bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential Seasonal Prevalence of Yellowing Viruses Infecting Melon Crops in Southern California and Arizona Determined by Multiplex RT-PCR and RT-qPCR
Authors: Mondal Shaonpius , Hladky Laura Jenkins , Wintermantel William M.
Published: February 2023

Viruses transmitted by the whitefly (Bemisia tabaci) are an increasing threat to cucurbit production in the southwestern United States and many other cucurbit production regions of the world. The crinivirus cucurbit yellow stunting disorder virus (CYSDV) has severely impacted melon production in California and Arizona since its 2006 introduction to the region. Within the past few years, another crinivirus, cucurbit chlorotic yellows virus (CCYV), and the whitefly-transmitted ipomovirus squash vein yellowing virus (SqVYV) were found infecting melon plants in California’s Imperial Valley. CYSDV, CCYV, and an aphid-transmitted polerovirus, cucurbit aphid-borne yellows virus (CABYV), occur together in the region and produce identical yellowing symptoms on cucurbit plants. Mixed infections of these four viruses in the Sonoran Desert and other regions pose challenges for disease management and efforts to develop resistant varieties. A multiplex single-step RT-PCR method was developed that differentiates among these viruses, and this was used to determine the prevalence and distribution of the viruses in melon samples from fields in the Sonoran Desert melon production region of California and Arizona during the spring and fall melon seasons from 2019 through 2021. TaqMan probes were developed, optimized, and applied in a single-step multiplex RT-qPCR to quantify titers of these four viruses in plant samples, which frequently carry mixed infections. Results of the multiplex RT-PCR analysis demonstrated that CYSDV is the predominant virus during the fall, whereas CCYV was by far the most prevalent virus during the spring each year. Multiplex RT-qPCR was used to evaluate differential accumulation and spatiotemporal distribution of viruses within plants and suggested differences in competitive accumulation of CCYV and CYSDV within melon. This study provides the first official report of SqVYV in Arizona and offers an efficient method for virus detection and quantification for breeding and disease management in areas impacted by cucurbit yellowing viruses.
Genome-Wide Association Study Discovers Novel Germplasm Resources and Genetic Loci with Resistance to Gibberella Ear Rot Caused by Fusarium graminearum
Authors: Yuan Guangsheng , He Dandan , Shi Jiaxin , Li Youliang , Yang Yan , Du Juan , Zou Chaoying , Ma Langlang , Gao Shibin , Pan Guangtang , Shen Yaou
Published: February 2023

Gibberella ear rot (GER) in maize caused by Fusarium graminearum is one of the most devastating maize diseases reducing grain yield and quality worldwide. The genetic bases of maize GER resistance remain largely unknown. Using artificial inoculation across multiple environments, the GER severity of an association panel consisting of 316 diverse inbred lines was observed with wide phenotypic variation. In the association panel, a genome-wide association study using a general linear model identified 69 single-nucleotide polymorphisms (SNPs) significantly associated with GER resistance at the threshold of 2.04 × 10−5, and the average phenotypic variation explained (PVE) of these SNPs was 5.09%. We also conducted a genome-wide association study analysis using a mixed linear model at a threshold of 1.0 × 10−4, and 16 significantly associated SNPs with an average PVE of 4.73% were detected. A combined general linear model and mixed linear model method obtained 10 co-localized significantly associated SNPs linked to GER resistance, including the most significant SNP (PZE-105079915) with the greatest PVE value, 9.07%, at bin 5.05 following 10 candidate genes. These findings are significant for the exploration of the complicated genetic variations in maize GER resistance. The regions and genes identified herein provide a list of candidate targets for further investigation, in addition to the elite germplasm resources that can be used for breeding GER resistance in maize.
The Expression of Cytoplasmic Effectors by Phytophthora infestans in Potato Leaves and Tubers Is Organ-Biased
Authors: Lacaze Aline , Sormany François , Judelson Howard S. , Joly David L.
Published: February 2023

Potato late blight is a devastating disease caused by Phytophthora infestans that affects organs, such as leaves and tubers. Previous studies of organ specificity in this interaction have mainly addressed the plant side (i.e., screening for resistance to late blight in potato leaves versus tubers). However, the extent of the organ specificity of P. infestans virulence mechanisms remains understudied. Here, we investigated the extent of organ-specific expression of effector genes using RNA-seq by contrasting the infection of leaves and tubers of potato (cultivar Russet Burbank) by the P. infestans strain 1306. We focused on RxLR and Crinkler (CRN) effectors to obtain insight on genes putatively involved in P. infestans virulence exhibiting differential expression during leaf versus tuber infection. Our results indicated that (i) the proportion of differentially expressed genes (DEGs) increased over time; (ii) a high proportion of effector genes was differentially expressed at one or more time points (34% of RxLRs and 58% of CRNs); and (iii) some RxLR and CRN families appeared to host more DEGs than others. Quantitative reverse transcription PCR (RT-qPCR) was also used to assess the expression of seven RxLR effectors in a time-course experiment, allowing us to validate their organ-biased profiles. Organ-specific effector genes may perform distinct virulence roles at the organ level, which should be considered when performing effectoromics or any infection study. These results bring new insights into the organ specificity of the potato- P. infestans interaction that could lead to improved potato-breeding programs using effectoromics-based approaches.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Association of Surgical Resident Competency Ratings With Patient Outcomes
Authors: Kendrick Daniel E. , Thelen Angela E. , Chen Xilin , Gupta Tanvi , Yamazaki Kenji , Krumm Andrew E. , Bandeh-Ahmadi Hoda , Clark Michael , Luckoscki John , Fan Zhaohui , Wnuk Greg M. , Ryan Andrew M. , Mukherjee Bhramar , Hamstra Stanley J. , Dimick Justin B. , Holmboe Eric S. , George Brian C.
Published: February 2023

Purpose

Accurate assessment of clinical performance is essential to ensure graduating residents are competent for unsupervised practice. The Accreditation Council for Graduate Medical Education milestones framework is the most widely used competency-based framework in the United States. However, the relationship between residents’ milestones competency ratings and their subsequent early career clinical outcomes has not been established. It is important to examine the association between milestones competency ratings of U.S. general surgical residents and those surgeons’ patient outcomes in early career practice.

Method

A retrospective, cross-sectional study was conducted using a sample of national Medicare claims for 23 common, high-risk inpatient general surgical procedures performed between July 1, 2015, and November 30, 2018 (n = 12,400 cases) by nonfellowship-trained U.S. general surgeons. Milestone ratings collected during those surgeons’ last year of residency (n = 701 residents) were compared with their risk-adjusted rates of mortality, any complication, or severe complication within 30 days of index operation during their first 2 years of practice.

Results

There were no associations between mean milestone competency ratings of graduating general surgery residents and their subsequent early career patient outcomes, including any complication (23% proficient vs 22% not yet proficient; relative risk [RR], 0.97, [95% CI, 0.88–1.08]); severe complication (9% vs 9%, respectively; RR, 1.01, [95% CI, 0.86–1.19]); and mortality (5% vs 5%; RR, 1.07, [95% CI, 0.88–1.30]). Secondary analyses yielded no associations between patient outcomes and milestone ratings specific to technical performance, or between patient outcomes and composites of operative performance, professionalism, or leadership milestones ratings (P ranged .32–.97).

Conclusions

Milestone ratings of graduating general surgery residents were not associated with the patient outcomes of those surgeons when they performed common, higher-risk procedures in a Medicare population. Efforts to improve how milestones ratings are generated might strengthen their association with early career outcomes.
GABAergic Signaling during Spinal Cord Stimulation Reduces Cardiac Arrhythmias in a Porcine Model
Authors: Howard-Quijano Kimberly , Kuwabara Yuki , Yamaguchi Tomoki , Roman Kenny , Salavatian Siamak , Taylor Bradley , Mahajan Aman
Published: February 2023

Background

Neuraxial modulation, including spinal cord stimulation, reduces cardiac sympathoexcitation and ventricular arrhythmogenesis. There is an incomplete understanding of the molecular mechanisms through which spinal cord stimulation modulates cardiospinal neural pathways. The authors hypothesize that spinal cord stimulation reduces myocardial ischemia–reperfusion—induced sympathetic excitation and ventricular arrhythmias through γ-aminobutyric acid (GABA)–mediated pathways in the thoracic spinal cord.

Methods

Yorkshire pigs were randomized to control (n = 11), ischemia–reperfusion (n = 16), ischemia–reperfusion plus spinal cord stimulation (n = 17), ischemia–reperfusion plus spinal cord stimulation plus γ-aminobutyric acid type A (GABAA) or γ-aminobutyric acid type B (GABAB) receptor antagonist (GABAA, n = 8; GABAB, n = 8), and ischemia–reperfusion plus GABA transaminase inhibitor (GABAculine, n = 8). A four-pole spinal cord stimulation lead was placed epidurally (T1 to T4). GABA modulating pharmacologic agents were administered intrathecally. Spinal cord stimulation at 50 Hz was applied 30 min before ischemia. A 56-electrode epicardial mesh was used for high-resolution electrophysiologic recordings, including activation recovery intervals and ventricular arrhythmia scores. Immunohistochemistry and Western blots were performed to measure GABA receptor expression in the thoracic spinal cord.

Results

Cardiac ischemia led to myocardial sympathoexcitation with reduction in activation recovery interval (mean ± SD, –42 ± 11%), which was attenuated by spinal cord stimulation (–21 ± 17%, P = 0.001). GABAA and GABAB receptor antagonists abolished spinal cord stimulation attenuation of sympathoexcitation (GABAA, –9.7 ± 9.7%, P = 0.043 vs. ischemia–reperfusion plus spinal cord stimulation; GABAB, –13 ± 14%, P = 0.012 vs. ischemia–reperfusion plus spinal cord stimulation), while GABAculine alone caused a therapeutic effect similar to spinal cord stimulation (–4.1 ± 3.7%, P = 0.038 vs. ischemia–reperfusion). The ventricular arrhythmia score supported these findings. Spinal cord stimulation during ischemia–reperfusion increased GABAA receptor expression with no change in GABAB receptor expression.

Conclusions

Thoracic spinal cord stimulation reduces ischemia–reperfusion—induced sympathoexcitation and ventricular arrhythmias through activation of GABA signaling pathways. These data support the hypothesis that spinal cord stimulation–induced release of GABA activates inhibitory interneurons to decrease primary afferent signaling from superficial dorsal horn to sympathetic output neurons in the intermediolateral nucleus.

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Adverse effects following botulinum toxin A injections in children with cerebral palsy
Authors: Sapienza Marco , Kapoor Rahul , Alberghina Flavia , Maheshwari Ratna , McCracken Kathryn Louise , Canavese Federico , Johari Ashok N.
Published: February 2023

The study aimed to analyze the adverse events associated with botulinum toxin A (BoNT-A) injections in children with cerebral palsy (CP). The literature search was completed using the Medline, PubMed, Google Scholar, Scopus, and Cochrane Library databases from the earliest date possible up to December 2021. Search terms included ‘botulinum toxin’, ‘cerebral palsy’, ‘spasticity’, ‘adverse effects’, ‘side effects’, ‘undesirable effects’, ‘complications’, ‘lower limb’, ‘upper limb’, and ‘children’ including combinations of index and free-text terms. Fifty-five studies were included in the study. Data on 6333 pediatric patients and more than 14 080 BoNT-A injections were collected. Respiratory symptoms and respiratory tract infections were the most frequently registered adverse events (AEs). Other common AEs included procedural/focal AEs, flu-like symptoms, and asthenia. Sentinel events including four cases of death were reported. AEs were more frequent and severe in high-dose patients; however, the capacity of BoNT-A to spread systemically remains unclear. Since severe adverse events are not common, further research is needed to collect more definitive clinical and homogeneous data to support the findings of the present research and clarify the safety profile of BoNT-A, especially regarding the incidence of respiratory issues and complications in GMFCS IV or V patients.
Elucidating molecular and cellular targets and the antiprostate cancer potentials of promising phytochemicals: a review
Authors: Khan Habiba , Rais Juhi , Afzal Mohammad , Arshad Md
Published: February 2023

Prostate cancer (PCa) has become the major health problem and the leading causes of cancer mortality among men. PCa often progresses from an early androgen-dependent form of cancer to a late (metastatic) androgen-independent cancer, for which no effective treatment options are available. Current therapies target testosterone depletion, androgen axis inhibition, androgen receptor (AR) downregulation and regulation PSA expression. These conventional treatment options, however, are intense and pose severe side effects. From the past few years, plant-derived compounds or phytochemicals have attracted much attention by the researchers worldwide for their promising approach in inhibiting the development and growth of cancer. This review emphasizes mechanistic role of promising phytochemicals on PCa. This review imparts to score anticancer efficacy of promising phyto-agents luteolin, fisetin, coumestrol and hesperidin with focus on the mechanistic action in management and treatment of PCa. These phytocompounds were also selected for their best binding affinity with the ARs on the basis of molecular docking studies.
Host factors predisposing to kidney disease in people with HIV
Authors: Hung Rachel K.Y. , Winkler Cheryl A. , Post Frank A.
Published: February 2023

Purpose of review

To highlight advances in understanding of host factors, in particular host genetics, in the development of chronic kidney disease (CKD) in people with HIV.

Recent findings

In Black populations, the G1 and G2 variants of the apolipoprotein L1 (APOL1) gene predispose to HIV-associated nephropathy (HIVAN). The risk of HIVAN is mostly confined to individuals with two APOL1 variants (kidney-risk genotypes). APOL1 kidney-risk genotypes are present in approximately 80% of patients with HIVAN and account for nearly half the burden of end-stage CKD in people of African ancestry with HIV. Progress has been made in elucidating the mechanisms of kidney injury in APOL1 nephropathy, and several targeted molecular therapies are being investigated in clinical trials. Genome- and epigenome-wide association studies are identifying additional genes and pathways that may be involved in the pathogenesis of CKD in people with HIV.

Genetic variants of APOL1 are strongly associated with severe CKD and contribute to the high rates of CKD in Black populations with HIV. Most individuals with APOL1 kidney-risk genotypes, however, do not develop kidney disease and further studies are required to understand the role of additional genetic and environmental factors that may affect CKD risk in this population.
Novel co-axial, disposable, low-cost 3D printed videolaryngoscopes for patients with COVID-19: a manikin study
Authors: Gorman Laura , Dickson Andrew N. , Monaghan Myles , Vaughan Frank , Murphy Brian , Dowling Denis P. , McCaul Conan , Jones James F.X.
Published: February 2023

BACKGROUND

COVID-19 continues to present challenges to both patient management and the protection of the airway management team involved, in particular in resource-constrained low-income countries. Among the most concerning complications in affected patients is rapid hypoxemic respiratory failure requiring tracheal intubation and mechanical ventilation. Videolaryngoscopy without peri-intubation oxygenation is the recommended approach in COVID-19 patients. However, the absence of peri-intubation oxygenation during intubation attempts can lead to hypoxia, and result in life-threatening complications in already critically ill patients.

OBJECTIVE

To develop low-cost disposable 3D printed videolaryngoscope designs with integrated channels for oxygen, suction, WIFI-enabled camera and tracheal tube channels, as well as a flexible transparent barrier anchor to offer optional additional protection to the user and airway management team.

DESIGN

A manikin study.

SETTING AND PARTICIPANTS

Three experienced consultant anaesthetists in the Mater Misericordiae University Hospital, Dublin, Ireland.

MAIN OUTCOME MEASURES

To generate novel co-axial videolaryngoscopes that meet International Standards, ISO7376 : 2020 standards for anaesthetic and respiratory equipment (laryngoscopes for tracheal intubation), and to demonstrate successful tracheal intubation of a manikin trainer in a range of configurations (‘easy’ to ‘difficult’) in accordance with the Cormack-Lehane grading of laryngeal view.

RESULTS

Final design prototypes met the minimum criteria for strength and rigidity according to ISO7376 : 2020, including blade tip displacement under load (65 N and 150 N). Preliminary validation has demonstrated successful tracheal intubation of a manikin trainer in all configurations including ‘difficult’ (Cormack-Lehane Grade 3 view).

CONCLUSIONS

This low-cost, rapid in-house manufacture could offer a mitigation of supply chain disruptions that can arise during global pandemics. Furthermore, it could offer a low-cost solution in low-income countries where there is an infection risk caused by re-using most current videolaryngoscopes requiring sterilisation before re-use, as well as limitations in the availability of personal protective equipment.
Haemodynamic monitoring and management in patients having noncardiac surgery
Authors: Flick Moritz , Joosten Alexandre , Scheeren Thomas W.L. , Duranteau Jacques , Saugel Bernd
Published: February 2023

BACKGROUND

Haemodynamic monitoring and management is a mainstay of peri-operative anaesthetic care.

OBJECTIVE

To determine how anaesthesiologists measure and manage blood pressure and cardiac output, and how they guide fluid administration and assess fluid responsiveness in patients having noncardiac surgery.

DESIGN

Web-based survey.

SETTING

Survey among members of the European Society of Anaesthesiology and Intensive Care (ESAIC) in October and November 2021.

PARTICIPANTS

ESAIC members responding to the survey.

MAIN OUTCOME MEASURES

Respondents’ answers to 30 questions on haemodynamic monitoring and management, and fluid therapy.

RESULTS

A total of 615 fully completed surveys were analysed. Arterial catheters are usually not placed before induction of general anaesthesia (378/615; 61%) even when invasive blood pressure monitoring is planned. Mean arterial pressure (532/615; 87%) with lower intervention thresholds of 65 mmHg (183/531; 34%) or 20% below pre-operative baseline (166/531; 31%) is primarily used to guide blood pressure management. Cardiac output is most frequently measured using pulse wave analysis (548/597; 92%). However, only one-third of respondents (almost) always use cardiac output to guide haemodynamic management in high-risk patients (225/582; 39%). Dynamic cardiac preload variables are more frequently used to guide haemodynamic management than cardiac output [pulse pressure variation (almost) always: 318/589; 54%]. Standardised treatment protocols are rarely used for haemodynamic management (139/614; 23%). For fluid therapy, crystalloids are primarily used as maintenance fluids, to treat hypovolaemia, and for fluid challenges. The use of 0.9% saline and hydroxyethyl starch has declined over the last decade. The preferred methods to assess fluid responsiveness are dynamic preload variables and fluid challenges, most commonly with 250 ml of fluid (319/613; 52%).

CONCLUSION

This survey provides important information how anaesthesiologists currently measure and manage blood pressure and cardiac output, and how they guide fluid administration in patients having noncardiac surgery.
Accounting for the Potential of Overdispersion in Estimation of the Time-varying Reproduction Number
Authors: Ho Faith , Parag Kris V. , Adam Dillon C. , Lau Eric H. Y. , Cowling Benjamin J. , Tsang Tim K.
Published: February 2023

Background:

The time-varying reproduction number, R

t
, is commonly used to monitor the transmissibility of an infectious disease during an epidemic, but standard methods for estimating R

t
seldom account for the impact of overdispersion on transmission.

Methods:

We developed a negative binomial framework to estimate R

t
and a time-varying dispersion parameter (k

t
). We applied the framework to COVID-19 incidence data in Hong Kong in 2020 and 2021. We conducted a simulation study to compare the performance of our model with the conventional Poisson-based approach.

Results:

Our framework estimated an R

t
peaking around 4 (95% credible interval = 3.13, 4.30), similar to that from the Poisson approach but with a better model fit. Our approach further estimated k

t
<0.5 at the start of both waves, indicating appreciable heterogeneity in transmission. We also found that k

t
decreased sharply to around 0.4 when a large cluster of infections occurred.

Conclusions:

Our proposed approach can contribute to the estimation of R

t
and monitoring of the time-varying dispersion parameters to quantify the role of superspreading.
Approaches for Assessing Effects of Exposures on Human Fertility
Authors: Shi Min , Weinberg Clarice R.
Published: February 2023

Background:

Fecundability (conception rate per menstrual cycle) varies among non-contracepting couples. Time-to-pregnancy studies can identify exposures contributing to that variability, using three designs: incident cohort, prevalent cohort, and retrospective. Typically, researchers then apply semi-parametric, generalized linear time-to-pregnancy models to data, with either a log or a logit “link,” to estimate either a fecundability ratio (FR) or a fecundability odds ratio (FOR). The ongoing-attempt study design can also be informative.

Methods:

We consider a different generalized linear model, based on an inverse link. It models the heterogeneity as beta distributed and enables estimation of both the FR and FOR, defined based on population mean fecundabilities, without requiring constancy across attempt time. Under an ongoing-attempt design, the parameter associated with a dichotomous exposure has no clear meaning with a log or a logit link, but under the proposed approach estimates the ratio of the two average times to pregnancy. Basing simulations on conception rates from a large study, we compare the three analytic approaches for confidence interval coverage and power. We also assess the performance of a commonly used method for verifying the constancy of FOR or FR across time.

Results:

The inverse-link approach had slightly less power than the others, but its estimates maintained nominal confidence interval coverage under nonconstancy. A popular method for testing constancy across time for the FR and FOR had poor power.

Conclusions:

The inverse-link analysis offers a useful alternative to the usual methods, with estimation performance that generalizes to the ongoing-attempt design and does not require hard-to-verify constancy assumptions.
Short-term Air Pollution Levels and Blood Pressure in Older Women
Authors: Wen Tong , Liao Duanping , Wellenius Gregory A. , Whitsel Eric A. , Margolis Helene G. , Tinker Lesley F. , Stewart James D. , Kong Lan , Yanosky Jeff D.
Published: February 2023

Background:

Evidence of associations between daily variation in air pollution and blood pressure (BP) is varied and few prior longitudinal studies adjusted for calendar time.

Methods:

We studied 143,658 postmenopausal women 50 to 79 years of age from the Women’s Health Initiative (1993–2005). We estimated daily atmospheric particulate matter (PM) (in three size fractions: PM2.5, PM2.5-10, and PM10) and nitrogen dioxide (NO2) concentrations at participants’ residential addresses using validated lognormal kriging models. We used linear mixed-effects models to estimate the association between air pollution concentrations and repeated measures of systolic and diastolic BP (SBP, DBP) adjusting for confounders and calendar time.

Results:

Short-term PM2.5 and NO2 were each positively associated with DBP {0.10 mmHg [95% confidence interval (CI): 0.04, 0.15]; 0.13 mmHg (95% CI: 0.09, 0.18), respectively} for interquartile range changes in lag 3-5 day PM2.5 and NO2. Short-term NO2 was negatively associated with SBP [−0.21 mmHg (95%CI: −0.30, −0.13)]. In two-pollutant models, the NO2–DBP association was slightly stronger, but for PM2.5 was attenuated to null, compared with single-pollutant models. Associations between short-term NO2 and DBP were more pronounced among those with higher body mass index, lower neighborhood socioeconomic position, and diabetes. When long-term (annual) and lag 3-5 day PM2.5 were in the same model, associations with long-term PM2.5 were stronger than for lag 3-5 day.

Conclusions:

We observed that short-term PM2.5 and NO2 levels were associated with increased DBP, although two-pollutant model results suggest NO2 was more likely responsible for observed associations. Long-term PM2.5 effects were larger than short-term.
Smoking Inequality Trends by Disability and Income in Australia, 2001 to 2020
Authors: Disney George , Petrie Dennis , Yang Yi , Aitken Zoe , Gurrin Lyle , Kavanagh Anne
Published: February 2023

Background:

While policies to reduce smoking in many countries have been successful, disadvantaged groups (such as low-income groups) have only seen minor gains. People with disability are one such disadvantaged group and are more likely to smoke. However, evidence is limited on trends and inequalities in smoking for disabled people and on whether those also on low incomes are more likely to smoke.

Methods:

We use annual data from 2001 to 2020 of the Household Income and Labour Dynamics in Australia survey. We use a Bayesian model to estimate smoking prevalence trends and inequalities for people with disability (2020, n = 1,370) and without disability (2020, n = 6,229) across the whole population and within income tertiles. To avoid reverse causation (smoking causing disability), we focus on younger people (15–44 years).

Results:

Absolute reductions (per 100 people, [95% credible intervals]) in smoking were similar for people with (−13 [−16, −11]) and without disability (−15 [−16, −14]), with stable absolute but increasing relative inequalities. In the low-income group, absolute reductions in smoking prevalence for people with disability (−10 [−14, −6]) were smaller than in people without disability (−14 [−15, −12]), resulting in moderate evidence for increasing absolute inequalities (4 [0, 8]) and strong evidence for increasing relative inequalities. In high-income groups, disability-related absolute inequalities narrowed (−6 [−10, −3]), and relative inequalities were stable.

Conclusions:

Disabled people in Australia, especially those on low incomes, show signs of being left behind in efforts to reduce smoking.
Nationwide Bibliometric Analysis of Integrated Plastic Surgery Program Directors
Authors: Seu Michelle Y. , Esmaeeli Shooka , Wiegmann Aaron L. , Akin Jennifer , Jaraczewski Taylor , Dadrass Farnaz , Xu Thomas Q. , Dorafshar Amir H. , Shenaq Deana
Published: February 2023

Background:

Studies have linked bibliometric indices with the academic level of plastic surgeons, but this relationship has not been explored with residency program directors (PDs). As teachers of the next generation, PDs’ academic performance is an important component of residency program success. We sought to identify distinguishing characteristics of integrated plastic surgery programs, focusing on their PD bibliometric indices.

Methods:

We identified plastic surgery programs based on 2021 Doximity reputation and research output rankings, respectively, and then divided them into four quartiles (Q1–Q4). PD academic history and bibliometric indices (h-index, the number of publications, and citations) were collected through Doximity profiles and program websites: PubMed, Scopus, Google Scholar, American Society of Plastic Surgeons, and Accreditation Council for Graduate Medical Education.

Results:

Eighty-four programs were identified. There was a significant positive relationship between h-index, the number of publications, and type of research with reputation ranking (P < 0.05). After adjusting for years of experience post-training, h-index (OR = 1.24; P < 0.001) and the number of publications (OR = 1.05, P < 0.001) were significantly associated with reputation ranking. There was a statistically significant relationship between PD research fellowship completion and research output ranking (P < 0.01). After adjusting for years of experience post-training, h-index (OR = 1.05; P = 0.047) and the number of publications (OR = 1.01; P = 0.04) were significantly associated with research output ranking.

Conclusion:

Higher ranked programs tend to have PDs who have a strong record of scholarly activity, as evidenced by certain bibliometric indices.
SCI-QOL and WOUND-Q Have the Best Patient-reported Outcome Measure Design: A Systematic Literature Review of PROMs Used in Chronic Wounds
Authors: van Alphen Tert C. , ter Brugge Floor , van Haren Emiel L.W.G. , Hoogbergen Maarten M. , Rakhorst Hinne
Published: February 2023

Background:

Chronic wounds are a significant burden on healthcare systems due to high costs of care (2%–4% total healthcare cost) and a considerable burden on patient’s quality of life. Patient-reported outcome measures (PROMs) are questionnaires developed to enable patient self-assessments of their outcomes. A gap in knowledge exists because previous reviews on wound-specific PROMs did not evaluate the quality of the development. The main question is which PROM has the best quality development properties and should be used in clinical care and research.

Methods:

PubMed, Embase, and CINAHL were searched from their inception through December 2021. Studies that included patients aged 18 years or older, with chronic wounds, and who reported using a condition-specific PROM for wounds were extracted. We excluded generic PROMs, comments, guidelines, and editorial letters. The COSMIN-guidelines were used to evaluate the quality of the PROMs.

Results:

Of the 16,356 articles, a total of 251 articles describing 33 condition-specific PROMs for wounds were used. In total, 17 of 33 (52%) PROMs were developed for specific wound types, and nine of 33 (27%) PROMs were developed for any type of wound. Two of 33 (6%) PROMs were not rated because no development article was available. Only the SCI-QOL (Spinal Cord Injury-QOL) and the WOUND-Q rated “very good” in PROM design.

Conclusions:

Thirty-three condition-specific PROMs were found. Only the SCI-QOL and the WOUND-Q rated very good in PROM design. The WOUND-Q is the only condition-specific PROM, which can be used in all types of chronic wounds in any anatomic location.
Lacrimal Plasty with Dacryocystorhinostomy-Anastomosis Using Microsurgery
Authors: Yanagisawa Daisuke , Yuzuriha Shunsuke
Published: February 2023

Background:

Dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction, but it has the disadvantage of creating a raw surface, which may lead to reocclusion due to the development of postoperative granulation tissue. In this study, we developed and evaluated an ideal new surgical method, dacryocystorhinostomy-anastomosis (DCR-A), involving end-to-side anastomosis under microscopic visualization that does not result in raw surfaces.

Methods:

In DCR, the lateral aspect of the dacryocyst and the nasal mucosa are incised, and the mucosal valves are sutured together. In DCR-A, the occluded section of the dacryocyst or nasolacrimal duct was trimmed and anastomosed by circumferential suturing through a hole in the nasal mucosa. The success rate and the requirement for postoperative therapy were compared between 21 sides of DCR patients and 11 sides of nasal DCR-A patients.

Results:

DCR-A was significantly better than conventional DCR. No additional postoperative therapy was required for DCR-A.

Conclusion:

DCR-A improves symptoms of nasolacrimal duct obstruction to a greater extent than conventional DCR and does not require additional postoperative treatment.
An Evaluation of the Impact of Mental Illness on Postoperative Breast Reconstruction Revision Surgery
Authors: Saifee Jessica F. , Le Elliot L. H. , Constantine Ryan S. , Layne Jonathan E. , Kaoutzanis Christodoulos , Iorio Matthew L.
Published: February 2023

Background:

Breast cancer impacts millions of people yearly affecting various aspects of their lives—including but not limited to mental health. Patients with a known psychiatric history, specifically generalized anxiety disorder (GAD) and/or depression, have previously been shown to have an increased number of revisions after breast reconstruction.

Methods:

A commercially available database of 91 million unique patients, PearlDiver, was used to identify patients with breast cancer who underwent autologous free flap breast reconstruction. An average number of revisions were calculated from each group of patients—those with a history of anxiety and/or depression and patients without a history of anxiety and/or depression. A logistic regression was performed to determine risk factors associated with patients undergoing revision surgery.

Results:

A total of 39,683 patients with a history of breast cancer underwent autologous breast reconstruction between 2010 and 2020, of which 6308 (15.9%) patients had a history of GAD and/or depression before autologous reconstruction. A total of 13,422 (33.8%) patients received at least one revision surgery. Patients with GAD only, depression only, and concomitant GAD and depression received 1.40 revisions each with no significant differences between the control and any of the study groups (P = 0.956). Logistic regression did not find psychiatric history to be associated with patients undergoing revision surgery (OR, 0.94; 95% CI, 0.89–1.00).

Conclusion:

Patients who underwent autologous reconstruction for breast cancer demonstrated no difference in rates of secondary surgical revision, regardless of a concurrent mental health history.
Anatomical Variations of the Pectoralis Muscle and Its Importance for Breast Implant Surgery
Authors: Montemurro Paolo , Otte Maximilian , Wagner Johannes M. , Pafitanis Georgios , Cheema Mubashir , Hedén Per
Published: February 2023

Background:

In breast augmentation, during submuscular or dual plane dissection, anatomical variations of the inferior and costal origin of the pectoralis major muscle (PMM) play a key role to ensure optimal implant coverage. Especially, a short and narrow muscle or surgical release along the sternum increases the risk of irregularities and animation deformities of the implant.

Methods:

In 84 consecutive aesthetic breast augmentations intraoperatively, measurement of PMM dimensions was performed bilaterally. These PMM measurements were then correlated with the preoperative breast width, the inframammary fold, and the placement of the implant’s lower pole.

Results:

One hundred sixty-eight PMMs of 84 patients were dissected with a dual plane II or III technique for primary aesthetic breast augmentation. In 88% of breasts, the calculated implants’ lower pole was below the inferiomedial origin of the pectoralis muscle. In 10% of patients, a separation (more than 1 cm wide and 2 cm wide) in the inferior-medial origin of the PMM was noted. An asymmetry more than 0.5 cm in length between the left and right pectoralis major was noted in 36% of patients.

Conclusions:

In this series, the anatomy of the PMM demonstrates a substantial variability in width and length and a considerable asymmetry in its dimensions. These findings emphasize the importance of good access and visualization of the origin of the PMM fibers before its division.
The Average Facial Expressions: A Range of Motion Analysis for Different Sex and Age Groups
Authors: Schutte Hilde , Muradin Marvick S. M. , Bielevelt Freek , Seubring Karlien , Bleys Ronald L. A. W. , Rosenberg Antoine J. W. P.
Published: February 2023

Background:

Facial expressions are ubiquitous in communication. Therefore, assessment of mimic function is essential in facial surgery, but no reference standards are currently available. This prospective study aims to create reference values of three-dimensional landmark displacement for different sex and age groups.

Methods:

Three-dimensional photographs were taken from healthy subjects in rest, maximum closed smile, and pouting. Displacement for both exercises of perioral landmarks was analyzed with MATLAB as absolute displacement and as the ratio of mouth width. Additionally, displacement in three planes was analyzed for each landmark. Averages were calculated for both genders in four age groups: 4–8, 8–12, 12–16, and >16 years.

Results:

In total, 328 subjects were included. Oral landmarks predominantly moved forward and backward for both exercises. Nasal landmarks predominantly moved vertically. Growing up, oral landmark displacement decreased for smiling, whereas nasal landmark displacement increased. For pouting, oral landmark displacement increased while growing up, whereas nasal landmark displacement decreased.

Conclusions:

The present study creates reference values for movement of perioral structures for different sex and age groups, for two facial expressions. These data are of great value for the assessment of mimic function and give insight into the development of facial animation over time.
Five-year Follow-up Outcome of Total Omental Lymph Node Flap Transfer in Primary Lymphedema Patient
Authors: Yodrabum Nutcha , Poungjantaradej Nattanit
Published: February 2023

Lymphedemas are caused by the accumulation of protein-rich fluid in the interstitial space, resulting from lymphatic system obstruction. In recent years, omentum flap transfer has gained popularity as a treatment for lymphedema due to its immunogenic and lymphangiogenic properties, which aid in reducing infection rate and volume. Moreover, omental flaps have angiogenesis capabilities, which can aid in successful chronic wound covering. Using a flow-through procedure after omental flap transfer can help reduce complications including venous congestion and steal phenomenon at the recipient site. We present a long-term follow-up of a case of primary lymphedema treated with omental flap transfer with flow-through figuration, demonstrating a gradual decrease in volume, reduced infection rate, and chronic wound coverage. This case report illustrates intriguing postoperative compartment effect and vascular concerns.
Aesthetic Characteristics of the Ideal Female Breast
Authors: Bekisz Jonathan M. , Boyd Carter J. , Salibian Ara A. , Choi Mihye , Karp Nolan S.
Published: February 2023

Background:

The female breast is a subject of significant focus within plastic surgery. Little work to date has examined public perceptions of attractiveness with respect to breast anatomy and morphology. This study provides a comprehensive assessment of anatomic and aesthetic breast characteristics valued by the general population.

Methods:

A single-institution retrospective review was conducted of patients presenting for aesthetic or reconstructive breast surgery between 2009 and 2019. A cohort of 25 patients were included in a nationwide survey designed to assess subjective impressions of overall “breast attractiveness.” Survey responses were assessed, and the five patients with the highest mean scores were identified. An in-depth analysis of this subgroup was performed, evaluating anatomic metrics on both two-dimensional photographs and three-dimensional imaging. Statistical analysis examined correlations between objective breast characteristics and subjective perceptions of “attractiveness.”

Results:

There were 1021 survey responses. Across the entire patient cohort, the mean age was 47.4 years and mean BMI was 24.9 kg/m2. On a five-point Likert scale, the mean “breast attractiveness” score for the highest-scoring subgroup patients (n = 5) was 3.1 ± 0.1. Within this group, all patients had minimal ptosis and a projected contour. Average breast size was moderate, with mean volume of 299.4 ± 115.8 cm3.

Conclusions:

This study reverse engineers the aesthetically appealing female breast, beginning with overall impressions of attractiveness and subsequently analyzing the influence of objective anatomic parameters on subjective perceptions. In surveying a large and diverse population, moderately sized, projected breasts with upper pole fullness were found to be associated with increased “attractiveness” scores.
Changes in Personal Protective Equipment Practices of Craniofacial Surgeons during COVID-19: A Cross-sectional Study
Authors: Lee James C. , Martin Alexander , Ozaki Wayne
Published: February 2023

Background:

Surgeons who operate around nasal or oral airways are at particularly high risk for transmission of the severe acute respiratory syndrome coronavirus 2. This multipart study explores the changes in craniofacial surgeon preferences and practices for personal protective equipment (PPE) over the course of a worldwide pandemic.

Methods:

Two identical electronic survey studies, one in 2020 and one in 2022, were conducted on the use of PPE before, during, and after the pandemic among active craniomaxillofacial surgeons. Statistical changes in behaviors and preferences and differences across time points and demographic groups were evaluated.

Results:

The initial study included responses from 48 surgeons, and the follow-up study consisted of 36 responses. Although only 4.3% of surgeons wore N95 masks or powered air purifying respirator for craniomaxillofacial operations before the pandemic, 91.5% wore these measures during the early pandemic (P < 0.001). However, this fell to 74.3% 2 years later. Similarly, more than 95% of surgeons wore a mask in clinic during the pandemic at both time points compared to only 40.3% before the pandemic (P < 0.001). In 2020, 31.9% of surgeons planned to continue using N95 masks or powered air purifying respirator for craniofacial cases after the pandemic was over, but that fell to 11.4% in the follow-up study.

Conclusions:

Craniofacial surgeon practices have shifted significantly toward more protective PPE over the course of the coronavirus disease 2019 pandemic. However, this effect was dampened over the course of a protracted pandemic. Despite this, our studies indicate a long-term shift in surgeon preference that is likely to persist after the pandemic is over.
Transcription factor AP-2 gamma/Krüppel-like factor 10 axis is involved in miR-3656-related dysfunction of endothelial cells in hypertension
Authors: Ren Yaxuan , Shi Jikang , Liu Sainan , Zhu Wenfei , Shao Aiyu , Qiao Yichun , Li Yong , Liu Yunkai , Cheng Yi , Liu Yawen
Published: February 2023

Background:

Dysfunction of endothelial cells links to microvascular rarefaction, reflecting the pathogenesis of hypertension. Our previous studies found that miR-3656 reduces nitric oxide generation and von Willebrand factor (vWF) cleavage, thereby retarding blood flow and potentially increasing blood pressure. In this paper, we investigated mechanism of transcription regulation contributing to miR-3656-damaged endothelial cells in hypertension.

Methods:

The effects of miR-3656 on function of endothelial cells were analyzed on the basis of proliferation, migration, tube formation, and apoptosis. The mRNA level and protein level of genes were examined using quantitative real-time polymerase chain reaction (qRT-PCR) and western blot. Dual-luciferase reporter assay was performed to confirm the binding between miR-3656 and 3’ untranslated region (UTR) of transcription factor AP-2 gamma (TFAP2C). The binding between TFAP2C and the promoter region of Krüppel-like factor 10 (KLF10) was confirmed by chromatin immunoprecipitation-qPCR assay.

Results:

miR-3656 impaired the cell proliferation, migration, tube formation, and apoptosis of endothelial cells. miR-3656 inhibited the expression of TFAP2C by directly targeting 3’UTR of TFAP2C; moreover, miR-3656-induced injury of endothelial cells was rescued by TFAP2C overexpression. Furthermore, downregulated TFAP2C decreased KLF10 expression by binding to KLF10 promoter region, and upregulated KLF10 reversed the effects of silencing TFAP2C on endothelial cells. These inhibitory processes led to interference of miR-3656 to KLF10-promoted function of endothelial cells.

Conclusion:

TFAP2C/KLF10 axis is involved in miR-3656-related dysfunction of endothelial cells in hypertension. The 3’UTR of TFAP2C and KLF10 promoter region are the hubs of the TFAP2C/KLF10 axis.
MAP2K1 Mutation in Zebrafish Endothelial Cells Causes Arteriovenous Shunts Preventable by MEK Inhibition
Authors: Sudduth Christopher L. , Blum Nicola , Smits Patrick J. , Cheng Yu Sheng , Vivero Matthew P. , Harris Matthew P. , Lawson Nathan D. , Greene Arin K.
Published: February 2023

Objectives:

Arteriovenous malformation (AVM) is a congenital lesion with a nidus of irregular blood vessels connecting arteries to veins instead of a normal capillary bed. Somatic MAP2K1 activating mutations in endothelial cells cause extracranial AVM. The purpose of this study was to create a MAP2K1 AVM animal model using zebrafish and to test pharmacotherapy.

Methods:

Single-cell casper Tg(gata1a:DsRed) zebrafish embryos were injected with plasmid DNA (control [pTol2-Fli:GFP]; mutant [pTol2-Fli:GFP-kdrl:MAP2K1K57N]) and Tol2 transposase mRNA to mosaically express activated MAP2K1 in endothelial cells. Two cohorts of fish were examined: group 1 (n = 161) established phenotypes and group 2 (n = 126) tested MEK inhibition. Blood flow was visualized using DsRed fluorescence of erythrocytes. Embryos were imaged 72 hours postfertilization.

Results:

Group 1 exhibited abnormal arteriovenous shunts in 58 of 96 (60%) embryos expressing MAP2K1K57N in endothelial cells. Shunts occurred between the proximal aorta and common cardinal vein (n = 39; 67%) or between the major artery and vein within the trunk or tail (n = 19; 33%). Shunts were not present in control zebrafish (n = 65). MEK inhibition reduced shunt frequency caused by endothelial MAP2K1K57N expression in group 2 from 84% to 55% (0.2 μM) or 25% (0.4 μM) (P = .006).

Conclusions:

Zebrafish endothelial cells expressing mutant MAP2K1 form abnormal arteriovenous shunts supporting the causality of the variant in human AVMs. MEK inhibition reduced shunt formation validating its potential efficacy as a pharmacotherapeutic option for AVM. This zebrafish model may be used for further study of the etiopathogenesis of AVM as well as to test drugs.