bluuebunny/crossref_metadata_2025 huggingface dataset:
Removal of Woody Debris from Logging Gaps Influences Soil Physical and Chemical Properties in the Short Term: A Case Study in Central Amazonia
Authors: Trindade Alex de Sousa , Ferraz João Baptista Silva , DeArmond Daniel
Published: November 2021

Generally, woody residues generated from logging remain on site, although recently, forest managers have been harvesting this material for energy generation. We evaluated the impact on an Oxisol’s physical and chemical properties after removal of residues (coarse woody debris, CWD) from logging-created gaps. The logging operations occurred on private timberland in the Central Amazon. Eighteen months after creation of the gaps, soil samples were taken up to 150 cm depth in each treatment: mature undisturbed forest (FOR), gaps with residues retained on site (RET), and gaps with removal of large branches greater than 10 cm in diameter that were from logging (REM). Clay content, up to 20 cm depth, was higher in RET and REM soils than in FOR soils. Soil bulk density values increased progressively from areas of FOR to RET and REM at 0–5 cm. The highest carbon and nutrient contents were observed in the 0–5 and 5–10 cm soil layers of RET. In the 10–30 cm depth, the contents of all nutrients, except phosphorus, were higher in REM soils. According to these short-term results, it is not possible to affirm categorically that the removal of CWD has a negative impact on the nutrient status of soils in gaps created by logging operations.
Orthogonal CRISPR-Cas tools for genome editing, inhibition, and CRISPR recording in zebrafish embryos
Authors: Takasugi Paige R , Wang Shengzhou , Truong Kimberly T , Drage Evan P , Kanishka Sahar N , Higbee Marissa A , Bamidele Nathan , Ojelabi Ogooluwa , Sontheimer Erik J , Gagnon James A
Published: November 2021

The clustered regularly interspaced short palindromic repeats (CRISPR)-Cas universe continues to expand. The type II CRISPR-Cas system from Streptococcus pyogenes (SpyCas9) is the most widely used for genome editing due to its high efficiency in cells and organisms. However, concentrating on a single CRISPR-Cas system imposes limits on target selection and multiplexed genome engineering. We hypothesized that CRISPR-Cas systems originating from different bacterial species could operate simultaneously and independently due to their distinct single-guide RNAs (sgRNAs) or CRISPR-RNAs (crRNAs), and protospacer adjacent motifs (PAMs). Additionally, we hypothesized that CRISPR-Cas activity in zebrafish could be regulated through the expression of inhibitory anti-CRISPR (Acr) proteins. Here, we use a simple mutagenesis approach to demonstrate that CRISPR-Cas systems from S. pyogenes (SpyCas9), Streptococcus aureus (SauCas9), Lachnospiraceae bacterium (LbaCas12a, previously known as LbCpf1) are orthogonal systems capable of operating simultaneously in zebrafish. CRISPR systems from Acidaminococcus sp. (AspCas12a, previously known as AsCpf1) and Neisseria meningitidis (Nme2Cas9) were also active in embryos. We implemented multichannel CRISPR recording using three CRISPR systems and show that LbaCas12a may provide superior information density compared with previous methods. We also demonstrate that type II Acrs (anti-CRISPRs) are effective inhibitors of SpyCas9 in zebrafish. Our results indicate that at least five CRISPR-Cas systems and two anti-CRISPR proteins are functional in zebrafish embryos. These orthogonal CRISPR-Cas systems and Acr proteins will enable combinatorial and intersectional strategies for spatiotemporal control of genome editing and genetic recording in animals.
Regional Gray Matter Volume Changes in Brains of Patients With Ulcerative Colitis
Authors: Zhang Shuming , Chen Fenrong , Wu Jiayu , Liu Chengxiang , Yang Guang , Piao Ruiqing , Geng Bowen , Xu Ke , Liu Peng
Published: November 2021

Background

Ulcerative colitis (UC) and Crohn’s disease (CD) are 2 subtypes of inflammatory bowel disease (IBD). Several studies have reported brain abnormalities in IBD patients. This study aims to identify differences of gray matter volume (GMV) between patients with UC and healthy controls (HCs).

Methods

Fifty-seven patients with UC and 40 HCs underwent structural magnetic resonance imaging. Voxel-based morphometry method was used to detect GMV differences. Receiver operating characteristic (ROC) curve was applied to investigate reliable biomarkers for identifying patients with UC from HCs. Regression analysis was used to examine relationships between the structure alternations and clinical symptoms.

Results

Compared with HCs, patients with UC showed decreased GMV in the insula, thalamus, pregenual anterior cingulate cortex, hippocampus/parahippocampus, amygdala, and temporal pole; they showed increased GMV in the putamen, supplementary motor area, periaqueductal gray, hypothalamus, and precentral gyrus. Receiver operating characteristic analysis showed the highest classification power of thalamus. The inclusion of anxiety and depression as covariates eliminated the differences in the right insula, pregenual anterior cingulate cortex, supplementary motor area, and precentral gyrus. Most of the GMV changes were found in active patients with UC, with few changes in patients with UC in remission. We also found significantly negative correlation between UC duration and GMV in several regions.

Conclusion

The current neuroimaging findings were involved in visceral sensory pathways and were partially associated with the levels of anxiety and depression and clinical stage of patients with UC. This study might provide evidence for possible neuromechanisms of UC.
Diffusion and Decentralized Bargaining in International Organizations: Evidence from Mercosur's Dispute Settlement Mechanism
Authors: Lenz Tobias
Published: November 2021

How and with what effects do institutions diffuse between international organizations (IOs)? An emerging literature extends a key insight of the study of diffusion processes among states to the international level, establishing that the adoption of institutions in IOs is regularly conditioned by the choices of other IOs. Yet, this literature neglects a key contextual difference between the two settings: unlike in the hierarchically structured organizations that have dominated the literature on diffusion, institutional creation, and change in IOs are the result of decentralized bargaining among sovereign governments. This paper develops a heuristic model that shows how diffusion between IOs shapes decision-making within them through its impact on the institutional preferences of individual governments. The model establishes that, unlike in diffusion processes among states, convergence is an unlikely outcome of diffusion between IOs. By implication, studies that take institutional convergence as their starting point are likely to underestimate the pervasiveness of diffusion effects. I demonstrate these arguments with a case study of the establishment of a regional dispute settlement system in Mercosur, a regional organization in Latin America.
The Effect of Pension Subsidies on the Retirement Timing of Older Women
Authors: Ye Han
Published: November 2021

I estimate the effect of additional pension benefits on women’s retirement decisions by examining a German pension subsidy program. The subsidies have a kinked relationship with the recipients’ past pension contributions, creating a sharply different slope of benefits for similar women on either side of the kink point. I find that a 100 euro increase in the monthly benefit induces female recipients to claim their pensions six months earlier. Recipients also adjust their labor supply by using unemployment insurance as a stepping stone to retirement and by reducing the time spent in marginal employment. A back-of-the-envelope calculation suggests that the ratio of behavioral to mechanical costs for this subsidy program is 0.25, which is smaller than that of many other income support programs. (JEL: H55, J18, J21, J26)
Curvularia alcornii Aortic Pseudoaneurysm Following Aortic Valve Replacement: Case Report and Review of the Literature
Authors: Narayanasamy Shanti , Williams Adam R , Schell Wiley A , Moehring Rebekah W , Alexander Barbara D , Le Thuy , Bharadwaj Ramesh A , McGauvran Michelle , Schroder Jacob N , Perfect John R
Published: November 2021

We report the first case of Curvularia alcornii aortic pseudoaneurysm following bioprosthetic aortic valve replacement in an immunocompetent host. Infection was complicated by septic emboli to multiple organs. Despite aggressive surgical intervention and antifungal therapy, infection progressed. We review the literature on invasive Curvularia infection to inform diagnosis and management.
Bamlanivimab Efficacy in Older and High-BMI Outpatients With COVID-19 Selected for Treatment in a Lottery-Based Allocation Process
Authors: Rubin Emily B , Boiarsky Jonathan A , Canha Lauren A , Giobbie-Hurder Anita , Liu Mofei , Townsend Matthew J , Dougan Michael
Published: November 2021

Background

Given the challenges associated with timely delivery of monoclonal antibody (mAb) therapy to outpatients with coronavirus disease 2019 (COVID-19) who are most likely to benefit, it is critical to understand the effectiveness of such therapy outside the context of clinical trials.

Methods

This was a case–control study of 1257 adult outpatients with COVID-19, ≥65 years of age or with body mass index (BMI) ≥35, who were entered into a lottery for mAb therapy.

Results

Patients who were called to be offered mAb therapy had a statistically significant 44% reduction in the odds of hospitalization within 30 days of a positive severe acute respiratory syndrome coronavirus 2 test compared with those who were not called (odds ratio [OR], 0.56; 95% CI, 0.36–0.89; P=.01). Patients who actually received bamlanivimab had a statistically significant 68% reduction in the odds of hospitalization compared with those who did not receive bamlanivimab (OR, 0.32; 95% CI, 0.11–0.93; P=.04).

Conclusions

This study supports the effectiveness of bamlanivimab in reducing COVID-19-related hospitalizations in patients ≥65 or with BMI ≥35.
Differential Symptom Development and Viral RNA Loads in 10 Nicotiana benthamiana Accessions Infected with the Tobamovirus Yellow Tailflower Mild Mottle Virus
Authors: Xu Weinan , Guo Yuxia , Li Hua , Sivasithamparam Krishnapillai , Jones Michael G. K. , Chen Xin , Wylie Stephen J.
Published: November 2021

Yellow tailflower mild mottle virus (YTMMV, genus Tobamovirus) was identified from wild plants of solanaceous species in Australia. Nicotiana benthamiana is a species indigenous to the arid north of Australia. N. benthamiana accession RA-4 (the lab type), which has a mutant, functionally defective, RNA-dependent RNA polymerase 1 (Rdr1) gene (Nb-Rdr1m), has played a significant role in plant virology, but little study has been done regarding responses to virus infection by other accessions of N. benthamiana. All wild-collected N. benthamiana accessions used in this study harbored wild-type Rdr1 genes (Nb-Rdr1). We compared symptoms of YTMMV infection and viral RNA load on RA-4 and nine wild-collected accessions of N. benthamiana from mainland Western Australia, an island, and the Northern Territory. After inoculation with YTMMV, RA-4 plants responded with systemic hypersensitivity and all individuals were dead 35 days postinoculation (dpi). Plants of wild-collected accessions exhibited a range of symptoms, from mild to severe, and some, but not all, died in the same period. Quantitative reverse transcription PCR revealed that the Rdr1 mutation was not a predictor of viral RNA load or symptom severity. For example, wild-collected A019412 plants carried more than twice the viral RNA load of RA-4 plants, but symptom expression was moderate. For plants of most accessions, viral RNA load did not increase after 10 dpi. The exception was plants of accession Barrow-1, in which viral RNA load was low until 15 dpi, after which it increased more than 29-fold. This study revealed differential responses by N. benthamiana accessions to infection by an isolate of YTMMV. The Rdr1 gene, whether mutant or wild-type, did not appear to influence viral RNA load or disease expression. Genetic diversity of the 10 N. benthamiana accessions in some cases reflected geographical location, but in other accessions this was not so.
Evaluation of Maize Hybrids for Identifying Resistance to Northern Corn Leaf Blight in Northeast China
Authors: Ma Zhoujie , Hui Hongyan , Huang Yufei , Yao Yuan , Sun Yangqiu , Liu Bo , Gao Zenggui
Published: November 2021

Northern corn leaf blight (NCLB) caused by Setosphaeria turcica is one of the most devastating foliar diseases in maize (Zea mays L.), resulting in great economic losses worldwide. The mutation of the pathogen exacerbates the occurrence and harmfulness of NCLB in China. Therefore, there is an urgent need for evaluating and cultivating resistant hybrids. Here, the response of 239 maize hybrids approved in Northeast China to NCLB was evaluated during 2019 and 2020. The results showed that 92 (38.49%) and 75 (31.38%) hybrids were rated as moderately resistant and resistant, respectively, which together constituted the predominant resistant categories. We observed that maize hybrids from different certified sources had different levels of resistance to NCLB, whose disease parameter values varied significantly (P < 0.05) among 52 main cultivated hybrids. In 2019 and 2020, the average size of the lesions increased from 21.02 to 21.06 cm2, the average lesion density decreased from 1.36 to 1.33 lesions/100 cm2, and more than 30% of the hybrids registered final disease severity scores between 10 and 30%. The area under the disease progress curve of the main cultivated hybrids ranged from 57.96 to 986.86 cm2 in 2019 and from 50.75 to 1,028.65 cm2 in 2020. Correlation analysis revealed a significant relationship (P < 0.0001) among four disease parameters. Current research has shown that many maize hybrids in Northeast China are resistant to NCLB, suggesting that the large-scale cultivation of susceptible hybrids has led to the occurrence and prevalence of the disease. This study should assist growers in purposefully selecting resistant commercial hybrids to contribute to the management of NCLB.
Learners With Disabilities: An Important Component of Diversity, Equity, and Inclusion in Medical Education
Authors: Golden Robert N. , Petty Elizabeth M.
Published: November 2021

The population of people with physical or sensory disabilities is growing, yet they are underrepresented in the medical and other health professions. At the same time, there is a clear need to enhance didactic curricular content and clinical training experiences that explicitly address the full scope of medical needs that individuals with disabilities have. These gaps represent missed opportunities to advance the health of an important, underserved, and growing population. Based on the authors’ experience, the inclusion of people with physical or sensory disabilities in medical education greatly enhances the education of all learners and the professional development of faculty and staff, providing invaluable perspectives on the significant abilities of individuals with diverse physical or sensory disabilities. There are additional efforts and costs associated with the education of a medical student who is blind, is deaf, uses a wheelchair, or has another disability. But based on the authors’ experience, it is clear that the societal return on investment is enormous, and the costs associated with a failure to embrace full inclusivity are much greater. Medical education institutions should recognize the population of people with disabilities as a vital component of their commitment to diversity, equity, and inclusion and strive to provide inclusive education for learners with disabilities.
Reimbursement for Female-Specific Compared With Male-Specific Procedures Over Time
Authors: Polan Rosa M. , Barber Emma L.
Published: November 2021

OBJECTIVE:

To evaluate whether per-procedure work relative value units (RVUs) have changed over time and to compare time-based compensation for female-specific procedures compared with male-specific procedures.

METHODS:

Using the National Surgical Quality Improvement Program files for 2015–2018, we compared operative time and RVUs for 12 pairs of sex-specific procedures. Procedures were matched to be anatomically and technically similar. Procedure-assigned RVUs in 2015 were compared with 1997. Procedure compensation was determined using median dollars per RVU provided in SullivanCotter's 2018 Physician Compensation and Productivity Survey. This was compared with specialty-specific McGraw-Hill per-RVU data from 1994. Statistical analysis was performed with chi-square and Kruskal-Wallis tests.

RESULTS:

A total of 12,120 patients underwent 6,217 male-specific procedures and 5,903 female-specific procedures. Male-specific procedures had a median (interquartile range) RVU of 25.2 (21.4–25.2), compared with 7.5 (7.5–23.4) for female-specific procedures (P<.001). Male-specific procedures were 79 minutes longer (median [interquartile range] 136 minutes [98–186] vs 57 minutes [25–125], P<.001). Female-specific procedures were reimbursed at a higher hourly rate (10.6 RVU/hour [7.2–16.2] vs 9.7 RVU/hour [7.4–12.8], P<.001). However, male-specific procedures were better reimbursed ($599/h [$457–790] vs $555/h [$377–843], P<.001). Overall, per-procedure RVUs for male-specific surgeries have increased 13%, whereas, for female-specific surgeries, per-procedure RVUs have increased 26%. Reimbursement per RVU for male-specific procedures has decreased 8% ($67.30 to $61.65), whereas for female-specific procedures it has increased 14% ($44.50 to $52.02).

CONCLUSION:

Increases in RVUs and specialty-specific compensation have resulted in more equitable reimbursement for female-specific procedures. However, even with these changes, there is a lower relative value of work, driven by specialty-specific compensation rates, for procedures performed for women-only compared with equivalent men-only procedures.
Technical Note on Placement of Low-Profile Triangular Osteosynthesis for Unstable Posterior Pelvic Ring Injuries
Authors: Steelman Kevin , Bray Ryan , Vaidya Rahul
Published: November 2021

Triangular osteosynthesis is a technique used to stabilize posterior pelvic ring injuries. Conventional triangular fixation can be problematic for several reasons, including the need for advanced skill sets to place instrumentation, difficulty with pelvic reduction and placing the connecting construct, and prominent instrumentation. The purpose of this study is 2-fold: (1) to describe in detail a technique for lumbopelvic fixation using implants that are easy to connect, allow distraction for complex lumbosacral displacements, and are placed in a location minimizing soft tissue prominence and (2) to present our initial case series using this technique. We present a retrospective review of 18 consecutively treated patients with this technique. Inclusion criteria were patients with complete disruption through the sacrum or sacroiliac joint from blunt trauma (OTA/AO type C injuries). Outcomes included pelvic reduction/malreduction, wound healing, and complications. Fourteen patients underwent unilateral fixation (81%), and 4 patients underwent bilateral fixation (19%). All patients (18 of the 18) had a well-reduced pelvis after fixation. No patient (0%) required a return trip to the operating room for loss of reduction/malreduction, wound breakdown, or implant failure. This study presents an updated technique for a low-profile triangular osteosynthesis construct with straightforward application for unstable posterior pelvic ring injuries. This technique does not require rod bending, results in a consistently more recessed iliac screw and connecting rod, and can be used in a wide variety of unstable posterior pelvic ring injuries, including comminuted sacral fractures, L5/S1 facet fractures, and vertical shear injuries.
Short-term combined treatment with exenatide and metformin for overweight/obese women with polycystic ovary syndrome
Authors: Ma Rui-Lin , Deng Yan , Wang Yan-Fang , Zhu Shi-Yang , Ding Xue-Song , Sun Ai-Jun
Published: November 2021

Background:

Obesity and insulin resistance (IR) are common features of polycystic ovary syndrome (PCOS). Metformin (MET) increases insulin sensitivity, but it is associated with unsatisfactory weight loss. The glucagon-like peptide-1 receptor agonist exenatide has been shown to reduce weight and IR in patients with diabetes. This study aimed to explore the therapeutic effects of exenatide once-weekly (QW) combined with MET on body weight, as well as metabolic and endocrinological parameters in overweight/obese women with PCOS.

Methods:

Fifty overweight/obese women with PCOS diagnosed via the Rotterdam criteria were randomized to one of two treatment groups: MET (500 mg three times a day [TID]) or combination treatment (COM) (MET 500 mg TID, exenatide 2 mg QW) for 12 weeks. The primary outcomes were anthropometric changes associated with obesity, and the secondary outcomes included changes in reproductive hormone levels, glucose and lipid metabolism, and C-reactive protein.

Results:

Forty (80%) patients completed the study. COM therapy was superior to MET monotherapy in reducing weight (P = 0.045), body mass index (BMI) (P = 0.041), and waist circumference (P = 0.023). Patients in the COM group on an average lost 3.8 ± 2.4 kg compared with 2.1 ± 3.0 kg in the MET group. In the COM group, BMI and waist circumference decreased by 1.4 ± 0.87 kg/m2 and 4.63 ± 4.42 cm compared with 0.77 ± 1.17 kg/m2 and 1.72 ± 3.07 cm in the MET group, respectively. Moreover, levels of fasting glucose, oral glucose tolerance test (OGTT) 2-h glucose, and OGTT 2-h insulin were significantly lower with COM therapy than with MET (P < 0.050). Mild and moderate gastrointestinal reactions were the most common adverse events in both groups.

Conclusions:

COM therapy was more effective than MET alone in reducing body weight, BMI, and waist circumference, and improving insulin sensitivity in overweight/obese women with PCOS, with acceptable short-term side effects.

Trial registration:

ClinicalTrials.gov, NCT04029272. https://clinicaltrials.gov/ct2/show/NCT04029272
Virtual Surgical Planning for Oncologic Mandibular and Maxillary Reconstruction
Authors: Myers Paige L. , Nelson Jonas A. , Rosen Evan B. , Allen Robert J. , Disa Joseph J. , Matros Evan
Published: November 2021

Virtual surgical planning (VSP) with computer-aided design and computer-aided modeling (CAD/CAM) enables the opportunity to provide personalized medicine in complex head and neck reconstruction. This innovative technology allows ablative and reconstructive surgeons to virtually create and manipulate three-dimensional anatomic models to plan both the resection and reconstruction of complicated maxillofacial defects. Studies demonstrate improvements in preoperative planning, operative efficiency and accuracy, and postoperative outcomes. VSP facilitates immediate dental implantation in selected patients, which can improve the likelihood of achieving dental restoration. This article outlines strategies for technique optimization as well as the applications, advantages and disadvantages of VSP in complex oncologic head and neck reconstruction.
Quality Improvement: Effect of Standardized Plastic Surgery Consultation Note Templates on Charge Capture
Authors: Schaeffer Christine V. , Park Rachel , Lane Jaina , DeGeorge Brent R.
Published: November 2021

Background:

Effective medical record documentation is imperative for both patient care and reimbursement for care provided. The purpose of this study was to compare coding/billing patterns for plastic surgery consultations before and after implementation of a standardized documentation protocol.

Methods:

Standardized hand, facial trauma, and general plastic surgery consult note templates were created. Following institutional approval, records were reviewed for all plastic surgery consultations from January to October 2019. Template notes were universally implemented in July 2019. Medical coding was performed by a certified professional coder using the 1995 Evaluation and Management Review Worksheet. Coding/billing patterns between groups were compared with and without standardized documentation using univariate analysis.

Results:

Seventy-five consecutive preimplementation consult notes and 75 consecutive postimplementation consult notes were selected for review. Each group included 25 hand, 25 facial trauma, and 25 general plastic surgery consultation notes. The history and physical examination components of the visit code were more frequently coded as “comprehensive”postimplementation (P = 0.000). There was no significant difference in coding for medical decision making between the two groups (P = 0.340). The final visit code was significantly higher in the postimplementation group (45.3% 99254/99284 versus 2.7%, P = 0.000), and the charges were significantly higher post implementation—average charge per consult $250 versus $203 (P = 0.000) with a 22.8% increase in total charges generated.

Conclusion:

Utilization of standardized consultation note templates increases the accuracy of coding and associated billing of inpatient and emergency department plastic surgery consultations through documentation and reflection of level of service provided.
FFF Utilizing an Arteriovenous Vascular Loop of Two Peroneal Venae Comitantes for a PAM
Authors: Huddleston Hailey P. , Kurtzman Joey S. , Koehler Steven M.
Published: November 2021

Vascularized bone grafting is widely used for reconstruction of osseous defects of the forearm. Fibular free flap (FFF) is one option, which relies on harvesting the peroneal artery. This procedure is subject to lower extremity anatomic variants; therefore, some recommend preoperative angiography. However, high quality evidence for this approach and its cost-effectiveness are lacking and instead one can diligently assess the vascular anatomy intraoperatively. Here, we describe a case of a 73-year-old man who was found to have a peronea arteria magna intraoperatively during an FFF for a left radius reconstruction secondary to an infectious nonunion. We describe an approach to performing an FFF using an arteriovenous vascular loop through the fibula employing the two accompanying peroneal venae comitantes. The patient had no complications and was found to have appropriate healing of the upper extremity without lower extremity compromise at 3-month follow-up. This report illustrates an alternative to using an interpositional venous graft for peronea arteria magna found intraoperatively during FFFs.
How to Organize Affordable Microsurgical Training Laboratory: Optimal Price-quality Solution
Authors: Khachatryan Arbak , Arakelyan Gevorg , Tevosyan Artur , Nazarian David , Kovaleva Daria , Arutyunyan Grant , Gabriyanchik Mark , Dzhuganova Victoria , Yushkevich Alexey
Published: November 2021

Today, microsurgery is an integral part of plastic surgery, maxillofacial surgery, hand surgery, and neurosurgery. More and more surgical procedures are accompanied by microsurgical intervention. Long training is required to develop the necessary skills for fine work with microsurgical instruments and delicate tissues under magnification. We suggest a methodology as to how to organize an inexpensive microsurgical training laboratory with minimal investment. Suggested guidelines provide information about cost-effective ways of arranging a comfortable training environment. An adapted stereoscopic microscope allows working with a wide range of magnification and focus distance. An ergonomic working position is set up by adjustable handmade table and chair. For performing basic microsurgical manipulations, a set of four instruments and inexpensive suture materials are used. A total amount of 323.5 USD was spent to purchase all of the necessary components for the microsurgical laboratory. The described components are available worldwide regardless of manufacturers. We suggest an inexpensive way to arrange a microsurgical laboratory. This approach is especially beneficial for students and residents from low-income countries.
Double-sided Nipple-areola Complex Marker for Masculinizing Chest Surgery
Authors: Mundinger Gerhard S. (Sol)
Published: November 2021

In addition to chest contour and incision placement, nipple-areola complex size, orientation, and position is a primary concern of patients undergoing masculinizing chest surgery with free nipple grafting for gender dysphoria or gynecomastia. The author has developed a double-sided nipple-areola complex harvest and inset marker that facilitates graft healing in an optimized masculine orientation.
Primary and Revision Rhinoplasty: A Single Surgeon Experience and Patient Satisfaction
Authors: Suresh Rishi , Doval Andres F. , Newstrom Emily , Pham Truce , Alford Eugene L.
Published: November 2021

Background:

There is minimal information describing the common characteristics among patients seeking primary/revision rhinoplasty. Success is traditionally interpreted from the surgeon's viewpoint, without considering the patient's perspective. The study's aims were to (1) identify/compare anatomic and functional characteristics commonly found in patients seeking primary and revision rhinoplasties; (2) assess patient satisfaction using a survey; and (3) explore whether graft choice (auricular cartilage versus rib cartilage) affects patient satisfaction and outcome in revision rhinoplasty.

Methods:

A retrospective review of all rhinoplasties by a single surgeon from June 2016 to January 2020 was performed, focusing on preoperative anatomic/functional characteristics and operative interventions performed. A survey was then used to assess patient satisfaction. Finally, survey outcomes were compared between patients who received auricular and rib cartilage grafts in revision rhinoplasty.

Results:

A total of 102 rhinoplasties (53 primary and 49 revisions) were included. Primary rhinoplasties were noted to have more patients with “big” noses (P = 0.015) or humps (P < 0.010). Patients undergoing revision rhinoplasties more commonly exhibited middle vault collapse (P = 0.022). The survey response rate was 60%. Revision rhinoplasty patients had a higher incidence of dissatisfaction with their outcome

Conclusions:

Several features among patients seeking revision rhinoplasties could have been created in the primary operation. The rhinoplasty surgeon should be careful to not introduce new issues or create worse deformities than those seen following the initial operation. Survey-based outcome analysis demonstrated that revision rhinoplasty patients are more likely to have a greater rate of dissatisfaction following their operation.
A Ventral Hernia-repair–related Mycobacterium mageritense Mesh Infection Treated with NPWT without Mesh Removal
Authors: Ando Junji , Miyata Riyo , Harada Masayuki , Takeuchi Mika , Kasahara Kei , Yoshimoto Yuji , Koyama Fumikazu , Kuwahara Masamitsu
Published: November 2021

Abdominal hernias are often repaired using prosthetic mesh, which is susceptible to infections. Normally, it is necessary to remove the mesh. However, successful mesh salvation with negative-pressure wound therapy (NPWT) has recently been reported. We encountered Mycobacterium(M) mageritense infection after hernia repair using the mesh. M. mageritense is classified as a fast-growing nontuberculous mycobacterium, but few cases have been reported. Nontuberculous mycobacterium can cause rare chronic infections. Skin and soft-tissue infections by nontuberculous mycobacterium involving localized abscess formation and chronic abscesses under various situations have been reported. We report an 85-year-old woman in whom a ventral hernia repair-related M. mageritense mesh infection was treated with NPWT without mesh removal. The hernia was repaired using Bard Ventralex mesh. Pus discharge was seen on the seventh postoperative day, and there was a small area of necrosis under the mesh. From the 13th postoperative day, NPWT was performed for 4 weeks. On the 29th postoperative day, a M. mageritense infection was diagnosed, which was resistant to multiple drugs. After the NPWT, most of the wound showed good granulation tissue formation. In conclusion, the mesh used to repair a hernia became infected with M. mageritense, but NPWT was able to salvage it. In cases of mesh infection involving small necrotic areas, performing NPWT under the guidance of an infectious disease expert may make it possible to preserve the mesh.
Posttraumatic Vascular Anomalies in Hand Surgery—A Case-based Approach
Authors: Scheer Helene Sophie , Banz Yara , Grobbelaar Adriaan O. , Vögelin Esther
Published: November 2021

The field of vascular anomalies (VA) has been subject to changes during the last few decades. The current classification of the International Society for the Study of Vascular Anomalies (ISSVA) offers a simple diagnostic structure. Hand surgeons commonly appear to have limited exposure to VA. Already recognized for more than 120 years, pyogenic granuloma (PG) is by far the most commonly described VA by different disciplines with accordingly diverse treatment strategies and theories behind it. Arteriovenous fistula (AVF), venous aneurysms (VAN), and venous malformations (VM) are, however, rare in hand surgery. With a compilation of four illustrative cases of posttraumatic entities such as AVF, VAN, VM, and PG, we would like to highlight possible daily exposure to VA in the general hand surgery practice. We discuss diagnostic and therapeutic options as well as the current literature with focus on posttraumatic VA.
Facial and Eyelid Changes in Thyroid Eye Disease Are Reversed by Teprotumumab
Authors: Ugradar Shoaib , Braun Jenna , Wang Yao , Zimmerman Erin , Douglas Raymond S.
Published: November 2021

Background:

Thyroid eye disease (TED) causes orbital soft-tissue expansion. Recent studies have suggested that brow and temple changes may also occur. Teprotumumab, a monoclonal antibody to the insulin-like growth factor 1 receptor reduces soft-tissue swelling in TED. In this study, we quantified the changes to pan facial soft-tissue volumes and eyelid position, following treatment with teprotumumab.

Methods:

In this prospective study, consecutive patients who were treated with teprotumumab were appraised for study eligibility. All patients had 3D facial imaging using the Vectra H2. Soft-tissue volume changes in the upper face, periorbita, temples, midface, and lower face were quantified before and after teprotumumab therapy. Furthermore, the marginal reflex distance (MRD)1, MRD2, and intercanthal distance were also measured pretreatment and posttreatment.

Results:

Twenty-three patients were included in the study. The mean duration of TED was 29 months (38). Following teprotumumab therapy, the mean (SD) decrease in volume for each region was 0.75 mL (0.84) in the upper face, 1.8 mL (1.3) in the periorbital region, 0.17 mL (0.5) in the temples, 1.62 mL (3.16) in the midface, and 2.67 mL (4.6) in the lower face. The mean (SD) decrease in the volume of the full face was 8.9 mL (8.7). There was also a significant reduction in MRD1, MRD2, and the intercanthal space following treatment. There was no relationship between previous steroid use and total body weight reduction and changes in facial volume.

Conclusion:

TED may cause significant tissue expansion across the entire face and this may be reduced following teprotumumab therapy.
The Butterfly Technique: A Retrospective Study for Labia Minora Reduction Using an Integrated Approach
Authors: Tremp Mathias , Oranges Carlo M. , Schaefer Dirk J. , Waldkircher Natascha J. , Schleh Andrea C. , Kalbermatten Daniel F.
Published: November 2021

Background:

In recent years, the demand for genital plastic procedures has increased. Of those, the reduction of the labia minora has become very popular. Several techniques are described, with all its advantages and disadvantages. The aim of this study is to introduce a novel approach combining de-epithelialization with wedge resection.

Methods:

In this retrospective study, we included patients seen between September 2011 and April 2014 with hypertrophic labia minora. The surgical technique consisted in an integrated approach of de-epithelialization and wedge excision. Patients were examined for early and late postoperative complications. Furthermore, patient satisfaction was evaluated at the final follow-up.

Results:

A total of 17 labioplasties (Franco type II–IV) in 10 patients with a mean age of 29 ± 12 years (range 20–62 y) were performed. Three patients experienced wound-healing problems, requiring surgical revision. After a median follow-up of 39 ± 6 months (range 28–48 mo), a high overall patient satisfaction has been achieved (8.6 ± 1.1). No dyspareunia, hypertrophic scarring, or micturition problems have been reported.

Conclusions:

By using our integrated approach, hereby called the “butterfly technique,” the neurovascular supply remains preserved, and an efficient volume reduction can be achieved with a concealed scar. Nevertheless, suture techniques and suture materials have to be tested to reduce the incidence of wound dehiscence rate.
Comparison of Surgical and Oncological Outcomes between Chest Wall Perforator Flaps and Therapeutic Mammoplasty
Authors: Khan Samreen , Mathew John
Published: November 2021

Background:

Chest wall perforator flaps (CPF) and therapeutic mammoplasty (TM) are often done in patients with anticipated poor cosmetic outcome with level 1 breast conservation surgery. The aim of this study was to assess the complications and oncological outcomes between CPF and TM.

Methods:

Prospectively collected data of breast conservation surgery between September 2016 and January 2021 by a single surgeon were reviewed. Specific outcomes included complications needing intervention, re-excision and mastectomy rate, locoregional recurrence, and distant metastasis. Patients were followed up at 3 months and then every 12 months. Statistical analysis included chi-squared test and independent t test, and a P value of less than 0.05 was considered significant.

Results:

There was no statistically significant difference between CPF and TM with regard to patient characteristics except for BMI and bra cup size, which was significantly higher in the TM group. One patient who had TM returned to the operating room for a hematoma evacuation, and one patient who had CPF had fat grafting, for unsatisfactory cosmetic outcome. Five of the 30 patients having CPF had further re-excision surgery for inadequate margins, but none needed mastectomy, and four of the 43 patients having TM had further surgery (one had re-excision of margins and three had mastectomy) and this was not statistically significant (P = 0.346). There was no locoregional recurrence in CPF and TM groups after a median follow-up of 22 months and 25 months, respectively.

Conclusion:

There is no significant difference in early complications and oncological outcomes between CPF and TM.
Injection Cryolipolysis: First-in-human Study
Authors: Kandula Prasanthi , Javorsky Emilia , Austen William G. , Kaminer Michael S.
Published: November 2021

Background:

Injection cryolipolysis using an ice slurry has been hypothesized to be a novel method of reducing fat. The present first-in-human pilot study aims to investigate the feasibility, safety, and tolerability of ice slurry injection into human subcutaneous fat.

Methods:

Preabdominoplasty subjects were recruited. Baseline measurements and serial follow-up visits following a single ice slurry injection procedure into tissue to be excised during abdominoplasty were performed. Melted ice slurry injection was used as control. Feasibility using standard injection techniques was assessed. Thermal imaging was used to determine cooling efficacy. Safety was assessed by adverse event monitoring. Tolerability was assessed by subject-reported pain score. Histology and ultrasound were monitored for structural changes associated with cryolipolysis.

Results:

A single injection of ice slurry was feasible and sufficient to cool adipose below the target temperature (10C). There were no serious adverse events. The most common adverse events were bruising and erythema. The mean pain score for ice slurry-injected sites was 1.9/10 and 1.3/10 in control injection sites. Evidence of cryolipolysis was observed on ultrasound and tissue histology in ice slurry-injected sites.

Conclusions:

Ice slurry injections are feasible, with an observed safety and tolerability profile comparable to topical cryolipolysis. The ice slurry can cool tissue to induce cryolipolysis, as observed by thermal imaging, ultrasound, and tissue histology, and is selective for ice-injected sites. No significant changes were observed in control sites. The ice slurry may be a promising candidate to enable more precise, effective, and customizable aesthetic fat reduction that warrants further investigation.
Concurrent Excision of Dorsal Nasal Scars and Reduction Rhinoplasty: A Retrospective Cross-sectional Study
Authors: Omranifard Mahmood , Zare Neda , Mahabadi Maryam
Published: November 2021

Background:

Skin lesions and traumas can affect the skin by leaving scars. The purpose of this study was evaluating the results of a new technique in reconstructive surgery of scars on the nose. In this technique, extra skin remaining from reduction rhinoplasty is applied to the defect remained from removing the scar.

Methods:

This is a retrospective cross-sectional study performed on 33 patients who underwent reduction rhinoplasty from 2013 to 2018 due to scars on the dorsal nasal skin. Five sets of standards, criteria, and questionnaires were used to evaluate the cosmetic outcomes, scars, and nasal function. These included the Cakir concept, visual analogue scale, patient reported outcome measurement, Stony Brook scar evaluation scale, and sino-nasal outcome test-22.

Results:

According to the surface polygon concept, or Cakir concept, the number of affected polygons due to scars decreased in all included patients (P < 0.05). In addition, constant improvement in patients’ satisfaction, based on patient reported outcome measurement (P < 0.001) and visual analogue scale (P ≤ 0.05), as well as physicians’ satisfaction, based on Stony Brook scar evaluation scale, were determined. Furthermore, evaluating the patients’ breathing, based on sino-nasal outcome test-22 criteria (P < 0.09), indicated no adverse effects.

Conclusion:

Excision of scars from dorsal nasal skin and conducting rhinoplasty surgery from the same access can be considered an option for reconstructing nasal scars.
A Case Report of Misdiagnosed Breast Implant-associated Anaplastic Large Cell Lymphoma with Lymphatic Extension
Authors: Maglic Dino , Moss Whitney , Pires Giovanna , Agarwal Archana , Matsen Cindy , Kwok Alvin
Published: November 2021

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma associated with textured implants and usually presents as a late-onset periprosthetic seroma. We present a 70-year-old woman with a history of left breast invasive ductal carcinoma treated with mastectomy and textured implant-based reconstruction, and subsequent adjuvant chemotherapy due to lymphovascular extension. Eleven years following her reconstruction, the patient developed a periprosthetic seroma. Fine needle aspiration and partial capsulectomy were performed, but appropriate pathologic evaluation was not initially submitted. She then presented with lymphadenopathy, which was biopsied and revealed BIA-ALCL within an axillary lymph node. Despite implant explantation, complete capsulectomy, axillary lymph node dissection, and excision of groin lymphadenopathy, no evidence of primary ALCL was appreciated. This initially misdiagnosed case demonstrates the importance of following the National Comprehensive Cancer Network guidelines when a patient presents with late onset breast periprosthetic effusions.
The “Five-flap” Technique for Nipple–Areola Complex Reconstruction
Authors: Ferraro Giuseppe Andrea , Lanzano Giuseppe , Gentile Corrado , Izzo Sara , Grella Elisa , Gubitosi Adelmo , Nicoletti Giovanni Francesco
Published: November 2021

Background:

Nipple–areola complex reconstruction aims to be the last step in the postmastectomy treatment procedure. Different techniques have been developed with the purpose of achieving optimal symmetry in position, size, shape, pigmentation, and permanent projection of the reconstructed nipple, but to date, there is no gold standard technique. The five-flap technique provides an easy, simple nipple–areola complex reconstruction method, effectively maintaining longer nipple projection, with a negligible rate of complications.

Methods:

From November 2018 to April 2021, a total of 21 female patients with an absent unilateral nipple–areolar complex due to postoncological mastectomy were subjected to our technique consisting of a combination of local flaps and a full-thickness skin graft. Patients were observed for 6 months to estimate the percentage of the nipple projection loss. Overall satisfaction was evaluated by the patients themselves and by an external medical observer at the end of the follow-up period.

Results:

None of the reconstructed nipples experienced either total or partial necrosis. Two minor complications were observed. Nipple projection loss was negligible with an average reduction of 12% from the initial projection. The nipple–areolar complex shape remained excellent in all cases, with minimal alteration of the immediate postoperative results. The total average satisfaction score was 8.0 for patients and 9.0 for external observers.

Conclusion:

The five-flap technique represents a simple, safe, and efficacious procedure in patients with implant-based reconstruction requiring moderate to very projected nipples.
Comment on “Cornea Classic Article: Kim JC and Tseng SCG: Transplantation of Preserved Amniotic Membrane for Surface Reconstruction in Severely Damaged Rabbit Corneas (Cornea 1995;14:473–484)”
Authors: Kenyon Kenneth R.
Published: November 2021

Following identification of limbal stem cells, efforts have been devoted to restore and/or replace these essential progenitors of the corneal epithelium. Limbal stem cell deficiency, commonly a consequence of ocular chemical injury, results in clinically compromised vision consequent to corneal conjunctivalization. The insight of Kim and Tseng provided experimental proof of the concept that even in the presence of total limbal stem cell deficiency, amnion membrane overlay grafts can promote limbal recovery as a means of ocular surface reconstruction.
Grouped Vesicles on an Erythematous Base
Authors: Cantos Joshua , Macknet Cathy
Published: November 2021

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. The following is a teledermatology case of herpes zoster.

In the store-and-forward teledermatology modality, there is an electronic transfer of a patient's medical information, which includes both the history and visual data obtained in one location, to a provider who is in another location. The construct of this column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.
Scabies Infestation in the Pediatric Population
Authors: Vassantachart Janna M. , Florentino Abigail , Admani Shehla
Published: November 2021

Scabies infestation is a pruritic condition that is commonly seen in the pediatric population. Children are affected more than adults in certain geographic regions and can have variable clinical presentations. To avoid delays in diagnosis, healthcare providers should be aware of these differences. This article provides an overview of epidemiology and pathophysiology, clinical presentation and diagnosis, and management of scabies infestation, with a particular focus on infants and children.