bluuebunny/crossref_metadata_2025 huggingface dataset:
Seven-year Outcomes of Adolescent Forearm Fractures Treated With Plate Fixation
Authors: Folkman Matthew J. , Ren Bryan O. , Maheshwer Bhargavi , Klyce Walter B. , Mistovich R. Justin
Published: April 2023

Background:

Pediatric forearm fractures are common injuries and can sometimes require surgical treatment. Few studies have evaluated the long-term outcomes of pediatric forearm fracture plating. We evaluated long-term functional outcomes and satisfaction in children with forearm fractures treated with plate fixation.

Methods:

We performed a single-institution case series at a pediatric level 1 trauma center. Inclusion criteria were: patients with radius and/or ulna diaphyseal fractures, index surgery at 18 years of age or younger, plate fixation, and a minimum of 2 years follow-up. We surveyed patients with the QuickDASH outcome measure and supplemented this with functional outcomes and satisfaction questions. Demographics and surgery characteristics were obtained from the electronic medical record.

Results:

A total of 41 patients met the eligibility criteria, of whom 17 completed the survey with a mean follow-up of 7.2 ± 1.4 years. The mean age at index surgery was 13.1 ± 3.6 years (range, 4 to 17), with 65% males. All patients reported at least one symptom, with aching (41%) and pain (35%) occurring most frequently. There were 2 complications (12%), including one infection and one compartment syndrome treated with fasciotomy. Hardware removal occurred in 29% of patients. There were no refractures. The mean QuickDASH score was 7.7 ± 11.9, with an occupation module score of 1.6 ± 3.9 and a sports/performing arts module score of 12.0 ± 19.7. The mean surgery satisfaction was 92% and scar satisfaction was 75%. All patients returned to prior activities and 88% reported a return to their preoperative baseline level of function.

Conclusions:

Plate fixation for pediatric forearm fractures achieves osseous union but not without the potential for long-term sequelae. All patients reported residual symptoms 7 years later. Scar satisfaction and return to baseline function were imperfect. Patient education for long-term outcomes of surgery is essential, especially in the transition to adulthood.

Level of Evidence:

Level IV, therapeutic study.
Socioeconomic Deprivation and its Associations With Follow-up Compliance After In Situ Pinning of Slipped Capital Femoral Epiphysis
Authors: Batley Morgan G. , Lenart Jana , Sankar Wudbhav N.
Published: April 2023

Background:

Slipped capital femoral epiphysis (SCFE) is a common cause of hip pain in adolescents and is most often treated by in situ screw fixation. Orthopaedic follow-up is critical after treatment for SCFE due to risks of complications and subsequent contralateral slip. Recent studies have shown that socioeconomic deprivation is associated with decreased fracture care compliance, but no studies have explored this relationship with SCFEs. The study aims to determine the relationship between socioeconomic deprivation and SCFE follow-up care compliance.

Methods:

This study included pediatric patients treated with in situ pinning of SCFE between 2011 and 2019 at a single tertiary-care urban children’s hospital. Demographic and clinical information were obtained from electronic medical records. The Area Deprivation Index (ADI) was used to quantify the socioeconomic deprivation of each. Outcome variables included patient age and status of physeal closure at the most recent appointment, in addition to the length of follow-up (mo). Statistical relationships were evaluated using nonparametric bivariate analysis and correlation.

Results:

We identified 247 evaluable patients; 57.1% were male, and the median age was 12.4 years. Most slips were stable (95.1%) and treated with isolated unilateral pinning (55.9%). Median length of follow-up was 11.9 months (interquartile range, 4.95 to 23.1) with median patient age at final visit of 13.6 years (interquartile range, 12.4 to 15.1). Only 37.2% of patients were followed until physeal closure. The mean ADI spread in this sample was similar to the national distribution. However, patients in the most deprived quartile were lost to follow-up significantly earlier (median, 6.5 mo) than those in the least deprived quartile (median, 12.5 mo; P<0.001). Throughout the entire cohort, there was a significant, inverse relationship between deprivation and follow-up length (r

s(238)= −0.3; P<0.001), with this relationship most pronounced in the most deprived quartile.

Conclusions:

In this sample, ADI spread was representative of national trends, and the incidence of SCFE was distributed evenly across deprivation quartiles. However, follow-up length does not mirror this relationship; increased socioeconomic deprivation is associated with an earlier loss to follow-up (often well before physeal closure).

Level of Evidence:

Level II—retrospective prognostic study.
Customized 3-dimensional–printed Vertebral Implants for Spinal Reconstruction After Tumor Resection
Authors: Hirase Takashi , Vemu Sree M. , Boddapati Venkat , Ling Jeremiah F. , So Matthew , Saifi Comron , Marco Rex A.W. , Bird Justin E.
Published: April 2023

Study Design:

Systematic review.

Objective:

To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection.

Summary of Background Data:

Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection.

Materials and Methods:

A systematic review was registered with PROSPERO and performed according to “Preferred Reporting Items for Systematic Reviews and Meta-analyses” guidelines. All level I–V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included.

Results:

Eleven studies (65 patients; mean age, 40.9 ± 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 ± 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3–C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 ± 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications.

Conclusion:

There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction.

Level of Evidence:

Level V, systematic review of level I–V studies.
Burden of multiple myeloma in China: an analysis of the Global Burden of Disease, Injuries, and Risk Factors Study 2019
Authors: Liu Jiangmei , Liu Weiping , Mi Lan , Cai Cai , Gong Tiejun , Ma Jun , Wang Lijun
Published: April 2023

Background:

There is limited data to comprehensively evaluate the epidemiological characteristics of multiple myeloma (MM) in China; therefore, this study determined the characteristics of the disease burden of MM at national and provincial levels in China.

Methods:

The burden of MM, including incidence, mortality, prevalence, and disability-adjusted life years (DALYs), with a 95% uncertainty interval (UI), was determined in China following the general analytical strategy used in the Global Burden of Disease, Injuries, and Risk Factors Study 2019. The trends in the burden of MM from 1990 to 2019 were also evaluated.

Results:

There were an estimated 347.45 thousand DALYs with an age-standardized DALY rate of 17.05 (95% UI, 12.31–20.77) per 100,000 in 2019. The estimated number of incident case and deaths of MM were 18,793 and 13,421, with age-standardized incidence and mortality rates of 0.93 (95% UI, 0.67–1.15) and 0.67 (95% UI, 0.50–0.82) per 100,000, respectively. The age-specific DALY rates per 100,000 increased to more than 10.00 in the 40 to 44 years age group reaching a peak (93.82) in the 70 to 74 years age group. Males had a higher burden than females, with approximately 1.5 to 2.0-fold sex difference in age-specific DALY rates in all age groups. From 1990 to 2019, the DALYs of MM increased 134%, from 148,479 in 1990 to 347,453 in 2019.

Conclusion:

The burden of MM has doubled over the last three decades, which highlights the need to establish effective disease prevention and control strategies at both the national and provincial levels.
Astragaloside in cancer chemoprevention and therapy
Authors: Wang Yaning , Zhang Zhuo , Cheng Zhaohua , Xie Wei , Qin Hanjiao , Sheng Jiyao
Published: April 2023

Tumor chemoprevention and treatment are two approaches aimed at improving the survival of patients with cancers. An ideal anti-tumor drug is that which not only kills tumor cells but also alleviates tumor-causing risk factors, such as precancerous lesions, and prevents tumor recurrence. Chinese herbal monomers are considered to be ideal treatment agents due to their multi-target effects. Astragaloside has been shown to possess tumor chemoprevention, direct anti-tumor, and chemotherapeutic drug sensitization effects. In this paper, we review the effects of astragaloside on tumor prevention and treatment and provide directions for further research.
Acral Speckled Hypomelanosis: A Case Report and a Review of Literature
Authors: Azzazi Yousra , Korany Mona Mostafa , El-Nabarawy Eman Ahmed
Published: April 2023

Background:

Acral speckled hypomelanosis is a very rare pigmentation disorder that appears early in life with hypopigmented macules on background of normal skin, occurring on the acral parts.

Case report:

We report a 9-year-old female patient with a 3-year duration of progressive, hypopigmented, confetti-like macules occurring symmetrically on the dorsum of both hands and feet. Biopsy showed normal number of melanocytes with no evidence of macromelanosomes using special stains for melanocytes.

Conclusion:

Acral speckled hypomelanosis is a relatively, recently, discovered entity, with only 9 cases reported to date, and our case is the 10th. The exact etiopathogenesis is not yet known.
Use of HBV RNA and to predict change in serological status and disease activity in CHB
Authors: Ghany Marc G. , King Wendy C. , Hinerman Amanda S. , Lok Anna SF. , Lisker-Melman Mauricio , Chung Raymond T. , Terrault Norah , Janssen Harry L.A. , Khalili Mandana , Lee William M. , Lau Daryl T.Y. , Cloherty Gavin A. , Sterling Richard K.
Published: April 2023

Background and Aims:

Predicting changes in disease activity and serological endpoints is necessary for the management of patients with chronic hepatitis B (CHB). We examined whether HBV RNA and hepatitis B core-related antigen (HBcrAg), two specialized virological markers proposed to reflect the activity of covalently closed circular DNA, may improve the ability to predict not sustained inactive carrier phase, spontaneous alanine aminotransferase (ALT) flare, HBeAg loss, and HBsAg loss.

Approach and Results:

Among eligible participants enrolled in the North American Hepatitis B Research Network Adult Cohort Study, we evaluated demographic, clinical, and virologic characteristics, including HBV RNA and HBcrAg, to predict not sustained inactive carrier phase, ALT flare, HBeAg loss, and HBsAg loss through a series of Cox proportional hazard or logistic regression models, controlling for antiviral therapy use. Among the study population, 54/103 participants experienced not sustained inactive carrier phase, 41/1006 had a spontaneous ALT flare, 83/250 lost HBeAg, and 54/1127 lost HBsAg. HBV RNA or HBcrAg were predictive of all 4 events. However, their addition to models of the readily available host (age, sex, race/ethnicity), clinical (ALT, use of antiviral therapy), and viral factors (HBV DNA), which had acceptable-excellent accuracy (e.g., AUC = 0.72 for ALT flare, 0.92 for HBeAg loss, and 0.91 for HBsAg loss), provided only small improvements in predictive ability.

Conclusion:

Given the high predictive ability of readily available markers, HBcrAg and HBV RNA have a limited role in improving the prediction of key serologic and clinical events in patients with CHB.
Differential central integration of left versus right baroreceptor afferent input in spontaneously hypertensive rats
Authors: Salman Ibrahim M. , Ameer Omar Z. , McMurray Sheridan , Hassan Sarah F. , Sridhar Arun , Lewis Stephen J. , Hsieh Yee-Hsee
Published: April 2023

Background:

The blood pressure (BP) regulatory impact of the arterial baroreflex has been well established in health and disease. Under normotensive conditions, we have previously demonstrated functional differences in the central processing of the left versus right aortic baroreceptor afferent input. However, it is unknown if lateralization in aortic baroreflex function remains evident during hypertension.

Method:

We therefore, investigated the effects of laterality on the expression of baroreflex-driven cardiovascular reflexes in a genetic model of essential hypertension, the spontaneously hypertensive rat (SHR). Anesthetized male SHRs (total n = 9) were instrumented for left, right, and bilateral aortic depressor nerve (ADN) stimulation (1–40 Hz, 0.2 ms, and 0.4 mA for 20 s) and measurement of mean arterial pressure (MAP), heart rate (HR), mesenteric vascular resistance (MVR), and femoral vascular resistance (FVR).

Results:

Left right, and bilateral ADN stimulation evoked frequency-dependent decreases in MAP, HR, MVR, and FVR. Left and bilateral ADN stimulation evoked greater reflex reductions in MAP, HR, MVR, and FVR compared with right-sided stimulation. Reflex bradycardia to bilateral stimulation was larger relative to both left-sided and right-sided stimulation. Reflex depressor and vascular resistance responses to bilateral stimulation mimicked those of the left-sided stimulation. These data indicate a left-side dominance in the central integration of aortic baroreceptor afferent input. Furthermore, reflex summation due to bilateral stimulation is only evident on the reflex bradycardic response, and does not drive further reductions in BP, suggesting that reflex depressor responses in the SHRs are primarily driven by changes in vascular resistance.

Conclusion:

Together, these results indicate that lateralization in aortic baroreflex function is not only evident under normotensive conditions but also extends to hypertensive conditions.
Traffic-Related Air Pollution and Risk of Lung, Breast, and Urinary Tract Cancer in Halifax, Nova Scotia
Authors: Dummer Trevor J. B. , Yu Xing , Cui Yunsong , Nauta Laura , Saint-Jacques Nathalie , Sweeney Magee Molly , Rainham Daniel G. C.
Published: April 2023

Objectives

We assessed the association of traffic-related air pollution (TRAP) with the incidence of lung, breast, and urinary tract cancer in Halifax, Nova Scotia.

Methods

Our case-control study included 2315 cancers and 8501 age-sex–matched controls. Land-use regression was used to estimate TRAP concentrations. Logistic regression was used to assess cancer risk in relation to TRAP, adjusting for community social and material deprivation.

Results

There was no association between the risk of lung, breast, or urinary tract cancer in relation to TRAP. Lung cancer risk was significantly increased in the most deprived communities, whereas breast cancer risk was highest in the least deprived communities.

Conclusions

In a city characterized by low levels of ambient air pollution, there was no evidence of a linear increased lung, breast, or urinary tract cancer risk in relation to TRAP.
Post-cholecystectomy major bile duct injury: ideal time to repair based on a multicentre randomized controlled trial with promising results
Authors: Omar Mohammed A. , Kamal Ayman , Redwan Alaa A. , Alansary Marwa N. , Ahmed Emad Ali
Published: April 2023

Background:

Bile duct injury (BDI) is one of the serious complications of cholecystectomy procedures, which has a disastrous impact on long-term survival, health-related quality of life (QoL), healthcare costs as well as high rates of litigation. The standard treatment of major BDI is hepaticojejunostomy (HJ). Surgical outcomes depend on many factors, including the severity of the injury, the surgeons’ experiences, the patient’s condition, and the reconstruction time. The authors aimed to assess the impact of reconstruction time and abdominal sepsis control on the reconstruction success rate.

Methods:

This is a multicenter, multi-arm, parallel-group, randomized trial that included all consecutive patients treated with HJ for major post-cholecystectomy BDI from February 2014 to January 2022. Patients were randomized according to the time of reconstruction by HJ and abdominal sepsis control into group A (early reconstruction without sepsis control), group B (early reconstruction with sepsis control), and group C (delayed reconstruction). The primary outcome was successful reconstruction rate, while blood loss, HJ diameter, operative time, drainage amount, drain and stent duration, postoperative liver function tests, morbidity and mortality, number of admissions and interventions, hospital stay, total cost, and patient QoL were considered secondary outcomes.

Results:

Three hundred twenty one patients from three centres were randomized into three groups. Forty-four patients were excluded from the analysis, leaving 277 patients for intention to treat analysis. With univariate analysis, older age, male gender, laparoscopic cholecystectomy, conversion to open cholecystectomy, failure of intraoperative BDI recognition, Strasberg E4 classification, uncontrolled abdominal sepsis, secondary repair, end-to-side anastomosis, diameter of HJ (< 8 mm), non-stented anastomosis, and major complications were risk factors for successful reconstruction. With multivariate analysis, conversion to open cholecystectomy, uncontrolled sepsis, secondary repair, the small diameter of HJ, and non-stented anastomosis were the independent risk factors for the successful reconstruction. Also, group B patients showed decreased admission and intervention rates, decreased hospital stay, decreased total cost, and early improved patient QoL.

Conclusion:

Early reconstruction after abdominal sepsis control can be done safely at any time with comparable results for delayed reconstruction in addition to decreased total cost and improved patient QoL.
High-Dose Insulin for Hyperkalemic Cardiac Arrest
Authors: Shikhooun Mohammed A. , Abdulhadi Loai A. , Yafes Wael M. , Saleh Moataz R. , Corsentino Sue Anne , Pantin Enrique J.
Published: April 2023

Hyperkalemic cardiac arrest diagnosis can be elusive and management difficult as the cardiac rhythm restoration is often not achieved until the potassium level decreases to a relatively normal level for the patient who suffers the arrest. Current treatment modalities can take hours to achieve this goal. We describe two patients who survived a witnessed hyperkalemic cardiac arrest after being managed with conventional advanced cardiac life support and unconventionally high doses of intravenous insulin.
Methodologic Approaches for Using Electronic Medical Records to Identify Experiences of Violence in Transgender and Cisgender People: Closing the Gap Between Diagnostic Coding and Lived Experiences
Authors: Alpert Ash Blythe , Sayegh Sabrina Jamileh , Strawderman Myla , Cunliffe Scott , Griggs Jennifer J. , Cerulli Catherine
Published: April 2023

Background:

Transgender people experience extreme rates of violence and the electronic medical record (EMR) remains a mostly untapped resource to study the medical sequelae of such experiences.

Objectives:

To develop and test a method for identifying experiences of violence using EMR data.

Research Design:

Cross-sectional study utilizing EMR data.

People:

Transgender and cisgender people seen at a regional referral center in Upstate New York.

Measures:

We tested the utility of keyword searches and structured data queries to identify specific types of violence at various ages and in various contexts among cohorts of transgender and cisgender people. We compared the effectiveness of keyword searches to diagnosis codes and a screening question, “Are you safe at home?” using McNemar’s test. We compared the prevalence of various types of violence between transgender and cisgender cohorts using the χ2 test of independence.

Results:

Of the transgender cohort, 47% had experienced some type of violence versus 14% of the cisgender cohort (χ2
P value <0.001). Keywords were significantly more effective than structured data at identifying violence among both cohorts (McNemar P values all <0.05).

Conclusions:

Transgender people experience extreme amounts of violence throughout their lives, which is better identified and studied using keyword searches than structured EMR data. Policies are urgently needed to stop violence against transgender people. Interventions are also needed to ensure safe documentation of violence in EMRs to improve care across settings and aid research to develop and implement effective interventions.
Proximal tubule responses to injury: interrogation by single-cell transcriptomics
Authors: Cippà Pietro E. , McMahon Andrew P.
Published: April 2023

Purpose of review

Acute kidney injury (AKI) occurs in approximately 10–15% of patients admitted to hospital and is associated with adverse clinical outcomes. Despite recent advances, management of patients with AKI is still mainly supportive, including the avoidance of nephrotoxins, volume and haemodynamic management and renal replacement therapy. A better understanding of the renal response to injury is the prerequisite to overcome current limitations in AKI diagnostics and therapy.

Recent findings

Single-cell technologies provided new opportunities to study the complexity of the kidney and have been instrumental for rapid advancements in the understanding of the cellular and molecular mechanisms of AKI.

We provide an update on single-cell technologies and we summarize the recent discoveries on the cellular response to injury in proximal tubule cells from the early response in AKI, to the mechanisms of tubule repair and the relevance of maladaptive tubule repair in the transition to chronic kidney disease.
Deficits in our understanding of natural killer cell development in mouse and human
Authors: Schorr Christopher , Krishnan Maya Shraddha , Capitano Maegan
Published: April 2023

Purpose of review

Natural killer (NK) cells are a type of immune cell that play a crucial role in the defense against cancer and viral infections. The development and maturation of NK cells is a complex process, involving the coordination of various signaling pathways, transcription factors, and epigenetic modifications. In recent years, there has been a growing interest in studying the development of NK cells. In this review, we discuss the field's current understanding of the journey a hematopoietic stem cell takes to become a fully mature NK cell and detail the sequential steps and regulation of conventional NK leukopoiesis in both mice and humans.

Recent findings

Recent studies have highlighted the significance of defining NK development stages. Several groups report differing schema to identify NK cell development and new findings demonstrate novel ways to classify NK cells. Further investigation of NK cell biology and development is needed, as multiomic analysis reveals a large diversity in NK cell development pathways.

We provide an overview of current knowledge on the development of NK cells, including the various stages of differentiation, the regulation of development, and the maturation of NK cells in both mice and humans. A deeper understanding of NK cell development has the potential to provide insights into new therapeutic strategies for the treatment of diseases such as cancer and viral infections.
Improving Hepatitis B Screening at Family Health Centers Using Quality Improvement and Electronic Medical Record Tools
Authors: Huang Jeannie S. , Cruz Rusvelda , Schwarz Kathleen B. , Tran Thao
Published: April 2023

Chronic hepatitis B viral (HBV) infection is associated with significant morbidity and mortality with endemic areas carrying most of the global burden of HBV disease. Current HBV screening rates in the United States are suboptimal. We aimed to improve HBV screening rates at regional family health centers serving high-risk refugee populations by 20% over 2 years. We used quality improvement (QI) methodology and implemented interventions providing electronic medical record (EMR)-enabled HBV screening tools within known clinical workflows. EMR tools captured country-of-origin data to identify persons from HBV-endemic regions with provision of a laboratory order set to ensure performance of appropriate HBV screening tests. The project was initiated prior to the COVID pandemic but continued during the pandemic with imposed social isolation measures. We nevertheless demonstrated 4 statistical process control chart shifts and achieved our QI smart aim. Further, we demonstrated a high HBV detection rate (8.2%–12.8%) among persons identified for screening.
Matrix Metalloproteinase-7 and Osteopontin Serum Levels as Biomarkers for Biliary Atresia
Authors: Aldeiri Bashar , Si Tengfei , Huang Zhenlin , Torner Núria , Ma Yun , Davenport Mark , Hadzic Nedim
Published: April 2023

Objectives:

Matrix metallopeptidase-7 (MMP-7) and osteopontin (OPN) are important components in the pathophysiology of fibrosis in biliary atresia (BA). There has been much recent interest in MMP-7 serum level in the diagnosis of BA. We aimed to assess the diagnostic accuracy and prognostic value of both MMP-7 and OPN in a Western BA study.

Methods:

Diagnostic value was assessed by comparison of serum MMP-7 and OPN levels in infants with BA and age-matched cholestatic controls. Prognostic value was assessed through subsequent clearance of jaundice (COJ) and need for liver transplantation (LT).

Results:

Serum was assessed from 32 BA and 27 controls. Median MMP-7 was higher in BA (96.4 vs 35 ng/mL;P< 0.0001) with an optimal cut-off value of 69 ng/mL. Sensitivity and specificity was 68% and 93%, respectively [negative predictive value (NPV) = 71%]. Similarly, median OPN was higher in BA (1952 vs 1457 ng/mL;P= 0.0001) and an optimal cut-off of 1611 ng/mL. Sensitivity and specificity was 84% and 78%, respectively (NPV = 81%). MMP-7 level correlated positively with Ishak liver fibrosis score (r= 0.27,P= 0.04). Neither MMP-7 (70 vs 100 ng/mL;P= 0.2) nor OPN (1969 vs 1939 ng/mL;P= 0.3) were predictive of COJ, or need for LT (99 vs 79 ng/mL;P= 0.7, and 1981 vs 1899 ng/mL;P= 0.2), respectively.

Conclusions:

MMP-7 and OPN may have contributory value in the diagnosis of BA, but remain far of the “gold standard” role. Much more prospective data are required and collaborative multi-center initiatives should be the next logical steps.
Effect of Storytelling and Empathy Training to Support Affective Learning in Undergraduate Nursing Students
Authors: Roberts Michele Livich , Kaur Tresa
Published: April 2023

Background:

Empathy is a desired characteristic in nurses, but its development is often overlooked in nursing simulation.

Purpose:

This study evaluated the effect of a storytelling and empathy training intervention to enhance empathy development in simulation-based learning.

Methods:

A quasi-experimental control group design was used to evaluate differences in self-perceived and observed empathy in undergraduate nursing students (N = 71). Relationships between self-perceived and observed empathy were also assessed.

Results:

Repeated-measures analysis of variance revealed a statistically significant increase in self-perceived empathy, and higher, but nonstatistically significant differences in observed empathy for subjects in the treatment condition. No relationship between self-perceived and observed empathy was observed.

Conclusions:

Storytelling and empathy training may augment simulation-based learning experiences to promote empathy development in undergraduate nursing students.
Whitnall’s barrier: a technique for the management of lacrimal gland prolapse
Authors: Mathewson Priscilla A , Athwal Sarju , Hyer Jonathan N , Ezra Daniel G
Published: April 2023

Background:

Whitnall’s barrier procedure, a modified Beer and Kompatscher surgical technique to reposition the lacrimal gland is presented alongside a case series of patients demonstrating excellent aesthetic and functional outcomes.

Methods:

The Whitnall’s barrier procedure is illustrated procedurally and accompanied by a case series of 20 consecutive patients attending our institution between December 2016 and February 2020. All patients were cared for by a single surgical team. Lid contour and function were assessed post-operatively, as was patient satisfaction.

Results:

Thirty-seven eyes of 20 patients were included. All patients were female with an average age of 50 years. Fourteen patients underwent surgery for cosmesis; four had inactive thyroid eye disease and two had lacrimal gland enlargement secondary to dacryoadenitis. The degree of lacrimal gland prolapse was described as “mild” in two eyes and “moderate” in 35.

All cases had one or more additional surgical procedures. Mean follow up duration was 11 months with complete resolution of lacrimal gland prolapse in 34 eyes. The patient who did not have complete resolution had dacryoadenitis and required ongoing immunosuppressive therapy. Two patients were discharged on topical lubricants, one with thyroid eye disease, and one cosmetic patient who underwent upper and lower lid blepharoplasties at the same time. There were no intra-operative complications and no incidences of infection, dehiscence or damage to the lacrimal gland ductules.

Conclusions:

The Whitnall’s barrier technique is a safe and effective surgical procedure to restore the anatomical location of the lacrimal gland with excellent aesthetic and functional outcomes.
New and Recurrent Ulcerations After Free Tissue Transfer with Partial Bony Resection in Chronic Foot Wounds within a Comorbid Population: A Retrospective Cohort
Authors: Bhardwaj Priya , Zolper Elizabeth G. , Abadeer Andrew I. , Kim Kevin G. , Attinger Christopher E. , Atves Jayson N. , Fan Kenneth L. , Evans Karen K.
Published: April 2023

BACKGROUND:

Chronic foot wounds often require bony resection, however altering the tripod of the foot carries a risk of new ulcer development nearing 70%. Resulting defects often require free tissue transfer (FTT) reconstruction; outcomes data for various bony resection and FTT options may guide clinical decision-making regarding bone and soft tissue management. We hypothesize that alteration of the bony tripod will increase risk of new lesion development following FTT reconstruction.

METHODS:

A single-center retrospective cohort analysis of FTT patients from 2011-2019 with bony resection and soft tissue defects of the foot was performed. Data collected included demographics, comorbidities, wound locations, and FTT characteristics. Primary outcomes were recurrent lesion(RL) and new lesion(NL) development. Multivariate logistic regression and cox hazards regression were used to produce adjusted odds ratios(OR) and hazard ratios(HR).

RESULTS:

Sixty-four patients(mean age 55.9 years) that underwent bony resection and FTT were included. Mean Charlson Comorbidity Index(CCI) was 4.1(standard deviation 2.0) and median follow up was 14.6 months(range 7.5-34.6). Wounds developed post-FTT in 42(67.1%)(RL 39.1%, NL 40.6%). Median time to NL development was 3.7 months(range 0.47-9.1). First metatarsal defect(OR 4.8, 95% CI 1.5-15.7) and flap with cutaneous component(OR 0.24, 95% CI 0.07-0.8) increased and decreased odds of NL development, respectively.

CONCLUSION:

First metatarsal defects significantly increase NL risk following FTT. The majority of ulcerations heal with minor procedures but require long-term follow up. While soft tissue reconstruction with FTT achieves success in the short-term, NL and RL occur at high rates in the months to years following initial healing.
Morphological Changes in Postaxial Polydactyly of the Foot: A Standardized Quantitative Analysis Using the Watanabe–Fujita Classification
Authors: Makino Aiko , Saito Susumu
Published: April 2023

Background:

Postaxial polydactyly of the foot is one of the most common congenital abnormalities. A wide forefoot, short toe, and lateral joint deviation are associated with aesthetic and functional outcomes. This study used the Watanabe–Fujita classification to characterize the pre- and postoperative skeletal morphology of postaxial polydactyly of the foot.

Methods:

This retrospective study included 42 patients (51 feet) with postaxial polydactyly treated at the age of 1 year, and radiographs taken at ages 0 and 3–4 years were used for morphological analysis. The length of the reconstructed toe, the distance between the fourth and fifth metatarsals, and joint deviation angles were measured. The length parameters were standardized using the length of the third metatarsal. Morphological characteristics were compared based on the Watanabe–Fujita classification both at ages 0 and 3–4 years. Long-term outcomes were also evaluated in patients followed up for longer than 6 years.

Results:

The fifth-ray proximal phalangeal subtype had the shortest toe length both at ages 0 and 3–4 years. Proximal phalangeal joint lateral deviation improved postoperatively in 78% of patients with the fifth-ray middle phalangeal subtype, regardless of reconstruction type. There was no significant change in proximal phalangeal joint deviation between ages 3–4 and ≥7 years. A residual metatarsal was associated with lateral metatarsophalangeal joint deviation and a wide intermetatarsal distance, and required revision surgery.

Conclusion:

Morphological changes of postaxial polydactyly of the foot were successfully characterized using the Watanabe–Fujita classification. This classification could be useful for planning surgical strategies and anticipating morphological outcomes.

Level of Evidence:

Level III
In the Age of Social Media, How does the Public Choose a Plastic Surgeon? A Crowdsourcing Analysis of Major Deciding Factors
Authors: Elmer Nicholas A. , Veeramani Anamika , Hassell Natalie , Comer Carly , Manstein Samuel , Shiah Eric , Bustos Valeria , Lin Samuel J
Published: April 2023

Background:

There are many factors patients consider when selecting a plastic surgeon. Previous studies have demonstrated the importance of board certification and reputation in making this decision. Despite this, there is a paucity of knowledge on the role that cost of procedure, social media, and surgeon training factor into the decision-making process.

Methods:

Our study used a population-based survey administered via Amazon Mechanical Turk. Adults 18 years and older and residing in the United States were asked to rank the importance of thirty-six factors from 0 (least important) to 10 (most important) when selecting a plastic surgeon.

Results:

369 responses were analyzed. The mean age of respondents was 36.9 (SD 10.9) and 174 participants (47.2%) were female. Of those surveyed, 216 (55.0%) had previously undergone plastic surgery and all respondents were considering plastic surgery either at the time of survey or in the future. The most common first step respondents would utilize in identifying a plastic surgeon was a web-based search (32.2%). The top three most important factors in selecting a plastic surgeon were surgeon’s experience with the desired procedure (7.48), surgeon’s board certification (7.38), and surgeon’s years in practice (7.36). The three least important factors were the surgeon’s race (5.43), number of social media posts (5.62), and television appearances (5.64).

Conclusion:

Our survey provides insight into the role that different elements play in the decision of selecting a plastic surgeon in the US. Understanding how patients select a plastic surgeon can help surgeons optimize these elements in their practices.
Towards a consensus approach for assessing capsular contracture severity and progression: A systematic review
Authors: Mohan A. S. , Sullivan Janessa , Tenenbaum M.M. , Broderick K.B. , Myckatyn T. M.
Published: April 2023

Background:

Breast implants are the most commonly used medical devices in plastic surgery and capsular contracture is one of the most common complications. Yet, our assessment of capsular contracture is largely based on Baker grade which is problematically subjective and affords only 4 possible values.

Methods:

We performed a systematic review concluding in September 2021 in compliance with preferred reporting items for systematic reviews (PRISMA) guidelines. It identified 19 articles that propose approaches to measuring capsular contracture.

Results:

In addition to Baker’s grade, we identified several modalities reported to measure capsular contracture. These included magnetic resonance imaging, ultrasonography, sonoelastgraphy, mammacompliance measuring devices, applanation tonometry, histologic evaluation, and serology. Capsule thickness and other measures of capsular contracture inconsistently correlated with Baker grade while the presence of synovial metaplasia was consistently associated with Baker grade 1 and 2, but not 3 and 4 capsules.

Conclusions:

There remains no particular method to reliably and specifically measure the contracture of capsules that form around breast implants. As such, we would recommend that for research investigators use more than one modality to measure capsular contracture. Other variables that can impact breast implant stiffness and associated discomfort beyond capsular contracture need to be considered when evaluating patient outcomes. Given the value placed on capsular contracture outcomes in assessing breast implant safety, and the prevalence of breast implants overall, the need for a more reliable approach to measuring this outcome persists.
False-Positive Uptake in Splenic Hemangioma on 68Ga-DOTATATE PET/CT
Authors: Zhu Brian , Yoon Emily , Mahajan Sonia , Kranz Anca-Oana
Published: April 2023

Somatostatin receptor imaging using 68Ga-DOTATATE PET is widely popular for evaluation of neuroendocrine tumors. 68Ga-DOTATATE PET/CT shows highest physiologic uptake in spleen followed by other organs such as kidneys, adrenal glands, and liver. Hemangiomas, although rare, are the most common primary benign neoplasm of the spleen, composed of endothelial-lined vascular channels. We present a case of 77-year-old man who underwent 68Ga-DOTATATE PET/CT scan for evaluation of pancreatic neuroendocrine tumor and incidentally demonstrated intense radiotracer uptake in splenic hemangiomata.
68Ga-FAPI-04 PET/MR Versus 18F-FDG PET/CT in the Detection of Ovarian Cancer
Authors: Sun Gaofeng , Zou Ruoyao , Yao Liangqing , Zuo Changjing
Published: April 2023

A 75-year-old woman presented with right lower abdominal pain. Pelvic ultrasound showed a cystic solid mass in the right adnexa. Painless enlarged lymph nodes on the left supraclavicular side with biopsy were suggestive of metastatic cancer. 18F-FDG PET/CT performed to evaluate the primary tumor showed intense uptake in both regions of the right adnexa and the gastric sinus, but 68Ga-FAPI PET/MRI showed uptake only in the right adnexal region. A subsequent gastroscopic biopsy confirmed atrophic inflammation. Finally, surgery histopathology revealed ovarian cancer. This case demonstrated that 68Ga-FAPI PET/MRI may help exclude suspected primary gastric carcinoma with false-positive 18F-FDG uptake.
Pancreatic Perivascular Epithelioid Cell Tumor Revealed by 68Ga-DOTATATE PET/CT
Authors: Sun Rui , Zeng Guangping , Chen XiaoLiang
Published: April 2023

We report 68Ga-DOTATATE PET/CT findings of pancreatic perivascular epithelioid cell tumor in a 55-year-old woman. 68Ga-DOTATATE PET/CT showed increased radioactivity in the region of pancreatic body, which suggested malignant tumor. However, postoperative pathological findings demonstrated the presence of perivascular epithelioid cell tumor. This case emphasizes the need to increase awareness of this tumor in the differential diagnosis of pancreatic nodules with moderate DOTATATE activity.
Identification of Factors that May Predict Career Trajectory Among Neuro-Ophthalmology Fellows
Authors: Patel Aakash N. , Tian Jing , Henderson Amanda D.
Published: April 2023

Background:

There is modest literature regarding fellowship applicant factors that may predict future career achievement. We aim to characterize neuro-ophthalmology fellows and identify and analyze characteristics that may predict future career trajectory.

Methods:

Data, including demographic information, academic background, scholarly activities, and practice information, were collected using publicly available sources, on individuals who completed neuro-ophthalmology fellowships from 2015 to 2021. Summary statistics describing the cohort were calculated. Prefellowship characteristics were compared with postfellowship characteristics to evaluate which prefellowship characteristics may predict postfellowship academic productivity and career achievement.

Results:

Data were collected on 174 individuals (41.6% men, 58.4% women). Sixty-five percent were residency-trained in ophthalmology, 31% neurology, 1.7% both, and 1.7% pediatric neurology. Fifty-eight percent completed residency in the US, 8% in Canada, 32% internationally, and 2% in multiple locations. Among those practicing in the US/Canada, 63.8% practice at academic centers, 35.3% private practice, and 0.9% at both. Thirty-one percent completed additional subspecialty training and 17.8% additional graduate degrees. Completion of additional fellowship training or graduate degrees, and publication of more papers before fellowship, correlated with later academic productivity. There were no significant correlations between completion of an additional fellowship or graduate degree with current practice environment or attainment of leadership roles. There were no significant correlations between total publishing productivity prefellowship and practice environment or leadership roles postfellowship.

Conclusions:

Additional graduate degrees/subspecialty training, and prefellowship academic productivity, correlated with later academic productivity among neuro-ophthalmologists, suggesting that these metrics may be helpful in predicting future academic performance among fellowship applicants.
Are all forms of defence lost on islands? Persistence of a defensive mutualism in six island colonists from New Zealand
Authors: Biddick M.
Published: April 2023

The loss of defence hypothesis posits that island colonizers experience a release from predation on the mainland and subsequently lose their defensive adaptations. However, while support for the hypothesis from direct defensive traits is abundant, far less is known about indirect defensive traits. Leaf domatia are cave-like structures produced on the underside of leaves that facilitate an indirect defensive interaction with predaceous and microbivorous mites. I tested the loss of defence hypothesis in six domatia-bearing taxa inhabiting New Zealand and its offshore islands. No support for the loss of defence hypothesis was found. Changes in domatia investment were instead associated with changes in leaf size—a trait that has been repeatedly observed to undergo rapid evolution on islands. Overall results suggest that not all types of defence are lost on islands.
Biomechanics of the finger pad in response to torsion
Authors: du Bois de Dunilac Sophie , Córdova Bulens David , Lefèvre Philippe , Redmond Stephen J. , Delhaye Benoit P.
Published: April 2023

Surface skin deformation of the finger pad during partial slippage at finger–object interfaces elicits firing of the tactile sensory afferents. A torque around the contact normal is often present during object manipulation, which can cause partial rotational slippage. Until now, studies of surface skin deformation have used stimuli sliding rectilinearly and tangentially to the skin. Here, we study surface skin dynamics under pure torsion of the right index finger of seven adult participants (four males). A custom robotic platform stimulated the finger pad with a flat clean glass surface, controlling the normal forces and rotation speeds applied while monitoring the contact interface using optical imaging. We tested normal forces between 0.5 N and 10 N at a fixed angular velocity of 20° s
−1
and angular velocities between 5° s
−1
and 100° s
−1
at a fixed normal force of 2 N. We observe the characteristic pattern by which partial slips develop, starting at the periphery of the contact and propagating towards its centre, and the resulting surface strains. The 20-fold range of normal forces and angular velocities used highlights the effect of those parameters on the resulting torque and skin strains. Increasing normal force increases the contact area, the generated torque, strains and the twist angle required to reach full slip. On the other hand, increasing angular velocity causes more loss of contact at the periphery and higher strain rates (although it has no impact on resulting strains after the full rotation). We also discuss the surprisingly large inter-individual variability in skin biomechanics, notably observed in the twist angle the stimulus needs to rotate before reaching full slip.
Self-consistent Sierpinski iteration of toughening mechanism in elastomer undergoing scaled segment-chain-network
Authors: Xing Ziyu , Lu Haibao , Fu Yong-Qing
Published: April 2023

Understanding working principles and toughening mechanisms of soft elastomers has been a huge challenge due to their significant scaling effects from molecules to bulk polymer. In this study, by combining Sierpinski fractal and scaling theory, an extended Kelvin model is developed to investigate the mechanical behaviour of the soft elastomer undergoing scaled segment-chain-network. According to the scaling theory, a radial distribution function was initially introduced to explain the diffusion and relaxation behaviours of molecular segments with the Sierpinski fractal features. The self-consistent iteration of the Sierpinski fractal is then used to describe the scaling effects of segments and networks. Rubber elasticity of the polymer network is further formulated based on the self-consistent iteration equation and scaling theory. A constitutive stress–strain relationship is also derived to explore the toughness mechanism and working principle in the polymer elastomer. Finally, the effectiveness of the proposed model is verified using finite-element analysis and experimental results reported in the literature, to explore a scaling insight into toughening mechanisms of elastomers governed by the self-consistent Sierpinski iteration.