bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute venodilation properties of low-dose intravenous nitroglycerine in pulmonary veno-occlusive disease: a case report
Authors: Maruyama Hidekazu , Sakai Satoshi , Suzuki Shoji
Published: August 2023

Background

The use of pulmonary vasodilators for pulmonary arterial hypertension (PAH) has led to a favourable prognosis. In contrast, pulmonary veno-occlusive disease (PVOD) is characterized by the possibility of severe pulmonary oedema after specific PAH therapy. Pulmonary oedema presumably develops in association with pulmonary arterial vasodilation without concomitant pulmonary venodilation. The venous circulation maximally dilates with small amounts of nitroglycerine.

Case summary

A 59-year-old woman with advanced PVOD was referred to our hospital. We performed a right heart catheterization after administering combination therapy with selexipag and macitentan, and intravenous nitroglycerine at 0.2 and 0.4 μg/kg/min decreased pulmonary arterial wedge pressure (PAWP) and mean pulmonary arterial pressure (PAP) to minimal levels. The final dose of 1 μg/kg/min yielded an ∼20% decrease in mean PAP and pulmonary vascular resistance (PVR).

Discussion

Here, we described the acute effect of intravenous nitroglycerine on PAWP and PVR in a patient with PVOD. This case highlights the venodilation response even in advanced PVOD, suggesting the importance of further research into selective venous dilators as potent therapy.
Association between heart failure and the incidence of cancer: a systematic review and meta-analysis
Authors: Jaiswal Vikash , Ang Song Peng , Agrawal Vibhor , Hameed Maha , Saleeb Marina Raouf Abdelmessih , Jaiswal Akash , Shah Maitri , Lao Nicole Mae , Chia Jia Ee , Paudel Kusum , Gimelli Alessia , Zacks Jerome
Published: August 2023

Aims

The association between heart failure (HF) patients and the incidence of cancer is not well understood, with conflicting results to date. The aim of this meta-analysis was to evaluate whether patients with HF have a higher risk of developing cancer.

Methods and results

We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 10 December 2022. The primary clinical outcome was the incidence of cancer. Secondary endpoints were the incidence of breast cancer, lung cancer, haematological cancer, colorectal cancer, and prostate cancer. A total of 9 articles with 7 329 706 (515 041 HF vs. 6 814 665 non-HF) patients were involved in the analysis. The mean age of the patients in the HF and the non-HF groups was 69.06 and 66.76 years. The median follow-up duration was 6.7 years. The most common comorbidity among both groups includes diabetes mellitus (27.58 vs. 14.49%) and hypertension (81.46 vs. 57.38%). Patients with HF were associated with a significant increase in the incidence of cancer {hazard ratio [HR], 1.43 [95% confidence interval (CI): 1.21–1.68], P < 0.001}, breast cancer [HR, 1.28 (95% CI: 1.09–1.50), P < 0.001], lung cancer [HR, 1.89 (95% CI: 1.25–2.85), P < 0.001], haematological cancer [HR, 1.63 (95% CI: 1.15–2.33), P = 0.01], and colorectal cancer [HR, 1.32 (95% CI: 1.11–1.57), P < 0.001] compared with patients without HF. However, the incidence of prostate cancer was comparable between both groups [HR, 0.97 (95% CI: 0.66–1.43), P = 0.88].

Conclusion

This meta-analysis confirms that the state of HF is associated with a higher risk for incident cancer. These data may aid in raising awareness with physicians that cancer may develop in patients with prevalent heart failure and that early screening and evaluation may be useful in an early diagnosis of cancer.
Microbial chemolithoautotrophs are abundant in salt marsh sediment following long-term experimental nitrate enrichment
Authors: Vineis Joseph H , Bulseco Ashley N , Bowen Jennifer L
Published: August 2023

Long-term anthropogenic nitrate (NO3−) enrichment is a serious threat to many coastal systems. Nitrate reduction coupled with the oxidation of reduced forms of sulfur is conducted by chemolithoautotrophic microbial populations in a process that decreases nitrogen (N) pollution. However, little is known about the diversity and distribution of microbes capable of carbon fixation within salt marsh sediment and how they respond to long-term NO3− loading. We used genome-resolved metagenomics to characterize the distribution, phylogenetic relationships, and adaptations important to microbial communities within NO3−-enriched sediment. We found NO3− reducing sulfur oxidizers became dominant members of the microbial community throughout the top 25 cm of the sediment following long-term NO3− enrichment. We also found that most of the chemolithoautotrophic genomes recovered contained striking metabolic versatility, including the potential for complete denitrification and evidence of mixotrophy. Phylogenetic reconstruction indicated that similar carbon fixation strategies and metabolic versatility can be found in several phylogenetic groups, but the genomes recovered here represent novel organisms. Our results suggest that the role of chemolithoautotrophy within NO3−-enriched salt marsh sediments may be quantitatively more important for retaining carbon and filtering NO3− than previously indicated and further inquiry is needed to explicitly measure their contribution to carbon turnover and removal of N pollution.
Effects of Maternal HIV Infection on Early Kaposi Sarcoma-Associated Herpesvirus Seroconversion in a Kenyan Mother-Infant Cohort
Authors: Sabourin Katherine R , Ogolla Sidney , Reyes Gabriela Samayoa , Daud Ibrahim , Jackson Conner L , Labo Nazzarena , Miley Wendell , Whitby Denise , Lamb Molly M , Rochford Rosemary , Dent Arlene
Published: August 2023

Background

We identified whether maternal human immunodeficiency virus (HIV) infection during pregnancy affects transplacental transfer of Kaposi sarcoma-associated herpesvirus (KSHV)-specific antibodies and subsequent infant infection.

Methods

We followed pregnant Kenyan women through delivery and their infants until age 2 years. Children were classified as HIV-exposed uninfected (HEU) or HIV-unexposed uninfected (HUU) based on maternal HIV status. Maternal venous and cord blood at delivery and child venous blood every 6 months were tested for antibodies to 20 KSHV antigens by multiplex bead-based immunoassay. Multiple comparisons were adjusted using false discovery rate (FDR).

Results

Maternal HIV infection was significantly associated with decreased transplacental transfer of antibodies against all KSHV antigens and lower cord blood levels for 8 antigens at FDR P < .10. Neither birth to 6-month antibody level changes nor 6-month levels differed in HEU and HUU, except for ORF50. By age 24 months, 74% of children KSHV seroconverted but HEU and HUU did not differ in time to seroconversion nor 2-year seropositivity after adjustment for child malaria infection.

Conclusions

Maternal HIV infection reduced a child's initial KSHV antibody levels but did not affect age of infection. Regardless of HIV exposure in utero, KSHV seroconversion in Kenyan children occurred early; associated factors must be identified.
COVID-19 Outcomes Among People With HIV and COVID-19 in New York City
Authors: Braunstein Sarah L , Wahnich Amanda , Lazar Rachael
Published: August 2023

Background

Literature on the impact of human immunodeficiency virus (HIV) on coronavirus disease 2019 (COVID-19)–related outcomes remains mixed. Few studies have evaluated COVID-19 outcomes by HIV status using population-based data.

Methods

Using data from New York City COVID-19 surveillance and HIV surveillance systems prior to the widespread availability of COVID-19 vaccines, we conducted a retrospective cohort study comparing the risk of COVID-19 hospitalization and mortality by HIV status among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnoses from 29 February to 17 October 2020.

Results

Risk of hospitalization and death among people with HIV (PWH) withCOVID-19 were both nearly 30% higher compared with people without HIV. In crude models, incidence of adverse COVID-19 outcomes among PWH compared to people without HIV was elevated in certain groups, including women, and black, Hispanic/Latino, Native American, and multiracial people. CD4 cell count at SARS-CoV-2 diagnosis and presence of an underlying, non-HIV–related condition were independently and strongly associated with risk for COVID-19 hospitalization and death among PWH.

Conclusions

New Yorkers with HIV experienced elevated risk for poor COVID-19 outcomes compared to those without HIV during 2020. PWH, particularly those with low CD4 counts or underlying conditions, should be an ongoing focus for COVID-19 vaccination and rigorous identification and treatment of SARS-CoV-2 infections to prevent adverse outcomes.
Anti-inflammatory potential of lactic acid bacteria from southern Brazil by reducing TNF-α and increasing IL-10 synthesis: an in vitro study
Authors: Vincenzi Angélica , Goettert Márcia Inês , Volken de Souza Claucia Fernanda
Published: August 2023

Aims

To evaluate the adhesion capacity and anti-inflammatory activity of lactic acid bacteria (LAB) isolated from raw cow milk and artisan cheese in Southern Brazil, investigating their effect on the release of cytokines such as TNF-α and IL-10 and their influence on the activation of the p38/MAPK pathway.

Methods and results

Lentilactobacillus parabuchneri ML4, Lacticaseibacillus paracasei ML33, Lactiplantibacillus pentosus ML82, Lactiplantibacillus plantarum CH131, and L. paracasei CH135 demonstrated high adhesion potential in an in vitro model of the intestinal epithelium, as well as anti-inflammatory activity. After a 4-hour treatment, the strains significantly increased TNF-α levels, while a 24-hour treatment led to a significant decrease in TNF-α release. Moreover, IL-10 levels significantly increased after 24-hour and 48-hour treatments with LAB. The inhibition of p38/MAPK phosphorylation was identified as one of the mechanisms by which the L. paracasei ML33 and L. plantarum CH131 strains suppressed the production and release of TNF-α.

Conclusions

We identified LAB strains with potential anti-inflammatory properties that could adhere to the intestinal mucosa and alleviate the inflammatory response by reducing the production and release of TNF-α through the inhibition of the p38/MAPK pathway, while promoting the production of IL-10.
Therapeutic effects of CO2 laser therapy for congenital sebaceous nevus
Authors: Dartaha Rami , Jobran Afnan W M
Published: August 2023

Nevus sebaceous (NS) presents as alopecia and yellowish discoloration during infantile stage. In adult stage, lesions become verrucous. Importantly, various appendageal tumors such as trichoblastoma, syringocystadenoma papilliferum and basal cell carcinoma develop during this stage. Hence it is very important to follow the course of NS for early detection of neoplasms. We are presenting a case of a 10-year-old patient with a dome-shaped, dark-pigmented nodule on the left side of neck nape, which later diagnosed as NS and removed with a carbon dioxide laser.
Use of GWAS analysis in deciphering the inability of barley seeds to germinate after hypoxia
Authors: Fagerstedt Kurt V
Published: August 2023

This article comments on:

Gómez-Álvarez EM, Tondelli A, Nghi KN, Voloboeva V, Giordano G, Valè G, Perata P, Pucciariello C. 2023. The inability of barley to germinate after submergence depends on hypoxia-induced secondary dormancy. Journal of Experimental Botany 74, 4277–4289
The statistics of negative power spectrum systematics in some 21 cm analyses
Authors: Morales Miguel F , Pober Jonathan , Hazelton Bryna J
Published: August 2023

Through a very careful analysis Kolopanis and collaborators identified a negative power spectrum (PS) systematic. The 21 cm cosmology community has assumed that any observational systematics would add power, as negative PS are non-physical. In addition to the mystery of their origin, negative PS systematics raise the spectre of artificially lowering upper limits on the 21 cm PS. It appears that the source of the negative PS systematics is a subtle interaction between choices in how the PS estimate is calculated and baseline-dependent systematic power. In this paper, we present a statistical model of baseline dependent systematics to explore how negative PS systematics can appear and their statistical characteristics. This leads us to recommendations on when and how to consider negative PS systematics when reporting observational 21 cm cosmology upper limits.
The Relationship Between Reported Daily Nicotine Dose from NRT and Daily Cigarette Consumption in Pregnant Women Who Smoke in an Observational Cohort Study
Authors: Orton Sophie , Szatkowski Lisa , Naughton Felix , Coleman Tim ,   N-Ready team:, Clark Miranda , Cooper Sue , Dickinson Anne , Emery Joanne , Lewis Sarah , McDaid Lisa , Phillips Lucy , Thomson Ross
Published: August 2023

Introduction

For nonpregnant people unable to quit smoking, the NHS recommends nicotine replacement therapy (NRT) for smoking reduction. This is not recommended during pregnancy due to concerns about higher nicotine intake than smoking alone. We investigated the relationship between daily nicotine dose from NRT and cigarette consumption reported by pregnant women receiving smoking cessation support.

Methods

We conducted secondary analysis of data from currently smoking pregnant women, recruited from antenatal clinics (Nottingham University Hospitals, UK) or online between June 2019–September 2020. Participants set a quit date, received a prototype NRT adherence intervention, and reported cigarettes per day (CPD) and daily NRT dose (mg) via smartphone app for 28 days.

Results

388 women were screened, 32 (8%) were eligible and joined the study. 24 (75%) submitted 510 app reports in total. 17 (71%) reported smoking and using NRT concurrently on at least one day, with concurrent use reported on 109 (21%) of app reports.

The relationship between daily NRT dose and CPD followed an exponential decay curve of approximately 7%. In multilevel repeated measures modelling using 4 linear splines (knots 17, 40, and 85 mg/NRT), significant fixed effects of daily NRT dose on CPD were observed for splines 1, 3, and 4. The strongest association was spline 1 (0–17 mg/NRT), where each 10 mg NRT increase was associated with a 0.6 CPD reduction (24% on average).

Conclusions

Among women in a cessation study, many smoked and used NRT concurrently; within these women, daily nicotine dose and heaviness of smoking were inversely related.

Implications

Findings have implications for the design of future interventions intended to reduce harm associated with smoking in pregnancy. They suggest using NRT alongside smoking in pregnancy could help some women reduce the number of cigarettes they smoke per day.
The correlation between the 500 pc scale molecular gas masses and AGN powers for massive elliptical galaxies
Authors: Fujita Yutaka , Izumi Takuma , Kawakatu Nozomu , Nagai Hiroshi , Hirasawa Ryo , Ikeda Yu
Published: August 2023

Massive molecular clouds have been discovered in massive elliptical galaxies at the center of galaxy clusters. Some of this cold gas is expected to flow in the central supermassive black holes and activate galactic nucleus (AGN) feedback. In this study, we analyze archival Atacama Large Millimeter Array (ALMA) data of nine massive elliptical galaxies, focusing on CO line emissions, to explore the circumnuclear gas. We show that the mass of the molecular gas within a fixed radius (500 pc) from the AGNs (Mmol ∼ 107–108 M⊙) is correlated with the jet power estimated from X-ray cavities (Pcav ∼ 1042–1045 erg s−1). The mass accretion rate of the circumnuclear gas $\dot{M}$ also has a correlation with Pcav. On the other hand, the continuum luminosities at ∼1.4 GHz and ∼100–300 GHz have no correlation with Mmol. These results indicate that the circumnuclear gas is sustaining the long-term AGN activities (∼107 yr) rather than the current ones. The circumnuclear gas mass is a better indicator of the jet power than the continuum luminosity, which probably changes on a shorter time scale. We also study the origin of the continuum emission from the AGNs at ∼100–300 GHz and find that it is mostly synchrotron radiation. For low-luminosity AGNs, however, dust emission appears to contaminate the continuum.
Prevalence of ultrasound and clinical findings suggestive of inflammatory arthritis in children with skin psoriasis
Authors: Coronel Luis , Gouze Hélène , Gudu Tania , Ruel-Gagné Sophie , Padovano Ilaria , Costantino Félicie , Vidal François , Breban Maxime , Mahé Emmanuel , D’Agostino Maria-Antonietta
Published: August 2023

Objective

To evaluate the prevalence of clinical and US (grey-scale and Doppler) abnormalities in joints, periarticular structures and nails of children affected by skin psoriasis (PsO).

Methods

We conducted a cross-sectional study including consecutive children affected by PsO. A systematic clinical and US evaluation of joints, entheses, tendons and nails were performed by independent examiners blinded to each other’s assessment.

Results

A total of 57 children [26 girls (46%)] with a mean age of 9 years (s.d. 4) were divided into two groups, asymptomatic (Asy, 42 children) and symptomatic (Sy, 15 children), according to musculoskeletal pain. Differences were observed between the two groups in relation to age [9 years (s.d. 3) vs 11 years (s.d. 4), P < 0.05], PsO duration [2.4 years (s.d. 2.4) vs 5.4 years (s.d. 3.9), P < 0.001], systemic treatment [23 (54.8%) vs 2 [13.3%], P < 0.01], tender joint count [0 vs 12 children (80%), P < 0.001], swollen joint count [0 vs 3 children (20%), P < 0.01] and entheseal pain [0 vs 10 (66.7%), P < 0.001] in Asy and Sy children, respectively. US evaluation showed statistically significant differences between the Asy and Sy groups for the presence of US abnormalities [16/42 (38%) vs 12/15 (80%)], synovitis [1/42 (2%) vs 4/15 (25%)] and enthesitis [4/42 (9.5%) vs 5/15 (33%)]. Three children in the Sy group were classified with juvenile PsA (JPsA).

Conclusions

US abnormalities were higher in the Sy group, with synovitis and enthesitis as the most prevalent findings. Asy patients were more frequently under systemic treatment. US and a systematic clinical evaluation are useful tools for detecting subclinical JPsA in children with PsO and musculoskeletal symptoms.
HIV-1 transcriptional modulation: novel host factors and prospective therapeutic strategies
Authors: Gibaut Quentin M.R. , Mori Luisa P. , Valente Susana T.
Published: August 2023

Purpose of review

This review highlights advances in HIV transcription and epigenetic latency mechanisms and outlines current therapeutic approaches to eliminate or block the HIV-1 latent reservoir.

Recent findings

Novel host factors have been reported to modulate HIV-1 transcription and latency. Chromatin affinity purification strategies followed by mass spectrometry (ChAP-MS) identified the chaperone protein p32 to play an important role in HIV-1 transcriptional regulation via interactions with the viral transcriptional activator Tat. Similarly, an shRNA screen identified the methyltransferase SMYD5 contributing to HIV-1 transcriptional activation also by modulating Tat activity. These new factors, among others, represent potential druggable targets that could be explored in the ‘block-and-lock’ or ‘shock-and-kill’ approaches.

The HIV-1 latent reservoir is established early after infection, persists during antiretroviral therapy, and is the source of viral rebound after treatment interruption. An HIV cure requires either eliminating this reservoir or blocking latent proviral reactivation in the absence of antiretroviral therapy (ART). Understanding the mechanisms and key-players modulating HIV transcriptional and reactivation may facilitate therapeutic advancements. Here we summarize, the latest findings on host factors’ roles in HIV transcriptional regulation.
The changing use and program costs of HIV-related laboratory testing over 20 years in an HIV cohort
Authors: Dalere Jessica , Lang Raynell , Krentz Hartmut B. , Beckthold Brenda , Gill M. John
Published: August 2023

Purpose of review

The improved health of persons with HIV (PWH) resulting from antiretroviral therapy (ART) has led to recommendations for reduced laboratory monitoring. We studied, for all PWH in care over 20 years at the Southern Alberta Clinic (SAC), Canada, the changing use and results of HIV-specific laboratory testing [i.e., CD4+ testing, plasma HIV viral load (PVL), and genotypic antiretroviral resistance testing (GART)].

In this descriptive retrospective longitudinal cohort observational study, we examined HIV-specific laboratory testing for all PWH from 2000 to 2020 within the context of HIV-related health outcomes, program costs, and mortality.

Recent findings

The number of PWH in care increased from 755 in 2000 to 2050 in 2020. Annual CD4+ testing per PWH increased from 2.7 per person in 2000 peaking to 3.5 in 2005 but decreasing to 1.4 by 2020. Annual PVL tests per PWH gradually decreased from 3.2 in 2000 to 2.0 in 2020. GART increased from 93 tests in 2000 to 315 in 2008 decreasing to 127 in 2020. Patients received GART at baseline, and after a viral breakthrough when indicated. Viral suppression rates for the population increased from 66 to 96%; median CD4+ cell count increased from 443 to 470 cells/μl, and overall morbidity decreased from 9.2 to 2.0% by 2020, respectively. Annual per patient laboratory costs decreased from a high of $302 in 2008 to $161 by 2020.

The reduced annual laboratory surveillance per PWH associated with modern ART resulted in modest cost savings and no apparent loss in quality of HIV care.
Mitral Annular Disjunction: A Scoping Review
Authors: Gupta Sushan , Shihabi Ahmad , Patil Mihir Kishore , Shih Timothy
Published: August 2023

Mitral annular disjunction (MAD) is the atrial displacement of the mitral valve (MV) hinge point, especially along the posterior mitral leaflet, which leads to inhomogeneous blood flow into the left ventricle, causing chronic fibrotic changes, malignant arrhythmias, and even sudden cardiac arrest. Some studies suggest that MAD is a part of normal heart morphology; however, the origin is still controversial. MAD commonly occurs with MV prolapse and myxomatous degenerative MV disease. In almost 20% of cases, MAD can occur independently as well. The prevalence of MAD in normal hearts varies from 8.6% to 96%, depending on the imaging modality and the cutoff used to define MAD. Transthoracic echocardiography is often the initial screening test, but the low sensitivity of transthoracic echocardiography to identify MAD makes it easy to miss the diagnosis altogether. More advanced imaging, especially cardiac MRI, is the gold standard for diagnosing MAD and risk stratification. MAD is an independent predictor of malignant arrhythmia. Among patients with MAD, risk stratification is based on the age at diagnosis, previous syncopal attacks, premature ventricular contractions, papillary muscle fibrosis, and longitudinal disjunction distance. Most asymptomatic patients are managed conservatively; however, radiofrequency ablation should be considered in patients with high-risk or symptomatic MAD due to the risk of ventricular arrhythmias and sudden cardiac death.
Medium Definition Liposuction Abdominoplasty
Authors: Borille Giuliano , Pereira Filho Gustavo , Zancanaro Mariana , Giannini Renato , Reynosso Luis , Avalos Victor , Nahas Fabio
Published: August 2023

Background:

Not all patients who exercise regularly and follow a balanced diet will obtain a well-defined abdomen. Medium definition liposuction, together with the removal of abdominal skin, can recreate an adequate connection between the skin/subcutaneous components and the myo-aponeurotic layer, resulting in the perception of muscle definition.

Methods:

Over a period of 36 months, 351 patients underwent medium definition liposuction associated with abdominoplasty performed by a single surgeon (G.B.). All patients underwent an evaluation through digital photographs by two independent senior plastic surgeons, using an objective grading system for aesthetic outcomes proposed by Strasser, 12 months after the operation.

Results:

According to the Strasser Scale, 326 patients (93%) were considered to have good and excellent results. Twenty-two patients (6.2%) had moderate/mediocre results‚ and three patients (0.8%) had poor results. The overall complication rate was 4.8%.

Conclusion:

Medium definition liposuction associated with abdominoplasty has been shown to be effective, safe, and reproducible for most patients.
Superficially Herniated Loop of Facial Artery: A Potential Trap for the Unsuspecting Practitioner
Authors: von Haven Haley N. , Soares Danny J.
Published: August 2023

The anatomy of the facial artery is complex and prone to significant variations, rendering it susceptible to vascular injury secondary to injectable treatments. Despite the known variation in the course and branching pattern of this important arterial conduit, significant anomalies in the depth of the artery, including occurrences of vessel herniation, are not as well characterized. We describe an instance of a superficially herniated loop of facial artery presenting as a buccal mass erroneously targeted with an injectable suspension of triamcinolone.
What Does “Dr. Google” Show Patients Searching for Breast Reconstruction Outcomes Photographs?
Authors: Nicklaus Krista M. , Gonzalez Xiomara T. , Sachdev Koushalya , Liu Jun , Chopra Deepti , Hoffman Aubri S. , Hanson Summer E. , Markey Mia K. , Reece Gregory P.
Published: August 2023

Background:

Many women with breast cancer search the internet for photographs of their potential reconstruction outcomes, but little is known about the quality, variety, and relevance of images patients are viewing.

Methods:

Breast reconstruction outcome photographs identified by a Google Images search were assessed based on the American Society of Plastic Surgeons/Plastic Surgery Foundation photographic guidelines. Information such as source metadata, breast reconstruction procedure information, and subject demographics was collected from the photographs. Additional analyses were conducted to assess whether nipple reconstruction or tattooing occurred and was disclosed, whether a symmetry procedure was performed and disclosed, and whether donor site scarring is visible in abdominal flap photographs.

Results:

We acquired and analyzed 114 photograph sets. Although a variety of images were readily available, the majority of photograph sets did not follow photographic guidelines or provide sufficient information. Most photograph sets (60%) indicated symmetry procedures when a symmetry procedure was evident, but only 40% of photograph sets disclosed a nipple procedure when a nipple procedure was evident. Only 40% of abdominal flap photographs showed donor site scarring. Subject demographics were largely missing: 50% of photograph sets included subject age, 3% included race or ethnicity, and 12% included weight or BMI.

Conclusions:

Although breast reconstruction outcome photographs shown by “Dr. Google” represent a variety of reconstruction types, they typically lack information that a patient needs to assess self-applicability. Patients may benefit from discussion with their healthcare team about the strengths and limitations of breast reconstruction outcome photographs available on the internet.
Release of Severe Postburn Contracture of Index Finger with Two-stage Reconstruction
Authors: Buja Zejnë
Published: August 2023

Postburn contractures are the result of deep burns that are not treated properly and promptly. Severe contractures require more than one surgery to be completely relieved. Their surgical treatment is very difficult and challenging for reconstructive surgeons. The author presents a case with severe postburn contracture of the index finger especially at the DIP joint with an angle of 110 degrees, which was released with a full skin graft in two stages of reconstruction. The application of this procedure enables the complete release of severe contractures and protects the fingers from their loss as a result of the shortening of vascular structures.
Complications after Nonoperative Management of Hamate Fractures
Authors: Ta Canhnghi N. , Finley Zachary , Medvedev Gleb A.
Published: August 2023

Background:

Hamate fractures are an infrequent injury and are often missed or have a delayed diagnosis with potential for significant patient morbidity. There is a relative paucity in the literature involving large population studies of hamate fractures and subsequent complications. Gaining a better understanding of complications associated with nonoperative management will help guide the decision for operative intervention.

Methods:

The PearlDiver patient records database was used to query for patients who sustained a hamate fracture using ICD-9 and ICD-10 codes. Postinjury complications within 1 year of diagnosis were assessed using ICD-9 and ICD-10 codes for diagnoses of complications.

Results:

A total of 1120 patients who sustained a hamate hook or body fracture met inclusion and exclusion criteria and were included in the study. Patients who were managed nonoperatively showed a nonunion rate of 2%, ulnar neuropathy rate of 1.7%, and tendon rupture rate of 0.2%. In a subanalysis using only ICD-10 codes to distinguish between hook and body fractures, hook fractures demonstrated a nonunion rate of 2.2%, ulnar neuropathy rate of 2.7%, and tendon rupture rate of 0%, while body fractures had a nonunion rate of 1.2%, ulnar neuropathy rate of 1%, and tendon rupture rate of 0%.

Conclusion:

The current study shows very low rates of nonunion, ulnar neuropathy and tendon rupture after nonoperative management of hamate fractures.
Association between anterior chamber biometry and posterior capsular defects
Authors: Arad Tschingis , Engel Xenia , Ackermann Hanns , Schmack Ingo , Kohnen Thomas
Published: August 2023

Purpose:

To analyze the association between anterior chamber biometric factors and posterior capsular defects (PCDs) that occur during extracapsular cataract extraction.

Setting:

University Eye Hospital, Goethe University Frankfurt, Germany.

Design:

Population-based study.

Patients and methods:

Extracapsular cataract extractions for inpatient cases within 4 years were retrospectively analyzed. The data on the occurrence of PCDs, age, sex, surgeon, and biometry were obtained. For cases with PCDs, the secondary ocular diseases, number of procedures, lens implant, visual acuity, and course were also recorded. Swept-source optical coherence tomography measurements allowed the measurement of lens thickness (LT) in addition to the usual biometry values.

Results:

A total of 1967 cataract surgeries (patients age: 70.56 ± 8.42, 1005 women; 962 men) were included, and PCDs were documented for 59 (2.54%; 31 women, 28 men) cases (patient age: 70.95 ± 8.52 years). There were no differences (P = .76) related to the surgeons (n = 9) with minimal effect sizes. The mean LT, axial length, corneal curvature, and anterior chamber depth were 4950.36 ± 466.63 μm, 23.73 ± 1.77 mm, 43.89 ± 1.36 diopters, and 3.02 ± 0.71 mm, respectively. The Wilcoxon-Mann-Whitney test showed significant associations between LT (P = .01) and PCDs with moderate relevance for the Rosenthal effect size (LT R = 0.34; ACD R = 0.29).

Conclusions:

In addition to ACD, a tendency for the occurrence of PCD could be proven, especially for LT. Therefore, special attention should be paid to LT preoperatively for comprehensive risk stratification.
Efficacy of non-opioid analgesics and regional techniques for perioperative pain management in laparoscopic gynecological surgery: a systematic review and network meta-analysis
Authors: Ding Xinyun , Ma Yuan , Ma Yue , Chen Congmin , Zhang Xiaohui , Duan Qianwen , Ma Yuqing
Published: August 2023

Background:

The optimal approach for perioperative pain management in laparoscopic gynecological surgery is unclear due to a lack of comprehensive analysis, which limits the development of evidence-based ERAS protocols. This study aimed to conduct a systematic review and network meta-analysis to support clinical decision-making for optimal analgesia.

Materials and Methods:

This study conducted a systematic literature search in PubMed, Embase, CENTRAL, Web of Science, and CINAHL from inception to December 3, 2021, and updated on August 19, 2022. Randomized controlled trials comparing the perioperative use of non-opioid analgesics and regional techniques in adults undergoing elective laparoscopic gynecological surgery under general anesthesia were included in the analysis, either alone or in combination. The co-analgesic interventions during the perioperative period for the intervention and control groups of each eligible study were also considered. We assessed the risk of bias using the Risk of Bias 2 tool and evaluated the certainty of evidence using the Confidence in Network Meta-Analysis (CINeMA) approach. Bayesian network meta-analysis was used to estimate the efficacy of the analgesic strategies. The primary outcomes were pain score at rest and cumulative oral morphine milligram equivalents at 24 hours post-operatively.

Results:

Overall, 108 studies with 9582 participants and 35 different interventions were included. Compared with inert treatments, combinations of two or more interventions showed better efficacy and longer duration in reducing post-operative pain and opioid consumption within 24 hours than monotherapies, and showed stepwise enhanced effects with increasing analgesic modes. In combination therapies, regional techniques that included peripheral nerve blocks (PNBs) and intraperitoneal local anesthetics, in combination with non-opioid systemic analgesics, or combining local anesthetics with adjuvant drugs, were found to be more effective. Monotherapies were found to be mostly ineffective. The most effective PNBs were found to be ultrasound-guided transversus abdominis plane block with adjuvant and ultrasound-guided quadratus lumborum block.

Conclusions:

These results provide robust evidence for the routine use of regional techniques in combination with non-opioid analgesics in perioperative pain management. However, further better quality and larger trials are needed, considering the low confidence levels for certain interventions.
Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes
Authors: Plotsker Ethan L. , Stern Carrie S. , Graziano Francis D. , Rubenstein Robyn N. , Vingan Perri S. , Haglich Kathryn , Monge Jasmine , Disa Joseph J. , Mehrara Babak J. , Dayan Joseph H. , Allen Robert , Matros Evan , McCarthy Colleen , Nelson Jonas A.
Published: August 2023

Background:

Textured implants have been linked to breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL). Patients who undergo explantation have options for reconstruction, but data on safety and patient-reported outcomes (PROs) are limited. The purpose of this study was to classify complications and PROs in patients opting for surgical management of textured implants.

Methods:

Complication rates and BREAST-Q scores were compared between (1) asymptomatic patients who underwent conversion from textured to smooth implants (n = 224), (2) symptomatic patients who underwent conversion from textured to smooth implants (n = 83), (3) patients who underwent explantation without replacement (n = 44), and (4) patients who underwent replacement with autologous reconstruction (n = 33). Linear regression examined PROs controlling for clinical and surgical variables.

Results:

Overall complication rates in 384 patients (637 implants) differed across groups (P = 0.034), with the highest rate (25%) in patients who underwent explantation without replacement. These patients were specifically more impacted by minor complications, notably seroma. Capsulectomy extent did not significantly impact complications. Asymptomatic and symptomatic smooth implant patients had improvements in Satisfaction with Breasts (P < 0.05). Autologous reconstruction patients had significant improvements in Satisfaction with Breasts sustained after 3 months postoperatively (P < 0.01) and Sexual Well-being sustained after 6-months postoperatively (P < 0.05). Patients who underwent removal without replacement had lower Physical Well-being of the Chest scores at 1 year or more than the other groups.

Conclusions:

Replacement of textured implants with smooth implants or flaps is safe and is associated with improved satisfaction with breasts and quality of life. The degree of capsulectomy does not appear to impact the incidence of perioperative complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
A 9-Year Review of Ethics Complaints to the American Society of Plastic Surgeons
Authors: Makar Katelyn G. , Bajaj Anureet K. , Park Julie E. , Preminger B. Aviva , Vercler Christian J.
Published: August 2023

Background:

The American Society of Plastic Surgeons (ASPS) provides an avenue for filing formal complaints regarding unethical behavior of members. These complaints are investigated by the ethics committee and referred to the judicial council if a violation may have occurred.

Methods:

A review of complaints filed with the ASPS from 2013 through 2021 was performed. Data surrounding both complaints and complainant type were reviewed, as well as region of complaint origin. Categories of violations resulting in formal investigations and judicial council referrals were also reviewed.

Results:

A total of 584 complaints were filed with the ASPS ethics committee from 2013 through 2021, which was nearly 100 fewer than from a previous review of 2004 through 2008. Twenty-one percent of complaints were formally investigated by the ethics committee, and 26% of these were referred to the judicial council. The most common complaint investigated was related to advertising or misleading communications; the most common complaint referred to the judicial council was regarding expert testimony. Most complaints were filed by ASPS members.

Conclusions:

The total number of complaints filed over time has decreased significantly, the reasons for which are unclear. Evolution of culture and thought likely had an impact, not only on specific behaviors but also on the likelihood of reporting those behaviors. It remains incumbent on plastic surgeons to use the self-regulating mechanisms available to maintain the autonomy plastic surgery enjoys as a profession.
Revision Phalloplasty: Evaluation, Algorithms, and Techniques for Salvage after Major Complications
Authors: Keller Patrick R. , Chen Mang L. , Ovadia Steven A. , Reiche Erik , Safa Bauback , Coon Devin
Published: August 2023

Background:

Phalloplasty is among the most complex and technically demanding reconstructive procedures. As a larger pool of surgeons perform this difficult procedure, more patients will present with major complications. There are few published data on the comprehensive evaluation and management of these patients, particularly those needing correction of multiple ongoing complications, which may require consideration of starting over with a new microsurgical procedure versus salvage of the existing flap.

Methods:

A literature review on complications of phalloplasty was conducted in combination with drawing upon the experience of 2 high-volume phalloplasty teams (Johns Hopkins/Harvard and GU Recon Clinic/Buncke Clinic) in treating patients with severe postsurgical issues. The purpose was to analyze critical factors and develop algorithms for secondary revision.

Results:

Common complications of phalloplasty include urethral strictures and fistulas, diverticula, excess bulk, phalloplasty malposition, hypertrophic or keloidal scarring, and partial or total flap loss. In severe cases, local flaps or free flaps may be required for reconstruction. The decision to revise the existing neophallus or start over with a new flap for phalloplasty is particularly critical. Multidisciplinary team collaboration is essential to develop comprehensive plans that will resolve multiple concomitant problems while meeting patient goals for a functional and aesthetic neophallus.

Conclusions:

Preserving the original flap for phalloplasty is ideal when feasible. Additional local or free flaps are sometimes necessary in situations of significant tissue loss. In severe cases, complete redo phalloplasty is required. The algorithms proposed provide a conceptual framework to guide surgeons in analyzing and managing severe complications after phalloplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Frailty and pre-frailty phenotypes increase the odds of abnormal cognitive impairment screens in people living with HIV
Authors: Makinson Alain , Allavena Clotilde , Abulizi Xian , Slama Laurence , Case Antoine , Trouillet Marion Bourgey , Blondel Guillaume Martin , Geny Christian , Leclercq Pascale , Cazanave Charles , Bonnet Fabrice , Naqvi Alissa , David-Chevallier Perla , Arvieux Cédric , Katlama Christine , Cabie André , Andriantsoanirina Valérie , Blain Hubert , Meyer Laurence
Published: August 2023

Objective:

Evaluate whether pre-frail and frail PLWH have a higher risk of cognitive impairment on screens.

Methods:

Analysis of PLWH aged 70 or older included in the ANRS EP66 SEPTAVIH cohort, on antiretroviral therapy for at least 12 months and with a MoCA test at enrolment. Adjusted risk of a Montreal Cognitive Assessment (MoCA) <26 was compared in frail/pre-frail versus robust PLWH.

Results:

A total of 503 PLWH were enrolled with a median age of 73 years, IQR [71–77], 81.5% were male, 73.8% were French natives, 32.9% had low socio-economic status (EPICES score >30.2), and 41.3% were college graduates; 27.3% had a history of clinical AIDS. 294 (58.5%) PLWH had a MoCA score <26; 182 (36%) a MoCA score ≤ 23. Frailty, pre-frailty, and robustness were found in 13.1%, 63.6% and 23.3% participants, respectively. PLWH with a MoCA < 26 had a significantly higher risk of being frail/prefrail, this before (OR = 2.31 [95% CI: 1.50, 3.57]), and after adjustment for confounders (OR = 1.80, [1.07–3.01]). The risk of being frail/prefrail in patients with a MoCA ≤ 23 was higher (adjusted OR = 2.75, [95%CI: 1.46–5.16]). Other factors independently associated with a MoCA < 26 were older age, birth outside of France, and a lower education level and being diabetic.

Conclusions:

Abnormal MoCA screens were frequent in our cohort of PLWH aged 70 or older with controlled HIV disease. Cognitive impairment should be systematically screened in frail/prefrail PLWH. Frailty/pre-frailty, diabetes and social factors, but not HIV-related factors, are important determinants of cognitive function in PLWH with controlled disease.
Frequency of Atypical Pulmonary Manifestations of COVID-19 Patients on Chest CT-scan: A cross-sectional study
Authors: Borji Soheila , Isavand Pouria , Azami Mobin , Ghafouri Ehsan
Published: August 2023

Background

Chest CT examination is significant in COVID-19 diagnosis due to its high sensitivity. Although typical chest CT findings have been discussed thoroughly in the literature throughout the pandemic, we aimed to investigate the prevalence of the atypical conclusions during the start of the Omicron variant insurgency and compare the results to studies conducted before its outbreak.

Methods

606 confirmed COVID-19 cases were included in this study based on inclusion and exclusion criteria during January and February 2022. Demographic information of patients, including age and sex, was recorded. The computed tomography (CT) examination was carried out using a 100-slice scanner (Philips Brilliance 6 CT Scanner). One radiology attending and one resident evaluated SARS-CoV-2 RT-PCR-positive patients for atypical pulmonary CT findings. The obtained data were evaluated using R software version 4.1.1.

Results

55% of patients were female, and the median age was 56 (IQR: 42, 69) 59% of patients had atypical findings on their pulmonary CT examination. These findings showed that pleural abnormalities were the most frequent atypical findings, with pleural thickening being the most common (17%). The double halo sign represented the least frequent atypical sign (0.2%).

Conclusion

Atypical findings were more prevalent in this study than its predecessors, while we acknowledge that other factors, such as study design and patient population, could have impacted it. The presence of atypical signs generally was not correlated with specific demographic groups, while some of these signs were more frequent in some groups.
Unveiling a Potential Prognostic Biomarker in KRAS-Mutant Lung Adenocarcinoma Using Weighted Gene Co-Expression Network Analysis
Authors: Dodin Yasmeen
Published: August 2023

Background

Globally, lung cancer is the leading cause of cancer-related deaths, primarily non-small cell lung cancer (NSCLC). Kirsten Rat Sarcoma Oncogene Homolog (KRAS) mutations are common in NSCLC and linked to a poor prognosis. Covalent inhibitors targeting KRAS-G12C mutation have improved treatment for some patients, but most KRAS-mutant lung adenocarcinoma (KRAS-MT LUAD) cases lack targeted therapies. More research is required to identify prognostic genes in KRAS-MT LUAD.

Objective

We aimed to identify hub genes within key co-expression gene network modules specifically associated with KRAS-MT LUAD. These hub genes hold the potential to serve as therapeutic targets or biomarkers, providing insights into the pathogenesis and prognosis of lung cancer.

Methods

We performed a comprehensive analysis on KRAS-MT LUAD using diverse data sources. This included TCGA project data for RNA-seq, clinical information, and somatic mutations, along with RNA-seq data for adjacent normal tissues. DESeq2 identified differentially expressed genes (DEGs), while weighted gene co-expression network analysis (WGCNA) revealed co-expression modules. Overlapping genes between DEGs and co-expression module with the highest significance were analyzed using gene set enrichment analysis (GSEA) and protein-protein interaction (PPI) network analysis. Hub genes were identified with the Maximal Clique Centrality (MCC) algorithm in Cytoscape. Prognostic significance was assessed through survival analysis and validated using the GSE72094 dataset from Gene Expression Omnibus (GEO) database.

Results

In KRAS-MT LUAD, 3,122 DEGs were found (2,131 up-regulated, 985 down-regulated). The blue module, among 25 co-expression modules from WGCNA, had the strongest correlation. 804 genes overlapped between DEGs and the blue module. Among twenty hub genes in the blue module, leucine-rich repeats containing G protein-coupled receptor 4 (LGR4) overexpression correlated with worse overall survival (OS) in KRAS-MT LUAD patients (P=0.012). The prognostic significance of LGR4 was confirmed using GSE72094, but surprisingly, the direction of the association was opposite to what was expected.

Conclusion

LGR4 is a potential prognostic biomarker in KRAS-MT LUAD. Contrasting associations in TCGA and GSE72094 datasets reveal the complexity of KRAS-MT LUAD. Further investigations are required to understand LGR4’s role in lung adenocarcinoma prognosis, especially in the context of KRAS mutations.