bluuebunny/crossref_metadata_2025 huggingface dataset:
Phytoplankton community composition and biomass in the oligotrophic Gulf of Mexico
Authors: E Selph Karen , Swalethorp Rasmus , R Stukel Michael , B Kelly Thomas , N Knapp Angela , Fleming Kelsey , Hernandez Tabitha , R Landry Michael
Published: January 2021

Biomass and composition of the phytoplankton community were investigated in the deep-water Gulf of Mexico (GoM) at the edges of Loop Current anticyclonic eddies during May 2017 and May 2018. Using flow cytometry, high-performance liquid chromatography pigments and microscopy, we found euphotic zone integrated chlorophyll a of ~10 mg m−2 and autotrophic carbon ranging from 463 to 1268 mg m−2, dominated by picoplankton (<2 μm cells). Phytoplankton assemblages were similar to the mean composition at the Bermuda Atlantic Time-series Study site, but differed from the Hawaii Ocean Times-series site. GoM phytoplankton biomass was ~2-fold higher at the deep chlorophyll maximum (DCM) relative to the mixed layer (ML). Prochlorococcus and prymnesiophytes were the dominant taxa throughout the euphotic zone; however, other eukaryotic taxa had significant biomass in the DCM. Shallower DCMs were correlated with more prymnesiophytes and prasinophytes (Type 3) and reduced Prochlorococcus. These trends in ML and DCM taxonomic composition likely reflect relative nutrient supply—with ML populations relying on remineralized ammonium as a nitrogen source, and the taxonomically diverse DCM populations using more nitrate. These spatially separated phytoplankton communities represent different pathways for primary production, with a dominance of picoplankton in the ML and more nano- and microplankton at the DCM.
US-Guided Transforaminal Cervical Nerve Root Block: A Novel Lateral in-Plane Approach
Authors: Wu Junzhen , Xu Yongming , Pu Shaofeng , Zhou Jin , Lv Yingying , Li Cheng , Du Dongping
Published: January 2021

Objective

The aim of the present study was to investigate the effectiveness and safety of a novel lateral in-plane approach for ultrasound-guided transforaminal cervical nerve root block (US-guided TF-CNRB) in the treatment of cervical radiculopathic pain.

Design

The design of the present study consisted of an institutional, retrospective case series.

Setting

The present study was conducted at a university hospital.

Subjects

Thirty-two patients with cervical radiculopathy who were resistant to conservative therapies and regular US-guided CNRB were included as participants.

Methods

The included patients were treated with US-guided TF-CNRB. During the treatments, using real-time fluoroscopy, we monitored the spreading patterns of a contrast medium and double confirmed the positions of needle tips. Pain numeric rating scales (NRS) and symptom relief grades were determined via telephone interviews at one, four, and 12 weeks after the procedures.

Results

US-guided TF-CNRB was performed at the C5 level in six patients, the C6 level in 18 patients, and the C7 level in eight patients. Compared with NRS at baseline, pain scores decreased throughout the observation period. Symptom relief rates of US-guided TF-CNRB at one, four, and 12 weeks were 72%, 69%, and 63%, respectively. Venous blood was aspirated during the procedures in two patients, and the needle tips were corrected. No intravascular injections or neurologic injuries were observed.

Conclusion

US-guided TF-CNRB produced circumferential spreading around the involved cervical nerve root and showed significant clinical effectiveness in patients resistant to regular US-guided CNRB.
The Association Between Smoking Abstinence and Pain Trajectory Among Veterans Engaged in U.S. Department of Veterans Affairs Mental Health Care
Authors: Hammett Patrick J , Businelle Michael S , Taylor Brent C , Erbes Christopher R , Bastian Lori , Doran Neal , Sherman Scott E , Rogers Erin S , Burgess Diana J , Fu Steven S
Published: January 2021

Objective

To prospectively examine associations between smoking and nicotine abstinence and pain trajectory over 12 months among smokers with low, moderate, and severe pain and to assess whether these associations differ over time.

Design

A secondary analysis of the “Proactive Outreach for Smokers in VA Mental Health” study, a randomized controlled trial of proactive outreach for veteran smokers engaged in U.S. Department of Veterans Affairs (VA) mental health care.

Methods

Participants were categorized into “low” (n = 616), “moderate” (n = 479), and “severe” pain (n = 656) groups according to baseline pain score. Associations between self-reported abstinence from smoking and nicotine at 6 and 12 months and pain trajectory, measured via the PEG scale (Pain intensity, Enjoyment of life, General activity) composite score, were assessed through the use of general linear mixed models. Interaction tests assessed whether these associations differed at 6 and 12 months. Analyses were conducted within the overall sample and within the separate pain groups.

Results

There were significant interactions in the overall sample and the low and moderate pain groups, such that 7-day point prevalence smoking abstinence was associated with lower pain scores at 6 but not 12 months. In the severe pain group, 7-day abstinence from both smoking and nicotine was associated with lower pain scores across both time points. Six-month prolonged abstinence was not associated with pain scores.

Conclusions

In this prospective analysis conducted among veteran smokers engaged in mental health services, 7-day abstinence from smoking and nicotine was associated with significantly lower levels of pain. Education efforts could help better inform smokers on the relationship between smoking and pain.
How Do People Communicate About Knee Osteoarthritis? A Discourse Analysis
Authors: Bunzli Samantha , Taylor Nicholas , O’Brien Penny , Dowsey Michelle , Wallis Jason , Choong Peter , Shields Nora
Published: January 2021

Objective

To explore the ways in which people talk about knee osteoarthritis and how this may influence engagement in physical activity and activity-based interventions as recommended by clinical practice guidelines.

Design

A qualitative synthesis using discourse analysis methods.

Methods

Systematic review methods were used to identify qualitative studies exploring the perceptions of people with knee osteoarthritis, their carers, and/or clinicians. Methodological quality was evaluated through the use of the Critical Appraisal Skills Programme. Raw quotes extracted from each study were analyzed with inductive discourse analysis.

Results

A search of five electronic databases from inception until August 2019 yielded 778 articles. Sixty-two articles from 56 studies were included, reporting data (1,673 direct quotes) from people with knee osteoarthritis, carers, and clinicians in 16 countries. Two overarching discourses were identified—impairment and participation. The overarching impairment discourse prevailed in all participant groups and study settings. In this discourse, knee osteoarthritis was likened to a machine that inevitably wore down over time and required a doctor to repair. The overarching participatory discourse almost always coexisted alongside an impairment discourse. According to this discourse, a “busy body” was perceived as “healthy,” and people could remain active despite knee osteoarthritis.

Conclusion

The prevailing impairment discourse may potentially discourage people from using knees that have passed their “use-by date” and increase reliance on doctors to repair joint damage. Consistent with recommendations in clinical practice guidelines, a participatory discourse may provide an alternative way of communicating that may encourage people with knee osteoarthritis to continue to engage in physical activity by focusing on what they can do, rather than what they cannot do.
Structure-Activity Relationship of Neuroactive Steroids, Midazolam, and Perampanel Toward Mitigating Tetramine-Triggered Activity in Murine Hippocampal Neuronal Networks
Authors: Antrobus Shane , Pressly Brandon , Nik Atefeh Mousavi , Wulff Heike , Pessah Isaac N
Published: January 2021

Tetramethylenedisulfotetramine (tetramine or TETS), a potent convulsant, triggers abnormal electrical spike activity (ESA) and synchronous Ca2+ oscillation (SCO) patterns in cultured neuronal networks by blocking gamma-aminobutyric acid (GABAA) receptors. Murine hippocampal neuronal/glial cocultures develop extensive dendritic connectivity between glutamatergic and GABAergic inputs and display two distinct SCO patterns when imaged with the Ca2+ indicator Fluo-4: Low amplitude SCO events (LASE) and High amplitude SCO events (HASE) that are dependent on TTX-sensitive network electrical spike activity (ESA). Acute TETS (3.0 µM) increased overall network SCO amplitude and decreased SCO frequency by stabilizing HASE and suppressing LASE while increasing ESA. In multielectrode arrays, TETS also increased burst frequency and synchronicity. In the presence of TETS (3.0 µM), the clinically used anticonvulsive perampanel (0.1–3.0 µM), a noncompetitive AMPAR antagonist, suppressed all SCO activity, whereas the GABAA receptor potentiator midazolam (1.0-30 µM), the current standard of care, reciprocally suppressed HASE and stabilized LASE. The neuroactive steroid (NAS) allopregnanolone (0.1–3.0 µM) normalized TETS-triggered patterns by selectively suppressing HASE and increasing LASE, a pharmacological pattern distinct from its epimeric form eltanolone, ganaxolone, alphaxolone, and XJ-42, which significantly potentiated TETS-triggered HASE in a biphasic manner. Cortisol failed to mitigate TETS-triggered patterns and at >1 µM augmented them. Combinations of allopregnanolone and midazolam were significantly more effective at normalizing TETS-triggered SCO patterns, ESA patterns, and more potently enhanced GABA-activated Cl− current, than either drug alone.
Seasonal Variation in Parental Satisfaction With Pediatric Orthopaedics
Authors: Van de Velde Samuel K. , Cola Kristin , Bompadre Viviana , Steinman Suzanne E.
Published: January 2021

Background:

The degree of parental satisfaction with health care is determined by the family’s characteristics and expectations. Many aspects of human physiology and behavior have seasonal rhythms. The purpose of the present study was to determine whether parental satisfaction scores vary across the year in a pediatric orthopaedic outpatient population.

Methods:

We retrospectively reviewed a total of 22,951 parental satisfaction scores related to outpatient pediatric orthopaedic encounters between October 2015 and April 2019. Parental satisfaction was measured using the provider subdomain of the shortened version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Families were stratified according to various pediatric orthopaedic subspecialty services.

Results:

The satisfaction scores of all pediatric orthopaedic encounters combined did not vary significantly across the year (P=0.8745). When the families were stratified into groups by pediatric orthopaedic subspecialty clinic, variation in seasons was not associated with statistically significant variation in satisfaction scores for the elective surgery, sports medicine, trauma/fracture care, and hand/upper extremity services. However, satisfaction with the spine service was significantly lower in the winter compared with the summer and fall (73.9±3.8 vs. 83.5±5.3 and 82.6±3.6, respectively; P=0.0147).

Conclusions:

The provision of pediatric spine care in a region with 4 distinct seasons received lower parental satisfaction scores during the winter than during the summer and fall. This seasonal variation is an additional source of bias in the measurement of satisfaction with health care.

Level of Evidence:

Level II—retrospective study.
The Incidence of Vertebral Exostoses in Multiple Hereditary Exostoses and Recommendations for Spinal Screening
Authors: Wininger Austin E. , Chhabra Barkha N. , Haigler Richard E. , Hanson Darrell S. , Scott Allison C.
Published: January 2021

Background:

Multiple hereditary exostoses (MHE) lead to the development of pedunculated or sessile osteocartilaginous lesions. Vertebral involvement occurs in MHE and encroaching intracanal exostoses can result in devastating consequences. Magnetic resonance imaging (MRI) of the entire spine has been used to screen for vertebral exostoses to detect high-risk patients. The primary purpose of this investigation is to determine the incidence of vertebral and encroaching intracanal exostoses in patients with MHE. A secondary purpose is to determine if pelvis and rib exostoses serve as “harbinger” lesions of vertebral involvement in MHE.

Methods:

A retrospective chart review was performed on 39 patients (21 male and 18 female individuals) with MHE who underwent routine spinal screening with noncontrast entire spine MRI. The average age at screening was 12.3 years (range, 3 to 17 y). Screening was ordered consecutively on patients seen during the study period who were between ages 8 and 18 years or had complaints that could be related to encroaching intracanal exostoses.

Results:

The incidence of vertebral exostoses in this cohort of 39 patients with MHE was 28% (11 total). An encroaching intracanal exostosis was seen in 3 patients (2 cervical, 1 thoracic). Nonencroaching vertebral exostoses were discovered in 8 patients. Sufficient pelvis and rib imaging to determine the presence of pelvis and rib exostoses was available in 8 of those with vertebral exostoses and 19 of those with no vertebral exostoses on screening MRI. In this cohort, the sensitivity and specificity of the presence of both pelvis and rib exostoses for determining the presence of spinal involvement in MHE are 88% and 5%, respectively.

Conclusions:

Based on the results of this cohort, vertebral exostoses are common in MHE, and screening MRI of the entire spine can be used to determine which patients need close observation. If a more selective screening protocol is utilized, an entire spine MRI could be obtained for patients who desire increased physical activity levels or for patients with both pelvis and rib exostoses. At a minimum, treating physicians should monitor patients with MHE closely for neurological symptoms and have a low threshold to obtain advanced spinal imaging.

Level of Evidence:

Level III—diagnostic.
A Novel Nomogram for Survival Prediction of Patients with Spinal Metastasis From Prostate Cancer
Authors: Liu Yujie , Li Lin , Jiang Dongjie , Yang Minglei , Gao Xin , Lv Kai , Xu Wei , Wei Haifeng , Wan Wei , Xiao Jianru
Published: January 2021

Study Design.

A retrospective study of 84 patients with spinal metastasis from prostate cancer (SMPCa) was performed.

Objective.

The aim of this study was to predict the survival of patients with SMPCa by establishing an effective prognostic nomogram model, associating with the affecting factors and compare its efficacy with the existing scoring models.

Summary of Background Data.

Prostate cancer (PCa) is the second most frequently malignant cancer causing death in men, and the spine is the most common site of bone metastatic burden. The aim of this study was to establish a prognostic nomogram for survival prediction of patients with SMPCa, explore associated factors, and compare the effectiveness of the new nomogram prediction model with the existing scoring systems.

Methods.

Included in this study were 84 SMPCa patients who were admitted in our spinal tumor center between 2006 and 2018. Their clinical data were retrospectively analyzed by univariate and multivariate analyses to identify independent variables that enabled to predict prognosis. A nomogram, named Changzheng Nomogram for Survival Prediction (CNSP), was established on the basis of preoperative independent variables, and then subjected to bootstrap re-samples for internal validation. The predictive accuracy and discriminative ability were measured by concordance index (C-index). Receiver-operating characteristic (ROC) analysis with the corresponding area under the ROC was used to estimate the prediction efficacy of CNSP and compare it with the four existing prognostic models Tomita, Tokuhashi, Bauer, and Crnalic.

Results.

A total of seven independent variables including Gleason score (P = 0.001), hormone refractory (P < 0.001), visceral metastasis (P < 0.001), lymphocyte to monocyte ratio (P = 0.009), prostate-specific antigen (P = 0.018), fPSA/tPSA (P = 0.029), Karnofsky Performance Status (P = 0.039) were identified after accurate analysis, and then entered the nomogram with the C-index of 0.87 (95% confidence interval, 0.84–0.90). The calibration curves for probability of 12-, 24-, and 36-month overall survival (OS) showed good consistency between the predictive risk and the actual risk. Compared with the previous prognostic models, the CNSP model was significantly more effective than the four existing prognostic models in predicting OS of the SMPCa patients (p < 0.05).

Conclusion.

The overall performance of the CNSP model was satisfactory and could be used to estimate the survival outcome of individual patients more precisely and thus help clinicians design more specific and individualized therapeutic regimens.

Level of Evidence: 4
Accuracy and Reliability of Standing Lateral Lumbar Radiographs for Measurements of Spinopelvic Parameters
Authors: Wu Jingye , Wei Feng , Ma Lin , Li Jianing , Zhang Ning , Tian Wei , Sun Yuqing
Published: January 2021

Study Design.

Retrospective observational study.

Objective.

To assess the accuracy and reliability of standing lateral lumbar radiographs for measurements of spinopelvic parameters, compared with whole-spine EOS® images.

Summary of Background Data.

Lateral lumbar radiographs are commonly used for measurements of spinopelvic parameters. However, variable magnifications by fan-beam x-ray projection at margins may cause measurement errors.

Methods.

Fifty consecutive patients with standing lateral lumbar radiographs and whole-spine EOS® images were retrospectively reviewed from March to July in 2019. Two orthopedic surgeons (observers) independently measured the spinopelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) on the computers. These spinopelvic parameters of each patient were measured twice on both lateral lumbar radiograph and EOS® image by two observers with the usage of Surgimap software. The measurement difference and agreement of each parameter value between lateral lumbar radiographs and EOS® images were analyzed by paired t test and the interclass correlation coefficient (ICC) respectively. Intra- and inter-observer's reliabilities of both imaging methods were assessed by ICC.

Results.

The measurement difference of each spinopelvic parameter on EOS® images and lateral lumbar radiographs was less than 1° on average. Only the measurement difference of PI value revealed statistically significant (P = 0.020) with 0.9° discrepancy (95% confidential interval: 0.2–1.6), which indicated no clinical significance. The ICC values of lateral lumbar radiographs and EOS® images were more than 0.870 (range, 0.872–0.976), thus showed good to excellent measurement agreement between both imaging methods. All the ICC values for evaluating intra- and inter-observer reliability were greater than 0.960 (range, 0.963–0.993), indicating excellent reliability for observer's measurements.

Conclusion.

Measurements of spinopelvic parameters (PI, PT, SS, and LL) on standing lateral lumbar radiographs are accurate and reliable, which are comparable to whole-spine EOS® images.

Level of Evidence: 3
Anticoagulation in Elective Spine Cases
Authors: Thota Dharani Rohit , Bagley Carlos A. , Tamimi Mazin Al , Nakonezny Paul A. , Van Hal Michael
Published: January 2021

Study Design

Retrospective cohort study with propensity matched cohorts.

Objective

The purpose of this study was to evaluate the association of anticoagulation with VTE and hematoma complications after spine surgery.

Summary of Background Data

One of the major complications of surgery is VTE which can range in presentation. Spine surgery is an especially complex balance between minimizing the risk of a VTE event and also the increased risk of a hematoma which can lead to devastating neurological outcomes.

Methods

The elective spine surgery cases at a single academic center between 2015 and 2017 were identified. A total of 3790 patients were initially identified. Two hundred sixty patients were excluded. The cohort was then matched using a propensity score. This matched a single patient who did not receive anticoagulation to a single patient who did within the institution. This left a total of 1776 patients with 888 patients in each arm.

Results

The incidence of VTE, PE, and unplanned reoperation for hematoma in this cohort was 0.96%, 0.34%, and 1.13%, respectively. Predicted odds of VTE and PE were not significantly different; however, the odds of an unplanned reoperation for hematoma (odds ratio [OR] = 7.535, 95% confidence interval [CI]: 2.004–28.340, P = 0.002) were greater for those who received pharmacological anticoagulation in our institutional cohort.

Conclusion

In this study, anticoagulation does not lead to lower rates of VTE events, but it increases the risk of symptomatic hematomas which require a return trip to the OR. While this was not a randomized controlled trial, we attempted to correct for this with propensity matching. Future randomized control trials would be needed.

Level of Evidence: 3
Predictive Factors Affecting Surgical Outcomes in Patients with Degenerative Lumbar Spondylolisthesis
Authors: Inose Hiroyuki , Kato Tsuyoshi , Onuma Hiroaki , Morishita Shingo , Matsukura Yu , Yuasa Masato , Hirai Takashi , Yoshii Toshitaka , Okawa Atsushi
Published: January 2021

Study Design.

Post-hoc analysis of 5-year follow-up data from a prospective randomized multicenter trial.

Objective.

The purpose of this study was to identify preoperative factors that predict poor postoperative outcomes and define clinically important abnormal instabilities in degenerative lumbar spondylolisthesis.

Summary of Background Data.

Current evidence regarding prognostic factors affecting clinical outcomes after surgery for degenerative lumbar spondylolisthesis is still limited. Moreover, there is no consensus regarding parameters that define clinically important abnormal instability in patients with degenerative lumbar spondylolisthesis.

Methods.

This post-hoc analysis from a prospective randomized trial that compared the effectiveness of decompression, decompression with fusion, and decompression with stabilization for degenerative lumbar spondylolisthesis at the L4/5 level included 70 patients with a 5-year follow-up period. We investigated the correlation between the postoperative recovery rate and preoperative radiographic parameters. We then investigated differences between the good recovery and poor recovery groups.

Results.

Japanese Orthopaedic Association and visual analogue scale scores improved postoperatively. Of the 70 patients analyzed, 13 were judged to be in the poor recovery group based on their recovery rate. The recovery rate significantly correlated with the intervertebral angle at L4/5. Univariate analysis showed that while the degree of vertebral slippage and the presence of angulation were not associated with poor recovery, the intervertebral angle at L4/5 and the presence of translation were associated with poor recovery. Lastly, multiple stepwise logistic regression analysis revealed the intervertebral angle at L4/5 and the presence of translation as independent predictors of poor recovery after surgery for lumbar degenerative spondylolisthesis.

Conclusion.

While the degree of vertebral slippage and the presence of angulation were not associated with poor recovery after surgery for lumbar degenerative spondylolisthesis, postoperative outcomes were associated with the intervertebral angle and the presence of translation. Careful preoperative measurement of these factors may help to predict poor postoperative outcomes.

Level of Evidence: 3
Improving Outcomes for Children Requiring Extracorporeal Membrane Oxygenation Therapy Following Hematopoietic Stem Cell Transplantation
Authors: Olson Taylor L. , O’Neil Erika R. , Kurtz Kristen J. , MacLaren Graeme , Anders Marc M.
Published: January 2021

OBJECTIVES:

The objective of this study was to provide an updated review of survival for pediatric hematopoietic stem cell transplantation patients requiring extracorporeal membrane oxygenation therapy as well as characterize the demographics, clinical variables, and complications associated with mortality.

DESIGN:

Retrospective database review of the Extracorporeal Life Support Organization Registry from 1990 to 2019.

SETTING:

Extracorporeal membrane oxygenation centers reporting to Extracorporeal Life Support Organization.

PATIENTS:

Patients treated with extracorporeal membrane oxygenation greater than 28 days to 18 years old with International Classification of Diseases Ninth Revision, International Classification of Diseases Tenth Revision, and current procedural terminology codes consistent with hematopoietic stem cell transplantation were included.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Demographics, year of extracorporeal membrane oxygenation run, clinical variables, comorbid diagnoses, and extracorporeal membrane oxygenation complications were assessed in relation to the primary study outcome of survival to hospital discharge. Ninety patients were included in the final analysis. The overall survival rate for the study period was 19%. However, the survival rate in the last decade (2010–2019) improved to 26% (p = 0.01; odds ratio 9.4 [1.2–74.8]). Factors associated with decreased survival included comorbid malignancy, elevated peak inspiratory pressure in conventionally ventilated patients, and pulmonary and metabolic complications on extracorporeal membrane oxygenation.

CONCLUSIONS:

Pediatric patients posthematopoietic stem cell transplantation supported with extracorporeal membrane oxygenation have improving survival rates over time. With 26% of patients (16/62) surviving to hospital discharge in the last decade (2010–2019), history of hematopoietic stem cell transplantation may no longer be considered an absolute contraindication to extracorporeal membrane oxygenation. As advancements are made in hematopoietic stem cell transplantation therapies and extracorporeal membrane oxygenation management, the indications for life-saving extracorporeal membrane oxygenation support among patients posthematopoietic stem cell transplantation may expand accordingly.
Viral strategies for circumventing p53: the case of severe acute respiratory syndrome coronavirus
Authors: Cardozo Camila Martin , Hainaut Pierre
Published: January 2021

Purpose of review

Virtually all viruses have evolved molecular instruments to circumvent cell mechanisms that may hamper their replication, dissemination, or persistence. Among these is p53, a key gatekeeper for cell division and survival that also regulates innate immune responses. This review summarizes the strategies used by different viruses and discusses the mechanisms deployed by SARS-CoV to target p53 activities.

Recent findings

We propose a typology for the strategies used by different viruses to address p53 functions: hit and run (e.g. IAV, ZIKV), hide and seek (e.g. HIV1), kidnap and exploit (e.g. EBV, HSV1), dominate and suppress (e.g. HR HPV). We discuss the mechanisms by which SARS nsp3 protein targets p53 for degradation and we speculate on the significance for Covid-19 pathogenesis and risk of cancer.

p53 may operate as an intracellular antiviral defense mechanism. To circumvent it, SARS viruses adopt a kidnap and exploit strategy also shared by several viruses with transforming potential. This raises the question of whether SARS infections may make cells permissive to oncogenic DNA damage.
Content Evaluation of Integrated Plastic Surgery Residency Program Websites Regarding Sub-internships
Authors: Dayani Fara , Rahgozar Paymon
Published: January 2021

Background:

Sub-internships are an integral part of the residency application process for competitive specialties, including plastic and reconstructive surgery (PRS). This study evaluates the quality of online information regarding sub-internships offered by PRS programs.

Methods:

All the US integrated PRS residency programs were identified on Fellowship and Residency Electronic Interactive Database. Each program’s website was assessed for the presence of 4 criteria: mention of a sub-internship offered, contact information of rotation coordinator, learning objectives, and a web page dedicated solely to the sub-internship. Each residency program was assigned a website sub-internship (WSI) score from 0 to 4 accordingly.

Results:

We identified 81 residency programs. Fifty-two residency program received a score of 0, and 6 programs received a score of 4. The mean WSI score was 1.0 for community-based programs, compared with 0.98 for university-based programs (P = 0.93). There was a correlation between WSI score and number of faculty (r = 0.52; P < 0.0000) and number of residents per year (r = 0.34; P = 0.002). In logistic regression model, number of faculty [odds ratio (OR), 1.18; P = 0.003], large program size (OR, 12.1; P = 0.009), and southeast location (OR, 30.3; P = 0.034) were found to be important predictors for PRS programs to mention at least one criterion.

Conclusions:

A majority of the programs did not have any online information available on their websites regarding plastic surgery sub-internships. There is no difference between academic and community-based programs with regard to the quality of information. Programs with more trainees and faculty have higher odds of providing information about sub-internships offered at their institution.
Reconstruction for Severe Extracorporeal Membrane Oxygenation-induced Ischemic Lower Limb Injury Complicated by Osteomyelitis
Authors: Hidaka Takeaki , Kurita Masakazu , Miyamoto Shimpei , Watanabe Mika , Kitamura Yutaro , Okada Keita , Fujiwara Sayaka , Okazaki Mutsumi
Published: January 2021

Summary: Extracorporeal membrane oxygenation (ECMO) is a well-established mechanical circulatory support system used in patients with life-threatening cardiopulmonary conditions. However, severe complications associated with vascular access require consideration. We report a patient with fatal ventricular arrhythmia who was successfully resuscitated with ECMO but who developed severe lower limb ischemia, which resulted in compartment syndrome. Even with emergent fasciotomy, tissue necrosis developed in wide areas of the limb, with subsequent tibial osteomyelitis. After extensive debridement and tibial sequestrectomy, the soft tissue and bone defect were simultaneously reconstructed with free tissue transfer of the latissimus dorsi muscle and scapular tip composite flap. The limb was successfully salvaged with satisfactory functional outcomes without major complications. This report discusses limb reconstruction for ECMO-induced compartment syndrome and illustrates the importance of appropriate selection of reconstruction methods among various composite flaps.
Globalization of Plastic and Reconstructive Surgery: A Continent, Country, and State-Level Analysis of Publications
Authors: Liechty Andrew E. , Sherpa James R. , Trejo Jonathan S. , French Mackenzie M. , Kneib Cameron J. , Cho Daniel Y. , Friedrich Jeffrey B.
Published: January 2021

Background:

Over the past decade, there has been a worldwide increase in plastic and reconstructive surgery research as well as increased interest in global collaboration. However, little is known about who is contributing to this global expansion or the trends of individual countries. The aim of our study was to analyze the output of Plastic and Reconstructive Surgery (PRS) over a decade to elucidate trends in the plastic surgery field.

Methods:

The country of origin for all first authors of articles published by PRS from 2010 to 2019 were determined and date extracted using PubMed2XL. The change in frequency of publications over the decade by country, continental contributions, as well as state-level analysis within the United States were analyzed.

Results:

From 2010 to 2019, there were a total number of 8680 publications with an increase in total articles from 747 to 1049 per year. 54 countries contributed over the decade, with the United States producing the most followed by Italy, China, Canada, and the UK. The top producing states were Texas, New York, California, Massachusetts, and Pennsylvania.

Conclusions:

The last decade (2010–2019) saw a large international increase in research, not only with the total number of publications, but also in the diversity of originating country. Our work shows a shift away from a US-focused journal to incorporate more work from our international colleagues, as research is conducted in centers across the globe.
Clinical Assessment of Breast Volume: Can 3D Imaging Be the Gold Standard?
Authors: Killaars Renee C. , Preuβ Myriam L. G. , de Vos Nathalie J. P. , van Berlo Camille C. J. L. Y. , Lobbes Marc B. I. , van der Hulst René R. W. J. , Piatkowski Andrzej A.
Published: January 2021

Background:

Three-dimensional (3D) camera systems are increasingly used for computerized volume calculations. In this study we investigate whether the Vectra XT 3D imaging system is a reliable tool for determination of breast volume in clinical practice. It is compared with the current gold standard in literature, magnetic resonance imaging (MRI), and current clinical practice (plastic surgeon’s clinical estimation).

Methods:

Breast volumes of 29 patients (53 breasts) were evaluated. 3D images were acquired by Vectra XT 3D imaging system. Pre-existing breast MRI images were collected. Both imaging techniques were used for volume analyses, calculated by two independent investigators. Breast volume estimations were done by plastic surgeons during outpatient consultations. All volume measurements were compared using paired samples t-test, intra-class correlation coefficient, Pearson’s correlation, and Bland–Altman analysis.

Results:

Two 3D breast volume measurements showed an excellent reliability (intra-class correlation coefficient: 0.991), which was comparable to the reliability of MRI measurements (intra-class correlation coefficient: 0.990). Mean (SD) breast volume measured with 3D breast volume was 454 cm3 (157) and with MRI was 687 cm3 (312). These volumes were significantly different, but a linear association could be found: y(MRI) = 1.58 × (3D) – 40. Three-dimensional breast volume was not significantly different from volume estimation made by plastic surgeons (472 cm3 (69), P = 0.323).

Conclusions:

The 3D imaging system measures lower volumes for breasts than MRI. However, 3D measurements show a linear association with MRI and have excellent reliability, making them an objective and reproducible measuring method suitable for clinical practice.
A Novel Immediate Nipple Reconstruction Technique in Oncoplastic Breast Surgery: Inverted Lotus Bud Flap
Authors: Burusapat Chairat
Published: January 2021

Oncoplastic surgery is widely popular due to its ability to achieve curative tumor resection and symmetry of both breasts, and as a result of reduced psychological distress after mastectomy. Immediate nipple reconstruction was discussed and the gold standard procedure is inconclusive. Immediate nipple reconstruction with simultaneous breast reconstruction provides satisfactory esthetic results, compared with the delayed procedure. The “inverted lotus bud flap” was demonstrated as a new technique for immediate nipple reconstruction. The advantage of this technique is adequate nipple projection with minimization of scarring. In conclusion, oncoplastic breast surgery with immediate nipple reconstruction was demonstrated to be a safe and esthetically reliable procedure, leading to reduced psychological distress. This single-stage procedure promotes psychosocial well-being after breast cancer surgery. Immediate nipple reconstruction using the “inverted lotus bud flap” technique is versatile, reliable, and offers good esthetic results.
Early Expander-to-Implant Exchange after Postmastectomy Reconstruction Reduces Rates of Subsequent Major Infectious Complications
Authors: Schwartz Jean-Claude D.
Published: January 2021

Background:

Major infectious complications after implant-based postmastectomy reconstruction commonly occur late (>30 days postoperative). We set out to determine if early expander-to-implant exchange (3–6 weeks after tissue expander placement) reduced rates of subsequent major infectious complications.

Methods:

We retrospectively examined patients after mastectomy and tissue expander reconstruction followed by early expander-to-implant exchange versus exchange at least 6 months after initial tissue expander placement (the control group). Multivariate logistic regression analysis was performed to determine whether the timing of implant exchange independently predicted major infectious complications occurring more than 30 days after initial tissue expander placement after adjusting for differences in patient variables between groups.

Results:

In total, 252 consecutive patients (430 breasts) between August 2014 and October 2019 were included. While the rates of major early infectious complications after mastectomy and tissue expander placement were similar between the groups, the control group had more subsequent major infectious complications during the reconstructive process [9.8% (n = 22) versus 1.9% (n = 4), P < 0.001].

Conclusions:

Early implant exchange results in a reduced subsequent rate of major infectious complications. This protocol reduces the window of time for late infectious complications to develop by proceeding with exchange within 6 weeks of tissue expander placement instead of the standard 6 months, which is common practice. We hypothesize that early exchange allows for washout of the mastectomy cavity, eliminating indolent bacterial contamination that could have subsequently manifested as a late infection. This protocol also obviates the need to operate on patients that undergo post-mastectomy radiotherapy, which also reduces reconstructive failure rates.
Effect of Time to Hand Therapy following Zone II Flexor Tendon Repair
Authors: Johnson Shepard P. , Kelley Brian P. , Waljee Jennifer F. , Chung Kevin C.
Published: January 2021

Background:

This population-based study aimed to define how time to hand therapy following isolated zone II flexor tendon repairs impacts complications and secondary procedures.

Methods:

Insurance claims from the Truven MarketScan Databases were used to evaluate outcomes after isolated zone II flexor tendon repairs between January 2009 and October 2015. Cohorts differing in time to hand therapy were compared to evaluate the impact on complications, reoperation, and number of therapy sessions. Secondary outcomes analyzed how the number of therapy sessions affected rates of reoperation.

Results:

Hand therapy was identified in 82% of patients (N = 2867) following tendon reconstruction. Therapy initiation occurred within 1 week, 1–4 weeks, and after 4 weeks in 56%, 35%, and 9% of patients, respectively. Univariate analysis showed no difference in non-tendinous complications (27%, 30%, 29%; P = 0.29) or tendon rupture rates (13%, 13%, 10%; P = 0.42) within 90 days between cohorts. Multivariable analysis showed no difference in rates of tenolysis (6.3%, 6%, 4.4%; P > 0.01). In the early initiation cohort, >23 hand therapy sessions were associated with the highest rates of tenolysis (19%).

Conclusions:

Despite being a common fear of hand surgeons, early initiation of hand therapy was not associated with increased tendon rupture rates. Although delayed therapy is a concern for tendon scarring, it did not confer a higher risk of tenolysis. Complication rates do not appear to correlate with timing of hand therapy. Therefore, hand surgeons should promote early mobility following isolated flexor tendon injuries given the known functional outcome benefits.
Anatomical Study of the Descending Branch of the Lateral Femoral Circumflex Artery and Veins in Vascular Grafting in Japanese Cadavers
Authors: Ebisudani Shogo , Inagawa Kiichi , Suzuki Yoshinori , Osugi Ikuko
Published: January 2021

Background:

In microsurgery development, autologous vein grafting is necessary when there are no suitable blood vessels for anastomosis around the flap recipient site or when the vascular pedicle of the flap is short. The descending branches of the lateral femoral circumflex artery (LFCA) and vein have been used as a vascular bundle instead of vein grafts, but to our knowledge, there have been no reports on the relationship between thigh length and vessel length. In this study, we performed a macroscopic examination of the LFCA descending branch length required for grafting.

Methods:

The length of the LFCA descending branches and veins as well as thigh length were measured in 16 preserved cadaveric legs.

Results:

The average length of the thigh was 42.6 cm. It was possible to harvest a mean length of 14.2 cm of the descending branches of the lateral femoral circumflex vessels. Descending branches of the LFCA and veins were identified in all cases. It was estimated that the length of the LFCA descending branch and veins could be collected in 20% of the thigh length in 98% of cases.

Conclusion:

When preparing a preoperative plan, it is important to thoroughly consider the required length of blood vessels for grafting and whether it is possible to harvest vessels with sufficient length.
Cryopreservation of embryos: outcomes and implications
Authors: Maheshwari Abha
Published: January 2021

Cryopreservation of embryos is increasing worldwide. As more data are available we are now able to report on outcomes. With better outcomes for women and pregnancies as a result of frozen embryo transfer, we need to consider the implications of using it in routine practice especially in preference to current strategy of fresh embryo transfer.
Reproductive surgery in the 21st century
Authors: Koninckx Philippe R. , Ussia Anastasia , Adamyan Leila , Gomel Victor
Published: January 2021

The result of infertility treatment can be assessed accurately by the monthly fecundity rate and the cumulative pregnancy rate (CPR). The monthly fecundity rate, decreasing over time, and the time needed to reach the ultimate CPR are key factors in decision making. Depending on the clinical assessment, infertility treatment will be either with in vitro fertilization (IVF)/assisted reproduction technologies (ART) or with a diagnostic laparoscopy associated with reproductive surgery, which thereafter my require require IVF/ART. The comparison of IVF/ART treatment versus reproductive surgery is therefore the wrong debate as the CPR’s of reproductive surgery and of IVF are additive. Decisions should be based on the ultimate CPR’s and on effort and time, not on personal preferences. The large majority of women with infertility should have a diagnostic laparoscopy during which reproductive surgery can be performed if needed. IVF/ART treatment without a diagnosis decreases the ultimate CPR and is not without potentially serious adverse effects. Having excellent reproductive surgery readily available to patients, similar to the availability of IVF would increase CPR in women with infertility and decrease the overall cost.
The Changing Landscape of Catholic Hospitals and Health Systems, 2008–2017
Authors: Homan Mary E. , White Kenneth R.
Published: January 2021

EXECUTIVE SUMMARY

More than 600 Catholic hospitals operating in the United States face pressures for efficiency and effectiveness as well as compliance with demands of the Roman Catholic Church. They have responded to the pressures in various ways that have led to mixed models of organizational ownership and management. The purpose of this study was to describe and analyze the status of Catholic hospital ownership and management, especially the strategic and structural features of the parent health systems. Longitudinal data (2008–2017) were acquired and analyzed using repeated-measures analysis. Descriptive statistics were prepared using cross-sectional matched pairing for 2008 and 2017 data. Of 4,253 hospitals studied, 534 changed ownership or management. More Catholic Church-operated hospitals, regardless of type of ownership (for-profit, not-for-profit, church), became decentralized to a greater degree over the 8-year period and took on more attributes of non-Catholic hospitals.

The 21st century Catholic hospital is more likely to be partnered with a non-Catholic hospital or to be owned by a for-profit system than to be solely partnered with or operated by another Catholic system. Today’s Catholic hospitals appear to be more similar to their non-Catholic counterparts. With the trend toward larger systems that comprise more diverse partners, an increase in lay oversight could lead to further movement away from Catholic identity and the original mission of a hospital. As systems grow in size but shrink in number, administrators must make difficult decisions about the type and scope of services offered as well as the partners they need to deliver their services.
Differences in Work and Non-Work Support Associations With Job Stress, Burnout, and Well-Being Between Types of Healthcare Workers
Authors: Wolff Marilyn B. , O’Connor Patrick J. , Wilson Mark G. , Gay Jennifer L.
Published: January 2021

Objective:

To determine associations between work and non-work supports with employee well-being, job stress, and burnout among direct and non-direct care healthcare workers.

Methods:

Cross-sectional data were collected from 550 full-time (≥ 35 h/wk), US Amazon Mechanical Turk workers (≥ 18 years of age) in the healthcare industry, had at least one supervisor, and at least one coworker. Canonical correlational analysis assessed the shared variance of organizational, supervisor, coworker, and family/friend support on employee outcomes.

Results:

Non-direct care support workers indicated a significantly stronger association between work supports and employee outcomes than family/friend supports. Direct care support workers had significant support from both work and non-work sources of support.

Conclusion:

Workplace supports are important resources for healthcare workers responsible for ensuring patient care and safety. Workplace interventions may tailor interventions to encourage types of support for subgroups within the healthcare industry.
New carotid plaque, but not the progression of intima-media thickness, predicts the progression of high-risk coronary plaque
Authors: Chao Chieh-Ju , Lakshmanan Suvasini , Ceponiene Indre , Luo Yanting , Nakanishi Rine , Nezarat Negin , Kanisawa Mitsuru , Budoff Matthew J
Published: January 2021

Background

Carotid intima-media thickness (CIMT) is regarded as a controversial risk marker for cardiovascular disease (CVD). We aimed to evaluate the role of CIMT and carotid plaque progression as predictors for the progression of coronary plaque and compositions.

Methods

In the Garlic 4 study, asymptomatic patients with intermediate CVD risk (Framingham risk score 6–20%) were recruited for a serial carotid ultrasound, and coronary artery calcium score (CAC)/coronary computed tomography angiography (CCTA) studies for subclinical atherosclerosis at a baseline and 1 year. The association between progression of quantitatively measured coronary plaque compositions and the progression of CIMT/carotid plaque was analyzed. A P value <0.05 is considered as statistically significant.

Results

Forty-seven consecutive patients were included. The mean age was 58.5 ± 6.6 years, and 69.1 % were male. New carotid plaque appeared in 34.0 % (n = 16) of participants, and 55.3 % (n = 26) of subjects had coronary plaque progression. In multilinear regression analysis, adjusted by age, gender, and statin use, the development of new carotid plaque was significantly associated with an increase in noncalcified coronary plaque [β (SE) 2.0 (0.9); P = 0.025] and necrotic core plaque (1.7 (0.6); P = 0.009). In contrast, CIMT progression was not associated with the progression of coronary plaque, or coronary artery calcium (CAC) (P = NS).

Conclusion

Compared to CIMT, carotid plaque is a better indicator of coronary plaque progression. The appearance of a new carotid plaque is associated with significant progression of necrotic core and noncalcified plaque, which are high-risk coronary plaque components.