bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-focused drug development in primary sclerosing cholangitis: Insights on patient priorities and involvement in clinical trials
Authors: Li Michael , Pai Ruth-Anne , Gomel Rachel , Vyas Mary , Callif Sarah Curup , Hatchett Joanne , Bowlus Christopher L. , Lai Jennifer C.
Published: May 2024

Background:

According to the new AASLD Practice Guidance, all patients with primary sclerosing cholangitis (PSC) should be considered for participation in clinical trials. However, PSC’s rarity has posed challenges to characterizing patient interest in trial participation and identifying predictors of patient willingness to participate in drug trials.

Methods:

PSC Partners Seeking a Cure developed the “Our Voices” survey to inform the development of the Externally-Led Patient-Focused Drug Development Forum, an FDA initiative to capture patient experiences and perspectives on drug development.

Results:

Of 797 survey respondents from over 30 countries, 536 (67%) identified slowing disease progression as the most important outcome. Eighty-nine percent identified their hepatologist/gastroenterologist as someone they would approach for advice about trials. Although 61% reported being willing to participate in drug trials, only 26% had ever been asked to participate. Notable barriers to trial involvement included unknown long-term risks (71%), long travel times to the study center (32%), and a liver biopsy requirement (27%). On multivariable logistic regression, pruritus (OR 1.62, 95% CI: 1.09–2.40, p = 0.017) was positively associated with willingness to participate in disease-modifying therapy trials, while jaundice (OR 0.34, 95% CI: 0.19–0.61, p < 0.001) and inflammatory bowel disease (OR 0.64, 95% CI: 0.42–0.98, p = 0.038) were negatively associated. Pruritus (OR 2.25, 95% CI: 1.50–3.39, p < 0.001) was also independently associated with willingness to participate in symptom treatment trials.

Conclusions:

Most patients with PSC report interest in participating in clinical trials, but few have been asked to participate. Referral of patients with PSC by their hepatologist/gastroenterologist to clinical trials and patient education on trial participation are vital to closing the gap between trial interest and participation. Pruritus may serve as a key indicator of patient interest in trial participation.
Characteristics of Prescreened Patients Who Did Not Participate in the Zoster Eye Disease Study
Authors: Maja Ayodele K. , Gu Darren , Ge Lily , Lopez-Jimenez Carlos , Cohen Elisabeth J. , Zegans Michael E.
Published: May 2024

Purpose:

The Zoster Eye Disease Study (ZEDS) is a multicenter randomized clinical trial (RCT) funded by the National Eye Institute aiming to determine the efficacy of suppressive valacyclovir treatment in herpes zoster ophthalmicus (HZO) that enrolled fewer participants than planned (527/780, 67.6%). Understanding reasons for nonparticipation of likely eligible prescreened patients provides insights into patient populations that are not represented by ZEDS and barriers in clinical trials.

Methods:

In this retrospective cohort study, HZO adults likely eligible for ZEDS with a history of a typical rash and a medical record within the past year of an episode of epithelial or stromal keratitis or iritis were prescreened at activated Participating Clinical Centers from 2017 to 2022 using a standard prescreening log. De-identified data including demographic information, reasons for exclusion because of ineligibility, and patient refusal were retrospectively entered into REDCap and analyzed.

Results:

Prescreening logs with reasons for nonconsent (1244/1706, 72.9%) were included in the data set. Patients were excluded from the study (915/1244, 73.6%) because they did not meet all inclusion criteria (619/915, 67.7%) or met an exclusion criterion (296/915, 32.3%). Among the 12 exclusion criteria for the ZEDS study, immunocompromise (76/296, 25.7%) and renal insufficiency (50/296, 16.9%) were most frequently reported. Patient refusal to participate (327/1,244, 26.3%) was common.

Conclusion:

The most common reasons for ineligibility were immunocompromise and renal insufficiency. There may be benefits to long-term antiviral use in these populations not captured in ZEDS. A quarter (26.3%) of prescreened patients refused participation, showing the substantial impact of patient preferences on trial participation.
Lacrimal Obstruction in Craniosynostosis: Anatomical and Genetic Risk Factors
Authors: Landau-Prat Daphna , Taylor Jesse A. , Kalmar Christopher L. , Yu Yinxi , Ying Gui-Shuang , Bartlett Scott , Swanson Jordan , Revere Karen , Binenbaum Gil , Katowitz William R. , Katowitz James A.
Published: May 2024

Purpose:

To investigate whether patients with craniosynostosis exhibit higher rates of nasolacrimal duct obstruction (NLDO) and to explore potential risk factors.

Methods:

Retrospective review including all craniosynostosis patients treated at both the Divisions of Ophthalmology and Plastic, Reconstructive, and Oral Surgery at The Children’s Hospital of Philadelphia between 2009 and 2020 was conducted. Synostosis characteristics, lacrimal disorders, and genetic data were collected. Main outcome measures were the rate of NLDO and associations with anatomical and syndromic/genetic risk factors.

Results:

The total of 767 participants had a mean age of 2.8 ± 3.8 years, 465 (60.6%) were males, 485 (63.2%) had no syndromic association; 631 (82.3%) had one major suture involved, 128 (17%) had involvement of 2 to 4 major sutures, and 429 (55.9%) underwent craniofacial surgery. Forty-eight (6.2%) patients had NLDO, which more prevalent in the genetic/syndromic group (11.0% vs. 3.5%, respectively, p < 0.001), with the highest prevalence observed in patients with Apert syndrome (n = 4, 30.8%). The genetic variants most associated with NLDO were EFNB1 (n = 1, 100%) and FGFR2 (n = 6, 19.4%). There was no association between NLDO and the number or types of sutures involved or a history of craniofacial surgery.

Conclusions:

Nasolacrimal duct obstruction is more common in patients with craniosynostosis compared to the general population. Having a putative syndrome or a putative genetic variant and female sex were risk factors for NLDO. Ophthalmic evaluations for all craniosynostosis patients and careful assessments of any symptoms of tearing are recommended.
Inferior Ophthalmic Vein-Dominant Dural Cavernous Fistula Embolization via Combined Orbitotomy and Direct Puncture of Inferior Ophthalmic Vein: A Case Report and Literature Review
Authors: Azzam Daniel B. , Lanzo Erin , Burke Shane M. , Abu-Qamar Omar , Vuong Laurel N. , Malek Adel M. , North Victoria S.
Published: May 2024

Dural carotid-cavernous fistulas (DCF) typically drain into the superior ophthalmic vein. Predominant involvement of the inferior ophthalmic vein (IOV) is rare, with only 4 documented cases in the literature. Here, the authors describe a case of a 51-year-old man who presented with acute left-sided proptosis, dysmotility, and vision loss and was found to have an IOV-dominant type D dural carotid-cavernous fistulas. The fistula could not be embolized by transfemoral endovascular access or orbitotomy alone and was ultimately managed with combined orbitotomy and direct IOV puncture. All previous reports of IOV-dominant dural carotid-cavernous fistulas in the literature were similarly inaccessible via the transfemoral approach. This case highlights the challenges of IOV cutdown and proposes an alternative management strategy. When IOV cutdown is precluded by the fragile, collapsed, or deep nature of the vessel, conversion to percutaneous IOV puncture may offer a safe and effective approach and mitigate the risks of direct puncture alone.
Long-term Results of Punctoplasty With Canalicular Triangular Flap in Punctal Stenosis
Authors: Taskiran Comez Arzu , Kirmaci Kabakci Asli , Livan Turkoglu Elif Hazal
Published: May 2024

Purpose:

The aim was to describe the punctoplasty technique with canalicular triangular flap, and present the long-term results of the technique in patients with inferior punctal stenosis.

Methods:

The files of the patients who were diagnosed with punctal stenosis grade 0, 1, and 2 and underwent a canalicular triangular flap were evaluated retrospectively. The study was approved by the local ethical committee of the University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul. The demographic data, symptoms, prior interventions, punctal stenosis grading, associated eye pathologies, fluorescein clearance test, Munk score, and follow-up time were recorded. The puncta were evaluated biomicroscopically, and photographs were taken at each visit. The patients with at least 6 months of follow-up were included in the study. The loss of epiphora symptom, positive dye disappearance, and puncti ≥grade 3 opening were accepted as a success.

Results:

A hundred and nine inferior puncti of 64 patients with symptoms of epiphora and punctal stenosis diagnosis were included in the study. Thirteen eyes were excluded as they were diagnosed to have punctal atresia or canalicular stenosis of a variable degree beyond punctum. The rest 96 eyes of 55 patients—65 eyes of 36 females and 31 eyes of 19 males—were included in the study as having pure punctal stenosis. The mean age of the patients was 64.3 ± 9.01 years (40–88 years). Forty-one patients had bilateral and 14 patients had unilateral punctal stenosis. Sixty-six were grade 1, and 30 were grade 2. Epiphora was the most commonly reported symptom.

The mean follow-up time was 21.17 ± 10.5 months (6–46 months). In 76 (79.1%) eyes of 96, Munk score was 0 and in 15 (15.6%) eyes, Munk score was 1. Anatomical success as having puncta larger than grade 2 was recorded in 97.9%, and functional success was recorded in 94.6% of anatomically successful eyes. No restenosis was recorded in any punctum.

Conclusion:

Although the techniques of 1-snip, 2-snip, 3-snip, and 4-snip punctoplasty are performed with variable success rates in punctal stenosis patients, there is always a risk of restenosis due to the incision of the flap and unpredictability of the way the tissues will epithelize. In the canalicular triangular flap technique, the canalicular mucosal flap is preserved, and the continuity of the lacrimal mucosa with conjunctiva is provided, which utilizes appropriate re-epithelization of the wound edges, resulting in a wide punctal opening for the upper lacrimal system in the long term.
Effects of Teprotumumab on Eyelid Retraction in Thyroid Eye Disease
Authors: Al-Sharif Eman M. , Zhou Jason , Shoji Marissa K. , Acuff Kaela , Liu Catherine Y. , Korn Bobby S. , Kikkawa Don O.
Published: May 2024

Purpose:

This study evaluates the efficacy of teprotumumab in reducing eyelid retraction in thyroid eye disease (TED) patients.

Methods:

This retrospective study included patients with active or chronic moderate-to-severe TED who completed at least 4 cycles of teprotumumab. Patients with upper and/or lower eyelid retraction, defined as margin-to-reflex distance (MRD) 1 and/or MRD2 of more than 5 mm, in one or OU were included. The main outcome measure was a change in MRD1 and MRD2 after treatment. Changes in MRD1 and MRD2 were each analyzed for correlation (r) with changes in exophthalmolmetry. Student t test was performed for each comparison, and p values <0.05 were considered significant.

Results:

The study included 91 patients, predominantly female (87%), with an average age of 52.02 ± 14.6 years. The mean baseline proptosis measurement was 21.8 ± 2.9 OD and 21.7 ± 3.3 OS. The average MRD1 was 5.5 ± 1.5 OD and 5.4 ± 1.7 OS, and the average MRD2 was 6.1 ± 1.1 OD and 6.2 ± 1.1 OS. The follow-up duration post-treatment was 37.5 ± 31.7 weeks. At first follow-up post-treatment, the mean change in proptosis, MRD1, and MRD2 were −2.6 ± 2.0 OD, −2.5 ± 2.1 OS, −0.8.5 ± 1.4 OD, −0.8 ± 1.0 OS, and −0.7 ± 0.9 OD, −0.8 ± 1.0 OS, respectively. Correlation analysis showed that proptosis reduction was positively correlated with MRD1 and MRD2 reduction at the first post-treatment follow-up (MRD1: r = 0.23, p value < 0.01; MRD2: r = 0.17, p = 0.03].

Conclusion:

Teprotumumab treatment improves upper and lower eyelid retraction. The improvement in MRD correlated positively with proptosis reduction, indicating the influence of globe position on eyelid position.
Methods for pragmatic randomized clinical trials of pain therapies: IMMPACT statement
Authors: Hohenschurz-Schmidt David , Cherkin Dan , Rice Andrew S.C. , Dworkin Robert H. , Turk Dennis C. , McDermott Michael P. , Bair Matthew J. , DeBar Lynn L. , Edwards Robert R. , Evans Scott R. , Farrar John T. , Kerns Robert D. , Rowbotham Michael C. , Wasan Ajay D. , Cowan Penney , Ferguson McKenzie , Freeman Roy , Gewandter Jennifer S. , Gilron Ian , Grol-Prokopczyk Hanna , Iyengar Smriti , Kamp Cornelia , Karp Barbara I. , Kleykamp Bethea A. , Loeser John D. , Mackey Sean , Malamut Richard , McNicol Ewan , Patel Kushang V. , Schmader Kenneth , Simon Lee , Steiner Deborah J. , Veasley Christin , Vollert Jan
Published: May 2024

Pragmatic, randomized, controlled trials hold the potential to directly inform clinical decision making and health policy regarding the treatment of people experiencing pain. Pragmatic trials are designed to replicate or are embedded within routine clinical care and are increasingly valued to bridge the gap between trial research and clinical practice, especially in multidimensional conditions, such as pain and in nonpharmacological intervention research. To maximize the potential of pragmatic trials in pain research, the careful consideration of each methodological decision is required. Trials aligned with routine practice pose several challenges, such as determining and enrolling appropriate study participants, deciding on the appropriate level of flexibility in treatment delivery, integrating information on concomitant treatments and adherence, and choosing comparator conditions and outcome measures. Ensuring data quality in real-world clinical settings is another challenging goal. Furthermore, current trials in the field would benefit from analysis methods that allow for a differentiated understanding of effects across patient subgroups and improved reporting of methods and context, which is required to assess the generalizability of findings. At the same time, a range of novel methodological approaches provide opportunities for enhanced efficiency and relevance of pragmatic trials to stakeholders and clinical decision making. In this study, best-practice considerations for these and other concerns in pragmatic trials of pain treatments are offered and a number of promising solutions discussed. The basis of these recommendations was an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks.
Translation of paclitaxel-induced peripheral neurotoxicity from mice to patients: the importance of model selection
Authors: Cavaletti Guido , Alberti Paola , Canta Annalisa , Carozzi Valentina , Cherchi Laura , Chiorazzi Alessia , Crippa Luca , Marmiroli Paola , Meregalli Cristina , Pozzi Eleonora , Rodriguez-Menendez Virginia , Steinkühler Christian , Licandro Simonetta Andrea
Published: May 2024

Paclitaxel-induced peripheral neurotoxicity (PIPN) is a potentially dose-limiting side effect in anticancer chemotherapy. Several animal models of PIPN exist, but their results are sometimes difficult to be translated into the clinical setting. We compared 2 widely used PIPN models characterized by marked differences in their methodologies. Female C57BL/6JOlaHsd mice were used, and they received only paclitaxel vehicle (n = 38) or paclitaxel via intravenous injection (n = 19, 70 mg/kg) once a week for 4 weeks (Study 1) or intraperitoneally (n = 19, 10 mg/kg) every 2 days for 7 times (Study 2). At the end of treatment and in the follow-up, mice underwent behavioral and neurophysiological assessments of PIPN. At the same time points, some mice were killed and dorsal root ganglia, skin, and sciatic and caudal nerve samples underwent pathological examination. Serum neurofilament light levels were also measured. The differences in the neurotoxicity parameters were analyzed using a nonparametric Mann-Whitney test, with significance level set at P < 0.05. Study 1 showed significant and consistent behavioral, neurophysiological, pathological, and serological changes induced by paclitaxel administration at the end of treatment, and most of these changes were still evident in the follow-up period. By contrast, study 2 evidenced only a transient small fiber neuropathy, associated with neuropathic pain. Our comparative study clearly distinguished a PIPN model recapitulating all the clinical features of the human condition and a model showing only small fiber neuropathy with neuropathic pain induced by paclitaxel.
A comparison of national skin disease burden with standardized examination content for dermatology physician assistants
Authors: Young Peter A. , Prajapati Stuti , Bae Gordon H. , Feldman Steven R.
Published: May 2024

The dermatology physician assistant (PA) workforce is growing rapidly. The National Commission for Certification of PAs released a standardized written examination in the spring of 2023 to formally verify the competence of PAs dedicated to dermatology. How well this test prepares PAs to meet the needs of their future patients is not well known. We compared this examination’s content blueprint with existing data on the burden of skin disease in the United States to characterize whether examinees will be tested on skin diseases that significantly affect their presumed patient population. Our findings suggest reasonable concordance between written examination content and the actual burden of skin disease, with some potential areas for refinement.
Development and Validation of Prognostic Nomogram to Predict Overall Survival for Older Patients Who Age 75 Years or Older With Urothelial Carcinoma of Bladder
Authors: Li Junwei , Ye Yanfang , Li Xiaojing , Xie Xinxin , Qin Tao
Published: May 2024

Purpose:

Age is an important factor for prognostic factor in bladder cancer. However, most clinical studies targeting bladder cancer have limited the upper age limit to 75 years. With the higher age of diagnosis of older patients with bladder cancer, there is a lack of prognostic data for bladder cancer at advanced ages. In this study, we analyzed the prognostic factors of older patients with bladder cancer 75 years or older using Surveillance, Epidemiology, and End Results (SEER) data.

Materials and Methods:

Clinical parameters that constitute potential risk factors were analyzed by downloading a total of 13,505 patients with bladder cancer from the SEER database using univariate and multifactorial Cox proportional risk regression. Nomogram was constructed based on parameters significantly associated with overall survival (OS). The consistency index (c-index) and area under the curve were used to evaluate the predictive performance of the model.

Results:

From the SEER database, we analyzed 13,505 cases and found that the median survival time for the whole cohort was 52 months. However, the median survival was 11 months, 8 months, and 6 months in 75 to 79 years subgroup, 80 to 84 years subgroup, and older than 85 years subgroup, when patients were diagnosed with stage IV. OS was poorer in the high histological grade patients. Furthermore, it was found that patients with lymph node metastasis had a significantly unfavorable prognosis than those with negative lymph nodes. The more advanced stage and distant metastases of patients had the shorter survival. Patients who underwent surgery had better overall survival than nonsurgical patients, and chemotherapy had prolonged survival. Conversely, survival was documented to be shorter with radiotherapy than those without radiotherapy.

Conclusions:

The overall prognosis of older patients with bladder cancer was poor, especially in patients with lymph node metastasis, high histological grade, and advanced stage, while a combination of surgery and chemotherapy could prolong survival.
Retrospective study of Cognitive Behavioral Therapy for Obesity modified as FIRE method (CBT-F) in combination with medication for weight loss
Authors: Egoshi Masatoshi , Saito Akira , Nordeng Lena , Takayama Yasuyuki , Furukawa Yutaro
Published: May 2024

Obesity rates continue to rise globally, posing a significant public health concern. Current treatments often lack long-term effectiveness, necessitating the exploration of new approaches. This study examines the effectiveness of a modified treatment method called Cognitive Behavioral Therapy modified as FIRE method (CBT-F), which combines cognitive behavioral therapy with pharmacotherapy. The study involves 62 women seeking weight loss treatment, divided into a CBT-F group and a control group receiving only pharmacotherapy. Anthropometric measures and blood chemistry data were collected over an average follow-up period of 68.5 days. The results demonstrate that the CBT-F group achieved significantly greater weight loss compared to the control group. No notable differences were observed in blood chemistry data. The combination of CBT-F and pharmacotherapy offers a comprehensive and planned approach to obesity treatment by addressing psychological factors and leveraging the effects of medication. Modules specifically designed to handle medication side effects and changes in eating behavior may contribute to treatment success and sustainability. Although this study focused on women, future research should examine the effectiveness of CBT-F in diverse populations. CBT-F shows promise as an alternative or complementary treatment option for individuals who have undergone CBT for extended periods or struggle with lifestyle changes. Overall, the findings suggest that CBT-F, with its shorter treatment duration and immediate effects of pharmacotherapy, holds potential as an effective and sustainable approach to obesity treatment. Further studies are necessary to validate these findings and expand the evidence base for this novel treatment.
Improving our understanding on the clinical role of plasmin-mediated von Willebrand factor degradation
Authors: Otmani Hinde El , Vanhoorelbeke Karen , Tersteeg Claudia
Published: May 2024

Purpose of review

Von Willebrand factor (VWF) plays a pivotal role in primary hemostasis. A Disintegrin And Metalloproteinase with a ThromboSpondin type 1 motif, member 13 (ADAMTS13) is primarily responsible for cleaving ultra-large VWF multimers into smaller, less adhesive forms. However, plasmin has also been shown to cleave VWF multimers. This proteolytic cleavage of VWF results in a decreased multimer size and, hence, a lower VWF activity. This review aims to present a comprehensive overview of the involvement of plasmin-mediated VWF proteolysis in (micro)thrombosis.

Recent findings

Plasmin-mediated VWF proteolysis has been suggested to play a role in various pathologies involving microthrombosis in combination with an imbalance in VWF antigen levels and ADAMTS13 activity, as well as activation of the fibrinolytic system, but quantitative assays to demonstrate this were lacking. Recently, a VHH-based bioassay was developed designed specifically to quantify plasmin-cleaved VWF (cVWF). The novel ELISA assay holds significant promise for gaining further insights into the clinical relevance of plasmin-mediated VWF proteolysis in several pathologies. Furthermore, local plasmin activation at the site of microthrombosis has been shown to be a promising treatment strategy by degrading VWF-rich microthrombi.

Plasmin-mediated proteolysis of VWF is observed during microthrombosis; however, it remains unclear whether it impacts disease severity. A novel ELISA method to detect cVWF will improve our understanding of the clinical role of plasmin-mediated VWF degradation.
Graft repair during machine perfusion: a current overview of strategies
Authors: Broere Roberto , Luijmes Stefan H. , de Jonge Jeroen , Porte Robert J.
Published: May 2024

Purpose of review

With changing donor characteristics (advanced age, obesity), an increase in the use of extended criteria donor (ECD) livers in liver transplantation is seen. Machine perfusion allows graft viability assessment, but still many donor livers are considered nontransplantable. Besides being used as graft viability assessment tool, ex situ machine perfusion offers a platform for therapeutic strategies to ameliorate grafts prior to transplantation. This review describes the current landscape of graft repair during machine perfusion.

Recent findings

Explored anti-inflammatory therapies, including inflammasome inhibitors, hemoabsorption, and cellular therapies mitigate the inflammatory response and improve hepatic function. Cholangiocyte organoids show promise in repairing the damaged biliary tree. Defatting during normothermic machine perfusion shows a reduction of steatosis and improved hepatobiliary function compared to nontreated livers. Uptake of RNA interference therapies during machine perfusion paves the way for an additional treatment modality.

The possibility to repair injured donor livers during ex situ machine perfusion might increase the utilization of ECD-livers. Application of defatting agents is currently explored in clinical trials, whereas other therapeutics require further research or optimization before entering clinical research.
Laparoscopic antegrade spleen-preserving distal pancreatectomy with conservation of the splenic vessels: a prospective multi-centre case series (with video)
Authors: Nguyen Hoang , Luong Tuan Hiep , Nguyen An Khang , Nguyen Thanh Khiem
Published: May 2024

Introduction:

Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with conservation of the splenic artery and vein (Kimura’ technique) is considered a technically challenging procedure that requires a high level of expertise in laparoscopic and pancreatic surgery.

Methods:

A prospective descriptive study on 18 patients with laparoscopic “antegrade” spleen-preserving distal pancreatectomy with Kimura’ technique from 2018 to 2023. The perioperative indications, clinical data, intraoperative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated.

Results:

The mean age was 39.4±13.3. Only 2 male patients accounted for 11.1%. The average operating time is 171±23 min. The average blood loss is 65.7±43 ml. The average tumor size is 4.1 cm. The average hospitalization is 9.4 days. The rate of pancreatic fistula is 66.7%. There is no case of transferring open surgery or blood transfusion during surgery. The results of pathological after surgery there were eight cases of solid pseudopapillary tumors, four cases of mucinous cystadenoma, six cases of neuroendocrine tumors.

Conclusion:

Kimura’s technique for laparoscopic spleen-preserving distal pancreatectomy is safe and feasible, which can be applied to benign tumors in the body and tail of the pancreas. However, this is a difficult technique in laparoscopic surgery that requires surgeons to have a lot of experience and equipment need to be adequate.
Accelerated Diffusion-Weighted Magnetic Resonance Imaging of the Liver at 1.5 T With Deep Learning–Based Image Reconstruction: Impact on Image Quality and Lesion Detection
Authors: Ginocchio Luke A. , Jaglan Sonam , Tong Angela , Smereka Paul N. , Benkert Thomas , Chandarana Hersh , Shanbhogue Krishna P.
Published: May 2024

Objective

To perform image quality comparison between deep learning–based multiband diffusion-weighted sequence (DL-mb-DWI), accelerated multiband diffusion-weighted sequence (accelerated mb-DWI), and conventional multiband diffusion-weighted sequence (conventional mb-DWI) in patients undergoing clinical liver magnetic resonance imaging (MRI).

Methods

Fifty consecutive patients who underwent clinical MRI of the liver at a 1.5-T scanner, between September 1, 2021, and January 31, 2022, were included in this study. Three radiologists independently reviewed images using a 5-point Likert scale for artifacts and image quality factors, in addition to assessing the presence of liver lesions and lesion conspicuity.

Results

DL-mb-DWI acquisition time was 65.0 ± 2.4 seconds, significantly (P < 0.001) shorter than conventional mb-DWI (147.5 ± 19.2 seconds) and accelerated mb-DWI (94.3 ± 1.8 seconds). DL-mb-DWI received significantly higher scores than conventional mb-DWI for conspicuity of the left lobe (P < 0.001), sharpness of intrahepatic vessel margin (P < 0.001), sharpness of the pancreatic contour (P < 0.001), in-plane motion artifact (P = 0.002), and overall image quality (P = 0.005) by reader 2. DL-mb-DWI received significantly higher scores for conspicuity of the left lobe (P = 0.006), sharpness of the pancreatic contour (P = 0.020), and in-plane motion artifact (P = 0.042) by reader 3. DL-mb-DWI received significantly higher scores for strength of fat suppression (P = 0.004) and sharpness of the pancreatic contour (P = 0.038) by reader 1. The remaining quality parameters did not reach statistical significance for reader 1.

Conclusions

Novel diffusion-weighted MRI sequence with deep learning–based image reconstruction demonstrated significantly decreased acquisition times compared with conventional and accelerated mb-DWI sequences, while maintaining or improving image quality for routine abdominal MRI. DL-mb-DWI offers a potential alternative to conventional mb-DWI in routine clinical liver MRI.
Development of “Explore Plastic Surgery”
Authors: Friedman Rosie , Shen Abra H. , Kim Erin , Taskindoust Mahsa , Boustany Ashley N. , Singhal Dhruv , Lin Samuel J. , Lee Bernard T.
Published: May 2024

Background

Medical students who attend institutions without plastic surgery residency programs are at a disadvantage in the plastic surgery match. We developed an educational program for medical students without home programs called Explore Plastic Surgery to provide an overview of the steps toward a career in plastic surgery. The purpose of this study was to assess the impact, utility, and success of the novel program.

Methods

Pre- and postevent surveys were distributed to participants. Survey data were analyzed including participant demographics, perceptions of barriers unique to those without home programs, and the overall event utility.

Results

Two hundred seventeen students registered for the program. Ninety-five participants completed the pre-event survey (44%), and of those, 57 participants completed the post-event survey (60%). There was an increase in understanding of the steps toward a career in plastic surgery (P < 0.001), confidence in overcoming barriers (P = 0.005), and level of comfort in reaching out to faculty for opportunities (P = 0.01). There was a decrease in the perceived negative impact that attending medical schools without a home program will have on their abilities to pursue careers in plastic surgery (P = 0.006).

Conclusions

After the event, participants demonstrated an increase in their confidence in overcoming barriers and a decrease in their perceptions that attending an institution without a home program would negatively impact their ability to pursue plastic surgery. Initiatives focused on early exposure and recruitment of medical students may be important to promote accessibility and diversity within plastic surgery.
Mandibular Distraction in Patients With Pierre Robin Sequence
Authors: Goza Shelby D. , Brown Madyson I. , Hopper Samuel J. , Phillips John , Sink Matthew C. , Brown Kathryn W. , Fernstrum Colton J. , Friel Michael T. , Humphries Laura S. , Hoppe Ian C.
Published: May 2024

Objective

Mandibular distraction osteogenesis (MDO) is rapidly becoming a standard of care for management of patients with severe Pierre Robin sequence. The tongue is brought forward to alleviate airway obstruction. This study will look at an institutional, multisurgeon experience with MDO over 10 years.

Design

A retrospective chart review was conducted.

Setting

All patients who underwent MDO at the authors' institution from 2012 to 2022 were included. Three craniofacial surgeons performed all interventions.

Patients

Demographics, preoperative and postoperative respiratory and feeding status, and distraction data were collected for 27 patients meeting inclusion criteria.

Main Outcome Measures

Primary outcomes were avoidance of a gastrostomy tube, avoidance of a tracheostomy, discharge from hospital on room air, and complications. A significance value of 0.05 was utilized.

Results

The average age at MDO was 135 days, mean activation phase was 13.6 days, mean distraction length was 14.9 mm, and mean consolidation phase was 64.2 days. A longer activation phase was associated with discharge with a gastrostomy tube and a shorter activation phase was associated with discharge on full oral feeds. The ability to discharge on room air was associated with a shorter latency phase, shorter activation phase, and decreased distance of distraction.

Conclusions

The goal of MDO is to achieve full oral feeds with no respiratory support. Several different latency periods were used in this study, and a short latency period was demonstrated to be safe.
Effect of Different Treatment Modalities for Condylar Fractures in Childhood on Mandibular Symmetry and Temporomandibular Joint Function: A Retrospective Study
Authors: Shiyan Wu , Shi Jun , Zhang Wenbin
Published: May 2024

Objective:

In a retrospective study of the effects of different treatment modalities of condylar fractures in childhood on mandibular symmetry and temporomandibular function, the cases selected for this article were adult patients who had sustained a condylar fracture in childhood. The aim was to investigate the effects of condylar fractures in children on the development and function of the mandible and their specific manifestations after the completion of mandibular development.

Methods:

According to the different treatment modalities, the patients were divided into the conservative treatment group and the open surgical treatment group, and the effects of the 2 treatment modalities on the patients’ condylar healing, the difference in growth ability, and the symmetry of the jaws were evaluated. The effects of different treatment modalities of children’s condylar fracture on the growth, development, and function of the mandible were investigated using the Ai and Di, the grading of the imaging results, and the 3-dimensional CT fixation measurements from the aspects of both clinical examination and imaging examination.

Results:

The 2 groups had condylar malalignment and condylar morphology abnormality, and there was one case of joint ankylosis in the surgical treatment group. There was a statistical difference in the evaluation of condylar reconstruction between the 2 groups, and the condylar reconstruction in the surgical treatment group was better than that in the conservative treatment, and there was a statistical difference between the condylar length, condylar width, condylar height, and depth of TMJ fossa between the healthy side and the affected side in the closed treatment group. There was a statistical difference in the height of the mandibular ascending branch between the healthy side and the affected side, and the unilateral condylar fracture was treated conservatively; the difference in the bony chin point deviation between the 2 groups was not statistically significant.

Conclusion:

In children, after conservative treatment of condylar fracture, the growth of condylar process is poor, and the condylar shape and position are not as good as surgical repositioning, but through the proliferation of temporomandibular joint fossa, it can make up for the insufficient height of condylar process, which has no effect on the symmetry of the mandible, and the surgical treatment can achieve good anatomical repositioning, which has a greater effect on the symmetry of the mandible than the conservative treatment.
Facial Trauma Affects the Radiological Diagnosis of Nasal Bone Fractures
Authors: Kim Daehyun , Oh Joon Taek , Ahn Sang Hyeon , Kim Hyun Jin , Bae Mi Rye
Published: May 2024

Objectives:

Timely and accurate diagnosis of nasal bone fractures (NBFs) is crucial for preserving the cosmetic and functional aspects of the nose. This study aims to identify factors influencing radiographic and computed tomography (CT) diagnosis of NBF in patients with nasal trauma.

Methods:

Two hundred six patients with acute nasal trauma underwent both conventional radiography and facial bone CT. An experienced otorhinolaryngologist independently interpreted images. Results were categorized into “Concordance” or “Discrepancy” groups, with demographic and clinical data compared.

Results:

The study classified 167 patients into “Concordance” and 39 into “Discrepancy” groups based on radiography and CT interpretations. The “discrepancy group” showed higher rates of previous nasal bone fractures (P=0.044), rhinoplasty history (P=0.044), and concomitant facial bone fractures (P=0.001). Adjusted odds ratios revealed significant associations between discrepancies and a history of nasal bone fracture (OR=5.197, 95% CI 1.165–23.171), rhinoplasty (OR=6.114, 95% CI 1.393–26.847), and concomitant facial bone fractures (OR=3.765, 95% CI 1.663–8.523).

Conclusion:

This study highlights the impact of facial trauma, including rhinoplasty, on the radiological diagnosis of NBF. Consequently, in the presence of signs of concurrent facial trauma, previous nasal trauma, or rhinoplasty history, a prompt CT scan and comprehensive evaluation are recommended for accurate diagnosis and timely treatment, ultimately improving the patient’s prognosis.
Investigation of Skull Cortical Thickness Changes in Healthy Population and Patients With Schizophrenia on Computed Tomography Images
Authors: Bolat Esra , Polat Sema , Tunç Mahmut , Çoban Muhammet , Göker Pinar
Published: May 2024

Cortical bone thickness is essential for the mechanical function of bone. Some factors including aging, sex, body size, hormone levels, behavior, and genetics lead to changes in cranial cortical robusticity. Moreover, the skull is one of the hardest and most durable structures in the human body. Schizophrenia is defined as a psychiatric disease characterized by delusions and hallucinations, and these patients have reduced brain volume; however, there is no study including cortical bone structure. For this reason, the aim of this study was to determine whether there is a difference in the skull cortical thickness of patients with schizophrenia and, compare it with healthy subjects. The cranial length, cranial width, anterior cortical thickness, right and left anterior cortical thickness, right and left lateral cortical thickness, right and left posterior lateral thickness, and posterior cortical thickness were measured with axial computed tomography images of 30 patients with schizophrenia and 132 healthy individuals aged between 18 and 69years. A statistically significant difference was found between the two groups in the measurements of right and left posterior lateral thickness, and posterior cortical thickness (P = 0.006, P = 0.001, and P = 0.047, respectively). The sexes were compared, and it was found that the cranial width, anterior thickness, left anterior thickness, and right and left posterior thickness measurements of patients with schizophrenia showed a statistically significant difference compared with the control group (P < 0.001, P = 0.003, P = 0.001, P < 0.001 and P < 0.001, respectively). The authors observed that skull cortical thickness may be different in schizophrenia. The results obtained from this study may be beneficial for evaluating these structures for clinical and pathological processes. Furthermore, knowledge about the skull cortical thickness in planning surgical procedures will increase the reliability and effectiveness of the surgical method, and this will minimize the risk of complications.
Submental Artery Perforator Flap Drained Solely With the Vena Comitans of Facial Artery
Authors: Qin Qingyan , Chu Tianshu , Fu Yongzhen , Zhao Yitong , Yang Huihui , Liu Qilin
Published: May 2024

Background:

The submental artery perforator flap (SMAPF) is an alternative to reconstruct oral and maxillofacial defects secondary to oral cancers. However, vascular anomalies or surgical damage often lead to vascular crises or harvest failure. Our clinical findings suggest that the vena comitans of the facial artery (cFA) very commonly exist. This study aimed to investigate the reliability of the cFA as a sole venous reflux route for the SMAPF.

Method:

The patients were from the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University. All patients were treated for oral cancer between January 2016 and September 2022. Seventeen SMAPFs were successfully raised to reconstruct the postoperative defects, of which 7 had cFA as the sole reflux route.

Results:

The size of the flaps varied from 4.0×3.0 cm to 12.0×3.0 cm. All flaps survived. Patients were followed from 1 month to 5 years. Satisfactory restoration of contour and functional outcomes were achieved at the recipient sites. The scars were well camouflaged in the submental region. No local or regional recurrence was detected during follow-up. Patients had an overall 2-year survival rate of 100% with no suspected flaps-related recurrence.

Conclusions:

The cFA as the sole venous reflux route for SMAPF is reliable for flap harvesting and is applicable for immediate defect reconstruction secondary to cancer resection.
Health service use in major trauma survivors: A population-based cohort study from Ontario, Canada
Authors: Evans Christopher C. D. , Li Wenbin
Published: May 2024

BACKGROUND

Little is known about how major trauma survivors access health services in the years following their injury. Our study sought to characterize patterns of health services use in trauma survivors following discharge from a provincial trauma center and to identify sociodemographic factors associated with service utilization.

METHODS

We conducted a population-based retrospective case-control study using linked administrative data on trauma survivors' population-based controls between April 1, 2011, and March 31, 2021. For each major trauma survivor, we matched four cases based on age and sex. The primary outcome was the composite rate (sum) of health service use episodes including outpatient visits to family physicians and specialists, emergency department visits, and acute care hospital admissions during the 5-year period following discharge from the trauma center. We used multivariate regression to compute rate ratios comparing the rates of health service use in trauma survivors versus controls and to assess for associations between sociodemographic variables and health services use.

RESULTS

The study cohort consisted of a total of 273,406 individuals: 55,060 trauma survivors and 218,346 controls. Trauma survivors were predominately males (71%) with a median age of 46 years (interquartile range, 26–65 years). Health service use in trauma survivors peaked within a year of hospital discharge but remained increased throughout the follow-up period. Trauma survivorship was associated with a 56% increase in overall health services use (adjusted rate ratio, 1.56; 95% confidence interval, 1.55–1.57), including an 88% increase in hospital admissions (adjusted rate ratio, 1.88; 95% confidence interval, 1.85–1.92). Male sex and rural residence were associated with a reduced overall use of health services but greater use of emergency department services.

CONCLUSION

Major trauma survivors have long-term health services needs that persist for years after discharge from the trauma center. Future research should focus on the understanding why trauma survivors have prolonged health services requirements and ensure that care needs are aligned with service delivery.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
Risk of VMAT2 inhibitors on suicidality and parkinsonism: report utilizing the United States Food and Drug Administration adverse event reporting system
Authors: Wong Sabrina , Le Gia Han , Kwan Angela T.H. , Rhee Taeho Greg , Teopiz Kayla M. , Ho Roger C. , Cao Bing , Rosenblat Joshua D. , Mansur Rodrigo , McIntyre Roger S.
Published: May 2024

Prescription of vesicular monoamine transporter 2 (VMAT2) inhibitors, valbenazine, deutetrabenazine, and tetrabenazine, is becoming increasingly common in persons treated with antipsychotics. Reported suicidality and parkinsonism are safety concerns with VMAT2 inhibitors. Herein, we aim to evaluate the aforementioned safety outcomes using the FDA Adverse Event Reporting System. Reporting odds ratios (RORs) and lower limits of 95% confidence intervals of information components (IC025) were calculated to quantify VMAT2 inhibitor-associated adverse events. Acetaminophen was the reference agent. Suicidal ideation was significantly associated with VMAT2 inhibitors, with RORs ranging from 2.38 to 10.67 and IC025 ranging from 0.73 to 2.39. Increased odds of suicidal behavior was observed with tetrabenazine (ROR 3.011, IC025 0.0087), but not deutetrabenazine or valbenazine. Decreased odds of suicide attempts and completed suicide were observed with VMAT2 inhibitors, with RORs ranging from 0.011 to 0.10 (all IC025 < 0). Increased odds of parkinsonism were reported for all VMAT2 inhibitors, with RORs and IC025 ranging from 19.49 to 25.37 and 1.66 to 2.93, respectively. The mixed results with VMAT2 inhibitor-associated suicidality and parkinsonism do not establish causal relationships. The parameters of suicidality may be explained by underlying psychiatric disorders.
K-means clustering of hyperpolarised13C-MRI identifies intratumoural perfusion/metabolism mismatch in renal cell carcinoma as best predictor of highest grade
Authors: Horvat-Menih Ines , Khan Alixander S , McLean Mary A , Duarte Joao , Serrao Eva , Ursprung Stephan , Kaggie Joshua D , Gill Andrew B , Priest Andrew N , Crispin-Ortuzar Mireia , Warren Anne Y , Welsh Sarah J , Mitchell Thomas J , Stewart Grant D , Gallagher Ferdia A
Published: May 2024

Purpose

Conventional renal mass biopsy approaches are inaccurate, potentially leading to undergrading. This study explored using hyperpolarised [1-13C]pyruvate MRI (HP13C-MRI) to identify the most aggressive areas within the tumour of patients with clear cell renal cell carcinoma (ccRCC).

Experimental design

Six patients with ccRCC underwent presurgical HP13C-MRI and conventional contrast-enhanced MRI. Three k-means clusters were computed by combining thekPLas a marker of metabolic activity, and the13C-pyruvate signal-to-noise ratio (SNRPyr) as a perfusion surrogate. Combined clusters were compared to those derived from individual parameters and to those derived from percentage enhancement on nephrographic phase (%NG). The diagnostic performance of each cluster was assessed based on its ability to predict the highest histological tumour grade in postsurgical tissue samples. Tissues were further subject to MCT1 staining, RNA and whole-exome sequencing.

Results

Forty-four samples were collected in total. The clustering approach combining SNRPyrandkPLdemonstrated the best performance for predicting highest tumour grade: specificity 85%; sensitivity 64%; positive predictive value 82%; and negative predictive value 68%. Epithelial MCT1 was identified as the major determinant of the HP13C-MRI signal. The perfusion/metabolism mismatch cluster showed increased expression of metabolic genes and markers of aggressiveness, which may be due to genetic divergence.

Conclusions

This study demonstrates the potential of using HP13C-MRI-derived metabolic clusters to identify intratumoral variations in tumour grade with high specificity. This work supports the use of metabolic imaging to guide biopsies to the most aggressive tumour regions, which could potentially reduce sampling error.