bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of Automated Computed Tomography Volumetric Analysis Metrics With Motility Disturbances in Thyroid Eye Disease
Authors: Law James J. , Mundy Kevin M. , Kupcha Anna C. , Chaganti Shikha , Nelson Katrina M. , Harrigan Robert L. , Landman Bennett A. , Mawn Louise A.
Published: November 2020

Purpose:

The authors sought to examine relationships between CT metrics derived via an automated method and clinical parameters of extraocular muscle changes in thyroid eye disease (TED).

Methods:

CT images of 204 orbits in the setting of TED were analyzed with an automated segmentation tool developed at the institution. Labels were applied to orbital structures of interest on the study images, which were then registered against a previously established atlas of manually indexed orbits derived from 35 healthy individuals. Point-wise correspondences between study and atlas images were then compared via a fusion algorithm to highlight metrics of interest where TED orbits differed from healthy orbits.

Results:

Univariate analysis demonstrated several correlations between CT metrics and clinical data. Metrics pertaining to the extraocular muscles—including average diameter, maximum diameter, and muscle volume—were strongly correlated (p < 0.05) with the presence of ocular motility deficits with regards to the superior, inferior, and lateral recti (with exception of superior rectus motility deficits being mildly correlated with muscle volume [p = 0.09]). Motility defects of the medial rectus were strongly correlated with muscle volume, and only weakly correlated with average and maximum muscle diameter.

Conclusions:

The novel method of automated imaging metrics may provide objective, rapid clinical information which may have utility in prevention and recognition of visual impairments in TED before they reach an advanced or irreversible stage and while they are able to be improved with immunomodulatory treatments.
Postoperative Blepharoptosis After Pars Plana Vitrectomy Procedure
Authors: Abdolalizadeh Parya , Kashkouli Mohsen Bahmani , Falavarjani Khalil Ghasemi , Karimi Nasser , Khademi Behzad , Sedaghat Ahad
Published: November 2020

Purpose:

To describe the frequency of blepharoptosis and factors affecting it after the pars plana vitrectomy (PPV) procedure.

Methods:

In a prospective study, patients were recruited consecutively from October 2016 to June 2018. Upper eyelid margin reflex distance 1 and 2 (MRD1 and 2), upper eyelid crease height, and levator function were measured before, 1 and at least 6 months after surgery by the same investigator. Clinical and Clinically significant ptosis were defined as ≥0.5 and ≥2 mm drop of MRD1.

Result:

There were 60 eyes from 57 patients. The majority of surgeries were performed by the fellows (63.3%, 38/60) and under general anesthesia (95.0%, 57/60). Clinical and clinically significant ptosis following PPV were 47.2% (25/53) and 11.3% (6/53) at the last follow up (at least 6 months), respectively. MRD2 (p = 0.389) and eyelid crease height (p = 0.057) did not significantly change. Surgeons’ level, time of the procedure and other variables were not significantly impacting the frequencies.

Conclusion:

Persistent clinically significant ptosis was observed in 11% of patients undergoing PPV. No variable was significantly associated with persistent postoperative ptosis after PPV.
Pharmaceutical and Supply Waste in Oculofacial Plastic Surgery at a Hospital-Based Outpatient Surgery Center
Authors: Bhatter Param , Cypen Sanja G. , Carter Steven L. , Tao Jeremiah P.
Published: November 2020

Purpose:

To investigate the financial and environmental waste burden of unused disposable surgical supplies and pharmaceutical products in oculofacial plastic surgery at a hospital-based outpatient surgery center.

Methods:

This descriptive study was performed at a single academic hospital-based outpatient surgery center. Unused pharmaceuticals and disposable surgical materials were recorded for each of 34 consecutive oculofacial plastic surgeries performed by the same surgical team. Pharmaceutical products were grouped as local anesthetic (tetracaine, bupivacaine, lidocaine, and sodium bicarbonate), intraoperative (basic saline solution, methylene blue, and oxymetazoline hydrochloride), or antiseptic/antimicrobial (erythromycin ointment and hydrogen peroxide). Percentage of unused pharmaceutical product and disposable surgical material were calculated and extrapolated to direct costs to the institution and greenhouse gas emissions.

Results:

The mean percentage of disposable surgical supply waste per case was 11.6% ($29.32). The mean percentage of pharmaceutical waste was 96.1% ($271.84) for local anesthetic, 71.0% ($163.47) for intraoperative medications, and 26.7% ($2.19) for antiseptic medication. The mean emissions per surgical case for unused disposable surgical equipment and unused pharmaceutical product were 10 and 103 kg of carbon equivalent gases (kg CO2-e), respectively.

Conclusions:

Surgical supply waste was nominal, but pharmaceutical waste was considerable in this single hospital-based outpatient surgery center study. There may exist opportunities for quality improvement in waste, especially pharmacologic burden, in oculofacial plastic surgery.
Organizational Perspectives on How to Successfully Integrate Health Promotion Activities into Occupational Health and Safety
Authors: Biswas Aviroop , Begum Momtaz , Van Eerd Dwayne , Smith Peter M. , Gignac Monique A.M.
Published: November 2020

Objective:

There is increasing recognition of the value of integrating efforts to promote worker health with existing occupational health and safety activities. This paper aimed to identify facilitators, barriers and recommendations for implementing integrated worker health approaches.

Methods:

Thirteen stakeholders from different job sectors participated in a workshop that targeted key issues underlying integrated worker health approaches in their own and other organizations. Included were participants from human resources, occupational health and safety, government, and unions. Thematic analysis and an online ranking exercise identified recommendation priorities and contributed to a conceptual framework.

Results:

Participants highlighted the importance of planning phases in addition to implementation and evaluation. Themes highlighted organizational priorities, leadership buy-in, external pressures, training, program promotion and evaluation metrics.

Conclusions:

Findings provide practical directions for integrating worker health promotion and safety and implementation steps.
Website Survey Method for Assessing Higher Education Employee Health and Safety Programs
Authors: Malomet Maayan S. , Harber Philip
Published: November 2020

Objective:

The higher education industry in the United States is large (almost four million employees and 19 million students) with diverse hazards.

Methods:

We apply a novel health services research approach to systematically assess a sample of 55 institutional websites. The accessibility, content, and coverage of occupational health/safety program information were systematically coded for several domains (eg, Occupational Safety and Health Administration (OSHA)-related, specific hazards, clinical, person-oriented, COVID-19, and coverage).

Results:

Information was more available for programs related to OSHA mandates (eg, chemical hygiene) and specific hazards than for person-oriented programs (eg, counseling). Larger institutions provide better information and more comprehensive programs than smaller institutions.

Conclusions:

Higher education institutions warrant increasing attention to occupational health and safety, particularly as COVID-19 increased attention to workplace health issues.
Clinically Silent Brain Injury and Perioperative Neurological Events in Patients With Left Ventricular Assist Device: A Brain Autopsy Study
Authors: Kannapadi Nivedha V. , White Bartholomew , Woo Choi Chun , Chen Liam L. , Cho Sung-Min
Published: November 2020

Current studies underestimate the prevalence of brain injury in patients with left ventricular assist devices (LVADs), as CT scans are not sensitive in detecting cerebral ischemia. Using postmortem neuropathological evaluation, we sought to characterize the types and risk factors of brain injury in LVAD patients. We reviewed 24 LVAD patients who underwent brain autopsy with gross and microscopic examinations from 1993 through 2019 at a single tertiary center. Patients who expired less than 7 days after implantation or who underwent explantation more than 7 days before death were excluded. Our study demonstrated that all LVAD nonsurvivors developed brain injury. The most common brain injury was hemorrhage (71%), followed by infarct (42%) and hypoxic ischemic brain injury (HIBI) (33%), and 10 patients (42%) presented with more than 1 brain injury. Cerebral microbleeds (CMBs) and intracranial hemorrhage were present in 33% and 42%, respectively. In those with intracranial hemorrhage, subarachnoid hemorrhage (25%) and intracerebral hemorrhage (25%) were more common than subdural hematoma (4%). Intracranial hemorrhage was associated with driveline infection (P = 0.047), and HIBI was associated with prior history of chronic obstructive pulmonary disease (P = 0.037). Fourteen (60%) had clinically silent brain injury with 65% of hemorrhages and 70% of infarcts being silent. However, the impact of silent brain injury on neurologic outcome and mortality remains unclear. Standardized neurologic monitoring and surveillance are recommended to better detect these clinically silent brain injury.
Successful Treatment of Pregnant and Postpartum Women With Severe COVID-19 Associated Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation
Authors: Barrantes Jairo H. , Ortoleva Jamel , O’Neil Erika R. , Suarez Erik E. , Beth Larson Sharon , Rali Aniket S. , Agerstrand Cara , Grazioli Lorenzo , Chatterjee Subhasis , Anders Marc
Published: November 2020

There are limited data on the use of extracorporeal membrane oxygenation (ECMO) for pregnant and peripartum women with COVID-19 associated acute respiratory distress syndrome (ARDS). Pregnant women may exhibit more severe infections with COVID-19, requiring intensive care. We supported nine pregnant or peripartum women with COVID-19 ARDS with ECMO, all surviving and suffering no major complications from ECMO. Our case series demonstrates high-maternal survival rates with ECMO support in the management of COVID-19 associated severe ARDS, highlighting that these pregnant and postpartum patients should be supported with ECMO during this pandemic.
REabsorbable vs. DUrable Polymer Drug-Eluting Stents in All-Comer PatiEnts: the REDUCE registry
Authors: Piccirillo Francesco , Caiazzo Gianluca , Miglionico Marco , Nusca Annunziata , Melfi Rosetta , Gallo Paolo , Ricottini Elisabetta , De Michele Mario , Golino Luca , Manganiello Vincenzo , Fattore Luciano , Mangiacapra Fabio , Di Sciascio Germano
Published: November 2020

Background

While the superiority of reabsorbable-polymer drug-eluting stents (RP-DES) over bare-metal stents and first-generation durable-polymer (DP)-DES has been largely established, their advantage compared with new-generation DP-DES is still controversial. This study aimed was to compare clinical outcomes of all-comer patients undergoing percutaneous coronary intervention (PCI) with new generation DP-DES or RP-DES implantation.

Methods

We prospectively enrolled 679 consecutive patients treated with PCI with RP-DES or DP-DES. The primary endpoint was the 1-year incidence of major adverse clinical events (MACE), a composite of death, myocardial infarction (MI), and target vessel revascularization (TVR). Target lesion revascularization (TLR) and definite stent thrombosis were also recorded.

Results

A total of 439 (64.6%) received RP-DES and 240 (36.4%) received DP-DES. No significant difference in the incidence of MACE (5.9 vs. 4.9%; hazard ratio, 1.23; 95% confidence interval (CI), 0.61–2.49; P = 0.569), death (1.8 vs. 1.7%; hazard ratio, 1.09; 95% CI, 0.33–3.64; P = 0.882), MI (2.3 vs. 2.1%; hazard ratio, 1.05; 95% CI, 0.36–3.08; P = 0.927), TVR (2.3 vs. 1.3%; hazard ratio, 1.70; 95% CI, 0.47–6.20; P = 0.418), TLR (1.4 vs. 0.4%; hazard ratio, 3.06; 95% CI, 0.37–25.40; P = 0.301), and definite stent thrombosis (0.5 vs. 0.4%; hazard ratio, 1.09; 95% CI, 0.10–12.10; P = 0.942) was observed between RP-DES and DP-DES patients at 1-year follow-up. These results were confirmed in a propensity score-matched cohort (n = 134 per group).

Conclusion

In our registry including a real-world population of all-comer patients undergoing PCI, RP-DES, or durable polymer-DES showed similar efficacy and safety at a 1-year follow-up.
A randomized comparison of a novel iopromide-based paclitaxel-coated balloon Shenqi versus SeQuent Please for the treatment of in-stent restenosis
Authors: Zhu Jinzhou , Liu Lili , Zhu Zhengbin , Yang Zhenkun , Hu Jian , Ding Fenghua , Zhou Yujie , Su Xi , Ge Junbo , Liu Xuebo , Tang Lijiang , He Yong , Zhou Guowei , Ji Zheng , Li Ying , Pang Wenyue , Zhang Ruiyan
Published: November 2020

Background

Treatment of coronary in-stent restenosis (ISR) remains challenging in contemporary clinical applications. Drug-coated balloon (DCB) angioplasty offers an effective treatment for ISR. Shenqi is a novel iopromide-based paclitaxel-coated balloon and its clinical safety, effectiveness and angiographic efficacy in patients with ISR have not been investigated.

Methods

A total of 216 subjects with the first occurrence of ISR at 11 investigational sites in China were randomly allocated in a 1:1 fashion to treatment with DCB SeQuent Please or Shenqi. Clinical follow-up was planned at 1, 6, 9 and 12 months, and angiographic follow-up was planned at 9 months. The study was powered for the primary endpoint of 9-month in-segment late loss.

Results

At 9-month follow-up, the in-segment late loss was 0.29 ± 0.43 mm with Shenqi versus 0.30 ± 0.46 mm with SeQuent Please, and the one-sided 97.5% upper confidence limit of the difference was 0.14 mm, achieving noninferiority of Shenqi compared with SeQuent Please (P = 0.002). In total, 12 patients developed target lesion failure (TLF) in the Shenqi group compared with 16 patients in the SeQuent Please group (10.91% versus 15.09%; P = 0.42) within 1 year. TLF was mainly driven by target lesion revascularization (9.09%) followed by target vessel-related myocardial infarction (1.82%) and cardiovascular death (0.91%) in the Shenqi group.

Conclusions

Shenqi DCB was noninferior to SeQuent Please DCB for the primary endpoint of 9-month in-segment late loss. Shenqi DCB may become an attractive alternative treatment for patients with coronary ISR, withholding the need for additional stent implantation.
Adult obesity and its complications: a pediatric disease?
Authors: Malhotra Sonali , Sivasubramanian Ramya , Singhal Vibha
Published: November 2020

Purpose of review

Approximately 2.6 million people die each year secondary to obesity related diseases. The risk of developing serious comorbidities depends on the age of onset as well as duration of obesity. In this review, we discuss trends in BMI trajectories from early childhood to adulthood with latest evidence on comorbidities in adulthood stemming from pediatric obesity and benefits of early intervention and treatment in childhood obesity.

Recent findings

Childhood obesity poses high risk of metabolic and cardiovascular disorders like type 2 diabetes, hypertension, atherosclerosis, coronary artery disease, and some types of cancer in adulthood. Early life obesity also increases risks of developing menstrual irregularities, infertility, and pregnancy complications. Several grave concerns including malignancies, autoimmune disorders, higher asthma morbidity, and psychiatric implications are found to be associated with childhood obesity. Disease outcomes can be transgenerational, causing suboptimal health in children of mothers with obesity. Encouragingly, many risks associated with childhood obesity can be reduced, delayed, or even reversed by early resolution of obesity necessitating close BMI monitoring and treatment early.

Early identification and aggressive management of childhood obesity is critical in prevention of debilitating comorbidities in adult life.

Video abstract

http://links.lww.com/COE/A19
A Simple and Practical Guide for Triaging Lymphocyte-rich Effusions for Ancillary Studies
Authors: Liu Chih-Yi , Chuang Shih-Sung
Published: November 2020

Lymphocyte-rich effusions of the body cavities may represent a reactive/benign condition, primary effusion lymphoma, or systemic lymphoma with secondary malignant effusion, either as initial presentation or as a late complication. Cytomorphologic examination is essential and fundamental for diagnosis and may provide important clues to the nature of diseases. However, based on morphology alone, cytologic diagnosis of lymphocyte-rich effusions could be very challenging, particularly when the lymphocytes are small. Cytologists/cytopathologists might be uncertain when a lymphocyte-rich effusion specimen warrants a comprehensive hematopathologic workup. Herein we present a simple and practical algorithmic approach. On the basis of the cytomorphology of lymphocytes (small vs. large cells), presence or absence of cellular atypia, and clinical information (an earlier history or current lymphoma), the lymphocyte-rich effusion samples could be triaged for ancillary studies including immunophenotyping and molecular assays if indicated. Incorporation of cytomorphology, correlation with clinical information, and appropriate application of various ancillary techniques is mandatory for a correct diagnosis of lymphocyte-rich effusion specimens.
Contemporary Characterization and Recategorization of Adult Unclassified Renal Cell Carcinoma
Authors: Kwon Regina , Argani Pedram , Epstein Jonathan I. , Lombardo Kara A. , Wang Xiaoming , Pierorazio Phillip M. , Mehra Rohit , Matoso Andres
Published: November 2020

Our recent study of early-onset unclassified eosinophilic renal cell carcinoma (RCC) demonstrated that two third of cases could be reclassified by performing a limited number of immunohistochemistry stains. Following the same approach, we aimed to investigate what proportion of adult unclassified RCC could be reclassified. We identified 79 cases. The mean age at presentation was 58 years (range, 29 to 84 y). Tumors were grouped based on their predominant morphologic features as oncocytic (n=23); papillary (n=22); clear cell (n=22); mucinous tubular and spindle cell (MTSC; n=5); rhabdoid (n=4); or lacking a dominant pattern (n=3). By reviewing the morphologic features and performing ancillary studies, we were able to reclassify 10 cases (13%). Four cases were positive for CK20 and showed morphologic features consistent with eosinophilic solid and cystic RCC. Four cases were reclassified as MTSC based on VSTM2A expression by RNA in situ hybridization. One case was negative for SDHB and reclassified as succinate dehydrogenase–deficient RCC. None of the cases showed loss of expression of fumarate hydratase. One case was diffusely positive for CK7 and negative for CD117 and reclassified as a low-grade oncocytic tumor. Four cases were positive for both cathepsin-K and TFE3 by immunohistochemistry, although fluorescence in situ hybridization failed to identify rearrangement in either TFE3 or TFEB genes. Of the tumors that remained unclassified, those with oncocytic features were less likely to be a high grade (odds ratio [OR]=0.22, P=0.013) or advanced stage (OR=0.19, P=0.039) and were more common in women (OR=3.4, P=0.05) compared with those without oncocytic features. Tumors with rhabdoid morphology were associated with advanced stage (relative risk=3.6, P=0.009), while tumors with clear cell or papillary features had a wide range of grades and stages at presentation. In summary, the most frequent reclassified entity is eosinophilic solid and cystic RCC. Investigation of expression of succinate dehydrogenase or fumarate hydratase in individuals older than 35 years with unclassifiable tumors is low yield in the absence of specific morphologic features. A subset of MTSC without well-developed morphologic features can be reclassified by using RNA-ISH for VSTM2A. Recognition of more-recently described RCC subtypes allows for their distinction from the unclassified subtype and improves the prognostic information provided.
Optimal Timing for Reduction Mammaplasty in Adolescents
Authors: Nuzzi Laura C. , Pramanick Tannishtha , Walsh Landis R. , Firriolo Joseph M. , Massey Gabrielle G. , DiVasta Amy D. , Labow Brian I.
Published: November 2020

Background:

Reduction mammaplasty effectively alleviates symptoms and restores quality of life. However, operating on adolescents remains controversial, partly because of fear of potential postoperative breast growth. This cross-sectional study provides surgeons with a method to predict the optimal timing, or biological “sweet spot,” for reduction mammaplasty to minimize the risk of breast regrowth in adolescents.

Methods:

The authors reviewed the medical records of women aged 12 to 21 years who underwent reduction mammaplasty from 2007 to 2019. Collected data included symptomology, perioperative details, and postoperative outcomes.

Results:

Four hundred eighty-one subjects were included in analyses and were, on average, 11.9 years old at first menses (menarche) and 17.9 years old at surgery. Six percent of subjects experienced postoperative breast growth. Breast size appears to stabilize considerably later in obese adolescents compared to healthy-weight and overweight patients, and breast growth in obese macromastia patients may not end until 9 years after menarche. Operating on obese women before this time point increased the likelihood of glandular breast regrowth by almost 120 percent (OR, 1.18; 95 percent CI, 1.11 to 1.26). Surgery performed less than 3 years after menarche, the commonly regarded end of puberty, increased the likelihood of glandular regrowth by over 700 percent in healthy-weight and overweight subjects (OR, 7.43; 95 percent CI, 1.37 to 40.41).

Conclusions:

Findings suggest that reduction mammaplasty age restrictions imposed by care providers and third-party payors may be arbitrary. Surgical readiness should be determined on an individual basis incorporating the patient’s biological and psychological maturity, obesity status, potential for postoperative benefit, and risk tolerance for postoperative breast growth.

Clinical Question/Level of Evidence:

Risk, III.
Four-Year Follow-Up of the World’s First Pediatric Bilateral Hand-Forearm Transplants: Do They Grow as Expected?
Authors: Azoury Saïd C. , Milbar Niv , Kimia Rotem , Nguyen Jie C. , Othman Sammy , McAndrew Christine , Kovach Stephen J. , Carrigan Robert B. , Steinberg David R. , Bozentka David J. , Lin Ines C. , Levin L. Scott , Chang Benjamin
Published: November 2020

Background:

In 2015, the first bilateral pediatric hand-forearm transplant was performed in an 8-year-old boy. The growth rate of the transplanted upper extremities was unknown at the time.

Methods:

Forearm and hand radiographs were obtained annually. Radius and ulna measurements were performed by multiple coauthors and mathematically normalized using a standardized methodology. The Greulich and Pyle atlas was used to estimate hand bone age.

Results:

From July of 2015 to July of 2019, unadjusted bone length (metaphysis to metaphysis) increased 38.8 and 39.6 mm for the left radius and ulna, and 39.5 and 35.8 mm for the right radius and ulna, respectively. Distal physes of the donor limbs increasingly contributed to overall bone length relative to proximal physes. Normalized growth between the two limbs was statistically similar. At each annual follow-up, the bone age increased by 1 year.

Conclusions:

Successful pediatric hand-forearm transplantation offers the advantage of growth similar to that of nontransplanted pediatric patients. The transplanted distal physes contributes more to the overall growth, paralleling normal pediatric growth patterns. Chronologic age parallels the increase in bone age.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Single-Stage Adipofascial Turnover Flap as an Alternate Option for Large Nasal Defects Usually Requiring Two-Stage Forehead Flap
Authors: Gallagher Thomas M. , Capito Anthony E.
Published: November 2020

Background:

Large nasal defects involving the tip, ala, and/or columella with denuded cartilage have traditionally required a two-stage forehead flap. As many Mohs patients are presenting older with increased medical comorbidities, a single-stage adipofascial turnover flap with a full-thickness skin graft was developed by the senior author as an alternative method. The authors hypothesize that the adipofascial turnover flap would have similar success rates and cost less than the forehead flap.

Methods:

A retrospective review of all patients in the senior author’s practice who underwent either a forehead flap or adipofascial turnover flap between January of 2016 and February of 2019 was conducted. The two groups were compared regarding success, complications, and cost.

Results:

There were seven forehead flap patients and 11 patients with adipofascial turnover flaps. Overall complications were three of seven (43 percent) for the forehead flap group and one of 11 (9 percent) for the adipofascial turnover flap group. There was one mortality, one revision for asymmetry, and one with airflow obstruction in the forehead group. The adipofascial turnover flap group had one partial skin graft loss that healed with local wound care only. There were no flap failures in either group, and the cost savings averaged over $22,000 in the adipofascial turnover flap group.

Conclusions:

The single-stage adipofascial turnover flap with full-thickness skin grafting is a safe, reliable, and less expensive alternate to the forehead flap. The forehead flap will remain a workhorse in nasal reconstruction, but multiple operations increase cost and may contribute to higher complication rates. The adipofascial turnover flap appears to be an efficacious and reasonable option compared with the forehead flap.
Prevalence of Psychosocial Distress in Transmen Seeking Gender-Affirming Mastectomy
Authors: Lane Megan , Kirsch Michael J. , Sluiter Emily C. , Hamill Jennifer B. , Ives Graham C. , Gilman Robert H. , Cederna Paul S. , Kuzon William M. , Wilkins Edwin G.
Published: November 2020

Background:

Although the benefits of gender-affirming surgery may be apparent to patients and providers, there remains a paucity of studies assessing the impact of these procedures. As an initial step, preoperative patient-reported outcomes using validated measures of depression, anxiety, and body image were used and compared to cisgender normative data.

Methods:

Patients presenting for gender-affirming mastectomy were approached and surveyed using validated instruments measuring anxiety, depression, and body image. In addition, clinical data were collected from the medical record. Results were compared to published instrument norms in the general cisgender population.

Results:

One hundred three patients completed the preoperative assessment; 70.3 percent and 66.3 percent of the cohort screened positive for mild to severe depression and anxiety, respectively. Only 25 percent and 29.8 percent of the cohort, respectively, had a previous diagnosis of depression and anxiety. The rates of depression and anxiety were significantly higher than those in cisgender normative data [mean Patient Health Questionnaire score, 2.7 (p < 0.0001); mean Generalized Anxiety Disorder Scale 7 score, 2.66 (p < 0.0001)]. Body Image Quality of Life Index and BREAST-Q scores were also significantly lower than those in cisgender normative data.

Conclusions:

Patients seeking gender-affirming mastectomy have a significant mental health burden that appears to be underdiagnosed. They further have significant challenges with body image compared with cisgender normative data. These findings signify dramatic mental health disparities in the preoperative transgender population and the need for ongoing prospective research of gender-affirming surgery.
HIV-1 infection of the kidney: mechanisms and implications
Authors: Hughes Kelly , Chang Jerry , Stadtler Hannah , Wyatt Christina , Klotman Mary , Blasi Maria
Published: November 2020

People living with HIV are at higher risk for acute and chronic kidney disease compared with uninfected individuals. Kidney disease in this population is multifactorial, with several contributors including HIV infection of kidney cells, chronic inflammation, genetic predisposition, aging, comorbidities, and coinfections. In this review, we provide a summary of recent advancements in the understanding of the mechanisms and implications of HIV infection and kidney disease, with particular focus on the role of direct HIV infection of renal cells.
Quantifying the Evolving Contribution of HIV Interventions and Key Populations to the HIV Epidemic in Yaoundé, Cameroon
Authors: Silhol Romain , Baral Stefan , Bowring Anna L. , Mukandavire Christinah , Njindam Iliassou M. , Rao Amrita , Schwartz Sheree , Tamoufe Ubald , Billong Serge C. , Njoya Oudou , Zoung-Kanyi Bissek Anne-Cecile , Calleja Jesus M. G. , Vickerman Peter , Mishra Sharmistha , Boily Marie-Claude
Published: November 2020

Background:

Key populations (KP) including men who have sex with men (MSM), female sex workers (FSW), and their clients are disproportionately affected by HIV in Sub-Saharan Africa. We estimated the evolving impact of past interventions and contribution of unmet HIV prevention/treatment needs of key populations and lower-risk groups to HIV transmission.

Setting:

Yaoundé, Cameroon.

Methods:

We parametrized and fitted a deterministic HIV transmission model to Yaoundé-specific demographic, behavioral, HIV, and intervention coverage data in a Bayesian framework. We estimated the fraction of incident HIV infections averted by condoms and antiretroviral therapy (ART) and the fraction of all infections over 10-year periods directly and indirectly attributable to sex within and between each risk group.

Results:

Condom use and ART together may have averted 43% (95% uncertainty interval: 31–54) of incident infections over 1980–2018 and 72% (66–79) over 2009–2018. Most onward transmissions over 2009–2018 stemmed from sex between lower-risk individuals [47% (32–61)], clients [37% (23–51)], and MSM [35% (20–54)] with all their partners. The contribution of commercial sex decreased from 25% (8–49) over 1989–1998 to 8% (3–22) over 2009–2018, due to higher intervention coverage among FSW.

Conclusion:

Condom use and recent ART scale-up mitigated the HIV epidemic in Yaoundé and changed the contribution of different partnerships to onward transmission over time. Findings highlight the importance of prioritizing HIV prevention and treatment for MSM and clients of FSW whose unmet needs now contribute most to onward transmission, while maintaining services that successfully reduced transmissions in the context of commercial sex.
18F-FDG PET and 18F-FDG PET/CT in Vulvar Cancer
Authors: Triumbari Elizabeth K.A. , de Koster Elizabeth J. , Rufini Vittoria , Fragomeni Simona M. , Garganese Giorgia , Collarino Angela
Published: November 2020

Aim

The aims of this study were to determine the role of 18F-FDG PET/CT in vulvar cancer patients and to extract summary estimates of its diagnostic performance for preoperative lymph node staging.

Patients and Methods

PubMed/Medline and Embase databases were searched to identify studies evaluating 18F-FDG PET/CT in vulvar cancer patients. The assessment of methodological quality of the included articles was performed. Per-patient and per-groin pooled estimates, with 95% confidence intervals (CIs), of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) were calculated.

Results

Ten articles were included in the systematic review, 7 among which evaluated the diagnostic performance of preoperative 18F-FDG PET/CT for lymph node staging. Qualitative per-patient analysis (72 patients from 4 studies) resulted in estimated pooled sensitivity, specificity, PPV, NPV, and DOR of 0.70 (95% CI, 0.44–0.95), 0.90 (95% CI, 0.76–1.04), 0.86 (95% CI, 0.66–1.06), 0.77 (95% CI, 0.56–0.97), and 10.49 (95% CI, 1.68–65.50), respectively. Qualitative per-groin analysis (245 groins from 5 studies) resulted in estimated pooled sensitivity, specificity, PPV, NPV, and DOR of 0.76 (95% CI, 0.57–0.94), 0.88 (95% CI, 0.82–0.94), 0.70 (95% CI, 0.55–0.85), 0.92 (95% CI, 0.86–0.97), and 19.43 (95% CI, 6.40–58.95), respectively.

Conclusions

Despite limited literature data, this systematic review and meta-analysis revealed that a negative preoperative PET/CT scan may exclude groin metastases in at least early-stage vulvar cancer patients currently unfit for sentinel node biopsy and select those eligible for a less invasive surgical treatment. A positive PET/CT result should otherwise be interpreted with caution. Larger prospective studies are needed to confirm these results and to evaluate the diagnostic value of standardized semiquantitative analysis compared with the qualitative one.
Infection Control of COVID-19
Authors: Nawwar Ayah Adel , Searle Julie , Green Christopher , Lyburn Iain Douglas
Published: November 2020

In accordance with published international COVID-19 pandemic guidance (American College of Nuclear Medicine, British Nuclear Medicine Society, and European Association of Nuclear Medicine), the use of face masks has become an essential part of infection control for both patients and staff. A 56-year-old man with mantle cell lymphoma underwent staging FDG PET/CT, which demonstrated avid lymphadenopathy below the diaphragm and an unusual diffuse FDG uptake projected over the face, raising the suspicion of cutaneous lymphomatous involvement. On reflection of the clinical scenario and scanning conditions, cutaneous involvement was discounted; the pattern of uptake and lack of CT correlate were supportive of a cutaneous artifact related to the presence of the patient's mask.
Ultra-Low-Dose Computed Tomography Protocol for Preoperative Evaluation in Children With Craniofacial Anomalies
Authors: Komarraju Aparna , Mehta Sagar T. , Glacier Charles , Nabaweesi Rosemary , Choudhary Arabinda , Ramakrishnaiah Raghu
Published: November 2020

Purpose:

Preoperative three-dimensional computed tomography is currently the gold standard imaging modality in patients with craniofacial anomalies. In these patients, bone structural evaluation is paramount for surgical planning and evaluation of brain parenchyma is often secondary. With the significant complexity of these patients, a majority of patients undergo multiple Computed Tomography (CT) studies from infancy into adulthood. This study presents an ultra-low-dose CT protocol that limits the radiation exposure per CT scan in patients with craniofacial anomalies.

Material and Methods:

A total of 200 consecutive patients who underwent head CT for preoperative evaluation of craniofacial anomalies at Tertiary Children's Hospital were included in the study. The kVp, (KiloVoltage Peak) mA (milliAnperage), CT dose index (CTDI), and dose-length product (DLP) were documented from the dose page. Patients were stratified based on age for determining age specific effective dose and for age matched comparison. The age specific effective dose was derived by using the established conversion factor as described in the paper. (1) Standard t test was performed to determine the statistical significance of radiation dose reduction. The Institutional Review Board approved the study and data was collected from 2012–2014.

Findings:

Of the 200 patients assessed in our study, 90 patients had low-dose CT scans and 110 patients had ultra-low-dose CT scans of the head. All patients had diagnostic quality CT studies. The low-dose CT was performed at 120 kVp and 100 mA. The ultra-low-dose CT was performed at 80 kVp and fixed 80 mA. The minimum, maximum and mean effective dose before the introduction of the ultra-low-dose protocol was 0.8 mSv, 6.9 mSV and 2.82 mSv. The minimum, maximum and mean effective dose after the introduction of the ultra-low-dose protocol was 0.6 mSv, 3.8 mSV, and 1.37 mSv. The reduction in the effective radiation dose was statistically significant (standard t test; P = 0.0001).

Conclusion:

Compared to the regular low-dose protocol, the ultra-low-dose CT protocol provided appropriate diagnostic images with a significantly decreased radiation dose.
Clinical Difference Between Capillary and Cavernous Hemangiomas of Nasal Cavity
Authors: Lim Hye Rin , Lee Dong Hoon , Lim Sang Chul
Published: November 2020

Objective:

The authors analyzed the clinical characteristics and treatment results of capillary and cavernous hemangiomas in the nasal cavity.

Patients and Methods:

A total of 14 patients who underwent surgical treatment for sinonasal hemangiomas between January 2010 and May 2020 were analyzed. The study population was subdivided into capillary and cavernous hemangiomas groups.

Results:

The 14 patients with sinonasal hemangiomas involved 8 (57.1%) capillary hemangiomas and 6 (42.9%) cases of cavernous hemangioma. Clinical features, such as age, gender, medical condition, symptom, duration of symptom, size and site of sinonasal hemangiomas, surgery, anesthesia method, treatment outcomes, and recurrence of capillary and cavernous hemangiomas of nasal cavity showed no statistically significant difference (P > 0.05). A case of relapse involving a patient with cavernous hemangioma of vestibule was observed without recurrence after reoperation.

Conclusion:

The comparison of clinical features of capillary and cavernous hemangiomas of nasal cavity showed no statistical significance. Transnasal endoscopic tumor removal including the surrounding structure is a safe and effective procedure for sinonasal hemangiomas.
Have There Been any Changes in the Epidemiology and Etiology of Maxillofacial Trauma During the COVID-19 Pandemic? An Italian Multicenter Study
Authors: Salzano Giovanni , Dell’Aversana Orabona Giovanni , Audino Giovanni , Vaira Luigi Angelo , Trevisiol Lorenzo , D’Agostino Antonio , Pucci Resi , Battisti Andrea , Cucurullo Marco , Ciardiello Cristina , Barca Ida , Cristofaro Maria Giulia , De Riu Giacomo , Biglioli Federico , Valentini Valentino , Nocini Pier Francesco , Califano Luigi
Published: November 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a significant impact on people's behavior. The aim of this study has been to evaluate how the SARS-CoV-2 pandemic has impacted the incidence and the features of maxillofacial fractures presented at 6 Italian tertiary centers. Clinical records of all the patients diagnosed for facial fractures between February 23 and May 23, 2019 and 2020 were retrospectively reviewed. Any differences in patient number and characteristics and fracture etiology and site between the 2 groups were then statistically analyzed.

There has been a 69.1% decrease in the number of incoming patients during the pandemic. The number of foreign patients has decreased significantly (23.3% versus 9.6%, P = 0.011) while the average age has increased (38.6 versus 45.6 years old, P = 0.01). Specific statistical significant differences for accidental falls (31.8% versus 50.1%, P = 0.005) and sports injuries (16.9% versus 1.4%, P < 0.001) were found. Concerning fracture sites, significant differences have been found in relation to nasal (22.5% versus 11.4%, P = 0.009) and frontal sinus (0.9% versus 4.4%, P = 0.037) fractures. In conclusion, SARS-CoV-2 pandemic has significantly changed the epidemiology and the etiology of facial traumas.
Frontal Bone is Thicker in Women and Frontal Sinus is Larger in Men: A Morphometric Analysis
Authors: Ekşi Murat Şakir , Güdük Mustafa , Usseli Murat Imre
Published: November 2020

Cranial bone thickness and frontal sinus size are important parameters to be known before cranial procedures. Deep-learning systems have become popular for making bulk analyses to diagnose diseases/disorders and plan treatment algorithms in diverse fields of medicine. Deep-learning systems would be valuable assets also for cranial procedures. Deep-learning systems need normative values and variances of the population on which they are used. In the present study, the authors aimed to find out the normative values for skull bone thickness at 4 anatomical locations, and frontal sinus size. the authors also analyzed whether gender affected these values. Consecutive adult female and male patients that had presented to our outpatient and emergency clinics between December 2019 and April 2020 were evaluated. We included 174 patients (98 female and 76 male) into the final analysis. Skull bone thickness was measured in 4 anatomical compartments, and vertical dimension of the left and right frontal sinuses were measured. The mean thickness of frontal, parietal, temporal, and occipital bones was 7.9 mm, 9.7 mm, 6 mm, and 10.1 mm for men; 8.7 mm, 10.2 mm, 6.1 mm, and 10.1 mm for women, respectively. Women had significantly thicker frontal bone when compared to men (P = 0.009). Men had significantly larger frontal sinuses compared to women (16.1 mm versus 13.7 mm for right frontal sinus, P = 0.031; 16.4 mm versus 13.9 mm for left frontal sinus, P = 0.023). Women and men had thicker frontal bone, and larger frontal sinuses, respectively.
The Rising Interest in Canthoplasty: An Analysis of Online Search Trends
Authors: Panayi Adriana C. , Wu Mengfan , Liu Qinxin , Haug Valentin , Yu Zhen
Published: November 2020

Canthoplasty as a cosmetic procedure appears to be on the rise in the West. Online search query data offers a powerful tool for analyzing population trends, including changes in patient interest in surgical procedures. Cosmetic surgeons can utilize the internet to increase patient education and interest, as well as to provide information and address misinformation. In this study we sought to verify the increase in cosmetic canthoplasty, for the first time, through analysis of Internet search data, and to establish trends in the interest of Internet users for cosmetic canthoplasty. These trends were subsequently compared with trends in literature publication to establish whether there is a correlation between patient and surgeon interest in the procedure.
A New Graft Technique For Rhinoplasty: Modified One-Piece Nasal Cap With Alar Strut Graft
Authors: Resuli Ali Seyed , Oktem Fatih
Published: November 2020

Objectives:

This study was aimed to evaluate the effectiveness of the new graft technique-modified one-piece nasal cap with alar strut graft in rhinoplasty; both for aesthetical appearance and nasal functions.

Methods:

Forty-two patients, who underwent primary rhinoplasty operation with the new graft technique, were evaluated visually by photographing and functionally by the Cottle test and rhinomanometry measurement.

Results:

All of the patients had sufficient nasal vision; also nasal valve angles became wider and Cottle tests were negative in all patients after surgery. Postoperative nasal airflow values (both left and right) were significantly higher, and airway resistance (left, right, and total) values were significantly lower than preoperative values.

Conclusion:

With the new graft technique, the authors obtained both satisfying aesthetic results and intended functional improvement. This technique may be an alternative to combination of multiple graft techniques; with advantages of practical performing and less complication risks.
Findings and Prognostic Value of Lung Ultrasonography in Coronal Virus Disease 2019 (COVID-19) Pneumonia
Authors: Li Lu , Qin Aihua , Yang Xiao , Zhou Shuliang , Luo Yun , Zhu Fangfang , Hu Bo , Li Jianguo , Cai Shuhan , Peng Zhiyong
Published: November 2020

Purpose:

We used lung ultrasonography to identify features of COVID-19 pneumonia and to evaluate the prognostic value.

Patients and Methods:

We performed lung ultrasonography on 48 COVID-19 patients in an intensive care unit (ICU) (Wuhan, China) using a 12-zone method. The associations between lung ultrasonography score, PaO2/FiO2, APACHE II, SOFA, and PaCO2 with 28-day mortality were analyzed and the receiver operator characteristic curve was plotted.

Results:

25.9% areas in all scanning zones presented with B7 lines and 23.5% with B3 lines (B-pattern) on lung ultrasonography; 13% areas with confluent B lines (B-pattern), 24.9% in areas with consolidations, and 9.9% in areas with A lines. Pleural effusion was observed in 2.8% of areas. Lung ultrasonography score was negatively correlated with PaO2/FiO2 (n = 48, r = −0.498, P < 0.05) and positively correlated with APACHE II (n = 48, r = 0.435, P < 0.05). Lung ultrasonography score was independently associated with 28-day mortality. The areas under receiver operator characteristic curves of lung ultrasonography score were 0.735 (95% CI: 0.586–0.844). The sensitivity, specificity, and cutoff values were 0.833, 0.722, and 22.5, respectively.

Conclusions:

Lung ultrasonography could be used to assess the severity of COVID-19 pneumonia, and it could also reveal the pathological signs of the disease. The lung ultrasonography score on ICU admission was independently related to the ICU 28-day mortality.
Outcome Quality Beyond the Mean – An Analysis of 43,231 Pancreatic Surgical Procedures Related to Hospital Volume
Authors: Hunger Richard , Mantke Rene
Published: November 2020

Objective:

The aim of this study was to examine whether elevated in-hospital mortality rates in lower volume hospitals are only valid on average or also apply for individual hospitals.

Summary of Background Data:

Various studies demonstrated a volume-outcome relationship in pancreatic surgery with increased mortality in low volume hospitals. However, almost all studies assessed quality indicators only for groups of hospitals by averaged measures, neglecting variability of hospital performance.

Methods:

The German nationwide hospital discharge data (diagnosis-related groups-statistics) was used to determine risk-adjusted in-hospital mortality for all distal pancreatectomies (DP), pancreatoduodenectomies (Whipple-proce-dure, PD), and pylorus-preserving pancreatoduodenectomies (PPD) performed between 2011 and 2015. Hospitals were stratified according to annual and 5-year total procedure volume and examined in relation to average in-hospital mortality of the highest volume quintile.

Results:

Lowest adjusted mortality rates were observed in highest volume quintiles for each pancreatic resection procedure, with 6.2% for DP, 8.3% for PD, and 5.7% for PPD in the 5-year observation period. With these mortality rates as reference values the analysis revealed that a non-negligible proportion of hospitals performed equal or better (DP: 430/784, 54.5%; PD: 269/611, 44.0%; PPD: 255/565, 45.1%) than the hospitals of the highest volume quintile.

Conclusions:

High quality of care, with in-hospital mortality rates less or equal to high-volume hospitals, is also achieved in hospitals with lesser procedure volume. Therefore, mere volume seems not suitable as proximal measure for assessing individual hospital quality. instead, more sophisticated certification systems, that allow accurate quality assessment and better reflect clinical variability, should preferred to fixed minimum volume thresholds.