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Plastic and Reconstructive Surgery.... Jul 2024Modern science has conquered seas, land, and space. Although great strides have been made in technology and infectious diseases, global surgery, which was reborn in...
BACKGROUND
Modern science has conquered seas, land, and space. Although great strides have been made in technology and infectious diseases, global surgery, which was reborn in 2015, has not made much progress. The burden of surgical disease in low- and middle-income countries remains seemingly unconquerable, and its growth unstoppable. The myriad challenges in meeting the surgical needs of 5 billion people has intrigued the author.
METHODS
The author collected the views of plastic surgeons on sources and impediments to the scale-up of plastic surgery in low- and middle-income countries, as well as potential strategies for overcoming these obstacles. The author then performed a literature search reviewing the topics that arose from those discussions. The author proposes a strategy using plastic surgery as a model surgical discipline.
RESULTS
A root-cause analysis suggests that the Alma Ata Declaration, with its focus on primary healthcare, is the probable genesis of global surgery (GS) woes. The absence of a clear GS community leader and the fragmented nature of GS advocates who operate in multiple silos, without a clear unified goal, are the primary reasons GS advocates have achieved so little on the ground.
CONCLUSIONS
Global surgery requires a business model to sustainably meet the surgical needs of the 5 billion people globally. The proposed and implemented strategies must meet rigorous criteria to ensure sustainability, as quick-fix solutions are counterproductive. The development of centers of excellence offers a viable solution to problems that must be addressed successfully.
PubMed: 38962157
DOI: 10.1097/GOX.0000000000005953 -
Plastic and Reconstructive Surgery.... Jul 2024The ideal dose for indocyanine green (ICG) has not been established yet, although 5 mg per mL is widely accepted for free flap evaluation. Due to its high price and...
The ideal dose for indocyanine green (ICG) has not been established yet, although 5 mg per mL is widely accepted for free flap evaluation. Due to its high price and rarity in developing countries, this preliminary study aimed to find the lowest concentration of ICG without reducing the fluorescence quality read by near-infrared camera in animal models. An experimental study was conducted on 25 Wistar rats divided into five groups based on the injected ICG, which was in 5 mg per mL, 3.75 mg per mL, 2.5 mg per mL, 1.25 mg per mL, and 0.5 mg per mL concentrations. The epigastric flap was elevated and confirmed to be vital on the fifth day. Upon confirmation, bolus IV injection of ICG was given via the tail, and the flap was read using near-infrared camera. The 25 different videos are randomized and rated individually in a blind manner by five microsurgeons, chosen beforehand. The videos are evaluated with a scoring system ranging from 0 to 4, assessing fluorescence visibility and flap vasculature. Nonetheless, the intraclass correlation coefficient is 0.779. There was no difference between standard and diluted ICG concentrations to evaluate flap perfusion. The 2.5 mg per mL concentration of ICG was the most favorable. This finding is not clinically relevant for application in human subjects yet. However, this study shows promising results for further usage of ICG in daily practice at a lower cost.
PubMed: 38962156
DOI: 10.1097/GOX.0000000000005948 -
Plastic and Reconstructive Surgery.... Jul 2024NovoSorb biodegradable temporizing matrix (BTM) is a novel, bilayer, synthetic skin substitute made of biodegradable polyurethane foam covered with a sealing membrane....
BACKGROUND
NovoSorb biodegradable temporizing matrix (BTM) is a novel, bilayer, synthetic skin substitute made of biodegradable polyurethane foam covered with a sealing membrane. BTM has demonstrated excellent outcomes in burn literature; however, few studies have been published for hand and extremity soft tissue reconstruction.
METHODS
All patients who underwent extremity reconstruction with BTM from 2018 to 2023 were reviewed. Demographics, presentations, and clinical outcomes were recorded.
RESULTS
A total of 86 cases from 54 patients (53.7% pediatric; age range: 0-81 years) were included. Common indications included trauma (36%), infection (18.6%), and malignancy (11.6%). BTM was placed over exposed tendon (38.4%), bone (19%), joints (12.8%), nerves (8.1%), and/or blood vessels (7%). BTM served as temporary wound coverage in 26 cases. Complications included hematoma (8.1%), infection (4.7%), and spontaneous delamination (4.7%). Wound closure was successfully obtained without flap use in 93.3%. Poor BTM take was associated with peripheral vascular disease, hypertension, immunosuppression, and BTM hematoma and infection (<0.05).
CONCLUSION
This study contributes to the growing body of evidence favoring BTM use in challenging reconstructive cases. Although prospective comparative studies are forthcoming, BTM likely has broad applications in reconstructive surgery.
PubMed: 38962155
DOI: 10.1097/GOX.0000000000005956 -
Plastic and Reconstructive Surgery.... Jul 2024Mastectomy poses significant challenges to a woman's body image and psychological well-being, and breast reconstruction plays a pivotal role in postoperative quality of...
BACKGROUND
Mastectomy poses significant challenges to a woman's body image and psychological well-being, and breast reconstruction plays a pivotal role in postoperative quality of life. Following breast reconstruction, many patients choose to have subsequent aesthetic procedures. Data on the prevalence of such subsequent aesthetic interventions are lacking in the literature. The aim of this study was to analyze trends in aesthetic procedures in patients following mastectomy with and without breast reconstruction.
METHODS
The PearlDiver database was queried within its capabilities for patients who underwent mastectomy with and without breast reconstruction, and a variety of aesthetic procedures after mastectomy. Aesthetic procedure rates were compared between cohorts.
RESULTS
We identified 365,525 mastectomy patients: 282,815 without reconstruction and 82,710 with reconstruction. In total, 609 patients with reconstruction and 329 without underwent subsequent aesthetic procedures. The rate of aesthetic procedures was higher in the reconstruction group (0.7%) compared with the nonreconstruction group (0.1%; < 0.001).
CONCLUSIONS
Patients who chose to have breast reconstruction after mastectomy underwent significantly more subsequent aesthetic procedures compared with those who chose mastectomy alone. Our findings provide insights on the prevalence of aesthetic procedures in postmastectomy patients, highlighting the potentially longitudinal nature of the reconstructive and aesthetic journey beyond the index oncologic procedure. Further research is needed to address motivations for such procedures as well as patient-reported outcomes and satisfaction.
PubMed: 38962154
DOI: 10.1097/GOX.0000000000005947 -
Plastic and Reconstructive Surgery.... Jul 2024The highly competitive nature of the integrated plastic surgery residency match justifies the need for objective data that provide insights into some of the residents'...
BACKGROUND
The highly competitive nature of the integrated plastic surgery residency match justifies the need for objective data that provide insights into some of the residents' selection criteria. Many studies have sought to provide information on these criteria, but to our knowledge, none has described the inflection point where the match probability does not further increase. Although our study provides this information to potential applicants, it will also help them assess and optimize their chances of a successful match.
METHODS
We pooled and analyzed the data available on matched and unmatched integrated plastic surgery applicants on the national residency match program database between 2016 and 2022.
RESULTS
Step 2 score of 250 or more ( < 0.0001), number of publications more than 15 ( = 0.0007), number of research experiences five or more ( = 0.018), number of contiguous ranks more than 10 ( < 0.0001), number of volunteer experiences five or more ( < 0.0001), being a US MD applicant ( < 0.0001), and Alpha Omega Alpha membership ( < 0.0001) were all associated with increased probability of matching into the integrated plastic surgery program. Match probability did not further increase after 15 publications, five research experiences, 15 contiguous ranks, and 10 volunteer experiences have been reached. Having a PhD ( = 0.149) or a non-PhD graduate degree ( = 0.07) was not associated with increased match probability.
CONCLUSION
The law of diminishing returns sets in for applicants to the integrated plastic surgery match after 15 publications, 15 contiguous ranks, five research experiences, and 10 volunteer experiences have been reached.
PubMed: 38962153
DOI: 10.1097/GOX.0000000000005937 -
Plastic and Reconstructive Surgery.... Jul 2024Body contouring surgery removes excess skin and fat, often after massive weight loss. Some reports suggest that patients who have previously undergone obesity...
BACKGROUND
Body contouring surgery removes excess skin and fat, often after massive weight loss. Some reports suggest that patients who have previously undergone obesity (bariatric) surgery are at excess risk of subsequent bleeding, possibly due to complex nutritional and metabolic sequelae of massive weight loss.
METHODS
A retrospective cohort study of intraoperative blood loss and postoperative bleeding indicators were examined for patients who had undergone abdominoplasty. Participants were categorized based on their history of previous obesity surgery, and outcome variables were compared using odds ratio, followed by subgroup comparison between a history of restrictive versus malabsorptive obesity surgery.
RESULTS
The study included 472 patients, of which 171 (36.2 %) had a history of obesity surgery. Mean age was 40.4 years, and 402 (85.1%) participant were women. Fifty-five (11.6%) patients were smokers whereas 65 (13.7%) were hypertensive. Mean body mass index before surgery was 30.2 kg per m, and average time between obesity and body contouring surgery (if applicable) was 35.8 months. Patients with a history of obesity surgery exhibited greater intraoperative blood loss (162.2 mL versus 132.1 mL; = 0.001), drainage volume at 24 h (155 mL versus 135 mL; = 0.001), and total drainage volume (300ml versus 220 mL; = 0.001). Postoperative hematoma requiring surgical re-exploration was almost three times higher following a history of obesity surgery (4.7% versus 1.7 %; = 0.05).
CONCLUSIONS
History of obesity surgery increases intraoperative blood loss, postoperative serosanguinous drainage volumes, and the risk of postoperative hematoma requiring surgical evacuation after abdominal body contouring procedures.
PubMed: 38962152
DOI: 10.1097/GOX.0000000000005959 -
Frontiers in Microbiology 2024The genus is renowned for its remarkable resilience against environmental stresses, including ionizing radiation, desiccation, and oxidative damage. This resilience is...
The genus is renowned for its remarkable resilience against environmental stresses, including ionizing radiation, desiccation, and oxidative damage. This resilience is attributed to its sophisticated DNA repair mechanisms and robust defense systems, enabling it to recover from extensive damage and thrive under extreme conditions. Central to research, the strains ATCC BAA-816 and ATCC 13939 facilitate extensive studies into this remarkably resilient genus. This study focused on delineating genetic discrepancies between these strains by sequencing our laboratory's ATCC 13939 specimen (ATCC 13939K) and juxtaposing it with ATCC BAA-816. We uncovered 436 DNA sequence differences within ATCC 13939K, including 100 single nucleotide variations, 278 insertions, and 58 deletions, which could induce frameshifts altering protein-coding genes. Gene annotation revisions accounting for gene fusions and the reconciliation of gene lengths uncovered novel protein-coding genes and refined the functional categorizations of established ones. Additionally, the analysis pointed out genome structural variations due to insertion sequence (IS) elements, underscoring the genome's plasticity. Notably, ATCC 13939K exhibited a loss of six IS elements relative to BAA-816, restoring genes fragmented by IS, such as those encoding for α/β hydrolase and serine protease, and revealing new open reading frames, including genes imperative for acetoin decomposition. This comparative genomic study offers vital insights into the metabolic capabilities and resilience strategies of .
PubMed: 38962131
DOI: 10.3389/fmicb.2024.1410024 -
International Cancer Conference Journal Jul 2024Skin toxicity is the most common adverse event of treatment with immune check point inhibitors. Among them, erythema multiforme is a rare occurrence with a frequency of...
PD-L1 expression in keratinocyte and infiltration of CD4 + T lymphocyte can predict a severe type of erythema multiforme major induced by the anti-PD-1 antibody, pembrolizumab.
UNLABELLED
Skin toxicity is the most common adverse event of treatment with immune check point inhibitors. Among them, erythema multiforme is a rare occurrence with a frequency of 4%, with most of the cases developing grade 1/2 disease. We experienced high grade erythema multiforme major developing with pembrolizumab treatment for anal canal cancer with extensive skin metastases. Steroid ointment was ineffective, and the skin lesions with blisters expanded to > 45% of the body surface area. The patient was at risk for symptom aggravation, and a pulse therapy with methylprednisolone and increasing the dose of oral prednisolone (1 mg/kg) were started. The skin lesions improved in 1.8 months. Unless urgent and appropriate treatments such as high dose steroid administration were conducted, the skin toxicities could not be controlled. The presence of CD4 T cells and PD-L1 keratinocytes in the skin biopsy might be a predictive marker of erythema multiforme major resistant to standard steroid treatment.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s13691-024-00676-4.
PubMed: 38962048
DOI: 10.1007/s13691-024-00676-4 -
Heliyon Jun 2024The production and consumption of vegetables, such as tomatoes, have been growing in recent years, due to the combination of several factors, such as market demand,...
The production and consumption of vegetables, such as tomatoes, have been growing in recent years, due to the combination of several factors, such as market demand, investment in research, education and awareness about health benefits, as well as government incentives and improvements in cultivation technology. The combination of these factors results in an increasing demand for products that offer health benefits, such as tomatoes rich in antioxidants, which help combat free radicals in cells. To maintain most of the nutritional and sensory properties characteristic of the fresh product, it is important to identify the parameters that will help in maintenance. Thus, the study aims to characterize the influence of different packages and storage times with the variables of tomato. The experiment examined the storage of two tomato derivatives (atomized tomato and chips) using various packaging types and storage durations. It utilized a factorial design (2 × 4) with an extra control treatment, comprising 3 replications. Packaging options included low-density polyethylene plastic bags and laminated plastic bags with aluminum foil, while storage durations ranged from 10 to 40 days. Parameters related to color (°Hue and chroma), flavor (pH, titratable acidity, soluble solids, and maturation index), and bioactive compounds (lycopene and β-carotene) of two tomato derivatives (atomized tomato and chips) were analyzed. After the analyzes, it was observed that the transparent package was the one that allowed the best conservation among the studied variables of the atomized tomato derivative, the same happened for the laminated packaging for the derivative chips. Regarding storage time, 20 days showed the best results regarding the conservation of flavor and bioactive compounds.
PubMed: 38961955
DOI: 10.1016/j.heliyon.2024.e32545 -
Heliyon Jun 2024In today's digitally advanced society, there is a need to focus on collaborative educational approaches of a socio-community nature that incorporate technology. From...
In today's digitally advanced society, there is a need to focus on collaborative educational approaches of a socio-community nature that incorporate technology. From this perspective, the FEJYLEN and FEJYLENVAL programs were conceived and implemented for both remote (online) and face-to-face teaching. These programs are based on an E-Learning-Service methodology, enabling the training of university students in digital skills, and facilitating the transfer of their interactive educational video-animations to early childhood education centers. The study sample consisted of 221 students enrolled in Early Childhood Education and Speech Therapy Degrees. The study had two objectives: first, to compare digital competences before and after participating in the mentioned programs; and second, to evaluate the impact of the type of teaching and university training on the acquisition of digital competences. The findings indicate that students receiving face-to-face teaching demonstrated significant improvement across all digital competences' factors with a medium-high effect size. Conversely, for students receiving remote instruction, improvements were limited to only certain skill factors. Our study reveals that face-to-face teaching is associated with higher scores in digital competencies and more efficient digital content creation. In conclusion, this research highlights the advantages of face-to-face teaching in comparison to remote instruction. This has facilitated a closer connection between the university and the realities faced by educational centers, fostering the exchange of knowledge between learning communities.
PubMed: 38961932
DOI: 10.1016/j.heliyon.2024.e32589