bluuebunny/crossref_metadata_2025 huggingface dataset:
MCU proteins dominate in vivo mitochondrial Ca2+ uptake in Arabidopsis roots
Authors: Ruberti Cristina , Feitosa-Araujo Elias , Xu Zhaolong , Wagner Stephan , Grenzi Matteo , Darwish Essam , Lichtenauer Sophie , Fuchs Philippe , Parmagnani Ambra Selene , Balcerowicz Daria , Schoenaers Sébastjen , de la Torre Carolina , Mekkaoui Khansa , Nunes-Nesi Adriano , Wirtz Markus , Vissenberg Kris , Van Aken Olivier , Hause Bettina , Costa Alex , Schwarzländer Markus
Published: August 2022

Ca2+ signaling is central to plant development and acclimation. While Ca2+-responsive proteins have been investigated intensely in plants, only a few Ca2+-permeable channels have been identified, and our understanding of how intracellular Ca2+ fluxes is facilitated remains limited. Arabidopsis thaliana homologs of the mammalian channel-forming mitochondrial calcium uniporter (MCU) protein showed Ca2+ transport activity in vitro. Yet, the evolutionary complexity of MCU proteins, as well as reports about alternative systems and unperturbed mitochondrial Ca2+ uptake in knockout lines of MCU genes, leave critical questions about the in vivo functions of the MCU protein family in plants unanswered. Here, we demonstrate that MCU proteins mediate mitochondrial Ca2+ transport in planta and that this mechanism is the major route for fast Ca2+ uptake. Guided by the subcellular localization, expression, and conservation of MCU proteins, we generated an mcu triple knockout line. Using Ca2+ imaging in living root tips and the stimulation of Ca2+ transients of different amplitudes, we demonstrated that mitochondrial Ca2+ uptake became limiting in the triple mutant. The drastic cell physiological phenotype of impaired subcellular Ca2+ transport coincided with deregulated jasmonic acid-related signaling and thigmomorphogenesis. Our findings establish MCUs as a major mitochondrial Ca2+ entry route in planta and link mitochondrial Ca2+ transport with phytohormone signaling.
OAS Model Law and UNCITRAL Model Law: a Chilean view
Authors: Cortés Beltrán Sergio
Published: August 2022

This article provides an analysis of the OAS Model Law and the UNCITRAL Model Law on security interest and its impact on Chile. It analyses also the historical evolution of the Pledge Act and the incorporation of the OAS and UNCITRAL Model Law in Chile.
Tidal Volume and Positive End-expiratory Pressure and Postoperative Hypoxemia during General Anesthesia: A Single-center Multiple Crossover Factorial Cluster Trial
Authors: Turan Alparslan , Esa Wael Ali Sakr , Rivas Eva , Wang Jiayi , Bakal Omer , Stamper Samantha , Farag Ehab , Maheswari Kamal , Mao Guangmei , Ruetzler Kurt , Sessler Daniel I. ,   for the Ventilation-PEEP Trial Group
Published: August 2022

Background

Intraoperative mechanical ventilation is a major component of general anesthesia. The extent to which various intraoperative tidal volumes and positive end-expiratory pressures (PEEP) effect on postoperative hypoxia and lung injury remains unclear. We hypothesized that adults having orthopedic surgery, ventilation using different tidal volumes and PEEP levels affect the oxygenation within first hour in the postoperative care unit.

Methods

We conducted a two-by-two factorial crossover cluster trial at the Cleveland Clinic Main Campus. We enrolled patients having orthopedic surgery with general anesthesia who were assigned to factorial clusters with tidal volumes of 6 or 10 ml/kg of predicted body weight and to PEEP of 5 or 8 cm H2O in 1-week clusters. The primary outcome was the effect of tidal volume or PEEP on time-weighted average peripheral oxygen saturation measured by pulse oximetry divided by the fraction of inspired oxygen (Spo
2/Fio
2 ratio) during the initial postoperative hour.

Results

We enrolled 2,860 patients who had general anesthesia for orthopedic surgery from September 2018 through October 2020. The interaction between tidal volume and PEEP was not significant (P = 0.565). The mean ± SD time-weighted average of Spo
2/Fio
2 ratio was 353 ± 47 and not different in patients assigned to high and low tidal volume (estimated effect, 3.5%; 97.5% CI, –0.4% to 7.3%; P = 0.042), for those assigned to high and low PEEP (estimated effect, –0.2%; 97.5% CI, –4.0% to 3.6%; P = 0.906). We did not find significant difference in ward Spo
2/Fio
2 ratio, pulmonary complications, and duration of hospitalization among patients assigned to various tidal volumes and PEEP levels.

Conclusions

Among adults having major orthopedic surgery, postoperative oxygenation is similar, with tidal volumes between 6 and 10 ml/kg and PEEP between 5 and 8 cm H2O. Our results suggest that any combination of tidal volumes between 6 and 10 ml/kg and PEEP between 5 versus 8 ml cm H2O can be used safely for orthopedic surgery.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Differences in Neonatal Outcomes Among Premature Infants Exposed to Mother's Own Milk Versus Donor Human Milk
Authors: Cartagena Diana , Penny Frances , McGrath Jacqueline M. , Reyna Barbara , Parker Leslie A. , McInnis Joleen
Published: August 2022

Background:

Growing evidence supports the superior benefits of exposure to mother's own milk (MOM) in reducing prematurity-related comorbidities. Neonatal exposure to donor human Milk (DHM) is a suitable alternative when MOM is insufficient or unavailable. However, the same protective composition and bioactivity in MOM are not present in DHM. Additional evidence is needed to justify and inform evidence-based practices increasing MOM provision while optimizing adequate use of DHM for premature infants.

Purpose:

A systematic review of the literature was conducted to determine differences in neonatal outcomes among premature infants exposed to predominately MOM versus DHM.

Methods/Search Strategy:

Databases including PubMed, CINAHL and Cochrane were searched (2020-2021) using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. Evidence was classified using the John Hopkins evidence-based practice levels and quality of evidence.

Results:

Eleven studies met inclusion criteria. Studied neonatal outcomes included (a) growth parameters (n = 8), (b) neonatal morbidities (n = 6), and (c) gut microbiome (n = 4). Overall, evidence suggests DHM exposure is beneficial but not equivalent to MOM feeding. Compared with DHM, greater doses of MOM are ideal to enhance protection primarily related to infant growth, as well as gut microbiome diversity and richness.

Implications for Practice:

Standardized and evidence-based practices are needed to clearly delineate optimal use of DHM without undermining maternal and neonatal staff efforts to support and promote provision of MOM.

Implications for Research:

Additional evidence from high-quality studies should further examine differences in neonatal outcomes among infants exposed to predominately MOM or DHM in settings using standardized and evidence-based feeding practices.
Relationship Between Feeders and Exclusive Breastfeeding and Mixed Feeding During the First Month of Life
Authors: Srisopa Pornpan , Walsh Stephen , Amoo Tumilara , Gyamfi Adwoa , Henderson Wendy A. , Lucas Ruth
Published: August 2022

Background:

The critical time to continue or stop breastfeeding is during the first month after hospital discharge. Mothers receive lactation and physical support by fathers and others bottle-feeding human or formula milk to their infants.

Purpose:

To describe the effect of feeders (mothers, fathers, and others) and different milk feeding on infants' weekly exclusive breastfeeding rates, from birth to 1 month after discharge.

Methods:

This study was a secondary analysis of a descriptive longitudinal study of mothers' (full-term: n = 77; late preterm: n = 39) breastfeeding experience, frequency of feeding, and infant feeding behaviors. Mothers completed a weekly questionnaire of who (mothers, fathers, and others) fed their infants human or formula milk by direct breastfeeding or bottle-feeding.

Results:

More than 60% of mothers reported fathers and others bottle-fed their infants. Exclusive breastfeeding rates were significantly higher when only mothers fed their infants at week 1 (P < .001), week 3 (P < .05), and week 4 (P < .05). Exclusive breastfeeding rates were negatively affected across time by bottle-feeding any human or formula milk for all feeders. When fathers bottle-fed their infants at week 1, the relative rates of exclusive breastfeeding at week 4 decreased to 52% (OR = 0.103; 95% CI, 0.26-0.404; P < .0001).

Implication for Practice:

Individuals providing early bottle-feeding adversely affect breastfeeding outcomes. Providers need to address maternal and paternal knowledge gaps about early breastfeeding practice.

Implications for Research:

Further research is needed to explore clinical standard of care for management of infant weight loss, early supplementation, and support of exclusive breastfeeding outcomes.
Unintended Consequences of the Neonatal Intensive Care Unit Environment
Authors: Jones Carolyn West , Moya Fernando , Lynch Natalie
Published: August 2022

Background:

Recent trends in neonatal intensive care unit design have been directed toward reducing negative stimuli and creating a more developmentally appropriate environment for infants who require intensive care. These efforts have included reconfiguring units to provide private rooms for infants.

Purpose:

The purpose of this integrative review was to synthesize and critically analyze negative outcomes for patients, families, and staff who have been identified in the literature related to single-family room (SFR) care in the neonatal intensive care unit.

Methods/Search Strategy:

The electronic databases of CINAHL, ProQuest Nursing & Allied Health, and PubMed databases were utilized. Inclusion criteria were research studies in English, conducted from 2011 to 2021, in which the focus of the study was related to unit design (SFRs). Based on the inclusion criteria, our search yielded 202 articles, with an additional 2 articles found through reference list searches. After screening, 44 articles met our full inclusion/exclusion criteria. These studies were examined for outcomes related to SFR unit design.

Findings/Results:

Our findings revealed both positive and negative outcomes related to SFR unit design when compared with traditional open bay units. These outcomes were grouped into 4 domains: Environmental Outcomes, Infant Outcomes, Parent Outcomes, and Staff Outcomes.

Implications for Practice and Research:

Although SFR neonatal intensive care unit design improves some outcomes for infants, families, and staff, some unexpected outcomes have been identified. Although these do not negate the positive outcomes, they should be recognized so that steps can be taken to address potential issues and prevent undesired outcomes.
Preventive potential of Bacillus sonorensis exopolysaccharide upon hepatocellular carcinoma and quantitation of tumor suppressor protein p53
Authors: Abdelnasser Salma Magdy , Ahmed Youssri M.
Published: August 2022

Background

Exopolysaccharide, a carbohydrate polymer, is known to possess several biological activities. This approach was designed to clarify the cytotoxic mechanism of Bacillus sonorensis exopolysaccharide (EPS-1) on Huh7, HepG2 and BNL cells besides exploring its influence on the expression of the tumor suppressor protein p53. p53 is the biomarker of the prognosis and occurrence of severe stages of the tumor and activation of both cell-cycle arrest and apoptosis in cancer cells which are the most targeted cellular processes for the therapy of tumor patients.

Methods

The cytotoxic impact of EPS-1 was quantified via neutral red uptake assay and the results were confirmed by a morphology study. The expression level of p53 was analyzed using quantitative real-time PCR.

Results

The outcomes of the present study explicated that EPS-1 with IC50 = 164 and 398 µg ml-1 exhibited an inhibitory influence on Huh7 and HepG2 cells growth after 48 h incubation time respectively. EPS-1 showed no influence on normal BNL cells. Furthermore, the molecular genetic analysis revealed that EPS-1 provoked significant upregulation in the expression level of the p53 gene in the treated Huh7 cell line more than that in HepG2, whereas no significant gene expression was noticed in BNL cells (P = 0.006, 0.65 and 0.83), respectively.

Conclusion

The antitumor activity displayed by this compound may be of interest for further studies of its structure-activity relationship. Before application in phase 1 of the clinical study, in-vivo studies would be needed to confirm the results obtained in the hope of finding more active and selective anticancer agents for drug development in the future.
Smoking Cessation May Reduce Risk of Visual Field Progression in Heavy Smokers
Authors: Mahmoudinezhad Golnoush , Nishida Takashi , Weinreb Robert N. , Baxter Sally L. , Walker Evan , Eslani Medi , Liebmann Jeffrey M. , Girkin Christopher A. , Moghimi Sasan
Published: August 2022

Précis:

The earlier a person quits smoking the more likely is the optic nerve be spared from damage.

Purpose:

To investigate the effect of smoking cessation on visual field (VF) progression in glaucoma.

Methods:

Primary open angle glaucoma patients with a minimum of 3 years follow-up and 5 VFs were included. Linear mixed models were used to investigate the effects of smoking on the rates of 24-2 VF mean deviation loss after adjusting for confounding factors. Cox proportional hazard regression was used to identify whether different levels of smoking intensity were associated with VF progression with respect to different duration of quitting.

Results:

Five hundred eleven eyes of 354 patients were included over the mean follow-up of 12.4 years. Mean baseline age (95% confidence interval) was 62.3 (61.2, 63.4) years. One hundred forty nine (42.1%) patients were smokers. In a multivariable model, smoking intensity was associated with faster VF loss (−0.06, 95% confidence interval (−0.10, −0.01) dB/year per 10 pack-years, P=0.01) among smokers. Heavy smokers (≥20 pack-years) who had quit ˂25 years prior had significantly greater odds of VF progression compared with never smokers (odds ratio=2.49 (1.01, 6.08); P=0.046). There was no significant difference in odds of VF progression in heavy smokers who had quit smoking more than 25 years compared with never smokers (P=0.43). A significantly higher proportion of VF progression was found in heavy smokers who quit < 25 years compared with heavy smokers who quit ≥25 years by Kaplan-Meier analysis (P=<0.001).

Conclusions:

After ≥25 years of smoking cessation, the risk of VF progression in former heavy smokers becomes similar to never smokers. Long-term smoking cessation may be associated with lower VF progression in glaucoma patients.
Glucose transport in the regulation of T-cell activation: the journey may be as important as the destination
Authors: Barger Steven W.
Published: August 2022

A shift in the energy-metabolism balance from oxidative phosphorylation to glycolysis is observed in several phenomena, from oncogenesis to differentiation. And this shift is not merely an indicator of the phenotypic change—an increase in glucose delivery often drives the adaption. At first blush, it seems that any route of entry should be equivalent, as long as sufficient quantities are supplied. However, an extensive study comparing the Th17 and Th1 subtypes of T cells now suggests that similar glucose transporters may not be interchangeable. Manipulation of individual transporters, or the downstream metabolites of their substrates, may afford dampening of autoimmunity potential with some degree of precision.
MicroRNA-regulated B cells in obesity
Authors: Matz Alyssa J. , Qu Lili , Karlinsey Keaton , Zhou Beiyan
Published: August 2022

Obesity is a prevalent health risk by inducing chronic, low-grade inflammation and insulin resistance, in part from adipose tissue inflammation perpetuated by activated B cells and other resident immune cells. However, regulatory mechanisms controlling B-cell actions in adipose tissue remain poorly understood, limiting therapeutic innovations. MicroRNAs are potent regulators of immune cell dynamics through fine-tuning a network of downstream genes in multiple signaling pathways. In particular, miR-150 is crucial to B-cell development and suppresses obesity-associated inflammation via regulating adipose tissue B-cell function. Herein, we review the effect of microRNAs on B-cell development, activation, and function and highlight miR-150-regulated B-cell actions during obesity which modulate systemic inflammation and insulin resistance. In this way, we hope to promote translational discoveries that mitigate obesity-induced health risks by targeting microRNA-regulated B-cell actions.
Comparison of Persistent Symptoms Following SARS-CoV-2 Infection by Antibody Status in Nonhospitalized Children and Adolescents
Authors: Messiah Sarah E. , Hao Tianyao , DeSantis Stacia M. , Swartz Michael D. , Talebi Yashar , Kohl Harold W. , Zhang Shiming , Valerio-Shewmaker Melissa , Yaseen Ashraf , Kelder Steven H. , Ross Jessica , Gonzalez Michael O. , Wu Leqing , Padilla Lindsay N , Lopez Kourtney R. , Lakey David , Shuford Jennifer A. , Pont Stephen J. , Boerwinkle Eric
Published: August 2022

Background:

The prevalence of long-term symptoms of coronavirus disease 2019 (COVID-19) in nonhospitalized pediatric populations in the United States is not well described. The objective of this analysis was to examine the presence of persistent COVID symptoms in children by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody status.

Methods:

Data were collected between October 2020 and May 2022 from the Texas Coronavirus Antibody REsponse Survey, a statewide prospective population-based survey among 5-90 years old. Serostatus was assessed by the Roche Elecsys Anti-SARS-CoV-2 Immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein. Self-reported antigen/polymerase chain reaction COVID-19 test results and persistent COVID symptom status/type/duration were collected simultaneously. Risk ratios for persistent COVID symptoms were calculated versus adults and by age group, antibody status, symptom presence/severity, variant, body mass index and vaccine status.

Results:

A total of 82 (4.5% of the total sample [n = 1813], 8.0% pre-Delta, 3.4% Delta and beyond) participants reported persistent COVID symptoms (n = 27 [1.5%] 4–12 weeks, n = 58 [3.3%] >12 weeks). Compared with adults, all pediatric age groups had a lower risk for persistent COVID symptoms regardless of length of symptoms reported. Additional increased risk for persistent COVID symptoms >12 weeks included severe symptoms with initial infection, not being vaccinated and having unhealthy weight (body mass index ≥85th percentile for age and sex).

Conclusions:

These findings highlight the existence of nonhospitalized youth who may also experience persistent COVID symptoms. Children and adolescents are less likely to experience persistent COVID symptoms than adults and more likely to be symptomatic, experience severe symptoms and have unhealthy weight compared with children/adolescents without persistent COVID symptoms.
Clinical Features, Antimicrobial Resistance, and Serogroups of Nontyphoidal Salmonella Isolated From Infants Less Than 3 Months Old in the Recent Decade
Authors: Liu Fang-Ching , Chang Yi-Jung , Chen Chyi-Liang , Yang Hsin-Ping , Lee Chien-Chung , Chiu Cheng-Hsun
Published: August 2022

Background:

Antibiotic treatment is indicated for infants with nontyphoidal Salmonella (NTS) enterocolitis. However, whether antimicrobial resistance (AMR) is a problem among young infants is unknown. This study investigated the characteristics of NTS infections in young infants.

Methods:

Infants less than 3 months old with NTS infections were enrolled and grouped into 2 cohorts (diagnosed 2010–2015 or 2016–2021). Salmonella isolated from blood or cerebrospinal fluid was defined as invasive NTS (iNTS). The clinical features, AMR and serogroups were compared between cohorts.

Results:

In total, 102 young infants had NTS infections, 6.9% of which were iNTS. Infants with iNTS infections were younger, hospitalized longer, and received longer antibiotic courses. More than half of cases of iNTS were resistant to ciprofloxacin, ceftriaxone and greater than or equal to 3 antibiotics. iNTS was mainly observed in Salmonella groups C2 and E. Over the past decade, group B (44%), group E (26%) and group C2 (16%) have been the most common serogroups. NTS significantly increased AMR to ciprofloxacin, ceftriaxone and trimethoprim-sulfamethoxazole, and greater than or equal to 3 antibiotics. Both multidrug resistance and extensive drug resistance in NTS also significantly increased.

Conclusions:

The serogroups varied with time, and the main causes of iNTS, groups C2 and E, increased over the past decade. The prevalence of AMR also increased, especially for iNTS. Given the low iNTS rate and high AMR, routine antibiotic use among infants with NTS infections between 1 and 3 months old should be reconsidered. Further large-scale research is required to formulate therapeutic strategies.
Placing Care: The Impact of the Physical Environment on Experiences of Providing and Utilizing Palliative Care
Authors: AGOM David A. , SIXSMITH Judith , OMINYI Jude , ONYEKA Tonia C. , AGOM Joy C.
Published: August 2022

Background

Environmental design in palliative and end-of-life care is known to improve care outcomes, service-user satisfaction, and the continuation of service uptake. No study in the literature has investigated the influence of the environment on palliative and end-of-life care in Nigeria or other African contexts.

Purpose

This study was designed to explore the impact of the physical environment (i.e., place and people) on staff and service users and how these influence the experiences of providing and using palliative and end-of-life care in a Nigerian hospital context.

Methods

Ethnographic methodology was employed because this approach facilitates understanding of environmental realities. This study is part of a larger ethnographic research project developed to uncover aspects of organizational complexities related to the provision and use of palliative and end-of-life care in the Nigerian context. Three hundred fifty hours of participant observation was achieved, and semistructured interviews were used to gather data from 26 participants, including 10 patients, 11 members of a palliative care team, and five hospital managers. Informal chats and photographic capture were additional methods used in data collection. Thematic analysis was conducted to identify and analyze patterns within the collected data.

Results

Physical space, equipment, and placing staff were the three primary themes identified. The physical environment was untidy, and the ward layout prevented privacy, dignity, or comfort for patients and families. The equipment was old and inadequate, and the context of care was worsened by insufficient staffing and neglect of the environmental needs of the staff.

Conclusions

Hospital design for palliative and end-of-life care in Nigeria is “autoinhibitory” (a negative feedback mechanism whereby hospital design detracts rather than promote quality of care), and a physical environment that supports the provision and utilization of care must be implemented to promote palliative and end-of-life care success. Urgent policy action is needed to improve environmental and staffing conditions to advance palliative and end-of-life care in Nigeria.
Interstitial lung disease following coronavirus disease 2019
Authors: Vasarmidi Eirini , Ghanem Mada , Crestani Bruno
Published: August 2022

Purpose of review

The aim of this review was to summarize the recent data concerning interstitial lung disease after COVID-19, a field where knowledge is evolving very quickly.

Recent findings

It has been found that a proportion of patients displayed fibrotic-like pattern on chest computed tomography shortly after COVID-19 pneumonia. Those lesions can potentially represent precursors of fibrosis, although most of them will resolve until 1 year postinfection. There was a wide range of the prevalence of post-COVID-19 interstitial lung disease detected in the literature, which can be attributed to the heterogeneous definition of lung abnormalities and the discrepancy of study design. The severity of acute COVID-19 disease has been linked to increased risk of residual imaging and functional abnormalities, while reduced DLco was the most common functional abnormality in long-term survivors. Studies indicated that pathophysiology of post-COVID interstitial lung disease shares common mechanisms with idiopathic pulmonary fibrosis. Regarding therapeutic strategies of post-COVID-19 interstitial lung disease, the role of immunosuppressive and antifibrotic treatment is currently under investigation.

We still need to learn about the natural history of COVID-19 disease, allowing for a better targeting of therapeutic interventions through a multidisciplinary approach.
Short-term hyper-caloric high-fat feeding on a ketogenic diet can lower low-density lipoprotein cholesterol: the cholesterol drop experiment
Authors: Feldman David , Huggins Siobhan , Norwitz Nicholas G.
Published: August 2022

Purpose of review

Conventional knowledge holds that saturated fat is the primary dietary driver of increases in low-density lipoprotein-cholesterol (LDL-C), and that high LDL-C seen among some persons consuming low-carbohydrate, high-fat diets is driven by increased saturated fat intake. This simple paradigm cannot account for the lipid patterns, nor for the magnitude of effect, observed in ‘lean mass hyper-responders’ on low-carbohydrate diets. The Lipid Energy Model (LEM) provides an alternative explanation for LDL-C increases seen in persons without obesity who adopt ketogenic diets and makes testable predictions, including that acute overfeeding, including increased saturated fat consumption, would decrease LDL-C levels.

Recent findings

This study reports data from an n = 1 experiment, performed in duplicate, in which the subject consumed three ketogenic diets for 5 days that varied in caloric content: weight-maintenance (2278 kcal/day), hypo-caloric (1135 kcal/day), and hyper-caloric (4116 kcal/day). Consistent with the LEM, LDL-C and apolipoprotein B increased following caloric restriction and decreased following overfeeding, despite increased saturated fat consumption. Data from a case series of 24 individuals who underwent similar protocols similarly found that overfeeding on a ketogenic diet decreased LDL-C.

This n = 1 study and associated case series provide data that short-term overfeeding can lower LDL-C in the context of carbohydrate restriction.
Statin therapy is not warranted for a person with high LDL-cholesterol on a low-carbohydrate diet
Authors: Diamond David M. , Bikman Benjamin T. , Mason Paul
Published: August 2022

Purpose of review

Although there is an extensive literature on the efficacy of the low carbohydrate diet (LCD) for weight loss and in the management of type 2 diabetes, concerns have been raised that the LCD may increase cardiovascular disease (CVD) risk by increasing the level of low-density lipoprotein cholesterol (LDL-C). We have assessed the value of LDL-C as a CVD risk factor, as well as effects of the LCD on other CVD risk factors. We have also reviewed findings that provide guidance as to whether statin therapy would be beneficial for individuals with high LDL-C on an LCD.

Recent findings

Multiple longitudinal trials have demonstrated the safety and effectiveness of the LCD, while also providing evidence of improvements in the most reliable CVD risk factors. Recent findings have also confirmed how ineffective LDL-C is in predicting CVD risk.

Extensive research has demonstrated the efficacy of the LCD to improve the most robust CVD risk factors, such as hyperglycemia, hypertension, and atherogenic dyslipidemia. Our review of the literature indicates that statin therapy for both primary and secondary prevention of CVD is not warranted for individuals on an LCD with elevated LDL-C who have achieved a low triglyceride/HDL ratio.
Unlocking Performance Excellence: Review of Evidence-Based Mindful Meditation
Authors: Safran Tyler , Vorstenbosch Joshua , Doty James R. , Davison Peter
Published: August 2022

Mindfulness has recently been implemented by advanced military combatants, firefighters, as well as other very intellectually demanding and fast-paced professions. A surgeon, similarly, is faced with many difficult challenges. Whether it be a complex and meticulous surgery, extensive clinical responsibilities, or simply the challenges faced in residency. However, in our current curriculums, we are not trained to introspectively deal with these stressors. Regardless of what we face in our personal lives, the lives of patients are literately in our hands. Would it not be prudent and wise, to train our brain to not only deliver care to our patients but to be able to take care of ourselves and maybe even improve our performance? Regular practice of mindfulness has been shown to decrease rates of burnout, decrease medical errors, improve sleep, and even improve surgical performance. With the ever-changing pandemic situation and increasing stressors in the hospital, mindful meditation is perfectly primed to be added to our armamentarium as surgeons and physicians. This review aims to explain how mindfulness can enhance a surgeon’s performance, mindset, interactions and execution through a review of recent scientific advancements and evidence.
Plastic Surgery Residency Applicants' Perceptions of a Virtual Interview Cycle
Authors: Shen Abra H. , Shiah Eric , Sarac Benjamin A. , Maselli Amy M. , Nassar Amer H. , Lee Bernard T. , Janis Jeffrey E. , Lin Samuel J.
Published: August 2022

Background:

The 2020-2021 residency application cycle marked the first year of fully virtual integrated plastic surgery interviews. The virtual format was a double-edged sword for applicants with several advantages such as reduced costs and time lost from travel and disadvantages as the novel format introduced new stressors on top of an already demanding process. Concerns included unfair interview invitation (II) distribution, interview “hoarding,” and assessing “fit” virtually. In this study, we aimed to understand applicants’ experiences of the 2020-2021 virtual plastic surgery interview cycle.

Methods:

A survey was sent to 330 applicants in the 2020-2021 integrated plastic surgery application cycle. The survey included questions about participant demographics, pre-interview preparation, virtual interview experiences, and post-interview process. Statistical comparisons were performed on responses using SPSS.

Results:

Eighty-nine participants responded to the survey, representing a 27.0% response rate. Applicants received an average of 13.3 IIs (range 0-45) and attended an average of 11.4 interviews (range 0-30). Almost half (48.2%) did not feel IIs were distributed equitably and more than half (68.2%) reported that there should be a limit on the number of IIs an applicant can accept. The majority of respondents (88.1%) reported spending $500 or less on virtual interviews. Half (50.6%) participated in virtual sub-internships, of which 30.4% became significantly less interested in a program afterwards.

Conclusions:

The inaugural virtual interview cycle had several advantages and disadvantages. Lessons learned from this year could be utilized towards building a more equitable, fair, and effective potential virtual cycle in years to come.
The Superficial and Functional Lymphatic Anatomy of the Upper Extremity
Authors: Granoff Melisa D. , Pardo Jaime , Johnson Anna Rose , Fleishman Aaron , Tillotson Elizabeth , Thomson Sarah , Lee Bernard T. , Singhal Dhruv
Published: August 2022

Background:

Knowledge of detailed lymphatic anatomy in humans is limited as the small size of lymphatic channels makes it difficult to image. Most current knowledge of the superficial lymphatic system has been obtained from cadaveric dissections.

Methods:

Indocyanine green (ICG) lymphography was performed pre-operatively to map the functional arm lymphatics in breast cancer patients without clinical or objective evidence of lymphedema. A retrospective review was performed to extract demographic, ICG imaging, and surgical data.

Results:

Three main functional forearm channels with variable connections to two upper arm pathways were identified. The median forearm channel predominantly courses in the volar forearm (99%). The ulnar forearm channel courses in the volar forearm in the majority of patients (66%). The radial forearm channel courses in the dorsal forearm in the majority of patients (92%). Median (100%), radial (91%), and ulnar (96%) channels almost universally connect to the medial upper arm channel. In contrast, connections to the lateral upper arm channel occur less frequently from the radial (40%) and ulnar (31%) channels.

Conclusions:

This study details the anatomy of three forearm lymphatic channels and their connections to the upper arm in living adults without lymphatic disease. Knowledge of these pathways and variations is relevant to any individual performing procedures on the upper extremities as injury to the superficial lymphatic system can predispose patients to the development of lymphedema.
Informed Consent Practices in Global Surgery among Plastic Surgery Organizations
Authors: Thadikonda Kishan , Zhang Rosaline , Bruhn Jonathan , Nguyen Phuong D. , Poore Samuel O.
Published: August 2022

Background:

Global surgery organizations often serve vulnerable and complex patient populations, but there is limited knowledge on the protocols used to obtain informed consent for procedures and content sharing.

Methods:

The Plastic Surgery Foundation Volunteers in Plastic Surgery (VIPS) database was queried for organizations actively involved in global surgery. Seventy-nine organizations received email invitations to participate in a survey study regarding their protocols for obtaining consent for procedures and sharing multimedia content.

Results:

A total of 17 (22% yield) organizations completed the survey. All were active for at least 10 years and 88% (15/17) organized at least two mission trips annually. Eighty-eight percent (15/17) reported obtaining written consent for surgical procedures. Less than half (46%, 8/17) of used a written consent form that was created jointly with the local hospital. For sharing content related to global surgery experiences, 75% (12/16) obtained some form of written consent while 6% (1/16) did not routinely obtain any consent. Organizations shared content most commonly through their websites and Facebook. All organizations reported using interpreters to obtain informed consent at least some of the time. 62% (10/16) reported that they relied primarily on volunteers or community members to provide informal interpretation assistance, rather than formally trained professional interpreters.

Conclusion:

Practices related to obtaining informed consent vary widely among global surgery organizations. The development of standardized protocols and guidelines will ensure that global health organizations, in collaboration with their local partners, properly obtain informed consent for procedures and sharing publicly viewable content.
The Superthin Profunda artery perforator flap for Extremity Reconstruction: Clinical Implications
Authors: Chim Harvey
Published: August 2022

Background:

The profunda artery perforator (PAP) flap has numerous advantages. For coverage of extremity wounds, however, traditional subfascial harvest results in a thick flap, which routinely requires secondary thinning. The aim of this study was to describe our approach and experience with the thin and superthin PAP flap for extremity reconstruction.

Methods:

Using an approach of preoperative perforator localization with computed tomography angiogram (CTA), color and handheld doppler, we describe our experience with thin/ superthin PAP flaps using a single dominant perforator, for extremity reconstruction in 10 consecutive patients.

Results:

Mean age of patients who had a thin or superthin PAP flap for extremity reconstruction was 41.2 ± 21.3 years. Flaps were performed to cover wounds in the upper (n=3) and lower (n=7) extremities. Mean flap thickness was 0.7 ± 0.2 cm. Mean flap artery diameter was 16 ± 3 mm, mean flap vein diameter was 21 ± 6 mm. Mean pedicle length was 6.8 ± 1.2 cm. The difference between the actual measured intraoperative proximal-distal distance and the preoperative CTA measurement for each patient was calculated, with a mean difference of 1.2 ± 0.6 cm.

Conclusions:

Advantages of the PAP flap include a concealed donor site, large perforator caliber, long pedicle length and a straightforward perforator dissection. Intraoperative measurement of the proximal-distal distance of the dominant perforator fell within 2 cm of the preoperative CTA measurement in all cases. The thin and superthin PAP flap provides a new reconstructive option, particularly suited for use in the extremities.
“A Rectoprostatic Fascia Reinforcement Flap for the Treatment of Intraoperative Rectal Injury and Recto-Neovaginal Fistula in Gender Affirmation Surgery for Trans Women.”
Authors: Pansritum Kamol , Thomrongdullaphak Sarinthorn , Suwajo Poonpissamai
Published: August 2022

Background:

Intraoperative rectal injuries and recto-neovaginal fistulas are rare complications in gender affirmation surgery for trans women. Primary repair with an improper method may result in recurrence. The procedures required for the surgical treatment of these problems are rare. We herein describe the surgical technique using a rectoprostatic fascia reinforcement flap for intraoperative rectal injury and recto-neovaginal fistula correction in gender affirmation surgery for trans women.

Methods:

Retrospective data were collected on the female transgender patients underwent surgical treatment of intraoperative rectal injury and rectovaginal fistula with the prostaticovesicular fascia reinforcement flap. Patient demographics, follow-up, and intraoperative details were collected and analyzed.

Results:

From January 2006 to December 2018, 14 female transgender patients presented with intraoperative rectal injuries and 5 cases of rectovaginal fistulas from a total of 2,059 patients who underwent neovaginoplasty. Two patients with rectovaginal fistulas had their neovaginoplasty performed elsewhere. The mean location of intraoperative rectal injury was 5.2 cm (2-6.5 cm) and the recto-neovaginal fistula was 5.4 cm (3.5-6.5 cm) from the vaginal introitus. The mean size of intraoperative rectal injury and recto-neovaginal fistula was 2.5 cm (1-3.5 cm) and 2.3 cm (0.2-3.2 cm) in diameter, respectively. No recurrence of rectovaginal fistulas was reported after one-year follow-up.

Conclusions:

A rectoprostatic fascia reinforcement flap is an alternative technique to repair intraoperative rectal injury and recto-neovaginal fistulas incorporating the neovaginal lining with a skin graft or sigmoid colon in gender affirmation surgery for trans women.
The social dynamics of complex gestural communication in great and lesser apes (
Pan troglodytes
,
Pongo abelii, Symphalangus syndactylus
)
Authors: Amici Federica , Liebal Katja
Published: August 2022

Gestures play an essential role in primate communication. However, little is known about how complexity of gestural use (in terms of repertoire size, intentional use, flexibility and use of gestural sequences) relates to individual and dyadic measures of sociality and whether more complex gestural use is more effective in eliciting a response. We observed 19 captive chimpanzees (
Pan troglodytes
), 16 Sumatran orangutans (
Pongo abelii
) and 18 siamangs (
Symphalangus syndactylus
) to assess the complexity and effectiveness of their gestural use. We found that, beyond interspecies variation, the number of gesture types used in a dyad was higher when individuals had stronger social bonds; the probability of accounting for others' attention increased with age, especially for visual gestures; and sequences were more likely used by younger or socially less integrated individuals. In terms of effectiveness, older individuals and those using fewer sequences were more likely to be responded to, while across dyads, the probability of obtaining a response was higher when both individuals accounted for the other's attention and when they used fewer sequences. Overall, this confirms the link between sociality and complex gestural use and suggests that more complex forms of communication, at least in terms of intentional use, may be more effective at achieving communicative goals.

This article is part of the theme issue ‘Cognition, communication and social bonds in primates’.
Intentional gesturing increases social complexity by allowing recipient's understanding of intentions when it is inhibited by stress
Authors: Roberts Anna Ilona , Roberts Sam George Bradley
Published: August 2022

Examining the links between intentional communication and social relationships provides insights into the cognitive skills needed to manage a differentiated set of social bonds. Great apes gesture intentionally, but how this intentionality relates to sociality is still unclear. Stress in the form of dominant audience members inhibits understanding of intentions, downgrading cognition to understanding of behaviour, but intentional communication may enable social bonding in stressful conditions. We examined the associations between gestural communication, sociality, stress and the outcome of interactions in wild chimpanzees. Social network size was positively associated with intentional but not non-intentional communication. When a dominant bystander was present with whom the recipient was weakly bonded, and gesturing was non-intentional, recipients produced avoidance response toward signallers to whom they were weakly bonded, indicating understanding of behaviour. Signallers used intentional gestures more frequently to recipients who were stressed, and intentional gestures evoked approach behaviour by the recipients, indicating understanding of intentionality. These results suggest that the presence of dominant bystanders is stressful, inhibiting understanding of intentionality. However, intentional gestures facilitate social bonding by allowing understanding of intentions. The cognitive skills underpinning intentional gestures may therefore play a key role in enabling primates to meet the demands of sociality.

This article is part of the theme issue ‘Cognition, communication and social bonds in primates’.
Crested macaque facial movements are more intense and stereotyped in potentially risky social interactions
Authors: Clark Peter R. , Waller Bridget M. , Agil Muhammad , Micheletta Jerome
Published: August 2022

Ambiguity in communicative signals may lead to misunderstandings and thus reduce the effectiveness of communication, especially in unpredictable interactions such as between closely matched rivals or those with a weak social bond. Therefore, signals used in these circumstances should be less ambiguous, more stereotyped and more intense. To test this prediction, we measured facial movements of crested macaques (
Macaca nigra
) during spontaneous social interaction, using the Facial Action Coding System for macaques (MaqFACS). We used linear mixed models to assess whether facial movement intensity and variability varied according to the interaction outcome, the individuals' dominance relationship and their social bond. Movements were least intense and most variable in affiliative contexts, and more intense in interactions between individuals who were closely matched in terms of dominance rating. We found no effect of social bond strength. Our findings provide evidence for a reduction in ambiguity of facial behaviour in risky social situations but do not demonstrate any mitigating effect of social relationship quality. The results indicate that the ability to modify communicative signals may play an important role in navigating complex primate social interactions.

This article is part of the theme issue ‘Cognition, communication and social bonds in primates’.
Flexible signalling strategies by victims mediate post-conflict interactions in bonobos
Authors: Heesen Raphaela , Austry Diane A. , Upton Zoe , Clay Zanna
Published: August 2022

Compared to other animals, humans supposedly excel at voluntarily controlling and strategically displaying emotional signals. Yet, new data shows that nonhuman great apes' emotion expressions may also be subject to voluntary control. A key context to further explore this is during post-conflict (PC) periods, where signalling by distressed victims may influence bystander responses, including the offering of consolation. To address this, our study investigates the signalling behaviour of sanctuary-living bonobo victims following aggression and its relation to audience composition and PC interactions. Results show that the production of paedomorphic signals by victims (regardless of age) increased their chances of receiving consolation. In adults, the production of such signals additionally reduced the risk of renewed aggression from opponents. Signal production also increased with audience size, yet strategies differed by age: while immatures reduced signalling in proximity of close-social partners, adults did so especially after receiving consolation. These results suggest that bonobos can flexibly adjust their emotion signalling to influence the outcome of PC events, and that this tendency has a developmental trajectory. Overall, these findings highlight the potential role that flexible emotion communication played in the sociality of our last common ancestor withPan.

This article is part of the theme issue ‘Cognition, communication and social bonds in primates’.
Leucobacter chinensis sp. nov., with plant growth-promoting potential isolated from field soil after seven-years continuous maize cropping
Authors: Zhu Jie , Che Juan , Jiang Xin , Ma Mingchao , Guan Dawei , Li Li , Cao Fengming , Zhao Baisuo , Kang Yaowei , Zhao Ji , Kong Delong , Zhou Yiqing , Ruan Zhiyong , Li Jun
Published: August 2022

A novel Gram-stain-positive, aerobic, non-motile and rod-shaped bacterium, designated strain NC76-1T, was isolated from soil from a field that had undergone seven years continuous maize cropping from Liuba town located in Zhangye city, Gansu province, PR China. Colonies of strain NC76-1T were white, opaque and circular with a convex shape. The isolate was found to be able to grow at 10–40 °C (optimum 30 °C), pH 6.0 to 12.0 (optimum 7.0–8.0) and with 0–5.0 % (w/v) NaCl (optimum 0%). On the basis of the results of 16S rRNA gene sequence analysis, the strain fell within the clade of the genus

Leucobacter

, showing the highest sequence similarities with

Leucobacter iarius

40T (97.4%),

Leucobacter aridicollis

CIP 108388T (97.0%),

Leucobacter chromiireducens

subsp.

solipictus

TAN 31504T (96.7%) and

Leucobacter denitrificans

M1T8B10T (96.7%). The average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) values between NC76-1T and its closest relatives,

L. iarius

40T,

L. aridicollis

CIP 108388T,

L. chromiireducens

subsp.

solipictus

TAN 31504T and

L. denitrificans

M1T8B10T were ≤73.5 % and 20.3%, respectively. The genomic DNA G+C content of NC76-1T was 61.5 mol%. It presented MK-11 as the predominant menaquinone. The major cellular fatty acids were anteiso-C15 : 0 (49.2 %) and iso-C16 : 0 (35.7%). The major polar lipids were found to be diphosphatidyglycerol, phosphatidylglycerol, phosphatidylethanolamine, aminoglycolipid, five glycolipid and one unidentified lipids. The cell wall amino acids were 2,4-diaminobutyric acid, alanine, glutamic acid, glycine and threonine. On the basis of the phylogenetic, phenotypic and chemotaxonomic characteristics, strain NC76-1T is concluded to represent a novel species within the genus

Leucobacter

, for which the name Leucobacter chinensis sp. nov. is proposed. The type strain is NC76-1T (GDMCC 1.2286T= JCM 34651T).