bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnesium promotes tea plant growth via enhanced glutamine synthetase-mediated nitrogen assimilation
Authors: Zhang Qunfeng , Shi Yutao , Hu Hao , Shi Yuanzhi , Tang Dandan , Ruan Jianyun , Fernie Alisdair R , Liu Mei-Ya
Published: March 2023

Acidic tea (Camellia sinensis) plantation soil usually suffers from magnesium (Mg) deficiency, and as such, application of fertilizer containing Mg can substantially increase tea quality by enhancing the accumulation of nitrogen (N)-containing chemicals such as amino acids in young tea shoots. However, the molecular mechanisms underlying the promoting effects of Mg on N assimilation in tea plants remain unclear. Here, both hydroponic and field experiments were conducted to analyze N, Mg, metabolite contents, and gene expression patterns in tea plants. We found that N and amino acids accumulated in tea plant roots under Mg deficiency, while metabolism of N was enhanced by Mg supplementation, especially under a low N fertilizer regime. 15N tracing experiments demonstrated that assimilation of N was induced in tea roots following Mg application. Furthermore, weighted gene correlation network analysis (WGCNA) analysis of RNA-seq data suggested that genes encoding glutamine synthetase isozymes (CsGSs), key enzymes regulating N assimilation, were markedly regulated by Mg treatment. Overexpression of CsGS1.1 in Arabidopsis (Arabidopsis thaliana) resulted in a more tolerant phenotype under Mg deficiency and increased N assimilation. These results validate our suggestion that Mg transcriptionally regulates CsGS1.1 during the enhanced assimilation of N in tea plant. Moreover, results of a field experiment demonstrated that high Mg and low N had positive effects on tea quality. This study deepens our understanding of the molecular mechanisms underlying the interactive effects of Mg and N in tea plants while also providing both genetic and agronomic tools for future improvement of tea production.
Photoaging of polystyrene microspheres causes oxidative alterations to surface physicochemistry and enhances airway epithelial toxicity
Authors: El Hayek Eliane , Castillo Eliseo , In Julie G , Garcia Marcus , Cerrato Jose , Brearley Adrian , Gonzalez-Estrella Jorge , Herbert Guy , Bleske Barry , Benavidez Angelica , Hsiao Hsuan , Yin Lei , Campen Matthew J , Yu Xiaozhong
Published: March 2023

Microplastics represent an emerging environmental contaminant, with large gaps in our understanding of human health impacts. Furthermore, environmental factors may modify the plastic chemistry, further altering the toxic potency. Ultraviolet (UV) light is one such unavoidable factor for airborne microplastic particulates and a known modifier of polystyrene surface chemistry. As an experimental model, we aged commercially available polystyrene microspheres for 5 weeks with UV radiation, then compared the cellular responses in A549 lung cells with both pristine and irradiated particulates. Photoaging altered the surface morphology of irradiated microspheres and increased the intensities of polar groups on the near-surface region of the particles as indicated by scanning electron microscopy and by fitting of high-resolution X-ray photoelectron spectroscopy C 1s spectra, respectively. Even at low concentrations (1–30 µg/ml), photoaged microspheres at 1 and 5 µm in diameter exerted more pronounced biological responses in the A549 cells than was caused by pristine microspheres. High-content imaging analysis revealed S and G2 cell cycle accumulation and morphological changes, which were also more pronounced in A549 cells treated with photoaged microspheres, and further influenced by the size, dose, and time of exposures. Polystyrene microspheres reduced monolayer barrier integrity and slowed regrowth in a wound healing assay in a manner dependent on dose, photoaging, and size of the microsphere. UV-photoaging generally enhanced the toxicity of polystyrene microspheres in A549 cells. Understanding the influence of weathering and environmental aging, along with size, shape, and chemistry, on microplastics biocompatibility may be an essential consideration for incorporation of different plastics in products.
Effect of Laryngoscope Blade Size on First Pass Success of Tracheal Intubation in Critically Ill Adults
Authors: Landefeld Kevin R. , Koike Seiji , Ran Ran , Semler Matthew W. , Barnes Christopher , Stempek Susan B. , Janz David R. , Rice Todd W. , Russell Derek W. , Self Wesley H. , Vonderhaar Derek , West Jason R. , Casey Jonathan D. , Khan Akram ,   for the Pragmatic Critical Care Research Group
Published: March 2023

OBJECTIVES:

Tracheal intubation (TI) is a common procedure in critical care, often performed with a Macintosh curved blade used for direct laryngoscopy (DL). Minimal evidence informs the choice between Macintosh blade sizes during TI. We hypothesized that Macintosh 4 blade would have higher first-attempt success than Macintosh 3 blade during DL.

DESIGN:

Retrospective analysis using a propensity score and inverse probability weighting of data from six prior multicenter randomized trials.

SETTING AND PARTICIPANTS:

Adult patients who underwent nonelective TI at participating emergency departments and ICUs. We compared the first-pass success of TI with DL in subjects intubated with a size 4 Macintosh blade on the first TI attempt to subjects with a size 3 Macintosh blade on the first TI attempt.

MAIN RESULTS:

Among 979 subjects, 592 (60.5%) had TI using DL with a Macintosh blade, of whom 362 (37%) were intubated with a size 4 blade and 222 (22.7%) with a size 3 blade. We used inverse probability weighting with a propensity score for analyzing data. We found that patients intubated with a size 4 blade had a worse (higher) Cormack-Lehane grade of glottic view than patients intubated with a size 3 blade (adjusted odds ratio [aOR], 1.458; 95% CI, 1.064–2.003; p = 0.02). Patients intubated with a size 4 blade had a lower first pass success than those with a size 3 blade (71.1% vs 81.2%; aOR, 0.566; 95% CI, 0.372–0.850; p = 0.01).

CONCLUSIONS AND RELEVANCE:

In critically ill adults undergoing TI using DL with a Macintosh blade, patients intubated using a size 4 blade on first attempt had a worse glottic view and a lower first pass success than patients intubated with a size 3 Macintosh blade. Further prospective studies are needed to examine the optimal approach to selecting laryngoscope blade size during TI of critically ill adults.
Moral Orientation, Moral Decision-Making, and Moral Distress Among Critical Care Physicians: A Qualitative Study
Authors: Piquette Dominique , Burns Karen E. A. , Carnevale Franco , Sarti Aimée J. , Hamilton Mika , Dodek Peter M.
Published: March 2023

IMPORTANCE:

Moral distress is common among critical care physicians and can impact negatively healthcare individuals and institutions. Better understanding inter-individual variability in moral distress is needed to inform future wellness interventions.

OBJECTIVES:

To explore when and how critical care physicians experience moral distress in the workplace and its consequences, how physicians’ professional interactions with colleagues affected their perceived level of moral distress, and in which circumstances professional rewards were experienced and mitigated moral distress.

DESIGN:

Interview-based qualitative study using inductive thematic analysis.

SETTING AND PARTICIPANTS:

Twenty critical care physicians practicing in Canadian ICUs who expressed interest in participating in a semi-structured interview after completion of a national, cross-sectional survey of moral distress in ICU physicians.

RESULTS:

Study participants described different ways to perceive and resolve morally challenging clinical situations, which were grouped into four clinical moral orientations: virtuous, resigned, deferring, and empathic. Moral orientations resulted from unique combinations of strength of personal moral beliefs and perceived power over moral clinical decision-making, which led to different rationales for moral decision-making. Study findings illustrate how sociocultural, legal, and clinical contexts influenced individual physicians’ moral orientation and how moral orientation altered perceived moral distress and moral satisfaction. The degree of dissonance between individual moral orientations within care team determined, in part, the quantity of “negative judgments” and/or “social support” that physicians obtained from their colleagues. The levels of moral distress, moral satisfaction, social judgment, and social support ultimately affected the type and severity of the negative consequences experienced by ICU physicians.

CONCLUSIONS AND RELEVANCE:

An expanded understanding of moral orientations provides an additional tool to address the problem of moral distress in the critical care setting. Diversity in moral orientations may explain, in part, the variability in moral distress levels among clinicians and likely contributes to interpersonal conflicts in the ICU setting. Additional investigations on different moral orientations in various clinical environments are much needed to inform the design of effective systemic and institutional interventions that address healthcare professionals’ moral distress and mitigate its negative consequences.
The Christian Nurse's Role in Antibiotic Stewardship
Authors: Van Lonkhuyzen Catherine L. , Decker Tina , Carlson Clay
Published: March 2023

Antibiotic resistance is a growing health threat globally. Nurses can play key roles in combatting antibiotic resistance through participation in antibiotic stewardship programs and educating colleagues, other healthcare professionals, and the public. Improved education is necessary for nurses and healthcare institutions to effectively improve antibiotic use and reduce resistant organisms. Biblical elements of stewardship are described in this article.
Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery
Authors: Jonker Philip , van den Heuvel Sander , Hoeks Sanne , Heijkoop Èmese , Stolker Robert-Jan , Korstanje Jan-Wiebe
Published: March 2023

BACKGROUND

The design of the optimal preoperative evaluation is a much debated topic, with the anaesthetist-led in-person evaluation being most widely used. This approach is possibly leading to overuse of a valuable resource, especially in low-risk patients. Without compromising patient safety, we hypothesised that not all patients would require this type of elaborate evaluation.

OBJECTIVE

The current scoping review aims to critically appraise the range and nature of the existing literature investigating alternatives to the anaesthetist-led preoperative evaluation and their impact on outcomes, to inform future knowledge translation and ultimately improve perioperative clinical practice.

DESIGN

A scoping review of the available literature.

DATA SOURCES

Embase, Medline, Web-of-Science, Cochrane Library and Google Scholar. No date restriction was used.

ELIGIBILITY CRITERIA

Studies in patients scheduled for elective low-risk or intermediate-risk surgery, which compared anaesthetist-led in-person preoperative evaluation with non-anaesthetist-led preoperative evaluation or no outpatient evaluation. The focus was on outcomes, including surgical cancellation, perioperative complications, patient satisfaction and costs.

RESULTS

Twenty-six studies with a total of 361 719 patients were included, reporting on various interventions: telephone evaluation, telemedicine evaluation, evaluation by questionnaire, surgeon-led evaluation, nurse-led evaluation, other types of evaluation and no evaluation up to the day of surgery. Most studies were conducted in the United States and were either pre/post or one group post-test-only studies, with only two randomised controlled trials. Studies differed largely in outcome measures and were of moderate quality overall.

CONCLUSIONS

A number of alternatives to the anaesthetists-led in-person preoperative evaluation have already been researched: that is telephone evaluation, telemedicine evaluation, evaluation by questionnaire and nurse-led evaluation. However, more high-quality research is needed to assess viability in terms of intraoperative or early postoperative complications, surgical cancellation, costs, and patient satisfaction in the form of Patient-Reported Outcome Measures and Patient-Reported Experience Measures.
The Relative Citation Ratio: A Modern Approach to Assessing Academic Productivity within Plastic Surgery
Authors: Didzbalis Christopher James , Avery Cohen David , Herzog Isabel , Park John , Weisberger Joseph , Lee Edward S.
Published: March 2023

Background:

The accurate assessment of physician academic productivity is paramount and is frequently included in decisions for promotion and tenure. Current metrics such as h-index have been criticized for being biased toward older researchers and misleading. The relative citation ratio (RCR) is a newer metric that has been demonstrated within other surgical subspecialties to be a superior means of measuring academic productivity. We sought to demonstrate that RCR is a valid means of assessing academic productivity among plastic surgeons, and to determine demographic factors that are associated with higher RCR values.

Methods:

All Accreditation Council for Graduate Medical Education-accredited plastic and reconstructive surgery residency programs and faculty throughout the United States were compiled from the American Council of Academic Plastic Surgeons website. Demographic information was obtained for each surgeon via the program’s website, and RCR data were obtained utilizing iCite, a bibliometrics tool provided by the National Institutes of Health. Surgeons were excluded if any demographic or RCR data were unavailable.

Results:

A total of 785 academic plastic surgeons were included in this analysis. Surgeons who belonged to departments with more than six members had a higher median RCR (1.23). Increasing academic rank (assistant: 12.27, associate: 24.16, professor: 47.58), chief/chairperson status (47.58), male gender (25.59) and integrated model of residency training program (24.04) were all associated with higher median weighted RCR.

Conclusions:

RCR is a valid metric for assessing plastic surgeon academic productivity. Further research is warranted in assessing disparities among different demographics within academic plastic surgery.
Demystifying Small Concha-type Microtia: Advancements in Classification and Surgical Approach
Authors: Chwa Emily S. , Laub Peter J. , Yamada Akira
Published: March 2023

The accurate identification of microtia type is foundational to preoperative planning and intraoperative strategies for auricular reconstruction using an autologous costal cartilage framework. Although the repair of lobule type microtia has similarities to that of small concha-type, the latter has specific nuances that must be considered to optimize functional and aesthetic outcomes. The article describes the senior author’s advancements in repair of all microtia types: use of an “auricular rectangle” to determine ideal ear placement, W-flap manipulation for vestige transposition, and skin trimming. The additional focus on small concha-type microtia addresses common errors in identification and reconstruction of the conchal bowl.
SPINE: An Initiative to Reduce Pressure Sore Recurrence
Authors: Brown Amanda L. , Hassanein Aladdin H. , Gabriel Keith , Mailey Brian A.
Published: March 2023

The recurrence rate after pressure sore reconstruction remains high. Primary inciting factors can be organized into efforts aimed at wound prevention: spasticity relief, pressure off-loading, infection and contamination prevention, nutrition optimization, and maximizing extremity function. This article presents our detailed protocol, SPINE, to address each inciting factor with a summary of cases at our facility and review best practices from evidence-based medicine in the literature.
Sensory Symptoms Associated with Aesthetic Botulinum Toxin A Treatments
Authors: Corduff Niamh
Published: March 2023

Background:

A retrospective review of patients who switched from onabotulinumtoxinA (onaA) and/or abobotulinumtoxinA (aboA) to incobotulinumtoxinA (incoA) found anecdotal reports of differences in “feel,” including a “lighter” feel or treatment-associated tightness. We surveyed the frequency of these sensations as an initial proof of concept of toxin proprioception among our patients who switched toxins.

Methods:

Seventy-nine patients who had past facial aesthetic treatments with more than one botulinum toxin A (BoNT/A) formulation completed a questionnaire on their experience of treatment-associated sensations, including stiffness or a frozen feeling.

Results:

Treatment-associated sensations of tightness (47.3%), headache (41.8%), heaviness (38.2%), feeling frozen (29.1%), stiffness (20.0%), and weakness (20.0%) were reported by 55 of 79 patients. Furthermore, 78.2% of 55 patients noted an interformulation sensory difference. Of 79 patients surveyed, 68.4% of onaA-treated patients associated sensations with onaA, 39.1% of aboA-treated patients associated sensations with aboA, and 12.2% of incoA-treated patients associated sensations with incoA.

Conclusions:

Some patients reported a different feel between toxins, and the difference in frequency of treatment-associated sensation varies between the different formulations used. Given the fine coordination of facial expressive muscles, we suspect that associated proprioceptive afferents are involved. Our findings confirm that post-toxin treatment-associated sensations can be detected by some patients, and this is likely due to the variations between the formulations. Failing to advise patients of this before switching formulations may cause a misperception that the treatment is not working well or that its effect has worn off prematurely, and some patients may consider switching formulations to reduce these conscious proprioceptive sensations.
Validating a Novel Device to Improve Skin Color Matching for Face Transplants
Authors: Gornitsky Jordan , Saleh Eli , Bouhadana Gabriel , Borsuk Daniel E.
Published: March 2023

Introduction:

Facial vascularized composite allotransplantation (VCA) offers an added layer of complexity when compared to solid organ transplantation. VCAs must account for aesthetic variables such as skin tone and color. The goal of this study is to validate the Nix Color Sensor as a novel tool to be added to the plastic surgeon’s armamentarium for evaluating skin color match of the donor and recipient.

Methods:

A prospective study of 100 individuals was conducted. All participants were photographed and scanned with the Nix Color Sensor. Sixty pairwise comparisons were randomly generated. Skin color analysis was performed using photographs and the Nix Color Sensor. Delta E2000 values were compared to mean evaluator ratings using a Spearman correlation analysis.

Results:

One hundred patients were included. A Spearman’s correlation demonstrated a strong inverse correlation between Delta E2000 values and the mean evaluator ratings. The higher the mean evaluator rating for likeness, the lower the delta. A correlation coefficient of −0.850 demonstrates a statistically significant relationship (P < 0.01).

Conclusions:

When the Delta E2000 rises above 5 there is a significant drop in the mean evaluator ratings. As mean evaluator ratings of 5 and above would be considered adequate for face transplant amongst most plastic surgeons, an E2000 value of 5 or lower should be targeted when matching donors with recipients for face transplant. The Nix Color Sensor positively correlates to the plastic surgeon’s perception of skin color and can serve as an adjunct in donor selection for facial VCAs.
Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis
Authors: Bloom Joshua A. , Granoff Melisa , Karlsson Tobias , Greene Arin K. , Brorson Håkan , Chatterjee Abhishek , Singhal Dhruv
Published: March 2023

Background:

Lymphedema is a chronic, debilitating disease that has been described as the largest breast cancer survivorship burden. Debulking surgery has been shown to improve extremity volume, improve patient quality of life, and decrease the incidence of cellulitis in the literature. This procedure is routinely covered in numerous other developed countries, yet it is still inconsistently covered in the United States.

Methods:

Extremity volumes from all patients who underwent debulking surgery of the upper extremity at two institutions between December 2017 and January 2020 with at least 12 months follow-up were included. Procedural costs were calculated using Medicare reimbursement data. Average utility scores were obtained for each health state using a visual analog scale, then converted to quality-adjusted life years. A decision tree was generated, and incremental cost-utility ratios were calculated. Sensitivity analyses were performed to evaluate our findings.

Results:

Debulking surgery is associated with a higher clinical effectiveness (quality-adjusted life year) of 27.05 compared to conservative management (23.34), with a relative cost reduction of $74,487. Rollback analysis favored debulking surgery as the cost-effective option compared to conservative management. The resulting negative incremental cost-utility ratio of −20,115.07 favored debulking surgery and indicated a dominant strategy.

Conclusion:

Our study supports the use of debulking surgery for the treatment of chronic lymphedema of the upper extremity.
Keller Funnel Efficacy in “No Touch” Breast Augmentation and Reconstruction: A Systematic Review
Authors: Morkuzu Suat , Ozdemir Mehmet , Leach Garrison A. , Kanapathy Muholan , Mosahebi Afshin , Reid Chris M.
Published: March 2023

Background:

Breast augmentation is one of the most common aesthetic surgical procedures. Tissue expansion followed by permanent implants is the most frequent postmastectomy breast reconstruction method. Implant contamination remains a critical problem with these procedures‚ resulting in acute infection as well as capsular contracture. To reduce the risk of implant contamination, the “no-touch technique” utilizing the Keller funnel has been adopted by many surgeons. This systematic review aims to investigate the advantages of the Keller funnel method for breast augmentation–reconstruction.

Methods:

A systematic review of PubMed, Embase, the Cochrane database, and Google Scholar was performed between 2005 and 2021. All clinical-based, retrospective and prospective studies utilizing the Keller funnel method for breast implant insertion were selected.

Results:

Six studies were identified for evaluation: five were retrospective cohorts and one was a prospective trial. No randomized controlled trials were found. Outcomes reported included lower rates of capsular contracture (RR, 0.42; P = 0.0006; 95% CI, 0.25–0.69), shorter incision lengths (35.5 ± 2.1 mm), less insertion time (mean = 6 seconds), and decreased complications, and one paper reported ultimately greater patient satisfaction with outcomes (BREAST-Q Score: 92%).

Conclusions:

This review suggests that the Keller funnel is a useful method for no-touch breast augmentation and reconstruction surgery. The Keller funnel reduces subsequent capsular contracture rate, surgical time, and incision length and allows for easier insertion. However, our findings support recommendation of a prospective randomized controlled clinical trial with larger population size and follow-up intervals.
The Virtual Interview Experience: Advantages, Disadvantages, and Trends in Applicant Behavior
Authors: Steele Thomas N. , Prabhu Shamit S. , Layton Ryan G. , Runyan Christopher M. , David Lisa R.
Published: March 2023

Introduction:

Residency programs and applicants were forced to hold virtual interviews during the 2020–2021 application cycle. Inability to evaluate a program and/or applicant in person has intangible drawbacks. However, there are obvious advantages: cost, convenience, and comfort. Do the advantages outweigh the disadvantages? How have applicant behaviors changed to learn about programs in a virtual-only interview process?

Methods:

A survey was distributed to 302 applicants to a single plastic surgery residency program during the 2020 application cycle. Demographics, social media presence and utilization, and experience with the virtual application and interview process were analyzed. A 2018 survey from our institution was compared with a subset of questions for longitudinal analysis.

Results:

Seventy-six respondents (25.2%) completed the survey. Most applicants (88.2%) spent less than $1000 during the interview and application cycle. Over half (56.6%) did not receive letters of recommendation from outside their home program. A significant minority (27.6%) of applicants attended more than one interview in a single day. Compared to 2018, applicants in 2021 were significantly more likely to access alternative digital resources (forums/discussion boards, social media, and podcasts) when learning about programs. Average number of interviews remains in the range of pre-COVID studies, but the percentage of interviews attended increased.

Conclusions:

Applicants spent substantially less money on interviews and relied on alternative digital sources to learn about residency programs. This study objectively quantifies the advantages of virtual interviews. Disadvantages include inability to assess “fit” and lack of nonverbal communication.
Myofibroblasts Are Not Characteristic Features of Keloid Lesions
Authors: Hahn Jennifer M. , McFarland Kevin L. , Combs Kelly A. , Powell Heather M. , Supp Dorothy M.
Published: March 2023

Background:

Keloids are disfiguring, scar-like lesions that are challenging to treat, with low response rates to current interventions and frequent recurrence. It has been widely reported that keloids are characterized by myofibroblasts, specialized contractile fibroblasts that express alpha-smooth muscle actin (α-SMA). However, evidence supporting a role for myofibroblasts in keloid pathology is inconclusive, with conflicting reports in the literature. This complicates development of more effective therapies, as the benefit of interventions targeting myofibroblasts is unclear. This study was undertaken to determine whether myofibroblasts can be considered characteristic of keloids.

Methods:

Myofibroblasts in tissue sections from keloids, hypertrophic scars (HTSs), and normal skin were localized by α-SMA immunostaining. Expression of α-SMA mRNA (ACTA2 gene) in normal skin and keloid tissue, and in fibroblasts from normal skin, keloid, and HTSs, was measured using quantitative polymerase chain reaction.

Results:

Normal skin did not exhibit α-SMA-expressing myofibroblasts, but myofibroblasts were identified in 50% of keloids and 60% of HTSs. No significant differences in ACTA2 expression between keloid and normal skin tissue were observed. Mean ACTA2 expression was higher in HTS (2.54-fold, P = 0.005) and keloid fibroblasts (1.75-fold, P = 0.046) versus normal fibroblasts in vitro. However, α-SMA expression in keloids in vivo was not associated with elevated ACTA2 in keloid fibroblasts in vitro.

Conclusions:

Despite elevated ACTA2 in cultured keloid fibroblasts, myofibroblast presence is not a consistent feature of keloids. Therefore, therapies that target myofibroblasts may not be effective for all keloids. Further research is required to define the mechanisms driving keloid formation for development of more effective therapies.
How to Create an Exceptional Hand Surgery Patient Experience with WALANT
Authors: Brutus Jean Paul , Lalonde Donald H.
Published: March 2023

This article provides practical tips that surgeons can use to improve their patient experience with wide awake local anesthesia no tourniquet hand surgery. The difference between patient satisfaction and patient experience is explained. Delivering a superior patient experience leads to better outcomes for patients, less postoperative complications, and a better quality of life and practice for the surgeon. Practical tips are presented, broken down into the preoperative, operative, and postoperative phases. Surgeons who commit to improving their patient experience will enjoy superior outcomes, patient loyalty, more fulfillment, and a rejuvenated sense of purpose.
A Case of Multiple Radiation-related Complications during Long-term Follow-up after Sacral Ulcer Surgery
Authors: Miyata Riyo , Wada Takuya , Nashihara Sakuka , Kanagawa Saori , Kuwahara Masamitsu
Published: March 2023

We report the clinical course of a patient who developed a sacral radiation ulcer 19 years after treatment for cervical cancer. The patient’s postoperative course after a free latissimus dorsi muscle flap transfer was favorable, but various late radiation complications, including rectal perforation, a rectal fistula, sacral necrosis, a rectointestinal fistula, and sacroiliac joint osteomyelitis, occurred within 11 years. Plastic surgeons who treat such ulcers need to know that patients may develop other serious radiation-related complications. Being aware of these complications will allow appropriate measures to be taken and aid decisions regarding future surgical strategies. More careful assessment of sacral necrosis and bone resection may have ameliorated some of the complications. When encountering similar patients, we believe that careful magnetic resonance imagery (MRI) and intraoperative evaluation are warranted, as sacral necrosis may be detectable in some patients.
Simultaneous Salvage Auto-augmentation: Contemporary Strategy for Management of the Breast Explantation Patient
Authors: Kirwan Laurence , Wazir Umar , Mokbel Kefah
Published: March 2023

Background:

The treatment of patients requiring explantation of breast prostheses is a complicated clinical issue, for which a consensus regarding the best way forward is still evolving. We believe that simultaneous salvage auto-augmentation (SSAA) is a viable option for the treatment of patients with explantation.

Methods:

Sixteen cases (32 breasts) were reviewed over a 19-year period. The management of the capsule is based on intraoperative findings and not on preoperative evaluation because of the poor interobserver correlation of Baker grades.

Results:

The mean age and clinical follow-up duration were 48 years (range: 41–65) and 9 months, respectively. We observed no complications, and only one patient underwent unilateral surgical revision of the periareolar scar, under local anaesthesia.

Conclusions:

This study suggests that SSAA with or without autologous fat injection is a safe option for women undergoing explantation, with potential aesthetic and cost-saving benefits. In the current climate of public anxiety regarding breast implant illness, breast implant-associated atypical large cell lymphoma, and asymptomatic textured implants, it is anticipated that the number of patients desiring explantation and SSAA will continue to increase.
Standing on the shoulders of bias: lack of transparency and reporting of critical rigor characteristics in pain research
Authors: Plumb Ashley N. , Lesnak Joseph B. , Berardi Giovanni , Hayashi Kazuhiro , Janowski Adam J. , Smith Angela F. , Bailey Dana , Kerkman Cassie , Kienenberger Zoe , Martin Ben , Patterson Ethan , Van Roekel Hannah , Vance Carol G.T. , Sluka Kathleen A.
Published: March 2023

Rigorous experimental design with transparent reporting in biomedical science reduces risk of bias and allows for scientists to judge the quality of the research. Basic factors of rigor such as blinding, randomization, power analysis, and inclusion of both sexes impact the reproducibility by reducing experimental bias. We designed a systematic study to analyze basic factors of rigor, inclusion of sex, and whether data were analyzed or disaggregated by sex over the past 10 years in the journal PAIN. Studies that included humans reported randomization in 81%, blinding in 48%, and the use of a power analysis calculation in 27% over the past 10 years. Studies that included mice reported randomization in 35%, blinding in 70%, and the use of a power analysis in 9%. Studies that included rats reported randomization in 38%, blinding in 63%, and the use of power analysis in 12%. This study also found that human studies consistently included both sexes over the past decade, but less than 20% of data were disaggregated or analyzed for sex differences. Although mouse and rat studies predominately used males only, there has been a slight increase in inclusion of both sexes over the past few years. Justification for single-sex studies was below 50% in both human and rodent data. In both human and animal studies, transparency in reporting of experimental design and inclusion of both sexes should be considered standard practice and will result in improved quality and reproducibility of published research.
Victim-Centered Care Among College Women of Color
Authors: Gepshtein Yana , Burton Candace W.
Published: March 2023

Aims

Women of color are disproportionally affected by intimate partner violence (IPV) and sexual assault (SA), and those on college campuses may have additional risk factors. The purpose of this study was to explore how college-affiliated women of color assign meaning to their interaction with individuals, authorities, and organizations tasked to help survivors of SA and IPV.

Methods

Semistructured focus group interviews (N = 87) were transcribed and analyzed using Charmaz's constructivist grounded theory methodology.

Results

Three priority theoretical elements were identified: what hurts, namely, distrust, uncertain outcomes, and silencing of experiences; what helps, namely, support, autonomy, and safety; and desired outcomes, namely, academic progress, supportive social networks, and self-care.

Conclusion

Participants were concerned about uncertain outcomes of their interaction with organizations and authorities that are set to help victims. Results can inform forensic nurses and other professionals about the care priorities and needs of college-affiliated women of color in the context of IPV and SA.
The PHF21A neurodevelopmental disorder: an evaluation of clinical data from 13 patients
Authors: Poole Rebecca L. , Bijlsma Emilia K. , Houge Gunnar , Jones Gabriela , Mikštienė Violeta , Preikšaitienė Eglė , Thompson Louise , Tatton-Brown Katrina
Published: March 2023

Potocki–Shaffer syndrome (PSS) is a rare neurodevelopmental disorder caused by deletions involving the 11p11.2-p12 region, encompassing the plant homeodomain finger protein 21A (PHF21A) gene. PHF21A has an important role in epigenetic regulation and PHF21A variants have previously been associated with a specific disorder that, whilst sharing some features of PSS, has notable differences. This study aims to expand the phenotype, particularly in relation to overgrowth, associated with PHF21A variants. Analysis of phenotypic data was undertaken on 13 individuals with PHF21A constitutional variants including four individuals described in the current series. Of those individuals where data were recorded, postnatal overgrowth was reported in 5/6 (83%). In addition, all had both an intellectual disability and behavioural issues. Frequent associations included postnatal hypotonia (7/11, 64%); and at least one afebrile seizure episode (6/12, 50%). Although a recognizable facial gestalt was not associated, subtle dysmorphic features were shared amongst some individuals and included a tall broad forehead, broad nasal tip, anteverted nares and full cheeks. We provide further insight into the emerging neurodevelopmental syndrome associated with PHF21A disruption. We present some evidence that PHF21A might be considered a new member of the overgrowth-intellectual disability syndrome (OGID) family.
Population Health
Authors: Harrington Susan A.
Published: March 2023

Background:

Nursing education is engaged in efforts to respond and adapt to the dynamic fluctuations of health care in the United States. Population health has been revived in this venue of health care involvement in the community and social determinants of health.

Purpose:

The purpose of the study was to define population health and identify topics to include in the undergraduate curriculum, teaching strategies, and skills and competencies needed by new nurses for implementation of population health to improve health outcomes.

Methods:

The study had a mixed-methods design with a survey and an interview distributed to public/community health faculty across the United States.

Results:

Extensive population health topics were suggested for the curriculum, but a significant lack of a structured framework and consistent concepts was noted.

Conclusions:

Topics identified in the survey and through the interviews are illustrated in the tables. These will assist in integrating and scaffolding population health throughout a nursing curriculum.
Baker-IV capsular contracture is correlated with an increased amount of silicone material: an intra-patient study.
Authors: de Bakker Erik , Zada Liron , Schmidt Robert W. , van Haasterecht Ludo , Vethaak A. Dick , Ariese Freek , Dijkman Henry B.P.M. , Bult Peter , Gibbs Susan , Niessen Frank B.
Published: March 2023

Background:

Breast implant surgery is one of the most frequently performed procedures by plastic surgeons worldwide. However, the relationship between silicone leakage and the most common complication, capsular contracture, is far from understood. This study aimed to compare Baker-I with Baker-IV capsules regarding their silicone content in an intra-donor setting, using two previously validated imaging techniques.

Methods:

Twenty-two donor-matched capsules from eleven patients experiencing unilateral complaints were included after bilateral explantation surgery. All capsules were examined using both Stimulated Raman Scattering (SRS) imaging and staining with Modified Oil Red O (MORO). Evaluation was done visually for qualitative and semi-quantitative assessment and automated for quantitative analysis.

Results:

Using both SRS and MORO techniques, silicone was found in more Baker-IV capsules (8/11 and 11/11, respectively) than in Baker-I capsules (3/11 and 5/11, respectively). Baker-IV capsules also showed significantly more silicone content compared to the Baker-I capsules. This was true for semi-quantitative assessment for both SRS and MORO techniques (p=0.019 and p=0.006, respectively), while quantitative analysis proved to be significant for MORO alone (p=0.026 vs. p=0.248 for SRS).

Conclusions:

In this study, a significant correlation between capsule silicone content and capsular contracture is shown. An extensive and continued foreign body response to silicone particles is likely to be responsible. Considering the widespread use of silicone breast implants these results affect many women worldwide and warrant a more focused research effort.
Difference in the occurrence of capsular contracture according to the characteristics of the tissue in an irradiated rat model
Authors: Kim Hyung Bae , Han Hyun Ho , Eom Jin Sup
Published: March 2023

Background:

In this study, it was hypothesized that the capsule formation varies according to the radiation dose in the muscle tissues; chest wall tissues, including the ribs; and acellular dermal matrices (ADM) that are in contact with the silicone implant.

Methods:

This study consisted of 20 SD rats that underwent submuscular plane implant reconstruction using ADM. They were divided into four groups: Group 1 as the un-radiated control (n = 5), Group 2 with non-fractionated radiation at a dose of 10 Gy (n = 5), Group 3 with non-fractionated radiation at a dose of 20 Gy (n = 5), and Group 4 with fractionated radiation at a dose of 35 Gy (n = 5). Three months after surgery, hardness was measured. Moreover, the histology and immunochemistry of the capsule tissues of the ADM, muscle tissues, and chest wall tissues were analyzed.

Results:

As the radiation dose increased, the silicone implant became harder. But no significant difference in capsule thickness according to the radiation dose was observed. Based on the tissue in contact with the silicone implant, ADM has a thinner capsule thickness than the muscle tissues and less inflammation as well as less neovascularization compared with the other tissues.

Conclusions:

This study described a new rat model of clinically relevant implant-based breast reconstruction using a submuscular plane and ADM with irradiation. Therefore, it was confirmed that the ADM in contact with the silicone implant, even after irradiation, was protected from radiation compared with the other tissues.
Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Upper Limb Trauma
Authors: Sivagurunathan Gayathri , Shirodkar Kapil , Hegde Ganesh , Shamshuddin Sameer , Proctor Robin , Naqvi Jawad , Knowles David , Ali Imran
Published: March 2023

There is increasing reliance on computed tomography to evaluate fractures and dislocations following routine evaluation with plain radiography, critical in preoperative planning; computed tomography can provide multiplanar reformats and 3-dimensional volume-rendered imaging, providing a better global assessment for the orthopedic surgeon. The radiologist plays a critical role in appropriately reformatting the raw axial images to illustrate best the findings that will help determine further management. In addition, the radiologist must succinctly report the pertinent findings that will have the most significant bearing on treatment, assisting the surgeon in deciding between nonoperative and operative management. The radiologist should also carefully review imaging to look for ancillary findings in the setting of trauma beyond the bones and joints, including the lungs and rib cage when visualized.

In this review article, we will systematically describe key features for fractures of the scapula, proximal humerus, distal humerus, radial head and neck, olecranon, coronoid process through a case-based approach, and distal radius. Although there are numerous detailed classification systems for each of these fractures, we aim to focus on the core descriptors that underpin these classification systems. The goal is to provide the radiologist with a checklist of critical structures they must assess and findings that they should mention in their report, emphasizing those descriptors that influence patient management.
Importance of Age and Noncontrast-Enhancing Tumor as Biomarkers for Isocitrate Dehydrogenase–Mutant Glioblastoma: A Multicenter Study
Authors: Uetani Hiroyuki , Azuma Minako , Khant Zaw Aung , Watanabe Yoshiyuki , Kudo Kohsuke , Kadota Yoshihito , Yokogami Kiyotaka , Takeshima Hideo , Kuroda Jun-Ichiro , Shinojima Naoki , Hamasaki Tadashi , Mukasa Akitake , Hirai Toshinori
Published: March 2023

Purpose

This study aimed to investigate the most useful clinical and magnetic resonance imaging (MRI) parameters for differentiating isocitrate dehydrogenase (IDH)-mutant and -wildtype glioblastomas in the 2016 World Health Organization Classification of Tumors of the Central Nervous System.

Methods

This multicenter study included 327 patients with IDH-mutant or IDH-wildtype glioblastoma in the 2016 World Health Organization classification who preoperatively underwent MRI. Isocitrate dehydrogenase mutation status was determined by immunohistochemistry, high-resolution melting analysis, and/or IDH1/2 sequencing. Three radiologists independently reviewed the tumor location, tumor contrast enhancement, noncontrast-enhancing tumor (nCET), and peritumoral edema. Two radiologists independently measured the maximum tumor size and mean and minimum apparent diffusion coefficients of the tumor. Univariate and multivariate logistic regression analyses with an odds ratio (OR) were performed.

Results

The tumors were IDH-wildtype glioblastoma in 306 cases and IDH-mutant glioblastoma in 21. Interobserver agreement for both qualitative and quantitative evaluations was moderate to excellent. The univariate analyses revealed a significant difference in age, seizure, tumor contrast enhancement, and nCET (P < 0.05). The multivariate analysis revealed significant difference in age for all 3 readers (reader 1, odds ratio [OR] = 0.960, P = 0.012; reader 2, OR = 0.966, P = 0.048; reader 3, OR = 0.964, P = 0.026) and nCET for 2 readers (reader 1, OR = 3.082, P = 0.080; reader 2, OR = 4.500, P = 0.003; reader 3, OR = 3.078, P = 0.022).

Conclusions

Age and nCET are the most useful parameters among the clinical and MRI parameters for differentiating IDH-mutant and IDH-wildtype glioblastomas.
Comparison of the Level of Staphylococcus Aureus and Escherichia Coli in Complete Cleft Infants With Normal Infants
Authors: Qays Rula Abdulkareem , Jafar Zainab Juma
Published: March 2023

Background:

There are many types of oral bacteria, and they differ between healthy children and children with an oral cleft. The purpose of this study was to compare the level of Staphylococcus aureus and Escherichia coli in complete cleft infants with normal infants.

Materials and Methods:

Fifty-two Iraqi infants had participated in this study (26 infants were with cleft and 26 infants were the control healthy group), the study group included 13 infants with class III Veau’s palatal classification, and 13 with class IV Veau’s palatal classification). All are aged from 1 day to 4 months. They were selected and submitted to a questionnaire and clinical examination and bacterial examination. Data description, analysis and presentation were performed using statistical package for social science (SPSS version 21).

Results:

The counting and colonization of S. aureus and GV- (E. coli) were higher in cleft group than in control group.
SILENCING M6A READER YTHDC1 REDUCES INFLAMMATORY RESPONSE IN SEPSIS-INDUCED CARDIOMYOPATHY BY INHIBITING SERPINA3N EXPRESSION
Authors: Xie Wenjing , Zhang Anqi , Huang Xuliang , Zhou Hui , Ying Hangbo , Ye Changzhou , Ren Miao , Qian Meizi , Liu Xia , Mo Yunchang
Published: March 2023

Sepsis-induced cardiomyopathy (SIC) is one of the most common complications of infection-induced sepsis. An imbalance in inflammatory mediators is the main factor leading to SIC. N6-methyladenosine (m6A) is closely related to the occurrence and development of sepsis. N6-methyladenosine reader YTH domain containing 1 (YTHDC1) is an m6A N6-methyladenosine recognition protein. However, the role of YTHDC1 in SIC remains unclear. Herein, we demonstrated that YTHDC1-shRNA inhibits inflammation, reduces inflammatory mediators, and improves cardiac function in a LPS-induced SIC mouse model. Based on the Gene Expression Omnibus database analysis, serine protease inhibitor A3N is a differential gene of SIC. Furthermore, RNA immunoprecipitation indicated that serine protease inhibitor A3N (SERPINA3N) mRNA can bind to YTHDC1, which regulates the expression of SERPINA3N. Serine protease inhibitor A3N–siRNA reduced LPS-induced inflammation of cardiac myocytes. In conclusion, the m6A reader YTHDC1 regulates SERPINA3N mRNA expression to mediate the levels of inflammation in SIC. Such findings add to the relationship between m6A reader YTHDC1 and SIC, providing a new research avenue for the therapeutic mechanism of SIC.