bluuebunny/crossref_metadata_2025 huggingface dataset:
Rectal Injury during Penile Inversion Vaginoplasty: An Algorithmic Approach to Prevention and Management
Authors: Morris Martin P. , Wang Chien-Wei , Holan Cole , Lane Megan E. , Sluiter Emily C. , Morrison Shane D. , Kuzon William M.
Published: February 2023

Objective:

This study reports outcomes in 146 patients that underwent PIV. The results, in conjunction with a systematic review of the literature, were used to develop a treatment algorithm for the prevention, surgical management and postoperative considerations of iatrogenic rectal injuries.

Background:

PIV is a common procedure for transfeminine patients, with the goal of creating a functional vaginal canal and clitoris, as well as a natural-appearing vulva. Creation of the neovagina requires opening of the pre-rectal space, most commonly from a perineal approach, and the reported rates of rectal perforation during this dissection range from 3 to 5%.

Methods:

Adult patients who underwent PIV at our institution were retrospectively identified. Demographics, operative information, and postoperative clinical outcomes were extracted from the electronic medical record.

Results:

Ten of 146 patients experienced a rectal injury (6.8%). All patients underwent an immediate repair (2-layer in 8, 3-layer in 2) with two patients subsequently requiring temporary fecal diversion and two requiring muscle flaps (1.4% each). Literature review identified eighteen relevant publications, with scarce in-depth analysis of management of initial rectal injuries.

Conclusions:

This algorithmic approach to rectal injury during PIV is designed to facilitate decision-making based on preoperative preparation, consistent intraoperative monitoring, feasibility of primary repair of the rectum, and a multidisciplinary approach to longitudinal postoperative care.
Within-Person Temporal Associations Among Self-Reported Physical Activity, Sleep, and Well-Being in College Students
Authors: McGowan Amanda L. , Boyd Zachary M. , Kang Yoona , Bennett Logan , Mucha Peter J. , Ochsner Kevin N. , Bassett Dani S. , Falk Emily B. , Lydon-Staley David M.
Published: February 2023

Objective

A holistic understanding of the naturalistic dynamics among physical activity, sleep, emotions, and purpose in life as part of a system reflecting wellness is key to promoting well-being. The main aim of this study was to examine the day-to-day dynamics within this wellness system.

Methods

Using self-reported emotions (happiness, sadness, anger, anxiousness) and physical activity periods collected twice per day, and daily reports of sleep and purpose in life via smartphone experience sampling, more than 28 days as college students (n = 226 young adults; mean [standard deviation] = 20.2 [1.7] years) went about their daily lives, we examined day-to-day temporal and contemporaneous dynamics using multilevel vector autoregressive models that consider the network of wellness together.

Results

Network analyses revealed that higher physical activity on a given day predicted an increase of happiness the next day. Higher sleep quality on a given night predicted a decrease in negative emotions the next day, and higher purpose in life predicted decreased negative emotions up to 2 days later. Nodes with the highest centrality were sadness, anxiety, and happiness in the temporal network and purpose in life, anxiety, and anger in the contemporaneous network.

Conclusions

Although the effects of sleep and physical activity on emotions and purpose in life may be shorter term, a sense of purpose in life is a critical component of wellness that can have slightly longer effects, bleeding into the next few days. High-arousal emotions and purpose in life are central to motivating people into action, which can lead to behavior change.
Biological Burden of Adverse Childhood Experiences in Children
Authors: de la Rosa Rosemarie , Zablotny David , Ye Morgan , Bush Nicole R. , Hessler Danielle , Koita Kadiatou , Bucci Monica , Long Dayna , Thakur Neeta
Published: February 2023

Objective

Examine relationships between adverse childhood experiences (ACEs) and related life events and allostatic load (AL) – “wear and tear” from chronic stress – in a pediatric population.

Methods

Children were screened with the PEARLS tool, a 17-item questionnaire capturing experiences of abuse, neglect, household challenges, and related life events. Biologic data was available for 207 participants and AL was operationalized using clinical or empirical cutoff points across 4 physiologic systems (i.e., cardiac, metabolic, inflammatory, neurologic). Covariate-adjusted multivariable regression models were used to examine associations between AL with adversity and health.

Results

Children (Mean age = 6.5 years, range = 1-11 years) had an average AL score of 1.9 (SD 1.7), and a U-shaped relationship was observed with child’s age. Continuous PEARLS and original ACE scores were not associated with AL. However, children with a reported PEARLS score of 1-2 or original ACEs score of 1-3 had 1.5 (IRR 1.50; 95% CI 1.09, 2.08) and 1.4 (IRR 1.41; 95% CI 1.08, 1.84) times greater AL, respectively, compared to participants with none reported. In secondary analyses, caregiver mental illness was associated with higher child AL (adjusted IRR 1.27; 95% CI 1.01, 1.58). AL was also associated with poorer perceived child general health (aß = -0.87, 95% CI: -1.58, -0.15) and greater odds of child obesity (aOR 1.51; 95% CI: 1.23, 1.89).

Conclusions

Measuring AL in a pediatric population requires careful consideration of age. Higher AL was associated with a greater number of reported adversities and worse child health.
Exploration of Ward-Based Nurses’ Perspectives on Their Preparedness to Recognize Clinical Deterioration: A Scoping Review
Authors: Mikhail John , King Lindy
Published: February 2023

Background

Despite initiatives in the early recognition of clinical deterioration, the incidence of failure to recognize clinical deterioration in patients continues to occur contributing to the ongoing rise of in-hospital mortality and morbidity.

Objective

The aim of the study was to explore and appraise the research evidence that related to ward-based nurses’ preparedness to recognize the clinically deteriorating patient.

Methods

A scoping review was undertaken as this approach enabled the researchers to investigate the breadth of the available evidence through broad inclusion criteria. A comprehensive database search was conducted through the Cochrane Library; Cumulative Index to Nursing and Allied Health Literature; MEDLINE; ProQuest; PubMed; and Wiley Online Library. Each article was critically appraised and analyzed using a critical appraisal tool and thematic analysis, respectively. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews checklist.

Results

Twelve primary sources of literature met the eligibility criteria. Through thematic analyses 6 primary themes were identified: implication of experience on preparedness; interprofessional and intraprofessional relationships; knowledge of calling criteria, process and procedures; requirement for a supportive system and culture; existence of hierarchy within healthcare impacting care; and clinical deterioration as an education opportunity.

Conclusions

This review identified central issues that impacted on ward-based nurses’ preparedness. Further development of collaborative, supportive professional relationships across-and-within disciplines is needed. Effective use of clinical deterioration situations as educational opportunities would also assist nurses’ preparedness through skill and knowledge development. However, more research evidence will be needed because of the limited data available on the topic.
Communicating Patient Safety Information Through Video and Oral Formats—A Comparison
Authors: Bånnsgård Margareta , Nouri Arazoo , Finizia Caterina , Engström My , Moreno Johanna , Roos Ulrika , Tubic Bojan
Published: February 2023

Objective

One way to decrease adverse events is to increase patient participation in their own care. Sahlgrenska University Hospital has introduced a patient safety advisory, consisting of an animated video and structured oral information. This article investigates how the animated video and structured oral information regarding was perceived by the patients and determines which communication method the patients preferred.

Method

In this study, we compared patients’ attitudes toward patient safety information delivered in video or oral format. Data were collected after intervention through a survey consisting of 5 questions.

Results

One hundred thirty-four patients were recruited to the study. Ninety-two patients either watched the video or received oral information. Forty-two patients were given both oral information and viewed the video. Information received by the patients was rated as good or very good by 90% of those viewing the video and by 100% who received the oral presentation (P = 0.007). Of the 42 participants who received both formats, 74% preferred the oral presentation (P < 0.001).

Conclusions

The patients thought the patient safety information to be good and beneficial. An informative video can complement the oral information, but not replace, when informing patients about patient safety. Providing patients with information in a manner they prefer may increase patient’s involvement in their care and possibly reduce the risk of adverse events.
Characteristics and clinical manifestations of monkeypox among people with and without HIV in the United States: a retrospective cohort
Authors: Chastain Daniel B. , Motoa Gabriel , Ortiz-Martínez Yeimer , Gharamti Amal , Henao-Martínez Andrés F.
Published: February 2023

Objectives:

To compare characteristics and clinical manifestations of monkeypox (MPX) between people with and without HIV in the United States.

Design:

Retrospective cohort study using TriNetX, a federated research network.

Methods:

Patients 18 years and older with MPX were identified based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code B04 and divided into two groups: people with HIV (PWH) and people without HIV. Differences in baseline characteristics, clinical manifestations, and all-cause healthcare utilization were examined between groups. Outcomes were reported before and after propensity score matching.

Results:

Of 322 cases of MPX included, 29% (n = 93) were PWH. Baseline characteristics were similar, but PWH were more likely to identify as Black or African American persons (24% vs. 11%, P = 0.0303) or as Hispanic or Latino persons (24% vs. 11%, P = 0.0345) and more likely to report lifestyle factors affecting health status. Rash and rectal pain were more common in PWH (25% vs. 11%, P < 0.01, and 25% vs. 10%, P < 0.001, respectively). In addition, PWH had higher rates of anal or rectal abscesses (11% vs. 0%, P < 0.0001), phimosis (11% vs. 0%, P < 0.0001), and pneumonia (11% vs. 0%, P < 0.0001). More PWH required urgent care visits (53% vs. 29%, P < 0.0001) and hospitalizations (11% vs. 4%, P = 0.0314), but not emergency department visits (42% vs. 58%, P = 0.0085).

Conclusion:

PWH had higher rates of clinical manifestations and required greater utilization of healthcare resources for any reason compared with those without HIV.
Effect of HIV stigma on depressive symptoms, treatment adherence, and viral suppression among youth with HIV
Authors: Mugo Cyrus , Kohler Pamela , Kumar Manasi , Badia Jacinta , Kibugi James , Wamalwa Dalton C. , Kapogiannis Bill , Agot Kawango , John-Stewart Grace C.
Published: February 2023

Objective:

We estimated the effects of HIV stigma on mental health and treatment outcomes for youth with HIV (YWH).

Design:

Secondary analysis of data for YWH ages 15–24 years in Western Kenya.

Methods:

Participants completed a longitudinal survey (baseline, months 6 and 12) assessing socio-demographics, antiretroviral therapy (ART) adherence, depressive symptoms (PHQ-9), and HIV stigma (10-item Wright scale). First viral load (VL) after enrollment was abstracted from records. We estimated risk of depressive symptoms (score > 4), nonadherence (missing ≥2 days of ART in a month), and detectable VL (≥50 copies/ml) for each standard deviation (SD) increase in HIV stigma score, adjusted for age and sex (and regimen in VL model). The generalizing estimating equation models included measures for the three visits.

Results:

Median age for the 1011 YWH was 18 years. At baseline, frequency of nonadherence, depressive symptoms and detectable VL was 21%, 21%, and 46%, respectively. Mean stigma score was 25 (SD = 7.0). Each SD stigma score increment was associated with higher risk of depressive symptoms {adjusted relative risk [aRR] 1.31 [95% confidence interval (CI): 1.20–1.44]}, nonadherence [aRR 1.16 (CI: 1.05–1.27)] and detectable VL [aRR 1.20 (CI: 1.08–1.32)]. Experienced and anticipated stigma were associated with detectable VL [aRR 1.16 (CI: 1.10–1.22) and aRR 1.23 (CI: 1.12–1.35), respectively]. Internalized and perceived community stigma were associated with depressive symptoms [aRR 1.31 (CI: 1.21–1.40) and aRR 1.24 (CI: 1.13–1.36), respectively].

Conclusions:

Stigma was associated with depressive symptoms, nonadherence and detectable VL. Interventions to decrease stigma may improve virologic and mental health outcomes in YWH.
HIV acquisition prior to entry into formal sex work: inference from next-generation viral sequencing
Authors: Neufeld Bronwyn , Cholette François , Sandstrom Paul , Musyoki Helgar , Ma Huiting , Kaosa Shem , Kioko Japheth , Isac Shajy , Bhattacharjee Parinita , Cheuk Eve , Pickles Michael , Mwatelah Ruth , Capiña Rupert , Daniuk Christina , Mckinnon Lyle R. , Blanchard James , Mishra Sharmistha , Becker Marissa
Published: February 2023

Objective:

To infer the timing of HIV acquisition in relation to self-reported events in the sexual life course of adolescent girls and young women (AGYW) who self-identify as female sex workers (FSW) in Mombasa, Kenya.

Design:

Next-generation viral sequencing of samples of AGYW living with HIV in the Transitions study, a cross-sectional bio-behavioural survey of AGYW aged 14–24 years in Mombasa, Kenya.

Method:

Dried blood spot specimens were collected from study participants (n = 37, all FSW). A portion of the HIV pol gene was sequenced using an in-house next-generation sequencing assay for HIV drug resistance mutation genotyping. Estimated time since infection (ETI) was inferred using the HIV EVO web-based tool (https://hiv.biozentrum.unibas.ch/ETI/), and data on self-reported events were obtained from the survey.

Results:

The median ETI among FSW was 3.4 (interquartile range = 1.7, 6.3) years, with a median ETI of 1.5 years prior to entry into formal sex work. We estimated that 74.1% (95% confidence interval = 53.7–88.9%) of participants living with HIV and who self-identified as FSW likely acquired HIV prior to self-identification as a sex worker.

Conclusions:

Findings suggest a large fraction of prevalent HIV infection among AGYW engaged in sex work stems from acquisition prior to entry into formal sex work. Current HIV prevention programs tailored for sex workers may miss key opportunities for HIV prevention as they are designed to reach women after entry into formal sex work, signaling a need for tailored programs to reach high-risk AGYW earlier on in their sexual life course.
Prepandemic Predictors of Medication Adherence and HIV Viral Load During the First Year of COVID-19
Authors: Kalichman Seth C. , Eaton Lisa A. , Kalichman Moira O. , Sam Soya S. , Caliendo Angela M.
Published: February 2023

Studies have reported significant immediate impacts of the COVID-19 pandemic on the social relationships and health care of people living with HIV. This study followed a closed cohort of young people living with HIV over the first year of the COVID-19 pandemic. Participants were men and women (N = 140) age 36 years and younger who were living with HIV and had demonstrated suboptimal adherence to antiretroviral therapy, unsuppressed HIV viral load, or active substance use in a run-in study. The results confirmed that participants continued to experience significant disruptions to their social relationships and health care over the course of the first year of the COVID-19 pandemic. There was evidence for sustained impacts on transportation, housing stability, and food security during the first year of COVID-19. Multivariable models showed that greater pre–COVID-19 social support predicted greater antiretroviral therapy adherence and greater HIV suppression (lower viral load) over the first year of the COVID-19 pandemic. Efforts to plan and prepare people living with HIV for future social crises, including future pandemics, should emphasize building and sustaining social support.
Ongoing High Prevalence of Severe Immune Suppression Among Children in South Africa
Authors: Patten Gabriela , Sipambo Nosisa , Technau Karl-Günter , Euvrard Jonathan , Ford Nathan , Davies Mary-Ann
Published: February 2023

Background:

Among children in Southern Africa severe immune suppression (SIS) has declined, but most continue to initiate antiretroviral therapy (ART) with SIS.

Setting:

Using data from South Africa, we describe SIS at ART start and on ART between 2007 and 2020, among children <5 years with a CD4%/cell count at ART start and ≥1 subsequent measure.

Methods:

Gap in care was defined as >9 months without a recorded visit. We defined SIS according to age and CD4%/cell count. A multistate model was used to estimate transition probabilities between 5 states: SIS on ART; Stable, not SIS; Early Gap, commencing <9 months from ART start; Late Gap, commencing ≥9 months on ART; and Death.

Results:

Among 2536 children, 70% had SIS at ART start, and 36% experienced SIS on ART. An increasing proportion were age <1 year at ART initiation (2007–2009: 43% to 2013–2020: 55%). Increasingly, SIS on ART occurred after a gap, in those with SIS on ART for >1 year, and after a period of unknown immune status. Later year of ART initiation was associated with reduced transition from SIS on ART to Stable. Infants and those initiating ART with SIS were more likely to transition from Stable to SIS. Viremia strongly predicted death from both the on ART states.

Conclusions:

Increasingly SIS occurred among ART-experienced children. Those starting ART with SIS and during infancy remained especially vulnerable to SIS once on treatment. Managing ART in these children may be more complex and further reducing AIDS-related mortality is likely to remain challenging.
Indicators of Oxidative Stress in the Prediction of Coronary Artery Lesions in Patients With Kawasaki Disease
Authors: Wu Rouyi , Jiang Wei , Sun Yangkai , Wu Ling , Di Yazhen , Wang Jiapei , Zhong Shiling , Wang Wenbo
Published: February 2023

Objectives

The aim of this study was to examine the clinical significance of oxidative stress (OS)–related indices, including inflammatory markers and lipid and platelet (PLT) parameter, in coronary artery lesions (CALs) in Kawasaki disease (KD).

Methods

Clinical data of 952 KD patients diagnosed between January 2019 and March 2022 were collected and divided into CAL and NCAL groups. All the KD patients were randomly divided into training set and verification set. The univariate analysis and multivariate logistic regression analysis of training set were used to identify the OS-related independent risk factors of CALs, which were then used to construct a predictive nomogram. Calibration curve and receiver operating characteristic curve were used to evaluate the performance of the model. The predictive nomogram was further validated on verification set.

Results

In the training set, 137 KD patients (18.0%) showed CALs. C-reactive protein, serum amyloid A, PLT count, monocyte–to–high-density lipoprotein (HDL) ratio, and PLT-to-lymphocyte ratio were significantly higher, whereas HDL was lower in the CAL group than the NCAL group. Increased C-reactive protein, serum amyloid A, PLT, and decreased HDL were identified as independent risk factors. The nomogram constructed using these factors showed satisfactory calibration degree and discriminatory power (the area under the curve, 0.887). In the verification set, the area under the curve was 0.795.

Conclusion

The predictive nomogram constructed using 4 OS-related risk factors associated with CALs in patients with KD could be a useful tool for early diagnosis of CALs in KD.
68GA-FAPI-04 PET/CT Versus 18F-FDG PET/CT in Imaging of Malignant Mixed Germ Cell Testicular Tumor
Authors: Kaplan İhsan , Can Canan , Güzel Yunus , Alabalik Ulaş , Kömek Halil
Published: February 2023

18F-FDG PET/CT imaging was performed for restaging in in a 16-year-old boy who was operated on for right testicular tumor and was diagnosed with malignant mixed germ cell tumor. Mild FDG uptake was observed in 2 nodules in both lungs and retroperitoneal lymph node in the abdomen. 68Ga–FAPI (fibroblast activation protein inhibitor) 04 PET/CT showed moderate uptake of FAPI in lung nodules and retroperitoneal lymph node. In this case, 68Ga-FAPI-04 PET/CT was shown to be superior to 18F-FDG PET/CT in the evaluation of malignant mixed germ cell testicular tumor metastases.
68Ga-DOTA.SA.FAPI as a Potential, Noninvasive Diagnostic Probe for Recurrent and Metastatic Adrenocortical Carcinoma
Authors: Chopra Sejal , Walia Rama , Mathur Yamini , Roesch Frank , Moon Euy Sung , Rana Nivedita , Pandey Somit , Chatterji Debajyoti , Kumar Rajender , Singh Harmandeep , Mittal Bhagwant Rai , Shukla Jaya
Published: February 2023

Metastatic or recurrent adrenocortical carcinoma (ACC) is a potentially fatal malignancy, which poses major challenges in disease management owing to lack of effective systemic therapies. The drastically reduced survival rates require prompt identification of selective molecules for development of targeted therapeutics. We evaluated the squaric acid containing FAPI derivative, DOTA.SA.FAPI (FAPI), as a potential diagnostic probe in 2 cases of histopathologically proven metastatic and recurrent ACC. Both patients underwent 18F-FDG and 68Ga-FAPI PET/CT scans for comparative analysis. 68Ga-DOTA.SA.FAPI emerged as an excellent diagnostic agent for ACC and performed similar to 18F-FDG.
FDG PET/CT in a Case of Esophageal Extranodal NK/T-Cell Lymphoma, Nasal Type
Authors: Zhang Jun , Ji Xia , Dong Aisheng , Wang Yang
Published: February 2023

Lymphoma involving the esophagus is rare. We describe FDG PET/CT findings in a case of extranodal NK/T-cell lymphoma, nasal type involving the larynx, hypopharynx, and cervical and upper thoracic esophagus. The esophageal tumor showed segmentally increased FDG uptake mimicking esophagitis. This case indicates that esophageal lymphoma should be included in the differential diagnosis of the hypermetabolic esophageal diseases.
Cardiac Magnetic Resonance Imaging and Clinical Follow-up in Antimalarial-induced Cardiomyopathy in Patients With Systemic Lupus Erythematosus
Authors: Shalmon Tamar , Thavendiranathan Paaladinesh , Harvey Paula , Akhtari Shadi , Tselios Kostantinos , Gladman Dafna D. , Hanneman Kate
Published: February 2023

Antimalarial-induced cardiomyopathy is under-recognized in clinical practice and there is limited data on the evolution of cardiac imaging abnormalities after cessation of anti-malarial therapy. In this case series of 9 patients with antimalarial-induced cardiomyopathy, follow-up cardiac magnetic resonance imaging demonstrated interval increase in late gadolinium enhancement extent in 89% of patients and interval decrease in left ventricular ejection fraction in all, despite cessation of anti-malarial therapy. Progression of cardiac abnormalities despite cessation of therapy underscores the important role of imaging in the early recognition of antimalarial-related treatment changes.
The Efficiency of Diffusion-weighted Magnetic Resonance Imaging in the Differentiation of Malign and Benign Cavitary Lung Lesions
Authors: Durmaz Fatma , Özgökçe Mesut , Aydin Yener , Yildiz Hanifi , Özkaçmaz Sercan , Dündar İlyas , Türko Ensar , Arisoy Ahmet , Göya Cemil
Published: February 2023

Purpose:

The present study investigates the diagnostic efficiency of apparent diffusion coefficient (ADC) values in differentiating between malignant and benign cavitary lesions on diffusion-weighted magnetic resonance imaging (DWI).

Materials and Methods:

This prospective study included 45 consecutive patients identified with a cavitary lung lesion with a wall thickness of ≥5 mm on thoracic computed tomography in our clinic between 2020 and 2022, and who underwent thoracic DWI within 1 week of their original computed tomography. ADC measurements were made on DWI by drawing a region of interest manually from the cavity wall, away from the lung parenchyma in the axial section where the lesion was best demonstrated. The patients were then classified into benign and malignant groups based on the pathology or clinico-radiologic follow-up.

Results:

The sample included 29 (64.4%) male and 16 (35.6%) female patients, with a mean age of 59.06±17.3 years. Included in the study were 1 patient with 3 and 3 patients with 2 cavitary lesions each, with a total for the sample of 50 cavitary lesions. There were 23 (46%) malignant and 27 (54%) benign cavitary lung lesions. The mean ADC value (×10−3 mm2/s) of the malignant and benign cavitary lesions was 0.977±0.522 (0.511 to 2.872) and 1.383±0.370 (0.930 to 2.213), respectively. The findings were statistically significant using an independent samples t test (P=0.002). The mean wall thickness of the malignant and benign lesions was 12.47±5.51 mm (5 to 25 mm) and 10.11±4.65 mm (5 to 22 mm), respectively. Although malignant cavities had a higher mean wall thickness than benign cavities, the difference was statistically insignificant (P=0.104).

Conclusion:

A significant difference was identified between the ADC values measured in DWI of the malignant and benign cavitary lung lesions. DWI, a noninvasive and rapid imaging method, can provide useful information for the differential diagnosis of cavitary lesions and can minimize unnecessary biopsies.
Is Nitropaste Effective in Stressed Flaps?
Authors: DeVito Robert G. , Stranix John T.
Published: February 2023

Topical nitroglycerine (nitropaste) is an agent that has seen popularization in plastic surgery in recent years. A low-cost medication functioning, by inducing vasodilation primarily in the venous system and inhibiting platelet aggregation, has shown the ability to provide benefits in clinically concerning skin flaps. In random-pattern skin flaps, research shows that topical nitroglycerine decreases flap loss and increases the percentage of viable tissue. In mastectomy skin flaps, there have been multiple studies showing significant decreases in flap necrosis and need for debridement in patients undergoing topical nitroglycerine application without changes in complications profiles. These studies have included patients undergoing and not undergoing implant-based breast reconstruction. There are no data examining myocutaneous or perforator flaps. In free flaps, there is research showing benefit of nitroglycerine in breaking vasospasm and inducing vasodilation in microsurgery. Overall, topical nitroglycerine is a proven entity effective at increasing viable tissue in random-pattern skin flaps and shows clear benefits in the reduction of mastectomy skin flap necrosis with minimal adverse effects or additional cost. Further research is needed into other areas of plastic surgery where it may be of value.
The Effects of Burr-Assisted Rhinoplasty on Hearing
Authors: Zorlu Mehmet E. , Aysel Abdulhalim , Aydin Enes , Catli Tolgahan
Published: February 2023

Aim:

The aim of this study is to examine the effects of the burr used for hump reduction and osteoplasty on cochlear function.

Materials and Methods:

The design of this study was prospective, randomized, and controlled. Twenty patients who underwent burr-assisted septorhinoplasty were included in the study group. The control group consisted of 20 patients who underwent septoplasty. Pure tone audiometry, distortion product otoacoustic emission test, and tympanometry were performed to determine the auditory functions.

Results:

No significant difference was observed between the bone conduction thresholds of the right and left ears in both groups, except for a single frequency (1000 Hz in the left ear) in the control group. There was no significant difference between the 2 groups’ air conduction thresholds at frequencies of 500, 1000, 2000, 4000, 6000, and 8000 Hz preoperatively and postoperatively. In addition, the study and control group did not differ significantly in signal-to-noise ratio measurements at frequencies of 500, 1000, 2000, and 4000 Hz. The comparison of preoperative and postoperative otoacoustic emission measurement results of the study group revealed a statistically significant difference only at the frequencies of 2000 Hz in the right ear and 500 Hz in the left ear. Despite those differences, otoacoustic emissions were still present at those frequencies postoperatively.

Conclusions:

Our study showed that using burrs during rhinoplasty slightly impacts hearing, but it does not cause significant hearing loss. Burr-assisted rhinoplasty appears to be a safe operation regarding the auditory functions.
Anthropometric Comparison of 3-Dimensional Facial Scan Taken With a Low-Cost Facial Scanner With Cone-Beam Computed Tomography Scan
Authors: Aljawad Hussein , Lim Hoi-Jeong , Lee Kyungmin Clara
Published: February 2023

Objective:

The aim of this study was to evaluate the accuracy of 3-dimensional (3D) facial scans taken with a low-cost facial scanner compared with cone-beam computed tomography (CBCT).

Materials and Methods:

Twenty-five patients had their CBCT scan and 3D facial scan taken on the same day. Facial scans were taken with a low-cost facial scanner (Bellus3D, ARC-1 scanner) in an upright position. The facial scans were imported into Invivo5 software and were integrated with the corresponding CBCT scans. Then, 16 soft tissue landmarks were identified on the CBCT scans and the 3D-integrated facial scans. The 6 vertical, 7 horizontal, 10 oblique linear, and 11 angular anthropometric measurements were obtained and compared between the CBCT scans and 3D-integrated facial scans using paired t test and Bland-Altman plots.

Results:

The differences between CBCT scans and 3D-integrated facial scans showed no statistical significance except for 2 vertical measurements. Bland-Altman plots showed that all anthropometric measurements were within the limit of agreement. The differences between CBCT scans and 3D-integrated facial scans were <1.5 mm or 1.5 degrees except for 2 vertical measurements.

Conclusions:

Three-dimensional facial scans taken with facial scanner showed a clinical acceptance when compared with CBCT scans.
The ‘Facelift’ Flap Revisited
Authors: Seretis Konstantinos , Boptsi Anastasia , Boptsi Eleni , Lykoudis Efstathios G.
Published: February 2023

The reconstruction of facial defects focuses on the preservation of function without compromising facial symmetry and esthetics. The aim of the study is to describe and evaluate a revised ‘facelift’ flap technique to reconstruct large defects of the cheek, temple, frontotemporal area, and zygomatic arch. A prospective, observational study of facial defect reconstruction by means of a ‘facelift’ flap was conducted from January 2019 to January 2022. The revised ‘facelift’ flap technique, based on the defect location and characteristics, is described. The postoperative outcomes and patient satisfaction were evaluated. The flap was applied to 34 patients with defect diameters ranging from 3 cm to 9 cm. The mean operation time was 67±17 minutes and the mean hospital stay was 1 day. No major postoperative complications were encountered; reoperation was not needed. High patient satisfaction rates were reported (9.6±0.5). The revised facelift flap is a reliable and safe method for the reconstruction of large defects of the cheek, temple, frontotemporal area, and zygomatic arch, based on local tissue availability that ensures satisfactory esthetic outcomes with undetectable scars.
Brain White Matter Structural Alteration in Hemifacial Spasm: A Diffusion Tensor Imaging Study
Authors: Zhang Tianran , Zhao Chuan , Qi Xianlong , Li Rui , Liu Yali , Chen Fangfang
Published: February 2023

Objective:

To analyze the changes in the white matter structure of the whole brain in hemifacial spasm (HFS) patients by using the tract-based spatial statistics (TBSS) method.

Materials and Methods:

29 HFS patients without anxiety and depression and 29 healthy controls with matching age, sex, and education were selected. All subjects received a 3.0T magnetic resonance (MR) brain diffusion tensor imaging scan. Tract-based spatial statistics method was used to analyze the changes in white matter structure in the whole brain and obtained the cerebral white matter fibrous areas exhibiting significant intergroup differences. The fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity of these areas were abstracted. Analyzed the correlation between these diffusion metrics and clinical variables (disease duration, spasm severity).

Results:

Compared with the healthy controls group, the HFS group exhibited significantly lower FA in the forceps minor, bilateral anterior thalamic radiation, and right superior longitudinal fasciculus (P<0.05, threshold-free cluster enhancement corrected). Cohen grading scale of HFS patients was negatively correlated with FA of forceps minor.

Conclusion:

Based on TBSS analysis, the injury of white matter fiber tracts in HFS patients was found, including forceps minor, bilateral anterior thalamic radiation, and right superior longitudinal fasciculus. The changes of FA values in forceps minor were negatively correlated with the Cohen grading scale, suggesting that the alteration of white matter fiber in the genu-of-corpus-callosum-cortex circuit plays an important role in the neuro-pathological mechanism of HFS. Combined with previous research, it is also necessary to further explore the change of the superior longitudinal fasciculus in the future.
The Efficacy of Ozonized Water Versus Ringer Lactate Arthrocentesis for the Treatment of Temporomandibular Joint Internal Derangement
Authors: Hassan Thair A. , Suhail Zaid Abdullah
Published: February 2023

Background:

Temporomandibular disorders are musculoskeletal conditions characterized by facial pain and impaired temporomandibular joint function, limited mouth opening, joint and muscular pain, and noises during mandibular movements are some of the most common symptoms. The most frequent cause of temporomandibular joint dysfunction is internal derangement (ID), which refers to an alteration in the normal pathways of motion of the joint that largely involves the function of the articular disc, therefore, these alterations have been also referred to as disc derangement. Arthrocentesis is a minimally invasive technique, less expensive than surgical treatment. Adhesions are released after arthrocentesis of the upper joint space under sufficient hydraulic pressure. Intra-articular ozone gas injection is used as conservative treatment modalities for ID of the temporomandibular as it possesses anti-inflammatory, analgesic effects, enhancement the host defense mechanism and accelerates the healing process of the damaged cells.

Aim:

The aim of this study was to compare the effectiveness of ozonized water against lactated ringer solution in the arthrocentesis of the temporomandibular joint.

Patients and Methods:

Sixty patients were used in this study, suffered from ID of the temporomandibular joint treated by arthrocentesis under hydraulic pressure and were allocated into 2 groups; the study group (A), which included 30 patients, managed by arthrocentesis utilizing ozonized water and the control group (B) with 30 patients also treated by the same procedure using ringer lactate solution. Visual analog scale pain scores, temporomandibular joint sounds, and maximal mouth opening were assessed preoperatively and at different intervals postoperatively.

Results:

The age in this study ranged from 14 to 66 years. The mean age of group A was 29.93 years with an SD of ±11.79. For group B, the mean age was 27.56 years and the SD was ±10.80, the prominent percentage in both groups was <30 years. Regarding sex, 45 patients were females, whereas the males were 15 with a ratio of 3:1. Group A registered the highest reduction in the visual analog scale at all postoperative intervals. With respect to the mouth opening, there was no significant difference in maximal mouth opening between the 2 groups after 1 week and 12 weeks in comparison with the preoperative measurements. The temporomandibular joint sounds improved in all patients in group A after 12 weeks, whereas in group B the sounds dropped to 33.3%.

Conclusion:

The data from the present study suggested more favorable treatment outcomes for ozonized water lavage and it is a promising new treatment modality for the relief of symptoms associated with the ID of the temporomandibular joint.
Giant Pilomatricoma Mistaken for a Malignant Tumor
Authors: Choi Jun Ho , Oh Sang Seong , Kim Kwang Seog , Hwang Won Joo , Choi Yoo Duk , Hwang Jae Ha , Lee Sam Yong
Published: February 2023

Pilomatricomas are tumors originating from the matrices of hair follicles. Giant pilomatricomas, defined as pilomatricomas that are 5 cm or larger, are benign but may appear malignant clinically. We present the case of a 69-year-old man with a rapidly growing mass on his scalp. When he visited our department, the tumor measured 10.0×6.0×4.0 cm and showed inflammation and ulceration. Magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography-computed tomography showed findings resembling lymph node metastasis from a malignant tumor. However, upon an incisional biopsy, the tumor was diagnosed as a pilomatricoma. Therefore, we performed an excisional biopsy instead of radical surgery and lymph node dissection. The tumor was ultimately diagnosed as a giant pilomatricoma based on the excisional biopsy, and the patient received reconstruction only at the site of the defect. A giant pilomatricoma can be mistaken for a malignant tumor due to its characteristics. In such uncertain cases, it can be helpful to first perform an excisional biopsy.
Long Non-Coding RNA uc003jox.1 Promotes Keloid Fibroblast Proliferation and Invasion Through Activating the PI3K/AKT Signaling Pathway
Authors: Bu Wenbo , Fang Fang , Zhang Mengli , Zhou Wuqing
Published: February 2023

The pathogenesis of keloids is complex and unclear, and the treatment of this condition remains challenging. The long non-coding RNA uc003jox.1 is highly expressed in keloid tissues compared with in normal skin tissues. We assessed the role of uc003jox.1 in keloid fibroblasts and its underlying mechanism, focusing on the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway. Keloid fibroblasts were transfected with a small interfering RNA targeting uc003jox.1. Colony formation, transwell, and flow cytometry assays were conducted to evaluate the proliferation, invasion, and apoptosis of keloid fibroblasts, respectively. The interaction between uc003jox.1 and the PI3K/AKT pathway was explored by using polymerase chain reaction and western blotting. Knockdown of uc003jox.1 markedly suppressed keloid fibroblast proliferation, clone-forming activity, and invasion, as well as promoted apoptosis. Silencing of uc003jox.1 decreased the phosphorylation levels of PI3K, AKT, and mammalian target of rapamycin and increased both the mRNA and protein expression levels of phosphatase and tensin homolog. Our in vitro results suggest that the long non-coding RNA uc003jox.1 can be used as a biomarker for keloid fibroblasts and that its expression is closely related to the proliferation and invasion of keloid fibroblasts through the PI3K/AKT/mammalian target of rapamycin pathway. Thus, uc003jox.1 shows potential as a treatment target for keloids.
Three-Dimensional Printed Polycaprolactone Mesh in Pediatric Cranial Vault Remodeling Surgery
Authors: Gonzalez Matheus Isabel , Phua Yun
Published: February 2023

Background:

The surgical management of craniosynostosis has greatly evolved with improvements in both technology and understanding of the disease process. Some drawbacks remain regarding bone regeneration within the surgical bony gaps. Generally, bony gaps improve in the 12 to 24 months after surgery, but some gaps may remain for longer and cause deformity and/or require additional bony reconstruction. These considerations make tissue-engineered bone very attractive. Novel 3-dimensional printed bioresorbable mesh implants made of Polycaprolactone (PCL) can be used to fill the surgical bony defects.

Objectives:

The authors seek to investigate how the use of a 3-dimensional printed biodegradable PCL mesh applied to bony defects in cranial vault surgery affects bone healing.

Methods:

Case series analysis of 8 pediatric patients who have undergone surgical intervention using PCL mesh implants for reconstruction of bony defects during craniosynostosis correction surgery.

Findings:

Radiological evaluation of 3 patients at random time points between 9 and 12 months postoperative revealed persistent bony gaps in areas where PCL mesh was laid. One patient who underwent a subsequent cranial vault surgery at 9 months was found to have less bone regeneration in the defect area where PCL mesh was used when compared with an adjacent area where a particulate bone graft was used.

Conclusions:

Based on our experience, the use of PCL mesh on its own did not augment bone regeneration. It is possible that a greater amount of time or increased vascularization of the scaffold is required, which supports the concept of regenerative matching axial vascularization or the further addition of osteogenic factors to increase the rate of bone formation.
Investigation of Morphologic Changes in Temporomandibular Joint With Anterior Disk Displacement Based on 3-Dimensional Reconstructive Imaging
Authors: Shao Bo , Li Chen-xi , Liu Xu , Pataer Parekejiang , Gong Zhong-cheng
Published: February 2023

The objective of this study was to measure the association between the disk position and condylar alteration in patients diagnosed with anterior disk displacement (ADD) of temporomandibular joint (TMJ). A retrospective cross-sectional study was designed, dividing into 4 groups: normal articular disk position (NADP) of unilateral ADD patients (n=10), ADD with reduction (ADDwR, n=16), ADD without reduction (ADDwoR, n=24), and healthy volunteers (HV, n=30) based on magnetic resonance imaging and cone-beam computed tomography. After morphologic parameters were calculated from 3-dimensional reconstructive images, differences in parameters with respect to ADD status were tested with analysis of variance and Fisher least significant difference multiple comparisons were performed. Condylar volume of ADDwR, ADDwoR, NADP, and HVs were 1768.29±404.19, 1467.13±438.20, 1814.48±753.60, and 1914.66±476.48 mm, respectively, showing a significant downward trend from healthy disk to a displaced one (P<0.05). Same trend also found in condylar superficial area, with the condylar superficial area of the ADDwR, ADDwoR, NADP, and HVs were 842.56±138.78 mm, 748.52±157.42 mm, 842.87±263.00 mm, and 892.73±164.19 mm, respectively. From NADP to ADDwR to ADDwoR, superior joint space (SJS) was declined, [SJS(NADP) (2.10±0.91 mm) > SJS(ADDwR) (1.85±0.61 mm) > SJS(ADDwoR) (1.50±0.50 mm), P=0.034]; medial joint space was significantly associated with the different disk displacement types (P
(HV-ADDwR)=0.001; P
(HV-ADDwoR)=0.021; P
(NADP-ADDwR)=0.022; P
(ADDwR-ADDwoR)=0.001). Our findings suggest that condylar volume and superficial area, and superior and medial joint space, albeit with a small sample size, are significantly associated with different disk displacement types, detection of which might therefore be worth exploring for assessing ADD.
Impact of a Modified Restoration of Tensor Veli Palatini on Hearing and Middle Ear Function in Cleft Palate Children—a Retrospective Study
Authors: Shi Dianyin , Zhou Lian , Shang Yingying , Zhao Jizhi
Published: February 2023

Background:

Many children with cleft palate also exhibit hearing loss and middle ear dysfunction, which could last for years. There are still arguments on how to treat this problem. This study aimed to evaluate the impact of a modified restoration of tensor veli palatine (TVP) on hearing and middle ear function in the cleft palate children.

Methods:

This retrospective study was completed using records of the cleft palate children who received surgery in Peking Union Medical College Hospital from May 2013 to December 2020. They were divided into 2 groups: Group 1: children who received cleft palate surgery without specific restoration of TVP; Group 2: children who received palate surgery with a specific TVP restoration technique. Perioperative information was collected. The conductive auditory brainstem response and the 226-Hz tympanometry before and after the cleft surgery were compared intragroup and intergroup.

Results:

Totally 42 children were included in this study, 21 children in each group. There were no significant differences considering clinical characteristics between the 2 groups. The modified TVP restoration didn’t increase operation time or complication compared with no TVP restoration. Statistically, neither the auditory brainstem response air conduction hearing thresholds nor the 226-Hz tympanometry results had significant differences between the 2 groups after the surgery.

Conclusions:

This modified restoration of TVP was not time-consuming and did not increase complications. The beneficial effect of the modified TVP restoration on the hearing or the middle ear function of cleft palate children was uncertain around 6 months after surgery compared with no restoration.
Pediatric Orbital Fractures: Outcomes in Relation to Time of Surgery
Authors: Gudnadottir Gunnhildur , Hammarfjord Oscar , Johansson Sara , Hellgren Johan
Published: February 2023

Introduction:

Orbital trapdoor fractures in children and adolescents can cause persistent problems with vision and appearance. Early surgery is recommended, although, because of the rarity of these fractures, there is a lack of evidence regarding the optimal timing of surgery.

The objective of this study was to examine the effect of the time from trauma to surgery on the recovery time and severity of diplopia in children and adolescents with orbital trapdoor fractures.

Materials and Methods:

A retrospective cohort study was performed of all orbital fractures in children and adolescents aged 0 to 20 years, treated at a tertiary referral center in 2005-2017. Data relating to demographics, cause of injury, surgery, time of follow-up, and final outcomes were extracted. The cases of trapdoor fracture were specifically examined with regard to the time from trauma to surgery and diplopia at last follow-up, which was the primary outcome.

Results:

One hundred thirty-five patients, aged 2.4 to 20 years (mean 17.0), were treated for orbital fractures during the period; 37 (27%) had an isolated orbital floor fracture and 12 (9%) had a trapdoor fracture. All patients with trapdoor fractures underwent surgery; the mean time to surgery was 11.9 days in 2007-2011 and 1.1 days in 2012-2017. Although statistical significance cannot be proven in this small and retrospective study, a shorter time from trauma to surgery seems to lead to fewer problems with diplopia and 2 patient cases that highlight this are presented.

Conclusions:

Delayed surgical intervention in pediatric orbital trapdoor fractures increases the risk of delayed recovery and persistent diplopia. Other factors, such as the degree of muscle incarceration and necrosis and the surgeon’s experience and skill, may, however, also influence the outcomes.