bluuebunny/crossref_metadata_2025 huggingface dataset:
“A Prospective, Randomized Study Comparing Closed Incision Negative Pressure Wound Therapy with Standard Care in Immediate Postmastectomy Breast Reconstruction.”
Authors: Pieszko Karolina , Pieszko Konrad , Wichtowski Mateusz , Cieśla Sławomir , Ławnicka Agnieszka , Jamont Robert , Boyd J Brian , Murawa Dawid
Published: February 2023

Background:

Breast cancer remains the most common non-skin cancer among women. Prophylactic methods for reducing surgical-site complications after immediate breast reconstruction (IBR) are crucial to prevent acellular dermal matrices or prosthesis exposure and loss. We assessed the impact of closed-incision negative-pressure wound therapy (ciNPWT) versus standard dressings (ST) after IBR on surgical-site complications, superficial skin temperature (SST), skin elasticity, and subjective scar quality, to determine the potential benefit of prophylactic ciNPWT application.

Methods:

A multicenter, prospective, randomised, and controlled study of 60 adult female patients was conducted between January 2019 and July 2021. All patients had oncological indications for IBR using implants or expanders.

Results:

Application of ciNPWT correlated with a significant decrease in surgical-site complications within one year of surgery (total 40%; ST 60%; ciNPWT 20%; p=0.003) and resulted in more elastic scar tissue as measured with a Cutometer® (average coefficient of elasticity, 0.74; ST 0.7; ciNPWT 0.9; p<0.001). The SST of each scar one week after surgery was significantly higher in the ciNPWT group (average SST, 31.5; ST SST, 31.2; ciNPWT SST, 32.3; p=0.006). According to the Patient and Observer Scar Assessment Scale v2.0, subjective scar outcomes in both groups were comparable.

Conclusions:

This is the first prospective, randomised, and controlled study which demonstrated a significant decrease in surgical-site wound complications within one year of surgery in IBR patients receiving ciNPWT. A high probability of postoperative radiotherapy should be a relative indication for the use of ciNPWT.
A Systematic Review of Vascularized Toe and Non-Vascularized Toe Phalangeal Transfer for Reconstruction of Congenital Absence of Digits or Thumb”
Authors: Meyers Abigail , Bassiri Gharb Bahar , Rampazzo Antonio
Published: February 2023

Background:

The aim of this study was to compare the indications, techniques, and outcomes of vascularized and non-vascularized toe-to-hand transfer surgery in patients with congenital hand differences.

Methods:

A systematic review was conducted according to PRISMA guidelines. Studies containing data on indications, surgical technique, and outcomes for patients with congenital absence or deficiency of digits or thumb treated with toe-to-hand transfer were included. Failure was defined as resorption of the transfer or necrosis necessitating removal.

Results:

Forty studies published between 1978-2020 were included. Three hundred nineteen patients (59.7%) had vascularized transfers, 214 (40.1%) non-vascularized, and one had both (0.2%). Symbrachydactyly was the most common indication in both groups (46.3% vascularized and 45.3% non-vascularized). The most commonly transplanted toe was the second one in the vascularized group (72.6 %) and fourth in the non-vascularized group (32.2%). Vascularized toe transfers were most commonly used to reconstruct the thumb (53.3%), as were non-vascularized transfers (30%).

Vascular complications occurred after 6.8% of vascularized transfers, though 94.7% were ultimately successful after re-operation. Resorption accounted for most complications after non-vascularized transfers. More secondary procedures were required after non-vascularized transfers. In the vascularized group, there was a higher success rate of 98.6% (95% CI 97.4%-99.7%), compared to 86.8% (95% CI 83.6%-90) in the non-vascularized group, (p<0.001).

Conclusions:

Our study found a higher success rate in vascularized transfers. The ideal technique must be assessed on an individual patient basis, accounting for baseline hand structure, as well as the ultimate aesthetic and functional goals.
Quality of life, patient satisfaction, and complications after nipple-sparing versus skin-sparing mastectomy followed by immediate breast reconstruction. A systematic review and meta-analysis.
Authors: Clarijs Marloes E. , Peeters Noelle J.M.C. Vrancken , van Dongen Sophie A.F , Koppert Linetta B. , Pusic Andrea L. , Mureau Marc A.M. , Rijken Bianca F.M.
Published: February 2023

Background:

Nipple-sparing mastectomy (NSM) has emerged as an alternative procedure for skin sparing mastectomy (SSM), followed by immediate breast reconstruction. Because oncological safety appears similar, patient-reported outcomes (PROs) and complication risks may guide decision-making in individual patients. Therefore, the aim of this systematic review was to compare PROs and complication rates after NSM and SSM.

Methods:

A systematic literature review evaluating NSM versus SSM was performed using Embase, Medline and Cochrane databases. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Form for Cohort Studies. Primary outcomes were PROs and complications. Studies that evaluated Breast-Q scores were used to perform meta-analyses on five Breast-Q domains.

Results:

Thirteen comparative studies including 3895 patients were selected from 1202 articles found. Meta-analyses of the Breast-Q domains showed a significant mean difference of 7.64 in the Sexual Well-being domain (p = 0.01) and 4.71 in the Psychosocial Well-being domain (p = 0.03), both in favor of NSM. Using the specifically designed questionnaires, no differences in overall satisfaction scores were found. There were no differences in overall complication rates between the two groups.

Conclusions:

Patient satisfaction scores were high after both NSM and SSM, however, NSM led to a higher sexual and psychosocial well-being. No differences in complication rates were found. In combination with other factors, such as oncological treatments, complication risk profile, and fear of cancer recurrence, the decision for NSM or SSM has to be made on an individual basis and only if NSM is considered to be oncologically safe.
“HoloLens in breast reconstruction: what is the future?”
Authors: Masterton Gary , Miller Robert , Patel Jaymin , Pratt Philip , Gosling Nicholas , Saour Samer
Published: February 2023

Autologous breast reconstruction utilising the deep inferior epigastric perforator flap has been established as the gold standard for perforator-based free flap breast reconstruction. This technique relies on the ability of the surgeons to identify the patients’ relevant abdominal vasculature to facilitate accurate dissection, optimise surgical outcomes and minimise morbidity. A technique is described in which the authors incorporate augmented reality through utilising HoloLens technology in their surgical planning to identify patients’ epigastric arteries and perforators. This technology allows the surgeon to superimpose computed tomography angiography (CTA) images directly onto the patient, facilitating an “in-vivo” appreciation of underlying anatomy prior to incision and dissection. This allows real-time surgical planning, increasing the value and tangibility of pre-operative CTA imaging with potential to enhance the accuracy and efficiency of the operative technique. Although the authors did not utilise the HoloLens technology to make clinical decisions they provide evidence of its accuracy and ease of use, offering a proof of concept. The potential of this technology is demonstrated and the authors encourage future application in the practice of free flap breast reconstruction and beyond.
Algorithm for Correction of Unaesthetic High Eyelid Folds
Authors: Wattanakrai Kamol , Chiemchaisri Nattawut , Wattanakrai Penpun
Published: February 2023

Background:

Unaesthetic high eyelid fold is one of the most challenging problems for plastic surgeons. Several methods have been introduced to overcome different deformities. Decision-making on how to select the most appropriate procedure for each patient with diverse underlying causes requires ample surgical experiences. The authors present an algorithm as a guideline to manage this inconclusive situation

Methods:

A retrospective review of planned surgical correction among 368 patients with high eyelid folds in accordance with the advocated algorithm covering 6 years was conducted, graded and analyzed using both objective and subjective measurements. The follow-up period ranged from 1 month to 5 years (average =7months).

Results:

Of 368 cases, 232 (63.05 %), 96 cases (26.08%), and 40 cases (10.87%) were classified as excellent, good, and fair result, respectively. We did not have a poor result defined as failure in reducing the fold after we have followed this algorithm. The crease size before surgery, ranging from 9-13 mm (average =10.345 mm), was reduced to 6-9 mm (average =7.324 mm).

Conclusion:

We propose an algorithm to correct high eyelid folds supported by our clinical study over 6 years. Surgical techniques and rationale behind the procedures were discussed.
“Regret after Gender Affirming Surgery – A Multidisciplinary Approach to a Multifaceted Patient Experience”
Authors: Jedrzejewski Breanna Y. , Marsiglio Mary C. , Guerriero Jess , Penkin Amy ,   OHSU Transgender Health Program “Regret and Request for Reversal” workgroup, Berli Jens U.
Published: February 2023

Introduction:

Lasting regret after g ender-affirming surgery (GAS) is a difficult multifaceted clinical scenario with profound impacts on individual wellbeing as well as a politically charged topic. Currently we lack professional guidelines or standards of care to help providers and patients navigate this entity . This article summarizes our Transgender Health Program’s cohesive multi-disciplinary lifespan approach to mitigate, evaluate , and treat any form of temporary or permanent regret after GAS.

Methods:

A multidisciplinary (primary care, pediatric endocrinology, psychology, social work, plastic surgery, urology, gynecology, and bioethics) workgroup including cisgender, transgender and gender diverse professionals met for a duration of 14 months. The incidence of individuals who underwent GAS at our program between 2016 and 2021 and subsequently expressed desire to reverse their gender transition was reported.

Results:

A total of 1989 individual underwent GAS, 6 patients (0,3%) were encountered that either requested reversal surgery or transitioned back to their sex-assigned at birth. A multi-disciplinary assessment and care pathway for patients who request reversal surgery is presented in the article.

Conclusions:

A care environment that welcomes and normalizes authentic expression of gender identity, affirms surgical goals without judgement, and de-stigmatizes the role of mental health in the surgical process are foundational to mitigating the occurrence of any form of regret. We hope this can provide a framework to distinguish between normal postoperative distress, temporary forms of grief and regret, and regret due to societal repercussions, surgical outcomes or gender identity.
Identifying Safety Practices Perceived as Low Value: An Exploratory Survey of Healthcare Staff in the United Kingdom and Australia
Authors: Halligan Daisy , Janes Gillian , Conner Mark , Albutt Abigail , Debono Deborah , Carland Jane , Sheppard-Law Suzanne , Taylor Natalie , Middleton Sandy , McInnes Elizabeth , Ferguson Caleb , Lawton Rebecca
Published: February 2023

Objectives

Up to 30% of healthcare spending is considered unnecessary and represents systematic waste. While much attention has been given to low-value clinical tests and treatments, much less has focused on identifying low-value safety practices in healthcare settings. With increasing recognition of the problem of “safety clutter” in organizations, it is important to consider deimplementing safety practices that do not benefit patients, to create the time needed to deliver effective, person-centered, and safe care. This study surveyed healthcare staff to identify safety practices perceived to be of low value.

Methods

Purposive and snowball sampling was used. Data collection was conducted from April 2018 to November 2019 (United Kingdom) and May 2020 to November 2020 (Australia). Participants completed the survey online or in hard copy to identify practices they perceived to not contribute to safe care. Responses were analyzed using content and thematic analysis.

Results

A total of 1394 responses from 1041 participants were analyzed. Six hundred sixty-three responses were collected from 526 UK participants and 515 Australian participants contributed 731 responses. Frequently identified categories of practices identified included “paperwork,” “duplication,” and “intentional rounding.” Five cross-cutting themes (e.g., covering ourselves) offered an underpinning rationale for why staff perceived the practices to be of low value.

Conclusions

Staff identified safety practices that they perceived to be low value. In healthcare systems under strain, removing existing low-value practices should be a priority. Careful evaluation of these identified safety practices is required to determine whether they are appropriate for deimplementation and, if not, to explore how to better support healthcare workers to perform them.
Economic evaluation of improving HIV self-testing among MSM in China using a crowdsourced intervention: a cost-effectiveness analysis
Authors: Ong Jason J. , Booton Ross D. , Tucker Joseph D. , Tang Weiming , Vickerman Peter , Zhang Lei , Mitchell Kate M.
Published: February 2023

Objectives:

Crowdsourcing, which taps into the wisdom of crowds, has been successful in generating strategies to enhance HIV self-testing (HIVST) uptake. We determined the cost-effectiveness of a crowdsourced intervention (one-off or annual) compared with a control scenario (no crowdsourcing) among MSM living in China.

Design:

Economic evaluation.

Methods:

We used data from our cluster randomized controlled trial of MSM (NCT02796963). We used a micro-costing approach to measure direct health costs ($USD2017) from a health provider perspective. Using outputs from a dynamic transmission model over a 20-year time horizon, we estimated the incremental cost-effectiveness ratios using cost per disability-adjusted life years (DALYs) averted with 3% discounting. An intervention was considered highly cost-effective if it was less than one gross domestic product (GDP, $8823) per DALY averted.

Results:

Across all cities, the crowdsourced intervention was highly cost-effective compared with the control scenario (incremental cost-effectiveness ratios ranged from $2263 to 6152 per DALY averted for annual crowdsourcing; $171 to 204 per DALY averted for one-off crowdsourcing). The one-off intervention was cost-saving in Guangzhou and Qingdao. Sensitivity analyses confirmed the robustness of the findings; specifically, changes in discounting, costs of the crowdsourced intervention, costs of HIV testing and cost of antiretroviral therapy did not alter our conclusions.

Conclusion:

Scaling up a one-off or annual crowdsourced HIV prevention intervention in four cities in China was very likely to be cost-effective. Further research is warranted to evaluate the feasibility of scaling up crowdsourced HIV prevention interventions in other settings and populations.
Hypertension and one-year risk of all-cause mortality among women with treated HIV in the United States
Authors: Sadinski Leah M. , Westreich Daniel , Edmonds Andrew , Breger Tiffany L. , Cole Stephen R. , Ramirez Catalina , Brown Todd T. , Ofotokun Igho , Konkle-Parker Deborah , Kassaye Seble , Jones Deborah L. , D'Souza Gypsyamber , Cohen Mardge H. , Tien Phyllis C. , Taylor Tonya N. , Anastos Kathryn , Adimora Adaora A.
Published: February 2023

Objective:

Hypertension is a critical cause of cardiovascular disease, and women with HIV have a higher prevalence of hypertension than women without HIV. The relationship between hypertension and mortality has not been well characterized in women with treated HIV. Here, we estimate the effect of hypertension on 1-year risk of all-cause mortality among women with HIV on antiretroviral therapy (ART) in the United States.

Design:

An analysis of multicenter, observational cohort data from the Women's Interagency HIV Study (WIHS) collected between 1995 and 2019.

Methods:

We included women with HIV who reported ever using ART. We used parametric g-computation to estimate the effect of hypertension (SBP ≥140  mmHg, DBP ≥90 mmHg, or use of hypertensive medication) on all-cause mortality within 1 year of a WIHS visit.

Results:

Among 2929 unique women, we included 57 034 visits with a median age of 45 (interquartile range: 39, 52) years. Women had hypertension at 34.5% of visits, and 641 deaths occurred within 1 year of a study visit. Comparing women at visits with hypertension to women at visits without hypertension, the standardized 1-year risk ratio for mortality was 1.16 [95% confidence interval (95% CI): 1.01–1.33]. The risk ratios were higher in Hispanic (risk ratio: 1.23, 95% CI: 0.86–1.77) and non-Hispanic black women (risk ratio: 1.19, 95% CI: 1.04–1.37) and lower in non-Hispanic white women (risk ratio: 0.93, 95% CI: 0.58–1.48).

Conclusion:

Among women with treated HIV, those with hypertension, compared with those without, had an increased 1-year risk of all-cause mortality.
Electronic Dose Monitoring Device Patterns in Youth Living With HIV Enrolled in an Adherence Intervention Clinical Trial
Authors: Lindsey Jane C. , Hudgens Michael , Gaur Aditya H. , Horvath Keith J. , Dallas Ronald , Heckman Barbara , Mueller Johnson Megan , Amico K. Rivet
Published: February 2023

Introduction:

Youth living with HIV in the US have low rates of viral suppression, in part because of challenges with antiretroviral therapy adherence.

Methods:

Daily dosing in the Adolescent Medicine Trials Network for HIV/AIDS Interventions 152 study, a randomized controlled trial of a 12-week adherence intervention (triggered escalating real-time adherence intervention) for viremic youth, compared with standard of care (SOC), was measured by electronic dose monitoring (EDM) throughout 48 weeks of follow-up. EDM data collected over the first 24 weeks were used to characterize patterns of antiretroviral therapy adherence with group-based trajectory models.

Results:

Four trajectory groups were identified among the 85 participants included in the analysis during the intervention phase of the study: (Worst) no interaction with EDM, (Declining) initially moderate EDM-based adherence followed by steep declines, (Good) initially high EDM-based adherence with modest declines, and (Best) consistently high EDM-based adherence. Being in the SOC arm, not being in school, higher evasiveness and panic decision-making scores, and lower adherence motivation were associated with higher odds of being in a worse trajectory group (P < 0.05). A general decline in dosing was observed in the 12 weeks postintervention, when all participants were managed using SOC.

Conclusions:

Use of group-based trajectory models allowed a more nuanced understanding of EDM-based adherence over time compared with collapsed summary measures. In addition to the study intervention, other factors influencing EDM-based adherence included being in school, decision-making styles, and adherence-related motivation. This information can be used to design better intervention services for youth living with HIV.
Evaluation of the Revised Versus Original Ryan White Part A HIV Care Coordination Program in a Cluster-Randomized, Stepped-Wedge Trial
Authors: Irvine Mary K. , Levin Bruce , Abdelqader Faisal , Carmona Jennifer , Avoundjian Tigran , Thomas Jacinthe , Braunstein Sarah L. , Robertson McKaylee , Nash Denis
Published: February 2023

Background:

To address challenges with delivery of an evidence-based HIV care coordination program (CCP), the New York City Health Department initiated a CCP redesign. We conducted a site-randomized stepped-wedge trial to evaluate effectiveness of the revised versus the original model.

Setting:

The CCP is delivered in New York City hospitals, community health centers, and community-based organizations to people experiencing or at risk for poor HIV outcomes.

Methods:

The outcome, timely viral suppression (TVS), was defined as achievement of viral load <200 copies/mL within 4 months among enrollees with unsuppressed viral load (≥200 copies/mL). Seventeen original-CCP provider agencies were randomized within matched pairs to early (August 2018) or delayed (May 2019) starts of revised-model implementation. Data from 3 periods were examined to compare revised versus original CCP effects on TVS. The primary analysis of the intervention effect applied fully conditional maximum likelihood estimation together with an exact, conditional P-value and an exact test-based 95% CI. We assigned each trial enrollee the implementation level of their site (based on a three-component measure) and tested for association with TVS, adjusting for period and study arm.

Results:

Over 3 nine-month periods, 960 individuals were eligible for trial inclusion (intention to treat). The odds ratio of TVS versus no TVS comparing revised with original CCP was 0.88 (95% CI: 0.45, 1.7). Thus, the revised program yielded slightly lower TVS, although the effect was statistically nonsignificant. TVS was not significantly associated with revised-CCP implementation level.

Conclusion:

Program revisions did not increase TVS, irrespective of the implementation level.
The role of the genital microbiota in the acquisition and pathogenesis of sexually transmitted infections
Authors: Waltmann Andreea , Thomas Cynthia , Duncan Joseph A.
Published: February 2023

Purpose of review

There are an estimated 374 million new sexually transmitted infections (STIs) worldwide every year. Our review article examines the current evidence of how STI acquisition, transmission, and pathogenesis is impacted upon by the genital microbiota, with a focus on epidemiological, biochemical, and immunological features.

Recent findings

At least in women, a genital microbiota dominated by lactobacilli has long been considered optimal for reproductive health, while depletion of lactobacilli may lead to a genital microenvironment dominated by anaerobic pathogens, which can manifest clinically as bacterial vaginosis. Recent research efforts have characterized genital microbiota composition in greater resolution, sometimes at species-level, using proteomics, metabolomics, and deep sequencing. This has enhanced our understanding of how specific microbiota members influence acquisition or clinical manifestation of STI pathogen infection. Other advances include a steady, though still slow, increase in the number of studies that sought to determine the genital (penile or urethral) microbiota of males and how it may impact that of their female partners’ genital microbiota and risk of STI acquisition. Altogether, these data enabled us to explore the concept that genital microbiota may be sexually transmitted and influence pathogenesis and clinical presentation of other STI.

With STI infection rates increasing worldwide, it is important now more than ever to find novel STI prevention strategies. Understanding if and how the genital microbiota is a modifiable risk factor for STI transmission, acquisition, and clinical manifestation may prove to be an important strategy in our efforts to curb morbidity in at risk populations.
Impact of COVID-19 infection during pregnancy on maternal and fetal outcomes
Authors: Anter Mohamed Elsibai , Abd El-Aal Nasser Kamal , Rezk Mohamed Abd Allah , Moawad Hussein Fahmy , Abudakika Ahmed Tharwat
Published: February 2023

Objectives:

The objective of this study is to assess the impact of coronavirus disease 2019 (COVID-19) infection during pregnancy on maternal and fetal outcome in relation to gestational age.

Methods:

This retrospective study was conducted between May 2020 and July 2021. Sixty-five women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hospitalized at a quarantine hospital were included. Thirty-four women received prenatal care at the hospital until delivery, while 31 dropped out from the study due to COVID-19 recovery and discharge before delivery.

Results:

COVID-19 was found in 83% of the pregnant women after 20 weeks of pregnancy. The most common symptoms were cough and fever. Medical complications included severe pneumonia and thrombosis. The maternal mortality rate was 9.2%. Premature rupture of membranes and severe hypertension during labor affected nearly 9% of the pregnant women who completed prenatal care until delivery at the hospital. Preterm labor occurred at a rate of 38.2%. There were seven (20.8%) stillbirths and two cases of infant mortality.

Conclusion:

Hospitalized pregnant women who have coronavirus infection, lymphopenia, and a high C-reactive protein level were at a higher risk of developing severe illness, which can lead to maternal and neonatal complications.
Low Rates of Reproductive Counseling Documentation in Women With Interstitial Pneumonia With Autoimmune Features
Authors: Joerns Elena K. , Mills Brooke , Makris Una E. , Adams Traci N. , Bermas Bonnie
Published: February 2023

Background/Objective

Women with interstitial pneumonia with autoimmune features (IPAFs), a subset of interstitial lung disease (ILD), are at risk for pregnancy complications. Family planning discussions improve pregnancy outcomes in women with ILD. The objective of this study was to evaluate the documentation of reproductive counseling in IPAF female patients of childbearing age by pulmonary and rheumatology providers at an academic medical center.

Methods

We conducted a medical record review study of pulmonary and rheumatology encounters in reproductive-aged women with IPAF to evaluate documentation of family planning discussions and contraceptive use. We used nonparametric measures of association and logistic regression to evaluate the relationship between patient characteristics and the presence of reproductive counseling documentation by providers.

Results

Thirty-one women met IPAF classification and were ≤50 years at initial ILD clinic visit. Twenty-five (81%) of these women had risk factors for adverse pregnancy outcomes. Ten women (32%) had a record of reproductive counseling during any visit with their pulmonary provider. Of the 21 patients who also saw a rheumatology provider, 12 (57%) women had a record of reproductive counseling during any visit with their rheumatology provider. No baseline characteristics were associated with odds of reproductive counseling documentation.

Conclusions

Neither pulmonary nor rheumatology providers consistently discussed family planning/contraceptive use with reproductive-aged women with IPAF. There was a trend for rheumatology providers to discuss reproductive issues with IPAF patients more frequently than pulmonary providers. Efforts should focus on educating providers about the need for reproductive counseling in women with IPAF of childbearing age.
Skin Thickening of the Scalp and High Signal Intensity of Dentate Nucleus in Multiple Sclerosis
Authors: Quattrocchi Carlo C. , Parillo Marco , Spani Federica , Landi Doriana , Cola Gaia , Dianzani Caterina , Perrella Eleonora , Marfia Girolama A. , Mallio Carlo A.
Published: February 2023

Objective

The aim of this study was to assess the presence of detectable changes of skin thickness on clinical brain magnetic resonance imaging (MRI) scans in patients with MS, history of multiple gadolinium-based contrast agents (GBCAs) administrations, and evidence of gadolinium deposition in the brain.

Materials and Methods

In this observational cross-sectional study, 71 patients with MS who underwent conventional brain MRI with an imaging protocol including enhanced 3D volumetric interpolated breath-hold examination (VIBE) T1-weighted with fat saturation were assessed. Patients with bilateral isointense dentate nucleus on unenhanced T1-weighted images were assigned to group A (controls without MRI evidence of gadolinium deposition), and patients with visually hyperintense dentate nuclei were assigned to group B. Qualitative and quantitative assessment of the skin thickness were performed.

Results

Group A included 27 patients (median age, 33 years [IQR, 27–46]; 20 women), and group B included 44 patients (median age, 42 years [IQR, 35–53]; 29 women). Qualitative and quantitative assessment of the skin revealed significant differences between group A and group B. The average skin–to–scalp thickness ratios was significantly higher in group B than in group A (mean ± standard deviation = 0.52 ± 0.02 in group B vs 0.41 ± 0.02 in group A, P < 0.0001) and showed a positive correlation with the total number of enhanced MRI scans (r = 0.39; 95% confidence interval, 0.17–0.57, P < 0.01).

Conclusions

Brain MRI detects increased skin thickness of the scalp in patients with MS and dentate nucleus high signal intensity on unenhanced T1-weighted images and shows positive association with previous exposures to linear GBCAs rather than macrocyclic GBCAs.
Longitudinal Assessment of Multiple Sclerosis Lesion Load With Synthetic Magnetic Resonance Imaging—A Multicenter Validation Study
Authors: Schlaeger Sarah , Li Hongwei Bran , Baum Thomas , Zimmer Claus , Moosbauer Julia , Byas Sebastian , Mühlau Mark , Wiestler Benedikt , Finck Tom
Published: February 2023

Introduction

Double inversion recovery (DIR) has been validated as a sensitive magnetic resonance imaging (MRI) contrast in multiple sclerosis (MS). Deep learning techniques can use basic input data to generate synthetic DIR (synthDIR) images that are on par with their acquired counterparts. As assessment of longitudinal MRI data is paramount in MS diagnostics, our study's purpose is to evaluate the utility of synthDIR longitudinal subtraction imaging for detection of disease progression in a multicenter data set of MS patients.

Methods

We implemented a previously established generative adversarial network to synthesize DIR from input T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences for 214 MRI data sets from 74 patients and 5 different centers. One hundred and forty longitudinal subtraction maps of consecutive scans (follow-up scan—preceding scan) were generated for both acquired FLAIR and synthDIR. Two readers, blinded to the image origin, independently quantified newly formed lesions on the FLAIR and synthDIR subtraction maps, grouped into specific locations as outlined in the McDonald criteria.

Results

Both readers detected significantly more newly formed MS-specific lesions in the longitudinal subtractions of synthDIR compared with acquired FLAIR (R1: 3.27 ± 0.60 vs 2.50 ± 0.69 [P = 0.0016]; R2: 3.31 ± 0.81 vs 2.53 ± 0.72 [P < 0.0001]). Relative gains in detectability were most pronounced in juxtacortical lesions (36% relative gain in lesion counts—pooled for both readers). In 5% of the scans, synthDIR subtraction maps helped to identify a disease progression missed on FLAIR subtraction maps.

Conclusions

Generative adversarial networks can generate high-contrast DIR images that may improve the longitudinal follow-up assessment in MS patients compared with standard sequences. By detecting more newly formed MS lesions and increasing the rates of detected disease activity, our methodology promises to improve clinical decision-making.
18F-FMISO PET of an Intracranial Tuberculoma
Authors: Sakata Akihiko , Fushimi Yasutaka , Arakawa Yoshiki , Shimizu Yoichi , Nakamoto Yuji
Published: February 2023

Solitary intracranial tuberculomas are rare and frequently misdiagnosed as brain tumors. We report a case of intracranial tuberculous granuloma mimicking a high-grade glioma with avid uptake on 18F-fluoromisonidazole PET/CT. It has been believed that hypoxia exists within the tuberculosis granuloma, and that this hypoxic environment causes Mycobacterium tuberculosis to lie dormant and asymptomatic infection to occur. This hypoxic and necrotic condition inside tuberculous granuloma may lead to high accumulation of 18F-fluoromisonidazole in this case.
18F-Choline Versus 68Ga-PSMA-11 PET/CT Imaging Comparison in Incidental Clear Cell Renal Cell Carcinoma
Authors: Urso Luca , Rocca Giovanni Christian , Uccelli Licia , Ippolito Carmelo , Bartolomei Mirco
Published: February 2023

Few articles in literature describe the potential usefulness of 18F-choline PET/CT and particularly 68Ga-PSMA-11 PET/CT in imaging of clear cell renal cell carcinoma (ccRCC). We report a unique comparison in literature between the 2 radiotracers in a patient who underwent left nephrectomy with diagnosis of ccRCC, grade 3. 68Ga-PSMA-11 PET/CT confirmed its emerging role in imaging ccRCC, as the incidentally detected renal neoplasm showed a significant higher uptake in comparison to 18F-choline PET/CT, inducing surgical indication.
Novel Depiction of Collateral Flow in Chronic Thromboembolic Pulmonary Hypertension Using 4D Dynamic 82Rb PET/CT
Authors: Dixon James T. , DiFilippo Frank P. , Renapurkar Rahul D. , Huang Steve S.
Published: February 2023

CT pulmonary angiogram and ventilation-perfusion scintigraphy are the 2 primary imaging modalities for evaluating patients with CTEPH (chronic thromboembolic pulmonary hypertension). PET/CT and MRI currently have a limited role in the evaluation of acute or chronic pulmonary embolism. We present incidentally captured dynamic pulmonary perfusion images in a patient with history of CTEPH who underwent 82Rb myocardial perfusion PET/CT for evaluation of chest pain. Analysis of the PET data revealed delayed perfusion of the affected lobes suggesting collateralization, highlighting a potentially new imaging paradigm for assessment of pulmonary perfusion.
Evaluation of Soft-Tissue Hematomas With Real-Time, Contrast-Enhanced Ultrasound
Authors: Kummer Tobias , Mohn Kelli J. , Bardwell Abigail J. , Boyum James H.
Published: February 2023

In this study, we investigated the feasibility of using contrast-enhanced ultrasound (CEUS) to detect active hemorrhage in patients presenting with soft-tissue hematomas. Adult patients with clinically suspected, actively bleeding hematomas were prospectively enrolled. Contrast-enhanced ultrasound was used to assess for contrast extravasation. Ultrasound results were compared with those of multidetector computed tomographic (MDCT) imaging, operative findings, and clinical course. Sixteen patients (9 women, 7 men; mean age, 69 [SD, 13] years) were enrolled. Thirteen patients underwent MDCT imaging during their initial visit, and for 11, CEUS and computed tomography (CT) findings were concordant. The remaining patients had a negative CEUS study that was consistent with their clinical course. In 8 patients, CT imaging showed active extravasation (6 arterial, 1 indeterminate, 1 slow venous). Contrast-enhanced ultrasound and CT findings were concordant for all cases of arterial bleeding. For 1 patient, CEUS provided superior diagnostic information by identifying a pseudoaneurysm. The 2 discrepant patient cases had a ≥3-hour delay between CT and CEUS, and in 1 patient, CEUS was limited by body habitus. The second patient had no active bleeding identified in the operating room. Compared with CT, CEUS had a sensitivity and specificity of 75% and 100%, respectively, and positive and negative predictive values were 100% and 71%, respectively. Diagnostic accuracy was 85% in this limited study. Contrast-enhanced ultrasound is a promising alternative to MDCT in select patients and may sometimes provide superior clinical information. Limiting factors are large hematoma size, unfavorable anatomic location, and body habitus.
The Role of Reconstruction on Desmoid Tumor Recurrence
Authors: Meade Anna , Wisecarver Ian , Cho Min-Jeong , Davis Justin J. , Duque Sofia , Farewell Jordyn T. , Zhang Andrew Y.
Published: February 2023

Background

Desmoid tumors occur throughout the body, presenting as aggressive, locally invasive lesions that can impede quality of life. Many controversies remain regarding the optimal surgical treatment of desmoid. This article presents a systematic review and meta-analysis on surgical management, focusing on risk of recurrence and the utility of reconstruction within this unique patient population.

Methods

A systematic review was conducted to search for articles. The clinical course of patients diagnosed with desmoid tumors and treated by our institution's multidisciplinary team was retrospectively reviewed over a 13-year period. Meta-analysis study findings were compared with our cohort.

Results

From the systematic review, 10 studies with level of evidence III were found, which resulted in 981 patients. Twenty patients from our institution met the inclusion criteria for our study. In both our study cohort and the pooled results, recurrence was significantly higher in patients with positive microscopic margin after resection. In our study cohort, patients with recurrence had higher rates of positive margins compared with those without recurrence (83.3% vs 7.1%, P = 0.004), whereas the pooled study showed a difference of margin positivity of 50% vs 40% (P = 0.01). No patients who underwent reconstruction in our study cohort had a recurrence during the study period.

Conclusion

In both our cohort and pooled results, recurrence was significantly higher in patients with positive margins after initial resection. Reconstruction was not found to be a risk factor for recurrence. Reconstruction following desmoid tumor resection should be considered a viable option if a large and aggressive resection is required to obtain negative margins.
Supratentorial Acute Subdural Hematoma During Fully Endoscopic Microvascular Decompression Surgery for Hemifacial Spasm
Authors: Wang Jing , Wang Xin , Luo Tian , Wang Xuelian , Qu Yan
Published: February 2023

The endoscope has been widely used in microvascular decompression (MVD), which is the best curative treatment for hemifacial spasm. Supratentorial subdural hematoma (SDH) is rarely happened in MVD. The authors report 2 cases of SDH during full endoscopic MVD. The origin of bleeding is not confirmed during the operation. Rapid and excessive drainage of cerebrospinal fluid and the operation position may result the rupture of bridging veins, which result in the occurrence of SDH. However, there is no clear evidence to explain the clinical symptoms.
The Rule of 10s for Cleft Repair: A Historical Review of the Literature
Authors: Schalet Grant , Langlie Jake , Kim Minji , Thaller Seth
Published: February 2023

Background:

Cleft lip is a ubiquitous maxillofacial birth defect encountered globally. Repair of this anomaly has been well established in the literature. Historically, studies have recommended initiating surgical repair by the “Rule of 10s.” This states that a baby should be at least 10 weeks of age or older, achieve a weight of 10 pounds, have a hemoglobin exceeding 10 g/dL, and have a white blood cell count <10,000/mm3 before undergoing surgery. However, with advances in both pediatric anesthesia and surgical technique, the concept of prioritizing earlier surgery requires a closer examination of this widespread concept.

Objective:

The aim of this study was to assess the validity of the Rule of 10s for cleft lip repair and to determine whether plastic surgeons should continue to follow this as a strict rule or employ it as a guideline.

Methods:

A literature search was conducted by G.S., and reviewed by J.L. and M.K. All studies that addressed the “Rule of 10s” for cleft lip patients were considered. Articles were chosen from a comprehensive set of databases, including EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials databases in March 2022. A literature search was conducted using the following keywords: rule of 10s, Millard criteria, cleft lip/palate, cleft lip/palate repair, and cleft lip/palate complications. Reference lists of selected studies were reviewed for other appropriate publications. Meta-analyses, prospective, randomized clinical trials, retrospective reviews, letters, and literature reviews were included. Single case reports, non-English publications, animal studies, and comments were excluded.

Results:

Among the studies included in this review, the authors found that the Rule of 10s has undergone a limited evaluation within the context of today’s advances in surgical technique and anesthesia. The current articles generally conclude surgeons may proceed with earlier cleft repair on otherwise healthy infants who do not meet all criteria of the Rule of 10s.

Conclusions:

When taking into consideration the current advances in surgical technique and diminished risks of anesthesia, the Rule of 10s should be applied only as a guideline instead of a rule in plastic surgery. Surgeons should address each patient individually and adhere more rigidly to the Rule of 10s when the infant does not have characteristics warranting expedited repair.
Vascular Anatomy for the Prevention of Sublingual Hematomas: Life-Threatening Complication of Genioplasty
Authors: Choi Bong-Kyoon , Lee Sang-Soo , Yun In-Sik , Yang Eun-Jung
Published: February 2023

After genioplasty, the occurrence of bleeding is rare; however, rapid enlargement or displacement of the tongue secondary to lingual or sublingual hematoma can lead to life-threatening airway obstruction, necessitating prompt recognition, and immediate management. Therefore, the investigators aimed to evaluate the underlying etiologies of sublingual hematoma and relevant anatomy to facilitate early recognition of the initial presentation of these hematomas and appropriate management. The authors conducted a literature review on cases of delayed sublingual hematoma after genioplasty. The authors also report a case of delayed hematoma after performing genioplasty. The anatomical structures involved with the development of rare and serious hematomas therein are the sublingual and submental arteries, which are located in the sublingual area, rendering them susceptible to injury during genioplasty. The results of this study suggest that submental artery ligation should be performed for proper management of airway obstruction, if symptoms of sublingual bleeding are observed during the surgical procedure. If there is continuous bleeding despite the submental artery ligation, sublingual artery ligation should be performed.
Radiomics and Artificial Intelligence Study of Masseter Muscle Segmentation in Patients With Hemifacial Microsomia
Authors: Han Wenqing , Xia Wenjin , Zhang Ziwei , Kim Byeong Seop , Chen Xiaojun , Yan Yingjie , Sun Mengzhe , Lin Li , Xu Haisong , Chai Gang , Wang Lisheng
Published: February 2023

Background:

Hemifacial microsomia (HFM) is one of the most common congenital craniofacial condition often accompanied by masseter muscle involvement. U-Net neural convolution network for masseter segmentation is expected to achieve an efficient evaluation of masseter muscle.

Methods:

A database was established with 108 patients with HFM from June 2012 to June 2019 in our center. Demographic data, OMENS classification, and 1-mm layer thick 3-dimensional computed tomography were included. Two radiologists manually segmented masseter muscles in a consensus reading as the ground truth. A test set of 20 cases was duplicated into 2 groups: an experimental group with the intelligent algorithm and a control group with manual segmentation. The U-net follows the design of 3D RoI-Aware U-Net with overlapping window strategy and references to our previous study of masseter segmentation in a healthy population system. Sorensen dice-similarity coefficient (DSC) muscle volume, average surface distance, recall, and time were used to validate compared with the ground truth.

Results:

The mean DSC value of 0.794±0.028 for the experiment group was compared with the manual segmentation (0.885±0.118) with α=0.05 and a noninferiority margin of 15%. In addition, higher DSC was reported in patients with milder mandible deformity (r=0.824, P<0.05). Moreover, intelligent automatic segmentation takes only 6.4 seconds showing great efficiency.

Conclusions:

We first proposed a U-net neural convolutional network and achieved automatic segmentation of masseter muscles in patients with HFM. It is a great attempt at intelligent diagnosis and evaluation of craniofacial diseases.
The Rise of Facial Palsy on Social Media Over the Last 5 Years
Authors: Knoedler Leonard , Knoedler Samuel , Chartier Christian , Panayi Adriana C. , Orgill Dennis P. , Moog Philipp , Oezdemir Berkin , von Isenburg Sarah , Studier-Fischer Alexander , Prantl Lukas , Kehrer Andreas
Published: February 2023

Background:

Social media (SoMe) has become a powerful platform for distributing health information. Facial palsy (FP) results in functional and social impairment and lowers quality of life. Social media may help to raise awareness of FP sequalae. This study aims to determine the FP information growth on SoMe platforms and parameters that influence user engagement on FP content.

Methods:

Five commonly used SoMe platforms (Facebook, Instagram, TikTok, Twitter, and Reddit) were analyzed. Data on 18 FP hashtags and their social interaction parameters (posts, likes, reaches, comments, shares, language, and country of origin) over the past 5 years (July 31, 2016, to July 31, 2021) were collected. In-depth account analysis was performed on the 5 most popular Instagram profiles associated with FP.

Results:

The annual growth curve was positive on each platform. Facial Palsy Awareness Week 2021 trended best on TikTok. Facebook accumulated 315,411 likes and 1,922,678 reaches on 8356 posts. On Instagram, 24,968 posts gathered 4,904,124 likes and 9,215,852 reaches. TikTok users interacted on 3565 posts, accumulating 4,304,155 likes and 4,200,368 reaches. The implementation of reels (P<0.001) and the profile host interacting with their followers by liking (P<0.001) and replying (P<0.001) to users’ comments significantly increased the engagement rate.

Conclusions:

Facial palsy is of increasing interest on SoMe. Facial palsy surgeons may post reels, interact with their community, and engage into FPAW to promote user engagement.
Surgical Anatomy for Asian facial Contouring: A Personal Perspective
Authors: Hwang Kun
Published: February 2023

This paper introduces my personal perspective on anatomic structures for reduction malarplasty, mandibular contouring surgery, and masseter muscle resection. The zygomaticofacial nerve innervates a rectangular area, and each side measures 18.8±4 and 15.8±3.4 mm. The center of the rectangle is located laterally, at 17.3±5.5 mm from the lateral canthus, and then inferiorly, at 18.1±3.1 mm. The point of the zygomaticotemporal nerve appears at the margin of the zygomatic bone, 11.29±2.65 mm below the zygomaticofrontal suture and 21.76±2.76 mm from the superior border of the zygomatic arch. The inferior alveolar nerve in the mandibular canal runs above the lower one-third of the mandibular body. The terminal mandibular canal is located at an average of 4.5 mm under the mental foramen, advances 5.0 mm anteriorly, loops, and ends at the foramen. The facial nerve trunk is located 11 to 14 mm medial to the posterior border of the mandible. The trunk emerges out of the stylomastoid foramen and runs anteroinferiorly at an angle of 45°. The deep branch of the middle masseteric artery travels deep in the muscle, close to the periosteum of the mandible in 94% of cases. The average diameter is 1.23±0.26 mm. The masseteric nerve runs anteriorly and inferiorly between the deep and the middle layers of the masseter. It is observed at 33±5.6 mm from the inferior border of the muscle on the anterior third vertical line of the masseter muscle and at 47±5.5 mm in the posterior third.