bluuebunny/crossref_metadata_2025 huggingface dataset:
Baseline and Temporal Changes in Sensitivity of Zymoseptoria tritici Isolates to Benzovindiflupyr in Oregon, U.S.A., and Cross-Sensitivity to Other SDHI Fungicides
Authors: Hagerty Christina H. , Klein Ann M. , Reardon Catherine L. , Kroese Duncan R. , Melle Caroline J. , Graber Kaci R. , Mundt Christopher C.
Published: June 2020

Zymoseptoria tritici is the causal agent of Septoria tritici blotch (STB), a disease of wheat (Triticum aestivum) that results in significant yield loss worldwide. Z. tritici’s life cycle, reproductive system, effective population size, and gene flow put it at high likelihood of developing fungicide resistance. Succinate dehydrogenase inhibitor (SDHI) fungicides (FRAC code 7) were not widely used to control STB in the Willamette Valley until 2016. Field isolates of Z. tritici collected in the Willamette Valley at dates spanning the introduction of SDHI (2015 to 2017) were screened for sensitivity to four SDHI active ingredients: benzovindiflupyr, penthiopyrad, fluxapyroxad, and fluindapyr. Fungicide sensitivity changes were determined by the fungicide concentration at which fungal growth is decreased by 50% (EC50) values. The benzovindiflupyr EC50 values increased significantly, indicating a reduction in sensitivity, following the adoption of SDHI fungicides in Oregon (P < 0.0001). Additionally, significant reduction in cross-sensitivity among SDHI active ingredients was also observed with a moderate and significant relationship between penthiopyrad and benzovindiflupyr (P = 0.0002) and a weak relationship between penthiopyrad and fluxapyroxad (P = 0.0482). No change in cross-sensitivity was observed with fluindapyr, which has not yet been labeled in the region. The results document a decrease in SDHI sensitivity in Z. tritici isolates following the introduction of the active ingredients to the Willamette Valley. The reduction in cross-sensitivity observed between SDHI active ingredients highlights the notion that careful consideration is required to manage fungicide resistance and suggests that within-group rotation is insufficient for resistance management.
Auxin Profiling and GmPIN Expression in Phytophthora sojae−Soybean Root Interactions
Authors: Stasko Anna K. , Batnini Amine , Bolanos-Carriel Carlos , Lin Jinshan Ella , Lin Yun , Blakeslee Joshua J. , Dorrance Anne E.
Published: June 2020

Auxin (indole-3-acetic acid, IAA) has been implicated as a susceptibility factor in both beneficial and pathogenic molecular plant−microbe interactions. Previous studies have identified a large number of auxin-related genes underlying quantitative disease resistance loci (QDRLs) for Phytophthora sojae. Thus, we hypothesized that auxin may be involved the P. sojae−soybean interaction. The levels of IAA and related metabolites were measured in mycelia and media supernatant as well as in mock and inoculated soybean roots in a time course assay. The expression of 11 soybean Pin-formed (GmPIN) auxin efflux transporter genes was also examined. Tryptophan, an auxin precursor, was detected in the P. sojae mycelia and media supernatant. During colonization of roots, levels of IAA and related metabolites were significantly higher in both moderately resistant Conrad and moderately susceptible Sloan inoculated roots compared with mock controls at 48 h postinoculation (hpi) in one experiment and at 72 hpi in a second, with Sloan accumulating higher levels of the auxin catabolite IAA-Ala than Conrad. Additionally, one GmPIN at 24 hpi, one at 48 hpi, and three at 72 hpi had higher expression in inoculated compared with the mock control roots in Conrad. The ability of resistant cultivars to cope with auxin accumulation may play an important role in quantitative disease resistance. Levels of jasmonic acid (JA), another plant hormone associated with defense responses, were also higher in inoculated roots at these same time points, suggesting that JA also plays a role during the later stages of infection.
Nonoperating room anesthesia in different parts of the world
Authors: Fernandez-Robles Claudia , Oprea Adriana D.
Published: June 2020

Purpose of review

Advances in early diagnosis and treatment of diseases using minimally invasive procedures has led to an increase in the number of cases in locations outside the operating room. This surge created the need for anesthesia services to expand to these areas to provide well tolerated and favorable procedural conditions. The present review describes nonoperating room anesthesia patterns in different parts of the world.

Recent findings

Nonoperating room anesthesia has grown exponentially over the last years. Patients scheduled in these areas are sicker and older compared to the operating room patients. Anesthesiologist-directed care has proven to be well tolerated, with less serious complications and improvement in patients and proceduralist satisfaction.

There are marked variations in how anesthesia services are delivered in out of operating room locations in different parts of the world. Although there are some data available from the United States, expansion of minimally invasive procedures across continents will likely lead to the emergence of various models of delivering anesthetic care.
Risk stratification in patients undergoing nonoperating room anesthesia
Authors: Bockstael Brecht , Najafi Nadia , Poelaert Jan
Published: June 2020

Purpose of review

A growing numerical and complexity of patients requiring nonoperating room anesthesia (NORA) necessitates a multidisciplinary approach of a highly experienced team in a highly technological setting of the cathlab or radiology suite. These requirements are even more magnified in the context of the coronavirus disease 2019 (COVID-19) pandemic.

Recent findings

This review describes the aspects of risk stratification both in adults and children with respect to patient morphology, airway management, cardiorespiratory function and finally future developments, which could beneficially interfere with imminent management in NORA. Moreover, some particular features related to COVID-19 are also discussed.

Apart from a thorough preoperative assessment, preventive strategies and well-chosen monitoring should be implemented to preclude inadvertent events in sometimes high-risk patients. Timely preventive measures and early recognition of complications could only be achieved by a multidisciplinary cooperating team. In addition, the implementation of safety measurements due to the infectious transmission to both the patients and care givers is crucial.
Recent advances in nonoperating room anesthesia for cardiac procedures
Authors: Lee Delice W. , Wąsowicz Marcin
Published: June 2020

Purpose of review

The number of complex procedures performed in the cardiac catheterization laboratory (CCL) is rapidly increasing. Because of their complexity, they frequently require the assistance of an anesthesiologist. The CCL is primarily designed to facilitate a percutaneous cardiac intervention; therefore, it might be a challenging workplace for an anesthesiologist. The aim of this review is to briefly present tasks and challenges of providing anesthesia in the CCL and to provide a concise description of common cardiac procedures performed there.

Recent findings

Recent literature indicates that many complicated cardiac procedures can be performed in CCL under monitored anesthesia care. At the same time several of them (e.g. transcatheter aortic valve replacement) are quickly becoming a viable alternative for surgical valve replacement. The most recent expansion of CCL procedures is related to rapidly growing population of grown-ups with congenital heart disease. All aforementioned developments present new challenges to an anesthesiologist.

New and fast development of percutaneous cardiac interventions has created a new working place for the anesthesiologist – the CCL. Our expertise in complex cardiac pathophysiology allows conduct of complicated procedures outside of the operating theater. For the same reasons, there is ongoing discussion whether anesthesia support in CCL should be provided by a general or cardiac anesthesiologist.
Standard procedures in nonoperating room anesthesia
Authors: Dabu-Bondoc Susan M.
Published: June 2020

Purpose of review

This article provides an overview of standard procedures currently performed in nonoperating room anesthesia (NORA) and highlights anesthetic implications.

Recent findings

Novel noninvasive interventional procedures remain on the rise, accelerating demand for anesthesia support outside the conventional operating room. The field of interventional oncology has introduced a variety of effective minimally invasive therapies making interventional radiology gain a major role in the management of cancer. Technical innovation brings newer ablative and embolotherapy techniques into practice. Flexible bronchoscopy has replaced rigid bronchoscopy for many diagnostic and therapeutic indications. Endobronchial ultrasonography now allows sampling of mediastinal, paratracheal, or subcarinal lymph nodes rendering more invasive procedures such as mediastinoscopy unnecessary. Similarly, endoscopic ultrasonosgraphy currently plays a central position in the management of gastrointestinal disease. Sophisticated catheter techniques for ablating cardiac arrhythmias have become state of the art; Watchman procedure gaining position in the prevention of stroke resulting from atrial fibrillation.

NORA is a rapidly evolving field in anesthesia. Employing new technology to treat a wide variety of diseases brings new challenges to the anesthesiologist. Better understanding of emerging interventional techniques is key to safe practice and allows the anesthesia expert to be at the forefront of this swiftly expanding multidisciplinary arena.
Extramedullary Motorized Lengthening of the Femur in Young Children
Authors: Dahl Mark T. , Morrison Stewart G. , Laine Jennifer C. , Novotny Susan A. , Georgiadis Andrew G.
Published: June 2020

Background:

Limb lengthening by distraction osteogenesis is now achievable via motorized intramedullary devices, mitigating many complications of lengthening by external fixation. In young patients, antegrade intramedullary nailing of the femur risks avascular necrosis of the femoral head. A method of extramedullary placement of a motorized expandable intramedullary nail has been employed by the senior author to safely achieve femoral lengthening without the use of an external fixator in young patients.

Methods:

Eleven skeletally immature patients with lower limb length discrepancy were reviewed who underwent extramedullary placement of a magnetic, expandable intramedullary nail for lengthening of the femur. Surgical details, lengthening parameters, and complications were reviewed and classified according to the modified Clavien-Dindo Classification.

Results:

Average lengthening was 32.3 mm (range: 27 to 40 mm) comprising an average 14.8% of femoral segment length. The average lengthening duration was 6.3 weeks, and average full weight-bearing began at 12.6 weeks. All but 1 patient underwent early removal of the device at an average of 4.5 months, and 5 had immediate plating of the femur. Complications rates were comparable to other methods of femoral lengthening, including varus or procurvatum through the regenerate, and unplanned reoperation in 3 of 11 cases. Preoperative considerations included careful planning of implant length due to short femoral segments and protection of the knee joint from contracture or iatrogenic instability.

Conclusions:

Extramedullary placement of a magnetic expandable intramedullary lengthening nail can achieve lengthening of the femur without the use of external fixation. Considerations with this technique include careful planning of implant length relative to trochanteric-physeal distance, protection against knee subluxation during lengthening, and mitigating deformity of the regenerate. Off-label, extramedullary use of these devices can be considered to decrease the burdens of external fixation in young children. The technique begs the advent of future all-internal technology specifically designed for safe limb lengthening in this age group.

Level of Evidence:

Level IV—retrospective case series.
A Standardized Protocol for Cervical Spine Evaluation in Children Reduces Imaging Utilization: A Pilot Study of the Pediatric Cervical Spine Clearance Working Group Protocol
Authors: Pennell Christopher , Gupta Jayesh , March Michael , Arthur L. Grier , Lindholm Erika , Herman Martin , Grewal Harsh
Published: June 2020

Background:

Cervical spine injuries (CSI) have the potential to cause severe morbidity in children. Multiple imaging studies are used during evaluation of CSIs but come at a cost, both financially and in radiation exposure. To reduce resource utilization and radiation exposure, we implemented the Pediatric Cervical Spine Clearance Working Group (PCSCWG) standardized protocol (SP) for evaluating CSIs in children.

Methods:

Children below 18 years old presenting with concern for CSI at a level 1 pediatric trauma center were reviewed before (July 2015 to May 2016) and after (November 2017 to June 2018) protocol implementation. Demographics, injuries, and imaging utilization were extracted. The primary outcomes were the proportion of patients cleared with clinical exam, and the proportion undergoing x-ray, computed tomography, or magnetic resonance image. The secondary outcome was the estimated difference in imaging charges based on the annual reduction in radiographic studies.

Results:

During the study 359 children were evaluated for CSIs (248 pre-SP, 111 post-SP). Patients were similar with respect to age, injury severity score, and mechanism of injury. Protocol adherence was 87.4%. The prevalence of CSI was similar in the preprotocol and postprotocol cohorts (2.8% vs. 1.8%, P=0.567). Children treated after protocol implementation were significantly more likely to be cleared by clinical exam (15.3% vs. 43.2%, P<0.001). Significantly fewer children had x-rays (70.2% vs. 55.0%, P=0.005) and computed tomography scans (14.5% vs. 5.4%, P=0.013) in the postprotocol period. There was no difference in the utilization of magnetic resonance image (6.9% vs. 7.2%, P=0.904) or the proportion of children discharged with a cervical collar (10.1% vs. 12.6%, P=0.476). No patients in either group were found to have a previously undiagnosed injury at follow-up. The reduction in radiographic studies translates to an estimated annual reduction in imaging charges of $396,476.

Conclusions:

The PCSCWG protocol for evaluating CSIs reduced the number of radiographic studies performed and estimated imaging charges while reliably identifying CSIs.
Comparison of FOLFIRINOX and Gemcitabine Plus Nab-paclitaxel for Treatment of Metastatic Pancreatic Cancer
Authors: Lee Jong-chan , Woo Sang Myung , Shin Dong Woo , Kim Jinkook , Yang Se Yeol , Kim Min Jae , Kim Jin Won , Kim Ji-Won , Lee Woo Jin , Cha Hyo Soung , Park Philiip , Kim Jaihwan , Hwang Jin-Hyeok
Published: June 2020

Objective:

By using the Korean Pancreatic Cancer (K-PaC) registry, we compared the clinical outcomes of FOLFIRINOX (FFX) and gemcitabine plus nab-paclitaxel (GNP) in patients with metastatic pancreatic cancer (MPC).

Methods:

We constructed a web-based database of 3748 anonymized patients diagnosed with pancreatic ductal adenocarcinoma. MPC patients who received first-line FFX or GNP were enrolled. Overall survival (OS), progression-free survival, grade III to IV toxicity, and cross-over treatment were analyzed.

Results:

A total of 413 patients (232 vs. 181, FFX vs. GNP; all data are presented in this sequence) were eligible. Median age was 63 years (60 vs. 69 y) with 43% (39% vs. 47%) comprising female individuals. The major metastatic sites were the liver (64%), peritoneum (25%), and distant lymph nodes (18%). The median OS was 11.5 versus 12.7 months (hazard ratio [HR]=0.87, 95% confidence interval [CI]: 0.68-1.12, P=0.286), and median progression-free survival was 7.5 versus 8.1 months (HR=0.92, 95% CI: 0.70-1.20, P=0.517), respectively. The frequency of grade III to IV febrile neutropenia was higher in the FFX group (18% vs. 11%, P=0.040), and that of peripheral neuropathy was higher in the GNP group (8% vs. 14%, P=0.046). The chance to receive second-line chemotherapy was higher in the GNP group (45% vs. 56%, P=0.036). In the cross-over treatment, the median OS of the FFX-GNP group (n=43) and the GNP-FFX group (n=47) was 16.8 versus 17.7 months (HR=0.79, 95% CI: 0.44-1.41, P=0.425).

Conclusions:

FFX and GNP showed similar efficacy and comparable toxicity in MPC patients. Although the GNP group had a higher chance to receive second-line chemotherapy, they did not have improved overall survival.
8-0 Polypropylene Suture Looping and Overhand Knot: Transconjunctival Approach to Four-Point Scleral Fixation of an Akreos Adapt Intraocular Lens
Authors: Chen Shijiu , Yuan Gongqiang , Zhu Wenhua , Shan Tianhui , Liu Chunli , Zhang Jingjing
Published: June 2020

Purpose:

To evaluate a novel surgical technique for transscleral fixation of the intraocular lens (IOL) with four hollow haptics using 8-0 polypropylene suture looping and overhand knot.

Methods:

An 8-0 polypropylene suture was tied to a 10-0 polypropylene suture with an overhand knot. One set of 8-0 polypropylene suture was then passed through the IOL four haptics. The suture knot was buried by rotating into the sclera tunnel. Best-corrected visual acuity, intraocular pressure, and complications were determined.

Results:

The IOLs were fixed with using an 8-0 polypropylene suture in 13 eyes of 11 patients with aphakia and dislocated crystalline lens. The mean preoperative corrected distance visual acuity was 0.71 ± 0.58 logarithm of the minimum angle of resolution (Snellen 20/103), and it improved to 0.24 ± 0.25 logarithm of the minimum angle of resolution (Snellen 20/35) at the final follow-up (P < 0.05). No vitreous hemorrhage, hypotony, suture exposed, and pupillary capture of the IOL were observed in any of the patients.

Conclusion:

The authors have developed a new technique for transscleral IOL fixation with one set of an 8-0 polypropylene suture tied to a 10-0 polypropylene suture with an overhand knot. The overhand knot offers the opportunity to use an 8-0 polypropylene suture for the long-term safety and may not require the surgeon to learn any new technique.
CORRELATION STUDY BETWEEN DRUSEN MORPHOLOGY AND FUNDUS AUTOFLUORESCENCE
Authors: Flores Rita , Carneiro Angela , Serra Joana , Gouveia Nélia , Pereira Telmo , Mendes Jorge M. , Coelho Pedro S. , Tenreiro Sandra , Seabra Miguel C.
Published: June 2020

Purpose:

To correlate drusen morphology and outer retinal status with autofluorescence (AF) imaging in patients with intermediate age-related macular degeneration.

Methods:

Drusen type and morphology were analyzed using color fundus photography and spectral-domain optic coherence tomography, whereas fundus AF was used for drusen AF evaluation. Additional structural changes on spectral-domain optic coherence tomography, such as disruption of external limiting membrane, ellipsoid zone, and retinal pigment epithelium/Bruch membrane complex, as well as the presence of choroidal hypertransmission at correspondent locations were also evaluated and correlated with fundus AF findings. Spearman's correlation coefficient was used to analyze the correlation between spectral-domain optic coherence tomography morphological characteristics of drusen and AF appearance of the corresponding drusen. Strength of correlation was calculated (r), and a P value < 0.05 was considered statistically significant.

Results:

Two hundred and twenty-eight drusen from 53 eyes of 53 patients were analyzed, 130 soft drusen (57.02%) and 98 cuticular drusen (42.98%). Sixty percent of the drusen were isoautofluorescent (n = 136), 35% hyperautofluorescent (n = 80), and 5% hypoautofluorescent (n = 12). We found positive correlation between drusen AF and hyperreflective foci (r = 0.4). Outer retinal layers morphology (external limiting membrane and ellipsoid zone status and hypertransmission) also correlates with autofluorescent findings (r = 0.3).

Conclusion:

Multimodal imaging reveals a broad spectrum of ultrastructural changes, which may reflect different stages in the evolution of drusen. Our results suggest that drusen morphological characteristics and autofluorescent findings are correlated but other factors or cofactors may be involved. The described correlations will help us understand new progression biomarkers of nonexudative age-related macular degeneration.
Is There a Place for the Introduction of Colposcopy Quality Standards?
Authors: Bornstein Sandy , Schejter Eduardo , Chodick Gabriel , Yakir Orly , Bornstein Jacob
Published: June 2020

Objectives

The aims of the study were to examine the degree of compliance with international quality measures for colposcopy in Israel, which does not currently have formal guidelines and to compare the achievement of quality measures between clinical settings.

Methods

This is a retrospective cohort study, in a hospital, a community clinic, and 2 private colposcopy clinics in Israel, including women aged 18–70 years presenting for colposcopy after abnormal Pap results. Compliance was compared between clinical sites regarding 6 international standards: documentation of reason for referral, type of transformation zone, biopsy location, and grade; proportion of women with high-degree cytological abnormalities (atypical squamous cells - cannot exclude high grade squamous intraepithelial lesion and above) receiving a colposcopy within 4 weeks; and the positive predictive value of colposcopy to detect cervical intraepithelial neoplasia 2 and above.

Results

Documentation of reason for referral (1.3% of target), transformation zone type (22.6% of target), biopsy location (18% of target), and lesion grade (31% of target) all failed to meet international standards, as did the proportion of patients with high-degree cytological abnormalities who underwent colposcopy within 4 weeks (32.9% of the target). The positive predictive value of colposcopy exceeded standards (30% above target). Differences existed between clinical settings.

Conclusions

In Israel, there is a considerable shortfall in performance and documentation of most international quality measures for colposcopy. Quality measures for cervical examinations and colposcopy should be considered for inclusion in the National Program for Quality Measures.
Recent developments in head and neck melanoma
Authors: Deot Neal , Suryadevara Amar
Published: June 2020

Purpose of review

To provide an overview of recently published articles covering melanoma management of the head and neck region.

Recent findings

Melanoma management represents a rapidly evolving field. The advent of immunotherapy has led to significant changes in diagnosis, treatment, and surveillance for these patients. Invasive interventions including completion lymph node dissection have been largely replaced with increased surveillance driven by robust data showing no significant difference in overall survival. Studies have explored various treatment regimens that offer improved outcomes with the least adverse events, with a recent trend towards neoadjuvant therapy. Research has also shifted towards better understanding genetics and biomarkers that influence response to these medications. The best means to both identify and monitor these changes is being explored. As our understanding of this complex disease process continues to grow, prognosis in patients suffering with melanoma should continue to improve.

The expansion of immunotherapy use in melanoma management has led to significantly improved prognosis in diagnosed patients. Present research is largely focused on better understanding the ideal patient populations, dosing, and surveillance for these therapies. Data from these studies will be crucial in better staging and treating patients with melanoma.
Minimally invasive techniques in rhinoplasty
Authors: Gassner Holger G. , Magdum Ashish A. , Tasman Abel-Jan
Published: June 2020

Purpose of review

To present criteria of minimally invasive surgery, which include minimal and hidden incision lines, reduced injury to tissue and application of endoscopic techniques, when feasible; to analyze techniques in rhinoplasty for their minimally invasive character – in light of recent publications; and to discuss the techniques that best meet the criteria of minimally invasive surgery.

Recent findings

The nose consists of about 60 percent soft tissue and 40 percent skeletal elements. Surgery causes injury to both tissue types through various mechanisms, including mechanical traction, separation, incision, heat, desiccation, and others. Multiple aspects including extent of approach and degree of tissue undermining determine the minimally invasive character of techniques and maneuvers in rhinoplasty.

A single incision endonasal approach, the subperichondrial and subperiosteal septal plane, the supraperichondrial plane over the cartilaginous dorsum, the subperiosteal plane over the bony dorsum, limited dorsal undermining with endoscopic visualization when feasible, conventional straight lateral osteotomy or percutaneous curved lateral osteotomy; percutaneous transverse osteotomy; conventional straight paramedian osteotomy; piezo and drill paramedian ostectomy; dorsal uncapping osteotomy; conventional rasp gross dorsal contouring; piezo or drill fine dorsal contouring; (cartilaginous) middle vault ‘let down’; and minimal access subperiosteal turbinate bone resection were found to best fulfil the criteria of minimally invasive surgery. A classification system for the degree of minimally invasiveness of rhinoplasty techniques is proposed as a basis for discussion.
The science of art: Leonardo Da Vinci and facial plastic surgery
Authors: Shaye David A.
Published: June 2020

Purpose of review

Leonardo Da Vinci possessed one of humanity's greatest minds, known for exploring the boundaries of art and science. The discipline of facial plastic surgery also relies on art and science for its advancement. This review focuses on key elements of Leonardo Da Vinci's work, and how they relate to concepts within facial plastic surgery.

Recent findings

Leonardo Da Vinci was a self-taught creative genius. Common themes that permeated his art were those of proportion, perspective, light and shadow, anatomy, and science. These principles are reflected in key aspects of facial plastic surgery, such as facial analysis, human gaze, facial subunits, surgery of the craniofacial skeleton, and evidence-based medicine.

Leonardo Da Vinci's approach to scientific inquiry and artistic beauty strikes a balance from which facial plastic surgeons have much to learn. In depth study of how Leonardo Da Vinci viewed the world furthers the analytical and creative sides of a facial plastic surgeon as well as informs their personal development.
PHOX2B Immunostaining
Authors: Drabent Philippe , Bonnard Arnaud , Guimiot Fabien , Peuchmaur Michel , Berrebi Dominique
Published: June 2020

Hirschsprung disease (HD) is a congenital disorder of the enteric nervous system that occurs in ∼1 in 5000 live births. It is characterized by the absence of ganglionic cells (GCs) in the distal intestine. The diagnosis relies on the thorough analysis of a rectal suction biopsy (RSB), which must show a complete absence of GCs after careful examination of at least 100 serial sections. Such a negative characteristic explains the difficulty of this diagnosis. Moreover, GCs may be immature in very young or preterm born children, making them hard to recognize. Therefore, ancillary techniques have been developed as diagnostic help, such as acetylcholinesterase histochemistry and calretinin immunostaining. These techniques reveal only indirect clues, focusing mainly on the changes in nerve fibers, but not on GCs themselves. As PHOX2B has been shown to be a very specific transcription factor in GCs and in progenitor enteric nerve cells, we have assessed (i) PHOX2B immunostaining in immature enteric ganglia and (ii) the use of PHOX2B immunostaining for the recognition of GCs on RSBs for suspicion of HD. We have observed PHOX2B expression in all GCs, both mature and immature, and its complete absence in Hirschsprung cases. We suggest that the use of PHOX2B immunostaining is of great help (i) in the recognition of GCs on RSBs regardless of their differentiation and therefore (ii) in the diagnosis of HD.
Inversion Recovery Susceptibility Weighted Imaging With Enhanced T2 Weighting at 3 T Improves Visualization of Subpial Cortical Multiple Sclerosis Lesions
Authors: Beck Erin S. , Gai Neville , Filippini Stefano , Maranzano Josefina , Nair Govind , Reich Daniel S.
Published: June 2020

Objectives

Cortical demyelination is common in multiple sclerosis (MS) and can be extensive. Cortical lesions contribute to disability independently from white matter lesions and may form via a distinct mechanism. However, current magnetic resonance imaging methods at 3 T are insensitive to cortical, and especially subpial cortical, lesions. Subpial lesions are well seen on T2*-weighted imaging at 7 T, but T2*-weighted methods on 3 T scanners are limited by poor lesion-to-cortex and cerebrospinal fluid-to-lesion contrast. We aimed to develop and evaluate a cerebrospinal fluid–suppressed, T2*-weighted sequence optimized for subpial cortical lesion visualization.

Materials and Methods

We developed a new magnetic resonance imaging sequence, inversion recovery susceptibility weighted imaging with enhanced T2 weighting (IR-SWIET; 0.8 mm × 0.8 mm in plane, 0.64 mm slice thickness with whole brain coverage, acquisition time ~5 minutes). We compared cortical lesion visualization independently on IR-SWIET (median signal from 4 acquisitions), magnetization-prepared 2 rapid acquisition gradient echoes (MP2RAGE), double inversion recovery (DIR), T2*-weighted segmented echo-planar imaging, and phase-sensitive inversion recovery images for 10 adults with MS. We also identified cortical lesions with a multicontrast reading of IR-SWIET (median of 2 acquisitions), MP2RAGE, and fluid-attenuated inversion recovery (FLAIR) images for each case. Lesions identified on 3 T images were verified on “gold standard” 7 T T2* and MP2RAGE images.

Results

Cortical, and particularly subpial, lesions appeared much more conspicuous on IR-SWIET compared with other 3 T methods. A total of 101 true-positive subpial lesions were identified on IR-SWIET (average per-participant sensitivity vs 7 T, 29% ± 8%) versus 36 on MP2RAGE (5% ± 2%; comparison to IR-SWIET sensitivity, P = 0.07), 17 on FLAIR (2% ± 1%; P < 0.05), 28 on DIR (6% ± 2%; P < 0.05), 42 on T2*-weighted segmented echo-planar imaging (11% ± 5%; P < 0.05), and 13 on phase-sensitive inversion recovery (4% ± 2%; P < 0.05). When a combination of IR-SWIET, MP2RAGE, and FLAIR images was used, a total of 147 subpial lesions (30% ± 5%) were identified versus 83 (16% ± 3%, P < 0.01) on a combination of DIR, MP2RAGE, and FLAIR. More cases had at least 1 subpial lesion on IR-SWIET, and IR-SWIET improved cortical lesion subtyping accuracy and correlation with 7 T subpial lesion number.

Conclusions

Subpial lesions are better visualized on IR-SWIET compared with other 3 T methods. A 3 T protocol combining IR-SWIET with MP2RAGE, in which leukocortical lesions are well seen, improves cortical lesion visualization over existing approaches. Therefore, IR-SWIET may enable improved MS diagnostic specificity and a better understanding of the clinical implications of cortical demyelination.
Onset, Duration, and Pain Score Obtained Using Lidocaine Mixed With Epinephrine and Bicarbonate in Plastic Surgery
Authors: Kim Hun , Hwang Kun
Published: June 2020

The aim of this study was to systematically review the effects of lidocaine mixed with epinephrine and bicarbonate in plastic surgery in terms of onset, duration, and the pain score.

In PubMed, Embase, Web of Science, and the Cochrane Library, the terms “epinephrine” AND “lidocaine” AND “plastic surgery” were searched, resulting in 210 titles. Among them, 25 full papers were reviewed, 11 were excluded, and 5 mined papers were added. Therefore, 19 papers were analyzed.

The mean time for the onset of maximum vasoconstriction caused by lidocaine with epinephrine (LE) ranged from 1.3 minutes (1:50,000 epinephrine) to 25.9 minutes (1:100,000 epinephrine). The mean duration of vasoconstriction caused by LE ranged from 40 minutes (1:100,000 epinephrine) to 136.7 minutes (1:50,000 epinephrine) on the forearm, and 60 minutes (1:100,000 and 1:200,000 epinephrine) on the face. The mean duration of local anesthesia ranged from 112.0 minutes (1:1,600,000 epinephrine) to 480 minutes (1:80,000 epinephrine). Before sodium bicarbonate (SB) was mixed with 1% lidocaine and 1:100,000 epinephrine, the mean pH ranged from 4.05 to 4.24. After mixing SB with 1% lidocaine and 1:100,000 epinephrine, the solution became alkalized, and the mean pH ranged from 7.05 to 7.66. For alkalization, the ratio of LE to SB was 9:1 to 10:1. Before alkalization of LE, the mean pain score ranged from 2.35 to 7.6. In contrast, after alkalizing the mixture by adding 8.4% SB, the mean pain score ranged from 0.64 to 4.3.

The results of this study may be helpful for using lidocaine in plastic surgery.
Planning Minimal Access Incisions in Resectioning Benign Parotid Tumors
Authors: Guan Boyu , Tan Xuexin , Li Yuexiao , Xie Zhijun , Li Sisi , Sun Changfu
Published: June 2020

Background:

Traditional parotid surgery leaves visible submaxillary cicatrices, unaesthetic results from incisions, and a high incidence of postoperative complications. This study aimed to examine the feasibility of newly designed incisions for the removal of benign parotid lesions.

Methods:

The authors randomly assigned patients (n = 48) with benign parotid lesions admitted to our department from November 2016 to April 2019. In the study group, an aesthetic incision was designed through a preoperative examination combined with a medical history and physical examination. Half of the patients (n = 24) underwent surgery with the new incision design, while the patients in the control group (n = 24) received conventional surgery. The therapeutic effects and outcomes of the two groups were compared.

Results:

The postoperative complication rate of the study group (n = 6) was significantly lower than that of the control group (n = 15). Compared to conventional surgery, patients who received the hidden incisions had less total drainage volume, decreased length of incision, and fewer days of postoperative hospitalization (P < 0.05). On an average follow-up of 20 months, no recurrence was found in any patient.

Conclusions:

Minimal access incisions, aided with loupe magnification, greatly improve the surgical safety, patient outcomes, and final scar appearance. The described technique is worth further study and utilization.
The Effect of Atmospheric Pressure Cold Plasma Application on Titanium Barriers: A Vertical Bone Augmentation
Authors: Akçay Hüseyin , Ercan Utku Kürşat , Bahçeci Selen , Ulu Murat , Ibiş Fatma , Enhoş Şükrü
Published: June 2020

Objective:

The aim of the present, microcomputed tomographic (μCT) and histological study, was to evaluate the effect of surface modification by atmospheric pressure cold plasma (APCP) on vertical guided bone regeneration in a rabbit calvaria model.

Material-Methods:

The experimental study was conducted on 12 male New Zealand rabbits with healing periods of 45 and 90 days. Following surgical exposure of the calvarium, 4 customized titanium cylindricalders were fixed. Surface modification was achieved by application of APCP on 2 of cylinders (P+) in each calvarium and other cylinders were set as control (P−). In both experimental and control groups, one of the cylinders was filled with bone graft (G+) while the other one was left empty (G−). To evaluate short term effects, randomly selected 6 animals were sacrificed at the end of 45 days and remaining 6 animals were left for observing long term effects. Histological and μCT evaluations were used to examine new bone formation.

Results:

In μCT imaging; the bone volume was greater (P < 0.05) in grafted groups than nongrafted groups in both short and long term. The bone height values were significantly different in (P-G-) group than other groups (P < 0.05) in both evaluation periods. The histological evaluations revealed significant differences between P+G+ group and other groups but in long term both plasma treated groups revealed more bone formation than non plasma treated groups.

Conclusion:

Modification of the surfaces of titanium cylinders by APCP treatment, accelerated the bone regeneration either bone graft used or not in a rabbit calvaria model.
Le Fort I Osteotomy Complicated by Presence of Maxillary Sinus Septa
Authors: Samsudin Ab Rani , Qabbani Ali , Wahbi Saad
Published: June 2020

Presence of maxillary sinus septa, an anatomical variant, has never been documented as a possible complication of Le Fort I orthognathic surgery procedure. This case report describes the difficulty faced by an experienced surgeon during Le Fort I down-fracture procedure. The osteotomized maxilla remained firm despite confirmation that all osteotomy cuts have been performed adequately. The presence of a bilateral sagittally oriented maxillary sinus septa extending from the floor to the roof of the sinus in this case had prevented separation of the lower maxilla during down-fracture maneuver. Such normal anatomical variant must be identified during orthognathic surgery treatment planning session to avoid grave complications.
Morphometric Development of the Mandible in Fetal Cadavers
Authors: Kastamoni Yadigar , Dursun Ahmet , Sanli Onur Can , Yuzbasioglu Neslihan , Albay Soner
Published: June 2020

Purpose:

The aim of this study is to present reliable data by measuring the morphometric properties of the mandible in the fetal period.

Methods:

A study was performed on mandibles of 35 fetuses (18 male fetuses and 17 female fetuses), aged between 21 and 40 weeks of gestation. Fetuses were examined in 3 groups according to their developmental stages: 2nd trimester, 3rd trimester, and full-term. Morphometric measurements were performed for both the right and left sides of each mandible. The measurements of the mental foramen were performed using a digital caliper, and other measurements were performed using the ImageJ program. The data obtained were analyzed using the SPSS 20 for Windows program.

Results:

There was no significant gender difference for all parameters. When the parameters were compared by the trimesters, no significant difference was determined in the 2nd trimester - 3rd trimester, 3rd trimester-full-term, and second trimester - full-term comparisons of the angle of the mandible, and there was a significant difference in all other parameters (P < 0.05). According to the trimesters, all parameters, except the angle of the mandible, increased naturally with the development of the mandible. It was observed that the angle of the mandible decreased from the 2nd trimester to the 3rd trimester and increased from the 3rd trimester to the full term. When the right and left measurements were compared, no significant difference was found for all parameters in both general and trimester groups.

Conclusion:

The present study includes fetal mandibular parameters that have not been reported elsewhere. It is thought that the obtained data will contribute to the determination of anomalies, pathologies, and variations.
Combined Technique of Temporal Muscle Augmentation for Muscle Reconstruction in Case of Small to Medium Anatomic Defects
Authors: Gagliardi Filippo , Roncelli Francesca , Noris Alice , Piloni Martina , Bailo Michele , Caputy Anthony J. , Mortini Pietro
Published: June 2020

Inadequate temporal muscle (TM) reconstruction after surgery may hesitate in potentially severe functional and aesthetic sequelae, making it of paramount importance to carefully consider TM reconstruction even in case of small deformities.

The authors describe the combined temporal muscle augmentation technique (CTMA), an innovative technique for TM augmentation for muscle reconstruction in case of small to medium substance loss.

A cadaver study was conducted as preclinical validation of the technique for the assessment of CTMA coverage capability. CTMA consists in a combination of 2 techniques for muscle surface coverage (MSC) increase: the radial (RA) and the longitudinal augmentation (LA), which enables to harvest a radial (RF) and a longitudinal flap (LF), respectively.

Each flap derives from a different muscle-bundle, spearing TM segmentation and functional performance, and are supplied by a specific neuro-vascular peduncle, which makes flaps functionally independent.

A surgical case is reported to demonstrate the feasibility of the technique.

Combined temporal muscle augmentation technique provides an overall coverage surface of 6.5 ± 0.6 cm2, which corresponds to a gap distance of 2.5 ± 0.2 cm, with RF providing a statistically significant larger surface of coverage compared to LF (×2.1; P = 0.0001).

Combined temporal muscle augmentation technique is easy and fast to perform displaying a good reconstructive capability with complete preservation of temporal muscle anatomic compartmentalization and segmental vasculature. It might be considered as a safe and effective alternative in the reconstruction of small-to medium TM defects.
Outcomes in Velopharyngeal Dysfunction Treatment: Comparing Two Approaches for Pharyngeal Flaps
Authors: Rangwani Shiva , Baylis Adriane , Khansa Ibrahim , Pearson Gregory
Published: June 2020

Background:

The most common surgical intervention to treat velopharyngeal dysfunction in the US is the posterior pharyngeal flap (PPF). In this retrospective study, the authors compare surgical and speech outcomes across 2 PPF surgical approaches: the palatal split (PS) and fish mouth (FM) techniques.

Methods:

An Institutional Review Board approved retrospective chart review was performed for PPF cases performed by a single surgeon between 2008 and 2016. Overall, 40 patients received the PS technique and 47 received the FM technique. Age at surgery, operative length, length of stay (LOS), revisional surgery, and pain medication administration were measured. Speech outcomes were measured based on the Universal Parameters for Reporting Speech Outcomes and included Speech Language Pathologist ratings of hypo- and hypernasality, speech acceptability, and audible nasal emission. Two sample t-tests and multivariable-mixed effects logistic regression were used to analyze the data.

Results:

Comparing the 2 groups (PS versus FM), there were statistically significant differences among the operative approaches across multiple measures: LOS (32.86 hours versus 26.20 hours, P = 0.01), acetaminophen use (1523.54 mg versus 805.74 mg, P = 0.01), revisional surgery rate (17.5% versus 2.10%, P = 0.02), and degree of postoperative hypernasality (0.61 versus 0.29, P = 0.03). Syndromic patients were more likely to receive the FM technique (PS: 15% versus FM: 29.8%; P = 0.05). The odds ratio for revision surgery with the FM technique was –2.32 (CI: –4.32 to –0.35, P = .04).

Conclusions:

In this study, the FM technique offered a shorter LOS, lower revision rate, less acetaminophen administration, and more favorable speech outcomes when compared to the PS technique.
Long-Term Clinical Outcomes, Recurrence, Satisfaction, and Regret After Total Colpocleisis With Concomitant Vaginal Hysterectomy: A Retrospective Single-Center Study
Authors: Lu Meiqiu , Zeng Wei , Ju Rui , Li Shasha , Yang Xin
Published: June 2020

Objective

This study aimed to investigate long-term study outcomes of colpocleisis along with concomitant vaginal hysterectomy for pelvic organ prolapse (POP).

Methods

A retrospective cohort study was conducted in elderly women with advanced POP who underwent total colpocleisis with or without hysterectomy from 2012 to 2017.

Results

A total of 242 elderly women were included in this study, of which 172 underwent total colpocleisis along with concomitant vaginal hysterectomy (CH group) and 70 underwent partial colpocleisis-retained uterus (LeFort group). More than one comorbidity was observed among 154 (85.9%) patients in the CH group and 56 (81.4%) patients in the LeFort group. The difference between 2 groups (CH and LeFort) in mean length of hospital staying, mean day of removing urinary catheter, mean day of farting time after operation, and postoperative complications was not statistically significant. In total colpocleisis along with hysterectomy group, a case (0.6%) of early asymptomatic endometrial cancer was diagnosed unexpectedly by pathology after hysterectomy. Median follow-up was 43.0 (19.0–85.0) months in the CH group and 45.0 (26.0–79.0) months in the LeFort group. Only one patient reported recurrence. Subjective satisfaction rate was 98.8% (CH group) versus 98.6% (LeFort group). Regret rate was 0.58% (CH group) versus 0% (LeFort group). No significant difference was observed between the 2 groups.

Conclusions

Both colpocleisis along with hysterectomy and partial colpocleisis-retained uterus are safe, with fewer complications and high long-term satisfaction. Colpocleisis along with hysterectomy is more conducive to discovery of early asymptomatic malignant tumors of the uterus, which is a suitable alternative for elderly frail women with severe POP.
Occult Uterine Malignancy at the Time of Surgery for Pelvic Organ Prolapse: A Systematic Review and Meta-analysis
Authors: Davenport Erica , James Lucas , Parks Tegan , Howard David L.
Published: June 2020

Objective

To conduct a systematic review and meta-analysis to estimate the prevalence of occult uterine malignancy of any subtype specifically at the time of hysterectomy for pelvic organ prolapse (POP).

Methods

We primarily used MEDLINE to access existing literature. The search terms used were “occult malignancy” or “occult uterine pathology” paired with “morcellation” or “hysterectomy.” Our cutoff date for articles was March 25, 2019. We further narrowed articles down based on whether they included data on occult malignancy at time of hysterectomy specifically for POP.

Results

Our search yielded a total of 233 journal articles, of which 53 met the criteria for a full-text review. Eight studies provided specific data on occult uterine malignancy among women undergoing surgery for POP and formed the basis for this meta-analysis. Among the 8 studies examined, the total number of patients combined was 35,880, and there were 144 total occult uterine malignancies. There were 7 case series and 1 population-based study included. The pooled prevalence of occult uterine malignancy at the time of hysterectomy for POP was 0.22% (95% confidence interval, 0.11%–0.35%]. There was very little heterogeneity observed across the 8 studies (I
2 = 12.06%, Q χ2[7] = 7.96, P = 0.336).

Conclusions

The pooled prevalence of occult uterine malignancy, of any subtype, at the time of surgery for POP specifically is 0.22% based on meta-analysis of existing studies. Surgeons can use this statistic as part of the preoperative counseling of patients with POP before hysterectomy.