bluuebunny/crossref_metadata_2025 huggingface dataset:
Ventriculoperitoneal Shunt Malfunction, a Rare Cause of Paraplegia after Kyphosis Correction
Authors: Patel Bharat K. , Bapat Mihir R.
Published: November 2020

Ventriculoperitoneal shunt (VPS) malfunction after kyphosis surgery in 12-year boy caused a sudden hydrocephalus which increased cerebrospinal fluid pressure within the spinal cord and decreased cord perfusion. Spinal cord at apex of deformity was vulnerable to ischemia which caused paraplegia. The ischemic event was reversible after re-insertion of the VPS.

Study Design.

Case report and literature review.

Objective.

The aim of this study was to report a rare case of hydrocephalus due to ventriculoperitoneal shunt (VPS) malfunction following kyphosis correction that resulted in paraplegia in the postoperative period. The available English literature to explain the possible cause of paraplegia is reviewed.

Summary of Background Data.

Twelve-year male child presented with a severe dorsal kyphoscoliosis deformity with spastic paraparesis since 4 months. The lower extremities had grade-2 power and spasticity. The sensation was reduced below D9. The deep tendon reflexes were exaggerated with ankle clonus. Bowel-bladder had urgency and frequency. The radiographs and CT showed D6-7 hemi-vertebra with complex kyphoscoliosis deformity. magnetic resonance imaging showed a stretching cord at D6-7 due to 92° angular kyphosis. The somatosensory evoked potential showed posterior column involvement. The VPS was placed for hydrocephalus at 4 months of age. The shunt remained functioned throughout childhood.

Methods.

He underwent posterior vertebral column resection and kyphosis correction surgery. Postoperative CNS function was normal. Neurology was status quo. After 20 hours, the boy appeared irritable, confused with a headache and repetitive vomiting (Glasgow coma scale: 7-8/15). Computed tomography brain showed dilated both ventricles with left shunt in situ. Immediate re-shunting was done from right side. The CNS status improved dramatically and regained consciousness. Neurology deteriorated to grade-0 with increased spasticity and further decreased sensation below D9. The spinal causes (hematoma, implant malposition, syrinx) were ruled out.

Results.

Delayed neurological recovery was seen at 6th week after shunt surgery. The Rapid motor march was observed and became independent ambulatory at 12th week. At 6 months, he improved up-to grade4 power with grade 2 spasticity which maintained at 2 years.

Conclusion.

VPS blockage caused a sudden hydrocephalus which increased CSF pressure within the spinal cord and decreased cord perfusion. Spinal cord at apex of deformity was vulnerable to ischemia which caused paraplegia.

Level of Evidence: 5
Risk Factors for Poor Outcome of Cervical Laminoplasty
Authors: Machino Masaaki , Ando Kei , Kobayashi Kazuyoshi , Nakashima Hiroaki , Kanbara Shunsuke , Ito Sadayuki , Inoue Taro , Ito Keigo , Kato Fumihiko , Ishiguro Naoki , Imagama Shiro
Published: November 2020

The risk factors for poor outcome after cervical laminoplasty in patients with cervical spondylotic myelopathy (CSM) were demonstrated. These findings suggest that advanced age, long-term CSM symptoms, and lower score of preoperative 10-second step test are risk factors for poor cervical laminoplasty outcomes in patients with CSM.

Study Design..

A prospective study.

Objective..

The aim of this study was to characterize the risk factors for poor outcome following cervical laminoplasty in patients with cervical spondylotic myelopathy (CSM).

Summary of Background Data..

Previous research has identified a variety of potential predictive factors that might affect outcomes after cervical laminoplasty. However, no study till date has assessed the effects of such risk factors, including internal medicine comorbidity and quantitative performance tests, on the outcome of laminoplasty in a large series of patients with CSM.

Methods..

A total of 505 consecutive patients with CSM (311 males; 194 females; mean age, 66.6 years; age range, 41–91 years) who underwent double-door laminoplasty were prospectively included. The average postoperative follow-up period was 26.5 months (range, 12–66 months). We evaluated the recovery rate (RR) on the basis of the Japanese Orthopaedic Association score. Logistic regression analysis was performed to identify the risk factors for poor outcome, which was defined as a postoperative RR of <50%. Relationship between outcome and various clinical and imaging predictors was examined.

Results..

Two hundred ninety-five patients had good outcomes with RR >50%, whereas 210 patients had poor outcomes with RR <50%. Compared with the good-outcome group, the poor-outcome group had a significantly higher prevalence of diabetes and hypertension and use of anticoagulant/antiplatelet agent and smoking history (P < 0.05). Multivariate logistic regression analysis showed independent risks associated with increased age (odds ratio [ORs]  = 1.029, 95% confidence interval [CI] = 1.004–1054, P = 0.023). Logistic regression analysis determined that symptom duration of CSM (OR = 1.017, 95% CI = 1.008–1.026, P < 0.001) and preoperative 10-second step test (OR = 0.922, 95% CI = 0.865–0.983, P = 0.013) were significant risk factors for poor outcome.

Conclusion..

These findings suggest that advanced age, long-term CSM symptoms, and lower score of preoperative 10-second step test are risk factors for poor outcome in patients with CSM.

Level of Evidence: 2
Urinary Tract Infection after Elective Spine Surgery: Timing, Predictive Factors, and Outcomes
Authors: Pertsch Nathan J. , Darveau Spencer C. , Tang Oliver Y. , Toms Steven A. , Weil Robert J.
Published: November 2020

Study Design.

Retrospective review of prospectively collected data.

Objective.

The aim of this study was to investigate risk factors associated with the timing of urinary tract infection (UTI) after elective spine surgery, and to determine whether postoperative UTI timing affects short-term outcomes.

Summary of Background Data.

Urinary tract infection (UTI) is a common post-surgical complication; however, the predominant timing, location, and potential differential effects have not been carefully studied.

Methods.

We analyzed elective spine surgery patients from 2012 to 2018 in the ACS National Surgical Quality Improvement Program (NSQIP). We grouped patients with postoperative UTI by day of onset relative to discharge, to create cohorts of patients who developed inpatient UTI and post-discharge UTI. We compared both UTI cohorts with a control (no UTI) population and with each other to identify differences in baseline characteristics including demographic, comorbidity and operative factors. We performed multivariate logistic regression to identify predictors of UTI in each cohort and to assess adjusted risks of poor outcomes associated with UTI timing.

Results.

A total of 289,121 patients met inclusion criteria and 0.88% developed UTI (n = 2553). Only 31.6% of UTIs occurred before discharge (n = 806), with 68.4% occurring after discharge (n = 1747). The inpatient UTI cohort had significantly longer operative time, more fusion procedures, more posterior procedures, and more procedures involving the lumbar levels than the post-discharge cohort. Predictors of inpatient UTI included procedure type, spine region, and approach. Predictors of post-discharge UTI included length-of-stay and discharge destination. Both UTI cohorts were significantly associated with sepsis; however, post-discharge UTI carried a higher odds (adjusted odds ratio [aOR] = 24.90, 95% confidence interval [CI] = 21.05–29.45, P < 0.001 vs. aOR = 14.31, 95% CI = 11.09–18.45, P < 0.001). Inpatient UTI was not associated with 30-day readmission, although post-discharge UTI was (aOR = 8.23, 95% CI = 7.36–9.20, P < 0.001). Conversely, inpatient UTI was associated with increased odds of 30-day mortality (aOR = 3.23, 95% CI = 1.62–6.41, P = 0.001), but post-discharge UTI was not.

Conclusion.

Predictive factors and outcomes differ based on timing of UTI after elective spine surgery. Before discharge, procedure -specific details predict UTI, but after discharge they do not. These findings suggest that traditional thinking about UTI prevention may need modification.

Level of Evidence: 3
Influence of Etiology and Onset of Deformity on Spatiotemporal, Kinematic, Kinetic, and Electromyography Gait Variables in Patients with Scoliosis—A Prospective, Comparative Study
Authors: Garg Bhavuk , Gupta Manish , Mehta Nishank , Malhotra Rajesh
Published: November 2020

Study Design.

Prospective comparative study.

Objective.

The aim of this study was to compare the spatiotemporal, kinematic, kinetic and electromyographic (EMG) gait variables in patients with adolescent idiopathic scoliosis (AIS) and congenital scoliosis and to compare these gait variables of scoliosis patients with healthy controls.

Summary of Background Data.

Earlier studies have solely focussed on the possibility of altered gait patterns in AIS patients; not much light has been shed on the differences in gait patterns in congenital and adolescent scoliosis patients.

Methods.

Forty scoliosis patients (20 each with AIS and congenital scoliosis) and 20 healthy volunteers were prospectively recruited. After thorough clinical and radiological examination, all patients underwent gait analysis in accordance with standard protocols.

The outcome measures included spatiotemporal, kinetic, kinematic and EMG activity. Composite indices for gait analysis—Gait Profile Score (GPS) and Gait Deviation Index (GDI)—were also calculated. Relevant statistical tests were applied to compare the different groups.

Results.

No significant difference was found between the AIS and congenital scoliosis groups with respect to baseline demographic and radiological parameters. The two subgroups of scoliosis patients (AIS and congenital) did not differ significantly with respect to any of the measured gait analysis parameters. However, when compared to the healthy age-matched control group, the scoliosis patients differed significantly with respect to gait speed, stride length, step length, GDI, GPS and peak EMG activation for erector spinae, biceps femoris, semimembranosus, rectus femoris, gastrocnemious, and tibialis anterior.

Conclusion.

Our findings confirm the previous findings of literature regarding the alteration in gait patterns in scoliosis patients when compared to normal individuals. However, the lack of difference in gait analysis variables between AIS and congenital scoliosis patients suggests that this alteration in gait is secondary to the existence of the deformity and does not correlate with the onset or etiology of deformity.

Level of Evidence: 2
Nonsevere Diabetic Ketoacidosis and Adrenal Insufficiency: Exploring the Impact of Glucocorticoid Replacement on Metabolic Outcomes and ICU Length of Stay
Authors: Sheung Nicole , Beechar Arpita , Belalcazar L. Maria
Published: November 2020

Background:

There is a paucity of clinical data on corticosteroid replacement in patients with adrenal insufficiency who present with nonsevere noncomplicated diabetic ketoacidosis.

Case Summary:

We analyzed five consecutive admissions for diabetic ketoacidosis of mild/moderate severity due to insulin omission in a 21-year-old man with type 1 diabetes and stable Addison disease. Despite similar presentations, the approach to steroid replacement differed: maintenance/moderate doses of hydrocortisone (< 60 mg/d) or high stress-doses (≥ 120 mg/d). Resolution of diabetic ketoacidosis and ICU and hospital length of stay were prolonged when high-dose versus maintenance/moderate glucocorticoids were provided: 45.5, 47.0, and 63.0 versus 12.0, 24.5, and 31 hours, respectively.

Conclusions:

Although our findings remain hypothesis-generating, our case study raises awareness on the importance of categorizing diabetic ketoacidosis by severity and complication status when deciding on the intensity of steroid replacement in patients with stable Addison disease. Excessive glucocorticoid administration may delay the resolution of nonsevere and otherwise noncomplicated diabetic ketoacidosis and prolong ICU and hospital stays.
Safety and efficacy of allogeneic natural killer cell immunotherapy on human immunodeficiency virus type 1 immunological non-responders: a brief report
Authors: Xia Huan , Wang Yin , Sun Hua-Li , Gao Li-Ying , Cao Yu , Zaongo Silvere D. , Zeng Rong-Nan , Wu Hao , Zhang Ming-Jie , Ma Ping
Published: November 2020

Background:

Allogeneic natural killer (NK) cell immunotherapy is recognized as a promising anti-tumor strategy, but whether it plays a role in poor CD4 recovery among human immunodeficiency virus type 1 (HIV-1) infected patients is unknown. This study aimed to investigate the safety and effectiveness of allogeneic NK cells immunotherapy on HIV-1 immunological non-responders (INRs) receiving antiretroviral therapy (ART).

Methods:

From February to April 2018, a prospective, randomized, controlled, open-label clinical trial, which enrolled 20 HIV-1 INRs following specific inclusion criteria, was conducted at Nankai University Second People's Hospital. Participants were randomly allocated (simple randomization 1:1) to either the combined treatment (NK + ART) group (n = 10) or the control (ART) group (n = 10). The allogenic highly activated NK cells from killer cell immunoglobulin-like receptor (KIR)/human leukocyte antigen (HLA)-Cw mismatched healthy donor were prepared (108 cells in each injection) and intravenously infused to each recruited patient of NK+ART group in three courses. Key immune parameters (CD4 count, CD8 count, CD4/CD8 ratio), laboratory tests (count of blood cells, biochemistry panel) and symptoms at baseline and at month 1, 3, 6, 9, 12, and 24 were measured/collected to analyze the safety and efficacy of the therapy. Comparisons were between the seven time-points of both groups using repeated measurement analysis of variance (ANOVA) test. Generalized estimating equations (GEE) model was performed to evaluate the overall effect of the NK+ART group vs. the ART group.

Results:

From baseline to 24 months, we noted a mean CD4 count augmentation (139 to 243 cells/μL) in the NK + ART group and (144 to 176 cells/μL) in the ART group (difference, 67; 95% CI, 10 to 124; P = 0.024). Our estimations revealed that NK+ART group could improve CD4 level (β = 54.59, P = 0.006) and CD8 level (β = 322.47, P = 0.010) on average among the six measurements compared with the ART group. Only two (2/10, 20%) participants in the NK+ART group developed a transient mild fever after the first course.

Conclusions:

This preliminary study informs that HIV-1 INRs, allogenic NK cells immunotherapy is safe and could significantly improve CD4 recovery but not CD4/CD8 ratio. The practical effects, however, need long-term follow-up observations. Further study on the potential underlying mechanism is warranted.

Registration info:

www.chictr.org.cn/showproj.aspx?proj=34912 (No. ChiCTR1900020634).
Transcriptional analysis of metastatic uveal melanoma survival nominates NRP1 as a therapeutic target
Authors: Bao Riyue , Surriga Oliver , Olson Daniel J. , Allred Jacob B. , Strand Carrie A. , Zha Yuanyuan , Carll Timothy , Labadie Brian W. , Bastos Bruno R. , Butler Marcus , Hogg David , Musi Elgilda , Ambrosini Grazia , Munster Pamela , Schwartz Gary K. , Luke Jason J.
Published: November 2020

Uveal melanoma is a rare form of melanoma with particularly poor outcomes in the metastatic setting. In contrast with cutaneous melanoma, uveal melanoma lacks BRAF mutations and demonstrates very low response rates to immune-checkpoint blockade. Our objectives were to study the transcriptomics of metastatic uveal melanoma with the intent of assessing gene pathways and potential molecular characteristics that might be nominated for further exploration as therapeutic targets. We initially analyzed transcriptional data from The Cancer Genome Atlas suggesting PI3K/mTOR and glycolysis as well as IL6 associating with poor survival. From tumor samples collected in a prospective phase II trial (A091201), we performed a transcriptional analysis of human metastatic uveal melanoma observing a novel role for epithelial-mesenchymal transition associating with survival. Specifically, we nominate and describe initial functional validation of neuropillin-1 from uveal melanoma cells as associated with poor survival and as a mediator of proliferation and migration for uveal melanoma in vitro. These results immediately nominate potential next steps in clinical research for patients with metastatic uveal melanoma.
Mapping sentinel lymph nodes in cutaneous melanoma: a vast array of perioperative imaging modalities
Authors: Beniey Michèle , Tran Alphonse , Boulva Kerianne
Published: November 2020

Sentinel lymph node biopsy (SLNB) is a decisive step in the staging process of melanoma, critically impacting patients’ oncological outcome and driving the decision-making process. SLNB limits the extent of the dissection in cases where no metastases are found. Conversely, when metastases are detected, SLNB has the potential to improve regional control of the disease when complete lymphadenectomy or early administration of adjuvant treatment are indicated. Thus, accurately identifying sentinel lymph nodes represents an important prognostic factor. Several strategies have been studied, including novel procedures that are not commonly used in the clinical setting. This review highlights the different tracers, preoperative and intraoperative imaging modalities studied to perform SLNB in cutaneous melanoma. The development of innovative modalities has been fueled by a need to optimize current approaches, offering new alternatives that can overcome some of the limitations of the standard method.
Immune Checkpoint Markers in Superficial Angiosarcomas: PD-L1, PD-1, CD8, LAG-3, and Tumor-Infiltrating Lymphocytes
Authors: Googe Paul B. , Flores Kyle , Jenkins Francie , Merritt Bradley , Moschos Stergios J. , Grilley-Olson Juneko E.
Published: November 2020

Cutaneous angiosarcomas may express programmed death ligand-1 (PD-L1) and PD-L1 expression, and the presence of tumor-infiltrating lymphocytes (TILs) correlates with outcome. These observations provide a basis for PD-1/PD-L1 inhibitor therapy. Lymphocyte activation gene 3 (LAG-3) is an inhibitory receptor that interacts with the PD-L1 axis and is considered to be a marker of immune exhaustion. The presence of LAG-3–positive lymphocytes in cutaneous angiosarcoma has not been established. We reviewed 10 cases of treatment naive angiosarcoma of skin and superficial soft tissue and assessed for PD-L1 (ZR3) expression, presence of TILs, and expression of CD8, PD1, and LAG-3 by tumor-associated inflammatory cells by immunohistochemistry. All 10 angiosarcomas were positive for PD-L1: 7 with high expression and 3 with low expression. TILs were present in all tumors: brisk in 7 and nonbrisk in 3. CD8 lymphocytes were present in all tumors with a range of 212–1274 cells per square millimeter (mean 557 CD8 cells/mm2). LAG-3–positive lymphocytes were present in 9 of 10 angiosarcomas with a range of 0–728 cells/mm2 (mean 146 LAG-3 cells cells/mm2). The ratio of LAG-3 lymphocytes to CD8 lymphocytes was 0%–59% (mean 27%). The PD1 cell counts were intermediate between CD8 and LAG3 counts. Cutaneous angiosarcomas frequently express PD-L1, have prominent numbers of CD8 positive, and have smaller numbers of LAG-3–positive and PD-1–positive TILs. Our findings provide further evidence of PD-L1 expression in cutaneous angiosarcoma and the promise for immune checkpoint inhibitor therapy.
Topical Erythropoietin as a Novel Treatment for Necrotizing Scleritis After Pterygium Surgery: A Pilot Study
Authors: Feizi Sepehr , Javadi Mohammad Ali
Published: November 2020

Purpose:

To share our initial experience with the innovative use of topical erythropoietin for the treatment of necrotizing scleritis manifesting immediately after pterygium excision surgery.

Methods:

This study enrolled 3 patients who developed necrotizing scleritis immediately after undergoing pterygium excision. All cases with pterygium were primary, and topical mitomycin C and conjunctival autografts were used at the time of surgery. Noninvasive therapy that included ophthalmic lubricants and topical and systemic corticosteroids failed to improve the avascular scleral lesions. The patients were prescribed erythropoietin-containing drops (3000 U/mL) every 6 hours in addition to topical antibiotics and lubricant. The effect of topical erythropoietin on the healing process of avascular scleral lesions was investigated, and its ocular and systemic side effects were evaluated.

Results:

The mean age of the participants was 69.0 ± 14.8 years, and 2 of the 3 eyes belonged to male subjects. The time between pterygium surgery and presentation to our clinic was 33.0 ± 14.7 days. There were no infectious causes or underlying systemic diseases in any of the cases. After treatment with topical erythropoietin for an average of 34.3 ± 20.3 days, the lesions were completely vascularized in all 3 eyes without any ocular or systemic adverse effects. The patients were followed up for an average of 126 ± 94 days after discontinuation of erythropoietin. There was no evidence of recurrence during the last examination in any of the eyes.

Conclusions:

Topical erythropoietin might be a safe and an effective method for treating cases of necrotizing scleritis that manifests immediately after pterygium surgery.
Novel Evidence Concerning Lacrimal Sac Movement Using Ultra-High-Frequency Ultrasound Examinations of Lacrimal Drainage Systems
Authors: Bohman Elin , Berggren Johanna , Bunke Josefine , Albinsson John , Engelsberg Karl , Dahlstrand Ulf , Hult Jenny , Hasegawa Hideyuki , Cinthio Magnus , Sheikh Rafi
Published: November 2020

Purpose:

Current hypothesis regarding the mechanism of active tear drainage is based on studies performed ex vivo or under nonphysiological conditions. Novel ultra-high-frequency ultrasound has the advantage of generating images with superior resolution, enabling measurements of low flow in small vessels, and the tracking of tissue motion in real time. The purpose of this study was to investigate the lacrimal drainage system and active drainage using this modality.

Methods:

The upper lacrimal drainage system was investigated with 40–70 MHz ultrasound in 22 eyes in 13 patients. Irrigation confirmed a lacrimal obstruction in 10 eyes. Motion tracking was used to map movement of the lateral lacrimal sac wall and to measure flow when possible.

Results:

The anatomy of the upper lacrimal drainage system was mapped in vivo, including the proximal canaliculi, which have not previously been imaged. The lacrimal sac lumen is slit shaped in its resting state but is distended when irrigated or if a nasolacrimal duct obstruction is present. Thus, the healthy lacrimal sac is not a cavity, and the medial retinaculum does not act against a stretched structure. Motion tracking visualized the “lacrimal pump,” showing that the direction of motion of the lateral lacrimal sac wall is mainly in the sagittal plane during blinking.

Conclusions:

Ultra-high-frequency ultrasound allows detailed physiological monitoring of the upper lacrimal drainage system in vivo. Our findings suggest that current theories of active tear drainage need to be reappraised.
Occult Rosacea Diagnosed After Recurring Blepharoplasty Incision Inflammation
Authors: Medsinge Anagha , Googe Paul , Fowler Amy M
Published: November 2020

We report an unusual case of a 58-year-old Caucasian female who developed intermittent eyelid erythema, edema, and wound thickening in the early postoperative period after bilateral upper eyelid blepharoplasty. These flares of inflammation sometimes appeared to respond to systemic antibiotics and steroid preparations and sometimes not. Because of concerns for possible mycobacterial infection, biopsy of the upper eyelid incision was performed and histopathology confirmed rosacea. Symptoms resolved with oral azithromycin. Our patient did not have a diagnosis of rosacea preoperatively. We believe that rosacea should be kept in mind in cases with either prolonged inflammation or recurrent inflammation in previously quiet eyelid incisions.
Frontalis Suspension Using Autologous Fascia Lata in Children Under 3 Years Old
Authors: García-Cruz Ignacio , Barrancos Constanza , Alonso-Formento Nieves , Albandea Ana Rosa , Losada-Bayo Diego , García-Ruiz Oscar Andree , Sales-Sanz Marco
Published: November 2020

Purpose:

To analyze functional results and complications of the use of autologous fascia lata in frontalis suspension in children under 3 years old and to confirm its technical viability.

Methods:

A retrospective review of 8 patients (12 eyes) who underwent frontalis suspension using autologous fascia lata sling.

Results:

Twelve eyes of 8 patients were analyzed, with an average age of 1.8 ± 0.6 years. Preoperatively, the mean margin-to-reflex distance 1 was −0.17 ± 0.577 mm. Postoperatively the mean margin-to-reflex distance 1 was 2.66 ± 0.492 mm without any graft donor site or corneal complications. No recurrence was recorded in the follow-up period (mean follow-up period 28.5 ± 32.33 months).

Conclusions:

Autologous fascia lata is an eligible material in frontalis suspension in children under 3 years old, despite the traditional oculoplastic dogma that advises against.
Ophthalmic Presentation of Undiagnosed Sinonasal Masses
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: November 2020

Aims:

To evaluate clinical features of patients who first present with orbital symptoms and signs due to undiagnosed sinonasal pathology.

Patients and methods:

Retrospective chart review for patients seen at Moorfields Eye Hospital between 1969 and 2020. Patient demographics and clinical features were reviewed.

Results:

Four hundred and forty-eight patients (250 males; 56%) presented to ophthalmologists with undiagnosed sinonasal pathologies, the patients attending at an average age of 47 years and having first symptoms at an average age of 46 years. The commonest presenting symptoms were proptosis (153 patients; 34%), orbital ache or pain (133; 31%), periorbital swelling (130; 29%), and diplopia (98; 22%). Eighty-seven patients (20%) had a corrected acuity of 6/18 or worse, and 66 (16%) had an ipsilateral relative afferent pupillary defect. There was 2.3 mm relative exophthalmos (median 2 mm; range 0–17 mm) in patients with unilateral disease, an orbital mass was palpable in 218 patients (49%), ocular movements were reduced in 252/448 (56%), and nonaxial displacement of the globe was recorded in 296/424 (74%). The commonest pathologies were sinus mucoceles (38%), sinus carcinoma (11%), and granulomatous polyangiitis (10%). Multivariate regression analysis of mass lesions identified periorbital pain (odds ratio, 6.0; 95% confidence interval, 1.7–21.5; P = 0.005) and reduced motility (odds ratio, 3.2; 95% confidence interval, 1.1–9.0; P = 0.03) as features most predictive for undiagnosed sinonasal malignancy.

Conclusion:

This study describes a large group of patients in whom unknown midfacial masses presented initially to the ophthalmologist: Mucoceles and sinonasal malignancy were the commonest lesions, and nonaxial globe displacement—particularly inferolateral, lateral, or upward—is commonly associated with sinonasal pathology. Pain and reduced ocular movements significantly favor a malignant, rather than benign, tumor.
Malignant Cutaneous Adnexal Tumor in Posterior Occipital Region of a Child: A Case Report
Authors: Zhu Jian-Jian , Li Xin , Long Jian , He Ping
Published: November 2020

Introduction:

The most common cutaneous adnexal tumors in children were follicular, especially pilomatricoma, and a few were predominant glandular/ductal differentiation, malignant forms are occasionally encountered. Here, a case of a malignant cutaneous adnexal tumor with eccrine differentiation was reported.

Case presentation:

A 10-year-old male child was presented with a nodular in posterior occipital for half a year with no symptoms. Histopathology showed there was acanthosis in epidermis, partially with local ulceration and crusting; and in the dermis, there was irregular scattered or agglomerated infiltration of diffused epithelial cells, partly presenting as basaloid, but no obvious peripheral palisading arrangement; and in the center there was extensive necrosis; cellular pleomorphism, scattered mitotic figures, focal clear cell areas, and adenoid differentiation can also be seen, there was scattered infiltration of mixed inflammatory cells in the stroma. Immunohistochemistry showed cytokeratin (CK) 5/6+, CK 8/18+, epithelial membrane antigen +, gata3 transcription factor 3+, cell adhesion15 (focal +), Ki67 (+, 30%), carcinoembryonic antigen (focal+), CK 7 (focal+), gross cystic disease fluid protein-15−, P63+, S-100−. Final diagnosis was the malignant cutaneous adnexal tumor with eccrine differentiation, most likely the nodular clear cell hidradenocarcinoma. The patient has no special discomfort follow-up observation after extended resection and lymph node examination.

Discussion:

The histopathology showed infiltrative growth pattern, deep extension, necrosis, nuclear pleomorphism, mitoses, desmoplastic stromal reaction and the clear cell area and adenoid differentiation. Immunohistochemistry was positive for CK8/18, EMA, CK5/6, P63, gata3 transcription factor 3 and negative for S-100 and GCDFP-15, some gland-derived markers such as CK7, CEA were focal positive, and we have not found the preexisting benign poroma and porocarcinoma in situ, so we preferred the diagnosis of hidradenocarcinoma. The differential diagnosis such as porocarcinoma, clear cell squamous cell carcinoma, and basal cell carcinoma were taken into account.

Conclusion:

The diagnosis was challenging by clinical manifestations. Histopathology and immunohistochemistry should be combined with clinical presentation, history to reach the final diagnose.
Clinical Retrospective Analysis of 340 Inpatients with Malignant Skin Tumors in Western Inner Mongolia
Authors: Jia Min-Xin , Li Dong-Xia , Liu Yu-Lei
Published: November 2020

Objective:

This study was performed to evaluate the clinical and epidemiological characteristics of inpatients with malignant skin tumors in western Inner Mongolia during the past 10 years.

Methods:

We collected the clinical data of inpatients with histopathologically diagnosed malignant skin tumors admitted to the Affiliated Hospital of Inner Mongolia Medical University from June 2008 to December 2018. Morbidity was compared using the Chi-square test.

Results:

In total, 340 inpatients with malignant skin tumors were evaluated, including 163 (47.94%) patients with basal cell carcinoma, 134 (39.41%) with squamous cell carcinoma, 5 (1.47%) with malignant melanoma, 21 (6.18%) with Bowen disease, and 6 (1.76%) with Paget's disease. Four (1.18%) patients had metastatic skin cancer and seven (2.06%) had other malignant skin tumors. The patients comprised 132 (38.8%) men and 208 (61.1%) women, and there were no statistically significant sex-related differences among the skin malignancies (x
2 = 5.006, P > 0.05). Among the 340 patients, 314 (92.4%) were of Han nationality and 26 (7.6%) were of ethnic minorities. Statistically significant differences were found in the various types of malignant skin tumors between the Han and minority groups (x
2 = 19.446, P < 0.05). Among the selected patients, 61.76% were farmers and herdsmen, and the sites mainly affected were the head, face, neck, trunk, limbs, and vulva.

Conclusion:

The incidence of malignant skin tumors in western Inner Mongolia has substantially increased during the past decade, especially in the past 2 years. Therefore, we should increase the awareness of prevention and treatment of malignant skin tumors to achieve early diagnosis and treatment effects.
Perceptions of Acne and Its Treatments Among Chinese College Students: A Cross-Sectional Survey
Authors: Liu Li-Ping , Li Yu-Mei , Gu Si-Meng , Wu Wei , Fang Mei , Zhou Hang
Published: November 2020

Objective:

This cross-sectional survey aimed to explore Chinese college students’ perceptions regarding acne and its topical medications, and to evaluate whether these perceptions affect their motivation to seek and adhere to treatments.

Methods:

A cross section survey was performed using a 14-item questionnaire was administered via WeChat. among Chinese college students at Jiangsu University aged 18–24 years.

Results:

One thousand and four hundred and fifteen responses were received. The prevalence of self-diagnosed acne was 34.1%. The factors associated with a greater likelihood of seeking treatment were being female, having acne for a longer duration, and having severe acne. Nearly two-thirds of the respondents had discontinued topical medication use within 1 month, with only 4.8% continuing for over 6 months. The main reason for discontinuation was slow onset of action. Patients who considered acne a long-term condition were more likely to seek treatment and use medication for longer periods than those who considered it a short-term condition. Lack of knowledge about medication features, proper usage, and prevention of adverse effects may lead to early discontinuation. Furthermore, 93.8% of the respondents hoped to obtain the above information from doctors.

Conclusion:

Detailed explanations of acne and medication guidance are necessary to help patients understand the necessity of continuous treatment and the expected efficacy.
Landmark Analysis Exploring the Optimal Period for Intensive Monitoring After Return to Work for Employees With Sickness Absence Due to Common Mental Disorders
Authors: Mishima Masayoshi , Adachi Hiroyoshi , Mishima Chieko
Published: November 2020

Objective:

This study aimed to clarify when and how long intensive monitoring should be performed after return to work (RTW) of employees experiencing common mental disorders using landmark analysis.

Methods:

We conducted a retrospective survey of workers who experienced sickness absences (SAs) during 36 months after RTW. Sustainability rates of attendance among the following groups were compared before and after the landmark (18 months): one SA episode (Group 1), two SA episodes (Group 2), and three or more SA episodes (Group 3).

Results:

Before the landmark, sustainability in Group 1 was higher than in the other groups, with no significant differences among groups after the landmark. Sustainability rate of attendance tended to be lower before than after the landmark in each group.

Conclusions:

Intensive monitoring is suggested in the first 18 months after RTW.
Gut Microbiome: The Third Musketeer in the Cancer-Immune System Cross-Talk
Authors: Sharma Prateek , Jain Tejeshwar , Sethi Vrishketan , Iyer Srikanth , Dudeja Vikas
Published: November 2020

The fascinating hypothesis that microbes lead to cancer has long been dwelled upon but has only been recently investigated in cancers other than those of stomach and colon. Microbes can affect cancer cells directly through toxins or metabolites. They also play a significant role in the development and maturation of the immune system and can indirectly affect cancer cells through the immune system. Reliable mouse models and affordable sequencing technologies, have made it possible in current times, to delineate the role of microbes in undermining cancer immune surveillance and indirectly promoting oncogenesis. In this review, we explore the cancer-gut microbiome-immune trialogue, focusing on pancreatic cancer. We review how gut-microbiome interacts with immune system to promote oncogenesis and how modulation of gut-microbiome can be used as an effective therapeutic strategy to reprogram the immune system for augmenting anti-tumor response and enhance immunotherapy efficacy in traditionally resistant pancreatic cancer.
Exploring the knowledge and attitudes about cancer of older adults in Barcelona, Spain
Authors: Estapé Tania , Carrion Iraida V. , Estapé Jordi , Neelamegam Malinee
Published: November 2020

Background:

The prevalence of cancer increases with age. Cancer related knowledge and attitudes towards the disease affects health seeking behavior. The knowledge and attitudes of older adults in Barcelona, Spain regarding cancer are unknown.

Methods:

A survey consisting of 42 questions in five focus areas pertaining to the knowledge and attitudes about cancer, prevention, early diagnosis, treatment, and support was administered to 814 adults 65 years of age and older while they were attending one of the seven senior centers throughout Barcelona and the provinces. Trained social workers and psychologists conducted the interviews.

Results:

The average age of survey participants was 74 years. Of the participants, 44.89% were male, 55.11% were female, and 18% had cancer in the past. The percentage of older adults with cancer was low at 18%; among those with cancer, many erroneous beliefs existed, such as attributing cancer to an undeserved punishment and the belief that the illness can be acquired through contact. Only a third of the participants considered themselves at high risk for developing cancer, and 94% were unaware of the European Code against Cancer and its recommendations. 34.2% indicated they would prefer to receive no treatment if they developed cancer in the future.

Conclusions:

Older adults residing in Barcelona, Spain were unaware of their high risk of developing cancer. Their attitudes included fear and pessimism toward the illness and treatment. Their limited knowledge and attitudes about cancer caused older adults to minimize and ignore symptoms. They attributed symptoms and discomfort to aging rather than cancer, which resulted in worsening health problems.
Standardized Work Rounds Enhance Teaming, Comprehensiveness, Shared Mental Model Development, and Achievement Rate of End-of-Shift Goals*
Authors: Lucrezia Samantha , Noether Julia , Sochet Anthony A.
Published: November 2020

Objectives:

To determine the impact of standardized PICU work rounds on the frequency of ideal teaming behaviors, rounds comprehensiveness, shared mental model index development, and rate of completed end-of-shift goals.

Design:

A single-center, pre-post, prospective cohort study.

Setting:

A 259-bed, quaternary, pediatric referral center.

Patients:

Children 0–18 years old from November 2018 to January 2020.

Interventions:

Standardized, bedside, nurse-led PICU work rounds, emphasizing ideal teaming behaviors using a collaboratively developed rounding script and quality/safety checklist.

Measurements and Main Results:

Study data were collected by direct observation and immediate postrounds participant questionnaire data. Primary outcomes were frequency of observed ideal teaming behaviors, rounds comprehensiveness, efficiency (rounds content divided by duration), shared mental model index (congruence among rounds participants regarding key healthcare data and planning), rounds face validity, and achievement rate of rounds-established, end-of-shift goals. During study, 154 encounters were observed (50 preintervention, 52 after Plan-Do-Study-Act cycle 1, and 52 after Plan-Do-Study-Act cycle 2). We observed improvements in overall shared mental model index (24–87%), rounds comprehensiveness (72–98%), and ideal teaming behaviors (including closed-loop communication: 82–100%; responsibility delegation: 74–100%; interdependence behaviors: 26–98%, all p < 0.01) by the end of study. Nursing presentations accounted for 3.6 ± 1.5 minutes of rounds and rounds duration was unchanged postintervention (11 ± 5 min preintervention and 11 ± 4 min after Plan-Do-Study-Act cycle 2, p > 0.99). Face validity, assessed using questionnaire data from 953 participants, revealed positive attitudes regarding efficiency, clarity, and participant self-value. Greatest enhancements in self-value were noted among advanced practice providers and respiratory therapists. On exploratory modeling, we noted associations between ideal teaming behaviors, rounds comprehensiveness, and shared mental model index. Similarly, we noted a positive association between the shared mental model index and the rate of achieved rounds-established, end-of-shift goals (odds ratio, 8.9; 95% CI, 1.7–46; p < 0.01).

Conclusions:

Standardization of PICU work rounds may encourage ideal teaming behaviors, enhance rounds comprehensiveness, strengthen the congruence of participant shared mental model, and affect the rate of achieved goals established during rounds without compromising workplace efficiency.
Machine Learning to Predict Cardiac Death Within 1 Hour After Terminal Extubation*
Authors: Winter Meredith C. , Day Travis E. , Ledbetter David R. , Aczon Melissa D. , Newth Christopher J. L. , Wetzel Randall C. , Ross Patrick A.
Published: November 2020

Objectives:

Accurate prediction of time to death after withdrawal of life-sustaining therapies may improve counseling for families and help identify candidates for organ donation after cardiac death. The study objectives were to: 1) train a long short-term memory model to predict cardiac death within 1 hour after terminal extubation, 2) calculate the positive predictive value of the model and the number needed to alert among potential organ donors, and 3) examine associations between time to cardiac death and the patient’s characteristics and physiologic variables using Cox regression.

Design:

Retrospective cohort study.

Setting:

PICU and cardiothoracic ICU in a tertiary-care academic children’s hospital.

Patients:

Patients 0–21 years old who died after terminal extubation from 2011 to 2018 (n = 237).

Interventions:

None.

Measurements and Main Results:

The median time to death for the cohort was 0.3 hours after terminal extubation (interquartile range, 0.16–1.6 hr); 70% of patients died within 1 hour. The long short-term memory model had an area under the receiver operating characteristic curve of 0.85 and a positive predictive value of 0.81 at a sensitivity of 94% when predicting death within 1 hour of terminal extubation. About 39% of patients who died within 1 hour met organ procurement and transplantation network criteria for liver and kidney donors. The long short-term memory identified 93% of potential organ donors with a number needed to alert of 1.08, meaning that 13 of 14 prepared operating rooms would have yielded a viable organ. A Cox proportional hazard model identified independent predictors of shorter time to death including low Glasgow Coma Score, high Pao
2-to-Fio
2 ratio, low-pulse oximetry, and low serum bicarbonate.

Conclusions:

Our long short-term memory model accurately predicted whether a child will die within 1 hour of terminal extubation and may improve counseling for families. Our model can identify potential candidates for donation after cardiac death while minimizing unnecessarily prepared operating rooms.
Presacral Myelolipoma
Authors: Guillaume Laurent , Vander Borght Thierry , Bertrand Claude , Dupont Michael , Krug Bruno
Published: November 2020

Myelolipoma is a rare mesenchymal tumor consisting of adipose tissue and hematopoietic cells. Found usually in the adrenal region, however, few cases have been reported in extra-adrenal regions, most frequently in the presacral region. It is important to recognize such tumor, as it can attain massive size and causes pressure symptoms, and needs to be differentiated from malignant tumors, including liposarcomas. Although CT and MRI can suggest a diagnosis of myelolipoma, these are not conclusive. The hematopoietic cells are enhanced by a 99mTc–albumin nanocolloid scintigraphy and help to distinguish myolipoma from other entities.
Rare Thyroid Cartilage Metastasis From Breast Cancer Visualized on 18F-NaF PET/CT
Authors: Usmani Sharjeel , Ahmed Najeeb , Ilyas Muhammad Waqas , Murad Sarah , Al Kandari Fareeda
Published: November 2020

Metastatic involvement of the thyroid cartilage is rare due to the absence of vessels within the cartilaginous tissue. We present the case of a 65-year-old woman recently diagnosed with breast cancer referred for skeletal staging with 18F-NaF PET/CT. She was found to have multiple osteoblastic metastases along with thyroid cartilage metastasis. Rare thyroid cartilage metastasis on 18F-NaF PET/CT may have prognostic significance in cancer patients.
Sarcoidosis Mimicking Primary Pulmonary Artery Sarcoma
Authors: Masrani Abdulrahman , Raptis Demetrios A. , Siegel Barry A.
Published: November 2020

A 71-year-old man with coronary artery disease, sarcoid uveitis, and recurrent ventricular tachycardia treated with implantable cardioverter-defibrillator presented with increasing dyspnea for several months. Echocardiography showed a large echogenic mass causing severe narrowing of the proximal main pulmonary artery and a resultant gradient of 65 mm Hg. Ventilation-perfusion scintigraphy showed diffusely decreased perfusion of the left lung and an additional mismatched segmental perfusion defect in the left upper lobe. Cardiac MRI could not be performed because of the implantable cardioverter-defibrillator.
The Use of the Bipedicled Deep Inferior Epigastric Perforator Flap for Unilateral Breast Reconstruction
Authors: Christopoulos Georgios , Sergentanis Theodoros N. , Vlachogiorgos Apostolos , Mackey Simon P. , Ghanem Ali M.
Published: November 2020

Introduction

The use of abdominal flaps is recognized as a very advantageous approach for breast reconstruction with gradual refinements leading from the pedicled transverse rectus abdominis musculocutaneous flap to the criterion standard deep inferior epigastric perforator (DIEP) flap and its several variations. A systematic review with meta-analysis attempts to investigate the safety of the bipedicled DIEP flap for unilateral breast reconstruction.

Methods

The literature search used “PubMed” database, and a relevant study conducted at the Queen Victoria Hospital was also included. The extraction of data included study type, follow-up, patients' age, body mass index, preexisting abdominal scars, timing of reconstruction, operating time, flap inset, pedicles' configuration, flap failure, revision, and complication rates. Proportions were pooled with Freeman-Tukey arcsine transformation, and meta-regression was performed to evaluate whether complication rates were modified by different variables.

Results

Fourteen eligible articles provided an overall sample of 486 flaps, with a median follow-up of 18.5 months. In most cases, immediate reconstruction with undivided flap was performed, with equal use of extraflap and intraflap pedicles' configuration. Only 4 cases of flap failure (0.82%) were documented, with 18% overall complications and 3% fat necrosis rate. The forest plot showed significant between-study heterogeneity, and meta-regression revealed marginal positive association between older patient and complication rate.

Conclusions

Bipedicled DIEP flap for unilateral breast reconstruction is a technique that maintains the complications rate relatively low in challenging postmastectomy cases. Further comparative studies are needed to substantiate the findings of this study.
Hanno Millesi: Pioneer of Plastic Surgery and Nerve Surgery (1927–2017)
Authors: Holzer Elad , Schmidhammer Robert , Borschel Gregory H.
Published: November 2020

Recently, plastic surgery lost one of its most prominent surgeons—Dr. Hanno Millesi. His contributions to the field continue to impact the practice of medicine and surgery. As such, it is appropriate to reflect upon his career and recognize his accomplishments in peripheral nerve surgery, hand surgery, and Dupuytren disease.