bluuebunny/crossref_metadata_2025 huggingface dataset:
The Disease Triangle of Chestnut: A Review of Host, Pathogen, and Environmental Interactions of Chestnuts Cultivated in the Eastern United States
Authors: Miller Amy C. , Lewis Ivey Melanie L.
Published: June 2024

Chestnuts, the edible seeds of the genus Castanea, are a perennial food crop closely tied to the global migration of humans throughout history and have recently been gaining popularity in agriculture and forest restoration in eastern North America. Cultivation of chestnuts yields nutritionally balanced food while fostering economic development, food security, and environmental health. However, diseases and insect pests threaten successful ecological restoration and food production. In this review we explore conditions affecting chestnuts in the eastern United States through the lens of the disease triangle. A “host” in the disease triangle is not merely a single tree but a tree including its constituent population of fungal endophytes. Chestnut trees are rich with microbial life, and the sustainability of chestnuts in forest and cultivated settings may lie in understanding and manipulating microbial communities to improve plant health and control destructive diseases. To benefit from the ecological and economic potential of chestnuts on the landscape, it may be necessary to select locally adapted chestnut trees, regardless of pedigree, that are resilient against cosmopolitan pathogens. With transport of plants and pathogens throughout the globe, and with landscape-level environmental changes over the last century, chestnut trees in the eastern United States are in a unique disease landscape compared with their ancestors. Diseases of economic concern from fungi and fungal-like organisms include chestnut blight (Cryphonectria parasitica) and ink disease (Phytophthora cinnamomi) on American and European chestnuts, oak wilt (Bretziella fagacearum) on all chestnut species, and the emerging diseases of brown rot (Gnomoniopsis smithogilvyi) and chestnut anthracnose (Colletotrichum henanense). The eastern United States has experienced profound environmental changes over the twentieth century and into the early twenty-first century. These changes happen to coincide with the demise of the American chestnut in the eastern forest, efforts to re-establish chestnut as a forest species, and the rise in cultivation of multiple chestnut species and hybrids as a culinary crop. Chestnut trees growing in the early twenty-first century face different environmental circumstances than the American chestnuts of precolonial times, including changes in forest composition, rainfall changes and acidification, industrialized agriculture’s increased chemical inputs, rising global temperatures, and increased levels of carbon dioxide in the atmosphere. We conclude that chestnut tree species for both forestry and agriculture should be considered based on current fitness, adaptability, and economic and ecological value considering continued dynamics in host and pathogen distributions and anthropogenically driven climatic and edaphic conditions.
Bioproducts of Pseudomonas chlororaphis Suppress DMI Fungicide-Induced CsCYP51A and CsCYP51B Gene Expression in Colletotrichum siamense and Generate Synergistic Effects with Metconazole and Propiconazole
Authors: Wesche Johanna , Wu Peishan , Luo Chao-Xi , Faust James E. , Schnabel Guido
Published: June 2024

Mixtures of fungicides with different modes of action are commonly used as disease and resistance management tools, but little is known of mixtures of natural and synthetic products. In this study, mixtures of metabolites from the rhizobacterium Pseudomonas chlororaphis strain ASF009 formulated as Howler EVO with below-label rates (50 µg/ml) of conventional sterol demethylation inhibitor (DMI) fungicides were investigated for control of anthracnose of cherry ( Prunus avium) caused by Colletotrichum siamense. Howler mixed with metconazole or propiconazole synergistically reduced disease severity through lesion growth. Real-time PCR showed that difenoconazole, flutriafol, metconazole, and propiconazole induced the expression of DMI target genes CsCYP51A and CsCYP51B in C. siamense. The addition of Howler completely suppressed the DMI fungicide-induced expression of both CYP51 genes. We hypothesize that the downregulation of DMI fungicide-induced expression of the DMI target genes may, at least in part, explain the synergism observed in detached fruit assays.
PAs' perspective on leadership in medicine
Authors: Roberts Amy Lynn , Rizzolo Denise , Bruza-Augatis Mirela , Pontrelli Gina , Zammit Christine , Banahan Mary
Published: June 2024

Objective:

This study evaluated physician associate/assistant (PA) training and confidence in leadership and leadership skills, as well as where best to incorporate leadership training for the profession.

Methods:

A quantitative survey was administered to assess PAs' perceptions of leadership and degree of leadership training during their primary PA education. The study also solicited where in the career trajectory leadership training is perceived to be most effective. Of the 284 participants who responded to the survey, 207 had complete responses that were used in the analysis.

Results:

Nearly 92% of PAs agreed that they aspire to be leaders, and 93.2% agreed or strongly agreed that leadership training would be beneficial during PA school. Additionally, more than 50% of PAs agreed that they had no training but desired more regarding personal mastery, teaching, administration, ideals of a healthy workforce, vision and goal setting, getting results, coalitions, and system transformation.

Conclusions:

This study demonstrated that PAs desired supplemental training in leadership to cultivate career goals and reported that formal leadership training would be useful to cope with and overcome adversity in clinical practice.
The Physician Is on Campus
Authors: Hutchinson Jennifer C.
Published: June 2024

The purpose of this project was to determine if physician participation in simulation affects students’ perceptions of nurse/physician communication and collaboration. Fifty-five students participated in six groups. Three groups had a physician present and involved during their eight-hour pediatric simulation; the others continued with current practice, which involved phone contact with an individual posing as a physician. There was a statistically significant difference in two items on the Nurse Attitudes About Communicating and Collaborating With Physicians tool when pre- and post-simulation means were compared. Findings are consistent with previous research, indicating simulation-based learning can improve students’ perceptions of nurse-physician collaboration.
Resident Recruitment in a New Era
Authors: Collins Stephen , Baker E. Brooke
Published: June 2024

This chapter focuses on resident recruitment and recent US National Resident Matching Program changes and the impact in the evaluation and ranking of applicants within the specialty of anesthesiology. Recruitment challenges are examined as well as program strategies and potential future directions. Also discussed are DEI initiatives within the recruitment process.
Foot Tapping Test as a Simple Quantitative Index of Motor Function for Lumbosacral Radiculopathy
Authors: Kobayashi Hiroshi , Nikaido Takuya , Otani Koji , Watanabe Kazuyuki , Kato Kinshi , Kobayashi Yoshihiro , Hakozaki Michiyuki , Kameda Takuya , Kaneuchi Yoichi , Sekiguchi Miho , Yabuki Shoji , Konno Shin-ichi , Matsumoto Yoshihiro
Published: June 2024

Study Design.

We conducted a retrospective review of data from patients who underwent surgical treatment for lumbosacral radiculopathy.

Objective.

To assess the effectiveness of the foot tapping test (FTT) in evaluating lower limb motor function in patients with lumbosacral radiculopathy pre and postsurgery.

Background.

Lumbosacral radiculopathy is becoming increasingly common in aging populations. Despite standard treatments, paralysis often leads to incomplete postoperative recovery, necessitating early detection and interventions.

Patients and Methods.

We enrolled individuals who underwent surgery for lumbosacral radiculopathy at our facility between 2009 and 2020. Patients with a history of lumbar surgeries, dialysis, rheumatoid arthritis, and transitional vertebrae were excluded. The FTT score was measured by having the sole of the foot tap as many times as possible for 10 seconds while keeping the heel in contact with the floor. The L4, L5, and S1 groups were assigned using the scores on the side of the radiculopathy, and the control group was assigned using the scores on the intact side. Data were analyzed using the Dunnett test for group comparisons and paired t-tests for pre and postsurgery comparisons.

Results.

Of the 522 eligible patients, 80 (159 nerve roots, 1 patient with hemi-prosthetic leg) were analyzed. The preoperative FTT scores in the L4 and L5 groups were significantly lower than those in the control group, indicating functional impairment. One year postsurgery, all groups showed improvements in FTT scores, with the L5 group exhibiting significant improvements compared with the control; this was supported by the results of sensitivity analyses considering the effects of paralysis and pain.

Conclusion.

The FTT is a valuable tool for the early detection of lower limb motor dysfunction in lumbosacral radiculopathy, particularly for L5 nerve root impairment, where it aids in timely surgical intervention and may improve postoperative outcomes and quality of life.
Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study
Authors: Bunge Jeroen J. H. , Mariani Silvia , Meuwese Christiaan , van Bussel Bas C. T. , Di Mauro Michele , Wiedeman Dominik , Saeed Diyar , Pozzi Matteo , Loforte Antonio , Boeken Udo , Samalavicius Robertas , Bounader Karl , Hou Xiaotong , Buscher Hergen , Salazar Leonardo , Meyns Bart , Herr Daniel , Matteucci Sacha , Sponga Sandro , MacLaren Graeme , Russo Claudio , Formica Francesco , Sakiyalak Pranya , Fiore Antonio , Camboni Daniele , Raffa Giuseppe Maria , Diaz Rodrigo , Wang I-wen , Jung Jae-Seung , Belohlavek Jan , Pellegrino Vin , Bianchi Giacomo , Pettinari Matteo , Barbone Alessandro , Garcia José P. , Shekar Kiran , Whitman Glenn J. R. , Gommers Diederik , Dos Reis Miranda Dinis , Lorusso Roberto ,   on behalf of the Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators
Published: June 2024

OBJECTIVES:

Most post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) runs last less than 7 days. Studies on the outcomes of longer runs have provided conflicting results. This study investigates patient characteristics and short- and long-term outcomes in relation to PC ECMO duration, with a focus on prolonged (> 7 d) ECMO.

DESIGN:

Retrospective observational cohort study.

SETTING:

Thirty-four centers from 16 countries between January 2000 and December 2020.

PATIENTS:

Adults requiring post PC ECMO between 2000 and 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Characteristics, in-hospital, and post-discharge outcomes were compared among patients categorized by ECMO duration. Survivors and nonsurvivors were compared in the subgroup of patients with ECMO duration greater than 7 days. The primary outcome was in-hospital mortality. Two thousand twenty-one patients were included who required PC ECMO for 0–3 days (n = 649 [32.1%]), 4–7 days (n = 776 [38.3%]), 8–10 days (n = 263 [13.0%]), and greater than 10 days (n = 333 [16.5%]). There were no major differences in the investigated preoperative and procedural characteristics among ECMO duration groups. However, the longer ECMO duration category was associated with multiple complications including bleeding, acute kidney injury, arrhythmias, and sepsis. Hospital mortality followed a U-shape curve, with lowest mortality in patients with ECMO duration of 4–7 days (n = 394, 50.8%) and highest in patients with greater than 10 days ECMO support (n = 242, 72.7%). There was no significant difference in post-discharge survival between ECMO duration groups. In patients with ECMO duration greater than 7 days, age, comorbidities, valvular diseases, and complex procedures were associated with nonsurvival.

CONCLUSIONS:

Nearly 30% of PC ECMO patients were supported for greater than 7 days. In-hospital mortality increased after 7 days of support, especially in patients undergoing valvular and complex surgery, or who had complications, although the long-term post-discharge prognosis was comparable to PC ECMO patients with shorter support duration.
Validation of Math Model Using Porous Media for Determining Alveolar CO2 in Ventilated Patients
Authors: Jiménez-Posada L. D. , Palacio- Sánchez A. F. , Montagut-Ferizzola Y. J. , Ardila-Villegas M. , Maya Juan C.
Published: June 2024

OBJECTIVES:

To validate a mathematical model using porous media theory for alveolar CO
2 determination in ventilated patients.

DESIGN:

Mathematical modeling study with prospective clinical validation to simulate CO
2 exchange from bloodstream to airway entrance.

SETTING:

ICU.

PATIENTS:

Thirteen critically ill patients without chronic or acute lung disease.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Model outcomes compared with patient data showed correlations for end-tidal CO
2 (EtCO2), area under the CO
2 curve, and PaCO
2 of 0.918, 0.954, and 0.995. Determination coefficients (R
2) were 0.843, 0.910, and 0.990, indicating precision and predictive power.

CONCLUSIONS:

The mathematical model shows potential in pulmonary critical care. Although promising, practical application demands further validation, clinician training, and patient-specific adjustments. The path to clinical use will be iterative, involving validation and education.
Faith Community Nursing
Authors: Burt Susan , Lewis Rosalie , Braithwaite Yvonne
Published: June 2024

Faith community nurses (FCNs) are well positioned to serve individuals needing community-based healthcare within local healthcare systems, large church denominations, or through the support and resources of nonprofit faith community nursing organizations. This article briefly outlines development of the specialty of faith community nursing and proposes areas of research needed to grow the impact of this nursing specialty. Examples of FCNs working in and collaborating with healthcare systems, educational institutions, and congregations illustrate the value and diversity of FCN services for impacting community-based care. An exhaustive list of national, denominational, and regional organizations supporting FCN practice is included.
Partial Gluteus Muscle Flap for Treatment of Chronic, Recalcitrant Pilonidal Cyst Disease
Authors: Farhat Souha , De la Fuente Hagopian Alexa , Andrawes Peter , Dinh Tue A.
Published: June 2024

Background:

Pilonidal cyst disease is a challenging condition requiring excision and wound management when it is chronic and symptomatic. Primary closure of the excision site can lead to high recurrence rates, necessitating flap-based reconstruction. This article discusses the use of a partial gluteus maximus muscle flap to address recurrent pilonidal disease and reduce its recurrence.

Methods:

From 2014 to 2021, 11 patients aged 14–31 with recurrent pilonidal cysts underwent two-stage surgery involving excision and wound debridement by general surgery, followed by plastic surgery for wound closure using the partial gluteus muscle flap.

Results:

Eleven patients were included in the study (four women and seven men). The mean age was 23 ± 5.2, and the average body mass index was 28.59 (±6.7). The mean number of previous procedures was 2.25 (range, 2–3). Operative time was 158.7 ± 37 minutes. The average length of stay when both procedures were done in the same admission was 8 ± 6 days (range 3–21 days) and when procedures were done separately, the length of hospital stay after the wound closure using a partial gluteus muscle flap was 3 days, and the range for reliable follow-up was 1.6–7 years postoperatively. In our study cohort of 11 patients, the majority, specifically seven individuals, experienced uneventful healing. However, a subset of patients encountered complications. Three patients developed an infection recurrence: one was treated conservatively, and one required reoperation with resolution of symptoms, and one patient also experienced wound dehiscence, which was closed with a small procedure.

Conclusion:

Partial gluteal muscle flap offers a promising approach for treating recalcitrant, difficult-to-treat pilonidal disease in young adults, enhancing wound healing and reducing the risk of recurrence.
Microvascular Thrombosis in Celiac Disease: Is Free Flap an Option? Case Presentation and Literature Review
Authors: Khubrani Abdullah Mohammed , Alobaidi Hussain Amin , Alzahrani Isra’a Abdulaziz , Alelyani Rakan H. , Wani Musaib Shabeer , AlThubaiti Ghazi A.
Published: June 2024

Celiac disease is an autoimmune disease that occurs due to gluten intolerance. The prevalence of breast cancer among celiac disease patients is the same as in the general population. It is of note that breast cancer is the most common type of cancer in women. Following mastectomy, these patients visit plastic surgeons for breast reconstruction. Based on various factors, autologous reconstruction using abdominal-based flaps is the best option. Patients with celiac disease have a high incidence of thromboembolic disorders, which may prevent plastic surgeons from doing breast reconstruction with free flaps. We present a case of a patient with celiac disease who underwent a free flap for breast reconstruction with an uneventful course after using our routine postoperative protocol. This case report highlights that patients with celiac disease cannot be denied the option of breast reconstruction with free flaps.
Using Cognitive Rehearsal to Address Faculty Incivility in Nursing Academe
Authors: M. Clark Cynthia
Published: June 2024

Background:

Faculty-to-faculty incivility is a national and global problem. Recent studies examining faculty incivility in nursing academe found that respondents expressed emotional and physical distress stemming from workplace incivility, and most avoid dealing with the problem. A top strategy for improving workplace civility includes providing ongoing education to improve communication skills.

Problem:

Faculty and academic nurse leaders require evidence-based strategies to prevent and address the range of uncivil behaviors occurring in academic work environments.

Approach:

Cognitive Rehearsal (CR) is a primary prevention and intervention communication strategy used to address incivility in health care and educational settings. Working with a skilled facilitator, participants practice addressing stressful situations in a non-threatening environment. This is the first known publication using CR to address faculty-to-faculty incivility.

Conclusions:

The author uses real-life situations derived from faculty-to-faculty incivility research studies and in-person conversations to describe each step of the CR process.
Big data study using health insurance claims to predict multidisciplinary low vision service uptake
Authors: Stolwijk Miriam L. , van Nispen Ruth M. A. , van der Pas Stéphanie L. , van Rens Ger H. M. B.
Published: June 2024

SIGNIFICANCE

There is a lack of research from high-income countries with various health care and funding systems regarding barriers and facilitators in low vision services (LVS) access. Furthermore, very few studies on LVS provision have used claims data.

PURPOSE

This study aimed to investigate which patient characteristics predict receiving multidisciplinary LVS (MLVS) in the Netherlands, a high-income country, based on health care claims data.

METHODS

Data from a Dutch national health insurance claims database (2015 to 2018) of patients with eye diseases causing potentially severe visual impairment were retrieved. Patients received MLVS (n = 8766) and/or ophthalmic treatment in 2018 (reference, n = 565,496). MLVS is provided by professionals from various clinical backgrounds, including nonprofit low vision optometry. Patient characteristics (sociodemographic, clinical, contextual, general health care utilization) were assessed as potential predictors using a multivariable logistic regression model, which was internally validated with bootstrapping.

RESULTS

Predictors for receiving MLVS included prescription of low vision aids (odds ratio [OR], 8.76; 95% confidence interval [CI], 7.99 to 9.61), having multiple ophthalmic diagnoses (OR, 3.49; 95% CI, 3.30 to 3.70), receiving occupational therapy (OR, 2.32; 95% CI, 2.15 to 2.51), mental comorbidity (OR, 1.17; 95% CI, 1.10 to 1.23), comorbid hearing disorder (OR, 1.98; 95% CI, 1.86 to 2.11), and receiving treatment in both a general hospital and a specialized ophthalmic center (OR, 1.23; 95% CI, 1.10 to 1.37), or by a general practitioner (OR, 1.23; 95% CI, 1.18 to 1.29). Characteristics associated with lower odds included older age (OR, 0.30; 95% CI, 0.28 to 0.32), having a low social economic status (OR, 0.91; 95% CI, 0.86 to 0.97), physical comorbidity (OR, 0.87; 95% CI, 0.82 to 0.92), and greater distance to an MLVS (OR, 0.95; 95% CI, 0.92 to 0.98). The area under the curve of the model was 0.75 (95% CI, 0.75 to 0.76; optimism = 0.0008).

CONCLUSIONS

Various sociodemographic, clinical, and contextual patient characteristics, as well as factors related to patients' general health care utilization, were found to influence MLVS receipt as barriers or facilitators. Eye care practitioners should have attention for socioeconomically disadvantaged older patients when considering MLVS referral.
Comparative 3-Dimensional Analysis of Philtral Ridge Projection in Unilateral Cleft Lip Repair Enhanced with Muscle-to-Subdermis Suture
Authors: Kim Tae Hyung , Hong Dae Won , Kim Young Chul , Oh Tae Suk
Published: June 2024

Background:

Recreating the philtral ridge and restoring orbicularis oris muscle (OOM) continuity in patients with cleft is a challenging task. The muscle-to-subdermis technique introduces an effective method for achieving the desired philtral ridge reconstruction.

Methods:

From August of 2015 to July of 2023, a retrospective study was conducted with a follow-up period of at least 6 months. This procedure involved a suture technique using muscle-to-subdermis sutures. Measurements of philtral projection were taken at 2 distinct points: one above Cupid’s bow and the other at the midphiltral level. In the comparative analysis of philtral ridges between the cleft and noncleft sides, the root mean square projection value was assessed. In addition, an analysis of the restoration of the OOM included the use of color mapping from the midsagittal plane and covered 7 different points across 3 distinct horizontal planes: below subnasale, at the midphiltral level, and above Cupid’s bow.

Results:

A total of 134 patients were included, with a 37.8-month follow-up (SD 9.4). Philtral side projection was well maintained, measuring −0.36 (0.43) mm, −0.24 (0.49) mm in the classic group versus 0.23 (0.29) mm, 0.20 (0.21) mm in the muscle-to-subdermis group (P = 0.001). The root mean square projection value was 0.57 (0.46) versus 0.14 (0.046), indicating greater symmetry in the muscle-to-subdermis group, with no difference in sagittal vector analysis of the OOM between normal and cleft sides.

Conclusions:

A suturing technique using muscle-to-subdermis sutures has shown promising results in philtral projection and dimple formation. This improvement can be attributed to the combined effect of subdermis and fewer muscle sutures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Skin Color Match in Autologous Breast Reconstruction: Which Donor Site Gives the Best Result?
Authors: Paulus Vera A. A. , van Raay Stephan H. C. , Teunissen Joris S. , Lese Ioana , Ulrich Dietmar J. O.
Published: June 2024

Background:

Color match of a reconstructed breast with the surrounding area is of importance for the overall aesthetic result. The objective of the authors’ study was to quantify the degree of color match achieved with different autologous breast reconstructions and to analyze the changes in color over time by analyzing digital photographs.

Methods:

A total of 193 patients who underwent a delayed autologous breast reconstruction (deep inferior epigastric perforator [DIEP], profunda artery perforator [PAP], lumbar artery perforator [LAP], latissimus dorsi [LD]) were included. Standardized photographs from 242 flaps at 3 months and 9 to 12 months postoperatively were analyzed, and the L*a*b* values and delta E2000 (dE) values were determined to qualify the color match. The Kruskal-Wallis and Wilcoxon rank sum tests were used for statistical analysis.

Results:

Initially, DIEP flaps had a significant lower dE value compared with LD (P = 0.012) and PAP flaps (P < 0.001), when compared with the natural breast. PAP flaps showed a significant decrease after 9 to 12 months (P = 0.003). Perception of color match was comparable in all flaps. Compared with the cleavage, at late follow-up, DIEP flaps had a significant higher dE value compared with LD (P = 0.017) and PAP flaps (P < 0.001). PAP flaps presented a significant decrease of dE after 9 to 12 months (P = 0.031). Abdominal skin presented no better skin color match in patients with PAP, LD, and LAP flaps.

Conclusions:

All analyzed flaps had a comparable color match with the surrounding tissue and with the contralateral breast approximately 1 year after surgery. The color of PAP flaps changes more, which leads to an improvement at a later follow-up.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
The Nasoorbitofrontal Complex in Facial Feminization Surgery
Authors: Beaufils Tristan , Berkane Yanis , Luca-Pozner Vlad , Watier Éric , Bertheuil Nicolas , Qassemyar Quentin
Published: June 2024

Background:

With the increasing demand for facial feminization surgery, there is a growing need for reliable and reproducible techniques to enhance outcomes. The authors aimed to evaluate the effectiveness of single-stage nasoorbitofrontal (NOF) complex reshaping in facial feminization surgery. Effectiveness was gauged by computed tomographic assessments and an unvalidated patient satisfaction survey at 6 months postoperatively.

Methods:

The study included 155 transfeminine patients undergoing surgery of the upper third of the face. Outcomes were compared in patients receiving either orbitofrontal (OF) surgery or combined NOF surgery. A comparative analysis of preoperative and postoperative standardized computed tomography sections was performed, focusing on multiple anatomic angles in 2 dimensions. A self-administered satisfaction questionnaire based on 6 FACE-Q items was completed at 6 months.

Results:

Among the 155 patients, 65 underwent OF surgery and 90 underwent NOF surgery. The follow-up period ranged from 6 to 36 months, with an average follow-up of 18 months. Significant changes in craniometric measurements were observed. In the OF group, average changes in nasofrontal, frontal tilt, and metopion angles were +12.3 ± 0.2 degrees, −8.5 ± 2.2 degrees, and +20.0 ± 0.1 degrees, respectively (P < 0.001); in the NOF group, they were +28.5 ± 0.3 degrees, −9.3 ± 2.4 degrees, and +23.9 ± 0.1 degrees, respectively (P < 0.001). The NOF group demonstrated higher overall satisfaction (median, 4 of 5) compared with the OF group (median, 3 of 5). No early complications were reported.

Conclusion:

The NOF complex surgery is an effective approach in gender-affirming surgery of the upper third of the face, yielding predictable results and higher patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Patient actor training improves preexposure prophylaxis delivery for adolescent girls and young women in Kenya: a cluster randomized trial
Authors: Kohler Pamela , Larsen Anna , Abuna Felix , Owiti George , Sila Joseph , Owens Tamara , Kemunto Valarie , Lagat Harrison , Vera Melissa , Richardson Barbra A. , Wilson Kate , Pintye Jillian , John-Stewart Grace , Kinuthia John
Published: June 2024

Objective:

To evaluate effectiveness of a standardized patient actor (SP) training intervention to improve quality of preexposure prophylaxis (PrEP) services for adolescent girls and young women (AGYW) in Kenya.

Design:

Cluster randomized trial and mystery shopper evaluation.

Methods:

Twelve of 24 maternal child health and family planning facilities were randomized to SP training. Providers at intervention facilities participated in 2-day training in adolescent health, PrEP guidelines, values clarification, and communication skills, followed by role-playing and de-briefing with trained actors. Control facilities received standard national training. The primary outcome was quality of care, assessed by unannounced SPs (USPs) or “mystery shoppers” blinded to intervention arm. Quality was measured in two domains: guideline adherence and communication skills. Intent to treat analysis compared postintervention quality scores by randomization arm, clustering on facility, and adjusting for baseline scores and USP.

Results:

Overall, 232 providers consented to USP visits, and 94 providers completed the training. Following training, USPs posed as AGYW seeking PrEP in 142 encounters (5–6 encounters per site). The mean quality score was 73.6% at intervention sites and 58.4% at control sites [adjusted mean difference = 15.3, 95% confidence interval (CI): 9.4–21.1, P < 0.001]. Mean guideline adherence scores were 57.2% at intervention sites and 36.2% at control sites (adjusted mean difference = 21.0, 95% CI: 12.5–29.4, P < 0.001). Mean communication scores were 90.0% at intervention sites and 80.5% at control sites (adjusted mean difference = 9.5, 95% CI: 5.5–13.6, P < 0.001).

Conclusions:

SP training significantly improved quality of PrEP care for AGYW in Kenya. Incorporating SP training and unannounced SP evaluation could improve PrEP uptake among AGYW.
Weight excess and obesity are associated with binge-eating behaviours in people with HIV
Authors: Mazzitelli Maria , Cozzolino Claudia , Gasparini Gianluca , Chiaro Eleonora , Brazzale Camilla , Mancino Flavia , Mingardo Sara , Sasset Lolita , Leoni Davide , Baldo Vincenzo , Favaro Angela , Cattelan Annamaria
Published: June 2024

Objective:

Binge eating is a mental health disorder related to weight gain, whose prevalence/correlation with weight excess in people with HIV (PWH) have been scarcely investigated.

Design: A cross-sectional study of PWH who underwent the validated Binge Eating Scale (BES) questionnaire.

Methods:

We included adult PWH during routine visits from October 2022 to February 2023. The BES questionnaire was administered with the support of a psychiatrist (score <17 binge eating very unlikely, binge eating ≥17 possible/very likely). We performed a logistic regression for the binary outcome BES at least 17 and being overweighted/obese as effect measure of risk association, and then adjusted for possible confounders (as integrase inhibitor exposure) and performed a sensitivity analysis fitting the regression model including and excluding depression (which may drive binge eating).

Results:

We included 1204 PWH, 75.2% men, median age 53 years [interquartile range (IQR): 44–60], 95.6% with undetectable HIV-RNA. As for BMI, we had overweight and obesity in 35.1 and 19.4% cases. Considering BES, 1089 (90.4%) PWH had a score less than 17, 115 (9.6%) at least 17. Multivariable analysis showed that obesity [odds ratio (OR) = 6.21, P < 0.0001), overweight (OR = 2.21, P = 0.006) and depression (OR = 1.98, P = 0.028) were significantly associated with high BES score. By excluding depression, our results were confirmed, and obesity/overweight remained significantly associated with binge eating (obesity OR = 6.58, P < 0.0001, overweight OR = 2.17, P = 0.023).

Conclusion:

Binge eating should be considered among possible causes of weight gain in PWH. Our results push towards an in-depth study of this topic for a better understanding of the phenomenon in PWH, possibly identifying subgroups of this population who could benefit from a psychoeducational/psychological intervention to preventing WG.
Free-Breathing High-Resolution, Swap-Free, and Motion-Corrected Water/Fat Separation in Pediatric Abdominal MRI
Authors: Nosrati Reyhaneh , Calakli Fatih , Afacan Onur , Pelkola Kristina , Nichols Reid , Connaughton Pauline , Bedoya M. Alejandra , Tsai Andy , Bixby Sarah , Warfield Simon K.
Published: June 2024

Objectives

The T1-weighted GRE (gradient recalled echo) sequence with the Dixon technique for water/fat separation is an essential component of abdominal MRI (magnetic resonance imaging), useful in detecting tumors and characterizing hemorrhage/fat content. Unfortunately, the current implementation of this sequence suffers from several problems: (1) low resolution to maintain high pixel bandwidth and minimize chemical shift; (2) image blurring due to respiratory motion; (3) water/fat swapping due to the natural ambiguity between fat and water peaks; and (4) off-resonance fat blurring due to the multipeak nature of the fat spectrum. The goal of this study was to evaluate the image quality of water/fat separation using a high-resolution 3-point Dixon golden angle radial acquisition with retrospective motion compensation and multipeak fat modeling in children undergoing abdominal MRI.

Materials and Methods

Twenty-two pediatric patients (4.2 ± 2.3 years) underwent abdominal MRI on a 3 T scanner with routine abdominal protocol and with a 3-point Dixon radial-VIBE (volumetric interpolated breath-hold examination) sequence. Field maps were calculated using 3D graph-cut optimization followed by fat and water calculation from k-space data by iteratively solving an optimization problem. A 6-peak fat model was used to model chemical shifts in k-space. Residual respiratory motion was corrected through soft-gating by weighting each projection based on the estimated respiratory motion from the center of the k-space. Reconstructed images were reviewed by 3 pediatric radiologists on a PACS (picture archiving and communication systems) workstation. Subjective image quality and water/fat swapping artifact were scored by each pediatric radiologist using a 5-point Likert scale. The VoL (variance of Laplacian) of the reconstructed images was used to objectively quantify image sharpness.

Results

Based on the overall Likert scores, the images generated using the described method were significantly superior to those reconstructed by the conventional 2-point Dixon technique (P < 0.05). Water/fat swapping artifact was observed in 14 of 22 patients using 2-point Dixon, and this artifact was not present when using the proposed method. Image sharpness was significantly improved using the proposed framework.

Conclusions

In smaller patients, a high-quality water/fat separation with sharp visualization of fine details is critical for diagnostic accuracy. High-resolution golden angle radial-VIBE 3-point Dixon acquisition with 6-peak fat model and soft-gated motion correction offers improved image quality at the expense of an additional ~1-minute acquisition time. Thus, this technique offers the potential to replace the conventional 2-point Dixon technique.
Implementation of an Enhanced Recovery After Surgery Protocol for Cleft Palate Repair
Authors: Hopper Samuel J. , Fernstrum Colton J. , Phillips John B. , Sink Matthew C. , Goza Shelby D. , Brown Madyson I. , Brown Kathryn W. , Humphries Laura S. , Hoppe Ian C.
Published: June 2024

Objective

This study examines an Enhanced Recovery After Surgery (ERAS) protocol for patients with cleft palate and hypothesizes that patients who followed the protocol would have decreased hospital length of stay and decreased narcotic usage than those who did not.

Design

Retrospective cohort study.

Setting

The study takes place at a single tertiary children's hospital.

Patients

All patients who underwent cleft palate repair during a 10-year period (n = 242).

Interventions

All patients underwent cleft palate repair with the most recent cohort following a new ERAS protocol.

Main Outcome Measures

Primary outcomes included hospital length of stay and narcotic usage in the first 24 hours after surgery.

Results

Use of local bupivacaine during surgery was associated with decreased initial 24-hour morphine equivalent usage: 2.25 vs 3.38 mg morphine equivalent (MME) (P < 0.01), and a decreased hospital length of stay: 1.71 days vs 2.27 days (P < 0.01). The highest 24-hour morphine equivalent a patient consumed prior to the ERAS protocol implementation was 24.53 MME, compared with 6.3 MME after implementation. Utilization of the ERAS protocol was found to be associated with a decreased hospital length of stay: 1.67 vs 2.18 days (P < 0.01).

Conclusions

Use of the proposed ERAS protocol may lead to lower narcotic usage and decreased length of stay.
Increased Time Interval of Postoperative Flap Monitoring After Autologous Breast Reconstruction
Authors: Schwartzberg Harel G. , Doran Hannah E. , Bartow Matthew J. , Patterson Charles , Stalder Mark W. , Allen Robert J. , St. Hilaire Hugo
Published: June 2024

Background

Hourly flap checks are the most common means of flap monitoring during the first 24 hours following autologous breast reconstruction (ABR). This practice often requires intensive care unit (ICU) admission, which is a key driver of health care costs and decreased patient satisfaction. This study addresses these issues by demonstrating decreased cost and length of admission associated with a 4-hour interval between flap checks during the first 24 hours following ABR.

Methods

This is a retrospective review of ABR surgeries performed by multiple surgeons from 2017 to 2020. Two cohorts were identified, one that underwent flap checks every hour in the ICU (Q1 cohort) and the other that underwent flap checks every 4 hours on the hospital floor (Q4 cohort). Our primary outcome measures were length of stay (LOS), flap takebacks, flap loss, and encounter cost.

Results

Rates of flap takeback and loss did not differ between cohorts (P = 0.18, P = 0.21). The Q4 cohort's average LOS was shorter than the Q1 cohort (P = 0.002). The Q4 cohort's average cost was also $25,554.80 less than the Q1 cohort (P < 0.001). This association persisted after controlling for LOS, operating room takeback, timing and laterality of reconstruction, and flap configuration (hazard ratio = 0.65, P = 0.0007).

Conclusion

This study demonstrates the benefits of lengthened flap check intervals during the first 24 hours following ABR. These intervals decrease the cost of ABR while also maintaining safety, making ABR a more accessible option for breast reconstruction patients.
Optimizing Safety and Aesthetics in Facial Feminization: Laryngoscopic-Assisted Chondrolaryngoplasty (2019–2023)
Authors: James Andrew J. , Assi Patrick E. , Torres-Guzman Ricardo A. , Nemani Sriya V. , Saad Mariam , Kalmar Christopher L. , Perdikis Galen , Al Kassis Salam
Published: June 2024

Introduction:

The thyroid cartilage, an androgen-sensitive structure, enlarges during puberty in individuals assigned male at birth, often resulting in a pronounced neck protuberance. This feature can exacerbate gender dysphoria in transfeminine patients. Chondrolaryngoplasty, commonly known as tracheal shave, is a procedure incorporated into facial feminization surgery (FFS) to address this issue. This study reports on the implementation of an endoscopic-assisted chondrolaryngoplasty technique, its safety, and the outcomes observed.

Methods:

The authors conducted a retrospective review of chondrolaryngoplasty cases at our center, examining patient outcomes and procedural safety. The analysis included a breakdown of concurrent gender-affirming surgeries performed. An endoscopic-guided technique was utilized, and its procedural steps were documented in a video.

Results:

In the past five years, 32 patients received chondrolaryngoplasty at our facility. Postoperative complications were minimal, with no infections, wound separations, or surgical site complications reported. Only one patient experienced temporary hoarseness, which resolved within 6 weeks without intervention. The procedure was frequently combined with other surgical interventions, with the average patient undergoing 3 additional procedures, the most common being augmentation mammaplasty, brow lifting, and frontal bone reduction.

Conclusions:

Tracheal shave is an effective surgical technique for alleviating gender dysphoria in transfeminine patients. Keys to its success include the accurate identification of thyroid cartilage, especially in patients with enlarged cricoid cartilages, intraoperative coordination with anesthesia for laryngoscopic vocal cord visualization, sub-perichondrial cartilage excision to minimize the risk of bleeding and damage near the vocal cords, and carefully layered closure to optimize scar healing.
A Comparison of Automatically Extracted Quantitative EEG Features for Seizure Risk Stratification in Neonatal Encephalopathy
Authors: Keene Jennifer C. , Loe Maren E. , Fulton Talie , Keene Maire , Morrissey Michael J. , Tomko Stuart R. , Vesoulis Zachary A. , Zempel John M. , Ching ShiNung , Guerriero Réjean M.
Published: June 2024

Purpose:

Seizures occur in up to 40% of neonates with neonatal encephalopathy. Earlier identification of seizures leads to more successful seizure treatment, but is often delayed because of limited availability of continuous EEG monitoring. Clinical variables poorly stratify seizure risk, and EEG use to stratify seizure risk has previously been limited by need for manual review and artifact exclusion. The goal of this study is to compare the utility of automatically extracted quantitative EEG (qEEG) features for seizure risk stratification.

Methods:

We conducted a retrospective analysis of neonates with moderate-to-severe neonatal encephalopathy who underwent therapeutic hypothermia at a single center. The first 24 hours of EEG underwent automated artifact removal and qEEG analysis, comparing qEEG features for seizure risk stratification.

Results:

The study included 150 neonates and compared the 36 (23%) with seizures with those without. Absolute spectral power best stratified seizure risk with area under the curve ranging from 63% to 71%, followed by range EEG lower and upper margin, median and SD of the range EEG lower margin. No features were significantly more predictive in the hour before seizure onset. Clinical examination was not associated with seizure risk.

Conclusions:

Automatically extracted qEEG features were more predictive than clinical examination in stratifying neonatal seizure risk during therapeutic hypothermia. qEEG represents a potential practical bedside tool to individualize intensity and duration of EEG monitoring and decrease time to seizure recognition. Future work is needed to refine and combine qEEG features to improve risk stratification.
Comparing behaviours induced by natural memory retrieval and optogenetic reactivation of an engram ensemble in mice
Authors: Park Sungmo , Ko Sang Yoon , Frankland Paul W. , Josselyn Sheena A.
Published: June 2024

Memories are thought to be stored within sparse collections of neurons known as engram ensembles. Neurons active during a training episode are allocated to an engram ensemble (‘engram neurons’). Memory retrieval is initiated by external sensory or internal cues present at the time of training reactivating engram neurons. Interestingly, optogenetic reactivation of engram ensemble neurons alone in the absence of external sensory cues is sufficient to induce behaviour consistent with memory retrieval in mice. However, there may exist differences between the behaviours induced by natural retrieval cues or artificial engram reactivation. Here, we compared two defensive behaviours (freezing and the syllable structure of ultrasonic vocalizations, USVs) induced by sensory cues present at training (natural memory retrieval) and optogenetic engram ensemble reactivation (artificial memory retrieval) in a threat conditioning paradigm in the same mice. During natural memory recall, we observed a strong positive correlation between freezing levels and distinct USV syllable features (characterized by an unsupervised algorithm, MUPET (Mouse Ultrasonic Profile ExTraction)). Moreover, we observed strikingly similar behavioural profiles in terms of freezing and USV characteristics between natural memory recall and artificial memory recall in the absence of sensory retrieval cues. Although our analysis focused on two behavioural measures of threat memory (freezing and USV characteristics), these results underscore the similarities between threat memory recall triggered naturally and through optogenetic reactivation of engram ensembles.

This article is part of a discussion meeting issue ‘Long-term potentiation: 50 years on’.
Differential effectiveness of dietary zinc supplementation with autism-related behaviours in
Shank2
knockout mice
Authors: Lee Kevin , Jung Yewon , Vyas Yukti , Mills Zoe , McNamara Laura , Montgomery Johanna M.
Published: June 2024

The family of SHANK proteins have been shown to be critical in regulating glutamatergic synaptic structure, function and plasticity.
SHANK
variants are also prevalent in autism spectrum disorders (ASDs), where glutamatergic synaptopathology has been shown to occur in multiple ASD mouse models. Our previous work has shown that dietary zinc in

Shank3
−/−

and

Tbr1
+/−

ASD mouse models can reverse or prevent ASD behavioural and synaptic deficits. Here, we have examined whether dietary zinc can influence behavioural and synaptic function in

Shank2
−/−

mice. Our data show that dietary zinc supplementation can reverse hyperactivity and social preference behaviour in

Shank2
−/−

mice, but it does not alter deficits in working memory. Consistent with this, at the synaptic level, deficits in NMDA/AMPA receptor-mediated transmission are also not rescued by dietary zinc. In contrast to other ASD models examined, we observed that SHANK3 protein was highly expressed at the synapses of

Shank2
−/−

mice and that dietary zinc returned these to wild-type levels. Overall, our data show that dietary zinc has differential effectiveness in altering ASD behaviours and synaptic function across ASD mouse models even within the
Shank
family.

This article is part of a discussion meeting issue 'Long-term potentiation: 50 years on'.
Equal levels of pre- and postsynaptic potentiation produce unequal outcomes
Authors: Savtchenko Leonid P. , Rusakov Dmitri A.
Published: June 2024

Which proportion of the long-term potentiation (LTP) expressed in the bulk of excitatory synapses is postsynaptic and which presynaptic remains debatable. To understand better the possible impact of either LTP form, we explored a realistic model of a CA1 pyramidal cell equipped with known membrane mechanisms and multiple, stochastic excitatory axo-spinous synapses. Our simulations were designed to establish an input–output transfer function, the dependence between the frequency of presynaptic action potentials triggering probabilistic synaptic discharges and the average frequency of postsynaptic spiking. We found that, within the typical physiological range, potentiation of the postsynaptic current results in a greater overall output than an equivalent increase in presynaptic release probability. This difference grows stronger at lower input frequencies and lower release probabilities. Simulations with a non-hierarchical circular network of principal neurons indicated that equal increases in either synaptic fidelity or synaptic strength of individual connections also produce distinct changes in network activity, although the network phenomenology is likely to be complex. These observations should help to interpret the machinery of LTP phenomena documented
in situ
.

This article is part of a discussion meeting issue ‘Long-term potentiation: 50 years on’.