bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Competency Committees in Plastic Surgery Residency
Authors: Blau Jared A. , Atia Andrew N. , Powers David B. 
Published: November 2021

Background:
Clinical competency committees (CCCs) are now an Accreditation Council on Graduate Medical Education (ACGME) requirement for plastic surgery training programs. They serve to monitor resident progress and make formal recommendations to program directors on promotion, remediation, and dismissal, based on resident progress toward the curricular milestones.

Methods:
Here, we present an overview on building, conducting, and improving a CCC, reviewing the literature available regarding best practices regarding this novel assessment system, with attention to the particular requirements for plastic surgery training.

Results:
We present the results of the Duke University CAQCC as a case study in the efficacy of a well-executed group in terms of improved resident outcomes, particularly regarding In-service Examination scores as an objective measure.

Conclusions:
Rather than simply serving as a necessary ACGME dictum, the CCC has the opportunity to demonstrably improve resident education. This article is valuable for department leaders, program directors, faculty, and residents toward understanding the purpose and design of their CCC.
Lower Pole Breast Reconstruction Using Muscle-sparing Latissimus Dorsi Flap in Postburn Breast Deformity
Authors: Hussein Mohammed Ahmed , Abdelkader Rasha , El-Henawy Ayman Noaman , Makarem Kyrillos 
Published: November 2021

Background:
Full-thickness burns of the anterior chest wall during childhood are a devastating problem that results in significant distortion of the developing breast. This deformed burnt breast represents a serious aesthetic problem, and can lead to functional impairment as well as severe emotional trauma for patients.

Methods:
Patients with postburn scarring affecting the lower pole of the breast were included. Only patients with small to medium-sized breasts were targeted. The lower breast pole was reconstructed using muscle-sparing latissimus dorsi flap. All patients had been subjectively assessed, including overall patient satisfaction regarding breast aesthetics, donor site morbidity, and functional deficits of latissimus dorsi muscle, 3 months postoperatively.

Results:
Six patients (seven breasts) were included in this study. Muscle-sparing latissimus dorsi flap was used to reconstruct lower breast pole in all patients. A horizontally-oriented skin paddle was used in five patients, whereas a vertically oriented skin paddle was used in one patient. Average patient satisfaction was 9.1 (SD 0.6) for the reconstructed lower breast pole. For the donor site, average overall satisfaction was 9.1 (SD 0.8). Latissimus dorsi muscle function was objectively confirmed in 90% of cases after 3 months postoperatively. Patients had an average score of 3.9 (SD 0.4) for the activity score as well.

Conclusions:
The muscle-sparing latissimus dorsi flap is a good reconstructive tool for lower breast pole in postburn breast reconstruction. It has a reliable versatile skin paddle that can resurface the whole lower breast pole, while avoiding many of the latissimus flap morbidities.
Breast Reconstruction during the COVID-19 Pandemic: A Systematic Review
Authors: Hemal Kshipra , Boyd Carter J. , Bekisz Jonathan M. , Salibian Ara A. , Choi Mihye , Karp Nolan S. 
Published: November 2021

Introduction:
The COVID-19 pandemic posed unique challenges for breast reconstruction. Many professional organizations initially placed restrictions on breast reconstruction, leading surgeons to conceive innovative protocols for offering breast reconstruction. This study reviewed the current evidence on breast reconstruction during the COVID-19 pandemic to provide guidance for surgeons facing future crises.

Methods:
The MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews were searched for studies (1) describing implant and autologous breast reconstruction following mastectomy and (2) occurring during or pertaining to the COVID-19 pandemic.

Results:
Of the 1347 studies identified, 26 were included. Studies discussed type of reconstruction (18, 69%), complications (11, 42%), timing of reconstruction (10, 38%), protocols (10, 38%), COVID-19 screening (7, 27%), and length of hospital stay (7, 27%). The type of reconstruction varied depending on the stage of the pandemic: early on, autologous breast reconstruction was halted to preserve resources, but was later resumed. Within implant-based reconstruction, direct-to-implant was favored over serial tissue expansion. Several protocols were developed, with many emphasizing multidisciplinary collaborations for patient selection, use of specialized measures to reduce risk of COVID-19 transmission, and optimization of same-day discharge. Complication rates following breast reconstruction were similar to pre-pandemic rates.

Conclusions:
The COVID-19 pandemic has forever changed the landscape of breast reconstruction by raising important questions about delivery of care, cost, and resource utilization. The findings of this review may inform surgeons as they plan for similar future crises or strive for improved patient care and efficacy even during nonpandemic times.
Eyelid Crease Height Affects the Evaluation of Age-related Changes in the Eyelids
Authors: Akita Shinsuke , Maki Satoshi , Shiko Yuki , Kawasaki Yohei , Yamaji Yoshihisa , Tokumoto Hideki , Kosaka Kentaro , Ogata Hideyuki , Kubota Yoshitaka , Mitsukawa Nobuyuki 
Published: November 2021

Background:
Although the functional and anatomical differences between the left and right eyelids are important in the evaluation of age-related changes in the eyelids, they have not been described clearly as indications for surgical treatments. This study aimed to investigate how laterality of the eyelids affects evaluation of age-related changes.

Methods:
Photographs of either one or both eyelids of 100 people were evaluated in four stages by 10 plastic surgeons. To investigate the consistency of the results between evaluations, surgeons evaluated the single-eyelid photographs (group U) or two-eyelid photographs (group B). It was investigated whether the difference in margin reflex distance 1, height of the upper eyelid crease, height of eyebrow, and levator contractile function were associated with mismatched evaluations.

Results:
The weighted kappa coefficient for groups B and U was 0.77 (substantial agreement). One-point difference in scores was observed in 23 cases. In the multiple logistic regression analysis, only the laterality the height of the eyelid crease was significantly different between patients whose evaluations were matched and those whose evaluations were mismatched (0.9 ± 0.1 mm versus 1.7 ± 0.2 mm; OR = 1.06, 95%CI: 1.01–1.10; P = 0.01).

Conclusions:
Besides the structure and function of each eyelid, the laterality of the height of the eyelid crease was important in the evaluation of the age-related changes in the eyelids. This factor may be important in evaluating the aesthetic and visual impressions of age-related changes in the eyelids.
Instructional Dermatology Surface Models
Authors: Ousley Lisa Ellen , Gentry Retha , Short Candice 
Published: November 2021

ABSTRACT
The need for improving dermatology education is supported by the prevalence of skin cancer and by the high rates of skin disease. Instructional dermatology surface models were created by nurses in response to the rising incidence of skin cancer, the predominance of skin disease, and inadequate dermatology education. The aims of this nonexperimental descriptive research included (a) to establish the face validity and content validity of the models, (b) to assess the educational applicability for nursing and nondermatology students and clinicians, and (c) to further develop the models. A convenience sample of four physicians was recruited to evaluate the skin cancer models. A Likert scale was used to answer questions related to face and content validity and the applicability to dermatology education. The mean responses for the face and content validity and applicability to nondermatologist training were all ≤1.85, falling between the “strongly agree” and “agree” categories. The responses suggested good face and content validity of the skin cancer models. The models were created to promote effective learning and innovative nursing dermatology education.
Acne Management in Transgender Men and Boys
Authors: Somers Kathryn , Greenberg Katherine 
Published: November 2021

ABSTRACT
Transgender men often seek hormonal therapy with testosterone and are thus prone to develop acne. Dermatology practitioners should be knowledgeable in the treatment of acne in transgender men. Isotretinoin and the iPledge system have particular hurdles in the transgender population that are discussed within.
Development of the Proposed 13 Entrustable Professional Activities for Physician Assistant Graduates
Authors: Acker Shekitta , Noelke Ashley , Huckabee Michael , Rieck Katie M. 
Published: November 2021

Abstract:
Competency-based training has not consistently produced medical professionals who are ready to practice. To address this situation, entrustable professional activities (EPAs) have been introduced as a means to assess medical trainee readiness for their next phase of training or practice. Thirteen EPAs were developed by the Physician Assistant Education Association (PAEA) Presidents Commission in 2016 to indicate what activities they thought future physician assistant (PA) students should be expected to perform at the completion of their PA education. The 13 EPAs as proposed by the PAEA Presidents Commission were adopted by the Mayo Clinic PA program and further developed through multiple steps, including (1) Discovery and Alignment; (2) EPA Development; (3) Curriculum Development; (4) Assessment and Rubric Development, and (5) Implementation.
Dental Anesthesia for Medical Providers: A Novel Interprofessional Course
Authors: Howell Scott Emil Irving , Jafferbhoy Hennah , Trombly Colleen , Thompson Jesse , Knutson Linda 
Published: November 2021

Purpose
To limit the use of opioids for nontraumatic dental conditions in emergency settings, the physician assistant (PA) and dental faculty at A.T. Still University designed a course that teaches PA students to administer dental anesthesia.

Methods
Dental faculty and teacher assistants taught PA students proper dental anesthesia. The course consisted of a recorded, prelaboratory lecture and in-person lab. During the laboratory, students rotated through 3 stations where they reviewed dental anatomy, practiced injections on dental anesthesia manikins, and simulated injections on student volunteers using the Safe-D-Needle. Students completed verbal and hands-on assessments.

Results
Ninety-seven percent of students passed the assessments on their first attempt. Course evaluations suggested the course had a positive effect on students' attitudes toward oral pain management.

Conclusion
This educational model allowed PAs to expand their emergency medicine toolbox. In the future, this model should be adapted to incorporate other healthcare professionals as well.
Examining the Hepatic Immune System in Children With Liver Disease With Fine Needle Aspiration
Authors: Yuksel Muhammed , Demirbaş Burak , Mizikoğlu Özlem , Tütüncü Yildiz , Kanmaz Turan , Oğuzkurt Levent , Arikan Cigdem 
Published: November 2021

ABSTRACTObjectives:Liver biopsy is the standard in diagnosing liver diseases. Yet, it provides little space to perform comprehensive immune profiling of the liver. Hence, we explored whether fine needle aspirates (FNAs) could be used to elucidate the hepatic immunity in children.Methods:We enrolled 74 children undergoing diagnostic (n = 17) or protocol biopsy (n = 57) following liver transplantation (LT). Matched blood and FNAs were obtained. Additionally, explant liver tissue was collected from children (n = 14) undergoing LT. Immune cells were isolated from peripheral blood, FNAs and explanted livers. Immune‐phenotypical profiling was done by flow cytometry.Results:Biopsied patients (58% female) were at a median age of 46 months (interquartile range [IQR]: 12–118) and LT patients (71% female) were 48 months (IQR: 21–134, P = 0.78) old. CD69+, a hallmark of tissue‐resident immune cells was expressed in 1.3% of CD3+ T cells from blood being higher in FNA (20%) and tissue (49%, P < 0.001). CD4+ T‐cell frequencies in tissue (13%) and FNAs (20%) were lower compared to blood (35%, P < 0.001) whereas CD8+ T cells in tissue (33.5%) and FNA (32%) were higher than in blood (25%, P < 0.01). Mucosal associated invariant T cells were enriched in liver tissue (8.8%) and in the FNA (4.4%) compared to blood (1.7%, P < 0.001). Whereas the percentage of total Tregs (CD4+CD25+FOXP3+CD127low/−) decreased, the proportion of activated Tregs (CD4+CD45RA‐FOXP3high) increased in FNA and explant. Breg (CD19+CD20+CD24highCD38high) frequencies were similar in all groups.Conclusion:FNA is a practical method to sample the liver immune system collecting even small cell subsets such as regulatory T/B cells.
Neurobrucellosis
Authors: Bouferraa Youssef , Bou Zerdan Maroun , Hamouche Ramzi , Azar Eid , Afif Claude , Jabbour Rosette 
Published: November 2021

Background:
Brucella are small, nonmotile, intracellular, and aerobic gram-negative bacteria. Of the 10 species that currently form the genus Brucella, 5 were shown to be pathogenic in humans.

Review Summary:
The epidemiology, clinical manifestations, diagnosis and imaging, and treatment of neurobrucellosis will be reviewed.
Brucellosis’s transmission to humans occurs by direct contact with contaminated animals. Older patients are at increased risk of nervous system involvement in brucellosis. Brucella spp. can lead to central nervous system involvement through direct damage via invasion of neural tissue or indirect damage caused by endotoxins or immune inflammatory reactions elicited by the presence of the bacteria in the body. Patients can have general nonspecific symptoms in addition to neurological and psychiatric symptoms. There are 4 diagnostic criteria for the diagnosis of neurobrucellosis, which include signs and symptoms suggestive of neurobrucellosis, a positive finding of Brucella spp. in the cerebrospinal fluid (CSF), and/or a positive titer of antibodies targeting brucella in the CSF, lymphocytosis with high protein levels and low glucose levels in CSF, and imaging findings (either cranial magnetic resonance imaging or computed tomography) peculiar to neurobrucellosis. For the treatment, a combined therapy is favored over monotherapy for the eradication of Brucella. Moreover, a multirouted therapy has been associated with increased treatment efficacy. The prognosis of neurobrucellosis is dependent on patients’ clinical presentation: brucellar meningitis is associated with a good prognosis, whereas diffuse central nervous system involvement is associated with the development of long-term sequelae.

Conclusions:
Neurobrucellosis affects patients globally and in endemic areas. Neurologists should familiarize themselves with its clinical presentation, diagnosis, and treatment to provide optimal care for their patients.
COVID-19 Associated Wake-Up Stroke Treated With DWI/FLAIR Mismatch Guided Intravenous Alteplase
Authors: Biag Earl , Solis Krystian , Abd Elazim Ahmed , Hussein Omar 
Published: November 2021

Introduction:
Wake-up strokes are challenging to manage due to unknown time of onset. Recently, the wake-up trial demonstrated that recombinant tissue plasminogen activator (rtPA) could be administered based on the magnetic resonance imaging (MRI)- diffusion weighted imaging/fluid attenuated inversion recovery mismatch. Many still doubt the safety results due to the higher rate of hemorrhagic conversion reported. Although it was statistically insignificant, the study was terminated early. Furthermore, Corona virus disease-19 is associated with coagulopathy and a higher risk of hemorrhagic conversion.

Case Report:
A 46-year-old fully functioning male presented with a wake-up right hemiparesis, right facial droop, and expressive aphasia. His National Institute of Health Stroke Scale was 4 upon arrival. Last known well state was >4.5 hours. He tested positive for SARS-CoV-2 viral infection. He had left distal-M2 occlusion. He was deemed not a candidate for rtPA. Hyperacute-MRI protocol showed diffusion weighted imaging/fluid attenuated inversion recovery mismatch. The patient received rtPA at 6.5 hours from the last knwn well state. Follow-up MRI-susceptibility weighted imaging revealed fragmented clot. The stroke burden was less than that shown on the initial computed tomography-perfusion scans implying saved penumbra. There was no hemorrhagic conversion despite low fibrinogen levels.

Conclusion:
The hyperacute-MRI protocol for wake-up COVID-19 associated strokes might be a safe option.
COVID-19 Infection and Recurrent Stroke in Young Patients With Protein S Deficiency
Authors: Ali Leila , Jamoussi Hela , Kouki Nessrine , Fray Saloua , Echebbi Slim , Ben Ali Nadia , Fredj Mohamed 
Published: November 2021

Introduction:
Protein S deficiency and coronavirus disease 2019 (COVID-19) are rare etiologies of ischemic stroke. We describe a case of an ischemic stroke revealing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a patient with a history of protein S deficiency and cerebral imaging suggestive of vasculitis.

Case Report:
A 52-year-old woman, with history of protein S deficiency, was admitted for right hemiparesis and aphasia that happened 6 hours before her consultation. Her National Institutes of Health Stroke Scale (NIHSS) was 11. She had hypoxia (SpO2 93%). COVID-19 polymerase chain reaction was positive. Cerebral computed tomography scan showed an ischemic stroke in the territory of the superficial left middle cerebral artery. The recommended time period for thrombolysis was exceeded and we did not dispose of sufficient resources to deliver thrombectomy. She was treated with aspirin, statins, antibiotic therapy, and oxygen. Considering the high risk of thromboembolic complications and the history of protein S deficiency, anticoagulation treatment with heparin followed by acenocoumarol was started. Evolution was marked by the appearance of 24 hours regressive, acute symptoms of confusion. Brain magnetic resonance imaging showed new ischemic strokes in both anterior cerebral arteries and on magnetic resonance angiography narrowing of the left internal carotid artery and both anterior cerebral arteries suggestive of vasculitis was seen. We maintained anticoagulation and prescribed methylprednisolone 500 mg daily for 3 days. Evolution was marked by improvement of clinical deficit and respiratory status.

Conclusions:
SARS-CoV-2 infection potentializes the prothrombotic effect and vascular inflammation by accentuating protein S deficit. The place of steroids seems justifiable in the presence of symptoms of vasculitis in brain imaging.
Neurological Symptoms and Diagnoses in Patients Hospitalized With COVID-19
Authors: Haki Cemile , Demirci Hakan , Ayar Yavuz , Demir Canan , Caliskan Gulbahar 
Published: November 2021

Background:
Coronavirus disease 2019 (COVID-19) is a disease that affects many organs, especially the lung, and may lead to multiorgan failure. Studies describing neurological dysfunctions involving the central and peripheral nervous systems have emerged. In our study, we aimed to evaluate the neurological signs and symptoms in hospitalized patients with COVID-19.

Methods:
The data of 290 patients admitted to our center (ward and intensive care unit) who received a diagnosis of COVID-19 were analyzed retrospectively. Patients’ demographic, clinical and laboratory data, and their neurological diseases, symptoms, and complications were compared.

Results:
Male sex, heart disease, chronic obstructive pulmonary disease and having a history of neurological disease were associated with increased mortality in patients with COVID-19. Seizures and altered consciousness were also found to be more common in patients who died. In addition, lower platelet counts (P=0.001), higher C-reactive protein levels (P<0.001) and higher D-dimer levels (P=0.003) were associated with increased risk of mortality.

Conclusions:
We believe that close monitoring of any possible neurological manifestations is mandatory in hospitalized patients at the onset of COVID-19 and during disease progression. Clinical findings such as neurological symptoms and acute phase reactants are important in the follow-up and treatment of the disease.
Caste, sex, and parasitism influence brain plasticity in a social wasp
Authors: Gandia Kristine M. , Cappa Federico , Baracchi David , Hauber Mark. E. , Beani Laura , Uy Floria M. K. 
Published: November 2021

ABSTRACTPhenotypic plasticity is the capacity of a single genotype to exhibit different phenotypes, and can be an adaptive response to specific environmental and social conditions. Social insects are particularly well-suited to study plasticity, because the division of labor amongst females and the different life histories of males and females are associated with specific sensory needs. Here, we take advantage of the social waspPolistes dominulato explore if brain plasticity is influenced by caste and sex, and the exploitation by the parasiteXenos vesparum. Within sexes, males had proportionally larger optic lobes, while females, regardless of caste, had larger antennal lobes, which is consistent with sensory needs of sex-specific life histories. Within castes, reproductive females had larger calyces, as predicted by their sensory needs for extensive within-colony interactions and forming winter aggregations, than workers who spend more time foraging for nest material and prey. Surprisingly, parasites had different effects on female and male hosts. Female workers were castrated and behaviorally manipulated by female or male parasites, but only showed moderate differences in relative allocation of different brain tissue compared to non-parasitized workers. In contrast, the testes and behavior of parasitized males were essentially unaffected, but they had smaller brains and greater relative volume of most sensory brain regions than non-parasitized males. Our results are consistent with caste and sex mediating brain plasticity inP. dominulaand that the parasite’s manipulation can also drive differential allocation of brain regions depending on host sex.