bluuebunny/crossref_metadata_2025 huggingface dataset:
Tracking Complications and Unplanned Healthcare Utilization in Aesthetic Surgery: A Nationwide Analysis of 214,504 Patients using the TOPS Database
Authors: Sergesketter Amanda R. , Shammas Ronnie L. , Geng Yisong , Levinson Howard , Matros Evan , Phillips Brett T.
Published: February 2023

BACKGROUND:

Tracking surgical complications and unplanned healthcare utilization is essential to inform quality initiatives in aesthetic surgery. This study utilized the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database to characterize rates and predictors of surgical complications and unplanned healthcare utilization across common aesthetic surgery procedures.

METHODS:

The TOPS database was queried for all patients undergoing breast augmentation, liposuction, blepharoplasty, rhinoplasty, and abdominoplasty from 2008-2019. Incidence and risk factors for complications and unplanned readmission, reoperation, and emergency room visits were determined.

RESULTS:

A total of 214,504 patients were identified. Overall, 94,618 breast augmentations, 56,756 liposuction procedures, 29,797 blepharoplasties, 24,946 abdominoplasties, and 8,387 rhinoplasties were included. A low incidence of peri-operative complications was found, including seroma (1.1%), hematoma (0.7%), superficial wound complication (0.9%), deep surgical site infection (0.2%), need for need for blood transfusion (0.05%), and DVT/PE (0.1%). Incidence of unplanned readmission, emergency room visits, and reoperation were 0.34%, 0.25%, and 0.80%, respectively. Patients who underwent an abdominoplasty more commonly presented to the emergency room and had unplanned readmissions or reoperations compared to other studied procedures. Furthermore, an increased age, diabetes, higher BMI, ASA class, longer operative times, and pursuit of combined aesthetic procedures were associated with increased risk for unplanned healthcare utilization.

CONCLUSIONS:

There is a low incidence of perioperative complications and unplanned healthcare utilization following common aesthetic surgery procedures. Continued entry into large national databases in aesthetic surgery is essential for internal benchmarking and quality improvement.
Branding a Plastic Surgery Group Practice: A Case Study
Authors: Bank Jonathan , Feingold Randall S. , Korn Peter , Light David , Israeli Ron
Published: February 2023

Background:

You only get one opportunity to make a first impression. In today’s era, that first impression is frequently a digital one. Our old digital brand “face” was stale and not a true representation of how we view ourselves as a practice. In an evolving arena of competition and surgical scope, we felt compelled to engage in rebranding our practice.

Methods:

This article details the steps we took to launch a new website, generate collateral branded material, and execute a social media marketing plan. We attempt to keep the outline general enough to be applicable to the range of practice types of the journal’s readership, and present relevant results of the process.

Results:

Sample of “creative” products are shown. Quantifiable outcomes were direct website traffic (91% increase), website sessions (82% increase), unique users (55% increase), page views (118% increase), time spent browsing (100% increase). We experienced a 21% increase in new patient volume and a similar increase in total cases performed.

Conclusions:

This article outlines steps we took to rebrand our practice, in the face of current challenges in the plastic surgery landscape and how prospective patients seek surgeons. Benchmarking the steps of a successful branding process is crucial and informative to developing and executing a plan. While there are many potential contributors to the growth of a practice, the impact of our branding appears to be a significant factor.
“Reconstruction of Forequarter and Extended Forequarter Amputations: Indications and Outcomes.”
Authors: Roubaud Margaret S. , Mericli Alexander F. , Adelman David M. , Hanasono Matthew M. , Lewis Valerae O. , Moon Bryan S.
Published: February 2023

BACKGROUND:

Forequarter amputations (FQAs) and extended forequarter amputations (EFQAs) are rare procedures with high morbidity that often require significant soft tissue and/or bony reconstruction. We describe the largest series of oncologic FQAs and EFQAs to date with associated reconstructive and oncologic outcomes.

METHODS:

We retrospectively reviewed data from all patients who underwent FQA or EFQA at The University of Texas MD Anderson Cancer Center from January 1, 2008, to January 1, 2019. Surgical outcomes, survival, and local recurrence rates were summarized and compared.

RESULTS:

Forty-seven patients met the inclusion criteria, including 14 with EFQAs. Most patients (53%) were male; the median age was 58 years (range, 2-74). The most common tumor type was sarcoma (79%) and most common presentation was recurrent (34%). Nineteen patients (40%) had distant metastases. The median defect size was 351 cm 2; flap reconstruction was required in 30 patients (64%). Eight patients (17%) experienced immediate complications and 12 (26%) experienced delayed complications. The median overall survival (OS) time was 21 months, and the 5-year OS rate was 28.1%. OS and disease-free survival (DFS) were superior in the EFQA group (69.8% vs 11.6%, p=0.017; 58.9% vs 9.8%, p=0.014, respectively). However, metastases at presentation was the most important predictor of survival on multivariate analysis (OR= 3.98, p=0.004).

CONCLUSIONS:

EFQA patients had better OS and DFS than FQA patients, owing to a lower incidence of metastatic disease. This study suggests a benefit to more aggressive resection and reconstruction when disease is locally confined.
Creating a Policy for Coverage of Lymphatic Surgery: Addressing a Critical Unmet Need
Authors: Johnson Anna Rose , Otenti Desiree , Bates Kathy D. , Repicci William , Dallow Katherine , Deterling William , Lee Bernard T. , Singhal Dhruv
Published: February 2023

Our paper will describe the key stakeholders and process involved in developing an insurance policy in the United States to establish medical necessity criteria for lymphatic surgery procedures. Lymphedema is a chronic health issue that impacts over 1.2 million patients and is associated with lifelong health, economic, and psychosocial costs. Patients affected have been described as “medical nomads”, as they often interface with multiple providers before receiving an accurate diagnosis and treatment. This underscores the lack of attention and understanding about this disease across all sectors of the medical system. Unlike nations including Sweden and the United Kingdom, which provide insurance coverage for treatment, the United States has lagged behind. As a country, we have neglected to fully recognize the consequences of inadequate treatment of lymphedema, including chronic morbidities such as loss of mobility, psychosocial sequelae, recurrent infections, and even death. Recently, our Lymphatic Center had the unique opportunity to help develop a policy that merged our clinical experience, recently established lymphatic care center of excellence criteria, and third-party payer policy expertise. This experience spanned one year from June 2018 to June 2019. We identify how key partnerships helped fill evidentiary gaps that ultimately resulted in policy change.
Mental nerve distribution and connections in the lower lip: Anatomical basis for the recovery of sensation following inferior alveolar nerve damage
Authors: Toure Gaoussou
Published: February 2023

Background:

Inferior alveolar nerve damage is one of the most common complications of surgery on the lower third of the face. It can have a significant psychological and social impact, and its evolution varies in terms of the duration and degree of recovery. In the literature, few studies adequately explain this phenomenon. We therefore aim to establish the anatomical basis of recovery and its variability.

Methods:

We studied 60 mental nerves on 30 lips. A total of 25 lips were studied in situ, including five receiving an intra-arterial injection of latex, while five lips were removed and dissected under transillumination.

Results:

We identified three types of intralabial distribution of the mental nerves: type I: Absence of connections ; type II : connections on the upper third of the lower lip; type III: Connections on the upper, middle, and lower third of the lower lip. Some cases also had a dominant side with more numerous fibers and a larger diameter than the contralateral side.

Conclusions:

Rapid or total recovery after inferior alveolar nerve damage is well known. Our study showed the nerve map to repair nerve damage, and for the first time to our knowledge, it highlighted the connections between the mental nerves in the lip. Types II and III allow the
Hospital Mortality and Trainee Experiences: How General Medical Council Survey Findings Correlate With Summary Hospital-Level Mortality Indicator
Authors: Barton Jack Charles , Richardson Daniel , Corrigan Amber Elyse , Kuri Ashvin , Round Jonathan
Published: February 2023

Objectives

This study aimed to investigate whether components of junior doctor satisfaction are associated with patient mortality within the United Kingdom.

Methods

We conducted a cross-sectional study of publicly available data (the General Medical Council [GMC] National Survey and the Summary Hospital-level Mortality Indicator [SHMI]) pertaining to subjective physician trainee satisfaction and patient mortality within 80 United Kingdom–based healthcare institutions. The direction and strength of correlation between components of the GMC National Survey and relative patient mortality as described by the SHMI were calculated. Additional outcomes included mean GMC survey scores for reported domains and mean SHMI by healthcare institution.

Results

SHMI for included healthcare institutions ranged from 0.69 to 1.21 (mean [SD], 1.01 [0.1]). Mean GMC domain scores ranged between 44.61 and 88.62 (mean [SD], 71.16 [10.84]). Statistically significant correlations were observed for clinical supervision, clinical supervision out of hours, rota design, overall satisfaction, and teamwork. After application of Bonferroni correction, statistically significant correlations remained for both clinical supervision and clinical supervision out of hours.

Conclusions

There is a significant association between components of subjective trainee satisfaction and patient mortality within the United Kingdom. Further investigation to examine these relationships, perhaps to target intervention, may prevent avoidable patient harm.
Fracture prevalence and its association with bone density among children living with HIV in Zimbabwe
Authors: Rukuni Ruramayi , Simms Victoria , Rehman Andrea M. , Mukwasi-Kahari Cynthia , Mujuru Hilda , Ferrand Rashida A. , Gregson Celia L.
Published: February 2023

Objectives:

HIV infection impairs bone density in children living with HIV (CLWH). We aimed to determine the prevalence of self-reported fracture (past or current), associated risk factors and disability, by HIV status in Zimbabwean children.

Design:

Cross-sectional study.

Methods:

We recruited CLWH aged 8–16 years taking antiretroviral therapy (ART) for ≥2 years from HIV clinics, and HIV-uninfected children from schools in Harare. Interviewer-administered questionnaires collected data on fracture site and management, sociodemographics, dietary calcium and vitamin D, physical activity and HIV history. Dual-energy X-ray absorptiometry (DXA) measured size-adjusted bone density.

Results:

We recruited 303 CLWH [mean (SD) age 12.5 (2.5) years; 50% female] and 306 children without HIV [12.5 (2.5) years; 51% female]. Median age at HIV diagnosis in CLWH was 3.0 years [interquartile range (IQR) 1.2, 5.9], and median ART duration 8.1 years [IQR 6.2, 9.5]. 53.8% CLWH had self-reported disability and/or functional impairment, vs. 29.4% children without HIV. Fracture prevalence was 5.9% with no difference by HIV status [21/306 (6.9%) vs. 14/303 (4.6%), P = 0.24]. Male sex was associated with fractures. Low size-adjusted bone density (Z-score < −2) was associated with prevalent fractures in CLWH {risk ratio [RR] 1.14 (95% confidence interval (CI) −0.02, 2.29]}, but not in children without HIV [RR −0.04 (−2.00, 1.91)], P-interaction = 0.27. All sought medical attention for their fracture(s), but CLWH were less often admitted to hospital [2/14 (14.3%) vs. 7/21 (33.3%)].

Conclusion:

Prevalent fractures may be associated with low lumbar spine bone density in CLWH. Fracture surveillance and strategies to reduce future fracture risk are warranted as CLWH enter adulthood.
Adverse events and SARS-CoV-2 antibody responses after immunization with Sputnik V, ChAdOx1-S, and BBIBP-CorV vaccines in people with HIV
Authors: Mauas Romina , Urueña Analia , Cecchini Diego , Strada Maria L. , Arietti Soledad , Cassetti Isabel , Nogueira Nicholas F. , Salazar Ana S. , Rodriguez Violeta J. , Jones Deborah L. , Alcaide Maria L.
Published: February 2023

Objective:

This study describes adverse events following immunization (AEFIs) and the development of SARS-COV-2 antibodies after Sputnik V, AstraZeneca, and Sinopharm COVID-19 vaccination in people with HIV (PWH).

Methods:

In total, 595 adult PWH at an HIV center in Argentina from March to December 2021 were enrolled. Analysis included participants who received COVID-19 vaccination with Sputnik V, AstraZeneca, and Sinopharm, and did not receive mRNA COVID-19 vaccines. Clinical data, and local or systemic AEFI variables were collected using an online questionnaire after the first dose. Detection of S1-RBD IgG antibodies was performed between days 28 and 60 after the second dose in a subsample (SARS-CoV-2 IgG chemiluminescent immunoassay; Siemens). A multivariable logistic regression and spearman test were used for analyses.

Results:

Mean age was 46.1 years (SD = 11.8); 70.4% were men; and median CD4+ T cells count was 659 (500–852) cells/μl. AEFIs were reported in 214 (36.0%) participants. More participants reported AEFIs after Sputnik V (29.4%) and AstraZeneca (47.5%) than Sinopharm (13.9%) (χ2 = 35.85, P < 0.001). Higher odds of reporting an AEFIs were associated with receiving Sputnik V [aOR = 2.90; 95% confidence interval (95% CI) = 1.40–6.04; P = 0.004] and AstraZeneca (aOR = 5.38; 95% CI = 2.63–11.01; P < 0.001) compared with Sinopharm. Lower odds were associated with age (aOR = 0.97; 95% CI = 0.95–0.99; P < 0.001). Overall, 76 (95.0%) individuals assessed for the presence of SARS-CoV-2 antibody reached S1-RBD IgG antibody titers at least 1 U/ml; mean titer was 51.3 (SD = 51.07) U/ml. Higher antibody titers correlated with higher CD4+ T cells count (Rho = 0.280; P = 0.012).

Conclusion:

NonmRNA vaccines showed a good safety profile and adequate SARS-CoV-2 antibody responses among PWH suggesting adequate protection to SARS-CoV-2.
Decentralized, Integrated Treatment of RR/MDR-TB and HIV Using a Bedaquiline-Based, Short-Course Regimen Is Effective and Associated With Improved HIV Disease Control
Authors: Govender Thiloshini , Jham Menal A. , Zhang Justin C. , Pillay Selvan , Pak Youngju , Pillay Prenisha , Furin Jennifer , Malenfant Jason , Murphy Richard A.
Published: February 2023

Background:

In decentralized sites, with fewer resources and a high prevalence of advanced HIV, the effectiveness of the new short-course, bedaquiline-based regimen for rifampicin-resistant and multidrug-resistant tuberculosis (RR/MDR-TB) is not well-described.

Setting:

Adults with pulmonary RR/MDR-TB initiating the short-course regimen in KwaZulu-Natal, South Africa were prospectively enrolled at a decentralized program that integrated person-centered TB care.

Methods:

In addition to standard of care monitoring, study visits occurred at enrollment and months 1, 2, 4, 6, and 9. Favorable RR/MDR-TB outcome was defined as cure or treatment completion without loss to follow-up, death, or failure by treatment. In patients with HIV, we assessed antiretroviral therapy (ART) uptake, virologic and immunologic outcomes.

Results:

Among 57 patients, HIV was present in 73.7% (95% CI: 60.3–84.5), with a median CD4 count of 170 cells/mm3 (intraquartile range 49–314). A favorable RR/MDR-TB outcome was achieved in 78.9% (CI: 67.1–87.9). Three deaths occurred, all in the setting of baseline advanced HIV and elevated viral load. Overall, 21.1% (95% CI: 12.1–32.9) experienced a severe or life-threatening adverse event, the most common of which was anemia. Among patients with HIV, enrollment resulted in increased ART uptake by 24% (95% CI: 12.1%–39.4%), a significant improvement from baseline (P = 0.004); virologic suppression during concomitant treatment was observed in 71.4% (n = 30, 95% CI: 55.4–84.3).

Conclusion:

Decentralized, person-centered care for RR/MDR-TB in patients with HIV using the short-course, bedaquiline-based regimen is effective and safe. In patients with HIV, enrollment led to improved ART use and reassuring virologic outcomes.
Beyond Antiretroviral Treatment: Patterns and Factors Associated With Composite Medication Adherence Before and During the COVID-19 Pandemic in Patients With HIV With Multiple Chronic Conditions
Authors: Miller Michael J. , Eberhart Lindsay G. , Jefferson Celeena R. , Horberg Michael A.
Published: February 2023

Background:

Polypharmacy for multiple chronic conditions (MCCs) poses an increasing challenge in people with HIV (PWH). This research explores medication adherence in PWH with MCCs before and during COVID-19.

Setting:

Kaiser Permanente Mid-Atlantic States.

Methods:

Medical and pharmacy records of a continuously enrolled cohort (September 2018–September 2021) of adult PWH were used. To estimate medication adherence, monthly proportion of days covered (PDC) was measured individually for antiretrovirals (ARVs), diabetes medications (DMs), renin–angiotensin antagonists (RASMs), and statins (SMs) and combined into composite measures (CMs) with and without ARVs. Descriptive statistics, time-series models, and multivariable population-averaged panel general estimating equations were used to profile trends, effects, and factors associated with adherence.

Results:

The cohort (n = 543) was predominantly 51–64 years old (59.3%), Black (73.1%), male (69.2%), and commercially insured (65.4%). Two-thirds (63.7%) of patients were taking medications in 2 medication groups (ie, ARVs and either DMs, RASMs, or SMs), 28.9% were taking medications in 3 medication groups, and 7.4% were taking medications in all 4 medication groups. Overall, PDC for CMs without ARVs was 77.2% and 70.2% with ARVs. After March 2020, negative monthly trends in PDC were observed for CMs without ARVs (β = −0.1%, P = 0.003) and with ARVs (β = −0.3%, P = 0.001). For CMs with ARVs, Black race (aOR = 0.5; P < 0.001; ref: White) and taking medications for 3 medication groups (aOR = 0.8; P < 0.02; ref: 2) were associated with lower adherence.

Conclusion:

Decreasing medication adherence trends were observed during the COVID-19 pandemic with variations among population subgroups. Opportunity exists to improve medication adherence for non-White populations and those taking medications for MCCs beyond ARVs.
The Effects of Participation in an Intensive HIV Prevention Trial on Long-Term Socio-Demographic Outcomes Among Young Women in Rural South Africa
Authors: Stoner Marie C.D. , Browne Erica N. , Kabudula Chodziwadziwa , Rosenberg Molly , Gomez- Olive F. Xavier , Neilands Torsten B. , Kang Dufour Mi-Suk , Ahern Jennifer , Kahn Kathleen , Lippman Sheri A. , Pettifor Audrey E.
Published: February 2023

Background:

Research trial participation may influence health outcomes regardless of the intervention assigned, but is often not assessed.

Setting:

We investigated how participation in an HIV prevention trial (the HIV Prevention Trials Network (HPTN) 068 study) affected health outcomes 4 years after the study in adolescent girls and young women in South Africa beyond effects of the tested intervention.

Methods:

We developed an analytical cohort that included the HIV Prevention 068 trial (HPTN 068) trial participants from the Agincourt Health and Demographic Surveillance System and resembled HPTN 068 trial enrollees (aged 13–20 years and in grades 8–11 in 2011) using inverse probability of treatment weights. We estimated risk differences for the association between trial participation and education and early parity (age <20 years) in 2019, after accounting for differences at baseline between the trial participants and nonparticipants.

Results:

There were 3442 young women enrolled in grades 8–11 in 2011; 1669 were in the HPTN 068 trial. Trial participants were more likely to have completed secondary school by 2019 (adjusted RD (aRD) 5.0%, 95% confidence interval (CI) 2.2%, 7.9%; 82.3% in trial participants vs. 77.2% in nonparticipants). Trial participants had similar risk of parity before age 20 compared with nontrial participants (aRD 2.3%, 95% CI: −0.8%, 5.5%).

Conclusions:

Trial participation did not seem to influence early parity, but did increase educational attainment. Our results are compatible with an explanation of Hawthorne effects from trial participation on schooling behaviors that were small, but observable even 4 years after the end of the trial.
Multimodal In Vivo Tracking of Chimeric Antigen Receptor T Cells in Preclinical Glioblastoma Models
Authors: Wu Wei Emma , Chang Edwin , Jin Linchun , Liu Shiqin , Huang Ching-Hsin , Kamal Rozy , Liang Tie , Aissaoui Nour Mary , Theruvath Ashok J. , Pisani Laura , Moseley Michael , Stoyanova Tanya , Paulmurugan Ramasamy , Huang Jianping , Mitchell Duane A. , Daldrup-Link Heike E.
Published: February 2023

Objectives

Iron oxide nanoparticles have been used to track the accumulation of chimeric antigen receptor (CAR) T cells with magnetic resonance imaging (MRI). However, the only nanoparticle available for clinical applications to date, ferumoxytol, has caused rare but severe anaphylactic reactions. MegaPro nanoparticles (MegaPro-NPs) provide an improved safety profile. We evaluated whether MegaPro-NPs can be applied for in vivo tracking of CAR T cells in a mouse model of glioblastoma multiforme.

Materials and Methods

We labeled tumor-targeted CD70CAR (8R-70CAR) T cells and non–tumor-targeted controls with MegaPro-NPs, followed by inductively coupled plasma optical emission spectroscopy, Prussian blue staining, and cell viability assays. Next, we treated 42 NRG mice bearing U87-MG/eGFP-fLuc glioblastoma multiforme xenografts with MegaPro-NP-labeled/unlabeled CAR T cells or labeled untargeted T cells and performed serial MRI, magnetic particle imaging, and histology studies. The Kruskal-Wallis test was conducted to evaluate overall group differences, and the Mann-Whitney U test was applied to compare the pairs of groups.

Results

MegaPro-NP-labeled CAR T cells demonstrated significantly increased iron uptake compared with unlabeled controls (P < 0.01). Cell viability, activation, and exhaustion markers were not significantly different between the 2 groups (P > 0.05). In vivo, tumor T2* relaxation times were significantly lower after treatment with MegaPro-NP-labeled CAR T cells compared with untargeted T cells (P < 0.01). There is no significant difference in tumor growth inhibition between mice injected with labeled and unlabeled CAR T cells.

Conclusions

MegaPro-NPs can be used for in vivo tracking of CAR T cells. Because MegaPro-NPs recently completed phase II clinical trial investigation as an MRI contrast agent, MegaPro-NP is expected to be applied to track CAR T cells in cancer immunotherapy trials in the near future.
Functional Imaging Evidence of Tumor Response to High-Specific-Activity 131I-MIBG Therapy in an 84-Year-Old Patient With Metastatic Pheochromocytoma/Paraganglioma
Authors: Jimenez Camilo , Lu Yang
Published: February 2023

An 84-year-old man with history of metastatic pheochromocytoma/paraganglioma (mPPGL) received surgery 13 years ago, with recent biopsy-proven mPPGL in the T11. 123I-MIBG scan showed MIBG-avid liver and osseous. Given his medical condition and body habitus (weight, 45 kg; height, 140 cm), the patient was treated with high-specific-activity 131I-MIBG (Azedra) 300 mCi ×2. He tolerated the medication and was totally asymptomatic. Series 123I-MIBG scan showed good responses till 22 months after the first treatment at the last visit. This is probably the oldest and smallest adult mPPGL patient treated with Azedra and with prolonged good response.
Increased PSMA Expression in 177Lu-PSMA-617 Scan in Metastatic Castrate-Resistant Prostate Cancer Patient Treated With PSMA Radioligand Therapy and Enzalutamide
Authors: Aggarwal Piyush , Kaur Komalpreet , Sood Ashwani , Periasamy Kannan , Nagi Shreya , Mittal Bhagwant Rai
Published: February 2023

Androgen deprivation therapy plays an integral role in the treatment algorithm of advanced prostate cancer. Enzalutamide has shown great benefit in castrate-sensitive as well as resistant prostate cancer. Few studies have shown that enzalutamide can potentially increase the PSMA expression on 68Ga-PSMA-11 PET/CT imaging in patients with metastatic castrate-resistant prostate cancer. We present an interesting case where addition of short course of enzalutamide resulted in increased localization of 177Lu-PSMA-617 in metastatic lesions on posttherapy scan pointing to the added benefit of PSMA RLT.
FDG PET/CT in a Case of Lung Adenocarcinoma With Diffuse Cavitary Intrapulmonary Metastases
Authors: Guo Jia , Liao Zhongjian , Dong Aisheng
Published: February 2023

We describe FDG PET/CT findings in a case of lung adenocarcinoma with diffuse cavitary intrapulmonary metastases at initial diagnosis. High-resolution CT of the chest showed the primary solid tumor in the right upper lobe and numerous cavitating metastases ranging from a few millimeters to 1 cm in the bilateral lungs. FDG PET/CT showed intense activity of the primary tumor, diffuse activity of the lung metastases, and hypermetabolic metastases in the mediastinal lymph nodes and bones. Familiarity with this atypical intrapulmonary metastatic pattern of lung cancer may be helpful for the diagnosis and differential diagnosis.
Incidental Diagnosis of Metastatic Breast Cancer in a Man With 99mTc-PSMA SPECT/CT
Authors: Zárate-García César D. , Cardoza-Ochoa David R. , Sánchez-Vera Yazmín , González-Díaz Jorge Iván
Published: February 2023

Breast cancer in men is a rare and unsuspected malignancy. A 48-year-old man begins with disabling low back pain. The CT scan reported a compression fracture in L2 and diffuse skeletal lesions suggestive of metastatic disease. The serum prostate-specific antigen was 6.2 ng/mL. He was referred for SPECT/CT with 99mTc-EDDA/HYNIC-inhibitor prostate-specific membrane antigen due to clinical suspicion of prostate cancer. SPECT/CT with 99mTc-EDDA/HYNIC-inhibitor prostate-specific membrane antigen showed a primary lesion in the left breast and multiple bone lesions. Biopsy confirmed infiltrating ductal carcinoma with positive hormone receptors and indeterminate HER2 (human epidermal growth factor receptor 2).
Cervix Abscess Mimicking Cervical Cancer Explored With 18F-FDG PET/CT and MRI
Authors: Dhomps Anthony , Trecourt Alexis , Tordo Jeremie
Published: February 2023

We report the case of a 32-year-old woman gravida 2 para 2 with pelvic pain evolving for 2 months, who underwent imaging examinations, including 18F-FDG PET/CT and MRI, which showed a tumor-like cervix tissular mass with pathological lymph nodes and pelviperitonitis. An endocervical curettage with conization revealed a bacterial infection with cervical abscess and without neoplastic component. The follow-up 18F-FDG PET/CT 3 months after starting antibiotherapy confirmed a complete metabolic and morphological response of the cervical abscess.
Brain Nocardiosis Defined by 18F-Fluorocholine PET/CT
Authors: García Vicente Ana María , Noriega Álvarez Edel , González Rodríguez Jose Carlos , Soriano Castrejón Ángel María
Published: February 2023

Nocardia infection (nocardiosis) is usually acquired by inhalation; so pulmonary nocardiosis is the most common clinical presentation. Extrapulmonary localization occurs through hematogenous dissemination or contiguous spread. Nocardia can involve the central nervous system in a very reduced number of patients, mainly in immunocompromised. We present a case of a 56-year-old woman with a history of aggressive systemic mastocytosis, treated with chemotherapy 1 year ago. Patient reported intense headache, disorientation, and blurry vision without other symptoms being diagnosed with a rare brain nocardiosis by Nocardia cerradoensis. Neither bacteremia nor pulmonary involvement was detected. Brain PET/CT illustrated 18F-fluorocholine avidity on brain abscesses.
Comparison of 68Ga-DOTATATE PET/CT and 68Ga-Pentixiafor PET/CT Imaging in a Case of Merkel Cell Carcinoma
Authors: Rao Zijuan , Zhang Yu , Liu Liyi , Wang Min , Zhang Chunyin
Published: February 2023

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma with a high rate of metastasis and mortality. We present 68Ga-DOTATATE PET/CT and 68Ga-pentixiafor PET/CT findings of MCC in a 62-year-old man. Both 68Ga-DOTATATE PET/CT and 68Ga-pentixiafor PET/CT revealed increased radioactive uptake of lesions in the scan range. Compared with 68Ga-DOTATATE PET/CT, the lesions showed higher uptake in 68Ga-pentixiafor PET/CT. Our case showed that 68Ga-pentixiafor might be a promising radiotracer in the evaluation of MCC.
Syringe Suction Yields Greater Adipocyte Viability for Fat Grafting
Authors: Kuykendall Lauren , Threet Abby , Le Nicole K. , Moffitt Joseph , McLaughlin Mariel , Serraneau Karisa
Published: February 2023

Autologous fat grafting is a technique that can be used for cosmetic and reconstructive indications such as oncologic defects, aging, trauma, and congenital malformations. However, there is no standardized technique, and one of the main challenges is the unpredictable rate of fat resorption. When using fat grafting, it is crucial to understand the different factors that contribute to adipocyte viability. A literature search, using PubMed, was conducted in 2022 with variations of the terms “autologous fat grafting,” “fat harvesting,” “fat processing,” and “fat injection.” Articles in the English language that presented original data about different factors that may affect adipocyte viability for fat grafting were included in this review. Syringe suction harvests (lower pressures), compared with other methods with higher pressures, were found to have increased adipocyte counts and viability, but this did not translate clinically during in vivo studies. The studies have shown that, despite our efforts in optimizing fat harvest, processing, and injection, no statistical or clinical differences have been found. Additional studies are still needed to determine a universal protocol for optimal fat graft survival.
The Efficacy of Subdermal Pocket Procedure in Fingertip Replantation With Composite Graft
Authors: Yeh Jui-Po , Lin Tsan-Shiun
Published: February 2023

Background

Microsurgical replantation of fingertip amputation is sometimes difficult because of a lack of available vessels. Composite grafting is an alternative method for nonvascularized replantation, but it has a limited success rate. The subdermal pocket (SDP) procedure is proposed to increase the survival of composite graft.

Aim and Objectives

We aimed to compare the success rate of the composite graft used in fingertip replantation with or without application of the SDP procedure.

Patients and Methods

From 2000 to 2020, 29 fingertip amputations (28 complete amputations, 1 near-complete amputation) from 28 patients were included. Five of the fingertip amputations were classified as Ishikawa zone Ib and 24 as Ishikawa zone II. Seventeen fingers underwent replantation with composite graft plus SDP procedure, whereas the remaining 12 fingers received replantation with composite graft only.

Results

The overall success rate was 70.59% (12 of 17) in the SDP group and 41.67% (5 of 12) in the composite graft-only group (P= 0.119; odds ratio, 3.36). In the subgroup of Ishikawa zone II fingertip amputations, the success rate was 66.67% (10 of 15) in the SDP group and 22.22% (2 of 9) in the composite graft-only group (P= 0.035; odds ratio, 7.0).

Conclusions

The SDP procedure could increase the success rate of fingertip replantation with composite graft, especially for Ishikawa zone II amputations.
Arrested Pneumatization of the Sphenoid Sinus
Authors: Cho Hyung Joon , Hahm Myong Hun , Kim Jung Soo , Heo Sung Jae
Published: February 2023

The sphenoid bone is a complex structure in terms of its embryological origin. At birth, the sphenoid sinus is nonpneumatized. Arrested pneumatization of the sphenoid sinus is considered a normal anatomic variant but may be mistaken for disease in imaging studies. We report 2 cases of arrested pneumatization of the sphenoid sinus, a normal variant commonly misdiagnosed as a serious disease of the skull base. A 29-year-old man with a complaint of dizziness visited a local clinic for assessment. Computed tomography (CT) of the paranasal sinuses (PNS) showed a noneroding, nonexpansile, and nonhomogenous lesion in the sphenoid bone. Magnetic resonance imaging (MRI) of the brain revealed a high-signal lesion on both T1-weighted and T2-weighted images. Given these typical findings in the CT of PNS and MRI of the brain, the lesion was diagnosed as arrested pneumatization of the sphenoid sinus. In the second case, a 60-year-old woman with a complaint of headache visited a local clinic for assessment. CT of PNS showed a fibro-osseous lesion (with features of sclerosis and osteolysis) in the skull base. Brain MRI revealed a low-signal lesion on a T1-weighted image containing a high-signal intensity around the sphenoid bone, thereby suggesting internal fat contents. A precise interpretation of CT of PNS and brain MRI is essential to distinguish arrested pneumatization of the sphenoid sinus and to help establish a differential diagnosis and avoid needless biopsy.
Application of Autogenous Dermis Combined With Local Flap Transplantation in Repair of Titanium Mesh Exposure After Cranioplasty
Authors: Wei Zhiyi , Yang Xiaolan , Lin Tianlai , Zhu Jingfa , Fang Xiangjian , Zhu Yixin , Cheng Juntao
Published: February 2023

Objectives:

To investigate the clinical outcome of autogenous dermis combined with local flap transplantation in the treatment of titanium mesh exposure after cranioplasty.

Methods:

We studied a total of 8 patients with titanium mesh exposure after cranioplasty. After debridement of the head wound, the autogenous dermal tissue from the lateral thigh was transplanted to the surface of titanium mesh, and the local skin flap was then applied after suturing and fixation to repair the wound on the surface of the dermis. To repair the lateral thigh dermal tissue area, a local skin flap was obtained, and a blade thick skin graft was used.

Results:

Both dermal tissue and local skin flap survived. In the meanwhile, the donor skin area of the lateral thigh healed well, with only slight scar hyperplasia, and the titanium mesh was preserved. There was no recurrence after 6 months of follow-up.

Conclusions:

The application of autogenous dermis combined with local skin flap to repair titanium mesh exposure can effectively avoid skin flap necrosis, potential re-exposure of titanium mesh, sub-flap effusion, infection, and other problems. This method has an ideal effect, has easy access to materials, and reduces patients’ economic burden. It is worth popularizing.
Comparison of Piezosurgery and Conventional Osteotomy for Orbital Hypertelorism Surgical Correction
Authors: Liu Xiangqi , Zhang Ziwei , Kim Byeong Seop , Lin Li , Han Wenqin , Chai Gang , Xu Haisong , Yang Xianxian
Published: February 2023

The purpose of this study was to compare the safety and effect of piezosurgery with conventional osteotomy in a box-shifting procedure for orbital hypertelorism (ORH) correction surgery. This study retrospectively analyzed the clinical record of 10 ORH patients aged from 5 to 12 years, and they were second-degree ORH with an interorbital distance (IOD) of 35 to 37.8 mm. Three of them received the osteotomy with piezosurgery (the piezosurgery group), whereas the other 7 patients received osteotomy with the conventional osteotomy method (the control group). They were compared with age and preoperative IOD. All the patients’ IOD was effectively improved to normal range after the surgery. The results showed that the application of piezosurgery did not prolong the surgery time (piezosurgery group: 8.3±0.5 hours; control group: 8.7±1.4 hours, P=0.68). Furthermore, the patients in the piezosurgery group had less drainage volume (piezosurgery group: 79.1±12 mL; the control group: 170±41.3 mL, P=0.0065) and shorter postoperative hospital stay (piezosurgery group: 8.3±2.0 d; control group: 12.43±2.29 d, P=0.029). There were 2 patients who had wound infections, 1 in the piezosurgery group and 1 in the control group, respectively. However, 1 patient in the control group suffered from cerebrospinal fluid leakage. On the basis of the results, the application of piezosurgery benefited the patients on a better and smoother recovery course with less drainage and shorter hospital stays. The advantages of piezosurgery are the fine and precise osteotomy and the protection for soft tissue, which make it a comparatively safe and effective tool for craniofacial surgery, especially for young patients.
Recurrent Cerebellar Infarction Caused by Rare Thyroid Steal Syndrome: A Patient Report
Authors: Tian Yingzhao , Lu Lijun , Tang Chunhai
Published: February 2023

Thyroid steal syndrome is an extremely rare condition characterized by recurrent transient ischemic attacks. It is usually detected by the presence of an enlarged thyroid gland or thyroid dysfunction on examination. Herein, the authors reported a case of a severe patient with recurrent cerebellar infarction due to thyroid steal syndrome, which was initially considered to be due to intracranial arterial stenosis based on the patient’s computed tomography angiogram but was later found to be due to circulation shunt caused by goiter.
Update on Upper Limb Neuroma Management
Authors: Sayegh Anas , Jaloux Charlotte , Witters Marie , Mayoly Alice , Kachouh Najib
Published: February 2023

Painful terminal neuromas in the upper limb due to nerve injury are common. Neuroma symptoms include a sharp and burning sensation, cold intolerance, dysesthesia, pain, numbness, and paresthesia. These symptoms could have a negative impact on the functional ability of the patient and quality of life. In addition, Prostheses use might be abandoned by amputees due to neuroma-induced pain. Many clinicians face challenges while managing neuromas. Contemporary “active” methods like regenerative peripheral nerve interface (RPNI), targeted muscle reinnervation (TMR), and processed nerve allograft repair (PNA) are replacing the conventional “passive” approaches such as excision, transposition, and implantation techniques. RPNI involves inducing axonal sprouting by transplanting the free end of a peripheral nerve into a free muscle graft. TMR includes reassigning the role of the peripheral nerve by the transfer of the distal end of a pure sensory or a mixed peripheral nerve to a motor nerve of a nearby muscle segment. To give the peripheral nerve a pathway to re-innervate its target tissue, PNA entails implanting a sterile extracellular matrix prepared from decellularized and regenerated human nerve tissue with preserved epineurium and fascicles. Of these, RPNI and TMR appear to hold a promising treatment for nerve-ending neuromas and prevent their relapse. In contrast, PNA may reduce neuroma pain and allow meaningful nerve repair. The aim of this article is to provide an overview of the newer approaches of TMR, RPNI, and PNA and discuss their implications, surgical techniques, and reported consequences.
Sunken Upper Eyelid Deformity Correction by Orbital Fat Pad Repositioning and Orbicularis Oculi Muscle Folding in Blepharoplasty
Authors: Li XiuQi , Xia Lin , Ma Ling
Published: February 2023

Background:

Sunken upper eyelid deformity results in an aged and unnatural appearance and is common among Asians along with the single eyelid. The upper eyelid volume restoration is as important as the creation of a supratarsal fold for patients with sunken eyelids. In the present study, the combination of orbital fat pad repositioning and orbicularis oculi muscle flap folding was established to correct the upper eyelid depression during blepharoplasty.

Methods:

A retrospective study was conducted on patients who underwent the orbital fat pad repositioning and orbicularis oculi muscle flap folding to correct the upper eyelid depression between July 2020 and October 2021. The preoperative and postoperative sunken depths were calculated and compared, and overall patient satisfaction was performed to evaluate the operation efficiency.

Results:

There were 40 patients, including 39 females and 1 male, who underwent surgery with an average age of 25.4 years. During the mean follow-up period of 12.7 months, the sunken depth improved from 3.2 mm preoperatively to 1.5 mm postoperatively with a statistical significance. Satisfactory results were achieved without major complication.

Conclusions:

For patients with mild to moderate sunken upper eyelids, the combination of orbital fat pad repositioning and orbicularis oculi muscle folding has been proved efficient and consistent to restore the upper eyelid volume and helpful to build esthetic double eyelids.
Forgotten Pioneers of Plastic and Reconstructive Surgery During the Medieval Period
Authors: Atiyeh Bishara , Habal Mutaz B.
Published: February 2023

Sushruta who lived in India sometime between 1000 and 800 BC is traditionally recognized for being the “Father of Plastic Surgery.” However, “plastic surgery” has been performed much earlier in antiquity, with the earliest origins of primitive procedures dating back to 1600 BC in Ancient Egypt on the southeastern shores of the Mediterranean. Some centuries later, simple plastic cosmetic surgeries were performed, as well on the Northern Mediterranean shores in ancient Greece and Rome to repair damaged parts caused by war mutilation, punishment, or humiliation. Afterward, there has been a historical gap moving rapidly from the Greco-Roman period to the European Renaissance. Ignoring valuable contributions made by surgeons of the Medieval period, like Albucasis and Avicenna, has denied scholars of the Arabic Golden Age that bridged the eastern and western cultures recognition. In fact, all Mediterranean populations, albeit not together or simultaneously, have participated in the development of plastic and reconstructive surgery art and science. All have made valuable innovations, together with others, which cumulatively have resulted in progressive buildup of knowledge and technical skills.
Patient-Specific Implants and Fat Grafting for Contour Deformities Post Craniosynostosis Reconstruction: A Therapeutic Approach
Authors: Chocron Yehuda , Alabdulkarim Abdulaziz , Gilardino Mirko S.
Published: February 2023

Background:

Contour deformities after fronto-orbital advancement for craniosynostosis reconstruction are commonly encountered. There is a paucity of literature describing secondary procedures to correct such deformities with reported outcomes. An approach to defect analysis and procedure selection is lacking. The authors present our experience utilizing fat grafting (FG) and patient-specific implant (PSI) reconstruction as management strategies for this population.

Methods:

A retrospective analysis of consecutive patients who underwent secondary onlay PSI or FG for contour deformities after primary craniosynostosis reconstruction was carried out. Patient demographics, defect analysis, surgical approach, postoperative complications, and esthetic outcomes were recorded. Data were pooled across the entire cohort and presented in a descriptive manner.

Results:

Fourteen patients (36% syndromic and 64% isolated) were identified that either underwent PSI (n = 7) with a mean follow-up of 56.3 weeks, FG (n = 5) with a mean follow-up of 36 weeks or a combination of both (n = 2) for deformities postcraniosynostis surgery. Supraorbital retrusion and bitemporal hollowing were the most common deformities. There were no intraoperative or postoperative complications. All patients achieved Whitaker class I esthetic outcomes and there were no additional revisions during the defined study period. The presence of a significant structural component or large (>5 mm) depression typically necessitated a PSI.

Conclusions:

Contour deformities after fronto-orbital advancement reconstruction can be successfully managed using FG and PSI either as a combination procedure or in isolation. The authors have proposed anatomical criteria based on our experience to help guide procedure selection. Future prospective studies would be beneficial in providing more objective assessment criteria.
An Unusual Case of Severe Trismus After Craniotomy
Authors: Graca Sebastian , Houle Ashley , Callahan Nicholas
Published: February 2023

Myositis ossificans Traumatica (MOT) is a non-neoplastic, heterotrophic ossifying disease process in muscle and soft tissue rarely involving the craniofacial area. Treatment depends on the extent of ossification and functional limitations. We present the first case of MOT of the temporalis muscle following neurosurgical intervention. This is the case of a 28-year-old male patient who underwent numerous neurosurgical interventions and reported progressive trismus following these interventions. Imaging demonstrated a right temporal region radio-opacity consistent with ossification of the temporalis muscle. The patient underwent coronoidectomy with excision of the ossified right temporalis muscle and reconstruction with an anterolateral thigh adipofascial vascular free flap. Postoperatively, he maintained intact function with increased incisal opening and no cosmetic defects. Limited mouth opening after the neurological procedure has a wide differential, and MOT must be considered. Surgical repair and reconstruction are multifaceted problems. Free flap reconstruction should be considered in multiple operated patients.
THE ROLES OF EXTRACELLULAR VESICLES IN SEPSIS AND SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
Authors: Weber Birte , Henrich Dirk , Hildebrand Frank , Marzi Ingo , Leppik Liudmila
Published: February 2023

Sepsis is a life-threatening organ dysfunction, caused by dysregulation of the host response to infection. To understand the underlying mechanisms of sepsis, the vast spectrum of extracellular vesicles (EVs) is gaining importance in this research field. A connection between EVs and sepsis was shown in 1998 in an endotoxemia pig model. Since then, the number of studies describing EVs as markers and mediators of sepsis increased steadily. Extracellular vesicles in sepsis could be friends and foes at the same time depending on their origin and cargo. On the one hand, transfer of EVs or outer membrane vesicles can induce sepsis or systemic inflammatory response syndrome with comparable efficiency as well-established methods, such as cecal ligation puncture or lipopolysaccharide injection. On the other hand, EVs could provide certain therapeutic effects, mediated via reduction of reactive oxygen species, inflammatory cytokines and chemokines, influence on macrophage polarization and apoptosis, as well as increase of anti-inflammatory cytokines. Moreover, EVs could be helpful in the diagnosis of sepsis. Extracellular vesicles of different cellular origin, such as leucocytes, macrophages, platelets, and granulocytes, have been suggested as potential sepsis biomarkers. They ensure the diagnosis of sepsis earlier than classical clinical inflammation markers, such as C-reactive protein, leucocytes, or IL-6. This review summarizes the three roles of EVs in sepsis—mediator/inducer, biomarker, and therapeutic tool.