bluuebunny/crossref_metadata_2025 huggingface dataset:
Adverse Impact of HIV-1 on Long-term Outcomes Following HCV DAA Treatment: Final Results of ACTG A5320, the Viral Hepatitis C Infection Long-term Cohort Study (VHICS)
Authors: Wyles David L , Kang Minhee , Matining Roy M , Murphy Robert L , Peters Marion G
Published: March 2023

Background

Long-term outcome data after hepatitis C virus (HCV) treatment are limited, particularly for comparisons between persons with and without HIV.

Methods

A5320 was a prospective cohort study that enrolled participants within 12 months of completing HCV DAA therapy, with or without sustained virologic response (SVR). The primary end point was composite: time to death or development of a targeted diagnosis. Component outcomes (death and targeted diagnosis) and liver-related events were also analyzed. The effects of HIV serostatus, HIV RNA and CD4, and liver disease stage on the outcomes were assessed. Follow-up was designated for 5 years.

Results

Three hundred thirty-two participants enrolled: 184 with HIV/HCV (130 SVR) and 148 with HCV (125 SVR). The primary analysis was dominated by targeted diagnoses. Increased rates of targeted diagnoses were seen in HCV-HIV/SVR compared with HCV/SVR (P = .016), with an incidence rate of 6.7 and 3.4 per 100 person-years, respectively. Among persons without HIV, higher rates of targeted diagnoses were observed in non-SVRs (P = .007), 10.8 vs 3.4/100 person-years. No significant difference was seen by SVR status among those with HIV. There were 15 deaths; all liver-related deaths (n = 4) occurred in non-SVR groups.

Conclusions

HCV cure following therapy reduces subsequent development of new clinical events, supporting the use of SVR as a predictor for clinical outcomes. Despite HIV control, a significant decrease in incident events or mortality was not demonstrated for people with HIV who achieved SVR, suggesting that coinfection attenuates the beneficial impact of SVR. Research is needed to better define mechanisms accounting for the long-term negative impact of controlled HIV infection.
Evaluation of factors associated with the effectiveness of radiation protection glasses
Authors: Imai Shinya , Yamahata Asuka , Kakimoto Akihiro , Kawaji Yasuyuki , Gotanda Tatsuhiro , Akagawa Takuya , Yatake Hidetoshi
Published: March 2023

The effects of lead equivalent and lens area of radiation-protective eyewear on lens exposure control were examined. The simulated patient underwent 10-min X-ray fluoroscopy, and the lens dose of the simulated surgeon wearing radiation protection glasses was measured using lens dosemeters attached to the corner of the eye and eyeball. In total, 10 types of radiation protection glasses were selected for measurement. Correlation analysis of the equivalent dose in the lens of the eye with lead equivalence and lens area was performed. The equivalent dose in the lens of the eye of the corner of the eye was negatively correlated with the area of the lens. The equivalent dose in the lens of the eye and the eyeball showed a strong negative correlation with lead equivalence. Lens dosemeters worn at the corner of the eye may overestimate the equivalent dose in the lens of the eye. Moreover, the reduction in exposure of the lens was significantly influenced by the lead equivalent.
A two-night polysomnography preliminary study in pregnant women with insomnia: suicidal ideation and nocturnal cognitive arousal prospectively predict objective nocturnal wakefulness
Authors: Kalmbach David A , Cheng Philip , Roth Thomas , Fellman-Couture Cynthia , Sagong Chaewon , Drake Christopher L
Published: March 2023

Study objectives

Sleep disruption is common in pregnancy, manifesting as insomnia in half of pregnant women as well as increasing objective nocturnal wakefulness across gestation. Despite potential overlap between insomnia and objective sleep disturbances in pregnancy, objective nocturnal wakefulness and its potential contributing factors remain uncharacterized in prenatal insomnia. The present study described objective sleep disturbances in pregnant women with insomnia and identified insomnia-related predictors of objective nocturnal wakefulness.

Methods

Eighteen pregnant women with clinically significant insomnia symptoms (n = 12/18 with DSM-5 insomnia disorder) underwent two overnight polysomnography (PSG) studies. Insomnia symptoms (Insomnia Severity Index), depression and suicidal ideation (Edinburgh Postnatal Depression Scale), and nocturnal cognitive arousal (Pre-Sleep Arousal Scale, Cognitive factor) were assessed before bedtime on each PSG night. Unique to Night 2, participants were awakened after 2 minutes of N2 sleep and reported their in-lab nocturnal (i.e. pre-sleep) cognitive arousal.

Results

Difficulty maintaining sleep was the most common objective sleep disturbance affecting 65%–67% of women across both nights, which contributed to short and inefficient sleep. Nocturnal cognitive arousal and suicidal ideation were the most robust predictors of objective nocturnal wakefulness. Preliminary evidence suggested nocturnal cognitive arousal mediates the effects of suicidal ideation and insomnia symptoms on objective nocturnal wakefulness.

Conclusions

Nocturnal cognitive arousal may facilitate upstream effects of suicidal ideation and insomnia symptoms on objective nocturnal wakefulness. Insomnia therapeutics reducing nocturnal cognitive arousal may benefit objective sleep in pregnant women presenting with these symptoms.
Innovative Learning
Authors: Cieslowski Bethany , Haas Tanya
Published: March 2023

The development of critical thinking and decision-making skills is essential to link knowledge to practice in prelicensure nursing education. Immersive virtual reality (VR) is a teaching modality that provides students with an interactive way to develop their knowledge and skills. Faculty at a large mid-Atlantic university developed an innovative strategy to deploy immersive VR in a senior-level advanced laboratory technologies course with 110 students. Implementation of this approach to VR was intended to augment clinical learning in a safe learning environment.
Two-Year Outcomes of Cochlear Implant Use for Children With Unilateral Hearing Loss: Benefits and Comparison to Children With Normal Hearing
Authors: Park Lisa R. , Dillon Margaret T. , Buss Emily , Brown Kevin D.
Published: March 2023

Objectives:

Children with severe-to-profound unilateral hearing loss, including cases of single-sided deafness (SSD), lack access to binaural cues that support spatial hearing, such as recognizing speech in complex multisource environments and sound source localization. Listening in a monaural condition negatively impacts communication, learning, and quality of life for children with SSD. Cochlear implant (CI) use may restore binaural hearing abilities and improve outcomes as compared to alternative treatments or no treatment. This study investigated performance over 24 months of CI use in young children with SSD as compared to the better hearing ear alone and to children with bilateral normal hearing (NH).

Design:

Eighteen children with SSD who received a CI between the ages of 3.5 and 6.5 years as part of a prospective clinical trial completed assessments of word recognition in quiet, masked sentence recognition, and sound source localization at regular intervals out to 24-month postactivation. Eighteen peers with bilateral NH, matched by age at the group level, completed the same test battery. Performance at 24-month postactivation for the SSD group was compared to the performance of the NH group.

Results:

Children with SSD have significantly poorer speech recognition in quiet, masked sentence recognition, and localization both with and without the use of the CI than their peers with NH. The SSD group experienced significant benefits with the CI+NH versus the NH ear alone on measures of isolated word recognition, masked sentence recognition, and localization. These benefits were realized within the first 3 months of use and were maintained through the 24-month postactivation interval.

Conclusions:

Young children with SSD who use a CI experience significant isolated word recognition and bilateral spatial hearing benefits, although their performance remains poorer than their peers with NH.
Attrition and Retention of Rehabilitation Professionals: A Scoping Review
Authors: Mak Susanne , Hunt Matthew , Riccio Serena Speranza , Razack Saleem , Root Kelly , Thomas Aliki
Published: March 2023

Introduction:

Attrition is defined as a permanent departure from one's profession or the workforce. Existing literature on retention strategies, contributing factors to the attrition of rehabilitation professionals and how different environments influence professionals' decision-making to stay in/leave their profession, is limited in scope and specificity. The objective of our review was to map the depth and breadth of the literature on attrition and retention of rehabilitation professionals.

Methods:

We used Arksey and O'Malley's methodological framework. A search was conducted on MEDLINE (Ovid), Embase (Ovid), AMED, CINAHL, Scopus, and ProQuest Dissertations and Theses from 2010 to April 2021 for concepts of attrition and retention in occupational therapy, physical therapy, and speech-language pathology.

Results:

Of the 6031 retrieved records, 59 papers were selected for data extraction. Data were organized into three themes: (1) descriptions of attrition and retention, (2) experiences of being a professional, and (3) experiences in institutions where rehabilitation professionals work. Seven factors across three levels (individual, work, and environment) were found to influence attrition.

Discussion:

Our review showcases a vast, yet superficial array of literature on attrition and retention of rehabilitation professionals. Differences exist between occupational therapy, physical therapy, and speech-language pathology with respect to the focus of the literature. Push, pull, and stay factors would benefit from further empirical investigation to develop targeted retention strategies. These findings may help to inform health care institutions, professional regulatory bodies, and associations, as well as professional education programs, to develop resources to support retention of rehabilitation professionals.
Early Quality-of-Life Changes in Mild Traumatic Brain Injury: A Prospective Study
Authors: Mulyadi Mulyadi , Harianto Susilo , Tonapa Santo Imanuel , Lee Bih-O
Published: March 2023

BACKGROUND:

Postinjury symptoms and decreased quality of life are common after mild traumatic brain injury. However, few studies have examined how soon, after injury, these changes dissipate.

OBJECTIVES:

This study aimed to compare changes in postconcussion symptoms, posttraumatic stress, and illness representations and identify predictors of health-related quality of life before and 1 month after hospital discharge for mild traumatic brain injury.

METHODS:

A prospective, multicenter, correlational design was used to measure postconcussion symptoms, posttraumatic stress, illness representations, and health-related quality of life. The survey was administered to 136 patients with mild traumatic brain injury between June 2020 and July 2021 at three hospitals in Indonesia. Data were collected at discharge and 1 month later.

RESULTS:

Compared with before hospital discharge, data collected 1 month after discharge showed that patients experienced reduced postconcussion symptoms, posttraumatic stress, better illness perceptions, and quality of life. Those with postconcussion symptoms (β =−.35, p < .001), more posttraumatic stress symptoms (β =−.12, p = .044), more identity symptoms (β = .11, p = .008), worsened personal control (β =−.18, p = .002), worsened treatment control (β =−.16, p = .001), and negative emotional representations (β =−.17, p = .007) were significantly related to worsened health-related quality of life.

CONCLUSION:

This study shows that within 1 month of hospital discharge, patients with mild traumatic brain injury had decreased postconcussion symptoms, posttraumatic stress, and improved illness perceptions. Efforts to impact mild brain injury quality of life should focus on inhospital care to optimize the transition to discharge.
Trauma Team High-Fidelity Simulation Training in a Rural Level III Trauma Center: An Interprofessional Experience
Authors: Knapp Ginger M.
Published: March 2023

BACKGROUND:

Emergency department trauma resuscitation requires teamwork and high-stakes clinical decision-making. Rural trauma centers with low trauma activation volumes must ensure that resuscitations are efficient and safe.

OBJECTIVE:

The purpose of this article is to describe the implementation of high-fidelity, interprofessional simulation training to foster trauma teamwork and role identification for trauma team members responding to trauma activations in the emergency department.

METHODS:

High-fidelity, interprofessional simulation training was developed for members of a rural Level III trauma center. Subject matter experts created trauma scenarios. An embedded participant led the simulations using a guidebook that outlined the scenario and learner objectives. The simulations were implemented from May 2021 through September 2021.

RESULTS:

Postsimulation survey results identified that participants found training with other professions valuable and that knowledge was gained.

CONCLUSION:

Interprofessional simulations enhance team communication and skills. Combining interprofessional education with high-fidelity simulation creates a learning environment that optimizes trauma team function.
Forum Theater: An Innovative Strategy to Enhance Clinician Communication With Marginalized Trauma Patients
Authors: Schombs Michele , Khedr Shahenda , Sullivan Francesca , Alkattan Abdulaziz , Brown Candace , Morgan Liz , Norful Allison A. , Sample Jason , Chen Chun-Cheng
Published: March 2023

BACKGROUND:

Marginalized groups experience a higher frequency of traumatic injury and are more likely to report negative experiences in the health care setting. Trauma center staff are prone to compassion fatigue, which impairs patient and clinician interactions for these groups. Forum theater (a form of interactive theater designed for addressing social issues) is proposed as an innovative method of exploring bias and has never been applied in the trauma setting.

OBJECTIVE:

This article aims to determine the feasibility of implementing forum theater as an adjunct to enhance clinician understanding of bias and its influence on communication between clinicians and trauma populations.

METHODS:

This is a descriptive qualitative analysis of adopting forum theater at a Level I trauma center in a New York City borough with a racially and ethnically diverse population. The implementation of a forum theater workshop was described, including our work with a theater company to address bias in the health care setting. Volunteer staff members and theater facilitators participated in an 8-hr workshop leading to a 2-hr multipart performance. Participant experiences were collected in a postsession debrief to understand the utility of forum theater.

RESULTS:

Debriefing sessions after forum theater performances demonstrated that forum theater is a more engaging and effective method for dialogue surrounding bias than personal past experiences with other educational models.

CONCLUSION:

Forum theater was feasible as a tool to enhance cultural competency and bias training. Future research will examine the impact it has on levels of staff empathy and its impact on participants' level of comfort communicating with diverse trauma populations.
An international telehealth experience in Guatemala
Authors: Lyerla Frank , Sobczak Bernadette , Jennings Greg
Published: March 2023

An increase in competition for nurse practitioner preceptors and United States–based clinical practicum sites along with an increase in required direct patient care clinical hours demand innovative methods for gaining valuable nurse practitioner clinical experiences. Involving nurse practitioner students in medical mission trips to low-resource countries and follow-up telehealth clinics have been beneficial for all involved. Guatemala is a developing country in Latin America that has a high rate of poverty, malnutrition, and a lack of health care. Annual medical mission trips are beneficial in meeting the health care needs of Guatemalans but lack the frequent follow-up necessary to promote a more sustained impact. A monthly telehealth program was established in a rural area of Guatemala to promote the continuity of care for children with malnutrition. This article discusses associated barriers, strategies to overcome those barriers, and the inclusion of nurse practitioner students to meet the needs of the Guatemalan children with malnutrition using a telehealth program.
An extensive evaluation of hepatic markers of damage and regeneration in controlled and uncontrolled donation after circulatory death
Authors: Basta Giuseppina , Melandro Fabio , Babboni Serena , Del Turco Serena , Ndreu Rudina , Torri Francesco , Martinelli Caterina , Silvestrini Beatrice , Peris Adriano , Lazzeri Chiara , Guarracino Fabio , Morganti Riccardo , Maremmani Paolo , Bertini Pietro , De Simone Paolo , Ghinolfi Davide
Published: March 2023

Livers from donations after circulatory death (DCDs) are very sensitive to ischemia/reperfusion injury and thus need careful reconditioning, such as normothermic regional perfusion (NRP). So far, its impact on DCDs has not been thoroughly investigated. This pilot cohort study aimed to explore the NRP impact on liver function by evaluating dynamic changes of circulating markers and hepatic gene expression in 9 uncontrolled DCDs (uDCDs) and 10 controlled DCDs. At NRP start, controlled DCDs had lower plasma levels of inflammatory and liver damage markers, including α-glutathione s-transferase, sorbitol-dehydrogenase, malate dehydrogenase 1, liver-type arginase-1, and keratin-18, but higher levels of osteopontin, sFas, flavin mononucleotide, and succinate than uDCDs. During 4-hour NRP, some damage and inflammatory markers increased in both groups, while IL-6, HGF, and osteopontin increased only in uDCDs. At the NRP end, the tissue expression of early transcriptional regulators, apoptosis, and autophagy mediators was higher in uDCDs than in controlled DCDs. In conclusion, despite initial differences in liver damage biomarkers, the uDCD group was characterized by a major gene expression of regenerative and repair factors after the NRP procedure. Correlative analysis among circulating/tissue biomarkers and the tissue congestion/necrosis degree revealed new potential candidate biomarkers.
Subjective Toxicity Profiles of Children With Cancer During Treatment
Authors: Ruan Haishan , Sun Jiwen , Zhao Kangjia , He Mengxue , Yuan Changrong , Fu Lijuan , Shen Nanping
Published: March 2023

Background

Children and adolescents may experience a variety of subjective adverse events (AEs) caused by cancer treatment. The identification of distinct groups of patients is crucial for guiding symptomatic AE management interventions to prevent AEs from worsening.

Objective

The aim of this study was to identify subgroups of children with cancer experiencing similar patterns of subjective toxicities and evaluate differences among these subgroups in demographic and clinical characteristics.

Methods

A cross-sectional survey was conducted of 356 children in China with malignancies who received chemotherapy within the past 7 days using the pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. A latent class analysis (LCA) was conducted to identify subgroups of patients with distinct profiles of symptomatic AE occurrence.

Results

Nausea (54.5%), anorexia (53.4%), and headache (39.3%) were the top 3 AEs children experienced. Nearly all participants (97.8%) experienced ≥1 core AEs, and 30.3% experienced ≥5 AEs. The LCA results identified 3 subgroups (“high gastrotoxicity and low neurotoxicity” [53.2%], “moderate gastrotoxicity and high neurotoxicity” [23.6%], and “high gastrotoxicity and high neurotoxicity” [22.8%]). The subgroups were differentiated by monthly family per-capita income, time since diagnosis, and Karnofsky Performance Status score.

Conclusions

Children experienced multiple subjective toxicities during chemotherapy, especially gastrotoxicity and neurotoxicity. Heterogeneity was found in the LCA in the patients’ toxicities. The prevalence of toxicities could be distinguished by the children’s characteristics.

Implications for Practice

The results showing different subgroups in our study may assist clinical staff in focusing on patients with higher toxicities to provide effective interventions.
A Cross-sectional Study of Regret in Cancer Patients After Sharing Test Results for Pathogenic Germline Variants of Hereditary Cancers With Relatives
Authors: Fukuzaki Naomi , Kiyozumi Yoshimi , Higashigawa Satomi , Horiuchi Yasue , Matsubayashi Hiroyuki , Nishimura Seiichiro , Mori Keita , Notsu Akifumi , Suishu Izumi , Ohnami Sumiko , Kusuhara Masatoshi , Yamaguchi Ken , Doorenbos Ardith Z. , Takeda Yuko
Published: March 2023

Background

Research on whole genome/exome sequencing is increasing worldwide. However, challenges are emerging in relation to receiving germline pathogenic variant results and sharing them with relatives.

Objective

The aim of this study was to investigate the occurrence of and reasoning related to regret among patients with cancer who shared single-gene testing results and whole exome sequencing with family members.

Methods

This was a single-center, cross-sectional study. The Decision Regret Scale was administered, and descriptive questionnaires were used with 21 patients with cancer.

Results

Eight patients were classified as having no regret, 9 patients were classified as having mild regret, and 4 patients were classified as having moderate to strong regret. Reasons patients felt that sharing was the right decision included the following: to allow relatives and children to take preventive measures, the need for both parties to be aware of and ready for the hereditary transmission of cancer, and the need to be able to discuss the situation with others. On the other hand, some patients did not think it was a good decision to share the information because of the associated anxiety.

Conclusions

Regret over sharing test results for pathogenic germline variants of hereditary cancers with relatives tended to be low. The main reason was that patients believed that they were able to benefit others by sharing.

Implications for Practice

Healthcare professionals need to understand the postsharing perceptions and experiences of patients and support them throughout the sharing process.
Heterogeneity in HIV/STI Prevalence and Prevention Among the Partners of Transgender and Nonbinary People
Authors: Tordoff Diana M. , Minalga Brian , Perry Nicole Lynn , Gross Bennie , Khosropour Christine M. , Glick Sara N. , Barbee Lindley A. , Duerr Ann ,   the Seattle Trans and Nonbinary Sexual Health (STARS) Advisory Board
Published: March 2023

Background

Transgender and nonbinary (TNB) people are diverse in their sexual orientation and partnerships. We describe the epidemiology of HIV/STI prevalence and prevention utilization among the partners of TNB people in Washington State.

Methods

We pooled data from five 2017-2021 cross-sectional HIV surveillance data sources to generate a large sample of TNB people and cisgender people who had a TNB partner in the past year. We describe characteristics of recent partners of trans women, trans men, and nonbinary people and use Poisson regression to assess if having a TNB partner was associated with self-reported HIV/STIs prevalence, testing, and PrEP use.

Results

Our analysis included 360 trans women, 316 trans men, 963 nonbinary people, 2896 cis women, and 7540 cis men. Overall, 9% of sexual minority cis men, 13% of sexual minority cis women, and 36% of TNB participants reported having any TNB partners. There was significant heterogeneity in HIV/STI prevalence, testing, and PrEP use among the partners of TNB people by study participant gender and the gender of their sex partners. In regression models, having a TNB partner was associated with a higher likelihood of HIV/STI testing and PrEP use but was not associated with higher HIV prevalence.

Conclusions

We observed significant heterogeneity in HIV/STI prevalence and preventative behaviors among the partners of TNB people. Given that TNB people are diverse in their sexual partnerships, there is a need to better understand individual-, dyad-, and structural-level factors that facilitate HIV/STI prevention across these diverse partnerships.
Factors Associated With Rapid Linkage to HIV Medical Care Among Persons Newly Diagnosed With HIV Infection in the United States, 2019 to 2020
Authors: Song Wei , Mulatu Mesfin S.
Published: March 2023

Background

Rapid linkage to HIV medical care, ideally within 7 days of a person's diagnosis with HIV infection, is a vital strategy of the Ending the HIV Epidemic initiative in the United States. We analyzed HIV testing data to evaluate the prevalence of and factors associated with rapid linkage to HIV medical care.

Methods

We used HIV testing data reported by Centers for Disease Control and Prevention–funded 60 state and local health departments and 29 community-based organizations from 2019 to 2020. Variables analyzed include rapid linkage to HIV medical care (within 7 days of diagnosis), demographic/population characteristics, geographic region, test site type, and test year. Multivariable Poisson regression analysis was conducted to evaluate the characteristics associated with rapid linkage to HIV medical care.

Results

A total of 3,678,070 HIV tests were conducted, and 11,337 persons were newly diagnosed with HIV infection. Only 4710 persons (41.5%) received rapid linkage to HIV medical care, which was more likely among men who have sex with men or persons who were diagnosed in Phase I Ending the HIV Epidemic jurisdictions and less likely among persons diagnosed in sexually transmitted disease clinics or the South region.

Conclusions

Less than one-half of persons newly diagnosed with HIV infection in Centers for Disease Control and Prevention–funded HIV testing programs were linked to HIV medical care within 7 days of diagnosis. Rapid linkage to care varied significantly by population characteristics and setting. Identifying and removing potential individual, social, or structural barriers to rapid linkage to care can help improve HIV-related health equity and contribute to the national goal of ending the HIV epidemic.
Timeline and Incidence of Postoperative Complications in Prepectoral, Dual-Plane, and Total Submuscular Alloplastic Reconstruction With and Without Biosynthetic Scaffold Usage
Authors: Chen Yunchan , Wang Marcos Lu , Black Grant G. , Bernstein Jaime L. , Chinta Malini , Otterburn David M.
Published: March 2023

Introduction

Acellular dermal matrices and synthetic meshes are commonly used to improve inframammary-fold definition, minimize muscle excision, and allow for greater control over the surgical technique in implant-based breast reconstruction. The aims of this study are to compare various combinations of placement planes and biosynthetic scaffolds and to further examine the respective incidences of postoperative complications and the timeline of capsular contracture development.

Methods

A data set consisting of 220 patients (393 samples) who underwent 2-stage reconstruction between 2012 and 2021 was used in the study. χ2, Fisher exact test, and 1-way analysis of variance were used to identify significant differences between the 4 subgroups. Cox proportional-hazards model and Kaplan-Meier estimator were used for survival analysis.

Results

On univariate logistic regression (odds ratio, 0.21; P = 0.005), survival analysis (P = 0.0082), and Cox-proportional hazard model (hazard ratio, 1.6; P = 0.01), poly-4-hydroxybutyrate mesh usage was linked to an increased risk of capsular contracture development. Prepectoral placement with no mesh and dual-plane placement with acellular dermal matrix showed similar timelines of capsular contracture development. The lowest incidences of capsular contracture occurred in the prepectoral placement and no mesh (49/161, 30.4%) and total submuscular subgroups (3/14, 21.4%). Infection, necrosis, and revision surgery rates did not differ significantly between the 4 groups.

Conclusions

The use of poly-4-hydroxybutyrate mesh in 2-stage breast reconstruction is correlated with a statistically significant increase in capsular contracture. Prepectoral placement with no biosynthetic scaffold had one of the lowest rates of contracture and may provide the most optimal balance between economic and clinical considerations in implant-based reconstruction.
The Impact of Socioeconomic Factors on the 2022 Plastic Surgery Match
Authors: Girard Alisa O. , Lopez Christopher D. , Khoo Kimberly H. , Lake Isabel V. , Yusuf Cynthia T. , Lopez Joseph , Redett Richard J. , Yang Robin
Published: March 2023

Background

In 2022, the plastic and reconstructive surgery (PRS) match faced unprecedented system-wide transitions that have redefined conventional measures of applicant success. This challenges the equitable assessment of student competitiveness and diversity in the field.

Methods

A survey of demography, application content, and 2022 match outcomes was distributed to applicants to a single PRS residency program. Comparative statistics and regression models were performed to assess the predictive value of factors in match success and quality.

Results

A total of 151 respondents (response rate 49.7%) were analyzed. Although step 1 and step 2 CK scores were significantly higher among matched applicants, neither examination predicted match success. Most respondents (52.3%) were women, although gender was also not significantly associated with match success. Underrepresented in medicine applicants made up 19.2% of responses and 16.7% of matches, and the plurality of respondents (22.5%) were raised with a household income ≥$300,000. Both Black race and household income ≤$100,000 were associated with lower odds of scoring above a 240 on either step 1 or step 2 CK (Black: OR, 0.03 and 0.06; P < 0.05 and P < 0.001; income: OR, 0.07–0.47 and 0.1 to 0.8, among income subgroups), receiving interview offers (OR, −9.4; P < 0.05; OR, −11.0 to −5.4), and matching into PRS (OR, 0.2; P < 0.05; OR, 0.2 to 0.5), compared with White and high-income applicants, respectively.

Conclusions

Systemic inequities in the match process disadvantage underrepresented in medicine candidates and those from lower household incomes. As the residency match continues to evolve, programs must understand and mitigate the impacts of bias in various application components.
A Study on Breast Augmentation Using Fat Grafting With Stromal Vascular Fraction
Authors: Shin Dong-Jin
Published: March 2023

Background

Stromal vascular fraction (SVF) and fat grafting are emerging alternatives to implants for breast augmentation. However, the lack of controlled clinical data has led to conflicting results regarding the effectiveness of surgical treatments. This study aimed to identify the key factors affecting the outcomes of fat grafting with SVF and to recognize novel methods to improve the retention rate.

Patients and Methods

In total, 384 women underwent breast augmentation using fat grafting with SVF. The patients were preoperatively and postoperatively managed and recalled for follow-up at 3, 6, and 18 months.

Results

The average volume of the injection in the left breast was 162.35 mL (range, 50–260 mL). The postoperative retention rates were 78.65% in 384 patients at 3 months, 77.17% in 273 patients at 6 months, and 77.48% in 102 patients at 18 months. The retention rates were compared based on the number of SVF cells; patients with more than 60 million cells had a retention rate of 70.77%, and those with less than 60 million cells had a retention rate of 85.60% at 18 months. The retention rates at the 18-month follow-up were 65.62% and 85.09% in stiff and soft breasts, respectively. A higher number of cells in the SVF was associated with a greater retention volume, and the retention volume was greater in patients with soft breasts.

Given the higher use of the right arm, after 18 months of the surgery, the retention rate of the right breast (60.35%) was lower than that of the left breast (77.48%) (P < 0.05; t = −13.199).

Conclusions

Limiting arm movement, increasing the number of cells in the SVF, and improving the skin tension might enhance the retention rate in patients undergoing breast augmentation.
Posterior Cranial Retraction Combined With Bilateral Parietal Distraction for Children With Nonsyndromic Craniosynostosis
Authors: Shen Weimin , Ji Yi , Cui Jie , Chen Jianbing , Kong Liangliang
Published: March 2023

Background

The nonsyndromic craniosynostosis is the most common of craniosynostoses in childhood. There are many treatments. We aim to treat 12 cases of nonsyndromic craniosynostosis via posterior cranial vault distraction osteogenesis combined with bilateral parietal distraction.

Methods

Data of a total of 12 patients (7 boys and 5 girls) with nonsyndromic sagittal synostosis who underwent distraction osteogenesis between January 2015 and August 2020 were retrospectively analyzed. Bilateral parietal bone flaps and posterior occipital flaps were designed and cut. Then, distraction device was placed, which was distracted at 5 days after surgery (twice per day, 0.4–0.6 mm/d, and lasting for 10–15 days). After 6 months of fixation, the secondary surgery was performed to remove the device.

Results

The scaphocephaly was corrected, and the appearance was satisfactory. Postoperative follow-up time was 6 to 14 months, with an average of 10 months, and the mean CI was 63.2 and 78.25 before and after surgery, respectively; the mean anterior-posterior skull diameter was shortened (12.63 ± 3.47) mm, the transverse diameter of both temporal regions was lengthened (15.4 ± 4.18) mm, and the scaphocephalic deformity was significantly improved. There was no detachment or rupture of the extender postoperatively. No severe complications, such as radiation necrosis or intracranial infection, were observed.

Conclusion

Posterior cranial retraction combined with bilateral parietal distraction in children with nonsyndromic craniosynostosis, in which the proposed technique did not exhibit severe complications, and it is worthy of further promotion and application in clinical practice.
Soft Tissue Reconstruction Using the Free Forearm Fillet Flap in the Salvage of Forequarter Amputations for Recurrent Sarcoma
Authors: Arikawa Masaki , Akazawa Satoshi , Kageyama Daisuke , Kawai Akira , Miyamoto Shimpei
Published: March 2023

Reconstruction after radical forequarter amputation for recurrent proximal extremity sarcoma is challenging because the defect is significant, and the axillary or subclavian vessels are resected with the tumor, indicating that the pedicle of nearby flaps is often cut off. Free flaps are commonly used to cover the defect, but the donor site morbidity is problematic. Another problem with resecting the axillary or subclavian vessels is difficulty obtaining recipient vessels with matching calibers for another free flap. The authors presented 2 cases that successfully solved all these problems by covering the defects by the forearm fillet flaps.

The forearm fillet flap has the advantage of using a portion that is usually discarded, so there is no donor site morbidity. Moreover, using the brachial artery as the pedicle of the flap allows the anastomosis to the stump of the resected axillary or subclavian artery because differences in caliber are slight.

The use of the forearm fillet flaps has been reported less frequently than the fillet flaps in the lower extremities, and most cases are posttraumatic. In cases of trauma, complications are reported to occur in about 1 in 4 patients, but in cases after tumor resection, ischemic time can be controlled, and there are no risks of contamination or unnoticed forearm damage, so more stable results can be expected as in this report.

Using the free flap from the distal portion of the resected upper limb, especially in cases with a short prognosis, is a viable option that effectively minimizes damage to the donor site and maintains quality of life.
An Evolution of the Surgical Management of Synpolydactyly
Authors: Xu Wen , Graham Emily M. , Shubinets Valeriy , Mendenhall Shaun D. , Chang Benjamin , Lin Ines C.
Published: March 2023

Introduction

Synpolydactyly is a rare congenital anomaly characterized by syndactyly and polydactyly in the central hand. Limited treatment guidelines exist for this complex condition.

Methods

A retrospective review of synpolydactyly patients was conducted at a large, tertiary pediatric referral center to describe our surgical experience and evolution of management. The Wall classification system was used to categorize cases.

Results

Eleven patients (21 hands) with synpolydactyly were identified. Most of the patients were White and had at least one first-degree relative who also had synpolydactyly. The Wall classification yielded the following results: 7 type 1A hands, 4 type 2B hands, 6 type 3 hands, and 4 uncategorizable hands. Each patient had an average of 2.6 surgeries and an average follow-up time of 5.2 years. The rates of postoperative angulation and flexion deformities were 24% and 38%, respectively, with many of these cases also demonstrating preoperative alignment abnormalities. These cases often required additional surgeries including osteotomies, capsulectomies, and/or soft tissue releases. The rate of web creep was 14% with 2 of these patients requiring revision surgery. Despite these findings, at the time of final follow-up, most patients had favorable functional outcomes, were able to engage in bimanual tasks, and were able to perform activities of daily living independently.

Conclusions

Synpolydactyly is a rare congenital hand anomaly with a significant degree of variability in clinical presentation. The rates of angulation and flexion deformities as well as web creep are not insignificant. We have learned to prioritize correcting contractures, angulation deformities, and skin fusion, over simply trying to delete the “extra” number of bones as this may destabilize the digit(s).
Comprehensive Reconstructive Care for Patients of All Gender Identities After Cancer of the Breast
Authors: Bagwell Alexis K. , Nauta Allison C. , Peters Blair R.
Published: March 2023

Breast cancer can affect anyone; therefore, it affects people of all gender identities. Reconstructive options after breast cancer must then address the needs of all people. Our institution is unique in its provision of both high-level comprehensive breast and gender affirmation care. In our practice, patients have expressed gender diverse identities during their breast cancer reconstructive journey. In these cases, goals have deviated from traditional breast restoration, gravitating toward gender-affirming mastectomy, or results often seen with “top surgery.” We present a framework for the administration of breast cancer care and discussions of reconstruction from a lens of gender inclusivity. Breast cancer is a diagnosis that has been gendered, resulting in the erasure and exclusion of reconstructive needs for people affected by breast cancer that are not cisgender women. This is illustrated through the case of a nonbinary individual seen in breast cancer clinic for multifocal ductal carcinoma in situ. Our standard review of options of “going flat,” implant-based reconstruction, and autologous reconstruction led to initial confusion given their early exploration of gender identity co-occurring with a new diagnosis of breast cancer. These scenarios can be challenging when viewed solely from the perspective of a breast reconstructive surgeon or a gender-affirming surgeon alone. Both perspectives are often needed. Our gender-affirming and breast reconstructive teams have discussed methods to identify patients who require more robust discussion of gender identity and reconstructive options in the setting of breast cancer, such as chest masculinization. By adding gender-affirming surgeons to the list of providers available to counsel breast cancer patients, we may be able to better provide early education on all reconstructive options and appropriately address the needs of transgender and gender diverse people affected by breast cancer.
Morphological Studies to Identify the Nasopalatine and Inferior Alveolar Nerve Using a Special Head and Neck MRI Coil
Authors: Grandoch Andrea , Oeser Julia , Zöller Joachim E. , Große Hokamp Nils , Lichtenstein Thorsten , Neugebauer Jörg
Published: March 2023

Objectives:

Procedures in oral and maxillofacial surgery bear a high risk of nerve damage. Three-dimensional imaging techniques can optimize surgical planning and help to spare nerves. The aim of this study was to investigate the diagnostic value of a 1.5Tmagnetic resonance imaging (MRI) scanner with a dedicated dental signal amplification coil for the assessment of nerves in the oral cavity as compared with cone beam computed tomography (CBCT).

Methods:

Based on 6 predefined criteria, the assessability of the inferior alveolar and nasopalatine nerves in CBCT and MRI with a dedicated 4-channel dental coil were compared in 24 patients.

Results:

Compared with CBCT, MRI with the dental coil showed significantly better evaluability of the inferior alveolar nerve in the sagittal and axial plane and the nasopalatine nerve in the axial plane. In the sagittal plane; however, the assessability of the nasopalatine nerve was significantly better in CBCT as compared with MRI. Yet, pertaining to overall assessability, no significant differences between modalities were found.

Conclusions:

In this pilot study, it can be reported that 1.5-TMRI with a dedicated dental coil is at least equivalent, if not superior, to CBCT in imaging nerve structures of the stomatognathic system.

Clinical Relevance:

Preoperative, 3-dimensional images are known to simplify and refine the planning and execution of operations in maxillofacial surgery. In contrast to computed tomography and CBCT, MRI does not cause radiation exposure while enabling visualization of all relevant hard and soft tissues and, therefore, holds an advantage over well-established techniques.
Bias in the trauma bay: A multicenter qualitative study on team communication
Authors: Bankhead Brittany K. , Bichard Shannon L. , Seltzer Trent , Thompson Lisa A. , Chambers Barbie , Davis Bayli , Knowlton Lisa M. , Tatebe Leah C. , Vella Michael A. , Dumas Ryan P.
Published: March 2023

BACKGROUND

Team communication and bias in and out of the operating room have been shown to impact patient outcomes. Limited data exist regarding the impact of communication bias during trauma resuscitation and multidisciplinary team performance on patient outcomes. We sought to characterize bias in communication among health care clinicians during trauma resuscitations.

METHODS

Participation from multidisciplinary trauma team members (emergency medicine and surgery faculty, residents, nurses, medical students, emergency medical services personnel) was solicited from verified level 1 trauma centers. Comprehensive semistructured interviews were conducted and recorded for analysis; sample size was determined by saturation. Interviews were led by a team of doctorate communications experts. Central themes regarding bias were identified using Leximancer analytic software (Leximancer Pty Ltd., Brisbane, Australia).

RESULTS

Interviews with 40 team members (54% female, 82% White) from 5 geographically diverse Level 1 trauma centers were conducted. More than 14,000 words were analyzed. Statements regarding bias were analyzed and revealed a consensus that multiple forms of communication bias are present in the trauma bay. The presence of bias is primarily related to sex but was also influenced by race, experience, and occasionally the leader's age, weight, and height. The most commonly described targets of bias were females and non-White providers unfamiliar to the rest of the trauma team. Most common sources of bias were White male surgeons, female nurses, and nonhospital staff. Participants perceived bias being unconscious but affecting patient care.

CONCLUSION

Bias in the trauma bay is a barrier to effective team communication. Identification of common targets and sources of biases may lead to more effective communication and workflow in the trauma bay.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
Effects of exercise and bryostatin-1 on functional recovery and posttranslational modification in the perilesional cortex after cerebral infarction
Authors: Mizutani Kenmei , Sonoda Shigeru , Wakita Hideaki , Takahashi Yu
Published: March 2023

Strokes can cause a variety of sequelae, such as paralysis, particularly in the early stages after stroke onset. Rehabilitation therapy atthis time often provides some degree of paralysis recovery. Neuroplasticity in the peri-infarcted cerebral cortex induced by exercise training may contribute to recovery of paralysis after cerebral infarction. However, the molecular mechanism of this process remains unclear. This study focused on brain protein kinase C (PKC), which is speculated to be involved in neuroplasticity. We evaluated the functional recovery of cerebral infarction model rats, by using rotarod test after running wheel training and with/without administration of bryostatin, a PKC activator. In addition, the expression of phosphorylated and unphosphorylated PKC subtypes, glycogen synthase kinase 3β (GSK3β), and collapsin response-mediator proteins 2 (CRMP2) were analyzed by Western blotting. In the rotarod test, bryostatin administration alone had no effect on gait duration, but the combination of training and this drug significantly prolonged gait duration compared with training alone. In protein expression analysis, the combination of training and bryostatin significantly increased phosphorylation of PKCα and PKCε isoforms, increased phosphorylation of GSK3β, which acts downstream of PKC, and decreased phosphorylation of CRMP2. The effect of bryostatin in combination with training appears to be mediated via PKC phosphorylation, with effects on functional recovery occurring through the downstream regulation of GSK3β and CRMP2 phosphorylation.
Xenon attenuates hypoxic-ischemic brain damage by inhibiting autophagy in neonatal rats
Authors: Sun Mengya , An Zengyue , Wei Hongli , Li Ting , Qin Miao , Liu Yan , Jiang Hong
Published: March 2023

Xenon (Xe) is an inert, colorless and odorless heavy gas and has many biological functions. However, little is known about whether and how Xe can modulate hypoxic-ischemic brain damage (HIBD) in neonatal rats. This study employed a neonatal rat model to explore the potential effect of Xe on neuron autophagy and the severity of HIBD. Neonatal Sprague–Dawley rats were subjected to HIBD, randomized and treated with Xe or mild hypothermia (at 32 °C) for 3 h. The degrees of HIBD, neuron autophagy and the neuronal functions in some neonates from each group were tested by histopathology, immunochemistry, transmission electron microscopy, western blot, open-field and Trapeze tests at 3 and 28 days post-induction of HIBD, respectively. Compared with the Sham group, hypoxic-ischemia caused larger volumes of cerebral infarction and severe brain damage, and increased autophagosome formation and Beclin-1 and microtubule-associated protein 1A/1B-light chain 3 class II (LC3-II) expression in the brain of rats, accompanied by the defect in neuronal functions. In contrast, treatment with Xe and/or hypothermia significantly reduced infarct volumes and ameliorated neurological defects in the HIBD rats, particularly for the combination of Xe and hypothermia. Xe significantly mitigated the relative levels of Beclin-1 and LC3-II expression and autophagosome formation induced by HIBD in rats. Xe acted as a neuroprotective factor against HIBD, possibly by inhibiting the hypoxia-induced neuron autophagy in rats.