bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond MPOWER: a systematic review of population-level factors that affect European tobacco smoking rates
Authors: Watson Leah K , Weldon Isaac , Lin Gigi O , Nanyangwe-Moyo Tina , Hoffman Steven J , Poirier Mathieu J P
Published: July 2023

Background

Population-level factors within and beyond the scope of the World Health Organization’s (WHO) MPOWER policy package have significant impacts on smoking rates. However, no synthesis of the existing evidence exists. This systematic review identifies population-level factors that influence cigarette smoking rates in European countries.

Methods

We searched the ProQuest database collection for original, peer-reviewed quantitative evaluations that investigated the effects of population-level exposures on smoking rates in European countries. Of the 3122 studies screened, 62 were ultimately included in the review. A standardized data extraction form was used to identify key characteristics of each study including publication year, years evaluated, countries studied, population characteristics, study design, data sources, analytic methods, exposure studied, relevant covariates and effects on tobacco smoking outcomes.

Results

One hundred and fifty-five population-level exposures were extracted from the 62 studies included in the review, 99 of which were related to WHO MPOWER measures. An additional 56 exposures fell into eight policy realms: economic crises, education policy, macro-economic factors, non-MPOWER tobacco regulations, population welfare, public policy, sales to minors and unemployment rates. About one-half of the MPOWER exposures affected smoking rates (55/99) and did so in an overwhelmingly positive way (55/55). Over three-quarters of the non-MPOWER exposures were associated with statistically significant changes in smoking outcomes (43/56), with about two-thirds of these exposures leading to a decrease in smoking (29/43).

Conclusions

Population-level factors that fall outside of the WHO’s MPOWER measures are an understudied research area. The impacts of these factors on tobacco control should be considered by policymakers.
RNA viruses, M satellites, chromosomal killer genes, and killer/nonkiller phenotypes in the 100-genomes S. cerevisiae strains
Authors: Vijayraghavan Sriram , Kozmin Stanislav G , Strope Pooja K , Skelly Daniel A , Magwene Paul M , Dietrich Fred S , McCusker John H
Published: July 2023

We characterized previously identified RNA viruses (L-A, L-BC, 20S, and 23S), L-A–dependent M satellites (M1, M2, M28, and Mlus), and M satellite–dependent killer phenotypes in the Saccharomyces cerevisiae 100-genomes genetic resource population. L-BC was present in all strains, albeit in 2 distinct levels, L-BChi and L-BClo; the L-BC level is associated with the L-BC genotype. L-BChi, L-A, 20S, 23S, M1, M2, and Mlus (M28 was absent) were in fewer strains than the similarly inherited 2µ plasmid. Novel L-A–dependent phenotypes were identified. Ten M+ strains exhibited M satellite–dependent killing (K+) of at least 1 of the naturally M0 and cured M0 derivatives of the 100-genomes strains; in these M0 strains, sensitivities to K1+, K2+, and K28+ strains varied. Finally, to complement our M satellite–encoded killer toxin analysis, we assembled the chromosomal KHS1 and KHR1 killer genes and used naturally M0 and cured M0 derivatives of the 100-genomes strains to assess and characterize the chromosomal killer phenotypes.
A photoaffinity glycan-labeling approach to investigate immunoglobulin glycan-binding partners
Authors: Holborough-Kerkvliet Miles D , Mucignato Greta , Moons Sam J , Psomiadou Venetia , Konada Rohit S R , Pedowitz Nichole J , Pratt Matthew R , Kissel Theresa , Koeleman Carolien A M , Tjokrodirijo Rayman T N , van Veelen Petrus A , Huizinga Thomas , van Schie Karin A J , Wuhrer Manfred , Kohler Jennifer J , Bonger Kimberly M , Boltje Thomas J , Toes Reinaldus E M
Published: July 2023

Glycans play a pivotal role in biology. However, because of the low-affinity of glycan-protein interactions, many interaction pairs remain unknown. Two important glycoproteins involved in B-cell biology are the B-cell receptor and its secreted counterpart, antibodies. It has been indicated that glycans expressed by these B-cell-specific molecules can modulate immune activation via glycan-binding proteins. In several autoimmune diseases, an increased prevalence of variable domain glycosylation of IgG autoantibodies has been observed. Especially, the hallmarking autoantibodies in rheumatoid arthritis, anti-citrullinated protein antibodies, carry a substantial amount of variable domain glycans. The variable domain glycans expressed by these autoantibodies are N-linked, complex-type, and α2–6 sialylated, and B-cell receptors carrying variable domain glycans have been hypothesized to promote selection of autoreactive B cells via interactions with glycan-binding proteins. Here, we use the anti-citrullinated protein antibody response as a prototype to study potential in solution and in situ B-cell receptor–variable domain glycan interactors. We employed SiaDAz, a UV-activatable sialic acid analog carrying a diazirine moiety that can form covalent bonds with proximal glycan-binding proteins. We show, using oligosaccharide engineering, that SiaDAz can be readily incorporated into variable domain glycans of both antibodies and B-cell receptors. Our data show that antibody variable domain glycans are able to interact with inhibitory receptor, CD22. Interestingly, although we did not detect this interaction on the cell surface, we captured CD79 β glycan–B-cell receptor interactions. These results show the utility of combining photoaffinity labeling and oligosaccharide engineering for identifying antibody and B-cell receptor interactions and indicate that variable domain glycans appear not to be lectin cis ligands in our tested conditions.
Insights into the molecular mechanisms underlying responses of apple trees to abiotic stresses
Authors: Li Xuewei , Ma Ziqing , Song Yi , Shen Wenyun , Yue Qianyu , Khan Abid , Tahir Muhammad Mobeen , Wang Xiaofei , Malnoy Mickael , Ma Fengwang , Bus Vincent , Zhou Shuangxi , Guan Qingmei
Published: July 2023

Apple (Malus$ \times $domestica) is a popular temperate fruit crop worldwide. However, its growth, productivity, and quality are often adversely affected by abiotic stresses such as drought, extreme temperature, and high salinity. Due to the long juvenile phase and highly heterozygous genome, the conventional breeding approaches for stress-tolerant cultivars are time-consuming and resource-intensive. These issues may be resolved by feasible molecular breeding techniques for apples, such as gene editing and marker-assisted selection. Therefore, it is necessary to acquire a more comprehensive comprehension of the molecular mechanisms underpinning apples’ response to abiotic stress. In this review, we summarize the latest research progress in the molecular response of apples to abiotic stressors, including the gene expression regulation, protein modifications, and epigenetic modifications. We also provide updates on new approaches for improving apple abiotic stress tolerance, while discussing current challenges and future perspectives for apple molecular breeding.
Classified and Secret: Understanding the Literature on Diversity in the Intelligence Sector
Authors: Stephenson Elise , Rimmer Susan Harris
Published: July 2023

Intelligence services are important sites of contestation, often the foci of reform and calls for greater transparency. Yet, while growing attention has been paid to intersectionality, gender equality reform, and progress in other areas of international affairs, little of this same transparency and attention has been paid to diversity in the intelligence sector. This paper seeks to bridge the gap, comprising a systematic review of the literature on diversity in the intelligence sector to improve our understanding of what is known and what can be known about the history and current make-up of the intelligence sector—and those who “do intelligence work”. By identifying strengths and gaps in the literature and setting an agenda for future research within these “secret institutions”, this paper argues that the lack of transparency, data, and knowledge on the interplay of gender, race, and sexuality, among other aspects of diversity in intelligence, is deeply troubling. It hampers our knowledge of how the sector may be “gendered” or otherwise experienced, as well as how this particular area of the security sector may or may not be integrating gender and other perspectives into their work. This paper finds that diversity in the intelligence and national security sectors is both an asset and a liability to be managed. Diversity is seen as a source of intelligence gathering and analysis strength, as well as a potential threat to hegemonic masculinity in intelligence practice. Further, language and processes for promoting diversity in intelligence can reinforce stereotyped knowledge of marginalized groups that ultimately hamper calls for greater representation, diversity, inclusion, access, and opportunities in the intelligence sector.
On the Decoupling of Evolutionary Changes in mRNA and Protein Levels
Authors: Jiang Daohan , Cope Alexander L , Zhang Jianzhi , Pennell Matt
Published: July 2023

Variation in gene expression across lineages is thought to explain much of the observed phenotypic variation and adaptation. The protein is closer to the target of natural selection but gene expression is typically measured as the amount of mRNA. The broad assumption that mRNA levels are good proxies for protein levels has been undermined by a number of studies reporting moderate or weak correlations between the two measures across species. One biological explanation for this discrepancy is that there has been compensatory evolution between the mRNA level and regulation of translation. However, we do not understand the evolutionary conditions necessary for this to occur nor the expected strength of the correlation between mRNA and protein levels. Here, we develop a theoretical model for the coevolution of mRNA and protein levels and investigate the dynamics of the model over time. We find that compensatory evolution is widespread when there is stabilizing selection on the protein level; this observation held true across a variety of regulatory pathways. When the protein level is under directional selection, the mRNA level of a gene and the translation rate of the same gene were negatively correlated across lineages but positively correlated across genes. These findings help explain results from comparative studies of gene expression and potentially enable researchers to disentangle biological and statistical hypotheses for the mismatch between transcriptomic and proteomic data.
Identification and molecular characterization of Culex flavivirus in Culex quinquefasciatus (Diptera: Culicidae): first report from India
Authors: Anakha A , Shah Harish Kumar , Fathima P A , Aiswarya R S , Ajithlal P M , Kumar N Pradeep , Kumar Ashwani , Saini Prasanta
Published: July 2023

Background

Culex quinquefasciatus is a notorious vector known to transmit pathogens such as Wuchereria bancrofti (causing Lymphatic filariasis) and flaviviruses such as West Nile virus in India and St. Louis Encephalitis virus in the USA. It is the vector of the Rift Valley Fever virus, also on the African continent. Mosquitoes also harbor other non-pathogenic insect-specific flaviviruses (ISFs), such as Culex flavivirus (CxFV) and Aedes flavivirus. Recent studies have implicated ISFs interfering with the vectorial efficiency of the pathogenic arbo-viruses.

Methods

One hundred specimens of the Cx. quinquefasciatus population in two urban areas in Kerala State, India, were screened to have an understanding of the prevalence of these flaviviruses in this vector species. Viral RNA was extracted from individual specimens and was subjected to RT-PCR towards amplification of the CxFV non-structural protein 5 (NS5) gene.

Results

Among the 100 specimens, 7.0% were found to be harboring CxFV infection. The phylogenetic analysis of the gene sequences showed that the virus isolates were genetically related to Kenya, with 98–99% sequence similarities.

Conclusion

This is the first report on the occurrence of CxFV from Cx. quinquefasciatus from India. The occurrence of these viruses in mosquitoes could play a critical role in disease vector management.
A Survey of Phytophthora spp. in Eastern Indian Nurseries and Their Sensitivity to Six Oomycete-Targeted Commercial Fungicides
Authors: Dhali Rikta , Dey Tanmoy , Tewari Susanta , Roy Sanjoy Guha
Published: July 2023

A survey of the flori-horticultural nurseries in eastern India found Phytophthora nicotianae to be the most widespread Phytophthora species associated with different foliar symptoms of nursery plants and identified the presence of P. palmivora in eastern Indian nurseries for the first time. The survey also led to the first worldwide finding of P. nicotianae on Dipteracanthus prostratus (Poir.) Nees; Ocimum tenuiflorum L. (syn. Ocimum sanctum L.); Philodendron xanadu Croat, Mayo & J. Boos; and Pyrostegia venusta (Ker-Gawl.) Miers and P. palmivora on Episcia cupreata (Hook.) Hanst., as well as the first report from India of P. nicotianae on Spathiphyllum wallisii Regel; Anthurium andraeanum Linden ex André; and Adenium obesum (Forsk.) Roem. & Schult. Sensitivity to commercial fungicides Glazer 35WS, Rallis India (metalaxyl, FRAC code 4); Ridomil Gold, Syngenta (mefenoxam + mancozeb); Revus, Syngenta (mandipropamid, FRAC code 40); Aliette Bayer (fosetyl-Al, FRAC code 33); Acrobat, BASF (dimethomorph, FRAC code 40); and Amistar, Syngenta (azoxystrobin, FRAC code 11) was analyzed, showing EC50 values ranging from 0.75 to 16.39 ppm, 0.74 to 1.45 ppm, 2.43 to 17.21 ppm, 63.81 to 327.31 ppm, 8.88 to 174.69 ppm, and 0.1 to 1.13 ppm, respectively, with no cross-resistance of the isolates to the fungicides. The baseline information produced about these Phytophthora spp. from ornamental and horticultural host associations could help prevent the pathogens from becoming primary drivers of new disease outbreaks and their large-scale distribution beyond their natural endemic ranges.
The Effects of Coping Strategies Between Uncertainty and Quality of Life of Korean Women With Gynecological Cancer
Authors: Ko Eungil , Lee Yaelim
Published: July 2023

The objective of this study was to explore the mediation effects of coping strategies on the relationship between uncertainty and quality of life in Korean women with gynecological cancer. Mishel's Uncertainty in Illness Theory and Lazarus and Folkman's Stress and Coping Theory were used to guide the study. Three coping strategies (problem-focused, active emotional, and avoidant emotional) partially mediated the relationship between uncertainty and quality of life. This work provides evidence that reducing uncertainty has significant effects on coping strategies and positively affects the quality of life in women with gynecological cancer.
Ovarian preservation in gynecologic oncology: current indications and techniques
Authors: Bizzarri Nicolò , Pavone Matteo , Loverro Matteo , Querleu Denis , Fagotti Anna , Scambia Giovanni
Published: July 2023

Purpose of review

Early menopause represents a relevant clinical issue for women. Nevertheless, this issue should be balanced with the risks of ovarian metastasis, ovarian recurrence, and the risk of recurrence in hormone-sensitive gynecological cancers. The purpose of this review was to provide an overview on current indications and techniques of ovarian preservation in patients with gynecological cancers.

Recent findings

The potential discussion about ovarian conservation could be proposed to patients with FIGO-stage IA grade 1-2 endometrioid endometrial cancer aged 40 years or less, FIGO-stage IB1-IB2 node-negative cervical cancer with squamous cell carcinoma and HPV-associated adenocarcinoma, FIGO-stage IA-IC grade 1-2 serous, endometrioid, mucinous expansile pattern ovarian cancer, any stage germ cell ovarian tumors, and FIGO-stage IA sex cord-stromal tumors. Technique to perform ovarian transposition in cervix cancer is also reported.

Ovarian conservation is a surgical approach that involves preserving one or both ovaries during the treatment of gynecologic cancers. This approach has gained popularity in recent years, as it offers several benefits to the patient, including the preservation of hormonal function and fertility. The decision to perform ovarian conservation depends on several factors, such as the stage and type of cancer, the patient's age, fertility desire, and should be carefully discussed with patients.
New boundaries for fertility sparing management in endometrial cancer
Authors: Rodolakis Alexandros , Pergialiotis Vasilis , Thomakos Nikolaos
Published: July 2023

Purpose of review

The increasing rates of endometrial cancer in premenopausal women that accompanies modern lifestyle options that enhance the prevalence of obesity as well as the trend of delayed childbearing are expected to increase the need for fertility sparing techniques. Currently, the cornerstone of fertility sparing treatment is hormonal handling with progestin treatment and is reserved for women with well differentiated endometrioid lesions that are limited in the myometrial layer.

Recent findings

Innovative approaches in the surgical treatment of patients with the use of operative hysteroscopy seem to offer decreased intervals to remission of lesions and longer progression free survival. Recent small case series also dictate that patients with endometrioid lesions of medium differentiation as well as those with superficial myometrial invasion may be adequately treated with the use of operative hysteroscopy. Moreover, the novel classification system may help better understand patients that will likely respond better to hormonal treatment.

In the near future, further data from clinical trials will be available that will help optimize patient selection as well select surgical and medical options that will help establish a personalized approach of fertility preservation in endometrial cancer patients.
A Systematic Review of Artificial Intelligence Applications in Plastic Surgery: Looking to the Future
Authors: Spoer Daisy L. , Kiene Julianne M. , Dekker Paige K. , Huffman Samuel S. , Kim Kevin G. , Abadeer Andrew I. , Fan Kenneth L.
Published: July 2023

Background:

Artificial intelligence (AI) is presently employed in several medical specialties, particularly those that rely on large quantities of standardized data. The integration of AI in surgical subspecialties is under preclinical investigation but is yet to be widely implemented. Plastic surgeons collect standardized data in various settings and could benefit from AI. This systematic review investigates the current clinical applications of AI in plastic and reconstructive surgery.

Methods:

A comprehensive literature search of the Medline, EMBASE, Cochrane, and PubMed databases was conducted for AI studies with multiple search terms. Articles that progressed beyond the title and abstract screening were then subcategorized based on the plastic surgery subspecialty and AI application.

Results:

The systematic search yielded a total of 1820 articles. Forty-four studies met inclusion criteria warranting further analysis. Subcategorization of articles by plastic surgery subspecialties revealed that most studies fell into aesthetic and breast surgery (27%), craniofacial surgery (23%), or microsurgery (14%). Analysis of the research study phase of included articles indicated that the current research is primarily in phase 0 (discovery and invention; 43.2%), phase 1 (technical performance and safety; 27.3%), or phase 2 (efficacy, quality improvement, and algorithm performance in a medical setting; 27.3%). Only one study demonstrated translation to clinical practice.

Conclusions:

The potential of AI to optimize clinical efficiency is being investigated in every subfield of plastic surgery, but much of the research to date remains in the preclinical status. Future implementation of AI into everyday clinical practice will require collaborative efforts.
Ultrasound as an Educational Tool in Facial Aesthetic Injections
Authors: Schelke Leonie , Farber Nimrod , Swift Arthur
Published: July 2023

Injection therapies for cosmetic enhancement, particularly antiaging treatments, are increasingly popular. However, once the needle has penetrated the skin, the injector is “blind” to the depth and exact location of the needle tip. Duplex ultrasound use before and after treatment can allow the injector to visualize in real time the individual anatomy, thereby improving and confirming the accuracy of the injections through visualization of both the target layer and the vital structures to be avoided. Previously injected permanent filler treatments can also be visualized. In this way, ultrasound use becomes an important educational tool in promoting “safer” facial injection therapy. It shifts static anatomy to mobile real-time facial anatomy, thereby establishing itself as an invaluable learning tool through follow-up imaging, with subsequent optimization in techniques and patient outcomes.
Venous Thromboembolism Risk Assessment Models in Plastic Surgery: A Systematic Review and Meta-Analysis
Authors: Mrad Mohamed Amir , Al Qurashi Abdullah A. , Shah Mardan Qutaiba N. M. , Al Ghamdi Abdulrahman Abdulaziz , Al Jabr Faisal Ali , Almenhali Ahmed Abdullah , AlMansour Abdullah , Al Maghrabi Aroub , Allhybi Abdulaziz Khalid , Merdad Reyan Hatem , Alaa'adeen Abdulqader
Published: July 2023

Background:

Postoperative venous thromboembolism (VTE) is the most common complication of plastic surgery procedures. Diverse risk assessment models (RAMs) exist to stratify patients by VTE risk, but due to a lack of high-quality evidence and heterogeneity in RAM data, there is no recommendation regarding RAM that can be used for plastic surgery patients. This study compares the reliability and outcomes of Caprini and American Society of Anesthesiologists (ASA) physical status classification RAMs used in plastic surgery to help surgeons stratify the risk of VTE.

Methods:

MEDLINE and Embase databases were searched between February 2010 and December 2021. All published English articles that report the incidence of VTE stratified by a RAM among patients who underwent plastic surgery were included. The results of the presented meta-analysis were pooled using a random-effects model.

Results:

The database search revealed 809 articles, out of which eight studies (n = 1,348,606) were eligible. Out of the eight studies, six utilized the Caprini score, and three utilized ASA score. Super-high-risk patients were significantly more likely to present with VTE than their high-risk [odds ratio (OR), 2.92; 95% confidence interval (CI), 1.26–6.78], medium-risk (OR, 5.29; 95% CI, 2.38–11.79), or low-risk counterparts (OR, 10.00; 95% CI, 2.32–43.10) at Caprini score. High-risk patients in ASA score showed significant increase in VTE incidents (OR, 2.72; 95% CI, 1.10–6.72).

Conclusions:

Both Caprini and ASA RAMs showed compelling evidence of efficacy in our study. However, the Caprini RAM is more predictive of postoperative VTE incidents in high-risk plastic surgery patients than the ASA grading system.
Obesity and Complications in Mammoplasty: A Retrospective Review in an Obese Patient Population
Authors: Hinson Chandler , Alford Hayden , Huett Wilson , Zeidan Melody , Moore Rachel , Lee Yann-Leei , Quang Kenny , Brooks Ronald
Published: July 2023

Background:

With trends of obesity increasing, plastic surgeons are resecting larger weights from larger patients. Published literature has demonstrated the association between body mass index (BMI) and resection weight to postsurgical complications; however, these relationships are unclear in a population that is primarily overweight or obese. Our study examines these relationships to assist plastic surgeons in identifying high-risk patients and discussing preoperative measures to decrease the likelihood of surgical complications.

Methods:

We performed a retrospective electronic medical record review of a cohort of 182 bilateral reduction mammoplasty procedures performed at a single institution over a four-year period. Patient data were obtained and correlated with postoperative complications.

Results:

Within our identified patient cohort, 95% were classified as either overweight or obese. Incidence of complications was 51%, with wound dehiscence having the highest incidence of 36.26%. Using a multivariate regression, our analysis found statistical significance between surgical complications and both smoking status and BMI (P = 0.042 and P = 0.025, respectively). Smokers had an increased risk of complications with an odds ratio of 5.165. For every additional 1 kg/m2 increase in BMI, the odds for surgical complication increased by 1.079. In a subanalysis focusing on wound dehiscence, the use of postoperative drains was a protective factor (P = 0.0065).

Conclusions:

Our study population, with a high average BMI and smoking status, demonstrated a statistically significant increase in postsurgical complications. These findings will help counsel obese patients preoperatively on their increased risk of complications.
Utilization of the Free Fibular Flap for First Metatarsal Reconstruction
Authors: Gupta Rohun , Pfennig Mitchell , Gannon James , Young Devin , Gupta Rushil , Hart Justin , Kissel Brian G. , Kissel Erik C. , Fortin Paul , Chaiyasate Kongkrit
Published: July 2023

Beyond being aesthetically unpleasing, metatarsal defects have been known to lead to several patient concerns such as intermetatarsal malpositioning and metatarsalgia. There are several reconstructive techniques that have been utilized for reconstruction of bony defects in the foot, including the free dorsal toe flap and dorsal metatarsal perforator flap. Our institution has utilized the free fibular flap for surgical management pertaining to tarsal reconstruction. Our study looks to evaluate the work of a single plastic surgeon and identify patient postoperative outcomes. A retrospective chart review was conducted at Beaumont Health System, Royal Oak for patients who underwent first metatarsal reconstruction with a free fibular flap between the years 2015 and 2022. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively gathered and analyzed. A total of two patients were isolated after chart review. Both patients were found to have tolerated the procedure well and had no intraoperative complications. In addition, all patients had clinically viable flaps and were satisfied with their surgical results. The free fibular flap may be used effectively in the management of metatarsal defects that have failed prior therapy. In our study, both patients who underwent surgical management with a free fibular flap were noted to have successful long-term results. With the right expertise and patient population, a free fibular flap can be highly successful in the repair of metatarsal defects.
Tuberous Breast Management: A Review of Literature and Novel Technique Refinements
Authors: Grella Roberto , D’Andrea Francesco , Nicoletti Giovanni Francesco , Lanzano Giuseppe
Published: July 2023

Background:

The tuberous breast is a rare malformation that can affect psychosocial well-being in young women. Its management represents a great challenge to plastic surgeons. Many surgical procedures have been described to correct different grades of tuberous breast deformity (TBD). The authors describe their one-stage technique for correcting grade 2 TBD.

Methods:

Sixteen women affected by grade 2 TBD treated with glandular flaps, silicone gel prosthesis, and only an hemiperiareolar incision between January 2018 and January 2019 were reviewed. The age range was 19–27 years (mean age was 25). Follow-up average was 25 months (range 16–33 months). To evaluate the results, we used two analogic scales with values from 1 to 3, where the lower value was the worst result. First, an independent medical team of three plastic surgeons evaluated two parameters: correction of deformity and symmetry. Then, patients were asked to judge the result obtained.

Results:

The resulting breast has a normal-shaped areola without bulging, a natural shape, a volume matching the contralateral breast, and no evidence of “double-bubble” deformity or irregularities of the lower pole shape.

Conclusion:

We propose this one-stage approach with hemiperiareolar incision, to minimize time interval to obtain final results in TBD correction, with reduced scar dimensions to avoid all the possible complications related to the round block suture.
Immediate Breast Reconstruction with Deep Inferior Epigastric Perforator Flap in a Patient with Previous Surgical Correction of Pectus Excavatum
Authors: Piccolo Paulo P. , Nahabedian Maurice Y. , Venturi Mark , Mesbahi Ali
Published: July 2023

Pectus excavatum is a deformity of the chest wall characterized by a sternal depression and possibly cardiac and pulmonary compression. Procedures performed during infancy for its correction may disrupt local anatomy and pose challenges to breast and reconstructive surgeons during mastectomy and reconstruction. We present a case report of a 45-year-old woman who had a Ravitch procedure for pectus excavatum correction in infancy who was diagnosed with right breast cancer undergoing bilateral nipple-sparing mastectomy with immediate deep inferior epigastric perforator flap reconstruction. A computed tomography angiography was used to study chest and abdominal anatomy before surgery. Patient safely underwent immediate breast reconstruction with deep inferior epigastric perforator flaps using the internal mammary vessels as recipient vessels. This case highlights the importance of preoperative vascular imaging and proper communication between the breast and plastic surgery teams during reconstructive surgery. It also displays the safety of performing immediate breast reconstruction using free tissue transfer and the internal mammary vessels as recipients for microvascular anastomosis.
Down with the Bean Bag: A Multi-institutional Experience with Total Latissimus Muscle Free Flap Harvest in the Supine Position
Authors: Shuck John W. , Felder John A. , Shammas Ronnie L. , Chang Edward I. , Selber Jesse C. , Phillips Brett T.
Published: July 2023

The latissimus muscle continues to be a head to toe workhorse in free tissue transfer for coverage of large defects. Traditional full muscle harvest is performed in the lateral decubitus position which is frequently suboptimal or requires position change based on the recipient site and laterality. We present a multi-institutional case series of full muscle flap harvest from the supine position for a range of defects in 32 patients. The relevant operative setup and technique are described. In our experience, supine harvest has become the preferred open harvest technique compared to lateral positioning for both optimal exposure of the pedicle and reduction in operating time.
Trade-offs in locational choices for care coordination resources in accountable care organizations
Authors: Tsuei Sian Hsiang-Te , Alcusky Matthew , Florio Collen , Kerrissey Michaela June
Published: July 2023

Background

Care coordination is central to accountable care organizations (ACOs), especially in Medicaid where many patients have complex medical and social needs. Little is known about how to best organize care coordination resources in this context, particularly whether to centralize them. We examined how care coordinators’ location, management, and colocation of both (within ACO headquarters, practice sites, or other organizations) relate to care quality and coordination.

Methods

We conducted a cross-sectional analysis of surveys administered to a sample of practice sites covering all 17 Medicaid ACOs in Massachusetts (n = 225, response rate = 64%). We applied controlled, cluster-robust regressions, adjusting the significance threshold for the number of ACO clusters, to assess how clinical information sharing across settings, care quality improvement, knowledge of social service referral, and cross-resource coordination (i.e., the ability of multiple resources to work well together) relate to where care coordinators were physically located and/or managed.

Results

Centralizing care coordinators at ACO headquarters was associated with greater information sharing. Embedding care coordinators in practices was associated with greater care quality improvement. Embedding coordinators at other organizations was associated with less information sharing and care quality improvement. Managing coordinators at practice sites and other organizations were associated with better care quality improvement and cross-resource coordination, respectively. Colocating the two functions showed no significant differences.

Practice Implications

Choosing care coordinators’ locations may present trade-offs. ACOs may strategically choose embedding care coordinators at practice sites for enhanced care quality versus centralizing them at the ACO to facilitate information sharing.
An Open-Label Study of Adjunctive Dextromethorphan/Quinidine in Treatment-Resistant Depression
Authors: Wang Philip R. , Yavi Mani , Lee Holim , Kotb Yasmine , Shora Lorie , Park Lawrence T. , Zarate Carlos A.
Published: July 2023

Background

Approximately one third of individuals with major depressive disorder have treatment-resistant depression (TRD). Glutamatergic modulators such as the N-methyl-d-aspartate receptor antagonist ketamine have rapid and robust antidepressant effects, but their use has been limited by accessibility and route of administration. This open-label pilot study assessed the adjunctive antidepressant efficacy of dextromethorphan/quinidine (DM/Q) in TRD.

Methods

Inpatients with TRD (n = 17, 40.8 ± 12.3 years; 9 females/8 males) received adjunctive open-label DM/Q (20 mg/10 mg) up to 3 times daily. The study had no set endpoint; participants were followed until they discontinued DM/Q or were discharged. Montgomery-Asberg Depression Rating Scale (MADRS) scores were obtained at baseline (before DM/Q administration) and regularly during hospitalization. Full response was defined as a ≥50% reduction in baseline MADRS score, partial response as a 25% to 50% decrease in baseline MADRS score, and nonresponse as a <25% reduction or an increase in baseline MADRS score.

Results

The 17 inpatients received open-label DM/Q for 5.1 ± 2.7 weeks. Forty-seven percent of participants responded to DM/Q—12% achieved a full response and 35% achieved a partial response. The largest MADRS difference observed at any time point was −6.4 ± 8.4 (−21.0% ± 29.9%), and the MADRS difference observed at time of DM/Q discontinuation or hospital discharge was −4.8 ± 8.4 (−15.9% ± 29.7%). Twenty-four percent of participants experienced a nonserious adverse event; none experienced a serious adverse event.

Conclusions

In this open-label pilot study, 47% of participants responded to adjunctive DM/Q, which was well tolerated. Larger placebo-controlled trials are needed to determine the real-world efficacy of DM/Q.
The pluripotential evolution and journey of Botox (onabotulinumtoxinA)
Authors: Brin Mitchell F. , Blitzer Andrew
Published: July 2023

Clinical use of onabotulinumtoxinA evolved based on strategic, hypothesis-driven applications, as well as serendipitous observations by physicians and patients. The success of onabotulinumtoxinA in blepharospasm and strabismus led to its study in other head and neck dystonias, followed by limb dystonia, tremor, and spasticity. The aesthetic use of onabotulinumtoxinA followed initial reports from patients of improved facial lines after injections for facial dystonias and hemifacial spasm. Although patients with dystonias and spasticity regularly reported that their local pain improved after injections, onabotulinumtoxinA was not systematically explored for chronic migraine until patients began reporting headache improvements following aesthetic injections. Clinicians began assessing onabotulinumtoxinA for facial sweating and hyperhidrosis based on its inhibition of acetylcholine from sympathetic cholinergic nerves. Yet another line of research grew out of injections for laryngeal dystonia, whereby clinicians began to explore other sphincters in the gastrointestinal tract and eventually to treatment of pelvic sphincters; many of these sphincters are innervated by autonomic nerves. Additional investigations in other autonomically mediated conditions were conducted, including overactive bladder and neurogenic detrusor overactivity, achalasia, obesity, and postoperative atrial fibrillation. The study of onabotulinumtoxinA for depression also grew out of the cosmetic experience and the observation that relaxing facial muscle contractions associated with negative emotions may improve mood. For approved indications, the safety profile of onabotulinumtoxinA has been demonstrated in the formal development programs and post-marketing reports. Over time, evidence has accumulated suggesting clinical manifestations of systemic effects, albeit uncommon, particularly with high doses and in vulnerable populations. Although onabotulinumtoxinA is approved for approximately 26 indications across multiple local regions, there are 15 primary indication uses that have been approved in most regions, including the United States, Europe, South America, and Asia. This review describes many uses for which AbbVie has not sought and/or received regulatory approval and are mentioned for historical context only.
Treatment of glabellar lines with Botox (onabotulinumtoxinA): Development, insights, and impact
Authors: Carruthers Jean , Carruthers Alastair , Blitzer Andrew , Eadie Nina , Brin Mitchell F.
Published: July 2023

OnabotulinumtoxinA is an injectable medication that produces muscle relaxation through local chemical denervation at the neuromuscular junction. Discovery of onabotulinumtoxinA’s aesthetic benefits occurred serendipitously in the 1980s at the intersection of several medical disciplines, including ophthalmology, neurology, otolaryngology, and dermatology. Patients receiving onabotulinumtoxinA for blepharospasm, hemifacial spasm, and dystonia noticed their periorbital wrinkles disappearing, particularly frown lines between the eyebrows called glabellar lines (GL).

Aesthetic use of onabotulinumtoxinA necessitated rigorous training programs and vigilant monitoring by Allergan. Approval for the GL indication was based on 2 similarly designed, double-blind, randomized, multicenter clinical studies. Subjects with moderate to severe GL receiving onabotulinumtoxinA achieved significantly greater improvement in GL severity than those receiving placebo. In subsequent studies, more than 80% of subjects were satisfied with onabotulinumtoxinA treatment through day 60, and many reported looking approximately 4 years younger at weeks 4 and 12 than at baseline. OnabotulinumtoxinA has a rapid onset of action, and peak effect occurs between 30 and 60 days. The median duration of response for dynamic GL in the initial studies was 120 days and response progressively improved with subsequent treatments. OnabotulinumtoxinA was well tolerated, and the 2 most common adverse events, headache and blepharoptosis, tended to decrease in frequency with repeat treatment.

The novel use of onabotulinumtoxinA for treating GL was an important step in addressing the clinical need for a noninvasive, straightforward, office-based procedure for facial lines that also left patients extremely satisfied with its treatment effects and represented the beginning of its widespread use for numerous aesthetic indications.
Treatment of crow’s feet lines and forehead lines with Botox (onabotulinumtoxinA): Development, insights, and impact
Authors: Carruthers Alastair , Carruthers Jean , De Boulle Koenraad , Lowe Nicholas , Lee Elisabeth , Brin Mitchell F.
Published: July 2023

Extrinsic and age-related intrinsic factors contribute to the development of facial lines, including lateral canthal lines (called crow’s feet lines [CFL]) and horizontal forehead lines (FHL).

OnabotulinumtoxinA is a highly effective treatment for facial lines that inhibits acetylcholine release at the neuromuscular junction. This temporary chemical denervation leads to localized muscle relaxation and subsequent wrinkle reduction. Early studies of onabotulinumtoxinA treatment for facial neuronal disorders such as dystonia documented improvements in FHL and CFL. After the neurotoxin was approved for treating frown lines (glabellar lines [GL]), individuals requested treatment for other rhytids, and physicians continued assessing use in new areas. Once onabotulinumtoxinA was in clinical trial development, its efficacy and safety for CFL and FHL were successively evaluated as required by the US Food and Drug Administration and by key global health authorities, including those in the European Union, Japan, and China.

Allergan, collaborating with leading physicians, established clinical programs that included novel safety and efficacy measures to meet regulatory requirements. Global, phase 3, randomized, controlled studies of CFL and FHL met rigorous primary endpoints. Some countries mandated clinical trial data beyond US and European regulations, and Allergan conducted 11 studies in total, fulfilling diverse regulatory and study population data requirements.

Adverse events associated with local spread, including brow and eyelid ptosis, diplopia, headache, and eyelid sensory disorder, were infrequent and well tolerated. Consequently, onabotulinumtoxinA treatment of upper facial lines is now established globally as a highly effective, minimally invasive treatment for patients to achieve a natural appearance and look younger.
The Design of Nested Adaptive Clinical Trials of Multiple Organ Dysfunction Syndrome Children in a Single Study
Authors: VanBuren John M. , Hall Mark , Zuppa Athena F. , Mourani Peter M. , Carcillo Joseph , Dean J. Michael , Watt Kevin , Holubkov Richard
Published: July 2023

OBJECTIVES:

Describe the statistical design of the Personalized Immunomodulation in Sepsis-induced Multiple Organ Dysfunction Syndrome (MODS) (PRECISE) study.

DESIGN:

Children with sepsis-induced MODS undergo real-time immune testing followed by assignment to an immunophenotype-specific study cohort. Interventional cohorts include the granulocyte macrophage-colony stimulating factor (GM-CSF) for the Reversal of Immunoparalysis in Pediatric Sepsis-induced MODS (GRACE)-2 trial, which uses the drug GM-CSF (or placebo) to reverse immunoparalysis; and the Targeted Reversal of Inflammation in Pediatric Sepsis-induced MODS (TRIPS) trial, which uses the drug anakinra (or placebo) to reverse systemic inflammation. Both trials have adaptive components and use a statistical framework in which frequent data monitoring assesses futility and efficacy, allowing potentially earlier stopping than traditional approaches. Prespecified simulation-based stopping boundaries are customized to each trial to preserve an overall one-sided type I error rate. The TRIPS trial also uses response-adaptive randomization, updating randomization allocation proportions to favor active arms that appear more efficacious based on accumulating data.

SETTING:

Twenty-four U.S. academic PICUs

PATIENTS:

Septic children with specific immunologic derangements during ongoing dysfunction of at least two organs.

INTERVENTIONS:

The GRACE-2 trial compares GM-CSF and placebo in children with immunoparalysis. The TRIPS trial compares four different doses of anakinra to placebo in children with moderate to severe systemic inflammation.

MEASUREMENTS AND MAIN RESULTS:

Both trials assess primary efficacy using the sum of the daily pediatric logistic organ dysfunction-2 score over 28 days. Ranked summed scores, with mortality assigned the worst possible value, are compared between arms using the Wilcoxon Rank Sum test (GRACE-2) and a dose-response curve (TRIPS). We present simulation-based operating characteristics under several scenarios to demonstrate the behavior of the adaptive design.

CONCLUSIONS:

The adaptive design incorporates innovative statistical features that allow for multiple active arms to be compared with placebo based on a child’s personal immunophenotype. The design increases power and provides optimal operating characteristics compared with traditional conservative methods.
Repair of Fingertip Degloving Injuries Using the Extended Reverse Second Dorsal Metacarpal Artery Flap
Authors: Zhang Wenlong , Zhang Xu , Liu Yingnan , Xu Tao , Zhuang Yongqing , Chen Chao
Published: July 2023

Background:

This study aimed to introduce modified reverse second dorsal metacarpal artery flap (MRSDMAF) transfer for the treatment of fingertip degloving injuries.

Methods:

From January of 2004 to March of 2020, 31 patients with fingertip degloving injuries underwent MRSDMAF transfer. The mean defect and flap size were 4.5 × 1.6 cm and 4.7 × 1.7 cm, respectively. Nerve repair was performed in 18 fingers. Flap sensation, function restoration of the reconstructed fingers, and donor-site morbidity were assessed. For comparison, we reviewed a cohort of 45 patients undergoing modified cross-finger flap (MCFF) transfer.

Results:

Complete flap survival was achieved in 28 fingers, and partial distal flap necrosis was noted in 3 fingers. After a mean of 24 months, the static 2-point discrimination was 8.6 ± 1.0 mm and 7.2 ± 0.8 mm in the MRSDMAF and MCFF groups, with a significant difference (P < 0.0001). Sensory restoration of the MRSDMAF group was inferior to that of the MCFF group. In addition, the MRSDMAF group presented a higher incidence of fingertip pain (P = 0.019) and suboptimal appearance of the reconstructed finger (P = 0.036). On the donor site, the MRSDMAF group presented a lower incidence of scar pain (P = 0.030) and better appearance (P = 0.025).

Conclusion:

MRSDMAF transfer is an alternative treatment for fingertip degloving injuries, especially when MCFF transfer is not feasible.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Guidance on conducting methodological studies – an overview
Authors: Khalil Hanan , Munn Zachary
Published: July 2023

Purpose of review

Methodological studies are defined as studies that are used to develop the validity and reliability of instruments or methods to measure constructs used as variables in research. Other terms used to describe them include methodological review, meta-epidemiological review and research on research. Methodological studies have previously been used to examine the characteristics of certain tools or methods used in research, to examine the adherence of reporting guidelines by researchers, to advance the methodology of certain methods, to examine the heterogeneity and exploring causes of research methodologies and to develop new methodologies.

Recent findings

To date, the guidance to undertake methodological studies is limited. Some studies used either systematic, scoping or mapping approach to undertake them. This narrative review will present a summary of published methodological studies guidance for researchers to consider in the future.

This article presented a detailed summary of published methodological studies ranging from methods, naming, database searching, data selection and reporting. To date, there is no clear consensus on how to report methodological studies. Further research is warranted in this area to produce robust guidance for undertaking methodological studies.