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Proactive Surgical Management and Outcomes of Unilateral Zygomaticomaxillary Complex Fractures in Major Trauma Patients: A National Level I Center Experience
No full textOBJECTIVE: Managing facial trauma in patients with severe polytrauma presents significant challenges due to competing priorities, poor systemic conditions, and delayed surgical timing. At a national level I trauma center, the authors evaluated the feasibility and outcomes of proactive surgical intervention for unilateral zygomaticomaxillary complex (ZMC) fractures in severe trauma patients. METHODS: This retrospective study included 81 patients with unilateral ZMC fractures treated at a regional level I trauma center between October 2019 and August 2021. Patients were categorized into high and low trauma severity groups based on the injury severity score (ISS). Three-dimensional (3D) computed tomography analyses were performed to evaluate surgical outcomes, including dimensional distances (Dx, Dy, and Dz) and the Asymmetry Index. RESULTS: Of the 81 patients, 52 underwent surgical intervention. No significant differences were observed in 3D distances (Dx, Dy, and Dz) between the high and low ISS groups, both preoperatively and postoperatively. However, postoperative symmetry was superior in the high ISS group ( P < 0.010). The average delay from injury to surgery was slightly longer in the high ISS group (8.69 versus 7.35 d, P = 0.248). Complications such as diplopia and paresthesia were more common in the high ISS group, but no significant differences in overall complication rates were observed between the groups. CONCLUSION: Proactive surgical management of unilateral ZMC fractures in major trauma patients is effective. Despite the systemic challenges in this population, timely intervention resulted in superior postoperative symmetry in the high ISS group and comparable 3D outcomes across trauma severities
Maxillary skeletal expander with 6 miniscrews and tadlock: A case report
No full textMiniscrew-assisted rapid palatal expansion (MARPE) devices offer an alternative to orthognathic surgery for postpubertal patients, but a limitation of MARPE is the possible migration of miniscrews during maxillary expansion. This becomes critical when palatal bone is thin at the miniscrew insertion sites, potentially leading to miniscrew failure. In this article, a maxillary skeletal expander (MSE), a particular type of MARPE appliance, was adopted to skeletally expand the maxilla in a postpubertal patient with a thin palatal bone. To reinforce the skeletal anchorage, the MSE was modified by adding 2 lateral miniscrews in the palatal slope between the second premolar and first molar. A virtual model of the MSE with 4 miniscrews was imported into the merged model of the patient's cone-beam computed tomography and maxillary dental arch. Then, a computer-aided design/manufacturing structure with appliance arms, 2 bushings for additional lateral miniscrews, and molar bands was 3-dimensionally designed and manufactured with selective laser melting technology and was laser welded to the MSE body to produce the modified MSE with 6 miniscrews. Because appliance arms tend to slide along the additional lateral miniscrews during maxillary expansion because of the lateral force vector, a steel ligature (the “tadlock”) is tied between the miniscrew head and the bushing pin present on the appliance arms to eliminate the problem. The digital workflow to fabricate the MSE with 6 miniscrews and the tadlock mechanism are presented along with the procedure to expand the maxilla in a postpubertal patient with a thin palatal bone
Eye blinking characteristics as potential biomarkers in Isolated REM sleep behavior disorder during visuospatial attention tasks
No full textINTRODUCTION: Isolated REM sleep behavior disorder (iRBD) is a prodromal stage of alpha-synucleinopathies, such as Parkinson's disease (PD). Although altered eye blinking patterns are recognized as a clinical feature in PD, no studies have investigated its prodromal stage. This study aimed to investigate eye blinking characteristics in iRBD patients during a visuospatial attention task. METHODS: A total of 131 iRBD (aged 67.1 years) and 50 healthy controls (HCs; aged 66.2 years) participated. Patients who developed PD (PD-CV) or dementia with Lewy bodies (DLB-CV) were grouped as converters, while the others as non-converters (iRBD-NC). At baseline, during Posner's task, electroencephalogram and electrooculogram signals were recorded, and vertical ocular components were extracted. Blinking events were automatically identified within two temporal windows, where eye blinks were predominantly observed. Blink latency and rate in each window were compared between groups. RESULTS: In the 2nd window (1300 ms-1800 ms), iRBD exhibited delayed blink latency compared to HC (1549 ms vs. 1529 ms, p = 0.021) while blink rate was not different. Blink rate showed correlations with cognitive (r = 0.192, p = 0.028) and motor (r = -0.254, p = 0.009) functions in iRBD patients. PD-CV (n = 18) exhibited a decreasing trend in blink rate compared to iRBD-NC (n = 105; 25.9 % vs. 40.9 %, Bonferroni-corrected p = 0.052). CONCLUSIONS: Altered eye blink characteristics potentially serve as markers reflecting pathophysiology of alpha-synucleinopathies. iRBD is linked to delayed blink latency; moreover, a decreased blink rate could serve as a predictor of PD-specific neurodegeneration
Sex differences in outcomes after rheumatic and degenerative mitral surgery: A long-term follow-up analysis on 3012 patients
No full textOBJECTIVES: This study aimed to assess the long-term outcomes of mitral valve (MV) disease depending on sex and its differences within the MV aetiology in patients undergoing MV surgery. METHODS: We reviewed 3012 patients undergoing isolated MV surgery with or without tricuspid valve (TV) surgery/ablation between January 2000 and December 2022. The primary end-points were all-cause mortality and a composite valve-related adverse events including heart failure, stroke, reoperation and infective endocarditis. Multivariate analysis with interaction terms identified independent risk factors, with median follow-up of 8.3 years (total 30 180.6 patient-years). RESULTS: Among the 3012 patients (54.8 +/- 12.7 years), 1671 were females (55.5%). Rheumatic and degenerative MV diseases comprised 54.1% and 45.9%, respectively, with higher rates of rheumatic disease in females (69.7% vs 34.7%). Compared to males, females were older with higher prevalence of atrial fibrillation, TV insufficiency and advanced heart failure symptoms, consequently undergoing more MV replacements and concomitant procedures. Females showed higher rates of composite adverse outcomes (hazard ratio [HR], 1.25; 95% confidence intervals [CIs], 1.07-1.46; P = 0.006). Significant interaction was observed between sex and aetiology, with females showing higher mortality (HR 1.51; 95% CIs, 1.12-2.04; P = 0.007) and composite outcomes (HR 1.48; 95% CIs 1.15-1.91; P = 0.002) in degenerative disease (P for interaction = 0.021 and 0.016, respectively). Multivariate Cox regression demonstrated female sex as an independent risk factor for composite valve-related adverse outcomes (adjusted HR, 1.46; 95% CIs, 1.04-2.04; P = 0.028). CONCLUSIONS: Significant sex-based differences exist in MV disease patient characteristics and surgical outcomes, with females experiencing worse results, particularly in degenerative disease. Female sex was an independent risk factor for composite valve-related adverse outcomes after MV surgery. These differences suggest the need for sex-specific diagnostic criteria to reduce the disparities in patients with MV disease
Association between humidifier disinfectant use duration and lung cancer development in Korea
No full textOBJECTIVES: This study was conducted to assess the association between the duration of humidifier disinfectant use and lung cancer development. METHODS: We analyzed data from 3,605 applicants registered for compensation from the Korean government due to health conditions related to humidifier disinfectant exposure. Among these individuals, 121 were diagnosed with lung cancer at least 4 years after their initial exposure (through December 2021). Hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence were estimated according to the duration of disinfectant use using Cox proportional hazards models. RESULTS: Compared with <5 months of use, the HRs for lung cancer were 1.81 (95% CI, 0.41 to 7.97) for 5-14 months, 2.45 (95% CI, 0.58 to 10.41) for 15-29 months, and 4.61 (95% CI, 1.12 to 18.91) for >/=30 months. Using never smokers with <15 months of use as the reference category, the HRs were 2.97 (95% CI, 1.34 to 6.56) for never smokers with >/=15 months of use, 2.73 (95% CI, 0.94 to 7.95) for current or former smokers with <15 months of use, and 4.74 (95% CI, 1.94 to 11.61) for current or former smokers with >/=15 months of use. CONCLUSIONS: Our study provides some of the first robust epidemiological evidence that prolonged humidifier disinfectant use contributes to lung cancer development. Future studies-particularly those including unexposed populations-are needed to confirm these findings
Global, regional and national burden of dietary iron deficiency from 1990 to 2021: a Global Burden of Disease study
No full textAlthough iron deficiency is well documented, less is known about dietary involvement in symptomatic iron deficiency manifesting in medical conditions. In this study, we quantified the global burden of dietary iron deficiency, focusing on where inadequate dietary iron intake leads to clinical manifestations such as anemia. We analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to estimate dietary iron deficiency prevalence and disability-adjusted life years (DALYs), stratified by age, sex, geography and socio-demographic index (SDI) across 204 countries. In 2021, global age-standardized prevalence and DALY rates were 16,434.4 (95% uncertainty interval (UI), 16,186.2-16,689.0) and 423.7 (285.3-610.8) per 100,000 population, with rates decreasing by 9.8% (8.1-11.3) and 18.2% (15.4-21.1) from 1990 to 2021. A higher burden was observed in female individual (age-standardized prevalence, 21,334.8 (95% UI, 20,984.8-21,697.4); DALYs, 598.0 (402.6-854.4)) than in male individual ((age-standardized prevalence, 11,684.7 (11,374.6-12,008.8); DALYs, 253.0 (167.3-371.0)). High-SDI countries presented greater improvement, with a 25.7% reduction compared to 11.5% in low-SDI countries. Despite global improvements, dietary iron deficiency remains a major health concern with a global prevalence of 16.7%, particularly affecting female individuals, children and residents in low-SDI countries. Urgent interventions through supplementation, food security measures and fortification initiatives are essential
Cost-effectiveness and clinical outcomes comparison between noninvasive ventilation and high-flow nasal cannula use in patients with multiple rib fractures
No full textBACKGROUND: Patients with multiple rib fractures often require advanced respiratory support to prevent intubation and associated morbidity. Noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC) are commonly used, but direct comparisons of clinical outcomes and cost-effectiveness remain limited. This study aimed to compare NIV versus HFNC using a large, nationwide US database. METHODS: This retrospective cohort study used the 2020-2021 National Inpatient Sample database to identify adult trauma patients (18-89 years) with two or more rib fractures who received either NIV or HFNC without prior intubation. To focus on isolated thoracic injuries, patients with significant injuries elsewhere (Abbreviated Injury Scale score >/=3) or who died within 24 hours were excluded. Inverse probability of treatment of weighting was used to balance patient characteristics, including demographics, comorbidities, and injury severity. Primary outcomes included mortality, tracheostomy, pulmonary complications, and intubation rates. Hospital length of stay and total costs were also assessed. Cost-effectiveness analyses were conducted with intubation avoidance as the effectiveness measure, and a willingness-to-pay threshold of US 42,505 vs. US $32,024, p < 0.001). Cost-effectiveness analysis revealed that NIV dominated HFNC, yielding better outcomes at lower costs. CONCLUSION: Among patients with multiple rib fractures, NIV yielded superior clinical outcomes, shortened hospital stays, and reduced costs compared with HFNC. These findings suggest that NIV may be a more cost-effective and clinically advantageous choice. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III
Interreader Agreement of Lung-RADS: A Systematic Review and Meta-Analysis
No full textBACKGROUND. Lung-RADS has shown variable interreader agreement in the literature, in part related to a broad range of factors that may influence the consistency of its implementation. OBJECTIVE. The purpose of this study was to assess the interreader agreement of Lung-RADS and to investigate factors influencing the system's variability. EVIDENCE ACQUISITION. The Embase, PubMed, and Cochrane databases were searched for original research studies published through June 18, 2024, that reported the interreader agreement of Lung-RADS on chest CT. Random-effects models were used to calculate pooled kappa coefficients for Lung-RADS categorization and pooled intraclass correlation coefficients (ICCs) for nodule size measurements. Potential sources of heterogeneity were explored using metaregression analyses. EVIDENCE SYNTHESIS. The analysis included 11 studies (1470 patients) for Lung-RADS categorization and five studies (617 patients) for nodule size measurement. Interreader agreement for Lung-RADS categorization was substantial (kappa = 0.72 [95% CI, 0.57-0.82]), and that for nodule size measurement was almost perfect (ICC = 0.97 [95% CI, 0.90-0.99]). Interreader agreement for Lung-RADS categorization was significantly associated with the method of nodule measurement (p = .005), with pooled kappa coefficients of 0.95, 0.91, and 0.66 for studies using computer-aided detection (CAD)-based semiautomated volume measurements, CAD-based semiautomated diameter measurements, and manual diameter measurements, respectively. Interreader agreement for Lung-RADS categorization was also significantly associated with studies' nodule type distribution (p < .001), with pooled kappa coefficients of 0.85, 0.76, and 0.55 for studies evaluating 100% solid nodules, 30-99% solid nodules, and fewer than 30% solid nodules, respectively. Interreader agreement for nodule size measurement was significantly associated with radiation dose (p < .001), with pooled ICCs of 0.97, 0.96, and 0.59 for studies that used standard-dose CT, low-dose CT, and ultralow-dose CT, respectively. Interreader agreement for nodule size measurement was also significantly associated with the Lung-RADS version that was used (p = .02), with pooled ICCs of 0.99 and 0.93 for studies using Lung-RADS 1.1 and Lung-RADS 1.0, respectively. CONCLUSION. Although they support the overall reliability of Lung-RADS, the findings indicate roles for CAD assistance as well as training and standardized approaches for nodule type characterization to further promote reproducible application. CLINICAL IMPACT. Consistent nodule assessments will be critical for Lung-RADS to optimally impact patient management and outcomes
The Impact of Delayed Intubation on Outcomes and Resource Utilization of Patients Sustaining Multiple Rib Fractures
No full textBackground: Patients with multiple rib fractures may require mechanical ventilation due to respiratory insufficiency. We hypothesized that delayed intubation leads to worse outcomes compared to early intubation.
Methods: We analyzed data from the Trauma Quality Improvement Program database (2017-2021) for adults with ≥ 3 rib fractures requiring intubation. Patients were divided into groups of early and delayed intubation (after 24 hours from admission). Outcomes included in-hospital mortality, complications, and tracheostomy need. Resource utilization metrics were compared. Groups were balanced using inverse probability of treatment weighting, and complex samples logistic regression was used to evaluate the effect of delayed intubation on outcomes while controlling for covariates.
Results: Out of 191,816 patients with ≥3 rib fractures, 5339 underwent early intubation and 4004 underwent delayed intubation. Delayed intubation patients were older, more often female, less severely injured, had fewer bilateral fractures and flail chest, but higher tracheostomy need. Factors associated with delayed intubation included age > 60, ISS < 16, absence of bilateral fractures, smoking, and COPD. After adjustment, delayed intubation was associated with higher mortality (19.7% vs 13.7%), longer hospital and ICU stays, increased mechanical ventilation duration, and fewer ICU- and ventilator-free days. Additionally, delayed intubation was linked to increased ARDS, pulmonary embolism, severe sepsis, and acute kidney injury. It independently increased mortality odds (OR 1.584).
Discussion: Delayed intubation in patients with multiple rib fractures is associated with worse clinical outcomes and increased resource utilization. This link between delayed intubation and worse outcomes highlights the importance of recognizing at-risk individuals and considering early intubation
Risk factors for lateral neck lymph node metastasis in papillary thyroid ultra micro carcinoma with implications for active surveillance
No full textPapillary thyroid ultra-microcarcinoma (PTUMC), defined as a tumo