bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Pain and Pain Management After Ambulatory Plastic Surgery
Authors: Bernstein Jaime L. , Schlechtweg Kathryn A. , Nwigwe Viemma , Fullerton Natalia , Imahiyerobo Thomas A. 
Published: May 2022

Background
Overprescribing by physicians has been shown to be a major contributor to the opioid epidemic. Although pediatric ambulatory plastic surgery patients are commonly prescribed opioids for postoperative pain control, there is a lack of evidence for their necessity. This study aimed to investigate the role of prescribed narcotics in the ambulatory pediatric plastic surgery setting.

Methods
All assenting patients/guardians, ages 0 to 17 years, who underwent an ambulatory plastic surgery procedure by 1 attending surgeon from March 2018 to March 2019, were asked to participate in the study. A questionnaire was distributed at the first postoperative visit to interrogate postoperative pain, management, and narcotic use.

Results
A total of 95 patients/guardians completed the questionnaire. Seventy-eight percent (74) of patients picked up the narcotic medication, with 33% (31) taking at least 1 dose of narcotics, and only 9% (9) taking 4 or more doses. Patients overall found no difference in efficacy of the narcotics versus nonprescription analgesics (3.93/5 and 4.31/5, P = 0.11). Age was a significant predictor, with older patients requiring more narcotics (odds ratio, 1.12; 95% confidence interval, 1.02–1.24; P = 0.019). The type of surgery a patient underwent was not a significant predictor of the amount of narcotic used. Few patients knew how to properly dispose of the excess narcotics, with almost 50% still having it stored in their homes.

Conclusions
This study demonstrates that the majority of pediatric ambulatory plastic surgery patients do not require narcotic pain medications and experience adequate pain relief with over-the-counter analgesics. Importantly, education on proper disposal of narcotic medications may be a simple, yet effective target to decrease opioid availability for abuse.
Diversity in Plastic Surgery: Analysis of Representation of Sex and Ethnic Diversity in Plastic Surgery Residency Social Media Accounts
Authors: Maisner Rose S. , Kapadia Kailash , Zhu Aretha , Patel Nikita , Ravikumar Vaishali , Lad Meeki , Zingaro Lauren , Ayyala Haripriya S. , Lee Edward S. 
Published: May 2022

Background
Increasing health care diversity is critical to overcoming disparities. Plastic surgery has been working to improve diversity through various efforts, including social media movements like Diversify PRS and #ilooklikeasurgeon. Because residency programs' social media sites serve as a public symbol of the programs' values and can attract potential applicants, we sought to analyze such platforms for content highlighting sex and ethnic diversity.

Methods
Integrated plastic surgery residency programs during the 2020 to 2021 academic year were found on the American Council of Academic Plastic Surgeons website, and their associated social media accounts were identified. The authors reviewed each program's account for all posts published by November 8, 2021, for content promoting sex or ethnic diversity. Any hashtags related to diversity were also recorded. Nonparametric Mann-Whitney U and Kruskal-Wallis tests were used to compare percentages of total social media posts related to sex and ethnic diversity between programs (α = 0.05).

Results
Of 82 programs, 76 (92.7%) had active Instagram accounts, 29 (35.4%) had active Facebook accounts, and 29 (35.4%) had active Twitter accounts. Across all platforms, 19.0% of all posts were promoting sex diversity and 3.3% were promoting ethnic diversity. Of 4651 posts promoting sex diversity, 4067 (87.4%) highlighted women, 1017 (21.9%) featured all-women teams, 779 (16.7%) used sex diversity-related hashtags, and 300 (6.5%) included purposeful statements. Of 808 posts promoting ethnic diversity, 527 (65.2%) used ethnic diversity-related hashtags, 224 (27.7%) included purposeful statements, 199 (24.6%) mentioned ethnic background, and 36 (4.5%) used different skin-toned emojis. Programs did not vary in percentages of posts related to diversity by geographic region, ranking, accreditation length, or engagement rate. The percentage of posts promoting sex diversity was greater than that promoting ethnic diversity (P < 0.001). The most used diversity hashtag was #ilooklikeasurgeon.

Conclusions
Despite the importance of increasing recruitment of trainees from diverse backgrounds to plastic surgery and the global reach of social media movements like #ilooklikeasurgeon, sex and ethnic diversity are still poorly promoted on residency social media accounts. Increasing such content is a simple yet powerful way to create a culture of inclusivity for all applicants.
Evaluating the Inaccuracy of the National Surgical Quality Improvement Project Surgical Risk Calculator in Plastic Surgery: A Meta-analysis of Short-Term Predicted Complications
Authors: Basta Marten N. , Rao Vinay , Paiva Marcelo , Liu Paul Y. , Woo Albert S. , Fischer John P. , Breuing Karl H. 
Published: May 2022

Background
Preoperative surgical risk assessment is a major component of clinical decision making. The ability to provide accurate, individualized risk estimates has become critical because of growing emphasis on quality metrics benchmarks. The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) Surgical Risk Calculator (SRC) was designed to quantify patient-specific risk across various surgeries. Its applicability to plastic surgery is unclear, however, with multiple studies reporting inaccuracies among certain patient populations. This study uses meta-analysis to evaluate the NSQIP SRC’s ability to predict complications among patients having plastic surgery.

Methods
OVID MEDLINE and PubMed were searched for all studies evaluating the predictive accuracy of the NSQIP SRC in plastic surgery, including oncologic reconstruction, ventral hernia repair, and body contouring. Only studies directly comparing SCR predicted to observed complication rates were included. The primary measure of SRC prediction accuracy, area under the curve (AUC), was assessed for each complication via DerSimonian and Laird random-effects analytic model. The I
2 statistic, indicating heterogeneity, was judged low (I
2 < 50%) or borderline/unacceptably high (I
2 > 50%). All analyses were conducted in StataSE 16.1 (StataCorp LP, College Station, Tex).

Results
Ten of the 296 studies screened met criteria for inclusion (2416 patients). Studies were classified as follows: (head and neck: n = 5, breast: n = 1, extremity: n = 1), open ventral hernia repair (n = 2), and panniculectomy (n = 1). Predictive accuracy was poor for medical and surgical complications (medical: pulmonary AUC = 0.67 [0.48–0.87], cardiac AUC = 0.66 [0.20–0.99], venous thromboembolism AUC = 0.55 [0.47–0.63]), (surgical: surgical site infection AUC = 0.55 [0.46–0.63], reoperation AUC = 0.54 [0.49–0.58], serious complication AUC = 0.58 [0.43–0.73], and any complication AUC = 0.60 [0.57–0.64]). Although mortality was accurately predicted in 2 studies (AUC = 0.87 [0.54–0.99]), heterogeneity was high with I
2 = 68%. Otherwise, heterogeneity was minimal (I
2 = 0%) or acceptably low (I
2 < 50%) for all other outcomes.

Conclusions
The NSQIP Universal SRC, aimed at offering individualized quantifiable risk estimates for surgical complications, consistently demonstrated poor risk discrimination in this plastic surgery–focused meta-analysis. The limitations of the SRC are perhaps most pronounced where complex, multidisciplinary reconstructions are needed. Future efforts should identify targets for improving SRC reliability to better counsel patients in the perioperative setting and guide appropriate healthcare resource allocation.
Smooth Versus Textured Tissue Expander Breast Reconstruction: Complications and Efficacy
Authors: McLaughlin Caroline , Hughes Alexa J. , Parham Christopher S. , Fritsche Madelaine , Potochny John D. , Kunselman Allen , Ravnic Dino J. 
Published: May 2022

Introduction
Ongoing recognition of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) and its link with textured devices has brought a paradigm shift in prosthetic-based breast reconstruction. Many institutions no longer offer textured expansion devices for staged reconstruction. However, there is a paucity of data regarding the efficacy of smooth tissue expanders (TE). We hypothesized that the time to final reconstruction and complication profile between smooth and textured TEs would be similar in breast reconstruction patients.

Methods
A retrospective chart review was performed of all patients who underwent TE breast reconstruction during a 6-year period at the Penn State Hershey Medical Center. Rates of complications treated nonoperatively and those requiring reoperation were assessed. Mechanical complications, including expander malposition and rupture, were evaluated. Time to final breast reconstruction was quantified. Mixed-effects logistic regression and linear regression models, as appropriate, were used to compare textured to smooth TEs. Patient characteristics and anatomic plane placement were adjusted for in all analyses of outcomes.

Results
Data were collected on 389 patients, encompassing 140 smooth and 604 textured TEs. Textured devices had an increased incidence of complications treated nonsurgically (16.7% vs 10.7%; P = 0.14). However, smooth TEs had an increased incidence of reoperation (12.1% vs 7.6%; P = 0.06). Most noteworthy was that although smooth TEs had a 40-fold increase in malposition (13.6% vs 0.3%; P < 0.001), no reoperation for this complication was warranted. Further, the time to final reconstruction was comparable between the 2 devices (textured expanders: 221 days and smooth expanders: 234 days; P = 0.15).

Conclusions
Staged, implant-based reconstruction is the most common surgical approach to recreate the breast mound following mastectomy. Textured TEs were the cornerstone to this approach. Unfortunately, the association between textured devices and BIA-ALCL now mandates an alternative. We postulated that smooth expanders would compare favorably for breast reconstruction. Although our study suggests that smooth TEs suffer more malposition, this has a negligible impact on the reconstructive timeline. Thus, smooth TEs may prove beneficial when considering the risk of BIA-ALCL associated with textured devices.
Revision Pharyngoplasty in Cleft Palate and Velopharyngeal Insufficiency
Authors: Bruce Madeleine K. , Zhang Casey , Vodovotz Lena , Irgebay Zhazira , Maliha Samantha , Pfaff Miles , Ford Matthew , Goldstein Jesse A. , Losee Joseph E. 
Published: May 2022

Introduction
Velopharyngeal insufficiency (VPI), a stigmatizing hallmark of palatal dysfunction, occurs in a wide spectrum of pediatric craniofacial conditions. The mainstays for surgical correction include palate repair and/or pharyngeal surgery. However, primary pharyngoplasty has a failure rate of 15% to 20%. Although revision pharyngoplasty may be necessary in those with persistent VPI, little is known regarding the indications for and outcomes after such procedures. The purpose of this study is to describe the authors' experience with indications for and outcomes after revision pharyngoplasty.

Methods
A single-center retrospective review was performed of all patients undergoing revision pharyngoplasty between 2002 and 2019. Demographic data and Pittsburgh Weighted Speech Scores, diagnoses, comorbidities, and complications were tabulated. Two-tailed Student t test was used, and a P value of 0.05 or less was considered statistically significant.

Results
Thirty-two patients (65.6% male) met inclusion criteria for this study. The most common diagnoses included cleft palate (68.8%), submucous cleft palate (SMCP, 18.8%), and congenital VPI (6.3%, likely occult SMCP). Most patients (84.4%) underwent palatoplasty before their initial pharyngoplasty. The primary indication for initial pharyngoplasty was VPI (mean age 7.1 ± 4.6 years). The most common indication for revision pharyngoplasty (mean age 11.2 ± 5.1 years) included persistent VPI (n = 22), followed by obstructive sleep apnea (OSA) (n = 11). Persistent VPI (n = 8) and OSA (n = 6) were the most common complications after secondary pharyngoplasty. Thirteen patients (40.6%) within the revision pharyngoplasty cohort required additional surgical intervention: 4 underwent tertiary pharyngoplasty, 4 underwent takedown for OSA (n = 3) or persistent VPI (n = 1), 3 underwent takedown and conversion Furlow for persistent VPI (n = 2), OSA (n = 2) and/or flap dehiscence (n = 1), and 2 underwent palatal lengthening with buccal myomucosal flaps for persistent VPI. Of the 4 patients who required a tertiary pharyngoplasty, the mean age at repair was 6.6 ± 1.1 years and their speech scores improved from 13.5 to 2.3 after tertiary pharyngoplasty (P = 0.11). The overall speech score after completion of all procedures improved significantly from 19 to 3.3.

Conclusion
Patients who fail primary pharyngoplasty represent a challenging population. Of patients who underwent secondary pharyngoplasty, nearly half required a tertiary procedure to achieve acceptable speech scores or resolve complications.
Cutaneous surgical wounds have distinct microbiomes from intact skin
Authors: Gupta Sameer , Poret Alexandra J. , Hashemi David , Eseonu Amarachi , Yu Sherry H. , D’Gama Jonathan , Neel Victor A. , Lieberman Tami D. 
Published: May 2022

AbstractInfections are relatively rare following cutaneous surgical procedures, despite the potential for wound exposure to pathogens both during surgery and throughout the healing process. Although gut commensals are believed to reduce the risk of intestinal infections, an analogous role for skin commensals has not been described. In fact, the microbiome of normally healing surgical skin wounds has not yet been profiled using culture-independent techniques. We characterized the wound microbiome in 53 patients who underwent skin cancer surgery and healed without signs or symptoms of infection. A week after surgery, several bacterial species displayed significant differences in relative abundance when compared to control, non-operated skin from the same patient. The most common bacteria found on intact skin, Cutibacterium acnes, was depleted in wounds 5-fold. Staphylococcus aureus, a frequent cause of postoperative skin infections, was enriched 6.4-fold in clinically non-infected wounds, suggesting active suppression of pathogenicity. Finally, members of the Corynebacterium genus were the dominant organism in postoperative wounds, making up 37% of the average wound microbiome. The enrichment of these bacteria in normally healing wounds suggests they might be capable of providing colonization resistance. Future studies focused on the biological and clinical significance of the wound microbiome may shed light on normal wound healing and potential therapeutic opportunities to mitigate infection risk.ImportanceCommensal bacteria on skin may limit the ability of pathogenic bacteria to cause clinically-significant infections. The bacteria on healing acute wounds, which might provide such a protective effect, have not been described using culture-independent approaches in the absence of antibiotics. We compare the microbiome of wounds a week after skin cancer removal surgery with intact skin from the same patient. We find that the potentially pathogenic species S. aureus is common on these normally healing wounds, despite the absence of symptoms or signs of infection. We report that bacteria often considered as potential skin probiotics, including S. epidermidis, do not reach high abundance in wound microbiomes. In contrast, specific members of the Cornyebacterium genus, rarely associated with skin infections, were enriched in healing wounds relative to intact skin. Future work is needed to see if Corynebacterium species or derivatives thereof could be employed to lower the risk of wound infection.
Cross-link assisted spatial proteomics to map sub-organelle proteomes and membrane protein topology
Authors: Zhu Ying , Akkaya Kerem Can , Lima Diogo Borges , Wang Cong , Lehmann Martin , Liu Fan 
Published: May 2022

AbstractThe specific functions of cellular organelles and sub-compartments depend on their protein content, which can be characterized by spatial proteomics approaches. However, many spatial proteomics methods are limited in their ability to resolve organellar sub-compartments, profile multiple sub-compartments in parallel, and/or characterize membrane-associated proteomes. Here, we develop a cross-link assisted spatial proteomics (CLASP) strategy that addresses these shortcomings. Using human mitochondria as a model system, we show that CLASP can elucidate spatial proteomes of all mitochondrial sub-compartments and provide topological insight into the mitochondrial membrane proteome in a single experiment. Biochemical and imaging-based follow-up studies demonstrate that CLASP allows discovering mitochondria-associated proteins and revising previous protein sub-compartment localization and membrane topology data. This study extends the scope of cross-linking mass spectrometry beyond protein structure and interaction analysis towards spatial proteomics, establishes a method for concomitant profiling of sub-organelle and membrane proteomes, and provides a resource for mitochondrial spatial biology.
Failure of digit tip regeneration in the absence of Lmx1b suggests Lmx1b functions disparate from dorsoventral polarity
Authors: Castilla-Ibeas Alejandro , Zdral Sofía , Galán Laura , Haro Endika , Allou Lila , Campa Víctor M. , Icardo Jose M. , Mundlos Stefan , Oberg Kerby C. , Ros Marian A. 
Published: May 2022

ABSTRACTMammalian digit tip regeneration is linked to the presence of nail tissue, but a nail-explicit model is missing. Here, we report that nail-less double-ventral digits of ΔLARM1/2 mutants that lack limb-specific Lmx1b enhancers fail to regenerate. To separate the nail’s effect from the lack of DV polarity, we also interrogate double-dorsal double-nail digits and show that they regenerate. Thus, DV polarity is not a prerequisite for regeneration and the nail requirement is supported. Transcriptomic comparison between wild-type and non-regenerative ΔLARM1/2 mutant blastemas reveals differential up-regulation of vascularization and connective tissue functional signatures in wild-type versus upregulation of inflammation in the mutant. These results, together with the finding of uniform Lmx1b expression in the wild-type blastema and in the dorsal dermis underneath the nail, indicate that, in addition of the nail’s effect, a direct role for Lmx1b in driving the progression of digit tip regeneration is likely.
Semi-automated protocol to quantify and characterize fluorescent three-dimensional vascular images
Authors: Xie Danny F. , Crouzet Christian , LoPresti Krystal , Wang Yuke , Robinson Christopher , Jones William , Muqolli Fjolla , Fang Chuo , Cribbs David H. , Fisher Mark , Choi Bernard 
Published: May 2022

AbstractThe microvasculature facilitates gas exchange, provides nutrients to cells, and regulates blood flow in response to stimuli. Vascular abnormalities are an indicator of pathology for various conditions, such as compromised vessel integrity in small vessel disease and angiogenesis in tumors. Traditional immunohistochemistry enables visualization of tissue cross-sections containing exogenously labeled vasculature. Although this approach can be utilized to quantify vascular changes within small fields-of-view, it is not a practical way to study the vasculature on the scale of whole organs. Three-dimensional (3D) imaging presents a more appropriate method to visualize the vascular architecture in tissue. Here we describe the complete protocol that we use to characterize the vasculature of different organs in mice encompassing the methods to fluorescently label vessels, optically clear tissue, collect 3D vascular images, and quantify these vascular images with a semi-automated approach. To validate the automated segmentation of vascular images, one user manually segmented fifty random regions of interest across different vascular images. The automated segmentation results had an average sensitivity of 80±8% and an average specificity of 90±5% when compared to manual segmentation. Applying this procedure of image analysis presents a method to reliably quantify and characterize vascular networks in a timely fashion. This procedure is also applicable to other methods of tissue clearing and vascular labels that generate 3D images of microvasculature.
Sucrose rather than GA transported by AtSWEET13 and AtSWEET14 supports pollen fitness at late anther development stages
Authors: Wang Jiang , Xue Xueyi , Zeng Houqing , Li Jiankun , Chen Li-Qing 
Published: May 2022

SummaryBoth sugar and hormone gibberellin (GA) are essential for anther-enclosed pollen development and thus for plant productivity in flowering plants. Arabidopsis (Arabidopsis thaliana) AtSWEET13 and AtSWEET14, which are expressed in anthers and associated with seed yield, transport both sucrose and GA. However, it is still unclear which substrate transported by them directly affects anther development and seed yield.Histochemical staining, cross-sectioning and microscopy imaging techniques were used to investigate and interpret the phenotypes ofAtSWEET13andAtSWEET14double mutant during anther development. Genetic complementation ofatsweet13;14using AtSWEET9 that transports sucrose but not GA was conducted to test the substrate preference relevant to the biological process.The loss ofAtSWEET13andAtSWEET14resulted in reduced pollen viability and therefore decreased pollen germination. AtSWEET9 fully rescuedthe defects in pollen fertility ofatsweet13;14, indicating AtSWEET13/14 mediated sucrose rather than GA is essential to pollen fertility.AtSWEET13 and AtSWEET14 mainly function at the anther wall during late anther development stages and are likely responsible for sucrose efflux into locules to support pollen development to maturation, which is vital for subsequent pollen viability and germination.
Nanoscale prognosis of colorectal cancer metastasis from AFM image processing of histological sections
Authors: Gavriil Vassilios , Ferraro Angelo , Cefalas Alkiviadis-Constantinos , Kollia Zoe , Pepe Francesco , Malapelle Umberto , De Luca Caterina , Troncone Giancarlo , Sarantopoulou Evangelia 
Published: May 2022

ABSTRACTEarly ascertainment of metastatic tumour phases is crucial to improve cancer survival, formulate an accurate prognostic report of disease advancement and, most important, quantify the metastatic progression and malignancy state of primary cancer cells with a universal numerical indexing system. This work proposes an early improvement of cancer detection with 97nmspatial resolution by indexing the metastatic cancer phases from the analysis of atomic force microscopy images of human colorectal cancer histological sections. The procedure applies variograms of residuals of Gaussian filtering and theta statistics of colorectal cancer tissue image settings. The methodology elucidates the early metastatic progression at the nanoscale level by setting metastatic indexes and critical thresholds from relatively large histological sections and categorising the malignancy state of a few suspicious cells not identified with optical image analysis. In addition, we sought to detect early tiny morphological differentiations indicating potential cell transition from epithelial cell phenotypes of low to high metastatic potential. The metastatic differentiation, also identified by higher moments of variograms, sets different hierarchical levels for the metastatic progression dynamic, potentially impacting therapeutic cancer protocols.