bluuebunny/crossref_metadata_2025 huggingface dataset:
Tendon repair with intercalated partial extensor carpi radialis longus tendon graft for chronic extensor pollicis longus tendon rupture
Authors: Lo I-Ning , Yin Cheng-Yu , Yu Jin-Huei , Huang Hui-Kuang , Huang Yi-Chao , Wang Jung-Pan
Published: May 2021

Background:

The main treatment choices for chronic extensor pollicis longus (EPL) tendon rupture consists of tendon transfer and tendon repair with tendon graft. Tendon transfer with extensor indicis proprius (EIP) is currently considered the gold standard treatment which yields predictable and satisfactory results, but potentially compromises the strength of independent extension of the index finger. We propose our method of using a partial extensor carpi radialis longus (ECRL) tendon graft to repair chronic EPL tendon tears.

Methods:

The distal stump of the EPL was located through an incision at the basal joint level. The proximal stump was located through a curved incision at the dorsoradial wrist where the partial ECRL tendon graft was harvested. The tendon graft was subcutaneously transposed, sutured at both ends, and tensioned at full thumb extension with a neutral wrist position.

Results:

From March 2016 to June 2019, 23 patients (mean age: 59.7 years; mean follow-up: 29.6 months) were retrospectively reviewed. All the patients were followed for a minimum of 12 months. The final total active motion was 93.2% of the contralateral thumb. The mean Quick Disabilities of the Arm, Shoulder and Hand score was 6.0. There was one complication possibly due to poor EPL muscle quality, and the patient was subsequently treated with EIP tendon transfer.

Conclusion:

Our study showed that using a partial ECRL tendon graft to repair chronic EPL tendon rupture results in satisfactory functional outcomes. The advantages of this method include preservation of EIP function and using the same incision for graft harvesting and tendon repair. This method can be considered an alternative to EIP tendon transfer in patients with high demand for their index finger function.
Anesthesia services in Taiwan: A nationwide population-based study
Authors: Ho Shung-Tai , Chen Tzeng-Ji , Yeh Te-Chun , Kao Senyeong , Lin Tso-Chou , Wang Ju-O
Published: May 2021

Background:

This study was conducted to provide an overview of anesthesia services in Taiwan from 2001 to 2010.

Methods:

A retrospective population-based analysis was performed using data from Taiwan’s National Health Insurance Research Database for the period 2001 to 2010. The results were stratified by patient sex, patient age, anesthesia type, and hospital setting. Categorical data are presented as totals and percentages. Linear regression was performed to analyze the anesthesia trends.

Results:

The annual use of anesthesia increased continually from 964,440 instances in 2001 to 1,073,160 in 2010, totaling 10,076,600 cases with a total cost of 25.4 billion USD. The overwhelming majority (83.9%) of anesthesia cases was for anesthesia in an inpatient setting; general anesthesia accounted for 73.8% of anesthesia cases, and female patients outnumbered male patients (52.4% vs 47.6%). The average number of anesthesia cases was 44.2 per thousand of the population annually, but this percentage was much higher in elderly people (100.9 cases per thousand people annually). The annual number of anesthesia cases per thousand of the population increased from 104.4 in 2001 to 113.0 in 2010 in the oldest group (>80 years). By contrast, a considerable decline in use of anesthesia was discovered over the study period among those aged younger than 18 years.

Conclusion:

The use of anesthesia services in Taiwan has increased over the years. The relationships of age with anesthesia volume and cost were found to follow an inverse U-shaped pattern. Elderly people used anesthesia services more frequently. The planning of geriatric anesthesia services deserves attention, especially in continually aging societies such as Taiwan.
The Correlation Between COVID-19 Activities and Climate Factors in Different Climate Types Areas
Authors: Liu Zhenchao , Zhu Lin , Wang Yue , Zhou Zhen , Guo Yunliang
Published: May 2021

Objective:

To investigate the epidemiological characteristics of human infection with corona virus disease 2019 (COVID-19) in Moscow, Lima, Kuwait, and Singapore to analyze the effects of climate factors on the incidence of COVID-19.

Methods:

Collect the daily incidence of COVID-19 and related climate data in four areas, construct a negative binomial regression model, and analyze the correlation between the incidence of COVID-19 and meteorological factors.

Results:

AH was the climate factor affecting the incidence of COVID-19 in Moscow, Lima, and Singapore; Ta and RH were the climate factors affecting the incidence of COVID-19 in Kuwait.

Conclusions:

The incidence of COVID-19 in four areas were all associated with the humidity, and climate factors should be taken into consideration when epidemic prevention measures are taken, and environment humidification may be a feasible approach to decrease COVID-19 virus transmission.
Prevention, Medical Management, and Adjudication of Workplace Injuries
Authors: Bernacki Edward J. , Kalia Nimisha , Soistman Sharon , Minor Sebastian A. , Barry Jill , Lavin Robert A. , Tao Xuguang (Grant)
Published: May 2021

Objective:

To describe the cost outcomes of an integrated workers’ compensation program.

Methods:

We studied a population that increased from 20K to 59K, incurring 8807 lost-time claims between 1988 and 2020.

Results:

Lost-time claims decreased from 22.15 to 4.32 per 1000 employees (1988 to 2020), and total closed lost-time claim costs per $100 payroll, decreased from $0.62 to $0.17 (1988 to 2017). The percent of claims resolved within 3 years of the accident increased from 10% to 89% (1988 to 2017). Adjusting for medical inflation and wage increases, total workers’ compensation benefits paid per claim decreased $124 per year, medical benefits decreased $45 per year and indemnity benefits decreased $79 per year.

Conclusion:

On both a population (per employee) and on a per claim basis, workers’ compensation costs decreased substantially, which is attributable to improvements in accident prevention and decreases in claim duration.
Ten-Word List Performance in Healthy Athletes and Athletes at 3-to-5 Days Following Concussion
Authors: Hutchison Michael G. , Di Battista Alex P. , Pyndiura Kyla L. , Corallo Danielle N. , Lawrence David W. , Richards Doug
Published: May 2021

Objective:

Although the word recall component of the Sport Concussion Assessment Tool (SCAT) was updated from 5-to-10 words, its clinical utility across athletic populations remains unknown. The purpose of this study was to provide normative data on the SCAT-5 10-word test and examine its discriminative ability between healthy university level athletes and those with sport-related concussion (SRC).

Design:

Cross-sectional.

Setting:

University.

Participants:

Three hundred sixty-three (363, M = 220, F = 153) healthy athletes and 49 (M = 30, F = 19) athletes following SRC.

Independent Variable:

Healthy athletes measured preseason were compared with athletes following an SRC (median = 4.0 days postinjury).

Main Outcome Measure:

Ten-word list performance from the SCAT-5.

Results:

There were no significant differences in either immediate (P = 0.228, Cohen's D = 0.18) or delayed (P = 0.908, Cohen's D = 0.02) recall tests between athletes with SRC and healthy athletes; the null findings extended to both the male and female subset comparisons. Among healthy athletes, females outperformed males on both immediate (mean difference = 1.0, P < 0.001) and delayed (mean difference = 0.5, P = 0.006) recall tasks.

Conclusion:

Concussion does not seem to impact immediate or delayed recall of the 10-word list in the subacute period following injury. Practitioners should be mindful of sex differences and the time point of administration following injury.
Kidney lymphatics: new insights in development and disease
Authors: Donnan Michael D.
Published: May 2021

Purpose of review

This review will highlight recent advances in our understanding of the kidney lymphatics regarding their development, physiologic function, and their potential role in the progression of kidney disease.

Recent findings

Although sparse in comparison to the blood vasculature, lymphatic vessels within the healthy kidney perform an important role in maintaining homeostasis. Additionally, in response to kidney injury, lymphatic vessels undergo substantial expansion, termed lymphangiogenesis, which shows a direct correlation to the extent of tubulointerstitial fibrosis. Kidney lymphatics expand through both the proliferation of lymphatic endothelial cells from existing lymphatic vessels, as well as from direct contribution by other cell types of nonvenous origin. The primary driver of lymphatic growth is vascular endothelial growth factor C, both in development and in response to injury. The clinical implications of lymphangiogenesis in the setting of kidney diseases remains debated, however growing evidence suggests lymphatic vessels may perform a protective role in clearing away accumulating interstitial fluid, inflammatory cytokines, and cellular infiltrates that occur with injury.

There is increasing evidence the kidney lymphatics perform an active role in the response to kidney injury and the development of fibrosis. Recent advances in our understanding of these vessels raise the possibility of targeting kidney lymphatics for the treatment of kidney disease.
Scaling an Enhanced Recovery Program to an Institution-Wide Initiative: It Takes a Village
Authors: Kruse Brittany , Recinos Iris , Eska Jarrod , Amaku Ruth , Aloia Thomas , Luciano Margaret , Gottumukkala Vijaya
Published: May 2021

Background and Objective:

With the inclusion of Enhanced Recovery Programs (ERPs) into routine clinical practice, scaling programs across an institution is important to drive sustainable change in a patient-centric care delivery paradigm. A review of ERP implementation within a large institution was performed to understand key components that hinder or facilitate success of scaling an ERP.

Methods:

From January 2018 to March 2018, a needs assessment was completed to review implementation of enhanced recovery across the institution. Implementation progress was categorized into one of 5 phases including Define, Implement, Measure, Analyze, and Optimize.

Results:

Only 25% of service line ERPs reached the optimization phase within 5 years. One hundred percent of respondents reported more strengths (n = 41) and opportunities (n = 41) than weaknesses or threats (n = 25 and 14, respectively). Commonly identified strengths included established enhanced recovery pathways, functional team databases, and effective provider education. Weaknesses identified were inconsistencies in data quality/collection and a lack of key personnel participation including buy-in and time availability. Respondents perceived the need for data standardization to be an opportunity, while personnel factors were viewed as key threats.

Conclusion:

Identification of strengths, weaknesses, opportunities, and threats could prove beneficial in helping scale an ERP across an institution. Successful optimization and expansion of ERPs require robust data management for continuous quality improvement efforts among clinicians, administrators, executives, and patients.
Dysbiosis and Gut Microbiota Modulation in Systemic Sclerosis
Authors: Lemos Maria Paula Calil , Zucoloto Talita Graminha , Oliveira Maria Carolina , de Oliveira Gislane Lelis Vilela
Published: May 2021

Gastrointestinal (GI) involvement is an early manifestation in systemic sclerosis (SSc), affecting more than 90% of patients, and severe GI disease is a marker of poor prognosis and mortality. Recent studies have hypothesized that alterations of the intestinal microbiota, known as dysbiosis, may represent 1 of the possible environmental factors influencing SSc disease status. In addition, specific microorganisms may be associated with SSc pathogenesis, progression, and GI manifestations. Therapeutic approaches aiming to modulate the intestinal microbiota have emerged, as alternatives to treat GI symptoms, and dietary interventions, probiotic administration, and fecal microbiota transplantation are potential therapies for SSc patients. However, given the complexity and variability of pathogenesis and clinical manifestations in SSc, these therapies need to be combined with additional interventions that target other disease components. Here, we summarize studies addressing intestinal dysbiosis in SSc and discuss the potential of microbiota modulators to treat SSc-related GI disorders.
Diagnosis of Ectopic Pancreas in Small Intestine With 18F-DOPA PET/CT
Authors: Jacquet-Francillon Nicolas , Passot Guillaume , Galan Alexandre , Tordo Jérémie , Dhomps Anthony
Published: May 2021

A 77-year-old man was referred for a PET/CT 18F-FDG after incidental discovery of a lobulated jejunal lesion during surgery for an abdominal aortic aneurysm. The lesion was not removed due to the risk of digestive perforation. PET/CT 18F-FDG did not show pathologic hypermetabolism. Subsequently, we decided to perform PET/CT 18F-DOPA to better characterize this incidentaloma. A moderate uptake was showed, less than the pancreas. After multidisciplinary discussion, taking into account macroscopic and imaging aspects, the hypothesis of an ectopic pancreas was retained, allowing the exclusion of surgical excision.
Response to Oral Erlotinib Monotherapy in a Patient With EGFR-Negative Status in Histology and Progressive Disease on Conventional Chemotherapy
Authors: Sharma Anshul , Kumar Rakesh
Published: May 2021

An 80-year-old woman, presenting with weight loss and dyspnea for 8 months, showed bilateral lung consolidation in baseline 18F-FDG PET/CT and adenocarcinoma in bronchoscopy-guided biopsy. Epidermal growth factor receptor mutational status was negative in immunohistochemistry analysis, as well as in repeat liquid biopsy. When she developed progression on conventional chemotherapy, a trial of T. Erlotinib was given (since patient was a nonsmoker woman). Within a month, patient reported significant improvement in the dyspnea and did not require nebulization. 18F-FDG PET/CT was repeated after ~6 months, which showed significant response to the oral erlotinib monotherapy. Patient was doing well at 1-year follow-up, with only dermatological adverse effects (rashes).
68Ga-FAPI PET/CT Versus 18F-FDG PET/CT for the Evaluation of Disease Activity in Takayasu Arteritis
Authors: Wu Simin , Pang Yizhen , Zhao Liang , Zhao Long , Chen Haojun
Published: May 2021

Evaluation of disease activity in Takayasu arteritis (TA) is challenging because clinical, biological, and imaging data do not always correlate. In this case, a 19-year-old woman with TA underwent18F-FDG PET/CT for evaluating disease activity. However, no abnormal18F-FDG uptake was observed in the large arteries. Follow-up with68Ga-FAPI PET/CT showed intense activity in the mildly thickened walls of bilateral carotid, subclavian arteries, and thoracic and abdominal aorta. This case presented an example where68Ga-FAPI outperformed18F-FDG for detecting active inflammation of TA. Therefore,68Ga-FAPI PET/CT may allow monitoring of disease activity and facilitate selecting the optimal therapy for TA patients.
Bone Marrow Activation After Chemotherapy Presenting as Diffuse Skeletal Uptake on 18F-Fluorocholine PET/CT
Authors: Taralli Silvia , Cocciolillo Fabrizio , Alitto Anna Rita , Caldarella Carmelo
Published: May 2021

Diffuse 18F-FDG skeletal uptake due to chemotherapy-induced bone marrow activation is well documented, whereas it has never been reported with 18F-fluorocholine. We described a patient with pelvic recurrence of prostate cancer at 18F-fluorocholine PET/CT. A second PET/CT after docetaxel showed minimal residual activity in pelvis, but it revealed diffuse, intense 18F-fluorocholine skeletal uptake. Considering biochemical and metabolic response and absence of morphologically suspected bone lesions, skeletal hyperactivity was interpreted as chemotherapy-related bone marrow rebound rather than diffuse metastatic involvement, as confirmed by its resolution after treatment ended. The occurrence of such 18F-fluorocholine pattern should be considered to avoid imaging misinterpretation.
Petrous Apex Cholesterol Granuloma Showing 68Ga-DOTATATE Uptake
Authors: Filizoglu Nuh , Soydemir Efe , Ones Tunc , Ozguven Salih , Sen Feyza
Published: May 2021

The importance of 68Ga-DOTATATE PET/CT in the evaluation of neuroendocrine tumors is well established. However, false-positive results can occur due to inflammatory pathologies. We report a 47-year-old man who was diagnosed with a neuroendocrine tumor of the stomach. Initial 68Ga-DOTATATE PET/CT showed intense 68Ga-DOTATATE uptake in the petrous apex. Histopathological confirmation could not be obtained, thus the asymptomatic patient was followed with periodic clinical/radiologic examinations for more than 2.5 years. Therefore, this lesion was diagnosed as a cholesterol granuloma of the temporal bone. These results suggested that an initial wait-and-scan approach is a feasible management strategy for similar presentations.
Comparing 99mTc-PSMA to 99mTc-MDP in Prostate Cancer Staging of the Skeletal System
Authors: Kabunda Joseph , Gabela Lerato , Kalinda Chester , Aldous Colleen , Pillay Venesen , Nyakale Nozipho
Published: May 2021

Purpose

This prospective study was aimed at assessing the ability of 99mTc-PSMA scan to detect bone metastases in prostate cancer (PCa) against 99mTc-MDP scan as a standard and assess the correlation of these modalities in PCa staging of bone involvement.

Patients and Methods

Forty-one patients (41) with histologically confirmed PCa were scanned using both methods. Planar imaging was performed with additional regional SPECT/CT 3 to 4 hours posttracer injection. Scans were reported as positive, negative, or equivocal. In the case of positive scans, lesions were quantified by each of the 3 reporters separately. Planar and SPECT/CT images were reported together to obtain the final report on each scan.

Results

Our preliminary results showed no significant difference in the detection of bone metastases between the 2 scans. 99mTc-PSMA detected 52 of the 55 bone lesions detected on 99mTc-MDP. However, 99mTc-PSMA provided extra information by reporting lymph nodal metastases in 7 patients and residual disease in the prostate in 2 patients with biochemical progression after radical therapy. In 1 patient, the PSMA scan resulted in change in management with patient now on 177Lu-PSMA radioligand therapy. Equivocal findings were reported in 4 patients on 99mTc-MDP and none on 99mTc-PSMA.

Conclusions

99mTc-PSMA was comparable to 99mTc-MDP in detection of bone metastases and demonstrated an additional benefit of providing information on visceral disease. 99mTc-PSMA may be a better alternative to 99mTc-MDP in staging, restaging, and assessment of patients with biochemical progression after radical therapy of PCa in a resource-limited setup like ours while also assisting to detect patients eligible for PSMA-labeled radioligand therapy.
Patient-centered Reporting in Radiology
Authors: Barrett Spencer K. , Patrie James , Kitts Andrea B. , Hanley Michael , Swanson Christina M. , Vitzthum von Eckstaedt Hans , Krishnaraj Arun
Published: May 2021

Purpose:

This study aimed to assess whether patients preferred traditional or patient-friendly radiology reports and, secondarily, whether one reporting style led to a subjective improvement in patients’ understanding of their imaging results and next steps in their clinical care.

Materials and Methods:

This randomized study included patients who had previously enrolled in an institutional comprehensive lung cancer screening program. Three hundred patients were randomly selected from the program database to receive both traditional and patient-centered radiology reports. Randomization also occurred at both the risk level of the fictitious test results (low, intermediate, or high) and the order in which the reports were read by each participant. Participants completed a survey providing demographic information and indicating which report style was preferred and which report style led to a better understanding of screening results and future options. In addition, each report style was rated (from 1 to 5) for clarity, understandability, attractiveness, and helpfulness.

Results:

A total of 46 responses for report preference data and 41 responses for attribute rating data were obtained. Overall, participants demonstrate a preference for patient-friendly reports (65.2%) over traditional reports (21.7%). On a 5-point scale, average ratings for patient-friendly reports were higher than traditional reports by 1.2 (P<0.001) for clarity, 1.5 (P<0.001) for understandability, 1.5 (P<0.001) for attractiveness, and 1.0 (P<0.001) for helpfulness.

Conclusion:

Data suggest that patients prefer patient-friendly reports over traditional reports and find them to be clearer, more comprehensible, more attractive, and more helpful.
Comprehensive Computed Tomography Imaging of Vessel-specific and Lesion-specific Myocardial Ischemia
Authors: Patel Pratik , Emrich Tilman , Schoepf U. Joseph , Mehta Varun , Bayer Richard R. , von Assen Marly , Giovagnoli Vincent , Jeudy Jean , Varga-Szemes Akos , White Charles
Published: May 2021

Coronary computed tomographic angiography (CCTA) has emerged as a fast and robust tool with high sensitivity and excellent negative predictive value for the evaluation of coronary artery disease, but is unable to estimate the hemodynamic significance of a lesion. Advances in computed tomography (CT)-based diagnostic techniques, for example, CT-derived fractional flow reserve and CT perfusion, have helped transform CCTA primarily from an anatomic assessment tool to a technique that is able to provide both anatomic and functional information for a stenosis. With the results of the ISCHEMIA trial published in 2019, these advanced techniques can elevate CCTA into the role of a better gatekeeper for decision-making and can help guide referral for invasive management. In this article, we review the principles, limitations, diagnostic performance, and clinical utility of these 2 functional CT-based techniques in the evaluation of vessel-specific and lesion-specific ischemia.
Cystic Primary Lung Cancer
Authors: Byrne Danielle , English John C. , Atkar-Khattra Sukhinder , Lam Stephen , Yee John , Myers Renelle , Bilawich Ana-Maria , Mayo John R. , Mets Onno M.
Published: May 2021

Purpose:

Primary lung cancers associated with cystic airspaces are increasingly being recognized; however, there is a paucity of data on their natural history. We aimed to evaluate the prevalence, pathologic, and imaging characteristics of cystic lung cancer in a regional thoracic surgery center with a focus on the evolution of computed tomography morphology over time.

Materials and Methods:

Consecutive patients referred for potential surgical management of primary lung cancer between January 2016 and December 2018 were included. Clinical, imaging, and pathologic data were collected at the time of diagnosis and at the time of the oldest computed tomography showing the target lesion. Descriptive analysis was carried out.

Results:

A total of 441 cancers in 431 patients (185 males, 246 females), median age 69.6 years (interquartile range: 62.6 to 75.3 y), were assessed. Overall, 41/441 (9.3%) primary lung cancers were cystic at the time of diagnosis. The remaining showed solid (67%), part-solid (22%), and ground-glass (2%) morphologies. Histopathology of the cystic lung cancers at diagnosis included 31/41 (76%) adenocarcinomas, 8/41 (20%) squamous cell carcinomas, 1/41 (2%) adenosquamous carcinoma, and 1/41 (2%) unspecified non–small cell lung carcinoma. Overall, 8/34 (24%) cystic cancers at the time of diagnosis developed from different morphologic subtype precursor lesions, while 8/34 (24%) cystic precursor lesions also transitioned into part-solid or solid cancers at the time of diagnosis.

Conclusions:

This study demonstrates that cystic airspaces within lung cancers are not uncommon, and may be seen transiently as cancers evolve. Increased awareness of the spectrum of cystic lung cancer morphology is important to improve diagnostic accuracy and lung cancer management.
Has the Increase of Women in Surgical Training Programs Led to a Concomitant Increase in Female Leadership Positions? A 10-Year Analysis
Authors: Yin Christine , McAuliffe Phoebe B. , Liao Christopher D. , Marquez Jocellie E. , Monroig Kaitlin G. , Hanson Olivia L. , Shroyer A. Laurie W. , Huston Tara L. , Khan Sami U.
Published: May 2021

Introduction

Women represent greater than 50% of medical students in America and are becoming increasingly well represented in surgical fields. However, parity at the trainee level has yet to be accomplished, and surgical leadership positions have remained disproportionately biased toward men. To date, there have been no comparisons on the progress within plastic surgery and other surgical specialties. This investigates the gender disparity in resident and leadership representation over the past 10 years within surgical specialties and how these disparities compare to plastic surgery.

Methods

Counts of female and male residents and surgical society leaders were collected from 2008 to 2018. Surgical fields included plastic, vascular, urologic, neurologic, orthopedic, cardiothoracic, and general surgery. Leadership positions were defined as board seats on executive committees of major surgical societies or board associations. Data were acquired from publicly available sources or provided directly from the organizations. Resident data were obtained from the Accreditation Council of Graduate Medical Education residents' reports. Individuals holding more than 1 leadership position within a year were counted only once.

Results

In our aggregated analysis, the proportion of women in surgical leadership lags behind women in surgical residency training across all specialties (13.2% vs 27.3%, P < 0.01). General surgery had the highest proportion of female residents and leaders (35% and 18.8%, P < 0.01), followed by plastic (32.2% and 17.3%, P < 0.01), vascular (28.2% and 11.3%, P < 0.01), urologic (24.3% and 5.1%), and cardiothoracic surgery (20.5% and 7.8%, P < 0.01). Women in surgical leadership, however, increased at a faster rate than women in surgical training (11% vs 7%, P < 0.05). Plastic surgery showed the greatest rate of increase in both residents and leaders (17% and 19%, P < 0.05) followed by cardiothoracic surgery (16% and 9%, P < 0.05) and general surgery (8% and 14%, P < 0.05). For neurologic and orthopedic surgery, neither the difference in proportions between residents and leaders nor the yearly growth of these groups were significant.

Conclusions

Between 2008 and 2018, women in plastic surgery training and leadership positions have shown the most significant growth compared with other surgical subspecialties, demonstrating a strong concerted effort toward gender equality among surgical professions.
The Impact of Digital Nerve Injury on the Outcome of Flexor Tendon Tenolysis
Authors: Diehm Yannick F. , Haug Valentin , Thomé Julia , Kotsougiani-Fischer Dimitra , Böcker Arne , Bickert Berthold , Kneser Ulrich , Fischer Sebastian
Published: May 2021

Background

Tenolysis is an established treatment for flexor tendon adhesions at the hand. Concomitant finger nerve injuries with incomplete reinnervation may negatively influence outcomes. This study investigates the impact of finger nerve injuries on outcomes of flexor tendon tenolysis.

Methods

A retrospective pair-matched study was conducted, including patients undergoing tenolysis for flexor tendon adhesion after primary repair of isolated superficial and deep flexor tendon injury and both finger nerves (test group [TG]). These were compared with patients (control group [CG]) with similar injuries without affection of nerves and pair-matched in age, zone of injury and follow-up. Patients' demographics, finger sensitivity, total active range of motion (TAM) before and after tenolysis and complications were retrieved.

Results

For both study groups, 10 patients each were included in this study. There were no significant differences regarding patients' demographics and follow-up. Mean follow-up was 37 (CG) and 41 (TG) months. Total active range of motion was preoperatively 81 ± 47° (CG) and 68 ± 54° (TG) and reached postoperatively 125 ± 57° (CG) and 79 ± 43° (TG). Hence, TAM improvement was significantly higher in patients without nerve damage (58 ± 16 vs 21 ± 11%; P > 0.05). Tendon ruptures occurred significantly more frequent in patients with nerve injury (n = 0.4 ± 0.52) compared with patients of the CG (n = 0; P < 0.05).

Conclusions

This study shows that finger nerve injury with incomplete recovery after combined flexor tendon and nerve injuries of the finger negatively influences the outcomes of flexor tendon tenolysis.
How Big Is Too Big?
Authors: Van Vliet Austin , Girardot Alexandra , Bouchez Jonathan , Bigness Alec , Wang Kevin , Moino Daniela , Theodotou Alex , Pothuraju Tejit , Felder Seth , Smith Paul , Kumar Ambuj , Dayicioglu Deniz
Published: May 2021

Background

The vertical rectus abdominis myocutaneous (VRAM) flap has been frequently used for perineal reconstruction given the high potential for wound complications associated with direct closure of this area. However, the relationship between defect size and postoperative complications remains undefined.

Methods

A retrospective chart review of the last 20 years for VRAM flaps was performed. Defect size, age, body mass index (BMI), cause of defect, sex, radiation, and flap donor laterality were recorded. Complications of infection, partial flap loss, total flap loss, minor wounds, treated nonoperatively, and major wound, which required reoperation, were analyzed with respect to defect size. Descriptive statistics were used to summarize the demographic and clinical characteristics of the included patients. Associations were assessed using binary logistic regression analysis, and difference in means for compared groups was assessed using the independent samplesttest.Pvalues were set at 5% for all comparisons.

Results

There were 65 patients with VRAM flaps identified during the review period. Mean defect size was 204.71 cm2. Mean age was 63.97, and mean BMI was 27.18. History of prior radiation was noted in 90.77% of patients (n = 59). When adjusted for age and BMI, mean defect area was significantly different for patients with minor or major wounds. Larger perineal defects were associated with increased risk of major wound complications (odds ratio, 1.012; 95% confidence interval, 1.003–1.022).

Conclusions

The vertical rectus abdominis flap has been a workhorse flap for perineal reconstruction. Defect size does not affect risk of partial flap necrosis, complete flap loss, infection, abdominal fascial dehiscence, ventral hernia, or seroma, which supports the utility of VRAM flap for perineal reconstruction. Larger perineal defects are associated with increased risk for major wound complications, which required reoperation, regardless of age or BMI. Future studies should be performed to determine if there is a maximum defect size cutoff that limits the utility of VRAM flap reconstruction or to develop a predictive model to assess the risk of major wound complications based on defect size.
Comparative Analysis of Open Reduction Internal Fixation and Closed Reduction Percutaneous Pinning of Hand Fractures
Authors: Burbano Felipe Molina , Jones Pierce , Raghava Narayan , Herrera Fernando A.
Published: May 2021

Purpose

The purpose of our study was to compare postoperative outcomes between patients receiving closed reduction percutaneous pinning (CRPP) to open reduction internal fixation (ORIF) following metacarpal and phalanx fractures.

Methods

A retrospective chart review was performed at a single academic center for all patients suffering a metacarpal or phalanx fracture and receiving either CRPP or ORIF between 2012 and 2018. Patients were divided into fracture mechanism, high-energy mechanism of injury, low-energy mechanism of injury, or unknown, and treatment of fracture with either ORIF or CRPP. High-energy mechanism of injury included gunshot wounds, motor vehicle crash, and blast injuries, whereas low-energy mechanism of injury included all other causes. Patient demographics, postoperative complications, 30-day readmission, and return to the operating room were recorded.

Results

A total of 408 patients, with 524 fractures, were included in the study. There were 127 fractures that resulted from high-energy mechanisms and 394 fractures that resulted from low-energy mechanisms. Open reduction internal fixation was used to treat 299 fractures, whereas CRPP was used for 225 fractures. Among fracture fixation, there was a total of 8.4% complication rate with ORIF, accounting for 10.4% of complications, and CRPP accounting for 5.8%. Among the fracture mechanism, the high-energy mechanism of injury had a 21.3% complication rate, whereas the low-energy mechanism of energy was 4.3%. When comparing the above variables, only high-energy mechanism of injury was a statistically significant predictor of complications (odds ratio, 3.2; confidence interval, 1.5–7.0; P = 0.002). The average operating room time for the ORIF group was 124.82 minutes compared with 97.6 minutes for the CRPP group.

Conclusion

Patients with hand fractures corrected by ORIF appeared to have a higher postoperative complication rate. When the 2 procedures, ORIF and CRPP, were controlled for mechanism of injury, there was not a statistically significant difference in postoperative complication rate (P = 0.14). However, a fracture sustained by a high-energy mechanism was a statistically significant predictor of postoperative complications (P = 0.002).
Evaluation of National Resident Matching Program and Electronic Residency Application Service Data in the Integrated Plastic Surgery Match
Authors: Gallegos Jose , Raghava Narayan , Inglesby Dani C. , Zlomke Haley A. L. , Young Zachary T. , Herrera Fernando A.
Published: May 2021

Introduction

The National Resident Matching Program and Electronic Residency Application Service provide data for tracking trends among applicants in each specialty over the past 5 years. The purpose of this study was to examine this information and determine sex and race/ethnicity distribution over the past 5 years.

Methods

The National Resident Matching Program and Electronic Residency Application Service databases were surveyed for trends in the following categories: number of positions, number of applicants, percent of applicants per position, and number of applicants by sex and self-identified race/ethnicity. This information was analyzed graphically for visual representation of the changes in the field.

Results

While there has been a steady increase in number of positions offered, there has also been a significant decrease in number of applicants, resulting in an increase in number of positions offered per applicant. While female and Asian applicants have increased in number, rates of applications from other diverse groups have remained stagnant.

Conclusions

The number of plastic surgery positions offered has increased, whereas the number of applicants has decreased, resulting in a reduction in the number of applicants per position. Lack of racial diversity remains a significant issue in the applicant pool.
Impact of Radiation on Implant-Based Breast Reconstruction in Prepectoral Versus Submuscular Planes
Authors: Thuman Jenna M. , Worbowtiz Nestor , Jain Abishek , Ulm Jason P. , Delaney Kevin O. , Herrera Fernando A.
Published: May 2021

Background

Postmastectomy implant-based breast reconstruction (IBR) in the setting of radiation (XRT) comes with a high risk of perioperative complications regardless of reconstruction method. The aim of study was to identify the effects of XRT on IBR using a prepectoral versus submuscular approach.

Methods

A retrospective chart review was performed after institutional review board approval was obtained. Patients at a single institution who had 2-stage IBR from June 2012 to August 2019 were included. Patients were separated into 4 groups: prepectoral with XRT (group 1), prepectoral without XRT (group 2), submuscular with XRT (group 3), and submuscular without XRT (group 4). Patient demographics, comorbidities, and postoperative complications were recorded and analyzed.

Results

Three hundred eighty-seven breasts among 213 patients underwent 2-stage IBR. The average age and body mass index were 50.10 years and 29.10 kg/m2, respectively. One hundred nine breasts underwent prepectoral reconstruction (44 in group 1, 65 in group 2), and 278 breasts underwent submuscular reconstruction (141 in group 3, 137 in group 4). Prepectoral tissue expander placement was associated with higher complication rates in the radiated group (38.6% compared with 34.0% submuscular) and lower complication rates in the nonradiated group (26.2% compared with 29.2% submuscular), although significantly less explants were performed in prepectoral group, regardless of XRT status. The 3 most common complications overall were contracture (15.1% radiated, 10.4% nonradiated), infection (18.4% radiated, 11.9% nonradiated), and seroma (15.7% radiated, 10.9% nonradiated).

Conclusions

Two-stage, prepectoral tissue expander placement performs clinically better than submuscular in nonradiated patients compared with radiated patients; however, no statistical significance was identified. Prepectoral had a significantly less incidence of reconstructive failure than submuscular placement regardless of XRT status. Future larger-scale studies are needed to determine statistically significant difference in surgical approach.
Pediatric Orbital Entrapment
Authors: Glassman Gabriella E. , Jackson Kianna , Pontell Matthew E. , Golinko Michael , Drolet Brian C.
Published: May 2021

Introduction

Although orbital fractures are less common in children than adults, the literature suggests that orbital entrapment occurs more frequently in the pediatric population. Orbital entrapment is an emergency, and early diagnosis and prompt management are critical. Specific radiographic manifestations such as herniation of extraocular muscles (EOMs) through orbital fractures have led to increased suspicion and overdiagnosis of orbital entrapment. This study evaluated the value of specific radiographic findings in predicting clinical findings after pediatric orbital floor fractures.

Methods

A retrospective review at a pediatric level 1 trauma center was performed. ICD-9 and ICD-10, codes identified patients with orbital fractures. Computed tomography (CT) reports were queried for the following terms: “herniation,” “herniated,” “entrapped,” and “entrapment.” Patients 16 years and older were excluded, as were all patients who were unable to undergo EOM evaluation on presentation. Electronic medical records were reviewed for fracture type, mechanism of injury, clinical and radiographic findings, surgical interventions, and demographic information. Medical diagnosis tests, including positive and negative predictive values, sensitivity, as well as specificity, were calculated to identify the relationship between radiographic findings and specific symptomology.

Results

One hundred fifty-three patients with 265 orbital fractures were included. “Entrapment” was mentioned in 34.6% of CT reports, whereas the incidence of clinical entrapment was 12.4% (19/153). Radiographic fat herniation, EOM herniation, and EOM irregularity had positive predictive values of 25%, 31%, and 10%, respectively, for clinical entrapment diagnosis at the initial examination. Overall, 32.7% (50/153) of patients with orbital fractures required surgery.

Conclusions

Although the radiographic description of soft tissue herniation has become interchangeable with entrapment, these CT findings alone are poorly predictive. Orbital entrapment should be diagnosed preoperatively by physical examination, with radiographs as an adjunct only. Radiographic statements without clinical correlation may lead to the improper management of pediatric facial trauma patients.
Metabolic Profiling Reveals Changes in Serum Predictive of Venous Ulcer Healing
Authors: Bergner Richmond T. , Onida Sarah , Velineni Rahul , Spagou Konstantina , Gohel Manjit S. , Bouschbacher Marielle , Bohbot Serge , Shalhoub Joseph , Holmes Elaine , Davies Alun H.
Published: May 2021

Objective:

The aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration.

Summary Background Data:

Venous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and time-consuming, with significant recurrence rates. The identification of a reliable biochemical signature with the ability to identify nonhealing ulcers has important translational applications for disease prognostication, personalized health care and the development of novel therapies.

Methods:

Twenty-eight patients were assessed at baseline and at 20 weeks. Untargeted metabolic profiling was performed on urine, serum, and ulcer fluid, using mass spectrometry and nuclear magnetic resonance spectroscopy.

Results:

A differential metabolic phenotype was identified in healing (n = 15) compared to nonhealing (n = 13) venous leg ulcer patients. Analysis of the assigned metabolites found ceramide and carnitine metabolism to be relevant pathways. In this pilot study, only serum biofluids could differentiate between healing and nonhealing patients. The ratio of carnitine to ceramide was able to differentiate between healing phenotypes with 100% sensitivity, 79% specificity, and 91% accuracy.

Conclusions:

This study reports a metabolic signature predictive of healing in venous leg ulceration and presents potential translational applications for disease prognostication and development of targeted therapies.
Performance of Residents During Laparoscopic Cholecystectomy: Is Self-assessment Reliable?
Authors: Yildirim Murat , Saglam Ali I. , Ugurlu Celil , Angin Yavuz S. , Dasiran Fatih , Okan Ismail
Published: May 2021

Background:

To compare the self-assessment of surgical residents and observers (faculty members and nurses) during laparoscopic cholecystectomy (LC).

Materials and Methods:

A prospective observational study was conducted between February 2020 and July 2020 at a medical school hospital. Seventy-four LC surgeries were performed by surgical residents in the presence of faculty members. A self-assessment of the technical and nontechnical performance of the residents was requested. The self-assessment of residents was compared with observer evaluations using the Kruskal-Wallis test. Gwet AC2 fit coefficient was used to determine the consistency between the observers’ and residents’ assessments. Bland-Altman plots were generated with 95% limits of agreement to describe the agreement between the total scores of the observers.

Results:

The self-assessment of residents had a statistically significant higher score when compared with observers (faculty and nurses) (P<0.001). However, no significant difference was observed between the total scores given by the observers (faculty members and nurses) (P>0.05). There was a moderate agreement between the resident versus faculty members [0.503; 95% confidence interval (CI), 0.430-0.576] and resident versus nurse (0.518; 95% CI, 0.432-0.605) when evaluating technical skills. However, there was substantial agreement between faculty members and nurses (0.736; 95% CI, 0.684-0.789). Postoperative pain was significantly correlated with resident self-assessment (P=0.022).

Conclusion:

The self-assessment scores of surgical residents in LC operations were overestimated compared with observer assessments.
Genome-Wide Association Study of Pelvic Organ Prolapse Using the Michigan Genomics Initiative
Authors: Cox Caroline K. , Pandit Anita , Zawistowski Matthew , Dutta Diptavo , Narla Goutham , Swenson Carolyn W.
Published: May 2021

Objectives

The aim of this study was to (1) replicate previously identified genetic variants significantly associated with pelvic organ prolapse and (2) identify new genetic variants associated with pelvic organ prolapse using a genome-wide association study.

Methods

Using our institution’s database linking genetic and clinical data, we identified 1,329 women of European ancestry with an International Classification of Diseases, Ninth Revision (ICD-9)/ICD-10 code for prolapse, 767 of whom also had Current Procedural Terminology (CPT)/ICD-9/ICD-10 procedure codes for prolapse surgery, and 16,383 women of European ancestry older than 40 years without a prolapse diagnosis code as controls. Patients were genotyped using the Illumina HumanCoreExome chip and imputed to the Haplotype Reference Consortium. We tested 20 million single nucleotide polymorphisms (SNPs) for association with pelvic organ prolapse adjusting for relatedness, age, chip version, and 4 principal components. We compared our results with 18 previously identified genome-wide significant SNPs from the UK Biobank, Commun Biol (2020;3:129), and Obstet Gynecol (2011;118:1345–1353).

Results

No variants achieved genome-wide significance (P = 5 × 10−8). However, we replicated 4 SNPs with biologic plausibility at nominal significance (P ≤ 0.05): rs12325192 (P = 0.002), rs9306894 (P = 0.05), rs1920568 (P = 0.034), and rs1247943 (P = 0.041), which were all intergenic and nearest the genes SALL1, GDF7, TBX5, and TBX5, respectively.

Conclusions

Our replication of 4 biologically plausible previously reported SNPs provides further evidence for a genetic contribution to prolapse, specifically that rs12325192, rs9306894, rs1920568, and rs1247943 may contribute to susceptibility for prolapse. These and previously reported associations that have not yet been replicated should be further explored in larger, more diverse cohorts, perhaps through meta-analysis.
IL-6 and IL-1β upregulation and tau protein phosphorylation in response to chronic alcohol exposure in the mouse hippocampus
Authors: Jiang Cihao , Zhang Yi , Tang Xiaolu , Jing Chenchen , Qiu Shasha , Li Baolin , Li Yanning
Published: May 2021

Alcoholism and alcohol abuse can lead to memory loss and cognitive dysfunction. The neuroinflammatory response plays an important role in the neurotoxic mechanism of chronic alcohol exposure. Additionally, the phosphorylation status of the tau protein is closely related to neurotoxicity and synaptic function. As inflammatory cytokines have been shown to regulate tau phosphorylation, in the present study, the aim was to determine whether cognitive impairment caused by chronic alcohol exposure is associated with neuroinflammation and tau hyperphosphorylation in the hippocampus. We established a chronic alcohol exposure model of C57BL/6J mice. The Y maze was used to assess the spatial recognition ability of mice, and ELISA was used to detect the levels of inflammatory cytokines IL-1β and IL-6 in the serum. Immunohistochemical and western blot assays were used to assess the expression levels of IL-1β and IL-6, as well as tau protein and its phosphorylation status in the hippocampus. We also analyzed the mRNA and protein expression of the synapse-associated proteins PSD95 and synaptophysin in the hippocampus. Our results showed that chronic alcohol exposure impaired the spatial recognition ability of mice upregulated the expression of IL-1β and IL-6 in the serum and hippocampus and increased the phosphorylation of tau protein in the hippocampus. In addition, chronic alcohol exposure downregulated PSD95 and synaptophysin protein levels. The present results indicate that hippocampal IL-1β, IL-6, and phosphorylated tau proteins may be involved in the neurotoxic mechanism of chronic alcohol exposure by mediating synaptic dysfunction.