bluuebunny/crossref_metadata_2025 huggingface dataset:
Dust environment of active asteroids P/2019 A4 (PANSTARRS) and P/2021 A5 (PANSTARRS)
Authors: Moreno Fernando , Licandro Javier , Cabrera-Lavers Antonio , Morate David , Guirado Daniel
Published: June 2021

We report on the characterization of the dust activity and dynamical evolution of two faint active asteroids, P/2019 A4, and P/2021 A5, observed with the 10.4 m GTC using both imaging and spectroscopy. Asteroid P/2019 A4 activity is found to be linked to an impulsive event occurring some ±10 d around perihelion, probably due to a collision or a rotational disruption. Its orbit is stable over 100 Myr time-scales. Dust tail models reveal a short-term burst producing (2.0 ± 0.7) × 106 kg of dust for maximum particle radius rmax = 1 cm. The spectrum of P/2019 A4 is featureless, and slightly redder than the Sun. P/2021 A5 was active ∼50 d after perihelion, lasting ∼5 to ∼60 d, and ejecting (8 ± 2) × 106 kg of dust for rmax = 1 cm. The orbital simulations show that a few percent of dynamical clones of P/2021 A5 are unstable on 20–50 Myr time-scales. Thus, P/2021 A5 might be an implanted object from the JFC region or beyond. These facts point to water-ice sublimation as the activation mechanism. This object also displays a featureless spectrum, but slightly bluer than the Sun. Nuclei sizes are estimated in the few hundred meters range for both asteroids. Particle ejection speeds (≈0.2 m s−1) are consistent with escape speeds from those small-sized objects.
Coma morphology and dust emission pattern of comet C/2020 F3 (NEOWISE)
Authors: Manzini F , Oldani V , Ochner P , Barbotin E , Bedin L R , Behrend R , Fardelli G
Published: June 2021

The recent close approach of comet C/2020 F3 (NEOWISE) allowed us to study the morphology of its inner coma. From the measurement of the dust ejection velocity on spiral structures expanding around the nucleus, we estimated a mean deprojected expansion velocity Vd  = 1.11 ± 0.08 km s−1. Assuming that a new shell formed after every rotation of the comet, a period of 7.8 ± 0.2 h was derived. The spin axis orientation was estimated at RA 210° ± 10°, Dec.  +35° ± 10°. The coma morphology appears related to two strong, diametrically opposite emissions located at mid-latitudes on the nucleus. A qualitative modelling of the coma produced consistent results with a wide range of dust sizes (0.80–800 μm), with inversely correlated densities (0.003–3.0 g cm−3). Images taken with Vj and r-Sloan filters showed a greater concentration of dust in the first two shells, and an increasing density of radicals emitting in the B and V band passes from the third shell outwards. Striae-like structures in the tail suggest that dust particles have different sizes.
RBFOX2 alters splicing outcome in distinct binding modes with multiple protein partners
Authors: Zhou Delong , Couture Sonia , Scott Michelle S , Abou Elela Sherif
Published: June 2021

RBFOX2 controls the splicing of a large number of transcripts implicated in cell differentiation and development. Parsing RNA-binding protein datasets, we uncover that RBFOX2 can interact with hnRNPC, hnRNPM and SRSF1 to regulate splicing of a broad range of splicing events using different sequence motifs and binding modes. Using immunoprecipitation, specific RBP knockdown, RNA-seq and splice-sensitive PCR, we show that RBFOX2 can target splice sites using three binding configurations: single, multiple or secondary modes. In the single binding mode RBFOX2 is recruited to its target splice sites through a single canonical binding motif, while in the multiple binding mode RBFOX2 binding sites include the adjacent binding of at least one other RNA binding protein partner. Finally, in the secondary binding mode RBFOX2 likely does not bind the RNA directly but is recruited to splice sites lacking its canonical binding motif through the binding of one of its protein partners. These dynamic modes bind distinct sets of transcripts at different positions and distances relative to alternative splice sites explaining the heterogeneity of RBFOX2 targets and splicing outcomes.
EANO guideline on the diagnosis and management of meningiomas
Authors: Goldbrunner Roland , Stavrinou Pantelis , Jenkinson Michael D , Sahm Felix , Mawrin Christian , Weber Damien C , Preusser Matthias , Minniti Giuseppe , Lund-Johansen Morten , Lefranc Florence , Houdart Emanuel , Sallabanda Kita , Le Rhun Emilie , Nieuwenhuizen David , Tabatabai Ghazaleh , Soffietti Riccardo , Weller Michael
Published: June 2021

Meningiomas are the most common intracranial tumors. Yet, only few controlled clinical trials have been conducted to guide clinical decision making, resulting in variations of management approaches across countries and centers. However, recent advances in molecular genetics and clinical trial results help to refine the diagnostic and therapeutic approach to meningioma. Accordingly, the European Association of Neuro-Oncology (EANO) updated its recommendations for the diagnosis and treatment of meningiomas. A provisional diagnosis of meningioma is typically made by neuroimaging, mostly magnetic resonance imaging. Such provisional diagnoses may be made incidentally. Accordingly, a significant proportion of meningiomas, notably in patients that are asymptomatic or elderly or both, may be managed by a watch-and-scan strategy. A surgical intervention with tissue, commonly with the goal of gross total resection, is required for the definitive diagnosis according to the WHO classification. A role for molecular profiling including gene panel sequencing and genomic methylation profiling is emerging. A gross total surgical resection including the involved dura is often curative. Inoperable or recurrent tumors requiring treatment can be treated with radiosurgery, if the size or the vicinity of critical structures allows that, or with fractionated radiotherapy (RT). Treatment concepts combining surgery and radiosurgery or fractionated RT are increasingly used, although there remain controversies regard timing, type, and dosing of the various RT approaches. Radionuclide therapy targeting somatostatin receptors is an experimental approach, as are all approaches of systemic pharmacotherapy. The best albeit modest results with pharmacotherapy have been obtained with bevacizumab or multikinase inhibitors targeting vascular endothelial growth factor receptor, but no standard of care systemic treatment has been yet defined.
‘Alms! Alms! Give us some support!’: an inquiry on the homeless
Authors: Pacaol Niñoval F
Published: June 2021

COVID-19 is an infectious disease caused by a new coronavirus named SARS-CoV-2. The prevalence of the virus on a global scale led to a global health crisis which prompted countries like the Philippines to address the issue through the implementation of various health-related protocols, legislative laws, and COVID-19 mass vaccination programs for the establishment of herd immunity. Such government actions are undeniably significant in resolving the booming positive cases but the subjects (or who should receive the services) are, to some extent, unclear and overlooked the situation of ‘Others’ – the homeless. The author argues that the Philippine government, other social institutions, and organizations must consider the well-being of this group as one of the hidden disadvantaged individuals amid the crisis.
Managing to climatology: Improving semi-arid agricultural risk management using crop models and a dense meteorological network
Authors: Mauget Steven A , Mitchell-McCallister Donna
Published: June 2021

Without reliable seasonal climate forecasts, farmers and managers in other weather-sensitive sectors might adopt practices that are optimal for recent climate conditions. To demonstrate this principle, crop simulation models driven by a dense meteorological network were used to identify climate-optimal planting dates for US Southern High Plains (SHP) unirrigated agriculture. This method converted large samples of SHP growing season weather outcomes into climate-representative cotton and sorghum yield distributions over a range of planting dates. Best planting dates were defined as those that maximized median cotton lint (April 24) and sorghum grain (July 1) yields. Those optimal yield distributions were then converted into corresponding profit distributions reflecting 2005–19 commodity prices and fixed production costs. Both crops’ profitability under variable price conditions and current SHP climate conditions were then compared based on median profit and loss probability, and through stochastic dominance analyses that assumed a slightly risk-averse producer.
Conditional Superior Predictive Ability
Authors: Li Jia , Liao Zhipeng , Quaedvlieg Rogier
Published: June 2021

This article proposes a test for the conditional superior predictive ability (CSPA) of a family of forecasting methods with respect to a benchmark. The test is functional in nature: under the null hypothesis, the benchmark’s conditional expected loss is no more than those of the competitors, uniformly across all conditioning states. By inverting the CSPA tests for a set of benchmarks, we obtain confidence sets for the uniformly most superior method. The econometric inference pertains to testing conditional moment inequalities for time series data with general serial dependence, and we justify its asymptotic validity using a uniform non-parametric inference method based on a new strong approximation theory for mixingales. The usefulness of the method is demonstrated in empirical applications on volatility and inflation forecasting.
Relationships between cortical, cardiac, and arousal-motor activities in the genesis of rhythmic masticatory muscle activity across sleep cycles in primary sleep bruxism children
Authors: Shiraishi Yuki , Tachibana Masaya , Shirota Ai , Mohri Ikuko , Taniike Masako , Yamashiro Takashi , Kato Takafumi
Published: June 2021

Study Objectives

The present study aimed to clarify the physiological relationships between rhythmic masticatory muscle activity (RMMA) and cyclic changes in cortical, autonomic, and arousal-motor activities during sleep in sleep bruxism (SB) children.

Methods

Polysomnographic recordings were performed on 15 SB children (9 boys, 6 girls, 10.3 ± 2.5 years) and 18 control children (5 boys, 13 girls, 10.7 ± 3.1 years) free from sleep and developmental disorders. Sleep and RMMA were scored by the standard rules. Sleep cycle was divided into NREM and REM sleep segments and the frequency of RMMA, transient arousal and movement, and cortical and cardiac activities were then quantitatively analyzed in relation to sleep cycles.

Results

Neither sleep architecture nor sleep stage distribution of RMMA significantly differed between the two groups. In sleep cycles, SB children showed more frequent RMMA in all segments than controls, while cyclic changes in cortical and autonomic activities did not significantly differ between the two groups. In SB children, RMMA was the most frequent in the last NREM segment before REM sleep and was associated with increases in cortical beta activity and arousal; more than 70% of RMMA time-dependently occurred with cortical and motor arousals.

Conclusions

This is the first study to suggest that the potentiation of RMMA occurrence was associated with transient arousal under cyclic sleep processes in primary SB children.
Bee-Vectored Aureobasidium pullulans for Biological Control of Gray Mold in Strawberry
Authors: Iqbal Mudassir , Jützeler Matilda , França Soraya C. , Wäckers Felix , Andreasson Erik , Stenberg Johan A.
Published: June 2021

Gray mold caused by Botrytis cinerea is a common postharvest disease in strawberries, reducing shelf life considerably. We investigated the potential of the yeast-like biocontrol fungus Aureobasidium pullulans (AP-SLU6) vectored by bumblebees (Bombus terrestris) in the Flying Doctors® system to inhibit the pathogen and increase the shelf life of harvested strawberries (cultivar Sonata). Using bumblebees as vectors of various biocontrol agents is becoming increasingly popular, but any potentially negative effects on bee performance have been understudied. Our results show that, over the 4-week period of the trial, the performance and activity of the bees were not negatively affected by A. pullulans. The bees successfully picked up the powder formulation; then, they carried and deposited it on the flowers. The vectoring of the biocontrol agent significantly reduced gray mold development on the harvested fruits by 45% and increased shelf life by 100% in comparison with control treatments. This suggests that the biocontrol fungus applied during flowering successfully reduced Botrytis infection and thus, effectively protected the fruits from gray mold. In addition, the bee-vectored application of the biocontrol agent was found to be significantly more effective than spray application because the latter may temporarily increase humidity around the flower, thereby creating a suitable environment for the pathogen to thrive. In summary, our study demonstrates that A. pullulans vectored by bumblebees can decrease gray mold infection and improve the shelf life of strawberries without adversely affecting the bees, thus providing a basis for the sustainable and efficient control of gray mold on strawberry.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Turning Back the Clock: Artificial Intelligence Recognition of Age Reduction after Face-Lift Surgery Correlates with Patient Satisfaction
Authors: Zhang Ben H. , Chen Kevin , Lu Stephen M. , Nakfoor Bruce , Cheng Roger , Gibstein Alexander , Tanna Neil , Thorne Charles H. , Bradley James P.
Published: June 2021

Background:

Patients desire face-lifting procedures primarily to appear younger, more refreshed, and attractive. Because there are few objective studies assessing the success of face-lift surgery, the authors used artificial intelligence, in the form of convolutional neural network algorithms alongside FACE-Q patient-reported outcomes, to evaluate perceived age reduction and patient satisfaction following face-lift surgery.

Methods:

Standardized preoperative and postoperative (1 year) images of 50 consecutive patients who underwent face-lift procedures (platysmaplasty, superficial musculoaponeurotic system–ectomy, cheek minimal access cranial suspension malar lift, or fat grafting) were used by four neural networks (trained to identify age based on facial features) to estimate age reduction after surgery. In addition, FACE-Q surveys were used to measure patient-reported facial aesthetic outcome. Patient satisfaction was compared to age reduction.

Results:

The neural network preoperative age accuracy score demonstrated that all four neural networks were accurate in identifying ages (mean score, 100.8). Patient self-appraisal age reduction reported a greater age reduction than neural network age reduction after a face lift (−6.7 years versus −4.3 years). FACE-Q scores demonstrated a high level of patient satisfaction for facial appearance (75.1 ± 8.1), quality of life (82.4 ± 8.3), and satisfaction with outcome (79.0 ± 6.3). Finally, there was a positive correlation between neural network age reduction and patient satisfaction.

Conclusion:

Artificial intelligence algorithms can reliably estimate the reduction in apparent age after face-lift surgery; this estimated age reduction correlates with patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
Toward Competency-Based Training: To What Extent Are We Competency-Based?
Authors: Al-halabi Becher , Bilgic Elif , Vassiliou Melina , Gilardino Mirko
Published: June 2021

Background:

Time-based training models in plastic surgery vary in exposure, resulting in low confidence levels among graduates. The evolution of postgraduate medical education into a competency-based model to address these issues requires an understanding of interventions described in the plastic surgery literature to identify gaps and guide creation of assessments to demonstrate competence.

Methods:

A systematic search of the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Cochrane databases from inception until December of 2017 was conducted using search terms and synonyms of educational interventions reported in plastic surgery. Full texts were retrieved following filtering and data extracted were related to intervention design and execution, involvement of competency assessment, and educational objectives and alignment to Accreditation Council for Graduate Medical Education competencies and Royal College of Physicians and Surgeons of Canada Canadian Medical Education Directives for Specialists roles. Study quality was assessed using Kirkpatrick’s levels of learning evaluation, validity evidence, and the Medical Education Research Study Quality Instrument score.

Results:

Of the initial 4307 results, only 36 interventions met the inclusion criteria. Almost all interventions aligned to medical knowledge and patient care Accreditation Council for Graduate Medical Education competencies. One-fifth of the interventions involved no assessment of competency, whereas most displayed assessment at the level of design as opposed to outcomes. Quality assessment revealed low levels of learning evaluation and evidence of validity; the average Medical Education Research Study Quality Instrument score was 10.9 of 18.

Conclusion:

A systematic review of educational literature in plastic surgery was conducted to assess the quality of reported educational interventions, and to help guide creating tools that ensure competency acquirement among trainees.
Pisa Tower Concept: A New Paradigm in Crooked Nose Treatment
Authors: Finocchi Valerio , Vellone Valentino , Ramieri Valerio , de Angelis Francesca , Marianetti Tito M.
Published: June 2021

Background:

The primary element of a crooked nose is a midline deviation of the nasal pyramid. To date, no surgical strategies have been described as compatible with the philosophy of dorsal preservation. The dorsal preservation technique differs from the Joseph structured rhinoplasty because it preserves both the keystone area and the continuity of the cartilaginous vault. The authors focused on the versatility of the dorsal preservation technique even for the deviated nose, introducing the “Pisa Tower concept.”

Methods:

From January of 2015 to June of 2019, 280 patients diagnosed as having a crooked nose underwent primary septorhinoplasty with dorsal preservation through an asymmetric bony wedge resection and lowering of the bony pyramid onto the frontal process of the maxilla (the let-down osteotomy), in accordance with the Pisa Tower concept. Inclusion criteria were a preoperative computed tomography examination, nasal axis deviation, a complete photographic examination preoperatively, and at least a 1-year follow-up.

Results:

The mean nasal axis deviation was 7.62 degrees preoperatively and 1.15 degrees postoperatively (p < 0.05). Of the 84 patients, 47 (55.95 percent) were very satisfied, 33 (39.28 percent) were satisfied, and four (4.76 percent) were unsatisfied with surgical results and required revision surgery.

Conclusions:

The authors’ opinion is that the association of “swinging door” septoplasty with the Pisa Tower concept can be a valid alterative to other techniques when working with the structured rhinoplasty philosophy in patients with a crooked nose. Although this is only a preliminary study, the decreased use of spreaders graft and less aggressive reconstructive methods look very promising.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Is Nipple-Sparing Mastectomy Indicated after Previous Breast Surgery? A Series of 387 Institutional Cases
Authors: Vicini Elisa , De Lorenzi Francesca , Invento Alessandra , Corso Giovanni , Radice Davide , Bozzo Samantha , Kahler Ribeiro Fontana Sabrina , Caldarella Pietro , Veronesi Paolo , Galimberti Viviana
Published: June 2021

Background:

Previous breast surgery does not represent an absolute contraindication for nipple-sparing mastectomy, although it may negatively interfere with surgical outcomes. The aim of the authors’ study was to confirm the feasibility of nipple-sparing mastectomy after previous breast surgery, focusing on skin incisions and risk factors, complications, and oncologic outcomes.

Methods:

The authors retrospectively identified 368 patients who underwent 387 nipple-sparing mastectomies and reconstruction after previous surgery (quadrantectomy, breast resection, augmentation and reduction mammaplasty, mastopexy) at the European Institute of Oncology from January of 2003 to November of 2017. Patterns of skin incisions (i.e., radial, hemiperiareolar, periareolar, vertical pattern, inframammary fold, Wise-pattern, and round-block) for primary surgery and for mastectomy, type of reconstruction, and radiotherapy have been recorded. The authors collected data regarding early and late complications and further operations (implant change, fat grafting) performed within 2 years to improve cosmetic outcomes. Oncologic follow-up has been reported for in-breast recurrences.

Results:

Complete and partial nipple-areola complex necrosis occurred, respectively, in 2.8 percent and in 5.4 percent of cases. The authors recorded 5.4 percent failures resulting in implant removal. The analysis of risk factors for complications or for the need for further operations showed no significant association with skin incision for first surgery and mastectomy, use of the same skin incision, previous radiotherapy, or type of primary surgery. Five-year overall survival and disease-free survival were 99.1 and 93.8 percent, respectively. No nipple recurrence was recorded.

Conclusions:

The authors’ results confirm that nipple-sparing mastectomy can be a safe surgical procedure after previous breast surgery. Surgical planning should be tailored to each patient.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Reduction Mammaplasty for Macromastia in Adolescents: A Systematic Review and Pooled Analysis
Authors: Hudson Alexandra S. , Morzycki Alexander D. , Guilfoyle Regan
Published: June 2021

Background:

Reduction mammaplasty for macromastia is one of the most common operations performed by plastic surgeons. There remains hesitancy in operating on adolescents, as there is ongoing debate about breast regrowth and potential impact on breastfeeding. The goal of this study was to analyze these concerns by reviewing the current literature.

Methods:

A systematic review of MEDLINE, Scopus, and Google Scholar was conducted using the following terms: “breast reduction” or “mammaplasty” or “breast reconstruction” and “adolescent” or “youth” or “pediatric” or “child” or “teen.” Primary outcomes were success of breastfeeding after the procedure and procedure-related complications.

Results:

Twenty-three studies (87 percent retrospective), consisting of 2926 patients with preoperative cup sizes of C to KK (mean, DDD), met inclusion criteria. Mean age at the time of surgery ranged from 16 to 21 years, with the youngest patient being 12 years old. The overall complication rate was 27.3 percent (95 percent CI, 14.4 to 42.5 percent). Minor complications (22.8 percent; 95 percent CI, 10.2 to 38.5 percent) were more common than major (4.2 percent; 95 percent CI, 1.6 to 7.9 percent). Eighteen percent of patients (95 percent CI, 2.2 to 43.8 percent) reported regrowth of their breast tissue postoperatively, with 2.7 percent (95 percent CI, 0.9 to 5.5 percent) undergoing a second revision mammaplasty. Fifty-three percent of patients (95 percent CI, 36.0 to 69.3 percent) did not attempt breastfeeding. Of those who attempted, 55.1 percent (95 percent CI, 34.4 to 74.9 percent) were successful.

Conclusions:

Prospective data are lacking. Patient counseling should focus on encouraging a trial of breastfeeding, despite surgical history. One-fifth of adolescent patients may notice breast regrowth postoperatively; however, the amount of regrowth is likely small and unlikely to reexacerbate symptoms, as the rate of revision surgery is small.
Detection of Perfusion Deficits in Multiphase Computed Tomography Angiography—A Stroke Imaging Technique Based on Iodine Mapping on Spectral Computed Tomography: Initial Findings
Authors: Fransson Veronica , Mellander Helena , Wasselius Johan , Ydström Kristina
Published: June 2021

Objective

The purpose of this study was to explore a novel method for brain tissue differentiation using quantitative analysis of multiphase computed tomography (CT) angiography (MP-CTA) on spectral CT, to assess whether it can distinguish underperfused from normal tissue, using CT perfusion (CTP) as reference.

Methods

Noncontrast CT and MP-CTA images from 10 patients were analyzed in vascular regions through measurements of Hounsfield unit (HU) at 120 kV, HU at 40 keV, and iodine density. Regions were categorized as normal or ischemic according to CTP. Hounsfield unit and iodine density were compared regarding ability to separate normal and ischemic tissue, the difference in maximum time derivative of the right over left hemisphere ratio.

Results

Iodine density had the highest maximum time derivatives and generated the largest mean separation between normal and ischemic tissue.

Conclusions

The method can be used to categorize tissue as normal or underperfused. Using iodine quantification seems to give a more distinct differentiation of perfusion defects compared with conventional HU.
Evaluation of Synovitis of Hand in Patients With Rheumatoid Arthritis Using Diffusion Kurtosis Magnetic Resonance Imaging: Initial Findings
Authors: Liu Kaifang , Meng Jie , Zhou Nan , Zhao Cheng , Wei Yu , He Jian , Chen Weibo , Sun Lingyun , Zhou Zhengyang
Published: June 2021

Objective

To explore the role of diffusion kurtosis magnetic resonance (MR) imaging in the noninvasive identification of synovitis in hand arthritis.

Methods

A total of 30 patients with rheumatoid arthritis (RA) and 10 patients suspected of RA were enrolled in the prospective study. A 3.0-T MR imaging including the diffusion kurtosis MR imaging sequence (b = 0, 500, 1000, 1500, 2000 s·mm2) was performed. A total of 210 regions of interest were confirmed and diffusion kurtosis MR imaging parameters were generated. The suspected synovitis or effusion was scored on a scale of 0 (effusion) to 3 (mild, moderate, severe synovitis), according to RA-MR imaging scoring system. The performance of diffusion kurtosis MR imaging parameters (the apparent diffusion coefficient [ADC], diffusion coefficient [D], and kurtosis [K]) in distinguishing different synovitis scores was evaluated.

Results

There were significant differences in ADC, D, and K values among different synovitis scores (all P < 0.001). Synovitis scores were negatively correlated with the ADC and D values significantly (r = −0.725, −0.757, respectively, all P < 0.001), but positively correlated with the K values significantly (r = 0.429, P < 0.001). The area under the curve values of D, ADC, and K values were 0.884, 0.874, and 0.728 for differentiating score 1–3 from score 0, respectively. Diffusion coefficient and ADC had similar diagnostic performance, and both were higher than K in detecting synovitis. No significant difference was found between the ADC and D values in detecting synovitis.

Conclusions

The diffusion kurtosis MR imaging may be feasible as a noninvasive method for the diagnosis and grading of synovitis in the hands of RA patients, and the D and ADC values showed similar diagnostic performance, both of which were higher than K values.
Automated Diseased Lung Volume Percentage Calculation in Quantitative CT Evaluation of Chronic Obstructive Pulmonary Disease and Idiopathic Pulmonary Fibrosis
Authors: Kitaguchi Yoshiaki , Fujimoto Keisaku , Droma Yunden , Yasuo Masanori , Wada Yosuke , Ueno Fumika , Kinjo Takumi , Kawakami Satoshi , Fukushima Kiyoyasu , Hanaoka Masayuki
Published: June 2021

Objective

Several software-based quantitative computed tomography (CT) analysis methods have been developed for assessing emphysema and interstitial lung disease. Although the texture classification method appeared to be more successful than the other methods, the software programs are not commercially available, to our knowledge. Therefore, this study aimed to investigate the usefulness of a commercially available software program for quantitative CT analyses.

Methods

This prospective cohort study included 80 patients with chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF).

Results

The percentage of low attenuation volume and high attenuation volume had high sensitivity and high specificity for detecting emphysema and pulmonary fibrosis, respectively. The percentage of diseased lung volume (DLV%) was significantly correlated with the lung diffusion capacity for carbon monoxide in all patients with COPD and IPF patients.

Conclusions

The quantitative CT analysis may improve the precision of the assessment of DLV%, which itself could be a useful tool in predicting lung diffusion capacity in patients with the clinical diagnosis of COPD or IPF.
The Modified Sublay Technique for the Management of Major Subcostal Incisional Hernia
Authors: Zuvela Marinko , Galun Danijel , Bogdanovic Aleksandar , Bidzic Nemanja , Zivanovic Marko , Zuvela Milos , Zuvela Milan
Published: June 2021

Background

The aims of this study were to present the concept of original technique in the management of major incisional subcostal hernias and to evaluate short- and long-term outcome.

Method

Between January 2010 and January 2020, 280 patients underwent hernia repair surgery for incisional lateral abdominal hernia at Clinic for Digestive Surgery, Clinical Center of Serbia. Among them, 37 patients underwent the modified sublay technique for major incisional subcostal hernia with minimal hernia defect surface of 100 cm2 or greater or minimal hernia defect width or height of 10 cm or greater. The operative techniques are as follows: retromuscular dissection of rectus muscle from posterior sheath on the both sides of hernia defect, external oblique muscle dissection from internal oblique muscle in a circle around hernia defect at the side of the hernia defect, complete reconstruction of the posterior myofascial layer, large heavyweight polypropylene mesh placement in a sublay position, and complete or partial reconstruction of anterior myofascial layer.

Results

A median (range) hernia defect surface was 150 (100–500) cm2. A median operative time was 130 (90–330) minutes. The morbidity rate was 18.9%. A median (range) postoperative hospital stay was 7 (2–24) days. After the median follow-up of 50 (1–108) months, 2 patients (5.4%) developed recurrent hernia.

Conclusions

The modified sublay technique using large heavyweight polypropylene mesh provides good results in the management of major subcostal abdominal wall defects.
Transabdominal Breast Augmentation With Silicone Gel Implants
Authors: Stümpfle Rubem Lang , Piccinini Pedro Salomão , Zanin Eduardo Madalosso
Published: June 2021

Background

Breast augmentation is frequently performed together with abdominoplasty. Although breast augmentation incisions generally heal well, patients almost universally will appreciate having fewer scars; this is the basic rationale for transabdominal breast augmentation. In addition, a transabdominal approach may decrease the risk of implant contamination because there is no contact of the implants with skin.

Methods

A chart review of the senior author's private practice, from 2012 to 2020, was performed; 68 female patients who underwent abdominoplasty in association with transabdominal breast augmentation, with at least 1 year of follow-up, were included. All patients underwent liposuction, standard abdominoplasty with wide suprafascial abdominal flap undermining, and liposuction of the abdominal flap as needed. Round, silicone gel implants (Mentor Siltex, Santa Monica, CA) were used.

Results

A total of 68 patients were operated on. Mean age was 49 years (range, 25–68 years), mean body mass index was 25.7 kg/m2 (range, 22.3–29.5 kg/m2). The most commonly used implant volume (mode) was 270 mL (range, 225–395 mL). Implants were high (75%) or ultrahigh profile (25%). Eight patients (15%) had previously undergone breast augmentation. Seven patients (12%) underwent simultaneous breast fat grafting. There were no major complications. There were no complications related to the breast augmentation (ie, no extrusion or infection, malposition requiring revision, or capsular contracture). No patients requested upsizing or other revision of their implants.

With regard to the abdominoplasty, there were 4 cases of well-circumscribed seroma treated with serial aspiration in the office. There were no cases of abdominoplasty site infection. Five patients required revision of abdominoplasty incisions. Two patients requested revision liposuction after weight gain.

Conclusions

Breast augmentation through an abdominoplasty incision may incur benefits beyond the obvious single surgical scar. Overall, transabdominal breast augmentation, in adequately selected patients, is an option which is safe, does not increase operative time, can lead to good results, and may potentially decrease some complications related to breast augmentation through other incision sites.
A New Decade for Diversity
Authors: Xun Helen , He Waverley , Chen Jonlin , Long Chao , Kraenzlin Franca , Lee Erica , Yesantharao Pooja , Cooney Carisa S. , Amalfi Ashley , Huston Tara L. , Broderick Kristen
Published: June 2021

Background

In 2018, the Northeastern Society of Plastic Surgeons first Women in Plastic Surgery was established, reflecting the national trend to address the gender gap between men and women in surgery. Conferences, such as the annual NESPS, are important opportunities to increase visibility of female role models and resources to address deterrents to surgical careers. We thus sought to examine the participation and visibility of women in the NESPS over the last decade.

Methods

Abstracts and programs from the NESPS regional conferences between 2013 and 2019 were accessed via the publicly available past meetings archives, and registration lists were provided by the NESPS. Registrants, panelists, speakers, moderators, and first author and senior author listed for each poster presentation, podium presentation was listed, sex was determined (male or female), and sex were aggregated by category of participation. Significance was set at a P value of less than 0.05.

Results

Registration of women for the NESPS annual conferences was constant for 5 years (2013–2017), followed by an increase in female registrants from 27.1% in 2017 to 42.3% in 2019. Female representation among poster and podium presentations also increased from 2017 to 2019 (7.7%–23.3% poster presentations and 11.1%–23.4% podium presentations). Invited positions (speakers, panelists, and moderators) had a peak of 32.2% in 2017, but otherwise, there is no clear evidence of improved representation of women.

Conclusions

We found an increase in the proportion of female registrants at the annual NESPS conferences from 2013 to 2019. However, visibility of female participants fluctuated over the same period; addressing this represents one opportunity for closing the gender gap at the NESPS. As the percentage of female trainees continues to rise, we look to female faculty to continue to participate in educational events, such as the NESPS meeting, and to be present as role models for the growing new generation of female plastic surgeons.
In Home Caregivers' Experiences With Percutaneous Endoscopic Gastrostomy Patients
Authors: Sezer Rana Elcin , Talas Melek Serpil
Published: June 2021

In home caregivers of patients with percutaneous endoscopic gastrostomy face physical, social, and psychological problems. The results of qualitative studies play a key role in determining in home caregivers' percutaneous endoscopic gastrostomy-related problems, attitudes, views, and experiences. The aim of this review was to survey the literature to assess the problems faced by in home caregivers of percutaneous endoscopic gastrostomy patients and identify solutions to these problems. PubMed, Cochrane, and Web of Science databases were screened using the key words qualitative research, percutaneous endoscopic gastrostomy, enteral nutrition, and mixed method for relevant articles published between 1945 and November 2019. The literature search yielded 446 scholarly articles. Their titles and abstracts were screened for possible inclusion in this review. Fifteen articles that met the inclusion criteria were included in the study. The quality of the included qualitative articles were assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist, whereas mixed-methods articles were assessed using the Mixed Methods Appraisal Tool. Five major themes were developed: percutaneous endoscopic gastrostomy tube problems, training requirement, health support system, effect on life, and tube necessity. We believe that determining caregivers' physical and psychosocial problems around managing patients' percutaneous endoscopic gastrostomy tubes and developing support systems can help solve those problems and improve both patients' and caregivers' quality of life.
What is physiologging? Introduction to the theme issue, part 2
Authors: Hawkes L. A. , Fahlman A. , Sato K.
Published: June 2021

The physiological mechanisms by which animals regulate energy expenditure, respond to stimuli and stressors, and maintain homeostasis at the tissue, organ and whole organism levels can be described by ‘physiologging’—that is, the use of onboard miniature electronic devices to record physiological metrics of animals in captivity or free-living in the wild. Despite its origins in the 1960s, physiologging has evolved more slowly than its umbrella field of biologging. However, the recording of physiological metrics in free-living animals will be key to solving some of the greatest challenges in biodiversity conservation, issues pertaining to animal health and welfare, and for inspiring future therapeutic strategies for human health. Current physiologging technologies encompass the measurement of physiological variables such as heart rate, brain activity, body temperature, muscle stimulation and dynamic movement, yet future developments will allow for onboard logging of metrics relating to organelle, molecular and genetic function.

This article is part of the theme issue ‘Measuring physiology in free-living animals (Part II)’.
Rapid, large-scale wastewater surveillance and automated reporting system enabled early detection of nearly 85% of COVID-19 cases on a University campus
Authors: Karthikeyan Smruthi , Nguyen Andrew , McDonald Daniel , Zong Yijian , Ronquillo Nancy , Ren Junting , Zou Jingjing , Farmer Sawyer , Humphrey Greg , Henderson Diana , Javidi Tara , Messer Karen , Anderson Cheryl , Schooley Robert , Martin Natasha , Knight Rob
Published: June 2021

Wastewater based surveillance has gained prominence and come to the forefront as a leading indicator of forecasting COVID-19 infection dynamics owing to its cost-effectiveness and its ability to inform early public health interventions. A university campus could especially benefit from wastewater surveillance as they are characterized by largely asymptomatic populations and are potential hotspots for transmission that necessitate frequent diagnostic testing. In this study, we employed a large-scale GIS (Geographic information systems) enabled building-level wastewater monitoring system associated with the on-campus residences of 7614 individuals. Sixty-eight automated wastewater samplers were deployed to monitor 239 campus buildings with a focus on residential buildings. Time-weighted composite samples were collected on a daily basis and analyzed within the same day. Sample processing was streamlined significantly through automation, reducing the turnaround time by 20-fold and exceeding the scale of similar surveillance programs by 10 to 100-fold, thereby overcoming one of the biggest bottlenecks in wastewater surveillance. An automated wastewater notification system was developed to alert residents to a positive wastewater sample associated with their residence and to encourage uptake of campus-provided asymptomatic testing at no charge. This system, integrated with the rest of the “Return to Learn” program at UC San Diego-led to the early diagnosis of nearly 85% of all COVID-19 cases on campus. Covid-19 testing rates increased by 1.9-13X following wastewater notifications. Our study shows the potential for a robust, efficient wastewater surveillance system to greatly reduce infection risk as college campuses and other high-risk environments reopen.

IMPORTANCE

Wastewater based epidemiology can be particularly valuable at University campuses where high-resolution spatial sampling in a well-controlled context could not only provide insight into what affects campus community as well as how those inferences can be extended to a broader city/county context. In the present study, a large-scale wastewater surveillance was successfully implemented on a large university campus enabling early detection of 85% of COVID-19 cases thereby averting potential outbreaks. The highly automated sample processing to reporting system enabled dramatically reduced the turnaround time to 5h (sample to result time) for 96 samples. Furthermore, miniaturization of the sample processing pipeline brought down the processing cost significantly ($13/sample). Taken together, these results show that such a system could greatly ameliorate long-term surveillance on such communities as they look to reopen.
Models of COVID-19 vaccine prioritisation: a systematic literature search and narrative review
Authors: Saadi Nuru , Chi Y-Ling , Ghosh Srobana , Eggo Rosalind M , McCarthy Ciara , Quaife Matthew , Dawa Jeanette , Jit Mark , Vassall Anna
Published: June 2021

Background

How best to prioritise COVID-19 vaccination within and between countries has been a public health and an ethical challenge for decision-makers globally. We systematically reviewed epidemiological and economic modelling evidence on population priority groups to minimise COVID-19 mortality, transmission and morbidity outcomes.

Methods

We searched the National Institute of Health iSearch COVID-19 Portfolio (a database of peer-reviewed and pre-print articles), Econlit, the Centre for Economic Policy Research and the National Bureau of Economic Research for mathematical modelling studies evaluating the impact of prioritising COVID-19 vaccination to population target groups. We narratively synthesised the main study conclusions on prioritisation and the conditions under which the conclusions changed.

Findings

The search identified 1820 studies. 36 studies met the inclusion criteria and were narratively synthesised. 83% of studies described outcomes in high-income countries. We found that for countries seeking to minimise deaths, prioritising vaccination of senior adults was the optimal strategy and for countries seeking to minimise cases the young were prioritised. There were several exceptions to the main conclusion, notably reductions in deaths could be increased, if groups at high risk of both transmission and death could be further identified. Findings were also sensitive to the level of vaccine coverage.

Interpretation

The evidence supports WHO SAGE recommendations on COVID-19 vaccine prioritisation. There is however an evidence gap on optimal prioritisation for low- and middle-income countries, studies that included an economic evaluation, and studies that explore prioritisation strategies if the aim is to reduce overall health burden including morbidity.
The development and usability testing of two digital knowledge translation tools for parents of children with urinary tract infections
Authors: Le Anne , Hartling Lisa , Scott Shannon D.
Published: June 2021

Urinary tract infections (UTI) are a common source of acute illness for infants and children. Approximately 7-8% of girls and 2% of boys will experience a UTI before they are 8 years old. UTIs may be difficult to identify and treat as symptoms in children are different from expected adult symptoms. A previously conducted systematic review identified four common information needs expressed by parents. More specifically, the research identified that parents had difficulty recognizing signs and symptoms of UTIs, felt disappointed by health care provider’s responses, needed timely and relevant information, and feared the unknown due to lack of UTI knowledge. This demonstrates that more effective knowledge translation tools are needed to satisfy parent information needs.

The purpose of this research was to work with parents to develop and test the usability of an interactive infographic and video about UTIs in children. Prototypes were evaluated by parents through usability testing in two Alberta emergency department waiting rooms. Results were positive and overall, the tools were highly rated across all usability items, suggesting that arts-based digital tools are useful mediums for sharing health information with parents.
Therapeutic mammoplasty as a viable surgical approach in Breast Cancer Patients from India: A Single Institutional Audit
Authors: Koppiker C. B. , Joshi Sneha , Mishra Rupa , Kelkar Devaki A. , Chigurupati Pragnya , Joshi Anjali , John Jisha , Kadu Shweta , Gangurde Nutan , Thakkar Deepti , Sharan Gautam , Dhar Upendra , Allampati HariKiran , Nare Smeeta , Dewle Ankush , Nagarkar Sanket , Busheri Laleh
Published: June 2021

Introduction

Therapeutic mammoplasty (TM) is a type of oncoplastic breast surgery (OBS) well suited to breast cancers in medium-large sized breasts with ptosis, and in some cases of large or multifocal/Multicentric (MF/MC) tumors. It includes contralateral symmetrisation. This report describes our experiences and outcomes of TM in breast cancer patients in a single institutional cohort in India.

Methods

We present data for 207 cases (194 breast cancer, 13 benign disease) who underwent TM as part of their primary treatment. All patients underwent surgery after careful analysis of feasibility by a multidisciplanary tumor board and patient counselling. We report the clinicopathological profiles, surgical and oncological outcomes, and patient related outcome measures (PROMs) with different TM surgical procedures.

Results

Patients were relatively young at a median age of 49 years with moderate-large breasts and grade II-III ptosis. Patients underwent simple (n=96), complex (n=79) or extreme TM (n=46). Low post-operative complication rates and good-excellent cosmetic scores were observed. With median follow-up of 26 months, 148 patients completed more than 1 year follow-up. The 1-year BREAST-Q PROMs revealed good-to-excellent scores for all types of therapeutic mammoplasty.

Conclusion

We conclude that in a country where women present with large and locally advanced tumours, TM safely expands the indications for breast conservation surgery. PROMs scores show that this surgery is perceived to be physically and mentally satisfactory. With the popularization of this procedure, it is possible that more Indian patients with breast cancer will receive the benefits of breast conservation while maintaining their quality of life.