bluuebunny/crossref_metadata_2025 huggingface dataset:
Boundary speak in sustainability studies: Computational reading of a transversal field
Authors: Herberg Jeremias , Schmitz Seán , Stasiak Dorota , Schmieg Gregor
Published: January 2021

This article discusses the role of language in the collaboration between science, policy, and society. Combining computational methods of corpus linguistics (manifold learning) with sociological field theories, we analyze approximately 30,000 articles that were published in the field of transdisciplinary sustainability studies. We show that the field oscillates between deliberative and technocratic vocabularies and can therefore be characterized as a transversal field. We conclude that researchers who collaborate in science–society interstices are thrown into a semantic pluralism that cannot be boiled down to a common language. For transdisciplinary research practice and corresponding science policies, this involves trade-offs between generating a homogenous language and a collaborative appeal; between creating a stable creole and a situated semantic plurality. A corresponding theoretical viewpoint and science policy approach should be based on a pluralist view on the science–society–policy interplay.
Spare Rib, The British Women’s Health Movement and the Empowerment of Misery
Authors: Strimpel Zoe
Published: January 2021

This article elucidates Spare Rib’s (1972–1993) value as a source for considering the UK women’s health movement of the 1970s and 1980s. It focusses on the magazine’s role in mediating and shaping its readers’ relationship to negative bodily experience, and outlines its distinctiveness within the broader feminist landscape of women’s health coverage. While aspects of the British women’s health movement have attracted scholarly attention, such as mental health activism and abortion campaigns, we still know relatively little about how non-activist British women interpreted their bodily experiences and health through the feminist lens offered from the early 1970s. The first part of the article focusses on Spare Rib’s contribution to the British women’s health movement. The second part of the article zooms in on a selection of letters that show how readers took up, and found empowerment, in modes of bodily disclosure fostered by the magazine.
Apple Blossoms from a Swiss Orchard with Low-Input Plant Protection Regime Reveal High Abundance of Potential Fire Blight Antagonists
Authors: Gschwend Florian , Braun-Kiewnick Andrea , Widmer Franco , Pelludat Cosima
Published: January 2021

Erwinia amylovora causes fire blight, a serious disease of Rosaceae plants, including apple and pear. A predominant path of bacterial infection is entry through nectartodes after multiplication on the stigma. Depending on the inhibitory abilities of the native blossom microbiota, it may control the outbreak of fire blight and, therefore, may bar potential plant protection with reduced input of synthetic chemicals. Blossoms of five apple varieties in a low-input orchard, which had no fire blight history despite disease outbreaks in close proximity, were analyzed to assess bacterial and fungal communities. Metabarcoding indicated low microbial diversity and the presence of a few dominant operational taxonomic units (OTUs), including known fire blight antagonists such as Metschnikowia pulcherrima and Aureobasidium pullulans. The most dominant bacterial taxon (bOTU_01) was classified as Erwinia spp. To resolve sequences of species within bOTU_01, we used analyses of sequence variants and DNA signatures (i.e., nucleotide polymorphisms that are indicative for different species or species groups). These analyses revealed that >94.5% of the sequences of bOTU_01 derived from E. tasmaniensis, a potential E. amylovora antagonist. The latter was represented by up to 0.006% of the sequences. Cultivation-based analyses confirmed the prevalence of E. tasmaniensis. The high abundance of native potential E. amylovora antagonists likely indicates that this special set of native apple blossom microbiota counteracted the establishment of E. amylovora in this low-input orchard. This may allow for a new approach to assess possible components of synthetic apple blossom communities to mitigate fire blight infections.
Monoclonal Antibodies Receive EUA to Treat Mild to Moderate COVID-19
Authors: Aschenbrenner Diane S.
Published: January 2021

A combination of two monoclonal antibodies, casirivimab and imdevimab, has received emergency use authorization for the treatment of mild to moderate COVID-19.

Casirivimab and imdevimab come in separate packages but must be combined into one IV infusion after dilution.
Using a Mechanical Lift at Home
Authors: Fields Bronwyn E. , Whitney Robin L. , Bell Janice F.
Published: January 2021

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
Lessons from Fukushima: Potassium Iodide After a Nuclear Disaster
Authors: Sase Eriko , Eddy Christopher , Polivka Barbara J.
Published: January 2021

The release of radioactive iodine after a nuclear disaster, such as those that occurred at the Fukushima Daiichi Nuclear Power Plant in Japan 10 years ago and Three Mile Island in Pennsylvania in 1979, increases thyroid cancer risk among people who are exposed. Certain populations are especially vulnerable, including pregnant and breastfeeding women, children, and neonates. Potassium iodide (KI) can effectively block radioactive iodine from being absorbed by the thyroid gland if taken immediately after a radiation release. This article examines lessons learned from Fukushima to enhance disaster readiness and nursing actions. Nurses should be directly involved in vulnerability assessments, emergency planning, and in ensuring the availability, accessibility, and distribution of KI within U.S. nuclear power plant emergency planning zones before a crisis occurs.
Faculty Disclosure of Personal Mental Health History and Resident Physician Perceptions of Stigma Surrounding Mental Illness
Authors: Vaa Stelling Brianna E. , West Colin P.
Published: January 2021

Problem

Distress, depression, and burnout are common during medical training. Stigma surrounding seeking help for mental illness during medical training may involve fear of negative peer perceptions, academic jeopardy, and adverse future career consequences. Faculty disclosure of personal mental health illness may reduce stigma surrounding mental health disorders and reassure and encourage trainees to seek help when needed.

Approach

The authors aimed to assess the impact of faculty disclosure of mental health issues on stigma toward help-seeking during training, self-reflection about mental health, and resident physician awareness of mental health resources. Three self-selected faculty members shared their personal experiences with depression and mental health during a confidential noon conference intended for internal medicine residents at Mayo Clinic Rochester as part of their core curriculum in December 2016. Institutional and community mental health resources were provided. After the conference, attendees completed an anonymous survey assessing self-reported knowledge, attitudes, and behaviors surrounding mental health during medical training.

Outcomes

One hundred percent of residents (39/39) agreed that they enjoyed the conference. Thirty-five of 39 (89.7%) respondents agreed that their knowledge of available mental health resources increased and 33/39 (84.6%) agreed they were more likely to pursue mental health resources after attending the conference. Thirty-eight of 39 (97.4%) residents agreed that faculty sharing their personal struggles destigmatizes mental health issues during training, and the same percentage reported engaging in postconference self-reflection regarding their own mental health and well-being.

Next Steps

Resident conference sessions during which faculty self-disclose personal mental health experiences may help decrease the stigma of mental health issues during medical training and increase the likelihood residents will seek assistance when needed. The authors encourage further study of longer-term outcomes and actual help-seeking behaviors across learner levels and training environments.
Mistrust Reported by US Mexicans With Cancer at End of Life and Hospice Enrollment
Authors: Rising Margaret L. , Hassouneh Dena , Berry Patricia , Lutz Kristin
Published: January 2021

Hospice research with Hispanics mostly focuses on cultural barriers. Mindful of social justice and structural violence, we used critical grounded theory in a postcolonial theory framework to develop a grounded theory of hospice decision making in US Mexicans with terminal cancer. Findings suggest that hospice avoidance is predicted by mistrust, rather than culture, whereas hospice enrollers felt a sense of belonging. Cultural accommodation may do little to mitigate hospice avoidance rooted in discrimination-fueled mistrust. Future research with nondominant populations should employ research designs mitigating Eurocentric biases. Policy makers should consider concurrent therapy for nondominant populations with low trust in the health care system.
One Session of Spinal Manipulation Improves the Cardiac Autonomic Control in Patients with Musculoskeletal Pain
Authors: Rodrigues Pedro Teixeira Vidinha , Corrêa Leticia Amaral , Reis Felipe José Jandre , Meziat-Filho Ney Armando , Silva Bruno Moreira , Nogueira Leandro Alberto Calazans
Published: January 2021

Study Design.

Three-arm, parallel, randomized, placebo-controlled, assessor-blinded trial.

Objective.

To compare the immediate effect of manual therapy at the upper thoracic spine on the cardiovascular autonomic control of patients with musculoskeletal pain.

Summary of Background Data.

Musculoskeletal pain increases the risk of cardiovascular events. Thus, manual therapy applied to the upper thoracic region is likely efficient to improve the cardiac autonomic control.

Methods.

The study included 59 patients with musculoskeletal pain enrolled at an outpatient clinic. Participants were randomly assigned to spinal manipulation (n = 19), myofascial manipulation (n = 20), or placebo (n = 20) administered to the upper thoracic region. Resting heart rate variability provided indexes of the cardiac autonomic control, and the blood pressure response to the cold pressor test as a proxy of the sympathetic responsiveness to a stressor stimulus.

Results.

Groups were similar for baseline variables except for blood pressure. Two-way repeated-measures one-way analysis of covariance (ANCOVA) revealed that only spinal manipulation induced immediate increase of the square root of the mean squared differences of successive RR intervals (RMSSD), absolute (ms2), and normalized units (n.u.) of the high-frequency power (HF) as compared with pre-intervention evaluation, indicating an improvement in the parasympathetic activity to the heart. Normalized units of low-frequency power (LF) and the LF/HF ratio reduced after the spinal manipulation solely, suggesting a reduction of the sympathetic activity to the heart. There were no significant differences in the blood pressure responsiveness among the three treatments. There were no adverse events.

Conclusion.

In patients with musculoskeletal pain, spinal manipulation on the upper thoracic spine led to an immediate improvement in the resting cardiac autonomic control without an effect on the blood pressure responsiveness to a sympathoexcitatory stimulus. Myofascial manipulation or placebo did not change cardiovascular autonomic control.

Level of Evidence: 2
The Efficacy of Intraoperative Freehand Erector Spinae Plane Block in Lumbar Spondylolisthesis
Authors: Yeşiltaş Serdar , Abdallah Anas , Uysal Ömer , Yilmaz Sinan , Çinar İrfan , Karaaslan Kazim
Published: January 2021

Study Design.

Prospective randomized comparative (controlled) study.

Objective.

Management of the severe postoperative back pain followed the major spinal surgeries remains a challenge. The search is going on to find simple, efficient, and reliable perioperative analgesia with low side effects. We aimed to investigate the efficacy of intraoperative freehand erector spinae plane block (ESBP) after spinal surgeries.

Summary of Background Data.

A few case reports and randomized controlled studies demonstrated the analgesic efficacy of ESPB in spinal surgeries. Up-to-date, no randomized controlled studies investigated the effectiveness of ESPB on spinal instrumentation surgeries.

Methods.

We randomly divided 56 consecutive adult patients who underwent posterior spinal instrumentation and fusion for spondylolisthesis into two groups. The study (ESPB) group (n = 28) received intraoperative freehand bilateral ESPB with a 20-mL mixture solution of 0.25% bupivacaine and 1.0% lidocaine equally divided into all operating levels. In the control group (n = 28), 20 mL physiological saline was injected. Postoperatively, we ordered 1 g paracetamol thrice/day, besides patient-controlled analgesia pumps with morphine. We performed a postoperative evaluation with a visual analog scale (VAS), morphine consumption, ESPB-related adverse effects, and postoperative length of hospital stay (PLOS).

Results.

Morphine consumption was significantly higher in the controls within the first postoperative 24-hour 44.75 ± 12.3 mg versus 33.75 ± 6.81 mg in the ESPB participants (P < 0.001). Except for postoperative 24th-hour VAS (P = 0.127), all postoperative VAS scores recorded at all time-points were significantly higher in the controls (P < 0.05). In control individuals, the first analgesic demand time was shorter, and PLOS was longer (P < 0.001). Patient satisfaction was significantly higher in the ESPB group. We observed no significant difference regarding postoperative complications.

Conclusion.

Intraoperative ESPB as a part of multimodal analgesia was effective. For posterior instrumented patients with spondylolisthesis, it can relieve postoperative backache and reduce opioid consumption.

Level of Evidence: 1
Diagnosis and Management of Colonic Volvulus
Authors: Lai Samuel H. , Vogel Jon D.
Published: January 2021

Case Summary:

An 88-year-old man with no significant medical history, and in a good state of health, presented to the emergency department with 4 days of obstipation, progressive abdominal pain, and bloating. Examination revealed abdominal distension and generalized tenderness without signs of peritonitis. Laboratory values, including lactate and complete blood count, were within normal limits. Computed tomography imaging of the abdomen and pelvis revealed radiological signs of sigmoid volvulus and no evidence of bowel perforation (Fig. 1). Flexible sigmoidoscopic examination revealed no evidence of mucosal ischemia and enabled detorsion of the colon. The patient’s symptoms resolved after the detorsion. He was seen in consultation by a surgeon who advised surgical treatment only if the volvulus recurred. After hospital discharge, the patient self-educated about sigmoid volvulus and sought a second surgical opinion. Five weeks after his initial presentation and 1 week after complete colonoscopy, he underwent laparoscopic sigmoidectomy with colorectal anastomosis. His postoperative course was uneventful. At 6-month follow-up, he remained well with no bowel-related concerns.
A Modified Technique of Laparoscopic Lateral Lymph Node Dissection Combining Fascia-Oriented Dissection and Routine Upfront Distal Visceral Vessels Ligation for Mid- to Low-Lying Rectal Cancer
Authors: Zhang Xubing , Deng Xiangbing , Wei Mingtian , Zhang Hao , Yang Yuanquan , Wu Qingbin , Gu Chaoyang , Meng Wenjian , Wang Ziqiang
Published: January 2021

INTRODUCTION:

Lateral pelvic recurrence can be a cause of local failure after surgery for low rectal cancer. Lateral lymph node dissection is often performed in East Asia for patients with enlarged lateral lymph nodes or because of the presence of risk factors. However, the outcomes of the conventional lateral lymph node dissection are unsatisfactory, with a considerably high local recurrence rate for patients with positive lateral nodes. Here, we introduce a modified technique to improve lateral nodes clearance.

TECHNIQUE:

This modified technique has 4 key steps: 1) separation of the ureterohypogastric nerve fascia medially, 2) identification of the visceral pelvic fascia and dissection along the inferior vesical or vaginal veins down to the pelvic floor, 3) division of the distal ends of visceral vessels according to the orientation of ureterohypogastric nerve fascia and visceral pelvic fascia for better nerve preservation, and 4) en bloc dissection through a lateral approach over the surfaces of the sacral plexus and piriformis muscle to reveal the course of distal internal iliac vessels before the division of visceral veins.

RESULTS:

Twenty-nine patients underwent laparoscopic lateral lymph node dissection successively with no conversion. The median blood loss for each lateral procedure was 37.5 mL (range, 0–300.0 mL). Eleven lateral nodes (median; range, 1–22 lateral nodes) were harvested for each lateral side. There was no perioperative mortality, and 4 patients developed major complications (Clavien–Dindo III–IV).

CONCLUSION:

This modified technique characterized by the routine division of visceral vessels based on ureterohypogastric nerve fascia and visceral pelvic fascia is feasible and safe. It provides good lymph node harvest, autonomic nerve preservation, and improved bleeding control. Additional investigation is warranted to evaluate the safety, functional outcomes, and oncologic outcomes.
Genitourinary syndrome of menopause: the unmet need
Authors: Spadt Susan Kellogg , Larkin Lisa C.
Published: January 2021

Genitourinary syndrome of menopause (GSM) is a highly prevalent and progressive condition of postmenopausal women that has significant negative effects on vulvovaginal health, sexual health, and overall quality of life. Despite many available safe and effective therapies, GSM often goes undiagnosed and untreated. This Practice Pearl addresses the pathophysiology of GSM and reviews available treatment options.
The Value of Dynamic Infrared Thermography in Pedicled Thoracodorsal Artery Perforator Flap Surgery
Authors: Sjøberg Thomas , Mercer James B. , Weum Sven , de Weerd Louis
Published: January 2021

Background:

Dynamic infrared thermography (DIRT) is a noninvasive imaging technique that can provide indirect and real-time information on skin perfusion by measuring skin temperature. Although used in flap surgery, there are no reports on its value in procedures using a pedicled thoracodorsal artery perforator (TDAP) flap. The aim of this study was to assess the usefulness of DIRT in preoperative perforator mapping and in monitoring intra- and postoperative flap perfusion of pedicled TDAP flaps.

Methods:

This prospective study comprised 21 patients (21 flaps) scheduled for reconstructive surgery with a TDAP flap. Perforator mapping was done by DIRT, handheld unidirectional Doppler ultrasound, and computer tomography angiography. Intra- and postoperative flap perfusion was assessed by clinical signs and with the use of DIRT and handheld unidirectional Doppler ultrasound.

Results:

Perforator mapping with DIRT showed that first-appearing bright hotspots were always associated with arterial Doppler sounds and suitable perforators intraoperatively. Computer tomography angiography presented useful information on the thoracodorsal artery branching pattern but was less beneficial for perforator mapping. Intra- and postoperative flap monitoring with DIRT was more useful than handheld unidirectional Doppler ultrasound and clinical signs to detect early arterial and venous perfusion problems. DIRT demonstrated that TDAP flap perfusion is a dynamic process with an increase in perfusion during the first operative days. Nineteen flaps survived, of which 3 sustained distal necrosis. Two flaps were lost due to inadequate blood perfusion.

Conclusion:

DIRT provides valuable real-time information for perforator mapping and for monitoring TDAP flap perfusion intra- and postoperatively.
Aesthetic Training in Plastic Surgery Residency
Authors: O’Neill Rebecca , Raj Sarth , Davis Matthew J. , Abu-Ghname Amjed , Reece Edward M. , Winocour Julian , Buchanan Edward P. , Winocour Sebastian
Published: January 2021

Training in aesthetic surgery is a core element in a plastic surgery residency program. Nevertheless, in the past, many studies have shown the lack of resident confidence in aesthetic procedures upon graduation. In recent years, a number of efforts have been made to address this concern, including increasing the required residency aesthetic case requirements and the integration of resident aesthetic clinics to increase exposure and independence in this aspect of training. Numerous studies have been conducted to evaluate the efficacy of these resident-run clinics and have substantiated their value as an important educational tool in residency training and validated their safety in patient care. In fact, survey studies have shown that though residents today show a markedly increased confidence in their training when compared with the past, they still feel there is room for improvement in areas such as facial and minimally invasive surgeries, along with procedures that require higher patient volume to refine. In this article, we review the current state of aesthetic surgery training during plastic surgery residency and discuss future directions in the field.
Use of Simulation in Plastic Surgery Training
Authors: Agrawal Nikhil , Turner Acara , Grome Luke , Abu-Ghname Amjed , Davis Matthew J. , Reece Edward M. , Buchanan Edward P. , Winocour Sebastian
Published: January 2021

The nationwide focus on patient safety and the health of residents has increased the demand for educational tools outside the operating room. Simulation is a valuable tool for assessing and developing surgical skills in a controlled and safe environment. The use of simulation as a formal component of training has been increasing in various surgical subspecialties. In general surgery, simulation examinations such as the Fundamentals of Laparoscopic Surgery and Fundamentals of Endoscopic Surgery have become a prerequisite to board certification. Although formal simulation examinations in plastic surgery are not universal, there has been an increase in the use of simulation to increase resident competency in the operating room. For now, we will review the current state of simulation in craniofacial, hand, microvascular, and esthetic surgery and discuss applications for the future. We will also discuss the evolving role of artificial intelligence, virtual reality, and augmented reality in plastic surgery training and testing.
Comparing Independent and Integrated Plastic Surgery Residency Models: A Review of the Literature
Authors: Bhadkamkar Mohin A. , Luu Bryan C. , Davis Matthew J. , Reece Edward M. , Chu Carrie K. , Buchanan Edward P. , Winocour Sebastian
Published: January 2021

There are currently 2 approved residency training models in the United States conferring eligibility for the American Board of Plastic Surgery examination—the integrated pathway and the independent pathway. While both pathways allow for board certification, there has been much debate regarding the effectiveness of one training model over the other. In this article, we review the existing literature to compare these pathways with regard to quality of trainees, proficiency of graduates, and practice or career outcomes. Ongoing studies are strongly encouraged to continue to identify areas of improvement for both types of training programs.
Lymphovenous Bypass Using Indocyanine Green Mapping for Successful Treatment of Penile and Scrotal Lymphedema
Authors: Frojo Gianfranco , Castro Oscar , Tadisina Kashyap Komarraju , Xu Kyle Y.
Published: January 2021

Male genital lymphedema is a debilitating condition with significant physiologic and psychologic ramifications. Classical surgical treatments for male genital lymphedema include primarily ablative procedures through removal of excess soft tissue, which often have poor aesthetic and functional outcomes. Super microsurgical techniques (including lymphovenous bypass and lymph node transfers) are promising contemporary interventions. In this case report, we aim to share our experience of lymphovenous bypass with indocyanine green (ICG) lymphangiography in the management of penile and scrotal lymphedema. We performed ICG lymphography of the male genitalia and right thigh by injecting ICG at multiple sites followed by concomitant evaluation with a handheld fluorescent portable imager. Skin incisions were designed over the linear lymphatics upstream from the site of obstruction and dermal backflow. Four end-to-end and one end-to-side lymphovenous bypasses were performed. After completion, lymphovenous bypasses patency was confirmed by injecting ICG proximal to the incision and observing flow. At 10-month clinic follow-up, the patient showed marked improvement with improved skin tenting, softer tissues, improved sensation, visible dorsal penile vein, ability to retract foreskin for cleaning, and confidence to engage in sexual activities. This case report describes successful use of lymphovenous bypass in the treatment of penile and scrotal lymphedema using ICG lymphography intraoperatively to map functioning of superficial lymphatics. The full potential of this microsurgical approach is yet to be discovered, and future studies are needed to enhance the long-term outcomes for the treatment of penoscrotal lymphedema.
Simplified Repair of Traumatic Iliac Crest Flank Hernias with Mesh Strips
Authors: Kearney Aaron M. , Dumanian Gregory A.
Published: January 2021

Background:

Traumatic abdominal wall hernias are rare injuries resulting from blunt abdominal trauma. Traditional approaches have included both open and laparoscopic approaches, with placement of large meshes with giant overlaps. Perhaps the most technically difficult aspect of these repairs is fixating the abdominal wall to the iliac crest. The senior author has developed a method of repair using 2-cm strips of mesh. In this article, we present a description of 4 patients treated with this technique.

Methods:

We included 4 adult patients who underwent traumatic flank hernia repairs by the senior author. We excluded incisional hernias and patients who received a planar sheet of mesh. Demographics and outcomes collected included length of stay, follow-up time, and complications.

Results:

The average age was 38.5 years. Three hernias were due to motor vehicle collision injuries, and 1 was a crush injury at work. No planar meshes or bone anchors were used. No patients required component separation. There were no instances of surgical site infection, hematoma, or wound breakdown. All repairs were intact at the time of last follow-up (average, 24.3 months; range, 4–48.7 months).

Conclusions:

Traumatic flank hernias are rare injuries that can be difficult to address. Here, we describe a technique of primary repair with mesh strips that distribute the forces of repair across a greater surface area than can be achieved with sutures. Placing drill holes through the iliac crest avoids the cost and complexity of suture anchors.
Surgical Correction of Inverted Nipples
Authors: Mangialardi Maria Lucia , Baldelli Ilaria , Salgarello Marzia , Raposio Edoardo
Published: January 2021

Background:

Nipple inversion is a common pathologic condition affecting 2%–10% of women. Congenital inversions are the most common forms, while acquired inversions are less frequent. This condition can induce psychological discomfort, functional problems that could prevent adequate breast feeding, and cosmetic dissatisfaction, and create local irritation and infection. The aim of this article was to provide a comprehensive review of the literature about surgical treatment of inverted nipple.

Methods:

A literature search was conducted by using PubMed, Google Scholar, and Cochrane database using the following MeSH terms: “inverted nipple,” “inverted nipple surgery,” “inverted nipple treatment,” and “inverted nipple management.” Studies that described surgical treatment and included outcomes and recurrence rate were included.

Results:

Thirty-three articles were considered suitable, including 3369 inverted nipple cases. Eight studies described techniques with lactiferous ducts damaging, while 25 studies described techniques with lactiferous duct preservation using dermal flaps, sutures, or distractor systems. The average follow-up was 23.9 months. Overall, a satisfactory correction was reached in 88.6% of cases, and the recurrence rate was 3.89%.

Conclusions:

To our knowledge, our review includes the largest sample size in the literature. The heterogeneity and subjectivity of outcomes make it more complicated to state which is the best surgical strategy to adopt to obtain satisfactory and stable results with minimal morbidity. This study highlights the need of a standardized method to evaluate outcomes, including aesthetic, functional and psychological results, while using objective and subjective measurement instruments.
Breast Reconstruction in a Coronavirus Disease 2019 Hub
Authors: Lisa Andrea , Battistini Andrea , Giannasi Silvia , Veronesi Alessandra , Bandi Valeria , Maione Luca , Vinci Valeriano , Tinterri Corrado , Babbini Marco , Klinger Marco
Published: January 2021

Background:

The coronavirus disease 2019 (COVID-19) pandemic presented a dramatic challenge to healthcare systems. Humanitas Clinical and Research Hospital (Rozzano, MI, Italy) was declared a regional hub for the treatment of COVID-19 patients. Our plastic surgery team, in consultation with our breast surgery colleagues, decided to perform immediate implant-based breast reconstruction for patients undergoing mastectomy for cancer. In this report, we present our experience performing breast reconstruction with a new protocol in the first month following the COVID-19 pandemic in the most affected region in Italy.

Methods:

We adopted a new protocol to treat patients with breast cancer during the COVID-19 pandemic. The main goals of our protocol were to reduce the risk of COVID-19 spread for both patients and clinicians, postpone nononcologic and more advanced surgery, develop rapid recovery for early patient discharge (within 24 hours from surgery) through pain management, and finally reduce postoperative consultations.

Results:

The protocol was applied to 51 patients between early March and early April 2020. After 1 month, we decided to retrospectively review our experience. We found no significant differences in terms of postoperative pain and complication rate compared with our data in the pre-COVID period.

Conclusion:

Our new protocol is safe and effective, enabling tumor resection and immediate implant-based breast reconstruction, without increasing risks to the patient or staff.
Plastic Surgery Lockdown Learning during Coronavirus Disease 2019: Are Adaptations in Education Here to Stay?
Authors: Mohan Anita T. , Vyas Krishna S. , Asaad Malke , Khajuria Ankur
Published: January 2021

Summary: The novel coronavirus disease 2019 has had a major impact on human life and livelihood. The unprecedented challenges have expanded beyond just social and work life, and have grown to impact resident education. In this article, we review the structure of plastic surgery education before the pandemic, the different online learning opportunities for self-directed learning. A summary of the range of platforms and approaches of online remote access delivery of conferences and education that emerged or expanded as a result of the crisis has been reported. This article highlighted the rapid initiatives and efforts of programs and national and international societies to support continuing medical education in conjunction with the guidelines to “shelter at home” and maintain social distancing, and possible future for expanding the reach of online academic initiatives, in addition to the role of developing virtual technologies. The coronavirus disease 2019 crisis has created an opportunity to analyze and advance online learning options to overcome the associated challenges and continue as a reliable platform even following the resolution of the social distancing requirements.
How to Treat a Tongue-tie: An Evidence-based Algorithm of Care
Authors: Shekher Rohil , Lin Lawrence , Zhang Rosaline , Hoppe Ian C. , Taylor Jesse A. , Bartlett Scott P. , Swanson Jordan W.
Published: January 2021

Background:

Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear.

Methods:

A meta-analysis was performed to identify the extent of the benefit from frenotomy in breastfeeding measures, degree of tongue-tie, and maternal pain during feeding in randomized controlled trials. A structured literature review analyzed the optimal type and timing of repair. An algorithm was developed to incorporate this evidence into a management pathway.

Results:

Among 424 studies reviewed, 5 randomized controlled trials met inclusion criteria for meta-analysis. Frenotomy significantly improved the degree of tongue-tie, with a 4.5-point decrease in Hazelbaker Assessment Tool for Lingual Frenulum Function score compared with a decrease of 0 in those who did not undergo frenotomy (P< 0.00001). This was associated with improved self-reported breastfeeding (relative risk [RR] = 3.48,P< 0.00001) and decreased pain (Short-Form McGill Pain Questionnaire,P< 0.00001); however, Breastfeeding Self-Efficacy–Short Form and Latch, Audible Swallowing, Type of Nipple, Comfort, Hold scores did not significantly improve. Multiple studies demonstrated significant improvements following frenuloplasty when compared with frenotomy but demonstrated mixed results as to the effect of timing of tongue-tie division.

Conclusions:

Frenotomy is associated with breastfeeding improvements that vary individually but trend toward significance collectively during a critical time in infant development. Among patients with a severe Hazelbaker Assessment Tool for Lingual Frenulum Function score or difficulty breastfeeding, we conclude that simple frenotomy without anesthetic is generally indicated in infancy and frenuloplasty under general anesthesia for older children.
Endoscopic Lipoabdominoplasty
Authors: di Diego Juan M.
Published: January 2021

Endoscopic lipoabdominoplasty is the surgical technique utilizing endoscopy, as in a conventional abdominoplasty, to repair acquired abdominal wall defects, such as diastasis recti or ventral hernias. A conventional liposuction is carried out through 4 ports, which shall be used later to place the laparoscopic trocars for fat removal and supra-aponeurotic undermining. Three trocars are introduced through these ports, one for the camera and the others to introduce surgical instruments. A CO2 insufflation is carried out; the supra-aponeurotic space is undermined up to the xiphoid process. Then a rectus muscle plication is carried out with slow-absorbing sutures in 2 or 3 sections. Two Jackson Pratt drains are placed, and the incisions are closed. The objective of this article is to describe the technique and establish the necessary safety criteria to obtain good results in patients with minimal skin laxity, with moderate fat tissue distribution, with musculofascial diastasis, with ventral hernias, and who do not need or do not accept a visible surgical scar.
Regenerative Wound Healing by Open Grafting of Autologous Fat and PRP-Gel – A New Concept and Potential Alternative to Flaps
Authors: Rangaswamy Mohan
Published: January 2021

A new regenerative technique is described that enabled in situ formation of soft tissue bridge for difficult wounds, which otherwise needed flaps, resulting in complete healing in 3/3 cases. The wounds were debrided till healthy bleeding and covered with a triple-layer matrix of platelet-rich fibrin gel, condensed liposuctioned autologous fat, and porous collagen dressing. Negative pressure wound therapy was applied after 48 hours for 4–5 days in 2 cases and after 11 days for 3 weeks in the third case. Rapid vascularization was noted, with regeneration of mature tissue bridge and subsequent epithelization even over the bone. One patient underwent elective replacement of healed epithelium by split skin graft for better aesthetics and durability. This technique, if further validated, may herald a new concept of in situ regeneration, namely transformation of autologous tissue (grafted in gel form) to viable soft tissue.
Evaluation of Live Surgery Meetings: Our Experience with the “Live Makeover Aesthetic Surgery Symposium”
Authors: Skouras George , Skouras Athanasios , Skoura Elena
Published: January 2021

Background:

Live Surgery Meetings have been established as a vey effective means to demonstrate certain surgical techniques and intraoperative decision-making. However, many authors still question the ethics of this approach. We present our experience as organizers of the Live Makeover Aesthetic Surgery Symposium, an annual international live surgery meeting taking place in Athens, Greece.

Methods:

Throughout the course of our meetings, 2 surveys were performed, 1 after Live Makeover Aesthetic Surgery Symposium 3, comparing the educational value between live surgery and pre-recorded videos, and the second after LMASS 6, re-evaluating the educational value of live surgery, as well as the ethics of this educational method and the patient safety. In addition, we studied the results of the patients operated on in all of our meetings, and their level of satisfaction.

Results:

Based on the results of the first survey, the superior educational value of live surgery was obvious. The second survey confirmed those valuable educational benefits. In addition, the concerns on both surgical outcomes and patient safety were minimal. The patients showed a very high level of satisfaction through their answers. The complications encountered were only 2 of the 49 live surgical demonstrations and were not directly related to the live demonstration.

Conclusions:

Based on our study, live surgery is an effective, safe educational tool. However, strict guidelines have to be followed to ensure high educational value and patient safety. Based on our 9-year experience with our live surgery meeting, we provide detailed guidelines for optimal outcomes.
Classification of Transgender Man’s Breast for Optimizing Chest Masculinizing Gender-affirming Surgery
Authors: Wolf Yoram , Kwartin Samuel
Published: January 2021

Background:

The purpose of mastectomy for the female-to-male transgender patient is to produce a masculine appearance of the chest. A number of algorithms have been proposed for selecting the surgical technique; these have generally been based on the degree of breast ptosis and the quality and elasticity of the skin. We present a series of subcutaneous mastectomies operated on by 1 surgeon during the last 2 decades. Based on our experience, we suggest a classification system for selecting surgical technique.

Methods:

Data were collected from the files of female-to-male transgender persons who underwent surgery during 2003–2019. The data included background and surgery information. Pictures from the clinic’s archive of the patients before, during, and after surgery were collected and analyzed.

Results:

In total, 220 mastectomies were performed on 110 patients aged 13.5–50 years (mean 22.5 ±6.1). The excision averaged 443 g per breast (range: 85–2550). A periareolar approach was performed in 14 (12.7%), omega-shaped resection (nipple–areola complex on scar) in 2 (1.8%), spindle-shaped mastectomy with a dermal nipple–areola complex flap approach in 38 (34.5%), and a complete mastectomy with a free nipple–areola complex graft in 56 (50.9%). Complications included 2 hypertrophic scars, 6 hematomas requiring revision surgery, 3 wound dehiscences, and 3 cases of partial nipple necrosis.

Conclusions:

Analysis of the data led to a proposed classification for female-to-male transgender mastectomy (Wolf’s classification), based on skin excess and the distance between the original and the planned position of the nipple–areola complex.
Mediterranean diet and antihypertensive drug use: a randomized controlled trial
Authors: Ribó-Coll Margarita , Lassale Camille , Sacanella Emilio , Ros Emilio , Toledo Estefanía , Sorlí José V. , Babio Nancy , Lapetra José , Gómez-Gracia Enrique , Alonso-Gómez Ángel M. , Fiol Miquel , Serra-Majem Lluis , Pinto Xavier , Castañer Olga , Díez-Espino Javier , González José I. , Becerra-Tomás Nerea , Cofán Montserrat , Díaz-López Andrés , Estruch Ramón , Hernáez Álvaro
Published: January 2021

Objective:

To examine in older individuals at high cardiovascular risk whether following a Mediterranean diet decreased the necessity of antihypertensive drugs and modulated their associated cardiovascular risk.

Methods:

In the PREvención con DIeta MEDiterránea study, we assessed whether volunteers randomly allocated to an intervention with a Mediterranean diet enriched with extra-virgin olive oil or nuts (relative to a low-fat control diet) disclosed differences in the risk of: initiating antihypertensive medication in nonusers at baseline (n = 2188); and escalating therapy in participants using one, two, or three drugs at baseline (n = 2361, n = 1579, and n = 554, respectively). We also assessed whether allocation to Mediterranean diet modified the association between antihypertensive drug use and incident cardiovascular events.

Results:

Participants allocated to Mediterranean diet interventions were associated with lower risk of initiating antihypertensive therapy [5-year incidence rates: 47.1% in the control diet, 43.0% in MedDiets; hazard ratio = 0.84, 95% CI (0.74--0.97), in a model adjusted for age, sex, and recruitment site]. Volunteers using two drugs at baseline in the Mediterranean diet intervention enriched with extra-virgin olive oil decreased their risk of therapy escalation [5-year incidence rates: 22.9% in the control diet, 20.1% in the MedDiet; hazard ratio = 0.77, 95% CI (0.60--0.99)]. Allocation to Mediterranean diet interventions attenuated the association between antihypertensive therapy at baseline and incidence of major adverse cardiovascular events (P interaction = 0.003).

Conclusion:

In an older population at high cardiovascular risk, following a Mediterranean diet reduced the risk of initiating or escalating antihypertensive medication and attenuated cardiovascular risk in antihypertensive drug users.
22q11 MICRODELETION (DIGEORGE) SYNDROME WITH MICROVASCULAR MACULOPATHY
Authors: Chaudhry Sarah G. , Fung Adrian T.
Published: January 2021

Purpose:

To describe a novel retinal finding of 22q11 microdeletion syndrome.

Methods:

Retrospective chart review of a single patient.

Results:

A 32-year-old man with genetically confirmed 22q11.2 microdeletion syndrome was found to have bilateral tortuous retinal vessels and right microvascular microangiopathy with microaneurysms, hard exudate, and cystoid macular oedema. Other underlying causes for this including diabetic and hypertensive retinopathy were excluded. No treatment was required because he was asymptomatic, and the visual acuity remained 20/30 in that eye with over one year of follow-up.

Conclusion:

22q11 microdeletion syndrome can be associated with microvascular microangiopathy.
The dual role of HMGB1 in pancreatic cancer
Authors: Kang Rui , Tang Daolin
Published: January 2021

Pancreatic ductal adenocarcinoma (PDAC) is the most common type of exocrine pancreatic cancer with a 9% 5-year survival rate. High mobility group box 1 (HMGB1) is a nuclear protein that can act as a DNA chaperone in the sustainment of chromosome structure and function. When released into the extracellular space, HMGB1 becomes the most well characterized damage-associated molecular pattern (DAMP) to trigger immune responses. Recent evidence indicates that intracellular HMGB1 is a novel tumor suppressor in PDAC, which is connected to its role in the prevention of oxidative stress, genomic instability, and histone release. However, since extracellular HMGB1 is a DAMP and proinflammatory cytokine, cancer cells can also exploit it to survive through the receptor for advanced glycation endproducts (RAGE) in the pancreatic tumor microenvironment. Interestingly, targeting the HMGB1-RAGE pathway has become a new anti-cancer therapy strategy for PDAC.
A Chinese consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency after pancreatic surgery (2018)
Authors: Zhang Taiping , Cao Zhe , Chen Rufu , Du Yiqi , Hong Defei , Jiang Kuirong , Jin Gang , Li Fei , Li Weiqin , Li Zhaoshen , Liang Tingbo , Liao Quan , Lou Wenhui , Miao Yi , Qian Jiaming , Qin Renyi , Sun Bei , Tang Zhaohui , Wang Chunyou , Wang Weilin , Wu Wenming , Yang Yinmo , Zhao Gang , Zhao Yupei
Published: January 2021

A consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency (PEI) after pancreatic surgery was developed based on the latest references, combined with China's actual situation. More than 20 Chinese excellent experts participated in this work and contributed many thorough discussions. This consensus discusses the definition, epidemiology, diagnosis, treatment, and follow-up of PEI after pancreatic surgery. The authors hope this consensus will promote the standard procedure of diagnosis and treatment of PEI in China.
Management of inadequate weight loss or weight regain in post-bariatric surgical patients
Authors: Sahebzamani Frances M.
Published: January 2021

Nurse practitioners play a key role in the front-line treatment of obesity in primary care practice settings. National guidelines for the management of obesity are provided by a majority of national organizations, yet little guidance is provided for the management of post-bariatric surgical patients who experience inadequate weight loss or early weight regain. As the number of surgical procedures increases, guidelines and interventions for managing this complex outcome are needed.
The influence of the gut microbiome on obesity
Authors: Blanco Christy
Published: January 2021

Obesity is a disease with multiple environmental and genetic factors, which when combined contribute to the maintenance of an elevated body weight, thereby reducing long-term success of weight loss. The human gut microbiome is becoming a new potential contributor to obesity. Specifically, gut bacteria and their metabolites are known to affect dysbiosis, metabolism, endotoxemia, and inflammation. Many environmental and lifestyle factors can alter the gut microbiota affecting obesity. Potential therapies to alter the gut microbiota include supplementation with probiotic organisms and the use of fecal microbiota transplantation. This review will examine the growing evidence supporting the mechanisms with which the human gut microbiota may influence obesity, various influences on the microbiota, and potential therapies.