Improving Community Understanding of Lyme Disease Prevention and Treatment in the Age of Misinformation in Digital Media

Approximately 30,000 cases of Lyme disease are reported to the CDC annually, but the CDC estimates that 300,000 individuals in the US become infected. The average cost of Lyme disease is $3,000 per patient over the course of the disease costing the US healthcare system approximately$1 billion per year ($712m –$1.3b). An additional $1 billion is spent annually on treating post-treatment Lyme disease syndrome. Despite the prevalence of Lyme disease and the availability of credible patient education materials, misconceptions and knowledge gaps are still evident among community members, media sources, and some providers. There is a need for continued community education and recommendations for evidence-based treatment for this disease.https://scholarworks.uvm.edu/fmclerk/1705/thumbnail.jp

Development of a Deep Learning Algorithm for Periapical Disease Detection in Dental Radiographs

Periapical radiolucencies, which can be detected on panoramic radiographs, are one of the most common radiographic findings in dentistry and have a differential diagnosis including infections, granuloma, cysts and tumors. In this study, we seek to investigate the ability with which 24 oral and maxillofacial (OMF) surgeons assess the presence of periapical lucencies on panoramic radiographs, and we compare these findings to the performance of a predictive deep learning algorithm that we have developed using a curated data set of 2902 de-identified panoramic radiographs. The mean diagnostic positive predictive value (PPV) of OMF surgeons based on their assessment of panoramic radiographic images was 0.69(± 0.13), indicating that dentists on average falsely diagnose 31% of cases as radiolucencies. However, the mean diagnostic true positive rate (TPR) was 0.51(± 0.14), indicating that on average 49% of all radiolucencies were missed. We demonstrate that the deep learning algorithm achieves a better performance than 14 of 24 OMF surgeons within the cohort, exhibiting an average precision of 0.60(± 0.04), and an F1 score of 0.58(± 0.04) corresponding to a PPV of 0.67(± 0.05) and TPR of 0.51(± 0.05). The algorithm, trained on limited data and evaluated on clinically validated ground truth, has potential to assist OMF surgeons in detecting periapical lucencies on panoramic radiographs

E-cigarette and tobacco use on a tobacco-free UVM campus

The prevalence of e-cigarette use has significantly increased in recent years. In the US, e-cigarettes are now the most common nicotine products used by adolescents. The CDC reported 1,299 cases of lung injury correlating to the use of e-cigarette and vaping products; the current recommendation is to refrain from using e-cigarette products that contain THC and/or nicotine.https://scholarworks.uvm.edu/comphp_gallery/1296/thumbnail.jp

Spontaneity Assessment in Dually Innervated Gracilis Smile Reanimation Surgery

Key PointsQuestionCan a video time-stamping method be used to measure spontaneity of smile after dually innervated gracilis smile reanimation surgery? FindingsIn this cohort study of 25 patients treated with dually innervated gracilis free muscle transfers vs 24 patients treated with masseteric nerve-driven transfers (n=11) or cross-face nerve graft-driven gracilis (n=13), a spontaneous smile was present in a median of 33% of smiles, which was more than was present in masseteric nerve-driven transfers (20%) but less than in cross-face nerve graft-driven smile reanimation surgery (75%). MeaningDual innervation may improve synchronicity compared with masseteric nerve transfer but not to the level of cross-face nerve graft-driven gracilis free muscle transfer. This cohort study assesses the outcomes of dually innervated gracilis free muscle transfers using a novel clinical assessment tool. ImportanceSurgeons have sought to optimize outcomes of smile reanimation surgery by combining inputs from nerve-to-masseter and cross-face nerve grafts. An objective assessment tool could help surgeons evaluate outcomes to determine the optimal neural sources for smile reanimation. ObjectiveTo evaluate the use of a novel video time-stamping method and standard outcome measurement tools to assess outcomes of facial reanimation surgery using various innervation strategies. Design, Setting, and ParticipantsCohort study assessing the outcomes of dually innervated gracilis free muscle transfers vs single-source innervated gracilis transfer performed at a tertiary care facial nerve center between 2007 and 2017 using a novel, video time-stamping spontaneity assessment method. The statistical analyses were performed in 2018. InterventionsDually innervated gracilis free muscle transfers or single-source innervated gracilis transfer. Main Outcomes and MeasuresSpontaneous smiling was assessed by clinicians and quantified using blinded time-stamped video recordings of smiling elicited while viewing humorous video clips. ResultsThis retrospective cohort study included 25 patients (12 men and 13 women; median [range] age, 38.4 [29.3-46.0] years) treated with dually innervated gracilis free functional muscle graft for unilateral facial palsy between 2007 and 2017. Smile spontaneity assessment was performed in 17 patients and was compared with assessment performed in 24 patients treated with single-source innervated gracilis transfer (ie, nerve-to-masseter-driven or cross-face nerve graft-driven gracilis [n=13]) (demographic data not available for NTM and CFNG cohorts). The use of time-stamped video assessment revealed that spontaneous synchronous oral commissure movement in a median percentage of smiles was 33% in patients with dually innervated gracilis (interquartile range [IQR], 0%-71%), 20% of smiles in patients with nerve-to-masseter-driven gracilis (IQR, 0%-50%), and 75% of smiles in patients with cross-face nerve graft-driven gracilis (IQR, 0%-100%). Clinicians graded smile spontaneity in dually innervated cases as absent in 40% (n=6 of 15), trace in 33% (n=5 of 15) and present in 27% (n=4 of 15). No association was demonstrated between clinician-reported spontaneity and objectively measured synchronicity. Conclusions and RelevanceDually innervated gracilis free muscle transfers may improve smile spontaneity compared with masseteric nerve-driven transfers but not to the level of cross-face nerve graft-driven gracilis transfers. Quantifying spontaneity is notoriously difficult, and most authors rely on clinical assessment. Our results suggest that clinicians may rate presence of spontaneity higher than objective measures, highlighting the importance of standardized assessment techniques. Level of Evidence4

Patient experience in nerve-to-masseter-driven smile reanimation

Introduction: The nerve-to-masseter is one of the most frequently used neural sources in smile reanimation surgery. Very little information has been reported on patient experience with regard to reanimated smile usage and sequelae following transfer. The aim of this study was to quantify patient perception of nerve-to-masseter use in smile reanimation surgery. Methods: An online questionnaire was developed based on the clinical expertise of our team, patient interviews, and existing questionnaires of facial palsy-related quality of life and temporomandibular joint dysfunction. All patients treated with nerve-to-masseter-driven smile reanimation surgery, both nerve transfers and muscle transplantations, between 2007 and 2016 with a valid email address were invited to participate. Results: Of 171 operated patients, 122 with a valid email address were invited to participate. Seventy-one patients responded (63.4% female, mean age 51.1 years) after a median follow-up of 3.8 years. A voluntary smile while biting down at least "most of the time" was reported by 83.1% of patients; 46.5% reported ability to smile on the affected side without bite. A "normal" or "almost normal" spontaneous smile was reported in 23.9% of patients. A total of 18.3% of patients self-reported masseter muscle atrophy, and 1.4-14.1% reported temporomandibular joint dysfunction. Forty-one patients (57.7%) reported prandial movement of the face at least "most of the time," with 9 patients (12.7%) considering this bothersome. Conclusion: Patients report good voluntary smiling ability following nerve-to-masseter-driven smile reanimation surgery, with low rates of sequelae. (C) 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved

Patient-perceived severity of synkinesis reduces quality of life in facial palsy: A cross-sectional analysis in 92 patients

KEY POINTS: Synkinesis can decrease quality of life in facial palsy patients. Patient-perceived severity of synkinesis may be of additional value in predicting facial palsy related-quality of life. We analyzed the additional value of the SAQ total score (perceived severity of synkinesis) in predicting FaCE total scores (quality of life) in 92 patients cross-sectionally. SAQ total score accounted for a relatively large improvement in the prediction of FaCE total scores (R2 change = 0.113, total R2 = 0.428). Patient-perceived severity synkinesis should be included in clinical management and studies of synkinesis. This article is protected by copyright. All rights reserved