Can Electrical Stimulation Prevent Recurrence of Keloid Scars? A Scoping Review.

Objective: Keloids represent a symptomatic, aberrant healing process that is difficult to treat with high recurrence rates spanning from 55% to 100% if treated via excision without adjuvant therapy. Electrical stimulation (ES) has demonstrated findings that suggest it could reduce the recurrence rate of keloids after resection. Therefore, the aim of this study is to conduct a scoping review to investigate ES as an adjuvant therapy for decreasing keloid recurrence after excision. Approach: A scoping review was performed using PubMed and Web of Science databases. The search strategy encompassed terms linking keloids and various aspects of electrical stimulation. Results: Our search yielded 2,229 articles, of which 115 articles were analyzed as full text and 1 article met inclusion criteria. Despite this, ES has demonstrated other evidence that suggests its utility. ES has been shown to counter keloidic features by reducing mast cell counts, shifting wound composition from M2 to M1 macrophages, promoting angiogenesis, and controlling fibroblast orientation and location. An alternating current will orient fibroblasts perpendicular to the current without unintended migration. Innovation: Our study indicates that, based on a compilation of clinical and preclinical in vitro data, the optimal scenario for ES in the role of keloid treatment is after excision with a biphasic pulsed application and square waveform. Conclusions: ES could serve as a multifaceted, adjuvant treatment after keloid excision, steering the healing process away from keloid-associated characteristics. Its cost-effectiveness means it could be adopted globally, providing a strategy to mitigate the burden of keloids irrespective of other available treatments or economic conditions.

Diversity Drives Representation: An Internal Audit of Gender Representation in Citation Practices of a Single Surgical Laboratory.

Background: Large-scale retrospective studies have identified implicit gender bias in citation behaviors across multiple medical fields. There are minimal resources to directly assess one's own citation behavior before publication at a laboratory level. In this study, we performed an internal audit of our own citation practices and behavior, looking at the representation of authors by gender in our own bibliographies. Methods: Bibliographies were collated from our laboratory's publications between 2015 and 2022 with a single senior author, who was excluded from participating in this study. Bibliographies were run through a simulation originally constructed and used by authors from the University of Pennsylvania that categorized authors of each article by gender: man or woman, according to external database records. Results: Of the 1697 citations, the first and last authorship sequences displayed to be 60.8% male/male, 10.1% male/female, 16.3% female/male and 12.8% female/female. Men-led articles within our laboratory cited 67.4% male/male articles in their bibliographies compared with women-led articles citing 53.9%. All laboratory bibliographies consisted of 77.1% male senior authors compared with 22.9% female senior authors. Conclusions: Our data confirm that a gender bias in citation practices exists at the laboratory level. Promisingly, these data also indicate that diversity within an individual laboratory group leads to diversity in representation; therefore, diversifying a team of researchers is prone to improve the overall work and success of the laboratory. We encourage laboratory groups to challenge their own biases by replicating their own results and discovering how these biases might be impacting their publications.

Livestreaming Microsurgery Education: An Avenue to Expand Global Plastic Surgery.

Microsurgery is a complex subspecialty requiring fine manual dexterity and a thorough understanding of microsurgical techniques, requiring years of training to reach proficiency. On a global scale, trainees may not have access to a longitudinal microsurgery curriculum and instead attend brief courses to learn microsurgical techniques, limiting their ability to practice the nuances of microsurgery. There remains a gap in global microsurgical education for trainees to have consistent educational exposure. This article presents a novel and easy to use software-based microsurgical system for virtual microsurgical teaching. In doing so, this system provides a free-of-cost and highly accessible avenue to deliver consistent microsurgical education worldwide.

Social media analysis of pain outcomes following targeted muscle reinnervation.

AIM: Targeted muscle reinnervation (TMR) was developed to improve myoelectric prosthesis control for amputees; however, it has become an area of interest in pain modulation. Evidences indicate that this procedure alleviates chronic pain in amputees. The primary objective of this study was to use social media analysis to understand patients' post-operative pain, satisfaction, and recovery time after TMR. METHODS: Data were collected from one Facebook group via posts and comments referencing TMR. Posts published between January 1, 2020, and March 24, 2023 were analyzed. Data collected included pain prior to surgery, pain in immediate post-op period, and change in pain after surgery. RESULTS: Forty-three individuals commented on their TMR experience. Among them, 31 had favorable surgical outcomes, 7 felt that the surgery worsened their pain or there was no significant change in their pain levels, and 5 commented during the initial post-operative period. Twenty-four patients described their pain in the immediate post-operative period and all patients said that the post-operative pain was worse than chronic pain. Among the 28 authors who commented on overall reduction in chronic pain, 24 reported that TMR reduced their pain, whereas 4 reported no change or worsened pain. CONCLUSIONS: The number of patients (24) who reported improvement in chronic pain aligns with the results in current literature suggesting that TMR is a viable treatment option for pain management. With the current medical management of similar conditions, up to 80% of patients remain unsatisfied with pain management. This analysis supports the evidence that TMR is an effective treatment for patients experiencing post-amputation pain.

Trigeminal or peripheral nerve stimulation improves functional outcomes of nerve recovery in a rodent forelimb gap repair model.

BACKGROUND: The hypothesis of this study was that trigeminal nerve stimulation (TNS) or peripheral nerve stimulation (PNS) could improve functional outcomes of peripheral nerve injury in a rat forelimb model when compared to control rats not receiving electrical stimulation (ES). While PNS is known to improve outcomes after nerve surgery, the role of TNS has not been explored. METHODS: Lewis rats were trained to perform a reach and grasp task before receiving a 2 mm gap repair of the ulnar and median nerves and randomized into four treatment groups: (1) sham injury, (2) nerve injury with sham ES, (3) nerve injury with PNS, and (4) nerve injury with TNS. Functional motor (median pull force and percent success in motor task) and sensory metrics (forelimb paw withdrawal thresholds) were collected both pre-injury and throughout rehabilitation. Nerves stained using Gomori's trichrome were assessed quantitatively and qualitatively. RESULTS: The sham ES group did not recover their pre-injury baseline functional outcomes. In contrast, the TNS and PNS groups fully recovered following injury, with no difference in functional outcomes between the pre-injury baseline and the final week of rehabilitation (P > 0.05, all). Histomorphology results demonstrated no quantitative difference, but qualitative differences in architecture were evident. CONCLUSIONS: Electrical stimulation of the trigeminal nerve or the injured nerve improved the functional outcomes of nerve regeneration in rodents. Histomorphology results of nerves from the TNS group support the proposed central mechanisms. This is an important step in translating this therapy as an adjunct, non-invasive treatment for high, mixed nerve injuries in humans.

A framework for understanding prosthetic embodiment for the plastic surgeon.

Plastic surgeons play a critical role in the management of amputations and are uniquely positioned to improve the lives and functional abilities of patients with limb loss. The embodiment of a prosthesis describes how effectively it replaces a missing limb and is an important aspect of patient care. Despite its importance, the current prosthetics literature lacks a formal definition of embodiment, and descriptions are often vague or incomplete. In this narrative review, we assess the current literature on prosthetic embodiment to explore the main mechanisms of embodiment and how each allows a prosthesis to interface with the human body. In doing so, we provide a comprehensive, holistic framework for understanding this concept.

Towards a data transfer agreement for the South African research community: The empowerment approach.

The idea of a data transfer agreement (DTA) template for the South African (SA) research community is receiving increasing attention. While developing such a DTA template is certainly a worthwhile project, questions regarding the project's practical execution should be addressed, including how to best operationalise the envisioned DTA template, and the content of the envisioned DTA template. It is proposed that an empowerment approach be followed in operationalising the envisioned DTA template, which is contrasted with the regulatory approach followed with the material transfer agreement that the Minister of Health promulgated in 2018. While the regulatory approach would entail government making the use of the envisioned DTA template compulsory regardless of the quality of such a template, the empowerment approach, by contrast, entails a focus on developing a high-quality, professionally drafted DTA template for the SA research community and making the use thereof a matter of own choice. Regarding the content of the envisioned DTA template, four hot-button content provisions are analysed, and it is argued that SA research institutions and researchers should be empowered to: (i) have clarity and legal certainty regarding their ownership of data, where relevant; (ii) be able to commercialise their research findings without unnecessary contractual constraints; (iii) avoid falling into the trap of unlawful benefit sharing with research participants; and (iv) be aware that their legal role as responsible parties, where relevant, cannot be contracted out via a DTA.

Evaluation of a Full-Time Microsurgeon Educator on Resident Training, Research Collaboration, and Grant Funding.

BACKGROUND: The value of a fully trained microsurgeon dedicated to a laboratory setting at an academic institution is largely unknown. Microsurgery training lacks a national standard despite its highly complicated nature. Our study aims to evaluate the impact of a single laboratory-dedicated microsurgeon on the microsurgical training of integrated plastic surgery residents and collaborative efforts in research. METHOD: We devised a three-faceted microsurgical training curriculum, including a collaborative multi-institutional microsurgery course, novel high-fidelity simulator models, and a dedicated microsurgeon. We cataloged grant funding achieved through support to other divisions' protocols. Time, in hours, spent on training and the number of anastomoses completed with the microsurgical educator in a laboratory setting over a 4-year period (2017-2021) were evaluated. Resident independence scores were collected from attending microsurgeons to quantify the translation of microsurgical training. RESULTS: Purchasing and maintenance costs of rats in our rodent facility decreased by $16,533.60 as 198 rats were replaced by our models. The residents who participated in our novel microsurgical training program were able to independently perform anastomoses in the OR by their postgraduate year 6. Additionally, the surgical support offered by our laboratory-dedicated microsurgeon led to a total of $24,171,921 in grant funding between 2017 and 2020. CONCLUSION: Hiring an expert microsurgical educator to train residents in a laboratory has proved promising in accelerating microsurgical mastery. Novel training modules, alternatives to animal models, save resources in housing and animal costs. The addition of a research-oriented-microsurgeon has improved collaborative efforts to advance a range of surgical fields.

Artificial intelligence in healthcare: Proposals for policy development in South Africa.

Despite the tremendous promise offered by artificial intelligence (AI) for healthcare in South Africa, existing policy frameworks are inadequate for encouraging innovation in this field. Practical, concrete and solution-driven policy recommendations are needed to encourage the creation and use of AI systems. This article considers five distinct problematic issues which call for policy development: (i) outdated legislation; (ii) data and algorithmic bias; (iii) the impact on the healthcare workforce; (iv) the imposition of liability dilemma; and (v) a lack of innovation and development of AI systems for healthcare in South Africa. The adoption of a national policy framework that addresses these issues directly is imperative to ensure the uptake of AI development and deployment for healthcare in a safe, responsible and regulated manner.

Electrical Stimulation of Acute Fractures: A Narrative Review of Stimulation Protocols and Device Specifications.

Orthopedic fractures have a significant impact on patients in the form of economic loss and functional impairment. Beyond the standard methods of reduction and fixation, one adjunct that has been explored since the late 1970s is electrical stimulation. Despite robust evidence for efficacy in the preclinical arena, human trials have mixed results, and this technology is not widely accepted. The purpose of this review is to examine the body of literature supporting electrical stimulation for the purpose of fracture healing in humans with an emphasis on device specifications and stimulation protocols and delineate a minimum reporting checklist for future studies of this type. We have isolated 12 studies that pertain to the administration of electrical stimulation for the purpose of augmenting fracture healing in humans. Of these, one was a direct current electrical stimulation study. Six studies utilized pulsed electromagnetic field therapy and five used capacitive coupling. When examining these studies, the device specifications were heterogenous and often incomplete in what they reported, which rendered studies unrepeatable. The stimulation protocols also varied greatly study to study. To demonstrate efficacy of electrical stimulation for fractures, the authors recommend isolating a fracture type that is prone to nonunion to maximize the electrical stimulation effect, a homogenous study population so as to not dilute the effect of electrical stimulation, and increasing scientific rigor in the form of pre-registration, blinding, and sham controls. Finally, we introduce the critical components of minimum device specification reporting for repeatability of studies of this type.

Diversity Drives Innovation: The Impact of Female-Driven Publications.

BACKGROUND: Gender disparities are pervasive in academic plastic surgery. Previous research demonstrates articles authored by women receive fewer citations than those written by men, suggesting the presence of implicit gender bias. OBJECTIVES: The aim of this study was to describe current citation trends in plastic surgery literature and assess gender bias. The expectation was that women would be cited less frequently than their male peers. METHODS: Articles published between 2017 and 2019 were collected from 8 representative plastic surgery journals stratified by impact factor. Names of primary and senior authors of the 50 most cited articles per year per journal were collected and author gender was determined via online database and internet search. The median numbers of citations by primary and senior author gender were compared by Kruskal-Wallis test. RESULTS: Among 1167 articles, women wrote 27.3% as primary author and 18% as senior author. Women-authored articles were cited as often as those authored by men (P > 0.05) across all journal tiers. Articles with a female primary and male senior author had significantly more citations than articles with a male primary author (P = 0.038). CONCLUSIONS: No implicit gender bias was identified in citation trends, a finding unique to plastic surgery. Women primary authors are cited more often than male primary authors despite women comprising a small fraction of authorship overall. Additionally, variegated authorship pairings outperformed homogeneous ones. Therefore, increasing gender diversity within plastic surgery academia remains critical.

Electronic Bone Growth Stimulators for Augmentation of Osteogenesis in In Vitro and In Vivo Models: A Narrative Review of Electrical Stimulation Mechanisms and Device Specifications.

Since the piezoelectric quality of bone was discovered in 1957, scientists have applied exogenous electrical stimulation for the purpose of healing. Despite the efforts made over the past 60 years, electronic bone growth stimulators are not in common clinical use. Reasons for this include high cost and lack of faith in the efficacy of bone growth stimulators on behalf of clinicians. The purpose of this narrative review is to examine the preclinical body of literature supporting electrical stimulation and its effect on bone properties and elucidate gaps in clinical translation with an emphasis on device specifications and mechanisms of action. When examining these studies, trends become apparent. In vitro and small animal studies are successful in inducing osteogenesis with all electrical stimulation modalities: direct current, pulsed electromagnetic field, and capacitive coupling. However, large animal studies are largely unsuccessful with the non-invasive modalities. This may be due to issues of scale and thickness of tissue planes with varying levels of resistivity, not present in small animal models. Additionally, it is difficult to draw conclusions from studies due to the varying units of stimulation strength and stimulation protocols and incomplete device specification reporting. To better understand the disconnect between the large and small animal model, the authors recommend increasing scientific rigor for these studies and reporting a novel minimum set of parameters depending on the stimulation modality.

Whole body PD-1 and PD-L1 positron emission tomography in patients with non-small-cell lung cancer.

PD-L1 immunohistochemistry correlates only moderately with patient survival and response to PD-(L)1 treatment. Heterogeneity of tumor PD-L1 expression might limit the predictive value of small biopsies. Here we show that tumor PD-L1 and PD-1 expression can be quantified non-invasively using PET-CT in patients with non-small-cell lung cancer. Whole body PD-(L)1 PET-CT reveals significant tumor tracer uptake heterogeneity both between patients, as well as within patients between different tumor lesions.

Technical note: Comparison of dry matter measurements from handheld near-infrared units with oven drying at 60°C for 48 hours and other on-farm methods.

This study compared dry matter (DM) predictions of 3 handheld near-infrared spectrophotometer (NIRS) units (Moisture Tracker, Digi-Star Inc., Fort Atkinson, WI) to conventional oven drying at 60°C using 2 alfalfa and 2 corn silages. In addition, on-farm DM methods [microwave, Koster tester (Koster Moisture Tester Inc., Brunswick, OH), and food dehydrator methods] were also compared. Corn and alfalfa silages (1,600 g) obtained from the University of Wisconsin Dairy Cattle Center (DCC) and the Arlington Research Station (ARS) were analyzed for DM daily for 20 d. Two NIRS calibration methods were also tested within each unit. The DM predicted from the factory-preset calibrations was NIRf. The adjusted DM prediction was NIRa, where the average difference between oven-dried and NIRf determined on duplicate forage samples for 3 d before the experiment was used as a bias adjustment for all subsequent DM determinations. The average predicted DM from the 20 scans was recorded as the forage DM. The process was repeated 3 times with each NIRS unit. Two 100-g subsamples of each forage were also oven-dried for 48 h at 60°C daily in a forced-air oven. Oven DM of ARS and DCC alfalfa silages were 37.3 ± 1.1% and 48.5 ± 1.9%, respectively (mean ± standard deviation). Oven DM of ARS and DCC corn silages were 34.7 ± 1.2% and 37.4 ± 0.5%, respectively (mean ± standard deviation). Dry matter determinations from NIRf were on average 3.5 units higher than the oven DM values. The NIRa DM predictions were on average 1.7 DM units lower than the oven DM values. Additionally, differences among the 3 NIRf probe results were detected (43.1, 40.7, and 41.3% DM, respectively), but all other results were similar between probes. Determinations of DM by the microwave and food dehydrator were also similar with the 60°C, 48-h oven method, whereas the Koster tester was lower than the oven. The handheld NIRS units more accurately predicted DM content of the alfalfa silage but were not as accurate with corn silages when the factory preset calibrations were corrected for bias.

Technical note: A comparison of alkali treatment methods to improve neutral detergent fiber digestibility of corn stover.

The objective of this study was to compare neutral detergent fiber (NDF) digestibility of corn stover that had been treated by 2 alkali treatment methods. Two experiments were conducted to test a sodium hydroxide (NaOH) treatment method that uses an ethanol/water co-solvent (NaOH/ethanol-H2O, United States Patent No. 20140220228) and a calcium hydroxide (CaOH) treatment method, which uses water as a solvent (CaOH/H2O). An in situ trial was conducted to compare NDF digestion kinetics between NaOH/ethanol-H2O-treated stover, CaOH/H2O-treated stover, untreated corn stover, and soy hulls. The digestion rate of potentially digestible NDF (kd) of NaOH/ethanol-H2O-treated corn stover (5.36%/h) was higher than CaOH/H2O-treated stover (2.27%/h), or untreated corn stover (1.76%/h) and similar to the kd of soy hulls (4.93%/h). The indigestible NDF (iNDF) fraction of untreated corn stover (35.1% of NDF) was reduced by CaOH/H2O treatment (27.3% of NDF) and by NaOH/ethanol-H2O treatment (2.8% of NDF). The iNDF fraction in soy hulls (3.6% of NDF) was similar to iNDF of NaOH/ethanol-H2O-treated stover. An in vivo digestibility trial was also conducted to compare fiber digestibility of diets supplemented with untreated corn stover, NaOH/ethanol-H2O-treated corn stover, or soy hulls. Total-tract apparent dry matter (DM) and NDF digestibility were measured with 8 lactating Holstein cows in a replicated 4 × 4 Latin square with four 21-d periods. Apparent DM digestibility (DMD) was improved when supplemental soy hulls were added to the base diet (60.0% DMD) compared with the base diet with no supplemental fiber (57.7% DMD). Apparent DM digestibility was reduced when diets were supplemented with untreated stover (52.4%). Dry matter digestibility of NaOH/ethanol-H2O-treated stover was similar (54.8% DMD) to all other treatments. Digestibility of NDF was lowest when cows were fed the diet with supplemented untreated stover (35.5% of NDF), and improved when soy hulls (40.6% of NDF) or NaOH/ethanol-H2O-treated stover (43.8% of NDF) were added to the diets. The NaOH/ethanol-H2O treatment process improves the DM and NDF digestibility of corn stover to values similar to those of soy hulls.

Endophenotypes: A conceptual link between anorexia nervosa and autism spectrum disorder.

The paper, by translating the concept and the two models of endophenotype (EP), strengthens the hypothesis that there exists a linkage between anorexia nervosa (AN) and autism spectrum disorder (ASD). Specifically, the paper synthesizes empirical research that supported the idea that individuals with AN and individuals with ASD share similarities with respect to their neurocognitive EPs and temperament EPs. The paper then introduces an innovative structure to emphasize the subtle difference between neurocognitive EPs and temperament EPs in relation to AN and ASD. This structure constitutes the categorization of the shared neurocognitive EPs to the liability-index model of EP and the shared temperament EPs to the mediational model of EP. The paper argues that the shared neurocognitive EPs under the liability index model of EP are trait markers signaling the effects of genes on the phenotypes of AN and ASD; whereas, the shared temperament EPs under the mediational model of EP are state markers describing the symptomatic status of AN and ASD. The proposition of the paper suggests clinicians and researchers should target the atypical state markers (i.e., temperament EPs) shared between AN and ASD when tailoring environment-based treatments for individuals with AN who exhibit autistic behaviors and individuals with ASD who display disordered eating behaviors or anorexic symptoms.

Mortality Among Children And Young People Who Survive Cancer In Northern Ireland.

ABSTRACT: Whilst survival rates for childhood cancers are excellent, it is known that these patients have an increased risk of death from disease recurrence and other causes. We investigate patterns, trends and survival of cancers in children and young adults in N. Ireland. MATERIALS AND METHODS: 21 years (1993-2013) of cancer incidence data including non-malignant brain tumours from the N. Ireland Cancer Registry for persons aged 0-24 years was analysed using Joinpoint regresssion for trend and the Kaplan Meier method for survival analysis up to end 2013 with excess mortality calculated at one and five years after first cancer diagnosis using standardised mortality ratios. RESULTS: 2633 children and young people were diagnosed with cancer, 1386 (52.6%) male and 1247 female with 1139 (43.3%) aged 0-14. While trends increased over time they did not reach statistical significance except in the 15-24 age group for males and females combined. The most common cancers for age 0-14 were brain, eye and central nervous system and leukaemia with skin (including non-melanoma skin) the most common in the 15-24 age group. 59 patients (2.2%) had a record of a second cancer. Survival was high at 90.7% after 1 year, better among females and similar for older and younger groups. Although mortality in children is low overall, there was an excess mortality 24.7% (22-27.5) p<0.001 at one year and 7.3% (5.5-9.2) p<0.001 for those who survived 5 years. Excluding the primary cancer there was an excess mortality for one year survivors, with deaths twice that of the background level (SMR= 2.2 (1.3-3.0)p=0.005 and although one and a half times background levels at 5 years, the excess mortality was not significant 1.5 (0.6-2.3 p=0.269). CONCLUSION: Whilst survival from childhood cancers is excellent, this work in common with larger studies, highlights the need for ongoing monitoring of cancer survivors. Preventable skin cancer was identified as a problem in young adults.

Physico-chemical changes in tomato with modified atmosphere storage and UV treatment.

Physico-chemical changes in ripe tomato (Lycopersicon esculentum Mill.) were analyzed on day 0 and 2 weeks after ultraviolet-C (UV-C) light treatment or modified atmosphere (MA) storage and combined UV-C + MA storage at 10 °C. Modified atmosphere packaging (MAP) film was used to create MA conditions. The tomatoes were evaluated for surface colour, mass loss, firmness, respiration rate, total soluble solids and antioxidant capacity. The tomatoes treated with UV-C and MA storage underwent least changes in their physico-chemical properties, indicating that combination of UV-C and MA storage was successful in retaining the attributes of the fresh product. The increase in antioxidant capacity of the tomatoes during UV-C treatment suggested that UV treatment during post harvest handling may be successfully combined with MA storage, resulting in a product with better nutritive value.