by the Diagnostic and statistical manual of mental disorders, fifth edition within the “OCD with poor insight” category—and S-OCD could represent the continuum between OCD and psychotic conditions. Additional investigation is required to better understand psychotic and nonpsychotic shared disorders.
Parental Engagement and Early Interactions With Preterm Infants Reduce Risk of Late Postpartum Depression
Authors: Xie Jun , Zhu Lihong , Zhu Tingli , Jian Ying , Ding Ye , Zhou Min , Feng Xiaoyan
Published: March 2019

Recent studies have shown that preterm delivery is a risk factor for the development of postpartum depression, which not only impairs maternal-infant interactions, leading to infant developmental delay and social interaction difficulties in affected children, but also increases the risk of depression in the mother. Hence, this article aims to study the effects of parental engagement and early interactions with preterm infants on subsequent infant development and behavior, maternal adjustment, and mother-infant relationship. A total of 151 infants/mothers were enrolled in our study. Infants were randomized either to receive early parent interaction or standard care. The early parent interaction program was performed in addition to routine standard of care, Kangaroo Mother Care, during the neonatal intensive care unit stay based on PremieStart Protocol. The behavioral competencies of preterm infants were assessed, as were their mothers' adjustment (depression and coping) and competencies (knowledge of child development). At 12 months of postnatal age, child competencies (development and behavior) were assessed, together with maternal adjustment (parenting stress and depression). Mother-infant interaction was also observed. Early parent interaction did not alter early or later infant development. Furthermore, early parent interaction did not alter early maternal adjustment or late mother-infant relationship, but it reduced the risk of late postpartum depression. Taken together, these studies provide a strong basis for interventions that support parents in the parenting role and guide parents in developmentally appropriate interactions with their preterm babies. These interventions have the potential to lessen the adverse impact of preterm birth on babies and mothers. In addition, the positive benefits of reduced stress can improve parent mental health outcomes and ultimately may further improve parents' relationships with their babies.
Introduction: Cannabis in Society Today
Authors: Pressman Peter , Clemens Roger
Published: March 2019

This introductory review discusses the history, chemistry, and metabolism of Cannabis sativa, commonly referred to as marijuana. Whether the science is there for its use in foods and dietary supplements depends on evidence that the required production and safety standards have been met and clinical evidence of benefit of food applications for cannabis-related or derived products.
Communicating About Risk in a Food-Obsessed World—Reprised
Authors: Rowe Sylvia , Alexander Nick
Published: March 2019

Nutrition and health communicators have, in the past, struggled with messaging around dietary guidance, weight management, and obesity. In recent months, a plethora of food safety crises has focused the attention of communicators on how best to deal with messages under conditions of crisis and high risk. Numerous cases of Salmonella, cyclosporiasis, Listeria, a deadly form of Escherichia coli, and other pathogenic outbreaks have raised consumers’ concern about the safety of the food they consume as well as about the US food system itself. In this article, the authors revisit well-established rules for communicating about scientific uncertainty and real or perceived health risks around food. They analyze some of the more serious communication challenges in the most recent romaine lettuce and other food safety scares, and they propose reasons for the ensuing public confusion. Finally, they offer suggestions on meeting the evolving challenges in the new digital information era, with its perpetual news deadlines.
Optimizing resilience in orofacial pain: a randomized controlled pilot study on hope
Authors: Bartley Emily J. , LaGattuta Natalie R. , Robinson Michael E. , Fillingim Roger B.
Published: March 2019

Introduction:

Over recent years, there has been growing interest in the role of positive, psychological resources that promote resilience and optimal functioning in chronic pain. Although multiple factors comprise resilience, hope is a strength-based motivational state known to contribute to positive psychosocial adjustment and adaptive pain coping. Emerging evidence supports the viability of therapeutic approaches that foster resilience; however, interventions designed to target hope in the context of pain have been remarkably understudied.

Objectives:

The objectives of this pilot study were to test the feasibility and preliminary efficacy of a resilience-oriented hope intervention for clinical pain, as well as psychosocial outcomes and experimental pain sensitivity in individuals with orofacial pain.

Methods:

Twenty-nine participants with temporomandibular disorder were randomized to a 3-session intervention intended to increase hope or a control intervention (EDU) involving education about pain and stress. Before and after the intervention, participants attended 2 laboratory sessions whereby they completed psychosocial questionnaires and sensitivity to heat, cold, and pressure pain was assessed. Hope was measured using the Adult State Hope Scale.

Results:

Compared with EDU, the Hope group exhibited an increase in state hope, lower heat pain sensitivity, higher pressure pain thresholds at the temporomandibular joint, and reductions in pain catastrophizing.

Conclusion:

Although preliminary, results suggest that a resilience-based hope intervention may be beneficial in reducing pain sensitivity and catastrophizing and could serve as a target for pain management.
Transverse Facial Artery Perforators: Anatomical, Two- and Three-Dimensional Radiographic Study
Authors: Pierrefeu Antoine , Brosset Sophie , Lahon Morgan , Guerid Samia , Shipkov Hristo , Boucher Fabien , Breton Pierre , Sigaux Nicolas , Mojallal Ali
Published: March 2019

Background:

Increased anatomical knowledge of skin vascularization, such as the recent description of angiosome and perforasome concepts, has led to important innovations in flap surgery. In this sense, few studies have been performed on face vascularization especially for facial artery perforasomes. The aim of this study was to analyze the number, size, and localization of transverse facial artery perforators and their perfusion area.

Methods:

Fourteen hemifaces of fresh adult cadavers from the Department of Anatomy of Lyon University were harvested. Transverse facial artery perforators were identified, dissected, cannulated, and selectively injected with 1 ml of patent blue or contrast solution. Photography, microangiography, and computed tomography were performed. Perforator diameter and localization from the lateral canthus were measured. Exact topography and size of the perforasome were analyzed.

Results:

Twenty-three transverse facial artery perforators were identified. Mean perforator diameter was 1.01 ± 0.3 mm. Mean perforating site was 31.0 ± 8.0 mm lateral to and 38.7 ± 8.8 mm below the lateral canthus. Mean single perforasome surface area was 25.3 ± 18.34 cm2 and mean transverse facial artery skin territory was 40.5 ± 9.78 cm2.

Conclusions:

The transverse facial artery provides at least one perforator that can be accurately localized using a Doppler probe. Clinical applications related to the improved knowledge of transverse facial artery perforators could be as follows: (1) performing a lateral facial skin flap; (2) facial composite allotransplants; (3) face-lift procedures to improve skin perfusion; and (4) prevention of vessel injury in aesthetic procedures such as dermal filler injection or thread-lift techniques.
Prophylactic Use of Buccal Fat Flaps to Improve Oral Mucosal Healing following Furlow Palatoplasty
Authors: Qiu Cecil S. , Fracol Megan E. , Bae Hanah , Gosain Arun K.
Published: March 2019

Furlow palatoplasty is increasingly used both for primary palatoplasty and for secondary correction of velopharyngeal insufficiency. Although Furlow palatoplasty offers the advantage of lengthening the palate, the most tenuous component of the oral mucosal repair is anterior transposition of the oral mucosal Z-plasty flap, with superficial separation of the oral mucosa observed in up to 53 percent of cases of secondary Furlow palatoplasty. To mitigate this problem, the authors prophylactically placed pedicled buccal fat pad flaps to provide an additional vascular layer to promote healing of the overlying oral mucosal Z-plasty flap. The authors report their experience comprising seven patients who underwent Furlow palatoplasty with buccal fat flap augmentation. Four of these patients had secondary Furlow palatoplasty procedures; one of them experienced oral mucosal separation that healed uneventfully. No patients developed an oronasal fistula. The authors’ experience suggests that buccal fat flaps may minimize vascular compromise and dehiscence of the oral mucosal Z-plasty following Furlow palatoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Is Skin the Most Allogenic Tissue in Vascularized Composite Allotransplantation and a Valid Monitor of the Deeper Tissues?
Authors: Robbins Nicholas L. , Wordsworth Matthew J. , Parida Bijaya K. , Kaplan Bruce , Gorantla Vijay S. , Weitzel Erik K. , Breidenbach Warren C.
Published: March 2019

Since the 1960s, skin has been considered to be the most allogenic tissue in humans. This tenet has remained unquestioned in the reconstructive transplant arena, which has led to skin serving as the sole monitor for early rejection in vascularized composite allotransplantation. In this article, the authors question the validity of this belief. The authors’ hypothesis is that skin is not always an accurate monitor of rejection in the deep tissues, thus questioning the positive and negative predictive value of the punch biopsy for suspected vascularized composite allotransplantation rejection. A search was carried out identifying vascularized composite allotransplantation publications where the allogenicity of transplanted skin was evaluated. Eighteen publications claimed skin was found to be the most allogenic tissue in humans, justifying its use as a superior monitor for rejection. Eight publications demonstrated skin to be a poor monitor of rejection deeper to the skin. Two vascularized composite allotransplantation animal studies reported skin rejecting simultaneously with the deeper tissues. Finally, three publications discussed a skin and kidney allograft, transplanted simultaneously, indicating skin allogenicity was equivalent to the that of the kidney allograft. Much of the literature in human vascularized composite allotransplantation claims skin to be an excellent monitor of the deep tissues. The conclusion from this study is that skin does not always function as a good monitor for what could be rejecting in the deep tissues. The authors believe continued research is necessary to focus on expanding novel monitoring techniques and technologies to accurately diagnose vascularized composite allotransplantation rejection without tissue destruction.
Quality and Quantity–Cultured Murine Endothelial Progenitor Cells Increase Vascularization and Decrease Fibrosis in the Fat Graft
Authors: Geeroms Maxim , Hamdi Moustapha , Hirano Rie , Hagiwara Hiroko , Fujimura Satoshi , Mizuno Hiroshi , Tanaka Rica
Published: March 2019

Background:

Fat grafting has become a valuable technique for soft-tissue reconstruction; however, long-lasting success depends on several determinants. An early blood supply to the transplanted adipocytes is important to prevent ischemia. The recently developed quality and quantity (QQ) culture increases the vasculogenic potential of endothelial progenitor cells. The authors used a murine fat grafting model to address the hypothesis that QQ-cultured endothelial progenitor cells stimulate the establishment of a blood vessel network and increase graft success.

Methods:

c-Kit+Sca-1+Lin− (KSL) cells were isolated as endothelial progenitor cell precursors from C57BL/6 mice. Adipose tissue was grafted with QQ-cultured KSL cells (QQKSL group), uncultured KSL cells (KSL group), adipose-derived stem cells (ASC group), and a combination (QQKSL+ASC group), and compared to a control group. Five and 10 weeks later, grafts were weighed, histologic and immunohistochemical parameters were evaluated, and gene expression was quantified by quantitative polymerase chain reaction.

Results:

The highest vessel density was observed in the combined QQKSL+ASC group (68.0 ± 4.3/mm2; p < 0.001) and the QQKSL group (53.9 ± 3.0/mm2; p < 0.001). QQKSL cells were engrafted in proximity to the graft vasculature. QQKSL cells decreased the fibrosis percentage (13.8 ± 1.8 percent; p < 0.05). The combined QQKSL+ASC group (22.4 ± 1.8/mm2; p < 0.001) showed the fewest local inflammation units. A significant up-regulation of platelet-derived growth factor and adiponectin expression was observed in the QQKSL group and QQKSL+ASC group. Graft weight persistence was not significantly different between groups.

Conclusions:

Supplementing fat grafts with quality and quantity–cultured endothelial progenitor cells improves graft quality by stimulating vascularization. The increased vessel density is associated with less fibrosis, less inflammation, and better adipose tissue integrity. Enriching fat grafts with QQ-cultured endothelial progenitor cells is a potential solution to their clinical shortcomings.
Current Concepts in Masculinizing Gender Surgery
Authors: Safa Bauback , Lin Walter C. , Salim Ali M. , Deschamps-Braly Jordan C. , Poh Melissa M.
Published: March 2019

Learning Objectives:

After reading this article and viewing the video, the participant should be able to: 1. Discuss appropriate treatment guidelines, including preoperative mental health and hormonal treatment before gender-affirmation surgery. 2. Name various surgical options for facial, chest, and genital masculinization. 3. Recognize key steps and anatomy during chest-wall contouring and phalloplasty reconstruction. 4. Discuss major risks and complications of chest-wall contouring and phalloplasty reconstruction.

Transgender and gender-nonconforming individuals may experience conflict between their gender identity and their gender assigned at birth. With recent advances in health care and societal support, appropriate treatment has become newly accessible and has generated increased demand for gender-affirming care, which is globally guided by the World Professional Association for Transgender Health. This CME article reviews key terminology and standards of care, and provides an overview of various masculinizing gender-affirming surgical procedures.
Validation of the BOOST Risk Stratification Tool as a Predictor of Unplanned 30-Day Readmission in Elderly Patients
Authors: Sieck Carol , Adams William , Burkhart Lisa
Published: March 2019

Introduction:

Risk stratification tools can identify patients at risk for 30-day readmission, but available tools lack predictive strength. One of these tools is the Better Outcomes by Optimizing Safe Transitions (BOOST) 8 P's tool.

Objectives:

The primary objective of this study was to validate the 8 P's tool as well as measure the predictive strength of variables within this tool.

Methods:

This was a quantitative study that included 1 year of hospitalized elderly patients (n = 6849). Odds ratios were used to determine the strength of the association between variables individually with readmission. Multivariable logistic regression was used to evaluate the predictive strength of the BOOST risk stratification tool.

Results:

This study demonstrated that 5 of the 8 variables in the BOOST risk stratification tool showed significant association with 30-day readmission including the variables of health literacy (P = .030), depression (P = .003), problem medications (P = .001), physical limitations (P ≤ .001), and prior hospitalization (P ≤ .001). Combining variables using multivariable logistic regression, the BOOST 8 P's tool had limited predictive capability with a C-statistic of 0.631.

Conclusion:

This study was the first attempt to validate the BOOST 8 P's tool and to utilize nursing documentation within an electronic medical record to capture social determinants of health.
Pericranial Flap Anterior Skull Base Reconstruction With Gelfoam Intradural Compression
Authors: Song Tae-wook , Lee Seul-kee , Kim Tae-Sun , Joo Sung-Pil
Published: March 2019

Anterior cranial base reconstruction is occasionally necessary following severe trauma. Several methods for reconstruction have been described and some authors have described their experiences regarding the use of a pericranial flap for anterior skull base reconstruction after trauma. A 26-year-old woman was admitted to our department with multiple facial bone fractures identified using facial bone computed tomography. Plastic surgeons performed surgery under general anesthesia for the patient's nasal bone fractures. On the seventh day after admission, the patient's brain computed tomography showed an abscess in the frontal lobe. Antibiotic treatment was started, but the lesion deteriorated. Anterior skull base reconstruction was then performed using a pericranial flap with gelfoam compression. No complications, including leakage of cerebrospinal fluid, cerebral hemorrhage, necrosis of the pericranial flap, or frontal lobe herniation, were observed 1 year following surgery. In our case, the authors performed a simple and effective treatment with reconstruction using pericranial flap and gelfoam compression without complications. This technique is useful for reconstructing defects in the base of the frontal bone resulting from various causes, as well as for fracture of the anterior skull base following trauma.
Analysis In Vivo of the Hemifacial Transplantation Surgical Technique
Authors: Rodrigues Ithalo Queiroz , Cunico Caroline , Silva Alfredo Benjamim Duarte da , Brum Juliana Sperotto , Robes Rogério Ribeiro , Freitas Renato da Silva
Published: March 2019

Approximately 35 facial transplants have been performed worldwide. Many under-explored aspects of this procedure remain, some emerging as the survivors age. Human-like preclinical trial models, including swine, can be explored and developed as a foundation for subsequent studies. A previously described surgical technique for face transplantation in swine carcasses has been employed herein, evaluating its reproducibility in a live pig and the viability of the vascular pedicles.

Method:

Flap construction was performed according to the experimental model developed in our service. Under general anesthesia, the structures of the left hemiface of a pig were dissected. Vascular pedicles were the facial artery, caudal auricular artery, and external jugular vein. After dissection, adequate tissue perfusion of the entire explant by those pedicles was documented through vessel filling, observation of the ischemic area, and posterior reperfusion.

Results:

A capillary reperfusion test confirmed that the main arterial pedicle irrigating the hemiface flap was the facial artery. The same technique showed that despite divergent literary opinions on the irrigation of the auricular region, the caudal auricular artery provides the arterial supply for the external ear. Performing the surgical technique was more difficult in vivo due to the inherent complications of a live subject.

Conclusion:

The methodology for the facial transplant technique in swine carcasses was satisfactorily reproducible in a live animal. The main arterial pedicle responsible for flap irrigation is the facial artery, and the fact that the vessel supplying the outer ear is the caudal atrial artery was confirmed
Solitary Plasmacytoma of the Mandible: Early Diagnosis and Surgical Management
Authors: Rullo Rosario , Scalzone Paola , Laino Luigi , Russo Andrea , Festa Vincenzo Maria , Fiorillo Luca , Cicciù Marco
Published: March 2019

Solitary plasmacytoma is an abnormal proliferation of B-lymphoid cells that involves a single bone. It mainly affects the axial skeleton; the jaw localization is a rare condition. The authors present a case of a 70-year-old female patient with a radiolucency of the angle of the mandible later diagnosed as solitary plasmacytoma.
A Rare Potential Compression Can Be Avoided by Lateral Spread Response Recordings During Microvascular Decompression for Hemifacial Spasm
Authors: Chen Yukun , Wang Jing , Wang Xuelian
Published: March 2019

The authors report a 34-year-old female with hemifacial spasm who was identified as a candidate for microvascular decompression. Lateral spread response (LSR) was not recorded at first because of anatomical shift of neurovascular relationship after drainage of cerebrospinal fluid, but they reappeared only after a piece of shredded gelatin sponge was placed near the posteroinferior cerebellar artery to expand surgical field. As the authors removed the gelatin sponge, the LSRs disappeared instantly. Subsequently, the authors put some soft shredded Teflon between the offending vessel and brainstem. Since then the authors did not find LSRs anymore. Clinical follow-up had been carried out with a questionnaire from 1 week to 3 months postoperatively, and the patient was cured with no complications. This report presented that the gelatin sponge placed in an inappropriate position resulting in compression potentially leading to the opposite effect of treatment. Such kind of excessive operation could be avoided by electrophysiological monitoring.
Tonsillar and Adenoid Noncaseating, Epithelioid Granulomas in a Young Girl
Authors: Battat Nir , Tamir Sharon Ovnat , Marom Tal
Published: March 2019

Waldeyer's lymphatic ring granulomas in children are infrequent, and may represent an underlying systemic disease, often nondiagnosed before adenotonsillectomy is performed. The authors report on a 5-year-old otherwise healthy girl presented with remarkable tonsillar asymmetry as well as adenoid hypertrophy, with no systemic signs or complaints. Adenotonsillectomy was performed to rule out malignancy. Blood workup was normal. Microscopy of both adenoidectomy and tonsillectomy specimens showed multiple foci of epithelioid, noncaseating granulomas with giant multinucleated cells surrounded by nonspecific chronic inflammation. Immunostainings for B-cell markers, Ki-67, and Ziehl-Neelson were negative. This unusual pathology raised a differential diagnosis which included inflammatory diseases (sarcoidosis, Crohn's disease), foreign body reaction, lymphoma and infections (tuberculosis, fungi). However, none of these entities could be attributed to the girl's condition, and the reason for her pathologic findings remained unknown.
Gastric Bypass Versus Sleeve Gastrectomy
Authors: Poelemeijer Youri Q. M. , Liem Ronald S. L. , Våge Villy , Mala Tom , Sundbom Magnus , Ottosson Johan , Nienhuijs Simon W.
Published: March 2019

Objective:

The aim of this study was to compare the use and short-term outcome of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Sweden, Norway, and the Netherlands.

Background:

Although bariatric surgery is performed in high volumes worldwide, no consensus exists regarding the choice of bariatric procedure for specific groups of patients.

Methods:

Data from 3 national registries for bariatric surgery were used. Patient selection, perioperative data (severe complications, mortality, and rate of readmissions within 30 days), and 1-year results (follow-up rate and weight loss) were studied.

Results:

A total of 47,101 primary operations were registered, 33,029 (70.1%) RYGB and 14,072 (29.9%) SG. Patients receiving RYGB met international guidelines for having bariatric surgery more often than those receiving SG (91.9% vs 83,0%, P < 0.001). The 2 procedures did not differ in the rate of severe complications (2.6% vs 2.4%, P = 0.382), nor 30-day mortality (0.04% vs 0.03%, P = 0.821). Readmission rates were higher after RYGB (4.3% vs 3.4%, P < 0.001).

One-year post surgery, less RYGB-patients were lost-to follow-up (12.1% vs 16.5%, P < 0.001) and RYGB resulted in a higher rate of patients with total weight loss of more than 20% (95.8% vs 84.6%, P < 0.001). While the weight-loss after RYGB was similar between hospitals, there was a great variation in weight loss after SG.

Conclusion:

This study reflects the pragmatic use and short-term outcome of RYGB and SG in 3 countries in North-Western Europe. Both procedures were safe, with RYGB having higher weight loss and follow-up rates at the cost of a slightly higher 30-day readmission rate.
Long-term Health Outcomes and Health System Costs Associated With Surgical Site Infections
Authors: Petrosyan Yelena , Thavorn Kednapa , Maclure Malcolm , Smith Glenys , McIsaac Daniel I. , Schramm David , Moloo Husein , Preston Roanne , Forster Alan J.
Published: March 2019

Objectives:

To examine the association between surgical site infections (SSIs) and hospital readmissions and all-cause mortality, and to estimate the attributable health care costs of SSIs 1 year following surgery.

Background:

SSIs are a common postoperative complication; the long-term impact of SSI on health outcomes and costs has not been formally evaluated.

Methods:

This retrospective cohort study included all adult patients who underwent surgery at the 1202-bed teaching hospital in Ottawa, Ontario, Canada, and were included in the National Surgical Quality Improvement Program database between 2010 and 2015. The study exposure was postoperative SSI. The study outcomes included hospital readmission, all-cause mortality, and health care costs at 1 year (primary) and at 30 days and 90 days (secondary) following surgery.

Results:

We identified 14,351 patients, including 795 patients with SSIs. Our multivariable analyses that accounted for competing risks demonstrated that at 1-year following the index date, superficial and deep/organ space SSIs were significantly associated with an increase in hospital readmission [hazard ratio (HR) = 1.63, 95% confidence interval (95% CI) 1.39–1.92 and HR = 3.49, (95% CI 2.76–4.17, respectively) and all-cause mortality (HR = 1.35, 95% CI 1.10–1.98 and HR = 2.21, 95% CI 1.44–2.78, respectively]. At 1 year after surgery, patients with superficial and deep/organ space SSIs incurred higher health care costs C$20,648 (95% CI) C$16,980- C$24,112and C$53,075 (95% CI) C$44,628- C$60,936), than non-SSI patients.

Conclusion:

SSIs, especially deep/organ space SSI, contribute to adverse health outcomes and health care costs across the entire year after surgery. Our findings highlight the importance of effective prevention/monitoring strategies targeting both short- and long-term consequences of SSI.
Safety and Efficacy of Reduced Prolonged-release Tacrolimus Exposure in De Novo Kidney Transplantation: A Randomized, Open-label, Pilot Study in Asia—OPTIMIZE Study
Authors: Kim Young Hoon , Chiang Yang-Jen , Kim Sung-Joo , Kim Myoung Soo , Park Sung Bae , Wu Sheng-Tang , Horita Kazuhiro , Nakashima Yoshihiro , Jiang Hongsi , Han Duck-Jong
Published: March 2019

Background

A multicenter, randomized, open-label, parallel group, pilot, 52-week study in Asian countries that assessed the renal function, efficacy, and safety of reduced-exposure versus standard-exposure prolonged-release tacrolimus (PR-T) in adult kidney transplant recipients (KTRs).

Methods

Posttransplantation, KTRs received PR-T from weeks 0 to 4 (initial dose, 0.2–0.3 mg/kg; target trough level, 6–10 ng/mL). At week 4, KTRs were randomized (1:1) to receive reduced-exposure PR-T (target 4–6 ng/mL, weeks 4–12; 3–5 ng/mL, weeks 12–52) or standard-exposure PR-T (target: 6–10 ng/mL, weeks 4–52). Primary end point: estimated glomerular filtration rate (eGFR) over 52 weeks. Secondary end points (week 52) included creatinine clearance, serum creatinine, graft/patient survival, biopsy-confirmed acute rejection (AR), composite of graft loss/patient death/biopsy-confirmed AR, and steroid-resistant AR. Treatment-emergent adverse events were recorded.

Results

Sixty-six KTRs received PR-T (reduced-exposure, n = 32; standard-exposure, n = 34) and were analyzed. After per-protocol dose adjustment, mean ± standard deviation tacrolimus trough level was lower with reduced- versus standard-exposure PR-T (week 52, 4.5 ± 1.1 ng/mL vs 8.0 ± 2.2 ng/mL). In the reduced- versus standard-exposure group, eGFR was similar at weeks 8 to 52 (overall least-square mean difference, –2.82; 95% confidence interval, −7.91 to 2.27; P = 0.272). At week 52, there was no significant difference in creatinine clearance (P = 0.375) or serum creatinine (P = 0.547) between groups. All grafts/patients survived, no steroid-resistant AR was reported, and 4 and 3 patients had AR in reduced- and standard-exposure groups, respectively. Drug-related treatment-emergent adverse events were reported in 34.4% and 38.2% of patients, respectively.

Conclusions

Reducing exposure to PR-T resulted in a clinically acceptable short-term safety profile and was generally as effective as standard tacrolimus exposure for Asian patients.
Genomic and transcriptomic characterization of Pseudomonas aeruginosa small colony variants derived from a chronic infection model
Authors: Irvine Sharon , Bunk Boyke , Bayes Hannah K. , Spröer Cathrin , Connolly James P. R. , Six Anne , Evans Thomas J. , Roe Andrew J. , Overmann Jörg , Walker Daniel
Published: March 2019

Phenotypic change is a hallmark of bacterial adaptation during chronic infection. In the case of chronic

Pseudomonas aeruginosa

lung infection in patients with cystic fibrosis, well-characterized phenotypic variants include mucoid and small colony variants (SCVs). It has previously been shown that SCVs can be reproducibly isolated from the murine lung following the establishment of chronic infection with mucoid

P. aeruginosa

strain NH57388A. Using a combination of single-molecule real-time (PacBio) and Illumina sequencing we identify a large genomic inversion in the SCV through recombination between homologous regions of two rRNA operons and an associated truncation of one of the 16S rRNA genes and suggest this may be the genetic switch for conversion to the SCV phenotype. This phenotypic conversion is associated with large-scale transcriptional changes distributed throughout the genome. This global rewiring of the cellular transcriptomic output results in changes to normally differentially regulated genes that modulate resistance to oxidative stress, central metabolism and virulence. These changes are of clinical relevance because the appearance of SCVs during chronic infection is associated with declining lung function.