bluuebunny/crossref_metadata_2025 huggingface dataset:
Ferulic Acid Alleviates Myocardial Ischemia Reperfusion Injury Via Upregulating AMPKα2 Expression-Mediated Ferroptosis Depression
Authors: Liu Xinliang , Qi Kai , Gong Yi , Long Xiang , Zhu Shuqiang , Lu Feng , Lin Kun , Xu Jianjun
Published: December 2021

Ferroptosis, a recently discovered form of regulated cell death that is characterized by iron accumulation and excessive reactive oxygen species generation, has been favored by most researchers. Increasing evidence suggest that ferulic acid (FA) could exert marked effects to myocardial ischemia reperfusion (I/R) injury, although the understanding of its molecular mechanism is still limited. In our study, the myocardial I/R injury model was established to explore the relationship between I/R injury and ferroptosis. First, we successfully constructed myocardial I/R injury model with changes in ST segment, increased creatine phosphokinase, lactate dehydrogenase activities, and N-Terminal Pro Brain Natriuretic Peptide content, and a significantly larger infarct size. Then, the increased levels of the Ptgs2 mRNA, Fe2+ accumulation, and a decreased reduced glutathione/oxidized glutathione disulfide ratio were detected in ischemia-reperfusion-injured heart, which is highly consistent with ferroptosis. However, these effects were significantly improved after FA treatment. Based on these results, FA increased the activities of the antioxidant enzymes superoxide dismutase, catalase and glutathione peroxidase, decreased the malondialdehyde level, ameliorated the production of reactive oxygen species, and promoted the generation of adenosine triphosphate. These effects of FA are similar to those of the ferroptosis inhibitor ferrostatin-1. Upregulation of AMPKα2 and Glutathione Peroxidase 4 expression were also observed in the FA group. Compound C, a specific Adenosine 5'-monophosphate (AMP)-activated protein kinase inhibitor, significantly blocked the protective effect of FA. These findings underlined that FA inhibits ferroptosis by upregulating the expression of AMPKα2 and serves as a cardioprotective strategy.
Total Costs of Applying to Integrated Plastic Surgery: Geographic Considerations, Projections, and Future Implications
Authors: Gordon Adam M. , Sarac Benjamin A. , Drolet Brian C. , Janis Jeffrey E.
Published: December 2021

Background:

In 2020, the American Council of Academic Plastic Surgeons and the Association of American Medical Colleges recommended residency programs suspend away rotations and in-person interviews. This study quantifies applicant costs and potential savings in the residency application process resulting from that change, while also evaluating differences in cost with respect to geographic region of the applicant.

Methods:

A retrospective evaluation of the 2019–2020 Texas STAR (Seeking Transparency in Application to Residency) database was conducted. We queried responses from plastic surgery residency applicants, including expenses associated with the application, away rotations, interviews, and total costs for medical school seniors. Applicant characteristics were recorded. A Kruskal-Wallis H-test was used to evaluate differences in mean costs by medical school region.

Results:

In total, 117 US allopathic applicants to plastic surgery residency were included. Total expenses for the application cycle were $10,845. This was made up of $1638 in application costs, $4074 in away rotation costs, and $5486 in interview costs. No significant differences were observed for mean total costs for applicants from schools in the Central ($11,045/applicant), Northeast ($9696/applicant), South ($11,332/applicant), and West ($11,205/applicant) (P = 0.209).

Conclusion:

Assuming relatively minimal expenditures related to a virtual interview cycle and lack of away rotations in 2021, the average cost savings for plastic surgery residency applicants during the COVID-19 pandemic was estimated to be over $9000.
SYSTEMATIC CORRELATION OF CENTRAL SUBFIELD THICKNESS WITH RETINAL FLUID VOLUMES QUANTIFIED BY DEEP LEARNING IN THE MAJOR EXUDATIVE MACULAR DISEASES
Authors: Pawloff Maximilian , Bogunovic Hrvoje , Gruber Anastasiia , Michl Martin , Riedl Sophie , Schmidt-Erfurth Ursula
Published: December 2021

Purpose:

To investigate the correlation of volumetric measurements of intraretinal (IRF) and subretinal fluid obtained by deep learning and central retinal subfield thickness (CSFT) based on optical coherence tomography in retinal vein occlusion, diabetic macular edema, and neovascular age-related macular degeneration.

Methods:

A previously validated deep learning–based approach was used for automated segmentation of IRF and subretinal fluid in spectral domain optical coherence tomography images. Optical coherence tomography volumes of 2.433 patients obtained from multicenter studies were analyzed. Fluid volumes were measured at baseline and under antivascular endothelial growth factor therapy in the central 1, 3, and 6 mm.

Results:

Patients with neovascular age-related macular degeneration generally demonstrated the weakest association between CSFT and fluid volume measurements in the central 1 mm (0.107–0.569). In patients with diabetic macular edema, IRF correlated moderately with CSFT (0.668–0.797). In patients with retinal vein occlusion, IRF volumes showed a moderate correlation with CSFT (0.603–0.704).

Conclusion:

The correlation of CSFT and fluid volumes depends on the underlying pathology. Although the amount of central IRF seems to partly drive CSFT in diabetic macular edema and retinal vein occlusion, it has only a limited impact on patients with neovascular age-related macular degeneration. Our findings do not support the use of CSFT as a primary or secondary outcome measure for the quantification of exudative activity or treatment guidance.
ONSET-1 Phase 2b Randomized Trial to Evaluate the Safety and Efficacy of OC-01 (Varenicline Solution) Nasal Spray on Signs and Symptoms of Dry Eye Disease
Authors: Wirta David , Torkildsen Gail L. , Boehmer Blair , Hollander David A. , Bendert Edward , Zeng Lijuan , Ackermann Michael , Nau Jeffrey
Published: December 2021

Purpose:

The purpose of this trial was to evaluate the safety and efficacy of OC-01 (varenicline solution), a nicotinic acetylcholine receptor agonist nasal spray, on signs and symptoms of dry eye disease.

Methods:

A phase 2b, multicenter, randomized, double-masked, vehicle-controlled trial (ONSET-1; NCT03636061) was performed. Patients were aged 22 years or older with a physician's diagnosis of dry eye disease and previous use of artificial tears were randomized 1:1:1:1 to control (vehicle nasal spray twice daily [BID]), OC-01 0.006 mg BID, OC-01 0.03 mg BID, and OC-01 0.06 mg BID. The primary end point was the change in the anesthetized Schirmer test score from baseline to day 28 in the study eye. The secondary end points included the change in the eye dryness score from baseline to day 28.

Results:

One hundred eighty-two patients were randomized. After 28 days, patients who received OC-01 0.03 or 0.06 mg showed a statistically significant improvement in tear film production relative to vehicle, with least squares mean differences from vehicle of 7.7 mm [95% confidence interval, 3.8–11.7; P < 0.001] with OC-01 0.03 mg and 7.5 mm (95% confidence interval, 3.4–11.6; P < 0.001) with OC-01 0.06 mg. Patients receiving OC-01 0.03 mg showed a significant reduction in the eye dryness score by day 28 versus vehicle (P = 0.021); those receiving the OC-01 0.06 mg dose showed a nonsignificant reduction versus vehicle. OC-01 administration was associated with sneezing (62%–84%) and cough (9%–25%); these were transient and predominantly mild in severity.

Conclusions:

OC-01 nasal spray administered BID at 0.03 and 0.06 mg resulted in significant improvements in signs and symptoms of dry eye disease, was well tolerated, and warrants further clinical investigation.
Toric intraocular lens implantation vs femtosecond laser–assisted arcuate keratotomy for correction of moderate astigmatism in cataract surgery
Authors: Hernandez Ruben , Almenara Cristina , Soriano Diana , Idoipe Miriam , Larrosa Jose M. , Pablo Luis E. , Garcia-Martin Elena
Published: December 2021

Purpose:

To compare toric intraocular lens (TIOL) implantation and femtosecond laser–assisted arcuate keratotomy (FSAK) during phacoemulsification surgery in correction of moderate astigmatism.

Setting:

Clinical research study.

Design:

Prospective randomized comparison study.

Methods:

Patients with age-related cataract and moderate preoperative corneal astigmatism of 1.25 to 3.0 diopters (D) were randomized into a TIOL implantation group and an FSAK group with symmetrical paired corneal arcuate keratotomies. The preoperative evaluation included corrected distance visual acuity (CDVA), corneal topography, autokeratometry, and ocular biometry. Postoperative examinations were performed at 1 month and 3 months and included CDVA and uncorrected distance visual acuity, manifest refraction, autokeratometry, and corneal topography. Vector analysis of astigmatic changes was performed using the Alpins vector method.

Results:

This study comprised 75 eyes from 67 patients. The mean residual refractive astigmatism at 3 months was −0.63 ± 0.55 D in the TIOL group and −0.90 ± 0.53 D in the FSAK group (P = .037) and was ≤1.00 D in 32 eyes (84%) and 25 eyes (64%), respectively. There were no statistically significant differences between the 2 groups in difference vector, angle of error, magnitude error, or correction index in the 3-month follow-up. The index of success was 0.32 ± 0.33 D in the TIOL group and 0.48 ± 0.29 D in the FSAK group (P = .029).

Conclusions:

TIOL implantation showed better results in correcting moderate astigmatism. Despite this, FSAK is shown to be a safe technique for reducing astigmatism.
Facilitators and Barriers to Implementing Two Quality Improvement Interventions Across 10 Pediatric Intensive Care Units: Video Laryngoscopy-Assisted Coaching and Apneic Oxygenation
Authors: Davis Katherine Finn , Rosenblatt Samuel , Buffman Hayley , Polikoff Lee , Napolitano Natalie , Giuliano John S. , Sanders Ronald C. , Edwards Lauren R. , Krishna Ashwin S. , Parsons Simon J. , Al-Subu Awni , Krawiec Conrad , Harwayne-Gidansky Ilana , Vanderford Paula , Salfity Nina , Lane-Fall Meghan , Nadkarni Vinay , Nishisaki Akira ,   for the National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: December 2021

To better understand facilitators and barriers to implementation of quality improvement (QI) efforts, this study examined 2 evidence-based interventions, video laryngoscopy (VL)-assisted coaching, and apneic oxygenation (AO). One focus group with frontline clinicians was held at each of the 10 participating pediatric intensive care units. Qualitative analysis identified common and unique themes. Intervention fidelity was monitored with a priori defined success as >50% VL-assisted coaching or >80% AO use for 3 consecutive months. Eighty percent of intensive care units with VL-assisted coaching and 20% with AO met this criteria during the study period. Common facilitator themes were adequate device accessibility, having a QI culture, and strong leadership. Common barrier themes included poor device accessibility and perception of delay in care. A consistently identified theme in the successful sites was strong QI leadership, while unsuccessful sites consistently identified insufficient education. These facilitators and barriers should be proactively addressed during dissemination of these interventions.
Comparison of LACE and HOSPITAL Readmission Risk Scores for CMS Target and Nontarget Conditions
Authors: Jones Stephen L. , Cheon Ohbet , Manzano Joanna-Grace Mayo , Park Anne K. , Lin Heather Y. , Halm Josiah K. , Baek Juha , Graviss Edward A. , Nguyen Duc T. , Kash Bita A. , Phillips Robert A.
Published: December 2021

This study evaluated the utility and performance of the LACE index and HOSPITAL score with consideration of the type of diagnoses and assessed the accuracy of these models for predicting readmission risks in patient cohorts from 2 large academic medical centers. Admissions to 2 hospitals from 2011 to 2015, derived from the Vizient Clinical Data Base and regional health information exchange, were included in this study (291 886 encounters). Models were assessed using Bayesian information criterion and area under the receiver operating characteristic curve. They were compared in CMS diagnosis-based cohorts and in 2 non-CMS cancer diagnosis-based cohorts. Overall, both models for readmission risk performed well, with LACE performing slightly better (area under the receiver operating characteristic curve 0.73 versus 0.69; P ≤ 0.001). HOSPITAL consistently outperformed LACE among 4 CMS target diagnoses, lung cancer, and colon cancer. Both LACE and HOSPITAL predict readmission risks well in the overall population, but performance varies by salient, diagnosis-based risk factors.
Mental Health, Burnout, and Resilience in Healthcare Professionals After the First Wave of COVID-19 Pandemic in Spain
Authors: Luceño-Moreno Lourdes , Talavera-Velasco Beatriz , Vázquez-Estévez Daniel , Martín-García Jesús
Published: December 2021

Objective:

This study aims to examine whether there are differences in symptoms of posttraumatic stress, depression, anxiety, levels of burnout and resilience in Spanish healthcare staff between the first wave of the COVID-19 pandemic and after it, depending on several demographic and work-related variables.

Methods:

A longitudinal study was conducted in April 2020 (T0), and July 2020 (T1). Symptoms of posttraumatic stress, depression, anxiety, burnout, levels of resilience, along with demographic and work-related variables in 443 workers were assessed.

Results:

Symptoms and burnout were more pronounced at T0, whereas the levels of resilience were higher at T1. Being women, being young, holding a lower-level job, less years of experience, lower educational level, and/or working rotating shifts are associated with having more posttraumatic stress symptoms and burnout.

Conclusion:

These variables would be considered in similar situations.
Long-Term Healthcare Utilization and the Cost of Bipolar Disorder Among Participants in a Large Employer's Health Benefit Plan
Authors: Leung Nina , Bernacki Seth E. , Kalia Nimisha , Bernacki Edward J. , Almeida Jorge R.C.
Published: December 2021

Objective:

Bipolar disorder (BD) is a chronic illness with recurrent exacerbations. The objective was to evaluate longitudinal costs related to BD in an employer-sponsored medical plan.

Methods:

This analysis utilized 5 years of administrative claims data. Claimants with a diagnosis of BD were matched to plan members (1:5) based on age, sex, and years of follow-up.

Results:

Medical costs for hospitalized BD members were 3.5 times more expensive than the general population (BDhosp = $92.2K vs General population = $26.8K). Average 5-year paid costs among hospitalized members with BD was $107K, $105.4K with cancer, and $103.3K with myocardial infarction (MI).

Conclusions:

Hospitalized BD plan members consumed more than 3.5 times the medical resources and were similar in longitudinal costs when compared with members with other costly conditions. These findings highlight the need for novel employer-sponsored programs to help manage BD.
Isolated CNS Relapse in 2 High-Risk B-cell Acute Lymphoblastic Leukemia Patients Following SARS-CoV-2 Infection
Authors: Walker Shannon C. , Reppucci Jennifer R. , Ann Thompson Mary , Borinstein Scott C. , Friedman Debra L. , Zarnegar-Lumley Sara
Published: December 2021

B-cell acute lymphoblastic leukemia (B-ALL) is the most common pediatric malignancy with a highly favorable overall prognosis. Central nervous system (CNS) relapse of B-ALL is relatively rare and is associated with inferior survival outcomes. We present two patients with B-ALL who developed isolated CNS relapse following confirmed infection with severe acute respiratory syndrome coronavirus 2. In addition to individual and disease factors, we posit that delays in therapy together with immune system modulation because of severe acute respiratory syndrome coronavirus 2 may account for these 2 cases of CNS relapsed B-ALL. We report on this clinical observation to raise awareness of this potential association.
Wanting, Liking, and Missing Out
Authors: Olin Cecilia C. , McDevitt-Murphy Meghan E. , Leonard Samuel J. , Acuff Samuel F.
Published: December 2021

Diminished reward functioning (anhedonia) is an aspect of multiple psychiatric diagnoses and is a critical component of depression, yet it has rarely been examined in the context of posttraumatic stress disorder (PTSD). Deficits in reward function may be a transdiagnostic factor contributing to the high rate of comorbidity between PTSD and depression. The present study examined the commonality and distinction between PTSD and depression and their relationship to reward functioning using a bifactor model in a sample of 106 trauma-exposed undergraduates. Results indicated a strong commonality factor between PTSD and depression. Of three indices of reward functioning (i.e., hedonic pleasure, reward motivation, and environmental reward availability), environmental reward availability alone was related to unique latent factors for PTSD and depression, and their commonality. Findings suggest that environmental context may be the key to understanding the role of reward in PTSD, depression, and psychopathology broadly.
Pain Intensity, Depression, and Anxiety Levels Among Patients With Chronic Pain During COVID-19 Pandemic
Authors: Bilen Aysegul , Kucukkepeci Hakan
Published: December 2021

Limited data are available for real-world impact of the COVID-19 pandemic on chronic pain patients. This study aimed to evaluate pain intensity, depression, and anxiety status in chronic pain patients during the COVID-19 pandemic. A total of 110 patients with chronic pain participated on a voluntary basis in this questionnaire survey. The questionnaire form elicited information on sociodemographic characteristics and prepandemic and pandemic data on analgesic need, access to medication, visual analog scale (VAS) pain, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores. The COVID-19 pandemic resulted in increased levels of depression (74.5%), anxiety (66.4%), increase in analgesic need (60%), and limited access to analgesic drugs (40.0%). In conclusion, our findings revealed significant increase in VAS pain intensity, BDI, and BAI scores during the COVID-19 pandemic compared with prepandemic period among chronic pain patients, particularly for patients with increased need of analgesics during pandemic.
Management of Cerclage in Patients With Preterm Prelabor Rupture of Membranes
Authors: Wu Jenny , Denoble Anna E. , Kuller Jeffrey A. , Dotters-Katz Sarah K.
Published: December 2021

Importance

Women undergoing cerclage placement remain at high risk for preterm labor and preterm prelabor rupture of membranes (PPROMs). The management of cervical cerclage after PPROM is controversial given the potential for prolonged latency when the cerclage is kept in place balanced with a potential increased risk of maternal infectious morbidity.

Objective

In this review, we compared studies that examined maternal, fetal, and neonatal outcomes in women with cerclage at the time of PPROM. We evaluated latency after PPROM and maternal and neonatal complications in the setting of PPROM with cervical cerclage.

Evidence Acquisition

Original research articles, review articles, and guidelines on cerclage removal were reviewed.

Results

Nine studies comparing cerclage retention versus removal were examined with mixed results, in particular between studies before the routine use of latency antibiotics and corticosteroid administration. There was an associated increase in latency to delivery with retention of cerclage, with a potential increase in maternal infectious morbidity. No significant differences were noted for neonatal mortality, neonatal sepsis, or other neonatal morbidity outcomes. The majority of studies were limited by their retrospective nature and small sample sizes.

Conclusions and Relevance

Cerclage removal at the time of diagnosis of PPROM can be considered due to the concern for increased risk of maternal morbidity without definitive benefit in latency to delivery or neonatal outcomes. However, data are limited, and clinicians should engage in shared decision-making with patients in this setting.

Target Audience

Obstetricians and gynecologists, pediatricians

Learning Objectives

After participating in this activity, the provider should be better able to summarize the current evidence regarding maternal, obstetric, and neonatal outcomes for women with PPROM in the setting of cervical cerclage; describe clinical evaluation for women who present with cerclage at the time of PPROM; and evaluate management considerations for women who present with cerclage at the time of PPROM.
Negative-Pressure Wound Therapy Application in Fingertip Replantations and a Systematic Review
Authors: Hu Ching-Wei , Chang Tommy Nai-Jen , Chen Yi-Chieh , Hu Ching-Hsuan
Published: December 2021

Background:

Fingertip replantation is technically challenging. Venous congestion is one of the most common causes of replantation failure. Therefore, various venous drainage procedures and salvage techniques have been used in venous congestion. Negative-pressure wound therapy has proven beneficial in limb injuries, yet limited studies of fingertip replantation exist. This study aims to analyze risk factors in fingertip replantation and to evaluate the feasibility and clinical benefits of negative-pressure wound therapy compared with other salvage techniques.

Methods:

From January of 2015 to December of 2019, 27 patients (27 digits) who experienced fingertip amputation over Tamai zone I or II underwent replantation. Salvage negative-pressure wound therapy was applied for venous congestion postoperatively. Replantation data were collected for further analysis.

Results:

The overall survival rate of digit replantation with salvage negative-pressure wound therapy was 92.6 percent (25 of 27). The blood transfusion rate was 11.1 percent (three of 27). The average hospitalization time was 8.04 ± 1.43 days and the median duration of negative-pressure wound therapy was 6 days (range, 4 to 8 days; interquartile range, 2 days). There is no significant difference between the survival and failure groups for all risk factors evaluated.

Conclusion:

Negative-pressure wound therapy is a simple and effective salvage option to relieve venous congestion in fingertip replantation with a satisfactory survival rate, low blood transfusion rate, and short inpatient stay.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Poverty and Risk of Cleft Lip and Palate: An Analysis of United States Birth Data
Authors: Vu Giap H. , Warden Clara , Zimmerman Carrie E. , Kalmar Christopher L. , Humphries Laura S. , McDonald-McGinn Donna M. , Jackson Oksana A. , Low David W. , Taylor Jesse A. , Swanson Jordan W.
Published: December 2021

Background:

The relationship between poverty and incidence of cleft lip and cleft palate remains unclear. The authors investigated the association between socioeconomic status and cleft lip with or without cleft palate and cleft palate only in the United States after controlling for demographic and environmental risk factors.

Methods:

The U.S. 2016 and 2017 natality data were utilized. Proxies for socioeconomic status included maternal education, use of the Special Supplemental Nutrition Program for Women, Infants, and Children, and payment source for delivery. Multiple logistic regression controlled for household demographics, prenatal care, maternal health, and infant characteristics.

Results:

Of 6,251,308 live births included, 2984 (0.05 percent) had cleft lip with or without cleft palate and 1180 (0.02 percent) had cleft palate only. Maternal education of bachelor’s degree or higher was protective against, and delayed prenatal care associated with, cleft lip with or without cleft palate (adjusted ORs = 0.73 and 1.14 to 1.23, respectively;p< 0.02). Receiving assistance under the Special Supplemental Nutrition Program for Women, Infants, and Children was associated with cleft palate only (adjusted OR = 1.25;p= 0.003). Male sex, first-trimester tobacco smoking, and maternal gestational diabetes were also associated with cleft lip with or without cleft palate (adjusted ORs = 1.60, 1.01, and 1.19, respectively;p< 0.05). Female sex, prepregnancy tobacco smoking, and maternal infections during pregnancy were associated with cleft palate only (adjusted ORs = 0.74, 1.02, and 1.60, respectively;p< 0.05).

Conclusions:

Increased incidence of orofacial clefts was associated with indicators of lower socioeconomic status, with different indicators associated with different cleft phenotypes. Notably, early prenatal care was protective against the development of cleft lip with or without cleft palate.

CLIINCAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Microvascular Free Tissue Transfer for Reconstruction of Complex Abdominal Wall Defects
Authors: Bauder Andrew , Othman Sammy , Asaad Malke , Butler Charles E. , Kovach Stephen J.
Published: December 2021

Patients with significant loss of abdominal wall soft tissue represent a reconstructive challenge. The purpose of this study was to describe the authors’ experience using microvascular free tissue transfer to repair complex abdominal wall defects with insufficient overlying soft tissue. In this report, the authors highlight their techniques and experiences in performing microvascular free tissue transfer to the abdominal wall for these massive, complex defects. In total, 14 patients who underwent 16 free-flap reconstructions were included in the series. The patients’ mean age was 50 ± 14 years, and mean body mass index was 27 ± 5 kg/m2. The mean hernia defect size was 412 ± 149 cm2. Ten flaps were fasciocutaneous anterolateral thigh flaps, one myocutaneous anterolateral thigh flap, two subtotal thigh flaps, one myocutaneous latissimus dorsi flap, one parascapular/latissimus dorsi flap, and one free filet of the lower leg. Five cases (36 percent) developed hernia recurrence, and seven developed surgical site complications. All flaps survived, with no total flap loss. This report highlights that microsurgical free tissue transfer in combination with mesh repair is a safe and reliable method for restoring complex, large, full-thickness abdominal wall defects. This case series illustrates a number of techniques and considerations that are of importance to achieve a favorable outcome when faced with these complex defects.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Use of Three-Dimensional Imaging to Assess the Effectiveness of Volume as a Critical Variable in Breast Implant Selection
Authors: Hammond Dennis C. , Kim Kuylhee , Bageris Matthew H. , Chaudhry Arif
Published: December 2021

Background:

In breast augmentation, breast base diameter has been recognized as an important variable in implant selection. However, breast implant volume also has a tremendous impact on the final result. Previous methods of preoperative volume determination have been limited to external devices in a bra. Computer-based three-dimensional simulation technology now allows the physician to effectively communicate with the patient preoperatively regarding volume.

Methods:

A cohort of 40 consecutive patients underwent routine breast augmentation with either anatomically shaped or round implants. Five methods of preoperative volume determination including the Crisalix three-dimensional computer imaging system (Crisalix Virtual Aesthetics, Lausanne, Switzerland), along with an associated virtual reality tool, were used to assess the preoperative desires of the patients. A postoperative questionnaire was used to assess patient satisfaction with each volume determination method.

Results:

Of the 40 patients, 100 percent were satisfied with their result; however, given the opportunity, 12 percent would have chosen a larger implant. The virtual reality tool and external sizers were shown to be the most effective in choosing an implant. The virtual reality tool was judged to be very helpful (62 percent), very accurate (78 percent), and important (88 percent) in helping patients choose their desired implant size.

Conclusion:

Prioritizing volume as an implant selection variable in breast augmentation results in a very high rate of patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Pushing the Limits in Extremity Reconstruction Using Virtual Surgical Planning: A Case Series Study
Authors: Pereira Nicolás , Kufeke Matías , Roa Ricardo
Published: December 2021

Technology is advancing in benefit to solving complex problems. Preoperative planning is essential in any reconstructive process given the importance of achieving good results. New technologies facilitate the process to anticipate intraoperative findings. Virtual surgical planning has contributed in the evolution of craniomaxillofacial surgery. However, limited reports have been published regarding its usefulness in extremity reconstruction. The aim of this study was to push the limits and evaluate the use of virtual surgical planning with three-dimensional images for reconstruction of complex extremity defects using a free, open-source software. Patient candidates for upper or lower extremity microsurgical reconstruction with multiple defects or defects requiring reconstruction of various tissue components were included. Computed tomography angiography images were analyzed for virtual surgical planning using Horos software (Horos, Annapolis, Md.). Two upper and eight lower extremities were reconstructed with free flaps using virtual surgical planning; six cases had multiple defects, and four cases underwent different tissue components reconstruction. The postoperative period was uneventful, and there was no flap failure. A didactic video of the process and examples of some cases are presented. Virtual surgical planning is a powerful planning method, and the authors propose its use in complex extremity defects reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Severity of Flare Reactions in Diethylenetriamine Pentaacetate Chelations
Authors: Semelka Richard C. , Castro Pereira José F. , Ramalho Miguel
Published: December 2021

Purpose

The aim of this study was to report early clinical experience with various forms of immune dampening to mitigate the expected flare reaction in patients suffering from gadolinium deposition disease (GDD) receiving DTPA chelation.

Materials and Methods

All patients were clinical subjects, and no prospective research was performed on them. The study included 31 consecutive patients (21 women; age, 46.2 ± 12.5 years). The diagnosis of GDD was clinically made. The severity of the flare over the week after each chelation session was rated on a scale from 1 to 10 (where 1 is negligible, 10 is intolerably severe). Patients were followed for up to 5 chelation sessions. Four immune dampening strategies were used: (1) no concurrent treatment; (2) antihistamine plus montelukast (AH); (3) steroid/antihistamine taper postchelation (SAHT); and (4) steroid/antihistamine extending from prechelation to 5 days postchelation (extended hypersensitivity medication regimen; EHMR). The data were analyzed with generalized linear mixed models and with linear regression.

Results

A total of 102 flare scores were obtained at different time points. Ten patients underwent 5 chelations. The severity of the flare after the first chelation was significantly higher in cases of no concurrent therapy (8.4 ± 2.6) and AH (7 ± 1.4) compared with SAHT (6 ± 1.3) and EHMR (5 ± 1.1). Patients who underwent SAHT and EHMR experienced less severity of flare after the first chelation (P = 0.0049 and P = 0.0005, respectively). Considering all time points, the results were also significantly better with SAHT and EHMR.

Conclusion

Based on early clinical experience, EHMR seems to manage flare reactions in DTPA chelation well. This strategy may represent the first standard therapy in patients with GDD.
Clinical and Ultrasonographic Features of Papillary Thyroid Carcinoma Located in the Isthmus
Authors: Fan Jinfang , Zhou Wei , Zhan Weiwei , Tao Lingling , Li Weiwei , Kuang Lijun
Published: December 2021

The aim of this research was to investigate the clinical and ultrasonographic features of papillary thyroid carcinoma (PTC) in the isthmus. A total of 823 patients with 823 PTCs including 133 in the isthmus and 690 in the lateral lobe were included in our study. All patients were confirmed by postoperative pathology. The clinical and ultrasonographic characteristics were retrospectively analyzed and compared. Univariate analysis and multivariate logistic regression analysis were performed. Multifactor analyses showed that PTC in the isthmus was significantly different from PTC originating from the lateral lobe in aspect ratio, microcalcification, extrathyroid extension, lymph node metastases, and lymph node density (P < 0.05, for all). There were no significant differences in age, sex, tumor size, margin, halo, echogenicity, and homogeneity (P > 0.05, for all). The results indicated that the sonographic appearances of PTC in the isthmus were relatively atypical; however, it had a higher incidence of extrathyroidal extension, central lymph node metastasis, and a tendency of higher lymph node density. Therefore, more careful ultrasound evaluation should be performed for these nodules.
Process Modeling of ABCDE Primary Survey in Trauma Resuscitations
Authors: Lodemann Tobias , Akçalı Elif , Fernandez Rosemarie
Published: December 2021

Introduction

Trauma teams are ad hoc, multidisciplinary teams that perform complex patient care and medical decision making under dynamic conditions. The ability to measure and thus understand trauma team processes is still limited. Agent-based simulation modeling (ABSM) can be used to investigate complex relationships and performance within a trauma team. However, the foundational work to support such efforts is lacking. The goal of this work is to develop a comprehensive process model for the primary survey in trauma that can support ABSM.

Methods

A process model for the primary survey of patients with blunt traumatic injuries was developed using Advanced Trauma Life Support guidelines and peer-reviewed publications. This model was then validated using video recordings of 25 trauma resuscitations in a level 1 trauma center. The assessment and treatment pathway followed in each video were mapped against the defined pathway in the process model. Deviations were noted when resuscitations performance did not follow the defined pathway.

Results

Overall the process model contains 106 tasks and 78 decision points across all domains, with the largest number appearing in the circulation domain, followed by airway and breathing. A total of 34 deviations were observed across all 25 videos, and a maximum of 3 deviations were observed per video.

Conclusions

Overall, our data offered validity support for the blunt trauma primary survey process model. This process model was an important first step for the use of ABSM for the support of trauma care operations and team-based processes.
A national study defining 1.0 full-time employment in trauma and acute care surgery
Authors: Murphy Patrick B. , Coleman Jamie , Karam Basil , Morris Rachel S. , Figueroa Juan , de Moya Marc
Published: December 2021

BACKGROUND

Trauma and acute care surgery (ACS) staffing models vary widely across the United States, resulting in large discrepancies in staffing, compensation, schedule, and clinical/nonclinical expectations. An urgent need exists to define clinical, academic, and schedule expectations for a full-time employment (FTE) of a trauma and ACS surgeon in the United States.

METHODS

A survey was distributed to departmental leaders at Levels I, II, III trauma centers across the United States regarding current workload. Variables concerning the responsibilities of surgeons, compensation models, and clinical expectations were collected. This was followed by virtual semistructured interviews of agreeable respondents. A thematic analysis was used to describe current staffing challenges and “ideal” staffing and compensation models of trauma centers.

RESULTS

Sixty-eight of 483 division chiefs/medical directors responded (14%), the majority (66%) representing Level I centers. There were differences in clinical responsibilities, elective surgery coverage as well as number of and reimbursement for call. The median description of an FTE was 26 weeks (interquartile range, 13 weeks) with a median of 8 (interquartile range, 8) 12-hour call shifts per month. Level III centers were more likely to perform elective surgery and covered more call shifts, typically from home. In our qualitative interviews, we identified numerous themes, including inconsistent models and staffing of services, surgeon—administration conflict and elective surgery driven by productivity and desire.

CONCLUSION

Defining the workload of a full-time trauma and ACS surgeon is nuanced and requires consideration of local volume, acuity and culture. Between the quantitative and qualitative analysis, a reasonable workload for a 1.0 FTE acute care surgeon at a Level I center is 24 to 28 service weeks per year and four to five in-house calls per month. Nighttime and daytime staffing needs can be divergent and may lead to conflict with administration. Future research should consider the individual surgeon's perspective on the definition of an FTE.

LEVEL OF EVIDENCE

Prognostic and epidemiological, Level III.
Single Cord Blood Transplantation Versus HLA-Haploidentical-related Donor Transplantation Using Posttransplant Cyclophosphamide in Patients With Hematological Malignancies
Authors: Wada Fumiya , Kanda Junya , Yoshioka Satoshi , Ishikawa Takayuki , Akasaka Takashi , Ueda Yasunori , Hirata Hirokazu , Arai Yasuyuki , Yago Kazuhiro , Anzai Naoyuki , Watanabe Mitsumasa , Ikeda Takashi , Yonezawa Akihito , Imada Kazunori , Itoh Mitsuru , Kitano Toshiyuki , Takeoka Tomoharu , Hishizawa Masakatsu , Nohgawa Masaharu , Arima Nobuyoshi , Asagoe Kousuke , Kondo Tadakazu , Takaori-Kondo Akifumi ,   Kyoto Stem Cell Transplantation Group (KSCTG)
Published: December 2021

Background.

Unrelated cord blood (UCB) and haploidentical related donor transplantation using posttransplant cyclophosphamide (PTCy-haplo) have become alternative options to treat patients with hematological malignancies without a HLA-matched donor.

Methods.

We conducted a retrospective study using registry data from the Kyoto Stem Cell Transplantation Group for patients with hematological malignancies who received their first allogeneic hematopoietic cell transplantation using a single UCB unit (n = 460) or PTCy-haplo (N = 57) between 2013 and 2019.

Results.

We found that overall survival in the UCB group was comparable to that in the PTCy-haplo group (hazard ratio, 1.00; 95% confidence interval, 0.66-1.52), although neutrophil and platelet engraftment were significantly delayed. Nonrelapse mortality risk and the incidence of graft-versus-host disease in the UCB group were also comparable to those in the PTCy-haplo group. Although the relapse risk was similar between the UCB group and the PTCy-haplo group regardless of the disease risk, acute myeloid leukemia patients benefit from UCB transplant with a significantly lower relapse rate (hazard ratio, 0.38; 95% confidence interval, 0.18-0.76).

Conclusions.

UCB transplant gives outcomes comparable to PTCy-haplo transplant, and both UCB and PTCy-haplo units are suitable as alternative donor sources for patients without an HLA-matched sibling or unrelated donor.
Causation without correlation: parasite-mediated frequency-dependent selection and infection prevalence
Authors: Lively Curtis M. , Xu Julie , Ben-Ami Frida
Published: December 2021

Parasite-mediated selection is thought to maintain host genetic diversity for resistance. We might thus expect to find a strong positive correlation between host genetic diversity and infection prevalence across natural populations. Here, we used computer simulations to examine host–parasite coevolution in 20 simi-isolated clonal populations across a broad range of values for both parasite virulence and parasite fecundity. We found that the correlation between host genetic diversity and infection prevalence can be significantly positive for intermediate values of parasite virulence and fecundity. But the correlation can also be weak and statistically non-significant, even when parasite-mediated frequency-dependent selection is the sole force maintaining host diversity. Hence correlational analyses of field populations, while useful, might underestimate the role of parasites in maintaining host diversity.
Maternal responses to pup calls in a high-cost lactation species
Authors: Linossier Juliette , Casey Caroline , Charrier Isabelle , Mathevon Nicolas , Reichmuth Colleen
Published: December 2021

Bonding between mothers and their young is fundamental to mammalian reproductive behaviour and individual fitness. In social systems where the risk of confusing filial and non-filial offspring is high, mothers should demonstrate early, strong and consistent responses to their kin throughout the period of offspring dependence, irrespective of maternal traits. We tested this hypothesis through playback experiments in the northern elephant seal
Mirounga angustirostris
, a phocid species that breeds in high-density colonies. We found that mothers recognized their offspring throughout lactation and as early as 1–2 days after parturition. Measures of experience (age) and temperament (aggressivity) did not predict their response strength to filial playback treatments, nor did pup age or sex. Some mothers showed great consistency in behavioural responses throughout the lactation period, while others were less predictable. The strength of a female's response did not influence her pup's weaning weight; however, more consistent females weaned pups of higher mass. This is a rare demonstration of individual recognition among phocid mothers and their offspring, and suggests that consistency in maternal responsiveness may be an important social factor influencing the pup's growth and survival.
Wildfires modify the parasite loads of invasive cane toads
Authors: Kaiser Shannon W. , Greenlees Matthew J. , Shine Richard
Published: December 2021

The frequency and severity of wildfires are increasing due to anthropogenic modifications to habitats and to climate. Post-fire landscapes may advantage invasive species via multiple mechanisms, including changes to host–parasite interactions. We surveyed the incidence of endoparasitic lungworms (Rhabdias pseudosphaerocephala) in invasive cane toads (Rhinella marina) in near-coastal sites of eastern Australia, a year after extensive fires in this region. Both the prevalence of infection and number of worms in infected toads increased with toad body size in unburned areas. By contrast, parasite load decreased with toad body size in burned areas. By killing moisture-dependent free-living lungworm larvae, the intense fires may have liberated adult cane toads from a parasite that can substantially reduce the viability of its host. Smaller toads, which are restricted to moist environments, did not receive this benefit from fires.
Genetic data from the extinct giant rat from Tenerife (Canary Islands) points to a recent divergence from mainland relatives
Authors: Renom Pere , de-Dios Toni , Civit Sergi , Llovera Laia , Sánchez-Gracia Alejandro , Lizano Esther , Rando Juan Carlos , Marquès-Bonet Tomàs , Kergoat Gael J. , Casanovas-Vilar Isaac , Lalueza-Fox Carles
Published: December 2021

Evolution of vertebrate endemics in oceanic islands follows a predictable pattern, known as the island rule, according to which gigantism arises in originally small-sized species and dwarfism in large ones. Species of extinct insular giant rodents are known from all over the world. In the Canary Islands, two examples of giant rats, †
Canariomys bravoi
and †
Canariomys tamarani
, endemic to Tenerife and Gran Canaria, respectively, disappeared soon after human settlement. The highly derived morphological features of these insular endemic rodents hamper the reconstruction of their evolutionary histories. We have retrieved partial nuclear and mitochondrial data from †
C. bravoi
and used this information to explore its evolutionary affinities. The resulting dated phylogeny confidently places †
C. bravoi
within the African grass rat clade (
Arvicanthis niloticus
). The estimated divergence time, 650 000 years ago (95% higher posterior densities: 373 000–944 000), points toward an island colonization during the Günz–Mindel interglacial stage. †
Canariomys bravoi
ancestors would have reached the island via passive rafting and then underwent a yearly increase of mean body mass calculated between 0.0015 g and 0.0023 g; this corresponds to fast evolutionary rates (in darwins (d), ranging from 7.09 d to 2.78 d) that are well above those observed for non-insular mammals.
The lose-to-win strategy of the weak: intraspecific parasitism via egg abduction in a termite
Authors: Tamaki Chihiro , Takata Mamoru , Matsuura Kenji
Published: December 2021

Predation by larger conspecifics poses a major threat to small juveniles in many animal species. However, in social insects, raids perpetrated by large colonies may provide smaller colonies with opportunities for parasitization. Herein, in the termiteReticulitermes speratus, we demonstrate that small incipient colonies parasitize large mature colonies through egg abduction when attacked by raiding conspecifics. We observed that the eggs of incipient colonies were brought into raiding colonies while their parents were killed during the attack. In this species, unmated females found new colonies with female–female (FF) cooperation, in addition to the typical monogamous colony foundation. Interestingly, the abducted eggs of FF pairs developed into nymphs (reproductive caste) in the raiding colonies, whereas the eggs of male–female (MF) pairs developed into workers (non-reproductive caste). Parthenogenetic eggs are known to be developmentally predisposed to becoming female reproductives owing to genomic imprinting in termites. This study demonstrates that the plundering of small colonies by larger conspecific colonies not only results in the extinction of the weaker colonies, but also serves as a strategy that incipient colonies use to obtain the reproductive position in large colonies by stealth. The results elucidate the diversity and complexity of inter-colonial interactions in social insects.
John Horton Conway. 26 December 1937—11 April 2020
Authors: Curtis Robert Turner
Published: December 2021

John Conway was without doubt one of the most celebrated British mathematicians of the last half century. He first gained international recognition in 1968 when he constructed the automorphism group of the then recently-discovered Leech lattice, and in so doing discovered three new sporadic simple groups. At around the same time he invented The Game of Life, which brought him to the attention of a much wider audience and led to a cult following of Lifers. He also combined the methods of Cantor and Dedekind for extending number systems to construct what Donald Knuth (ForMemRS 2003) called ‘surreal numbers’, the achievement of which Conway was probably most proud. Throughout his life he continued to make significant contributions to many branches of mathematics, including number theory, logic, algebra, combinatorics and geometry, and in his later years he teamed up with Simon Kochen to produce the Free Will theorem, which asserts that if humans have free will then, in a certain sense, so do elementary particles. In this biographical memoir I attempt to give some idea of the depth and breadth of Conway's contribution to mathematics.