bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence-Based Patient Selection in Headache Surgery: The Impact of Preoperative RFA Treatment on Surgical Outcomes
Authors: Casari Maria E. , Chartier Christian , Gfrerer Lisa , Austen William G.
Published: February 2023

Background:

Radiofrequency ablation (RFA) of the greater occipital nerve (GON) is a minimally- invasive treatment option commonly used in patients with occipital neuralgia. Patients who undergo occipital surgery for headaches after failed RFA treatment present a unique opportunity to evaluate RFA- treated occipital nerves and determine the impact on headache surgery outcomes.

Methods:

Of 115 patients who underwent headache surgery at the occipital site, twenty- nine had a history of prior RFA treatment. Migraine Headache Index, Pain Self- Efficacy Questionnaire, and Pain Health Questionnaire- 2 outcome scores were recorded preoperatively and at follow- up visits. Intraoperative macroscopic nerve damage and surgical outcomes were compared between RFA and non- RFA patients.

Results:

RFA- treated patients had a higher rate of macroscopic nerve damage (45%) than non RFA- treated patients (24%) (p= 0.03), and were significantly more likely to require a second surgery at the site of primary decompression (27.6% versus 5.8%; p= 0.001), as well as GON transection (13.8% versus 3.5%; p= 0.04). Outcome scores at the last follow up visit showed no statistically significant difference between RFA- treated and non RFA- treated patients (p= 0.96).

Conclusion:

RFA patients can ultimately achieve outcomes that are not significantly different from non- RFA patients in occipital headache surgery. However, a higher number of secondary surgery at the site of primary decompression and nerve transections are required to treat refractory symptoms. RFA- treated patients should be counselled about an increased risk of same-site surgery and possible GON transection to achieve acceptable outcomes.
Fertility & Childbearing Outcomes of Practicing Female Plastic Surgeons
Authors: Hemal Kshipra , Chen Wendy , Bourne Debra A.
Published: February 2023

Background:

Women now represent approximately a third of plastic surgery residents. 1,2 The impact of a career in plastic surgery on family planning is unknown. The aim of this study is to report the current status of fertility and childbearing outcomes of practicing female plastic surgeons.

Methods:

Following IRB approval, an anonymous online survey was distributed to all female active and candidate members of the American Society of Plastic Surgeons. Data collected included demographics, number and outcomes of pregnancies, obstetrical complications, infertility, maternity leave, and breastfeeding.

Results:

Response rate was 20%. Female plastic surgeons were less likely to have children and gave birth to their first child at an older age compared to the U.S. population. Plastic surgeons had 7 times higher odds of having difficulty conceiving or carrying a pregnancy than American women. The rate of miscarriage was twice that of the U.S. population. Furthermore, the rate of obstetrical complications and congenital malformations was higher than the U.S. population (47% vs 20%, and 8% vs 4%, respectively).

Women took a mean of 6.6 weeks for maternity leave. Forty-three percent were dissatisfied with leave and longer leave correlated with higher satisfaction. The mean length of breastfeeding was 7.6 months. Women who breastfed for a longer duration were more likely to feel satisfied with the amount of time they breastfed.

Conclusions:

Plastic Surgeons are at high risk for infertility, miscarriage, congenital malformations, and obstetrical complications. The data in this article provide a groundwork for identifying areas of concern and potential solutions.
Facial nerve high-resolution visualization and topographic microanatomy analysis from the distal intratemporal to extracranial pes segment – reconstructive implications
Authors: Mohanty Ahneesh J. , Cleveland Patrick , Shang Zhiguo , Glick Samuel , Sanchez Cristina , Jamieson Andrew R. , Rozen Shai M.
Published: February 2023

Background:

Current knowledge of facial nerve topography between the stylomastoid foramen to the pes anserinus is very limited. Elucidating this segment's intraneural microanatomy may be advantageous in certain clinical settings: the planning of nerve grafts for gaps extending from the proximal facial nerve trunk to distal branches or in determining coaptation sites for hypoglossal jump grafts to provide selective upper and lower facial tone. This study is the first to provide high definition intraneural topography of the aforementioned segment to optimize reconstructive outcomes.

Methods:

16 facial nerves extending from the 2 nd genu to the pes anserinus were harvested from 8 cadavers en bloc to preserve orientation. Specimens were imaged by microCT using a serial 6-micron protocol and digitally reconstructed three- dimensionally to be analyzed using bioinformatic tools.

Results:

No clinically significant fascicular separation was noted between 14.4 mm proximal to the stylomastoid foramen until 4.4 mm distal to the foramen. Fascicles remained separate throughout the remainder of the specimen and found to undergo a mean rotation of 45.5 degrees (p=0.0002) between 8.9-13.7 mm distal to the stylomastoid foramen. This reliable clockwise rotation in left nerves and counterclockwise rotation in right nerves resulted in superficially-oriented fascicles entering the upper division of the pes anserinus, while deep-oriented fascicles entered the lower division.

Conclusion:

Intraneural facial nerve topography and rotation are consistent from 4 to 14 mm distal to the stylomastoid foramen, enabling surgeons to accurately place grafts targeted to either upper or lower face, thus optimizing functional accuracy and minimizing synkinesis.
Subfascial Axillary Hybrid Breast Augmentation: Technical Highlights and Step-by-Step Video Guide
Authors: Munhoz Alexandre Mendonça , Neto Ary de Azevedo Marques , Maximiliano João
Published: February 2023

Advances in breast augmentation techniques have led to safety improvements and better aesthetic results. The concurrent combination of the axillary approach with a subfascial pocket has been suggested for augmentation procedures, since it avoids breast scarring and the limitations of submuscular positioning represented by breast animation when the pectoral muscle is contracted. With the improvement of autogenous fat grafting techniques, new implant coverage options and more natural results have been proposed with more superficial implant pockets; simultaneous autogenous fat grafting with silicone implants (defined as hybrid breast augmentation) has recently been evaluated as a promising technique. Combining these two procedures allows core volume projection and natural cleavage, while camouflaging implant edges. Fat grafting is also useful in reducing intermammary distance and achieving a smaller and smoother transition between the breasts. This article and the accompanying videos provide a detailed, step-by-step guide to hybrid breast augmentation using a subfascial axillary approach, with a predictable and optimized surgical outcome.
Stem-cell enriched hybrid breast reconstruction reduces risk for capsular contracture in a hybrid breast reconstruction animal model
Authors: Diehm Yannick F. , Thomé Julia , Will Patrick , Kotsougiani-Fischer Dimitra , Haug Valentin F. , Siegwart Laura C. , Kneser Ulrich , Fischer Sebastian
Published: February 2023

Background:

Hybrid breast reconstruction (HBR) combines silicone implants with fat grafting to improve implant coverage, treating local tissue deficiencies and leading to a more natural breast appearance. Recent data also indicated less capsular contracture after HBR. We developed a novel technique and animal model of cell-assisted HBR (CA-HBR) to illuminate its effects on capsular contracture.

Methods:

Animals received silicone implants in a dorsal sub-muscular pocket. While animals of group HBR received fat grafting around the implant without stem cell enrichment, rats of the CA-HBR1 and the CA-HBR2 group received stem-cell enriched fat grafting with 2x10 6 and 4x10 6 adipose derived stem cells immediately after implant insertion. On day 60, animals underwent sonography and elastography imaging, were euthanized and outcome analysis was performed by means of histology, immunohistochemistry, chemical collagen quantification and gene expression analysis.

Results:

With this novel technique, long-term survival of ADSCs within the implant pocket was demonstrated after 60 days post implant insertion. CA-HBR led to significantly reduced thickness and collagen density of capsular contractures. Additionally, CA-HBR resulted in reduced fibrotic responses with less occurrence of collagen I and TGFβ in capsule tissue. Moreover, the addition of stem cells suppressed fibrotic and inflammatory responses on a genetic level with significant under-expression of collagen I and TGFβ1.

Conclusion:

With this new technique and animal model, we observed a preventive effect on capsular contracture substantiating the basis of clinical outcomes of HBR. We propose that the addition of stem cells to HBR might booster its beneficial results.
Modifying effect of outdoor recreational activity on the association between anger expression and cardiovascular disease risk: the Circulatory Risk in Communities Study
Authors: Tezuka Kazuhide , Kubota Yasuhiko , Ohira Tetsuya , Muraki Isao , Hayama-Terada Mina , Shimizu Yuji , Imano Hironori , Shirai Kokoro , Okada Takeo , Kiyama Masahiko , Iso Hiroyasu
Published: February 2023

Objective

Outdoor recreational activity (ORA) has been suggested as a practical strategy for anger management to moderate the risk of cardiovascular disease (CVD). However, there is a lack of evidence pertaining to this topic. Our aim was to examine whether ORA modified the association between anger expression and the risk of CVD.

Methods

A community-based cohort study was conducted among 1877 Japanese individuals aged 40—79 years at baseline in 1997. The anger expression was measured using the Spielberger Anger Expression Scale. Stratified into low and high ORA (0 and ≥ 1 of the four behaviors), a Cox proportional hazards model was used to assess the anger expression-related risk of incident CVD (ischemic heart disease and stroke).

Results

We identified 76 incident CVDs during a median follow-up of 18.8 years. Among participants with low ORA, anger expression was associated with an increased risk of CVD, whereas no association was identified among those with high ORA. The standardized hazard ratios were 1.53 (95% CI, 1.23-1.91) and 0.77 (0.51-1.15) among those with low and high ORA, respectively: p for interaction = .004. Similar associations were observed regarding the risk of total and ischemic stroke, and ischemic CVD.

Conclusions

We found an elevated risk of CVD associated with anger expression among participants with low ORA but not among those with high ORA, suggesting that ORA use may mitigate the association between anger expression and CVD risk.
Evaluation of Policies Limiting Opioid Exposure on Opioid Prescribing and Patient Pain in Opioid-Naive Patients Undergoing Elective Surgery in a Large American Health System
Authors: Rennert Lior , Howard Kerry A. , Walker Kevin B. , Furmanek Douglas L. , Blackhurst Dawn W. , Cancellaro Vito A. , Litwin Alain H.
Published: February 2023

Objectives

Overprescribing to opioid-naive surgical patients substantially contributes to opioid use disorders, which have become increasingly prevalent. Opioid stewardship programs (OSPs) within healthcare settings provide an avenue for introducing interventions to regulate prescribing. This study examined the association of OSP policies limiting exposure on changes in surgery-related opioid prescriptions and patient pain.

Methods

We evaluated policies implemented by an OSP in a large American healthcare system between 2016 and 2018: nonopioid medication during surgery, decrease of available opioid dosage vials in operating rooms, standardization of opioid in-patient practices through electronic health record alerts, and limit to postsurgery opioid supply. Generalized linear mixed effects models examined the association of interventions with outcome changes in 9262 opioid-naive patients undergoing elective surgery. Outcomes were discharge pain, morphine milligram equivalent in the first prescription postsurgery, and opioid prescription refills.

Results

Decreases in all prescription outcomes and discharge pain were observed following onset of OSP interventions (P’s < 0.001). Among individual policies, standardization of in-patient prescribing practices was associated with the strongest decrease in prescribed morphine milligram equivalent. Importantly, there was no evidence of an increase in discharge pain related to any intervention.

Conclusions

This study promotes the potential of OSP formation and policies to reduce opioid prescribing without compromising patient pain. The most effective policy, standardization of in-patient prescribing practices through alerts, suggests that reminding prescribers to re-evaluate the patient’s need is effective in changing behavior. The findings offer considerations for OSP formation and policy implementation across health systems to improve quality and safety in opioid prescribing.
Uptake of medical male circumcision with household-based testing, and the association of traditional male circumcision and HIV infection
Authors: Zewdie Kidist , Pickles Michael , Floyd Sian , Fidler Sarah , Ayles Helen , Bock Peter , Hoddinott Graeme , Mandla Nomtha , Shanaube Kwame , Simwinga Musonda , Fraser Christophe , Seeley Janet , Piwowar-Manning Estelle , Hayes Richard , Donnell Deborah
Published: February 2023

Objectives:

Voluntary medical male circumcision (VMMC) is an important component of combination HIV prevention. Inclusion of traditionally circumcised HIV negative men in VMMC uptake campaigns may be important if traditional male circumcision is less protective against HIV acquisition than VMMC.

Methods:

We used data from the HIV Prevention Trials Network (HPTN) 071 (PopART) study. This cluster-randomized trial assessed the impact of a combination prevention package on population-level HIV incidence in 21 study communities in Zambia and South Africa. We evaluated uptake of VMMC, using a two-stage analysis approach and used discrete-time survival analysis to evaluate the association between the types of male circumcision and HIV incidence.

Results:

A total of 10 803 HIV-negative men with self-reported circumcision status were included in this study. At baseline, 56% reported being uncircumcised, 26% traditionally circumcised and 18% were medically circumcised. During the PopART intervention, 11% of uncircumcised men reported uptake of medical male circumcision. We found no significant difference in the uptake of VMMC in communities receiving the PopART intervention package and standard of care {adj. rate ratio=1·10 [95% confidence interval (CI) 0.82, 1.50, P = 0.48]}. The rate of HIV acquisition for medically circumcised men was 70% lower than for those who were uncircumcised adjusted hazard ratio (adjHR) = 0.30 (95% CI 0.16–0.55; P < 0.0001). There was no difference in rate of HIV acquisition for traditionally circumcised men compared to those uncircumcised adjHR = 0.84 (95% CI 0.54, 1.31; P = 0.45).

Conclusions:

Household-based delivery of HIV testing followed by referral for medical male circumcision did not result in substantial VMMC uptake. Traditional circumcision is not associated with lower risk of HIV acquisition.
Creatinine and cystatin C-based estimated glomerular filtration rate estimates of kidney function in Black people with HIV on antiretroviral therapy
Authors: Mazaheri Tina , Buchanan Devon , Hung Rachel , Campbell Lucy , Hamzah Lisa , Bramham Kate , Vincent Royce P. , Post Frank A.
Published: February 2023

Background:

To reduce health inequalities, the creatinine-based chronic kidney disease epidemiology collaboration 2021 formula for estimated glomerular filtration rate (eGFR) is replacing the 2009 formula, which required adjustment specifically for Black individuals. We compared the 2021 and 2009 creatinine-based formulae with cystatin C-based eGFR in Black people on antiretroviral therapy (ART) with HIV RNA <200 c/ml.

Methods:

Cross-sectional analysis of paired serum creatinine and cystatin C measurements. Bias, imprecision, accuracy, and performance for identifying individuals with eGFR cystatin C <60 (units: ml/min per 1.73 m2) were determined. The effects of ART with no, mild-moderate, or marked effect on tubular creatinine secretion on the performance of the 2021 formula was assessed.

Results:

We included 362 individuals (mean age 51 years, 56% female, mean eGFR-cystatin C 88.3). Overall, the 2021 (vs. the 2009 race-adjusted) formula was less biased and had improved imprecision and accuracy compared with eGFR-cystatin C but underestimated eGFR-cystatin C in those with eGFR ≥90 and overestimated eGFR-cystatin C in those with eGFR <60. The 2021 (vs. the 2009) formula had high specificity (95% vs. 97%) and negative predictive value (97% vs. 96%), but low sensitivity (56% vs. 52%) and positive predictive value (44% vs. 54%) for identifying individuals with eGFR-cystatin C <60 (P > 0.25). Performance at the eGFR <60 cut-off was minimally affected by ART exposure group.

Conclusion:

The CKD-EPI 2021 creatinine-based formula was better aligned with eGFR-cystatin C than the 2009 formula. eGFR-cystatin C may provide clinically useful information in Black people with eGFR <60 irrespective of ART regimen.
Assessing renal impairment in treatment-naïve adolescents living with HIV commencing antiretroviral therapy in Zimbabwe
Authors: Byers Bradley W. , Drak Douglas , Shamu Tinei , Chimbetete Cleophas , Dahwa Rumbidzai , Gracey David M.
Published: February 2023

Objective:

People with HIV (PWH) are increasingly experiencing non-communicable complications, including renal impairment, which are associated with worse clinical outcomes. Limited information exists surrounding renal impairment in paediatric PWH, of which the majority live in sub-Saharan Africa, and further information is required to guide clinical practice. This study describes the prevalence of new or worsening renal impairment in adolescents commencing antiretroviral therapy (ART) in Zimbabwe and associated risk factors.

Design:

Retrospective cohort study.

Methods:

Data were collected between January 2010 to January 2019 from the medical records of adolescents aged 12–17 years initiating ART at an outpatient HIV clinic in Zimbabwe. Renal function (estimated glomerular filtration rate, eGFR) was calculated using the Full Age Spectrum formula. Proteinuria was defined as a single urine dipstick score of ≥1+. Potential predictors of renal impairment at follow-up were assessed by logistical regression.

Results:

Two hundred and sixty-six adolescents were included in analysis. Baseline renal impairment (eGFR < 90 ml/min/1.73 m2) and proteinuria were present in 13% and 7% of the cohort, respectively. After a median of 4.1 years (interquartile range: 1.9–6.9) following ART commencement, mean eGFR increased by 10 ml/min/1.73 m2 (P < 0.01), and the prevalence of renal impairment decreased to 8% (P < 0.01). Baseline renal impairment predicted renal impairment at follow-up (odds ratio [OR] 8.98; 95% confidence interval [CI] 2.81–28.68; P < 0.01). Proteinuria trended towards association with renal impairment at follow-up (OR 4.39; 95% CI 0.95–20.31; P = 0.06).

Conclusions:

Renal impairment is common in adolescent ART-naïve PWH, and baseline renal impairment is associated with longstanding renal impairment, whereas baseline proteinuria trended towards an association with longstanding renal impairment.
A review of pre-implantation genetic testing technologies and applications
Authors: Du Ren-Qian , Zhao Ding-Ding , Kang Kai , Wang Fan , Xu Rui-Xia , Chi Chun-Li , Kong Ling-Yin , Liang Bo
Published: February 2023

The first practice of pre-implantation genetic testing (PGT) was reported more than 30 years ago. PGT, originally named pre-implantation genetic screening (PGS) and pre-implantation genetic diagnosis (PGD), is now categorized as PGT for aneuploidies (PGT-A), PGT for monogenic/single-gene defects (PGT-M), and PGT for chromosomal structural rearrangements (PGT-SR). Patients with fertility issues caused by advanced maternal age, carrier status of chromosomal abnormalities, or harboring pathogenic variant(s) are recommended to undergo PGT to increase the possibility of successful live birth and avoid potentially affected newborns. High-throughput techniques, such as DNA microarrays and next-generation sequencing (NGS), have enabled comprehensive screening of all 24 chromosomes, instead of few loci at a time. Furthermore, as a comprehensive PGT, PGT-Plus was enabled by the rapid development of a genome-wide single-cell haplotyping technique to detect embryo aneuploidy, single-gene disorders, and chromosomal aberrations simultaneously using a single universal protocol. In addition, non-invasive approaches enable a more intact embryo during the biopsy procedure, which may avoid potential mosaicism issues at a certain scale by testing spent culture media (SCM). As a novel PGT application, PGT-P detects genome-wide variations in polygenic diseases, which account for a large proportion of premature human deaths and affect a markedly larger population than monogenic diseases, using polygenic risk score calculation to decrease the potential of affecting complex conditions. Owing to the emergence of new technologies recruited to PGTs, more couples with infertility issues have a promising chance of conceiving a healthy baby, ultimately facilitating the human species to live more prosper.
Identifying miRNA biomarkers of polycystic ovary syndrome through text mining
Authors: Wang Yan , Yuan Xiao-Jing , Zhao Bin
Published: February 2023

Objective:

Polycystic ovary syndrome (PCOS) is an endocrine disorder with diverse clinical manifestations that often occurs in women of childbearing age. However, its molecular pathogenesis remains unclear, and this study aimed to identify miRNA targets in PCOS through text mining and database analysis.

Methods:

First, three different sets of text mining genes (TMGs) associated with “polycystic ovary syndrome”, “obesity/adiposis”, and “anovulation” keywords were retrieved from the GenCLiP3 database, and overlapping genes were selected. Second, Gene ontology annotation and biological pathway enrichment analyses of these overlapping TMGs were performed, followed by protein–protein interaction (PPI) network analysis. Third, genes in the gene module clustered in the PPI were selected to predict potential miRNAs for PCOS via miRNA-mRNA analysis.

Results:

A total of 4291 TMGs related to three different keywords were obtained through text mining; 72 intersect TMGs were retained among the three gene sets, and 62 TMGs participated in the establishment of the PPI network, of which 18 were aggregated in the gene module. Finally, 11 miRNAs that simultaneously bound to two TMGs (IGF1, ESR1, MAPK1, NAMPT, PIK3CA, and SERPINE1) could be prioritized as targets to study PCOS.

Conclusion(s):

The discovery of 11 miRNAs (miR-301a-3p, miR-301b-3p, miR-3666, miR-454-3p, miR-130a-3p, miR-130b-3p, miR-4295, miR-190a-3p, miR-5011-5p, miR-548c-3p, and miR-4799-5p) and 6 TMGs, which are associated with the HIF-1 signaling pathway (P = 4.799E-08), could be used as potential targets for PCOS.
Magnetic Resonance Elastography (MRE) of Bleomycin-Induced Pulmonary Fibrosis in an Animal Model
Authors: Fakhouri Faisal , Joseph Matthew , Ballinger Megan , Shukla Vasudha , Weimar David , Novak Caymen , Ghadiali Samir , Kolipaka Arunark
Published: February 2023

Background

Idiopathic pulmonary fibrosis is responsible for 40,000 deaths annually in the United States. A hallmark of idiopathic pulmonary fibrosis is elevated collagen deposition, which alters lung stiffness. Clinically relevant ways to measure changes in lung stiffness during pulmonary fibrosis are not available, and new noninvasive imaging methods are needed to measure changes in lung mechanical properties.

Objectives

Magnetic resonance elastography (MRE) is an in vivo magnetic resonance imaging technique proven to detect changes in shear stiffness in different organs. This study used MRE, histology, and bronchoalveolar lavage (BAL) to study changes in the mechanical and structural properties of the lungs after bleomycin-induced pulmonary fibrosis in pigs.

Materials and Methods

Pulmonary fibrosis was induced in 9 Yorkshire pigs by intratracheal instillation of 2 doses of bleomycin into the right lung only. Magnetic resonance elastography scans were performed at baseline and week 4 and week 8 postsurgery in a 1.5 T magnetic resonance imaging scanner using a spin-echo echo planar imaging sequence to measure changes in lung shear stiffness. At the time of each scan, a BAL was performed. After the final scan, whole lung tissue was removed and analyzed for histological changes.

Results

Mean MRE-derived stiffness measurements at baseline, week 4, and week 8 for the control (left) lungs were 1.02 ± 0.27 kPa, 0.86 ± 0.29 kPa, and 0.68 ± 0.20 kPa, respectively. The ratio of the shear stiffness in the injured (right) lung to the uninjured control (left) lung at baseline, week 4, and week 8 was 0.98 ± 0.23, 1.52 ± 0.41, and 1.64 ± 0.40, respectively. High-dose animals showed increased protein in BAL fluid, elevated inflammation observed by the presence of patchy filtrates, and enhanced collagen and α-smooth muscle actin staining on histological sections. Low-dose animals and the control (left) lungs of high-dose animals did not show significant histopathological changes.

Conclusion

This study demonstrated that MRE can be used to detect changes in lung stiffness in pigs after bleomycin challenge.
Exploiting the Potential of Photon-Counting CT in Abdominal Imaging
Authors: Schwartz Fides Regina , Samei Ehsan , Marin Daniele
Published: February 2023

Photon-counting computed tomography (PCCT) imaging uses a new detector technology to provide added information beyond what can already be obtained with current CT and MR technologies. This review provides an overview of PCCT of the abdomen and focuses specifically on applications that benefit the most from this new imaging technique. We describe the requirements for a successful abdominal PCCT acquisition and the challenges for clinical translation. The review highlights work done within the last year with an emphasis on new protocols that have been tested in clinical practice. Applications of PCCT include imaging of cystic lesions, sources of bleeding, and cancers. Photon-counting CT is positioned to move beyond detection of disease to better quantitative staging of disease and measurement of treatment response.
Langerhans Cell Histiocytosis of Bilateral Parotid and Submandibular Glands
Authors: Prakash Sneha , Shamim Shamim Ahmed , Bakhshi Sameer , Pushpam Deepam , Sharma Aparna
Published: February 2023

Langerhans cell histiocytosis is a disorder of the mononuclear phagocytic system. Virtually any organ can be involved, the bone, skin, lungs, and pituitary gland being the most common. We describe the case of a 30-year-old man who presented with painless neck swelling.18F-FDG PET/CT showed bilateral bulky parotid and submandibular glands with increased metabolic activity. Histopathology confirmed the diagnosis of Langerhans cell histiocytosis. To our knowledge, there has been no description of18F-FDG PET/CT findings in Langerhans cell histiocytosis of salivary glands in literature. We aim to aid in the diagnosis and management of this rare presentation.
Malignant Transformation of Warthin Tumor in the Cervical Lymph Node
Authors: Park Soonchan , Lee Young Chan , Lim Sung-Jig , Kim Chanwoo
Published: February 2023

Warthin tumor is the second most common benign tumor of salivary glands. Here we present an interesting case of squamous cell carcinoma arising from the Warthin tumor in the cervical lymph node. The patient had another Warthin tumor in the parotid gland as well. Both the malignant transformation of Warthin tumor and the heterotopic occurrence of Warthin tumor in the cervical lymph node are rare. This exceptionally rare case demonstrates that the 2 rare clinical entities can occur simultaneously and affect clinical decisions.
The Virtual Surgical Management of Facial Fibrous Dysplasia
Authors: Khashaba Mohammed M. , Ibrahim Waleed H. , Shaker Shady M. , Shaheen Hamed A.
Published: February 2023

Purpose:

Fibrous dysplasia (FD) is a benign condition, which is characterized by the replacement of normal bone with fibrous tissue and the deposition of woven bone in an irregular manner. Surgical resection, careful corrective osteotomies as debulking, and recontouring procedures are frequently performed, but can be complicated by postoperative regrowth of the lesion. The main aim of this study was to introduce a computer-guided technique for a predetermined technique of bone contouring of craniofacial FD involving the facial bones.

Methods:

This case report was conducted on an 18-year-old girl complaining of unilateral craniofacial dysplasia. Upon clinical examination and radiographic examination, a customized computer-generated bone contouring guide was designed using virtual surgical software for accurate contouring of excess bone in the cranial vault and frontal bone. This guide was virtually designed after importing the multislice computerized tomography scans into the virtual surgical planning software. It was generated based on the mirroring option of the unaffected normal side along the median sagittal plane. In the surgery, the guide was seated in place and 5 mm implant drills were inserted through the guide depth holes. Bone removal was made using surgical burs connecting the guiding depth holes.

Results:

At the end of the follow-up, the patient showed acceptance of her external appearance with no signs of infection or dehiscence.

Conclusion:

This patient-specific cutting guide shows a promising solution for preplanned bone removal in cases with unilateral craniofacial FD.
Does the Mutation Type Affect the Response to Cranial Vault Expansion in Children With Apert Syndrome?
Authors: Goodarzi Mohammad R. , Breakey William F. , van de Lande Lara S. , Borghi Alessandro , O’Hara Justine , Ong Juling , James Greg , Hayward Richard , Schievano Silvia , Dunaway David J. , Jeelani Nu Owase
Published: February 2023

Most cases of Apert syndrome are caused by mutations in the FGFR2 gene, either Ser252Trp or Pro253Arg. In these patients, over the last decades, spring-assisted posterior vault expansion (SA-PVE) has been the technique of choice for cranial vault expansion in the Craniofacial Unit of Great Ormond Street Hospital for Children (GOSH), London. The aim of this study was to investigate if there is a difference in preoperative intracranial volume (ICV) in patients with Apert syndrome with Ser252Trp or Pro253Arg mutation and whether these mutations affect the change in ICV achieved by SA-PVE. The GOSH craniofacial SA-PVE database was used to select patients with complete genetic testing and preoperative and postoperative computed tomography scans. ICV was calculated using FSL (FMRIB Analysis Group, Oxford) and adjusted based on Apert-specific growth curves. Sixteen patients were included with 8 having Ser252Trp mutation and 8 having Pro253Arg mutation. The mean preoperative adjusted computed tomography volume for patients in the Ser252Trp group was 1137.7 cm3 and in the Pro253Arg group was 1115.8 cm3 (P=1.00). There was a significant increase in ICV following SA-PVE in all patients (P<0.001) with no difference in mean change in ICV between the groups (P=0.51). Four (50%) patients with Ser252Trp mutation and 3 (37.5%) with Pro253Arg mutations required a second operation after primary SA-PVE. The results demonstrate that regardless of the mutation present, SA-PVE was successful in increasing ICV in patients with Apert syndrome and that a repeat volume expanding procedure was required by a similar number of patients in the 2 groups.

Level of Evidence:

III.
Advances in Robot-Assisted Surgery for Facial Bone Contouring Surgery
Authors: Lin Li , Zhao Zhijie , Han Wenqing , Sun Mengzhe , Zhang Ziwei , Kim Byeong Seop , Yan Yingjie , Chen Xiaojun , Aung Zin Mar , Liu Xiangqi , Wang Xuetong , Li Xing , Yang Xianxian , Wang Bingshun , Chai Gang , Xu Haisong
Published: February 2023

Since our team reported the application of robot-assisted surgery in facial contouring surgery in 2020, further clinical trials with large samples have been conducted. This paper will report the interim results of a single-center, large-sample randomized controlled trial of the first robot developed by our team for facial contouring surgery. Meanwhile, this research field will be systematically reviewed and prospected.
Longitudinal Assessment of Neurodevelopment in Patients With Nonsyndromic Single-Suture Craniosynostosis: A Retrospective Review of 66 Patients
Authors: Lynn Jeremy V. , Buchman Lauren K. , Breuler Christopher J. , Buchman Steven R.
Published: February 2023

The neurodevelopmental consequences of nonsyndromic single-suture (NSS) craniosynostosis are the subject of continued debate. Although the predictive validity of the Bayley Scales of Infant and Toddler Development (Third Edition) (BSID-III) have been questioned, this neurodevelopmental testing battery continues to be widely utilized among multidisciplinary craniofacial teams. The purpose of this study is to evaluate the neurodevelopmental functioning of patients with NSS craniosynostosis before and after surgical correction and the impact of surgical correction on neurodevelopmental trajectory based on BSID-III testing. All patients with NSS craniosynostosis who underwent cranial vault remodeling between 2009 and 2020 were considered for inclusion. Patients who failed to complete BSID-III testing within 2 months of surgery preoperatively and 2 years of surgery postoperatively were excluded. A total of 66 patients met criteria for the study. On language testing, both the preoperative mean score (P=0.007) and postoperative mean score (P=0.003) were significantly lower than the population norm. Furthermore, on motor testing, both the preoperative mean score (P=0.005) and postoperative mean score (P=0.001) were significantly lower than the population norm. Bayley Scales of Infant and Toddler Development (Third Edition) testing revealed no significant change between preoperative and postoperative neurodevelopmental functioning. Overall, this study suggests that patients with NSS craniosynostosis experience modest delays in language and motor development, which are present before and after cranial vault remodeling. In addition, this study provides evidence that cranial vault remodeling does not significantly impact the neurodevelopmental trajectory. Multicenter st udies and refined neurodevelopmental testing methods are necessary to definitively establish the neurodevelopmental implications of NSS craniosynostosis.
Origins of Maxillofacial Surgery in Mediterranean Medical History
Authors: Atiyeh Bishara , Habal Mutaz B.
Published: February 2023

Maxillofacial and dental surgery has been around for a surprisingly long time. The first evidence of oral dental treatment can be traced back to Northern Italy 13,000 to 14,000 years ago. The first known evidence of dental filling with beeswax dates back to 6500 years ago in a site located in Slovenia. Fixing teeth with gold wires and prostheses and replacing them was performed for millennia in ancient Egypt and Phoenicia as well as in Etruria predating the Roman empire. In 1210, the earliest-known oral surgery group was formed in France leading to rapid advancement of the specialty over the following years with Pierre Fauchard, known as the father of modern dentistry, who turned dentistry from a craft into a profession. Despite diverse populations of various ethnic backgrounds, the Mediterranean civilization is truly one and unique. It was always at the forefront of scientific progress and technologic innovations in all fields of medicine and surgery and in particular in maxillofacial surgery.
NUCLEAR FACTOR-ERYTHROID-2–RELATED FACTOR REGULATES SYSTEMIC AND PULMONARY BARRIER FUNCTION AND IMMUNE PROGRAMMING AFTER BURN AND INHALATION INJURY
Authors: Seim Roland F. , Mac Michelle , Sjeklocha Lucas M. , Kwiatkowski Alex J. , Keselowsky Ben G. , Wallet Shannon M. , Cairns Bruce A. , Maile Robert
Published: February 2023

Major burn injury is associated with systemic hyperinflammatory and oxidative stresses that encompass the wound, vascular, and pulmonary systems that contribute to complications and poor outcomes. These stresses are exacerbated if there is a combined burn and inhalation (B+I) injury, which leads to increases in morbidity and mortality. Nuclear factor-erythroid-2–related factor (NRF2) is a transcription factor that functions to maintain homeostasis during stress, in part by modulating inflammation and oxidative injury. We hypothesized that the NRF2-mediated homeostasis after burn alone and combined B-I injury is insufficient, but that pharmacological activation of the NRF2 pathway has the potential to reduce/reverse acute hyper inflammatory responses. We found that, after burn and B+I injury, Nrf2−/−
mice have higher mortality and exhibit greater pulmonary edema, vascular permeability, and exacerbated pulmonary and systemic proinflammatory responses compared with injured wild-type (WT) controls. Transcriptome analysis of lung tissue revealed specific Nrf2-dependent dysregulated immune pathways after injury. In WT mice, we observed that B+I injury induces cytosolic, but not nuclear, accumulation of NRF2 protein in the lung microenvironment compared with sham-injured controls. Bardoxolone methyl (CDDO-Me)–containing microparticles (CDDO-MPs) were developed that allow for dilution in saline and stable release of CDDO-Me. When delivered intraperitoneally into mice 1 hour after B+I injury, CDDO-MPs significantly reduced mortality and cytokine dysfunction compared with untreated B-I animals. These data implicate the role of NRF2 regulation of pulmonary and systemic immune dysfunction after burn and B+I injury, and also a deficiency in controlling immune dysregulation. Selectively activating the NRF2 pathway may improve clinical outcomes in burn and B+I patients.
A Study of Surgical Residents' Self-Assessment of Open Surgery Skills Using Gap Analysis
Authors: Thinggaard Ebbe , Zetner Diana Bregner , Fabrin Anja , Christensen John Brochorst , Konge Lars
Published: February 2023

Background

Surgical residents need structured and objective feedback to develop their skills and become capable of performing surgical procedures autonomously. A shortage of experienced surgical staff has prompted residents to seek feedback from self-assessment and peer assessments.

Objectives

We investigated whether surgical residents can reliably rate their own and their peers' basic surgical skills using the Global Rating Scale (GRS) from the Objective Structured Assessment of Technical Skills.

Methods

The study was a prospective and descriptive study conducted using gap analysis at the Copenhagen Academy for Medical Education and Simulation (Copenhagen, Denmark) from 2016 to 2017. Surgical residents were recruited during a course in basic open surgical skills. Among 102 course participants, 53 met the inclusion criteria and 22 participated in the study.

Results

We recruited surgical residents based in the Capital Region and Zealand Region of Demark, and 42% of eligible residents participated in the study. Surgical residents underestimated their own surgical performance (median, 17 [range, 15–18] vs. 20 [range, 19.75–22]; P < 0.001). They also rated their peers lower than an experienced rater did (median 10 [range, 8.75–14] vs. 15 and median 20.5 [range, 19–22] vs. 23; both P < 0.001). Gap analysis revealed residents had unrecognized strengths (ie, self-underappraisal) in most GRS domains.

Conclusions

Ratings are unreliable when surgical residents assess their own and their peers' performances using GRS. A gap analysis revealed unrecognized strengths in time and motion, instrument handling, knowledge of instruments and sutures, and knowledge of specific procedure as well as unrecognized weaknesses in flow of operation and forward planning.
Overuse and Misuse of Antibiotics and the Clinical Consequence in Necrotizing Pancreatitis
Authors: Timmerhuis Hester C. , van den Berg Fons F. , Noorda Paula C. , van Dijk Sven M. , van Grinsven Janneke , Sperna Weiland Christina J. , Umans Devica S. , Mohamed Yasmin A. , Curvers Wouter L. , Bouwense Stefan A.W. , Hadithi Muhammed , Inderson Akin , Issa Yama , Jansen Jeroen M. , de Jonge Pieter Jan F. , Quispel Rutger , Schwartz Matthijs P. , Stommel Martijn W.J. , Tan Adriaan C.I.T.L. , Venneman Niels G. , Besselink Marc G. , Bruno Marco J. , Bollen Thomas L. , Sieswerda Elske , Verdonk Robert C. , Voermans Rogier P. , van Santvoort Hjalmar C. ,   for the Dutch Pancreatitis Study Group
Published: February 2023

Objective:

The use and impact of antibiotics and the impact of causative pathogens on clinical outcomes in a large real-world cohort covering the entire clinical spectrum of necrotizing pancreatitis remain unknown.

Summary Background Data:

International guidelines recommend broad-spectrum antibiotics in patients with suspected infected necrotizing pancreatitis. This recommendation is not based on high-level evidence and clinical effects are unknown.

Materials and Methods:

This study is a post-hoc analysis of a nationwide prospective cohort of 401 patients with necrotizing pancreatitis in 15 Dutch centers (2010-2019). Across the patient population from the time of admission to 6 months postadmission, multivariable regression analyses were used to analyze (1) microbiological cultures and (2) antibiotic use.

Results:

Antibiotics were started in 321/401 patients (80%) administered at a median of 5 days (P25-P75: 1-13) after admission. The median duration of antibiotics was 27 days (P25-P75: 15-48). In 221/321 patients (69%) infection was not proven by cultures at the time of initiation of antibiotics. Empirical antibiotics for infected necrosis provided insufficient coverage in 64/128 patients (50%) with a pancreatic culture. Prolonged antibiotic therapy was associated with Enterococcus infection (OR 1.08 [95% CI 1.03-1.16], P=0.01). Enterococcus infection was associated with new/persistent organ failure (OR 3.08 [95% CI 1.35-7.29], P<0.01) and mortality (OR 5.78 [95% CI 1.46-38.73], P=0.03). Yeast was found in 30/147 cultures (20%).

Discussion:

In this nationwide study of patients with necrotizing pancreatitis, the vast majority received antibiotics, typically administered early in the disease course and without a proven infection. Empirical antibiotics were inappropriate based on pancreatic cultures in half the patients. Future clinical research and practice must consider antibiotic selective pressure due to prolonged therapy and coverage of Enterococcus and yeast. Improved guidelines on antimicrobial diagnostics and therapy could reduce inappropriate antibiotic use and improve clinical outcomes.
Transumbilical Reduced-port Laparoscopic Urachal Resection for Pediatric and Adolescent Patients
Authors: Aiyoshi Tsubasa , Jimbo Takahiro , Gotoh Chikashi , Masumoto Kouji
Published: February 2023

Background:

Port placement in laparoscopic urachal resection has not yet been standardized. We herein report an approach for transumbilical reduced-port laparoscopic urachal resection for pediatric and adolescent patients.

Methods:

We retrospectively reviewed the outcomes of pediatric and adolescent patients for urachal remnant treated with reduced-port laparoscopic urachal resection from 2016 to 2020 in our department. Regarding our surgical procedure, a skin incision was made around the umbilicus, and the urachus was dissected partially under direct vision. Two transumbilical 5 mm ports and a 3.5 mm port in the right lateral abdomen were placed. In the laparoscopic view, the urachus was dissected from the abdominal wall and resected at the bladder dome. The defect of the peritoneum was closed by suturing.

Results:

Sixteen patients underwent the procedure. The median patient age was 12.5 years old. Surgery was performed by trainee surgeons in all patients without intraoperative complications or conversion to open surgery. The median postoperative hospital stay was 2 days.

Conclusions:

Our transumbilical reduced-port laparoscopic urachal resection technique has advantages in terms of safety, operability, and cosmetic appearance.
Impact of Perioperative Ketamine on Postoperative Bariatric Surgery Opioid Use and Length of Stay
Authors: Aghazarian Gary S. , Lind Romulo , Ardila Sara , Lastrapes Linda , Ghanem Muhammad , Teixeira Andre F. , Jawad Muhammad A.
Published: February 2023

Settings:

Postoperative pain management is an ever-growing challenge with the rise of the opioid crisis. Ketamine is an NMDA channel blocker, considered an alternative to perioperative opioid use; small concentrations are safe. Objective: The primary objective of this study was to evaluate the impact of perioperative ketamine administration on postoperative opioid use and the length of hospital stay in bariatric patients.

Methods:

Four hundred (366) charts were retrospectively reviewed; of those, 187 received ketamine and were placed in the Ketamine group, 179 received standard-of-care pain management and were part of the No-Ketamine group. Data was collected using medical databases from July 2020 to January 2021.

Results:

A greater length of stay was recorded in the No-Ketamine group (45.67±20.6 hours) when compared with the Ketamine group (40.6±14.3 hours); P<0.05. The Ketamine group had a mean MME of 17.5±16.5 whereas the No-Ketamine had a mean MME of 22.3±17.7, P<0.05.

Conclusions:

Ketamine may be a feasible alternative to reduce opioid use and hospital length of stay. We believe that ketamine can be an important contribution to ERABS pathways, being responsible for improved outcomes after bariatric/metabolic surgical procedures.
Small Bowel Refractory Bleeding
Authors: AL-Magedi Ahmed A. S. , Xv Yifan , Wang Zhi , Xu Wei , Wu Rong , Zhang Weiyu , Tao Qingsong
Published: February 2023

Introduction:

Small bowel (SB) bleeding is one of the common gastrointestinal problems, particularly in elders. The study aimed to find the causes of refractory bleeding and overcome the challenges and difficulties of surgical treatment for SB refractory bleeding.

Methods:

All patients with SB refractory bleeding who underwent surgical treatment were included in this study. Patients’ characteristics, surgical finding, and follow-up assessments were reviewed and analyzed through Hospital Information System records from October 1, 2014, to November 30, 2020. All analyses were performed using SPSS v23.0.

Results:

The causes of SB bleeding include vascular lesions (angioectasia, arteriovenous malformations, and dieulafoy lesions) 29.6%, tumors (Polyps, gastrointestinal stromal tumor, Adenocarcinoma, and other) 24.5%, diverticular 18.4%, ulcers/erosion 15.3%, inflammatory bowel disease 7.1%, and other 5.1%. Patients (age below 60 y) were highly developed SB bleeding caused by diverticular 26.4% compared with patients (age 60 y or older) 8.9%, whereas bleeding caused by vascular lesions was significantly higher in patients (age 60 y or older) 37.8%. Other causes, such as tumors and inflammatory bowel disease, showed no significant difference related in age. Exploratory laparotomy was the standard method of bowel extrinsic examination. The intraoperative enteroscopy enterotomy (IOE-E) and IOE-combined were performed in 52 patients (1:1). IOE-E shows lower postoperative morbidity and shorter time of operation P<0.05 compared with the IOE-combined approach.

Conclusions:

Age and exhaustive patient history can assist in finding out the etiology. IOE-E is safe, and coordination between surgeon and endoscopist is necessary for IOE if an identifiable source cannot be found in endoscopy or exploratory laparotomy alone.