bluuebunny/crossref_metadata_2025 huggingface dataset:
Nipple-Sparing Mastectomy and Immediate Implant-Based Breast Reconstruction: A Propensity Score Matched Analysis of Satisfaction and Health Related Quality of Life
Authors: Kokosis George , Stern Carrie S. , Shamsunder Meghana G. , Polanco Thais O. , Patel Vaidehi M. , Slutsky Hanna , Morrow Monica , Moo Tracy-Ann , Sacchini Virgilio , Coriddi Michelle , Cordeiro Peter G. , Matros Evan , Pusic Andrea , Disa Joseph J. , Mehrara Babak J. , Nelson Jonas A.
Published: September 2022

Background:

Although it is intuitive that nipple-sparing mastectomy (NSM) in selected patients would result in excellent cosmetic outcomes and high patient satisfaction, studies of clinical outcomes and health-related quality of life (HRQOL) are limited and show mixed results. This study aimed to use a propensity score matching analysis to compare satisfaction and HRQOL outcomes in patients who underwent implant-based reconstruction following bilateral NSM or skin-sparing mastectomy (SSM).

Methods:

A propensity score matching analysis (1:1 matching, no replacement) was performed comparing patients undergoing NSM or SSM with immediate bilateral implant-based breast reconstruction. Patients with a history of any radiation therapy were excluded. Matched covariates included age, BMI, race, smoking history, neoadjuvant chemotherapy, bra size, and history of psychiatric diagnosis. Outcomes of interest included BREAST-Q scores and complications.

Results:

We examined 1371 patients for matching and included 460 patients (230 NSM and 230 SSM) in the final analyses. We found no significant differences in baseline, cancer, and surgical characteristics between matched NSM and SSM patients, who also had similar profiles for surgical complications. Interestingly, we found that postoperative satisfaction-with-breast scores and all other HRQOL domains were stable over a 3-year period and did not significantly differ between the two groups.

Conclusion:

Compared with SSM, bilateral NSM did not improve patient-reported or clinical outcomes when combined with immediate implant-based reconstruction. The impact that NSM may have on breast aesthetics and the ability of the BREAST-Q to gauge an aesthetic result following NSM warrant further investigation.
Comparing Breast Sensation between Alloplastic and Autologous Breast Reconstruction Patients using the BREAST-Q Sensation Module
Authors: Voineskos Sophocles H. , Olaiya Oluwatobi R. , Tsangaris Elena , Kaur Manraj , Klassen Anne F. , Pusic Andrea L.
Published: September 2022

Background:

Sensory recovery of the breast is a compelling frontier in comprehensive post-mastectomy breast reconstruction. This study uses the BREAST-Q Sensation Module to evaluate the differences in women who underwent an alloplastic versus autologous breast reconstruction.

Methods:

Women with a history of breast cancer and post-mastectomy breast reconstruction were recruited through the Love Research Army, United States. Participants completed the BREAST-Q Sensation Module (3 scales: Breast Symptoms, Breast Sensation, Quality of Life Impact). Descriptive statistics and multiple linear regression analyses were used to compare outcomes between women undergoing alloplastic or autologous breast reconstruction.

Results:

Of 1204 respondents, 933 were included for analysis, 620 (66.5%) underwent alloplastic reconstruction and 313 (33.5%) underwent autologous reconstruction. The average age and BMI were 59.2 years (±10.1) and 26 (±5) respectively. Autologous reconstruction patients scored an average of 6.1 points (95% CI 3.9-8.4, p<0.001) and 5.3 points (95% CI 2.5-8.1, p=0.001) higher on the Breast Symptoms and Quality of Life Impact scales, respectively. No difference (0.0 points, 95% CI -2.9-3.0, p=0.75) was observed for the Breast Sensation scale. Increased time since reconstruction had a positive impact on Breast Symptoms scores. Radiotherapy negatively affected scores on both Breast Symptoms and Quality of Life Impact scales.

Conclusions:

Autologous breast reconstruction may be associated with fewer abnormal breast sensations and better sensation-related quality of life in comparison to alloplastic reconstruction. This information can be incorporated during preoperative patient counseling when discussing reconstructive options.
Evaluation of Brain Tumors Using Amide Proton Transfer Imaging: A Comparison of Normal Amide Proton Transfer Signal With Abnormal Amide Proton Transfer Signal Value
Authors: Sugawara Kazuaki , Miyati Tosiaki , Wakabayashi Hikaru , Yoshimaru Daisuke , Komatsu Shuhei , Hagiwara Kazuchika , Saigusa Kuniyasu , Ohno Naoki
Published: September 2022

Objective

The aim of the study was to evaluate the relationship of amide proton transfer (APT) signal characteristics in brain tumors and uninvolved brain tissue for patients with glioblastoma and those with brain metastases.

Methods

Using the mDIXON 3D-APT sequence of the fast spin echo method, an APT image was obtained. The mean APT signal values of tumor core, peritumor edema, ipsilateral normal-appearing white matter (INAWM), and contralateral normal white matter (CNAWM) were obtained and compared between glioblastoma and brain metastases. Receiver operating characteristic curves were used to evaluate parameters for distinguishing between glioblastoma and brain metastases. In addition, the difference and change rate in APT signal values between tumor core and peritumoral edema (PE) and CNAWM were evaluated, respectively.

Results

The APT signal values of glioblastoma were the highest in tumor core (3.41% ± 0.49%), followed by PE (2.24% ± 0.29%), INAWM (1.35% ± 0.15%), and CNAWM (1.26% ± 0.12%, P < 0.001). The APT signal value of brain metastases was the highest in tumor core (2.74% ± 0.34%), followed by PE (1.86% ± 0.35%), INAWM (1.17% ± 0.13%), and CNAWM (1.2% ± 0.09%, P < 0.01). The APT change rate (between PE and CNAWM) was not significantly different at 78% and 56% for glioblastoma and brain metastases, respectively (P > 0.05).

Conclusions

Performing APT imaging under the same parameters used in this study may aid in the identification of brain tumors.
Inferiorly Directed Posterior Cranial Vault Distraction for Treatment of Chiari Malformations
Authors: Lu Stephen M. , Hazkour Nissim , Atamian Elisa K. , Bradley James , Bastidas Nicholas
Published: September 2022

Objective:

The authors present a case series of patients with Chiari I malformations treated with distraction osteogenesis of the posterior cranial vault, utilizing a vertical distraction vector for appropriate cranial vault expansion while mitigating the risks of scaphocephaly and cerebellar ptosis.

Patients and Methods:

Patients with syndromic and nonsyndromic Chiari I malformations treated with vertical-vector distraction osteogenesis of the posterior cranial vault were identified from 2008 to 2014. Demographics, preoperative and postoperative clinical symptoms, and perioperative details were assessed. Long-term esthetic outcomes, complications, and symptomatic improvement were evaluated in conjunction with neurosurgery.

Results:

Nine patients were identified. Five had known syndromes, 2 likely had unidentified syndromes, and 2 were nonsyndromic. Seven had prior Chiari-related surgeries. Most presented with hydrocephalus, motor symptoms, and developmental delay. Operatively, 2 to 3 internal distraction fixators were applied such that the vector of distraction was along a cephalad-caudad axis. Devices were activated on postoperative day 5 and distracted 1 mm per day. Three postoperative complications were found within the first 3 months which included a dislodged distraction arm, a device extrusion, and a local cellulitis. No complications affected the clinical outcome. Radiographic follow-up showed good bone formation, decompression of the posterior fossa, improved cerebrospinal fluid flow, and no cerebellar ptosis. Neurological surveillance showed improvement in intracranial pressure, hydrocephalus, motor symptoms, and behavioral problems.

Conclusion:

The authors have presented 9 patients with Chiari I malformations treated with distraction osteogenesis, along with a novel technique to safely and effectively expand the posterior fossa while minimizing the risk of cerebellar ptosis.

Level of Evidence:

Level II (prognostic/risk studies).
Accuracy of Maxillary Positioning During Orthognathic Surgery: A Comparison of Web-based 3-Dimensional Virtual Surgical Planning and Actual Outcomes
Authors: Nam In-Hye , Ma Yoon-Hee , Jaiswal M. Shriya , Hwang Jong-Min , Hwang Dae-Seok
Published: September 2022

Purpose:

To determine the accuracy of planned maxillary positioning by virtual surgery by comparing planned and actual postoperative outcomes.

Materials and Methods:

Twenty patients who underwent 2-jaw orthognathic surgery performed by a single surgeon from May 2017 to December 2020 were the subjects of this retrospective study. The coordinates of reference points in horizontal, sagittal, and coronal planes as determined by virtual surgery were compared with those of actual surgical outcomes. The reference points used were as follows: #16 mesiobuccal cusp tip (#16), #26 mesiobuccal cusp tip (#26), and #11 mesial tip (U1); anterior nasal spine; and posterior nasal spine. Three-dimensional linear distances between the reference point on which virtual surgery was performed and the reference point after the actual operation was calculated.

Results:

Of the 20 patients, there were 11 males and 9 females of average age 20.65±2.41 years. Three-dimensional printed wafers had high accuracy with a maximum difference of 0.3 mm. No significant difference was observed in horizontal or coronal planes for any reference point, but a significant difference was observed in the sagittal plane. However, positional differences between planned and actual reference points were all <1 mm.

Conclusions:

Virtual surgical planning and 3-dimensional printed wafer achieved excellent maxillary positioning accuracies after orthognathic surgery.
The Feasibility of Computer Simulations and 3-Dimensional–Printed Resection Guides for Skin Cancer Resection
Authors: Park Hojin , Jeong Woo Shik , Ock Junhyeok , Lee Sangwook , Kim Namkug , Choi Jong Woo
Published: September 2022

The surgical resection margin in skin cancer is traditionally determined by the lesion’s surface boundary without 3-dimensional information. Computed tomography (CT) can offer additional information, such as tumor invasion and the exact cancer extent. This study aimed to demonstrate the clinical application of and to evaluate the safety and accuracy of resection guides for skin cancer treatment. This prospective randomized comparison of skin cancer resection with (guide group; n=34) or without (control group; n=28) resection guide use was conducted between February 2020 and November 2021. Patients with squamous cell carcinoma or basal cell carcinoma were included. In the guide group, based on CT images, the surgical margin was defined, and a 3-dimensional–printed resection guide was fabricated. The intraoperative frozen biopsy results and distance from tumor boundary to resection margin were measured. The margin involvement rates were 8.8% and 17.9% in the guide and control groups, respectively. The margin involvement rate was nonsignificantly higher in the control group as compared with the guide group (P=0.393). The margin distances of squamous cell carcinoma were 2.3±0.8 and 3.4±1.6 mm (P=0.01) and those of basal cell carcinoma were 2.8±1.0 and 4.7±3.2 mm in the guide and control groups, respectively (P=0.015). Margin distance was significantly lower in the guide group than the control group. The resection guide demonstrated similar safety to traditional surgical excision but enabled the minimal removal of normal tissue by precisely estimating the tumor border on CT scans.
The Lived Experience of Jordanian Persons With a Stoma
Authors: Al-Husban Raya Yousef , Abu Shosha Ghada
Published: September 2022

Individuals may live with an intestinal stoma either temporarily or for the rest of their lives. The purpose of this study was to understand the lived experience of Jordanian persons living with a stoma. Qualitative design was employed via semistructured interviews with 22 Muslim participants who had an intestinal stoma. Thematic analysis of the transcripts resulted in 3 main themes. The first core theme was stoma burden, which represented difficulties and challenges resulting from the creation of a stoma. This theme was divided into 4 subthemes: physical, self-care, social, and psychological burdens. The second theme was the adaptation to a stoma, whereas the third theme was suggestions for healthcare providers to decrease stoma burden. Conclusively, these themes conveyed that the presence of supportive family members and qualified healthcare providers can decrease the burden of a stoma. Generally, persons with a stoma (ostomates) experienced stoma-related physical, social, psychological, and financial burdens. Therefore, ostomates were in need of training, psychosocial therapy, and more follow-ups to prevent and treat stoma complications and adapt to living easily with the stoma.
Impact of Repeat Extracorporeal Life Support on Mortality and Short-term In-hospital Morbidities in Neonates With Congenital Diaphragmatic Hernia
Authors: Danzer Enrico , Harting Matthew T. , Dahlen Alex , Mesas Burgos Carmen , Frenckner Björn , Lally Kevin P. , Ebanks Ashley H. , van Meurs Krisa P. ,   for the Congenital Diaphragmatic Hernia Study Group
Published: September 2022

Objective:

To evaluate the impact of repeat extracorporeal life support (ECLS) on survival and in-hospital outcomes in the congenital diaphragmatic hernia (CDH) neonates.

Background:

Despite the widespread use of ECLS, investigations on multiple ECLS courses for CDH neonates are limited.

Methods:

This is a retrospective cohort study of all ECLS-eligible CDH neonates enrolled in the Congenital Diaphragmatic Hernia Study Group registry between 1995 and 2019. CDH infants with estimated gestational age at birth <32 weeks and a birth weight <1.8 kg and/or with major cardiac or chromosomal anomalies were excluded. The primary outcomes were survival and morbidities during the index hospitalization.

Results:

Of 10,089 ECLS-eligible CDH infants, 3025 (30%) received 1 ECLS course, and 160 (1.6%) received multiple courses. The overall survival rate for patients who underwent no ECLS, 1 ECLS course, and multicourse ECLS were 86.9±0.8%, 53.8±1.8%, and 43.1±7.7%, respectively. Overall ECLS survival rate is increased by 5.1±4.6% (P=0.03) for CDH neonates treated at centers that conduct repeat ECLS compared with those that do not offer repeat ECLS. This suggests that there would be an overall survival benefit from increased use of multiple ECLS courses. Infants who did not receive ECLS support had the lowest morbidity risk, while survivors of multicourse ECLS had the highest rates of morbidities during the index hospitalization.

Conclusions:

Although survival is lower for repeat ECLS, the use of multiple ECLS courses has the potential to increase overall survival for CDH neonates. Increased use of repeat ECLS might be associated with improved survival. The potential survival advantage of repeat ECLS must be balanced against the increased risk of morbidities during the index hospitalization.
Outcomes after Child Physical Abuse and Association with Community-Level Social Determinants of Health
Authors: Ruffolo Luis I , Gaba Harshita , Dale Benjamin S , Sandler Mardy , Vella Michael A , Stassen Nicole A , Wilson Nicole A , Wakeman Derek S
Published: September 2022

BACKGROUND:

Child physical abuse is a significant cause of pediatric injury and death. Previous studies have described disparities in outcomes for physically abused children according to insurance status. We hypothesized that children treated for physical abuse would be more likely to live in neighborhoods with increased socioeconomic deprivation.

STUDY DESIGN:

We performed a retrospective review of children who were admitted with suspected physical abuse from 2011 to 2021. Home addresses at the time of admission were used to assign an Area Deprivation Index (ADI) of the neighborhood. Clinicopathologic and outcome variables were compared between children from neighborhoods in the top 10th and bottom 90th national neighborhood ADI percentile. Univariate and multivariate logistic models were constructed.

RESULTS:

One hundred eighty-four children were included for analysis. Children from the top 10th (more impoverished) ADI percentile presented with more severe injuries, had higher area injury scores in the abdomen and extremities, and required admission to the intensive care unit more often, compared with children from the bottom 90th ADI percentile (all p Values <0.05). Children from high ADI neighborhoods were more likely to be discharged to a different caretaker than children from low ADI neighborhoods (71% caretaker change vs 49% caretaker change, p = 0.005). Univariate and multivariate logistic regression demonstrated statistically significant association between the ADI score and the need for caretaker change at the time of discharge (p = 0.004).

CONCLUSIONS:

Community-level social determinants of health are closely associated with child physical abuse. Child abuse reduction strategies might consider increased support for families with fewer resources and social support systems.
Alvimopan for Enhanced Gastrointestinal Recovery after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Randomized Controlled Trial
Authors: Baumgartner Joel M , Chen Ruifeng , Messer Karen , Veerapong Jula , Kelly Kaitlyn J , Ramamoorthy Sonia , Lowy Andrew M
Published: September 2022

BACKGROUND:

Surgical management of peritoneal metastases with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with prolonged length of stay and time to return of bowel function. Alvimopan is a peripherally acting opioid antagonist that reduces postoperative ileus. We sought to determine the efficacy of alvimopan on return of bowel function in patients undergoing CRS-HIPEC.

METHODS:

A double-blind, randomized, placebo-controlled, single-institution, IRB-approved trial was conducted in patients undergoing CRS-HIPEC from March 2018 to April 2020. Patients received alvimopan or placebo preoperatively and twice daily postoperatively for 7 days. The primary endpoint (GI-2) was the time of tolerance of solid food and first bowel movement (BM). Secondary endpoints were the proportion of patients with prolonged ileus, time to first flatus, first BM, tolerance of solid food, discharge, and adverse events (AEs).

RESULTS:

Sixty-two patients met eligibility criteria and received placebo (n = 32) or alvimopan (n = 30), and were included in the analysis. The median time to GI-2 was 152 hours (95% CI 134, 204) in the placebo arm versus 117 hours (95% CI 102, 158) in the alvimopan arm (p = 0.04). The time to BM was 89 hours (95% CI 71, 114) in the placebo arm vs 67 hours (95% CI 62, 89) in the alvimopan arm (p = 0.02). There were no significant differences in AE rates, proportion of patients with prolonged ileus, or other secondary endpoints.

CONCLUSION:

Perioperative alvimopan was well tolerated and accelerated bowel function recovery in patients undergoing CRS-HIPEC.
Do General Surgery Residents Begin Specializing Before Fellowship? A Multi-Institutional Study from the US ROPE Consortium
Authors: Woeste Matthew R , Salyer Christen E , Hammaker Austin C , Dodwad Shah-Jahan , Foote Darci C , Nahmias Jeffry T , Callahan Zachary M , Quillin Ralph C , Cortez Alexander R ,   for the US Resident OPerative Experience (ROPE) Consortium
Published: September 2022

BACKGROUND:

Single-center data suggest that general surgery residents perform more cases related to their future fellowship compared with their peers. This study aimed to determine whether this experience was true for residents across multiple programs.

STUDY DESIGN:

Data from graduates of 18 Accreditation Council for Graduate Medical Education (ACGME)–accredited general surgery residency programs in the US Resident OPerative Experience (ROPE) Consortium were analyzed. Residents were categorized as entering 1 of 12 fellowships or entering directly into general surgery practice. Case log operative domains were mapped to each fellowship, and analyses were performed between groups.

RESULTS:

Of 1,192 graduated general surgery residents, 955 (80%) pursued fellowship training whereas 235 (20%) went directly into general surgery practice. The top 3 fellowships pursued were trauma/surgical critical care (18%), vascular surgery (13%), and minimally invasive surgery (12%). Residents entering minimally invasive surgery performed the most total cases, whereas residents pursuing breast performed the least (1,209 [1,056–1,325] vs 1,091 [1,006–1,171], p < 0.01). For each fellowship type, graduates completed more total fellowship-specific cases in their future specialty compared with their peers (all p < 0.05). This association was observed for all 12 fellowships at the surgeon chief level (all p < 0.05) and for 10 of 12 fellowships at the surgeon junior level (all p < 0.05).

CONCLUSIONS:

General surgery residents perform more cases related to their future specialty choice compared with their peers. These data suggest that the specialization process begins during residency. This tendency among residents should be considered as general surgery residency undergoes structural redesign in the future.
Impact of Surgical Delay on Tumor Upstaging and Outcomes in Estrogen Receptor–Negative Ductal Carcinoma in Situ Patients
Authors: Deliere Amanda E , Kuchta Kristine M , Pesce Catherine E , Kopkash Katherine A , Yao Katharine A
Published: September 2022

BACKGROUND:

The delay of elective surgeries by the coronavirus 2019 (COVID-19) pandemic prompted concern among surgeons to delay estrogen receptor (ER)-negative ductal carcinoma in situ (DCIS) for fear of missing an ER-negative invasive cancer and compromising survival of patients.

STUDY DESIGN:

Female patients ≥40 years old diagnosed with ER-negative DCIS from 2004 to 2017 were examined from the National Cancer Database. Multivariable logistic regression, adjusting for patient and tumor factors, was used to determine factors associated with tumor upstage. Multivariable Cox proportional hazards modeling was used to determine if surgical delay impacted overall survival of ER-negative DCIS patients that were upstaged to invasive disease.

RESULTS:

There were 219,731 patients with DCIS of which 24,338 (11.1%) had tumor upstage. Of these patients, 5,675 (16.2%) of ER-negative and 18,663 (10.1%) of ER-positive DCIS patients were upstaged (p ≤ 0.001). From 2004 to 2017, ER-negative DCIS upstage rates increased from 12.9% to 18.9%. Independent factors associated with tumor upstage were younger age (odds ratio [OR] 0.75 [95% CI 0.69 to 0.81]) and Black race (OR 1.34 [95% CI 1.22 to 1.46]). Compared with patients with ≤30 days between biopsy and surgery, patients with a 31- to 60-day interval (OR 1.13 [95% CI 1.05 to 1.20]) and a >60-day interval (OR 1.12 [95% CI 1.02 to 1.23]) had an increased rate of tumor upstage. Among ER-negative DCIS patients whose tumors were upstaged to invasive disease, Cox proportional hazard regression modeling showed no association between the number of days between biopsy and surgery and overall survival.

CONCLUSIONS:

Delays in surgery were associated with higher tumor upstage rates but not with worse overall survival.
Outcomes of Vitreoretinal Complications Requiring Operation after Abusive Head Trauma
Authors: Islam Yasmin Florence Khodeja , Khurshid Syed Gibran
Published: September 2022

Abusive head trauma (AHT) can result in retinal complications that require operative intervention. There is no review evaluating the outcomes of vitreoretinal operations in aggregate or on the timing of vitreoretinal intervention. This systematic review aims to fill this knowledge gap. A literature search between 2011 and 2021 was performed with PubMed, Web of Science, and Embase. Included articles described outcomes of vitreoretinal operations after AHT either in aggregate or as individual cases. Nine articles met criteria; the direct outcomes of operations were collected to minimize bias. Visual acuity (VA) and anatomic outcomes were compared between patients who received operations within 4 weeks of diagnosis and those who had delayed intervention. This review found that vitreoretinal surgery after AHT has excellent anatomical success rates, but there is a trend toward improved VA outcomes when performed within 4 weeks of diagnosis. This highlights the importance of urgent referral to a pediatric retina surgeon for non-clearing vitreous hemorrhage, retinal detachment, and retinal tears after AHT.
Retrospective Evaluation of Short-Term Outcomes of an Enhanced Recovery Protocol for Patients Undergoing Complex Abdominal Wall Reconstruction
Authors: Wiener Jameson GD , Bellido Dasiel , Smolinsky Todd , Boudreau Sellers , Wood Lauren , Corey Britney , Chu Daniel I , Parmar Abhishek D
Published: September 2022

BACKGROUND:

Enhanced recovery protocols (ERPs) have the potential to streamline care and improve short-term outcomes for surgical patients. However, for patients undergoing modern iterations of complex abdominal wall reconstruction (AWR), little literature exists on the effectiveness of these protocols.

STUDY DESIGN:

In this retrospective study we reviewed our institutional experience with complex AWR throughout a 2-year period with 1 year immediately before and 1 year after implementation of our ERP. Patients undergoing primarily minimally invasive complex AWR who were compliant with 11 elements of our ERP were compared with patients who received surgery before implementation of the protocol or did not meet these criteria. Baseline patient characteristics and patient outcomes including hospital length of stay, narcotic usage, and readmission were compared across groups. Multivariable regression models were used to estimate the associations of our ERP protocol with outcomes adjusting for surgical approach.

RESULTS:

Median length of stay for the overall cohort (n = 132) was 3 days (interquartile range 1 to 4). Morbidity and mortality rates were 22.6% and 0.7%, respectively. ERP patients were less likely to have a complication (ERP compliant 8.7% [n = 46] vs non-ERP 30.2% [n = 86], p < 0.01), had a shorter median postoperative length of stay (median 1 vs 3 days, p < 0.01), and received fewer morphine equivalents (median 30.8 vs 45 mg, p < 0.01). Readmission rate for ERP patients did not differ significantly vs non-ERP patients (6.5% vs 11.8%, p = 0.34).

CONCLUSIONS:

Use of ERPs in patients undergoing complex AWR may provide benefits for both patients and hospitals.
Core Entrustable Professional Activities for Entering Residency: A National Survey of Graduating Medical Students’ Self-Assessed Skills by Specialty
Authors: Grbic Douglas , Gielissen Katherine A , Obeso Vivian , Amiel Jonathan M , Jayas Amy , Andriole Dorothy A
Published: September 2022

BACKGROUND:

The Association of American Medical Colleges described 13 Core Entrustable Professional Activities (EPAs) that graduating students should be prepared to perform under indirect supervision on day one of residency. Surgery program directors recently recommended entrustability in these Core EPAs for incoming surgery interns. We sought to determine if graduating students intending to enter surgery agreed they had the skills to perform these Core EPAs.

STUDY DESIGN:

Using de-identified, individual-level data collected from and about 2019 Association of American Medical Colleges Graduation Questionnaire respondents, latent profile analysis was used to group respondents based on their self-assessed Core EPAs skills’ response patterns. Associations between intended specialty, among other variables, and latent profile analysis group were assessed using independent sample t-tests and chi-square tests and multivariable logistic regression methods.

RESULTS:

Among 12,308 Graduation Questionnaire respondents, latent profile analysis identified 2 respondent groups: 7,863 (63.9%) in a high skill acquisition agreement (SAA) group and 4,445 (36.1%) in a moderate SAA group. Specialty was associated with SAA group membership (p < 0.001), with general surgery, orthopaedic surgery, and emergency medicine respondents (among others) overrepresented in the high SAA group. In the multivariable logistic regression models, each of anesthesiology, ophthalmology, pediatrics, psychiatry, and radiology (vs general surgery) specialty intention was associated with a lower odds of high SAA group membership.

CONCLUSION:

Graduating students’ self-assessed Core EPAs skills were higher for those intending general surgery than for those intending some other specialties. Our findings can inform collaborative efforts to ensure graduates’ acquisition of the skills expected of them at the start of residency.
Supervised Exercise Therapy and Adjuvant Chemotherapy for Pancreatic Cancer: A Prospective, Single-Arm, Phase II Open-Label, Nonrandomized, Historically Controlled Study
Authors: Okada Ken-ichi , Kouda Ken , Kawai Manabu , Hirono Seiko , Miyazawa Motoki , Kitahata Yuji , Kawanishi Makoto , Natsume Yuki , Wan Ke , Yamaue Hiroki
Published: September 2022

BACKGROUND:

Improvement of the completion rate of postoperative adjuvant chemotherapy is a key to obtaining favorable prognosis in patients who undergo macroscopically curative pancreatectomy for pancreatic ductal adenocarcinoma.

STUDY DESIGN:

This study is a prospective single-center phase II trial that aimed to examine whether a supervised exercise therapy for pancreatic ductal adenocarcinoma improved the completion rate of S-1 adjuvant chemotherapy in the development of a tolerable and effective exercise plan for patients undergoing adjuvant therapy.

RESULTS:

Forty-three patients were included in the study. The completion rate of S-1 therapy, the primary endpoint, was 93%, which exceeded the threshold completion rate of 53% (p < 0.001). As secondary endpoints, the relative dose intensity of S-1 was 100.0 [95.9 to 100.0] (median [interquartile range]), the median recurrence-free survival was 20.4 months, and the median overall survival was not reached, confirming the safety of the protocol treatment. Regarding frailty status, there was significant decrease in the Kihon checklist score (p = 0.002) and significant increase in G8 questionnaire score (p < 0.001), indicating that exercise therapy reduced frailty. There were no incidences of serious adverse events except for 1 case of grade 3 febrile neutropenia. The differences between before/after therapy (between 6 months/baseline) of mean muscle mass, mean body fat mass, mean body fat percentage, and mean controlling nutrition status score were 1.52 (p < 0.001), –1.18 (p = 0.007), –2.47 (p < 0.001), and –0.59 (p = 0.006), respectively.

CONCLUSIONS:

Adjuvant chemotherapy combined with supervised exercise therapy for pancreatic ductal adenocarcinoma was confirmed to improve the completion rate of S-1 adjuvant chemotherapy.
Prenatal transcript levels and metabolomics analyses reveal metabolic changes associated with intrauterine growth restriction and sex
Authors: Ponsuksili Siriluck , Murani Eduard , Hadlich Frieder , Iqbal Muhammad Arsalan , Fuchs Beate , Galuska Christina E. , Perdomo-Sabogal Alvaro , Sarais Fabio , Trakooljul Nares , Reyer Henry , Oster Michael , Wimmers Klaus
Published: September 2022

The metabolic changes associated with intrauterine growth restriction (IUGR) particularly affect the liver, which is a central metabolic organ and contributes significantly to the provision of energy and specific nutrients and metabolites. Therefore, our aim was to decipher and elucidate the molecular pathways of developmental processes mediated by miRNAs and mRNAs, as well as the metabolome in fetal liver tissue in IUGR compared to appropriate for gestational age groups (AGA). Discordant siblings representing the extremes in fetal weight at day 63 post conception (dpc) were selected from F2 fetuses of a cross of German Landrace and Pietrain. Most of the changes in the liver of IUGR at midgestation involved various lipid metabolic pathways, both on transcript and metabolite levels, especially in the category of sphingolipids and phospholipids. Differentially expressed miRNAs, such as miR-34a, and their differentially expressed mRNA targets were identified. Sex-specific phenomena were observed at both the transcript and metabolite levels, particularly in male. This suggests that sex-specific adaptations in the metabolic system occur in the liver during midgestation (63 dpc). Our multi-omics network analysis reveals interactions and changes in the metabolic system associated with IUGR and identified an important biosignature that differs between IUGR and AGA piglets.
Cuproptosis is correlated with clinical status, tumor immune microenvironment and immunotherapy in colorectal cancer: a multi-omic analysis
Authors: Shao Yanfei , Fan Xiaodong , Yang Xiao , Li Shuchun , Huang Ling , Zhou Xueliang , Zhang Sen , Zheng Minhua , Sun Jing
Published: September 2022

Copper, like double-edged sword, either too little or too much can lead to cell death. Cuproptosis, a novel identified cell death form induced by copper, is characterized by aggregation of lipoylated mitochondrial enzymes and the destabilization of Fe–S cluster proteins. However, the function and potential clinical value of cuproptosis in colorectal cancer remains largely unknown. In this study, 16 cuproptosis-related molecules (CPRMs) were identified and analyzed by transcriptomics, genomics, and single-cell transcriptome profiling from multiple databases. We established two cuproptosis-related molecular phenotypes (CMP1 and 2) to distinguish CRC individuals, in which there were significantly differences in prognosis, biological function, somatic mutation frequency, immune cell infiltration in CRC individuals. A novel cuproptosis-related scoring system (CuproScore) was also constructed to predict the prognosis of CRC individuals, TME and the response to immunotherapy. Of notion, the value of CuproScore was also confirmed in our transcriptome cohort, demonstrating that CRC individuals in the high CuproScore group tended to have higher immune cell infiltrations and higher immune checkpoint expression. We also checked and analyzed the expression and clinical significance of 16 CPRMs in CRC cell lines and CRC tissues. This study indicated that cuproptosis and CPRMs played significant role in CRC progression and in modeling the TME. Inducing cuproptosis may be a useful tool for tumor therapy in the future.
Effect of Soret on MHD rotating fluid flow through a porous medium with heat and mass transfer
Authors: T. Lawanya , M. Vidhya , A. Govindarajan
Published: September 2022

Purpose

The purpose of this paper to analyze the effect of Soret with heat and mass transfer on an unsteady two-dimensional Magnetohydrodynamics flow through a porous medium under the influence of the uniform transverse magnetic field in a rotating parallel plate is considered.

Design/methodology/approach

A mathematical model was developed using the slip conditions under unsteady state situations. Analytical expressions for the velocity, temperature and concentration profiles, wall shear stress, rates of heat and mass transfer and volumetric flow rate were obtained and computationally discussed with respect to the non-dimensional parameters. Further, the velocity reduces with increasing Hartmann number M and increases with Grashof number Gr and permeability parameter K.

Findings

It is observed that temperature reduces with an increase in Prandtl number Pr and ω. It is noted that the thermal radiation increases with increase in Soret number Sr, Schmidt number Sc, Prandtl number pr and ω.

Originality/value

Concentration decreases with an increase in radiation parameter R and chemical reaction parameter Kc.
Towards digital access during pandemic age: better learning service or adaptation struggling?
Authors: Huda Miftachul
Published: September 2022

Purpose

The presence of digital learning space is widely seen as there is an active engagement between educators and learners. However, the challenge raised mainly amidst the pandemic age, which is potentially leading to the interference on the active engagement in education process. The necessary act to have a critical response from the student’s feedback towards the online learning services should be taken into consideration in ensuring the continuance of teacher education in enabling to grab the potential chance to advance the assessment of strategic approach in online learning. This paper aims to examine the digital access during the pandemic age through elaborating the extensive value of better learning service or adaptation for the online learning achievement amidst the pandemic age.

Design/methodology/approach

This study is conducted with a qualitative approach through the particular method of data collection, namely, structured interview. This qualitative approach was selected to enable obtaining the richness of information and related data. The insightful feedback will be coming from 27 higher education learners.

Findings

The finding revealed that better design of achievement pathway on the digital access could be enhanced in supporting the online learning performance through the online services. The main point refers to look into detail about digital online infrastructure insufficiency for online access support and improvements on digital online infrastructure for accessibility of learning service. The main occupations are clearly pointed in the following phase. Those are empowering digital access for learning service support and enhancing digital-adaptation for online learning achievement.

Originality/value

This study is supposed to contribute in assisting the value contribution with an extensive point to continue the digital access during pandemic age through the adaptation empowerment of higher learner’s online learning services.
E-learning programs in executive education: effects of perceived quality and perceived value on self-regulation and motivation
Authors: Kumar Ranjan
Published: September 2022

Purpose

The purpose of this study is to investigate the effects of perceived quality and perceived value on learner motivation and engagement in executive education e-learning programs.

Design/methodology/approach

The structural model comprising four constructs – perceived quality (PQ), perceived value (PV), self-regulated learning (SRL) and intrinsic motivation (IM) – was empirically validated through path analysis. Mediation analysis and importance-performance map analysis (IPMA) was also conducted.

Findings

This study shows that PQ has a positive effect on PV; PV has a positive effect on SRL and on IM; and SRL has a positive effect on IM. Further, variance accounted for (VAF)-based mediation analysis established the partial mediating effect of SRL between PV and IM.

Practical implications

One, perceived quality and perceived value play a pivotal role in driving learner engagement and motivation in e-learning-based executive education programs. Two, the “pathway” effect of self-regulated learning between perceived value and intrinsic motivation has a crucial bearing on the design-execution-outcome lifecycle of such programs. Three, low-moderate performance scores of PQ, PV, and SRL in IPMA analysis implies these inputs are inadequate, adversely impacting learner motivation and engagement.

Originality/value

Recommendations from this pioneering study can be adopted by higher education (HE) ecosystem stakeholders to enhance perceived quality and value, learner motivation, engagement and learning outcomes in e-learning programs for executive education.
Does market performance mediates the nexus between production performance and financial performance in manufacturing companies?
Authors: Shanak Hosni Shareif Hussein , Abu-Alhaija Ahmad Saifalddin
Published: September 2022

Purpose

Based on recent government reports, the manufacturing industry is considered one of the most important sectors in Palestine. In this sense, this empirical study aims to investigate the influence of production performance on financial and market performances, assess the influence of market performance on financial performance and test the mediating role of market performance on the relationship between production and financial performances.

Design/methodology/approach

A convenience sampling method was applied. Accordingly, a set of questionnaires was distributed to 384 managers at Palestinian manufacturing enterprises. Structural equation modelling (SEM) was applied to analyse the collected data.

Findings

The study findings unveiled that production performance directly positively has a positive and direct influence on the financial and market performances. Furthermore, the result revealed that financial performance is positively affected by market performance level, whereas market performance has a partial mediation role in the relationship between financial and production performances.

Research limitations/implications

The study designs are restricted to the manufacturing companies. Hence, the empirical results may not generalise to the other industries.

Practical implications

The findings of this study can draw responsible parties and firms’ top management attention in developing countries to the importance of market performance as a key pillar of firm performance.

Originality/value

To the best of authors’ knowledge, most of the prior contemporary studies have been restricted to examine the direct relationship and have not considered the mediating influence of market performance. Besides, this study emphasised the inter-relationships between the firms’ performance dimensions. This study contributes to manufacturing firms’ performance literature by providing further validation of the performance scales from a developing countries “Palestine” with unique business environment because it is under ongoing occupation.
Libraries respond to the COVID-19 pandemic: drawing a science map of published articles
Authors: Nadi-Ravandi Somayyeh , Batooli Zahra
Published: September 2022

Purpose

The lockdown of libraries has led to changes in the delivery of services. Reviewing many studies in this regard appears to be of great importance. Thus, this study aims to analyze the articles related to libraries and COVID-19 using the co-occurrence analysis.

Design/methodology/approach

The current study is applied in terms of purpose and scientometrics in terms of type, which has been conducted using a retrospective bibliometric analysis method and drawing a science map. The relevant keywords were searched in the Scopus and 225 articles were reviewed in terms of author, year of publication, journal, organization and subject. Then, the VOSviewer software was used to analyze and illustrate the keywords and draw the scientific map of the articles.

Findings

The results showed that 225 articles by 496 authors from 66 countries and 379 organizations were published in the subject area of libraries and COVID-19. These articles have received 620 citations. The co-occurrence analysis of words showed that these scientific productions are classified into four clusters: “The role of libraries and librarians”, “The use of media, social network and communication technologies in order provide library services”, “Online Library Services” and “Infodemic and misinformation in the COVID-19 Pandemic”.

Originality/value

It is the first time during the COVID-19 pandemic that a scientific map has been drawn up of studies that have examined the role of libraries in this pandemic. The results of the present study may help libraries to access what they need to consider in any crisis.
The potential health benefits and food applications of jamun (Syzygium cumini L.), an indigenous fruit of India
Authors: Ayenampudi Surendra Babu , Verma Riya , Adeyeye Samuel Ayofemi Olalekan
Published: September 2022

Purpose

Jamun is an underutilised fruit crop of India whose utilization needs to be considerably increased. Despite its impressive nutritional profile and several health benefits, its cultivation is still very limited. Hence, this study aims to highlight the essential nutrients, health benefits and value-added products of jamun fruit and seed.

Design/methodology/approach

Major sources of bibliometric information such as Web of Science, Scopus, PubMed and Google Scholar were extensively searched with keywords such as nutritional composition of jamun, bioactive compounds, health benefits and jamun-based food products to obtain a database of 317 papers. Thirty four publications met the criteria for review.

Findings

Jamun fruit (Syzygium cumini L.) is known for its attractive colour, astringent taste, enormous nutrients and nutraceutical properties; nevertheless, this fruit is seasonal, perishable and underutilised. Furthermore, the fruit is used for the treatment of diabetes and also possess anti-cancer, anti-inflammatory, anti-obesity and cardio-protection properties. Investigations were done on the production of value-added food products such as read-to-serve beverages, jam, cookies and cake from jamun due to their several health benefits. The present review was an attempt to provide spotlights on the health benefits and food product applications of jamun fruit and its by-products.

Originality/value

This review systematically collates evidence from various published sources regarding the nutritional profile, development of food products from jamun and their health benefits. The compiled information will help researchers and professional become aware of the significance of jamun fruit and thereby enhances its processing and applications in food systems.
Service recovery efforts' influence on consumers' desire to reciprocate and forgiveness: the mediating role of perceived justice
Authors: Umar Rana Muhammad
Published: September 2022

Purpose

This paper investigated the impact of firms' service recovery efforts on consumers' desire to reciprocate and forgiveness in the hospitality industry of Pakistan. Additionally, this study examined the mediating role of perceived justice between service recovery efforts and their outcomes.

Design/methodology/approach

Using snowball sampling technique, an online survey was administered and 259 responses were collected from casual-dining restaurant customers. A partial least squares structural equation modeling (PLS-SEM) and multivariate analysis of covariance (MANCOVA) were used to examine the hypotheses.

Findings

The results indicate that perceived justice significantly mediates the effect of service recovery efforts on the consumers' desire to reciprocate and forgiveness. Moreover, high (vs. low) service recovery efforts lead to high consumer forgiveness.

Practical implications

The study provides insights for managers into how optimal recovery efforts predict consumers' positive responses and minimize the effect of service failure in South Asian consumers.

Originality/value

This research is among the early endeavors to examine consumers' desire to reciprocate in service recovery context. Also, this is the first study to validate the impact of service recovery efforts on consumers' desire to reciprocate and consumer forgiveness in a South Asian country.