Bifurcation of Patient Reviews: An Analysis of Trends in Online Ratings.

BACKGROUND: Online reviews have become increasingly important drivers of healthcare decisions. Data published by the Pew Research Center from 2016 suggest that 84% of adult Americans use online rating sites to search for information about health issues. The authors sought to analyze physician reviews collected from a large online consumer rating site to better understand characteristics that are associated with positive and negative review behavior. METHODS: Published patient reviews from RealSelf were sampled over a 12-year period (June 2006 to August 2018). SQL, Python, and Python SciPy were used for statistical analysis on 156,965 reviews of 10,376 unique physicians. Python VADER was used to quantify consumer sentiment with review text as input. RESULTS: Surgical procedures tended to be higher rated than nonsurgical treatments. The highest-rated procedures were breast augmentation, rejuvenation of the female genitalia, and facelift. The lowest-rated surgical procedures were buttock augmentation, rhinoplasty, and eyelid surgery. The mean physician rating was 4.6, with 87% of reviews being 5-star and 5% being 1-star. Sentiment analysis revealed positive consumer sentiment in 5-star reviews and negative sentiment in 1-star reviews. CONCLUSIONS: These findings suggest that online reviews of doctors are polarized by extreme ratings. Within the surgical category, significant differences in ratings exist between treatments. Perceived problems with postprocedural care are most associated with negative reviews, whereas satisfaction with a physician's answers to patient questions is most associated with positive reviews. Polarization of physician reviews may suggest selection bias in reviewer participation.

Female Genital and Vaginal Plastic Surgery: An Overview.

LEARNING OBJECTIVES: After studying this article and viewing the video, the participant should be able to: 1. Accurately describe the relevant aesthetic anatomy and terminology for common female genital plastic surgery procedures. 2. Have knowledge of the different surgical options to address common aesthetic concerns and their risks, alternatives, and benefits. 3. List the potential risks, alternatives, and benefits of commonly performed female genital aesthetic interventions. 4. Be aware of the entity of female genital mutilation and differentiation from female genital cosmetic surgery. SUMMARY: This CME activity is intended to provide a brief 3500-word overview of female genital cosmetic surgery. The focus is primarily on elective vulvovaginal procedures, avoiding posttrauma reconstruction or gender-confirmation surgery. The goal is to present content with the best available and independent unbiased scientific research. Given this relatively new field, data with a high level of evidence are limited. Entities that may be commonly encountered in a plastic surgery practice are reviewed. The physician must be comfortable with the anatomy, terminology, diagnosis, and treatment options. Familiarity with requested interventions and aesthetic goals is encouraged.

Posterior dislocation in a voluntary subluxator: a case report.

PURPOSE: Posterior instability of the shoulder is an uncommon occurrence. Its etiology has been classified as traumatic or atraumatic and its type as voluntary (individual can subluxate the shoulder posteriorly) or involuntary. Typically, patients with posterior voluntary instability do not have a history of trauma, can be treated successfully with physical therapy; and undergo surgery if the instability becomes symptomatic or develops an involuntary component. We present a patient with voluntary posterior subluxation who developed a symptomatic posterior instability after a traumatic event. PATIENT PRESENTATION: This patient was unable to return to his preinjury function despite nonoperative interventions, including rehabilitation, and required operative treatment of his posterior labrum lesion. This patient had a rare combination of voluntary, atraumatic instability that coexisted with traumatic posterior shoulder instability. CONCLUSION: This case emphasizes the importance of recognizing this constellation of instability patterns and documents that traumatic posterior instability, even in the presence of preexisting voluntary posterior subluxations, may require operative intervention in young, active individuals.

Substrate specificity of type III flagellar protein export in Salmonella is controlled by subdomain interactions in FlhB.

FlhB, an integral membrane protein, gates the type III flagellar export pathway of Salmonella. It permits export of rod/hook-type proteins before hook completion, whereupon it switches specificity to recognize filament-type proteins. The cytoplasmic C-terminal domain of FlhB (FlhBC) is cleaved between Asn-269 and Pro-270, defining two subdomains: FlhBCN and FlhBCC. Here, we show that subdomain interactions and cleavage within FlhB are central to substrate-specificity switching. We found that deletions between residues 216 and 240 of FlhBCN permitted FlhB cleavage but abolished function, whereas a deletion spanning Asn-269 and Pro-270 abolished both. The mutation N269A prevented cleavage at the FlhBCN-FlhBCC boundary. Cells producing FlhB(N269A) exported the same amounts of hook-capping protein as cells producing wild-type FlhB. However, they exported no flagellin, even when the fliC gene was being expressed from a foreign promoter to circumvent regulation of expression by FlgM, which is itself a filament-type substrate. Electron microscopy revealed that these cells assembled polyhook structures lacking filaments. Thus, FlhB(N269A) is locked in a conformation specific for rod/hook-type substrates. With FlhB(P270A), cleavage was reduced but not abolished, and cells producing this protein were weakly motile, exported reduced amounts of flagellin and assembled polyhook filaments.