bluuebunny/crossref_metadata_2025 huggingface dataset:
Regulation of lipid rafts, angiogenesis and inflammation by AIBP
Authors: Fang Longhou , Miller Yury I.
Published: April 2019

Purpose of review

Recent studies demonstrate an important role of the secreted apolipoprotein A-I binding protein (AIBP) in regulation of cholesterol efflux and lipid rafts. The article discusses these findings in the context of angiogenesis and inflammation.

Recent findings

Lipid rafts are cholesterol-rich and sphingomyelin-rich membrane domains in which many receptor complexes assemble upon activation. AIBP mediates selective cholesterol efflux, in part via binding to toll-like receptor-4 (TLR4) in activated macrophages and microglia, and thus reverses lipid raft increases in activated cells. Recent articles report AIBP regulation of vascular endothelial growth factor receptor-2, Notch1 and TLR4 function. In zebrafish and mouse animal models, AIBP deficiency results in accelerated angiogenesis, increased inflammation and exacerbated atherosclerosis. Spinal delivery of recombinant AIBP reduces neuraxial inflammation and reverses persistent pain state in a mouse model of chemotherapy-induced polyneuropathy. Inhalation of recombinant AIBP reduces lipopolysaccharide-induced acute lung injury in mice. These findings are discussed in the perspective of AIBP's proposed other function, as an NAD(P)H hydrate epimerase, evolving into a regulator of cholesterol trafficking and lipid rafts.

Novel findings of AIBP regulatory circuitry affecting lipid rafts and related cellular processes may provide new therapeutic avenues for angiogenic and inflammatory diseases.
Integrative roles of microRNAs in lipid metabolism and dyslipidemia
Authors: Sedgeman Leslie R. , Michell Danielle L. , Vickers Kasey C.
Published: April 2019

Purpose of review

The purpose of the review is to discuss recent advances in microRNA (miRNA) regulation of lipid metabolism and highlight the importance of miRNA-mediated gene regulation in dyslipidemia and fatty liver disease. This article reviews examples of miRNAs that bridge disparate metabolic pathways in the liver. For example, we highlight miRNAs that are regulated by the sterol-sensing pathway in the liver that in turn regulate cellular or systemic cholesterol, fatty acid, and glucose levels.

Recent findings

The most widely studied of these miRNAs are miR-33a/b; however, we recently reported that miRNAs in the miR-183/96/182 cluster are also likely regulated by hepatic cholesterol content and mediate the observed glucose-lowering effects of the bile acid sequestrant colesevelam through the sterol-sensing pathway. In addition, several other hepatic and adipose miRNAs have been recently demonstrated to be key regulators of cellular lipid synthesis, storage, and catabolism, as well as systemic lipid metabolism. Moreover, many of these miRNAs are altered in fatty liver disease and dyslipidemia.

miRNAs are not just fine-tuners of lipid metabolism, but critical regulatory factors in lipid homeostasis and health. Loss of these miRNA regulatory modules very likely contributes to the underlying metabolic defects observed in lipid disorders.
Genetics-driven discovery of novel regulators of lipid metabolism
Authors: Ha Elizabeth E. , Van Camp Andrew G. , Bauer Robert C.
Published: April 2019

Purpose of review

Residual cardiovascular disease risk and increasing metabolic syndrome risk underscores a need for novel therapeutics targeting lipid metabolism in humans. Unbiased human genetic screens have proven powerful in identifying novel genomic loci, and this review discusses recent developments in such discovery.

Recent findings

Recent human genome-wide association studies have been completed in incredibly large, detailed cohorts, allowing for the identification of more than 300 genomic loci that participate in the regulation of plasma lipid metabolism. However, the discovery of these loci has greatly outpaced the elucidation of the underlying functional mechanisms. The identification of novel roles for long noncoding RNAs, such as CHROME, LeXis, and MeXis, in lipid metabolism suggests that noncoding RNAs should be included in the functional translation of GWAS loci.

Unbiased genetic studies appear to have unearthed a great deal of novel biology with respect to lipid metabolism, yet translation of these findings into actionable mechanisms has been slow. Increased focus on the translation, rather than the discovery, of these loci, with new attention paid to lncRNAs, can help spur the development of novel therapeutics targeting lipid metabolism.
Substance Use in Adolescents and Young Adults With Inflammatory Bowel Diseases
Authors: Plevinsky Jill M. , Maddux Michele H. , Greenley Rachel N.
Published: April 2019

Objectives:

Adolescents and young adults (AYAs) with chronic illnesses use substances at similar, if not greater, rates compared to healthy peers. The present study aimed to examine rates and patterns of tobacco use, marijuana use, and binge drinking in AYAs with inflammatory bowel diseases. We expected that substance use would be associated with poorer physical health, psychosocial functioning, and disease management.

Methods:

One hundred thirty‐two AYAs completed a single set of surveys assessing demographics, disease activity, healthcare utilization, health‐related quality of life (HRQoL), inflammatory bowel disease–specific self‐efficacy, adherence barriers, disease management skills, and substance use in the last 30 days (eg, tobacco use, marijuana use, binge drinking). Exploratory cluster analyses, followed by chi‐square tests and analyses of variance examined patterns of substance use and correlates of cluster membership.

Results:

Four patterns emerged from the sample: Global Users (n = 17), Marijuana Users Engaging in Binge Drinking (n = 18), Exclusive Binge Drinkers (n = 21), and Global Abstainers (n = 76). Groups differed by age, gender, disease activity, healthcare utilization, HRQoL, self‐efficacy, and adherence barriers with medium and large effect sizes (P < .05).

Conclusions:

Older age, male gender, active disease, at least 1 hospitalization in the past year, low self‐efficacy, low HRQoL, and high adherence barriers were significantly more likely for those reporting multisubstance use. In addition, all those reporting both marijuana use and binge drinking also reported tobacco use. Future research ought to examine these associations longitudinally and throughout the transition to adult care.
Mental Health Status of Medical Students
Authors: El-Gilany Abdel-Hady , Amro Mostafa , Eladawi Noha , Khalil Mohamed
Published: April 2019

Mental health illnesses are increasing in severity and number among medical students. This study aims to estimate the prevalence of mental disorders among medical students and their associated factors. Nine hundred students were selected from Mansoura Faculty of Medicine by the cluster sampling method. Data were collected using an Arabic self-administered questionnaire and the Arabic version of the Symptoms Checklist 90 Revised. Both bivariate and multivariate logistic regression analyses were done. Approximately 59% of students had one or more mental disorders. The prevalence of high Positive Symptom Distress Index (PSDI), depression, and somatization was 30.1%, 25.2%, and 21.7%, respectively. Logistic regression revealed that being male, younger than 20 years age, living away from family, rural families, and very low or low social class were independent risk factors for most of the mental disorders studied. In conclusion, mental disorders were common among medical students. Mental health care should be mandatory for these students.
Is Online Treatment as Effective as In-Person Treatment?
Authors: Church Dawson , Clond Morgan
Published: April 2019

Psychotherapy has undergone a widespread change recently, with many interventions now available as wireless device apps or online courses. The current study compared the efficacy of an online program with a personal group treatment intervention. The in-person group (n = 37) attended a 6-day workshop called Tapping Deep Intimacy that focused on the development of interpersonal skills. The online group (n = 37) consumed to the same information in the form of a 12-week online course. The content of both courses was drawn from the curriculum for Whole Energy Lifestyle, which trains participants in 12 evidence-based interpersonal and stress-reduction skills designed to reduce emotional triggering and promote health. These include mindfulness, breathwork, meditation (EcoMeditation), heart coherence, Clinical Emotional Freedom Techniques, active listening, and qigong. In both groups, depression, anxiety, and relationship satisfaction were assessed pre, post, and at 1-year follow-up. Anxiety reduced in the in-person but not the online group. Significant improvements in depression (p < 0.001) were found in both groups, although sharper symptom declines were found in the in-person group. A 29% improvement in relationship satisfaction was found in both groups (p < 0.003), and both maintained their gains over time. Anxiety and depression symptoms were much higher in the in-person group pretest despite similar demographic characteristics, suggesting differences in the population that uses online courses. These preliminary findings suggest that while online programs may play a role in the development of stress-reduction and interpersonal skills, it cannot be assumed that they mirror the therapeutic efficacy of in-person treatment in every dimension.
Recent Suicidal Ideation and Behavior in the General Population
Authors: Briere John , Kwon Omin , Semple Randye J. , Godbout Natacha
Published: April 2019

The multivariate relationship between suicidality and three potential etiologic variables (depression, posttraumatic stress, and reactive avoidance) was examined in a stratified sample of 679 individuals from the general population. Lifetime exposure to a trauma or another very upsetting event was prevalent among those reporting suicidal behavior in the previous 6 months (58%) and those reporting recent suicidal ideation alone (40%), relative to those with no recent suicidal thoughts or behaviors (26%). Canonical correlation analysis indicated two independent sources of variance: the first loading on both suicidal ideation and behavior, predicted by depression, posttraumatic stress, and reactive avoidance, and the second indicating a unique relationship between suicidal behavior and reactive avoidance alone. Results indicate that the etiology of suicidality is likely multidimensional, and point to a significant variant of suicidal behavior that is unrelated to depression or posttraumatic stress, but may reflect emotional dysregulation and subsequent distress reduction behaviors.
Comprehension of Embedded Clauses in Schizophrenia With and Without Formal Thought Disorder
Authors: Çokal Derya , Zimmerer Vitor , Varley Rosemary , Watson Stuart , Hinzen Wolfram
Published: April 2019

Formal thought disorder (FTD) in schizophrenia (SZ) is clinically manifested primarily through language production, where linguistic studies have reported numerous anomalies including lesser use of embedded clauses. Here, we explored whether problems of language may extend to comprehension and clause embedding in particular. A sentence-picture matching task was designed with two conditions in which embedded clauses were presupposed as either true (factive) or not. Performance across these two conditions was compared in people with SZ and moderate-to-severe FTD (SZ + FTD), SZ with minimal FTD (SZ-FTD), first-degree relatives of people with SZ, and neurotypical controls. The SZ + FTD group performed significantly worse than all others in both conditions, and worse in the nonfactive than in the factive one. These results demonstrate language dysfunction in comprehension specific to FTD is a critical aspect of grammatical complexity and its associated meaning, which has been independently known to be cognitively significant as well.
Toward an Understanding of Incongruent Affect in People With Schizophrenia
Authors: Mote Jasmine , Kring Ann M.
Published: April 2019

Previous studies have found that people with schizophrenia report more negative affect (NA) in response to positive and neutral stimuli (incongruent NA) than people without schizophrenia, perhaps related to heightened overall NA. We sought to decrease NA and increase positive affect (PA) using the Broad-Minded Affective Coping (BMAC) procedure in people with (n = 29) and without (n = 26) schizophrenia. We also investigated whether decreased NA would contribute to a decrease in incongruent NA in people with schizophrenia. The BMAC procedure increased PA but did not decrease NA in participants, nor did it influence reports of incongruent NA (in response to positive and neutral films) in people with schizophrenia. Baseline NA in people with schizophrenia was correlated with incongruent NA and symptom severity. Results indicate that people with schizophrenia report heightened NA that does not readily diminish in the face of heightened PA.
The willingness of orthopaedic trauma patients in Uganda to accept financial loans following injury
Authors: O’Hara Nathan N. , Odull Edmond , Potter Jeffrey , Kajja Isaac
Published: April 2019

Background:

Early access to a monetary loan may mitigate some of the socioeconomic burden associated with surgical treatment and lost wages following injury. The primary objective of this study was to determine the willingness of orthopaedic trauma patients in Uganda to accept a formal financial loan shortly after their time of injury.

Methods:

A consecutive sample of adult orthopaedic trauma patients admitted to Uganda's national referral hospital was included in the survey. The primary outcome was the self-reported willingness to accept a financial loan. Secondary outcomes included the preferred loan terms, fracture treatment costs, and the factors associated with loan willingness.

Results:

Of the 40 respondents (mean age, 40 years; 58% male), the median annual income was $582 United States dollars (USD) (range: $0–$6720). Around 50% reported a willingness to accept a loan with any terms. Patients requested loans with a median principal of $500 USD and a median interest rate of 5% with 12 months to pay back. Patients had received loans with a median principal of $142 USD, an interest rate of 10%, and payback of 6 months. These received loans covered a mean of 63% of the treatment costs. Patients with higher median incomes ($857 USD vs $342 USD) were more willing to accept a loan.

Conclusion:

This study demonstrated a limited interest of orthopaedic trauma patients in Uganda to procure loans through formalized lending. This observed resistance must be overcome in future programs that rely on mechanisms such as conditional cash transfers or microfinancing to improve clinical and socioeconomic outcomes after injury.
Toward a Consensus for Musculoskeletal Ultrasonography Education in Physical Medicine and Rehabilitation
Authors: Bockbrader Marcia A. , Thompson Ryan D. , Way David P. , Colachis Sam C. , Siddiqui Imran J. , Luz Jennifer , Borg-Stein Joanne , O'Connor Kevin , Kohler Minna J. , Bahner David P.
Published: April 2019

Objectives

The aims of the study were to evaluate integration of musculoskeletal ultrasonography education in physical medicine and rehabilitation training programs in 2014–2015, when the American Academy of Physical Medicine & Rehabilitation and Accreditation Council for Graduate Medical Education Residency Review Committee both recognized it as a fundamental component of physiatric practice, to identify common musculoskeletal ultrasonography components of physical medicine and rehabilitation residency curricula, and to identify common barriers to integration.

Design

Survey of 78 Accreditation Council for Graduate Medical Education–accredited physical medicine and rehabilitation residency programs was conducted.

Results

The 2015 survey response rate was more than 50%, and respondents were representative of programs across the United States. Most programs (80%) reported teaching musculoskeletal ultrasonography, whereas a minority (20%) required mastery of ultrasonography skills for graduation. Ultrasonography curricula varied, although most programs agreed that the scope of resident training in physical medicine and rehabilitation should include diagnostic and interventional musculoskeletal ultrasonography, especially for key joints (shoulder, elbow, knee, wrist, hip, and ankle) and nerves (median, ulnar, fibular, tibial, radial, and sciatic). Barriers to teaching included insufficient expertise of instructors, poor access to equipment, and lack of a structured curriculum.

Conclusions

Musculoskeletal ultrasonography has become a required component of physical medicine and rehabilitation residency training. Based on survey responses and expert recommendations, we propose a structure for musculoskeletal ultrasonography curricular standards and milestones for trainee competency.
Active metabolites of dipyrone induce a redox-dependent activation of the ion channels TRPA1 and TRPV1
Authors: Schenk Stefan Alexander , Dick Felicia , Herzog Christine , Eberhardt Mirjam Jeanette , Leffler Andreas
Published: April 2019

Introduction:

The nonopioid analgesic and antipyretic dipyrone (metamizol) is frequently used worldwide. Dipyrone is a prodrug, and the metabolites 4-N-methylaminoantipyrine (MAA) and 4-aminoantipyrine (AA) seem to induce analgesia and antipyresia in part by inhibiting cyclooxygenase. In mice, however, the analgesic effect of dipyrone also seems to depend on the ion channel TRPA1. In this study, we explored the effects of dipyrone and its active metabolites on recombinant and native TRPA1 and TRPV1 channels.

Methods:

Constructs human (h) TRPA1 and TRPV1 were expressed in HEK293 cells, and dorsal root ganglion neurons were isolated from adult mice. Effects of dipyrone, MAA, and AA were explored by means of whole-cell patch clamp recordings and ratiometric calcium imaging.

Results:

Dipyrone failed to activate both hTRPA1 and hTRPV1. However, both MAA and AA evoked small outwardly rectifying membrane currents and an increase of intracellular calcium in cells expressing hTRPA1 or hTRPV1. MAA also sensitized both channels and thus potentiated inward currents induced by carvacrol (hTRPA1) and protons (hTRPV1). MAA-induced activation was inhibited by the antioxidant 10-mM glutathione included in the pipette, and the mutant constructs hTRPA1-C621/C641/C665S and hTRPV1-C158A/C391S/C767S were insensitive to both MAA and AA. Mouse dorsal root ganglion neurons exhibited a marginal calcium influx when challenged with MAA.

Conclusion:

The metabolites MAA and AA, but not dipyrone itself, activate and sensitize the nociceptive ion channels TRPA1 and TRPV1 in a redox-dependent manner. These effects may be relevant for dipyrone-induced analgesia and antipyresia.
Are painDETECT scores in musculoskeletal disorders associated with duration of daily pain and time elapsed since current pain onset?
Authors: Berthelot Jean-Marie , Biha Noura , Darrieutort-Laffite Christelle , Le Goff Benoît , Maugars Yves
Published: April 2019

Objectives:

We aimed to compare painDETECT scores in outpatients seen in a rheumatology department over a 1-month period and search for correlations between painDETECT scores and the estimated duration of daily pain and time elapsed since the onset of current pain.

Patients and Methods:

A total of 529 of 738 outpatients agreed to complete a set of questionnaires, including painDETECT.

Results:

The mean painDETECT score was 14.14 ± 7.59, and 31% of the patients had painDETECT scores of >18. Fibromyalgia ranked first (21.2 ± 6.0), followed by osteoarthritis of the lower limbs (17.8 ± 8.2), back pain and radiculopathies (16.1 ± 6.8), osteoarthritis of the upper limbs (15.7 ± 8.1), spondylarthrosis (15.1 ± 7.2), entrapment neuropathies (14.1 ± 2.4), rheumatoid arthritis (13.8 ± 7.1), miscellaneous conditions (13.8 ± 8.2), tendinitis (13.4 ± 7.9), connectivitis (11.5 ± 6.7), and osteoporosis (8.5 ± 6.9). The duration of daily pain was much longer in patients with painDETECT scores of >18 (12.41 ± 8.45 vs 6.53 ± 7.45 hours) (t = 0.0000), but very similar painDETECT scores were observed for patients suffering from pain for less than 1 week (13.7 ± 8.2; 38% > 18), for 1 month (14.5 ± 8.2; 25% > 18), several months (12.7 ± 7.3; 23% > 18), 1 year (13.8 ± 7.7; 29% > 18), or several years (14.7 ± 7.4; 33% > 18).

Conclusion:

PainDETECT scores differed little depending on the musculoskeletal condition, strongly correlated with the duration of daily pain, and appeared to be as high in patients with recent pain as in those suffering for years.
The Treatment Strategy of Cleidocranial Dysplasia: Combined Orthodontic and Orthognathic Treatment
Authors: Li Juan , Shen Jiawei , Xu Ji , Weng Luxi , Pan Jiale , Lin Jun
Published: April 2019

Cleidocranial dysplasia is a rare autosomal-dominant condition that affects ossification. The main symptoms of this cleidocranial dysplasia patient include craniofacial abnormalities, hypoplasia of clavicles, narrow thorax, retarded exfoliation of deciduous teeth, retarded eruption of permanent teeth, and multiple impacted supernumerary teeth. The aim of this treatment was to correct the craniofacial abnormalities and provide an adequate functional reconstruction of the occlusion. The patient was treated with a multidisciplinary therapeutic protocol including removal of supernumerary teeth, surgical exposure of impacted teeth, orthodontic, and orthognathic surgery. After 6 years’ follow-up, the treatment objectives of acceptable occlusion, normal function, and acceptable profile were achieved.
The Three-Dimensional Computed Tomography Anatomic Features of Internal Carotid Artery–Ophthalmic Artery
Authors: Xu Bingqiang , Liu Huitong
Published: April 2019

Objective:

This research aimed at exploring the measurement of anatomic parameters of internal carotid artery–ophthalmic artery (ICA-OA) and the clinical significance with 3-dimensional (3D) separating, fusing, opacifying, false-coloring, and volume rendering (SFOF-VR) technique.

Methods:

A total of 109 patients with no significant lesions in ICA-OA were randomly selected, including 56 males and 53 females, who were divided into 3 groups: young age group (18–40 years, n = 36), middle age group (41–60 years, n = 40) and old age group (>60 years, n = 33). The 3D images were constructed by AW 4.6 workstation, and the anatomic parameters were measured. The SFOF-VR technique explicitly displayed ICA, OA, and their concomitant relationship with ophthalmic nerves (ONs) and adjacent structures. The study protocol was approved by the Medical Ethical Committee of Shaanxi Provincial People's Hospital and all patients have signed consent forms.

Results:

The diameters of initial segment of left and right ophthalmic ICA (ICA-C6) were 3.58 ± 0.51 mm and 3.58 ± 0.43 mm, respectively; the diameters of the left and right OA were 1.16 ± 0.16 mm and 1.15 ± 0.19 mm, respectively; the lengths of left and right ICA-C6 were 10.43 ± 2.08 mm and 10.01 ± 2.32 mm, respectively. There were statistically significant differences between bilateral ICA-C6 lengths, right ICA-C6 diameter, right OA diameter, and OA-ON space between male and female.

Conclusion:

The SFOF-VR technique can distinctly present the structures of ICA-OA and adjacent tissues, providing valuable information for surgical operation. The 3D computed tomography data about ICA-OA can enrich references for basic and clinical researches.
Electromyographic Changes in the Masseter and Temporalis Muscles Before and After Orthognathic Surgery in Patients With Mandibular Prognathism
Authors: González Olivares Hilda , García Pérez Alvaro , López Saucedo Francisco , Ángeles Medina Fernando
Published: April 2019

Objective:

Evaluate the electromyographic changes in the Masseter (MM) and Temporalis (TM) muscles during voluntary clenching of the teeth both before and after orthognathic surgery in patients aged 18 years and older and diagnosed with mandibular prognathism.

Methods:

Eleven patients with prognathism were included in the study, in all of whom the initial phase of orthodontic treatment had been completed. The orthognathic procedure to reduce prognathism comprised intraoral oblique sliding (or subsigmoid) osteotomy, after which intermaxillary fixation with ligaments in the maxilla and mandible was undertaken in all patients for 6 weeks post-surgery. Electromyographic activity was recorded during the baseline maximum voluntary contraction of the teeth, with the same measurement taken 3 and then 6 months after orthognathic surgery.

Results:

Significant differences were found in the mean amplitude (17.0 vs 14.7, P = 0.020) and peak-to-peak amplitude (left [761.6 vs 457.0, P = 0.003] and right [676.9 vs 357.4, P = 0.007]) for the MM between the baseline score and 6 months after surgery. Likewise, significant differences were found in the mean amplitude (18.2 vs 25.6, P = 0.009) and peak-to-peak amplitude (left [856.4 vs 1594.2, P = 0.004] and right [804.4 vs 1813.4, P = 0.004]) for the TM between the baseline score and that taken 6 months post-surgery. Only 18.2% (2/11) presented orthodontic appliances problem in the 3 months post-surgery.

Conclusion:

Electromyographic activity was restored 6 months after the orthognathic surgery. From a clinical perspective, the results obtained confirm that orthognathic surgery has not only an esthetic but also a functional objective in terms of achieving equilibrium and occlusal harmony.
Modification of Rhytidectomy: Stepped Lift of the Superficial Musculoaponeurotic System
Authors: Zhou Jing , Qi Zuoliang , Jin Xiaolei
Published: April 2019

Rhytidectomy is a complicated surgery. Less experienced surgeons are often confronted with technical challenges. To simplify the procedure and achieve long-lasting effects, the authors propose a modified rhytidectomy method, reorder surgical sequences and suggest a stepped lift of the superficial musculoaponeurotic system.

A total of 54 patients underwent this surgical procedure. Superficial musculoaponeurotic layers of the temple, face, and neck were dissected sequentially and suspended to lift the ptosis tissue. They scored the frontalis and excised the corrugator after raising the flap in the subgaleal plane. The operation time, complication events, drainage volume, and hospital days were compared with conventional surgical technique. Patient-reported outcomes were described using a modified Face-Q questionnaire. Three laypersons evaluated pre- and postoperative pictures.

In the current technique, the average operation time was 265 minutes. The total complication rate was 7.40%; only 1 patient with hematoma needed extra treatment. Compared with previous technique, the operating time of current technique shortened, and the drainage volume decreased. Three-year follow-up showed all patients were satisfied with the surgical outcomes and thought they looked 8.3 years younger than their actual age. The areas with greatest satisfaction were midface, temple, and nasolabial folds. Significant improvements were seen comparing pre- and postoperative photos.

Follow-up indicated that modified facelift procedure and stepped superficial musculoaponeurotic layer lift technique worked well for elderly patients who have severe facial wrinkles and ptosis, and provide a long-lasting natural and youthful appearance.

Level of Evidence: Level IV, therapeutic study.
Comparison of the Efficacies of Dry Needling and Botox Methods in the Treatment of Myofascial Pain Syndrome Affecting the Temporomandibular Joint
Authors: Kütük Sinem Gökçe , Özkan Yasemin , Kütük Mustafa , Özdaş Talih
Published: April 2019

Background:

To compare the efficacies of botulinum toxin-A injection and dry needling methods in the treatment of patients with myofascial pain syndrome (MPS) in the temporomandibular joint (TMJ).

Methods:

In this prospective study, 40 MPS patients (29 women, 11 men) were randomly assigned to abobotulinum toxin-A injection (Group 1, n = 20) or dry needling (Group 2, n = 20) groups. Pain, crepitation, functional limitation, maximum mouth opening, jaw strength were evaluated at baseline and 6 weeks, and the results in both groups were compared.

Results:

The average age of the authors’ patients was 33.8±8.1. There was a remarkable difference between 2 groups regarding visual analog scale for TMJ pain at rest (P = 0.048). The pain at rest was relieved more effectively in Group 2 at the end of 6 weeks. Improvement in jaw protrusion angles on the right (P = 0.009) and left (P = 0.002) sides was more evident in Group 2 after 6 weeks. There were significant pain relief and functional improvement after treatment in both groups. In Group 2, recovery of the TMJ function was more obvious in 6 weeks following dry needling (P = 0.002).

Conclusion:

The authors suggest that abobotulinum toxin-A injection and dry needling yield satisfactory therapeutic outcomes regarding pain relief and restoration of function in patients with MPS involving TMJ. Further multicentric, randomized, controlled trials on larger series are warranted to obtain more accurate and reliable information.
Management of the Midface in the Transgender Patient
Authors: Natghian Hamidreza , Farnebo Filip , Lundgren Kalle Conneryd
Published: April 2019

Management of the midface has a central role to achieve harmony in the transgender patient requesting facial feminization surgery. The relative projection of separate areas of the craniofacial skeleton largely determines the appearance of the facial framework. In this article the authors describe the management of the midface; bony remodeling and soft tissue aspects, in the transgender patient.
Caterpillar Graft for Secondary Rhinoplasty
Authors: Elfeki Bassem , Park Seong Hyuk , Eun Seokchan
Published: April 2019

Background:

Different autologous materials are recently used in the purpose of augmentation of the nasal dorsum. Despite the benefits and drawbacks, nasal reconstruction with autologous tissue remains a better method for excellent results and lower morbidity rates.

Methods:

The authors harvested conchal cartilage from the ears and use it after dicing. The superficial temporal fascia was harvested from the temporal region. Diced cartilage was wrapped with superficial temporal fascia, making a roll. After creating a cavity in the nasal dorsum, the combined roll graft was inserted over the nasal dorsum in a “caterpillar” fashion. The authors have operated on 18 patients of secondary nasal deformity cases.

Results:

The results were excellent in most of the cases. This procedure presented many advantages: optimum nasal contouring, satisfactory volume for the nasal dorsum, and with low rates of infection and exposure.

Conclusions:

Nasal deformities were reconstructed using crushed cartilage harvested from the concha and enclosed in temporal fascia. This procedure could provide more psychologic comfort and long-lasting appearance.
Surgical Outcomes of Intraconal Cavernous Venous Malformation According to Their Location in Four Right-Angled Sectors
Authors: Kim Min Ho , Kim Ji Hyun , Kim Sung Eun , Yang Suk-Woo
Published: April 2019

The present study evaluated the surgical outcomes of intraconal cavernous venous malformation according to their location in 4 right-angled sectors. Data regarding the surgical method and approach, surgical outcome, and postoperative complications were retrospectively analyzed for 18 patients with intraconal cavernous venous malformations that were surgically treated at the authors’ center between March 2006 and May 2017. The lesion location was defined using 2 perpendicular lines connecting the optic disc and the 4 surrounding rectus muscles in the coronal plane, which resulted in the formation of 4 right-angled sectors (upper-outer quadrant, upper-inner quadrant, lower-inner quadrant, and lower-outer quadrant). Accordingly, there were 3, 3, 8, and 4 lesions in the upper-outer, upper-inner, lower-outer, and lower-inner quadrants, respectively. Ten patients received anterior orbitotomy and 8 received lateral orbitotomy. There were no recurrences during the follow-up period. All patients exhibited reduced proptosis after surgery. Vision improved in 4 patients and remained unchanged in 14. Five patients experienced ocular movement limitation (1 permanent and 4 temporary), 1 developed an inferomedial blowout fracture, 2 developed a temporary sensory deficit, and 1 developed temporary ptosis. The authors’ findings suggest that intraconal cavernous venous malformations most frequently occur in the lower-outer quadrant. Although most lesions can be removed via anterior orbitotomy, large lesions located near the orbital apex or on the orbital wall require lateral orbitotomy. Ocular movement limitation is a common complication and can become permanent in rare cases, necessitating close monitoring. Lesion location and surgical approach do not seem to influence the postoperative complication rate.
Clean-Cut Smoothing of the Visible Cartilage Grafts by Sanding With a Scalpel
Authors: Çerçi Özkan Aret , Bilgili Ahmet Mert
Published: April 2019

The visibility of cartilage grafts underneath the skin is a complication of rhinoplasty particularly in patients with thin nasal skin. Preparing the graft with optimum dimensions, symmetry, and smoothness is crucial for the fine crafting of the cartilage to prevent visibility. The camouflage of the visible cartilage graft with a crushed cartilage, a resected cephalic portion of the lower lateral cartilage, fascia, connective and/or fatty tissues is another option for hiding the visibility. The nasal tip is the most common location where the graft visibility is of concern.

The authors introduce the smoothing of the cartilage graft by sanding it with a scalpel. This technique safely provides perfection and precision of smoothing of the cartilage in very desired shape. It is possible to obtain 3D super clean-cut shining surface.

The tangential sculpting of the cartilage graft with a scalpel carries the risk of over resection. However, the sanding with a scalpel moves forward so gentle that over resection is not possible.

It is also possible to smooth non-visible structural grafts such as strut and spreader grafts to reduce surface irregularities.

Additionally, the sand-dust caused by cartilage sanding is a ‘cartilage pâté’ which can be used for camouflage of minute irregularities of the nasal dorsum.
Significant Factors Influencing the Effectiveness of Cranial Remolding Orthoses in Infants With Deformational Plagiocephaly
Authors: Graham Tiffany , Gilbert Nicole , Witthoff Kirsten , Gregory Terran , Walsh Mary
Published: April 2019

Infants with deformational plagiocephaly may be indicated for a cranial remolding orthosis (CRO) depending on the severity of deformation. Studies have found torticollis and prematurity to be risk factors for the development of deformational plagiocephaly and indicate younger infants have faster and greater correction. However, clinical decisions about which infants should be recommended for CRO treatment differ among healthcare providers and insurance coverage criteria vary. In order to provide insight into treatment recommendations, this study aims to examine the influence of 4 specific factors on CRO treatment time and the infant's resultant posttreatment head shape. Results indicate that presenting age, presenting severity, and the presence of torticollis significantly influence treatment duration. Presenting age and severity were found to significantly influence final head shape. The presence of prematurity was not found to be significant when infants were categorized by their corrected postpartum ages.
Preschool Age Anthropometric Evaluation of the Nose After Bilateral Complete Cleft Lip Repair
Authors: Winaikosol Kengkart , Patthanapalakornskul Jirapat , Jenwitheesuk Kamonwan , Punyavong Pattama , Surakunprapha Palakorn , Chowchuen Bowornsilp
Published: April 2019

Objective:

To evaluate the aesthetic outcomes of surgery in preschool-aged bilateral complete cleft lip patients by comparing their nasal aesthetic parameters with those of normal children.

Setting and Sample Population:

Twenty-six 4 to 6-year-old (preschool age) patients with bilateral complete cleft lip who underwent primary cheiloplasty and a control group of 30 children in Northeast Thailand of the same age were enrolled.

Materials and Methods:

Nasal aesthetic parameters were analyzed in terms of 3 ratios and 1 angle using three-dimensional photographs. The data from bilateral cleft lip patients were compared with those from a control group.

Results:

The nasal parameters of patients in the cleft group were the same as those in the control group in terms of nasal tip height (NTH), columella height (CH), and dome height (DH) (P values were 0.361, 0.494, and 0.086), but nasal width (NW) was greater in the cleft group (P < 0.001). The nasal aesthetic parameters differed significantly between the 2 groups in terms of CLA (P < 0.001) and ratio of NTH and NW (P < 0.001), but not in terms of the CH:NW (P = 0.190) and DH:CH ratios (P = 0.147).

Conclusion:

This treatment protocol for bilateral cleft lip was able to achieve most of the aesthetic goals in terms of NTH, CH, DH, ratio of CH to NW, and ratio of DH to CH. However, more surgical correction of NW and CLAs may be needed.
Cost-Effective Technique of Fabrication of Polymethyl Methacrylate Based Cranial Implant Using Three-Dimensional Printed Moulds and Wax Elimination Technique
Authors: Desai Jimish B.
Published: April 2019

Objective:

Cranioplasty is one of the oldest known neurosurgical procedure performed. Many materials have been used for cranioplasty since ages. Polymethyl methacrylate (PMMA) has become the workhorse for fabrication of cranial implants since World War II in cases where autologous bone is not available or cannot be harvested. The aim of the present study is to present author's experience in the management of cranioplasty using acrylic implants fabricated using 2 different techniques.

Methods:

The author conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between October 2016 and January 2018. The surgical results were classified based on surgical time, blood loss, and the 3 scales of patient satisfaction, improvement of facial symmetry, and need for additional surgery along with the rate of wound complications.

Results:

Thirty patients underwent cranioplasty with PMMA-based implants, whether fabricated using alginate impression technique (56.67%) or fabricated using 3-dimensional (3D) printed patient-specific moulds (43.33%). Complications included infection (13.3%). The authors considered the craniofacial aesthetics based on patient satisfaction excellent (69%) with the degree of improvement of craniofacial symmetry satisfactory (92.3%), and 1 patient requiring resurgery in alginate impression technique fabricated implants.

Conclusion:

The author recommends a unique technique for fabrication of PMMA-based implants using 3D printed moulds to achieve a better fitting implant and highly cosmetic outcome for cranioplasty at affordable cost.
Extrusion of Alloplastic Septal Silicone Implant: 25 Years After Rhinoplasty
Authors: Safakogullari Hasan , Yalcinozan Eda Tuna , Tinazli Remzi , Kazikdas Kadir Cagdas , Safak Mustafa Asim
Published: April 2019

Multiple techniques and a variety of materials used for grafting have been described and applied over the years. Silicone implants are one of the most widely used alloplastic materials in Asian rhinoplasty, however, there are several complications. The authors report a case of an Asian woman who presented with implant rejection after 25 years later as a late complication of rhinoplasty. The patient was underwent revision augmentation rhinoplasty and stayed uneventful for 6 months as she was satisfied with aesthetic results and nasal airflow. The silicone implants are still going to be the most popular grafts in Asian augmentation rhinoplasty even so the long term complications must be kept in mind.
Long-term Physical Activity Levels and Physical Functioning Outcomes After Midurethral Sling
Authors: Shinnick Julia K. , Raker Christina A. , Sung Vivian W.
Published: April 2019

Objectives

The objective of this study was to describe changes in leisure physical activity (PA) levels and physical functioning (PF) in women 60 months or more after midurethral sling for stress urinary incontinence (SUI).

Methods

This is a long-term follow-up study of a previously published prospective study of women undergoing outpatient midurethral sling for SUI from 2009 to 2011. Women completed questionnaires for incontinence, PA, and PF at baseline, 6, 12, and 60 months or more postoperatively. Women were categorized as having sedentary, insufficient, or sufficient leisure PA levels by metabolic equivalents (MET min/week on the International Physical Activity Questionnaire). Physical functioning was measured from the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System. Physical activity and PF levels were compared preoperatively and at 60 months or more. Statistical tests were applied as appropriate with a P < 0.05 considered significant.

Results

Of the 85 women enrolled in the primary study, contact was made with 49, and 35 completed surveys. The follow-up range was 5.8 to 8 years (median, 6.8). Baseline mean age was 49.8 (SD, 8) years. Urinary Impact Questionnaire scores were lower at 60 months or more postprocedure (33.33 vs 0, P < 0.001), with no differences at 6, 12, and 60 months or more. At baseline, 31.3% of patients had sedentary, 12.5% had moderate, and 56.3% had sufficient leisure PA levels. On long-term follow-up, this improved to 21.9% sedentary, 12.5% moderate, and 65.6% sufficient leisure PA levels. Physical functioning also improved (mean, 44.95 vs 53.18 points; P < 0.001).

Conclusions

Midurethral sling procedures are associated with modest improvements in leisure PA levels and significant improvements in PF 60 months or more after surgery.
Critical Anatomy for Robotic Sacrocolpopexy: A Long-term Follow-up Study
Authors: Crisp Catrina C. , Herfel Charles V. , Kleeman Steven D. , Pauls Rachel N.
Published: April 2019

Objective

This study aimed to assess anatomy relative to sacral sutures 20 to 24 months after robotic sacrocolpopexy.

Methods

This was an institutional review board–approved prospective anatomy study of women undergoing robotic sacrocolpopexy. After placement of suture into the anterior longitudinal ligament, a small vascular clip was secured on the base of the suture. Subjects were imaged at 6 weeks and between 20 and 24 months after surgery. Measurements were calculated by the primary investigator and radiologist coinvestigator.

Results

Of the 11 subjects enrolled in the initial 6-week postoperative study, 5 (45%) completed the long-term follow-up. Regarding the vascular anatomy, no significant changes were documented. Similarly, the major urologic structure, the right ureter, was stable at 16 mm from the clip. A significant change was noted, however, in the distance from the apex of the vagina to the sacral suture. At 6 weeks postoperatively, the mean (SD) distance from the vaginal apex to the clip was 69.3 (14) mm; this increased to 85.2 (11.3) mm at the long-term follow-up (P = 0.004).

Conclusions

Reassuringly, the position of the clip remained stable, which is reflected in the constancy of the measurements to the vascular landmarks. Nevertheless, alteration in the distance to the vaginal apex suggests elongation of the mesh or vaginal tissue with time. Although the increase in length was greater than 1.5 cm, it may bear clinical relevance in certain patients. This information may help guide surgeons regarding appropriate mesh tensioning during this critical step of the procedure.
Sarcopenia Predicts Post-transplant Mortality in Acutely Ill Men Undergoing Urgent Evaluation and Liver Transplantation
Authors: Kuo Selena Z. , Ahmad Myra , Dunn Michael A. , Montano-Loza Aldo J. , Carey Elizabeth J. , Lin Shezhang , Moghe Akshata , Chen Hui-Wei , Ebadi Maryam , Lai Jennifer C.
Published: April 2019

Background.

We examined the association between sarcopenia and post-transplant mortality in acutely ill inpatients with cirrhosis who underwent urgent liver transplantation.

Methods.

Included were inpatients at 4 centers who were urgently listed as nonstatus 1 and transplanted from 2005 to 2017 with an abdominal computed tomography scan <90 days before transplantation. Skeletal muscle index (SMI) = total skeletal muscle cross-sectional area at the L3 vertebral level, normalized to height. Cox regression associated SMI with post-transplant mortality. Optimal search identified SMI cutoffs to detect survival.

Results.

Of 126 inpatients, 63% were male patients, model for end-stage liver disease (MELDNa) was 32, and follow up was 5.1 years. Among men, 23% died. Median SMI was lower in men who died versus survived (45 versus 51 cm2/m2). SMI was associated with post-transplant mortality (hazard ratio [HR] = 0.96 per cm2/m2, 95% CI 0.92-0.99). Patients with SMI ≤ 48 cm2/m2 versus >48 cm2/m2 experienced higher rates of death at 1 year (86% versus 95%) and 3 years (73% versus 95%) (Log-rank P = 0.01). In MELD-adjusted analysis, sarcopenia was strongly associated with post-transplant mortality (HR = 4.39, 95% CI 1.49-12.97). Among women, 35% died. Median SMI was similar in women who died versus survived (45 versus 44 cm2/m2). SMI was not associated with post-transplant mortality (HR = 1.02, 95% CI 0.96-1.09). Optimal search did not identify any SMI cutoff that predicted post-transplant mortality.

Conclusions.

Among patients who underwent urgent inpatient evaluation and liver transplantation, we identified an SMI cutoff value of 48 cm2/m2 to predict post-transplant mortality in men. Our data support the use of SMI as a tool to capture the impact of muscle depletion on post-transplant mortality in acutely ill men with cirrhosis undergoing urgent liver transplantation.
Pituitary Adenylate Cyclase-activating Polypeptides Prevent Hepatocyte Damage by Promoting Yes-associated Protein in Liver Ischemia-Reperfusion Injury
Authors: Liu Yuan , Lu Tianfei , Zhang Cheng , Xue Zhengze , Xu Jin , Busuttil Ronald W. , Xia Qiang , Xu Ning , Kupiec-Weglinski Jerzy W. , Ji Haofeng
Published: April 2019

Background.

Hepatic ischemia-reperfusion injury (IRI) is a severe complication in liver transplantation, hepatectomy, and hemorrhagic shock. As neuropeptides transmit the regulatory signal between nervous and immune systems communication, our previous study documented that pituitary adenylate cyclase-activating polypeptides (PACAP) depressed hepatic Toll-like receptor 4 immune response in liver IRI.

Methods.

Here, we focused on how PACAP suppressed hepatocellular damage and enhanced hepatocyte regeneration in a murine model of partial liver warm IRI.

Results.

Yes-associated protein (YAP), a cellular modulator of tissue regeneration, was readily induced in wild type (WT) mouse IR-livers. As its induction was failed in PACAP-deficient livers, PACAP supplement enhanced YAP expression in WT mouse and promoted its nuclear translocation and downstream antioxidative/regenerative genes expression both in vivo and in vitro. Further, verteporfin, a YAP transcriptional inhibitor, abolished PACAP-mediated hepatoprotection significantly. Meanwhile, blockade of protein kinase A (PKA)–CRE-binding protein (CREB) signaling recreated liver damage in PACAP-protected liver as well as impeded stimulation on YAP and its downstream gene expressions. Consistently, inhibition of PKA-CREB decreased PACAP-promoted YAP expression in primary hepatocytes culture, and made them vulnerable to H2O2 stress in vitro. In addition, lysophosphatidic acid, another Hippo pathway inhibitor, failed to affect PACAP-mediated hepatoprotection or hepatocellular YAP induction. This implies that PACAP regulated YAP through PKA-CREB pathway at the transcriptional level rather than canonical hippo pathway.

Conclusions.

Our study discovered the neural modulation of PACAP-YAP axis in hepatic cytoprotection and homeostasis in liver IRI. These reveal a novel insight of neuropeptide PACAP in combating liver IRI in clinical patients.