bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Atonic Postpartum Hemorrhage
Authors: Ende Holly B. , Lozada M. James , Chestnut David H. , Osmundson Sarah S. , Walden Rachel L. , Shotwell Matthew S. , Bauchat Jeanette R.
Published: January 2021

OBJECTIVE:

To identify and quantify risk factors for atonic postpartum hemorrhage.

DATA SOURCES:

PubMed, CINAHL, EMBASE, Web of Science, and and ClinicalTrials.gov databases were searched for English language studies with no restrictions on date or location. Studies included randomized trials, prospective or retrospective cohort studies, and case–control studies of pregnant patients who developed atonic postpartum hemorrhage and reported at least one risk factor.

METHODS OF STUDY SELECTION:

Title, abstract, and full-text screening were performed using the Raayan web application. Of 1,239 records screened, 27 studies were included in this review. Adjusted or unadjusted odds ratios (ORs), relative risks, or rate ratios were recorded or calculated. For each risk factor, a qualitative synthesis of low and moderate risk of bias studies classifies the risk factor as definite, likely, unclear, or not a risk factor. For risk factors with sufficiently homogeneous definitions and reference ranges, a quantitative meta-analysis of low and moderate risk of bias studies was implemented to estimate a combined OR.

TABULATION, INTEGRATION, AND RESULTS:

Forty-seven potential risk factors for atonic postpartum hemorrhage were identified in this review, of which 15 were judged definite or likely risk factors. The remaining 32 assessed risk factors showed no association with atonic postpartum hemorrhage or had conflicting or unclear evidence.

CONCLUSION:

A substantial proportion of postpartum hemorrhage occurs in the absence of recognized risk factors. Many risk factors for atonic hemorrhage included in current risk-assessment tools were confirmed, with the greatest risk conferred by prior postpartum hemorrhage of any etiology, placenta previa, placental abruption, uterine rupture, and multiple gestation. Novel risk factors not currently included in risk-assessment tools included hypertension, diabetes, and ethnicity. Obesity and magnesium were not associated with atonic postpartum hemorrhage in this review.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42020157521.
Factors Considered in Ranking Spine Surgery Fellowship Applicants
Authors: Bernatz James T. , Johnson Kristina P. , Stokman James J. , Cannada Lisa K. , Williams Seth K. , Whiting Paul S.
Published: January 2021

Study Design

Cross-sectional study.

Objective

To determine which factors spine surgery fellowship program directors (PDs) consider most important when ranking applicants.

Summary of Background Data

Spine surgery is a popular orthopedic subspecialty. As such, the spine fellowship match process is highly competitive. Surveys of fellowship PDs in orthopedic sports medicine and hand surgery have demonstrated differing opinions regarding factors considered most important when ranking fellowship applicants. The factors considered important to spine surgery fellowship PDs have not been evaluated.

Methods

A web-based questionnaire was sent to the PDs of all spine surgery fellowships participating in the San Francisco (SF) Match Program. The questions were designed to identify criteria considered most important in ranking spine surgery fellowship applicants. A list of 12 criteria was presented and PDs were asked to rank these in order of importance. A weighted score for each criterion was calculated using the following scale: 5 points for each criterion ranked 1st, 4 points for 2nd, 3 points for 3rd, 2 points for 4th, and 1 point for 5th.

Results

Of the 73 PDs queried, 52 responded (71% response rate). The interview was the most important factor when ranking fellowship applicants. The other criteria deemed most important in order of weighted scoring were letters of recommendation and personal connections to the applicant and/or familiarity with the applicant's letter writer(s).

Conclusion

Spine surgery fellowship PDs consider the interview, letters of recommendation, and personal connections with the applicant/letter writers to be the most important factors when ranking candidates. These results may be valuable to orthopedic residents and mentors of those pursuing fellowship training in spine surgery.

Level of Evidence: 4
A Study on the Anatomical Relationship of the Lumbar Extrapedicular Puncture Approach with the Spinal Nerve and its Branches
Authors: Zhong Yuan , Luo Lei , Zhao Chen , Li Pei , Dong Bozan , Wang Zili , Jiang Dianming , Zhou Qiang , Liu Liehua
Published: January 2021

Mini

The anatomical relationship of the extrapedicular approach with the spinal nerve and its branches was researched in cadavers. Three types of extrapedicular paths were simulated: puncture inside the medial branch (MB), puncture outside the MB, and puncture outside the lateral branch (LB). At L1–L3, puncture outside the LB could avoid damage to these nerves.

Study Design.

An anatomical study in 15 cadavers.

Objective.

To observe the anatomical relationship of the extrapedicular puncture approach with the spinal nerve and its branches, evaluate the risk of injury to these nerves and recommend a safe puncture path for lumbar extrapedicular percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP).

Summary of Background Data.

There have been no reports on the anatomical relationship of the extrapedicular approach with the spinal nerve and its branches.

Methods.

The positions, diameters, and paths of the anterior ramus (AR), medial branch (MB), and lateral branch (LB) outside the pedicles of L1–L4 were observed, and the related anatomical parameters were measured. Three types of extrapedicular puncture paths were simulated: puncture inside the MB, puncture outside the MB, and puncture outside the LB. By evaluating the risk of injury to the MB, LB, and AR, an appropriate puncture path was recommended.

Results.

During puncture inside the MB, the incidence of MB injury was 93.3% to 100%. During puncture outside the MB, the incidence rates of MB injury at L1 and L2 were 10.0% and 3.3%, respectively, and the incidence of LB injury at L4 was 10.0%. During puncture outside the LB, there were no cases of injury to the LB or MB. There was no incidence of AR injury during L1–L3 extrapedicular puncture, but the risk of AR injury was 3.3% when the procedure was performed at L4. The recommended technique is puncture outside the LB, where the needle vertically crosses the transverse process, slides inward, and advances while being held tightly against the bone.

Conclusion.

Extrapedicular puncture occurs adjacent to the spinal nerve and its branches, posing a risk of injury to these nerves. At the L1–L3 levels, puncture outside the LB can avoid damage to the spinal nerve and its branches.

Level of Evidence: N/A.
Capillary Leukocytes, Microaggregates, and the Response to Hypoxemia in the Microcirculation of Coronavirus Disease 2019 Patients
Authors: Favaron Emanuele , Ince Can , Hilty Matthias P. , Ergin Bülent , van der Zee Philip , Uz Zühre , Wendel Garcia Pedro D. , Hofmaenner Daniel A. , Acevedo Claudio T. , van Boven Wim Jan , Akin Sakir , Gommers Diederik , Endeman Henrik
Published: January 2021

OBJECTIVES:

In this study, we hypothesized that coronavirus disease 2019 patients exhibit sublingual microcirculatory alterations caused by inflammation, coagulopathy, and hypoxemia.

DESIGN:

Multicenter case-controlled study.

SETTING:

Two ICUs in The Netherlands and one in Switzerland.

PATIENTS:

Thirty-four critically ill coronavirus disease 2019 patients were compared with 33 healthy volunteers.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The microcirculatory parameters quantified included total vessel density (mm × mm–2), functional capillary density (mm × mm–2), proportion of perfused vessels (%), capillary hematocrit (%), the ratio of capillary hematocrit to systemic hematocrit, and capillary RBC velocity (μm × s–1). The number of leukocytes in capillary-postcapillary venule units per 4-second image sequence (4 s–1) and capillary RBC microaggregates (4 s–1) was measured. In comparison with healthy volunteers, the microcirculation of coronavirus disease 2019 patients showed increases in total vessel density (22.8 ± sd 5.1 vs 19.9 ± 3.3; p < 0.0001) and functional capillary density (22.2 ± 4.8 vs 18.8 ± 3.1; p < 0.002), proportion of perfused vessel (97.6 ± 2.1 vs 94.6 ± 6.5; p < 0.01), RBC velocity (362 ± 48 vs 306 ± 53; p < 0.0001), capillary hematocrit (5.3 ± 1.3 vs 4.7 ± 0.8; p < 0.01), and capillary-hematocrit-to-systemic-hematocrit ratio (0.18 ± 0.0 vs 0.11 ± 0.0; p < 0.0001). These effects were present in coronavirus disease 2019 patients with Sequential Organ Failure Assessment scores less than 10 but not in patients with Sequential Organ Failure Assessment scores greater than or equal to 10. The numbers of leukocytes (17.6 ± 6.7 vs 5.2 ± 2.3; p < 0.0001) and RBC microaggregates (0.90 ± 1.12 vs 0.06 ± 0.24; p < 0.0001) was higher in the microcirculation of the coronavirus disease 2019 patients. Receiver-operating-characteristics analysis of the microcirculatory parameters identified the number of microcirculatory leukocytes and the capillary-hematocrit-to-systemic-hematocrit ratio as the most sensitive parameters distinguishing coronavirus disease 2019 patients from healthy volunteers.

CONCLUSIONS:

The response of the microcirculation to coronavirus disease 2019-induced hypoxemia seems to be to increase its oxygen-extraction capacity by increasing RBC availability. Inflammation and hypercoagulation are apparent in the microcirculation by increased numbers of leukocytes and RBC microaggregates.
Deviated Nose: A Systematic Approach for Correction
Authors: Abu El-Wafa Ahmed M. , Emara Sherif S.
Published: January 2021

Background:

Attaining a straight dorsum in patients with deviated nose is a main task in rhinoplasty. The basis of this difficulty is the presence of multiple anatomical abnormalities; hence, many methods are used to correct such a deformity. In this study, a sequential comprehensive surgical approach is proposed for the correction of deviated nose.

Methods:

Seventy-six patients who presented with developmental or posttraumatic external nasal deviation were enrolled in this study. All patients were subjected to open septorhinoplasty using a systematic approach. The outcome was assessed throughout for patient satisfaction.

Results:

The postoperative course was uneventful. Minor complications were encountered as transient hypoesthesia in the nasal tip in 4 patients and as prolonged tip edema in 10 patients. Residual significant nasal deviation was observed in 3 patients, and only 1 of them necessitated revision. All patients reported improvement of their nasal airway, and the percentages of their aesthetic satisfaction were as follows: very satisfied (n = 57, 75%), satisfied (n = 18, 23.7%), and unsatisfied (n = 1, 1.3%).

Conclusions:

A simple and comprehensive approach for correction of deviated nose is presented, which resulted in a better long-term cosmetic and functional outcome. This approach could correct the deviations in various anatomic locations, and helps the surgeon to deal with nasal deviation in an effective and straightforward manner wherever the pathology of deviation.
Impact of FDA Updates on Public Interest in Breast Implant-associated Anaplastic Large Cell Lymphoma
Authors: Singh Mansher , Singh Gayatri , Singh Chauhan Anupam , Lee Harrison H. , Sacks Justin M. , Hultman Charles S. , Albert Mark G.
Published: January 2021

In the United States, the Food and Drug Administration (FDA) is responsible for protecting the public health by assuring the safety, efficacy, and security of drugs, biological products, and medical devices. In that role, FDA releases timely updates with regard to medical devices and their possible adverse effects. However, the impact of such FDA updates on public interest has not been studied. The timing of multiple FDA updates regarding Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) was noted from September 2014 to September 2019. Impact on Public interest related to ALCL was measured using Google Trends and the number of YouTube video uploads. These objective markers were used to compare the public interest during FDA updates versus weeks with no FDA updates. Five major updates were released by FDA regarding BIA-ALCL during the past 5 years. Google Trends demonstrated a significant increase in public interest regarding ALCL during the week of FDA release, with a mean score of 69 ± 20.82 when compared with a mean score of 10.68 ± 4.71 (P < 0.001) during weeks with no FDA release. The mean number of YouTube videos uploaded during the period of FDA release was 11.8 ± 9.42, which was significantly higher than the mean of 2.42 ± 1.31 videos (P < 0.001) during the period of no FDA updates. FDA updates correlates with temporal increase in public interest. Plastic surgeons should be aware of FDA information releases on BIA-ALCL and anticipate an increased interest in additional information from patients and the public.
Treatment of Non-melanoma Skin Cancers in the Absence of Mohs Micrographic Surgery
Authors: Ferry Andrew M. , Sarrami Shayan M. , Hollier Pierce C. , Gerich Caitlin F. , Thornton James F.
Published: January 2021

Non-melanoma skin cancers are the most common malignancies globally. Although non-melanoma skin cancers exhibit low metastatic potential, they can be locally destructive, necessitating complex excisions and reconstructions. Mohs micrographic surgery is the gold-standard treatment for high-risk non-melanoma skin cancers in patients who are appropriate surgical candidates. Despite its efficacy, Mohs micrographic surgery is not readily available in most geographic regions, necessitating that plastic surgeons be well-versed in alternative treatment modalities for non-melanoma skin cancer. Herein, we will discuss the management of non-melanoma skin cancers in settings where Mohs micrographic surgery is not readily available.
Negative-pressure Wound Therapy for Sacral Pressure Ulcer in Gorham-Stout Disease
Authors: Shiokawa Ichiro , Oshima Naoya , Mizumura Nao , Momosawa Akira
Published: January 2021

Gorham-Stout disease (GSD) is a rare musculoskeletal disorder characterized by progressive bone resorption and overgrowth of lymphatic vessels. The mechanism of GSD is still largely unknown. Negative-pressure wound therapy (NPWT) is known to accelerate wound healing and is used worldwide. Herein, we report a successful treatment of a patient with GSD having a sacral pressure ulcer, using NPWT. An 18-year-old female GSD patient was referred to our department for treating a sacral wound. The wound was disinfected by pocket incision, cleansing, and administration of antibiotics; however, the lesion remain unhealed. Histopathology of the debrided sacral wound revealed fibrous granulation tissue, with no sign of lymphatic anomalies. NPWT was started with −75 mm Hg of pressure, and neither lymphorrhea nor growth of lymphangioma was noted. Negative pressure was gradually increased to −125 mm Hg. The ulcer size decreased to 2 × 2 cm2, which healed 3 months after hospital discharge, with no recurrence for 8 months. For progressive diseases such as GSD, NPWT may cause the regrowth of lymphangioma or other neoplasms due to an increase in vessel endothelial growth factor. NPWT appears to be one of the safest and most effective wound therapies even for this rare and difficult disease, provided the use of the following treatment protocol: Pathohistological assessment before application of NPWT, and negative pressure initially set at a low level; then, gradually increased, with careful observation to avoid lymphorrhea. When changing the foam dressing, careful checking is important to determine whether the wound is necrotic, or if there is tumor-like tissue accumulation rather than healthy granulation.
Cohesive Round Implants and the Risk of Implant Flipping
Authors: Jong Justin , Gabriel Allen , Trekell Melissa , Lawser Amy S. , Heidel Eric , Buchanan Dallas , Chun Joseph T.
Published: January 2021

Background:

Fifth-generation, round, form-stable implants have a higher cohesive gel, a higher fill volume, and distinct anterior and posterior profiles. Due to these implant features, anterior-posterior (AP) flipping of round, form-stable implants is discernible, but little is known of this complication of implant reconstruction.

Methods:

Patients who underwent skin- or nipple-sparing mastectomy followed by direct-to-implant reconstruction with round, cohesive, smooth implants were included in this retrospective study. Implants were placed submuscularly or prepectorally. Incidence of flipping was retrieved from patient records. Patients were stratified by presence or absence of flipping; data on patient demographic characteristics, neoadjuvant/adjuvant treatment, mastectomy characteristics, and acellular dermal matrix (ADM) type (AlloDerm or FlexHD) and coverage technique (inferior pole, tenting, or wrapping) were compared between the groups to identify risk factors associated with flipping.

Results:

A total of 117 patients (230 breasts) were evaluated. Sixteen cases of implant flipping were documented for a flip rate of 7.0%, all occurring in patients with prepectoral implants. On univariate analysis, prepectoral implant placement, highly cohesive implants, use of AlloDerm, and ADM wrapping/tenting were found to be significantly associated with AP flipping. On logistic regression analyses, ADM type and ADM coverage technique were no longer significant predictors of AP flipping.

Conclusions:

Patients who undergo prepectoral implant reconstruction with highly cohesive round implants appear to be at an increased risk of AP flipping. Subpectoral reconstruction is not associated with AP flipping.
Technical Challenges in “Micro” Lymph Node Identification during Vascularized Submental Lymph Node Flap Harvesting
Authors: Yodrabum Nutcha , Patchanee Krittayot , Oonjitti Thanaphorn , Piyaman Parkpoom
Published: January 2021

Background:

The outcome of autologous lymph node (LN) transfer has depended on the number of LNs in the donor site. Unknown accuracy of the LN counting method has thrown some doubts on the reliability of the previous statistics. This study aimed to assess the accuracy of naked eye (NK) and stereo microscopy (SM) as tools for LN count.

Methods:

In total, 40 vascularized submental LN flaps were harvested from 23 fresh cadavers. The colored polymer was injected into the external carotid arteries before the harvest. LNs in each flap were counted by NK, SM, and histology in sequential order.

Results:

An estimated 175 LNs were confirmed, 4.4 ± 1.8 per flap. NK sensitivity was 33.7% compared with that of SM at 63.5%. Both methods missed all micro-lymph nodes (micro-LNs), contributing to 5.1% (9 nodes) of all LNs. Non-LN structures (647 negative counts) were composed of fat lobules, salivary gland lobules, and muscle fibers. NK specificity was 98.0%, compared with that of SM at 96.1%. SM showed a higher false positive rate at 14.3%, compared with NK at 7.4%. False positive counts were located mostly in Ib sublevel.

Conclusions:

NK and SM are imperfect tools for LN count due to poor sensitivity. If the method needs to be applied, points of considerations are (1) undetectable micro-LNs, (2) interposition of LNs with the digastric muscle and submandibular salivary gland, (3) confusion of LNs with lobules of salivary gland supplied by glandular artery or fat lobules supplied by lobular artery.
The Impact of the COVID-19 Pandemic on Plastic Surgery Consultations in the Emergency Department
Authors: Paiva Marcelo , Rao Vinay , Spake Carole S.L. , King Victor A. , Crozier Joseph W. , Liu Paul Y. , Woo Albert S. , Schmidt Scott T. , Kalliainen Loree K.
Published: January 2021

Background:

Stay-at-Home (SAH) orders implemented in the United States to combat COVID-19 had a significant impact on health care delivery for patients with all conditions. In this study, we examined the effect SAH orders had on the Emergency Department (ED) consultation volume, injury patterns, and treatment of patients managed by our plastic surgery service.

Methods:

In Rhode Island, SAH orders were instituted from March 28, 2020, to June 30, 2020. A retrospective chart review of patients presenting to our Level-1 academic medical center was performed. Patient demographics, types of injuries, and need for treatment in the ED or operating room (OR) were collected. Tests of significance were conducted using a comparison group spanning the same time period, in 2019.

Results:

There was a 36% decrease in ED consultations to plastic surgery during SAH orders when compared with those in 2019. No observed differences were noted in patient demographics between time periods. There were significant increases in the proportions of hand injuries secondary to power tools and facial injuries secondary to falls. No observed differences were identified in injury severity and need for either operating-room interventions or ED interventions for patients seen in consultation during SAH orders.

Conclusions:

SAH orders resulted in a decreased volume of plastic surgery consults in the ED but did not alter patient demographics, injury severity, or need for procedural interventions. There was a 2.9% positivity rate for COVID-19 for asymptomatic patients presenting in the ED with primary hand and facial injuries.
Female age and assisted reproductive technology
Authors: Pierce Nicole , Mocanu Edgar
Published: January 2021

The age at first birth is ever increasing. Women above 35 years of age are a growing segment of patients attending for fertility services like in vitro fertilization. Open discussion about the limitations of assisted reproductive technology therapy at advanced female age, risks of pregnancy for the mother and child ensure that couples are fully informed and have realistic expectation before pursuing emotionally and financially exhaustive interventions. Preventive education to include the importance of establishing a family early in the female adulthood should be considered by health policy makers. Ideally, Institutions educating young adults should equally provide contraceptive and fertility advice under one umbrella of female and male reproductive health.
EIGHTEEN-MONTH RESULTS OF INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR ON VISION AND MICROCIRCULATION IN RADIATION MACULOPATHY
Authors: Eandi Chiara M. , Polito Maria S. , Schalenbourg Ann , Zografos Leonidas
Published: January 2021

Purpose:

To evaluate 18 months' results of a strict anti–vascular endothelial growth factor protocol for radiation maculopathy following proton therapy in choroidal melanoma.

Methods:

Retrospective, comparative, nonrandomized study of 74 radiation maculopathy patients presenting macular lipid deposits, hemorrhages, microaneurysms, cystoid edema, nerve layer infarction, telangiectasia, or capillary nonperfusion. The study group included 52 consecutive patients injected with intravitreal anti–vascular endothelial growth factors (bevacizumab/ranibizumab: 46/6) every two months for the first and every 3 months for the second year, with minimum 12 months' follow-up. The control group consisted of 22 patients having declined this treatment. Best-corrected visual acuity, spectral domain-optical coherence tomography and optical coherence tomography angiography were recorded at baseline, 6, 12, and 18 months. The foveal avascular zone and capillary density were measured at the superficial capillary plexus.

Results:

Radiation maculopathy was diagnosed at 2 years (1.5–3.5) after proton therapy. Best-corrected visual acuity at baseline, 12 and 18 months improved in the study group from 0.45, 0.3 to 0.2 logarithm of the minimum angle of resolution, but decreased in the control group from 0.5, 0.9 to 1.0 logarithm of the minimum angle of resolution respectively (P < 0.001 at 12 months). Simultaneously, foveal avascular zone enlargement was less in the study (from 0.377, 0.665 to 0.744 mm2) than control group (from 0.436, 1.463 to 2.638 mm2) (P = 0.05 at 12 months). CMT (280 and 276 µm) and capillary density (37% and 38%, at baseline, respectively) did not evolve significantly different.

Conclusion:

Intravitreal anti–vascular endothelial growth factors, every 2 months for the first and every 3 months for the second year, slow down, over up to 18 months, vision loss and anatomical degradation in radiation maculopathy following proton therapy for choroidal melanoma.
Biomarker-guided management of acute kidney injury
Authors: Kane-Gill Sandra L. , Meersch Melanie , Bell Max
Published: January 2021

Purpose of review

The current narrative review discusses practical applications of stress and damage biomarkers for the management of acute kidney injury (AKI) based on clinical trials and real-world evaluations.

Recent findings

In 2013 with the discovery and validation study of biomarkers for AKI (Sapphire) advancement in care was provided allowing for the early identification of patients at high risk for developing AKI. It was the combination of new biomarkers and the Kidney Disease Improving Global Outcomes (KDIGO) guidelines for managing patients with AKI that provided an opportunity to improve patient care. In 2017, the PrevAKI study implemented KDIGO guideline management in high-risk patients identified by biomarkers followed in 2018 with the BigPAK study that used a similar approach, both of which demonstrated positive outcomes in patient care. Next, real-world evaluations followed supporting biomarker guided management of AKI in clinical practice. Also, proposals for better nephrotoxin management, a major modifiable exposure to prevent AKI, were provided with the foresight in identifying high-risk patients.

Stress and damage biomarker-based approaches to patient care seem to be promising for identifying patients at high risk for developing AKI and thus offers an opportunity for early management to prevent and ameliorate AKI and drug-associated AKI.
Prognostic significance of inflammation-based score in patients with hepatocellular carcinoma after liver transplantation
Authors: Kong Weihao , Qu Enze , Sheng Nan , Zhang Jianfeng , Li Xutong , Zheng Jun , Gao Yufeng
Published: January 2021

Background

Recent studies have revealed that combining of the platelet to lymphocyte ratio (PLR) and the neutrophil to lymphocyte ratio (NLR) [(combination of neutrophil–lymphocyte ratio and platelet–lymphocyte ratio (CNP)] links with dismal prognosis in diverse cancers. Here, we elucidated the prognostic significance of CNP, acting as a novel inflammation-based score, for predicting the survival of hepatocellular carcinoma (HCC) patients following liver transplantation.

Method

We retrospectively recruited 100 patients with HCC who met the Hangzhou criteria for liver transplantation. The Kaplan–Meier approach, univariate, and multivariate assessments were employed to examine prognostic factors. We determined the optimal cutoff values for NLR, PLR, and haematological parameters using the receiver operating characteristic (ROC) curve evaluation. On the basis of the ROC curve, the optimal cutoff values for PLR and NLR were 3.4 and 114.6, discretely. Patients with increased NLR (>3.4) and high PLR (>114.6) scored 2, while one or none scored 1 or 0, respectively.

Results

Distinct differences were reported between CNP and Fibrinogen (P = 0.002), White blood cell (P = 0.048), NLR (P < 0.001), and PLR (P < 0.001). Based on the findings of Kaplan–Meier assessments, the CNP score linked to dismal overall survival (OS; P < 0.0001), as well as recurrence-free survival (RFS; P < 0.0001) in HCC patients after liver transplantation. Furthermore, multivariate assessments indicated that the CNP score was an independent prediction factor for OS (P = 0.002) and RFS (P < 0.001) in HCC patients after liver transplantation.

Conclusion

The CNP score can be considered as an effective predictor of survival events in HCC patients after liver transplantation.
Benign Pseudoglandular Mesothelial Cell Inclusions in Cervical Lymph Nodes of a Patient With Multiple Malignancies: Case Report and Review of Literature
Authors: Stefanko Daniel P. , Lin Grace Y. , Orosco Ryan K. , Vavinskaya Vera
Published: January 2021

Mesothelial cell inclusions in cervical lymph nodes are of exceedingly rare occurrence and can be mistaken for metastatic adenocarcinoma. We report the case of a 27-year-old woman with a history of chronic myelogenous leukemia, diagnosed at age 5 years, and a recent diagnosis of alveolar soft part sarcoma of the left parotid gland. The patient underwent a left parotidectomy and neck dissection with intraoperative finding of abnormal lymph nodes in levels II to V. Histological examination revealed clusters of bland cells with pseudoglandular formation in 6 of 14 level IV/V lymph nodes. Immunological stains were consistent with mesothelial origin, and the diagnosis of benign mesothelial cell inclusions was made. Recognition of this entity in the evaluation of lymph nodes is important to prevent misdiagnosis of metastatic disease, particularly in a patient with multiple known malignancies.
A Guide to Differentiating Thrombotic Microangiopathies Through a Case of Catastrophic Antiphospholipid Syndrome
Authors: Hardy Naomi , Stashek Kristen
Published: January 2021

Thrombotic microangiopathies are rare life-threatening diseases that require prompt diagnosis and treatment to increase patient survival. The prototypical thrombotic microangiopathies are classic hemolytic-uremic syndrome, caused by enterohemorrhagic Escherichia coli, and thrombotic thrombocytopenic purpura. Included in the differential diagnoses and showing overlapping clinical features is antiphospholipid syndrome (APS) and the more severe form, catastrophic APS. Here, we discuss the general approach to thrombotic microangiopathies through a case of APS that later developed into its catastrophic variant.
Poorly Controlled Pediatric Fracture Pain Requiring Unplanned Medical Assistance or Advice
Authors: Kopp Tara M. , Frey Theresa M. , Zakrajsek Mark , Nystrom Jennifer , Koutsounadis Gena N. , Falcone Kelly S. , Zhang Yin , Wall Eric , Byczkowski Terri , Mittiga Matthew R.
Published: January 2021

Objectives

This study aimed to define the proportion of children who seek assistance for poorly controlled fracture pain, identify factors associated with requesting help, and explore caregivers' opioid preferences.

Methods

We enrolled 251 children and their caregivers in the orthopedic surgery clinic of a tertiary care children’s hospital. Children 5 to 17 years old presenting within 10 days of injury for follow-up for a single-extremity, nonoperative long bone fracture(s) were eligible. The primary outcome was seeking unscheduled evaluation or advice for poorly controlled pain before the first routine follow-up appointment by telephone call, medical visit, or rescheduling to an earlier appointment. Factors associated with the outcome were assessed using bivariable analysis.

Results

Overall, 7.3% (95% confidence interval, 4.1%–10.6%) of participants sought unscheduled evaluation or advice for poorly controlled pain. The 2 most common reasons were to obtain over-the-counter analgesic dosage information (64.7%) and a stronger analgesic (29.4%). These children were more likely to have a leg fracture, have an overriding or translated fracture, or require manual reduction under procedural sedation. These children had higher Patient-Reported Outcomes Measurement Information System Pain Behavior and Pain Interference scores and more anxious caregivers. One-third of caregivers expressed hesitancy or refusal to use opioids to treat severe pain, and 45.7% reported potential addiction or abuse as the rationale.

Conclusions

A notable proportion of children seek assistance for poorly controlled fracture-related pain. Medical providers should target discharge instructions to the identified risk factors and engage caregivers in shared decision making if opioids are recommended.
Did COVID-19 Affect Time to Presentation in the Setting of Pediatric Testicular Torsion?
Authors: Littman Annalise R. , Janssen Karmon M. , Tong Li , Wu Hang , Wang May D. , Blum Emily , Kirsch Andrew J.
Published: January 2021

Objectives

To determine if boys with acute testicular torsion, a surgical emergency requiring prompt diagnosis and treatment to optimize salvage of the testicle, delayed presentation to a medical facility and experienced an extended duration of symptoms (DoS), and secondarily, a higher rate of orchiectomy, during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Single-center, descriptive retrospective chart review of boys presenting with acute testicular torsion from March 15, to May 4, 2020 (“during COVID-19” or group 2), as well as for the same time window in the 5-year period from 2015 to 2019 (“pre–COVID-19” or group 1).

Results

A total of 78 boys met inclusion criteria, group 1 (n = 57) and group 2 (n = 21). The mean age was 12.86 ± 2.63 (group 1) and 12.86 ± 2.13 (group 2). Mean DoS before presentation at a medical facility was 23.2 ± 35.0 hours in group 1 compared with 21.3 ± 29.7 hours in group 2 (P < 0.37). When DoS was broken down into acute (<24 hours) versus delayed (≥24 hours), 41 (71.9%) of 57 boys in group 1 and 16 (76.2%) of 21 boys in group 2 presented within less than 24 hours of symptom onset (P < 0.78). There was no difference in rate of orchiectomy between group 1 and group 2 (44.7% vs 25%, P < 0.17), respectively.

Conclusions

Boys with acute testicular torsion in our catchment area did not delay presentation to a medical facility from March 15, to May 4, 2020, and did not subsequently undergo a higher rate of orchiectomy.
Motor Unit Number Index in Evaluating Patients With Lumbar Spinal Stenosis
Authors: Cai Haibi , Kroll Mitchell , Annaswamy Thiru
Published: January 2021

Objective

Motor unit number index is a quantitative electrophysiological measure that provides an index of the number of motor neurons supplying a muscle. The aim of this exploratory study was to assess the utility of motor unit number index in the evaluation of patients with lumbar spinal stenosis.

Design

Participants were assigned to three groups: clinical and radiological lumbar stenosis (lumbar spinal stenosis with neurogenic intermittent claudication), group A; radiological lumbar spinal stenosis without neurogenic intermittent claudication, group B; and a control group, group C. Patients self-rated their pain and functional disability using the numerical rating scale and a series of functional questionnaires. An electromyographer performed nerve conduction tests, electromyography, and motor unit number index testing.

Results

Seventeen patients completed the study. There were 9, 5, and 3 patients in groups A, B, and C, respectively. There were no discernable differences in motor unit number index values of any individual muscle or combined motor unit number index score between the three groups. Motor unit number index values did not correlate to pain/functional measures.

Conclusions

In this exploratory study, motor unit number index did not demonstrate discriminatory ability between patients with lumbar spinal stenosis and was not correlated with pain and functional measures. Further study is needed to explore motor unit number index’s role in longitudinal evaluation of patients with the clinical syndrome of lumbar spinal stenosis.
Absorbable Versus Non-Absorbable Sutures in Open Rhinoplasty: Analysis of Columellar Scarring
Authors: Bozan Aykut , Dizdar Denizhan
Published: January 2021

Introduction:

Open rhinoplasty involving columellar incision has gained popularity since the 1930s. Many surgical incision techniques have been employed to obtain better results in terms of postoperative scarring. This study evaluated and compared the results of absorbable and non-absorbable sutures used in open technique rhinoplasty, assessed scar properties regardless of the techniques used, from the perspectives of patients and surgeons.

Objective:

This study evaluated and compared the results of absorbable and nonabsorbable sutures used in open technique rhinoplasty from the perspectives of patients and surgeons.

Material and Methods:

Study population included 70 patients who underwent primary open rhinoplasty between 2013 and 2018. Rhinoplasty Operations were performed in 2 different centers by a total of 2 rhinoplasty surgeons. Both surgeons used suture materials, which can be used for columellar closure, regardless of patients’ skin characteristics. Columellar scars were assessed at an outpatient clinic at least 6 months postoperatively. Patients who could not come to the clinic were excluded from the study. Columellar Scars were assessed using the Turkish Patient Observer Scar Assessment Questionnaire. Patients were also asked to complete a Scar Assessment Analysis Questionnaire at the outpatient clinic, and were photographed from the front, basal, and right and left oblique sides. Three surgeons, who were not part of the research team but routinely performed rhinoplasty, completed the Observer Scar Assessment Questionnaire by examining patients in person at the clinic as well as their photographs.

Results:

Observer Scar Assessment Questionnaire results; for the Vicryl group, surgeons ranked pigmentation of the scar as the best criterion (3.34 ± 0.97) and irregularity of the scar as the worst (3.82 ± 1.01). For the Prolene group, surgeons ranked irregularity as the best criterion (3.30 ± 0.97) and stiffness as the worst (3.54 ± 0.94). Although there was no statistically significant result between the two groups in the criteria, the mean scores of the Prolene group were less than the Vicryl group. (3.36 ± 0.46, 3.50 ± 0.65 respectively).

Scar Assessment Analysis Questionnaire Results; patients in both the Vicryl and Prolene groups ranked pain as the least important factor (mean 2.9 ± 1.11 and 3.33 ± 1.35, respectively). The Prolene group scored lower than the Vcryl group in terms of overall scarring (3.49 ± 0.72, 3.66 ± 1.37, respectively, P > 0,05).

Conclusions:

Absorbable sutures are a convenient alternative to nonabsorbable sutures

Level IV:

Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
An Investigation of Three-Dimensional Maxillary Arch Morphometry of Children With Unilateral Cleft Lip and Palate
Authors: Haque Sanjida , Khamis Mohd Fadhli , Alam Mohammad Khursheed , Ahmad Wan Muhamad Amir Wan
Published: January 2021

The aim of this study was to evaluate the effects of multiple factors (congenital and postnatal treatment factors) on the treatment outcome by assessing the maxillary arch dimension of children with unilateral cleft lip and palate (UCLP). Eighty-five Pakistani children with UCLP were taken who received cheiloplasty and palatoplasty. Laser scanned 3D digital models of UCLP subjects were prepared before any orthodontic treatment and bone grafting at 7.69 ± 2.46 (mean ± standard deviation) years of age. Inter-canine width (ICW), inter-molar width (IMW), and arch depth (AD) measurements of maxillary arch were measured with Mimics software. Multiple linear regression analyses were used to evaluate the association between congenital factors (age, gender, UCLP side, family history of cleft) and postnatal treatment factors (techniques of cheiloplasty and techniques of palatoplasty) with maxillary arch dimensions (ICW, IMW, and AD).Pvalue was set at 5%. The mean (standard deviation) dimensions of ICW, IMW, and AD are 26.7 (5.70) mm, 43.3 (4.66) mm, and 27.1 (5.26) mm, respectively. There is no significant association found between multiple factors and maxillary arch dimensions. This regression analysis shows no significant association between multiple factors and MAD in this sample.
Versatile Approach to Septonasal Deformity: Skyscraper Construction Based on an Old Relic
Authors: Anlatici Recep , Demiralay Sarp , Ozerdem Omer R.
Published: January 2021

Introduction:

Severely deformed noses usually harbor a combination of both bony pyramid and septal deformities. In this retrospective study, the authors aimed to evaluate our results of repair in patients with severe nasal deformities and importance of a versatile approach in these cases.

Materials and Methods:

A total of 32 cases with congenital or acquired (traumas or surgeries) severe nasal deformity were included in this retrospective study. Gender, age, etiology, reconstruction methods, complications, and results were recorded. Preoperative and postoperative pictures were compared; additionally, patients’ reviews on the esthetic and functional outcomes were noted. Open approach, weak L-strut template preparation attached to a strong keystone skeleton and reconstruction with a stable L- or T-strut on this template were carried out in all cases. In addition, glabellar flaps were used in 2 cases to restore the contracted skin envelope and wide-angle L-shape cartilage grafts in 7 cases for extensive alar cartilage reconstruction.

Results:

Favorable esthetic and functional results were obtained in most of the patients. The postoperative problems were recorded as intranasal synechiae; costochondral graft displacement; residual external deviation; nostril asymmetry; residual alar, columellar and tip problems; and prolonged edema.

Conclusions:

Sufficient sizes and amounts of skin, mucosa, cartilage, and bone tissue must be available to plan versatile repair using flaps and grafts according to the needs of each patient. Preserved stability of the keylock area is substantial. The authors advocate construction of a new structure based on the native weakened skeleton free from the extrinsic and intrinsic forces is an effective method.

EBM LEVEL 4
Tumor Size, Histology, and Survival After Stereotactic Ablative Radiotherapy and Sublobar Resection in Node-negative Non-small Cell Lung Cancer
Authors: Raman Vignesh , Jawitz Oliver K. , Cerullo Marcelo , Voigt Soraya L. , Rhodin Kristen E. , Yang Chi-Fu Jeffrey , D’Amico Thomas A. , Harpole David H. , Kelsey Christopher R. , Tong Betty C.
Published: January 2021

Background:

Although SABR is increasingly emerging as an alternative to surgery for node-negative non-small cell lung cancer, there is poor understanding of patients who may most benefit SABR compared to surgery.

Objective:

This study examined the relationship between tumor size and the comparative outcomes of SABR and sublobar resection in patients with node-negative non-small cell lung cancer.

Results:

A total of 59,949 patients met study criteria: 19,888 (33%) underwent SABR, 33,052 (55%) wedge resection, and 7009 (12%) segmental resection. In multivariable regression, a significant 3-way interaction was found between histology, tumor size, and type of treatment. After stratification by histology, a significant interaction between tumor size and treatment was preserved for patients with adenocarcinoma and squamous cell carcinoma. Sublobar resection was associated with greater survival compared to SABR for tumor sizes greater than 6 and 8 mm for patients with adenocarcinoma and squamous cell carcinoma, respectively. SABR was associated with similar survival compared to sublobar resection for patients with papillary and large cell histology.

Conclusions:

In this National Cancer Database analysis, sublobar resection was associated with greater survival compared to SABR for lesions >6or 8 mm in patients with adenocarcinoma or squamous cell carcinoma; however, SABR was associated with similar survival compared to sublobar resection in patients with aggressive tumors including papillary and large cell histology. Histologic diagnosis in patients with even small tumors may enable better treatment selection in those who cannot tolerate lobectomy.
A Case of Transient Monocular Vision Loss and Paracentral Acute Middle Maculopathy
Authors: Betsch Devin M. , Mishra Amit V. , Freund Paul R.
Published: January 2021

A 77-year-old man with multiple cerebrovascular risk factors presented with a history of transient monocular vision loss and residual paracentral visual disturbance in the right eye. Carotid ultrasounds, erythrocyte sedimentation rate, and C-reactive protein were all within normal limits. He was found to have retinal whitening within the macula in the right eye, corresponding to an area of decreased retinal perfusion on optical coherence topography (OCT)-angiography and a hyperreflective middle retina band on spectral domain-OCT. This was consistent with a diagnosis of paracentral acute middle maculopathy (PAMM). PAMM should be considered a part of the differential diagnosis in patients with focal visual disturbances, and OCT studies are recommended as part of the work up as subtle fundus findings may be missed.
Postinfectious Optic Neuritis After Hand–Foot–Mouth Disease
Authors: Barrett Spencer C. , Bhat Nita N. , Bindiganavile Shruthi H. , Lee Andrew G.
Published: January 2021

A 33-year-old man presented with acute painless loss of vision in his right eye after hand–foot–mouth disease (HFMD). Examination confirmed a right optic neuropathy. Neuroimaging and routine evaluations for alternative causes for an optic neuropathy were negative. He was treated with high dose corticosteroids and made an almost complete visual recovery. Postinfectious optic neuritis has been reported after a vast array of infections including: varicella zoster virus, influenza virus, herpes simplex virus, Epstein–Barr Virus, Lyme disease, and many others. Although Coxsackie virus infections are a known cause of HFMD and have been reported to cause maculopathy, to the best of our knowledge, this is the first reported case of optic neuritis after HFMD in the English language ophthalmic literature.
Can Bayesian phylogeography reconstruct migrations and expansions in linguistic evolution?
Authors: Neureiter Nico , Ranacher Peter , van Gijn Rik , Bickel Balthasar , Weibel Robert
Published: January 2021

Bayesian phylogeography has been used in historical linguistics to reconstruct homelands and expansions of language families, but the reliability of these reconstructions has remained unclear. We contribute to this discussion with a simulation study where we distinguish two types of spatial processes:migration, where populations or languages leave one place for another, andexpansion, where populations or languages gradually expand their territory. We simulate migration and expansion in two scenarios with varying degrees of spatial directional trends and evaluate the performance of state-of-the-art phylogeographic methods. Our results show that these methods fail to reconstruct migrations, but work surprisingly well on expansions, even under severe directional trends. We demonstrate that migrations and expansions have typical phylogenetic and spatial patterns, which in the one case inhibit and in the other facilitate phylogeographic reconstruction. Furthermore, we propose descriptive statistics to identify whether a real sample of languages, their relationship and spatial distribution, better fits a migration or an expansion scenario. Bringing together the results of the simulation study and theoretical arguments, we make recommendations for assessing the adequacy of phylogeographic models to reconstruct the spatial evolution of languages.