bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the demographic and wound characteristics of non-suicidal and suicidal self-wrist cutting injuries
Authors: Park Ho Youn , Kim Yoo Chang , Park Seung Chan , Cho Yoon Joo , Sur Yoo Joon
Published: February 2020

Patients who commit self-wrist cutting injuries (SWCIs) are a heterogeneous group composed of patients with non-suicidal self-injury (NSSI) and suicide attempt (SA). The purpose of this study was to compare the demographic features and wound characteristics of patients with NSSI and SA.

A retrospective review of 300 patients who visited the emergency department (ED) for treatment of SWCIs between January 2011 and December 2015 was performed. Data collected from the electronic medical records included age, sex, the reason for SWCIs, presence of suicidal ideation, concomitant intoxication with alcohol or drugs, past psychiatric history, whether or not the patient received psychiatric counseling at the ED, the principal psychiatric diagnosis, the number and severity of external wounds, and subsequent follow-up at the psychiatric or hand surgery outpatient department (OPD). The patients were divided into the NSSI and SA groups according to the presence of suicidal ideation and other variables were compared between the two groups.

There were 138 NSSI patients and 162 SA patients. The NSSI group was younger (33.9 years vs 40.9 years, P < .01), more female-dominant, and more non-compliant with psychiatric treatment than the SA group. Compared with the SA group, fewer NSSI patients had past psychiatric histories (26.1% vs 45.7%, P < .01) and more patients refused psychiatric counseling (30.4% vs 9.9%, P < .01) and follow-up at the psychiatric OPD (8.0% vs 17.3%, P < .01). In contrast, the number (P = .31) and severity (P = .051) of wounds and the rate of follow-up at the hand surgery OPD (P = .43) were not statistically different between the two groups.

Although the NSSI and SA groups showed different demographic features and degrees of compliance with psychiatric treatment, wound characteristics were not different between the two groups. Therefore, hand surgeons cannot estimate patients’ suicidal intent based on wound characteristics and all patients should be advised to receive psychiatric treatment.
Dietary Lipid Intake Influences the Alpha‐tocopherol Levels in Human Milk
Authors: da Mata Amanda M.B. , da Silva Ana G.C.L. , Medeiros Jeane F.P. , Lima Mayara S.R. , Bezerra Danielle S. , da Silva Alyne B. , Osório Mônica M. , Dimenstein Roberto , Ribeiro Karla D.S.
Published: February 2020

Objective:

Dietary lipid intake is associated with serum alpha‐tocopherol levels; however, its impact on human milk is unknown. The objective of this study was to evaluate the relationship between maternal intake of vitamin E, lipids, and fatty acids and the concentration of alpha‐tocopherol in human milk.

Methods:

We conducted a longitudinal observational study, including 143 lactating women on 7, 30, and 90 days postpartum. Dietary intake was collected using 24‐hour recall. On day 90, a human milk sample was collected and analyzed for alpha‐tocopherol concentration. The prevalence of inadequate vitamin E intake was determined by the Estimated Average Requirement (16 mg/day), and the alpha‐tocopherol concentration was analyzed by high‐performance liquid chromatography.

Results:

Dietary intake of vitamin E was associated with the intake of lipids (r = 0.237, P = 0.004) and fatty acids (P < 0.05), and 100% of the participants had inadequate vitamin intake. Mean alpha‐tocopherol concentration in the human milk samples was 7.11 (standard deviation 3.95) μmol/L and was correlated with lipid (r = 0.201, P = 0.042) and polyunsaturated fatty acid intake (r = 0.235, P = 0.017). Higher vitamin E levels were found in participants with the highest quartile of polyunsaturated fatty acid intake.

Conclusions:

Alpha‐tocopherol concentration was associated with the dietary intake of lipids and fatty acids, demonstrating that its bioavailability is associated with fats in the mammary gland. These results suggest development of appropriate strategies to increase the levels of vitamin E in breast milk that may help to prevent and treat vitamin E deficiency.
Beta-Spectrin Deletion Responsible for Hereditary Spherocytosis: When New Technologies Are Not the Key to Success
Authors: Panizo Morgado Elena , Darnaude María Teresa , Torres Mohedas Julián , Benedit María , Cervera Bravo Áurea
Published: February 2020

Hereditary spherocytosis arises from alterations in the genes encoding red blood cell membrane proteins. Although its diagnosis is mostly clinical, recent advances in next-generation sequencing (NGS) technologies have allowed for a faster cost-effective gene-based diagnosis. We report the case of a boy with spherocytic anemia and development delay in whom a de novo 2.84-Mb deletion at chromosome 14 including SPTB (ß-spectrin gene) was identified by array-based comparative genomic hybridization. This alteration, consistent with de novo spherocytosis, was missed by a NGS gene panel. When associated with other symptoms, especially neurologic, NGS may not be appropriate to genetically diagnose spherocytic anemia.
Asymptomatic Skeletal Cystic Angiomatosis May Be Managed Conservatively With Close Observation
Authors: Aumann Waitman K. , Maxfield Charles M. , Heath Jessica L.
Published: February 2020

Cystic angiomatosis (CA) is a rare disease characterized by the proliferation of vascular and lymphatic channels lined by a single layer of endothelial cells. CA may present with isolated skeletal or visceral disease. There is no consensus for the standard of care in these patients, and diverse regimens for CA have been reported, including observation, surgery, radiation, and a variety of medical therapies. We present a case of multifocal, isolated skeletal CA, treated with close observation alone and review the literature. We suggest that these cases may be safely followed without intervention and may be stable for prolonged periods of time.
Incidence and Predictors of Nonventilator Hospital–Acquired Pneumonia in a Community Hospital
Authors: Patty Christopher M. , Sandidge-Renteria Alisha , Orique Sabrina , Dixon Craig , Camarena Emma , Newsom Rose , Schneider Alicia
Published: February 2020

Background:

Nonventilator hospital–acquired pneumonia (NV-HAP) is a common hospital-acquired condition that is amenable to basic nursing care interventions.

Purpose:

The purpose of this study was to determine the incidence of NV-HAP in a California community hospital and to identify the patient and nursing care factors including missed nursing care associated with its development.

Methods:

A retrospective study identified possible NV-HAP cases with ICD-10 (International Classification of Diseases, Tenth Revision) codes and then validated cases using Centers for Disease Control and Prevention confirmatory criteria.

Results:

The incidence of NV-HAP in our hospital was 0.64 cases per 1000 patient-days. Patient factors most strongly associated with NV-HAP were age (each year of increased age was associated with a 4% increased likelihood of developing NV-HAP) (OR = 1.04-1.07) and the presence of underlying disease, which reduced odds of developing NV-HAP by 36% (OR = 0.36; 95% CI, 0.12-0.98). Head-of-bed elevation reduced by 26% the odds of developing NV-HAP (OR = 0.26; 95% CI, 0.07-0.08).

Conclusions:

NV-HAP can be predicted and potentially prevented. Paradoxically, the presence of underlying disease was not positively associated with the development of NV-HAP in this study.
Temperament, Character, and Defense Mechanism Changes With Treatment in Depression
Authors: Tabakci Abdulkadir Sencer , Yildirim Ejder Akgun , Erkiran Murat , Aksoy Umut Mert , Sahan Halide Erten , Tuna Ozgecan , Tomruk Nesrin Buket , Alpay Nihat
Published: February 2020

The aim of this study was to evaluate the changes in temperament, character, and defense mechanisms with the treatment and remission in patients with major depressive disorder. The study was designed as a longitudinal observational follow-up study of patients with repeated measures at 0, 12, and 36 weeks. In baseline comparisons, the major depression group showed higher harm avoidance and novelty seeking scores and lower self-directness and mature defense styles scores compared with healthy controls. In the follow-up, temperament dimensions and neurotic defenses remained unchanged, mature defense styles and self-directness revealed significant increase, and immature defense styles revealed significant decrease. Although there was no significant difference in the defense styles, harm avoidance and novelty seeking scores remained higher in MDD patients compare with healthy controls in 36 weeks. Our findings regarding continuation of hierarchically upward improvement in defense mechanism after the remission may support importance of treatment after remission.
Development of the Adverse Analgesic Drug Event Measure
Authors: McDonald Deborah Dillon , Ward Conor , Zhang Yiming
Published: February 2020

Background

Little is known about how people respond to an analgesic adverse drug event despite the significant incidence of deaths and hospitalizations associated with analgesic adverse drug events.

Objective

The purpose of this two-phase instrument development study was to test the validity and reliability of the Analgesic Adverse Drug Event Measure (AADEM).

Methods

Content validity was established during Phase I. Six experts rated the 58-item measure developed from a pilot survey of adults who had experienced an analgesic adverse drug event. Experts’ ratings supported a 17-item AADEM with a scale content validity index of .86. Phase II consisted of online administration of the AADEM to a national Qualtrics panel who reported an adverse drug event from a self-administered analgesic. Exploratory factor analysis was conducted using principal axis factoring and oblique rotation including Direct Oblimin and Promax rotations with Kaiser normalization.

Results

Four factors emerged from the analysis: sought care, consulted provider, discontinued or continued analgesic, and attributed adverse drug event with a total explained variance of 55.4%. Scale content validity index for the 13-item AADEM was .88. Internal consistency for the four subscales was acceptable, but low for the full 13-item AADEM.

Discussion

Results establish preliminary evidence for the validity and reliability of the 13-item AADEM to measure response to an analgesic adverse drug event. Next steps involve confirmatory factor analysis in a different sample to examine the underlying construct of the AADEM. The AADEM might help identify people at risk for serious analgesic adverse drug events.
Minimally Invasive Radical Hysterectomy for Cervical Cancer: When Adoption of a Novel Treatment Precedes Prospective, Randomized Evidence
Authors: Melamed Alexander , Rauh-Hain J. Alejandro , Ramirez Pedro T.
Published: February 2020

(Abstracted from J Clin Oncol 2019;37:3069–3074)

Prior to 2018, there existed a widespread consensus among gynecologic oncologists that minimally invasive surgery and open radical hysterectomy were 2 approaches to the same operation with similar outcomes. The Laparoscopy Approach for Cervical Cancer (LACC) trial conducted in 2018 found a nearly 4-fold increase in the risk of recurrence (hazard ratio [HR], 3.7; 95% confidence interval [CI], 1.6–8.6) and a 6-fold increase in the risk of death (HR, 6.0; 95% CI, 1.77–20.3) in women randomly assigned to minimally invasive surgery compared with open radical hysterectomy.
A Randomized Trial of Prenatal n-3 Fatty Acid Supplementation and Preterm Delivery
Authors: Makrides Maria , Best Karen , Yelland Lisa , McPhee Andrew , Zhou Shao , Quinlivan Julie , Dodd Jodie , Atkinson Elinor , Safa Huda , van Dam Jacqueline , Khot Nisha , Dekker Gustaaf , Skubisz Monika , Anderson Amanda , Kean Beth , Bowman Anneka , McCallum Carly , Cashman Kara , Gibson Robert
Published: February 2020

(Abstracted from N Eng J Med 2019;381:1035–1045)

Preterm delivery (defined as delivery before 37 weeks' gestation) occurs in 15 million pregnancies each year. Of these, approximately 20% are early preterm deliveries, occurring before 34 weeks' gestation and accounting for the largest burden of neonatal death and childhood disability.
Paternal-Age-Related de Novo Mutations and Risk for Five Disorders
Authors: Taylor Jacob L. , Debost Jean-Christophe P. G. , Morton Sarah U. , Wigdor Emilie M. , Heyne Henrike O. , Lal Dennis , Howrigan Daniel P. , Bloemendal Alex , Larsen Janne T. , Kosmicki Jack A. , Weiner Daniel J. , Homsy Jason , Seidman Jonathan G. , Seidman Christine E. , Agerbo Esben , McGrath John J. , Mortensen Preben Bo , Petersen Liselotte , Daly Mark J. , Robinson Elise B.
Published: February 2020

(Abstracted from Nat Comm 2019;10:3043)

Epidemiologic associations have been made between advanced paternal age and increased offspring risk of autism spectrum disorder (ASD), schizophrenia (SCZ), congenital heart disease (CHD), epilepsy (EPI), and intellectual disability (ID). This association have been often attributed to de novo single nucleotide variants (dnSNVs) that occur 3 to 4 times more often in paternal compared with maternal germ cells.
Comparison of the Automated Pediatric Logistic Organ Dysfunction-2 Versus Manual Pediatric Logistic Organ Dysfunction-2 Score for Critically Ill Children*
Authors: Sauthier Michaël , Landry-Hould Florence , Leteurtre Stéphane , Kawaguchi Atsushi , Emeriaud Guillaume , Jouvet Philippe
Published: February 2020

Objectives:

The Pediatric Logistic Organ Dysfunction-2 is a validated score that quantifies organ dysfunction severity and requires complex data collection that is time-consuming and subject to errors. We hypothesized that a computer algorithm that automatically collects and calculates the Pediatric Logistic Organ Dysfunction-2 (aPELOD-2) score would be valid, fast and at least as accurate as a manual approach (mPELOD-2).

Design:

Retrospective cohort study.

Setting:

Single center tertiary medical and surgical pediatric critical care unit (Sainte-Justine Hospital, Montreal, Canada).

Patients:

Critically ill children participating in four clinical studies between January 2013 and August 2018, a period during which mPELOD-2 data were manually collected.

Interventions:

None.

Measurements and Main Results:

The aPELOD-2 was calculated for all consecutive admissions between 2013 and 2018 (n = 5,279) and had a good survival discrimination with an area under the receiver operating characteristic curve of 0.84 (95% CI, 0.81–0.88). We also collected data from four single-center studies in which mPELOD-2 was calculated (n = 796, 57% medical, 43% surgical) and compared these measurements to those of the aPELOD-2. For those patients, median age was 15 months (interquartile range, 3–73 mo), median ICU stay was 5 days (interquartile range, 3–9 d), mortality was 3.9% (n = 28). The intraclass correlation coefficient between mPELOD-2 and aPELOD-2 was 0.75 (95% CI, 0.73–0.77). The Bland-Altman showed a bias of 1.9 (95% CI, 1.7–2) and limits of agreement of –3.1 (95% CI, –3.4 to –2.8) to 6.8 (95% CI, 6.5–7.2). The highest agreement (Cohen’s Kappa) of the Pediatric Logistic Organ Dysfunction-2 components was noted for lactate level (0.88), invasive ventilation (0.86), and creatinine level (0.82) and the lowest for the Glasgow Coma Scale (0.52). The proportion of patients with multiple organ dysfunction syndrome was higher for aPELOD-2 (78%) than mPELOD-2 (72%; p = 0.002). The aPELOD-2 had a better survival discrimination (area under the receiver operating characteristic curve, 0.81; 95% CI, 0.72–0.90) over mPELOD-2 (area under the receiver operating characteristic curve, 0.70; 95% CI, 0.59–0.82; p = 0.01).

Conclusions:

We successfully created a freely available automatic algorithm to calculate the Pediatric Logistic Organ Dysfunction-2 score that is less labor intensive and has better survival discrimination than the manual calculation. Use of an automated system could greatly facilitate integration of the Pediatric Logistic Organ Dysfunction-2 score at the bedside and within clinical decision support systems.
Cardiac Dysfunction Identified by Strain Echocardiography Is Associated With Illness Severity in Pediatric Sepsis
Authors: Patel Meghna D. , Mariano Karley , Dunbar Trevor , Cornell Timothy T. , Punn Rajesh , Haileselassie Bereketeab
Published: February 2020

Objectives:

Sepsis-induced myocardial dysfunction has been associated with illness severity and mortality in pediatrics. Although early sepsis-induced myocardial dysfunction diagnosis could aid in hemodynamic management, current echocardiographic metrics for assessing biventricular function are limited in detecting early impairment. Strain echocardiography is a validated quantitative measure that can detect subtle perturbations in left ventricular and right ventricular function. This investigation evaluates the utility of strain echocardiography in pediatric sepsis and compares with to conventional methods.

Design:

Retrospective, observational study comparing left ventricular and right ventricular strain. Strain was compared with ejection fraction and fractional shortening and established sepsis severity of illness markers.

Setting:

Tertiary care medical-surgical PICU from July 2013 to January 2018.

Patients:

Seventy-nine septic children and 28 healthy controls.

Interventions:

None.

Measurements and Main Results:

Compared with healthy controls, patients with severe sepsis demonstrated abnormal left ventricular strain (left ventricular longitudinal strain: –13.0% ± 0.72; p = 0.04 and left ventricular circumferential strain: –16.5% ± 0.99; p = 0.046) and right ventricular (right ventricular longitudinal strain = –14.3% ± 6.3; p < 0.01) despite normal fractional shortening (36.0% ± 1.6 vs 38.1% ± 1.1; p = 0.5129) and ejection fraction (60.7% ± 2.2 vs 65.3% ± 1.5; p = 0.33). There was significant association between depressed left ventricular longitudinal strain and increased Vasotrope-Inotrope Score (r = 0.52; p = 0.034). Worsening left ventricular circumferential strain was correlated with higher lactate (r = 0.31; p = 0.03) and higher Pediatric Risk of Mortality-III score (r = 0.39; p < 0.01). Depressed right ventricular longitudinal strain was associated with elevated pediatric multiple organ dysfunction score (r = 0.44; p < 0.01)

Conclusions:

Compared with healthy children, pediatric septic patients demonstrated abnormal left ventricular and right ventricular strain concerning for early signs of cardiac dysfunction. This was despite having normal ejection fraction and fractional shortening. Abnormal strain was associated with abnormal severity of illness markers. Strain echocardiography may have utility as an early indicator of sepsis-induced myocardial dysfunction in pediatric sepsis.
Establishing Standardized Documentation for Anaphylaxis Treatment in a Tertiary Care Pediatric Allergy Clinic
Authors: Kraft Monica T. , Scherzer Rebecca , Strothman Kasey , Rogers Gayla , Montgomery Tricia , Grayson Mitchell H.
Published: February 2020

Introduction:

Anaphylaxis is a potentially life-threatening allergic reaction. Common allergy clinic procedures, including oral food challenges and subcutaneous immunotherapy, carry a risk of anaphylaxis, the treatment for which is epinephrine. Our goal was to develop a standardized process for the management and documentation of allergic reactions that occur in a tertiary care pediatric allergy clinic.

Methods:

This was a single institution quality improvement pilot study. A multidisciplinary team from the allergy department designed, implemented, and studied the use of a standardized form for the documentation and treatment of allergic reactions within the clinic.

Results:

A standardized form was developed based on evidence-based guidelines for the management of allergic reactions and included space for documentation. Both clinic providers and staff approved the form. One year after the introduction, we reached 100% adherence for the use of the form in visits during which a patient experienced a severe allergic reaction requiring epinephrine. Two patients required transfer to the emergency room; the quality improvement form was utilized in these cases to document treatment and assist with the hand-off to emergency room personnel before transfer.

Conclusions:

We successfully implemented a standardized form for the treatment and documentation of anaphylaxis within our allergy clinic. The next steps focus on further integrating this form into the electronic medical record, determining compliance with evidence-based management of anaphylaxis, and formally assessing the use of the form as a handoff tool in the event of patient transfer.
Utilization of Resources by Patients Who Are Morbid and Super Obese Admitted to a Tertiary Care Center
Authors: Jones Dennis , Martinez-Amezcua Pablo , Pandian Vinciya
Published: February 2020

Objectives

Data regarding the characteristics of patients who are morbidly and super obese, and the resources they use in nonbariatric hospital settings are limited. The aims of our study were to explore the frequency of inpatient admissions of patients who are morbid (body mass index [BMI] ≥ 40 kg/m2) and super obese (BMI ≥ 50 kg/m2), their specific characteristics, and to identify their utilization of hospital services and resources, 30-day readmission rates, safe patient handling equipment, and patient clinical outcomes.

Methods

We conducted a retrospective chart review of adult patients hospitalized at our institution (n = 1670) who are morbidly obese or super obese. We collected and compared data regarding the characteristics of patients, the services and resources used, the use of any special handling equipment, and patient clinical outcomes.

Results

After accounting for confounding variables, wound care and occupational therapy services were more likely to be required for the patients who are super obese (odds ratio [OR] = 1.49, P = 0.04) than for those who are morbidly obese (odds ratio [OR] = 1.36, P = 0.02). Use of safe patient handling devices was twice as likely for the super obese group (OR = 2.09, P < 0.01). There was no difference in mortality rates between the two patient groups (P = 0.81); patients who are super obese had higher odds of prolonged hospital stay by 32% (P = 0.009).

Conclusions

This study provides an understanding of the characteristics of patients with BMI of 40 kg/m2 or greater who are admitted to the hospital, the resources and services use, and their clinical outcomes. There is also a need to develop an organizational protocol to ensure safe handling using the right devices and activation of appropriate consult services.
Steady State Magnetic Resonance Angiography of the Thoracic Aorta Using Inversion-recovery Steady-State Free Precession and a High Relaxivity Contrast Agent
Authors: Abbasi Muhannad Aboud , Serhal Ali , Reese Olivia , Aouad Pascale , Collins Louise , Blaisdell Julie , Collins Jeremy , Carr James
Published: February 2020

Purpose:

To evaluate image quality and aortic dimension measurement accuracy of high resolution, motion compensated steady-state magnetic resonance angiography (SS-MRA) with a high relaxivity, extracellular fluid gadolinium-based contrast agent compared with standard first-pass contrast enhanced MRA (FP-CEMRA) in patients with thoracic aortic aneurysms.

Materials and Methods:

Sixty-nine patients (mean age, 51.7 y, 25% female) diagnosed with thoracic aortic aneurysms who underwent MRA on a 1.5 T scanner using FP-CEMRA and SS-MRA techniques were retrospectively identified. Quantitative analysis was performed by measuring the aortic diameters at 6 locations within the thoracic aorta for each technique. Two radiologists independently performed the qualitative analysis by assessing the image quality (1 to 5), presence of artifact (1 to 4), signal-to-noise (1 to 4), contrast-to-noise (1 to 4), and wall conspicuity (1 to 4) in the aorta at 4 different locations: the aortic root, the ascending aorta, the aortic arch, and the descending aorta.

Results:

The aortic dimensions obtained by SS-MRA had a good correlation with FP-CEMRA. Means for the aortic diameters between the FP-CEMRA and the SS-MRA at all 6 locations demonstrated minimal mean differences (0.013 to 0.044 mm).

Qualitative assessment of aorta at 4 locations by 2 reviewers demonstrated that SS-MRA had on average superior image quality at the aortic root and ascending aorta for both reviewers (P<0.05) and at the descending aorta for one reader (P<0.05). Otherwise, both techniques were comparable at the ascending aorta. SS-MRA demonstrated less artifact at the aortic root and the ascending aorta (P<0.05).

Conclusion:

Aortic dimension measurements provided by SS-MRA with a high relaxivity, extracellular fluid gadolinium-based contrast agent are comparable to the conventional FP-CEMRA. Furthermore, SS-MRA qualitatively demonstrated comparable to better overall image quality than FP-CEMRA at different aortic locations. Therefore, SS-MRA may provide a comparable alternative, or complementary examination to conventional FP-CEMRA in patients who have difficulty breath holding, or in situations where contrast bolus timing was poor.
An Update on Social Media in Academic Plastic Surgery Training Programs
Authors: Azoury Saïd Charbel , Mazzaferro Daniel M. , Piwnica-Worms William , Messa Charlie A. , Othman Sammy , Stranix John T. , Serletti Joseph M. , Kovach Stephen J. , Fosnot Joshua
Published: February 2020

Background

Increasing in popularity, social media provides powerful marketing and networking tools for private practice plastic surgeons. The authors sought to examine social media utilization by academic plastic surgery training programs.

Methods

Facebook, Instagram, and Twitter were queried for plastic surgery training program, program director, and chief/chair accounts. Training program posts were categorized as educational, operative, social, informational, self-promotional, visiting lecturer, research-related, and other. Factors influencing total number of followers were analyzed including number of accounts followed, frequency, total number, and types of posts as well as duration of account. Other variables included geographic location, 2018 to 2019 Doximity residency ranking, and US News and World Report rankings of affiliated hospital systems and medical schools. Social media accounts were analyzed using Kruskal-Wallis, Wilcoxon rank sum, and regression analysis.

Results

Facebook is the most popular social media platform among chiefs/chairs (34, 35.7%), followed by Instagram (20, 21.1%) and Twitter (19, 20.0%). Facebook is used more by program directors (31, 32.6%) followed by Instagram (22, 23.1%) and Twitter (15, 15.7%). The majority of Facebook and Twitter leadership accounts are for personal use (62%–67%), whereas Twitter is used primarily for professional purposes (60%–84%). Training program social media use is rising, with Instagram and Twitter presence growing at exponential rates (R
2 = 0.97 and 0.97, respectively). Of 95 training programs evaluated, 54 (56.8%) have Instagram accounts, 29 (30.5%) have Facebook accounts, and 27 (28.4%) have Twitter accounts. Most training programs using social media have 2 or more accounts (37, 67.3%). West coast programs have more Instagram followers than other geographic regions, significantly more than Southern programs (P = 0.05). Program accounts with more followers are affiliated with top-ranked hospitals (P = 0.0042) or top-ranked Doximity training programs (P = 0.02).

Conclusions

Similar to its adoption by private practice plastic surgery, social media use in academic plastic surgery is growing exponentially. Now, over half of residency programs have Instagram accounts. Program leaders are using Facebook and Instagram primarily for personal use and Twitter for professional use. Programs affiliated with a top-ranked hospital or ranked highly by Doximity have more followers on social media.
Galactorrhea/Galactocele After Breast Augmentation
Authors: Sharma Sanjeev Chaand , Basu Narendra Nath
Published: February 2020

Aims

To review cases of galactorrhea and galactocele postbreast augmentation, determine possible risk factors and consider management strategies of this rare complication.

Methods

A systematic literature review was conducted in July 2019 searching Pubmed, Embase, and Google Scholar.

Results

The searches revealed 19 articles (17 case reports/series and 2 retrospective chart reviews) collectively comprising 38 women. The average age was 28 years, 42% were on oral contraceptives, whereas a quarter were nulliparous. The most common incision was periareolar (48%) followed by transaxillary (24%). The most common implant location was subglandular (57%) followed by subpectoral (37%). The average time to symptom onset was 61 days (range, 3–912 days) but only 3 cases presented more than a month after implant insertion. Twenty-one patients had galactorrhea, 7 had galactocele, whereas 10 women had both. Bilateral symptoms were present in 72% of cases, whereas hyperprolactinemia was present in only 62%. Management strategies included simple surveillance, antibiotics, dopamine agonists, leukotriene receptor antagonists, estrogenic agents, surgical washout, and implant removal (8 patients). The mean time to symptom resolution was 22.6 days.

Conclusions

The numbers are too small for definitive conclusions but there is a weak suggestion that periareolar incisions, subglandular implants, prior hormonal contraceptive use, gravidity, and recent history of breastfeeding (<1 year) may be risk factors for galactorrhea/galactocele. Symptom onset is usually within 3 months. Treatments providing the fastest response (2 days) comprised of a composite approach (antibiotics, dopamine agonist, surgical drainage, and implant removal), whereas the use of estrogenic medications appeared to confer little benefit.
Challenges and Opportunities for Endovascular Treatment of Hemorrhage in Combat Casualty Care
Authors: Kauvar David , Cotton Bryan , Khan Mansoor , Perreira Bruno , Brenner Megan , Ferrada Paula , Horer Tal , Kirkpatrick Andrew , Ordoñez Carlos , Pirouzram Artai , Roberts Derek , Duchesne Juan
Published: February 2020

The care of the hemorrhaging patient continues to evolve. The use of endovascular techniques to treat hemorrhage has increased significantly in civilian trauma care over the past 15 years and is identified as a major national trauma care research priority. Endovascular techniques are being increasingly employed to treat major thoracoabdominal arterial injuries and resuscitative endovascular balloon occlusion of the aorta is being adopted at trauma centers as a supportive adjunct to resuscitation in the exsanguinating patient. Emerging endovascular technology offers the opportunity to provide temporary or permanent control of non-compressible torso hemorrhage, which remains a vexing problem in combat casualty care. Endovascular advances have not been translated to the care of combat casualties to any significant degree, however. This review provides a summary and analysis of the gap between civilian endovascular hemorrhage control and combat casualty care practice to better align future research and development efforts.
Resolvin D1 Improves Post-Resuscitation Cardiac and Cerebral Outcomes in A Porcine Model of Cardiac Arrest
Authors: Chen Weiting , Wang Hui , Wang Zhengquan , Zhao Changwei , Xu Jiefeng , Chen Qijiang
Published: February 2020

Following global ischemia reperfusion injury triggered by cardiac arrest (CA) and resuscitation, the ensuing cardiac and cerebral damage would result in high mortality and morbidity. Recently, resolvin D1 has been proven to have a protective effect on regional cardiac and cerebral ischemia reperfusion injury. In this study, we investigated the effects of resolvin D1 on cardiac and cerebral outcomes after cardiopulmonary resuscitation (CPR) in a porcine model.

Twenty-eight male domestic pigs weighing between 33 and 41 kg were randomly divided into one of the four groups: sham, CPR, low-dose resolvin D1 (LRD), and high-dose resolvin D1 (HRD). Sham animals underwent the surgical preparation only. Other animals were subjected to 8 min of untreated ventricular fibrillation and then 5 min of CPR. At 5 min after resuscitation, resolvin D1 was intravenously administered with the doses of 0.3 and 0.6 μg/kg in the LRD and HRD groups, respectively. The resuscitated animals were monitored for 6 h and observed for an additional 18 h.

After resuscitation, myocardial and neurological function were significantly impaired, and their serum levels of injury biomarkers were markedly increased in the CPR, LRD, and HRD groups compared with the sham group. In addition, tissue inflammation and oxidative stress in the heart and brain were observed in the three groups. However, myocardial function was significantly improved and its injury biomarker was significantly decreased starting 3 h after resuscitation in the LRD and HRD groups compared with the CPR group. Similarly, neurological function was significantly better at 24 h post-resuscitation and its injury biomarkers were significantly lower at 6 and 24 h post-resuscitation in the LRD and HRD groups than in the CPR group. In addition, myocardial, cerebral inflammation, and oxidative stress were significantly milder in the two resolvin D1-treated groups. Especially, HRD produced significantly greater post-resuscitation cardiac and cerebral protection compared with the LRD group.

In conclusion, resolvin D1 significantly improved post-resuscitation cardiac and cerebral outcomes in a porcine model of CA, in which the protective effects may be in a dose-dependent manner.
Endovascular Resuscitation and Trauma Management (EVTM)—Practical Aspects and Implementation
Authors: Hörer Tal M. , Pirouzram Artai , Khan Mansoor , Brenner Megan , Cotton Bryan , Duchesne Juan , Ferrada Paula , Kauvar David , Kirkpatrick Andrew , Ordonez Carlos , Perreira Bruno , Roberts Derek
Published: February 2020

In recent years there has been a tremendous increase in hemorrhage control by endovascular methods. Traumatic and non-traumatic hemorrhage is being more frequently managed with endografts, embolization agents, and minimal invasive methods. These methods initially were used in hemodynamically stable patients only, whereas now these are being implemented in acute settings and hemodynamically unstable patients. The strategy of using endovascular and combined open-endo methods approach for hemodynamic instability in trauma and non-trauma patients has been named EVTM- EndoVascular resuscitation and Trauma Management. The EVTM concept will be presented in this article, describing how it is developed and used, as well as its limitations and future aspects.
Changes in Smoking Behavior Before and After Gastric Bypass
Authors: King Wendy C. , White Gretchen E. , Belle Steven H. , Yanovski Susan Z. , Pomp Alfons , Pories Walter J. , Wolfe Bruce M. , Ahmed Bestoun , Courcoulas Anita P.
Published: February 2020

Objective:

To evaluate smoking history and change in smoking behavior, from 1 year before through 7 years after Roux-en-Y gastric bypass (RYGB) surgery, and to identify risk factors for post-surgery smoking.

Background:

Smoking behavior in the context of bariatric surgery is poorly described.

Methods:

Adults undergoing RYGB surgery entered a prospective cohort study between 2006 and 2009 and were followed up to 7 years until ≤2015. Participants (N = 1770; 80% female, median age 45 years, median body mass index 47 kg/m2) self-reported smoking history pre-surgery, and current smoking behavior annually.

Results:

Almost half of participants (45.2%) reported a pre-surgery history of smoking. Modeled prevalence of current smoking decreased in the year before surgery from 13.7% [95% confidence interval (CI) = 12.1–15.4] to 2.2% (95% CI = 1.5–2.9) at surgery, then increased to 9.6% (95% CI = 8.1–11.2) 1-year post-surgery and continued to increase to 14.0% (95% CI = 11.8–16.0) 7-years post-surgery. Among smokers, mean packs/day was 0.60 (95% CI = 0.44–0.77) at surgery, 0.70 (95% CI = 0.62–0.78) 1-year post-surgery and 0.77 (95% CI = 0.68–0.88) 7-years post-surgery. At 7-years, smoking was reported by 61.7% (95% CI = 51.9–70.8) of participants who smoked 1-year pre-surgery (n = 221), 12.3% (95% CI = 8.5–15.7) of participants who formerly smoked but quit >1 year pre-surgery (n = 507), and 3.8% (95% CI = 2.1–4.9) of participants who reported no smoking history (n = 887). Along with smoking history (ie, less time since smoked), younger age, household income <$25,000, being married or living as married, and illicit drug use were independently associated with increased risk of post-surgery smoking.

Conclusion:

Although most adults who smoked 1-year before RYGB quit pre-surgery, smoking prevalence rebounded across 7-years, primarily due to relapse.
Remote Therapy to Improve Outcomes in Lung Transplant Recipients: Design of the INSPIRE-III Randomized Clinical Trial
Authors: Blumenthal James A. , Smith Patrick J. , Sherwood Andrew , Mabe Stephanie , Snyder Laurie , Frankel Courtney , McKee Daphne C. , Hamilton Natalie , Keefe Francis J. , Shearer Sheila , Schwartz Jeanne , Palmer Scott
Published: February 2020

Background.

Impaired functional capacity and emotional distress are associated with lower quality of life (QoL) and worse clinical outcomes in post lung transplant patients. Strategies to increase physical activity and reduce distress are needed.

Methods.

The Investigational Study of Psychological Interventions in Recipients of Lung Transplant-III study is a single site, parallel group randomized clinical trial in which 150 lung transplant recipients will be randomly assigned to 3 months of telephone-delivered coping skills training combined with aerobic exercise (CSTEX) or to a Standard of Care plus Education control group. The primary endpoints are a global measure of distress and distance walked on the 6-Minute Walk Test. Secondary outcomes include measures of transplant-specific QoL, frailty, health behaviors, and chronic lung allograft dysfunction–free survival.

Results.

Participants will be evaluated at baseline, at the conclusion of 3 months of weekly treatment, at 1-year follow-up, and followed annually thereafter for clinical events for up to 4 years (median = 2 y). We also will determine whether functional capacity, distress, and health behaviors (eg, physical activity, medication adherence, and volume of air forcefully exhaled in 1 second (FEV1), mediate the effects of the CSTEX intervention on clinical outcomes.

Conclusions.

Should the CSTEX intervention result in better outcomes compared with the standard of care plus post-transplant education, the remotely delivered CSTEX intervention can be made available to all lung transplant recipients as a way of enhancing their QoL and improving clinical outcomes.
Protection of Rhesus Macaque from SARS-Coronavirus challenge by recombinant adenovirus vaccine
Authors: Chen Yiyou , Wei Qiang , Li Ruobing , Gao Hong , Zhu Hua , Deng Wei , Bao Linlin , Tong Wei , Cong Zhe , Jiang Hong , Qin Chuan
Published: February 2020

A recombinant adenovirus vaccine against the SARS Coronavirus (SARS-CoV) was constructed, which contains fragments from the S, N, and Orf8 genes. Rhesus Macaques immunized with the recombinant adenovirus generated antigen-specific humoral and cellular response. Furthermore, the vaccine provided significant protection against subsequent live SARS-CoV challenge. In contrast, three out of four monkeys immunized with placebo suffered severe alveolar damage and pulmonary destruction.
Preserving Vascular Integrity Protects Mice Against Multidrug-Resistant Gram-Negative Bacterial Infection
Authors: Gebremariam Teclegiorgis , Zhang Lina , Alkhazraji Sondus , Gu Yiyou , Youssef Eman G. , Tong Zongzhong , Kish-Trier Erik , de Araujo Claudia V. , Rich Bianca , French Samuel W. , Li Dean Y. , Mueller Alan L. , Odelberg Shannon J. , Zhu Weiquan , Ibrahim Ashraf S.
Published: February 2020

The rise in multidrug resistant (MDR) organisms portends a serious global threat to the healthcare system with nearly untreatable infectious diseases, including pneumonia and its often fatal sequelae, acute respiratory distress syndrome (ARDS) and sepsis. Gram-negative bacteria (GNB) includingAcinetobacter baumannii, Pseudomonas aeruginosa, and carbapenemase-producingKlebsiella pneumoniae(CPKP), are among the World Health Organization and National Institutes of Health’s high priority MDR pathogens for targeted development of new therapies. Here we show that stabilizing the host’s vasculature by genetic deletion or pharmacological inhibition of the small GTPase ADP-ribosylation factor 6 (ARF6) increases survival rates of mice infected withA. baumannii,P. aeruginosa, CPKP pneumonia. We show that pharmacological inhibition of ARF6-GTP phenocopies endothelial-specificArf6disruption in enhancing survival of mice withA. baumanniipneumonia, suggesting that inhibition is on target. Finally, we show that the mechanism of protection elicited by these small molecule inhibitors is by restoration of vascular integrity disrupted by GNB lipopolysaccharide (LPS) activation of TLR4/MyD88/ARNO/ARF6 pathway. By targeting the host’s vasculature with small molecule inhibitors of ARF6 activation, we circumvent microbial drug resistance and provide a potential alternative/adjunctive treatment for emerging and re-emerging pathogens.
Physiological and cognitive consequences of a daily 26h photoperiod in a primate(M. murinus)
Authors: Hozer Clara , Pifferi Fabien
Published: February 2020

Daily resetting of the circadian clock to the 24h natural photoperiod might induce marginal costs that would accumulate over time and forward affect fitness. It was proposed as the circadian resonance theory by Pittendrigh in 1972. For the first time, we aimed to evaluate these physiological and cognitive costs that would partially explain the mechanisms of the circadian resonance hypothesis. We evaluated the potential costs of imposing a 26h photoperiodic regimen compared to the classical 24h entrainment measuring several physiological and cognitive parameters (body temperature, energetic expenditure, oxidative stress, cognitive performances). We found significant higher resting body temperature and energy expenditure and lower cognitive performances when the photoperiodic cycle length was 26h. Together these results suggest that a great deviation of external cycles from 24h leads to daily greater synchronization costs, and lower cognitive capacities. To our knowledge, this study is the first to highlight potential mechanisms of circadian resonance theory.
Alternative splicing coupled nonsense-mediated decay shapes the temperature-dependent transcriptome
Authors: Neumann Alexander , Meinke Stefan , Goldammer Gesine , Strauch Miriam , Schubert Daniel , Timmermann Bernd , Heyd Florian , Preußner Marco
Published: February 2020

Mammalian body temperature oscillates with the time of the day and is altered in diverse pathological conditions. We recently identified a body temperature-sensitive thermometer-like kinase, which alters SR protein phosphorylation and thereby globally controls alternative splicing (AS). AS can generate mRNA variants containing premature termination codons, which are degraded by nonsense-mediated decay (NMD). Here we show extensive coupling of body temperature-controlled AS to NMD, leading to global control of temperature-dependent gene expression (GE). Temperature-controlled NMD-inducing splicing events are evolutionarily conserved and pervasively found within RNA-binding proteins, including most SR proteins. NMD-inducing exons are essential for rhythmic GE of SR proteins and have a global role in establishing temperature-dependent rhythmic GE profiles, both, in mammals under circadian body temperature cycles and in plants in response to ambient temperature changes. Together, these data identify body temperature-driven AS-NMD as an evolutionary ancient, core clock-independent mechanism to generate rhythmic GE.
Functional reorganization of sensory processing following long-term neural adaptation to optical defects
Authors: Barbot Antoine , Park Woon-Ju , Zhang Ru-Yuan , Huxlin Krystel R , Tadin Duje , Yoon Geunyoung
Published: February 2020

How we see is fundamentally limited by the eye’s optics, which determine retinal image quality and constrain neural processing. Elucidating how long-term exposure to optical defects alters visual processing is vital for understanding the human brain’s capacity for and limits of sensory plasticity. Using adaptive optics to bypass the eye’s optical aberrations, we assessed changes in visual processing in neurotypically-developed adults with keratoconus (KC)—a corneal disease causing severe optical aberrations during adulthood that cannot be fully corrected using conventional methods. As a result, KC patients are chronically exposed to degraded retinal images in their everyday life, making them an ideal model to understand how prolonged exposure to poor optical quality alters visual processing. Here, we show that when tested under similar fully-corrected optical conditions as neurotypical observers, KC patients exhibited altered contrast sensitivity, with impaired sensitivity for fine spatial details and better sensitivity for coarse spatial details. Both gains and losses in contrast sensitivity were more pronounced in patients with poorer habitual optical quality. Moreover, using an equivalent noise paradigm and a computational model of visual processing, we show that these alterations in visual processing are mediated by changes in signal enhancement of spatial frequency selective mechanisms. The present findings uncover fundamental properties of neural compensation mechanisms in response to long-term exposure to optical defects, which alter sensory processing and limit the benefits of improved optics. The outcome is a large-scale functional reorganization favoring the processing of sensory information less affected by the eye’s optics.

Significance statement

The eye’s optics represent an intrinsic limit to human visual perception, determining the quality of retinal images. Neural adaptation optimizes the brain’s limited sensory processing capacity to the structure of the degraded retinal inputs, providing an exceptional quality of vision given these optical limitations. Here, we show that prolonged exposure to poor optical quality results in a functional reorganization of visual processing that favors sensory information less affected by the eye’s optics. The present study helps elucidate how optical factors shape the way the brain processes visual information. Notably, the resulting adaptive neural plasticity limits the immediate perceptual benefits of optical interventions, a factor that must be taken into consideration when treating the increasing human population affected by optical defects.
The limits to parapatric speciation 3: Evolution of strong reproductive isolation in presence of gene flow despite limited ecological differentiation
Authors: Blanckaert Alexandre , Bank Claudia , Hermisson Joachim
Published: February 2020

Gene flow tends to impede the accumulation of genetic divergence. Here, we determine the limits for the evolution of postzygotic reproductive isolation in a model of two populations that are connected by gene flow. We consider two selective mechanisms for the creation and maintenance of a genetic barrier: local adaptation leads to divergence among incipient species due to selection against migrants, and Dobzhansky-Muller incompatibilities (DMIs) reinforce the genetic barrier through selection against hybrids. In particular, we are interested in the maximum strength of the barrier under a limited amount of local adaptation, a challenge that may initially face many incipient species. We first confirm that with classical two-locus DMIs, the maximum amount of local adaptation is indeed a limit to the strength of a genetic barrier. However, with three or more loci and cryptic epistasis, this limit holds no longer. In particular, we identify a minimal configuration of three epistatically interacting mutations that is sufficient to confer strong reproductive isolation.