bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of age and cycloplegia on the morphology of the human crystalline lens: swept-source OCT study
Authors: Li Zhangliang , Qu Wenyong , Huang Jinhai , Meng Ziqi , Li Xiuyuan , Zou Rui , Zhao Yune
Published: May 2021

Purpose:

To evaluate the effect of age and cycloplegia on the morphology of the crystalline lens using a swept-source optical coherence tomography (SS-OCT) system.

Setting:

Hospital.

Design:

Prospective cross-sectional study.

Methods:

The parameters including anterior chamber depth (ACD), the radii of curvature of the anterior and posterior surface of the crystalline lens (ALR and PLR), lens thickness (LT), lens equatorial diameter (LED), and lens vault (LV) were quantified by the SS-OCT before and after cycloplegia. The paired t test was used to compare the parameters before and after cycloplegia. A multivariate linear regression model was built to analyze the association between the parameters/cycloplegia-induced changes and age, while adjusting for the effect of axial length, refractive status, and sex.

Results:

76 individuals (age range, 18 to 86 years) were recruited. The ALR and ACD were negatively correlated with age (P ≤ .002), and the LT, LV, and LED were positively correlated with age (P ≤ .004). In participants younger than 60 years, the ALR and ACD significantly increased, whereas the LV and LT significantly decreased after cycloplegia (all P < .001). With aging, cycloplegia-induced differences of ALR (P = .001) and ACD (P = .014) significantly decreased, and of LT (P < .001), LT (P < .001), and LV (P = .001) significantly increased.

Conclusions:

The crystalline lens morphology measured by the SS-OCT revealed steepening anterior surface and increasing equatorial diameter with age. Cycloplegia caused a significant change of anterior surface morphology in participants younger than 60 years, and this effect diminished with age.
Outcomes of a Student-Led Telemedicine Clinic in Response to COVID-19
Authors: Akama-Garren Elliot H. , Shah Shivani A. , Zinzuwadia Aniket N. , Bartuska Andrew , Hashimoto Mie , Chu Jacqueline T. , Kruse Gina R. , Cohen Marya J.
Published: May 2021

In response to the coronavirus disease-2019 (COVID-19) pandemic, we developed and launched a student-led telemedicine program in Chelsea. From April to November 2020, over 200 student volunteers contacted over 1000 patients to assess COVID-19 symptoms, provide counseling, and triage patients. Through a retrospective cohort study, we determined that student triage decision was associated with patient outcomes, including hospitalization status, COVID-19 test administration, and COVID-19 test result. These results quantify the outcomes of a student-led telemedicine clinic to combat the ongoing pandemic and may serve as a model for implementation of similar clinics to alleviate mounting health care system burden.
Family nursing conversations with patients with chronic non-cancer pain and their selected family members
Authors: Roenne Pernille Friis , Esbensen Bente Appel , Broedsgaard Anne , Andersen Lasse Oestergaard , Hansen Carrinna Aviaja
Published: May 2021

Introduction:

Chronic non-cancer pain (CNCP) is a disabling condition with comprehensive physical, psychosocial and socio-economic consequences. The biopsychosocial approach is the gold standard in treatment planning. Still, pain rarely resolves, rendering CNCP a condition of life – which requires patient acceptance. From a social perspective, family involvement may increase patients’ ability to manage CNCP. However, the area is underexposed and needs research to describe the impact of specific involvement approaches on the manageability of CNCP. This trial aims to investigate whether an intervention with family nursing conversations (FNC) in the context of established CNCP treatment, compared to usual treatment, will improve both patients’ and family members’ self-efficacy.

Methods:

The trial has a prospective non-blinded quasi-experimental design with two comparable groups: A control group and an intervention group, including 25 family dyads in both groups, each consisting of the patient and between one and three selected family members. In the intervention group, every family dyad will be offered three-four FNC based on the family systems nursing framework. Each conversation lasts 1.5 hours with three weeks interval. The trial setting is a multidisciplinary pain centre in the Capital Region of Denmark. The intervention will be conducted by the employed nurses who will be trained in FNC over a three-day course, followed by practice with test families. Data in the control group will be collected before training onset. The primary outcome is self-efficacy. Secondary outcomes are family function, health-related quality of life, anxiety and depression. Data will be collected at baseline, week nine and, for the intervention group, also at week 26.

Discussion:

CNCP is a devastating condition that lacks effective treatment services. With this trial, an initial step is taken to fill the research gap by illuminating the family's role in the day-to-day management of CNCP, creating knowledge within the social part of the biopsychosocial treatment approach. With effective intervention, FNC may be implemented as a standard treatment in the future.

Trial registration:

ClinicalTrials.gov: Family Nursing for Patients With Chronic Nonmalignant Pain, NCT03981302, initial released June 4, 2019. Protocol version, March 2021. The collection of data for the intervention group is in progress.
Abdominal-based free flaps in head and neck reconstruction
Authors: Bloom Joshua A. , Homsy Christopher
Published: May 2021

Purpose of review

The head and neck reconstructive surgeon is intimately familiar with the anterolateral thigh, radial forearm, and parascapular flaps. This review serves to describe the major abdominal-based free tissue transfers in head and neck reconstruction that can be used as alternatives to these traditional workhorse flaps.

Recent findings

Abdominal-based free flaps, while not traditionally used in head and neck reconstruction, are great alternatives or second-line flaps. For example, the deep circumflex iliac artery flap is an excellent alternative to the fibular free flap due to its bone height and greater overall quality of life.

This review article serves to review the major abdominal-based free tissue transfers in head and neck reconstruction in order to expand the toolbox of the head and neck surgeon.
Acute and Severe Acute Pancreatitis and the Effect of Cannabis in States Before and After Legalization Compared With States Without Legalized Cannabis
Authors: Lara Luis F. , Nemer Laura , Hinton Alice , Balasubramanian Gokulakrishnan , Conwell Darwin L. , Krishna Somashekar
Published: May 2021

Objectives

Cannabis legalization has increased its use. The incidence of acute pancreatitis (AP) and severe acute pancreatitis (SAP) has also increased. In this study, data on pancreatitis were obtained from 2 states before and after cannabis legalization and compared with 2 states without legalized cannabis.

Methods

Data were extracted from State Inpatient Databases from the states of Colorado and Washington before recreational cannabis legalization (2011) and after legalization (2015). Arizona and Florida were used as the nonlegalized cannabis states. Multivariable logistic regression models were fit for AP and SAP to determine a trend difference between legalized and nonlegalized cannabis states.

Results

Cannabis use, AP, and SAP increased in all states. The increase in AP and SAP was not significantly different between the states that legalized cannabis use and those that did not. Legalized cannabis states had lower charges for AP and SAP and shorter length of hospitalizations.

Conclusions

The trend of AP and SAP increased during the study period, but this was not correlated to cannabis use. Cannabis users had lower hospitalization costs and hospital stay. The effects of other confounders such as cannabis dose and delivery methods, alcohol, tobacco, and others need to be studied further as use increases.
Maternal Obesity Is Associated With Higher Cord Blood Adipokines in Offspring Most Notably in Females
Authors: Jaramillo‐Ospina Ángela , Castaño‐Moreno Erika , Muñoz‐Muñoz Estefanía , Krause Bernardo J. , Uauy Ricardo , Casanello Paola , Castro‐Rodriguez José A.
Published: May 2021

Background:

Deleterious long‐term effects in the offspring from women with pregravid obesity have been described; however, the evidence supporting early metabolic and inflammatory markers in the offspring at birth and gender differences are conflicting.

Objective:

The present study aimed to compare cord blood adipokines and cytokines concentrations and anthropometric characteristics of the offspring of women with maternal obesity (MO) and normal‐weight mothers (NWM). Also, maternal and neonatal variables on the association of maternal body mass index (BMI) with cord blood adipokines were evaluated.

Methods:

A cross‐sectional analysis of a subsample of mother–child dyads participating in a cohort study (n = 221) was assessed. Anthropometrics, cord blood adipokines (leptin and adiponectin) and cytokines (interleukin [IL]‐1β, IL‐4, IL‐10, IL‐12 p40, IL‐12p70, IL‐13, and tumor necrosis factor α) concentrations in the offspring of normal‐weight women (BMI >18.5 and <24.9 kg/m2) and women with pregravid obesity (BMI > 30 kg/m2) without comorbidities was performed.

Results:

Offspring from mothers with obesity had higher birth weight, a higher proportion of large for gestational age, higher ponderal index, and heavier placentae than offspring from normal‐weight mothers (P < 0.05). Within the offspring from women with obesity, males had significantly higher weight, length, the proportion of large‐for‐gestational‐age newborns, higher weight for length ratio. Males had more efficient placentas than females (P < 0.05). Higher adiponectin and leptin in both sexes and higher leptin in female offspring of mothers with obesity after adjusting for birth size (P < 0.05) were found. Higher IL‐12p40 in the offspring of women with MO with no other differences in other cytokines among groups were evidenced.

Conclusions:

Maternal obesity associates with a higher concentration of adiponectin and leptin in their offspring at birth. There is a relevant effect on anthropometrics in male offspring and on leptin in female newborn. Further studies need to evaluate the extension of these effects in postnatal life.

Trail identification number:

NCT02903134
Creating a Nonprofit Spin-Off to Implement a Community Health Improvement Plan: A Case Study of a Midsize Health Department in the Midwest
Authors: Carroll Leslie D. , Wetherill Marianna S. , Rogers Monica , Teasdale Thomas A. , Salvatore Alicia L.
Published: May 2021

A common problem faced by local health departments is engaging cross-sector stakeholders to achieve shared community goals. Community engagement is critical for effective Community Health Improvement Plan (CHIP) development and implementation, while also being a standard for health department accreditation. This case study describes one city-county health department's development of a nonprofit arm to act as a catalyst for connecting community leaders to identify and collaboratively address community health goals. First, we describe our process to develop a nonprofit entity and strategically recruit community members to comprise the founding board of directors. Then, we describe methods employed by the nonprofit to create a community action plan in response to identified community health needs and how we incentivized progress. We evaluated our process using a mixed-methods approach and conclude that a nonprofit arm of a health department can be a novel strategy for effectively engaging community stakeholders to advance community health.
A Resident-driven Initiative to Increase Bedside Teaching on Interdisciplinary Rounds
Authors: Becker Andrew , Frosch Olivia , Argraves Melissa , Carroll Bryn , Kamsheh Alicia , Krass Polina , Mehta Sanjiv , Salazar Elizabeth , Taylor April , Hart Jessica
Published: May 2021

Introduction:

Inpatient rounding serves numerous roles. The American Academy of Pediatrics recommends a family-centered bedside model. Residents identified physical examination teaching during and satisfaction with rounds as areas for improvement. A resident group developed a project utilizing quality improvement (QI) methodology to address these concerns. We aimed to increase the frequency of bedside physical examination teaching most or every day on a single inpatient unit by 20% over 1 year, with secondary goals to increase the percentage of interns spending one hour or more at bedside per day by 10% and intern satisfaction by 15%, without impacting rounding duration.

Methods:

We developed an organizational structure to complete a long-term resident-led project. Interventions included daily bedside examination teaching on rounds, afternoon examinations, goal communication, topic recording, and a teaching “tip sheet.” Using an institutional QI framework, we utilized iterative plan-do-study-act cycles to implement interventions and surveys to assess outcomes, with rounding efficiency as a balancing measure.

Results:

The survey response rate was 57%. Bedside teaching frequency increased from a mean of 10% to 61%, perceived time at the bedside increased from 37% to 59%, and rounding satisfaction improved from a rating of 6.7/10 to 7.4/10. Efficiency was not impacted.

Conclusions:

We improved inpatient rounds bedside physical examination teaching and satisfaction without sacrificing efficiency. This project demonstrates the feasibility and success of a resident-driven education initiative to successfully motivate fellow residents and colleagues across disciplines to enact change. The organizational structure may serve as a model for resident-led QI projects across institutions.
Translational Simulation Improves Compliance with the NEAR4KIDS Airway Safety Bundle in a Single-center PICU
Authors: Colman Nora , Newman Jordan W. , Nishisaki Akira , Register Melinda , Gillespie Scott E. , Hebbar Kiran B.
Published: May 2021

Introduction:

The National Emergency Airway Registry for Children (NEAR4KIDS) Airway Safety Quality Improvement (QI) Bundle is a QI tool to improve the safety of tracheal intubations. The ability to achieve targeted compliance with bundle adherence is a challenge for centers due to competing QI initiatives, lack of interdisciplinary involvement, and time barriers. We applied translational simulations to identify safety and performance gaps contributing to poor compliance and remediate barriers by delivering simulation-based interventions.

Methods:

This was a single-center retrospective review following translational simulations to improve compliance with the NEAR4KIDS bundle
. The simulation was implemented between March 2018 and December 2018. Bundle adherence was assessed 12 months before simulation and 9 months following simulation. Primary outcomes were compliance with the bundle and utilization of apneic oxygenation. The secondary outcome was the occurrence of adverse tracheal intubation-associated events.

Results:

Preintervention bundle compliance was 66%, and the application of apneic oxygenation was 27.9%. Following the simulation intervention, bundle compliance increased to 93.7% (P < 0.001) and adherence to apneic oxygenation increased to 77.9% (P < 0.001). There was no difference in the occurrence of tracheal intubation-associated events.

Conclusions:

Translational simulation was a safety tool that improved NEAR4KIDS bundle compliance and elucidated factors contributing to successful implementation. Through simulation, we optimized bundle customization through process improvement, fostered a culture of safety, and effectively engaged multidisciplinary teams in this quality initiative to improve adherence to best practices surrounding tracheal intubations.
Improving Administration of Prehospital Corticosteroids for Pediatric Asthma
Authors: Riney Lauren C. , Schwartz Hamilton , Murtagh Kurowski Eileen , Collett Lindsey , Florin Todd A.
Published: May 2021

Introduction:

Early administration of systemic corticosteroids for asthma exacerbations in children is associated with improved outcomes. Implementation of a new emergency medical services (EMS) protocol guiding the administration of systemic corticosteroids for pediatric patients with asthma exacerbations went into effect in January 2016 in Southwest Ohio. Our SMART aim was to increase the proportion of children receiving systemic prehospital corticosteroids for asthma exacerbations from 0% to 70% over 2 years.

Methods:

Key drivers were derived and tested using multiple plan-do-study-act cycles. Interventions included community EMS outreach and education, improved clarity in the prehospital protocol language, distribution of pocket-sized educational cards, and ongoing individualized EMS agency feedback on protocol adherence. Eligible patients included children age 3–16 years, who were transported by EMS to the pediatric emergency department with diagnoses consistent with asthma exacerbation. Manual chart review assessed eligibility to receive prehospital corticosteroids. Statistical process control charts tracked adherence to corticosteroid recommendations.

Results:

A total of 256 encounters met the criteria for receiving prehospital corticosteroids for pediatric asthma exacerbations between January 1, 2016, and April 30, 2019. Special cause variation was demonstrated following education at high-volume EMS stations, and the centerline shifted to 34%. This shift has been sustained for 28 months.

Conclusion:

Improvement methodology increased prehospital corticosteroid administration for pediatric asthma exacerbations, although we failed to achieve our aim of increasing use to 70%. Many barriers exist in pediatric prehospital protocol implementation, many of which can be improved with quality improvement tools.
Expanding Hospital Capacity during the COVID-19 Pandemic: The Family Voice Matters
Authors: Connor Jean A. , Hurtig Michelle , Ormsby Jennifer A. , Hickey Patricia A.
Published: May 2021

Introduction:

During the initial COVID-19 response, this children’s hospital reduced its inpatient capacity by 52 beds with double rooms’ conversion to single patient occupancy, causing significant capacity constraints. To solve this challenge, the family perspective was engaged to safely redouble patient rooms and expand capacity as clinical activity increased during the COVID-19 response.

Methods:

The team conducted qualitative descriptive interviews with parents of children undergoing congenital heart surgery admitted to the inpatient cardiac unit in a 404-bed free-standing children’s hospital. A 2-week pilot study utilizing patient-specific inclusion criteria, newly developed patient room guidelines, universal masking, physical distancing, and inpatient room enhancements with parent COVID-19 testing was conducted.

Results:

Interviews were conducted [pre (n = 7) and post (n = 6)] regarding patient room redoubling. Participants perceived utilization of double rooms as safe with increased protection, including universal masking, physical distancing, room enhancements, and increased bathroom cleaning. However, some families verbalized anxiety regarding visitation restriction to one parent at a time at the bedside. Additional concerns were voiced around the timing of communication about the need to be placed in a double room. In response, visitation increased to 2 parents at bedside and communication of utilization of double rooms was included in preoperative preparations postpilot. Inclusion criteria were expanded to patients of all ages and included full use of shared in-room bathrooms by parents and patients.

Conclusions:

Parents perceived patient room redoubling as safe and family centered. Findings from the pilot study were used to scale broad utilization and increase access to care across the institution.
Development and Implementation of Pediatric ICU-based Mobility Guidelines: A Quality Improvement Initiative
Authors: Ames Stefanie G. , Alessi Lauren J. , Chrisman Maddie , Stanger Meg , Corboy Devin , Sinha Amit , Fink Ericka L.
Published: May 2021

Introduction:

Critical illness results in physical impairments which may be mitigated by intensive care unit (ICU)-based early mobility. This initiative aimed to develop and implement ICU-based mobility guidelines for critically ill children.

Methods:

A multidisciplinary team developed and implemented ICU-based mobility guidelines. Guideline implementation success was determined by comparing utilization of physical (PT) and occupational therapies (OT) and changes in functional status scale scores in preimplementation and postimplementation cohorts. The team also assessed barriers and adverse events.

Results:

Thirty-four patients were identified preimplementation and 55 patients postimplementation. PT/OT consultation by 72 hours occurred in 44 (81.5%) of patients postimplementation compared to 6 (17%) preimplementation (P < 0.001). Implementation did not result in more ICU-based therapy sessions or shorter time to active therapies. High deferral rates for PT/OT sessions [PT: n = 72 (46.2%) preimplementation versus 112 (39.4%) postimplementation; OT: n = 71 (46.1%) preimplementation versus 134 (41.5%) postimplementation] occurred. No difference in new morbidity between cohorts was identified. Barriers to treatment included the patient’s sedation status, severity of illness, and patient availability.

Conclusions:

Implementation of ICU-based mobility guidelines resulted in a 4-fold increase in PT/OT consultation. They did not result in increased treatment sessions due to frequent deferrals. Future guidelines should focus on interventions to address identified barriers to treatment in a critically ill pediatric population.
A Nationwide Analysis of Cleft Palate Repair: Impact of Local Anesthesia on Operative Outcomes and Hospital Cost
Authors: Vu Giap H. , Humphries Laura S. , Zimmerman Carrie E. , Kalmar Christopher L. , Bartlett Scott P. , Swanson Jordan W. , Taylor Jesse A.
Published: May 2021

Background:

This study investigates the associations between local anesthesia practice and perioperative complication, length of stay, and hospital cost for palatoplasty in the United States.

Methods:

Patients undergoing cleft palate repair between 2004 and 2015 were abstracted from the Pediatric Health Information System database. Perioperative complication, length of stay, and hospital cost were compared by local anesthesia status. Multiple logistic regressions controlled for patient demographics, comorbidities, and hospital characteristics.

Results:

Of 17,888 patients from 49 institutions who met selection criteria, 8631 (48 percent), 4447 (25 percent), and 2149 (12 percent) received epinephrine-containing lidocaine, epinephrine-containing bupivacaine, and bupivacaine or ropivacaine alone, respectively. The use of epinephrine-containing bupivacaine or bupivacaine or ropivacaine alone was associated with decreased perioperative complication [adjusted OR, 0.75 (95 percent CI, 0.61 to 0.91) and 0.63 (95 percent CI, 0.47 to 0.83); p = 0.004 and p = 0.001, respectively]. Only bupivacaine- or ropivacaine-alone recipients experienced a significantly reduced risk of prolonged length of stay on adjusted analysis [adjusted OR, 0.71 (95 percent CI, 0.55 to 0.90); p = 0.005]. Risk of increased cost was reduced in users of any local anesthetic (p < 0.001 for all).

Conclusions:

Epinephrine-containing bupivacaine or bupivacaine or ropivacaine alone was associated with reduced perioperative complication following palatoplasty, while only the latter predicted a decreased postoperative length of stay. Uses of epinephrine-containing lidocaine, epinephrine-containing bupivacaine, and bupivacaine or ropivacaine alone were all associated with decreased hospital costs. Future prospective studies are warranted to further delineate the role of local anesthesia in palatal surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Craniosynostosis Develops in Half of Infants Treated for Hydrocephalus with a Ventriculoperitoneal Shunt
Authors: Bryant Justin R. , Mantilla-Rivas Esperanza , Keating Robert F. , Rana Md Sohel , Manrique Monica , Oh Albert K. , Magge Suresh N. , Murnick Jonathan , Oluigbo Chima O. , Myseros John S. , Rogers Gary F.
Published: May 2021

Background:

Craniosynostosis following placement of a ventriculoperitoneal shunt for hydrocephalus has been sporadically described. The purpose of this investigation was to determine the general risk of developing craniosynostosis in this patient population.

Methods:

The authors retrospectively reviewed records and radiographs of infants who underwent ventriculoperitoneal shunt placement for hydrocephalus from 2006 to 2012. Recorded variables included date of shunt placement, demographics, comorbidities, cause of hydrocephalus, shunt type, and number of shunt revisions. Axial computed tomographic images obtained before and immediately after shunt placement and 2 to 4 years after shunt placement were evaluated by a panel of clinicians for evidence of craniosynostosis. Patients with preshunt craniosynostosis, craniosynostosis syndromes, or poor-quality computed tomographic images were excluded. Data were analyzed using STATA Version 15.1 statistical software.

Results:

One hundred twenty-five patients (69 male and 56 female patients) were included. Average age at shunt placement was 2.3 ± 2.58 months. Sixty-one patients (48.8 percent) developed craniosynostosis at a median of 26 months after shunt placement. Of these, 28 patients fused one suture; the majority involved the sagittal suture (n = 25). Thirty-three patients fused multiple sutures; the most common were the coronal (n = 32) and the sagittal (n = 30) sutures. Multivariable logistic regression identified older age at shunt placement and more shunt revisions as independent predictors of craniosynostosis. Shunt valve type was not significant.

Conclusions:

Craniosynostosis developed in nearly half of infants who underwent ventriculoperitoneal shunt placement for hydrocephalus. The sagittal suture was most commonly involved. The effect of suture fusion on subsequent cranial growth, shunt failure, or the development of intracranial pressure is unclear.

CLINICAL QUESITON/LEVEL OF EVIDENCE:

Risk, III.
A Report of Gender Bias and Sexual Harassment in Current Plastic Surgery Training: A National Survey
Authors: Chen Wendy , Schilling Benjamin K. , Bourne Debra A. , Myers Sara , De La Cruz Carolyn
Published: May 2021

Background:

Gender bias and sexual misconduct continue to pervade medicine. The authors hypothesize that gender bias and sexual misconduct disproportionately and negatively affect female plastic surgery trainees.

Methods:

A national survey of plastic surgery trainees (2018 to 2019) was conducted using previously validated sexual harassment surveys adapted for relevance to plastic surgery. Respondents were queried about experiences with workplace gender bias and harassment; personal and professional impact; and reporting practices. Analyses included chi-square, logistic regression, and analysis of variance. Significance was accepted for values of p < 0.05.

Results:

There were 236 responses (115 female respondents; 20.1 percent response rate). Most respondents were Caucasian (Asian/Pacific Islander, n = 34) residents (n = 123). The feeling of hindrance to career advancement was greater for women, by 10-fold (p < 0.001), and increased with age (p = 0.046). Women felt uncomfortable challenging attitudes regarding gender inequality (p < 0.001), regardless of training levels (p = 0.670) or race (p = 0.300). Gender bias diminished female trainees’ career goals/ambition (p < 0.001). Women were more likely to experience sexual harassment, in the form of jokes (p = 0.003) and comments about their body or sexuality (p = 0.014). Respondents reported the majority of perpetrators of harassment to be attending physicians (30 percent) and other trainees (37 percent). Most common reasons to not report incidents included “futility” (29 percent) and “fear” (20 percent). Women experienced at least three symptoms of depression/anxiety, significantly higher than men (p = 0.001).

Conclusions:

Gender bias and sexual misconduct negatively affect female trainees’ attitudes toward their career. Two-thirds of cases of sexual harassment originate from other physicians. Minority trainees are less prepared to address transgressions and more likely to experience sexual coercion. Trainees perceive a culture nonconducive to reporting. These findings can guide changes and discussions surrounding workplace culture in plastic surgery training.
Tips and Tricks in Gender-Affirming Mastectomy
Authors: Salibian Ara A. , Gonzalez Eduardo , Frey Jordan D. , Bluebond-Langner Rachel
Published: May 2021

Gender-affirming mastectomy has become a highly sought-after procedure for the treatment of gender dysphoria and has been shown to improve quality of life in transgender and gender-nonbinary individuals. Aesthetic outcomes after double-incision mastectomy can be influenced by several factors; however, certain operative variables can be controlled to obtain aesthetic and reproducible results. Chest wall contour is arguably the most critical component of these procedures and requires highlighting the definition of the pectoralis muscle. Planning incisions within the inferior and lateral borders of the pectoralis major rather than the inframammary fold, and ensuring removal of all breast tissue in the lateral and medial chest and the axillary tail, will help obtain an aesthetically pleasing chest wall shape while concealing scars. Finally, attention to nipple resizing and repositioning inferiorly and laterally relative to the borders of the pectoralis muscle are critical to an aesthetic outcome. The authors have found that appropriate preoperative planning to control these three factors—(1) contour, (2) nipple position, and (3) scars—and critical analysis and adjustment of on-table results will help achieve the goals of creating an aesthetic and gender-congruent chest.
BIA-ALCL and Textured Breast Implants: A Systematic Review of Evidence Supporting Surgical Risk Management Strategies
Authors: Nelson Jonas A. , McCarthy Colleen , Dabic Stefan , Polanco Thais , Chilov Marina , Mehrara Babak J. , Disa Joseph J.
Published: May 2021

Background:

Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a significant public health concern for women with breast implants. The increase in incidence rates underscores the need for improved methods for risk reduction and risk management. The purpose of this study was to perform a systematic review to assess surgical risk reduction techniques and analyze communication/informed consent practices in patients with textured implants.

Methods:

A systematic review of the literature was conducted in PubMed (legacy), Embase (Embase.com), and Scopus with four search strategies including key terms centered around breast reconstruction and BIA-ALCL.

Results:

A total of 571 articles were identified, of which 276 were included in the final review after duplicates were removed. After review, no articles were determined to fit the inclusion criteria of demonstrating data-driven evidence of BIA-ALCL risk reduction through surgical measures, demonstrating a significant lack of data on risk reduction for BIA-ALCL.

Conclusions:

Risk management for BIA-ALCL is an evolving area requiring additional investigation. Although removal of textured devices in asymptomatic patients is not currently recommended by the Food and Drug Administration, variability in estimates of risk has led many patients to electively replace these implants in an effort to decrease their risk of developing BIA-ALCL. To date, however, there is no evidence supporting the concept that replacing textured implants with smooth implants reduces risk for this disease. This information should be used to aid in the informed consent process for patients presenting to discuss management of textured breast implants.
Elective Implant Removal and Replacement in Asymptomatic Aesthetic Patients with Textured Devices
Authors: Calobrace M. Bradley
Published: May 2021

The management of patients with breast implants requires secondary procedures through the life of the implant, sometimes in the early postoperative period and more commonly many years after the initial surgery. In performing revisional procedures, removal and replacement of the implants is often required for a variety of reasons. With growing concerns of implant safety, implant exchange or removal with or without a capsulectomy has been increasingly requested by patients. In particular, textured breast implants have been under increased scrutiny secondary to their association with breast implant–associated anaplastic large cell lymphoma. Unfortunately, to date, there are no data and very little guidance as to the appropriate management of patients currently with textured implants as well as patients with a history of having had textured implants placed in the past. The surgeon must not only consider the appropriate management of patients with uncomplicated, asymptomatic textured devices but also consider the appropriate management when faced with another indication for revisional surgery and the need determine the appropriate course of action. An algorithm for the management of the explantation patient in general will be introduced in this review with a focus on the rationale, planning, and management of patients with an uncomplicated, asymptomatic textured implants.
The Capsule Question: How Much Should Be Removed with Explantation of a Textured Device?
Authors: Nahabedian Maurice Y.
Published: May 2021

Current controversies surrounding breast implants are focused not only on the implant but also on the capsule. There has been tremendous discussion regarding how much of the capsule, if any, should be removed during explantation for benign conditions. The appearance of benign capsules is highly variable ranging from a thin membrane to densely fibrotic with calcifications. The options for capsulectomy include none, partial, complete, complete-intact, and en bloc. Some patients are requesting en bloc capsulectomy even in the absence of anaplastic large cell lymphoma; however, the scientific evidence only supports this for patients with capsular malignancies. The purpose of this article is to review the old and new evidence to answer the question regarding how much capsule should be removed during explantation for benign conditions.
Evaluation of gait outcomes for individuals with established unilateral transfemoral amputation following the provision of microprocessor controlled knees in the context of a clinical service
Authors: Carse Bruce , Scott Helen , Brady Laura , Colvin John
Published: May 2021

Background:

Microprocessor controlled knees (MPKs) have been shown to improve gait outcomes for individuals with unilateral transfemoral amputation (TFA); however, previous studies have limitations, which may affect their applicability.

Objectives:

To compare gait outcomes between non-MPK and MPK conditions within a large and diverse cohort of established TFAs in the pragmatic context of an operational clinical service and to identify any demographic variables that correlate with changes in gait outcomes.

Study Design:

This is a retrospective cohort study.

Methods:

Full-body three-dimensional motion capture and a portable breath gas analyser were used to evaluate gait-specific outcomes both pre-MPK and 6 months post-MPK provisions in TFAs (n = 32). The primary outcome measure was gait profile score, along with the following secondary outcome measures: walking velocity, step length, step length symmetry ratio, step time symmetry ratio, vertical ground reaction force symmetry index, base of support, center of mass deviation, and oxygen cost of walking.

Results:

Data showed statistically significant improvement in gait profile score from 11.2° ± 2.2° to 10.1° ± 2.1° (p < 0.01) between non-MPK and MPK conditions. Other outcomes which showed significant improvement were walking velocity (p < 0.01), step length (p < 0.01), vertical ground reaction force symmetry index (p < 0.01), and center of mass deviation (p < 0.05).

Conclusions:

MPK provision offered significant gait improvements to this cohort of TFAs in an operational clinical setting. There still remains a large gap in gait outcomes between this cohort and those of healthy unimpaired adults. Improvements in socket design, prosthetic foot design, and physiotherapy intervention could further reduce this gap.
Discovering antiviral restriction factors and pathways using genetic screens
Authors: Jones Chloe E. , Tan Wenfang S. , Grey Finn , Hughes David J.
Published: May 2021

Viral infections activate the powerful interferon (IFN) response that induces the expression of several hundred IFN stimulated genes (ISGs). The principal role of this extensive response is to create an unfavourable environment for virus replication and to limit spread; however, untangling the biological consequences of this large response is complicated. In addition to a seemingly high degree of redundancy, several ISGs are usually required in combination to limit infection as individual ISGs often have low to moderate antiviral activity. Furthermore, what ISG or combination of ISGs are antiviral for a given virus is usually not known. For these reasons, and since the function(s) of many ISGs remains unexplored, genome-wide approaches are well placed to investigate what aspects of this response result in an appropriate, virus-specific phenotype. This review discusses the advances screening approaches have provided for the study of host defence mechanisms, including clustered regularly interspaced short palindromic repeats/CRISPR associated protein 9 (CRISPR/Cas9), ISG expression libraries and RNA interference (RNAi) technologies.
Effect of pH on the antimicrobial activity of the macrophage metabolite itaconate
Authors: Duncan Dustin , Lupien Andréanne , Behr Marcel A. , Auclair Karine
Published: May 2021

The production of itaconate by macrophages was only discovered in 2011. An increasing number of studies have since revealed essential biological functions for this small molecule, ranging from antimicrobial to immunomodulator. The antibacterial role of itaconate has however been questioned because the estimated concentration of itaconate in macrophages (low-millimolar) is lower than the minimum inhibitory concentration (MIC) of itaconate reported for several bacterial strains (low-to-mid-millimolar). We note that some of these investigations have tended to ignore the high acidity of this small diacid (pKas 3.85 and 5.45), thereby potentially biassing activity measurements. We measured the MIC of itaconate inEscherichia coli(not known to metabolize itaconate) and inSalmonella entericaserovar Typhimurium (known to metabolize itaconate) at varying pH values to probe the effect that pH has on itaconate toxicity. Herein, we demonstrate that the antimicrobial effect of itaconate is dependent upon the pH of the media and that itaconate does have antimicrobial activity at biologically relevant pH and concentrations. Under nutrient-poor conditions, the antimicrobial activity of itaconate in bothE. coliandS. Typhimurium increased approximately 200-fold when the pH was dropped by one unit, whereas itaconate was not found to be toxic under nutrient rich conditions. Our results also reveal that the activity of itaconate is synergistic with acidity, yet is not a function of increased permeability with protonation. Similar experiments performed with succinate (a pKa-matched diacid) yielded drastically different results, consistent with a target-based mechanism of action for itaconate. Overall, our work shows the importance of controlling the pH when performing experiments with itaconic acid.
Use of Environmental Variables to Predict SARS-CoV-2 Spread in the U.S.
Authors: Haring R. Sterling , Trende Sean , Ramirez Christina M.
Published: May 2021

Background

The COVID-19 pandemic has challenged even the most robust public health systems world-wide, leaving state and local health departments, hospitals, and physicians with little guidance on planning and resource allocation. Efforts at predicting the virus’ spread have largely failed to capture the nuances presented by national and local geographic, environmental, and sociological variables.

Objective

Using county-level data from the United States, we sought to measure the extent to which these demographic, geographic, and environmental variables correlate with the spread of COVID-19.

Methods

Using demographic data from the US Census Bureau’s American Community Survey, weather station data from the National Oceanic and Atmospheric Administration (NOAA), and COVID-19 case data from the Center for Systems Science and Engineering at Johns Hopkins University and the New York State Department of Health, we employed Bayesian hierarchical modeling with zero-inflated Negative Binomial regression to calculate correlations between these variables, COVID-19 case count, and rate of viral spread. Key predictors were identified and measured during two periods of two weeks each: March and June of 2020. The resultant model was then employed to predict case counts and spread rate for early July 2020.

Results

While demographic and environmental factors explain viral spread well, our findings challenge earlier conclusions about how these factors related to viral progress. Using these factors alone, we were able to predict spread to within 1% in all but 8 counties (99.9%), and within 0.1% in all but 51 counties (98.4%). The model was subsequently able to predict early July viral spread to within 0.5% in 98% of counties. Contrary to earlier findings, temperature had variable effect; as Spring temperatures warmed, cases decreased, but Summer heat increased cases, likely reflecting movement of populations from indoors to outdoors and back in. States varied little in their case rate relative to the model, and much of the variation could be linked to known “superspreader” events.

Conclusion

While environmental and demographic variables can help predict COVID-19 spread rates, some relationships are variable in ways earlier research failed to identify.

Role of Funding Source

There was no funding supporting this work.
A Developmental Reduction of the Excitation:Inhibition Ratio in Association Cortex during Adolescence
Authors: Larsen Bart , Cui Zaixu , Adebimpe Azeez , Pines Adam , Alexander-Bloch Aaron , Bertolero Max , Calkins Monica E. , Gur Raquel E. , Gur Ruben C. , Mahadevan Arun S. , Moore Tyler M. , Roalf David R. , Seidlitz Jakob , Sydnor Valerie J. , Wolf Daniel H. , Satterthwaite Theodore D.
Published: May 2021

Adolescence is hypothesized to be a critical period for the development of association cortex. A reduction of the excitation:inhibition (E:I) ratio is a hallmark of critical period development; however it has been unclear how to assess the development of the E:I ratio using non-invasive neuroimaging techniques. Here, we used pharmacological fMRI with a GABAergic benzodiazepine challenge to empirically generate a model of E:I ratio based on multivariate patterns of functional connectivity. In an independent sample of 879 youth (ages 8-22 years), this model predicted reductions in the E:I ratio during adolescence, which were specific to association cortex and related to psychopathology. These findings support hypothesized shifts in E:I balance of association cortices during a neurodevelopmental critical period in adolescence.

Teaser

Inhibitory maturation of the association cortex reflects an adolescent critical period.
Density of Pied Crows Corvus albus in two of South Africa’s protected areas
Authors: Johnson Thomas F. , Murn Campbell
Published: May 2021

In recent decades, the pied crow Corvus albus population has grown in southern Africa, and this may have had impacts on other species. Conservationists and land managers may question the degree of threat posed by pied crows to other species, but a scarcity of ecological information on pied crows limits evidence-based decision-making. Using a distance density function we provide initial pied crow density estimates of 0.24 crows km-2 (0.12-0.5; 95% CI) and 0.18 crows km-2 (0.07-0.45; 95% CI) in two protected areas in the Northern Cape Province of South Africa. We infer that pied crow density is negatively associated with the normalised difference vegetation index (NVDI).
Reading-related brain changes in audiovisual processing: cross-sectional and longitudinal MEG evidence
Authors: Caffarra Sendy , Lizarazu Mikel , Molinaro Nicola , Carreiras Manuel
Published: May 2021

The ability to establish associations between visual objects and speech sounds is essential for human reading. Understanding the neural adjustments required for acquisition of these arbitrary audiovisual associations can shed light on fundamental reading mechanisms and help reveal how literacy builds on pre-existing brain circuits. To address these questions, the present longitudinal and cross-sectional MEG studies characterize the temporal and spatial neural correlates of audiovisual syllable congruency in children (4-9 years old, 22 males and 20 females) learning to read. Both studies showed that during the first years of reading instruction children gradually set up audiovisual correspondences between letters and speech sounds, which can be detected within the first 400 ms of a bimodal presentation and recruit the superior portions of the left temporal cortex. These findings suggest that children progressively change the way they treat audiovisual syllables as a function of their reading experience. This reading-specific brain plasticity implies (partial) recruitment of pre-existing brain circuits for audiovisual analysis.

Significance Statement

Linking visual and auditory linguistic representations is the basis for the development of efficient reading, while dysfunctional audiovisual letter processing predicts future reading disorders. Our developmental MEG project included a longitudinal and a cross-sectional study; both studies showed that children’s audiovisual brain circuits progressively change as a function of reading experience. They also revealed an exceptional degree of neuroplasticity in audiovisual neural networks, showing that as children develop literacy, the brain progressively adapts so as to better detect new correspondences between letters and speech sounds.