bluuebunny/crossref_metadata_2025 huggingface dataset:
Vegetarian diet in dialysis patients
Authors: Chen Mei-Yin , Ou Shih-Hsiang , Yen Ming-Chen , Lee Meei-Shyuan , Chen Nai-Ching , Yin Chun-Hao , Chen Chien-Liang
Published: February 2021

Nutritional status is a predictor of mortality and morbidity in dialysis patients. This study aimed to assess dietary behaviors in dialysis patients compared to the recommendations of the Kidney Disease Outcomes Quality Initiative.

Ninety five dialysis patients recruited from a hospital completed a 24-hour dietary recall questionnaire. Body weight, energy requirements, protein requirements, albumin, normalized protein catabolic rate, and 25(OH) vitamin D levels were measured.

Of the 95 patients, 11 (11.6%) were below the desirable body mass index range, 59 (62.1%) were within the desired range, and 25 (26.3%) were above the desired range. However, only 32.7% of patients met the target energy intake, 29.5% reached the protein intake target, and 20.0% had adequate vitamin D concentrations. Vegetarian patients had lower energy, protein, fat, vitamin D intake, lower body mass index, serum blood urea nitrogen, creatinine, phosphate, normalized protein catabolic rate, and vitamin D status than the omnivorous patients (P < .05). After adjusting for age, sex, and body weight, vegetarianism was an independent risk factor for severe vitamin D deficiency (<10 ng/ml, P < .01).

Most dialysis patients do not meet their dietary recommendations or goals. The risk of a vegetarian diet may outweigh the benefits in dialysis patients. Careful consideration of dietary behaviors is required for dialysis patients to prevent malnutrition, more so in vegetarians.
Steroid-resistant nephrotic syndrome in infants caused by a novel compound heterozygous mutation of the NUP93
Authors: Zhao Bo , Chen Ji-Yu , Liao Ya-Bin , Li Yan-Fang , Jiang Xue-Mei , Bi Xin , Yang Mi-Feng , Li Li , Cui Jing-Jing
Published: February 2021

Rationale:

Steroid-resistant nephrotic syndrome (SRNS) is a special kidney disease. SRNS is characterized by steroid-resistant, clinical variability, and genetic heterogeneity. Patients with SRNS often may eventually need renal transplantation.

Patient concerns:

A 10-month-old Chinese male infant presented with oliguria, renal dysfunction, hypertension, and anemia.

Diagnoses:

Combined with clinical manifestations, laboratory testing and sequencing results, the patient was diagnosed as SRNS.

Interventions:

Combined intravenous methylprednisolone and cefoperazone sulbactam did not improve the patient's condition. Thus, SRNS associated with hereditary nephrotic syndrome was strongly suspected. Genetic testing for hereditary renal disease of the patient revealed 2 novel heterozygous mutations in the Nucleoporin 93 (NUP93) gene, which were predicted pathogenic and harmful by bioinformatic softwares of SIFT, PolyPhen_2 and REVEL.

Outcomes:

As general physical health deterioration and renal dysfunction, the patient died of a severe infection.

Lessons:

The novel NUP93 heterozygous mutations identified in the current study broadened the genetic spectrum of SRNS and further deepened our insight into pathogenic mutations of NUP93 to improve disease diagnosis.
A rare case of 46, XX (SRY positive) testicular disorder of sex development with growth hormone deficiency
Authors: Li Hanming , He Jianyu , Leong Iatlun
Published: February 2021

Rationale:

Chromosome karyotype analysis and SRY (sex determined region of Y chromosome) gene detection are routines for the diagnosis of growth hormone deficiency (GHD), but further whole exome gene sequencing occasionally leads to subversive results and unexpected conclusions.

Patient concerns:

We report a single case of a 7-year-old Chinese boy who had stunted growth since he was 1 year old. He was short in height (height Standard Deviation Score (SDS) was less than 2.9), bilateral scrotal dysplasia and delayed bone age.

Diagnosis:

His growth hormone (GH) stimulation tests showed GHD. His karyotype analysis and polymerase chain reaction (PCR) analyses indicated a 46, XX disorder of sex development (DSD) without the presence of the SRY gene. Nevertheless, considering that female gonad was not observed in the chest and abdominal magnetic resonance imaging, the whole exome gene sequencing was performed. Sequencing data confirmed the presence of SRY gene sequence and two copies of chromosome X. Later, using different primer sequences for PCR, it showed that the SRY gene was positive. The final diagnosis was a rare case of “46, XX (SRY positive) testicular DSD with GHD”.

Interventions:

The boy's parents agreed to use recombinant human growth hormone (rhGH) for GHD treatment, the starting dose was 0.035 mg / kg / day. But they disagreed with molecular diagnostics and genomic analysis of the Y chromosome.

Outcomes:

The boy was treated with rhGH for 3 months and his height increased by 2.2 cm. The patient will be followed-up until the end of his puberty.

Lessons:

In summary, whole exome gene sequencing overturned the preliminary diagnosis results of karyotype analysis and SRY gene detection, and found that there may be a certain correlation between testicular DSD and GHD.
Clinical characteristics in patients with coronary slow flow phenomenon
Authors: Huang Qiaojuan , Zhang Fan , Chen Siyu , Dong Zhaoying , Liu Weiwei , Zhou Xiaoli
Published: February 2021

Coronary slow flow phenomenon (CSFP) is a coronary artery disease in which coronary angiography shows no obvious stenosis, but there is a delay in blood flow perfusion. The etiopathogenic mechanisms of CSFP are still unclear. The aim of the present study was to investigate the role of clinical characteristics in patients with CSFP, and to provide a reference for exploring the potential mechanisms of CSFP. Patients with angiographically normal epicardial arteries were enrolled (145 patients with CSFP and 145 normal controls). Collected clinical information and laboratory indexes, which measured by peripheral venous blood samples before coronary angiography. Logistic regression analysis was performed for statistical analysis. The present study found 19 clinical and laboratory indexes with statistical differences between the two groups in univariate analysis. Multivariate analysis showed that monocyte count, haemoglobin, serum creatinine and globulin were independent predictors of CSFP. Moreover, the monocyte count, haemoglobin, creatinine and globulin levels were significantly higher in the CSFP patients than the controls, with positive associations between these parameters and the extent of CSFP. In addition, ROC analysis showed the diagnostic value of the above indexes for CSFP.
Interleukin-6 gene-174 G/C promoter polymorphism is not associated with multiple myeloma susceptibility: evidence from meta-analysis
Authors: Dong Xiaohui , Zhang Zongxin , Shou Lihong , Shen Jingjing
Published: February 2021

Purpose:

Presently, whether interleukin-6 (IL-6) gene-174 G/C promoter polymorphism is correlated to the susceptibility of multiple myeloma (MM) remains controversial. For this reason, the method of meta-analysis was applied to exploring the association between IL-6 gene-174 G/C promoter polymorphism and MM.

Method:

Two independent researchers systematically searched PubMed, EMBASE, Google academic, Cochrane Library and Chinese literature databases to screen case-control studies on IL-6 gene-174 G/C promoter polymorphism and MM susceptibility. The retrieval period was limited from the formation of the database to January 2020, and data analysis was conducted by employing Stata 11.0 software.

Result:

Seven articles were ultimately included in the present study, including 594 MM patients and 681 controls. Integration analysis exhibited that compared with GC or CC genotype, GG genotype did not increase MM susceptibility (OR = 0.95, 95% CI 0.75–1.22; OR = 0.79, 95% CI 0.52–1.19, respectively). Further, in comparison with CC genotype, GC genotype also presented no effect on increasing MM susceptibility (OR = 0.79, 95% CI 0.53–1.16), while compared with GC+CC genotype, GG genotype had no significant relationship with MM susceptibility (OR = 0.94, 95% CI 0.75–1.19). In subsequent analysis, an observation was made that allele G or C was not related to MM susceptibility (OR = 0.92, 95% CI 0.76–1.12). Funnel chart and Begg test did not reveal publication bias in the included articles.

Conclusion:

The results of the present study advocate that there is no testimony to support the relationship between IL-6 gene-174 G/C promoter polymorphism and MM susceptibility.
Moxibustion for the treatment of Alzheimer's disease
Authors: A Rigun , Yue Ruizhen , Chen Baoshan , Huang Xianbao
Published: February 2021

Background:

Alzheimer's disease (AD) occurs in the elderly and the early stage of aging, with early clinical manifestations of memory impairment, cognitive impairment, behavioral change and decline in language function, etc., and eventually loss of the ability to live independently, requiring 24-hour care, and a variety of complications. However, these complications are the direct cause of death in AD patients. With the acceleration of the aging process of society, the incidence of AD is increasing year by year, seriously threatening the physical health and quality of life of the elderly. There are many ways to treat AD, however, moxibustion is especially popular in China. Therefore, our systematic review aims to evaluate the efficacy and safety of moxibustion in the treatment of ADand to provide reliable evidence for clinical decision-makers.

Methods:

We will search electronic databases including PubMed, Embase, Cochrane Library, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database (WF), and China Scientific Journals Database (VIP) from inception to January 2021. Two authors will independently screen the studies, extract data information, and assess methodological quality through the Cochrane risk of bias (ROB) tool. The RevmanV.5.3 software will be used for statistical analysis.

Results:

The results of this study will evaluate the current status of moxibustion therapy for AD, aiming to prove the effectiveness and safety of moxibustion therapy, and will be published in a peer-reviewed journal.

Conclusion:

This systematic review will provide a credible evidence-based for moxibustion in the treatment of AD.

INPLASY Registration number:

INPLASY202110021
Long-term survival of advanced lung adenocarcinoma by maintenance chemotherapy followed by EGFR-TKI
Authors: Chen Hui Jun , Shen Ji Min , Lin Ying Ni , Du Wei , Zhou Jian Ping , Li Qing Yun
Published: February 2021

Rationale:

The incidence of nonsmall cell lung cancer (NSCLC) is high. Most nonsmall cell lung cancers have undergone multiple metastases at the time of initial diagnosis, and the 5 year survival rate is low. At present, comprehensive treatments, including systemic chemotherapy, targeted therapy, antiangiogenic therapy, and immunotherapy, prolong the survival of patients with advanced NSCLC. Herein, we report a case of NSCLC with long-term survival.

Patient concerns:

A 61-year-old woman complained of dry cough and shortness of breath and visited our hospital in July 2011. Imaging examination revealed a left upper lung mass with multiple metastases to the liver, adrenal gland, and bone.

Diagnoses:

Stage IVB (cT2aN3M1c) lung adenocarcinoma was diagnosed, with multiple metastases of the lymph nodes, liver, adrenal gland, and bone.

Interventions and outcomes:

The patient received systemic chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitor-targeted therapy, and has survived for more than 9 years.

Lessons:

The patient benefited from maintenance chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitor treatment and achieved long-term survival.
The recurrence of well-differentiated liposarcoma from benign giant intramuscular lipoma
Authors: Lee Yeon Ji , Cha Won Jin , Kim Yesol , Oh Deuk Young
Published: February 2021

Rationale:

Recurrent liposarcoma, previously confirmed as lipoma, has rarely been reported. However, the risk factors for recurrence and the correlation between benign lipoma and malignant liposarcoma remain unclear. In this case study, we suggest a precise diagnostic strategy to minimize recurrence and malignant transformation.

Patient concerns:

A 60-year-old male patient with a history of left chest wall swelling without any symptoms underwent excisional surgery, and the mass was confirmed as a benign lipoma in 2015. In 2019, the patient returned to the hospital with symptoms of a palpable mass on the left chest wall.

Diagnosis:

The mass was considered a recurrent lipomatous tumor with the possibility of malignant transformation. Magnetic resonance imaging (MRI) revealed a deep-seated, septate, intramuscular, irregular margin, and large lipomatous tumor invading the ribs, pleura, and adjacent muscle, suggestive of malignancy. The MRI findings were similar to those 4 years ago, except for margin irregularity and invasion to adjacent tissue.

Interventions:

Wide en bloc excisions encompassing the 5th to 7th ribs, pleura, and adjacent muscle were followed by reconstruction with a pedicled latissimus dorsi muscle flap.

Outcomes:

The recurrent large lipomatous tumor was confirmed as well-differentiated liposarcomas through histological and MDM2-FISH immunohistochemical staining. Postoperatively, follow-up visits continued for 1.5 years without recurrence.

Lessons:

We suggest that deep-seated, septate, and giant lipomatous tumors should be considered as risk factors for recurrence with the possibility of malignancy and misdiagnosis. It is important to inform patients of all these possibilities and plan close and long-term follow-up.
Spontaneous regression of central nervous system posttransplant lymphoproliferative disease
Authors: Gao Rupan , Zhang Yue , Chen Gong , Bhekharee Abhijeet Kumar , Du Zunguo , Chu Shuguang
Published: February 2021

Rationale:

Primary central nervous system (CNS) posttransplant lymphoproliferative disease (PTLD) is a very rare entity. Patients may respond to reduction of immunosuppression or other therapies, but the prognosis is still pessimistic.

Patient concerns:

Herein, we report a 40-year-old female with a history of renal transplantation developed brain masses 4 years ago. Although brain biopsy was performed, PTLD was underdiagnosed then. No relevant treatment was administered. However, the lesions resolved spontaneously. After 4 years, new lesion appeared in a different brain region.

Diagnoses:

The history of renal transplantation raised the suspicion of PTLD. Reexamination of previous brain sections confirmed the diagnosis of polymorphic PTLD (P-PTLD). A second biopsy of the new lesion also demonstrated P-PTLD.

Interventions:

She was referred to hematology department to receive rituximab.

Outcomes:

After 4 rounds of treatment, the lesion resolved satisfactorily.

Lessons:

This case demonstrates the natural history of primary CNS P-PTLD. Although self-remission and recurrence is possible, aggressive measures should be taken to this condition.
Evaluation of the modified Crohn's disease activity index in patients with Crohn disease with enterostomy
Authors: Ishida Natsuki , Miyazu Takahiro , Suzuki Takahiro , Tamura Satoshi , Tani Shinya , Yamade Mihoko , Hamaya Yasushi , Iwaizumi Moriya , Osawa Satoshi , Furuta Takahisa , Sugimoto Ken
Published: February 2021

Although the Crohn's Disease Activity Index (CDAI) is often used to evaluate the disease activity in Crohn's disease (CD), the number of liquid or soft stools cannot be precisely evaluated, and thus accurate scores cannot be calculated, in patients with enterostomy. Therefore, we created the modified CDAI (mCDAI), without the defecation frequency item from the CDAI, and examined its usefulness.

Study participants comprised 9 patients with CD with enterostomy and 20 patients with CD without enterostomy. Correlations between the mCDAI and serum albumin (Alb) levels or C-reactive protein (CRP) levels were examined using regression analysis. Additionally, regression analyses were conducted in patients with CD without enterostomy to determine the Alb and CRP levels corresponding to the CDAI at its cutoff value for remission status (150). The obtained values were applied to the mCDAI regression equations to determine the equivalent mCDAI cutoff value.

mCDAI and Alb levels were significantly negatively correlated (P < .0001). The mCDAI had a significant positive correlation with the CRP level and erythrocyte sedimentation rate (P = .0061 and P = .0133, respectively). From the regression analysis of patients with CD without enterostomy, the Alb and CRP levels equivalent to a CDAI of 150 were 3.85 g/dL and 0.62 mg/dL, respectively. When applying these values to the mCDAI regression formulas, the values of 113.8 and 115.2, respectively, were obtained. Thus, the cutoff value of the mCDAI indicating disease activity was estimated as 115.

The mCDAI fully reflects the nutritional status and inflammatory response, and is convenient and useful for assessing disease activity over time, in patients with CD with enterostomy. A mCDAI score ≥ 115 indicates disease activity.
Acupuncture to treat asymptomatic hyperuricemia
Authors: Hwang Ji Hye , Lee Kwang Ho , Nam Dong Woo , Song Ho Sueb
Published: February 2021

Background:

Hyperuricemia (HUA) plays an important role in metabolic syndrome, cardiovascular disease, and kidney disease. HUA without resulting gout is referred to as asymptomatic HUA. The purpose of the present systematic review protocol is to provide methods to assess the effectiveness and safety of acupuncture-based treatment for asymptomatic HUA.

Methods:

To identify randomized controlled trials (RCTs) involving acupuncture-based treatment for asymptomatic HUA, a search will be carried out using the following eight electronic databases: MEDLINE, EMBASE, Cochrane Library, Korea Med, Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System, China National Knowledge Infrastructure, and Japanese Institutional Repositories Online. Manual search and email contact with the author will also be conducted if necessary. Studies will be selected based on predefined criteria and summarized data regarding study participants, interventions, control groups, outcome measures, side effects, and risk of bias. No language restrictions will be imposed. Studies that evaluated any type of acupuncture will be eligible for inclusion, and the primary outcome will be the blood uric acid level. The methodological quality of the included RCTs will be assessed using the Cochrane risk of bias tool.

Results:

The present study will evaluate the efficacy and safety of acupuncture to treat HUA.

Conclusion:

Our findings will establish the evidence for acupuncture-based treatment of HUA and will be informative for patients with HUA, clinicians, policy makers, and researchers.

Registration number:

reviewregistry1054.
Development and validation of a risk stratification nomogram for predicting prognosis in bone metastatic breast cancer
Authors: Hou Niuniu , Yi Jun , Wang Zhe , Yang Lu , Wu Ying , Huang Meiling , Hou Guangdong , Ling Rui
Published: February 2021

Bone metastasis seriously affects the survival of breast cancer. Therefore, the study aimed to explore the independent prognostic factors in bone metastatic breast cancer (BMBC) and to construct a prognostic nomogram that can accurately predict the survival of BMBC and strictly divide the patients into different risk stratification.

Four thousand three hundred seventy six patients with BMBC from the surveillance, epidemiology, and end results database in 2010 to 2015 were collected and randomly divided into training and validation cohort. Multivariate Cox regression identified the independent prognostic factors of BMBC. A nomogram for predicting cancer-specific survival (CSS) in BMBC was created using R software. The predictive performance of the nomogram was evaluated by plotting receiver operating characteristic (ROC) curves and calibration curves.

Marital status, race, age, T stage, tumor grade, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, brain metastasis, liver metastasis, lung metastasis, chemotherapy, and breast surgery were identified as independent prognostic factors for CSS of BMBC. The area under the ROC curve at 1-, 3-, and 5-year of the nomogram were 0.775, 0.756, and 0.717 in the internal validation and 0.785, 0.737, and 0.735 in the external validation, respectively. Calibration curves further confirmed the unbiased prediction of the model. Kaplan-Meier analysis verified the excellent risk stratification of our model.

The first prognostic nomogram for BMBC constructed in our study can accurately predict the survival of BMBC, which may provide a practical tool to help clinicians evaluate prognosis and stratify the prognostic risk for BMBC, thereby determining which patients should be given intensive treatment and optimizing individual treatment strategies for BMBC.
Precision head and neck surgery: robotics and surgical vision technology
Authors: Holsinger Floyd Christopher , Birkeland Andrew C. , Topf Michael C.
Published: February 2021

Purpose of review

As the molecular basis of head and neck cancer becomes more clearly defined, precision medicine has gradually refined the multidisciplinary treatment paradigm for patients with oropharyngeal cancer. Although precision medicine is often thought to refer to new molecular diagnostics or unique medical therapy, the recent adoption of robotic surgery has ushered in the era of ‘precision’ head and neck surgery.

Recent findings

Surgeons now routinely utilize a virtual reality environment to reduce the morbidity of head and neck surgical care and improve oncologic and functional outcomes. The development and subsequent FDA approval of the da Vinci SP system, a single-arm system with a flexible camera, has allowed for improved visualization and access to the deep oropharynx and larynx. Groups investigating anti-EGFR antibodies tagged with fluorescent dye as well as inherent autofluorescence differences between normal and cancerous mucosal tissues show promise for improving positive surgical margin rates.

The evolution of robotics and visualization for oropharyngeal cancer represents a novel and innovative utilization of new technology to improve care. Further advancements in techniques, from refinement of the robotic platform itself, to novel real-time tumour imaging options will be critical to further advance precision care for these patients.
Pathophysiologic Mechanisms of Hypothermia-Induced Pancreatic Injury in a Rat Model of Body Surface Cooling
Authors: Inoue Hiroyuki , Harada Keisuke , Narimatsu Eichi , Uemura Shuji , Aisaka Wakiko , Bunya Naofumi , Nomura Kazuhito , Katayama Yoichi
Published: February 2021

Objective

The mechanisms underlying hypothermia-induced pancreatic injury are unclear. Thus, we investigated the pathophysiology of hypothermia-induced pancreatic injury.

Methods

We created a normal circulatory model with body surface cooling in rats. We divided the rats into control (36°C–38°C), mild hypothermia (33°C–35°C), moderate hypothermia (30°C–32°C), and severe hypothermia (27°C–29°C) (n = 5 per group) groups. Then, we induced circulatory failure with a cooling model using high-dose inhalation anesthesia and divided the rats into control (36°C–38°C) and severe hypothermia (27°C–29°C) (n = 5 per group) groups. Serum samples were collected before the introduction of hypothermia. Serum and pancreatic tissue were collected after maintaining the target body temperature for 1 hour.

Results

Hematoxylin and eosin staining of the pancreas revealed vacuoles and edema in the hypothermia group. Serum amylase (P = 0.056), lactic acid (P < 0.05), interleukin 1β (P < 0.05), interleukin 6 (P < 0.05), and tumor necrosis factor α (P = 0.13) levels were suppressed by hypothermia. The circulatory failure model exhibited pancreatic injury.

Conclusions

Hypothermia induced bilateral effects on the pancreas. Morphologically, hypothermia induced pancreatic injury based on characteristic pathology typified by vacuoles. Serologically, hypothermia induced protective effects on the pancreas by suppressing amylase and inflammatory cytokine levels.
Interest in Hypothetical Preexposure Prophylaxis Against Herpes Simplex Virus: A Cross-Sectional Survey
Authors: Tan Darrell H. S. , Tavangar Farideh , Fusca Laura , Ross Patrick , Hull Mark W. , Grennan Troy , Bayoumi Ahmed M. , Burchell Ann N.
Published: February 2021

We surveyed 383 men who have sex with men attending sexual health clinics regarding interest in hypothetical preexposure prophylaxis against herpes simplex virus. Overall interest was 62.5% and was associated with the number of different sexually transmitted infections previously diagnosed (adjusted odds ratio, 1.9; 95% confidence interval, 1.5–2.6) and previous HIV preexposure prophylaxis use (adjusted odds ratio, 2.9; 95% confidence interval, 1.1–8.3).
Prepectoral Versus Subpectoral Breast Reconstruction in High–Body Mass Index Patients
Authors: Walker Nicholas J. , Park Jungwon G. , Maus Jacob C. , Motamedi Vida , Rebowe Ryan E. , Runyan Christopher M. , Tucker Scott L.
Published: February 2021

Background

The effect of body mass index (BMI) on complication rates in prepectoral implant-based breast reconstruction is not well established. The purpose of this study was to compare complication rates between different BMI groups in subpectoral and prepectoral reconstruction.

Methods

A single-surgeon, 4-year, retrospective review was performed of consecutive prosthetic breast reconstructions. During this time, the senior author's practice shifted from a subpectoral to prepectoral technique. Patients were stratified into BMI subgroups (<25, 25–35, and >35 kg/m2) and complication rates were analyzed. A survey was administered to blinded medical personnel and patients comparing esthetic results.

Results

Implant-based reconstructions were performed in 195 patients (103 subpectoral and 92 prepectoral). No significant difference in major complication rate was observed between techniques. Among patients with BMI greater than 35 kg/m2, implant exposure occurred at a significantly higher rate in the prepectoral group (P = 0.04). In patients with BMI greater than 25 kg/m2, minor asymmetry was more prevalent with prepectoral reconstruction (12.3% vs 0%; P = 0.02). Regardless of technique, the odds of reoperation increased by 7% per point increase in BMI, although this did not reach statistical significance (P = 0.07; odds ratio, 1.07; 95% confidence interval, 0.99–1.15).

A total of 66 survey responses were received. Physicians rated esthetic results more positively than patients did. Patients with a BMI of less than 25 kg/m2 were rated better than other BMI groups in nearly all categories. The position of submuscular reconstruction was rated significantly better than prepectoral.

Conclusions

There is a trend toward higher complication rates in prepectoral versus subpectoral breast reconstruction with increasing BMI. Nonetheless, the technique appears to be safe, with comparable clinical and cosmetic results.
Reconstruction of Circumferential Upper Extremity Defect Using a Bipedicle Expanded Flank Flap
Authors: Li Xin , Fan Jincai , Ma Jiguang , Tian Jia
Published: February 2021

Background

Resurfacing of extensive upper extremity lesions remains a challenge for plastic surgeons because of optimal functional and aesthetic outcomes and limitations of flap size. We introduced a pre-expanded flank flap to reconstruct the circumferential upper extremity defect in one sequence of tissue expansion.

Method

Between March 2015 and June 2019, 14 consecutive patients underwent reconstructive treatment for circumferential soft tissue lesions in the upper extremity using a bipedicle expanded flank flap. Surgical treatment was divided into 3 stages consisting of expander implantation in the flank area, bipedicle flap transfer to resurface the skin lesion on upper extremity, and flap pedicle transection. Flap survival, complications, and functional and aesthetic outcomes were evaluated.

Result

Fourteen patients with circumferential upper extremity lesions were enrolled in this study, 2 of them were diagnosed as extensive scar and 12 of them as giant congenital melanocytic nevi. Twelve patients completed more than 6-month follow-up. One or 2 tissue expanders were implanted in flank, lateral thorax, or abdomen area. The average time of tissue expansion was 25.9 weeks. The pedicled thoracoabdominal flaps were used to resurface a mean skin defect area of 406.6 cm2 ranging from 252 to 660 cm2. In all cases, primary donor site closure was achieved. Seroma developed in 1 case after flap transferred. With aspiration, the flap survived completely. No marginal necrosis was seen. The reconstructed limbs showed satisfactory outcome in both aesthetic and functional aspects.

Conclusions

The bipedicle expanded flank flap enables reconstruction of circumferential upper limb skin lesions in 1 sequence of tissue expansion with low complication rate and high patient satisfaction.
A Comparison of Pronator Quadratus Preservation and Dissection Approaches for Volar Plating of Comminuted Intra-articular Distal Radius Fracture
Authors: Lee Sang Ki , Ma Sang Beom , Kim Woosuk , Choy Won Sik
Published: February 2021

Purpose

Although the pronator quadratus (PQ) preservation approach for volar plating of distal radius fracture has been commonly used recently, its superiority to the conventional PQ dissection approach, especially for comminuted intra-articular distal radius fractures, has not been well established. The purpose of this study was to assess the efficacy of PQ preservation for comminuted intra-articular fractures and to evaluate the healed PQ during hardware removal surgery.

Materials and Methods

From January 2014 to March 2019, 86 patients who underwent both volar plating for AO Foundation/Orthopedic Trauma Association classification type C2 or C3 distal radius fractures and subsequent hardware removal were assessed in this study. Radiographic measurements, clinical outcomes at each follow-up, and the integrity of healed PQ during hardware removal were compared between the PQ dissection (group D) and PQ preservation (group P) groups.

Results

Complete union with acceptable reduction on radiographic measurements was achieved in both groups. Group P showed a statistically significant earlier recovery of clinical outcomes at 2 weeks and 1 month postoperatively and improved anatomical restoration of PQ muscle covering the plate, which was identified during hardware removal surgery. Flexor tendon rupture was identified in 2 patients (5%) and tenosynovitis in 6 patients (14%) in group D; no patient had flexor tendon rupture (0%), and 2 patients (5%) had tenosynovitis in group P.

Conclusions

Pronator quadratus preservation approach for volar plating is easily applicable and useful even for comminuted intra-articular distal radius fractures and is helpful for earlier restoration of wrist function and in preventing flexor tendon problems in the latter postoperative period.
The Linton A. Whitaker Legacy
Authors: Azoury Saïd C. , Kalmar Christopher L. , Zimmerman Carrie E. , Swanson Jordan W. , Serletti Joseph M. , Bartlett Scott P. , Taylor Jesse A.
Published: February 2021

Background

Linton A. Whitaker is a pioneer of craniofacial surgery. He served as chief of plastic surgery at the Children's Hospital of Philadelphia and University of Pennsylvania and director of the craniofacial training program. Herein, the authors reflect on his legacy by studying the accomplishments of his trainees.

Methods

Dr Whitaker's trainees who completed (a) craniofacial fellowship training while he was director of the program or (b) residency training while he was chief were identified. Curricula vitae were reviewed. Variables analyzed included geographic locations, practice types, academic leadership positions, scholarly work, and bibliometric data.

Results

Between 1980 and 2011, 34 surgeons completed craniofacial fellowship training under Dr Whitaker, and 11 completed plastic surgery training under his chairmanship and subsequent craniofacial fellowship. The majority had active craniofacial practices after training (83.3%) and practice in an academic setting (78.0%). Most settled in the northeast (31.1%) and south (31.1%) but across 24 states nationally. Overall, the mean ± SD number of publications was 76 ± 81 (range, 2–339); book chapters, 23 ± 29 (0–135); H-index, 18 ± 12 (1–45); and grants, 13 ± 16 (0–66). Of those who pursued academia, 53.1% were promoted to full professor, 46.9% had a program director role, 75.0% directed a craniofacial program, and 53.1% achieved the rank of chief/chair.

Conclusions

Equally important to Dr Whitaker's clinical contributions in plastic and craniofacial surgery is the development and success of his trainees who will undoubtedly continue the legacy of training the next generation of craniofacial surgeon leaders.
Speech and Audiology Outcomes After Single-Stage Versus Early 2-Stage Cleft Palate Repair
Authors: Crowley Jiwon Sarah , Friesen Tzyynong L. , Gabriel Rodney A. , Hsieh Sun , Wacenske Amanda , Deal December , Tsai Catherine , Lance Samuel , Gosman Amanda A.
Published: February 2021

Purpose

The timing and management of patients with cleft palates have been controversial. Early soft palate closure at the time of cleft lip repair followed by hard palate closure at a second stage has been hypothesized to improve speech and audiology outcomes. This study compares cleft palate patients who have undergone single-stage versus 2-stage cleft palate repairs and the outcomes on speech and hearing.

Methods

A retrospective chart review identified patients with diagnosis of cleft lip with complete cleft palate who underwent either single or 2-stage repair from 2006 to 2012. Data collected included age at each surgery, necessity of further speech surgery for velopharyngeal insufficiency, frequency of tympanostomy tube placement, presence of hearing loss, and speech assessment data graded per the validated Americleft speech scale.

Results

A total of 84 patients were identified and subdivided into groups of single-stage and 2-stage repair. The mean age at the time of single-stage palate repair was 13.3 months. For the 2-stage group, the mean ages were 4.2 and 11.8 months for the soft palate and hard palate repairs, respectively. Comparing the single-stage versus 2-stage palate repairs, there was no significant difference in all speech parameters including hypernasality, hyponasality, nasal air emission, articulation, expressive language, receptive language, speech intelligibility, and speech acceptability for both unilateral and bilateral cleft lip/palate patients. Two-stage repair was associated with increased number of tympanostomy tube placement compared with single-stage repair (relative risk, 1.74; P = 0.009), and the first set of tubes was performed at a statistically significantly younger age, 4.5 months in the 2-stage repair compared with 16.9 months in the single-stage (P = 0.012) with 87.5% performed with first stage of repair. However, there was no difference in the types, degrees of hearing loss, or the presence of at least mild conductive hearing loss at latest follow-up audiograms between the groups.

Conclusions

There was no significant benefit with respect to speech or hearing outcomes between single-stage and 2-stage cleft palate repairs. This advocates for surgeon and family preference in the timing of cleft palate repair.
Subcortical Structure Disruption in Diffusion Tensor Tractography of the Patient With the Syndrome of Irreversible Lithium-Effectuated Neurotoxicity Combined With Neuroleptic Malignant Syndrome: A Case Report
Authors: Rhee Seung Yeon , Kim Hyoung Seop
Published: February 2021

Background

Lithium can cause not only acute neurotoxicity but also chronic and persistent neurotoxicity known as syndrome of irreversible lithium-effectuated neurotoxicity (SILENT). The combined use of lithium and antipsychotics increases the possibility of SILENT. Neuroleptic malignant syndrome (NMS) is a reversible, idiosyncratic, and potentially life-threatening reaction, which is usually caused by antipsychotics and other agents, such as mood stabilizers (eg, lithium and metoclopramide). Neuroleptic malignant syndrome is characterized by hyperpyrexia, muscle rigidity, and altered mental status. We describe a case of SILENT combined with NMS in this case report.

Case Report

A 46-year-old man who had been treated with lithium for bipolar II disorder since 2008 was prescribed lorazepam, lithium, and aripiprazole at his last outpatient visit. The patient experienced financial difficulties (bankruptcy) and suffered severe emotional stress. Subsequently, he overused lorazepam, lithium, and aripiprazole. Two days after the overdose, he experienced a high fever, confused mental status, and rhabdomyolysis and was diagnosed with NMS. However, even after resolution of NMS-related symptoms, quadriplegia, visual field defects, ataxia, and severe dysarthria persisted. A positron emission tomography-computed tomography brain scan showed decreased 15F-fludeoxyglucose uptake in bilateral primary motor cortices and in the thalamus, midbrain, and cerebellum. Brain magnetic resonance imaging diffusion tensor imaging and diffusion tensor tractography of the subcortical tracts revealed structural disruptions, especially in the corticospinal tract, dentatorubrothalamic tract, and optic radiation, which seemed to be correlated with the clinical symptoms of the patient.

Conclusion

This case suggests that the clinical use of diffusion tensor tractography could be helpful to explain the clinical features in the case of SILENT combined with NMS.
Long-Term Benzodiazepine Prescription During Maintenance Therapy of Individuals With Psychosis Spectrum Disorders—Associations With Cognition and Global Functioning
Authors: Savić Bojana , Jerotić Stefan , Ristić Ivan , Zebić Mirjana , Jovanović Nikolina , Russo Manuela , Marić Nadja P.
Published: February 2021

Background

Cognitive difficulties have a significant impact on life functioning and overall well-being in patients with psychosis spectrum disorders (PSDs). There are indications that continuous use of benzodiazepines (BZDs) in various patient groups has a detrimental effect on cognition. Our aim was to explore the association between long-term BZD prescription, global functioning, and cognitive functioning in persons with PSD.

Methods

This exploratory study included 55 PSD patients, recruited from 2 outpatient services in Serbia. Patients were grouped into BZD long-term prescription group and BZD-other group. Brief Psychiatric Rating Scale was used for symptom assessment, functioning was measured by Global Assessment and Functioning Scale, and cognition was assessed by the Global Assessment of Functioning–Cognition in Schizophrenia Scale.

Results

The sample comprised 52.7% patients who were prescribed with BZD for 6 months or more continually (29/55), with a mean daily dose of 3.16 ± 0.66 mg lorazepam equivalents. There were no differences between study groups in any of the sociodemographic characteristics, duration of illness, or antipsychotic daily dosages. The BZD long-term prescription group had lower global (P < 0.01) and cognitive functioning (P < 0.01), higher Brief Psychiatric Rating Scale scores (1.86 vs 1.58, respectively, P < 0.01), and more psychotropic drugs prescribed on a daily basis than the other group (median: 4 vs 2, respectively, P < 0.01).

Conclusions

The study explored a topic that continues to be underresearched, especially in the Balkans. Prospective studies and comprehensive cognitive batteries are needed to further elucidate the associations between polypharmacy, long-term BZD use, cognitive functioning, and global functioning during maintenance therapy of individuals with PSD.
Toward a neuropsychology of political orientation: exploring ideology in patients with frontal and midbrain lesions
Authors: Nam H. Hannah , Jost John T. , Meager Michael R. , Van Bavel Jay J.
Published: February 2021

How do people form their political beliefs? In an effort to address this question, we adopt a neuropsychological approach. In a natural experiment, we explored links between neuroanatomy and ideological preferences in two samples of brain lesion patients in New York City. Specifically, we compared the political orientations of patients with frontal lobe lesions, patients with amygdala lesions and healthy control subjects. Lesion type classification analyses revealed that people with frontal lesions held more conservative (or less liberal) beliefs than those with anterior temporal lobe lesions or no lesions. Additional analyses predicting ideology by extent of damage provided convergent evidence that greater damage in the dorsolateral prefrontal cortex—but not the amygdala—was associated with greater conservatism. These findings were robust to model specifications that adjusted for demographic, mood, and affect-related variables. Although measures of executive function failed to mediate the relationship between frontal lesions and ideology, our findings suggest that the prefrontal cortex may play a role in promoting the development of liberal ideology. Our approach suggests useful directions for future work to address the issue of whether biological developments precede political attitudes orvice versa—or both.

This article is part of the theme issue ‘The political brain: neurocognitive and computational mechanisms’.
Trust in information, political identity and the brain: an interdisciplinary fMRI study
Authors: Moore Adam , Hong Sujin , Cram Laura
Published: February 2021

Misinformation has triggered government inquiries and threatens the perceived legitimacy of campaign processes and electoral outcomes. A new identity polarization has arisen between Remain and Leave sympathizers in the UK Brexit debate, with associated accusations of misinformation use. Competing psychological accounts of how people come to accept and defend misinformation pit self-reinforcing motivated cognition against lack of systematic reasoning as possible explanations. We harness insights from political science, cognitive neuroscience and psychology to examine the impact of trust and identity on information processing regarding Brexit in a group of Remain identifiers. Behaviourally, participants' affective responses to Brexit-related information are affected by whether the emotional valence of the message is compatible with their beliefs on Brexit (positive/negative) but not by their trust in the source of information. However, belief in the information is significantly affected by both (dis)trust in information source and by belief compatibility with the valence of the information. Neuroimaging results confirm this pattern, identifying areas involved in judgements of the self, others and automatic processing of affectively threatening stimuli, ultimately supporting motivated cognition accounts of misinformation endorsement.

This article is part of the theme issue ‘The political brain: neurocognitive and computational mechanisms’.
The gender-binary cycle: the perpetual relations between a biological-essentialist view of gender, gender ideology, and gender-labelling and sorting
Authors: Saguy Tamar , Reifen-Tagar Michal , Joel Daphna
Published: February 2021

Gender inequality is one of the most pressing issues of our time. A core factor that feeds gender inequality is people's gender ideology—a set of beliefs about the proper order of society in terms of the roles women and men should fill. We argue that gender ideology is shaped, in large parts, by the way people make sense of gender differences. Specifically, people often think of gender differences as expressions of a predetermined biology, and of men and women as different ‘kinds’. We describe work suggesting that thinking of gender differences in thisbiological-essentialistway perpetuates a non-egalitarian gender ideology. We then review research that refutes the hypothesis that men and women are different ‘kinds’ in terms of brain function, hormone levels and personality characteristics. Next, we describe how the organization of the environment in a gender-binary manner, together with cognitive processes of categorization drive a biological-essentialist view of gender differences. We then describe the self-perpetuating relations, which we termthe gender-binary cycle, between a biological-essentialist view of gender differences, a non-egalitarian gender ideology and a binary organization of the environment along gender lines. Finally, we consider means of intervention at different points in this cycle.

This article is part of the theme issue ‘The political brain: neurocognitive and computational mechanisms’.
Visceral politics: a theoretical and empirical proof of concept
Authors: Tsakiris Manos , Vehar Neza , Tucciarelli Raffaele
Published: February 2021

While the study of affect and emotion has a long history in psychological sciences and neuroscience, the very question of how visceral states have come to the forefront of politics remains poorly understood. The concept ofvisceral politicscaptures how the physiological nature of our engagement with the social world influences how we make decisions, just as socio-political forces recruit our physiology to influence our socio-political behaviour. This line of research attempts to bridge the psychophysiological mechanisms that are responsible for our affective states with the historical socio-cultural context in which such states are experienced. We review findings and hypotheses at the intersections of life sciences, social sciences and humanities to shed light onhowandwhypeople come to experience such emotions in politics and what if any are their behavioural consequences. To answer these questions, we provide insights from predictive coding accounts of interoception and emotion and a proof of concept experiment to highlight the role of visceral states in political behaviour.

This article is part of the theme issue ‘The political brain: neurocognitive and computational mechanisms’.
Understanding and combating misperceived polarization
Authors: Lees Jeffrey , Cikara Mina
Published: February 2021

By many accounts politics is becoming more polarized, yielding dire consequences for democracy and trust in government. Yet a growing body of research on so-called false polarization finds that perceptions of ‘what the other side believes’ are inaccurate—specifically, overly pessimistic—and that these inaccuracies exacerbate intergroup conflict. Through a review of existing work and a reanalysis of published data, we (i) develop a typology of the disparate phenomena that are labelled ‘polarization’, (ii) use that typology to distinguish actual from (mis)perceived polarization, and (iii) identify when misperceived polarization gives rise to actual polarization (e.g. extreme issue attitudes and prejudice). We further suggest that a specific psychological domain is ideal for developing corrective interventions:
meta-perception
, one's judgement of how they are perceived by others. We review evidence indicating that correcting meta-perception inaccuracies is effective at reducing intergroup conflict and discuss methods for precisely measuring meta-perception accuracy. We argue that the reputational nature of meta-perception provides a motivational mechanism by which individuals are sensitive to the truth, even when those truths pertain to the ‘other side’. We conclude by discussing how these insights can be integrated into existing research seeking to understand polarization and its negative consequences.

This article is part of the theme issue ‘The political brain: neurocognitive and computational mechanisms’.