bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Fathers in Promoting Early Childhood Development in Low- and Middle-Income Countries: A Review of the Evidence
Authors: Evans David K , Jakiela Pamela
Published: June 2024

The role of fathers in parenting young children differs dramatically across societies. Policymakers in low- and middle-income countries (LMICs) are increasingly focused on increasing the amount of early childhood stimulation and other investments received by young children in an attempt to increase human capital accumulation, promote school readiness, and improve long-run outcomes. Until recently, few interventions targeted fathers, and most impact evaluations implicitly assumed that fathers played no meaningful role in parenting. We survey the emerging literature on fathers’ involvement in early childhood stimulation and parenting in LMICs and summarize the patterns of results from rigorous impact evaluations. We find that fathers spend less time stimulating their children's development than do mothers or other adults who live in the same households in almost every country in our sample, and that mothers’ and fathers’ investments are positively associated. We also find evidence that fathers’ take-up of parent training programs tends to be low, but that such programs have had effects on changing fathers’ knowledge and—to a lesser degree—behaviors.
Effectiveness of Objective Structured Clinical Examinations and Standardized Patient Simulations for Increasing Learner Knowledge in Family Nurse Practitioner Education: A Systematic Review of the Literature
Authors: Sibley Sean , Strout Kelley , Bonnet Jennifer
Published: June 2024

AIM

The aim of this systematic review was to evaluate the effectiveness of using objective structured clinical examinations (OSCEs) and standardized patient (SP) simulations in family nurse practitioner (FNP) education to increase students’ knowledge and skill competency.

BACKGROUND

Many programs use OSCE and SP simulation, but there is limited empirical data demonstrating their effectiveness for Kirkpatrick’s level of learning.

METHOD

A systematic search of published and unpublished literature was conducted in seven databases/registries in February 2023. Quantitative, experimental studies and quasi-experimental studies with comparison and explicit FNP learner population were included.

RESULTS

Of 4,442 records, zero studies met the inclusion criteria. Some studies with eligible designs investigated different populations (e.g., acute care nurse practitioner, prelicensure students).

CONCLUSION

The absence of included studies in this systematic review upholds the established need for continued investigation and can be used to support funding opportunities addressing this critical gap in nursing education science.
Educational Needs of Rural Students Interested in the Nursing Profession
Authors: Barron Keri A. , Scott Letisha
Published: June 2024

This study aimed to uncover the educational requirements of minority rural students who aspire to pursue a career in nursing. To achieve this goal, focus groups and interviews were organized for middle school students (seventh to ninth grade) and community members with a stake in education. The outcomes of these discussions revealed crucial themes: limited knowledge of educational pathways, constraints posed by limited community resources, and a strong yearning for a mentorship program that is both informative and interactive. The findings served as the cornerstone for the creation and development of a mentorship initiative tailored specifically for minority rural students.
A Comparison of Psychometric Properties of the American Board of Anesthesiology’s In-Person and Virtual Standardized Oral Examinations
Authors: Keegan Mark T. , Harman Ann E. , Deiner Stacie G. , Sun Huaping
Published: June 2024

Purpose

The COVID-19 pandemic prompted training institutions and national credentialing organizations to administer examinations virtually. This study compared task difficulty, examiner grading, candidate performance, and other psychometric properties between in-person and virtual standardized oral examinations (SOEs) administered by the American Board of Anesthesiology.

Method

This retrospective study included SOEs administered in person from March 2018 to March 2020 and virtually from December 2020 to November 2021. The in-person and virtual SOEs share the same structure, including 4 tasks of preoperative evaluation, intraoperative management, postoperative care, and additional topics. The Many-Facet Rasch Model was used to estimate candidate performance, examiner grading severity, and task difficulty for the in-person and virtual SOEs separately; the virtual SOE was equated to the in-person SOE by common examiners and all tasks. The independent-samples and partially overlapping-samples t tests were used to compare candidate performance and examiner grading severity between these 2 formats, respectively.

Results

In-person (n = 3,462) and virtual (n = 2,959) first-time candidates were comparable in age, sex, race and ethnicity, and whether they were U.S. medical school graduates. The mean (standard deviation [SD]) candidate performance was 2.96 (1.76) logits for the virtual SOE, which was statistically significantly better than that for the in-person SOE (mean [SD], 2.86 [1.75]; Welch independent-samples t test, P = .02); however, the effect size was negligible (Cohen d = 0.06). The difference in the grading severity of examiners who rated the in-person (n = 398; mean [SD], 0.00 [0.73]) versus virtual (n = 341; mean [SD], 0.07 [0.77]) SOE was not statistically significant (Welch partially overlapping-samples t test, P = .07).

Conclusions

Candidate performance and examiner grading severity were comparable between the in-person and virtual SOEs, supporting the reliability and validity of the virtual oral exam in this large-volume, high-stakes setting.
Prevalence and Correlates of Prohibited Questions in Internal Medicine and Pediatrics Fellowship Interviews During 1 Appointment Year
Authors: Scribner Katherine A. , West Colin P. , Myers Angela L. , Muchmore Elaine A. , Goldstein Risë B.
Published: June 2024

Purpose

This study sought to investigate how frequently applicants to internal medicine (IM) and pediatrics fellowships are subjected to prohibited questions, how correlates of these interview questions compare between IM and pediatrics fellowship applicants, and which applicant subgroups are most affected.

Method

The National Resident Matching Program (NRMP) emailed an anonymous survey to all applicants for the 2021 appointment year to the Medical Specialties Matching Program (i.e., IM fellowship Matches) and Pediatric Specialties Fellowship Match who certified rank order lists (ROLs). The survey addressed specific questions regarding the use of legally prohibited questions and questions that violate the NRMP’s Match Participation Agreement during interview-related activities. Experiences of respondents were compared by preferred subspecialty and respondent demographics within IM and pediatrics.

Results

The final response rates of IM and pediatrics fellowship applicants who certified ROLs, including complete and partial surveys, were 21.7% (1,483/6,847) and 23.4% (385/1,648), respectively. Of the IM and pediatrics respondents, 432/1,296 (33.3%) and 97/366 (26.5%), respectively, reported being asked at least one prohibited demographic question. The most commonly asked prohibited questions pertained to relationship or marital status (IM: 312/1,296, 24.1%; pediatrics: 69/367, 18.8%), national origin (IM: 200/1,296, 15.4%; pediatrics: 30/365, 8.2%), and family planning (IM: 104/1,288, 8.1%; pediatrics: 14/366, 3.8%). Nearly 25% of IM and pediatrics respondents reported being asked to identify other programs they applied to or interviewed with. Most often, these questions came from program faculty (IM: 238/303, 78.5%; pediatrics: 69/88, 78.4%) or program directors (IM: 84/303, 27.7%; pediatrics: 18/88, 20.5%).

Conclusions

Substantial proportions of IM and pediatrics fellowship applicants reported being asked prohibited questions during fellowship interview–related activities. Additional educational efforts are needed to eradicate such questions from the interview process.
Optimizing Opioid Prescription Quantity After Cesarean Delivery
Authors: Smid Marcela C. , Clifton Rebecca G. , Rood Kara , Srinivas Sindhu , Simhan Hyagriv N. , Casey Brian M. , Longo Monica , Landau Ruth , MacPherson Cora , Bartholomew Anna , Sowles Amber , Reddy Uma M. , Rouse Dwight J. , Bailit Jennifer L. , Thorp John M. , Chauhan Suneet P. , Saade George R. , Grobman William A. , Macones George A. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network*
Published: June 2024

OBJECTIVE:

To test whether an individualized opioid-prescription protocol (IOPP) with a shared decision-making component can be used without compromising postcesarean pain management.

METHODS:

In this multicenter randomized controlled noninferiority trial, we compared IOPP with shared decision making with a fixed quantity of opioid tablets at hospital discharge. We recruited at 31 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Study participants had uncomplicated cesarean births. Follow-up occurred through 12 weeks postdischarge. Individuals with complicated cesarean births or history of opioid use in the pregnancy were excluded. Participants were randomized 1:1 to IOPP with shared decision making or fixed quantity (20 tablets of 5 mg oxycodone). In the IOPP group, we calculated recommended tablet quantity based on opioid use in the 24 hours before discharge. After an educational module and shared decision making, participants selected a quantity of discharge tablets (up to 20). The primary outcome was moderate to severe pain (score 4 or higher [possible range 0–10]) on the BPI (Brief Pain Inventory) at 1 week after discharge. A total sample size of 5,500 participants was planned to assess whether IOPP with shared decision making was not inferior to the fixed quantity of 20 tablets.

RESULTS:

From September 2020 to March 2022, 18,990 individuals were screened and 5,521 were enrolled (n=2,748 IOPP group, n=2,773 fixed-quantity group). For the primary outcome, IOPP with shared decision making was not inferior to fixed quantity (59.5% vs 60.1%, risk difference 0.67%; 95% CI, −2.03% to 3.37%, noninferiority margin −5.0) and resulted in significantly fewer tablets received (median 14 [interquartile range 4–20] vs 20, P<.001) through 90 days postpartum.

CONCLUSION:

Compared with fixed quantity, IOPP with shared decision making was noninferior for outpatient postcesarean analgesia at 1 week postdischarge and resulted in fewer prescribed opioid tablets at discharge.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04296396.
Development of Consensus-Based Best Practice Guidelines for the Perioperative and Postoperative Care of Pediatric Patients With Spinal Deformity and Programmable Implanted Devices
Authors: Truong Walter H. , Matsumoto Hiroko , Brooks Jaysson T. , Guillaume Tenner J. , Andras Lindsay M. , Cahill Patrick J. , Fitzgerald Ryan E. , Li Ying , Ramo Brandon A. , Soumekh Benhoor , Blakemore Laurel C. , Carter Christopher , Christie Michelle R. , Cortez Daniel , Dimas V. Vivian , Hardesty Christina K. , Javia Luv R. , Kennedy Benjamin C. , Kim Peter D. , Murphy Robert F. , Perra Joseph H. , Polly David W. , Sawyer Jeffrey R. , Snyder Brian , Sponseller Paul D. , Sturm Peter F. , Yaszay Burt , Feyma Tim , Morgan Sara J.
Published: June 2024

Study Design.

Modified Delphi consensus study.

Objective.

To develop consensus-based best practices for the care of pediatric patients who have implanted programmable devices (IPDs) and require spinal deformity surgery.

Summary of Background Data.

Implanted programmable devices (IPDs) are often present in patients with neuromuscular or syndromic scoliosis who require spine surgery. Guidelines for monitoring and interrogating these devices during the perioperative period are not available.

Methods.

A panel was assembled consisting of 25 experts (i.e., spinal deformity surgeons, neurosurgeons, neuroelectrophysiologists, cardiologists, and otolaryngologists). Initial postulates were based on a literature review and results from a prior survey. Postulates addressed the following IPDs: vagal nerve stimulators (VNS), programmable ventriculoperitoneal shunts (VPS), intrathecal baclofen pumps (ITBP), cardiac pacemakers and implantable cardioverter-defibrillators (ICD), deep brain stimulators (DBS), and cochlear implants. Cardiologist and otolaryngologist participants responded only to postulates on cardiac pacemakers or cochlear implants, respectively. Consensus was defined as ≥80% agreement, items that did not reach consensus were revised and included in subsequent rounds. A total of 3 survey rounds and 1 virtual meeting were conducted.

Results.

Consensus was reached on 39 total postulates across 6 IPD types. Postulates addressed general spine surgery considerations, the use of intraoperative monitoring and cautery, the use of magnetically controlled growing rods (MCGRs), and the use of an external remote controller to lengthen MCGRs. Across IPD types, consensus for the final postulates ranged from 94.4% to 100%. Overall, experts agreed that MCGRs can be surgically inserted and lengthened in patients with a variety of IPDs and provided guidance for the use of intraoperative monitoring and cautery, which varied between IPD types.

Conclusion.

Spinal deformity correction surgery often benefits from the use of intraoperative monitoring, monopolar and bipolar cautery, and MCGRs. The final postulates from this study can inform the perioperative and postoperative practices of spinal deformity surgeons who treat patients with both scoliosis and IPDs.

Level of Evidence.

V-Expert opinion.
Self-Reported Religiosity and Spirituality of Registered Nurses in Virginia
Authors: Akers Shanna W. , Miller Kathryn M.
Published: June 2024

The professional nurse cares for an increasingly diverse population, varying in ethnicity, culture, and faith beliefs that influence health and wellness. The moral obligation of the nurse to provide individualized, holistic care of clients includes spiritual care. Supported by the Agape Model of Nursing, nurses should understand their personal religiosity and its impact on the care they provide. The purpose of this study was to better understand the self-reported religiosity and spirituality of registered nurses licensed to practice in the Commonwealth of Virginia.
Rhinomanometry evidence in children treated by Furlow’s palatoplasty for velopharyngeal insufficiency correlated to cleft palate
Authors: Rizzo Maria Ida , Fallico Nefer , Palmieri Annapina , Ciofalo Andrea , Ruoppolo Giovanni , Greco Antonio , Zama Mario
Published: June 2024

Background:

Speech surgery outcomes for velopharyngeal insufficiency (VPI) are difficult to quantify. We investigated the correlation between objective measurements of nasal emission and speech assessment ratings in children undergoing Furlow palatoplasty for the treatment of cleft-related VPI.

Methods:

A total of 20 patients with VPI after primary cleft palate repair were recruited for Furlow’s palatoplasty. All participants completed rhinomanometry (RM) and speech evaluation scored by two blinded speech-language pathologists. Pre- and postoperative results were compared using the paired t test. Statistical significance was set for P values < 0.05. Correlation tests were performed to identify the correspondence of the RM findings with the speech assessment ratings.

Results:

RM quantified a reduction of the expiratory flow postoperatively. The sensitivity for the RM was 1.00 and the specificity 0.95. The mean of the pre- versus postoperative values was 0.52 ± 0.43 (range: 0.14–1.69) versus 0.51 ± 0.54 (range: 0.18–1.8), P < 0.05. These values confirmed a reduction of the nasal emission postoperatively, which was consistent with the speech assessment reports.

Conclusions:

Combined subjective and objective measurements can complete the clinical assessment of these patients. RM measurements confirmed the velopharyngeal changes achieved with speech surgery.
A New Measuring Approach in Assessing Hamstring Flexibility: Reliability, Validity, and Applicability of Isolated Hamstring Flexibility Test
Authors: Talu Yasin , Tuncer Aysenur , Talu Burcu
Published: June 2024

Objective:

This study was planned to determine the reliability, validity, and applicability of the isolated hamstring flexibility test (IHFT).

Design:

A cohort study (diagnosis); level of evidence, 2.

Setting:

It was performed in the research and application laboratory.

Participants:

Seventy-five individuals aged 18 to 25 years, selected through simple probability random sampling, with a normal Beighton Horan and Joint Mobility Index scores, and who volunteered to participate, were included for evaluation.

Interventions:

On then first and third days, participants underwent muscle strength, sit-and-reach test, active knee extension test, IHFT for validity and reliability. Stretching exercises were prescribed as a home program for 31 patients with limited knee extension, and measurements were repeated at the end of the eighth week.

Main outcome measures:

Sit-and-reach test, active knee extension test, IHFT.

Results:

The test–retest reliability was high (intraclass correlation coefficient, 0.993). Our test demonstrated validity when compared in terms of flexibility gained. A significant difference was found between pre–post stretching exercise training in all 3 tests (P < 0.05).

Conclusion:

It was observed that the IHFT is reliable and applicable in determining hamstring flexibility. Given the absence of another test specifically measuring hamstring flexibility in isolation, its indirect validity was established through analysis with other tests using the gold standard for assessing gains in hamstring flexibility.
Astroblastoma With a Novel YAP1::BEND2 Fusion: A Case Report
Authors: Cuoco Joshua A. , Williams Serina , Klein Brendan J. , Borowicz Violet M. , Ho Hao , Stump Michael S. , Rogers Cara M.
Published: June 2024

In the most recent fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System, astroblastoma has been defined by molecular rearrangements involving the MN1 gene, with common partners being BEND2 or CXXC5. Accordingly, this tumor entity is now known as “astroblastoma, MN1-altered.” However, gliomas with EWSR1::BEND2 fusions, devoid of MN1 fusion alterations, have recently been shown to exhibit astroblastoma-like histomorphologic features and reside in a distinct epigenetic subgroup based on DNA methylation studies similar to high-grade neuroepithelial tumor with MN1 alteration, which includes astroblastoma, MN1 altered tumors. This new epigenetically distinct subtype of astroblastoma containing EWSR1::BEND2 fusions lacks the required MN1 alteration and, thus, does not satisfy the current molecular classification of these lesions. Here, we describe a case of glioma with histologic features and DNA methylation profiling consistent with astroblastoma with a novel YAP1::BEND2 fusion. This case and others further expand the molecular findings observable in astroblastoma-like tumors outside the constraints of MN1 alteration. Such cases of astroblastoma with EWSR1::BEND2 and YAP1::BEND2 fusions challenge the current molecular classification of astroblastoma based solely on an MN1 alteration.
Prevalence of Red Blood Cell Alloimmunization Among Pediatric Patients With Sickle Cell Disease in Saudi Arabia
Authors: Al-Asmari Badriah , Baothman Abdullah , Almohammadi Mohammed , Aljuaid Mohammed , Jastaniah Wasil
Published: June 2024

Objective:

Sickle cell disease (SCD) is a common hereditary hemoglobin disorder worldwide. One of the main treatments for patients with SCD is the requirement for blood transfusions. Posttransfusion alloimmunization with red blood cell (RBC) antigens continues to be a major risk factor for SCD. The objective of this study was to determine the rate, nature, and risk factors of red cell alloimmunization among pediatric patients with SCD in our center and compare our results with published reports from Saudia Arabia SA, regional countries, and some international countries.

Materials and Methods:

A retrospective chart review of patients with SCD at King Abdulaziz Medical City–Jeddah, between 2008 and 2019 was performed. Demographic characteristics and transfusion histories were recorded. Blood samples were analyzed for alloimmunization using immunohematologic techniques.

Results:

In total, 121 patients were analyzed. Alloantibodies were detected in 21 patients (17.4%) and were mostly single in 15 patients (71.4%), anti-K (23.7%), anti-E (19.0%), and anti-S (9.5%). The other 6 patients (28.6%) had multiple alloantibodies, especially the combination of anti-C and anti-K (9.5%) and the combination of anti-C and anti-E (9.5%). Alloantibody levels were significantly higher in patients with frequent hospital admissions (>5 times annually), those who had an exchange blood transfusion, those younger than 3 years old, and those who received a larger number of blood units (P ≤0.05).

Conclusion:

The rate of RBC alloimmunization is determined and considered relatively low compared with that in other nations. Matching for extended RBC antigens to include ABO, RH (D, C, c, E, e), K, Fya, Fyb, Jka, and Jkb antigens in the screening panel for donors and recipients is highly recommended to ensure better transfusion practices and avoid transfusion-related complications.
Stop Ischemic Event to the Brain
Authors: Yang Shi-Chang , Zhang Xing-Wen , Nie Xi-Ting , Liu Ying-Lu , Su Hui , Wang Yan , Cao Ya , Yuan Hui-Juan , Yu Zhe , Kong Shan-Shan , Yu Sheng-Yuan
Published: June 2024

Objectives:

In this study, we investigated the difference in risk factors between the 2 diseases, aiming to further clarify who needs to do ischemic cerebrovascular disease (ICVD)-related screening among coronary artery disease (CAD) patients.

Methods:

Clinical data of 326 patients with first-episode CAD from June 1, 2017, to July 31, 2020, in the Chinese PLA General Hospital were retrospectively reviewed. Outcomes, including clinical features and laboratory examination, were taken. Features related to ICVD including the extension of intracranial arterial (internal carotid artery intracranial segment, middle cerebral artery M1 segment, anterior cerebral A1 segment, vertebrobasilar artery intracranial segment, posterior cerebral artery P1 segment) and carotid arterial (internal carotid artery extracranial segment, common carotid artery, subclavian artery) stenosis were detected. Risk factors for the occurrence of ICVD in patients with CAD were analyzed.

Results:

Among patients with the onset of CAD, in comparison of the nonstenosis and stenosis of intracranial artery subgroups, there were statistical differences in the onset age, hypertension, and duration of hypertension as well as the biochemical indicators, including high-density lipoprotein and glycosylated hemoglobin. In addition, statistical differences were detected in the onset age as well as the biochemical indicators, including glycosylated hemoglobin and blood glucose serum protein, along with the difference in the degree of cardiovascular stenosis.

Conclusions:

The onset age of CAD was shown to serve as a vital risk factor for ICVD. The primary prevention of ICVD in patients with CAD should lay more emphasis on the management of hypertension and diabetes.
Predictive Value of Serum Inflammatory Factors and FT3 for Stroke-Associated Pneumonia in Patients With Acute Ischemic Stroke
Authors: Li Xin , Xie Xiaomei , Cheng Shenju , Luo Shan , Zhu Yancui , Wu Kun
Published: June 2024

Objective:

The ability of serum inflammatory factors and free triiodothyronine (FT3) in predicting the occurrence of stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) was assessed in this study.

Methods:

A retrospective analysis was conducted on 285 consecutive patients with AIS initially diagnosed and admitted to our hospital from January to December 2022. Patients were categorized into SAP and non-SAP groups based on the presence of SAP. Both groups were compared in terms of baseline characteristics, including National Institute of Health Stroke Scale (NIHSS) score, SAP risk assessment (A2DS2), TOAST classification. Independent risk factors for SAP were identified using multivariate logistic regression analysis, and the predictive value of inflammatory markers was evaluated through ROC curves.

Results:

Among 285 patients with AIS, 40 (14.03%) were found to have developed SAP. Higher NIHSS and A2DS2 scores, elevated serum IL-1β, IL-8, and IL-33 levels, increased age, atrial fibrillation, swallowing difficulties, and a higher proportion of patients with low FT3 levels were observed in the SAP group compared with the non-SAP group (all P<0.05). Significant risk factors for SAP in patients with AIS were identified through multivariate logistic regression analysis, including age, swallowing difficulties, NIHSS, A2DS2 , IL-1β , IL-8 , IL-33, and FT3 (P<0.05). The highest predictive values were observed for A2DS2, FT3, and IL-8 with AUC values of 0.854, 0.844, and 0.823, respectively.

Conclusion:

SAP can be highly predicted by A2DS2, FT3, and IL-8, enabling the early identification of patients with high-risk SAP and facilitating timely intervention and treatment.
Investigation of factors that may affect the foveal avascular zone: An optical coherence tomography angiography study
Authors: Scanlon Grainne , O'Shea Susan , Amarandei George , Butler John S. , O'Dwyer Veronica
Published: June 2024

SIGNIFICANCE

An understanding of factors that affect the foveal avascular zone (FAZ) in healthy eyes may aid in the early identification of patients at risk of retinal pathology, thereby allowing better management and preventive measures to be implemented.

PURPOSE

The size and shape of the FAZ can change due to retinal diseases associated with oxidative stress, including diabetic retinopathy, glaucoma, and macular degeneration. This study aimed to assess the relationship, if any, between factors that may affect the superficial FAZ (i.e., vessel density, vessel perfusion, overweight/obesity) and possible links with macular pigment optical density in young, healthy participants.

METHODS

One hundred thirty-nine participants aged 18 to 35 years were recruited to this cross-sectional study. The superficial FAZ area, foveal vascularity, and central macular thickness (CMT) were assessed using the Cirrus 5000. Health parameters, body mass index, trunk fat %, and macular pigment were analyzed to determine possible associations with the superficial FAZ.

RESULTS

Mean FAZ area was 0.23 ± 0.08 mm2. Females had a significantly larger mean FAZ area than males (p=0.002). The FAZ area was positively correlated with body mass index (Pearson'sr= 0.189, p=0.026). Significant correlates of the FAZ area in the multivariate model included vessel perfusion (central), CMT, and trunk fat %, collectively explaining 65.1% of the overall variability.

CONCLUSIONS

Study findings suggest that reduced vessel perfusion, thinner CMT, and higher trunk fat % are plausible predictors of a larger FAZ area in healthy Caucasian adults. Low macular pigment optical density was, however, not associated with increased FAZ size in young healthy eyes. Noninvasive optical coherence tomography angiography testing, in association with these predictors, may aid in the early detection and monitoring of retinal diseases associated with oxidative stress.
Preexpanded Brachial Artery Perforator Propeller Flap: An Addition to the Armamentarium for Postburn Axillary Contracture Reconstruction
Authors: Wang Yiou , Li Shanshan , Zhou Hongru , Zhu Shan , Zang Mengqing , Chen Zixiang , Han Tinglu , Jin Shengyang , Liu Yuanbo
Published: June 2024

Background:

Postburn axillary contracture is a common complication that leads to functional impairment and unsatisfactory aesthetic outcomes. The authors present their experience with axillary contracture reconstruction using preexpanded brachial artery perforator propeller (BAPP) flaps and provide a systematic review of other regional or free flaps.

Methods:

This retrospective study included patients who underwent postburn axillary contracture reconstruction using preexpanded BAPP flaps from 2015 to 2022. Data on the flap characteristics and function of the affected shoulders were recorded. A systematic review was conducted by retrieving studies that assessed the outcomes of regional or free cutaneous/fasciocutaneous flaps for treating axillary contracture from PubMed, Web of Science, Embase, and Scopus published before October 1, 2023.

Results:

Twelve preexpanded BAPP flaps measuring up to 26 × 11 cm (mean, 116.9 cm2) survived completely with no major complications, and the donor sites were closed primarily. The average range of shoulder abduction increased from 77.9 to 141.7 degrees (P = 0.002). The systematic review included 34 articles, reporting 12 regional and 3 free flaps. The most commonly reported flaps were the thoracodorsal artery perforator flap, scapular flap, and parascapular flap. The overall complication rate ranged from 0 to 25%, and the average change in shoulder abduction ranged from 72.5 to 99.4 degrees.

Conclusions:

Preexpanded BAPP flaps can be used effectively for reconstructing postburn anterior axillary fold contracture. Donor-site availability and the specific axillary contracture type should be considered when selecting a regional or free flap.
Intramuscular Breast Augmentation in Secondary Mastopexy Augmentation
Authors: Graf Ruth M. , Ono Maria C. C. , de Paula Dayane R.
Published: June 2024

Background:

Breast augmentation with implants is one of the most performed aesthetic surgical procedures performed worldwide. The authors describe a new option for breast implant secondary procedures, the intra–pectoralis major pocket, as a feasible and reproducible surgical technique.

Methods:

A retrospective chart review was conducted on all patients who underwent a revision augmentation or mastopexy augmentation procedure between 2005 and 2022 performed by the senior author (R.M.G.). The intramuscular pocket is dissected between the pectoralis muscle fascicles where it is almost not bleeding.

Results:

Patients were followed up for an average of 21.5 months. A total of 319 patients underwent revisionary breast augmentation/mastopexy performed by the senior author (R.M.G.). Indications for reoperation were based both on specific patient dissatisfaction with their original surgery and the surgeon’s physical examination and assessment. In 196 cases, the authors performed the intramuscular pocket technique. None of the intramuscular pockets had capsular contracture or animation deformity in the follow-up period.

Conclusion:

The intramuscular pocket technique is a valuable and safe technique for secondary breast augmentation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Monitoring for Breast Cancer Recurrence Following Goldilocks Breast Reconstruction
Authors: Wang Jennifer , Ghanouni Arian , Losken Albert , Thompson Peter
Published: June 2024

Background

The Goldilocks breast reconstruction utilizes redundant mastectomy skin flaps to fashion a breast mound; however, there is concern that imbrication of these skin flaps may predispose to fat necrosis and make detection of local breast cancer recurrence more difficult. Goldilocks patients follow a traditional postmastectomy screening pathway that includes clinical examination for locoregional recurrence, but it is unclear if this is sufficient. We evaluate our Goldilocks reconstruction case series to determine rates of diagnostic imaging, biopsy, and locoregional and distant recurrence.

Methods

Sixty-six patients (94 breasts) undergoing Goldilocks breast reconstruction were retrospectively reviewed. Any diagnostic postoperative imaging/biopsies performed and that confirmed local or distant breast cancer recurrence were noted.

Results

Average time of follow-up was 45 months. Most patients in this cohort had stage 0 (27.3%) or stage I (40.9%) breast cancer. There were a total of 11 (11.7%) concerning breast masses identified. Seven (7.4%) masses were biopsied, of which 5 were benign and 2 were invasive cancer recurrence. Four masses (4.3%) underwent diagnostic imaging only, all with benign findings. Five patients in this series were found to have either distant disease or a second primary cancer in the nonoperative contralateral breast.

Conclusions

Rates of local recurrence following Goldilocks are not higher than expected after other types of postmastectomy reconstruction. Clinical monitoring successfully detected local recurrence in all affected patients in this series. More definite guidelines around the routine screening of Goldilocks mastectomy patients may aid in early detection of local breast cancer recurrence.
The Modified Frailty Index Predicts Major Complications in Oncoplastic Reduction Mammoplasty
Authors: Brown Ciara A. , Ash Makenna E. , Styblo Toncred M. , Carlson Grant W. , Losken Albert
Published: June 2024

Background

An important component of preoperative counseling and patient selection involves surgical risk stratification. There are many tools developed to predict surgical complications. The Modified Frailty Index (mFI) calculates risk based on the following five elements: hypertension, chronic obstructive pulmonary disease, congestive heart failure, diabetes, and functional status. Recent literature demonstrates the efficacy of the mFI across multiple surgical disciplines. We elected to investigate its utility in oncoplastic reductions (OCR).

Methods

A retrospective review of all patients with breast cancer who underwent OCR from 1998 to 2020 was queried from a prospectively maintained database. Patient demographics, comorbidities, and surgical details were reviewed. The mFI was computed for each patient. The primary clinical outcome was the development of complications.

Results

547 patients were included in the study cohort. The average age was 55 and the average body mass index was 33.5. The overall complication rate was 19% (n = 105) and the major complication rate was 9% (n = 49). Higher frailty scores were significantly associated with the development of major complications (P < 0.05). mFI scores of 0 had a major complication rate of 5.7%; scores of 1, 13%; and scores of 2, 15.1%. The relative risk of a major complication in patients with elevated mFI (>0) was 2.2. Age, body mass index, and resection weights were not associated with complications (P = 0.15, P = 0.87, and P = 0.30 respectively) on continuous analysis.

Conclusions

Elevated mFI scores are associated with an increased major complication profile in patients who are undergoing OCR. Hypertension and diabetes are the most common comorbidities in our population, and this tool may assist with preoperative counseling and risk stratification. Benefits of this risk assessment tool include its ease of calculation and brevity. Our study is the first to demonstrate its utility in OCR; however, further study in high-risk patients would strengthen the applicability of this frailty index.
Selecting Flap Transfer Methods to Repair Helix Soft Tissue Defect Based on the Direction of Long Axis
Authors: Zhu Jingjing , Zhang Yuxin , Wang Wei , Zhou Yiqun , Guo Yu , Chen Liang , Wang Heng , Dong Dong , Liu Tianyi
Published: June 2024

Background:

The posterior auricular flap has long been favored for repairing skin defects on the ear’s surface. However, achieving optimal esthetic outcomes in ear reconstruction requires a flexible approach to flap transfer methods. While bipedicle advancement flaps are commonly used for body wound coverage, they are rarely used in auricular defect repair.

Objective:

To propose a modified flap transfer approach based on the orientation of the auricular defect’s long axis and assess the postoperative esthetic outcomes.

Methods:

The authors reported 12 patients treated using 2 distinct flap transfer techniques. Mild to moderate helix soft tissue defects remained after excision of the masses. A direct island flap was created for patients with longitudinal defects to cover the defect. For patients with transverse defects, a combination of bipedicle and island flaps was used for repair. Scar quality and esthetic outcomes were assessed at least 6 months postsurgery using the Scar Cosmesis Assessment and Rating scale.

Results:

All patients experienced no serious complications and achieved excellent cosmetic results. Patients undergoing combined flap transfer exhibited relatively more favorable esthetic outcomes.

Conclusion:

The authors propose a novel concept for repairing helix soft tissue defects by designing local flaps based on the direction of the defect’s long axis. For repairing helix soft tissue defects with a long axis parallel to the auricular edge, the combined utilization of bipedicle advancement flap and island rotation flap transfer should be consideration more.
Bone Density of the Midpalatal Suture After Surgically Assisted Rapid Maxillary Expansion: A Retrospective Cohort Study
Authors: da Silva Alexandre Augusto Ferreira , Lima Carlos Alysson Aragão , Montano-Pedroso Juan Carlos , Pereira Max Domingues
Published: June 2024

Objectives:

To evaluate the bone density in the midpalatal suture after 10 months of surgically assisted rapid maxillary expansion (SARME) with the separation of the maxilla into 2 segments.

Methods:

Sixty multislice computed tomography (MCT) from 20 patients undergoing SARME were analyzed in 3 periods of time (1 MCT per patient on each occasion): (1) 1 week before surgery, (2) postsurgery immediately after completing the expander activation, and (3) 10 months after the expander activation. On all occasions, the bone density was measured in Hounsfield units on MCT scans in axial and coronal sections, in the anterior (A1), middle (A2), and posterior (A3) regions of the midpalatal suture.

Results:

The mean percentage values of bone density in Hounsfield units, from the 10-month postactivation period to preoperative in the A1, A2, and A3 regions were 68.38%, 38.21%, and 55.90%, respectively, in the axial norm, and 64.06%, 36.81%, and 55.50% in coronal norm (A1 = A3>A2), with no significant difference in the tomographic cuts (P >0.05). There was no correlation between patient age or amount of expansion in the expander and bone density.

Conclusions:

The bone density in the midpalatal suture 10 months after SARME is lower than preexpansion. A denser new bone formation along the suture concentrates closer to the extremities rather than in the central region. Although the maturation of the new bone formation in the midpalatal suture is lower 10 months after SARME, it appears to be sufficient for satisfactory clinical results, regardless of patient age or the amount of expansion in the expander.
GluN2A- and GluN2B-containing pre-synaptic
N
-methyl-
d
-aspartate receptors differentially regulate action potential-evoked Ca
2+
influx via modulation of SK channels
Authors: Schmidt Carla C. , Tong Rudi , Emptage Nigel J.
Published: June 2024

N
-methyl-
d
-aspartate receptors (NMDARs) play a pivotal role in synaptic plasticity. While the functional role of post-synaptic NMDARs is well established, pre-synaptic NMDAR (pre-NMDAR) function is largely unexplored. Different pre-NMDAR subunit populations are documented at synapses, suggesting that subunit composition influences neuronal transmission. Here, we used electrophysiological recordings at Schaffer collateral-CA1 synapses partnered with Ca
2+
imaging and glutamate uncaging at boutons of CA3 pyramidal neurones to reveal two populations of pre-NMDARs that contain either the GluN2A or GluN2B subunit. Activation of the GluN2B population decreases action potential-evoked Ca
2+
influx via modulation of small-conductance Ca
2+
-activated K+ channels, while activation of the GluN2A population does the opposite. Critically, the level of functional expression of the subunits is subject to homeostatic regulation, bidirectionally affecting short-term facilitation, thus providing a capacity for a fine adjustment of information transfer.

This article is part of a discussion meeting issue ‘Long-term potentiation: 50 years on’.
Sleep and quiet wakefulness signify an idling brain hub for creative insights
Authors: Fayed Mostafa R. , Ghandour Khaled , Inokuchi Kaoru
Published: June 2024

Long-term potentiation of synaptic strength is a fundamental aspect of learning and memory. Memories are believed to be stored within specific populations of neurons known as engram cells, which are subsequently reactivated during sleep, facilitating the consolidation of stored information. However, sleep and offline reactivations are associated not only with past experiences but also with anticipation of future events. During periods of offline reactivation, which occur during sleep and quiet wakefulness, the brain exhibits a capability to form novel connections. This process links various past experiences, often leading to the emergence of qualitatively new information that was not initially available. Brain activity during sleep and quiet wakefulness is referred to as the ‘idling brain’. Idling brain activity is believed to play a pivotal role in abstracting essential information, comprehending underlying rules, generating creative ideas and fostering insightful thoughts. In this review, we will explore the current state of research and future directions in understanding how sleep and idling brain activity are interconnected with various cognitive functions, especially creative insights. These insights have profound implications for our daily lives, impacting our ability to process information, make decisions and navigate complex situations effectively.

This article is part of a discussion meeting issue ‘Long-term potentiation: 50 years on’.
Effect of dorsolateral prefrontal cortex structural measures on neuroplasticity and response to paired-associative stimulation in Alzheimer’s dementia
Authors: Naveed K. , Rashidi-Ranjbar N. , Kumar S. , Zomorrodi R. , Blumberger D. M. , Fischer C. E. , Sanches M. , Mulsant B. H. , Pollock B. G. , Voineskos A. N. , Rajji T. K.
Published: June 2024

Long-term potentiation (LTP)-like activity can be induced by stimulation protocols such as paired associative stimulation (PAS). We aimed to determine whether PAS-induced LTP-like activity (PAS-LTP) of the dorsolateral prefrontal cortex (DLPFC) is associated with cortical thickness and other structural measures impaired in Alzheimer’s dementia (AD). We also explored longitudinal relationships between these brain structures and PAS-LTP response after a repetitive PAS (rPAS) intervention. Mediation and regression analyses were conducted using data from randomized controlled trials with AD and healthy control participants. PAS-electroencephalography assessed DLPFC PAS-LTP. DLPFC thickness and surface area were acquired from T1-weighted magnetic resonance imaging. Fractional anisotropy and mean diffusivity (MD) of the superior longitudinal fasciculus (SLF)—a tract important to induce PAS-LTP—were measured with diffusion-weighted imaging. AD participants exhibited reduced DLPFC thickness and increased SLF MD. There was also some evidence that reduction in DLPFC thickness mediates DLPFC PAS-LTP impairment. Longitudinal analyses showed preliminary evidence that SLF MD, and to a lesser extent DLPFC thickness, is associated with DLPFC PAS-LTP response to active rPAS. This study expands our understanding of the relationships between brain structural changes and neuroplasticity. It provides promising evidence for a structural predictor to improving neuroplasticity in AD with neurostimulation.

This article is part of a discussion meeting issue ‘Long-term potentiation: 50 years on’.
Synapses tagged, memories kept: synaptic tagging and capture hypothesis in brain health and disease
Authors: Bin Ibrahim Mohammad Zaki , Wang Zijun , Sajikumar Sreedharan
Published: June 2024

The synaptic tagging and capture (STC) hypothesis lays the framework on the synapse-specific mechanism of protein synthesis-dependent long-term plasticity upon synaptic induction. Activated synapses will display a transient tag that will capture plasticity-related products (PRPs). These two events, tag setting and PRP synthesis, can be teased apart and have been studied extensively—from their electrophysiological and pharmacological properties to the molecular events involved. Consequently, the hypothesis also permits interactions of synaptic populations that encode different memories within the same neuronal population—hence, it gives rise to the associativity of plasticity. In this review, the recent advances and progress since the experimental debut of the STC hypothesis will be shared. This includes the role of neuromodulation in PRP synthesis and tag integrity, behavioural correlates of the hypothesis and modelling
in silico
. STC, as a more sensitive assay for synaptic health, can also assess neuronal aberrations. We will also expound how synaptic plasticity and associativity are altered in ageing-related decline and pathological conditions such as juvenile stress, cancer, sleep deprivation and Alzheimer’s disease.

This article is part of a discussion meeting issue ‘Long-term potentiation: 50 years on’.
To update or to create? The influence of novelty and prior knowledge on memory networks
Authors: Sekeres Melanie J. , Schomaker Judith , Nadel Lynn , Tse Dorothy
Published: June 2024

Schemas are foundational mental structures shaped by experience. They influence behaviour, guide the encoding of new memories and are shaped by associated information. The adaptability of memory schemas facilitates the integration of new information that aligns with existing knowledge structures. First, we discuss how novel information consistent with an existing schema can be swiftly assimilated when presented. This cognitive updating is facilitated by the interaction between the hippocampus and the prefrontal cortex. Second, when novel information is inconsistent with the schema, it likely engages the hippocampus to encode the information as part of an episodic memory trace. Third, novelty may enhance hippocampal dopamine through either the locus coeruleus or ventral tegmental area pathways, with the pathway involved potentially depending on the type of novelty encountered. We propose a gradient theory of schema and novelty to elucidate the neural processes by which schema updating or novel memory traces are formed. It is likely that experiences vary along a familiarity–novelty continuum, and the degree to which new experiences are increasingly novel will guide whether memory for a new experience either integrates into an existing schema or prompts the creation of a new cognitive framework.

This article is part of the theme issue ‘Long-term potentiation: 50 years on’.