bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Relapses or Recurrences in Patients With Giant Cell Arteritis
Authors: Gomes de Pinho Quentin , Daumas Aurélie , Benyamine Audrey , Bertolino Julien , Ebbo Mikaël , Schleinitz Nicolas , Harlé Jean-Robert , Jarrot Pierre André , Kaplanski Gilles , Berbis Julie , Boucekine Mohamed , Rossi Pascal , Granel Brigitte
Published: February 2023

Objective

Giant cell arteritis (GCA) is the most common systemic vasculitis in individuals aged ≥50 years. Its course is marked by a high relapse rate requiring long-term glucocorticoid use with its inherent adverse effects. We aimed to identify factors associated with relapses or recurrences in GCA at diagnosis.

Methods

We reviewed the medical records of consecutive patients with GCA diagnosed between 2009 and 2019 and followed for at least 12 months. We recorded their characteristics at onset and during follow-up. Factors associated with relapses or recurrences were identified using multivariable analysis.

Results

We included 153 patients, among whom 68% were female with a median age of 73 (47–98) years and a median follow-up of 32 (12–142) months. Seventy-four patients (48.4%) had at least 1 relapse or recurrence. Headache and polymyalgia rheumatica were the most frequent manifestations of relapses. The first relapse occurred at a median time of 13 months after the diagnosis, with a median dose of 5.5 (0–25) mg/d of glucocorticoids.

In multivariable analysis, patients with relapses or recurrences had a higher frequency of cough and scalp tenderness at diagnosis (20.3% vs 5.1%; odds ratio [OR], 4.73; 95% confidence interval [CI], 1.25–17.94; p = 0.022; and 41.9% vs 29.1%; OR, 2.4; 95% CI, 1.07–5.39; p = 0.034, respectively). Patients with diabetes mellitus at diagnosis had fewer relapses or recurrences during follow-up (5.4% vs 19%; OR, 0.24; 95% CI, 0.07–0.83; p = 0.024).

Conclusions

Cough and scalp tenderness at diagnosis were associated with relapses or recurrences, whereas patients with diabetes experienced fewer relapses or recurrences.
Better Together
Authors: Gatidis Sergios , Kart Turkay , Fischer Marc , Winzeck Stefan , Glocker Ben , Bai Wenjia , Bülow Robin , Emmel Carina , Friedrich Lena , Kauczor Hans-Ulrich , Keil Thomas , Kröncke Thomas , Mayer Philipp , Niendorf Thoralf , Peters Annette , Pischon Tobias , Schaarschmidt Benedikt M. , Schmidt Börge , Schulze Matthias B. , Umutle Lale , Völzke Henry , Küstner Thomas , Bamberg Fabian , Schölkopf Bernhard , Rueckert Daniel
Published: February 2023

Objectives

The UK Biobank (UKBB) and German National Cohort (NAKO) are among the largest cohort studies, capturing a wide range of health-related data from the general population, including comprehensive magnetic resonance imaging (MRI) examinations. The purpose of this study was to demonstrate how MRI data from these large-scale studies can be jointly analyzed and to derive comprehensive quantitative image-based phenotypes across the general adult population.

Materials and Methods

Image-derived features of abdominal organs (volumes of liver, spleen, kidneys, and pancreas; volumes of kidney hilum adipose tissue; and fat fractions of liver and pancreas) were extracted from T1-weighted Dixon MRI data of 17,996 participants of UKBB and NAKO based on quality-controlled deep learning generated organ segmentations. To enable valid cross-study analysis, we first analyzed the data generating process using methods of causal discovery. We subsequently harmonized data from UKBB and NAKO using the ComBat approach for batch effect correction. We finally performed quantile regression on harmonized data across studies providing quantitative models for the variation of image-derived features stratified for sex and dependent on age, height, and weight.

Results

Data from 8791 UKBB participants (49.9% female; age, 63 ± 7.5 years) and 9205 NAKO participants (49.1% female, age: 51.8 ± 11.4 years) were analyzed. Analysis of the data generating process revealed direct effects of age, sex, height, weight, and the data source (UKBB vs NAKO) on image-derived features. Correction of data source-related effects resulted in markedly improved alignment of image-derived features between UKBB and NAKO. Cross-study analysis on harmonized data revealed comprehensive quantitative models for the phenotypic variation of abdominal organs across the general adult population.

Conclusions

Cross-study analysis of MRI data from UKBB and NAKO as proposed in this work can be helpful for future joint data analyses across cohorts linking genetic, environmental, and behavioral risk factors to MRI-derived phenotypes and provide reference values for clinical diagnostics.
Usefulness of Breath-Hold Fat-Suppressed T2-Weighted Images With Deep Learning–Based Reconstruction of the Liver
Authors: Ichinohe Fumihito , Oyama Kazuki , Yamada Akira , Hayashihara Hayato , Adachi Yasuo , Kitoh Yoshihiro , Kanki Yusuke , Maruyama Katsuya , Nickel Marcel Dominik , Fujinaga Yasunari
Published: February 2023

Objectives

The aim of this study was to evaluate the usefulness of breath-hold turbo spin echo with deep learning–based reconstruction (BH-DL-TSE) in acquiring fat-suppressed T2-weighted images (FS-T2WI) of the liver by comparing this method with conventional free-breathing turbo spin echo (FB-TSE) and breath-hold half Fourier single-shot turbo spin echo with deep learning–based reconstruction (BH-DL-HASTE).

Materials and Methods

The study cohort comprised 111 patients with suspected liver disease who underwent 3 T magnetic resonance imaging. Fifty-eight focal solid liver lesions ≥10 mm were also evaluated. Three sets of FS-T2WI were acquired using FB-TSE, prototypical BH-DL-TSE, and prototypical BH-DL-HASTE, respectively. In the qualitative analysis, 2 radiologists evaluated the image quality using a 5-point scale. In the quantitative analysis, we calculated the lesion-to-liver signal intensity ratio (LEL-SIR). Friedman test and Dunn multiple comparison test were performed to assess differences among 3 types of FS-T2WI with respect to image quality and LEL-SIR.

Results

The mean acquisition time was 4 minutes and 43 seconds ± 1 minute and 21 seconds (95% confidence interval, 4 minutes and 28 seconds to 4 minutes and 58 seconds) for FB-TSE, 40 seconds for BH-DL-TSE, and 20 seconds for BH-DL-HASTE. In the qualitative analysis, BH-DL-HASTE resulted in the fewest respiratory motion artifacts (P < 0.0001). BH-DL-TSE and FB-TSE exhibited significantly less motion-related signal loss and clearer intrahepatic vessels than BH-DL-HASTE (P < 0.0001). Regarding the edge sharpness of the left lobe, BH-DL-HASTE scored the highest (P < 0.0001), and BH-DL-TSE scored higher than FB-TSE (P = 0.0290). There were no significant differences among 3 types of FS-T2WI with respect to the edge sharpness of the right lobe (P = 0.1290), lesion conspicuity (P = 0.5292), and LEL-SIR (P = 0.6026).

Conclusions

BH-DL-TSE provides a shorter acquisition time and comparable or better image quality than FB-TSE, and could replace FB-TSE in acquiring FS-T2WI of the liver. BH-DL-TSE and BH-DL-HASTE have their own advantages and may be used complementarily.
Efficacy and Safety of Gadopiclenol for Contrast-Enhanced MRI of the Central Nervous System
Authors: Loevner Laurie A. , Kolumban Balint , Hutóczki Gábor , Dziadziuszko Katarzyna , Bereczki Daniel , Bago Attila , Pichiecchio Anna
Published: February 2023

Objectives

Developing new high relaxivity gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging (MRI) allowing dose reduction while maintaining similar diagnostic efficacy is needed, especially in the context of gadolinium retention in tissues. This study aimed to demonstrate that contrast-enhanced MRI of the central nervous system (CNS) with gadopiclenol at 0.05 mmol/kg is not inferior to gadobutrol at 0.1 mmol/kg, and superior to unenhanced MRI.

Materials and Methods

PICTURE is an international, randomized, double-blinded, controlled, cross-over, phase III study, conducted between June 2019 and September 2020. Adult patients with CNS lesions were randomized to undergo 2 MRIs (interval, 2–14 days) with gadopiclenol (0.05 mmol/kg) then gadobutrol (0.1 mmol/kg) or vice versa. The primary criterion was lesion visualization based on 3 parameters (border delineation, internal morphology, and contrast enhancement), assessed by 3 off-site blinded readers. Key secondary outcomes included lesion-to-background ratio, enhancement percentage, contrast-to-noise ratio, overall diagnostic preference, and adverse events.

Results

Of the 256 randomized patients, 250 received at least 1 GBCA administration (mean [SD] age, 57.2 [13.8] years; 53.6% women). The statistical noninferiority of gadopiclenol (0.05 mmol/kg) to gadobutrol (0.1 mmol/kg) was achieved for all parameters and all readers (n = 236, lower limit 95% confidence interval of the difference ≥−0.06, above the noninferiority margin [−0.35], P < 0.0001), as well as its statistical superiority over unenhanced images (n = 239, lower limit 95% confidence interval of the difference ≥1.29, P < 0.0001).

Enhancement percentage and lesion-to-background ratio were higher with gadopiclenol for all readers (P < 0.0001), and contrast-to-noise ratio was higher for 2 readers (P = 0.02 and P < 0.0001). Three blinded readers preferred images with gadopiclenol for 44.8%, 54.4%, and 57.3% of evaluations, reported no preference for 40.7%, 21.6%, and 23.2%, and preferred images with gadobutrol for 14.5%, 24.1%, and 19.5% (P < 0.001).

Adverse events reported after MRI were similar for gadopiclenol (14.6% of patients) and gadobutrol (17.6%). Adverse events considered related to gadopiclenol (4.9%) and gadobutrol (6.9%) were mainly injection site reactions, and none was serious.

Conclusions

Gadopiclenol at 0.05 mmol/kg is not inferior to gadobutrol at 0.1 mmol/kg for MRI of the CNS, confirming that gadopiclenol can be used at half the gadolinium dose used for other GBCAs to achieve similar clinical efficacy.
Treatment Response to Lycopene in Recurrent Prostate Cancer Confirmed on 18F-Fluciclovine PET/CT
Authors: Wu Chenxi , Marcus Charles , Baum Yoram , Kucuk Omer , Schuster David M.
Published: February 2023

18F-fluciclovine (Axumin; Blue Earth Diagnostics, Ltd, Oxford, United Kingdom) PET has shown value in detecting biochemical recurrent prostatic cancer. Lycopene, a plant-based carotenoid, is reported to have potential inhibitory effect on prostate cancer, as a complementary treatment. We report a case of biochemically recurrent prostate cancer showing treatment response to lycopene as seen on an 18F-fluciclovine PET/CT correlating with serum prostate-specific antigen response.
Abdominopelvic Hemangiopericytoma Mimicking Neuroendocrine Tumor on 68Ga-DOTANOC PET/CT
Authors: Prakash Sneha , Shamim Shamim Ahmed , Rastogi Sameer
Published: February 2023

We present the case of a 60-year-old man who was being evaluated for 2 intra-abdominal masses. The masses were tracer avid on 68Ga-DOTANOC PET/CT and were suggestive of neuroendocrine tumor. Histopathology, however, confirmed the masses to be hemangiopericytoma. Hemangiopericytoma comes under the umbrella of solitary fibrous tumors, a rare tumor group arising from the mesenchymal cells. Solitary fibrous tumors commonly arise from the pleura but can occur anywhere in the body. Intra-abdominal hemangiopericytoma are extremely rare and should be kept in mind as one of the differential diagnoses for 68Ga-DOTA peptide–avid tumors.
Extrastriatal 99mTc-TRODAT-1 Uptake in the Previous Hemorrhage With Hemosiderin Deposition
Authors: Lee Tse-Hao , Wang Yuh-Feng , Peng Nan-Jing
Published: February 2023

We reported a 91-year-old man who was suspected of having parkinsonism, and brain 99mTc-TRODAT-1 scan revealed an extrastriatal uptake in the left side of brainstem, which was correlated to a previously hemorrhagic lesion with hemosiderin deposition. Macrophage or microglia might accumulate in the previous hemorrhagic lesion to phagocytize hemosiderin. We assumed that the 99mTc-TRODAT-1 uptake in the hemosiderin deposition might be partially mediated by macrophage expressing dopamine transporter.
Head-to-Head Comparison of 68Ga-P16-093 and 68Ga-PSMA-617 PET/CT in Patients With Primary Prostate Cancer
Authors: Wang Guochang , Li Linlin , Zang Jie , Hong Haiyan , Zhu Lin , Kung Hank F. , Zhu Zhaohui
Published: February 2023

Purpose

We aimed to compare the diagnostic performance of 68Ga-P16-093 and 68Ga-PSMA-617 PET/CT in primary prostate cancer (PCa) patients.

Patients and Methods

Thirty untreated primary PCa patients were enrolled. Each patient underwent 68Ga-P16-093 and 68Ga-PSMA-617 PET/CT within a week. In addition to visual analysis, SUV was measured for semiquantitative comparison and correlation analysis.

Results

68Ga-P16-093 PET/CT detected more positive tumors than 68Ga-PSMA-617 PET/CT (67 vs 56, P = 0.002), especially for intraprostatic lesions (29 vs 24, P = 0.025) and lymph node metastases (23 vs 17, P = 0.034). Further, 68Ga-P16-093 PET/CT exhibited significantly higher SUVmax of matched tumors (18.3 ± 14.4 vs 13.9 ± 11.8, P < 0.001). Besides, the SUVmax of high-risk patients (based on D’Amico classification) on 68Ga-P16-093 PET/CT was significantly higher than that of low- and intermediate-risk PCa patients (20.9 ± 9.9 vs 8.9 ± 9.1 vs 10.1 ± 5.2, P = 0.007). The SUVmax of tumor measured by 68Ga-P16-093 PET/CT had a moderate association with biopsy Gleason score (r = 0.462, P = 0.005) and prostate-specific antigen value (r = 0.491, P = 0.002), and significantly correlated with PSMA expression (r = 0.732, P < 0.001).

Conclusions

68Ga-P16-093 PET/CT exhibited higher tumor uptake and potentially better tumor detection capability than 68Ga-PSMA-617 PET/CT, which suggested that 68Ga-P16-093 may be more suitable in the diagnosis and staging of primary PCa patients.
68Ga-PSMA–Avid Intranasal Solitary Fibrous Tumor
Authors: Riaz Saima , Priftakis Dimitrios , Afaq Asim , Kayani Irfan , Bomanji Jamshed
Published: February 2023

The utility of molecular imaging in solitary fibrous tumors has not been fully established. We present a rare case of recurrent intranasal solitary fibrous tumor incidentally localized on 68Ga-PSMA PET/CT scan, which turned out to be metabolically inactive on 18F-FDG PET/CT.
Clinical Impact of SPECT/CT in Evaluation of Abdominothoracic Fistula
Authors: Kang Seo Young , Moon Byung Seok , Yoo Min Young , Yoon Hai-Jeon , Kim Bom Sahn
Published: February 2023

Abdominothoracic fistula is rarely observed but can be life-threatening. Pleuroperitoneal communication, known to occur in 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis, is an uncommon but well-recognized complication. The most common symptoms are dyspnea and right-sided pleural effusion. A biliopleural fistula is well-described as a complication of radiofrequency ablation and transcatheter arterial chemoembolization of hepatic lesions. It is important to diagnose the cause of pleural effusion early for proper treatment because if the abdominothoracic fistula effusion amount is not large, appropriate diagnosis may be difficult. Here, we introduce 2 cases showing the usefulness of SPECT/CT in evaluating pleuroperitoneal and biliopleural fistulas.
Radiological Evidence of Testicular Damage in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Sonoelastography's Potential Role
Authors: Dündar İlyas , Özkaçmaz Sercan , Demir Murat , Özgökçe Mesut , Durmaz Fatma , Özkaçmaz Ayşe , Taken Kerem , Göya Cemil
Published: February 2023

This preliminary study aimed to evaluate the possible damage to the male reproductive system that the severe acute respiratory syndrome coronavirus 2 virus causes by quantitatively measuring and comparing the tissue stiffness of the testis and epididymis with acoustic radiation force impulse sonoelastography in patients who have COVID-19 with a healthy control group. This prospective study was conducted between February and July 2021 with 65 cases. We used sonoelastography to evaluate male patients 18 years or older, who had applied to the urology clinic with nontesticular complaints, and were found to not have any underlying testicular pathology after a clinical-laboratory evaluation. The clinical-laboratory imaging findings and reverse transcription–polymerase chain reaction test results of all patients diagnosed with COVID-19 were reviewed from the hospital database. We measured the shear wave velocity values of the epididymis and the testes of 31 proven severe acute respiratory syndrome coronavirus 2 patients and 34 healthy subjects and compared them with an independent t test. For the patient and control group subjects, the mean age was 37.55 ± 13.08 (23–71) and 40.5 ± 16.25 (18–81) years, respectively. The mean shear wave velocity values of the left-right and bilateral testes and epididymis of the patient group were statistically substantially higher (P ˂ 0.05) than in the control group. In the receiver operating characteristic analysis, when the cutoff values for the bilateral testes and epididymis were determined as 1.39 and 1.64 m/s, respectively, the AUC was 77% to 73.4%, the sensitivity was 87% to 74%, and the specificity was 65% to 62%. Our findings show that testicular and epididymal tissue stiffness increased in patients with COVID-19. We recommend adding sonoelastography to urogenital examinations of male reproductive system in patients who are recovering from COVID-19.
Traditional Neuroma Management Strategies
Authors: Chou Jesse , Liston Jared M. , DeGeorge Brent R.
Published: February 2023

Background

In this systematic review, the authors discuss traditional management strategies of neuromas. Surgical management can be described as either passive and ablative or active and reconstructive. Our aim was to evaluate the evidence supporting traditional management strategies in patients affected by neuromas.

Methods

The systematic literature search was conducted in PubMed/MEDLINE databases using search terms related to neuromas and their surgical management. Studies involving targeted muscle reinnervation or regenerative peripheral nerve interface were excluded. Two reviewers selected the studies, evaluated their methodological quality, and retrieved data independently. This review was conducted in a manner consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Selected studies were analyzed for pain and functional outcomes.

Results

A total of 1064 articles were identified, and 22 studies were selected for review. Passive or ablative modalities for treatment of neuromata include excision of neuroma, excision with implantation into adjacent tissue, nerve caps, vein cap, and relocation nerve grafting. Active or reconstructive modalities that allow for nerve regeneration include hollow tube reconstruction, reconstruction with an allograft, and centrocentral nerve anastomosis.

Conclusions

Passive treatment modalities can offer reliable pain relief in appropriately selected patients but do not allow for nerve regeneration. As such active, reconstructive modalities should be used when possible.
Influence of Transforming Growth Factors beta 1 and beta 3 in the Scar Formation Process
Authors: Lee Joon Seok , Cho Hyun Geun , Lee Jeong Woo , Oh Eun Jung , Kim Hyun Mi , Ko Ung Hyun , Kang Minwoo , Shin Jennifer H. , Chung Ho Yun
Published: February 2023

Background:

Transforming growth factor-beta (TGF-β) plays an instrumental role in forming scars and keloids. TGF-β isoforms exhibit differential expression, indicating distinct wound healing and scar formation functions. However, the role of TGF-β1 and TGF-β3 in wound healing and scar formation remains unclear. This study aimed to compare the specific roles of TGF-β1 and TGF-β3 in wound healing and scar formation by biomolecular analysis.

Materials and Methods:

The study was conducted by cell isolation and culture cells from a total of 20 human samples. Normal human fibroblasts (NHF) were isolated from normal human samples and myofibroblasts from the different scar types, namely hypertrophic (HT) and keloid (K) scars. NHF and cells from the HT, and K scar, each of which were divided into 3 sample groups: the untreated control, TGF-β1 (10 µg/mL)-treated group, and TGF-β3 (10 µg/mL)-treated group. The results of confocal microscopy and fluorescence-activated cell sorting experiments were compared.

Results:

Both the HT and K groups had higher α-smooth muscle actin (α-SMA) expression than the NHF group in the untreated control group. In comparison with the untreated group, NHFs showed a significant increase in α-SMA expression in the TGF-β1-treated group. HT showed a high α-SMA level, which was statistically significant compared with the normal fibroblasts. In the TGF-β3-treated group, α-SMA expression was slightly increased in NHF as compared with the untreated group. TGF-β3 treated HT exhibited a greater reduction in α-SMA expression than in the TGF-β1 treated HT. K, on the other hand, had only a minimal effect on the treatment of TGF-β1 and TGF-β3.

Conclusions:

The findings suggest that TGF-β3 may play a regulatory role in the wound repair process, which could be useful in the development of scar-reducing therapies for patients with scar-related cosmetic concerns.
Apert Syndrome Type III Hand: Prevalence and Outcomes
Authors: Raposo-Amaral Cassio E. , Medeiros Lucas L. , Raposo-Amaral Cesar A.
Published: February 2023

Background:

The Upton type III hand, which represents the most severe hand type among Apert syndrome patients, has been considered the least prevalent hand type. The objective of this study is to address type III Apert hand prevalence and describe treatment strategies that will result in a 5 digit hand.

Methods:

The authors retrospectively reviewed 15 years of Apert syndrome hand practice at our hospital. Demographic (patient sex and age at the time of the operation), surgical (eg, techniques used for webspace release, osteotomy, and various aspects of soft-tissue reconstruction), and outcome (perioperative and long-term complication and need for revision operation) data was verified through medical records, clinical photographs, radiographic images, and interviews with patients’ families. Patients who had incomplete medical records and/or postoperative follow up <6 months in length were excluded from this study.

Results:

A total of 93 Apert patients [50 male (56.1%) and 43 female (43.9%)] were treated at our hospital from 2007 to 2021. Stratification of Apert hand severity using Upton’s classification system identified 34 patients with type I hands (36.4%), 19 patients with type II hands (20.6%), and 40 patients with type III hands (43%). Of the 40 patients with type III hands a 5 digit hand was achieved for 35 patients (87%), with an average of 3.37 operations per patient.

Conclusions:

The Upton type III hand is the most prevalent hand type among Apert syndrome patients. Following a three stage protocol, a surgical team can consistently achieve a 5 digit hand for the majority of Apert syndrome patients with type III hands.
Preliminary Application Research of 3D Bioprinting in Craniofacial Reconstruction
Authors: Yan Yingjie , Zhang Ziwei , Han Wenqing , Sun Mengzhe , Kim Byeong Seop , Zhang Yan , Xu Haisong , Lei Dong , Chai Gang
Published: February 2023

Introduction:

In recent years, 3-dimensional (3D) printing has been widely used in regenerative medicine research and other fields because of its ability to customize macroscopic morphology and precisely control microstructure. Polymer scaffolds are 1 of the commonly used 3D bioprinting materials for defect repair and have recently been a research focus. Our article explored the bone-formation accelerating effect of 3D-printed porous scaffold Poly(glycerol sebacate) [PGS] in the critical bone defect of an enhancing rabbit mandibular model. Also, we overview and summarize the classification of 3D bioprinting materials and prospects for their various application scenarios in craniofacial reconstruction surgery.

Materials and Methods:

A PGS elastomer scaffold was prepared by polymerizing equimolar amounts of sebacic acid and glycerol using a biological 3D printer. Six male New Zealand white rabbits were prepared (3 for the control group and 3 for the PGS group), each weighing 3 kg. Osteotomy was performed at the anterior edge of the ascending ramus of the mandible with a bone saw to open the 8 mm defect. Defects of the control group were empty, and defects of the PGS group were put into 8 mm-wide PGS elastomer scaffolds. The rabbits were euthanized 6 weeks after the operation, and the postoperative mandibles were collected. Information (presence or absence of pus from infection, nonunion, degree of macroscopic bone healing) was recorded, and the skeletal tissue was fixed in a paraformaldehyde solution.

Results:

The mandible on the enhanced side was significantly longer than that on the opposite side, and the contralateral incisor was hyperplasia. The mandibles of rabbits in each group healed well, and there was no obvious local infection and purulence. The gross specimen appearance showed that both ends of the defect were connected. When comparing the reconstructed mandibles of the two groups, it is apparent that the width and thickness of the new bone in the PGS group were significantly better than that in the control group.

Conclusions:

This article verifies the effect of 3D polypore PGS scaffolds in animal craniomaxillofacial bone defects and introduces various application scenarios of 3D printing materials in craniomaxillofacial reconstruction surgery. There are quite good application prospects for 3D bioprinting in animal experiments and even clinical treatment of craniofacial defects.
Skin Mixed Tumor of Right Nose
Authors: Sun Zhenbang , Li Jisen , Tian Bo , Wang Weijing , Wang Shaohua
Published: February 2023

Skin mixed tumors are extremely rare clinically, lack characteristic manifestations, and are easily confused with other diseases. An Asian male came to our hospital’s cosmetic and plastic surgery department because of a skin mass on the right side of his nose. After unanimous discussion by our doctors, the patient underwent subcutaneous tumor resection under local anesthesia and rotational flap transplantation to treat the disease and improve the shape of the nose. The surgery was a success. The patient was checked regularly, and the sutures were removed 1 week later. The patient’s wound was normal after suture removal. During the 5-month follow-up, the patient’s right nose showed no recurrence, the appearance was normal, and the scar was not obvious. The patient was satisfied.
A Rare Case of Metal Exposure After Internal Fixation of Facial Bone Fracture With Autogenous Bone Graft
Authors: Shin Jin Yong , Roh Si-Gyun , Lee Nae-Ho
Published: February 2023

Few studies have reported complications in metal fixation systems, such as infection or device exposure. Here, we report our experience with exposed metal screws after the reduction of facial bone fracture. This will be a useful guide to using a metal fixation system in situations in which metal fixation systems should not be used.
A Feasible Technique for Transoral Endoscopic Thyroidectomy Through Vestibular Access Using a Single-port Technique
Authors: Karimov Ziya , Turk Yigit , Ozdemir Murat , Celik Servet , Bilge Okan , Frattini Francesco , Dionigi Gianlorenzo , Makay Ozer
Published: February 2023

Background:

The aim of this study was to evaluate the safety and feasibility of a single-port system for transoral endoscopic thyroidectomy with vestibular access (TOETVA).

Materials and Methods:

Two embalmed human cadavers were used to test the single-port technique. After positioning, a median vestibular incision was made. Adipose tissue was dissected through the mentum with a Kelly clamp to reach the subplatysmal level. The Keyport Single Port System (Richard Wolf) was then inserted. After port placement, flexible endoscopic dissectors and a 5-mm endoscope were advanced. After removing the dissectors, we inserted the ArtiSential laparoscopic instruments. We also used a 3-port TOETVA on another human cadaver to compare the results with those of the single-port surgery.

Results:

In the first cadaver, skin tension was observed during trocar insertion and dissection. Trocar insertion resulted in skin perforation in the submental area. In the second cadaver, the single-port trocar was successfully inserted despite the significant skin tension. However, the trocar did not allow the necessary surgical maneuvers to proceed with subsequent surgical steps and create a working space. Postprocedural anatomic dissection revealed that the distal branches of the mental nerve were related to the trocar passage.

Conclusions:

Our cadaver study demonstrated that single-port TOETVA is unsafe and not feasible with the current technology of the Keyport single-port system. This approach needs to be improved to perform this technique without injury to distal branches of the mental nerve, skin perforation, and other complications.
Suction Drainage for Anastomotic Leakage After Ivor Lewis Esophagectomy
Authors: Lubbers Merel , van Det Marc J. , Crull David , van der Linden Andries , Vrij Anton A. , Kouwenhoven Ewout A.
Published: February 2023

Background:

Anastomotic leakage is one of the most life-threatening complications after Ivor Lewis esophagectomy (ILE), with various treatment strategies. Endoscopic techniques are emerging as a less invasive alternative to surgery. Among the current endoscopic techniques, a single placement of an endoluminal nasogastric tube inside the cavity with controlled suction drainage (SD) seems to be an attractive option. The aim of this study was to evaluate the efficacy of SD as treatment for anastomotic leakage after ILE.

Methods:

This retrospective analysis was performed among patients who underwent ILE in a high-volume esophageal cancer center in the Netherlands. Patients with an anastomotic leakage that received SD as primary treatment were selected. A nasogastric tube was endoscopically placed into the cavity of the leakage for controlled suction with 15 mm Hg.

Results:

A total of 34 patients received SD and was successful in 26 patients (77%). Seven patients (21%) developed empyema despite the SD for which additional video-assisted thoracoscopic surgery was performed. Mortality was 5.9% (2 patients) and median intensive care unit and hospital stay were 3 days (1 to 9) and 25 days (14 to 43), respectively. The median time to closure of the leak was 41 days (23 to 65). A total of 16 patients underwent home treatment for a median of 23 (14 to 42) days.

Conclusions:

Controlled SD seems to be an effective treatment for anastomotic leakage after ILE. This therapy can safely and effectively be completed in an ambulant, outpatient setting.
Endoscopic Submucosal Dissection for Large Duodenal Laterally Spreading Lesions is Feasible
Authors: Lian Jingjing , Wang Guoxiang , Li Shengxi , Chen Tao , He Lingnan , Xu Aiping , Xu Meidong
Published: February 2023

Background and Aims:

This retrospective study aimed to evaluate the effect and safety of endoscopic submucosal dissection (ESD) for large laterally spreading lesions located in the descending duodenum based on multi-center experiences.

Methods:

This multicentric retrospective study included 3 hospitals in China. Fifty-one patients with laterally spreading lesions of the duodenum who underwent ESD between February 2019 and December 2020 were enrolled. The en bloc resection rates, en bloc R0 resection rates, complication rates, and local recurrence after ESD were evaluated.

Results:

Of the 51 patients, the median age was 62 years old (ranging from 37 to 76 years old); among them, 29 were male and 22 were female. The average lesion size was 2.3 cm (ranging from 1.5 to 4.0 cm). All 51 lesions achieved en bloc R0 resection successfully, with the procedure time ranging from 20 to 117 min (median: 45.5 min). The hospital length of stay ranged from 4 to 90 days (median: 8.0 d). Two patients experienced delayed bleeding 3 days after ESD and 2 other patients were diagnosed with delayed perforation. Tumor residual and local recurrence did not occur during a short follow-up period.

Conclusions:

ESD for laterally spreading lesions of the descending duodenum is feasible.
Development and Validation of a Hypertension Risk Calculator for Living Kidney Donors
Authors: Helgeson Erika S. , Vempati Shruti , Palzer Elise F. , Mjoen Geir , Haugen Anders J. , Matas Arthur J.
Published: February 2023

Background.

Ideally, when deciding whether to donate, kidney donor candidates would understand their long-term risks. Using single-center data (N = 4055; median [quartiles] follow-up: 18 [9–28] y), we developed a calculator for postdonation hypertension and validated it using long-term data from an external single-center cohort (N = 1189, median [quartiles] follow-up: 9 [5–17] y).

Methods.

Risk factors considered were routinely obtained at evaluation from donor candidates. Two modeling approaches were evaluated: Cox proportional hazards and random survival forest models. Cross-validation prediction error and Harrell’s concordance-index were used to compare accuracy for model development. Top-performing models were assessed in the validation cohort using the concordance-index and net reclassification improvement.

Results.

In the development cohort, 34% reported hypertension at a median (quartiles) of 16 (8–24) y postdonation; and in the validation cohort, 29% reported hypertension after 17 (10–22) y postdonation. The most accurate model was a Cox proportional hazards model with age, sex, race, estimated glomerular filtration rate, systolic and diastolic blood pressure, body mass index, glucose, smoking history, family history of hypertension, relationship with recipient, and hyperlipidemia (concordance-index, 0.72 in the development cohort and 0.82 in the validation cohort).

Conclusions.

A postdonation hypertension calculator was developed and validated; it provides kidney donor candidates, their family, and care team a long-term projection of hypertension risk that can be incorporated into the informed consent process.
The Potential Pathogenicity of Myelin Oligodendrocyte Glycoprotein Antibodies in the Optic Pathway
Authors: Lerch Magdalena , Bauer Angelika , Reindl Markus
Published: February 2023

Background:

Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an acquired inflammatory demyelinating disease with optic neuritis (ON) as the most frequent clinical symptom. The hallmark of the disease is the presence of autoantibodies against MOG (MOG-IgG) in the serum of patients. Whereas the role of MOG in the experimental autoimmune encephalomyelitis animal model is well-established, the pathogenesis of the human disease and the role of human MOG-IgG is still not fully clear.

Evidence Acquisition:

PubMed was searched for the terms “MOGAD,” “optic neuritis,” “MOG antibodies,” and “experimental autoimmune encephalomyelitis” alone or in combination, to find articles of interest for this review. Only articles written in English language were included and reference lists were searched for further relevant papers.

Results:

B and T cells play a role in the pathogenesis of human MOGAD. The distribution of lesions and their development toward the optic pathway is influenced by the genetic background in animal models. Moreover, MOGAD-associated ON is frequently bilateral and often relapsing with generally favorable visual outcome. Activated T-cell subsets create an inflammatory environment and B cells are necessary to produce autoantibodies directed against the MOG protein. Here, pathologic mechanisms of MOG-IgG are discussed, and histopathologic findings are presented.

Conclusions:

MOGAD patients often present with ON and harbor antibodies against MOG. Furthermore, pathogenesis is most likely a synergy between encephalitogenic T and antibody producing B cells. However, to which extent MOG-IgG are pathogenic and the exact pathologic mechanism is still not well understood.
Is Low-Titer Group O Whole Blood Truly a Universal Blood Product?
Authors: Brill Jason B , Mueck Krislynn M , Tang Brian , Sandoval Mariela , Cotton Madeline E , McCoy C Cameron , Cotton Bryan A
Published: February 2023

BACKGROUND:

Whole blood (WB) was historically transfused as a type-specific product. Given recent advocacy for low-titer group O whole blood (LTOWB) as a universal blood product, we examined outcomes after LTOWB transfusion stratified by recipient blood groups.

STUDY DESIGN:

Adult trauma patients receiving prehospital or in-hospital transfusion of LTOWB (11/17-07/20) at a single trauma center were prospectively evaluated. Patients were divided into blood groups (O, A, B, AB). Major complications and survival to 30 days were compared. Univariate analyses among blood groups were followed by purposeful regression modeling, reflecting 6 variables of significance: male sex, White race, injury severity, arrival lactate, arrival SBP, and ED blood products.

RESULTS:

Of 1075 patients receiving any LTOWB, 539 (50.1%) were Group O, 340 (31.6%) Group A, 150 (14.0%) Group B, and 46 (4.3%) Group AB. There were no statistically significant differences in demographics, injury severity, hemolysis panels, prehospital vitals, or resuscitation parameters (all p>0.05). However, arrival systolic pressure was lower (91 vs 102, p=0.034) and lactate worse (5.5 vs 4.1, p=0.048) in Group B patients compared to other groups. While survival and most major complications did not differ across recipient groups, acute kidney injury (AKI) initially appeared higher for Group B. Stepwise regression did not show a difference in AKI rates. This analysis was repeated in patients receiving only component products. Group B again showed no significantly increased risk of AKI (13%) compared to other groups (O: 7%, A: 7%, AB: 5%; p=0.091).

CONCLUSIONS:

LTOWB appears to be a safe product for universal use across all blood groups. Group B recipients arrive with worse physiologic values associated with hemorrhagic shock whether receiving LTOWB or standard component products.
Lived experience of psychosis: challenges and perspectives for research and care
Authors: Sibeoni Jordan
Published: February 2023

Purpose of review

There is currently a recognition of the first-personal knowledge of people with lived experience of schizophrenia as an epistemic privilege that can influence and improve the quality of research and care. This review aims to identify and better understand the actual challenges and perspectives of this field.

Recent findings

Two main themes are present in the recent literature: first, the direct involvement of persons with lived experience of psychosis both in research (first person accounts, lived experience and participatory research) and care with the development of new professional positions such as expert patients and peer workers; second, the field of research on lived experience of psychosis based mostly on phenomenological psychiatry and qualitative research.

Both involvement of persons with lived experience in care and research, and research on lived experience of psychosis have direct impact and outcomes such as leading to a better understanding of psychotic phenomena and to reduced stigma and providing more person-centered and holistic care and better social support. This review also highlights the conceptual and ethical challenges to overcome, especially the risk of tokenism.
Update on genetics of attention deficit/hyperactivity disorder: current status 2023
Authors: Kranz Thorsten M. , Grimm Oliver
Published: February 2023

Purpose of review

Attention deficit/hyperactivity disorder (ADHD) shows consistently high heritability in genetic research. In this review article, we give an overview of the analysis of common and rare variants and some insight into current genetic methodology and their link to clinical practice.

Recent findings

The heritability of about 80% is also high in comparison to other psychiatric diseases. However, recent studies estimate the proportion of heritability based on single nucleotide variants at 22%. The hidden heritability is an ongoing question in ADHD genetics. Common variants derived from mega genome-wide association analyses (GWAS) and subsequent meta-analyses usually display small effect sizes and explain only a small fraction of phenotypic variance. Rare variants, on the contrary, not only display large effect sizes but also rather explain, due to their rareness, a small fraction on phenotypic variance. Applying polygenic risk score (PRS) analysis is an improved approach of combining effect sizes of many common variants with clinically relevant measures in ADHD.

We provide a concise overview on how genetic analysis, with a focus on GWAS and PRS, can help explain different behavioural phenotypes in ADHD and how they can be used for diagnosis and therapy prediction. Increased sample sizes of GWAS, meta-analyses and use of PRS is increasingly informative and sets the course for a new era in genetics of ADHD.
Factors Associated With Utilization of Electroconvulsive Therapy During Psychiatric Hospitalization Among Children and Adolescents in China
Authors: Geng Feng , Wang Song , Tian Yanghua , Jiang Feng , Conrad Rachel , Liu Tingfang , Liu Yuanli , Mo Daming , Liu Huanzhong , Tang Yi-lang
Published: February 2023

Purpose

Based on a nationally representative sample in China, we examined the demographic and clinical correlates of utilization of electroconvulsive therapy (ECT) in child and adolescent (C/A) patients younger than 18 years during psychiatric hospitalization.

Methods

As part of a national survey, 41 provincial tertiary psychiatric hospitals in mainland China were selected. Data from 196 C/A patients who were discharged from these psychiatric hospitals from March 19 to 31, 2019, were retrieved and analyzed.

Results

(1) The overall rate of ECT among C/A patients during psychiatric hospitalization was 15.6% (n = 30). (2) Between ECT and non-ECT groups, significant differences were found in sex, age, length of stay, Global Assessment of Functioning at admission, treatment outcome, and self-injurious behavior during hospitalization, and the ratio of marked improvement on discharge. (3) Multiple logistic regression analysis revealed that ECT use was independently and positively associated with an older age, male sex, lower Global Assessment of Functioning, and self-injurious behavior during hospitalization.

Conclusions

The frequency of ECT use was relatively frequent in C/A patients during psychiatric hospitalization in our nationally representative sample in China. Developing more specific and operational criteria for the use of ECT for C/A patients is needed to provide guidance for the optimal use of ECT in this patient population.
Associations of adolescent psychosocial factors to later benzodiazepine use: a population-based follow-up study of adolescent psychiatric inpatients in Northern Finland
Authors: Kujala Emmi , Hakko Helinä , Riipinen Pirkko , Riala Kaisa
Published: February 2023

We investigated factors associated with benzodiazepine (BZD) use during late adolescence and early adulthood. The study population consisted of 508 adolescents admitted to psychiatric inpatient care between April 2001 and March 2006. Information on adolescents’ family- and school-related factors, suicidality and psychiatric disorders were obtained by semistructured interviews. Data on BZD prescriptions from 1999 to 2012 were collected from the Social Insurance Institution of Finland. In males heavy BZD use associated with adolescent substance-use disorder (OR, 3.5; P < 0.004) and parents’ psychiatric problems (OR, 3.5; P = 0.029). Among females, conduct disorder (OR, 3.3; P = 0.016), being a bully/bully-victim (OR, 3.3; P = 0.019) and parental substance-use problems (OR, 2.6; P = 0.024) were related to heavy BZD use. The mean (±SD) age of first BZD prescription was significantly lower in heavy, compared with mild users (men: 19.3 ± 2.5 vs. 21.0 ± 2.5 years, P = 0.027; women: 19.7 ± 2.6 vs. 21.5 ± 3.4 years, P = 0.027). Heavy, compared with mild, BZD use is associated with female suicide attempts (OR, 5.0; P = 0.049). Physicians should be cautious when prescribing BZDs to young adults and must allocate treatment to those with carefully evaluated clinical indications.
Neural and visual processing of social gaze cueing in typical and ASD adults
Authors: Parker Termara Cerene , Zhang Xian , Noah Jack Adam , Tiede Mark , Scassellati Brian , Kelley Megan , McPartland James Charles , Hirsch Joy
Published: February 2023

Atypical eye gaze in joint attention is a clinical characteristic of autism spectrum disorder (ASD). Despite this documented symptom, neural processing of joint attention tasks in real-life social interactions is not understood. To address this knowledge gap, functional-near infrared spectroscopy (fNIRS) and eye-tracking data were acquired simultaneously as ASD and typically developed (TD) individuals engaged in a gaze-directed joint attention task with a live human and robot partner. We test the hypothesis that face processing deficits in ASD are greater for interactive faces than for simulated (robot) faces. Consistent with prior findings, neural responses during human gaze cueing modulated by face visual dwell time resulted in increased activity of ventral frontal regions in ASD and dorsal parietal systems in TD participants. Hypoactivity of the right dorsal parietal area during live human gaze cueing was correlated with autism spectrum symptom severity: Brief Observations of Symptoms of Autism (BOSA) scores (r = −0.86). Contrarily, neural activity in response to robot gaze cueing modulated by visual acquisition factors activated dorsal parietal systems in ASD, and this neural activity was not related to autism symptom severity (r = 0.06). These results are consistent with the hypothesis that altered encoding of incoming facial information to the dorsal parietal cortex is specific to live human faces in ASD. These findings open new directions for understanding joint attention difficulties in ASD by providing a connection between superior parietal lobule activity and live interaction with human faces.

Lay Summary

Little is known about why it is so difficult for autistic individuals to make eye contact with other people. We find that in a live face-to-face viewing task with a robot, the brains of autistic participants were similar to typical participants but not when the partner was a live human. Findings suggest that difficulties in real-life social situations for autistic individuals may be specific to difficulties with live social interaction rather than general face gaze.
Analysis of requests for reservation of blood concentrates in patients referred to urgent surgeries in a teaching hospital
Authors: Garcia Cintia de Lelis , Silveira Michelle Petrolli , Jesus-Silva Seleno Glauber de
Published: February 2023

Introduction

The rates of request and use of blood concentrates are still poorly reported in the literature. This study aimed to analyze the rates of requests for blood concentrates and their use in patients undergoing emergency surgery in a teaching hospital.

Methods

A retrospective, quantitative and descriptive study was conducted in 359 medical records of patients in urgent surgery scheduled with a request for a reserve of blood concentrate. The ratios between crossmatched and transfused units (C/T), transfusion index (TI), and probability (TP) were calculated, and the times between request and delivery at the transfusion agency (TA) and patient admission to the surgical center (SC).

Results

The mean age was 58.5 ± 22.2 years, with the majority being male (53.1%). There was an average of 27.5 monthly requests (min 12, max 44). Ninety-seven units of blood concentrates were transfused into 44 patients (C/T ratio 7.59; TI 0.27; TP 12.3%). Only seven patients had their requests made after admission to the OR. The median time between the request and arrival at the TA was 1h15min, while that between the request and the patient’s arrival at the SC was 5h23min. There was greater transfusion in major surgery (major 37, 14.8% vs. medium 7, 6.5%; p = 0.027) and non-orthopedic surgery (orthopedic 9, 4.0% vs. non-orthopedic 35, 26.9%; p < 0.001).

Conclusion

there was a significant discrepancy between the number of requests for blood reservation and its real use and an increased time between reservation requests and their arrival at the TA.