bluuebunny/crossref_metadata_2025 huggingface dataset:
Innovative virtual care delivery in a Canadian paediatric tertiary-care centre
Authors: Goldbloom Ellen B , Buba Melanie , Bhatt Maala , Suntharalingam Sinthuja , King W James
Published: May 2022

Health care systems and providers have rapidly adapted to virtual care delivery during this unprecedented time. Clinical programs initiated a variety of virtual care delivery models to maintain access to care, preserve personal protective equipment, and minimize infectious disease spread. Herein, we first describe the context within paediatric health delivery during the COVID-19 pandemic in Canada that fueled the rise of virtual care delivery. We then summarize the development, implementation, and beneficial impact of the innovative virtual care delivery programs currently in use at Children’s Hospital of Eastern Ontario (CHEO) for both inpatient and outpatient care, specifically in our ambulatory clinics, emergency department, and mental health program. We highlight the transferable unique ways CHEO has integrated virtual care delivery through our governance structure, stakeholder engagement including patient, caregivers and health care providers and staff, development, and use of eHealth tools and novel approaches for patient care requiring physical assessment. We conclude with our vision for the future of virtual care, one component of paediatric care delivery in the post-COVID-19 era, which requires a common framework for virtual care evaluation.

Importantly, rapid implementation of a primarily virtual care model at CHEO sustained high volume quality paediatric care. We believe many of these programs should and will remain in the post-pandemic era. A comprehensive, unified approach to evaluation is essential to yield meaningful results that inform sustainable care delivery models that integrate virtual care, and ultimately help ensure the best health outcomes for our patients.
Exploring Intra-State Tensions in Government Responses to COVID-19
Authors: Federman Peter Stanley , Curley Cali
Published: May 2022

Research and attention to federalism has vastly increased due to the COVID-19 pandemic. While political polarization has largely been used as a scapegoat to explain the U.S. policy response to the pandemic, federalism has also been credited and blamed for the policy response and has played an important role in providing avenues for conflict. This article explores intra-state conflict stemming from COVID-19. We utilize ten exploratory cases to identify three distinct but interrelated patterns of conflict that emerged within U.S. states, focusing on tensions between the executive and legislative branches, between bureaucratic officials and the legislature, and between state and local governments. We then examine a series of questions regarding the implication of these conflicts, focusing on the issuance of executive orders, the responses undertaken by officials who disagreed with and sought to push back against these orders, and the ways that inter-branch and inter-governmental disagreements about these orders were resolved.
Contributions of fundamental frequency and timbre to vocal emotion perception and their electrophysiological correlates
Authors: Nussbaum Christine , Schirmer Annett , Schweinberger Stefan R
Published: May 2022

Our ability to infer a speaker’s emotional state depends on the processing of acoustic parameters such as fundamental frequency (F0) and timbre. Yet, how these parameters are processed and integrated to inform emotion perception remains largely unknown. Here we pursued this issue using a novel parameter-specific voice morphing technique to create stimuli with emotion modulations in only F0 or only timbre. We used these stimuli together with fully modulated vocal stimuli in an event-related potential (ERP) study in which participants listened to and identified stimulus emotion. ERPs (P200 and N400) and behavioral data converged in showing that both F0 and timbre support emotion processing but do so differently for different emotions: Whereas F0 was most relevant for responses to happy, fearful and sad voices, timbre was most relevant for responses to voices expressing pleasure. Together, these findings offer original insights into the relative significance of different acoustic parameters for early neuronal representations of speaker emotion and show that such representations are predictive of subsequent evaluative judgments.
Sleep disturbances, circadian activity, and nocturnal light exposure characterize high risk for and current depression in adolescence
Authors: Tonon André Comiran , Constantino Débora Barroggi , Amando Guilherme Rodriguez , Abreu Ana Carolina , Francisco Ana Paula , de Oliveira Melissa Alves Braga , Pilz Luísa K , Xavier Nicóli Bertuol , Rohrsetzer Fernanda , Souza Laila , Piccin Jader , Caye Arthur , Petresco Sandra , Manfro Pedro H , Pereira Rivka , Martini Thaís , Kohrt Brandon A , Fisher Helen L , Mondelli Valeria , Kieling Christian , Hidalgo Maria Paz Loayza
Published: May 2022

Study Objectives

Major depressive disorder (MDD) in adolescence is associated with irregularities in circadian rhythms and sleep. The characterization of such impairment may be critical to design effective interventions to prevent development of depression among adolescents. This study aimed to examine self-reported and actimetry-based circadian rhythms and sleep–wake behavior associated with current MDD and high risk (HR) for MDD among adolescents.

Methods

Ninety-six adolescents who took part in the IDEA-RiSCo study were recruited using an empirically developed depression-risk stratification method: 26 classified as low risk (LR), 31 as HR, and 39 as a current depressive episode (MDD). We collected self-report data on insomnia, chronotype, sleep schedule, sleep hygiene as well as objective data on sleep, rest-activity, and light exposure rhythms using actimetry for 10 days.

Results

Adolescents with MDD exhibited more severe insomnia, shorter sleep duration, higher social jetlag (SJL), lower relative amplitude (RA) of activity, and higher exposure to artificial light at night (ALAN) compared with the other groups. They also presented poorer sleep hygiene compared with the LR group. The HR group also showed higher insomnia, lower RA, higher exposure to ALAN, and higher SJL compared with the LR group.

Conclusions

HR adolescents shared sleep and rhythm alterations with the MDD group, which may constitute early signs of depression, suggesting that preventive strategies targeting sleep should be examined in future studies. Furthermore, we highlight that actimetry-based parameters of motor activity (particularly RA) and light exposure are promising constructs to be explored as tools for assessment of depression in adolescence.
Pretreatment with Perlecan-Conjugated Laminin-E8 Fragment Enhances Maturation of Grafted Dopaminergic Progenitors in Parkinson’s Disease Model
Authors: Adachi Hiromasa , Morizane Asuka , Torikoshi Sadaharu , Raudzus Fabian , Taniguchi Yukimasa , Miyamoto Susumu , Sekiguchi Kiyotoshi , Takahashi Jun
Published: May 2022

The therapeutic effect of a cell replacement therapy for Parkinson’s disease (PD) depends on the proper maturation of grafted dopaminergic (DA) neurons and their functional innervation in the host brain. In the brain, laminin, an extracellular matrix protein, regulates signaling pathways for the survival and development of neurons by interacting with integrins. The heparan sulfate (HS) chain binds mildly to various neurotrophic factors and regulates their intracellular signaling. Perlecan-conjugated laminin 511/521-E8 fragments (p511/p521) were designed to contain an integrin-binding site and HS chains. Here we examined the effect of treating DA progenitors with p511/p521 prior to transplantation in rodent PD models. In vitro and in vivo experiments showed that p511/p521 treatment enhanced the maturation and neurite extension of the grafted DA progenitors by activating RAS-ERK1/2 signaling. This strategy will contribute to an efficient cell replacement therapy for PD in the future.
Aldicarb-related suicide attempt cases in North of France (2012–2021)
Authors: Lenski Marie , Letrillart Agnès , Gish Alexandr , Nisse Patrick , Gaulier Jean-michel , Allorge Delphine
Published: May 2022

Aldicarb, a carbamate pesticide banned in France since 2008, represents a persistent risk of human poisoning. There is no up-to-date picture of aldicarb intentional poisonings associated to detailed diagnosis and clinical management of cases to evaluate the effect of its ban on intoxication risk reduction, including suicide. This retrospective epidemiological study describes cases of suicidal intoxication from the Hauts-de-France region between 2012 and 2021 and illustrates this situation through one analytically documented case. 60 cases were collected, mostly presenting a pathognomonic symptomatology. Thirty-five victims presented a muscarinic syndrome (58.3%), 14 a nicotinic syndrome (23.3%), and 37 a central nervous system impairment (61.7%). Hospitalization was necessary for 44 cases (73.3%), with 2 fatal evolutions. Diagnosis was based on the blood cholinesterase activities. Among the 25 cases with toxicology results, 45.8% presented a moderate decrease of acetylcholinesterase activity, whereas 87.5% presented a strong decrease of butyrylcholinesterase activity. Blood or urine detection of aldicarb and its metabolites may be considered in therapeutic management, although their quantification is unlikely to change the emergency medical care. Our study updates epidemiology of aldicarb poisoning at a regional level, highlighting a persisting health threatening situation with banned pesticides. More than 65% of national cases occurred in this agricultural area, aldicarb remaining available from storage of previously purchased products. Robust evidence is presented that acute poisoning is an ongoing major global public health challenge. There is a need for continued international efforts in risk reduction, knowledge, and information strategies.
Pelvic Osteotomy in Patients With Previous Sacral-Alar-Iliac (SAI) Fixation
Authors: Mun Frederick , Vankara Ashish , Suresh Krishna V. , Margalit Adam , Crasta Nikitha , Sponseller Paul D.
Published: May 2022

Introduction:

Patients with neuromuscular disease are at high risk for developing hip dysplasia and scoliosis. The purpose of this study was to investigate the technical challenges and outcomes of pelvic osteotomy in patients with prior sacral-alar-iliac (SAI) fixation.

Methods:

We reviewed clinical and radiographic records of patients aged 18 years and below who underwent pelvic osteotomy after SAI fixation. We recorded technical challenges during the osteotomy, time from SAI fixation to osteotomy, type of osteotomy, migration index, and distance from the SAI screw to the acetabulum. A 2-sample Wilcoxon rank-sum test was used to assess the data.

Results:

Nineteen patients were included. Technical challenges were defined as having greater intraoperative fluoroscopy times and noted difficult osteotomy in the operative report. The mean time from SAI fixation to pelvic osteotomy was 2.2±1.5 years. For all 12 Chiari osteotomies, the ilium could not be laterally displaced; however, medial displacement of the distal segment of the osteotomy allowed adequate coverage. All 7 Dega osteotomies were performed by cutting the cortex at the tip of the SAI screw. The screw improved proximal leverage and provided a strong buttress for bone graft. The mean migration index before pelvic osteotomy was 59±19%, and at most recent follow-up was 13±4%. Twelve patients, who had a noted complicated osteotomy, had SAI screws that were ≤1.87 cm (P<0.01) from the acetabulum and significantly increased intraoperative fluoroscopy time (1.76 vs. 1.18 min, P<0.01).

Conclusions:

The presence of SAI screws may cause iliac osteotomies to be technically challenging if the tip of the SAI screw is ≤1.87 cm to the acetabulum. When initially implanting SAI screws in neuromuscular patients, surgeons should attempt to place screw tips ∼2 cm from the acetabulum in the event these patients require subsequent pelvic osteotomy.

Level of Evidence:

Level IV.
Ambulatory blood pressure monitoring in children during the COVID-19 pandemic
Authors: Woroniecki Robert P. , Flynn Joseph T.
Published: May 2022

The pandemic caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) had profound effects on healthcare delivery in the USA and abroad. Although ambulatory blood pressure monitoring (ABPM) is the recommended method for confirming hypertension (HTN) diagnosis and management, it is unclear how the pandemic affected ABPM utilization. We surveyed 81 pediatric nephrologists from 54 pediatric nephrology centers regarding their ABPM practices during the pandemic; 56.8% of providers continued to provide ABPM to their patients, but only 21% used disposable cuffs, and only 28.4% had specific equipment cleaning protocols in place. Only a minority of 81 practitioners felt comfortable (26.2%) or very comfortable (11.2%) in following published guidelines on ABPM during the pandemic, and 22.5% felt uncomfortable or very uncomfortable (7.5%). Additionally, only about half (49.4%) of practitioners were comfortable with managing HTN via telehealth. Our findings underscore the need to supplement existing and future guidance on how to manage HTN protocols, HTN patients, and equipment during healthcare crises.
Representation of Global Health Initiatives in Plastic Surgery Training
Authors: Naides Alexandra I. , Kapadia Kailash , Salem Jena , Dalena Margaret , Cohen David , Ayyala Haripriya S. , Lee Edward S.
Published: May 2022

Introduction

Over the last several years, various social media platforms have been used to increase collaboration, education, and research internationally. The purpose of this study was to evaluate how plastic surgery residency programs use social media to promote global surgery education, research, and collaboration.

Methods

A full list of active integrated residency programs was obtained from the American College of Academic Plastic Surgeons website. A total of 82 programs were identified. Instagram, Facebook, and Twitter were searched for active accounts. Only accounts dedicated to plastic surgery programs or had a significant amount of residency-related content were included. Inclusion criteria included posts relating to global health, global surgery, mission trips, international plastic surgery education, and global surgery research. Caption language was analyzed and classified as either “resident education in global surgery,” “an individual’s interest in global surgery,” “research in global surgery,” “visiting international professor,” or “global collaboration.” Image content was then assessed for “images with patients,” “images with other surgeons/residents,” “images of international location,” a combination thereof, “other,” or “none.”

Results

Instagram was by far the most used by plastic surgery residency programs with a total of 76 programs having accounts compared with only 32 programs and 33 programs having Facebook and Twitter accounts, respectively. There was no significant difference in the proportional number of posts relating to global surgery across the 3 platforms (P = 0.1911). On all 3 social media platforms, the majority of posts fell into the category of “international collaboration” with 42.5%, 50.7%, and 48.8% on Instagram, Facebook, and Twitter, respectively. None of the caption categories examined showed a significantly different proportion of posts across the 3 platforms. Image analysis showed a significant difference in the proportional representation across the 3 platforms in the categories of “images with other surgeons/residents” (P = 0.0196) “images with patients” (P = 0.0082), combination (P = 0.0225), and other (P = 0.0114).

Conclusions

Although social media offers programs an easy way to promote global surgery research, collaboration, and education with a wider audience, it is being underused for this purpose as evident by the relatively lower number of postings on each platform relating to this content.
Pediatric Pain and Pain Management After Ambulatory Plastic Surgery
Authors: Bernstein Jaime L. , Schlechtweg Kathryn A. , Nwigwe Viemma , Fullerton Natalia , Imahiyerobo Thomas A.
Published: May 2022

Background

Overprescribing by physicians has been shown to be a major contributor to the opioid epidemic. Although pediatric ambulatory plastic surgery patients are commonly prescribed opioids for postoperative pain control, there is a lack of evidence for their necessity. This study aimed to investigate the role of prescribed narcotics in the ambulatory pediatric plastic surgery setting.

Methods

All assenting patients/guardians, ages 0 to 17 years, who underwent an ambulatory plastic surgery procedure by 1 attending surgeon from March 2018 to March 2019, were asked to participate in the study. A questionnaire was distributed at the first postoperative visit to interrogate postoperative pain, management, and narcotic use.

Results

A total of 95 patients/guardians completed the questionnaire. Seventy-eight percent (74) of patients picked up the narcotic medication, with 33% (31) taking at least 1 dose of narcotics, and only 9% (9) taking 4 or more doses. Patients overall found no difference in efficacy of the narcotics versus nonprescription analgesics (3.93/5 and 4.31/5, P = 0.11). Age was a significant predictor, with older patients requiring more narcotics (odds ratio, 1.12; 95% confidence interval, 1.02–1.24; P = 0.019). The type of surgery a patient underwent was not a significant predictor of the amount of narcotic used. Few patients knew how to properly dispose of the excess narcotics, with almost 50% still having it stored in their homes.

Conclusions

This study demonstrates that the majority of pediatric ambulatory plastic surgery patients do not require narcotic pain medications and experience adequate pain relief with over-the-counter analgesics. Importantly, education on proper disposal of narcotic medications may be a simple, yet effective target to decrease opioid availability for abuse.
Diversity in Plastic Surgery: Analysis of Representation of Sex and Ethnic Diversity in Plastic Surgery Residency Social Media Accounts
Authors: Maisner Rose S. , Kapadia Kailash , Zhu Aretha , Patel Nikita , Ravikumar Vaishali , Lad Meeki , Zingaro Lauren , Ayyala Haripriya S. , Lee Edward S.
Published: May 2022

Background

Increasing health care diversity is critical to overcoming disparities. Plastic surgery has been working to improve diversity through various efforts, including social media movements like Diversify PRS and #ilooklikeasurgeon. Because residency programs' social media sites serve as a public symbol of the programs' values and can attract potential applicants, we sought to analyze such platforms for content highlighting sex and ethnic diversity.

Methods

Integrated plastic surgery residency programs during the 2020 to 2021 academic year were found on the American Council of Academic Plastic Surgeons website, and their associated social media accounts were identified. The authors reviewed each program's account for all posts published by November 8, 2021, for content promoting sex or ethnic diversity. Any hashtags related to diversity were also recorded. Nonparametric Mann-Whitney U and Kruskal-Wallis tests were used to compare percentages of total social media posts related to sex and ethnic diversity between programs (α = 0.05).

Results

Of 82 programs, 76 (92.7%) had active Instagram accounts, 29 (35.4%) had active Facebook accounts, and 29 (35.4%) had active Twitter accounts. Across all platforms, 19.0% of all posts were promoting sex diversity and 3.3% were promoting ethnic diversity. Of 4651 posts promoting sex diversity, 4067 (87.4%) highlighted women, 1017 (21.9%) featured all-women teams, 779 (16.7%) used sex diversity-related hashtags, and 300 (6.5%) included purposeful statements. Of 808 posts promoting ethnic diversity, 527 (65.2%) used ethnic diversity-related hashtags, 224 (27.7%) included purposeful statements, 199 (24.6%) mentioned ethnic background, and 36 (4.5%) used different skin-toned emojis. Programs did not vary in percentages of posts related to diversity by geographic region, ranking, accreditation length, or engagement rate. The percentage of posts promoting sex diversity was greater than that promoting ethnic diversity (P < 0.001). The most used diversity hashtag was #ilooklikeasurgeon.

Conclusions

Despite the importance of increasing recruitment of trainees from diverse backgrounds to plastic surgery and the global reach of social media movements like #ilooklikeasurgeon, sex and ethnic diversity are still poorly promoted on residency social media accounts. Increasing such content is a simple yet powerful way to create a culture of inclusivity for all applicants.
Evaluating the Inaccuracy of the National Surgical Quality Improvement Project Surgical Risk Calculator in Plastic Surgery: A Meta-analysis of Short-Term Predicted Complications
Authors: Basta Marten N. , Rao Vinay , Paiva Marcelo , Liu Paul Y. , Woo Albert S. , Fischer John P. , Breuing Karl H.
Published: May 2022

Background

Preoperative surgical risk assessment is a major component of clinical decision making. The ability to provide accurate, individualized risk estimates has become critical because of growing emphasis on quality metrics benchmarks. The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) Surgical Risk Calculator (SRC) was designed to quantify patient-specific risk across various surgeries. Its applicability to plastic surgery is unclear, however, with multiple studies reporting inaccuracies among certain patient populations. This study uses meta-analysis to evaluate the NSQIP SRC’s ability to predict complications among patients having plastic surgery.

Methods

OVID MEDLINE and PubMed were searched for all studies evaluating the predictive accuracy of the NSQIP SRC in plastic surgery, including oncologic reconstruction, ventral hernia repair, and body contouring. Only studies directly comparing SCR predicted to observed complication rates were included. The primary measure of SRC prediction accuracy, area under the curve (AUC), was assessed for each complication via DerSimonian and Laird random-effects analytic model. The I
2 statistic, indicating heterogeneity, was judged low (I
2 < 50%) or borderline/unacceptably high (I
2 > 50%). All analyses were conducted in StataSE 16.1 (StataCorp LP, College Station, Tex).

Results

Ten of the 296 studies screened met criteria for inclusion (2416 patients). Studies were classified as follows: (head and neck: n = 5, breast: n = 1, extremity: n = 1), open ventral hernia repair (n = 2), and panniculectomy (n = 1). Predictive accuracy was poor for medical and surgical complications (medical: pulmonary AUC = 0.67 [0.48–0.87], cardiac AUC = 0.66 [0.20–0.99], venous thromboembolism AUC = 0.55 [0.47–0.63]), (surgical: surgical site infection AUC = 0.55 [0.46–0.63], reoperation AUC = 0.54 [0.49–0.58], serious complication AUC = 0.58 [0.43–0.73], and any complication AUC = 0.60 [0.57–0.64]). Although mortality was accurately predicted in 2 studies (AUC = 0.87 [0.54–0.99]), heterogeneity was high with I
2 = 68%. Otherwise, heterogeneity was minimal (I
2 = 0%) or acceptably low (I
2 < 50%) for all other outcomes.

Conclusions

The NSQIP Universal SRC, aimed at offering individualized quantifiable risk estimates for surgical complications, consistently demonstrated poor risk discrimination in this plastic surgery–focused meta-analysis. The limitations of the SRC are perhaps most pronounced where complex, multidisciplinary reconstructions are needed. Future efforts should identify targets for improving SRC reliability to better counsel patients in the perioperative setting and guide appropriate healthcare resource allocation.
Charting the Effect of the Universal Offer Date on Plastic Surgery Residency Matches
Authors: Harris Jason M. , Janhofer David E. , Poveromo Luke P. , Otterburn David M.
Published: May 2022

In 2019, the plastic surgery residency match changed their method for inviting students to interview. Instead of offering interview invitations and scheduling interviews on a first come, first served basis, all plastic surgery residency programs sent out secured interview spots on the same day. This universal offer date was intended to remove student worry that surrounded not scheduling an interview fast enough, as well as cause students to more carefully select which interview invitations to accept, increasing the likelihood that residency programs could interview only those students most interested in matching at their institutions. The effect of universal offer date was studied through analysis of available National Residency Match Program data, with a focus on the mean number of contiguous programs students ranked to match, as well as the mean number of applicants who residency programs ranked to fill each available position. Historical trends in plastic surgery match, trends in the match in other competitive surgical subspecialties, and applicant qualifications were also analyzed. In breaking with the general trend among all surgical subspecialties toward ranking more applicants per residency position, in 2020, fewer plastic surgery applicants were ranked by residency programs per available position, suggesting a more effective interview process and match. Matched applicant qualifications remained excellent across the period studied.
Smooth Versus Textured Tissue Expander Breast Reconstruction: Complications and Efficacy
Authors: McLaughlin Caroline , Hughes Alexa J. , Parham Christopher S. , Fritsche Madelaine , Potochny John D. , Kunselman Allen , Ravnic Dino J.
Published: May 2022

Introduction

Ongoing recognition of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) and its link with textured devices has brought a paradigm shift in prosthetic-based breast reconstruction. Many institutions no longer offer textured expansion devices for staged reconstruction. However, there is a paucity of data regarding the efficacy of smooth tissue expanders (TE). We hypothesized that the time to final reconstruction and complication profile between smooth and textured TEs would be similar in breast reconstruction patients.

Methods

A retrospective chart review was performed of all patients who underwent TE breast reconstruction during a 6-year period at the Penn State Hershey Medical Center. Rates of complications treated nonoperatively and those requiring reoperation were assessed. Mechanical complications, including expander malposition and rupture, were evaluated. Time to final breast reconstruction was quantified. Mixed-effects logistic regression and linear regression models, as appropriate, were used to compare textured to smooth TEs. Patient characteristics and anatomic plane placement were adjusted for in all analyses of outcomes.

Results

Data were collected on 389 patients, encompassing 140 smooth and 604 textured TEs. Textured devices had an increased incidence of complications treated nonsurgically (16.7% vs 10.7%; P = 0.14). However, smooth TEs had an increased incidence of reoperation (12.1% vs 7.6%; P = 0.06). Most noteworthy was that although smooth TEs had a 40-fold increase in malposition (13.6% vs 0.3%; P < 0.001), no reoperation for this complication was warranted. Further, the time to final reconstruction was comparable between the 2 devices (textured expanders: 221 days and smooth expanders: 234 days; P = 0.15).

Conclusions

Staged, implant-based reconstruction is the most common surgical approach to recreate the breast mound following mastectomy. Textured TEs were the cornerstone to this approach. Unfortunately, the association between textured devices and BIA-ALCL now mandates an alternative. We postulated that smooth expanders would compare favorably for breast reconstruction. Although our study suggests that smooth TEs suffer more malposition, this has a negligible impact on the reconstructive timeline. Thus, smooth TEs may prove beneficial when considering the risk of BIA-ALCL associated with textured devices.
Revision Pharyngoplasty in Cleft Palate and Velopharyngeal Insufficiency
Authors: Bruce Madeleine K. , Zhang Casey , Vodovotz Lena , Irgebay Zhazira , Maliha Samantha , Pfaff Miles , Ford Matthew , Goldstein Jesse A. , Losee Joseph E.
Published: May 2022

Introduction

Velopharyngeal insufficiency (VPI), a stigmatizing hallmark of palatal dysfunction, occurs in a wide spectrum of pediatric craniofacial conditions. The mainstays for surgical correction include palate repair and/or pharyngeal surgery. However, primary pharyngoplasty has a failure rate of 15% to 20%. Although revision pharyngoplasty may be necessary in those with persistent VPI, little is known regarding the indications for and outcomes after such procedures. The purpose of this study is to describe the authors' experience with indications for and outcomes after revision pharyngoplasty.

Methods

A single-center retrospective review was performed of all patients undergoing revision pharyngoplasty between 2002 and 2019. Demographic data and Pittsburgh Weighted Speech Scores, diagnoses, comorbidities, and complications were tabulated. Two-tailed Student t test was used, and a P value of 0.05 or less was considered statistically significant.

Results

Thirty-two patients (65.6% male) met inclusion criteria for this study. The most common diagnoses included cleft palate (68.8%), submucous cleft palate (SMCP, 18.8%), and congenital VPI (6.3%, likely occult SMCP). Most patients (84.4%) underwent palatoplasty before their initial pharyngoplasty. The primary indication for initial pharyngoplasty was VPI (mean age 7.1 ± 4.6 years). The most common indication for revision pharyngoplasty (mean age 11.2 ± 5.1 years) included persistent VPI (n = 22), followed by obstructive sleep apnea (OSA) (n = 11). Persistent VPI (n = 8) and OSA (n = 6) were the most common complications after secondary pharyngoplasty. Thirteen patients (40.6%) within the revision pharyngoplasty cohort required additional surgical intervention: 4 underwent tertiary pharyngoplasty, 4 underwent takedown for OSA (n = 3) or persistent VPI (n = 1), 3 underwent takedown and conversion Furlow for persistent VPI (n = 2), OSA (n = 2) and/or flap dehiscence (n = 1), and 2 underwent palatal lengthening with buccal myomucosal flaps for persistent VPI. Of the 4 patients who required a tertiary pharyngoplasty, the mean age at repair was 6.6 ± 1.1 years and their speech scores improved from 13.5 to 2.3 after tertiary pharyngoplasty (P = 0.11). The overall speech score after completion of all procedures improved significantly from 19 to 3.3.

Conclusion

Patients who fail primary pharyngoplasty represent a challenging population. Of patients who underwent secondary pharyngoplasty, nearly half required a tertiary procedure to achieve acceptable speech scores or resolve complications.
Cutaneous surgical wounds have distinct microbiomes from intact skin
Authors: Gupta Sameer , Poret Alexandra J. , Hashemi David , Eseonu Amarachi , Yu Sherry H. , D’Gama Jonathan , Neel Victor A. , Lieberman Tami D.
Published: May 2022

Infections are relatively rare following cutaneous surgical procedures, despite the potential for wound exposure to pathogens both during surgery and throughout the healing process. Although gut commensals are believed to reduce the risk of intestinal infections, an analogous role for skin commensals has not been described. In fact, the microbiome of normally healing surgical skin wounds has not yet been profiled using culture-independent techniques. We characterized the wound microbiome in 53 patients who underwent skin cancer surgery and healed without signs or symptoms of infection. A week after surgery, several bacterial species displayed significant differences in relative abundance when compared to control, non-operated skin from the same patient. The most common bacteria found on intact skin, Cutibacterium acnes, was depleted in wounds 5-fold. Staphylococcus aureus, a frequent cause of postoperative skin infections, was enriched 6.4-fold in clinically non-infected wounds, suggesting active suppression of pathogenicity. Finally, members of the Corynebacterium genus were the dominant organism in postoperative wounds, making up 37% of the average wound microbiome. The enrichment of these bacteria in normally healing wounds suggests they might be capable of providing colonization resistance. Future studies focused on the biological and clinical significance of the wound microbiome may shed light on normal wound healing and potential therapeutic opportunities to mitigate infection risk.

Importance

Commensal bacteria on skin may limit the ability of pathogenic bacteria to cause clinically-significant infections. The bacteria on healing acute wounds, which might provide such a protective effect, have not been described using culture-independent approaches in the absence of antibiotics. We compare the microbiome of wounds a week after skin cancer removal surgery with intact skin from the same patient. We find that the potentially pathogenic species S. aureus is common on these normally healing wounds, despite the absence of symptoms or signs of infection. We report that bacteria often considered as potential skin probiotics, including S. epidermidis, do not reach high abundance in wound microbiomes. In contrast, specific members of the Cornyebacterium genus, rarely associated with skin infections, were enriched in healing wounds relative to intact skin. Future work is needed to see if Corynebacterium species or derivatives thereof could be employed to lower the risk of wound infection.
Cross-link assisted spatial proteomics to map sub-organelle proteomes and membrane protein topology
Authors: Zhu Ying , Akkaya Kerem Can , Lima Diogo Borges , Wang Cong , Lehmann Martin , Liu Fan
Published: May 2022

The specific functions of cellular organelles and sub-compartments depend on their protein content, which can be characterized by spatial proteomics approaches. However, many spatial proteomics methods are limited in their ability to resolve organellar sub-compartments, profile multiple sub-compartments in parallel, and/or characterize membrane-associated proteomes. Here, we develop a cross-link assisted spatial proteomics (CLASP) strategy that addresses these shortcomings. Using human mitochondria as a model system, we show that CLASP can elucidate spatial proteomes of all mitochondrial sub-compartments and provide topological insight into the mitochondrial membrane proteome in a single experiment. Biochemical and imaging-based follow-up studies demonstrate that CLASP allows discovering mitochondria-associated proteins and revising previous protein sub-compartment localization and membrane topology data. This study extends the scope of cross-linking mass spectrometry beyond protein structure and interaction analysis towards spatial proteomics, establishes a method for concomitant profiling of sub-organelle and membrane proteomes, and provides a resource for mitochondrial spatial biology.
Failure of digit tip regeneration in the absence of Lmx1b suggests Lmx1b functions disparate from dorsoventral polarity
Authors: Castilla-Ibeas Alejandro , Zdral Sofía , Galán Laura , Haro Endika , Allou Lila , Campa Víctor M. , Icardo Jose M. , Mundlos Stefan , Oberg Kerby C. , Ros Marian A.
Published: May 2022

Mammalian digit tip regeneration is linked to the presence of nail tissue, but a nail-explicit model is missing. Here, we report that nail-less double-ventral digits of ΔLARM1/2 mutants that lack limb-specific Lmx1b enhancers fail to regenerate. To separate the nail’s effect from the lack of DV polarity, we also interrogate double-dorsal double-nail digits and show that they regenerate. Thus, DV polarity is not a prerequisite for regeneration and the nail requirement is supported. Transcriptomic comparison between wild-type and non-regenerative ΔLARM1/2 mutant blastemas reveals differential up-regulation of vascularization and connective tissue functional signatures in wild-type versus upregulation of inflammation in the mutant. These results, together with the finding of uniform Lmx1b expression in the wild-type blastema and in the dorsal dermis underneath the nail, indicate that, in addition of the nail’s effect, a direct role for Lmx1b in driving the progression of digit tip regeneration is likely.
A Multidimensional Approach to Understanding the Emergence of Sex Differences in Internalizing Symptoms in Adolescence
Authors: Serio Bianca , Kohler Robert , Ye Fengdan , Lichenstein Sarah D , Yip Sarah W
Published: May 2022

Women are more vulnerable to internalizing disorders (e.g., depression and anxiety). This study took an integrative, developmental approach to investigate multidimensional factors associated with the emergence of sex differences in internalizing symptoms, using data from the Adolescent Brain Cognitive Development (ABCD) study. Indices of sex hormone levels (dehydroepiandrosterone, testosterone, and estradiol), physical pubertal development, task-based functional brain activity, family conflict, and internalizing symptoms were drawn from the ABCD study’s baseline sample (9-to 10-year-old; N = 11,844). Principal component analysis served as a data-driven dimensionality reduction technique on the internalizing subscales to yield a single robust measure of internalizing symptoms. Moderated mediation analyses assessed whether associations between known risk factors and internalizing symptoms vary by sex. Results revealed direct and indirect effects of physical pubertal development on internalizing symptoms through family conflict across sexes. No effects were found of sex hormone levels or amygdala response to fearful faces on internalizing symptoms. Females did not report overall greater internalizing symptoms relative to males, suggesting that internalizing symptoms have not yet begun to increase in females at this age. Findings provide an essential baseline for future longitudinal research on the endocrine, neurocognitive, and psychosocial factors associated with sex differences in internalizing symptoms.
Semi-automated protocol to quantify and characterize fluorescent three-dimensional vascular images
Authors: Xie Danny F. , Crouzet Christian , LoPresti Krystal , Wang Yuke , Robinson Christopher , Jones William , Muqolli Fjolla , Fang Chuo , Cribbs David H. , Fisher Mark , Choi Bernard
Published: May 2022

The microvasculature facilitates gas exchange, provides nutrients to cells, and regulates blood flow in response to stimuli. Vascular abnormalities are an indicator of pathology for various conditions, such as compromised vessel integrity in small vessel disease and angiogenesis in tumors. Traditional immunohistochemistry enables visualization of tissue cross-sections containing exogenously labeled vasculature. Although this approach can be utilized to quantify vascular changes within small fields-of-view, it is not a practical way to study the vasculature on the scale of whole organs. Three-dimensional (3D) imaging presents a more appropriate method to visualize the vascular architecture in tissue. Here we describe the complete protocol that we use to characterize the vasculature of different organs in mice encompassing the methods to fluorescently label vessels, optically clear tissue, collect 3D vascular images, and quantify these vascular images with a semi-automated approach. To validate the automated segmentation of vascular images, one user manually segmented fifty random regions of interest across different vascular images. The automated segmentation results had an average sensitivity of 80±8% and an average specificity of 90±5% when compared to manual segmentation. Applying this procedure of image analysis presents a method to reliably quantify and characterize vascular networks in a timely fashion. This procedure is also applicable to other methods of tissue clearing and vascular labels that generate 3D images of microvasculature.
Sucrose rather than GA transported by AtSWEET13 and AtSWEET14 supports pollen fitness at late anther development stages
Authors: Wang Jiang , Xue Xueyi , Zeng Houqing , Li Jiankun , Chen Li-Qing
Published: May 2022

Both sugar and hormone gibberellin (GA) are essential for anther-enclosed pollen development and thus for plant productivity in flowering plants. Arabidopsis (Arabidopsis thaliana) AtSWEET13 and AtSWEET14, which are expressed in anthers and associated with seed yield, transport both sucrose and GA. However, it is still unclear which substrate transported by them directly affects anther development and seed yield.

Histochemical staining, cross-sectioning and microscopy imaging techniques were used to investigate and interpret the phenotypes ofAtSWEET13andAtSWEET14double mutant during anther development. Genetic complementation ofatsweet13;14using AtSWEET9 that transports sucrose but not GA was conducted to test the substrate preference relevant to the biological process.

The loss ofAtSWEET13andAtSWEET14resulted in reduced pollen viability and therefore decreased pollen germination. AtSWEET9 fully rescued

the defects in pollen fertility ofatsweet13;14, indicating AtSWEET13/14 mediated sucrose rather than GA is essential to pollen fertility.

AtSWEET13 and AtSWEET14 mainly function at the anther wall during late anther development stages and are likely responsible for sucrose efflux into locules to support pollen development to maturation, which is vital for subsequent pollen viability and germination.
Nanoscale prognosis of colorectal cancer metastasis from AFM image processing of histological sections
Authors: Gavriil Vassilios , Ferraro Angelo , Cefalas Alkiviadis-Constantinos , Kollia Zoe , Pepe Francesco , Malapelle Umberto , De Luca Caterina , Troncone Giancarlo , Sarantopoulou Evangelia
Published: May 2022

Early ascertainment of metastatic tumour phases is crucial to improve cancer survival, formulate an accurate prognostic report of disease advancement and, most important, quantify the metastatic progression and malignancy state of primary cancer cells with a universal numerical indexing system. This work proposes an early improvement of cancer detection with 97nmspatial resolution by indexing the metastatic cancer phases from the analysis of atomic force microscopy images of human colorectal cancer histological sections. The procedure applies variograms of residuals of Gaussian filtering and theta statistics of colorectal cancer tissue image settings. The methodology elucidates the early metastatic progression at the nanoscale level by setting metastatic indexes and critical thresholds from relatively large histological sections and categorising the malignancy state of a few suspicious cells not identified with optical image analysis. In addition, we sought to detect early tiny morphological differentiations indicating potential cell transition from epithelial cell phenotypes of low to high metastatic potential. The metastatic differentiation, also identified by higher moments of variograms, sets different hierarchical levels for the metastatic progression dynamic, potentially impacting therapeutic cancer protocols.
A modified trust-region assisted variable-fidelity optimization framework for computationally expensive problems
Authors: Li Chengshan , Dong Huachao
Published: May 2022

Purpose

Variable-fidelity optimization (VFO) frameworks generally aim at taking full advantage of high-fidelity (HF) and low-fidelity (LF) models to solve computationally expensive problems. The purpose of this paper is to develop a novel modified trust-region assisted variable-fidelity optimization (MTR-VFO) framework that can improve the optimization efficiency for computationally expensive engineering design problems.

Design/methodology/approach

Though the LF model is rough and inaccurate, it probably contains the gradient information and trend of the computationally expensive HF model. In the proposed framework, the extreme locations of the LF kriging model are firstly utilized to enhance the HF kriging model, and then a modified trust-region (MTR) method is presented for efficient local search. The proposed MTR-VFO framework is verified through comparison with three typical methods on some benchmark problems, and it is also applied to optimize the configuration of underwater tandem wings.

Findings

The results indicate that the proposed MTR-VFO framework is more effective than some existing typical methods and it has the potential of solving computationally expensive problems more efficiently.

Originality/value

The extreme locations of LF models are utilized to improve the accuracy of HF models and a MTR method is first proposed for local search without utilizing HF gradient. Besides, a novel MTR-VFO framework is presented which is verified to be more effective than some existing typical methods and shows great potential of solving computationally expensive problems effectively.
Quality assessment of E-learning website using asymmetric impact–performance analysis and Kano’s customer satisfaction model: a case study based on WebQual 4.0
Authors: Esmaeili Givi Mohammadreza , Keshavarz Hamid , Kargar Azad Zahra
Published: May 2022

Purpose

Using asymmetric impact–performance analysis for examining an asymmetric relationship between user satisfaction and website features, the present research aims to identify features of high priority for quality improvement. For doing so, the current research was conducted in the context of the E-learning website of the most prestigious university in Iran, namely, the University of Tehran.

Design/methodology/approach

The main question was which of the three groups of basic, performance and excitement factors has the required dimensions of the quality of the website based on the model WebQual 4.0 by considering Kano’s user satisfaction model and impact–performance analysis. This is a descriptive survey, applied and cross-sectional study. The study population included Tehran University’s students who enrolled in virtual courses in the academic year 2020–2021 from which a sample of 457 students was selected. The data collection tool was the questionnaire of Webqual 4.0, as well as a researcher-made questionnaire to measure end-user satisfaction.

Findings

Using structural equation modeling and multiple regression, the findings showed that the customer’s overall satisfaction with the mentioned website is primarily affected by the feature interaction with services, including the two structures of trust and empathy, and then the dimensions of usability and quality of information. Examining the Webqual 0.4 dimensions indicated that the website usability dimension is a part of the high-performance excitement factors group, the information quality dimension is a part of the high-performance basic factors group and the website interaction dimension is in the low-performance basic factors group.

Originality/value

The research is highly innovative taking the theoretical model of Kano and methodological investigation of asymmetric impact–performance analysis into consideration alongside the WebQual 4.0 as a fundamental model for website assessment. Moreover, the research was conducted on an E-learning website, which is unique and a necessity amid the COVID-19 pandemic.