bluuebunny/crossref_metadata_2025 huggingface dataset:
P090 The Effect of Workload, Sleep Deprivation and Time of Day on Simulated Driving Performance
Authors: Marando I , Matthews R , Grosser L , Yates C , Banks S
Published: October 2021

Sustained operations expose individuals to long work periods, which deteriorates their ability to sustain attention. Biological factors, including sleep deprivation and time of day, have been shown to play a critical role in the ability to sustain attention. However, a gap in the literature exists regarding external factors, such as workload. Therefore, the aim of this study was to investigate the combined effect of sleep deprivation, time of day, and workload on sustained attention. Twenty-one participants (18–34y, 10 F) were exposed to 62 hours of sleep deprivation within a controlled laboratory environment. Every 8 hours, sustained attention was measured using a 30-minute monotonous driving task, and subjective workload was measured using the NASA-Task Load Index (TLX). Workload, defined as time on task was assessed by splitting the drive into two 15-minute loops. A mixed model ANOVA revealed significant main effects of day (sleep deprivation) and time of day on lane deviation, number of crashes, speed deviation and time outside the safe zone (all p<.001). There was a significant main effect of workload (time on task) on lane deviation (p=.042), indicating that a longer time on task resulted in greater lane deviation. NASA-TLX scores significantly increased with sleep deprivation (p<.001), indicating that subjective workload increased with sleep loss even though the task remained constant. Workload, sleep deprivation and time of day produced a deterioration in sustained attention. With this, countermeasures that not only consider sleep deprivation and time of day, but also workload (time on task) can be considered.
P094 CPAP Service Patient Experience Survey
Authors: Mihai R , Ellis K , Verginis N , Davey M , Nixon G
Published: October 2021

Introduction

Increasing numbers of children with obstructive sleep apnoea require continuous positive airway pressure (CPAP) treatment. We aimed to collect feedback from parents/carers about our CPAP education and follow-up programme.

Methods

An online survey link was texted to families of children starting outpatient CPAP from Jan 2019 -Feb 2021. Questions assessed satisfaction with the CPAP initiation process, including education by our nurse educator (NE), mask fitting, using equipment, accessing help, confidence using CPAP and follow up. Open-ended feedback was invited.

Results

17/55 (31%) of eligible families responded. “Very satisfied” responses regarding CPAP education ranged from 76% (discussion of costs) to 94% (machine use and maintenance). All families felt confident starting CPAP at home. Two reported issues starting CPAP, but reported feeling fully supported by staff remotely to troubleshoot. All families were “somewhat” or “very satisfied” with NE follow-up, with 2 families more neutral about physician follow-up. Two families reported lower satisfaction (“somewhat dissatisfied” or neutral) with the range of paediatric masks, rather than with the mask fitting process itself. Of 14 general comments, 64% were positive (most common theme was high standard of care from the NE); 21% negative (lack of mask choices, location of consulting suites); and 15% neutral. Suggestions for improvement included financial support information, support groups and online consumable ordering.

Discussion

Families feel confident and well supported to commence outpatient CPAP, highlighting the care, knowledge and support provided by our team. Findings emphasize the importance of a dedicated NE. Suggestions provided will inform future service improvements.
P096 Subjective ratings of medication strength of lemborexant over 6 months in subjects with moderate or severe insomnia
Authors: Drake C , Yardley J , Pinner K , Moline M
Published: October 2021

Introduction

In Study 303 (SUNRISE-2), significantly more subjects reported a positive effect of lemborexant (LEM), a dual orexin receptor antagonist, versus placebo (PBO) on their sleep at 1mo, 3mo and 6mo, as assessed by items 1–3 of the Patient Global Impression–Insomnia (PGI-I). LEM-treated subjects also reported larger and statistically significant decreases in the Insomnia Severity Index (ISI) versus PBO. This analysis examined potential LEM tolerance via patient-reported ratings of medication strength on PGI-I item 4 in subjects with moderate/severe insomnia.

Methods

In this 12mo double-blind, PBO-controlled (first 6mo), phase 3 study, subjects ≥18y with insomnia disorder and ISI scores ≥15 were randomized to PBO (n=318) or LEM (5mg, [LEM5], n=316; 10mg, [LEM10], n=315). The ISI and PGI-I were administered at 1mo, 3mo and 6mo.

Results

The percentage of subjects with moderate (ISI=15–21; n=692) or severe (ISI=22–28; n=223) insomnia at baseline who rated LEM as “just right” increased from 1mo (moderate: LEM5=46.4%; LEM10=43.3%; PBO=31.3%; severe: LEM5=35.8%; LEM10=40.6%; PBO=15.0%) to 6mo (moderate: LEM5=56.5%; LEM10=53.9%; PBO=39.7%; severe: LEM5= 54.8%; LEM10=55.4%; PBO=21.6%). Ratings of “too weak” decreased over 6 months in both ISI severity groups. PBO group ratings of “too weak” always exceeded the LEM groups by >15%. Ratings of “too strong” were low and stable over time.

Conclusions

Findings suggest that LEM tolerance does not occur over 6mo with either LEM dose since patient perceptions of LEM treatment being “too weak” did not increase over the study period. These data support the persistent efficacy of long-term LEM treatment for chronic insomnia.
P124 Chronotype and OSA combine to modify risk of hypertension
Authors: Sansom K , Walsh J , Eastwood P , Maddison K , Singh B , Reynolds A , McVeigh J , Mazzotti D , McArdle N
Published: October 2021

Introduction

There are limited data on the association of chronotype and hypertension and on their interaction on hypertension. This study aimed to investigate the independent and combined effects of chronotype and OSA on risk for prevalent hypertension in a middle-aged community population.

Methods

Baseline data on adult participants (n=1098, female=58%; age mean [range]=56.7[40.8–80.6] years) from an Australian community cohort study were analysed. Shift workers and individuals with incomplete data were excluded. Prevalent hypertension was defined as ‘doctor diagnosed’ and/or an elevated average systolic blood pressure (BP; ≥140mmHg) or diastolic BP (≥90mmHg). OSA was diagnosed when apnoea hypopnoea index (AHI) ≥10 events/hour from in-laboratory polysomnography. Chronotype was determined from actigraphy mid-sleep time on work free days. Tertiles of mid-sleep time were used to categorise morning, intermediate and evening chronotypes. Logistic regression (adjusted for sex, body mass index, age, alcohol consumption and sleep duration) were used to assess the cross-sectional relationship between chronotype, OSA and hypertension.

Results

After applying exclusion criteria 496 participants were analysed (female=58%; age mean[range]=57.0[42.1–81.6] years). All those with OSA had greater odds of hypertension than those without and there was no difference in risk of hypertension according to chronotype. Compared to morning chronotypes with no OSA (n=84), evening chronotypes with OSA (n=79) had non-significantly increased odds (OR 2.15, 95% CI 1.00–4.76; P=0.054) for hypertension while morning chronotypes with OSA (n=82) had significantly increased odds (OR 3.02, 95% CI 1.44–6.58; P=0.004).

Discussion

Morning chronotypes with OSA might be at increased risk of hypertension compared to evening chronotypes with OSA.
P128 Sleep Need is more Strongly Associated with Self-rated Health and Daytime Function than Sleep Duration
Authors: Scott H , Appleton S , Reynolds A , Gill T , Melaku Y , Adams R , Catcheside P , Perlis M
Published: October 2021

Introduction

Most studies examining associations between sleep and health outcomes focus on sleep duration or efficiency, ignoring individual differences in sleep need. We investigated whether sleep need is a more influential correlate of self-rated daytime function and health than sleep duration.

Methods

This study is a secondary analysis of the 2019 Sleep Health Foundation online survey of adult Australians (N=2,044, aged 18–90 years). Hierarchical multiple linear regressions assessed variance explained by demographics (Model 1: age, sex, BMI), self-reported sleep duration (Model 2: Model 1 + weighted variable of weekday/weekend sleep duration), and individual sleep need (Model 3: Model 2+ how often they get enough sleep to feel their best the next day, on a 5-point scale) on daytime function items for fatigue, concentration, motivation, and overall self-rated health (EQ-5D, VAS 0–100).

Results

Sleep need explained an additional 17.5–18.7% of the variance in fatigue, concentration, motivation, and health rating (all p < 0.001 for R² change) in Model 3. Model 2 showed that sleep duration alone only explained 2.0–4.1% of the variance in these outcomes. Findings were similar when stratified by sex. Sleep need also explained greater variance for older adults than for younger and middle-aged adults, especially on health rating (Model 3: R² change = 0.11 for ages 18-24y, 0.14 for 45-54y, 0.27 for 75y+).

Conclusions

Sleep need explains more variance in daytime function and self-rated health than sleep duration. The role of sleep need on other daytime consequences, and in clinical populations, needs further exploration.
P132 Research in the time of COVID-19: Recruitment to a clinical trial comparing models of NIV implementation in people with MND
Authors: Sheers N , Howard M , Hannan L , Retica S , Berlowitz D
Published: October 2021

Introduction

A pilot randomised controlled trial (RCT) examining the feasibility of a new model of non-invasive ventilation (NIV) implementation was due to commence in early 2020. Based on previous research, it was anticipated that 100% of people with motor neurone disease (MND) would be eligible, 60% would consent to participate and 20 people would be randomised in five months. The aim of this report is to describe the impact of COVID-19 pandemic contingencies on trial recruitment.

Methods

Report of project progress, participant screening and recruitment.

Results

First reports of COVID-19 coincided with study commencement and changed usual healthcare delivery. Lockdowns meant telehealth substituted for face-to-face assessment, respiratory function testing was limited and/or patients were reluctant to seek medical treatment. This modified pathway impacted evaluation of diagnosis, timing of need for NIV and procedural safety, with patients then referred specifically for a single-day hospital NIV implementation to enable face-to-face multidisciplinary assessment to aid decisions. Of 81 potential participants screened in an 8-month period, 64% were ineligible for the RCT. Despite this shift in eligibility rate, 16 people with MND have been recruited as of May 2021.

Conclusion

The current climate has amplified the significance of this research trial; people with MND have had reduced access to face-to-face services globally and clinicians have had to quickly adapt to a changing landscape of telemedicine and remote monitoring of patients. This trial’s screening data suggest that COVID-19 hasn’t stopped people with MND being implemented on NIV, but it has altered assessment pathways.
P148 Solriamfetol Titration & AdministRaTion (START): Dosing and titration strategies in patients with narcolepsy starting solriamfetol
Authors: Thorpy M , Hyman D , Parks G , Chen A , Foley C , Ito D , Singh H
Published: October 2021

Introduction

Solriamfetol (Sunosi) is a dopamine/norepinephrine reuptake inhibitor approved (EU/US) to treat excessive daytime sleepiness (EDS) in adults with narcolepsy (75–150 mg/day) or obstructive sleep apnoea (OSA) (37.5–150 mg/day). This study characterised real-world dosing and titration with solriamfetol in patients with narcolepsy.

Methods

A retrospective patient chart review was conducted among US-based physicians prescribing solriamfetol. Initiation strategies were de novo (no prior EDS medication), transition (switched/switching from existing EDS medications to solriamfetol), or add-on (adding solriamfetol to current EDS medication).

Results

Twenty-three physicians entered data from 70 patients with narcolepsy (type 1, 24/70; type 2, 46/70; mean+/-SD age, 40+/-11 years; 57% female; 6 also had OSA). EDS was mainly moderate (59%) or severe (36%). Nineteen patients (27%) initiated de novo, 31 (44%) transitioned, and 20 (29%) were add-on. Most patients started solriamfetol at 75 mg (86%) and were stable at 150 mg (76%). Most (67%) had 1 dose adjustment; median (range) time to a stable dose was 14 (1–60) days. EDS severity (44% of patients) was frequently considered when titrating. Fourteen of 22 (64%) transitioning from wake-promoting agents (WPAs) stopped them abruptly; 5/9 (56%) using stimulants tapered off.

Discussion

In a real-world study, most physicians prescribing solriamfetol to patients with narcolepsy started at 75 mg, tapered stimulants, abruptly discontinued WPAs, and made 1 dose adjustment.

Support

Jazz Pharmaceuticals
P153 Sleep timing and chronotype in perinatal periods: Longitudinal changes and associations with wellbeing from pregnancy to 2 years postpartum
Authors: Verma S , Pinnington D , Manber R , Bei B
Published: October 2021

Introduction

Significant changes to sleep occur during perinatal periods. Existing research focuses on sleep duration and quality, but not sleep timing or chronotype. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to two years postpartum, and examined associations between chronotype and insomnia, sleep-related impairment, and mood at seven different perinatal time-points.

Methods

Data were from a 2-arm randomised controlled trial testing behavioural sleep and diet interventions. A community sample of nulliparous females without severe sleep/mental health conditions participated. Participants self-reported bedtime, rise-time, chronotype (short Morningness-Eveningness Questionnaire), Insomnia Severity Index, and PROMIS Depression, Anxiety, and Sleep-Related Impairment over seven time points: gestation weeks 30 and 35, and postpartum months 1.5, 3, 6, 12 and 24.

Results

163 participants (mean age 33.4±3.4 years) took part. Mixed effects models adjusting for age and group allocation showed that both bed- and rise-times became progressively earlier by approximately 20–30 minutes over time (p<.001); chronotype shifted progressively towards more morningness (p<.01). After adjusting for covariates (sleep duration and efficiency, mental health history, social support, age, group allocation), greater morningness was significantly associated with lower symptoms of insomnia and sleep-related impairment over time (p-values<.001); at each time-point, associations between chronotype and symptoms of depression and anxiety were non-significant (p-values>0.65).

Conclusions

Sleep timing and chronotype became progressively earlier over the first two postpartum years. Greater morningness was associated with less sleep complaints and sleep-related daytime impairment during the postpartum period. The mechanisms of these findings may be investigated through further research.
Synthetic Amorphous Silica Nanoparticles Promote Human Dendritic Cell Maturation and CD4+ T-Lymphocyte Activation
Authors: Feray Alexia , Guillet Éléonore , Szely Natacha , Hullo Marie , Legrand François-Xavier , Brun Emilie , Rabilloud Thierry , Pallardy Marc , Biola-Vidamment Armelle
Published: October 2021

Innate immune cells such as dendritic cells (DCs) sense and engulf nanomaterials potentially leading to an adverse immune response. Indeed, as described for combustion-derived particles, nanomaterials could be sensed as danger signals, enabling DCs to undergo a maturation process, migrate to regional lymph nodes and activate naive T lymphocytes. Synthetic amorphous silica nanoparticles (SAS-NPs) are widely used as food additives, cosmetics, and construction materials. This work aimed to evaluate in vitro the effects of manufactured SAS-NPs, produced by thermal or wet routes, on human DCs functions and T-cell activation. Human monocyte-derived DCs (moDCs) were exposed for 16 h to 3 endotoxin-free test materials: fumed silica NPs from Sigma-Aldrich (no. S5505) or the JRC Nanomaterial Repository (NM-202) and colloidal LudoxTMA NPs. Cell viability, phenotypical changes, cytokines production, internalization, and allogeneic CD4+ T-cells proliferation were evaluated. Our results showed that all SAS-NPs significantly upregulated the surface expression of CD86 and CD83 activation markers. Secretions of pro-inflammatory cytokines (CXCL-8 and CXCL-12) were significantly enhanced in a dose-dependent manner in the moDCs culture supernatants by all SAS-NPs tested. In an allogeneic coculture, fumed silica-activated moDCs significantly increased T-lymphocyte proliferation at all T-cell: DC ratios compared with unloaded moDCs. Moreover, analysis of coculture supernatants regarding the production of T-cell-derived cytokines showed a significant increase of IL-9 and IL-17A and F, as well as an upregulation of IL-5, consistent with the pro-inflammatory phenotype of treated moDCs. Taken together, these results suggest that SAS-NPs could induce functional moDCs maturation and play a role in the immunization process against environmental antigens.
Molecular Mechanisms Associated with the Resistance of Rhizoctonia solani AG-4 Isolates to the Succinate Dehydrogenase Inhibitor Thifluzamide
Authors: Zhao Can , Li Yuting , Liang Zhijian , Gao Lihong , Han Chenggui , Wu Xuehong
Published: October 2021

Thifluzamide, a succinate dehydrogenase (SDH) inhibitor, possesses high activity against Rhizoctonia. In this study, 144 Rhizoctonia solani AG-4 (4HGI, 4HGII, and 4HGIII) isolates, the predominate pathogen associated with sugar beet seedling damping-off, were demonstrated to be sensitive to thifluzamide with a calculated mean median effective concentration of 0.0682 ± 0.0025 μg/ml. Thifluzamide-resistant isolates were generated using fungicide-amended media, resulting in four AG-4HGI isolates and eight AG-4HGII isolates with stable resistance and almost no loss in fitness. Evaluation of cross-resistance of the 12 thifluzamide-resistant isolates and their corresponding parental-sensitive isolates revealed a moderately positive correlation between thifluzamide resistance and the level of resistance to eight other fungicides from three groups, the exception being fludioxonil. An active efflux of fungicide through ATP-binding cassette and major facilitator superfamily transporters was found to be correlated to the resistance of R. solani AG-4HGII isolates to thifluzamide based on RNA-sequencing and quantitative reverse transcription-PCR analyses. Sequence analysis of sdhA, sdhB, sdhC, and sdhD revealed replacement of isoleucine by phenylalanine at position 61 in SDHC in 9 of the 12 generated thifluzamide-resistant isolates. No other mutations were found in any of the other genes. Collectively, the data indicate that the active efflux of fungicide and a point mutation in sdhC may contribute to the resistance of R. solani AG-4HGI and AG-4HGII isolates to thifluzamide in vitro. This is the first characterization of the potential molecular mechanism associated with the resistance of R. solani AG-4 isolates to thifluzamide and provides practical guidance for the use of this fungicide.
Factors That Affect the Success of Ethnically Diverse Nursing Students: An Integrative Review of the Literature
Authors: Everett Michele C.
Published: October 2021

AIM

The purpose of this research was to review nursing student retention literature to better understand how to help ethnically diverse undergraduate nursing students succeed.

BACKGROUND

Nursing student retention continues to be a major challenge. Additional research is needed to improve the retention of students from diverse ethnic and cultural backgrounds.

METHOD

An integrative literature review was conducted. Qualitative analysis of 10 studies was used to identify emergent themes.

RESULTS

Analyses of the studies reveal the magnitude, complexity, and distinctiveness of the challenges ethnically diverse nursing students face.

CONCLUSION

The findings have implications for developing strategies for helping this important at-risk population of students complete their nursing degrees.
The Otolaryngology Residency Program Preference Signaling Experience
Authors: Pletcher Steven D. , Chang C.W. David , Thorne Marc C. , Malekzadeh Sonya
Published: October 2021

Problem

In the 2021 residency application cycle, the average otolaryngology applicant applied to more than half of programs. Increasing application numbers make it difficult for applicants to stand out to programs of interest and for programs to identify applicants with sincere interest.

Approach

As part of the 2021 Match, otolaryngology applicants could participate in a preference signaling process, signaling up to 5 programs of particular interest at the time of application submission. Programs received a list of applicants who submitted signals to consider during interview offer deliberations. Applicants and program directors completed surveys to evaluate the signaling process and assess the impact of signals on interview offers.

Outcomes

All otolaryngology residency programs participated in the signaling process. In total, 611 students submitted applications for otolaryngology residency programs, 559 applicants submitted a Match list including an otolaryngology program, and 558 applicants participated in the signaling process. The survey response rate was 42% for applicants (n = 233) and 52% for program directors (n = 62). The rate of receiving an interview offer was significantly higher from signaled programs (58%) than from both nonsignaled programs (14%; P < .001) and the comparative nonsignal program (23%; P < .001) (i.e., the program an applicant would have signaled given a sixth signal). This impact was consistent across the spectrum of applicant competitiveness. Applicants (178, 77%) and program directors (53, 91%) strongly favored continuing the program.

Next Steps

Many specialties face high residency application numbers. Programs have difficulty identifying applicants with sincere interest, and applicants face limited opportunities to identify programs of particular interest. Applicants to these specialties may benefit from a preference signaling process like that in otolaryngology. Additional evaluation is needed to determine the impact of signals across racial and demographic lines and to validate these early outcomes.
Midwifery-oriented group counseling based on the GATHER approach on quality of life of women during the transition to menopause: a randomized controlled trial
Authors: Mardanpour Soraya , Kazemi Farideh , Refaei Mansoureh , Bakht Rafat , Hoseini Molod
Published: October 2021

Objective:

This study aimed to determine the effect of midwifery-oriented group counseling based on the GATHER model on the quality of life of women during the transition to menopause.

Methods:

This randomized controlled clinical trial was performed on 90 women 45 years or older in 2019 to 2020 in Kermanshah, Iran. The women were assigned into two groups using a randomized blocked design. In the intervention group, counseling sessions based on the GATHER approach (Greet, Ask, Tell, Help, Explain, and Return) were performed in four sessions of 45 to 90 minutes. Sociodemographic and quality of life (MENQOL) questionnaires were used for data gathering. Data were analyzed by Mann-Whitney test, sample t test, and Wilcoxon using SPSS 24.

Results:

The mean age of women was 49.04 ± 3.94 and 49.62 ± 3.63 in the intervention and control group, respectively (P = 0.412). There was no significant difference between the two groups regarding demographic characteristics and quality of life before the intervention (P > 0.05). There was a considerable difference between the mean score of quality of life 55.62 ± 18.37 and 73.64 ± 25.84 (P = 0.001) and its dimensions, especially for physical symptoms (P = 0.002), between the two groups 4 weeks after the intervention.

Conclusions:

The results of this study suggest that midwifery-oriented group counseling based on the GATHER approach may improve the life quality of women during the transition to menopause.

Video Summary:

http://links.lww.com/MENO/A816.
Dietary syringic acid reduces fat mass in an ovariectomy-induced mouse model of obesity
Authors: Tanaka Teruyoshi , Iwamoto Kazuko , Wada Maki , Yano Erika , Suzuki Toshiyuki , Kawaguchi Nobuhisa , Shirasaka Norifumi , Moriyama Tatsuya , Homma Yoshimi
Published: October 2021

Objective:

Postmenopausal women are at increased risk of metabolic diseases such as obesity and diabetes. Therefore, the chemoprevention of postmenopausal changes in health via dietary supplements is important. Syringic acid (SA) is a phenolic compound present in the fruit of the assai palm, Euterpe oleracea, and in the mycelium of the shiitake mushroom, Lentinula edodes. This compound shows no affinity for estrogen receptors and may exert disease-preventive effects. Reportedly, dietary SA ameliorates high-fat diet-induced obesity in mice; however, its effects on estrogen deficiency-induced obesity are still unclear. Therefore, in this study, we investigated whether and how dietary SA affects these factors in ovariectomized (OVX) mice.

Methods:

Ten-week-old OVX mice were fed SA-containing diets (100 mg/kg body weight/d) for 12 weeks. Their body weights, food intake, and uterus weights as well as other parameters were measured and comparisons were made with mice in the control group.

Results:

Dietary SA did not affect the body weight, food intake, or uterus weight of OVX mice over the study period; however, the SA-fed group showed lower fat mass (ie, visceral, subcutaneous, and total fat) than the OVX-control group (11.1 ± 3.3 vs. 8.3 ± 2.4, P < 0.05; 7.9 ± 1.1 vs. 5.9 ± 1.6, P < 0.05; 19.0 ± 4.2 vs. 14.1 ± 3.8, P < 0.05, respectively). Furthermore, blood analysis revealed that SA-treatment resulted in a dose-dependent decrease and increase in serum triglyceride (59.2 ± 8.3 vs. 43.9 ± 12.2 mg/dL P < 0.05) and adiponectin (7.7 ± 0.3 vs. 9.5 ± 0.6 μg/mL, P < 0.05) levels, respectively.

Conclusions:

These results suggest that the SA diet improves lipid metabolism without affecting the uterus in OVX mice. Therefore, dietary SA has potential applicability for the prevention of postmenopausal obesity and type 2 diabetes.
Potential of Intraoperative 3D Photography and 3D Visualization in Breast Reconstruction
Authors: Nicklaus Krista M. , Wang Haoqi , Bordes Mary Catherine , Zaharan Alex , Sampathkumar Urmila , Cheong Audrey L. , Reece Gregory P. , Hanson Summer E. , Merchant Fatima A. , Markey Mia K.
Published: October 2021

Background:

Although pre- and postoperative three-dimensional (3D) photography are well-established in breast reconstruction, intraoperative 3D photography is not. We demonstrate the process of intraoperative acquisition and visualization of 3D photographs for breast reconstruction and present clinicians’ opinions about intraoperative visualization tools.

Methods:

Mastectomy specimens were scanned with a handheld 3D scanner during breast surgery. The 3D photographs were processed to compute morphological measurements of the specimen. Three visualization modalities (screen-based viewing, augmented reality viewing, and 3D printed models) were created to show different representations of the 3D photographs to plastic surgeons. We interviewed seven surgeons about the usefulness of the visualization methods.

Results:

The average time for intraoperative acquisition of 3D photographs of the mastectomy specimen was 4 minutes, 8 seconds ± 44 seconds. The average time for image processing to compute morphological measurements of the specimen was 54.26 ± 40.39 seconds. All of the interviewed surgeons would be more inclined to use intraoperative visualization if it displayed information that they are currently missing (eg, the target shape of the reconstructed breast mound). Additionally, the surgeons preferred high-fidelity visualization tools (such as 3D printing) that are easy-to-use and have minimal disruption to their current workflow.

Conclusions:

This study demonstrates that 3D photographs can be collected intraoperatively within acceptable time limits, and quantitative measurements can be computed timely to be utilized within the same procedure. We also report surgeons’ comments on usability of visualization methods and of measurements of the mastectomy specimen, which can be used to guide future surgical practice.
Spirituality and Wellness in Plastic Surgery: A Survey of ASPS Members
Authors: Poteet Stephen J. , Yi Allen F. , Bai Shasha , Eisner Mariah , Hultman C. Scott , Janis Jeffrey E.
Published: October 2021

Background:

Spirituality is an important, yet often overlooked, component of personal well-being. The purpose of this study was to assess whether spirituality plays an important role in the well-being of US plastic surgeons and residents, and whether spirituality is viewed as an important component of patient care.

Methods:

An anonymous and voluntary email survey was distributed to 3375 members of ASPS during the months of April through June of 2020. The survey distribution included 2230 active members of ASPS and 1149 resident members, all who practice or train within the United States. The survey consisted of 18 multiple-choice questions with answer choices based on a descriptive five-point Likert scale and ranking by priority. Statistical analysis of the results was performed using StataCorp 2019 software.

Results:

A total of 431 completed surveys were received for a response rate of 12.7%. The majority of participants (70%) reported that personal spiritual beliefs and faith contribute positively to emotional well-being. In total, 65% agreed or strongly agreed that their spiritual beliefs provide a healthy framework for handling conflict, suffering, and loss. More than half (51%) reported that as a result of the COVID-19 global pandemic, their spiritual beliefs and practices have provided increased support and guidance.

Conclusions:

Spirituality is an important component of maintaining wellness for plastic surgeons, and spirituality is recognized by plastic surgeons as an important aspect of the healing process for patients. Efforts should be made to promote spiritual health among the surgical community both during training and in practice.
Simple to Extreme: Following the Reconstructive Ladder for Complex Posterior Trunk Reconstruction
Authors: Jabbour Samer , Chang Edward I. , Kapur Sahil K.
Published: October 2021

Reconstruction of the posterior trunk and torso defects presents unique challenges to the reconstructive surgeon, particularly in the setting of oncologic resection and adjuvant multimodality therapy such as chemotherapy and radiation. The operation can be more complicated in the setting of hardware exposure. Although local flaps represent the primary workhorse option, reconstruction using a microvascular free tissue transfer should be considered when local flap options have been exhausted. Here, we present a unique case reconstructing a complex, radiated back wound with exposed hardware that failed prior bilateral paraspinous, latissimus dorsi, and trapezius muscle flaps. A unilateral free TRAM flap was used and revascularized through an arteriovenous loop to provide stable coverage of the 15 × 25 cm defect. The patient also had preexisting upper extremity ischemia, which limited flap perfusion and positioning options. The usage of arteriovenous loops and free musculocutaneous flaps can provide another potential adequate option for the treatment of these complex defects.
Exposed polypropylene flange in the Canabrava double-flanged polypropylene technique
Authors: Canabrava Sergio Felix , Rabelo Neiffer Nunes , de Sousa Lima Josiane Lílian , de Nadai Ramon Fazzolo
Published: October 2021

Scleral fixation is a versatile surgical approach in the setting of lens bag instability. Recently, a double-flanged polypropylene technique to fixate the intraocular lens in the sclera has been described. A common concern in using any flanged scleral fixation technique is the risk of infection and endophthalmitis secondary to exposed fixation material, which can erode through the conjunctiva. In this report, a case of an exposed polypropylene flange presenting 1 month postoperatively in a 70-year-old female patient who underwent a 4-flanged fixation procedure is described. The successful surgical management of this case is described as well as other operative considerations to reduce the risk of exposed fixation material and subsequent postoperative infection. The correct placement of scleral fixation material as well as regular clinical review is vital in reducing the risk of postoperative endophthalmitis.
Corneal decompensation following intrastromal hydration of corneal wounds with 0.5% moxifloxacin
Authors: Fong Joseph W. , Ahmad Kinza T. , Chacko Joseph G. , Phillips Paul H.
Published: October 2021

Many ophthalmologists have adopted the off-label practice of injecting moxifloxacin intracamerally and into the corneal stroma around the incision at the conclusion of surgery for endophthalmitis prophylaxis. The safety and efficacy of intracameral moxifloxacin for routine cataract surgery has been investigated and endorsed by multiple authors, but to our knowledge, potential complications from intrastromal hydration of clear corneal incisions with 0.5% preservative-free moxifloxacin have not been documented. Two consecutive patients underwent surgery for traumatic ocular injuries. The first patient underwent removal of an intralenticular metallic foreign body with cataract surgery and intraocular lens placement. The second patient underwent repair of an extensive corneoscleral laceration with uveal prolapse. Both patients developed toxic anterior segment syndrome and corneal decompensation within 4 days of intracameral injection and intrastromal hydration of corneal wounds with 0.5% preservative-free topical-formulation moxifloxacin for endophthalmitis prophylaxis following surgery. Surgeons should avoid the use of undiluted 0.5% topical-formulation moxifloxacin drugs for intrastromal hydration of clear corneal incisions following intracameral administration to decrease the risk for corneal decompensation and toxic anterior segment syndrome. We recommend using only 0.1% compounded formulations for both intrastromal and intracameral injections or avoiding intrastromal injection altogether.
Determinants and Mechanisms of the Renin-Aldosterone Stress Response
Authors: Gideon Angelina , Sauter Christine , Pruessner Jens C. , Farine Damien R. , Wirtz Petra H.
Published: October 2021

Objective

The renin-angiotensin-aldosterone system (RAAS) plays a relevant role in regulating blood pressure and thus maintaining cardiovascular homeostasis. Although it was recently shown that RAAS parameters are responsive to acute psychosocial stress, the psychobiological determinants of the acute stress–induced RAAS activation have not yet been investigated. In a randomized placebo-controlled design, we investigated potential psychological and physiological determinants of the RAAS response and underlying mechanisms.

Methods

Fifty-seven young healthy male participants underwent either an acute standardized psychosocial stress test or a nonstress placebo task. We measured aldosterone in plasma and saliva, as well as renin, and the stress-reactive endocrine measures adrenocorticotropic hormone (ACTH), epinephrine, and norepinephrine in plasma at rest, immediately after the task and several times up to 3 hours thereafter. Moreover, we assessed stress-reactive psychological (anticipatory cognitive stress appraisal, mood, physical discomfort) and basal demographic-physiological measures (age, body mass index, blood pressure).

Results

Acute psychosocial stress elicited changes in all assessed endocrine (p values ≤ .028, η
p
2 values ≥ 0.07) and stress-reactive psychological measures (p values ≤ .003, η
p
2 values ≥ 0.15). The basal parameter body mass index, the stress-reactive endocrine parameters ACTH and norepinephrine, and the psychological parameter anticipatory stress appraisal were identified as determinants of higher RAAS parameter reactivity to acute psychosocial stress. The association between anticipatory cognitive stress appraisal and plasma RAAS measures was fully mediated by ACTH increases (p values ≤ .044, η
p
2 values ≥ 0.05).

Conclusions

Cognitive stress appraisal processes seem to modulate RAAS stress reactivity. This points to potential clinical implications for psychoeducative therapeutical interventions targeting stress appraisal processes to reduce endocrine stress reactivity.
Prospective Associations of Leisure-Time Physical Activity With Psychological Distress and Well-Being: A 12-Year Cohort Study
Authors: Werneck André O. , Stubbs Brendon , Kandola Aaron , Oyeyemi Adewale L. , Schuch Felipe B. , Hamer Mark , Vancampfort Davy , Silva Danilo R.
Published: October 2021

Objective

This study aimed to investigate the associations of leisure-time physical activity with psychological distress and well-being, and potential mediators.

Methods

We used data from the 1970 British Cohort Study (n = 5197; 2688 men), including waves 34y (2004), 42y (2012), and 46y (2016). Participants reported leisure-time physical activity frequency and intensity (exposure) at age 34 years (baseline); cognition (vocabulary test), body mass index, disability, mobility and pain perception (potential mediators) at age 42 years; and psychological distress (Malaise Inventory) and well-being (Warwick-Edinburgh scale) at age 46 years. Baseline confounders included sex, country, education, employment status, alcohol use, tobacco smoking, and psychological distress. Main analyses included logistic regression and mediation models.

Results

Higher leisure-time physical activity intensity at baseline was associated with lower psychological distress at 46y (β = −0.038 [95% confidence interval {CI} =−0.069 to −0.007]), but not leisure-time physical activity frequency. Baseline leisure-time physical activity frequency and intensity were associated with higher psychological well-being at 46y (frequency: β = 0.089 [95% CI = 0.002 to 0.176]; intensity: β = 0.262 [95% CI = 0.123 to 0.401]); and total: β = 0.041 [95% CI = 0.013 to 0.069]). Only body mass index at 42y partially mediated the association between leisure-time physical activity frequency (15.7%) and total leisure-time physical activity (6.2%) at 34y, with psychological well-being at 46y.

Conclusions

Our findings highlight the role of leisure-time physical activity in psychological distress and well-being, with greater effect sizes associated with higher frequency and intensity of leisure-time physical activity. Future interventions should consider examining potential mediators of the association of leisure-time physical activity with psychological well-being, such as body mass index.
Initial Diagnostic Evaluation of the Child With Suspected Arterial Ischemic Stroke
Authors: Negrotto Matias , Muthusami Prakash , Wasserman Bruce A. , Lee Sarah , Heit Jeremy J. , Chandra Ronil V. , Hui Ferdinand , Abruzzo Todd A.
Published: October 2021

Numerous factors make the initial diagnostic evaluation of children with suspected arterial ischemic stroke (AIS) a relatively unsettling challenge, even for the experienced stroke specialist. The low frequency of pediatric AIS, diversity of unique age-oriented stroke phenotypes, and unconventional approaches required for diagnosis and treatment all contribute difficulty to the process. This review aims to outline important features that differentiate pediatric AIS from adult AIS and provide practical strategies that will assist the stroke specialist with diagnostic decision making in the initial phase of care.
The Digital Footprint of Academic Plastic Surgeons
Authors: Ngaage Ledibabari M. , Borrelli Mimi , Knighton Brooks J. , Rawes Catherine , Ha Michael , Landford Wilmina N. , Nam Arthur J. , Rasko Yvonne
Published: October 2021

Introduction

The digital age and global pandemic have transformed the way patients select their plastic surgeon. However, as more patients turn to online resources, there is little information on the digital presence of academic plastic surgeons.

Methods

We identified all academic faculty from integrated and independent plastic surgery residency programs. Using a Google-based custom search, the top 10 search results for each surgeon were extracted and categorized as surgeon noncontrolled (eg, physician rating websites) or controlled (eg, social media, institutional, and research profiles).

Results

Eight hundred four academic plastic surgeons were included. Most search results were surgeon-noncontrolled sites (57%, n = 4547). Being male (odds ratio [OR], 0.60, P = 0.0020) and holding a higher academic rank (OR = 0.61, P < 0.0001) significantly decreased the prevalence of physician rating websites, whereas career length was significantly associated with a greater number of rating websites (OR = 1.04, P < 0.0001). Surgeon-controlled websites were significantly influenced by academic rank and years in practice; higher academic rank was associated with more social media platforms (OR = 1.42, P = 0.0008), institutional webpages (OR = 1.57, P < 0.0001), and research profiles (OR = 1.62, P = 0.0008). Conversely, longer career duration was a predictor for fewer social media platforms (OR = 0.95, P < 0.0001) and institutional webpages (OR = 0.95, P < 0.0001).

Conclusions

Academic plastic surgeons do not hold control of the majority of their search results. However, digitally savvy plastic surgeons can focus attention by building on certain areas to optimize their digital footprint. This study can serve as a guide for academic plastic surgeons wishing to control their online presence.
Long-term Effects of Repeated Botulinum Toxin Injection in Cosmetic Therapeutics
Authors: Crook Jennifer L. , Hamidian Jahromi Alireza , Konofaos Petros
Published: October 2021

Background

Botulinum toxin (BT), a potent neurotoxin, has been used in clinical medicine since the 1970s for cosmetic and therapeutic purposes. Studies have consistently shown positive outcomes with a very limited adverse effect profile and a conventional understanding that results dissipate after 3 to 5 months. However, more recent evidence suggests that changes in muscle composition, function, and appearance persist for much longer, even years. To examine the potential implications of these findings on cosmetic use of BT injections in reduction of skin lines and wrinkles, we first needed to further our understanding of the current literature on long-term outcomes after repeated BT injections.

Methods

A comprehensive review of the literature on long-term outcomes after repeated BT injections for cosmetic indications was performed. We evaluated the study designs, and results were compared.

Results

A total of 22 publications met our inclusion criteria, of which 14 were clinical trials. Few studies extended outcome measurement past 6 months postinjection, and many were funded or supported by industry. However, the studies that extended follow-up saw persistent changes after BT injection, in some cases as far as 4 years postinjection.

Conclusion

The current body of knowledge on the long-term results after repeated cosmetic BT injections is very limited, and the available literature provides insufficient evidence on how prolonged effects could alter clinical use of BT. Further clinical studies with extended follow-up periods with inclusion of both subjective and objective measured outcomes of appearance and muscle function are required to better understand the long-term impacts of repeated BT injections.
Breast Shape Evaluation After Free Flap Breast Reconstruction After More Than 10 Years Follow-up Using 3-Dimensional Imaging Device
Authors: Tsuruta Yuki , Yano Tomoyuki , Kuramoto Yukiko , Suesada Nobuko , Fuse Yuma , Karakawa Ryo , Yoshimatsu Hidehiko , Tanakura Kenta , Miyashita Hiroki
Published: October 2021

Background

Breast reconstruction using autologous tissue has been widely performed, and its safety and usefulness have been reported. However, there are few reports on the long-term morphological evaluation of autologous breast reconstruction cases. We evaluated long-term change of breast shape using Vectra, a 3-dimensional imaging device, for breast reconstruction cases with more than 10 years of follow-up.

Methods

The subjects had undergone autologous tissue breast reconstruction between 2007 and 2009. Sixteen deep inferior epigastric perforator flap cases were included in this study. For each patient, 4 items were measured as indicators: breast width, distance from the sternal notch to the nipple, distance from the nipple to the inframammary fold, and breast volume. The ratio of reconstructed breast to healthy breast was calculated for these 4 items.

Results

The long-term average ratio of breast width was 0.99, that of distance from the sternal notch to the nipple was 0.98, that of distance from the nipple to the inframammary fold was 0.94, and that of breast volume was 1.13. We evaluated the influence of body mass index and age at the time of the primary reconstructive surgery, but there was no significant difference in 2 body mass index groups (obese and nonobese groups) and 2 age groups (less than and more than 50 years old).

Conclusion

We assumed that the balance between the reconstructed breast and the contralateral native breast would become worse over time because of breast sagging and changes in breast elasticity. According to our study, the shape balance of left and right breasts was maintained over time. Limitation of this study is the fact that more than half of the cases included in this study had undergone small to moderate revision surgery during the course of follow-up.
The Declining Number of Finger Replantations in Germany
Authors: Kükrek Haydar , Moog Philipp , Nedeoglo Ekaterina , Wieschollek Stefanie , Megerle Kai
Published: October 2021

Introduction

Data from the United States have shown that finger replantation numbers have declined significantly in recent years. It is unclear whether this is due to a decrease in amputation injuries or other reasons.

Materials & Methods

Since 2005, all German hospitals have been required to produce structured quality reports. Based on these reports, we analyzed finger and hand replantation development and the incidence of amputation injuries between 2006 and 2018.

Results

Replantations decreased by 30%, whereas amputation injuries increased slightly. In 2018, only 17 centers carried out more than 10 replantations. Most hospitals had replanted less than 4 times a year. The majority of residents participated in fewer than 1 replantation per year. Most specialists performed fewer than 1 replantation per year. The reasons for the decline in replantation remain speculative.

Conclusions

However, a reduction in amputation injuries was not observed. A change in medical indications, technical skills, and economic motivations needs to be considered. A further loss of specialized technical skills and experience with replantations might be a future consequence of this trend.