bluuebunny/crossref_metadata_2025 huggingface dataset:
Resistance Training in Patients With Coronary Artery Disease, Heart Failure, and Valvular Heart Disease
Authors: Bjarnason-Wehrens Birna , Schwaab Bernhard , Reiss Nils , Schmidt Thomas
Published: August 2022

Purpose:

Current guidelines recommend individually adapted resistance training (RT) as a part of the exercise regime in patients with cardiovascular diseases. The aim of this review was to provide insights into current knowledge and understanding of how useful, feasible, safe, and effective RT is in patients with coronary artery disease (CAD), heart failure (HF), and valvular heart disease (VHD), with particular emphasis on the role of RT in elderly and/or frail patients.

Review Methods:

A review based on an intensive literature search: systematic reviews and meta-analyses published in 2010 or later; recent studies not integrated into meta-analyses or systematic reviews; additional manual searches.

The results highlight the evaluation of effects and safety of RT in patients with CAD and HF with reduced ejection fraction (HFrEF) in numerous meta-analyses. In contrast, few studies have focused on RT in patients with HF with preserved ejection fraction (HFpEF) or VHD. Furthermore, few studies have addressed the feasibility and impact of RT in elderly cardiac patients, and data on the efficacy and safety of RT in frail elderly patients are limited. The review results underscore the high prevalence of age-related sarcopenia, disease-related skeletal muscle deconditioning, physical limitations, and frailty in older patients with cardiovascular diseases (CVD). They underline the need for individually tailored exercise concepts, including RT, aimed at improving functional status, mobility, physical performance and muscle strength in older patients. Furthermore, the importance of the use of assessment tools to diagnose frailty, mobility/functional capacity, and physical performance in the elderly admitted to cardiac rehabilitation is emphasized.
What Are the Attributes Prioritized in the Choice of Therapy in Chronic Lymphocytic Leukemia? A Patient-physician Cross-matching Analysis of a Discrete Choice Experiment
Authors: Laurenti Luca , Gaidano Gianluca , Mauro Francesca Romana , Molica Stefano , Pasqualetti Patrizio , Scarfò Lydia , Ghia Paolo
Published: August 2022

Several treatment options are available for chronic lymphocytic leukemia (CLL) and, for this reason, treatment choice can result challenging after introducing oral targeted agents. This study aims at comparing patients’ and hematologists’ preferences for attributes of CLL treatments. An online cross-sectional survey has been delivered to clinicians and patients affected by CLL in Italy. A discrete choice experiment has been conducted so to estimate each attribute’s relative importance (RI) and assess the preference weight for each level of each attribute. An expert panel agreed on investigating the following attributes: progression-free survival (PFS) and measurable residual disease, route of administration/therapy duration and follow-up frequency, incidence of diarrhea (episodes/day), serious infections (grade 3 or 4), and atrial fibrillation. Overall, 746 patients and 109 clinicians accessed the survey, and 215 and 69, respectively, filled it in. The most important attributes were PFS (RI 30%) for hematologists and the risk of severe infections (RI 24%) for patients. Clinicians rated preference for maximum efficacy and lowest risk of severe infection very high (30%). Both patients and clinicians preferred oral administration while considering duration of therapy less relevant. The frequency of hospital appointments was negligible for patients, while clinicians preferred a quarterly frequency. Considering all attributes, diarrhea was weighted more by clinicians than by patients. Atrial fibrillation was not relevant for clinicians, while it was not negligible for patients. In conclusion, clinicians and patients favor an oral therapy, including continuous treatment, if associated with prolonged PFS, albeit with particular attention to the risk of serious infections.
Effect of Intense Pulsed Light Therapy in Dry Eye Disease Caused by Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis
Authors: Miao Sen , Yan Ran , Jia Yusong , Pan Zhiqiang
Published: August 2022

Background:

This study aimed to systematically evaluate the effect of intense pulsed light (IPL) therapy in patients harboring dry eye disease caused by meibomian gland dysfunction (MGD) based on qualified studies.

Methods:

The electronic databases, including PubMed, Cochrane, and Embase, were searched using keywords to identify available publications updated to November 2021. Relative risk or weighted mean difference combined with 95% confidence interval was used to synthesize the outcomes of included studies. The meta-analysis included 15 randomized controlled trials with 1,142 patients (2,284 eyes).

Results:

The results revealed that IPL could significantly decrease the ocular surface disease index (OSDI), standard patient evaluation of eye dryness (SPEED), artificial tear usage, tear film lipid layer, meibomian gland quality (MGQ), meibomian gland expression (MGX), and corneal fluorescein staining (CFS) while increase tear break-up time (TBUT) and noninvasive tear break-up time (NIBUT) compared with sham. Compared with MGX, IPL+MGX markedly decreased the SPEED, CFS, and tear meniscus height (TMH), but with increased TBUT. Compared with MGX, IPL showed significant effect in increasing the OSDI and TBUT, but decreasing the TMH and NIBUT. However, no significant differences were seen between IP+MGX and MGX in OSDI, MGQ, and MGX, nor between IPL and MGX in OSDI, SPEED, and TBUT.

Conclusion:

We identified that the application of IPL alone or IPL combined with MGX elicited superior clinical effect for improving the eye function and symptoms in the treatment of MGD-related dry eye disease, which is considered available for wide clinical application.
Gone Viral: A Cross-Sectional Analysis of Contact Lens-Related Videos on TikTok
Authors: Costantini Julia G. , Qi Yang Aaron Goh , Steinemann Thomas L.
Published: August 2022

Objectives:

To evaluate the content, sources, and quality of contact lens (CL)-related videos on TikTok, the fastest growing social media platform worldwide.

Methods:

TikTok was queried on October 25, 2021 for the top 200 posts with the hashtag “#contactlenses.” Posts meeting inclusion criteria were characterized and assessed for quality with DISCERN, a validated scoring instrument for the appraisal of consumer health information (score range 1–5 with a higher score indicating a higher quality video).

Results:

The included 113 posts showed a mean quality of 1.94±0.44. Content included product displays (42%), patient experiences (23%), educational (22%), and comedy (12%). Most product displays featured decorative lenses (98%). Although videos by eye-care providers (ECPs) accounted for most educational content (52%) and showed significantly higher mean quality compared with posts by non-ECPs (2.57±0.18 vs. 1.85±0.13, P<0.001), they were a minority (12%) and showed poor overall quality. Contact lens representation was greatly skewed toward decorative lenses (74%), whereas only 3.5% of videos promoted seeing an ECP.

Conclusions:

Poor quality and skewed representation of posts indicate that CL-related information on TikTok has serious shortcomings. These findings are particularly concerning given that most TikTok users are adolescents and young adults, the same population who tend to be decorative lens wearers and who are at increased risk of CL-related complications. Eye-care providers, professional organizations, and regulatory agencies should be urged to increase their engagement with the platform, especially regarding educational content creation and CL marketing oversight.
Inhibiting PI3K and MAPK Pathways
Authors: Liu Lucy Y. , Jeng Michael R. , Teng Joyce M. C.
Published: August 2022

Extracranial arteriovenous malformations (AVMs) are associated with significant morbidity and mortality and lack consistently effective non-surgical interventions. Genetic mutations have been associated with AVMs, leading to success in using targeted therapies to reduce comorbidities. We report a 19-year-old male with phosphatase and tensin homolog hamartoma tumor syndrome with a large AVM of the left leg, complicated by progressive dilated cardiomyopathy, requiring multiple trans-arterial and trans-venous embolizations. Despite management using systemic mammalian target of rapamycin inhibition by sirolimus and surgical interventions, this patient developed cardiac failure and chronic skin ulcers over the distal left leg, presumed to be due to stasis and tissue ischemia, leading to development of debilitating pain. Trametinib was added to target activation of mitogen-activated protein kinase pathway. His cardiac disease and AVM responded when trametinib and sirolimus were combined. After 2 months, his chronic skin ulcers healed completely. The patient can ambulate without the need for any pain medication, and his cardiac condition stabilized.
Evaluating the effect of COVID-19 on quality measures of patients with type 2 diabetes in two family nurse practitioner–owned clinics
Authors: Wright Wendy L. , White Patricia A. , Welsh Meredith , Cutting Kelly
Published: August 2022

Background:

The COVID-19 pandemic necessitated lockdowns resulting in the disruption of access to primary care. A family nurse practitioner (NP)–owned practice shifted many visits to telehealth to provide care to all their patients including those with chronic illness. The purpose of this project was to evaluate the impact of the pandemic on selected diabetes quality measures and adherence to national diabetes guidelines in two previously well-performing NP-owned primary care clinics.

Local Problem:

Previous quality improvement studies demonstrated high performing metrics for their patients with type 2 diabetes mellitus (DM). The evaluation of the patients with type 2 DM was necessary to assess the care being delivered in the practice.

Methods:

A retrospective record review and analysis of 179 patients older than 18 years was implemented during the early days of the pandemic. Demographic data, process, and outcome measures for diabetes care were collected and compared with previous data from 2013 to 2017 to identify gaps in care.

Interventions:

Telehealth was implemented to deliver care to patients because of the lockdown. The evaluation of these metrics during the period where telehealth was being used to provide care was warranted to evaluate the status of patients with type 2 DM.

Results:

Patients with type 2 DM receiving care with telehealth demonstrated worsening A1cs and other quality care measures, including fewer ophthalmology evaluations.

Conclusion:

While access to telehealth was important for these patients with type 2 DM, the findings demonstrated that the COVID-19 pandemic had a negative impact on diabetes quality measures. While these may have also reflected the challenges of adhering to lifestyle interventions during this stressful time, telehealth alone may not be an adequate delivery mechanism for primary care for those with type 2 DM.
Promoting Completion of Cranial Radiation Therapy Without Sedation in Young Patients With Brain Tumors: A Case Series Illustrating Flexible Application of Empirically Supported Intervention
Authors: Jurbergs Niki , Kennedy Amy , Harman Jennifer L.
Published: August 2022

Repeated anesthesia poses risks to patients but is often utilized to immobilize young children undergoing cranial radiation therapy for brain tumors. To enable young patients to remain still during cranial radiation therapy and thereby avoid sedation, medical and psychosocial clinicians can use behavioral and other supportive interventions. This case series illustrates the utility of behavioral training for motion control in 3 children 6 years old or younger who were treated for brain tumors. We demonstrate the efficacy of flexible, individualized intervention approaches to accommodate patients with brain tumors in the context of emotional dysregulation, significant communication barriers, and profound sensory deficits.
Inhibition Predicts the Course of Depression and Anxiety Symptoms Among Adolescents
Authors: Stevens Elizabeth S. , Funkhouser Carter J. , Auerbach Randy P. , Talati Ardesheer , Gameroff Marc G. , Posner Jonathan E. , Weissman Myrna M. , Shankman Stewart A.
Published: August 2022

Numerous theoretical models suggest that inhibition difficulties—the inability to moderate automatic responses—contribute to the onset and/or maintenance of internalizing symptoms. Inhibition deficits and internalizing disorders run in families and share overlapping genetic risk factors, suggesting that inhibition deficits may be particularly prognostic of internalizing symptoms in those with high familial risk. This study tested this hypothesis in a longitudinal sample during the transition from adolescence to early adulthood. As hypothesized, prospective associations between inhibition and anxiety and depressive symptoms 8 years later were moderated by familial risk for depression. Specifically, poorer inhibition prospectively predicted greater anxiety and depressive symptoms in those at high (but not low) familial risk for major depressive disorder. These findings provide preliminary support for impaired inhibition as an indicator of risk for later internalizing symptoms in those at high familial risk.
Predictive Factors for Hemorrhagic Transformation in Acute Ischemic Stroke in the REAL-World Clinical Practice
Authors: Grifoni Elisa , Bini Chiara , Signorini Ira , Cosentino Eleonora , Micheletti Irene , Dei Alessandro , Pinto Gabriele , Madonia Elisa Maria , Sivieri Irene , Mannini Marianna , Baldini Mariella , Bertini Elisabetta , Giannoni Sara , Bartolozzi Maria Letizia , Guidi Leonello , Bartalucci Paola , Vanni Simone , Segneri Antonio , Pratesi Alessandra , Giordano Antonio , Dainelli Francesca , Maggi Francesca , Romagnoli Mario , Cioni Elisa , Cioffi Elisa , Pelagalli Giulia , Mattaliano Chiara , Schipani Elena , Murgida Giuseppe Salvatore , Di Martino Stefania , Sisti Eleonora , Cozzi Andrea , Francolini Valentina , Masotti Luca
Published: August 2022

Background:

Few data exists on predictive factors of hemorrhagic transformation (HT) in real-world acute ischemic stroke patients. The aims of this study were: (i) to identify predictive variables of HT (ii) to develop a score for predicting HT.

Methods:

We retrospectively analyzed the clinical, radiographic, and laboratory data of patients with acute ischemic stroke consecutively admitted to our Stroke Unit along two years. Patients with HT were compared with those without HT. A multivariate logistic regression analysis was performed to identify independent predictors of HT on CT scan at 24 hours to develop a practical score.

Results:

The study population consisted of 564 patients with mean age 77.5±11.8 years. Fifty-two patients (9.2%) showed HT on brain CT at 24 hours (4.9% symptomatic). NIHSS score ≥8 at Stroke Unit admission (3 points), cardioembolic etiology (2 points), acute revascularization by systemic thrombolysis and/or mechanical thrombectomy (1 point), history of previous TIA/stroke (1 point), and major vessel occlusion (1 point) were found independent risk factors of HT and were included in the score (Hemorrhagic Transformation Empoli score (HTE)). The predictive power of HTE score was good with an AUC of 0.785 (95% CI: 0.749-0.818). Compared with 5 HT predictive scores proposed in the literature (THRIVE, SPAN-100, MSS, GRASPS, SITS-SIC), the HTE score significantly better predicted HT.

Conclusions:

NIHSS score ≥8 at Stroke Unit admission, cardioembolism, urgent revascularization, previous TIA/stroke, and major vessel occlusion were independent predictors of HT. The HTE score has a good predictive power for HT. Prospective studies are warranted.
Splenium of the Corpus Callosum Infarct Associated With COVID-19
Authors: Karp David A. , Beaudoin Gabriel , Egan Robert A.
Published: August 2022

Introduction:

Coronavirus disease 2019 (COVID-19) has been recently associated with infarction of the central splenium of the corpus callosum. These are described as cytotoxic lesions, and imaging rarely reveals enhancement. They have not been described in the body or head of the corpus callosum. Few diseases affect the corpus callosum, but the most common include multiple sclerosis, aquaporin-4 disease, and Susac syndrome. There is also emerging literature on Mild Encephalopathy with Reversible Splenial lesions associated with central and not basal lesions. The reason for the location of these lesions in acute COVID-19 infection is unknown.

Case Report:

A 22-year-old female presented to the ED for altered mental status after being found down. A brief history review indicated that the patient had been altered for 2-3 days before being found naked and covered in her own feces and urine by her family after they had not heard from her. As she lived alone, a clear history of the events preceding her admission remains unclear. On initial assessment, the patient was found to be somnolent and nonverbal, though she could follow simple commands. On admission, testing for SARS CoV-2 RNA PCR was positive. Patient was admitted to the hospital for further work up to determine the cause of the altered mental status.

Conclusion:

We present a new case of a young woman who developed a central splenium lesion during acute COVID-19 infection and explain the predilection for the callosum in these patients, as well as literature to show that COVID-19 was most likely the cause.
Feasibility of Using Joystick-Operated Ride-on-Toys to Promote Upper Extremity Function in Children With Cerebral Palsy: A Pilot Study
Authors: Amonkar Nidhi , Kumavor Patrick , Morgan Kristin , Bubela Deborah , Srinivasan Sudha
Published: August 2022

Purpose:

To evaluate the feasibility of implementation, acceptance, and perceived efficacy of a joystick-operated ride-on-toy intervention to promote upper extremity (UE) function in 3- to 14-year-old children with hemiplegic cerebral palsy.

Methods:

Exit questionnaires were collected from children, caregivers, and clinicians/camp staff following a 3-week ride-on-toy training program incorporated within a summer camp for children with hemiplegic cerebral palsy. Training encouraged children to use their affected UE to maneuver the ride-on-toy. Questionnaires included Likert scale and open-ended questions to assess enjoyment, acceptance, feasibility, and perceived efficacy of the training.

Results:

All stakeholder groups indicated that the training was enjoyable. Clinicians/staff and caregivers indicated that the training increased children's motivation to use their affected UE and reported perceived improvements in UE movement control and function following training.

Conclusions:

Our promising preliminary findings call for future research to systematically assess the efficacy of ride-on-toys to promote UE control and function in children with hemiplegic cerebral palsy.

Supplemental Digital Content 1 video abstract, available at: http://links.lww.com/PPT/A404
Effectiveness of Robotic-Assisted Gait Training and Aquatic Physical Therapy in a Child With Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency: A Case Report
Authors: Tucker Pamela
Published: August 2022

Purpose:

The purpose of this case study is to describe the outpatient rehabilitation program for a 15-year-old girl with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD).

Summary of Key Points:

The child presented with sudden-onset muscle weakness and fatigue with resultant dependence for all mobility and self-care. After 12 months of therapy, which included aquatic interventions and robotic-assisted gait training, the patient demonstrated independence with transfers, ambulation with a rolling walker, and stair navigation. Functional mobility, gross motor skills, and participation in activities of daily living significantly improved per the Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory.

Statement of Conclusion and Recommendations for Clinical Practice:

This is the first case in the literature to outline an outpatient physical therapy treatment plan to address mobility deficits secondary to exacerbation of LCHADD. This patient's rehabilitative course will hopefully add to future research and provide patients with guidelines for their recovery.
Sleep Variability and Inflammation in Midlife and Older Women
Authors: Leger Kate A. , Gloger Elana M. , Crofford Leslie J. , McDade Thomas W. , Segerstrom Suzanne C.
Published: August 2022

Objective

Shorter sleep duration and more sleep disturbances, in addition to greater night-to-night fluctuations in sleep (intraindividual variability; IIV), have been associated with elevated inflammation. However, these associations were only at the between-person level. The current study examined the within-person relationship between mean levels and IIV of sleep duration and sleep disturbances and C-reactive protein (CRP) in healthy, aging women.

Methods

Participants (N = 179) from a longitudinal study of activity and well-being in middle-aged and older women (mean age = 62 years; range = 50–75 years) completed a 7-day daily diary, every 3 months, for 2 years (up to nine bursts). Sleep was assessed each day asking participants how many hours of sleep they got the night before and with the four-item PROMIS Sleep Disturbance Short Form. Finger-stick dried blood spot samples were collected after each 7-day daily diary.

Results

In bursts when women experienced greater than average variability in sleep duration, they had higher CRP (γ = 0.06, p = .004). Within-person changes in mean sleep duration were not associated with CRP. In addition, neither mean sleep disturbances nor sleep disturbance IIV were associated with CRP.

Conclusions

This study is the first to show that within-person changes in variable sleep duration are related to changes in inflammation. Findings from the current study suggest that greater variability in sleep duration is related to higher CRP, which may increase risk for early morbidity and mortality. Future studies should investigate inflammation as a pathway linking sleep variability and health.
Through the Looking-Glass: Psychoneuroimmunology and the Microbiome-Gut-Brain Axis in the Modern Antiretroviral Therapy Era
Authors: Carrico Adam W. , Cherenack Emily M. , Rubin Leah H. , McIntosh Roger , Ghanooni Delaram , Chavez Jennifer V. , Klatt Nichole R. , Paul Robert H.
Published: August 2022

Objective

Depression, substance use disorders, and other neuropsychiatric comorbidities are common in people with HIV (PWH), but the underlying mechanisms are not sufficiently understood. HIV-induced damage to the gastrointestinal tract potentiates residual immune dysregulation in PWH receiving effective antiretroviral therapy. However, few studies among PWH have examined the relevance of microbiome-gut-brain axis: bidirectional crosstalk between the gastrointestinal tract, immune system, and central nervous system.

Methods

A narrative review was conducted to integrate findings from 159 articles relevant to psychoneuroimmunology (PNI) and microbiome-gut-brain axis research in PWH.

Results

Early PNI studies demonstrated that neuroendocrine signaling via the hypothalamic-pituitary-adrenal axis and autonomic nervous system could partially account for the associations of psychological factors with clinical HIV progression. This review highlights the need for PNI studies examining the mechanistic relevance of the gut microbiota for residual immune dysregulation, tryptophan catabolism, and oxytocin release as key biological determinants of neuropsychiatric comorbidities in PWH (i.e., body-to-mind pathways). It also underscores the continued relevance of neuroendocrine signaling via the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and oxytocin release in modifying microbiome-gut-brain axis functioning (i.e., mind-to-body pathways).

Conclusions

Advancing our understanding of PNI and microbiome-gut-brain axis pathways relevant to depression, substance use disorders, and other neuropsychiatric comorbidities in PWH can guide the development of novel biobehavioral interventions to optimize health outcomes. Recommendations are provided for biobehavioral and neurobehavioral research investigating bidirectional PNI and microbiome-gut-brain axis pathways among PWH in the modern antiretroviral therapy era.
Unhealthy Alcohol Use Is Associated With Suboptimal Adherence to Isoniazid Preventive Therapy in Persons With HIV in Southwestern Uganda
Authors: Muyindike Winnie R. , Fatch Robin , Cheng Debbie M. , Emenyonu Nneka I. , Forman Leah , Ngabirano Christine , Adong Julian , Linas Benjamin , Jacobson Karen R. , Hahn Judith A.
Published: August 2022

Background:

Unhealthy alcohol use is associated with increased progression to tuberculosis (TB) disease, but its effect on adherence to isoniazid (INH) preventive therapy is not known.

Methods:

This was a prospective study of persons with HIV with latent TB in southwestern Uganda reporting any current (previous 3 months) alcohol use or no alcohol consumption in the previous year (2:1 ratio). All received INH. We defined suboptimal adherence as <90% of days with at least 1 Medication Event Monitoring System cap opening, over the previous 90 days. Alcohol use was categorized as follows: none: no self-report and phosphatidylethanol (PEth) <8 ng/mL; moderate: Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) 1–2 (women) or 1–3 (men) and/or PEth 8 ≥ 50 ng/mL; and unhealthy: AUDIT-C ≥3 (women) or ≥4 (men) and/or PEth ≥50 ng/mL. We used generalized estimating equation logistic regression analyses to assess the association between the level of alcohol use and suboptimal INH adherence.

Results:

Three hundred two persons were enrolled; 279 were on INH for 3 or more months. The prevalence of suboptimal INH adherence was 31.3% at 3 months and 43.9% at 6 months. The odds of suboptimal INH adherence were higher for unhealthy (adjusted odds ratio, 2.78; 95% confidence interval: 1.62 to 4.76) and moderate (adjusted odds ratio, 1.59; 95% confidence interval: 0.94 to 2.71) compared with no alcohol consumption.

Conclusions:

Suboptimal adherence to INH at 3 and 6 months was high among prospective study of persons with HIV and associated with unhealthy alcohol use. Adherence support and alcohol reduction strategies are needed for this group at high risk for active TB.
Technical Considerations for Dynamic Myocardial Computed Tomography Perfusion as Part of a Comprehensive Evaluation of Coronary Artery Disease Using Computed Tomography
Authors: Møller Mathias B. , Schuijf Joanne D. , Oyama-Manabe Noriko , Linde Jesper J. , Kühl Jørgen T. , Lima Joao A.C. , Kofoed Klaus F.
Published: August 2022

Dynamic myocardial computed tomography perfusion (DM-CTP) has good diagnostic accuracy for identifying myocardial ischemia as compared with both invasive and noninvasive reference standards. However, DM-CTP has not yet been implemented in the routine clinical examination of patients with suspected or known coronary artery disease. An important hurdle in the clinical dissemination of the method is the development of the DM-CTP acquisition protocol and image analysis. Therefore, the aim of this article is to provide a review of critical parameters in the design and execution of DM-CTP to optimize each step of the examination and avoid common mistakes. We aim to support potential users in the successful implementation and performance of DM-CTP in daily practice. When performed appropriately, DM-CTP may support clinical decision making. In addition, when combined with coronary computed tomography angiography, it has the potential to shorten the time to diagnosis by providing immediate visualization of both coronary atherosclerosis and its functional relevance using one single modality.
Bioinformatics Analysis of Hub Genes Involved in Alcohol-Related Hemifacial Microsomia Pathogenesis
Authors: Ma Lunkun , Zhao Shanbaga , Xu Xi , Shu Kaiyi , Li Xiyuan , Liang Yingxiang , Liu Bingyang , Huang Changjin , Zhang Zhiyong
Published: August 2022

Objective:

Alcohol is a recognized teratogen, and alcohol exposure increases the risk for hemifacial microsomia (HFM) of the fetus during maternal pregnancy. The present study aimed to explore potential mechanisms and verify hub genes of HFM associated with alcohol by bioinformatics methods.

Methods:

First, HFM and alcohol pathogenic genes were obtained. Thereafter, a protein-protein interactional (PPI) network was constructed. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses and molecular complex detection were performed by Metascape. Finally, we used the cytoHubba plugin to screen the hub genes.

Results:

A total of 43 HFM genes and 50 optimal alcohol candidate genes were selected. The PPI networks for pathogenic genes contained 93 nodes and 503 edges. Functional enrichment analysis largely focused on tissue formation and development. Two modules were identified from the PPI network, and 10 hub genes were screened out. The genes most relevant to alcohol-induced HFM pathogenesis included CTNNB1, TP53, MYC, HDAC1, and SOX2.

Conclusions:

This study identified some significant hub genes, pathways, and modules of HFM related to alcohol by bioinformatics analyses. Our results suggest that the CTNNB1, TP53, MYC, HDAC1, and SOX B1 gene subfamilies may have played a major role in alcohol-induced HFM.
Horn-shaped Symmetric Nodules on the Earlobes: An Unusual Presentation of First Branchial Cleft Anomaly
Authors: Kwon Hyo Jeong , Yang Young Bin , Oh Deuk Young
Published: August 2022

First branchial cleft anomaly (BCA) is a rare congenital malformation of the head and neck, <10% of all BCA. it occurs between the first and second branchial arches. The diagnosis of first BCA is often delayed because of its atypical shape and rarity. A 30-year-old male presented to our clinic with bilateral earlobes nodules, he first noticed ~20 years prior. The lesions had gradually increased in size, and he stated no other specific symptoms. Bilaterally, a 1-cm-sized, sharp, horn-shaped, dark-colored, keratinized mass was palpated hardly, and no infectious signs were observed. Bilateral resection was performed, and the lesions did not form a tract in any other direction. Histopathology confirmed the lesions were first BCA composed of a cystic cavity lined by stratified squamous epithelium. Surgeons should suspect first BCA in patients with nonspecific lesions of the earlobe, and our case will help with future diagnoses.
Shortened Infrabrow Excision Blepharoplasty Combined with the Removal of Orbicularis Oculi Muscle for Dermatochalasis in Asians
Authors: Yang Xiao , Zhao Fangning , Yang Xiaonan
Published: August 2022

The periorbital area tends to be the first and most visible facial part where senility occurs and therefore is of great concern. Various blepharoplasty incisions are applied to correct upper eyelid dermatochalasis. In this study, we applied and evaluated the shortened infrabrow excision blepharoplasty (sIBEB) combined with the removal of the orbicularis oculi muscle to achieve more satisfactory effects. This retrospective study included 40 women who underwent sIBEB treatment at the Plastic Surgery Hospital of Beijing between February 2019 and June 2021. Preoperative and postoperative photographs, complications, objective Strasser system, and self-assessed subjective evaluations by the patient (on a scale of 1−10) were used to assess the results of the procedure. During the follow-up (6−16 mo; average, 12 mo), all 40 patients (age, 26−68 y; 47±9.44 y) presented effective correction of the dermatochalasis. The objective Strasser evaluation showed that all patients had a score of 0 to 4, and the subjective feedback revealed that 37 patients (92.5%) scored the procedure 9/10, indicating high satisfaction. No complications were detected, and repair surgery was not required in any patient. The application of a shortened incision enables the surgeon to accurately locate the excision area, resulting in less visible scars. Furthermore, removal of the orbicularis oculi muscle allows for the sagittal lifting of the superficial musculoaponeurotic system layer, adjusting the swelling and sagging appearance. The modified sIBEB may achieve more effective, sustainable, and satisfactory outcomes.
Orbital Exenteration Reconstruction for Medically Complex Patients: Bilaminate Dermal Substitute as an Alternative to Major Surgery
Authors: Bothwick Victoria , Polanik Marc , Lujan-Hernandez Jorge , Akyurek Mustafa
Published: August 2022

Reconstructive strategies after orbital exenteration range from the use of skin grafts to tissue flaps, depending on the classification of the defect, patient’s goals, and tolerance for surgery. We present a case of a 68-year-old, medically complex patient who underwent orbital exenteration, radiation therapy, and reconstruction with a bilaminate dermal substitute. Despite the placement in an irradiated area without periosteum, the bilaminate dermal substitute graft demonstrated acceptable integration and provided an adequate base for subsequent split thickness skin grafting, sparing a medically fragile patient from a morbid operation. This case highlights the advantages of a less invasive reconstructive modality when managing a patient with multiple comorbidities and a significant chance of cancer recurrence.
Revisional Asian Blepharoplasty of the High Eyelid Fold: Tarsus-Orbicularis Fixation Combined With Orbital Fat Repositioning Technique
Authors: Shi Heng , Liu Miaoqing , Huang Wen , Wang Zhijun
Published: August 2022

Background:

Abnormally high eyelid fold is a common unsatisfactory esthetic outcome after double eyelid surgery. At present, successful correction of high eyelid fold among Asians remains one of the most challenging procedures for eyelid plastic surgeons.

Objectives:

This article aims to propose a novel technique for correcting high eyelid fold to improve the cosmetic outcomes and patient satisfaction.

Materials and Methods:

This is a retrospective study of 86 patients (154 eyelids) with high eyelid folds who underwent revision blepharoplasty. A new proper height incision line was designed during the operation, and the adhesion between skin and levator aponeurosis was fully released. The residual orbital fat was adequately separated. If necessary, orbital fat from lower eyelid will be harvested for free fat grafting. The tarsus-orbicularis fixation combined with orbital fat repositioning technique was used to create a double eyelid fold and reconstruct the gliding zone. The surgical outcome and patient satisfaction are reviewed.

Results:

Among the 154 eyelids with high eyelid fold, mean lid crease height decreased from 9.8 mm preoperation to 6.8 mm (P<0.001) and mean pretarsal show decreased from 3.5 mm preoperation to 1.9 mm 6 months postoperation (P <0.001). The esthetic outcome was fully satisfied in 78 patients (90.7%) and basically satisfied in 6 patients (7.0%). Two patients (2.3%) were unsatisfied because of ptosis undercorrection in 1 patient and asymmetry in the other. They both got satisfied results after reoperation.

Conclusions:

The tarsus-orbicularis fixation combined orbital fat repositioning technique is a simple and effective method to correct high eyelid folds with high satisfaction and rare complications.
A Comparison of the Bilateral Axillo-breast Approach (BABA) Robotic and Open Thyroidectomy for Papillary Thyroid Cancer After Propensity Score Matching
Authors: Paek Se Hyun , Kwon Hyungju , Kang Kyung Ho
Published: August 2022

Background:

We aimed to investigate the potential advantages of bilateral axillo-breast approach (BABA) robotic thyroidectomy over conventional open surgery and to determine whether it is a safe and complete surgical procedure compared with open surgery in patients with papillary thyroid cancer.

Patients and Methods:

We retrospectively reviewed the records of 315 consecutive patients (robotic, n=54; open, n=261) who underwent total thyroidectomy and central neck dissection for papillary thyroid cancer from March 2013 to June 2014. Postoperative complication rate and surgical completeness were analyzed between patients who underwent BABA robotic thyroidectomy (robotic group) and those who chose open thyroidectomy (open group) after propensity score matching according to age, sex, body mass index, tumor size, extrathyroidal extension, and lymph node (LN) metastasis.

Results:

Transient hypoparathyroidism was higher in the open group than in the robotic group (13.0% vs. 1.9%; P=0.029). No difference was observed in the mean number of retrieved LNs and metastatic LNs. The mean level of stimulated thyroglobulin was acceptably low in both groups, and there was no difference in the proportion of patients who had stimulated thyroglobulin levels <1 ng/mL between the groups (P=0.543).

Conclusions:

Our results show that the outcomes of BABA robotic thyroidectomy may be comparable to those of conventional open thyroidectomy, with possibly better preservation of blood supply to the parathyroid glands, without sacrificing surgical completeness.
Efficient Initial Eradication of Large Esophageal Varices by Balloon-compression Endoscopic Injection Sclerotherapy
Authors: Zhang Qianqian , Wu Wenyue , Mei Xuecan , Zhang Fumin , Ren Xiaofei , Kong Derun
Published: August 2022

Background:

The management of large esophageal varices (EVs) remains challenging because of the difficulty of endoscopic variceal ligation and fatal post-endoscopic variceal ligation bleeding ulcers. The current study evaluated the efficacy and safety of balloon-compression endoscopic injection sclerotherapy (bc-EIS) in the treatment of large EVs.

Materials and Methods:

This retrospective study included 105 patients with cirrhosis exhibiting large EVs (64 in the bc-EIS group and 41 in the EIS group). Primary outcomes included the initial rate of variceal eradication and intraoperative bleeding signs. Secondary outcomes included incidences of rebleeding, mortality, complications, and optimal time of balloon-compression (bc).

Results:

The initial rate of variceal eradication in the bc-EIS group was significantly higher than that in the EIS group (46.9 vs. 24.4%; P=0.021). The incidence of intraoperative bleeding, which was represented as oozing and spurting, in the bc-EIS group was markedly lower than that in the EIS group (43.8 vs. 61.0% and 9.4 vs. 39.0%, respectively; P=0.043). Patients in the bc-EIS group showed a significantly lower incidence of rebleeding (0.0 vs. 17.1%; P=0.001). However, no significant difference in mortality rate was observed between different groups. Chest pain or discomfort tended to be more common in the EIS group than in the bc-EIS group (58.5 vs. 17.2%; P=0.001). The cut-off value of 11.5-minutes appeared to have a maximum combined sensitivity and specificity of 80.0% and 58.8%, respectively. The area under the curve was 0.708 (95% confidence interval =0.576-0.839; P=0.004).

Conclusion:

bc-EIS could achieve a higher variceal eradication rate and milder intraoperative bleeding signs in large EVs. Furthermore, 11.5-minutes appeared to be the optimal compression time in bc-EIS.
Interobserver agreement for the Chest Wall Injury Society taxonomy of rib fractures using computed tomography images
Authors: Van Wijck Suzanne F.M. , Curran Christian , Sauaia Angela , Van Lieshout Esther M.M. , Whitbeck SarahAnn S. , Edwards John G. , Pieracci Fredric M. , Wijffels Mathieu M.E.
Published: August 2022

BACKGROUND

In 2020, a universal nomenclature for rib fractures was proposed by the international Chest Wall Injury Society taxonomy collaboration. The purpose of this study is to validate this taxonomy. We hypothesized that there would be at least moderate agreement, regardless of the observers' background.

METHODS

An international group of independent observers evaluated axial, coronal, and sagittal computed tomography images on an online platform from 11 rib fractures for location (anterior, lateral, or posterior), type (simple, wedge, or complex), and displacement (undisplaced, offset, or displaced) of rib fractures. The multirater κ and Gwet's first agreement coefficient (AC1) were calculated to estimate agreement among the observers.

RESULTS

A total of 90 observers participated, with 76 complete responses (84%). Strong agreement was found for the classification of fracture location (κ = 0.83 [95% confidence interval (CI) 0.69–0.97]; AC1, 0.84 [95% CI, 0.81–0.88]), moderate for fracture type (κ = 0.46 [95% CI, 0.32–0.59]; AC1, 0.50 [95% CI, 0.45–0.55]), and fair for rib fracture displacement (κ = 0.38 [95% CI, 0.21–0.54], AC1, 0.38 [95% CI, 0.34–0.42]).

CONCLUSION

Agreement on rib fracture location was strong and moderate for fracture type. Agreement on displacement was lower than expected. Evaluating strategies such as comprehensive education, additional imaging techniques, or further specification of the definitions will be needed to increase agreement on the classification of rib fracture type and displacement as defined by the Chest Wall Injury Society taxonomy.

LEVEL OF EVIDENCE

Diagnostic Test or Criteria; Level IV.
Predicting Early Allograft Function After Normothermic Machine Perfusion
Authors: Watson Christopher J.E. , Gaurav Rohit , Fear Corrina , Swift Lisa , Selves Linda , Ceresa Carlo D.L. , Upponi Sara S. , Brais Rebecca , Allison Michael , Macdonald-Wallis Corrie , Taylor Rhiannon , Butler Andrew J.
Published: August 2022

Background.

Normothermic ex situ liver perfusion is increasingly used to assess donor livers, but there remains a paucity of evidence regarding criteria upon which to base a viability assessment or criteria predicting early allograft function.

Methods.

Perfusate variables from livers undergoing normothermic ex situ liver perfusion were analyzed to see which best predicted the Model for Early Allograft Function score.

Results.

One hundred fifty-four of 203 perfused livers were transplanted following our previously defined criteria. These comprised 84/123 donation after circulatory death livers and 70/80 donation after brain death livers. Multivariable analysis suggested that 2-h alanine transaminase, 2-h lactate, 11 to 29 mmol supplementary bicarbonate in the first 4 h, and peak bile pH were associated with early allograft function as defined by the Model for Early Allograft Function score. Nonanastomotic biliary strictures occurred in 11% of transplants, predominantly affected first- and second-order ducts, despite selection based on bile glucose and pH.

Conclusions.

This work confirms the importance of perfusate alanine transaminase and lactate at 2-h, as well as the amount of supplementary bicarbonate required to keep the perfusate pH > 7.2, in the assessment of livers undergoing perfusion. It cautions against the use of lactate as a sole indicator of viability and also suggests a role for cholangiocyte function markers in predicting early allograft function.
Impact of Older Donor Age on Recipient and Graft Survival After LDLT: The US Experience
Authors: Kanneganti Mounika , Olthoff Kim M. , Bittermann Therese
Published: August 2022

Background.

The impact of selecting older donors for living donor liver transplantation (LDLT) in the United States is incompletely studied, particularly in light of the recent expansion of LDLT nationally.

Methods.

Adult LDLTs from January 01, 2005 to December 31, 2019 were identified using the United Network for Organ Sharing database. Multivariable Cox models evaluated living donor (LD) age as a predictor of LDLT recipient and graft survival. The impact of increasing donor age on recipient outcomes was compared between LD and deceased donor recipients. Donor postoperative outcomes were evaluated.

Results.

There were 3539 LDLTs at 65 transplant centers during the study period. Despite the recent expansion of LDLT, the proportion of LDs aged ≥50 y was stable. There were no clinically significant differences in recipient or donor characteristics by LD age group. LD age ≥50 y was associated with an adjusted hazard ratio of 1.49 (P = 0.012) for recipient survival and 1.61 (P < 0.001) for graft survival (vs LDs aged 18–29 y). The negative impact of increasing donor age on graft survival was more profound after LDLT than deceased donor liver transplantation (interaction P = 0.019). There was a possible increased rate of early donor biliary complications for donors >55 y (7.1% versus 3.1% for age <40 y; P = 0.156).

Conclusions.

Increasing LD age is associated with decreased recipient and graft survival, although older donors still largely yield acceptable outcomes. Donor outcomes were not clearly impacted by increasing age, though this warrants further study.
Spontaneous relational and object similarity in wild bumblebees
Authors: Martin-Ordas Gema
Published: August 2022

Being able to abstract relations of similarity is considered one of the hallmarks of human cognition. While previous research has shown that other animals (e.g. primates) can attend to relational similarity, they struggle to focus on object similarity. This is in contrast with humans. And it is precisely the ability to attend to objects that it is argued to make relational reasoning uniquely human. What about invertebrates? Despite earlier studies indicating that bees are capable of learning abstract relationships (e.g. ‘same’ and ‘different’), no research has investigated whether bees can spontaneously attend to relational similarity and whether they can do so when relational matches compete with object matches. To test this, a spatial matching task (with and without competing object matches) previously used with children and great apes was adapted for use with wild-caught bumblebees. When object matches were not present, bumblebees spontaneously used relational similarity. Importantly, when competing object matches were present, bumblebees still focused on relations over objects. These findings indicate that the absence of object bias is also present in invertebrates and suggest that the relational gap between humans and other animals is due to their preference for relations over objects.
The ontogeny of children's social emotions in response to (un)fairness
Authors: Gerdemann Stella C. , McAuliffe Katherine , Blake Peter R. , Haun Daniel B. M. , Hepach Robert
Published: August 2022

Humans have a deeply rooted sense of fairness, but its emotional foundation in early ontogeny remains poorly understood. Here, we asked if and when 4- to 10-year-old children show negative social emotions, such as shame or guilt, in response to advantageous unfairness expressed through a lowered body posture (measured using a
Kinect
depth sensor imaging camera). We found that older, but not younger children, showed more negative emotions, i.e. a reduced upper body posture, after unintentionally disadvantaging a peer on (4,1) trials than in response to fair (1,1) outcomes between themselves and others. Younger children, in contrast, expressed more negative emotions in response to the fair (1,1) split than in response to advantageous inequity. No systematic pattern of children's emotional responses was found in a non-social context, in which children divided resources between themselves and a non-social container. Supporting individual difference analyses showed that older children in the social context expressed negative emotions in response to advantageous inequity without directly acting on this negative emotional response by rejecting an advantageously unfair offer proposed by an experimenter at the end of the study. These findings shed new light on the emotional foundation of the human sense of fairness and suggest that children's negative emotional response to advantageous unfairness developmentally precedes their rejection of advantageously unfair resource distributions.