bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecology and Epidemiology of Eastern Equine Encephalitis Virus in the Northeastern United States: An Historical Perspective
Authors: Armstrong Philip M , Andreadis Theodore G
Published: November 2021

In the current review, we examine the regional history, ecology, and epidemiology of eastern equine encephalitis virus (EEEV) to investigate the major drivers of disease outbreaks in the northeastern United States. EEEV was first recognized as a public health threat during an outbreak in eastern Massachusetts in 1938, but historical evidence for equine epizootics date back to the 1800s. Since then, sporadic disease outbreaks have reoccurred in the Northeast with increasing frequency and northward expansion of human cases during the last 20 yr. Culiseta melanura (Coquillett) (Diptera: Culicidae) serves as the main enzootic vector that drives EEEV transmission among wild birds, but this mosquito species will occasionally feed on mammals. Several species have been implicated as bridge vectors to horses and humans, with Coquilletstidia perturbans (Walker) as a leading suspect based on its opportunistic feeding behavior, vector competence, and high infection rates during recent disease outbreaks. A diversity of bird species are reservoir competent, exposed to EEEV, and serve as hosts for Cs. melanura, with a few species, including the wood thrush (Hlocichia mustelina) and the American robin (Turdus migratorius), contributing disproportionately to virus transmission based on available evidence. The major factors responsible for the sustained resurgence of EEEV are considered and may be linked to regional landscape and climate changes that support higher mosquito densities and more intense virus transmission.
Resurgence of Interest in Eastern Equine Encephalitis Virus Vaccine Development
Authors: Powers Ann M
Published: November 2021

Eastern equine encephalitis virus (EEEV; Family Togaviridae), is an endemic pathogen first isolated in 1933 with distribution primarily in the eastern US and Canada. The virus has caused periodic outbreaks in both humans and equines along the eastern seaboard and through the southern coastal states. While the outbreaks caused by EEEV have been sporadic and varied geographically since the discovery of the virus, it has continued to expand its range moving into the Midwest states as well. Additionally, one of the largest outbreaks was recorded in 2019 prompting concerns that outbreaks were becoming larger and more frequent. Because the virus can cause serious disease and because it is transmissible by both mosquitoes and aerosol, there has been renewed interest in identifying potential options for vaccines. Currently, there are no licensed vaccines and control relies completely on the use of personal protective measures and integrated vector control which have limited effectiveness for the EEEV vectors. Several vaccine candidates are currently being developed; this review will describe the multiple options under consideration for future development and assess their relative advantages and disadvantages.
(R)-(+)-Lasiodiplodin isolated from the endophytic fungus Sordaria tamaensis exhibits potent antimycobacterial and anti-inflammatory activities in vitro and in vivo: a dual approach for the treatment of severe pulmonary tuberculosis
Authors: Calixto Sanderson Dias , Simão Thatiana Lopes Biá Ventura , de Almeida Fabrício Moreira , Antunes Stella Schuenck , Romeiro Nelilma Correia , de Souza Borges Warley , das Chagas Fernanda Oliveira , Seldin Lucy , de Carvalho Eulógio Carlos Queiroz , Andrioli Willian Jonis , Guimarães Denise Oliveira , Lasunskaia Elena , Muzitano Michelle Frazão
Published: November 2021

Objectives

This study aimed to evaluate endophytic fungi isolated from Tocoyena bullata and Humiria balsamifera plant species for their antimycobacterial and anti-inflammatory activities, focusing on severe pulmonary tuberculosis cases which are often associated with exacerbated inflammation.

Methods

Mycobacterium suspensions were incubated with the samples for 5 days. RAW 264.7 macrophages stimulated with LPS were also incubated with them for 24 h to assess the inhibition of inflammatory mediator production and cytotoxicity. C57BL/6 mice were infected with Mtb M299 and treated for 15 days with lasiodiplodin (Lasio).

Key findings

Endophytic fungus Sordaria tamaensis, obtained from T. bullata, was the most promising. Its ethanolic extract impaired mycobacterial growth with MIC50 (µg/ml): 1.5 ± 0.6 (BCG), 66.8 ± 0.1 (H37Rv) and 80.0 ± 0.1 (M299). (R)-(+)-Lasio showed MIC50 92.2 ± 1.8 µg/ml (M299). In addition, Lasio was able to inhibit NO, IL-1β and TNF-α production and was not cytotoxic for macrophages. M. tuberculosis-infected C57BL/6 animals treated by Lasio reduced the number of acid-fast bacilli, lung pathology, leucocyte influx and proinflammatory cytokine production in the lungs. The class IIa fructose 1,6-bisphosphate aldolase was the predicted hypothetical target of Lasio.

Conclusions

(R)-(+)-Lasio stood out as a promising anti-TB compound, exhibiting anti-inflammatory and antimycobacterial effects, as well as low cytotoxicity.
Rostered Routine Testing: A Necessary Evil?
Authors: Tan Seow Yen , How Choon How , Poon Beng Hoong , Tan Thean Yen , Siau Chuin
Published: November 2021

We report our institution’s experience of detecting a staff member who was infected with severe acute respiratory syndrome coronavirus 2 while he was asymptomatic, as part of a rostered routine testing program, and how the institution was able to undertake measures to curb the spread, hence reducing the impact on the daily operations of our institution.
Proportions, Timing, and Re-equilibration Progress during the 1959 Summit Eruption of Kīlauea: an Example of Magma Mixing Processes Operating during OIB Petrogenesis
Authors: Helz Rosalind Tuthill
Published: November 2021

Petrographic and chemical analysis of scoria samples collected during the 1959 Kīlauea summit eruption illustrates the progress of thermal and chemical homogenization of the melts, and the gradual growth and/or re-equilibration of olivine phenocrysts, over the course of the eruption. Glass compositions show that thermal equilibration was largely complete within the span of the eruption, whereas chemical homogenization was a work in progress. The olivine phenocryst population, known to contain conspicuous antecrystic components, is also hybrid within the euhedral population. The bulk of the olivine reached the level of the erupting magma on November 18–19, 1959. Zoning patterns in olivine phenocrysts show that initially unzoned grains developed normal zoning by the end of the eruption. Reverse zoning in relatively Fe-rich olivine phenocrysts (interpreted as cognate to the stored magma) was progressively eliminated from November 21 to December 19, 1959, by diffusive re-equilibration between crystals and melt. Toward the end of the eruption, the only olivine composition in direct contact with the melt was Fo84–86, with the original rim compositional heterogeneity gone in 4–5 weeks’ time. Activity in December 1959 differed from that in November, as high fountaining events were more closely spaced and almost all samples were picritic, with bulk MgO ≥16·5 wt%. Three different levels were in play during the 1959 eruption: a deep source for high-MgO melts and forsteritic (Fo87–89) olivines, an intermediate source for the bulk of the stored magma, and a shallower source for the most differentiated magma. This model is consistent with geophysical, petrological and chemical observations. Comparison of the 1959 eruption with results from older explosive deposits suggests that stored and recharge melts and olivine from the deeper parts of Kīlauea’s plumbing are similar in composition to those observed or inferred in the 1959 eruption, so they behave similarly during extrusive and explosive periods alike.
Hexaconazole exposure ravages biosynthesis pathway of steroid hormones: revealed by molecular dynamics and interaction
Authors: Abdi Sayed Aliul Hasan , Alzahrani Abdulaziz , Alghamdi Saleh , Alquraini Ali , Alghamdi Adel
Published: November 2021

Widespread application of hexaconazole for agriculture purpose poses a threat to human health by disrupting normal endocrine homeostasis. To avoid adverse health effects on human, it is crucial to identify the effects of hexaconazole on key enzymes responsible for steroidal hormone synthesis. In view of this, present study was conducted to investigate the interaction mechanisms of hexaconazole with key enzymes in comparison with their food drug administration (FDA) approved inhibitor by molecular docking and molecular dynamics simulations. Results indicate that hexaconazole contacts with the active site of the key enzymes required for steroidal hormonal synthesis. Results pertaining to root-mean-square deviation, root-mean-square calculation, radius of gyration, hydrogen bonding and solvent accessible surface area exhibited that the interaction pattern and stability of interaction of hexaconazole was similar to enzyme specific inhibitor. In addition, ligand and enzyme complex interaction energy of hexaconazole was almost similar to key enzyme and FDA-approved enzyme specific inhibitor complex. This study offers a molecular level of understanding of hexaconazole with different enzymes required for steroidal hormonal synthesis. Findings of the study clearly suggest that hexaconazole has efficacy to stably interact with various enzyme required to progress the pathway of hormonal synthesis. If incessant exposure of hexaconazole occurs during agricultural work it may lead to ravage hormonal synthesis or potent endocrine disruption. The result of binding energy and complex interaction energy is depicted in the graphical abstract.
Active Time Use and Well-Being in Older Adulthood: Results From a Day Reconstruction Method Study
Authors: Möwisch Dave , Brose Annette , Schmiedek Florian
Published: November 2021

Active time use is considered to be one of the keys to successful aging. Previous studies have investigated the influence of various activities on subjective well-being (SWB) and health in later life. As different activities have often been investigated in isolation, showing only minor influences of each activity on well-being, a more global measure of active time use might show a stronger relation to well-being. Moreover, empirical evidence is still insufficient regarding the relationship between active time use and SWB in very old age and regarding the impact of socioeconomic factors that can hinder or promote active time use. Therefore, we examined (1) the association between active time use and SWB using information from the day reconstruction method (DRM) as a more global approach to active time use; (2) the association between active time use and SWB until very old age, and (3) income and education as relevant correlates for active time use. The results indicated that a global measure of active time use was associated with higher levels of SWB. This pattern was present until very old age for several dimensions of negative affect (NA). Finally, higher levels of income and education were associated with a higher level of active time use, potentially pointing at contextual constraints of active time use. In sum, the results show that a global index for measuring active time use provides a comprehensive insight into the relationship between time use and SWB, and we suggest that it should be considered in further studies.
Adaptation of Phytophthora nicotianae to Multiple Sources of Partial Resistance in Tobacco
Authors: Jin Jing , McCorkle Kestrel L. , Cornish Vicki , Carbone Ignazio , Lewis Ramsey S. , Shew H. David
Published: November 2021

Host resistance is an important tool in the management of black shank disease of tobacco. Race development leads to rapid loss of single-gene resistance, but the adaptation by Phytophthora nicotianae to sources of partial resistance from Beinhart 1000, Florida 301, and the Wz gene region introgressed from Nicotiana rustica is poorly characterized. In greenhouse environments, host genotypes with quantitative trait loci (QTLs) conferring resistance from multiple sources were initially inoculated with an aggressive isolate of race 0 or race 1 of P. nicotianae. The most aggressive isolate was selected after each of six host generations to inoculate the next generation of plants. The race 0 isolate demonstrated a continuous gradual increase in disease severity and percentage root rot on all sources of resistance except the genotype K 326 Wz/–, where a large increase in both was observed between generations 2 and 3. Adaptation by the race 0 isolate on Beinhart 1000 represents the first report of adaptation to this genotype by P. nicotianae. The race 1 isolate did not exhibit significant increases in aggressiveness over generations but exhibited a large increase in aggressiveness on K 326 Wz/– between generations 3 and 4. Molecular characterization of isolates recovered during selection was completed via double digest restriction-site associated DNA sequencing, but no polymorphisms were associated with the observed changes in aggressiveness. The rapid adaptation to Wz resistance and the gradual adaptation to other QTLs highlights the need to study the nature of Wz resistance and to conduct field studies on the efficacy of resistance gene rotation for disease management.
An Innovative Approach for Integrating Mandatory, Longitudinal Spirituality Training Into the Medical School Curriculum
Authors: Fleenor David W. , Atkinson Holly G. , Karani Reena , Lerner Susan , Leisman Staci , Marin Deborah
Published: November 2021

Problem

Most Americans indicate they are religious and/or spiritual and wish to have their beliefs taken into account when engaging with health care providers, yet gaps in medical education and health care practice remain. To underscore the importance of spirituality as a significant social determinant of health, a team at the Icahn School of Medicine at Mount Sinai in New York developed mandatory spirituality and health training for students integrated into all 4 years of the undergraduate medical education curriculum.

Approach

From 2014 to 2020, a small group of faculty took an innovative approach, launching the initiative and expanding the team by engaging interprofessional faculty and staff from across the institution. The team used an iterative process to integrate 4 distinct modules into 4 existing courses, spanning the 4 years of medical school.

Outcomes

The majority of students found that the spirituality and health curriculum was valuable to training and professional development. They appreciated the importance of patients’ spiritual needs, valued learning about the role chaplains play in patient care and how to initiate a consult, and indicated they intended to integrate spiritual history taking in their patient care. With respect to process, 3 key factors—establishing an interprofessional team, working through an iterative process, and integrating the curriculum into existing courses—were critical to designing and implementing the modules.

Next Steps

The team aims to expand and improve the curriculum by linking learning to specific standardized competencies as well as developing more specific performance assessments to demonstrate achievement of competencies. Professional development efforts will be enhanced so faculty can better model and reinforce the integration of spirituality into health care practices and expand the curriculum on spirituality and health into graduate medical education.
Differential Diagnosis of a Unique Vulvar Mass in an Adolescent
Authors: Chow Stephanie , Doyle Alexis , Hammer Phoebe , Tyson Nichole A.
Published: November 2021

BACKGROUND:

Vulvar masses in adolescents have a broad differential diagnosis, yet few reports exist detailing masses of mammary origin.

CASE:

A nulliparous, healthy 16-year-old adolescent presented with a longstanding, ulcerated, 17-cm vulvar mass of unknown origin and pronounced inguinal lymphadenopathy. The patient underwent a left radical partial vulvectomy, with pathology revealing terminal duct lobular units consistent with polymastia.

CONCLUSION:

Differential diagnosis of a vulvar mass in an adolescent should include polymastia.
Health Equity Morbidity and Mortality Conferences in Obstetrics and Gynecology
Authors: Reisinger-Kindle Keith , Dethier Divya , Wang Victoria , Nandi Preetha , Bradley Erin Tracy , Evans Megan L. , Ireland Luu Doan , Dhanraj David , Bryant Allison S.
Published: November 2021

Maternal mortality and morbidity continue to occur at unacceptably high levels in the United States, with communities of color experiencing significantly higher rates than their White counterparts, even after adjustment for confounding factors such as socioeconomic status. Many obstetrics and gynecology departments across the country have begun to incorporate routine discussion and analysis of health equity into peer review and educational processes, including grand rounds and morbidity and mortality conferences. Despite the desire and drive, there is little published guidance on best practices for incorporation of an equity component into these conferences. This document outlines the current processes at four academic institutions to highlight the variety of ways in which health equity and social justice can be incorporated when analyzing patient experiences and health outcomes. This commentary also provides a list of specific recommendations based on the combined experiences at these institutions so that others across the country can incorporate principles of health equity into their peer-review processes.
Etiology and Outcome of Isolated Fetal Ascites
Authors: Horgan Rebecca , Youssef Julia A. , Levy Ariel T. , Berger Seth I. , Dreux Sophie , Brizot Maria L. , Boutall Alison , Abuhamad Alfred Z. , Angarita Ana M. , Al-Kouatly Huda B.
Published: November 2021

OBJECTIVE:

To describe the etiology of isolated fetal ascites and associated perinatal outcomes, and to assess the progression of isolated fetal ascites to fetal hydrops.

DATA SOURCES:

PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov databases were searched using the following keywords: “fetus” OR “foetal” OR “fetal” OR “foetus” AND “ascites” from inception to February 2020. The search was limited to the English language.

METHODS OF STUDY SELECTION:

A total of 1,983 articles were identified through the search strategy. All studies containing five or more cases of isolated fetal ascites were included.

TABULATION, INTEGRATION, AND RESULTS:

Eleven studies, involving 315 cases of isolated fetal ascites, were eligible for inclusion in this systematic review. All included studies were evaluated using the tool for evaluating the methodologic quality of case reports and case series described by Murad et al. Data were summarized using narrative review and descriptive statistics. Two-tailed Fisher exact P values calculated from hypergeometric distribution were used to compare outcome by etiology. CIs were calculated with Clopper-Pearson exact binomial interval. The etiologies of isolated fetal ascites are genitourinary (24%), gastrointestinal (20%), viral or bacterial infections (9%), cardiac (9%), genetic disorders not otherwise categorized (8%), chylous ascites (6%), metabolic storage disorders (3%), other structural disorders (4%), other causes (4%) and idiopathic (13%). Survival is most favorable for cases of isolated fetal ascites as a result of chylous (100%), idiopathic (90%), gastrointestinal (77%) and genitourinary (77%) etiologies. Survival is least favorable for fetuses with isolated fetal ascites as a result of structural disorders (25%), cardiac etiology (32%) and metabolic storage disorders (33.3%). When pregnancy terminations were excluded, survival rates were similar between fetuses diagnosed at or after 24 weeks of gestation compared with those diagnosed at less than 24 weeks (74% vs 61%, P=.06). Progression of fetal ascites to fetal hydrops occurred in 6.6% (95% CI 3.6–9.6%) (17/259) of cases when pregnancies that were terminated were excluded.

CONCLUSION:

Isolated fetal ascites has a diverse etiology. Outcome is related to the etiology of isolated fetal ascites. In the majority of cases, fetal ascites does not progress to fetal hydrops.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42020213930.
Effect of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) with Hydroxyapatite Carrier in Induced Membrane Technique: A Retrospective Propensity Score-Matched Study
Authors: Son Whee Sung , Lim Eic Ju , Sakong Seungyeob , Kim HanJu , Choi Wonseok , Cho Jae-Woo , Oh Jong-Keon
Published: November 2021

Objectives:

To determine the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) with hydroxyapatite (HA) carrier augmentation in managing critical-sized bone defect (CSBD) with induced membrane technique (IMT).

Design:

Retrospective comparative study.

Setting:

Academic level I trauma center.

Patients/Participants:

The study included 14 patients who underwent rhBMP-2 with HA carrier (rhBMP-2/HA) augmentation in IMT for managing CSBD (BMP group). Moreover, 14 patients who underwent IMT without rhBMP-2 augmentation were matched by propensity score analysis (non-BMP group).

Intervention:

IMT with or without rhBMP-2/HA augmentation.

Main Outcome Measurement:

Changes in quality and quantity measurements of grafted bone to regenerated bone using serial computed tomography.

Results:

In the BMP and non-BMP groups, the changes in densities from grafted bone to regenerated bone were +379.63 Hounsfield unit and +248.55 Hounsfield unit (P = 0.034), changes in dense bone percentage were +37.52% and +23.31% (P = 0.027), corticalization rates under the plate were 79.70% and 39.30% (P = 0.007), changes in volume were −20.77% and −23.35% (P = 0.812), union rates were 85.71% and 78.57% (P = 0.622), numbers of patients requiring additional procedures were 4 and 3 (P = 0.663), and time to union were 316.3 and 585.45 days (P = 0.040), respectively.

Conclusions:

RhBMP-2/HA augmentation increases the density of regenerated bone, enhances corticalization under the plate, and shortens the time to union while managing CSBD with IMT.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Implementation of the pre-operative rehabilitation recovery protocol and its effect on the quality of recovery after colorectal surgeries
Authors: Peng Li-Hua , Wang Wen-Jian , Chen Jing , Jin Ju-Ying , Min Su , Qin Pei-Pei
Published: November 2021

Background:

Patients’ recovery after surgery is the major concern for all perioperative clinicians. This study aims to minimize the side effects of peri-operative surgical stress and accelerate patients’ recovery of gastrointestinal (GI) function and quality of life after colorectal surgeries, an enhanced recovery protocol based on pre-operative rehabilitation was implemented and its effect was explored.

Methods:

A prospective randomized controlled clinical trial was conducted, patients were recruited from January 2018 to September 2019 in this study. Patients scheduled for elective colorectal surgeries were randomly allocated to receive either standardized enhanced recovery after surgery (S-ERAS) group or enhanced recovery after surgery based on pre-operative rehabilitation (group PR-ERAS). In the group PR-ERAS, on top of recommended peri-operative strategies for enhanced recovery, formatted rehabilitation exercises pre-operatively were carried out. The primary outcome was the quality of GI recovery measured with I-FEED scoring. Secondary outcomes were quality of life scores and strength of handgrip; the incidence of adverse events till 30 days post-operatively was also analyzed.

Results:

A total of 240 patients were scrutinized and 213 eligible patients were enrolled, who were randomly allocated to the group S-ERAS (n = 104) and group PR-ERAS (n = 109). The percentage of normal recovery graded by I-FEED scoring was higher in group PR-ERAS (79.0% vs. 64.3%, P < 0.050). The subscores of life ability and physical well-being at post-operative 72 h were significantly improved in the group PR-ERAS using quality of recovery score (QOR-40) questionnaire (P < 0.050). The strength of hand grip post-operatively was also improved in the group PR-ERAS (P < 0.050). The incidence of bowel-related and other adverse events was similar in both groups till 30 days post-operatively (P > 0.050).

Conclusions:

Peri-operative rehabilitation exercise might be another benevolent factor for early recovery of GI function and life of quality after colorectal surgery. Newer, more surgery-specific rehabilitation recovery protocol merits further exploration for these patients.

Trial Registration:

ChiCTR.org.cn, ChiCTR-ONRC-14005096
Prognostic nomogram incorporating radiological features for predicting overall survival in patients with AIDS-related non-Hodgkin lymphoma
Authors: Li Xueqin , Pan Ziang , Wang Xing , Hu Tianli , Ye Wen , Jiang Dongmei , Shen Wen , Liu Jinxin , Shi Yuxin , Xia Shuang , Li Hongjun
Published: November 2021

Background:

Acquired immune deficiency syndrome (AIDS)-related non-Hodgkin lymphoma (AR-NHL) is a high-risk factor for morbidity and mortality in patients with AIDS. This study aimed to determine the prognostic factors associated with overall survival (OS) and to develop a prognostic nomogram incorporating computed tomography imaging features in patients with acquired immune deficiency syndrome-related non-Hodgkin lymphoma (AR-NHL).

Methods:

A total of 121 AR-NHL patients between July 2012 and November 2019 were retrospectively reviewed. Clinical and radiological independent predictors of OS were confirmed using multivariable Cox analysis. A prognostic nomogram was constructed based on the above clinical and radiological factors and then provided optimum accuracy in predicting OS. The predictive accuracy of the nomogram was determined by Harrell C-statistic. Kaplan–Meier survival analysis was used to determine median OS. The prognostic value of adjuvant therapy was evaluated in different subgroups.

Results:

In the multivariate Cox regression analysis, involvement of mediastinal or hilar lymph nodes, liver, necrosis in the lesions, the treatment with chemotherapy, and the CD4 ≤100 cells/μL were independent risk factors for poor OS (all P < 0.050). The predictive nomogram based on Cox regression has good discrimination (Harrell C-index = 0.716) and good calibration (Hosmer–Lemeshow test, P = 0.620) in high- and low-risk groups. Only patients in the high-risk group who received adjuvant chemotherapy had a significantly better survival outcome.

Conclusion:

A survival-predicting nomogram was developed in this study, which was effective in assessing the survival outcomes of patients with AR-NHL. Notably, decision-making of chemotherapy regimens and more frequent follow-up should be considered in the high-risk group determined by this model.
Identification and characterization of murine adipose tissue-derived somatic stem cells of Shenque (CV8) acupoint
Authors: Hao Yu-Hui , Liu Zhi-Zhen , Zhao Hong , Wang Lei , Khan Ajab , Mu Jian-Bin , Wang Yu-Fei , Yang Li-Hong , Zhou Ran , Xie Jun
Published: November 2021

Background:

Shenque (CV8) acupoint is located on the navel and has been therapeutically used for more than 2000 years in Traditional Chinese Medicine (TCM). However, clinical research on the underlying therapeutic molecular mechanisms of the CV8 acupoint lags far behind. This study aimed to study the mechanisms of umbilical acupoint therapy by using stem cells.

Methods:

The morphological characteristics of CV8 acupoint were detected under a stereomicroscope using hematoxylin and eosin (H&E) staining. Oil Red, Masson, and immunohistochemical staining on multi-layered slices were used to identify the type of cells at the CV8 acupoint. Cell proliferation was measured by a cell counting kit-8 (CCK-8) method. Flow cytometry and immunohistochemistry were used for cell identification. Induced differentiation was used to compare the differentiation of cells derived from CV8 acupoint and non-acupoint somatic stem cells into other cell types, such as osteogenic, adipogenic, and neural stem cell-like cells.

Results:

Morphological observations showed that adipose tissues at the linea alba of the CV8 acupoint in mice had a mass-like distribution. Immunohistochemical staining confirmed the distribution of stem cell antigen-1 (Sca-1) positive cells in the multi-layered slices of CV8 acupoint tissues. Cells isolated from adipose tissues at the CV8 acupoint exhibited high expression of Sca-1 and CD44 and low expression of CD31 and CD34, and these cells possessed osteogenic, adipogenic, and neurogenic stem cell-like cell differentiation ability. The cell proliferation (day 4: 0.5138 ± 0.0111 vs. 0.4107 ± 0.0180, t = 8.447, P = 0.0011; day 5: 0.6890 ± 0.0070 vs. 0.5520 ± 0.0118, t = 17.310, P < 0.0001; day 6: 0.7320 ± 0.0090 vs. 0.6157 ± 0.0123, t = 13.190, P = 0.0002; and day 7: 0.7550 ± 0.0050 vs. 0.6313 ± 0.0051, t = 42.560, P < 0.0001), adipogenic ([9.224 ± 0.345]% vs. [3.933 ± 1.800]%, t = 5.000, P = 0.0075), and neurogenic stem cell-like cell differentiation (diameter < 50 μm: 7.2000 ± 1.3040 vs. 2.6000 ± 0.5477, t = 7.273, P < 0.0001; diameter 50–100 μm: 2.6000 ± 0.5477 vs. 1.0000 ± 0.7071, t = 4.000, P = 0.0039; and diameter >100 μm: 2.6000 ± 0.5477 vs. 0.8000 ± 0.8367, t = 4.025, P = 0.0038) were significantly enhanced in somatic stem cells derived from the CV8 acupoint compared to somatic stem cells from the groin non-acupoint. However, cells possessed significantly weaker osteogenicity ([2.697 ± 0.627]% vs. [7.254 ± 0.958]%, t = 6.893, P = 0.0023) in the CV8 acupoint group.

Conclusions:

Our study showed that CV8 acupoint was rich with adipose tissues that contained abundant somatic stem cells. The biological examination of somatic stem cells derived from the CV8 acupoint provided novel insights for future research on the mechanisms of umbilical therapy.
Rethinking Global Health Education in Plastic Surgery Residency
Authors: Christie Brian M. , Kurnik Nicole M. , Park Eugene , Ranganathan Kavitha , Smith Anthony A.
Published: November 2021

Surgical disease is now among the most common, preventable, and growing contributors to the global burden of disease. The attitudes of trainees toward global surgery and the viability of a global surgery as an academic track have blossomed. More optimized experiences within residency education are necessary, however, to prepare the next generation of global surgeons. The field of plastic surgery is thus at an important crossroads in the effort to incorporate global surgery into training programs in a uniform fashion across the country. The recent American Council of Academic Plastic Surgeons meeting in February 2020 was dedicated to identifying strategies that will enhance the adoption of global surgery practices within plastic surgery. In this article, we discuss the principles, themes, and ideas that emerged from this session, and further develop concrete initiatives believed to be potentially fruitful. Some have been discussed in other surgical disciplines or presented in isolation to the plastic surgery community, but never as a cohesive set of recommendations that take into account the background and shortfalls of the current model for global health education in the 21st century. We then introduce five recommendations to optimize learner education: (1) clarification of learner expectations and roles; (2) domestic teaching for optimization of field experiences; (3) expansion of longitudinal, formal rotations; (4) strengthening of the role of research; and (5) integration of program financing.
Practical Review of the Management of Animal Bites
Authors: Savu Andrei N. , Schoenbrunner Anna R. , Politi Rachel , Janis Jeffrey E.
Published: November 2021

Background:

Animal bites are common worldwide. Due to the plethora of animals, there are diverse pathogens with specific associated risks and treatment algorithms. It is crucial to understand these to develop and execute appropriate management plans. This practical review was designed to amalgamate the most common bites worldwide and synthesize data to help guide treatment plans.

Methods:

A PubMed literature search was performed focusing on the major animal bites. High-level studies were preferred and analyzed but lower-level studies were also used if high-level studies did not exist.

Results:

The tables presented in this article cover the pertinent information regarding the incidence, common presentation, initial treatment, and potential complications associated with bites from dogs, cats, horses, rodents, snakes, marine life, and spiders. Many of the pathogens associated with the bites are treatable with various and somewhat common antimicrobials, though some are less easy to access. Basic irrigation, debridement, and wound culture are common to almost every animal and should be the first step in treatment.

Conclusions:

Based on the current studies, the most important factor in treating animal bites is timely presentation to a medical facility and/or physician. It is critical that the offending animal be accurately identified to help guide medical and surgical algorithms, including specific antimicrobial treatment guided by the most commonly presenting pathogens specific to certain animals.
Efficient DIEP Flap: Bilateral Breast Reconstruction in Less Than Four Hours
Authors: Haddock Nicholas T. , Teotia Sumeet S.
Published: November 2021

Introduction:

The DIEP flap is considered the gold standard in autologous breast reconstruction. Despite the benefit of a lifelong natural reconstruction, some argue that the potential drawbacks, specifically operative time and recovery, are significant. We recently focused specifically on process analysis in our DIEP flap practice and present a comprehensive analysis in efficient DIEP flap breast reconstructions.

Methods:

Fifty consecutive bilateral DIEP flaps were prospectively tracked (100 flaps). The procedure was divided into segments (recipient site preparation, DIEP flap dissection/harvest, microsurgery, breast shaping, and abdominal closure). All individual step times were recorded for each team member. Relevant patient characteristics, intraoperative details and postoperative outcomes were recorded.

Results:

Average surgical time was 3 hours and 58 minutes (the fastest time recorded was 2 h and 14 min). There were no immediate postoperative complications. The anastomotic revision rate was 6%. Four surgeons contributed 34.7% of the time, three surgeons 32.2% of the time, two surgeons 23.6% of the time, and one surgeon 4.8% of total time. In procedures under 4 hours, four surgeons contributed simultaneously 36.7% of the time compared to 21.8% in the longer procedures (P = 0.004). Four surgeons contributed 45.4% of the time (P = 0.01) in the sub-three-hour bilateral DIEP flap procedures.

Conclusions:

Efficient DIEP flap breast reconstruction can be accomplished with a well-trained and coordinated team approach involving like-minded surgeons with extensive experience working together. The synergistic map shows constant movement with utilization of hidden time, without sacrificing education, outcomes, or innovation.
Treatment Trends of Adult Brachial Plexus Injury: A Bibliometric Analysis
Authors: Čebron Urška , Mayer Johannes A. , Lu Chao , Daigeler Adrien , Prahm Cosima , Kolbenschlag Jonas
Published: November 2021

Background:

Brachial plexus injury is often debilitating because it can severely impair upper extremity function and, thus, quality of life. The surgical treatment of injuries to the brachial plexus is very demanding because it requires a profound understanding of the anatomy and expertise in microsurgery. The aim of this study was to get an overview of the landscape in adult brachial plexus injury surgery, and to understand how this has changed over the years.

Methods:

The most frequently cited articles in English relevant to adult brachial plexus injury were identified through the Web of Science online database.

Results:

The average number of citations per article was 32.8 (median 24, range 4–158). Authors from 26 countries contributed to our list, and the US was the biggest contributor. Almost half of all nerve transfer cases were described by Asian authors. Amongst nerve transfer, the spinal accessory nerve was the preferred donor overall, except in Asia, where intercostal nerves were preferred. Distal nerve transfers were described more often than plexo-plexal and extra-plexal-to-plexal transfers. The most common grafts were sural nerve grafts and vascularized ulnar nerve grafts, which became popular in the last decade.

Conclusions:

Our study sheds light on the regional variations in treatment trends of adult brachial plexus injury, and on the evolution of the field over the last 30 years. The articles included in our analysis are an excellent foundation for those interested in the surgical management of brachial plexus injuries.
Bridging Lymphatic Vessel Defects with a Perforator Flap that Contains Retrograde Axial Lymphatic Flow
Authors: Kagami Satoko , Akita Shinsuke , Kubota Yoshitaka , Mitsukawa Nobuyuki
Published: November 2021

Axiality of lymphatic flow is possibly an important consideration for stimulating recanalization of flow between the transferred flap and the recipient site during wound healing. Antegrade lymphatic flow reconstruction has previously been reported. Here we report the first case where lymph stasis following groin lymph nodes dissection could be recanalized in a pedicled anterolateral thigh flap in which the collecting lymphatics were arranged retrograde. A 78-year-old male patient presented with bilateral lower extremity lymphedema and bilateral inguinal skin ulcers with lymphorrhea. He had been treated for rectal cancer by low-anterior resection, lymph nodes dissection, colostomy, and subsequent heavy particle radiotherapy for a local recurrence involving pelvic lymph nodes. We planned a reconstruction using a pedicled anterolateral thigh flap that included retrograde collecting lymphatic vessels, with the flap rotated as a propeller flap. The flap successfully survived and clinical symptoms of edema in both lower limbs improved during the short postoperative course. Although the collecting lymphatic vessels within the flap were arranged retrograde to the direction of the anatomical lymphatic flow at the recipient site, linear lymphatic flow consistent with the transferred flap was confirmed by lymphoscintigraphy. This case shows that the lymphatic flow may recanalize after tissue transplantation, even if the collecting lymphatic vessels in the flap are arranged retrograde to the direction of lymphatic flow.
3D Printed Chest Wall: A Tool for Advanced Microsurgical Training Simulating Depth and Limited View
Authors: Papavasiliou Theodora , Ubong Sonia , Khajuria Ankur , Chatzimichail Stelios , Chan Jeffrey C. Y.
Published: November 2021

The deep inferior epigastric perforator (DIEP) flap has become the free flap of choice for autologous breast reconstruction. However, anastomoses of DIEP pedicles to internal mammary vessels in the chest wall are difficult due to restricted access and the depth of the vessels. Successful performance of such demanding procedures necessitates advanced requirements for microsurgical training models. The current chicken thigh model has been used to acquire microsurgical skills, allowing early learning curve trainees to practice repeatedly in inconsequential environments. Despite the increasing use of this model for training purposes, the resemblance to a clinical environment is tenuous. Such models should include anastomosis practice within the depth where the recipient vessels are located. To address this, we developed a three-dimensional (3D) printed chest wall as an addition to the current chicken thigh model, which reliably mimics the complexity of the anastomosis performed during DIEP breast reconstruction. This form of rapid prototyping facilitates a newfound ability for early learning curve trainees to exercise end-to-end anastomoses on vessels located with variable depths. Our enhancement of the current chicken thigh model is simple, cost-effective and offers a significantly more realistic resemblance to a clinical situation.
Evaluation of Patient Expectations before Carpal Tunnel Release
Authors: Rogers Miranda J. , Randall Dustin J. , Brennan Jayden N. , Zhang Chong , Presson Angela P. , Kazmers Nikolas H.
Published: November 2021

Background:

Carpal tunnel release (CTR) is common, yet patient treatment expectations remain unclear. The primary purpose was to describe patient expectations before CTR. Secondarily, we aimed to identify factors influencing expectations.

Methods:

Included patients underwent unilateral or bilateral CTR between 2015 and 2017 at a single academic center. Expectations regarding the level of relief/improvement were queried. Area deprivation index (ADI) was used to measure social deprivation. Univariate and multivariable logistic regression identified factors associated with expecting great relief/improvement.

Results:

Of 307 included patients, mean age was 54 ± 16 years and 63% were women. Patients most commonly expected great (58%) or some (23%) relief/improvement. Few patients expected little (3%) or no (4%) relief/improvement, and 13% had no expectations. In the multivariable analysis, male sex, lower social deprivation, and lower BMI were associated with expecting great relief/improvement. Age, surgical technique (open versus endoscopic), use of the operating room versus procedure room, and preoperative factors (constant numbness, weakness/atrophy, duration of symptoms, and QuickDASH) were not associated with expectations.

Conclusions:

Most patients expect some to great improvement after CTR. This was independent of several factors with a known association with worse outcomes (advanced age, atrophy/weakness, and constant numbness). Male sex was associated with the expectation of great improvement, in which superior outcomes relative to females have not been borne out in the literature. These findings highlight patient counseling opportunities. The observed association between social deprivation and expectations warrants further investigation, as the socioeconomically disadvantaged experience worse healthcare outcomes in general.
Hinge Flap of Rectus Abdominis Muscle Combined with Component Separation Technique: Clinical Cases
Authors: Aldana Celso A. , Caceres Heidi , Gimenez Alejandro , Saguier Guillermo
Published: November 2021

Some techniques to reconstruct the abdominal wall have been published, including the component separation procedure. The contribution of the rectus abdominis flap in the reconstruction of a giant incisional hernia is reported. The authors report three clinical cases in which the component separation technique was insufficient to reconstruct a giant midline incisional hernia. As a salvage technique, the rectus abdominis flap was dissected in the form of a hinge. The postoperative period was successful in all patients, combining both techniques. The rectus abdominis hinge flap could be used as a complementary technique to component separation to reconstruct a giant midline incisional hernia. There are several options to reconstruct the abdominal wall, such as anterior transposition of the posterior rectus sheath,
1
or rotation of the anterior sheath toward the midline. This strategy is known as open book.
2
The rectus turnover flap is also used.
3
The anterior component separation technique closes defects less than 20 cm width.
4
If it is wider, the reconstruction is more difficult. When the operative plan fails in the operating room, an additional technique should be considered. We report on the cases in which we use the rectus abdominis hinge flap.
Functional Recovery following Repair of Long Nerve Gaps in Senior Patient 2.6 Years Posttrauma
Authors: Foy Christian A. , Micheo William F. , Kuffler Damien P.
Published: November 2021

Sensory nerve grafts are the clinical “gold standard” for repairing peripheral nerve gaps. However, reliable good-to-excellent recovery develops only for gaps less than 3–5 cm, repairs performed less than 3–5 months posttrauma, and patients aged less than 20–25 years. As the value of any variable increases, the extent of recovery decreases precipitously, and if the values of any two or all increase, there is little to no recovery. One 9-cm-long and two 11-cm-long nerve gaps in a 56-year-old patient were repaired 2.6 years posttrauma. They were bridged with two sensory nerve grafts within an autologous platelet-rich plasma-filled collagen tube. Both were connected to the proximal ulnar nerve stump, with one graft end to the distal motor and the other to the sensory nerve branches. Although presurgery the patient suffered chronic level 10 excruciating neuropathic pain, it was reduced to 6 within 2 months, and did not increase for more than 2 years. Motor axons regenerated across the 9-cm gap and innervated the appropriate two measured muscles, with limited muscle fiber recruitment. Sensory axons regenerated across both 11-cm gaps and restored normal topographically correct sensitivity to stimuli of all sensory modalities, including static two-point discrimination of 5 mm, and pressure of 2.83 g to all regions innervated by both sensory nerves. This novel technique induced a significant long-term reduction in chronic excruciating neuropathic pain while promoting muscle reinnervation and complete sensory recovery, despite the values of all three variables that reduce or prevent axon regeneration and recovery being simultaneously large.
Clinical Competency Committees in Plastic Surgery Residency
Authors: Blau Jared A. , Atia Andrew N. , Powers David B.
Published: November 2021

Background:

Clinical competency committees (CCCs) are now an Accreditation Council on Graduate Medical Education (ACGME) requirement for plastic surgery training programs. They serve to monitor resident progress and make formal recommendations to program directors on promotion, remediation, and dismissal, based on resident progress toward the curricular milestones.

Methods:

Here, we present an overview on building, conducting, and improving a CCC, reviewing the literature available regarding best practices regarding this novel assessment system, with attention to the particular requirements for plastic surgery training.

Results:

We present the results of the Duke University CAQCC as a case study in the efficacy of a well-executed group in terms of improved resident outcomes, particularly regarding In-service Examination scores as an objective measure.

Conclusions:

Rather than simply serving as a necessary ACGME dictum, the CCC has the opportunity to demonstrably improve resident education. This article is valuable for department leaders, program directors, faculty, and residents toward understanding the purpose and design of their CCC.