bluuebunny/crossref_metadata_2025 huggingface dataset:
Term Structure of Risk in Expected Returns
Authors: Zviadadze Irina
Published: January 2021

This paper develops a methodology to test structural asset pricing models based on their implications for the multiperiod risk-return trade-off. A new measure, the term structure of risk, captures the sensitivities of multiperiod expected returns to structural shocks. The level and slope of the term structure of risk can indicate misspecification in equilibrium models. I evaluate the performance of asset pricing models with long-run risk, consumption disasters, and variance shocks. I find that only a model with multiple shocks in the variance of consumption growth is consistent with the propagation of and compensation for risk in the aggregate stock market.
Neutrophil extracellular traps release in gout and pseudogout depends on the number of crystals regardless of leukocyte count
Authors: Garcia-Gonzalez Estrella , Gamberucci Alessandra , Lucherini Orso-Maria , Alì Alessandra , Simpatico Antonella , Lorenzini Sauro , Lazzerini Pietro-Enea , Tripodi Sergio , Frediani Bruno , Selvi Enrico
Published: January 2021

Objectives

Microcrystal-induced arthritis is still an unresolved paradigm for medicine. Overt inflammation may be absent even when crystals occur in SF. Recently, the production of neutrophil extracellular traps (NETs) embedding MSU crystals has been proposed as a possible mechanism of the auto-resolution of the inflammatory phase during gout. We aimed to verify and quantify the release of NETs in SFs during gout and pseudogout attacks and to compare any differences with respect to crystals and neutrophils number, and to analyse activation of necroptosis pathway in SF from crystal-induced arthritis.

Methods

SF samples were obtained by arthrocentesis from 22 patients presenting acute crystal-induced arthritis, gout or pseudogout (n = 11 each group), and from 10 patients with acute non-crystal arthritis as controls. NETosis was quantified in SF by nucleic acid stain and by quantification of human neutrophil elastase. Activation of phosphorylated MLKL was assessed by western blot.

Results

We observed that SF neutrophils encountering MSU and CPPD crystals during episodes of gout and pseudogout release NETs in relation to the number of crystals in SF and irrespective of neutrophil density and type of crystal. This release was accompanied by necroptosis through the activation of the MLKL pathway.

Conclusions

Our findings suggest that a role of NETs in crystal-induced arthritis is to ‘trap extracellular particles’, including microcrystals. Embedding crystals in aggregates of NETs may be the basis of tophi and CPPD deposition, and may have implications for disease evolution rather than for spontaneous resolution of the acute attack.
Mer tyrosine kinase as a possible link between resolution of inflammation and tissue fibrosis in IgG4-related disease
Authors: Rovati Lucrezia , Kaneko Naoki , Pedica Federica , Monno Antonella , Maehara Takashi , Perugino Cory , Lanzillotta Marco , Pecetta Simone , Stone John H , Doglioni Claudio , Manfredi Angelo A , Pillai Shiv , Della-Torre Emanuel
Published: January 2021

Objectives

IgG4-related disease (IgG4-RD) is a systemic fibro-inflammatory disorder characterized by a dysregulated resolution of inflammation and wound healing response that might develop after an apoptotic insult induced by cytotoxic T lymphocytes (CTLs). Mer receptor tyrosine kinase (MerTK) and its ligand, protein S (ProS1), have a pivotal role in the resolution of inflammation, being implicated in the clearance of apoptotic cells, quenching of the immune response and development of tissue fibrosis. In the present work we aimed to investigate a possible involvement of the MerTK signalling pathway in the pathogenesis of IgG4-RD and development of tissue fibrosis.

Methods

MerTK and ProS1 expression patterns in IgG4-RD lesions were evaluated by immunohistochemistry and immunofluorescence studies. Circulating MerTK+ monocytes, soluble Mer and MerTK ligands were measured in the peripheral blood of IgG4-RD patients and healthy controls by flow cytometry and ELISA, respectively.

Results

MerTK was highly expressed by macrophages infiltrating IgG4-RD lesions. MerTK+ macrophages were more abundant in IgG4-RD than in Sjögren’s syndrome and interacted with apoptotic cells and ProS1-expressing T and B lymphocytes. Moreover, they expressed the pro-fibrotic cytokine TGF-β and their numbers declined following rituximab-induced disease remission. Circulating MerTK+ monocytes, soluble Mer and MerTK ligands were not increased in the peripheral blood of patients with IgG4-RD.

Conclusions

The MerTK–ProS1 axis is activated in IgG4-RD lesions, possibly leading to persistent stimulation of processes involved in the resolution of inflammation and tissue fibrosis.
Associations between serum antibodies to periodontal pathogens and preclinical phases of rheumatoid arthritis
Authors: Manoil Daniel , Courvoisier Delphine S , Gilbert Benoit , Möller Burkhard , Walker Ulrich A , Muehlenen Ines Von , Rubbert-Roth Andrea , Finckh Axel , Bostanci Nagihan
Published: January 2021

Objectives

To examine whether serum antibodies against selected periodontal pathogens are associated with early symptoms of RA development in healthy individuals at risk of developing the disease.

Methods

Within an ongoing study cohort of first-degree relatives of patients with RA (RA-FDRs), we selected four groups corresponding to specific preclinical phases of RA development (n = 201). (i) RA-FDR controls without signs and symptoms of arthritis nor RA-related autoimmunity (n = 51); (ii) RA-FDRs with RA-related autoimmunity (n = 51); (iii) RA-FDRs with inflammatory arthralgias without clinical arthritis (n = 51); and (iv) RA-FDRs who have presented at least one swollen joint (‘unclassified arthritis’) (n = 48). Groups were matched for smoking, age, sex and shared epitope status. The primary outcome was IgG serum levels against five selected periodontal pathogens and one commensal oral species assessed using validated-in-house ELISA assays. Associations between IgG measurements and preclinical phases of RA development were examined using Kruskal–Wallis or Mann–Whitney tests (α = 0.05).

Results

None of the IgGs directed against individual periodontal pathogens significantly differed between the four groups of RA-FDRs. Further analyses of cumulated IgG levels into bacterial clusters representative of periodontal infections revealed significantly higher IgG titres against periodontopathogens in anti-citrullinated protein antibodies (ACPA)-positive RA-FDRs (P = 0.015). Current smoking displayed a marked trend towards reduced IgG titres against periodontopathogens.

Conclusion

Our results do not suggest an association between serum IgG titres against individual periodontal pathogens and specific preclinical phases of RA development. However, associations between cumulative IgG titres against periodontopathogens and the presence of ACPAs suggest a synergistic contribution of periodontopathogens to ACPA development.
Proteomic Analysis Demonstrates a Molecular Dialog Between Trichoderma guizhouense NJAU 4742 and Cucumber (Cucumis sativus L.) Roots: Role in Promoting Plant Growth
Authors: Liu Qiumei , Tang Siyu , Meng Xiaohui , Zhu Han , Zhu Yiyong , Liu Dongyang , Shen Qirong
Published: January 2021

Trichoderma is a genus of filamentous fungi that play notable roles in stimulating plant growth after colonizing the root surface. However, the key proteins and molecular mechanisms governing this stimulation have not been completely elucidated. In this study, Trichoderma guizhouense NJAU 4742 was investigated in a hydroponic culture system after interacting with cucumber roots. The total proteins of the fungus were characterized, and the key metabolic pathways along with related genes were analyzed through proteomic and transcriptomic analyses. The roles played by the regulated proteins during the interaction between plants and NJAU 4742 were further examined. The intracellular or extracellular proteins from NJAU 4742 and extracellular proteins from cucumber were quantified, and the high-abundance proteins were determined which were primarily involved in the shikimate pathway (tryptophan, tyrosine, and phenylalanine metabolism, auxin biosynthesis, and secondary metabolite synthesis). Moreover, 15N-KNO3 labeling analysis indicated that NJAU 4742 had a strong ability to convert nitrogenous amino acids, nitrate, nitrile, and amines into ammonia. The auxin synthesis and ammonification metabolism pathways of NJAU 4742 significantly contributed to plant growth. The results of this study demonstrated the crucial metabolic pathways involved in the interactions between Trichoderma spp. and plants.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Marijuana and Nurses: Career Risks Remain
Authors: Molyneux Jacob
Published: January 2021

As laws change, workplace rules often don't.
Xofluza Now Indicated to Prevent Influenza
Authors: Aschenbrenner Diane S.
Published: January 2021

Baloxavir marboxil (Xofluza), an antiviral flu treatment, has now been approved to prevent influenza.

Patients should avoid taking calcium, aluminum, or magnesium products while receiving baloxavir as this will lead to a loss of antiviral efficacy.
Pressure Injury Prevention in Patients with Prolonged ED Stays Prior to Admission
Authors: Edwards Amanda , Sitanggang Novi , Wolff Kelly , Role Jewel , Cardona Trisha , Sanchez Myra , Radovich Patricia
Published: January 2021

Purpose:

The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units.

Methods:

A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention.

Results:

The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days.

Implications:

At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.
Beyond Screening: Health Systems Invest in Social Determinants of Health
Authors: Fauteux Nicole
Published: January 2021

This is the second of three articles exploring ways in which frontline nurses may be affected by recommendations of the forthcoming National Academy of Medicine Future of Nursing 2020-2030 study.

As pioneering health systems begin investing in housing and other services to support individuals and bolster communities, nurses gain new opportunities and responsibilities. On the one hand, nurses should expect their work to entail more tracking and sharing of patient data. On the other, nurses can apply their creativity and holistic approach to care to assist health systems in making an overdue cultural shift.
The Car Ride Home
Authors: Fletcher Paige
Published: January 2021

As stories of dying alone from COVID-19 pervade the news, a reminder of the intimacy and love that can surround a hospice patient's last moments.
Health After Cancer: An Innovative Continuing Medical Education Course Integrating Cancer Survivorship Into Primary Care
Authors: Smith Stephanie M. , Williams Pamela , Kim Jennifer , Alberto Jayzona , Schapira Lidia
Published: January 2021

Problem

The transition from oncology care back to primary care after cancer therapy is challenging for cancer survivors who seek services that address the effect of their cancer history on their present health. Lack of knowledge about the health needs of cancer survivors is a barrier to incorporating survivorship care into primary care practice. Formal training in cancer survivorship is rarely included in medical education and presents an opportunity for intervention.

Approach

The authors developed (January 2019–March 2020) an online continuing medical education (CME) course for primary care physicians (PCPs) that launched in April 2020. Course design and content were informed by critically reviewing cancer survivorship CME courses and understanding cancer survivors’ clinical experiences in a primary care setting. The course aims to pique learners’ interest through a concise, practical educational experience using peer-to-peer primary care-focused instruction in a case-based, multimedia-enriched format. In the course, 4 patient cases illustrate the physical and psychological effects of cancer treatment, and a primary care narrator demonstrates ways to approach these concerns during a clinic visit, providing tips for empathic communication with cancer survivors. The course development team—including a PCP, medical and pediatric oncologists, and medical educators with expertise in instructional design—used an iterative process to review and revise the content. PCPs and specialists reviewed the script and provided constructive feedback that was incorporated into revisions.

Outcomes

The authors will evaluate course effectiveness based upon user experience and perceived effect on clinical practice and professional growth. A follow-up survey will assess barriers to course completion and durability of effect.

Next Steps

Future directions include dissemination of the course to a broader audience including medical trainees, evaluation of higher-level learning outcomes (e.g., effect on PCPs’ clinical practice), and adaptation of the course for patients with a focus on self-management.
Machine Learning: The Next Paradigm Shift in Medical Education
Authors: James Cornelius A. , Wheelock Kevin M. , Woolliscroft James O.
Published: January 2021

Machine learning (ML) algorithms are powerful prediction tools with immense potential in the clinical setting. There are a number of existing clinical tools that use ML, and many more are in development. Physicians are important stakeholders in the health care system, but most are not equipped to make informed decisions regarding deployment and application of ML technologies in patient care. It is of paramount importance that ML concepts are integrated into medical curricula to position physicians to become informed consumers of the emerging tools employing ML. This paradigm shift is similar to the evidence-based medicine (EBM) movement of the 1990s. At that time, EBM was a novel concept; now, EBM is considered an essential component of medical curricula and critical to the provision of high-quality patient care. ML has the potential to have a similar, if not greater, impact on the practice of medicine. As this technology continues its inexorable march forward, educators must continue to evaluate medical curricula to ensure that physicians are trained to be informed stakeholders in the health care of tomorrow.
Preoperative Thoracic Curve Magnitude and L4 End Vertebra Were Risk Factors for Subjacent Disc Wedging After Selective Thoracolumbar/Lumbar Fusion with L3 as the Lowest Instrumented Vertebra in Lenke Type 5 Curve Patients
Authors: Banno Tomohiro , Yamato Yu , Oba Hiroki , Ohba Tetsuro , Hasegawa Tomohiko , Yoshida Go , Arima Hideyuki , Oe Shin , Mihara Yuki , Ushirozako Hiroki , Takahashi Jun , Haro Hirotaka , Matsuyama Yukihiro
Published: January 2021

Study Design.

Retrospective multicenter study.

Objective.

This study aimed to investigate the incidence and risk factors of subjacent disc wedging (SDW) in adolescent idiopathic scoliosis (AIS) patients with Lenke type 5 curve.

Summary of Background Data.

SDW is frequently observed after surgery; however, data about its mechanism and relations with outcome are limited.

Methods.

Data of 59 patients with AIS with Lenke type 5 curves who underwent posterior spinal fusion to L3 as the lowest instrumented vertebra (LIV) were retrospectively analyzed. The subjacent disc angle (SDA) was defined as the angle between L3 (LIV) and L4. SDW was defined as the absolute value of SDA of 10° or higher 2 years postoperatively. The incidence of SDW was investigated between nonselective and selective thoracolumbar/lumbar (TL/L) fusion group. In the selective group, patients with and without SDW were compared.

Results.

Among 59 patients, 11 had nonselective and 48 had selective fusion. No patients in the nonselective group showed SDW versus 13 patients in the selective group (27%) showed SDW. In the selective group, patients with SDW showed significantly greater main thoracic curve, apical vertebral translation of the main thoracic curve, upper instrumented vertebra tilt, LIV tilt, and SDA 2 years postoperatively, whereas no differences were found in the coronal balance or clinical outcome. Multivariate analysis revealed preoperative T curve and SDA as predictors of SDW occurrence. T curve greater than 30° and SDA greater than 0° were calculated as cutoff values based on the receiver operating characteristic curve.

Conclusion.

SDW is sometimes seen in Lenke type 5 patients with AIS who underwent selective TL/L fusion. SDW seemed to occur as a compensation mechanism for progressing deformity of unfused segments (thoracic curve and residual lumbar curve) to maintain coronal alignment. Preoperative T curve > 30° and SDA > 0° (lower-end vertebra as L4) were determined as risk factors for SDW occurrence.

Level of Evidence: 3
How Preoperative Motor Weakness Affects the Extent of Recovery After Elective Spine Surgery in Patients with Degenerative Lumbar Spinal Stenosis
Authors: Yagi Mitsuru , Suzuki Satoshi , Nori Satoshi , Okada Eijiro , Tsuji Osahiko , Nagoshi Narihito , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: January 2021

Study Design.

Retrospective review.

Objective.

This study sought to determine how baseline motor weakness (MW) affects elective spine surgery in patients with degenerative lumbar spinal stenosis (LSS).

Summary of Background Data.

Favorable clinical outcomes have been described for elective spine surgery in patients with LSS. However, the way preoperative MW affects the patient's health-related quality of life (HRQoL) after surgery is not well understood.

Methods.

A retrospective review of prospectively collected data from 305 surgically treated patients with LSS who had 2-year follow-up was performed (age 71 ± 9 yrs, male 62%). Demographic, radiographic, and clinical outcomes were analyzed at baseline and at 1-year, 2-year, and 3-year postoperation. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire was used to assess the HRQoLs. The HRQoLs were compared between those with or without preop MW. Adjusted multivariate logistic regression analyses were performed to determine whether MW affected HRQoLs.

Results.

One hundred sixteen patients (38%) were categorized as MW+. The patient background including age, sex, presence of degenerative spondylolisthesis, type of surgery, and presence of neurological claudication were similar between the two groups. However, the 1-, 2-, and 3-year postoperative visual analogue scale of back pain, leg pain, leg numbness, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire lumbar function, social life, mental health, and walking ability were all inferior in the MW+ group, whereas a similar percentage of patients achieved a minimum clinically important difference in all subdomains at 3 years. The adjusted multivariate logistic regression analyses showed that having ≥2 muscles with MW, and severity of MW (manual motor test grade) were independent risk factors for both difficulty climbing stairs and walking >15 minutes. (muscles with MW≥2; stair climbing: OR 6.4[2.3–17.4], walking: OR 3.2[1.4–7.3], severity of MW; stair climbing: OR 2.5[1.4–4.4], walking: OR 2.2[1.3–3.7]).

Conclusion.

The patients with baseline MW had inferior HRQoL for up to 3 years compared with that of those without MW; however, the amount of improvement in HRQoL was comparable. Timely follow-up is important to find out the deterioration of motor function.

Level of Evidence: 4
Understanding Restrictive Versus Liberal Fluid Therapy for Major Abdominal Surgery Trial Results: Did Liberal Fluids Associate With Increased Endothelial Injury Markers?
Authors: Bihari Shailesh , Dixon Dani-Louise , Painter Thomas , Myles Paul , Bersten Andrew D.
Published: January 2021

Objectives:

Liberal fluid strategies in critically ill patients are associated with harm, thought to be due to endothelial and glycocalyx injury. As the restrictive versus liberal fluid therapy for major abdominal surgery trial not only failed to report survival benefit with restrictive fluids but was associated with a higher rate of acute kidney injury, we hypothesized that factors other than endothelial and glycocalyx injury were likely to account for these findings. Consequently, we measured injury biomarkers in a cohort of the restrictive versus liberal fluid therapy for major abdominal surgery trial.

Design:

The restrictive versus liberal fluid therapy for major abdominal surgery trial was an international, randomized, assessor-blinded trial comparing restrictive with liberal IV fluid regimens that represented traditional care in patients undergoing major abdominal surgery.

Setting and Patients:

Cohort of restrictive versus liberal fluid therapy for major abdominal surgery bloods was collected at a single major site (161 patients) prior to, day 1 and day 3 after surgery.

Intervention:

Bloods were blindly and randomly batch analyzed for plasma markers of endothelial/glycocalyx injury—angiopoietin-1, angiopoietin-2, soluble tyrosine-protein kinase-2 receptor, soluble intracellular adhesion molecule-1, syndecan, and tumor necrosis factor-α. Data were examined as restrictive versus liberal enrollment groups and high versus low (± 5,000 mL) fluid groups. Differences were examined by linear mixed modeling.

Measurement and Main Results:

There were no significant differences in any biomarkers between the restrictive (n = 75) and liberal (n = 86) groups. When examined as low (n = 81) and high (n = 79) fluid groups, plasma angiopoietin-2 (p = 0.009) and soluble intracellular adhesion molecule-1 (p = 0.01) were elevated in the high fluid group. There were no differences in other biomarkers.

Conclusions:

Although these results are consistent with previous findings of vascular injury following liberal fluid therapy, they suggest alternative mechanisms underlie the clinical outcomes from restrictive versus liberal fluid therapy for major abdominal surgery study.

ClinicalTrials.gov identifier:

NCT01424150.
Developmental Regression, Depression, and Psychosocial Stress in an Adolescent with Down Syndrome
Authors: Stein David S. , Munir Kerim M. , Karweck Andrea J. , Davidson Emily J. , Stein Martin T.
Published: January 2021

CASE: Kristen is a 13-year-old girl with Down syndrome (DS) who was seen urgently with concerns of cognitive and developmental regression including loss of language, social, and toileting skills. The evaluation in the DS clinic focused on potential medical diagnoses including atlantoaxial joint instability, vitamin deficiency, obstructive sleep apnea (OSA), and seizures. A comprehensive medical evaluation yielded only a finding of moderate OSA. A reactive depression was considered in association with several psychosocial factors including moving homes, entering puberty/onset of menses, and classroom change from an integrated setting to a self- contained classroom comprising unfamiliar peers with behavior challenges.

Urgent referrals for psychological and psychiatric evaluations were initiated. Neuropsychological testing did not suggest true regression in cognitive, language, and academic skills, although decreases in motivation and performance were noted with a reaction to stress and multiple environmental changes as a potential causative factor. Psychiatry consultation supported this finding in that psychosocial stress temporally correlated with Kristen's regression in skills.

Working collaboratively, the team determined that Kristen's presentation was consistent with a reactive form of depression (DSM-IV-TR: depressive disorder, not otherwise specified). Kristen's presentation was exacerbated by salient environmental stress and sleep apnea, rather than a cognitive regression associated with a medical cause. Treatment consisted of an antidepressant medication, continuous positive airway pressure for OSA, and increased psychosocial supports. Her school initiated a change in classroom placement. With this multimodal approach to evaluation and intervention, Kristen steadily improved and she returned to her baseline function.
Uncomplicated Sigmoid Volvulus Is Ideal for Laparoscopic Sigmoidectomy With Transrectal Natural Orifice Specimen Extraction
Authors: Seow-En Isaac , Chang Sheng-Chi , Ke Tao-Wei , Shen Ming-Yin , Chen Hong-Chang , William Tzu-Liang Chen
Published: January 2021

INTRODUCTION:

Natural orifice specimen extraction is the next step in minimally invasive colorectal surgery but can be technically challenging, with additional risks, especially for oncologic surgery. For several key reasons, sigmoid volvulus is well suited for natural orifice specimen extraction surgery. We describe our method and experience with double-stapled anastomosis transrectal natural orifice specimen extraction for sigmoid volvulus.

TECHNIQUE:

Using 3- or 4-port laparoscopy, the mesentery is separated from the long sigmoid loop. After the distal bowel is tied off and washed out, the rectum is completely transected and the proximal bowel delivered transrectally through a wound protector. Proximal transection is performed externally, and the circular stapler anvil is set before the bowel is returned into the abdominal cavity. The rectum stump is closed with an endoscopic linear stapler, and a circular-stapled anastomosis is performed.

RESULTS:

After successful endoscopic decompression, 6 patients underwent elective laparoscopic sigmoidectomy with natural orifice specimen extraction for volvulus at China Medical University Hospital from 2015 to 2020. The median operative time was 179 minutes (range, 151–236 min). No intraoperative complications were encountered. The median postoperative length of stay was 4 days (range, 2–9 d). One patient experienced postoperative small-bowel ileus resulting in readmission. The median follow-up duration was 12 months (range, 2–49 mo). One recurrence of volvulus was recorded 27 months postsurgery.

CONCLUSION:

Uncomplicated sigmoid volvulus can be treated effectively with sigmoidectomy and natural orifice specimen extraction. Surgeons who attempt this procedure should be well versed with conventional laparoscopy but do not necessarily need to be experienced with natural orifice specimen extraction for successful surgery.
How Fat Grafting Works
Authors: Evans Brogan G. A. , Gronet Edward M. , Saint-Cyr Michel H.
Published: January 2021

Background:

Fat grafting has been shown to improve diseased soft issue. Although the mechanism behind fat grafting’s regenerative properties is currently debated, published studies agree that there is an associated vasculogenic effect. A systematic literature review was conducted to elucidate the biochemical pathways responsible for establishing neo-vasculature to grafted fat.

Methods:

A systematic literature review was conducted by searching PubMed for current basic science and clinical research relating to fat grafting. In total, 144 of 269 (54%) articles met the inclusion criteria for our literature review. These 144 articles were summarized, with 86 of them (60%) used to construct this article at the authors’ discretion.

Results:

Fat grafting–induced neovascularization can be divided into 3 parts. First, tissue trauma induced via fat injection activates a host inflammatory response necessary for cellular recruitment. Recruited cells promote the formation of connective tissue and neo-vasculature at the graft site. Second, cellular elements within the lipoaspirate contribute to neovascularization through a cytokine burst. Third, a synergistic relationship is established between recruited inflammatory cells and the cytokine burst of grafted fat. The end product of these processes is the differentiation of progenitor cells and the creation of neo-vasculature at the graft site.

Conclusions:

Establishing neovasculature is paramount for the survival of grafted fat. Fat graft take can be divided into 2 steps: imbibition and neovascularization. We believe this process occurs through 3 distinct concepts: host inflammation via graft injection, hypoxic response of lipoaspirate-derived cellular elements, and a synergistic relationship between host inflammation and grafted fat.
Progressive Surgical Management of Hemifacial Myohyperplasia for Improved Functional and Aesthetic Results
Authors: Zissman Sivan , Cooperman Yael , Leshem David , Gur Eyal
Published: January 2021

Hemifacial myohyperplasia (HMH) is a rare congenital disorder characterized by the unilateral enlargement of facial muscles and unilateral hypoplasia of the skeletal structures. The causes, risk of recurrence in subsequent offspring, and pathogenesis of HMH remain unclear, and the condition can involve a number of features. Among them are pronounced facial asymmetry and changes to both hard and soft tissue structures, as well as facial hemiparesis. We describe the long-term surgical management of HMH in a 3-year-old girl who presented to our department with no other systemic manifestation. We describe the treatment options as well as our approach, which included the use of botulinum toxin injections, and our considerations when choosing to employ careful preservation of the facial nerve and facial mimetic muscles (rather than facial paralysis and facial reanimation) in 2 stages using muscle and nerve grafts. We found that sequential debulking procedures undertaken at significant intervals have offered our patient improved aesthetic and functional results in comparison with the use of nonsurgical techniques, comparable to the more complex grafting technique used in facial reanimation surgery. Due, in part, to the rarity of HMH, there is currently no consensus regarding the optimal treatment approach to the condition. Our use of serial debulking rather than the more complex and problematic microsurgical approach of facial reanimation surgery offers a feasible surgical solution with both aesthetic and functional improvement for these patients.
Dupuytren’s Fasciectomy: Surgical Pearls in Planning and Dissection
Authors: Hever Pennylouise , Smith Oliver J. , Nikkhah Dariush
Published: January 2021

Fasciectomy remains the mainstay of surgical treatment for Dupuytren’s disease at many units worldwide, particularly in cases of recurrence after aponeurotomy or enzymatic fasciotomy. In some series, this has been reported as high as 48% in 3 years. The lead author has since abandoned the use of collagenase altogether. In this innovation article, we describe simple maneuvers to aid the planning and dissection of a Dupuytren’s fasciectomy. We describe techniques to enable efficient dissection of the cord and minimize problems when designing skin flaps. We also highlight technical points in revision cases.
Microsurgery Training in Plastic Surgery
Authors: Kania Kasia , Chang Daniel K. , Abu-Ghname Amjed , Reece Edward M. , Chu Carrie K. , Maricevich Marco , Buchanan Edward P. , Winocour Sebastian
Published: January 2021

Advances in surgical instruments, magnification technology, perforator dissection techniques, and vascular imaging over the past decades have facilitated exponential growth in the field of microsurgery. With wide application potential including but not limited to limb salvage, breast reconstruction, lymphedema treatment, and sex affirmation surgery, microsurgery represents a critical skill set that powerfully augments the reconstructive armamentarium of plastic surgeons. Accordingly, microsurgical training is now a critical component of the plastic surgery residency education curriculum. Trainees must meet minimum microsurgery case requirements in addition to the core competencies outlined by the Accreditation Council for Graduate Medical Education. Through the use of simulation models, residency programs increasingly incorporate early skills development and assessment in microsurgery in the laboratory. Beyond residency, microsurgery fellowships offer additional exposure and refinement by offering volume, complexity, autonomy, and possible focused specialization. With continued refinement in technology and advances in knowledge, new types of simulation training models will continue to be developed and incorporated into microsurgery training curricula.
Exploring the Role of Partner Satisfaction in Predicting Patient Satisfaction Regarding Post-mastectomy Breast Reconstruction
Authors: Cimaroli Sawyer , LoGiudice John A. , Doren Erin L.
Published: January 2021

Background:

Qualitative studies have suggested that perceived partner satisfaction is an important predictor of patient satisfaction in post-mastectomy breast reconstruction. To better characterize these relationships, a couple-based study employing a quantitative analysis was conducted.

Methods:

BREAST-Q and a novel partner survey were used to assess relationships among patient satisfaction, perceived partner satisfaction, and reported partner satisfaction in 11 couples. Breast reconstruction patients completed the postoperative BREAST-Q, and their partners completed a survey designed to assess satisfaction with their emotional relationship, partner’s breasts, partner’s medical care, and sexual relationship.

Results:

The majority of patients were married. Seventy-three percent of women had an implant-based reconstruction, while 27% had an abdominal-based reconstruction. The majority (82%) of patients reported no complications with reconstructive procedures. The mean patient BREAST-Q score was 86 (range, 48–97), and the mean partner score was 87 (64–98). There was a correlation of 0.85 between reported partner satisfaction and patient satisfaction. Fifty-eight percent of partners reported being afraid to touch their partner’s reconstructed breasts out of fear of causing pain; 7% of patients reported experiencing pain in the area of their reconstructed breasts.

Conclusions:

This study reveals that partner satisfaction with breast reconstruction correlates with patient satisfaction. With this knowledge, we will be able to formulate suggestions on how preoperative consultations could be conducted as to optimize patient and partner satisfaction and bridge the gap between patient and partner knowledge of postoperative pain.
Composite Cutaneous Anterolateral Thigh Flap with Rolled Fascia Lata for Tibialis Anterior Tendon Reconstruction
Authors: Bekeny Jenna C. , Zolper Elizabeth G. , Fan Kenneth L. , Evans Karen K.
Published: January 2021

Background:

Rupture of the tibialis anterior tendon (TAT) is a rare phenomenon with limited therapeutic options derived from sparse case reports. Without proper anchoring of the tibialis anterior, dorsiflexion and inversion of the foot become impaired, disrupting patient’s gait. Reported techniques for repair fall into nonoperative (ankle-foot orthosis) or operative (primary closure, tendon transfer, free gracilis) modalities, depending on patient factors, mechanism of injury, and extent of defect. In this report, we outline a novel method of tendon repair and soft tissue coverage for a large defect.

Methods:

We present a unique case of traumatic TAT rupture with a failed primary closure yielding a large (>15 cm) defect. The patient presented with a defect spanning the entire anterior compartment of the leg, limiting options for coverage and functional restoration.

Results:

The patient’s large, chronic defect was successfully repaired via a composite cutaneous anterolateral thigh and a rolled fascia lata free flap. The patient had robust return to function and is able to dorsiflex and invert the foot and ambulate.

Conclusions:

The use of this donor site offers a novel, advantageous option for TAT repair. It should be considered for patients with large defects that make other repair methods unfeasible.
Temporary Use of Acellular Dermal Matrix in Upper Extremity Salvage
Authors: Ali Barkat , Wu Jeffrey , Borah Gregory , Wu Eugene
Published: January 2021

Wound coverage of exposed vascular bypasses after acute limb revascularization may not be immediately possible, while delay may create a hostile environment for the bypass graft. The use of negative-pressure wound therapy may not be possible because of extrinsic compression. Temporary use of acellular dermal matrix can help salvage upper extremity. We present 2 patients with brachial artery transection secondary to blunt trauma, who had revascularization with interposition saphenous vein grafts. We used acellular dermal matrix as temporary coverage for the exposed arterial bypass grafts to allow for patient stabilization, serial debridement, and demarcation of the surrounding tissues before definitive coverage. Additionally, the use of negative-pressure wound therapy caused diminished pulses in the bypass graft, creating the need for reliable temporary coverage. The acellular dermal matrix dressing was left in place until definitive closure was possible. Both patients underwent successful wound coverage with fasciocutaneous flaps without disruption, thrombosis, or infection of the bypass grafts. Follow-up at 6 months demonstrated good healing and excellent function. The use of the acellular dermal matrix provides temporary coverage of vital structures until definitive reconstruction can be performed.
Benchmarking Residual Limb Pain and Phantom Limb Pain in Amputees through a Patient-reported Outcomes Survey
Authors: Mioton Lauren M. , Dumanian Gregory A. , Fracol Megan E. , Apkarian A. Vania , Valerio Ian L. , Souza Jason M. , Potter Benjamin K. , Tintle Scott M. , Nanos George P. , Ertl William J. , Ko Jason H. , Jordan Sumanas W.
Published: January 2021

Background:

More than 75% of major limb amputees experience chronic pain; however, data on severity and experience of pain are inconsistent. Without a benchmark using quantitative patient-reported outcomes, it is difficult to critically assess the efficacy of novel treatment strategies. Our primary objective is to report quantitative pain parameters for a large sample of amputees using the validated Patient-reported Outcomes Measurement System (PROMIS). Secondarily, we hypothesize that certain patient factors will be associated with worse pain.

Methods:

PROMIS and Numerical Rating Scales for residual limb pain (RLP) and phantom limb pain (PLP) were obtained from a cross-sectional survey of upper and lower extremity amputees recruited throughout North America via amputee clinics and websites. Demographics (gender, age, race, and education) and clinical information (cause, amputation level, and time since amputation) were collected. Regression modeling identified factors associated with worse pain scores (P < 0.05).

Results:

Seven hundred twenty-seven surveys were analyzed, in which 73.4% reported RLP and 70.4% reported PLP. Median residual PROMIS scores were 46.6 [interquartile range (IQR), 41–52] for RLP Intensity, 56.7 (IQR, 51–61) for RLP Behavior, and 55.9 (IQR, 41–63) for RLP Interference. Similar scores were calculated for PLP parameters: 46.8 (IQR, 41–54) for PLP Intensity, 56.2 (IQR, 50–61) for PLP Behavior, and 54.6 (IQR, 41–62) for PLP Interference. Female sex, lower education, trauma-related amputation, more proximal amputation, and closer to time of amputation increased odds of PLP. Female sex, lower education, and infection/ischemia-related amputation increased odds of RLP.

Conclusion:

This survey-based analysis provides quantitative benchmark data regarding RLP and PLP in amputees with more granularity than has previously been reported.
Use of Single-recipient Vessels for Cross-chest Abdominal Flap–based Breast Augmentation as an Outpatient
Authors: Deramo Paul , Martinez Carlos A. , Boutros Sean G.
Published: January 2021

Background:

Breast reconstruction with autologous tissue following mastectomy for breast cancer has become the standard of care. Microvascular breast augmentation is an alternative for patients with failed breast prostheses, including painful capsular contractures or poor cosmetic outcomes. We present a series of 4 patients who underwent microvascular breast augmentation with cross-chest flap recipient vessels.

Methods:

We perform a bilateral DIEP flap reconstruction in an outpatient setting following a modified recovery protocol, focused on decreasing postoperative pain and narcotic requirements, allowing early ambulation and discharge. This includes harvest of the flap via abdominal microfascial incisions and rib-sparing vessel dissection. Cosmetic microvascular augmentation of the contralateral breast was performed via cross-chest flap recipient vessel anastomoses, where the pedicle was tunneled across the chest and anastomosed to the primary flap.

Results:

Four patients underwent flap-based breast augmentation with cross-chest recipient vessels. Two patients underwent immediate DIEP flap breast reconstruction of the affected side and contralateral flap-based augmentation, while 2 patients underwent bilateral breast augmentation with DIEP flaps for cosmetic purposes due to undesired cosmetic results following implant-based augmentations. No intraoperative complications were reported, and all patients were discharged within 23 hours without signs of flap compromise or need for operative take-backs. Mean follow-up was 23 weeks.

Conclusions:

The DIEP flap is recognized as an option for breast augmentation, although its limitations are several, including the pain and recovery associated with autologous tissue-based breast reconstruction. Enhanced recovery protocols help reduce this burden, making it more acceptable and feasible.
Nummular Headache and Its Surgical Treatment
Authors: Baldelli Ilaria , Lucia Mangialardi Maria , Salgarello Marzia , Raposio Edoardo
Published: January 2021

Background:

Nummular headache (NH) is an uncommon primary headache characterized by pain limited to a precise small area of the scalp. There is no global consensus on its pathogenesis, but its extracranial origin is the most accepted theory. Moreover, peripheral mechanism is supported by the overlapping symptomatology of secondary forms of NH and is well described in the literature. However, a standard effective treatment is still lacking.

Methods:

A literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted to evaluate surgical strategies for NH. Inclusion criteria were English language, diagnosis of primary NH according to International Classification of Headache Disorders, 3rd Edition, or of secondary NH, and follow-up at a minimum of 3 months. The treatment had to consist of peripheral surgery.

Results:

One hundred eighty-seven records were identified after duplicates were removed, 15 full-text articles were assessed for eligibility, and 4 records were selected for inclusion. A total of 53 patients were included in this review, 50 of whom were diagnosed with primary NH. The general positive response after surgery (>50% reduction in occipital migraine headaches) was about 70.0% for primary NH, while secondary NH always showed complete pain relief. However, many variations in patient selection and type of surgery were described.

Conclusions:

Neurovascular relationship in the extracranial tissues seems to be involved in the onset of NH. However, only limited data from meager literature and from few patients are currently available. Shared multicentric research protocols are badly required.
Microvascular Reconstruction of Complex Nasal Defects: Case Reports and Review of the Literature
Authors: Gasteratos Konstantinos , Spyropoulou Georgia-Alexandra , Chaiyasate Kongkrit
Published: January 2021

Background:

The area of nasal reconstruction can be challenging for the microsurgeon, as the nose is a complex structure. A 3-dimensional understanding of the organ is a prerequisite for a successful outcome. A combination of procedures is usually necessary to completely repair subtotal or total nasal defects. Contouring and secondary revisions may ensue to enhance the postoperative functional and aesthetic outcome of the reconstruction. This study aimed to present a review of the various methods of microvascular reconstruction for complex nasal defects based on the radial forearm flap (RFF).

Methods:

Two independent reviewers screened the literature on PubMed according to the inclusion criteria. The keywords for the search were “microvascular,” “nasal reconstruction,” and “free flaps in nasal reconstruction.” Articles on locoregional flap reconstruction, experimental animal studies, letters to the editors, non-English literature, and articles without full text were excluded from the study. The protocol is registered at the International Prospective Register of Systematic Reviews (CRD42019146447) under the umbrella of the National Institute for Health Research, and it is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results:

Eighteen eligible studies were included in our articles. The infolding RFF, multiple skin paddles RFF, and prelaminated RFF were described. The results have been more than encouraging so far. Also, 3 clinical cases where the RFF provided intranasal lining and a forehead flap resurfaced the nose were presented.

Conclusion:

The RFF is a reliable technique for nasal reconstruction in expert hands.
Correcting Nipple Inversion Simultaneously with Implant Augmentation of the Breast, Using “Pirelli” Technique
Authors: Nara Kishen , Hodgkinson Darryl
Published: January 2021

Background:

Most techniques of isolated nipple inversion correction are well published. Simultaneous breast augmentation with nipple inversion correction is less often found in the literature. Previously, nipple inversion correction was thought to be performed as a staged procedure after other breast operations. We present a study of 19 patients and 34 breasts who had concomitant breast augmentation and nipple inversion correction treated with a “Pirelli” technique to assess the complication rates and the rate of recurrence of inversion.

Methods:

The Pirelli technique was used, involving division of lactiferous ducts and deep closure of breast tissue before closure. An external “Pirelli tire” was then applied and secured circumferentially around the nipple–areolar complex, which helped to maintain eversion of the nipple after 1 week. Patients were then followed up with specific postoperative instructions to ensure wound healing and maintenance of eversion.

Results:

Nineteen patients were included where 34 breasts were involved. Eighteen patients had primary breast implants. The recurrence rate was 5.9%, involving 2 patients who had unilateral recurrences. These patients were managed with the same technique and had no further recurrences. Two patients successfully breastfed at a median time of 10 years postoperatively.

Conclusion:

Simultaneous breast mammoplasty with nipple inversion correction using the Pirelli technique is safe with low complication rates and high long-term patient satisfaction.