bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective analysis of HEART Score results in cost saving
Authors: Arnold Sandra A. , Grant Cathy , Magdic Kathy , Hickey Gavin W. , Tedesco Mary Beth
Published: June 2019

Background and purpose:

Chest pain (CP) is one of the most frequent chief complaints of patients presenting to the emergency department (ED). Diagnoses range from life-threatening acute coronary syndrome (ACS) to less concerning musculoskeletal injury. Patients are frequently admitted for comprehensive cardiac evaluation. However, it is estimated that <10% are diagnosed with ACS. Identifying low-risk patients who can be safely discharged from the ED results in lower cost burden and less patient days. The HEART Score is a recently validated tool for undifferentiated CP in the ED used to identify low-risk patients. The purpose of this project was to ascertain if the HEART Score could be utilized in the Veteran population for the evaluation of undifferentiated chest pain.

Local problem:

There is no standard assessment tool used in the ED at the Veterans Administration Pittsburgh Healthcare System (VAPHS) to evaluate CP in low-risk patents.

Methods:

As part of a quality improvement initiative, a retrospective analysis was performed on patients presenting to the ED with CP over a 6-month period. A total of 197 VAPHS patients were identified through the computerized medical record system. HEART Scores were calculated for each patient. Patients scored as low risk (score of 0–3) were further evaluated for major adverse cardiac events (MACE) and cost saving.

Conclusions:

Approximately 28% (56) of the patients presenting to the ED with CP were at low risk based on the HEART Score. There were no MACE. There were cost savings compared with usual care ($1,145 vs. $4,700).

Implications for practice:

The HEART Score can be safely used to identify low-risk patients and result in cost savings for Veteran population.
Postpartum problems in primary care: Focus on postpartum depression and diabetes
Authors: Cabrera Jacqueline P.
Published: June 2019

Postpartum depression and diabetes are common diagnoses affecting many childbearing women annually. Nevertheless, disease management by the primary care provider can be complicated by late entry to care or insufficient care. Pharmacotherapeutic interventions must be initiated appropriately to address the disease progression while supporting breastfeeding. This study explores the course of postpartum depression and diabetes in a postpartum woman using the case study application and analysis along with interventions and education that can help primary care providers in reducing the complications that come from undiagnosed depression and diabetes in the postpartum period.
Incidence of dysphagia of zero-profile spacer versus cage-plate after anterior cervical discectomy and fusion
Authors: Yang Zhongmeng , Zhao Yao , Luo Jiaquan
Published: June 2019

Background:

The purpose of this study is to evaluate the rate of dysphagia between zero-profile spacer versus cage-plate for the treatment of multilevel cervical spondylotic myelopathy (CSM).

Methods:

The authors searched electronic databases for relevant studies that compared the clinical effectiveness of zero-profile spacer versus cage-plate for the treatment of patients with multilevel CSM. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) score and fusion rate, dysphagia rate, adjacent segment degeneration, and cervical lordosis. Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of each study. Data extraction and quality assessment were conducted, and RevMan 5.2 was used for data analysis.

Results:

A total of 10 studies were included in our meta-analysis. Our pooled data revealed that zero-profile spacer was associated with decreased dysphagia rate at postoperatively 1, 3, and 6 months, and the final follow-up when compared with cage-plate group. No significant difference was observed in terms of postoperative JOA score, NDI score, and fusion rate. Compared with zero-profile spacer, the postoperative adjacent segment degeneration was significant higher in cage-plate. Pooled data from the relevant studies revealed that cervical lordosis was significantly lower in zero-profile spacer compared with cage-plate.

Conclusions:

Our meta-analysis reveals zero-profile spacer is better than the cage-plate in terms of dysphagia. This suggests zero-profile spacer is a superior alternative invention for the treatment of multilevel CSM to reduce the risk of dysphagia.
Natural history of leiomyomas beyond the uterus
Authors: Barnaś Edyta , Raś Renata , Skręt-Magierło Joanna , Wesecki Mariusz , Filipowska Justyna , Książek Mariusz , Skręt Andrzej , Widenka Kazimierz
Published: June 2019

Rationale:

Most leiomyomas are located in the uterus. Leiomyomas are rarely found outside the uterus and classified as leiomyoma beyond the uterus (LBU). This group consists of disseminated peritoneal leiomyomatosis, benign metastasizing leiomyoma, intravenous leiomyomatosis, parasite leiomyoma located in the broad ligament and retroperitoneal space. The descriptions of the patients who suffer from these types of leiomyomas are presented mainly in case reports.

Patient concerns:

A 34-year-old multiparous woman was operated on multiple recurrent uterine leiomyoma in parametrium. At one time, 32 leiomyomas were removed. Thirteen months following it, in next laparotomy, 132 leiomyomas were excised. Histologically, both were intravenous leiomyomas (IVLs).

Diagnosis and Interventions:

In follow-up, computed tomography (CT) and magnetic resonance imaging scans were performed to look for next recurrent leiomyoma. Accidentally, the mass was found in inferior vena cava which was diagnosed as intravenous vena cava leiomyoma. The mass was removed and the final diagnosis of intravenous myoma was confirmed in histopathology.

Outcomes:

CT scan performed 3 months after the surgery for leiomyoma in vena cava revealed no pathology. Next 10 months’ follow-up was uneventful.

Lessons:

The recurrent multiple uterine leiomyoma precede LBU. The uterine leiomyoma spreads intravenously route to parametria as parasite leiomyoma, then to vena cava. It has to be taken into account in follow-up.
Romiplostim-related myelofibrosis in refractory primary immune thrombocytopenia
Authors: Kim Hyun-Young , Park Sung Woo , Kim Jung Hoon , Kang Jung Hun , Lee Won Seop , Song Haa-Na
Published: June 2019

Rationale:

Primary immune thrombocytopenia (ITP) is an immune-mediated disease that is defined as increased platelet destruction and impaired platelet production. Treatment is recommended for highly selected patients, the standard regimen includes glucocorticoid, intravenous immunoglobulin (IVIG). The recombinant thrombopoietin (TPO) receptor agonists, romiplostim, stimulate platelet production and have approved for glucocorticoid or IVIG, splenectomy-refractory chronic ITP patients.

Patient concerns:

A patient has been diagnosed with ITP, reftractory to steroid, IVIG, splenectomy, danazol, and cyclosporine. The patient received romiplostim to normalize his platelet count, however, over the course of the following year, his platelet counts progressively decreased despite increasing the romiplostim dosing.

Diagnoses:

A peripheral blood smear showed a severe leukoerythroblastic reaction and bone marrow biopsy demonstrated myelofibrosis due to romiplostim.

Outcomes:

Since this diagnosis, romiplostim was discontinued for a while, after 3 months, romiplostim was re-administered to improve thrombocytopenia. His platelet count recovered to 70,000/mm3 after the administration of romiplostim at 2 μg/kg, and he did not experience complications for 6 months.

Lessons:

This report represents the first evidence of romiplostim-induced myelofibrosis, which was associated with increased levels of bone marrow reticulin and Masson trichrome staining.
The relationship between physical fitness and health self-assessment in elderly
Authors: Knapik Andrzej , Brzęk Anna , Famuła-Wąż Anna , Gallert-Kopyto Weronika , Szydłak Dorota , Marcisz Czesław , Plinta Ryszard
Published: June 2019

Background:

The process of population aging inclines to seek determinants of the quality of life in the older people. Health self–assessment is the one of the main elements of the quality of life. In the older people it is associated with functional efficiency. The aim of the study was to determine correlations of physical fitness and health self-assessment.

Methods:

The study group included 123 people aged 60 to 86 years. Physical fitness was evaluated using the Senior Fitness Test (SFT). Self-esteem of health was assessed by the SF-36 questionnaire.

Results:

The analysis included sex factor and the occurrence of chronic diseases. When comparing with healthy participants, people suffering from chronic diseases revealed a lower level of physical fitness (P < .05) and health self-assessment (P < .05). The results of a significant percentage of study participants were worse than norms proposed as standards. The percentage of people below norms varied depending on sex, age, and SFT assessment and ranged from 0 to 89.5%.

Conclusion:

Physical fitness and health self-assessment among elderly may be strongly determined by cultural conditions, for example, habits, lifestyle in various regions. The application of conclusions suggests that the key element of rehabilitation programs among elderly should be focused on improving coordination and locomotor capabilities. Assessment of the elderly is more clearly associated with physical fitness in women than in men and also more in patients chronically ill than in healthy person. Comprehensive assessment of physical fitness according to standardized values does not indicate the diversity by sex.
Ketosis-prone diabetes mellitus in an obese adolescent
Authors: Tan Huiwen , Wang Chun , Yu Yerong
Published: June 2019

Rationale:

In recent years, there are more new insights into the clinical susceptibility, pathophysiological mechanism, and progression of classification and treatment of ketosis-prone diabetes mellitus (KPDM), which was once described as Idiopathic Type 1 Diabetes, Type 1B Diabetes or Flatbush Diabetes. ketosis-prone diabetes mellitus is still a heterogeneous syndrome reported in African-American or western Sub-Sahara-African, Hispanic descendant, and recently in Asian.

Patient concerns:

An obese 17-year-old student was admitted to a tertiary referral hospital (teaching hospital), presenting with thirst, polyuria fatigue, and a 9 kg weight loss in the preceding two weeks.

Diagnoses:

Physical examination showed body mass index (BMI) was 32.77 kg/m2, arterial blood gas revealed a pH of 7.31. Serum glucose was 27.8 mmol/L with strong positive uric ketones (++++). Hemoglobin A1c (HbA1c) was 13.6%. The glucose disposal ratio (GDR) during the steady-state of euglycemic clamp test was 5.62 mg/kg/min and M value was 2.87 mg/kg/min during hyperglycemic clamp test. Those findings were sufficient to establish a diagnosis of ketosis-prone diabetes mellitus.

Interventions:

This obese patient with KPDM received intensive insulin therapy and fluids infusion, and during the remainder of hospitalization his insulin requirement was approximately 1.5 U per kilogram of body weight per day. Blood glucose monitoring was rigorous until the diabetic ketoacidosis under control.

Outcomes:

He achieved the near-nomalglycemic remission uneventfully. At 12-month follow-up, his treatment was adjusted from insulin subcutaneous injection to oral hypoglycemic drugs.

Lesson:

The present study of this obese adolescent with negative auto-antibodies but unprovoked diabetic ketoacidosis and partially preserved beta cell functional reserve after the acute of diabetic ketosis suggested that he has the phenotype of “A–β+” KPDM. Further study of this syndrome will help illustrate the inadequacy of current classification and targeted therapies.
Allopurinol-induced toxic epidermal necrolysis featuring almost 60% skin detachment
Authors: Wang Feifei , Ma Zhuo , Wu Xinan , Liu Lihong
Published: June 2019

Rationale:

Toxic epidermal necrolysis (TEN) is a life-threatening, immunologically mediated, and usually drug-induced disease. Rarely, clinical pharmacists participating in finding the etiology have been reported.

Patients concerns:

A 33-year-old male presented to the emergency department with a 1-day history of fever and rash. The patient, being newly diagnosed with gout 10 days ago, received allopurinol at a dose of 250 mg by mouth daily. After 10 days’ exposure to allopurinol, the patient manifested with an “influenza-like” prodromal phase (fever of 38°C, throat pains), which was treated with amoxicillin and nonsteroidal anti-inflammatory drugs of the oxicam type. The next day, he developed a worsening fever of 39.5°C, accompanied by a pruriginous rash all over his body.

Diagnosis:

On physical examination, we observed coalescing dusky red macules over >60% of his body surface area, with blisters and detachment of large sheets of necrolytic epidermis all over his chest and face. The diagnosis of TEN was confirmed.

Interventions:

The patient recovered following treatment with short-term high-dose methylprednisolone sodium succinate, immunoglobulin therapy, topical medication, and supportive therapy.

Outcomes:

He showed a slow but progressive improvement both in symptoms and cutaneous manifestations. Reepithelization of the skin was achieved after 3 weeks.

Lessons:

Drug-induced-TEN is potentially fatal. This case underlines the necessity of asking medication history in detail and detecting related drug gene to correctly identify the cause of TEN.
Lung adenocarcinoma metastasizing to fibrous histiocytoma
Authors: Liu Yang , Dai Bing
Published: June 2019

Rationale:

Tumor-to-tumor metastasis is an uncommon phenomenon, and the tumor metastatic to mesenchymal tumor is extremely rare. To our knowledge, this is the first case of lung adenocarcinoma metastasizing to fibrous histiocytoma.

Patient concerns:

A 58-year-old Chinese woman was admitted to our hospital with a complaint of progressive enlargement of a mass in the right upper arm without pain, heat (localized warmth), redness, and swelling, for a year.

Diagnoses:

Ultrasound revealed a mass with relative clear boundary in the right upper arm near elbow joint. Uneven echoes, and blood flow signals were showed within the mass. The tumor was well-demarcated from the surrounding tissue a thin fibrous capsule. Scattered enlarged cells with hyperchromatic pleomorphic nuclei were dispersed in an otherwise typical cutaneous fibrous histiocytoma. These atypical cells arranged in poorly glandular structures or irregular epithelioid nest and were demonstrated as metastatic lung adenocarcinoma by immunohistochemical staining. We reviewed the biopsy section and found these 2 sites of adenocarcinoma shared similar histologic morphological features. Therefore, the final diagnosis was lung adenocarcinoma metastasizing to fibrous histiocytoma.

Interventions:

The patient was diagnosed with lung adenocarcinoma by bronchoscopic biopsy 3 months ago and received 4 cycles of NP (Vinoreltraye [NVB] + cis-platinum) chemotherapy program. The patient underwent a total resection of the mass in right upper arm.

Outcomes:

The patient died of multiple organ failure after 10 months since she was diagnosed as lung adenocarcinoma.

Lessons:

The accumulation of lipid droplets in fibrous histiocytoma may be a potential reason for modifying pre-metastatic niche, and therefore create a tumor microenvironment suitable for metastasis.
A typical 22q11.2 deletion syndrome and pseudohypoparathyroidism
Authors: Liu Xi-Juan , Yan Chen , Jia Jing-Yu
Published: June 2019

Rationale:

It is rare to find 22q11.2 deletion syndrome with pseudohypoparathyroidism in children. Furthermore, the phenotypic spectrum of this disorder varies widely.

Patient concerns:

A patient was diagnosed with pseudohypoparathyroidism at age 14 years because of convulsions, hypocalcemia, hyperphosphatemia, normal parathyroid hormone levels, and basal ganglia calcifications. Thereafter, the child presented with symptoms of nephrotic syndrome; subsequently, he was diagnosed with nephrotic syndrome at the local hospital.

Diagnosis:

At our hospital, multiplex ligation-dependent probe amplification confirmed that the patient had 22q11.2 deletion syndrome.

Interventions:

The patient continued to be treated with calcium supplements.

Outcomes:

Seizure activity and proteinuria ceased.

Lessons:

Signs of this syndrome include delayed speech development due to velofacial dysfunction, recurrent croup attacks during early childhood due to latent hypocalcemia, and mild dysmorphic features. The findings of this patient indicated that 22q11.2 deletion syndrome may include a wide spectrum of clinical findings and that this diagnosis needs to be considered for all patients presenting with hypocalcemia, regardless of age.
Clinical outcome after lipectomy in the management of patients with human immunodeficiency virus-associated dorsocervical fat accumulation
Authors: Chen Song , Gui Xi-en , Cao Qian , Routy Jean-Pierre
Published: June 2019

Lipo-accumulation of the dorsocervical fat pad (“buffalo hump”) is a complication observed in people living with human immunodeficiency virus (HIV). We described the clinical outcome of people living with HIV with “buffalo hump” treated by excisional lipectomy.

From April 2013 to March 2018, medical records of people living with HIV, who received care in our hospital have been evaluated. Among them, patients with dorsocervical fat accumulation treated by excisional lipectomy have been retrospectively assessed.

Nine patients with “buffalo hump” among 2886 people living with HIV (3.1‰, 9/2886) were included. Eight were women with a mean age of 47.9 ± 8.0 years old (range, 36–60). Most of them have been infected by blood transfusion (77%, 7/9) and the mean duration of HIV infection was 14.1 ± 5.5 years (range, 6–22). The mean duration for antiretroviral therapy was 8.8 ± 2.1 years (range, 6–11). The mean pre-ART CD4+ T cell count was 91.3 ± 76.5 cells/μL (range, 4–233) and 477.4 ± 271.8 cells/μL (range, 114–926) at the time of surgery. All 9 patients underwent excisional lipectomy of their hypertrophied dorsocervical fat pad. The mean size of the excised specimens was 14 × 11 × 6 cm. The median follow-up time was 24 months (range, 2–60), all 9 patients reported satisfaction with their results, with no recurrence has been observed.

Corrective surgery used to treat localized fat accumulations in people living with HIV with “buffalo hump” showed a favorable effect and can therefore be considered when necessary. Whereas drugs such as integrase inhibitors may avoid lipo-accumulation related syndrome and should be given to people living with HIV in China.
Management of venous perforation during central venous catheterization in hemodialysis patients
Authors: Xu Li-Yun , Chen De-Jun , Wang Sha-Sha , Chen Lu , Qi Feng , Liu Man-Man
Published: June 2019

Rationale:

In recent years, central venous catheterization (CVC) has become widely used for hemodialysis patients. Based on 3 cases, we discussed the detection and management of venous perforation at an early stage.

Patients concerns:

Patients 1 (male, 77 years), 2 (male, 82 years), and 3 (male, 30 years) were diagnosed with uremia and underwent hemodialysis.

Diagnoses:

Computed tomography suggested pneumomediastinum in patient 1 and pneumothorax in patient 2 after a replacement of the temporary hemodialysis catheter. In patient 3, X-ray suggested that the tip of the catheter was approximately at the plane of the fifth thoracic vertebrate after the temporary catheter was placed.

Interventions:

In patients 1 and 2, the catheters were maintained where they were for about 2 weeks until a false lumen formed outside the catheter. In patient 3, the catheter was withdrawn at once when vein perforation was observed.

Outcome:

In patients 1 and 2, the catheters were adjusted successfully under digital subtraction angiography (DSA) guidance 2 weeks later. In patient 3, hemothorax developed, and a total of approximately 1000 mL of bloody fluid was drained.

Lessons:

When venous perforation occurs during CVC, it is safer and more reliable to adjust or withdraw the catheter under DSA guidance after a false lumen forms outside the catheter.
Bacterial Content of Fortified and Unfortified Holder Pasteurized Donor Human Milk During Prolonged Refrigerated Storage
Authors: Mandru Cosmina , Perrin Maryanne T. , Iyer Radha , Liveris Dionysios , Schwartz Ira , Alpan Gad , Parvez Boriana
Published: June 2019

Objective:

To assess the microbial growth in unfortified and fortified Holder pasteurized donor human milk (HPDHM) during 96 hours of refrigerated storage in a clinical setting.

Methods:

Thirty‐six unfortified samples and 77 fortified samples of HPDHM were prepared in a neonatal intensive care milk preparation room and stored in the NICU refrigerator at 4°C to simulate a real‐life feeding environment. One milliliter aliquots were removed at 24‐hour intervals and cultured in duplicate for bacterial growth on solid blood agar medium. Viable bacterial colonies were characterized using standard microbiological methods.

Results:

96.5% of milk samples manipulated in a vertical laminar flow hood were negative for bacterial growth. In the remainder 3.5% of the samples, the maximum growth was 1 colony forming unit/0.1 ml plated. Higher colony counts were observed when the laminar hood was not used. In all cases, the colonies represented common skin bacteria and demonstrated an inconsistent and unsustained growth. Fortifier status and storage time were not significantly associated with increased bacterial growth (P > 0.05).

Conclusions:

Unfortified and fortified HPDHM remain largely free of bacterial growth for up to 96 hours of refrigerated storage in NICU settings. Sample handling techniques are important for preventing microbial contamination.
Decision-Making Around Positive Tracheal Aspirate Cultures: The Role of Neutrophil Semiquantification in Antibiotic Prescribing
Authors: Yalamanchi Sirisha , Saiman Lisa , Zachariah Philip
Published: June 2019

Objectives:

Ventilator-associated infections are a major contributor to antibiotic use in the PICU. Quantitative or semiquantitative assessment of neutrophils (microscopic purulence) is routinely reported in positive cultures from tracheal aspirates. The role of microscopic purulence in guiding antibiotic therapy or its association with symptoms of ventilator-associated infections is less described in children. We examine microscopic purulence as an independent predictor of antibiotic use for positive tracheal aspirate cultures in the PICU.

Design:

Retrospective cohort study.

Setting:

Tertiary care pediatric hospital.

Patients:

Children admitted to the PICU, neuro-PICU, or cardiac PICU with a positive tracheal aspirate culture from January 1, 2016, to December 31, 2016.

Interventions:

None.

Measurements and Main Results:

Positive tracheal aspirate cultures were reviewed. The outcome variable was antibiotic treatment that targeted the positive tracheal aspirate culture. The predictor variable was microscopic purulence, defined as moderate or many neutrophils on Gram stain report. Competing predictors included demographics, comorbidities, vital signs changes, respiratory support, and laboratory values. Of 361 positive cultures in the cohort, 81 (22%) were treated with antibiotics. Positive cultures with microscopic purulence were targeted for therapy more frequently (30% vs 11%). Microscopic purulence was the strongest predictor for antibiotic therapy (odds ratio, 3.3; 95% CI, 1.6–6.8) compared with fever (odds ratio, 2.0; 95% CI, 1.0–4.1) or increased respiratory support (odds ratio, 2.3; 95% CI, 1.2–4.3). There was no significant variation in symptomatology between microscopic purulence reported as moderate or many versus other (e.g., fever –24% vs 22%, increased respiratory support –36% vs 28%). Microscopic purulence was less prevalent with longer ventilator durations at the time of sampling.

Conclusions:

Microscopic purulence was an independent predictor of antibiotic therapy for positive tracheal aspirate cultures in our PICUs. However, microscopic purulence was not associated with clinical symptomatology.
Trauma Bay Disposition of Infants and Young Children With Mild Traumatic Brain Injury and Positive Head Imaging
Authors: Noje Corina , Jackson Eric M. , Nasr Isam W. , Costabile Philomena M. , Cerullo Marcelo , Hoops Katherine , Rasmussen Lindsey , Henderson Eric , Ziegfeld Susan , Puett Lisa , Robertson Courtney L.
Published: June 2019

Objectives:

To describe the disposition of infants and young children with isolated mild traumatic brain injury and neuroimaging findings evaluated at a level 1 pediatric trauma center, and identify factors associated with their need for ICU admission.

Design:

Retrospective cohort.

Setting:

Single center.

Patients:

Children less than or equal to 4 years old with mild traumatic brain injury (Glasgow Coma Scale 13–15) and neuroimaging findings evaluated between January 1, 2013, and December 31, 2015. Polytrauma victims and patients requiring intubation or vasoactive infusions preadmission were excluded.

Interventions:

None.

Measurements and Main Results:

Two-hundred ten children (median age/weight/Glasgow Coma Scale: 6 mo/7.5 kg/15) met inclusion criteria. Most neuroimaging showed skull fractures with extra-axial hemorrhage/no midline shift (30%), nondisplaced skull fractures (28%), and intracranial hemorrhage without fractures/midline shift (19%). Trauma bay disposition included ICU (48%), ward (38%), intermediate care unit and home (7% each). Overall, 1% required intubation, 4.3% seizure management, and 4.3% neurosurgical procedures; 15% were diagnosed with nonaccidental trauma. None of the ward/intermediate care unit patients were transferred to ICU. Median ICU/hospital length of stay was 2 days. Most patients (99%) were discharged home without neurologic deficits. The ICU subgroup included all patients with midline shift, 62% patients with intracranial hemorrhage, and 20% patients with skull fractures. Across these imaging subtypes, the only clinical predictor of ICU admission was trauma bay Glasgow Coma Scale less than 15 (p = 0.018 for intracranial hemorrhage; p < 0.001 for skull fractures). A minority of ICU patients (18/100) required neurocritical care and/or neurosurgical interventions; risk factors included neurologic deficit, loss of consciousness/seizures, and extra-axial hemorrhage (especially epidural hematoma).

Conclusions:

Nearly half of our cohort was briefly monitored in the ICU (with disposition mostly explained by trauma bay imaging, rather than clinical findings); however, less than 10% required ICU-specific interventions. Although ICU could be used for close neuromonitoring to prevent further neurologic injury, additional research should explore if less conservative approaches may preserve patient safety while optimizing healthcare resource utilization.
Distally Based Posterior Tibial Artery Perforator Flaps for Reconstruction of the Defects in Achilles Region
Authors: Li Pandeng , Li Zhihua , Shen Guoliang
Published: June 2019

Background

Patients with Achilles region defects remain a challenge for clinicians. The purpose of this article is to evaluate the surgical procedure to reconstruct the defects in Achilles region using distally based posterior tibial artery perforator flaps.

Methods

Between May 2015 and May 2017, 10 patients (aged from 35 to 68 years. 4 females and 6 males) with soft-tissue defects (sizes from 3 × 2 cm to 8 × 4 cm) in Achilles region received surgical therapy of posterior tibial artery perforator flap transplantation in the Affiliated Hospital of Xuzhou Medical University.

Results

The length of hospital stay ranged from 10 to 15 days (mean, 12 days). Local small superficial necrosis (5% of the area) was observed in only 1 case; however, it healed well after dressing was changed. All the others survived and healed well. At follow-up ranging from 12 to 24 months, all patients were satisfied with the aesthetic and functional aspects.

Conclusions

Using the posterior tibial artery perforator flaps to cover the Achilles region defects is a promising, feasible, first-line, safe option and should be extensively applied in clinical therapy.
The Molecular Pathogenesis of Dupuytren Disease
Authors: Sayadi Lohrasb R. , Alhunayan Danah , Sarantopoulos Nikolaos , Kong Christina , Condamoor Shreya , Sayadi Jamasb , Banyard Derek A. , Shaterian Ashkaun , Leis Amber , Evans Gregory R. D. , Widgerow Alan D.
Published: June 2019

Background

Ever since the classification of Dupuytren disease into the proliferative, involutional, and residual stages, extensive research has been performed to uncover the molecular underpinnings of the disease and develop better treatment modalities for patients. The aim of this article is to systematically review the basic science literature pertaining to Dupuytren disease and suggest a new approach to treatment.

Methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was conducted using the MEDLINE database to identify basic science literature on Dupuytren pathophysiology falling under 1 or more of the following categories: (1) Molecular alterations, (2) Structural alterations, and (3) Genetic predisposition.

Results

A total of 177 articles were reviewed of which 77 studies met inclusion criteria. Articles were categorized into respective sections outlined in the study methods.

Conclusion

The pathophysiological changes involved in Dupuytren’s disease can be divided into a number of molecular and structural alterations with genetic predisposition playing a contributory role. Understanding these changes can allow for the development of biologics which may disrupt and halt the disease process.
Labiolysis, Corrective Surgery for Iatrogenic Labium Minus Fusion
Authors: Ostrzenski Adam
Published: June 2019

Background

In this study, corrective labium minus iatrogenic fusion was termed labiolysis. This procedure is a new surgical concept for the therapy of iatrogenic, symptomatic labium minus fusion by revising scar and releasing the labium minus from iatrogenic unnatural fusion with the labium majus and intralabial crease. This study presents a new surgical technique and a review of the pertinent literature on labial fusion and its therapy. In addition, this investigation identified labial fusion risk factors associated with esthetic labioreduction of the labia minora and the likelihood of prevention of this surgical complication. The objectives were to (a) describe step-by-step labiolysis surgical intervention, (b) ascertain surgical outcomes of labiolysis, (c) authenticate specific symptom(s) associated with iatrogenic labium minus fusion and how these symptoms affect the quality of life, (d) assess the labiolysis' ability to relief symptoms of labium minus iatrogenic fusion, and (e) present a specific postoperative care.

Methods

A prospective cohort study with a control group was conducted. The study group consists of 7 subjects associated with iatrogenic, symptomatic labium minus fusion and the control group, which also consists of 7 women who were subjected to fenestration labioreduction of the labia minora. The follow-up was conducted for 3 years in both groups. All subjects, from both groups, consented in writing their participation in the study. Validated instruments were used before and after labiolysis to evaluate the outcomes.

Results

There are no data in the medical literature describing a conservative medical or surgical treatment for iatrogenic, symptomatic labium minus fusion. In both groups, surgeries were performed under local anesthesia. In either group, no reoperation was performed, and no major or minor complications were observed. All preoperative symptoms associated with iatrogenic labial fusion were cured by labiolysis. Anatomical deformities were either corrected or classified as a satisfactory anatomical outcome. In both groups, the postoperative course was uneventful with full ambulation on the first postoperative day, driving a car on the third day, and returning back to work within 1 week.

Conclusions

Labiolysis is a simple surgical operation with a short learning curve, which relieves symptoms, improves quality of life associated with iatrogenic labium minus fusion, and provides an esthetically pleasing surgical outcome. In this study group, no minor and no major surgical complications were observed, and no reoperation was performed.
Keloid Excision and Adjuvant Treatments
Authors: Siotos Charalampos , Uzosike Akachimere C. , Hong Hwanhee , Seal Stella M. , Rosson Gedge D. , Cooney Carisa M. , Cooney Damon S.
Published: June 2019

Background

Keloid disease treatment continues to be unsatisfactory with high recurrence rates. We evaluated the literature regarding the effectiveness of keloid excision with various adjuvant treatments following surgery and assessed recurrence rates.

Methods

We systematically searched databases through November 2016. We performed pairwise meta-analyses and Bayesian network meta-analyses on the number of recurrences.

Results

Following screening, 14 studies including 996 patients with various types of keloids were eligible for inclusion. Patients were categorized based on the receipt of surgery and the type of adjuvant treatment employed afterward. Paired meta-analysis (6 meta-analyses) showed that “excision + 1 adjuvant drug” led to statistically significantly higher odds of recurrence compared to “excision + radiation” (odds ratio [OR], 3.22; 95% confidence interval [CI], 1.35–7.67). Based on the network meta-analyses, the ORs of keloid recurrence following various treatments compared to no excision were as follows: “excision + pressure, 0.18 (95% CI, 0.01–7.07); excision + 2 adjuvants drugs, 0.47 (95% CI, 0.02–12.82); excision + radiation, 0.39 (95% CI, 0.04–3.31); excision + skin grafting, 0.58 (95% CI, 0.00–76.10); excision + 1 adjuvant drug, 1.76 (95% CI, 0.17–21.35); and excision only, 2.17 (95% CI, 0.23–23.95).

Conclusions

According to our results, “excision + radiation” had significantly better outcomes than excision alone. “Excision + pressure” had better outcomes than excision + any other treatment modality, and excision + nonradiation adjuvant therapies were also better than “excision only,” although these findings did not reach statistical significance.
Micro/nanobubbles
Authors: Sayadi Lohrasb R. , Alexander Michael , Sorensen Alexandria M. , Sarantopoulos Nikolaos , Lau Hien , Klopfer Michael , Ziegler Mary E. , Banyard Derek A. , Evans Gregory R. D. , Lakey Jonathan R. T. , Widgerow Alan D.
Published: June 2019

Purpose

The preservation of transplantable tissue is directly tied to and limited by the ischemia time. Micro/nanobubbles (MNBs) are miniature gaseous voids that allow for the oxygenation of tissue given their high oxygen-carrying capacity. One of the current limitations of islet cell transplantation for type 1 diabetes is poor islet survival, caused by hypoxia, after harvesting the cells from pancreata. As such, the purpose of this study was to elucidate whether MNBs, when added to standard culture medium, improve islet cell survival postharvest.

Materials and Methods

Islet cells were harvested from Sprague-Dawley rat pancreas tissue via a standard collagenase digestion and gradient purification. To create the MNB solution, a shear-based generation system was used to produce both air- and oxygen-filled MNBs in standard Connaught Medical Research Laboratories (CMRL) medium. Four groups, consisting of 500 islet equivalents, were cultured with either the standard CMRL medium, macrobubble-CMRL, MNB (air)-CMRL, or MNB (O2)-CMRL, and they were incubated at 37°C. Each treatment solution was replenished 24 hours postincubation, and after 48 hours of culture, dithizone staining was used to determine the islet cell counts, and the viability was assessed using Calcein AM/propidium iodide staining.

Results

Islet cells that were preserved in macrobubble-CMRL, MNB (air)-CMRL, and MNB (O2)-CMRL conditions showed an increased survival compared with those cultured with standard CMRL. The islet cells cultured in the MNB (air)-CMRL condition demonstrated the greatest cell survival compared with all other groups, including the pure oxygen-carrying MNBs. None of the MNB treatments significantly altered the viability of the islet cells compared to the control condition.

Conclusions

The addition of MNBs to culture medium offers an innovative approach for the oxygenation of transplantable tissue, such as islet cells. This study demonstrated that MNBs filled with air provided the most optimal addition to the islet cell culture medium for improving islet cell survival amongst the treatment groups we tested. Given these findings, we hypothesize that MNBs may also improve the oxygenation and survival of a variety of other tissues, including fat grafts from lipoaspirate, chronic wounds, and solid organs.
Fully Automatic Robot-Assisted Surgery for Mandibular Angle Split Osteotomy
Authors: Sun Mengzhe , Chai Yuanhao , Chai Gang , Zheng Xiaohu
Published: June 2019

With the development of computer-assisted surgery, preoperational design is detailed in software. However, it is still a challenge for surgeons to realize the surgical plan in the craniofacial surgery. Robot-assisted surgery has advantages of high accuracy and stability. It is suitable for the high-stress procedures like drilling, milling, and cutting. This study aims to verify the feasibility for automatic drilling without soft tissues in model test based on an industrial robot platform.

This study chose the data from digital laboratory in Shanghai 9th People's Hospital. The mandibular was reconstructed in software and surgical plan was also designed. Then, the coordinate data was input to the robot's software and matrix conversion was calculated by 4 marked points. The trajectory generation was calculated by inverse kinematics for target coordinates and robot coordinates. The model was fixed and calibrated for automatic drilling. At last, the accuracy was calculated by optic scanning instrument.

The installment and preparation cost 10 minutes, the drilling procedure cost 12 minutes. The outside position error was (1.71 ± 0.16) mm, the inside position error was (1.37 ± 0.28) mm, the orientation error was (3.04 ± 1.02)°. Additionally, a total of 5 beagles were tested, with an accuracy error of (2.78 ± 1.52) mm. No postoperative complications occurred.

This is the first study reported for robot-assisted automatic surgery in craniofacial surgery. The result shows it is possible to realize the automatic drilling procedure under the condition of no interference like soft tissues. With the development of artificial intelligence and machine vision, robot-assisted surgery may help surgeons to fulfill more automatic procedures for craniofacial surgery.
The Drilling Guiding Templates and Pre-Bent Titanium Plates Improves the Operation Accuracy of Orthognathic Surgery With Computer-Aided Design and Computer-Aided Manufacturing Occlusal Splints for Patients With Facial Asymmetry
Authors: Hu Pei , Li Jiayang , Du Wen , Ji Huanzhong , Xu Chunwei , Luo En
Published: June 2019

Facial asymmetry is a common maxillofacial deformity which requires surgery to recover the 3-dimensional relationship of bones. The computer-aided design and computer-aided manufacturing (CAD/CAM) has been developed and applied to improve orthognathic analysis and surgery design. How to accurately realize the preoperative design of orthognathic surgery with CAD/CAM occlusal splints during operation remains a big problem. In this study, 24 consecutive patients with facial asymmetry were recruited and assigned to 2 groups. For Group A, CAD/CAM was applied to designing and producing not only the occlusal splints, but also the drilling guiding templates and pre-bent titanium plates, and for Group B CAD/CAM was applied for occlusal splints only. Postoperative clinical examinations, symmetry evaluation through 3D cephalometric analysis, accuracy comparison using color distance maps and quantitative accuracy analysis were performed. Symmetry evaluation showed that patients of both groups achieved improved facial symmetry after surgery. The color distance maps and quantitative accuracy analysis together demonstrated significantly less difference found between virtual simulated surgery and postoperative CT scan data in Group A than in Group B. In conclusion, by navigation with the drilling guiding templates and pre-bent titanium plates, the facial symmetry for patients with facial asymmetry was successfully restored after orthognathic surgery, same as applying CAD/CAM occlusal splints only. However, the drilling guiding templates and pre-bent titanium plates would provide a more accurate performance according to preoperative simulation, especially for proximal mandibular segments.
Spontaneous Osteogenesis of a Traumatic Mandibular Defect in the Pediatric Population
Authors: Gornitsky Jordan , Azzi Alain Joe , Cugno Sabrina
Published: June 2019

Spontaneous osteogenesis of traumatic mandibular defects in the pediatric population remains a relatively rare phenomenon with only 2 patients reported in the literature. In the adult population, a low threshold exists for bone graft placement in the presence of small mandibular gaps, with no role for spontaneous osteogenesis in significant mandibular defects. The approach to traumatic mandibular defects in the pediatric population is not clearly described in the literature and the risks and benefits associated with donor site morbidity of bone graft harvest must be tempered by the possibility for potential spontaneous osteogenesis. The present study reports 1 such patient in whom a significant mandibular defect healed by means of rigid fixation of the defect and spontaneous osteogenesis, with no functional or esthetic sequelae at long-term follow-up. A review of the pertinent literature was performed, and the authors’ approach is discussed. The authors propose that traumatic mandibular defects of < 3 cm in patients under the age of 10 years should be considered for treatment with rigid internal fixation alone and spontaneous osteogenesis.
Objective Measurement of Eyelid Force in Ptosis Versus Controls
Authors: Pillar Shani , Almog Yehoshua , Sharon Tal , Dar Nimrod , Segal Ori , Nemet Arie Y.
Published: June 2019

Thorough evaluation of the upper eyelid is essential for diagnosis and management planning in blepharoptosis. In a previous study, our group described a novel force gauge for direct assessment of upper lid force in healthy subjects. In this study, the authors apply the same technique for measuring muscle forces in ptotic eyelids.

Patients scheduled to undergo surgical repair of aponeurotic blepharoptosis or dermatochalasis, from July 2017 to August 2018, in a tertiary care medical center, were enrolled in this prospective case series. When the eyelid disorder was unilateral, the normal eye was designated as control. The upward force generated by the eyelid was measured directly using a handheld dynamometer noninvasively attached to the upper eyelid. Measurements were conducted with and without fixation of the frontalis muscle, to differentiate between total lid force, levator force, and frontalis contribution.

A total of 56 eyes was included in the study: 34 in the ptosis group, 11 in the dermatochalasis group, and 11 as controls. Both the ptosis group and the dermatochalasis group had significantly lower total muscle force and levator force measurements when compared with control (P <0.05). Calculated frontalis force contribution to upgaze did not differ significantly between groups. In the control group, calculated frontalis force contribution to upgaze strongly correlated to marginal reflex distance1 (r = 0.75, P = 0.05)

In conclusion, the authors present a simple, inexpensive, new portable force gauge for direct eyelid force measurements in eyelid pathologies. Distinct differences between ptotic and healthy eyelids are demonstrated, suggesting potential applications in patient evaluation and management.
Brazilian-Portuguese Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcome Instrument
Authors: Denadai Rafael , Raposo-Amaral Cassio Eduardo , Sabbag Anelise , Ribeiro Rafael Andrade , Buzzo Celso Luiz , Raposo-Amaral Cesar Augusto , Hung Man , Skirko Jonathan R.
Published: June 2019

Background:

The purpose of this study was to conduct a linguistic validation of the velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for use in Brazilian-Portuguese patients with VPI.

Methods:

The original English version of the VELO instrument was translated into Brazilian-Portuguese, back-translated, and adapted among the Brazilian patients (n = 21) with VPI and their parents, based on the standardized guidelines for the cross-culture adaption process. Discrepancies in the forward and backward translation steps were computed. Comprehension rates were captured for each debriefing interview. The content validity index (CVI) per item (I-CVI) and of the scale (S-CVI universal agreement [S-CVI/UA] and averaging [S-CVI/Ave]) were calculated.

Results:

Reconciliation of the 2 forward translations and the comparison between the back translation and the original VELO version resulted in some item wordings with discrepancies which were reviewed by the research team (translators, expert committee, and original developers of instrument). Three rounds of cognitive interviews also led to some revisions of wording. Comprehension rates of patients and their parents were 60% to 100%, 80% to 100%, and 100% in the first, second, and third rounds of cognitive interviews, respectively. The I-CVI, S-CVI/AU, and SCI/Ave for the Brazilian-Portuguese VELO version were 0.83 (or higher), 0.83 (or higher), and 0.97, respectively.

Conclusions:

The linguistic validation process of the VELO instrument created a cross-culturally equivalent Brazilian-Portuguese version for use in Brazilian-Portuguese speaking patients with VPI.
Vitamin E Promotes Bone Formation in a Distraction Osteogenesis Model
Authors: Akçay Hüseyin , Kuru Keremcan , Tatar Birkan , Şimşek Fatma
Published: June 2019

The long consolidation period of distraction osteogenesis (DO) may lead to complications such as pain, infection, fracture, scar formation, malunion and delayed union. The aim of this study was to evaluate the effect of systemic Vitamin E application during mandibular DO on new bone regeneration in a rabbit model. 16 adult male 8 months old New Zealand rabbits underwent mandibular lengthening with a distractor for the study. After the latency period of 5 days, the distractor was activated at a rate of 0.5 mm/12 hours for 7 days. Experimental animals received 200 mg/kg injections of α-tocopherol intraperitoneally for 7 days starting with the operation. After the consolidation period of 30 days, rabbits were sacrificed. Lengthened mandibles were obtained and subjected to dual-energy X-ray absorptiometry (DXA), radiologic and histomorphometric analysis. Statistically, bone mineral density and bone mineral content values were found to be significantly higher in the experimental group than the control group during DXA analysis. Rabbits in the experimental group had statistically higher scores in terms of osteoblast, osteoclast, vessel numbers and newly formed bone area than the control group. Results of the present study showed that systemic Vitamin E application during DO may stimulate new bone formation in rabbits and thus results in shortened treatment time.