bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk prediction for severe COVID-19 progressing to critical illness and death in the ICU and efficacy analysis of using traditional Chinese medicine
Authors: Tang Wenyi , Ye Bo , Zhou Lina , Zou Lingyun
Published: April 2024

To reveal the key factors influencing the progression of severe COVID-19 to critical illness and death in the intensive care unit (ICU) and to accurately predict the risk, as well as to validate the efficacy of treatment using traditional Chinese medicine (TCM), thus providing valuable recommendations for the clinical management of patients. A total of 189 patients with COVID-19 in 25 ICUs in Chongqing, China, were enrolled, and 16 eventually died. Statistical models shown that factors influencing the progression of COVID-19 to critical illness include the severity of illness at diagnosis, the mode of respiratory support, and the use of TCM. Risk factors for death include a history of metabolic disease, the use of antiviral drugs and TCM, and invasive endotracheal intubation. The area under curve of the noncollinearity model predicted the risk of progression to critical illness and the risk of death reached 0.847 and 0.876, respectively. The use of TCM is an independent protective factor for the prevention of the progression of severe COVID-19, while uncorrectable hypoxemia and invasive respiratory support are independent risk factors, and antiviral drugs can help reduce mortality. The multifactorial prediction model can assess the risk of critical illness and death in ICU COVID-19 patients, and inform clinicians in choosing the treatment options and medications.
Profiling of immune infiltration landscape of ruptured intracranial aneurysm
Authors: Li Chenglong , Su Zhe , Su Wenjing , Wang Qingbo , Wang Shuangquan , Li Zefu
Published: April 2024

Background:

Previous research has indicated that the rupture of intracranial aneurysm (IA) is a significant contributor to mortality from stroke. The objective of this present study was to examine the infiltration patterns in ruptured intracranial aneurysm (RIA), with the aim of generating insights that could inform the development of effective immunotherapeutic approaches.

Methods:

To achieve this, we obtained Gene Expression Omnibus datasets pertaining to ruptured aneurysms, encompassing a total of 19 unruptured intracranial aneurysms (UIA) and 27 RIA. Subsequently, we conducted differential gene analysis and immune cell analysis specifically for the RIA.

Results:

According to the conducted studies, the analysis has identified 10 hub genes within key modules. Through the utilization of Kyoto Encyclopedia of Genes and Genomes pathway and gene ontology terms analyses, it has been established that genes exhibiting differential expression are associated with immune cell infiltration in the aneurysm wall. Furthermore, the implementation of the CIBERSORT algorithm has revealed that there are 22 distinct immune cells between RIA and tissues of UIA. IA samples contained a higher proportion of macrophages M1, mast cells resting, and CD4 naive T cells, while macrophages M0 and neutrophils were relatively lower in RIA compared with those in UIA.

Conclusion:

The current study initially identified highly conservative hub genes and immune cell infiltration patterns in IA. Data presented in the current study improved understanding of immune genes that drive IA which can be exploited in development of effective immunotherapies.
Differential expression of circular RNAs in human umbilical cord mesenchymal stem cells treated with icariin
Authors: Liu Xiaokun , Chu Xiaoqian , Li Lingling , Man Shanshan , Wang Li , Bian Yuhong , Zhou Huifang
Published: April 2024

Human umbilical cord mesenchymal stem cells (hUMSCs) belong to a multipotent stem cell population. Transplantation of icariin (ICA)-treated hUMSCs have better tissue repairing function in chronic liver injury. This study was to investigate whether the tissue-repairing effects and migration of hUMSCs after ICA treatment were regulated by circular RNAs (circRNAs). ICA was used to treat hUMSCs in vitro for 1 week and the expression profiles of circRNAs were generated using RNA sequencing. Differentially expressed circRNAs in hUMSCs after ICA intervention were screened. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis were carried out to predict the potential function of dysregulated circRNAs. There were 52 differentially expressed circRNAs (32 circRNAs up-regulated and 20 circRNAs down-regulated) with fold change ≥2.0 before and after ICA treatment. ADP-ribosylation factors were associated with the dysregulated circRNAs among Gene Ontology analysis. Kyoto Encyclopedia of Genes and Genomes analysis showed that only endocytosis pathway was associated with up-regulated circRNAs, whereas 4 pathways including homologous recombination, RNA transport, axon guidance, and proteoglycans in cancer were related to down-regulated circRNAs. Fifty-two differentially expressed circRNAs and 238 predicted microRNAs were included in circRNAs-microRNAs network. The mechanism of ICA inducing hUMSCs migration may be through regulating circRNAs expression which affects ADP-ribosylation factors protein signal pathways.
Well-Being Therapy and Lifestyle Intervention in Type 2 Diabetes: A Pilot Randomized Controlled Trial
Authors: Benasi Giada , Gostoli Sara , Zhu Boheng , Offidani Emanuela , Artin Michael G. , Gagliardi Lorenza , Rignanese Giovanni , Sassi Graziella , Fava Giovanni A. , Rafanelli Chiara
Published: April 2024

Objective

This pilot randomized controlled trial evaluates the preliminary efficacy of a 4-month well-being therapy (WBT) and lifestyle intervention among adults with type 2 diabetes and overweight/obesity.

Methods

Fifty-eight patients were recruited from two outpatient clinics and randomized to receive the WBT-lifestyle intervention or the lifestyle intervention alone. Data were collected at baseline (T0), immediate postintervention (T1), 6-month follow-up (T2), and 12-month follow-up (T3). Primary efficacy outcomes included changes in weight, psychological distress, and well-being, whereas secondary efficacy outcomes included changes in lifestyle and physiological parameters.

Results

Compared with the lifestyle-alone intervention, the WBT-lifestyle intervention showed greater improvements in depression (p = .009, d = −0.6), hostility (p = .018, d = −0.6), and personal growth (p = .026, d = 0.5) at T1, in self-reported physical activity at T2 (p = .013, d = 0.7) and T3 (p = .040, d = 0.5), and in triglycerides (p = .019, d = −1.12) at T3. There were no differences between treatment groups in weight and other physiological parameters.

Conclusions

These findings suggest that WBT may be a valuable addition to lifestyle interventions for improving short-term psychological outcomes and promoting long-term healthy changes in physical activity, with a potential impact on physiological outcomes.

Trial Registration:
ClinicalTrials.gov identifier: NCT03609463.
FDG PET/CT and MRI Findings of Extraskeletal Myxoid Chondrosarcoma Showing a Nonmyxoid Cellular Variant
Authors: Hirasawa Minami , Kikuchi Yoshinao , Sato Kenji , Yoshida Akihiko , Yamamoto Asako
Published: April 2024

We present a new, extremely rare nonmyxoid cellular variant of extraskeletal myxoid chondrosarcoma. Although diagnosis is radiologically and pathologically challenging, FDG PET/CT and MRI accurately showed the malignancy and high tumor density. A 52-year-old woman complained of a left dorsal mass, which presented inhomogeneous intermediate signals on T2-weighted images, with diffusion restriction, strong enhancement, and increased accumulation of FDG (SUVmax, 5.2). Although biopsy was inconclusive, a highly malignant tumor was suspected radiologically. The resected specimen was histologically diagnosed as extraskeletal myxoid chondrosarcoma by detection of EWSR1::NR4A3 fusion using fluorescence in situ hybridization.
A Rare False-Positive Whole-Body Scan in a Patient With Differentiated Thyroid Cancer
Authors: Ak Sivrikoz İlknur , Deveci Hakan , Yıldırım Nilgün
Published: April 2024

131I has been used effectively over the years in both diagnosis and therapy of differentiated thyroid cancer (DTC). Although whole-body scan with 131I is a highly sensitive tool for detecting normal thyroid tissue and metastasis of DTC, it is not specific; therefore, false-positive images can be seen in clinical practice, and their recognition is critical for correct management. Evaluation of false-positive uptake is important because it may be confused with metastatic involvement. Here, we present a rare false-positive result of whole-body scan in a patient with DTC. To our knowledge, it is the first report on 131I uptake of conjunctival concretions.
Systemic and Neurosarcoidosis With Rare Involvement of the Extremities’ Peripheral Nerves
Authors: Palot Manzil Fathima Fijula , Eichhorn Joshua , Kaur Harleen
Published: April 2024

We present a case of sarcoidosis with a rare presentation of involvement of peripheral nerves of the lower limbs and subcutaneous nodules detected on 18F-FDG PET/CT. The patient also had involvement of the spinal nerves and dura, histologically proven to be sarcoidosis. There were other manifestations of systemic sarcoidosis like metabolically active cervical and mediastinal lymphadenopathy. This case highlights the role of 18F-FDG PET/CT in evaluating the uncommon sites of sarcoid involvement. Although many cases of sarcoid involvement of central nervous system have been reported, peripheral nerves involvement in the extremities was not found on a literature search.
Early Return of Motion in Patients With Intramedullary Screw Placement for Metacarpal and Phalangeal Fracture Fixation
Authors: Humar Pooja , Thayer Jacob , Bengur Fuat Baris , Villalvazo Yadira , Hu Michael , Unadkat Jignesh
Published: April 2024

Introduction

Hand fractures are associated with significant morbidity. Current management standards often result in prolonged immobilization, stiffness, and delayed return to functional use. Intramedullary (IM) compression screws offer minimal soft tissue disruption and early postoperative active motion. In this study, we describe our outcomes after intraosseous fracture fixation using IM cannulated headless screws for a multitude of fracture patterns.

Methods

This study is a retrospective review of patients who underwent IM screw placement for fixation of metacarpal and phalangeal fractures by a single surgeon from 2017 to 2022. Data were collected to include patient demographics, fracture details, postoperative complications, and follow-up. Time to range of motion and return to unrestricted motion was recorded.

Results

There were 69 patients with 92 fractures (n = 54 metacarpal, n = 38 phalanx). The median patient age was 45 years (range, 18–89 years) with 75.4% males. Majority presented with a single fracture (n = 50, 72.5%), and 38 patients (55.1%) had open fractures. Small finger was the most affected digit (n = 35, 37.6%). The median time to allow range of motion from surgery was 8.7 days (interquartile range, 0–32) with 32 days (interquartile range, 10–62) for unrestricted use of the hand. Thirty-five patients (50.7%) were allowed controlled motion from the first postoperative day. One patient had loss of reduction requiring reintervention for hardware removal, and 1 patient had superficial skin infection managed with oral antibiotics.

Conclusions

Our findings indicate that the IM screw provides reliable fixation for a wide variety of fracture patterns with a low complication rate and offers early return to functional use.
Practice Patterns and Outcomes of Skin Cancer Reconstruction of the Head, Neck, and Face by Surgical Specialty
Authors: Diaddigo Sarah , Dagi Alexander , Trujillo Oscar
Published: April 2024

Introduction

Reconstructive procedures of the head, neck, and face after skin cancer resection are typically performed by surgeons trained in either ENT facial plastic surgery or plastic and reconstructive surgery. We analyzed a large national database to compare patient populations, practice, and outcomes of skin cancer reconstruction of the head, neck, and face performed by these 2 surgical specialties.

Methods

Cases were selected from the American College of Surgeons National Surgical Quality Improvement Program. Variables that differed significantly on univariate analysis were included in a nominal logistic regression, with having at least 1 wound-specific complication, medical complication, or unplanned reoperation within 30 days as the dependent variables.

Results

There were a total of 2850 cases, of which 61.36% were performed by ENT. Surgical specialty was not found to be a predictor of wound complications, medical complications, or unplanned reoperations. On multivariate analysis, operative times greater than 6 hours and anatomical location (specifically, skin cancer of the nose) predicted adverse outcomes. Significant differences were observed between the patient populations of the 2 specialties in terms of demographics, comorbidities, and the anatomical location of the cancer defect.

Conclusion

Reconstruction of the head, neck, and face after skin cancer removal represents an important and common element in the scope of practice of both ENT facial plastic surgeons and plastic surgeons. No evidence was found to suggest that surgical specialty is associated with adverse postoperative outcomes. However, ENT facial plastic surgeons and plastic surgeons seem to manage unique patient populations and use different reconstructive techniques, reflecting their distinct training and areas of expertise. A multidisciplinary approach where the complementary skills of both specialties can be leveraged may optimize patient outcomes.
The Development and Management of Neck Burn Scar Contracture Recurrence
Authors: Jeong Tiffany , Alessandri-Bonetti Mario , Pandya Sumaarg , Liu Hilary , Stofman Guy M. , Egro Francesco M.
Published: April 2024

Introduction

Burn neck contractures pose a great challenge for reconstructive surgeons. A paucity of literature exist regarding long-term outcomes based on different surgical management strategies. The aim of this study was to evaluate the long-term outcomes of the treatment of neck burn scar contractures and evaluate surgical strategies according to their long-term effectiveness and associated complications.

Methods

A retrospective cohort study was conducted to review outcomes of neck contractures release after burn injury. All patients operated on between January 2009 and February 2023 at a single institution were included.

Results

A total of 20 patients developed neck burn scar contracture and were included in this study. The mean age was 32.9 ± 20.3 years. The burn injuries were most commonly thermal (n = 19, 95%). All burn injuries were full-thickness burns, with an average neck defect size of 130.5 ± 106.0 cm2. Overall, 45 surgical scar release procedures were performed on the 20 patients who developed a neck contracture. Patients underwent 1.65 ± 1.04 surgeries on average to address neck contracture. Although 25% of patients only received 1 surgery to treat neck contracture, some patients underwent as many as 8 surgeries. Contracture recurrence (CR) was the most common complication and occurred in 28.9% of the cases. The mean percentage total body surface area did not significantly differ in CR patients (26.7% ± 14.9%) and no-CR patients (44.5% ± 30.2%). However, there was a significant difference (P = 0.01) in the average neck defect size between CR patients (198.5 ± 108.3 cm2) and no-CR patients (81.1 ± 75.1 cm2).

Conclusions

This study showed that risk factors for initial burn scar contractures may differ from those associated with CR, highlighting the importance of neck defect size as a predictor. The study also examines various surgical approaches, with Z-plasty showing promise for managing CR. However, the absence of data on neck range of motion is a limitation. This research underscores the complexity of managing CR and emphasizes the need for ongoing postoperative monitoring.
Infection After Lower-Limb Osseointegration
Authors: Black Grant G. , Vaeth Anna M. , Kochheiser Makayla , Chen Yunchan , Truong Albert Y. , Reif Taylor , Rozbruch S. Robert , Henry Michael W. , Otterburn David M.
Published: April 2024

Purpose

Osseointegration (OI) is a novel alternative to traditional socket-suspended prostheses for lower-limb amputees, eliminating the socket-skin interface and allowing for weight bearing directly on the skeletal system. However, the stoma through which the implant attaches to the external prosthesis creates an ingress route for bacteria, and infection rates as high as 66% have been reported. The aims of this study are to classify infection management and long-term outcomes in this patient population to maximize implant salvage.

Methods

An institutional review board–approved retrospective analysis was performed on all patients who underwent lower-limb OI at our institution between 2017 and 2022. Demographic, operative, and outcome data were collected for all patients. Patients were stratified by the presence and severity of infection. Chi-square and t tests were performed on categorical and continuous data, respectively, using an alpha of 0.05.

Results

One hundred two patients met our study criteria; 62 had transfemoral OI and 40 had transtibial OI. Patients were followed for 23.8 months on average (range, 3.5–63.7). Osteomyelitis was more likely than soft tissue infection to be polymicrobial in nature (71% vs 23%, P < 0.05). Infections at the stoma were mostly (96%) managed with oral antibiotics alone, whereas deeper soft tissue infections also required intravenous antibiotics (75%) or operative washout (19%). Osteomyelitis was managed with intravenous antibiotics and required operative attention; 5 (71%) underwent washout and 2 (29%) underwent explantation. Both implants were replaced an average of 3.5 months after explantation. There was no correlation between history of soft tissue infection and development of osteomyelitis (P > 0.05). The overall implant salvage rate after infection was 96%.

Conclusions

This study describes our institution's experience managing infection after OI and soft tissue reconstruction. Although infections do occur, they are easily treatable and rarely require operative intervention. Explantation due to infection is rare and can be followed up with reimplantation, reaffirming that OI is a safe and effective treatment modality.
Outcomes and Quality of Life After Resorbable Synthetic Ventral Hernia Repair in Contaminated Fields
Authors: Lemdani Mehdi S. , Niu Ellen F. , Amro Chris , Gala Zachary , Ewing Jane N. , Honig Stephanie E. , Broach Robyn B. , Fischer John P.
Published: April 2024

Introduction

The ideal mesh type for hernia repair in a contaminated field remains controversial. Data regarding outcomes beyond 1 year and the impact on quality of life (QoL) are unknown. This study aims to evaluate the long-term surgical outcomes and patient-reported outcomes (PROs) after contaminated repair with poly-4-hydroxybutyrate (P4HB) mesh.

Materials & Methods

Patients undergoing a contaminated hernia repair with P4HB between 2015 and 2020 were identified. Surgical site occurrences and hernia recurrences were recorded. Long-term PROs as defined by the Abdominal Hernia-Q and Hernia-Related Quality-of-Life Survey were assessed.

Results

Fifty-five patients were included with a mean age of 54.5 years, a body mass index of 34 kg/m2, and a defect size of 356.9 ± 227.7 cm2. Median follow-up time was 49 months with a reoperation rate of 14.5% and a hernia recurrence rate of 7.3%. Of the 55 patients, 37 completed preoperative and postoperative PRO questionnaires. When comparing preoperative with postoperative Abdominal Hernia-Q, there was significant improvement in overall PROs (2.1 vs 3.5, P < 0.001). This improvement was maintained with no significant changes between postoperative scores over the course of 5 years. Patients with complications saw the same improvement in postoperative PRO scores as those without complications.

Conclusions

Our study found a low hernia recurrence and acceptable long-term reoperation rates in patients undergoing hernia repair with P4HB mesh in a contaminated setting. We demonstrate a sustained significant improvement in QoL scores after hernia repair. These data yield insight into the long-term outcomes and QoL improvement, providing physicians further knowledge to better counsel their patients.
Replacing the Scalpel With a Computer Mouse
Authors: Oxford Madison A. , McLaughlin Caroline M. , McLaughlin Christopher J. , Johnson T. Shane , Roberts John M.
Published: April 2024

Background

Following the integration of the electronic health record (EHR) into the healthcare system, concern has grown regarding EHR use on physician well-being. For surgical residents, time spent on the EHR increases the burden of a demanding, hourly restricted schedule and detracts from time spent honing surgical skills. To better characterize these burdens, we sought to describe EHR utilization patterns for plastic surgery residents.

Methods

Integrated plastic surgery resident EHR utilization from March 2019 to March 2020 was extracted via Cerner Analytics at a tertiary academic medical center. Time spent in the EHR on-duty (0600–1759) and off-duty (1800–0559) in the form of chart review, orders, documentation, and patient discovery was analyzed. Statistical analysis was performed in the form of independent t tests and Analysis of Variance (ANOVA).

Results

Twelve plastic surgery residents spent a daily average of 94 ± 84 minutes on the EHR, one-third of which was spent off-duty. Juniors (postgraduate years 1–3) spent 123 ± 99 minutes versus seniors (postgraduate years 4–6) who spent 61 ± 49 minutes (P < 0.01). Seniors spent 19% of time on the EHR off-duty, compared with 37% for juniors (P < 0.01). Chart review comprised the majority (42%) of EHR usage, followed by patient discovery (22%), orders (14%), documentation (12%), other (6%), and messaging (1%). Seniors spent more time on patient discovery (25% vs 21%, P < 0.001), while juniors spent more time performing chart review (48% vs 36%, P = 0.19).

Conclusion

Integrated plastic surgery residents average 1.5 hours on the EHR daily. Junior residents spend 1 hour more per day on the EHR, including more time off-duty and more time performing chart review. These added hours may play a role in duty hour violations and detract from obtaining operative skill sets.
Women in Plastic Surgery Innovation
Authors: Xun Helen , Foppiani Jose A. , Bustos Valeria P. , Valentine Lauren , Weidman Allan , Hernandez Alvarez Angelica , Kinney JacqueLyn , Verbat Miroslava , Boustany Ashley , Lee Bernard T. , Lin Samuel J.
Published: April 2024

Background

This study aims to pioneer in evaluating women's representation in plastic surgery innovations, focusing on mammary prosthesis devices' inventorship. Despite growing gender parity in the field, women's involvement in innovation remains underexplored. This is especially crucial, as the predominant recipients of these innovative technologies are women, urging a necessity for broader female engagement in pioneering surgical advancements.

Method

Patents under the “A61F2/12: Mammary prostheses and implants” classification between the dates January 1, 2011, to December 31, 2020, were identified using Google Patents Advanced. Inclusion criteria included patents (not designs) in English and applications (not grants), with no litigation limitations. Data collected included ID, title, assignee (categorized as industry, academic, private, individual), inventors, and dates (priority, filing, and publication). Sex of inventors was identified with the literature validated gender API, with manual resolution of unresolved genders or with ga_accuracy scores of less than 75%. Data were analyzed using 2-tailed Student t tests, χ2 analysis, and Pearson correlation coefficient (significance set at P ≤ 0.05).

Results

Of the more than 130,000 plastic surgery patents in English identified between the 10-year period, 1355 were classified as A61F2/12. A total of 374 unique patents were included for analysis (841 duplicates were removed, and 140 patents were excluded because of non-English character author names). There was a significant increase in patents over the decade (from 15 in 2011 to 88 in 2020, R
2 = 0.74, P < 0.05), with a decrease in number of inventors per patent (R
2 = 0.12, P < 0.05). Of the 1102 total inventors, 138 were female (11.2%), with a 4-fold increase in representation over the decade (R
2 = 0.58, P < 0.05), including increase in patents filed with a woman first inventor (0%–14.8%). Women were equally likely to be first 3 inventors versus middle to last inventors (12.8% vs 11.1%, respectively).

Conclusions

Over a decade, mammary device innovations rose significantly. Although women inventors' representation improved, it remains disproportionate compared with women in residency/practice. Hence, interventions should aim to align inventor representation with training ratios, through institutional optimization, reducing gender segmentation, and enhancing funding opportunities.
Comparing Graduating Plastic Surgery Residents' Case Logs With Accreditation Council for Graduate Medical Education Requirements, Content at National Meetings, and In-Service Examination Test Items
Authors: O'Shea Aidan W. , Sweitzer Keith R. , Bell Derek E.
Published: April 2024

Background

The importance of adaptable and up-to-date plastic surgery graduate medical education (GME) has taken on new meaning amidst accelerating surgical innovation and increasing calls for competency-based training standards. We aimed to examine the extent to which the procedures plastic surgery residents perform, as represented in case log data, align with 2 core standardized components of plastic surgery GME: ACGME (Accreditation Council for Graduate Medical Education) minimum procedure count requirements and the PSITE (Plastic Surgery In-Service Training Examination). We also examined their alignment with procedural representation at 2 major plastic surgery meetings.

Methods

Nine categories of reconstructive and aesthetic procedures were identified. Three-year averages for the number of procedures completed in each category by residents graduating in 2019–2021 were calculated from ACGME national case log data reports. The ACGME procedure count minimum requirements were also ascertained. The titles and durations of medical programming sessions scheduled for Plastic Surgery The Meeting (PSTM) 2022 and the Plastic Surgery Research Council (PSRC) Annual Meeting 2022 were retrieved from online data. Finally, test items from the 2020 to 2022 administrations of the PSITE were retrieved. Conference sessions and test items were assigned to a single procedure category when possible. Percent differences were calculated for comparison.

Results

The distribution of procedures on plastic surgery resident case logs differs from those of the major mechanisms of standardization in plastic surgery GME, in-service examination content more so than ACGME requirements. Meeting content at PSTM and PSRC had the largest percent differences with case log data, with PSTM being skewed toward aesthetics and PSRC toward reconstructive head and neck surgery.

Discussion

The criteria and standards by which plastic surgery residents are evaluated and content at national meetings differ from the procedures they actually complete during their training. Although largely reflecting heterogeneity of the specialty, following these comparisons will likely prove useful in the continual evaluation of plastic surgery residency training, especially in the preparation of residents for the variety of training and practice settings they pursue.
Use of Absorbable Dermal Staples in Bilateral Breast Reduction Surgery
Authors: Kim Dylan K. , Wright Matthew A. , Ascherman Jeffrey A.
Published: April 2024

Background

Use of the absorbable deep dermal stapler in wound closure has become more common in plastic surgery because of its possible reduction in operative times and subsequent decrease in operative room costs. In this study, we examine the effects of this stapler on operative times and postoperative complications in bilateral reduction mammaplasties.

Methods

A retrospective, observational cohort study was conducted via electronic chart review on patients who underwent bilateral reduction mammaplasties. Patients were stratified by wound closure method. One group was closed with sutures only, and in the other group, deep dermal staples were used during closure of the inframammary fold incision. Incidences of patient comorbidities and postoperative complications were compared. In addition, a financial cost analysis was performed.

Results

The final patient cohort included 62 patients. Operative time was reduced by an average of 21.8 minutes when using deep dermal staples during closure, compared with when closing solely with sutures (P = 0.032). When controlling for mass of breast tissue removed and type of pedicle, deep dermal staple closure still predicted a reduction of 26.5 (SE, 9.9) minutes in operative time (P = 0.010). Postoperative complications were not affected by wound closure method (odds ratio, 4.36; 95% confidence interval, 0.91–31.7, P = 0.087). Though not statistically significant, financial charge was decreased with usage of deep dermal staples (P = 0.34).

Conclusions

Use of absorbable deep dermal staples produces a significant decrease in operative time for reduction mammaplasties with no increase in postoperative complication rates.
Comparative Analysis of Animal-Derived vs Fully Synthetic Acellular Dermal Matrices in Reconstructive Surgery
Authors: Olsen Timothy , Ali-Khan Safi , Bell Derek
Published: April 2024

Introduction

The fully synthetic skin substitute, NovoSorb Biodegradable Temporizing Matrix (BTM), may be a cost-effective alternative to the animal-derived Integra Dermal Regeneration Template (IDRT). However, the current literature insufficiently compares the two. Therefore, our study compared clinical, aesthetic, and economic outcomes in treating soft tissue wounds with IDRT, an animal-derived template, vs BTM, a fully synthetic template.

Methods

Our single-center retrospective study compared outcomes of 26 patient cases treated with BTM (57.7%) or IDRT (42.3%) during 2011–2022.

Results

The mean surgery time was significantly shorter in BTM cases (1.632 ± 0.571 hours) compared with IDRT cases (5.282 ± 5.102 hours, P = 0.011). Median postoperative hospital stay was notably shorter for BTM placement than IDRT placement (0.95 vs 6.60 days, P = 0.003). The median postoperative follow-up length approached a shorter duration in the BTM group (P = 0.054); however, median follow-up visits were significantly lower in the BTM group compared with the IDRT group (5 vs 14, P = 0.012). The median duration for complete wound closure was shorter for BTM (46.96 vs 118.91 days, P = 0.011). Biodegradable Temporizing Matrix demonstrated a notably lower infection rate (0.0%) compared with IDRT (36.4%, P = 0.022). Integra Dermal Regeneration Template exhibited higher wound hypertrophy rates (81.8%) than BTM (26.7%, P = 0.015). Revisionary surgeries were significantly more frequent in the BTM group (P < 0.001). Failed closure, defined as requiring one or more attempts, exhibited a significant difference, with a higher risk in the IDRT group (26.7%) compared with BTM (6.7%, P = 0.003). Biodegradable Temporizing Matrix showed a lower mean Vancouver Scar Scale adjusted fraction (0.279) compared with IDRT (0.639, P < 0.001). Biodegradable Temporizing Matrix incurred lower costs compared with IDRT but displayed a lower mean profit per square centimeter ($10.63 vs $22.53, P < 0.001).

Conclusion

Economically, although the net profit per square centimeter of dermal template may favor IDRT, the ancillary benefits associated with BTM in terms of reduced hospital stay, shorter surgery times, fewer follow-up visits, and lower revisionary surgery rates contribute substantially to overall cost-effectiveness. Biodegradable Temporizing Matrix use reflects more efficient resource use and potential cost savings, aligning with broader trends in healthcare emphasizing value-based and patient-centered care.
The Importance of Circulation in Airway Management
Authors: Anand Tanya , Hosseinpour Hamidreza , Ditillo Michael , Bhogadi Sai Krishna , Akl Malak N. , Collins William J. , Magnotti Louis J. , Joseph Bellal
Published: April 2024

Objective:

To identify the modifiable and nonmodifiable risk factors associated with postintubation hypotension (PIH) among trauma patients who required endotracheal intubation (ETI) in the trauma bay.

Background:

ETI has been associated with hemodynamic instability, termed PIH, yet its risk factors in trauma patients remain underinvestigated.

Methods:

This is a prospective observational study at a level I trauma center over 4 years (2019–2022). All adult (≥18) trauma patients requiring ETI in the trauma bay were included. Blood pressure was monitored both preintubation and postintubation. Multivariable logistic regression analysis was performed to identify the modifiable and nonmodifiable factors associated with PIH.

Results:

Seven hundred eight patients required ETI in the trauma bay, of which, 435 (61.4%) developed PIH. The mean (SD) age was 43 (21) years and 71% were male. Median [interquartile range] arrival Glasgow Coma Scale was 7 [3–13]. Patients who developed PIH had a lower mean (SD) preintubation systolic blood pressure [118 (46) vs 138 (28), P<0.001] and higher median [interquartile range] Injury Severity Score: 27 [21–38] versus 21 [9–26], P<0.001. Multivariable regression analysis identified body mass index >25, increasing Injury Severity Score, penetrating injury, spinal cord injury, preintubation packed red blood cell requirements, and diabetes mellitus as nonmodifiable risk factors associated with increased odds of PIH. In contrast, preintubation administration of 3% hypertonic saline and vasopressors were identified as the modifiable factors significantly associated with reduced PIH.

Conclusions:

More than half of the patients requiring ETI in the trauma bay developed PIH. This study identified modifiable and nonmodifiable risk factors that influence the development of PIH, which will help physicians when considering ETI upon patient arrival.

Level of Evidence:

Level III—Prognostic study.
A high-throughput method for quantifyingDrosophilafecundity
Authors: Gomez Andreana , Gonzalez Sergio , Oke Ashwini , Luo Jiayu , Duong Johnny B. , Esquerra Raymond M. , Zimmerman Thomas , Capponi Sara , Fung Jennifer C. , Nystul Todd G.
Published: April 2024

Measurements of Drosophila fecundity are used in a wide variety of studies, such as investigations of stem cell biology, nutrition, behavior, and toxicology. In addition, because fecundity assays are performed on live flies, they are suitable for longitudinal studies such as investigations of aging or prolonged chemical exposure. However, standard Drosophila fecundity assays have been difficult to perform in a high-throughput manner because experimental factors such as the physiological state of the flies and environmental cues must be carefully controlled to achieve consistent results. In addition, exposing flies to a large number of different experimental conditions (such as chemical additives in the diet) and manually counting the number of eggs laid to determine the impact on fecundity is time-consuming. We have overcome these challenges by combining a new multiwell fly culture strategy with a novel 3D-printed fly transfer device to rapidly and accurately transfer flies from one plate to another; the RoboCam, a low-cost, custom built robotic camera to capture images of the wells automatically; and an image segmentation pipeline to automatically identify and quantify eggs. We show that this method is compatible with robust and consistent egg laying throughout the assay period; and demonstrate that the automated pipeline for quantifying fecundity is very accurate (r2= 0.98 for the correlation between the automated egg counts and the ground truth) In addition, we show that this method can be used to efficiently detect the effects on fecundity induced by dietary exposure to chemicals. Taken together, this strategy substantially increases the efficiency and reproducibility of high throughput egg laying assays that require exposing flies to multiple different media conditions.
Ridge and crossrib height of butterfly wing scales is a toolbox for structural color diversity
Authors: Finet Cédric , Ruan Qifeng , Bei Yi Yang , Saranathan Vinodkumar , Monteiro Antónia
Published: April 2024

The brightest and most vivid colors of butterflies usually originate from light reflecting off the cuticular scales that cover the wing membrane. These scales have an intricate architecture that consists of an upper layer, a grid of longitudinal ridges and transverse crossribs, connected to a lower lamina by pillars called trabeculae. Whereas the role of the lower lamina as a reflector has been well documented in simpler scales, this study unveils the role of the scales’ upper surface in generating or fine-tuning hue, brightness, and saturation. In the nymphalidBicyclus anynana, we showed that changes in ridge and trabecula heights accompanied changes in hue of scales produced via artificial selection. We further found that this correlation between ridge height and hue can be generalized to 40 scale types from 35 species across butterfly families. By combining focused ion beam milling, microspectrophotometry, and optical modelling, we found that modifying the ridge height is sufficient to change ridge hue, notably inMorpho didiuswhose blue color was thought to be generated exclusively by lamella protruding from ridges, rather than ridge height. This study identifies the scale’s upper surface as a toolbox for structural color diversity in butterflies and proposes a geometrical model to predict color that unifies species with and withoutMorpho-type Christmas-tree ridges.
Carbon dioxide shapes parasite-host interactions in a human-infective nematode
Authors: Banerjee Navonil , Gang Spencer S. , Castelletto Michelle L. , Ruiz Felicitas , Hallem Elissa A.
Published: April 2024

Skin-penetrating nematodes infect nearly one billion people worldwide. The developmentally arrested infective larvae (iL3s) seek out hosts, invade hosts via skin penetration, and resume development inside the host in a process called activation. Activated infective larvae (iL3as) traverse the host body, ending up as parasitic adults in the small intestine. Skin-penetrating nematodes respond to many chemosensory cues, but how chemosensation contributes to host seeking, intra-host development, and intra-host navigation – three crucial steps of the parasite-host interaction – remains poorly understood. Here, we investigate the role of carbon dioxide (CO2) in promoting parasite-host interactions in the human-infective threadwormStrongyloides stercoralis. We show thatS. stercoralisexhibits life-stage-specific preferences for CO2: iL3s are repelled, non-infective larvae and adults are neutral, and iL3as are attracted. CO2repulsion in iL3s may prime them for host seeking by stimulating dispersal from host feces, while CO2attraction in iL3as may direct worms toward high-CO2areas of the body such as the lungs and intestine. We also identify sensory neurons that detect CO2; these neurons are depolarized by CO2in iL3s and iL3as. In addition, we demonstrate that the receptor guanylate cyclaseSs-GCY-9 is expressed specifically in CO2-sensing neurons and is required for CO2-evoked behavior. Ss-GCY-9 also promotes activation, indicating that a single receptor can mediate both behavioral and physiological responses to CO2. Our results illuminate chemosensory mechanisms that shape the interaction between parasitic nematodes and their human hosts and may aid in the design of novel anthelmintics that target the CO2-sensing pathway.
PREDICT:Advancing Accurate Gene Expression Prediction and Motif Identification in Plant Stress Responses
Authors: Thalimaraw Lavakau , Henry Eo Wei Xiong , Liu Ming-Jung , Wu Ting-Ying
Published: April 2024

Cells respond to environmental stimuli through transcriptional responses, orchestrated by transcription factors (TFs) that interpret the genecis-regulatory DNA sequences, determining gene expression dynamics timing and locations. Diversification in TFs andcis-regulatory element (CRE) interactions result in unique gene regulatory networks (GRNs) that underpin plant adaptation. A primary challenge is identifying Transcription Factor Binding Motifs (TFBMs) for temporal and condition-specific gene expressions in plants. While the Multiple EM for Motif Elicitation (MEME) suite identifies stress-responsive CREs in Arabidopsis, its predictive power for gene expression remains uncertain. Alternatively, thek-mer approach identifies CRE sites and consensus TF motifs, thereby improving gene expression prediction models. In this study, we harnessed the power of ak-mer pipeline to address sequence-to-expression prediction problems across diverse abiotic stresses, in both bryophytic and vascular plants, including monocots and dicots. Moreover, we characterized both un-gapped and gapped CREs and, coupled with GRN analyses, pinpointed key TFs within transcriptional cascades. Lastly, we developed thePredictiveRegulatoryElementDatabase for IdentifyingCis-regulatory elements andTranscription factors (PREDICT), a web tool for efficientk-mer identification. This advancement will enrich our understanding of thecis-regulatory code landscape that shapes gene regulation in plant adaptation. PREDICT web tool is available at [http://predict.southerngenomics.org/kmers/kmers.php].
Open-source, high performance miniature multiphoton microscopy systems for freely behaving animals
Authors: Madruga Blake A. , Dorian Conor C. , Sehgal Megha , Silva Alcino J. , Shtrahman Matthew , Aharoni Daniel , Golshani Peyman
Published: April 2024

Here we describe the development of the UCLA 2P Miniscope, an easily adopted, open-source miniature 2-photon microscope capable of recording calcium dynamics from neurons located in deep structures and in dendrites over a 445 μm x 380 μm field of view (FOV) during free behavior. The system weighs approximately 4g and utilizes two on-board silicon-based photon detectors for highly sensitive measurements. All hardware is designed for high performance and ease of assembly, while minimizing cost. To test the 2P miniature microscope, we recorded in three experimental conditions to highlight its capabilities during free behavior in mice. First, we recorded calcium dynamics from place cells in hippocampal area CA1. Next, we resolved calcium transients from dendrites in retrosplenial cortex during 30 minutes of free behavior. Last, we recorded dentate granule cell activity at a depth of over 620 μm, through an intact hippocampal CA1 during an open field behavior. The dentate granule cell recordings, to our knowledge, are the first optical recordings from these neurons ever performed in the intact hippocampus during free behavior. The miniature microscope itself and all supporting equipment are open-source and all files needed for building the scope can be accessed through the UCLA Golshani LabGitHub repository.
TDP43 proteinopathy exhibits disease, tissue, and context-specific cryptic splicing signatures
Authors: Newton Dwight F , Yang Rena , Gutierrez Johnny , Hofmann Jeffrey W , Yeh Felix L , Biever Anne , Friedman Brad A
Published: April 2024

Mislocalization of the nuclear protein TAR DNA-binding protein 43 (TDP43) is a hallmark of ALS and FTD which leads to de-repression and inclusion of cryptic exons. These cryptic exons represent promising biomarkers of TDP43 pathology in a spectrum of neurodegenerative diseases. However, most cryptic exons to date have been identified fromin vitromodels or a single cortical FTD dataset, limiting our understanding of tissue and cell-specific splices as well as differences betweenin vitroandin vivoprocesses. We meta-analyzed published bulk RNAseq datasets representing 1,778 RNAseq profiles of ALS and FTD post-mortem tissue, andin vitromodels with experimentally depleted TDP43. We identified 142 cryptic splices, including 76 novel events, and identified cryptic splicing signatures with distinct cortical and spinal cord enrichment, among other context-specific profiles. Using RNAseq and RT-qPCR, we validated a subset of these splices in an independent spinal cord cohort, and demonstrated a correlation of TDP43 pathology severity with degree of cryptic splicing. Leveraging multiple public single-nucleus RNAseq datasets of ALS and FTD motor and frontal cortex, we confirmed the elevation of cortical-enriched splices in disease and localized them to layer-specific neuronal populations. This catalog of cryptic splices could inform efforts to develop biomarkers for tissue-specific and cell type-specific TDP43 pathology.
Whole-Brain Dynamics Disruptions in the Progression of Alzheimer's Disease: Understanding the Influence of Amyloid-Beta and Tau
Authors: Patow Gustavo A. , Escrichs Anira , Ritter Petra , Deco Gustavo
Published: April 2024

INTRODUCTION: Alzheimer's disease (AD) affects brain structure and function along its evolution, but brain network dynamic changes remain largely unknown. METHODS: To understand how AD shapes brain activity, we investigated the spatiotemporal dynamics and resting state functional networks using the intrinsic ignition framework, which characterizes how an area transmits neuronal activity to others, resulting in different degrees of integration. Healthy participants, MCI, and AD patients were scanned using resting state fMRI. Mixed effects models were used to assess the impact of ABeta and tau, at the regional and whole-brain levels. RESULTS: Dynamic complexity is progressively reduced, with Healthy participants showing higher metastability (i.e., a more complex dynamical regime over time) than observed in the other stages, while AD subjects showed the lowest. DISCUSSION: Our study provides further insight into how AD modulates brain network dynamics along its evolution, progressively disrupting the whole-brain and resting state network dynamics.
Motion vision is tuned to maximize sensorimotor energy transfer in blowfly flight
Authors: Humbert J. Sean , Krapp Holger G. , Baeder James D. , Badrya Camli , Dawson Inés L. , Huang Jiaqi V. , Hyslop Andrew , Jung Yong Su , Lutkus Cosima , Mortimer Beth , Nagesh Indira , Ruah Clément , Walker Simon M. , Yang Yingjie , Żbikowski Rafał W. , Taylor Graham K.
Published: April 2024

Biological sensors have evolved to act as matched filters that respond preferentially to the stimuli they expect to receive during ecologically relevant tasks [1–3]. For instance, insect visual systems are tuned to detect stimuli ranging from the small-target motion of mates [4, 5] or prey [6, 7] to the polarization pattern of the sky [1, 8]. In flies, individually identified neurons called lobula plate tangential cells respond to optic flow fields matched to specific self-motions [9, 10], forming the output layer of what is presently nature’s best-understood deep convolutional neural network [11–13]. But what functional principle does their tuning embed, and how does this aid motor control? Here we test the hypothesis that evolution co-tunes physics and physiology by aligning the preferred directions of an animal’s sensors to the most dynamically-significant directions of its motor system [14]. We build a state-space model of blowfly flight by combining visual electrophysiology, synchrotron-based X-ray microtomography, high-speed videogrammetry, and computational fluid dynamics. We then apply control-theoretic tools to show that the tuning of the fly’s widefield motion vision system maximizes the flow of energy from control inputs and disturbances to sensor outputs, rather than optimizing state estimation as is the conventional approach to sensor placement in engineering [15, 16]. We expect the same functional principle to apply across sensorimotor systems in other organisms, with implications for the design of novel control architectures for robotic systems combining high performance with low computational load and low power consumption.