bluuebunny/crossref_metadata_2025 huggingface dataset:
Water Hammer Protection Measures and Calculation Analysis of Reservoir Water Pipelines
Authors: Xu Sen , Zhu Xiaolong , Tan Yuwu , Chen Chuping
Published: March 2023

In fluid mechanics, the large pressure fluctuation caused by the rapid change of fluid flow in a closed pipeline is called water hammer. It has huge destructive power for pressurized water pipelines, which often lead to pipeline leakage or even burst. In this paper, through the analysis of the dynamic characteristics of the gas in the pressurized water pipeline, the necessity of setting the air valve is drawn. Then based on the Bentley HAMMER model, combined with the example of the reservoir water pipeline engineering, the water hammer analysis was carried out. Compared with the maximum pressure head before and after adding the air valve, it is reduced from 126.89 m to 62.11 m, a decrease of about 50%. At the same time, the negative pressure in the pipeline under transient conditions is also eliminated. The results show that the air valve used in the pressure water pipeline has a good effect on the prevention of water hammer.
Research on the Arrangement Process of Marine Submersible Buoy System based on Computational Fluid Dynamics
Authors: Chen Xiaohan
Published: March 2023

This paper establishes the computational fluid dynamics models of marine submersible buoy system. The models use incompressible Navier-Stokes equations, Renormalization-Group (RNG) turbulence model and the fractional areas/volume obstacle representation method. Using the lumped mass mothed to simulate the anchor line and power supply cable. The result show that the great tension forces increase occurs at the moment when the mooring lines was straightened and after a marine submersible buoy system sinks to the sea floor.
High-Resolution Hemodynamic Analysis of a Wearable Oxygenator Using High-Performance Computing
Authors: Chen Wei , Chen Rongliang
Published: March 2023

In this paper, we study the hydrodynamics of a wearable oxygenator using computational fluid dynamics on a supercomputer. In this computation, the fiber bundle of the oxygenator is modeled by a porous medium model, and the incompressible Navier-Stokes equations with a K-ε turbulence model are used to model the flow in the channels. The blood flow velocity, pressure, and shear stress are carefully studied and the hemolysis index of the oxygenator NIH is calculated by using the fast three-dimensional numerical hemolysis approximation method, which is in the range 0.006 ~ 0.094 g/100L. The results show that the pressure loss of the wearable oxygenator mainly occurs in the fiber bundle area. The inlet, outlet, and channels have relatively high shear stress, which may damage the red blood cells. When the flow rate ranges from 2.0 L/min to 5.0 L/min, the estimated hemolysis meets the applicable range allowed by human physiology. In addition, the parallel performance is studied on a supercomputer, which shows that, for the simulation with over 9 million mesh cells, it scales up to 720 processors and the parallel efficiency is over 60%.
Design and Fluid Analysis of a Novel Power Supply Unit for Unmaned Marine Equipment
Authors: Wang Changlei , Lu Zhongyue , Luo Zirong , Wang Mangkuan
Published: March 2023

The problem of insufficient power supply for unmanned marine equipment at sea limits its development and utilization. In this paper, we designed a power supply unit capable of absorbing wave energy and converting it into electricity, which helps to solve the problem of limited power supply ability. Its main structure is demonstrated by theoretical design and modeling, and its operating principle is presented. Its performance (power coefficient and torque coefficient) was numerically simulated via Computational Fluid Dynamics tools, and the effect of blade groups’ solidity on its operating performance was investigated. The study found that the blades of the blade groups can absorb more energy by arranging along the outer ring, and the energy conversion efficiency of the blade groups is related to their load.
Auxetic properties of a tangram-inspired metamaterial
Authors: Lim Teik-Cheng
Published: March 2023

This paper explores a new anisotropic auxetic system that consists of rotating rhombi and right triangles by inspiration from tangram pieces. The Poisson’s ratio was developed by geometrical analysis on the representative unit with prescribed boundary requirements. Upon assigning rotational stiffness to the hinges, the Young’s modulus was established by matching the potential energy stored in the spiral springs with the strain energy of the deformation for the homogenized continuum. Results indicate that the on-axes Poisson’s ratio and dimensionless Young’s moduli are governed by the shapes and separation angles of the rigid units which, in turn, determine the dimension of the representative unit of the metamaterial. For the special case where the Poisson’s ratio is −1 when stretched on either axis, the Young’s moduli are equal. For this special case, the separation angles and the on-axes Young’s moduli increase monotonically with the shape descriptor of the rigid units. The capability of combining rotating rigid units of quadrilateral and triangular shapes suggests that new combinations of mechanical properties can be designed from rotation-based auxetic systems.
Feeding biomechanics reveals niche differentiation related to insular gigantism
Authors: Hennekam Jesse J , Herridge Victoria L , Cox Philip G
Published: March 2023

Insular gigantism is an evolutionary phenomenon whereby small animals become bigger on islands compared to their mainland relatives. The abundance of insular giant taxa in the fossil record suggests the presence of a universal “giant niche” present on islands, with resource limitation as a potential driver for this process. However, insular habitats are ecologically diverse, suggesting that island taxa adopt different survival strategies, including adaptations for foraging behaviors. Here, we used finite element analysis to evaluate insular feeding niche adaptations in some of the most extreme examples of insular gigantism: Mediterranean giant dormice. We calculated stress, strain, and mechanical advantage during incisor and molar biting for 3 extinct insular giant species (Leithia melitensis, Hypnomys morpheus, and H. onicensis), an extant giant (Eliomys quercinus ophiusae), and their extant non-giant mainland relative, the generalist-feeder Eliomys quercinus. Our results show that dietary adaptations vary between giant taxa on different islands, and can occur relatively rapidly. Furthermore, the functional mandibular morphology in some insular taxa indicate adaptations moving away from a generalist feeding strategy toward greater trophic specialization. We show that the “insular giant niche” varies between islands and across time periods, arguing against a universal ecological driver for insular gigantism in small mammals.
Circulation of SARS-CoV-2 virus among pilgrims at the 2022 Grand Magal of Touba
Authors: Diouf Coumba , Ouaddane Ihssane , Goumballa Ndiaw , Sambou Masse , Bassène Hubert , Dieng Mamadou , Gautret Philippe , Sokhna Cheikh
Published: March 2023

Among pilgrims departing from two villages in South Senegal who participated to the event, 45% had respiratory symptoms and 7% acquired SARS-CoV-2 nasopharyngeal carriage. Among patients with respiratory symptoms sampled at a health care centre close to Touba, 5% tested positive. In contrast, no SARS-CoV-2 infection was observed in 2020–21.
Moral Intuitions About Stigmatizing Practices and Feeding Stigmatizing Practices: How Haidt’s Moral Foundations Theory Relates to Infectious Disease Stigma
Authors: Damsté C , Kramer K
Published: March 2023

Despite extensive stigma mitigation efforts, infectious disease stigma remains common. So far, little attention has been paid to the moral psychology of stigmatizing practices (i.e. beliefs, attitudes, actions) rather than the experience of being stigmatized. Addressing the moral psychology behind stigmatizing practices seems necessary to explain the persistence of infectious disease stigma and to develop effective mitigation strategies. Our article proposes building on Jonathan Haidt’s moral foundations theory, which states that moral judgements follow from intuitions rather than conscious reasoning. Conceptual analysis was conducted to show how Haidt’s five moral foundations can be connected to (i) moral judgements about stigmatizing practices and (ii) stigmatizing practices themselves. We found that care/harm, fairness/cheating, loyalty/betrayal and sanctity/degradation intuitions can inform moral judgements about stigmatizing practices. Loyalty/betrayal and sanctity/degradation intuitions can sometimes also feed stigmatizing practices. Authority/subversion intuitions can inform moral judgements and stigmatizing practices towards people who disrespect authoritative rules meant to protect public health. Moral dumbfounding and posthoc reasoning might explain the persistence of stigmatizing practices. In conclusion, this study demonstrates the relevance of Haidt’s approach to infectious disease stigma research and mitigation strategies. We hope that this study motivates researchers to further test and assess this approach.
The Effect of Propagation Substrate on Pythium Root Rot Severity and the Efficacy of Biopesticides
Authors: DeGenring Liza , Poleatewich Anissa
Published: March 2023

Modern greenhouse crop production utilizes soilless substrates that range from inorganic substrates (Oasis foam and rockwool) to blends of organic substrates (sphagnum peat moss, coconut fiber, bark mulch, wood chips, and wood products). Additionally, greenhouse growers utilize beneficial microorganisms in the form of commercial biopesticides to reduce disease. Few research studies have examined the effect of propagation substrate on the efficacy of commercial biopesticides under greenhouse production conditions. The objective of this study was to evaluate the effect of propagation substrates on commercially available microbial biopesticides (Rootshield WP, Cease, and Regalia) applied during propagation and at transplant for management of Pythium root rot. In this study, cucumber and calibrachoa were used as model crops. Over both cropping systems, plants propagated in Oasis foam had lower root rot compared with plants propagated in coconut coir. Across all biopesticide treatments, cucumber plants propagated in Oasis foam had 52% less root rot compared with plants propagated in coconut coir. In both infested and noninfested calibrachoa plants, plants propagated in Oasis foam had 45 to 67% less disease, and plants propagated in peat had 25 to 40% less disease compared with plants propagated in coconut coir. There was no effect of biopesticide on Pythium root rot severity, except for a reduction seen in calibrachoa plants propagated in coconut coir and treated with Rootshield WP. This research suggests that propagation substrate is important for root disease management.
GPX2 promotes EMT and metastasis in non‐small cell lung cancer by activating PI3K/AKT/mTOR/Snail signaling axis
Authors: Peng Fang , Xu Qiushi , Jing Xiaomeng , Chi Xinming , Zhang Zheming , Meng Xiangpeng , Liu Xinyuan , Yan Jiao , Liu Xuefeng , Shao Shujuan
Published: March 2023

Lung cancer, with non‐small cell lung cancer (NSCLC) being the main subtype, is the leading cause of cancer death worldwide, which is mainly due to the cancer metastasis. Glutathione peroxidase 2 (GPX2), an antioxidant enzyme, is involved in tumor progression and metastasis. Nevertheless, the role of GPX2 in NSCLC metastasis has not been clarified. In this study, we found that GPX2 expression was elevated in NSCLC tissues and high GPX2 expression was correlated with poor prognosis in patients with NSCLC. In addtion, GPX2 expression was related to the patient's clinicopathological features, including lymph node metastasis, tumor size, and TNM stage. Overexpression of GPX2 promoted epithelial–mesenchymal transition (EMT), migration, and invasion of NSCLC cells in vitro. Knockdown of GPX2 showed the opposite effects in vitro and inhibited the metastasis of NSCLC cells in nude mice. Furthermore, GPX2 reduced reactive oxygen species (ROS) accumulation and activated the PI3K/AKT/mTOR/Snail signaling axis. Therefore, our results indicate that GPX2 promotes EMT and metastasis of NSCLC cells by activating the PI3K/AKT/mTOR/Snail signaling axis via the removal of ROS. GPX2 may be an effective diagnostic and prognostic biomarker for NSCLC.
Association of Urine Fentanyl Concentration With Severity of Opioid Withdrawal Among Patients Presenting to the Emergency Department
Authors: Thakrar Ashish P. , Faude Sophia , Perrone Jeanmarie , Milone Michael C. , Lowenstein Margaret , Snider Christopher K. , Spadaro Anthony , Delgado M. Kit , Nelson Lewis S. , Kilaru Austin S.
Published: March 2023

Background and Aims

Fentanyl is involved in most US drug overdose deaths and its use can complicate opioid withdrawal management. Clinical applications of quantitative urine fentanyl testing have not been demonstrated previously. The aim of this study was to determine whether urine fentanyl concentration is associated with severity of opioid withdrawal.

Design

This is a retrospective cross-sectional study.

Setting

This study was conducted in 3 emergency departments in an urban, academic health system from January 1, 2020, to December 31, 2021.

Participants

This study included patients with opioid use disorder, detectable urine fentanyl or norfentanyl, and Clinical Opiate Withdrawal Scale (COWS) recorded within 6 hours of urine drug testing.

Measurements

The primary exposure was urine fentanyl concentration stratified as high (>400 ng/mL), medium (40–399 ng/mL), or low (<40 ng/mL). The primary outcome was opioid withdrawal severity measured with COWS within 6 hours before or after urine specimen collection. We used a generalized linear model with γ distribution and log-link function to estimate the adjusted association between COWS and the exposures.

Findings

For the 1127 patients in our sample, the mean age (SD) was 40.0 (10.7), 384 (34.1%) identified as female, 332 (29.5%) reported their race/ethnicity as non-Hispanic Black, and 658 (58.4%) reported their race/ethnicity as non-Hispanic White. For patients with high urine fentanyl concentrations, the adjusted mean COWS (95% confidence interval) was 4.4 (3.9–4.8) compared with 5.5 (5.1–6.0) among those with medium and 7.7 (6.8–8.7) among those with low fentanyl concentrations.

Conclusions

Lower urine fentanyl concentration was associated with more severe opioid withdrawal, suggesting potential clinical applications for quantitative urine measurements in evolving approaches to fentanyl withdrawal management.
An Open-label Pilot Study of NicoBloc as a Novel Smoking Cessation Intervention
Authors: Chichester Keith R. , Sisson Michelle L. , Chana Sofia Mildrum , Wolford-Clevenger Caitlin , Hugley Mickeah J. , Hawes Elizabeth S. , Palenski Paige , Nguyen Angela , Dahne Jennifer , Hendricks Peter S. , Cropsey Karen L.
Published: March 2023

Introduction

NicoBloc is a viscous fluid applied to the cigarette filter designed to block tar and nicotine. This novel and understudied smoking cessation device presents a nonpharmacological means for smokers to gradually reduce nicotine and tar content while continuing to smoke their preferred brand of cigarette. This pilot study aimed to assess the feasibility, acceptability, and initial efficacy of NicoBloc as compared with nicotine replacement therapy (nicotine lozenge).

Methods

A community sample of predominately Black smokers (N = 45; 66.7% Black) were randomized to receive NicoBloc or nicotine lozenge. Both groups engaged in 4 weeks of smoking cessation therapy followed by 2 months of independent usage with monthly check-ins to assess medication adherence. The intervention lasted 12 weeks, and the study concluded with a 1-month postintervention follow-up visit (week 16).

Results

NicoBloc was comparable with nicotine lozenge in smoking reduction, feasibility, symptom adverse effects, and reported acceptability at week 16. Participants in the lozenge group endorsed higher treatment satisfaction ratings during the intervention and lower cigarette dependence. Adherence to NicoBloc was superior throughout the study.

Conclusion

NicoBloc was feasible and acceptable to community smokers. NicoBloc presents a unique, nonpharmacological intervention. Future research is needed to examine whether this intervention may be most effective in subpopulations where pharmacological approaches are restricted or in combination with established pharmacological methods such as nicotine replacement therapy.
The Single-Person Lateral Decubitus Ankle Sling Fracture Reduction Technique
Authors: Brooks Zachary , Willson Kyle
Published: March 2023

Ankle fractures are common pathologies encountered in the emergency department. Reduction of ankle fractures can be a challenging task to perform alone and can place medical personnel in mechanically disadvantageous positions. In addition, body weight and awkward lifting are leading preventable causes of musculoskeletal injuries among medical staff. The single-person lateral decubitus ankle sling fracture reduction method described is a simple and reproducible technique that utilizes the classic principles described by Dr Quigley in 1959. This technique optimizes patient positioning, utilizes gravity, and incorporates a stable ankle sling. This also incorporates a relaxed patient position to promote a successful ankle fracture reduction.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Comparison of the Diagnostic Accuracies of Monocyte Distribution Width, Procalcitonin, and C-Reactive Protein for Sepsis: A Systematic Review and Meta-Analysis
Authors: Huang Yu-Hsuan , Chen Ching-Jung , Shao Shih-Chieh , Li Chih‑Huang , Hsiao Chien-Han , Niu Kuang-Yu , Yen Chieh-Ching
Published: March 2023

OBJECTIVES:

We performed a systemic review and meta‐analysis to evaluate the diagnostic accuracy of monocyte distribution width (MDW) and to compare with procalcitonin and C‐reactive protein (CRP), in adult patients with sepsis.

DATA SOURCES:

A systematic literature search was performed in PubMed, Embase, and the Cochrane Library to identify all relevant diagnostic accuracy studies published before October 1, 2022.

STUDY SELECTION:

Original articles reporting the diagnostic accuracy of MDW for sepsis detection with the Sepsis-2 or Sepsis-3 criteria were included.

DATA EXTRACTION:

Study data were abstracted by two independent reviewers using a standardized data extraction form.

DATA SYNTHESIS:

Eighteen studies were included in the meta‐analysis. The pooled sensitivity and specificity of MDW were 84% (95% CI [79–88%]) and 68% (95% CI [60–75%]). The estimated diagnostic odds ratio and the area under the summary receiver operating characteristic curve (SROC) were 11.11 (95% CI [7.36–16.77]) and 0.85 (95% CI [0.81–0.89]). Significant heterogeneity was observed among the included studies. Eight studies compared the diagnostic accuracies of MDW and procalcitonin, and five studies compared the diagnostic accuracies of MDW and CRP. For MDW versus procalcitonin, the area under the SROC was similar (0.88, CI = 0.84–0.93 vs 0.82, CI = 0.76–0.88). For MDW versus CRP, the area under the SROC was similar (0.88, CI = 0.83–0.93 vs 0.86, CI = 0.78–0.95).

CONCLUSIONS:

The results of the meta-analysis indicate that MDW is a reliable diagnostic biomarker for sepsis as procalcitonin and CRP. Further studies investigating the combination of MDW and other biomarkers are advisable to increase the accuracy in sepsis detection.
The History of Men in Nursing
Authors: Mulkey David C.
Published: March 2023

Men have a long-standing history in the nursing profession. Once a predominantly male-dominated field, the history of male nurses is not well documented. The history of men in nursing is filled with pioneers whose impact influenced the current climate and future of nursing and male nurses. Although there have been fewer men in nursing in modern times, their presence is significant for the profession.
Nursing Education's Dynamic History
Authors: Akers Shanna W. , Mauk Kristen L.
Published: March 2023

Professional nursing education has changed through the decades, from experiential training governed by religious sisters to formal education on theory and research for practice. Numerous types of nursing programs have been developed to meet professional and healthcare needs, and the popularity of different programs has varied over time. The purpose of this article is to explore the history of nursing education and the challenges the 21st century presents to nurse educators and clinicians. Strategies are offered for Christian nurse leaders to forge new pathways for education and move the profession forward.
Reflections on the Effects of COVID on New Nurses
Authors: Peterson Debra
Published: March 2023

The virtual nature of education during the COVID-19 pandemic reduced nursing students' opportunities to learn and practice skills in hands-on settings, negatively impacting their readiness for nursing practice once licensed. Also, the importance of teaching nursing students self-care strategies became evident to nurse educators.
The Impact of Concomitant Proton Pump Inhibitors Therapy on Clinical Outcome of Cancer Patients Treated With Immune Checkpoint Inhibitors
Authors: Cao Xing , Wang Yafei , Huang Wei , Li Panyun , Guo Chongjie , Li Yuhui
Published: March 2023

Background:

In patients with advanced cancer receiving immune checkpoint inhibitors (ICIs) therapy, there are conflict perspectives about the influence of concomitant use of proton pump inhibitors (PPIs). We are aimed at exploring the influence of concomitant PPIs exposure on clinical outcome among cancer patients receiving ICIs treatment.

Methods:

We searched relevant literatures in PubMed, EMBASE, and the Cochrane Library without language restrictions. We extracted the data from selected studies and calculated the pooled hazard ratios (HRs) with 95% CIs through professional software for overall survival and progression-free survival among cancer patients undergoing ICIs therapy exposed to PPIs.

Results:

Fourteen studies including 6716 advanced cancer patients receiving ICIs treatment were appropriate for analysis judging by pre-set inclusion and exclusion criteria. The result indicated that concomitant PPIs exposure was significantly related to shorter overall survival (HR=1.388; 95% CI: 1.278-1.498, P<0.001) and progression-free survival (HR=1.285; 95% CI: 1.193-1.384, P<0.001) among multiple cancer patients receiving ICIs therapy.

Conclusions:

Our meta-analysis showed that concomitant PPIs exposure had an adverse impact on clinical outcome among patients receiving ICIs therapy. Clinical oncologists must be cautious of PPIs delivery during ICIs treatment.
Single Port Robotic Completion Proctectomy
Authors: Ozgur Ilker , Catalano Brogan , Gorgun Emre
Published: March 2023

Single Port Robotic Completion Proctectomy
The Safety and Efficacy of a Dual CO2 and 1570-nm Hybrid Laser for Periorbital Rejuvenation
Authors: Tsur Shenhav Leah , Shehade Waseem , Muravnik Gerardo , Horovitz Tamir , Artzi Ofir
Published: March 2023

BACKGROUND

Many modalities are used for periorbital rejuvenation, with a wide range of efficacy and safety. To achieve favorable outcomes with minimal downtime and adverse effects, professionals developed a hybrid laser, which allows simultaneous treatment with 2 wavelengths: fractional ablative and fractional nonablative lasers.

OBJECTIVE

To evaluate the safety and efficacy of a new hybrid laser for periorbital rejuvenation.

MATERIALS AND METHODS

This retrospective single-center study includes 24 patients who underwent a single-pass treatment with a CO2 and 1570-nm hybrid laser for periorbital rejuvenation between 2020 and 2022. Patients' standardized clinical photographs before and after the treatment were assessed by 4 independent physicians for objective improvement. Treatment data, safety, and patients' satisfaction were also reviewed.

RESULTS

Statistically significant objective improvements were found in all investigated scales with an improvement of 1 to 2 points on each scale. Patients' satisfaction was 3.1/4. Average downtime was 5.9 ± 1.7 days. Most adverse effects were mild to moderate in severity (89.7%), including erythema, crusting, pruritis, edema, and hyperpigmentation.

CONCLUSION

After a single-pass treatment, the laser generates 26% to 50% improvement in the periorbital area, with a strong safety profile and a relatively simple recovery. Further research is needed to validate the efficacy of this technology compared with more aggressive modalities.
Public Perceptions of Climate Change and Plastic and Reconstructive Surgery
Authors: Hyland Colby J. , Yates Elizabeth F. , Gadiraju Goutam , Dey Tanujit , Broyles Justin Michael
Published: March 2023

Background:

Healthcare has a major impact on climate change, and surgery is among the most energy-intensive hospital practices. Although most Americans believe climate change is happening, little is known regarding public awareness of the impact of healthcare on climate change and how this may impact perceptions of plastic surgery.

Methods:

A cross-sectional survey was administered to adults in the United States using Amazon Mechanical Turk in December 2021 to assess public perceptions of climate change, healthcare, and plastic surgery. Incomplete responses were excluded from analysis. Multivariable logistic regression models were used to determine predictors of responses.

Results:

There were 890 complete responses. Most participants strongly agreed or agreed that climate change is happening (89%). Fewer believed that healthcare has an impact on climate change (62%), with greater odds among respondents with an associate’s degree or higher (odds ratio 2.8, P < 0.001). After they were given information about the impact of healthcare on climate change, most respondents were more worried about the effects of cosmetic plastic surgery (64%). Many respondents would be willing to engage in personal climate change mitigation measures if undergoing surgery and pay higher professional fees to support sustainable hospital practices.

Conclusions:

Most Americans believe climate change is happening, but fewer believe healthcare has an impact on climate change. Knowledge regarding the impact of healthcare and surgery on climate change may make patients more worried about the effects of plastic surgery on climate change, but patients may be willing to personally mitigate climate impacts of surgery.
Double-flap Mandibular Reconstruction around the Condylar Head Using Fibula and Anterolateral Thigh Flaps
Authors: Tsuge Itaru , Yamanaka Hiroki , Katsube Motoki , Sowa Yoshihiro , Sakamoto Michiharu , Morimoto Naoki
Published: March 2023

We applied double-flap reconstruction with a vascularized fibula osteo flap and a Y-shaped anterolateral thigh (ALT) flap, which was separated into a fascial flap and a de-epithelialized fat flap to replace the temporomandibular joint capsule and temporal soft tissue volume, respectively. This technique achieved excellent functional and cosmetic results with acceptable operation time and donor site scarring. A 16-year-old girl had a rapidly growing mandibular osteosarcoma. Right mandibulectomy from the right first premolar tooth to right condylar head (including temporalis muscle, masseter muscle, buccal mucosa, and part of the right maxilla) was performed. A left fibula osteo flap and left ALT flap were prepared in a prefabricated manner using a three-dimensional model and a prebent titanium plate. The area of the ALT flap was 23 × 6 cm. A proximal 8 × 4 cm skin flap was positioned to replace the left cheek mucosa, and the distal part was divided into two layers: a de-epithelialized fat flap and a fascial flap. The de-epithelialized fat flap was used to prevent the depression deformation at the temporal area, and the fascial flap was used to cover around the alternate condylar head made by the fibula instead of the resected temporomandibular joint capsule. The peroneal artery and veins were microscopically anastomosed to the distal end of the artery and veins of the descending branch of the ALT flap in a flow-through manner. At 12 months after surgery, the occlusal function and aesthetic balance were excellent.
Low Baseline Expression of Fibrotic Genes in an Ex Vivo Human Skin Model is a Potential Indicator of Excessive Skin Scarring
Authors: Mouawad Joe E. , Heywood Jonathan , Armstrong Milton B. , Ogunleye Adeyemi , Feghali-Bostwick Carol
Published: March 2023

Background:

One of the challenges plastic surgeons face is the unpredictability of postoperative scarring. The variability of wound healing and subsequent scar formation across patients makes it virtually impossible to predict if a patient’s surgery will result in excessive fibrosis and scarring, possibly amounting to keloids or hypertrophic scars. There is a need to find predictive molecular indicators of patients or skin location with high risk of excessive scarring. We hypothesized that baseline expression levels of fibrotic genes in the skin can serve as a potential indicator of excessive scarring.

Methods:

An ex vivo model of skin fibrosis was used with abdominal and breast skin tissue from 45 patients undergoing breast reduction and/or abdominoplasty. Fibrosis was induced in skin explants in organ culture with transforming growth factor-β (TFGβ). Fibrotic gene response was assessed via quantitative real-time polymerase chain reaction and correlated with skin location, age, and baseline levels of fibrotic genes.

Results:

The increase in TFGβ-induced fibronectin1 (FN1) gene expression in skin explants was significantly higher than for Collagen 1A1, alpha smooth muscle actin, and connective tissue growth factor. Also, FN1 expression positively correlated with donor age. Moreover, lower expression of the fibrotic genes FN1, Collagen 1A1, and alpha smooth muscle actin correlated with a more pronounced fibrotic response, represented by higher induction levels of these genes.

Conclusions:

Skin sites exhibit different baseline levels of profibrotic genes. Further, low baseline expression levels of fibrotic genes FN1, Collagen 1A1, and alpha smooth muscle actin, in donor skin may indicate a potential for excessive scarring of the skin.
Body Mass Index (BMI) Impact on Anesthetic Safety among Adolescents Undergoing Bilateral Reduction Mammaplasty
Authors: Cappitelli Alex T. , McNamara Catherine T. , Nuzzi Laura C. , Alrayashi Walid , Ganske Ingrid M. , Ganor Oren , Labow Brian I.
Published: March 2023

Introduction:

Obesity is common in adolescents with macromastia seeking surgery, prompting concerns over anesthesia-related complications due to obesity. This may lead to weight-based surgical policies, despite limited research. This study’s purpose is to examine the impact of obesity status on perioperative anesthetic-related adverse events/surgical complications in adolescents/young adults undergoing bilateral reduction mammaplasty.

Methods:

A medical record query was performed to retrospectively identify patients who underwent bilateral reduction mammaplasty at our institution between January 2021 and December 2021. Patient demographics and clinical/surgical data were obtained from medical records. Pearson’s chi-square, Fisher exact, and Median tests were used to examine associations between body mass index (BMI) category and clinical/demographic data.

Results:

Two hundred patients were included in analyses, with a median age at surgery of 18.0 years. The majority of patients were obese (63.5%, n = 127), and none were underweight. The most common comorbidity was asthma (27.0%, n = 54). There were no anesthetic-related intraoperative complications or delayed waking. The following did not significantly differ by BMI category: proportion of patients who experienced oxygen desaturation (pre-, intra-, or postoperatively), frequency of postoperative complications, and length of postanesthesia care unit and total hospital stays (P > 0.05, all).

Conclusions:

While institutions may implement weight-based surgical policies due to anesthesia-related complication concerns in patients with obesity, our study showed that BMI category did not significantly impact anesthetic-related adverse events/surgical complications in our sample. This suggests that such policies are not warranted in all situations, and that decisions regarding their necessity be data-driven.
Severe Bilateral Mandibular Hyperplasia and Angle’s Class III Malocclusion in Indonesia: A Case Report
Authors: Bogari Melia , Hapsari Savitri , Hermawan Rahendra Wira , Andana Alki , Hutagalung Magda
Published: March 2023

Malocclusion is an abnormal relationship between the teeth of the upper and lower jaws, with irregular tooth position, including crossbite and underbite. Malocclusion can occur in the form of crooked, protruding, or crowded teeth, affecting appearance, pronunciation, and mastication. Many factors lead to malocclusions, such as heredity, growth disturbance, and bad habits. Many Indonesians undergo orthodontic treatment to improve both function and appearance. The large demand for orthodontic treatment is due to increasing public knowledge about the impact of untreated malocclusion and the rising standard of living. We present a severe and rare case of malocclusion in Indonesia. A 20-year-old man presented with bilateral mandibular condylar hyperplasia and Angle’s class III malocclusion. A multidisciplinary team, including plastic and oral surgeons, orthodontists, and psychologists, was created to address this problem. The first surgical procedure was chosen to achieve correction in the shortest possible time. Le Fort I osteotomy and mandibular bilateral sagittal split and anterior subapical osteotomies using Kole’s procedure were performed. The patient underwent preoperative and postoperative examinations. After surgery, the occlusion was corrected and facial symmetry significantly improved.
Arthroscopic Management of the Hamate Proximal Pole Arthrosis
Authors: Ali Barkat , Ozyurekoglu Tuna
Published: March 2023

Background:

Arthrosis of the proximal pole of the hamate is a peculiar cause of ulnar-sided wrist pain. We present clinical, functional, and patient-reported outcomes of arthroscopic management.

Methods:

In this retrospective study, all patients with arthrosis of the proximal pole of the hamate encountered in a 10-year period treated with arthroscopy were reviewed. Patient demographics, arthroscopic details, associated injuries, and procedures were reviewed. Functional and patient-reported clinical outcomes after arthroscopic osteochondroplasty were analyzed.

Results:

An analysis of 39 patients who underwent arthroscopic osteochondroplasty showed a type II lunate prevalence of 87.2%. On wrist arthroscopy, a triangular fibrocartilaginous complex tear was the most common diagnosis (64.1%), followed by scapholunate ligament tear (61.5%) and lunotriquetral ligament tear (35.9%). All patients were managed arthroscopically with 100% procedural success. Average follow-up of 42.8 ± 37.7 months showed statistically significant improvements in the visual analog score and Mayo wrist score postoperatively (P < 0.01). Three patients (7.7%) failed the procedure at a mean of 23 ± 31.4 months. Risk factors for salvage operations were nondominant wrist involvement 100% (P = 0.04), lunotriquetral ligament injury 100% (P = 0.04), the absence of triangular fibrocartilaginous complex injury 100% (P = 0.04), and the presence of scapholunate advanced collapse 100% (P < 0.01).

Conclusions:

Wrist arthroscopy is valuable for accurately diagnosing and treating hamate arthrosis and identifying a wide variety of pathologies associated. This study showed arthroscopic osteochondroplasty produced satisfactory clinical results. Furthermore, the presence of scapholunate advanced collapse wrist offers its prognostic value in determining treatment failure.
Incidence of Corneal Adverse Events in Children Wearing Soft Contact Lenses
Authors: Bullimore Mark A. , Richdale Kathryn
Published: March 2023

Objectives:

There is increasing interest in fitting children with soft contact lenses, in part due to the increase in prescribing of designs to slow the progression of myopia. This literature review summarizes large prospective and retrospective studies that include data on the incidence of microbial keratitis and corneal infiltrative events (CIEs) in children wearing soft contact lenses.

Methods:

Peer-reviewed prospective and retrospective studies that report contact lens–related complications in children with at least one year of wear and at least 100 patient years of wear were identified.

Results:

Seven prospective studies published between 2004 and 2022 were identified representing 3,752 patient years of wear in 1,756 children, nearly all of whom were fitted at age 12 years or younger. Collectively, they report one case of microbial keratitis and 53 CIEs, of which 16 were classified as symptomatic. The overall incidence of microbial keratitis was 2.7 per 10,000 patient years (95% CI: 0.5–15), and the incidence of symptomatic CIEs was 42 per 10,000 patient years (95% CI: 26–69). Two retrospective studies were identified representing 2,545 patient years of wear in 1,025 children, fitted at age 12 years or younger. One study reports two cases of microbial keratitis giving an incidence of 9.4 per 10,000 patient years (95% CI: 0.5–15).

Conclusions:

Accurate classification of CIEs is challenging, particularly in retrospective studies. The incidence of microbial keratitis in children wearing soft lenses is no higher than in adults, and the incidence of CIEs seems to be markedly lower.
Feasibility of Automated Gonioscopy Imaging in Clinical Practice
Authors: Barbour-Hastie Catriona , Deol Sundeep S. , Peroni Andrea , Gillan Stewart , Trucco Emanuele , Tatham Andrew J.
Published: March 2023

Précis:

Automated gonioscopy provided good-quality images of the anterior chamber angle. There was a short learning curve for operators, and the examination was well tolerated by patients. Patients expressed a preference for automated gonioscopy compared with traditional gonioscopy.

Purpose:

The purpose of this study was to assess the feasibility of using a desktop automated gonioscopy camera in glaucoma clinics by examining patient tolerability, ease of use, and image quality and comparing patient preference compared with traditional gonioscopy.

Patients and Methods:

A prospective study was conducted in a university hospital clinic. Traditional gonioscopy was performed followed by imaging of the iridocorneal angle (ICA) using the Nidek GS-1 camera by 2 glaucoma specialists. Participants were asked to rate the comfort of automated gonioscopy and which method they preferred. The clinicians graded the ease of acquisition for each patient, and the image quality was reviewed by a grader.

Results:

Forty-three eyes of 25 participants were included. Sixty-eight percent of participants viewed automated gonioscopy as “extremely comfortable,” and the remainder reported it “comfortable”. Forty percent preferred automated gonioscopy compared with traditional gonioscopy, while 52% were equivocal. Clinicians scored 32% of participants as “somewhat difficult” to the image. In 46% of eyes, good-quality photographs were obtained for 360 degrees of the ICA. Only 1 eye had no parts of the ICA clearly visible. Seventy-four percent of eyes had at least half of the ICA clearly visible in all 4 quadrants.

Conclusion:

Automated gonioscopy provided good-quality images of the ICA for most patients. It was often not possible to image the entire 360 degrees at the first attempt, but the examination was comfortable for patients, and only 8% preferred traditional gonioscopy to the automated photographic examination.
Banking Autologous Tarsus: A Simple Technique for Maximizing Preservation of Healthy Tissue
Authors: Goodyear Kendall , Roelofs Kelsey A. , Goldberg Robert A.
Published: March 2023

A 28-year-old female with congenital left-sided ptosis presented after 3 prior surgeries elsewhere. Although centrally her margin to reflex distance1 was 3 mm, persistent ptosis was noted laterally. In an effort to improve the symmetry of her eyelid contour, a lateral tarsectomy was performed. As the authors worried this might worsen her dryness, the decision was made to bank the excised tarso-conjunctival tissue in case additional revision surgery is required at a later date. To accomplish this, a conjunctival incision was created at the inferior tarsal margin in the ipsilateral lower lateral eyelid and the excised upper eyelid tarso-conjunctival tissue was secured in this pocket. Four months postoperatively, the banked tissue appeared healthy and the upper eyelid contour was improved. This technique may be most helpful in multi-operated situations, where the chance of future revision is not insignificant.
Sensory Innervation of the Upper Eyelid and Its Implication for Upper Eyelid Surgery
Authors: Mayr-Riedler Michael S. , Broer P. Niclas , Hirtler Lena , Grill Christoph
Published: March 2023

Purpose:

Sensory alterations of the upper eyelid skin and eyelashes are frequently encountered after upper eyelid surgery. The objective of this study was to provide information on the exact course and distribution of sensory nerve fibers through the anatomic planes in the upper eyelid.

Methods:

Ten formalin-fixed hemifaces were dissected. The nerve branches of the ophthalmic nerve in the upper eyelid were traced in an anterograde fashion.

Results:

A total of 151 nerve fibers were recorded during dissection. The infratrochlear, supratrochlear, supraorbital, and lacrimal nerve contributed each to both the upper eyelid skin innervation and the upper eyelid rim plexus in different distribution patterns. The mean distance from the eyelid margin at which nerve fibers pierced from preseptal into the orbicularis muscle was 14 ± 1.1 mm for nerve fibers targeting the eyelid dermis and 3.7 ± 1.2 mm for nerve fibers targeting the eyelid rim plexus (p < 0.001). The mean intraorbicular course of nerve fibers was 3 mm (0–17; standard deviation 4.1). The mean distance from the eyelid margin at which nerve fibers pierced from the orbicularis muscle into the preorbicular plane was 10 ± 1 mm for nerve fibers innervating the eyelid dermis and 1.3 ± 0.8 mm for nerve fibers innervating the eyelid rim plexus (p < 0.001). The mean distance of the preorbicular course of nerve fibers was 2 mm (0–15; standard deviation 3.6).

Conclusions:

Based on the findings, a certain degree of postoperative eyelid skin numbness is inevitable while eyelash innervation may be spared in upper blepharoplasty.
Nasolacrimal Duct Coronary Stent Recanalization (NCR): First Cadaver Experience and Its Potential as an Alternative to DCR
Authors: Ali Mohammad Javed
Published: March 2023

Purpose:

To investigate the feasibility of implanting a drug-eluting cobalt-chromium alloy coronary stent in the nasolacrimal ducts (NLDs) of human cadavers.

Methods:

The pilot study was carried out in 5 NLDs of 4 adult human cadavers. Sirolimus-eluting coronary stents of 2 mm in width and lengths of 8 and 12 mm, which were mounted on balloon catheters, were used. Following dilatation of the NLDs, the balloon catheters were introduced into the NLDs under direct endoscopy guidance. The stents were delivered following dilatation of the balloon to 12 ATMs and secured in a locked (spring out) position. The balloon is then deflated and securely extubated. The dacryoendoscopy confirmed the stent position. The lacrimal system was then dissected to assess several key parameters like the uniformity of the NLD expansion, anatomical interactions of the NLD mucosa with the stent rings and struts, integrity of the soft and bony NLD, stent movement on mechanical push and pull, and ease of manual removal.

Results:

The cobalt-chromium alloy coronary stents could be delivered with ease and secured in the cadaveric NLDs. Its position was confirmed by a dacryoendoscopy and later by the direct NLD dissection. The NLD was uniformly dilated 360° with a wide and uniform lumen. NLD mucosa was noted to be uniformly distributed in spaces between the stent rings without influencing the expanded lumen. Following the lacrimal sac’s dissection, the NLD stent showed significant resistance to downward movement but could be easily retrieved with forceps. The 12-mm stents could reach the near total length of the NLD with good luminal expansion. The integrity of the bony and soft-tissue NLD was maintained. The learning curve is shallow if the surgeon is adept with the techniques of balloon dacryoplasty.

Conclusion:

Drug-eluting cobalt-chromium alloy coronary stents can be precisely deployed and secured within the human NLDs. The study is the first of its kind to demonstrate the technique of NLD coronary stent recanalization in human cadavers. It is a step forward in the journey to evaluate their use in patients with primary acquired NLD obstructions and other NLD disorders.
Exploring Plan of Care Communication With a Multidisciplinary Rounding Plan to Nursing Care Plans
Authors: Perera Anjali C. , Joseph Sonia , Marshall Jade L. , Olson DaiWai M.
Published: March 2023

BACKGROUND: The nursing care plan (NCP) was developed approximately 100 years ago as a teaching tool for nursing students. Our neuroscience intensive care unit (NSICU) uses a multidisciplinary rounding plan (MDRP) that may provide more relevant and up-to-date information than the standard NCP. METHODS: In this prospective single-blind randomized pilot study, we examined nurses' abilities to respond to 7 clinical scenarios common to the NSICU. The NCPs and MDRPs from 70 patients were randomly assigned to 14 nurses (10 per nurse) who answered each of the 7 questions using only data from an NCP or data from an MDR. RESULTS: The MDRP mean score of 4.51 (1.50) correct answers was statistically significantly higher than the NCP mean score of 0.31 (0.71) correct answer (P < .0001). CONCLUSION: The MDRP was designed to address the modern-day communication needs of NSICU staff by leveraging technological advances. Data from this study suggest that the MDRP may have advantages over the NCP in providing contextually relevant information. Additional research is warranted to develop the MDRP as a replacement for the NCP in the NSICU setting.
Endobronchial Ultrasound-guided Mediastinal Lymph Nodal Cryobiopsy in Patients With Nondiagnostic/Inadequate Rapid On-site Evaluation
Authors: Maturu Venkata N. , Prasad Virender P. , Vaddepally Chetan R. , Dommata Raghotham R. , Sethi Shweta
Published: March 2023

Background:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered the investigation of choice for sampling mediastinal nodes. A major drawback of EBUS-TBNA is its lower diagnostic yield for lymphoma and benign diseases. EBUS-guided mediastinal cryobiopsy (EBUS-MCB) is a novel technique that provides larger nodal biopsy samples, with an acceptable safety profile. In this study, we aimed to evaluate the diagnostic yield of EBUS-MCB in patients with an inconclusive rapid on-site evaluation (ROSE).

Methods:

This is a prospective study of patients who underwent EBUS-TBNA for undiagnosed mediastinal lymphadenopathy. Patients in whom ROSE did not yield a diagnosis (nondiagnostic ROSE) or ROSE revealed scanty atypical cells (inadequate ROSE) were subjected to EBUS-MCB. The diagnostic yield, adequacy, and complications of EBUS-MCB were analyzed.

Results:

Of the 196 patients undergoing EBUS-TBNA, 46 patients underwent EBUS-MCB. Thirty-two cases underwent EBUS-MCB for a nondiagnostic ROSE. EBUS-MCB confirmed the diagnosis in 19/32 (59.3%) cases. The additive diagnostic yield of EBUS-MCB over EBUS-TBNA was 43.7% (14/32 cases). In all 14 cases where EBUS-MCB was performed for an inadequate ROSE, the material obtained by EBUS-MCB was adequate for ancillary studies. The most common complication observed was a minor bleed in 13 cases.

Conclusion:

EBUS-MCB has a diagnostic yield of 59.3% when performed in cases with a nondiagnostic EBUS-ROSE. The tissue obtained by EBUS-MCB is adequate for ancillary studies. We propose EBUS-MCB as an additional diagnostic step in cases with an inconclusive ROSE while performing EBUS-TBNA. Larger studies are, however, needed before EBUS-MCB can be incorporated in the diagnostic algorithm for the evaluation of mediastinal lesions.