bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistence of Chemotherapy-Induced Peripheral Neuropathy Despite Vincristine Reduction in Childhood B-Acute Lymphoblastic Leukemia
Authors: Rodwin Rozalyn L , Kairalla John A , Hibbitts Emily , Devidas Meenakshi , Whitley Moira K , Mohrmann Caroline E , Schore Reuven J , Raetz Elizabeth , Winick Naomi J , Hunger Stephen P , Loh Mignon L , Hockenberry Marilyn J , Angiolillo Anne L , Ness Kirsten K , Kadan-Lottick Nina S
Published: May 2022

Background

Children with B-acute lymphoblastic leukemia (B-ALL) are at risk for chemotherapy-induced peripheral neuropathy (CIPN). Children’s Oncology Group AALL0932 randomized reduction in vincristine and dexamethasone (every 4 weeks vs 12 weeks during maintenance in the average-risk subset of National Cancer Institute standard-B-ALL (SR AR B-ALL). We longitudinally measured CIPN, overall and by treatment group.

Methods

AALL0932 standard-B-ALL patients aged 3 years and older were evaluated at T1-T4 (end consolidation, maintenance month 1, maintenance month 18, 12 months posttherapy). Physical and occupational therapists (PT/OT) measured motor CIPN (hand and ankle strength, dorsiflexion and plantarflexion range of motion), sensory CIPN (finger and toe vibration and touch), function (dexterity [Purdue Pegboard], and walking efficiency [Six-Minute Walk]). Proxy-reported function (Pediatric Outcome Data Collection Instrument) and quality of life (Pediatric Quality of Life Inventory) were assessed. Age- and sex-matched z scores and proportion impaired were measured longitudinally and compared between groups.

Results

Consent and data were obtained from 150 participants (mean age = 5.1 years [SD = 1.7], 48.7% female). Among participants with completed evaluations, 81.8% had CIPN at T1 (74.5% motor, 34.1% sensory). When examining severity of PT/OT outcomes, only handgrip strength (P < .001) and walking efficiency (P = .02) improved from T1-T4, and only dorsiflexion range of motion (46.7% vs 14.7%; P = .008) and handgrip strength (22.2% vs 37.1%; P = .03) differed in vincristine and dexamethasone every 4 weeks vs vincristine and dexamethasone 12 weeks at T4. Proxy-reported outcomes improved from T1 to T4 (P < .001), and most did not differ between groups.

Conclusions

CIPN is prevalent early in B-ALL therapy and persists at least 12 months posttherapy. Most outcomes did not differ between treatment groups despite reduction in vincristine frequency. Children with B-ALL should be monitored for CIPN, even with reduced vincristine frequency.
Racial and Ethnic Disparities in Lung Cancer Screening by the 2021 USPSTF Guidelines Versus Risk-Based Criteria: The Multiethnic Cohort Study
Authors: Aredo Jacqueline V , Choi Eunji , Ding Victoria Y , Tammemägi Martin C , ten Haaf Kevin , Luo Sophia J , Freedman Neal D , Wilkens Lynne R , Le Marchand Loïc , Wakelee Heather A , Meza Rafael , Park Sung-Shim Lani , Cheng Iona , Han Summer S
Published: May 2022

Background

In 2021, the US Preventive Services Task Force (USPSTF) revised its lung cancer screening guidelines to expand screening eligibility. We evaluated screening sensitivities and racial and ethnic disparities under the 2021 USPSTF criteria vs alternative risk-based criteria in a racially and ethnically diverse population.

Methods

In the Multiethnic Cohort, we evaluated the proportion of ever-smoking lung cancer cases eligible for screening (ie, screening sensitivity) under the 2021 USPSTF criteria and under risk-based criteria through the PLCOm2012 model (6-year risk ≥1.51%). We also calculated the screening disparity (ie, absolute sensitivity difference) for each of 4 racial or ethnic groups (African American, Japanese American, Latino, Native Hawaiian) vs White cases.

Results

Among 5900 lung cancer cases, 43.3% were screen eligible under the 2021 USPSTF criteria. Screening sensitivities varied by race and ethnicity, with Native Hawaiian (56.7%) and White (49.6%) cases attaining the highest sensitivities and Latino (37.3%), African American (38.4%), and Japanese American (40.0%) cases attaining the lowest. Latino cases had the greatest screening disparity vs White cases at 12.4%, followed by African American (11.2%) and Japanese American (9.6%) cases. Under risk-based screening, the overall screening sensitivity increased to 75.7%, and all racial and ethnic groups had increased sensitivities (54.5%-91.9%). Whereas the screening disparity decreased to 5.1% for African American cases, it increased to 28.6% for Latino cases and 12.8% for Japanese American cases.

Conclusions

In the Multiethnic Cohort, racial and ethnic disparities decreased but persisted under the 2021 USPSTF lung cancer screening guidelines. Risk-based screening through PLCOm2012 may increase screening sensitivities and help to reduce disparities in some, but not all, racial and ethnic groups. Further optimization of risk-based screening strategies across diverse populations is needed.
The Impact of Androgen Deprivation Therapy on COVID-19 Illness in Men With Prostate Cancer
Authors: Shah Neil J , Patel Vaibhav G , Zhong Xiaobo , Pina Luis , Hawley Jessica E , Lin Emily , Gartrell Benjamin A , Febles Victor Adorno , Wise David R , Qin Qian , Mellgard George , Joshi Himanshu , Nauseef Jones T , Green David A , Vlachostergios Panagiotis J , Kwon Daniel H , Huang Franklin , Liaw Bobby , Tagawa Scott , Kantoff Philip , Morris Michael J , Oh William K
Published: May 2022

Background

TMPRSS2, a cell surface protease regulated by androgens and commonly upregulated in prostate cancer (PCa), is a necessary component for SARS-CoV-2 viral entry into respiratory epithelial cells. Previous reports suggested a lower risk of SARS-CoV-2 among PCa patients on androgen deprivation therapy (ADT). However, the impact of ADT on severe COVID-19 illness is poorly understood.

Methods

We performed a multicenter study across 7 US medical centers and evaluated patients with PCa and SARS-CoV-2 detected by polymerase-chain-reaction between March 1, 2020, and May 31, 2020. PCa patients were considered on ADT if they had received appropriate ADT treatment within 6 months of COVID-19 diagnosis. We used multivariable logistic and Cox proportional-hazard regression models for analysis. All statistical tests were 2-sided.

Results

We identified 465 PCa patients (median age = 71 years) with a median follow-up of 60 days. Age, body mass index, cardiovascular comorbidity, and PCa clinical disease state adjusted overall survival (hazard ratio [HR] = 1.16, 95% confidence interval [CI] = 0.68 to 1.98, P = .59), hospitalization status (HR = 0.96, 95% CI = 0.52 to 1.77, P = .90), supplemental oxygenation (HR 1.14, 95% CI = 0.66 to 1.99, P = .64), and use of mechanical ventilation (HR = 0.81, 95% CI = 0.25 to 2.66, P = .73) were similar between ADT and non-ADT cohorts. Similarly, the addition of androgen receptor–directed therapy within 30 days of COVID-19 diagnosis to ADT vs ADT alone did not statistically significantly affect overall survival (androgen receptor–directed therapy: HR = 1.27, 95% CI = 0.69 to 2.32, P = .44).

Conclusions

In this retrospective cohort of PCa patients, the use of ADT was not demonstrated to influence severe COVID-19 outcomes, as defined by hospitalization, supplemental oxygen use, or death. Age 70 years and older was statistically significantly associated with a higher risk of developing severe COVID-19 disease.
Azetidine-2-Carboxylic Acid-Induced Oligodendrogliopathy: Relevance to the Pathogenesis of Multiple Sclerosis
Authors: Sobel Raymond A , Albertelli Megan , Hinojoza Julian R , Eaton Mary Jane , Grimes Kevin V , Rubenstein Edward
Published: May 2022

The naturally occurring imino acid azetidine-2-carboxylic acid (Aze) is consumed by humans and can be misincorporated in place of proline in myelin basic protein (MBP) in vitro. To determine Aze effects on the mammalian CNS in vivo, adult CD1 mice were given Aze orally or intraperitoneally. Clinical signs reminiscent of MBP-mutant mice occurred with 600 mg/kg Aze exposure. Aze induced oligodendrocyte (OL) nucleomegaly and nucleoplasm clearing, dilated endoplasmic reticulum, cytoplasmic vacuolation, abnormal mitochondria, and Aze dose-dependent apoptosis. Immunohistochemistry demonstrated myelin blistering and nuclear translocation of unfolded protein response (UPR)/proinflammatory molecules (ATF3, ATF4, ATF6, eIF2α, GADD153, NFκB, PERK, XBP1), MHC I expression, and MBP cytoplasmic aggregation in OL. There were scattered microglial nodules in CNS white matter (WM); other CNS cells appeared unaffected. Mice given Aze in utero and postnatally showed more marked effects than their dams. These OL, myelin, and microglial alterations are found in normal-appearing WM (NAWM) in multiple sclerosis (MS) patients. Thus, Aze induces a distinct oligodendrogliopathy in mice that recapitulates MS NAWM pathology without leukocyte infiltration. Because myelin proteins are relatively stable throughout life, we hypothesize that Aze misincorporation in myelin proteins during myelinogenesis in humans results in a progressive UPR that may be a primary process in MS pathogenesis.
Spread, Vector Flight Behavior, and Impact of Laurel Wilt in Sassafras Beyond the Gulf-Atlantic Coastal Plain
Authors: Mayfield Albert E , Olatinwo Rabiu O , Hwang Jaesoon , Mudder Bryan T , Blevins Alexandra , Fraedrich Stephen W
Published: May 2022

Laurel wilt is a destructive vascular disease of trees in the laurel family (Lauraceae) caused by a nonnative insect/pathogen complex. This study monitored the recent spread and impact of laurel wilt in sassafras (Sassafras albidum [Nutt.] Nees) from the Gulf-Atlantic Coastal Plain region of the southeastern United States (US) into the adjacent Piedmont/Sandhills and Mountain regions. Laurel wilt was detected at thirteen of forty-six sassafras sites including seven outside the Coastal Plain. Compared to nondiseased sites, sassafras mortality due to laurel wilt increased rapidly from 2018 to 2020 and occurred in all diameter classes monitored (≥ 5 cm diameter at breast height, dbh). Flight trapping for the laurel wilt vector, the redbay ambrosia beetle (RAB, Xyleborus glabratus Eichhoff), with α-copaene lures did not enhance early detection of latent laurel wilt infections. Seasonal flight activity of the RAB in the Piedmont and Mountains suggested two generations per year with little to no flight from December through March.

Study Implications

Sassafras is the most widely-distributed lauraceous tree species in the US and is valued for its ecological functions, durable wood, and numerous cultural uses. Our results strongly suggest the potential for substantial loss of the existing sassafras resource as laurel wilt continues spreading through the eastern US. Survey traps baited with current lures for the primary insect vector are unlikely to improve early detection of new laurel wilt infections. The georeferenced network of plots established for this project provides baseline data for future monitoring efforts and could be revisited to look for evidence of sassafras resistance to the laurel wilt pathogen.
Comparative Genomics Reveals Insights into the Divergent Evolution of Astigmatic Mites and Household Pest Adaptations
Authors: Xiong Qing , Wan Angel Tsz-Yau , Liu Xiaoyu , Fung Cathy Sin-Hang , Xiao Xiaojun , Malainual Nat , Hou Jinpao , Wang Lingyi , Wang Mingqiang , Yang Kevin Yi , Cui Yubao , Leung Elaine Lai-Han , Nong Wenyan , Shin Soo-Kyung , Au Shannon Wing-Ngor , Jeong Kyoung Yong , Chew Fook-Tim , Hui Jerome Ho-Lam , Leung Ting-Fan , Tungtrongchitr Anchalee , Zhong Nanshan , Liu Zhigang , Tsui Stephen Kwok-Wing
Published: May 2022

Highly diversified astigmatic mites comprise many medically important human household pests such as house dust mites causing ∼1–2% of all allergic diseases globally; however, their evolutionary origin and diverse lifestyles including reversible parasitism have not been illustrated at the genomic level, which hampers allergy prevention and our exploration of these household pests. Using six high-quality assembled and annotated genomes, this study not only refuted the monophyly of mites and ticks, but also thoroughly explored the divergence of Acariformes and the diversification of astigmatic mites. In monophyletic Acariformes, Prostigmata known as notorious plant pests first evolved, and then rapidly evolving Astigmata diverged from soil oribatid mites. Within astigmatic mites, a wide range of gene families rapidly expanded via tandem gene duplications, including ionotropic glutamate receptors, triacylglycerol lipases, serine proteases and UDP glucuronosyltransferases. Gene diversification after tandem duplications provides many genetic resources for adaptation to sensing environmental signals, digestion, and detoxification in rapidly changing household environments. Many gene decay events only occurred in the skin-burrowing parasitic mite Sarcoptes scabiei. Throughout the evolution of Acariformes, massive horizontal gene transfer events occurred in gene families such as UDP glucuronosyltransferases and several important fungal cell wall lytic enzymes, which enable detoxification and digestive functions and provide perfect drug targets for pest control. This comparative study sheds light on the divergent evolution and quick adaptation to human household environments of astigmatic mites and provides insights into the genetic adaptations and even control of human household pests.
Refractory satellite ganglion cyst in the hallux and finger
Authors: Muramatsu Keiichi , Tani Yasuhiro , Kobayashi Masato , Sugimoto Hideaki , Iwanaga Ryuta , Mihara Atsushi , Sakai Koji
Published: May 2022

Painful ganglion cysts that develop in the hallux and finger usually enlarge progressively to the peripheral direction. Simple resection of satellite ganglion cyst alone has been reported to cause a high rate of recurrence and treatment is often very difficult. The purpose of this study is to evaluate the appropriate surgical treatment for painful satellite ganglion cysts in the hallux and finger and discuss the origin of the ganglion cysts in cases treated surgically at our hospital. We reviewed five cases (three males and two females, ages 55–87 years), three of which occurred in the hallux and two in the finger. In all cases, the preoperative magnetic resonance image showed a large fluid of the flexor tendon sheath. And also, joint effusion was found in the metatarsophalangeal joint and the proximal interphalangeal joint. The first case of the hallux ganglion underwent simple excision of the cyst and had recurrences three times. In the other four cases, the additional synovectomy of the metatarsophalangeal joint and the proximal interphalangeal joint was performed along with ganglion cyst excision. These cases had no recurrence up to 1 year after operation. Recently, there have been reports that tendon sheath ganglions are connected to the ankle, wrist, hallux, and phalangeal joints. Although there are a few cases in our department, satellite ganglion cyst of the hallux and finger possibly originates from adjacent joints. Additional synovectomy of the affected joint should be performed for the excision of satellite ganglion cyst to prevent recurrence.
enrichMiR predicts functionally relevant microRNAs based on target collections
Authors: Soutschek Michael , Germade Tomás , Germain Pierre-Luc , Schratt Gerhard
Published: May 2022

MicroRNAs (miRNAs) are small non-coding RNAs that are among the main post-transcriptional regulators of gene expression. A number of data collections and prediction tools have gathered putative or confirmed targets of these regulators. It is often useful, for discovery and validation, to harness such collections to perform target enrichment analysis in given transcriptional signatures or gene-sets in order to predict involved miRNAs. While several methods have been proposed to this end, a flexible and user-friendly interface for such analyses using various approaches and collections is lacking. enrichMiR (https://ethz-ins.org/enrichMiR/) addresses this gap by enabling users to perform a series of enrichment tests, based on several target collections, to rank miRNAs according to their likely involvement in the control of a given transcriptional signature or gene-set. enrichMiR results can furthermore be visualised through interactive and publication-ready plots. To guide the choice of the appropriate analysis method, we benchmarked various tests across a panel of experiments involving the perturbation of known miRNAs. Finally, we showcase enrichMiR functionalities in a pair of use cases.
Belatacept rescue conversion in kidney transplant recipients with vascular lesions (Banff cv score >2): a retrospective cohort study
Authors: Bertrand Dominique , Matignon Marie , Morel Antoine , Ludivine Lebourg , Lemoine Mathilde , Hanoy Mélanie , Roy Frank Le , Nezam Dorian , Hamzaoui Mouad , de Nattes Tristan , Moktefi Anissa , François Arnaud , Laurent Charlotte , Etienne Isabelle , Guerrot Dominique
Published: May 2022

Background

Immunosuppression in kidney transplant recipients with decreased graft function and histological vascular changes can be particularly challenging. The impact of a late rescue conversion to belatacept on kidney graft survival in this context has never been studied.

Methods

We report a bicentric retrospective cohort study comparing a calcineurin inhibitor (CNI) to belatacept switch versus CNI continuation in 139 kidney transplant recipients with histological kidney vascular damage (cv ≥2, g + cpt ≤1, i + t ≤1) and low estimated glomerular filtration rate (≤40 mL/min/1.73 m²). Primary outcome was death-censored graft survival.

Results

During the study follow-up, 10 graft losses (14.5%) occurred in the belatacept group (n = 69) versus 26 (37.1%) in the matched CNI group (n = 70) (P = .005). Death-censored graft survival was significantly higher in the belatacept group (P = .001). At 3 years, graft survival was 84.0% in the belatacept group compared with 65.1% in the control group. Continuing CNI was an independent risk factor for graft loss [hazard ratio (HR) 3.46; P < .005]. The incidence of cellular rejection after the conversion was low (4.3% in both groups) and not significantly different between groups (P = .84). Patients switched to belatacept developed significantly less donor-specific antibodies de novo. Belatacept was an independent risk factor for the occurrence of opportunistic infections (HR 4.84; P < .005).

Conclusion

The replacement of CNI with belatacept in patients with decreased allograft function and vascular lesions is associated with an improvement in graft survival and represents a valuable option in a context of organ shortage. Caution should be exercised regarding the increased risk of opportunistic infection.
Poisson–Lie T-plurality for dressing cosets
Authors: Sakatani Yuho
Published: May 2022

The Poisson–Lie T-plurality is an equivalence of string theories on various cosets $\mathcal {D}/\tilde{G},\ \mathcal {D}/\tilde{G}^{\prime },\ldots$, where $\mathcal {D}$ is a Drinfel’d double and $\tilde{G}$, $\tilde{G}^{\prime },\ldots$ are maximal isotropic subgroups. This can be extended to the equivalence for dressing cosets, i.e., $F\backslash \mathcal {D}/\tilde{G},\ F\backslash \mathcal {D}/\tilde{G}^{\prime },\ldots$, where F is an isotropic subgroup of $\mathcal {D}$. We explore this extended Poisson–Lie T-plurality, clarifying the relation between several previous approaches. We propose a gauged sigma model for a general gauge group F and obtain the formula for the metric and the B-field on the dressing coset. Using this formula and an ansatz for the dilaton, we show that the Poisson–Lie (PL) T-plurality for dressing cosets (with spectator fields) is a symmetry of double field theory. The formula for the Ramond–Ramond field strength is also proposed such that the equations of motion for the Neveu–Schwarz–Neveu–Schwarz fields are transformed covariantly. In addition, we provide specific examples of the PL T-plurality for dressing cosets.
Quantifying the population burden of musculoskeletal disorders, including impact on sickness absence: analysis of national Scottish data
Authors: Walker-Bone Karen , Storkey Helen , Peacock Julie , Ellis Benjamin , Ly Michael , Hill Jonathan , O’Malley James
Published: May 2022

Objectives

Musculoskeletal disorders (MSDs) account for the greatest burden of years lived with disability globally. To prevent disability, good-quality services need to be commissioned, appropriate for local need. We analysed data collected systematically from a new musculoskeletal service serving 70% of the population of Scotland to evaluate: age- and sex-specific occurrence; anatomical distribution; and impact and effect on work ability.

Methods

A new centralized telephone-based triage for people with musculoskeletal disorders was set up in Scotland in 2015. Available to most of the population aged >16 years (>3 million people), data were collected systematically into a database detailing: anatomical site, nature of onset, duration, impact/risk (modified STarT score), deprivation level and, for those in employment, sickness absence.

Results

Data were available from 219 314 new callers, 2015–18. Calls were more frequently from women (60%), increased with age until the eighth decade, and 66% reported symptoms that had been present for >6 weeks. Callers were more likely to be living in more deprived areas in each age band between 20 and 64 years and tended to have higher-impact symptoms. The majority (53%) of callers were in employment, and 19% of these were off sick because of their symptoms. Sickness absence was more common among those with highest impact/risk scores from deprived areas with more acute symptoms.

Discussion

Large-scale systematic data collection for MSDs emphasizes the size and impact of the burden among adults aged >16 years. A socio-economic gradient is evident in terms of prevalence and impact of MSDs, particularly for sickness absence.
Triterpenes from Olea europaea modulate in vitro ruminal fermentation
Authors: Cangiano Lautaro R , Henry Darren D , Ciriaco Francine M , Quintela Jose Carlos , DiLorenzo Nicolas , Ipharraguerre Ignacio R
Published: May 2022

Bioactive compounds present in Olea europaea have shown promising antimicrobial potential as an alternative to conventional coccidiostats. These effects are exerted by triterpenic acids (TT) present in the olive plant, namely, oleanolic acid (OA), ursolic acid (UA), and maslinic acid (MA). The objective of this study was to determine the effects of OA, UA, and MA on in vitro ruminal fermentation in comparison with monensin (MON). The study consisted of two experiments conducted as randomized complete block designs using bahiagrass hay or a high-concentrate mixed ration as basal substrates. In the first experiment (Exp. 1), a batch culture was performed with increasing doses of OA, UA, or MA. In Exp. 2, to increase the solubility of OA, two chemical forms were evaluated: a sodium salt (OA-NA) or a phyto-phospholipid complex (OA-PHYT) at 0, 4, 40, 100, and 200 mg/L of incubation inoculum. In both experiments, the dose 0 was used as control (CTL) and monensin (MON) as a positive control. Data were analyzed as a randomized complete block design with a factorial arrangement of treatments. For Exp. 2, orthogonal polynomial contrasts, adjusted for unequal spacing were used to determine the linear effects of increasing doses of OA-NA and OA-PHYT. In Exp. 1, OA reduced the concentration of CH4 in the high-concentrate substrate compared with CTL (P = 0.04). In Exp. 2 the total gas production was linearly decreased with increasing doses of OA-NA in both substrates (P ≤ 0.02). Furthermore, OA-NA and OA-PHYT decreased in vitro organic matter digestibility (P < 0.01) in the bahiagrass substrate to the same extent that MON did. However, the concentration of CH4/g of incubated DM was only reduced by the highest doses of OA-NA (P < 0.02). Lastly, no effects were observed for total VFA nor the VFA profile; however, OA-NA linearly decreased the A:P ratio in the bahiagrass substrate (P = 0.03). In conclusion, the acid form of OA as well as the sodium salt and phyto-phospholipid complex of OA were able to modify some fermentation parameters in this study; however, the magnitude of the responses was lower compared with monensin. Future studies should test OA in vivo to determine if the effects on ruminal fermentation observed here can translate into improve production efficiency while reducing carbon emissions.
Functional Restoration of Complex Segmental Middle Third Facial Defect Using Tensor Fascia Lata and Lipofilling
Authors: Abd Al-Moktader Magdy A. , Ayad Wael , Ouf Mohamed Osama , Shoulkami Khalad , Youssif Sherif Hamdeno , Dahshan Hazem , Zayid Tarek
Published: May 2022

Composite defects in the middle third of the face have devastating effects on a patient’s life and social impacts. Several techniques have been described for the restoration of facial defects. The dynamic reconstruction of such defects mainly comprises a complex two-stage procedure and/or microsurgery, functional muscle transfer for restoration of facial animation, and filling the defects. A novel idea for the dynamic reconstruction of the complex segmental midfacial defects includes employing a fascial interposition graft to bridge the gap between the proximally innervated remnants of the facial muscle supplied by the facial nerve and the distal paralyzed perioral muscle, which is simultaneously combined with lipofilling to obtain a good contour and functional restoration.
Transretroperitoneal Pedicled Omental Flap for Coverage of Traumatic Sacral Defect: A Case Report
Authors: Bruce William J. , Olla Danielle R. , Feimster James W. , Woldanski Lauren M. , Hart Kyle D. , Reid Adam , Schwartz Bradley , Berry Nada N.
Published: May 2022

The greater omentum is a reliable choice for salvage soft-tissue reconstruction. Benefits include consistent anatomy, long pedicle length, and a high concentration of lymphatic tissue that is resistant to infection. We report the case of a 46-year-old man with a complex traumatic sacral wound resulting in severe limitation of reconstructive options. A pedicled greater omentum flap was transposed through the retroperitoneum via the lumbosacral triangle, resulting in durable soft-tissue coverage.
Closing the Gap: Training Experiences and Career Outcomes for Underrepresented Minorities in Plastic Surgery
Authors: Diatta Fortunay , Mellia Joseph A. , Morris Martin P. , Murphy Alexander I. , Onyekaba Ginikanwa , Mares Jason , McAuliffe Phoebe B. , Broach Robyn B. , Fischer John P. , Butler Paris D.
Published: May 2022

Background:

The present study assesses training characteristics, scholastic achievements, and traditional career accomplishments of ethnically underrepresented in medicine (UIM) plastic and reconstructive surgery (PRS) faculty relative to non-UIM PRS faculty.

Method:

A cross-sectional analysis of core PRS faculty appointed to accredited United States residency training programs (n = 99) was performed.

Results:

Of the 949 US PRS faculty, a total of 51 (5.4%) were identified as UIM. Compared with non-UIM faculty, there were few differences when evaluating medical education, residency training, pursuit of advanced degrees, and attainment of subspecialty fellowship training. UIM faculty were more likely than non-UIM faculty to have graduated from a medical school outside the United States (25% versus 13%, P = 0.014). In addition, UIM faculty did not differ from non-UIM counterparts in traditional career accomplishments, including promotion to full professor, obtaining NIH funding, serving as program director, receiving an endowed professorship, appointment to a peer-reviewed editorial board, scholarly contributions (H-index and number of publications), and appointment to chief/chair of their division/department.

Conclusions:

The historical lack of ethnic diversity that comprise US academic PRS faculty persists. This study reveals that those UIM faculty who are able to obtain faculty appointments are equally successful in achieving scholastic success and traditional career accomplishments as their non-UIM counterparts. As we strive toward increasing representation of UIM physicians in academic plastic surgery, the field will benefit from efforts that promote a pipeline for underrepresented groups who traditionally face barriers to entry.
Opportunity Costs of Internal Promotions in Plastic Surgery: Are Women Given a Fair Shot?
Authors: Plana Natalie M. , Smith Kira L. , Hu Sophia , Xu Wen , Broach Robyn B. , Butler Paris D. , Lin Ines C.
Published: May 2022

Background:

Academic advancement in plastic surgery necessitates creation of opportunities for rising faculty, which are pivotal for women in their efforts to close prominent gender gaps in higher ranks. We study positions of academic prestige that benefit from internal nomination as surrogates for opportunities afforded to men and women seeking leadership roles.

Methods:

We collected the following datapoints: authors of invited discussions published in Plastic and Reconstructive Surgery from 2010 to 2019; current editorial board members of representative plastic surgery journals; recipients of society-sponsored traveling fellowships; and directors of the American Board of Plastic Surgery. Public profiles for all authors and surgeons were referenced to confirm gender identification.

Results:

Seven-hundred ninety-seven plastic and reconstructive surgery discussions were included, 18% of which included female first or senior authorship. Seventy-one (9%) discussions listed a female senior author. Male and female senior authors were equally as likely to collaborate with a female first co-author (25% and 26%, respectively). Only 17% of invited authors contributed to 55% of discussion articles. Women occupied 19% of journal editorial board positions, though none were editors-in-chief. American Society of Reconstructive Microsurgery, American Society of Maxiliofacial Surgeons, American Society for Surgery of the Hand, and Plastic Surgery Foundation traveling fellowships were awarded to one (3%), four (7%), five (13%), and 141 (15%) female plastic surgeons, respectively. Women comprise 26% of directors of American Board of Plastic Surgery.

Conclusions:

Female representation in plastic surgery is rising, but it is not mirrored across appointed positions in academia. We should strive to support advancements that allow selected prestigious positions to more accurately reflect the gender distribution within the plastic surgery community.
Surgical Treatment Outcome of de Quervain’s Disease: A Systematic Review and Meta-analysis
Authors: Bosman Romy , Duraku Liron S. , van der Oest Mark J.W. , Hundepool C.A. , Rajaratnam Vaikunthan , Power D.M. , Selles Ruud W. , Zuidam J. Michiel
Published: May 2022

Background:

Surgical release of the extensor retinaculum is performed as a treatment for de Quervain’s (DQ) disease when conservative treatment fails. In the literature, there is no consensus about the effectiveness of a surgical release in patients with DQ, the complication rate, or which type of incision is superior. Therefore, a systematic review and meta-analysis were conducted.

Methods:

A systematic search was performed in Embase, Medline Ovid, Web of Science Core Collection, Cochrane, and Google Scholar. Articles regarding surgical treatment of DQ disease that reported outcome and complications were included. We extracted exact values of visual analog scale scores and percentages of patients who experienced pain at follow-up. Complications assessed were (sub) luxation, superficial radial nerve injuries, wound infections, and scar problems.

Results:

Twenty-one studies with a total of 939 patients were included. Five percent of these patients (95% CI 1%–18%) did not show complete remission of pain at follow-up. When pooled, the mean reduction in visual analog scale scores was 5.7 (95% CI 5.3–6.1) on a 0–10 scale. No difference in outcome between different types of surgery or incisions was seen. Based on the meta-analysis, the pooled complication rate was 11% (95% CI 5%–22%).

Conclusions:

Five percent of patients still have residual pain after surgical release of the first extensor compartment. Surgery type, as well as the type of incision, did not affect outcome or complication. Thus, surgical release of the extensor retinaculum for DQ disease is an effective treatment, regardless of the type of surgery.
Liposuction and Controlled Compression Therapy Reduce the Erysipelas Incidence in Primary and Secondary Lymphedema
Authors: Karlsson Tobias , Hoffner Mattias , Brorson Håkan
Published: May 2022

Background:

Skin infections are a recurring problem for people with lymphedema, and lymphedema has been proven to be the single most important risk factor for developing erysipelas in the leg. This study aimed to determine whether liposuction for late-stage lymphedema reduces the rate of erysipelas in lower extremity lymphedema.

Methods:

One-hundred twenty-four patients with a median age of 49 years who had liposuction and controlled compression therapy for lower extremity lymphedema were included. Excess volumes were calculated before and after surgery. Median preoperative and postoperative patient years at risk were 11 and 5 years, respectively.

Results:

With a total of 1680 preoperative person years at risk and 335 bouts of erysipelas experienced in 64 patients, the preoperative incidence rate was 0.20 bouts per person per year, and the period prevalence was 52%. Postoperatively, the patients were followed over a total of 763 person years at risk, and 28 patients experienced a total of 53 bouts of erysipelas, resulting in a postoperative incidence rate of 0.07 bouts per person per year, and a period prevalence of 23%. This represents a 65% decrease in the erysipelas incidence rate (P < 0.001). The preoperative median excess volume of 3158 ml was reduced with a median of 100% (P < 0.0001).

Conclusions:

Liposuction and controlled compression therapy significantly reduce the risk for erysipelas in lower extremity lymphedema and completely reduces the excess volume. This finding is similar to our previous research including patients with upper extremity lymphedema.
Rintala Flap and Posterior Perichondrial Cutaneous Graft: A Combined Approach for Nasal Tip Reconstruction
Authors: Eseme Ebai A. , Da Rocha Daniel , Tremp Mathias , Tzika Evangelia , Merat Rastine , Kalbermatten Daniel F. , Oranges Carlo M.
Published: May 2022

Nasal tip reconstruction requires a meticulous approach due to the complexity of the nasal anatomy and its aesthetic importance. Many procedures have been described to restore this aesthetic unit, including the paramedian forehead flap, which is one of the workhorse flaps. However, despite excellent final outcomes, this procedure may be refused by patients, due to its temporary conspicuous appearance possibly associated with serious psychological implications, and the need of multiple interventions. We aimed to present an approach combining the Rintala flap and the posterior perichondrial cutaneous graft as a valuable alternative to treat large nasal tip defects.
Association Between Serum Vitamin D Level and Rates of Structural and Functional Glaucomatous Progression
Authors: Lee Terry , Jammal Alessandro A. , Medeiros Felipe A.
Published: May 2022

Précis:

In a retrospective cohort study, serum vitamin D levels were not associated with rates of structural or functional loss in glaucoma patients, suggesting that low vitamin D level is not a risk factor for progression.

Purpose:

To investigate the association between serum vitamin D level and rates of functional and structural glaucomatous loss over time.

Methods:

This study included 826 eyes of 536 glaucoma or suspect patients with an average follow-up of 4.8±1.9 years. All patients had at least 1 serum vitamin D measurement, and all eyes had at least 2 reliable standard automated perimetry (SAP) tests and 2 spectral-domain optical coherence tomography (SD OCT) tests with a minimum follow-up of 6 months. Multivariable linear mixed-effects models were used to estimate the association of vitamin D level with rates of change in SAP mean deviation (MD) and OCT retinal nerve fiber layer (RNFL) thickness over time while adjusting for potential confounding factors.

Results:

Patients had an average of 3.4±1.7 SAP tests, 4.8±1.9 SD OCT tests, and 2.3±1.9 vitamin D measurements. The average serum vitamin D level was 33.9±13.2 ng/mL. Mean rates of MD and RNFL change were −0.03±0.08 dB/y and −0.68±0.64 µm/y, respectively. After controlling for confounding factors, there was no statistically significant association between mean vitamin D level and rates of MD (β=0.038, 95% CI: −0.006, 0.082, P=0.09) or RNFL loss over time (β=−0.018, 95% CI: −0.092, 0.055, P=0.62).

Conclusions:

We did not find a significant association between vitamin D level and rates of visual field or RNFL loss over time in individuals with glaucoma and glaucoma suspect patients.
Iris Obstruction Following PRESERFLO™ Microshunt Implantation and Surgical Management
Authors: Trigaux Céline , Steindor Friedrich A. , Spaniol Kristina , Geerling Gerd , Borrelli Maria
Published: May 2022

Purpose:

To present a case of lumen obstruction after implantation of microshunt with subconjunctival drainage and subsequent management.

Case Report:

A 56-year-old male with primary open angle glaucoma underwent uneventful PRESERFLO™ MicroShunt implantation in both eyes. Five months after surgery the patient presented with an intraocular pressure of 26▒mmHg in the right eye due to iris obstruction.

Results:

The iris fibers were severed and removed surgically to free the lumen. Follow-up showed a normalised intraocular pressure of 10▒mmHg and a free lumen.

Conclusion:

Uncontrolled intraocular pressure due to iris obstruction following PRESERFLO™ Microshunt was addressed by surgical removal of iris fibers at the lumen entrance without the need for tube repositioning.
Promoting Health Equity
Authors: Dahlin Constance , DePace Nicole , Ford Jeanna , Maani-Fogelman Patricia , Chow Kimberly
Published: May 2022

In May 2021, the National Academies of Sciences, Engineering, and Medicine released the Future of Nursing 2020-2030—Charting a Path to Health Equity. The report provides an in-depth analysis of the history and evidence of structural racism, the role of social determinants of health, and the role of nurses improving health equity in times of conventional care, disasters and crises, and public health emergencies. Palliative nurses are integral to impacting health equity for individuals with serious illness. Three strategies can help palliative nurses provide more equitable palliative care: 1) develop a more culturally sensitive practice and communication skill; 2) learn about the elements of social determinants of health to perform a simple Social Determinants of Health assessment as part of every patient's assessment; and 3) gather a list of community resources to help direct patients to resources.
Physical, Emotional/Behavioral, and Neurocognitive Developmental Outcomes From 2 to 4 Years After PICU Admission: A Secondary Analysis of the Early Versus Late Parenteral Nutrition Randomized Controlled Trial Cohort*
Authors: Verlinden Ines , Güiza Fabian , Dulfer Karolijn , Van Cleemput Hanna , Wouters Pieter J. , Guerra Gonzalo Garcia , Joosten Koen F. , Verbruggen Sascha C. , Vanhorebeek Ilse , Van den Berghe Greet
Published: May 2022

OBJECTIVES:

PICU patients face long-term developmental impairments, partially attributable to early parenteral nutrition (PN) versus late-PN. We investigated how this legacy and harm by early-PN evolve over time.

DESIGN:

Preplanned secondary analysis of the multicenter PEPaNIC-RCT (ClinicalTrials.gov, NCT01536275) that enrolled 1,440 critically ill children from 2012 to 2015 and its 2- (2014–2018) and 4-year (2016–2019) cross-sectional follow-up studies.

SETTING:

PICUs of Leuven (Belgium), Rotterdam (The Netherlands), and Edmonton (Canada).

PATIENTS:

Patients and demographically matched healthy control children that underwent longitudinal assessment for physical/emotional/behavioral/neurocognitive functions at both follow-up time points.

INTERVENTIONS:

In the PEPaNIC-RCT, patients were randomly allocated to early-PN versus late-PN.

MEASUREMENTS AND MAIN RESULTS:

This within-individual longitudinal study investigated changes in physical/emotional/behavioral/neurocognitive functions from 2 to 4 years after PICU admission for 614 patients (297 early-PN and 317 late-PN, tested at mean ± sd age 5.4 ± 4.2 and 7.3 ± 4.3 yr) and for 357 demographically matched healthy children tested at age 5.6 ± 4.3 and 7.5 ± 4.3 years. We determined within-group time-courses, interaction between time and group, and independent impact of critical illness and early-PN on these time-courses. Most deficits in patients versus healthy children remained prominent over the 2 years (p ≤ 0.01). Deficits further aggravated for height, body mass index, the executive function metacognition, intelligence, motor coordination (alternating/synchronous tapping), and memory learning-index, whereas verbal memory deficits became smaller (working/immediate/delayed memory) (p ≤ 0.05). Adjustment for risk factors confirmed most findings and revealed that patients “grew-into-deficit” for additional executive functions (flexibility/emotional control/total executive functioning) and “grew-out-of-deficit” for additional memory functions (recognition/pictures) (p ≤ 0.05). Time-courses were largely unaffected by early-PN versus late-PN, except for weight loss and limited catch-up for visual-motor integration and alertness in early-PN patients (p ≤ 0.05).

CONCLUSIONS:

From 2- to 4-year post-PICU admission, developmental impairments remained prominent. Within that time-window, impaired growth in height, executive functioning and intelligence aggravated, and impaired memory and harm by early-PN only partially recovered. Impact on development into adulthood requires further investigation.
Immediate Interventions After Surgery to Reduce Readmission for Upper Extremity Infections
Authors: Fisher Alec Hayes , Gandhi Jigar , Nelson Zachery , Pascuzzi Caitlin , Donley Sarah , Franco Michael Joseph
Published: May 2022

Upper extremity infections (UEIs), commonly caused by intravenous drug use and direct trauma to the hand, can be devastating. Many studies support hand therapy postoperatively to improve outcomes. This population of patients often experience increased returns to the emergency department (ED) for treatment, repeat surgery, poor function, and increased hospital expenditure.

This is a 2-phase study to investigate and intervene on the care pathway for patients undergoing surgery for UEI at a single urban university hospital. For the first 6-month phase, all patients with UEI requiring surgery received the standard of care, including written discharge instructions, a scheduled follow-up, and a determination for hand therapy based on evaluation. During the second phase, over the following 6 months, all patients with UEI requiring surgery received an intervention before discharge, in addition to standard of care, including a scripted educational session on the importance of hand therapy by a resident physician, home exercise program instructions, and a referral to hand therapy before discharge. Outcome measures were assessed for 6 months. Outcome measures included follow-up, hand therapy attendance, ED visits for the same complaint, readmissions, and reoperations.

Forty-seven patients were in the first control group without intervention and 41 patients were in the second intervention group. Of the control group, 43% attended a follow-up appointment, 2% attended hand therapy, and 45% presented to the ED, resulting in a total of 167 visits. Eleven presented to the ED and were readmitted for complications from surgery, all 11 required a second operation. In the intervention group, 54% attended a follow-up appointment (P = 0.044), more patients attended hand therapy (22% P = 0.013), and 24% presented to the ED (P = 0.047), resulting in 40 ED visits.

Seven were readmitted for complications from surgery and 4 required a second operation (P = 0.1). Early, simple intervention and education prove to be an effective method to decrease emergency department burden and healthcare expenditure for treatment of a challenging population. Although additional education and referral to hand therapy utilization do not change operation rates, it decreased returns to the ED, readmissions, and increased follow-up.
An Analysis of 400 Sternal Wound Reconstructions at a Single Institution
Authors: Kuonqui Kevin , Levy Adam S. , Tiao Jonathan R. , Altchek Chloe , Ascherman Jeffrey A.
Published: May 2022

Background

Sternal wound (SW) infection and dehiscence after median sternotomy from cardiac surgery remain challenging complications with high morbidity. Knowledge of common pathogen types and variance with time from cardiac surgery can simplify the choice of antibiotics while awaiting definitive culture results.

Methods

Records of 505 patients undergoing SW reconstruction by the senior author from 1996 to 2018 at a high-volume cardiac surgery center were reviewed. The most common indications for reconstruction were SW infection and dehiscence. At surgery, all patients underwent removal of sternal hardware, thorough debridement, and closure with bilateral pectoralis major myocutaneous advancement flaps. Deep tissue and bone cultures were sent in nearly all cases. Patients were split into group 1 or group 2 based on timing of flap reconstruction after initial cardiac surgery: 0 to 30 days and longer than 30 days, respectively.

Results

Complete data were available for 400 SW procedures performed during this period. Group 1 included 203 patients, and group 2 had 197 patients, with a mean time to SW surgery of 16.3 and 138.1 days, respectively. Intraoperative cultures were positive in 147 of 203 (72.4%), and 122 of 197 (61.9%) patients, respectively. Forty-four patients grew polymicrobial cultures. There was a significant difference in culture positivity rates in the 2 groups (P = 0.0004). The most common bacteria cultured in group 1 was Staphylococcus epidermidis (54 of 203 vs 21 of 197; P < 0.0001), whereas methicillin-sensitive Staphylococcus aureus was most common in group 2 (15 of 203 vs 22 of 197; P = 0.23). Methicillin-resistant S. aureus was relatively common in both groups (17 of 203 vs 21 of 197; P = 0.50). Although not statistically significant, Pseudomonas, Klebsiella, and Candida were all found in a higher percentage of patients in group 2 (p = 0.11, 0.20, 0.20).

Conclusions

Microbial species cultured in SW flap reconstruction vary over time. Staphylococcus epidermidis is the most common infectious agent in patients having reconstruction within 30 days of cardiac surgery, whereas methicillin-sensitive S. aureus is most common after 30 days. The trend toward a higher incidence of Gram-negative and fungal organisms after 30 days may indicate a need for broader initial anti-infective coverage in this patient group. Awareness of these pathogen patterns can better inform antibiotic selection while awaiting culture data.