BACKGROUND:Free flap breast reconstruction (FFBR) offers substantial benefits after mastectomy. However, the impact of operative time on outcomes remains unclear. PATIENTS AND METHODS:In this retrospective cohort study, the American College of Surgeons National Surgical Quality Improvement Program database (2011-2022) was queried for patients undergoing immediate FFBR. Multivariate logistic regression assessed operative time as both a continuous and dichotomous variable. Thresholds for operative duration were determined using receiver operating characteristic (ROC) analysis and Youden's Index. RESULTS:Of 5826 patients, 61% underwent unilateral and 39% bilateral FFBR. Complications occurred in 27% of cases-25% in unilateral and 30% in bilateral procedures. In unilateral FFBR, prolonged operative time was significantly associated with increased risks of overall complications (OR 1.0020 per minute, P < .001), surgical (OR 1.0023, P < .001) and medical complications (OR 1.0019, P = .0011), reoperation (OR 1.0011, P = .013), and readmission (OR 1.0014, P = .0030). Each additional hour increased overall complication risk by 12%, with a 397-minute threshold identified (OR 1.8, P < .001). For bilateral FFBR, longer operative time correlated with higher odds of overall complications (OR 1.0012 per minute, P < .001), surgical complications (OR 1.0012, P = .0014), and reoperation (OR 1.0010, P = .026). A 7.2% increase in adverse event risk was noted per additional hour, with 536 minutes as a critical threshold (OR 1.6, P < .001). CONCLUSION:Prolonged operative time significantly increases complication risk in FFBR. Patients with procedures exceeding 397 and 536 minutes were 80% and 60% more likely to experience adverse events, respectively. These findings highlight the need to maximize surgical efficiency and minimize postoperative morbidity.

Vascularized composite allotransplantation (VCA) involves the transplantation of multiple tissue types -- including skin, muscle, bone, and nerves -- offering a promising reconstructive option for patients with severe traumatic injuries or disfigurements. Despite its transformative potential, VCA has encountered significant challenges such as graft rejection, chronic immunosuppression complications, and neuromuscular recovery's intricacies. We utilize a rat forelimb model as a cost-effective and anatomically relevant platform to address these challenges. The rat forelimb closely mirrors human limb anatomy, enhancing our findings' translational impact. Previous studies have validated this model for reliably and reproducibly measuring functional recovery, thereby establishing it as a key tool for assessing the rejection trajectory of forelimb grafts. Moreover, the model offers a valuable opportunity to explore innovative therapeutic approaches and serve as a good translational platform for novel preservation techniques. Through further investigation of this model, we aim to deepen our understanding of the mechanisms behind graft rejection and neuromuscular recovery. Ultimately, this work strives to pave the way for improving clinical outcomes of VCA, addressing both current limitations and future challenges in transplant medicine.

Astronomy's extensive collections of photographic glass plates contain historical images and spectra of celestial objects, documenting more than a century of the observable cosmos. Many reveal changes, both sudden (explosive), periodic, or gradual (evolutionary), which is material of immense interest for time-domain studies because of the long time-base they cover. Those early photographic observations also furnished all the basic data which supported our early understanding of the universe, and from which modern stellar classifications have been derived. Once the ubiquitous workhorse detector, plates or film are now replaced by electronic detectors, and systems are modified to take advantage of advances in telescope technology. This change poses challenges of preservation and accessibility for the plates, leading administrators to question the usefulness of the older materials in relation to the cost of their care and preservation. The following paper details many examples of reusing or re-purposing those plates, demonstrates their unique value to modern astronomy and the history of science, and makes a strong case for committing resources towards their long-term preservation and ultimately their comprehensive digitization.

Background: Reduction mammoplasty is popular among people of various age groups, yet the impact of age on postoperative outcomes remains debated. Methods: The American College of Surgeons National Surgical Quality Improvement Program (2008-2021) was queried to identify adult female patients who underwent reduction mammoplasty. Patients were categorized into 10-year age brackets (i.e., 18-29, 30-39, 40-49, 50-59, 60-69, and > 70 years). We compared age-dependent 30-day outcomes via confounder- adjusted multivariate analyses. Results: 40,958 female patients (mean age: 41 +/- 14 years and mean body mass index: 31 +/- 6.1 kg/m2) 2 ) were identified. Complications occurred in 6.4% (n = 2635) of cases, with 770 (1.9%) and 483 (1.2%) patients requiring reoperation and readmission, respectively. 1706 (4.2%) women experienced surgical complications, whereas medical complications were generally rare (n = 289; 0.7%). Compared with women aged 18-29 years, risks of any, surgical, and medical complications were higher for patients aged 30-39 years (OR: 1.22, p < 0.01; OR: 1.05, p = 0.51; OR: 1.84, p < 0.01), 40-49 years (OR: 1.34, p < 0.01; OR: 1.17, p = 0.04; OR: 1.54, p = 0.03), 50-59 years (OR: 1.45, p < 0.01; OR: 1.31, p < 0.01; OR: 1.78, p < 0.01), 60-69 years (OR: 1.38 years, p < 0.01; OR: 1.29, p = 0.01; OR: 1.71, p < 0.01), and > 70 years (OR: 1.25, p = 0.18; OR: 1.01, p = 0.98; OR: 1.86, p = 0.14). Patients aged > 30 years were also more likely to require readmissions and reoperations. Conclusion: Patient age significantly affects outcomes after reduction mammoplasty, with the lowest risk in patients aged < 30 years. Importantly, the association between age and postoperative morbidity was not linear. These findings can help guide informed decisions, recognizing that while age is a factor, it is not the sole determinant of risk. (c) 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BackgroundRespiratory tract infections (RTIs) drive lung function decline in children with cystic fibrosis (CF). While the respiratory microbiota is clearly associated with RTI pathogenesis in infants without CF, data on infants with CF is scarce. We compared nasal microbiota development between infants with CF and controls and assessed associations between early-life nasal microbiota, RTIs, and antibiotic treatment in infants with CF.MethodsWe included 50 infants with CF and 30 controls from two prospective birth cohorts followed throughout the first year of life. We collected 1511 biweekly nasal swabs and analyzed the microbiota after amplifying the V3-V4 region of the 16S rRNA gene. We conducted structured weekly interviews to assess respiratory symptoms and antibiotic treatment. We calculated generalized additive mixed models and permutational analysis of variance.ResultsHere, we show that the nasal microbiota is already altered before the first RTI or antibiotic treatment in infants with CF. Microbiota diversity differs between infants with CF and controls following RTIs and/or antibiotic treatment. CF infants with lower alpha-diversity have a higher number of subsequent RTIs.ConclusionsEarly nasal microbiota alterations may reflect predisposition or predispose to RTIs in infants with CF, and further change after RTIs and antibiotic treatment. This highlights the potential of targeting the nasal microbiota in CF-related RTI management, while also questioning current practices in the era of novel modulator therapies. Cystic fibrosis (CF) is an inherited condition which can increase the risk of developing respiratory tract infections (RTIs). We investigated the microorganisms present in the respiratory tract of infants from birth to the age of one. We found that infants with CF had differences in the microorganisms present immediately after birth compared to infants without CF. These differences increased after development of RTIs and following antibiotic treatment. Our results suggest that infants with CF could potentially benefit from treatments that modify microorganisms present in their respiratory tract prior to development of any RTI, or from different antibiotics to those used by infants without CF. Steinberg et al. explore the associations between the nasal microbiota, respiratory tract infections (RTIs) and antibiotics in infants with cystic fibrosis (CF) and controls during the first year of life. Infants with CF have a different microbiota before their first RTI or antibiotic treatment, with lower diversity linked to higher number of RTIs.

The clinical role and underlying mechanisms of valproic acid (VPA) on bone homeostasis remain controversial. Herein, we confirmed that VPA treatment was associated with decreased bone mass and bone mineral density (BMD) in both patients and mice. This effect was attributed to VPA-induced elevation in osteoclast formation and activity. Through RNA-sequencing, we observed a significant rise in precursor miR-6359 expression in VPA-treated osteoclast precursors in vitro, and further, a marked upregulation of mature miR-6359 (miR-6359) in vivo was demonstrated using quantitative real-time PCR (qRT-PCR) and miR-6359 fluorescent in situ hybridization (miR-6359-FISH). Specifically, the miR-6359 was predominantly increased in osteoclast precursors and macrophages but not in neutrophils, T lymphocytes, monocytes and bone marrow-derived mesenchymal stem cells (BMSCs) following VPA stimulation, which influenced osteoclast differentiation and bone-resorptive activity. Additionally, VPA-induced miR-6359 enrichment in osteoclast precursors enhanced reactive oxygen species (ROS) production by silencing the SIRT3 protein expression, followed by activation of the MAPK signaling pathway, which enhanced osteoclast formation and activity, thereby accelerating bone loss. Currently, there are no medications that can effectively treat VPA-induced bone loss. Therefore, we constructed engineered small extracellular vesicles (E-sEVs) targeting osteoclast precursors in bone and naturally carrying anti-miR-6359 by introducing of EXOmotif (CGGGAGC) in the 3’-end of the anti-miR-6359 sequence. We confirmed that the E-sEVs exhibited decent bone/osteoclast precursor targeting and exerted protective therapeutic effects on VPA-induced bone loss, but not on ovariectomy (OVX) and glucocorticoid-induced osteoporotic models, deepening our understanding of the underlying mechanism and treatment strategies for VPA-induced bone loss.

Online patient reviews are crucial in guiding individuals who seek plastic surgery, but artificial chatbots pose a threat of disseminating fake reviews. This study aimed to compare real patient feedback with ChatGPT-generated reviews for the top five US plastic surgery procedures.

Vascularized composite allotransplantation (VCA) is an evolving field of reconstructive surgery that has revolutionized the treatment of patients with devastating injuries, including those with limb losses or facial disfigurement. The transplanted units are typically comprised of different tissue types, including skin, mucosa, blood and lymphatic vasculature, muscle, and bone. It is widely accepted that the antigenicity of some VCA components, such as skin, is particularly potent in eliciting a strong recipient rejection response following transplantation. The fine line between tolerance and rejection of the graft is orchestrated by different cell types, including both donor and recipient-derived lymphocytes, macrophages, and other immune and donor-derived tissue cells (e.g., endothelium). Here, we delineate the role of different cell and tissue types during VCA rejection. Rejection of VCA grafts and the necessity of life-long multidrug immunosuppression remains one of the major challenges in this field. This review sheds light on recent developments in decoding the cellular signature of graft rejection in VCA and how these may, ultimately, influence the clinical management of VCA patients by way of novel therapies that target specific cellular processes.

Background: The mouse hind limb model represents a powerful research tool in vascularized composite tissue allotransplantation, but its applicability is limited due to poor graft survival (62%–83%). Vascular thrombosis and massive hemorrhage are the major causes for these drop-outs. We hypothesize that because of better anticoagulation effect and lower risk of thrombocytopenia, application of low molecular weight heparin (LMWH) will minimize vascular complications and enhance graft and animal survival. Methods: Fifty allogeneic hind limb transplantations were performed (C57BL/6 to DBA/2 mice) using five different anticoagulation protocols. Bleeding and thromboembolic events were recorded macroscopically by postoperative hemorrhage and livid discoloration of the graft, respectively. Graft perfusion and survival were monitored daily by capillary-refill-time of graft toes within 2–3 seconds. Vascular congestion and tissue necrosis were examined by histological evaluation of hematoxylin-eosin-stained tissue sections. Results: All transplantations were technically successful. Increase in thromboembolic events and a concomitant decrease in bleeding events were observed with the decreasing concentration of heparin in the perfusion solution. Although treatment of donor and recipient with low dose of LMWH could not reduce thromboembolic events, moderate dose effectively reduced these events. Compared with the poor outcome of graft perfusion with heparin alone, additional treatment of donor and recipient with low dose of LMWH improved graft and animal survival by 18%. Interestingly, animals treated with moderate dose of LMWH demonstrated 100% graft and animal survival. Conclusions: Treatment of donor and recipient mice with a moderate dose of LMWH prevents vascular complications and improves the outcome of murine hind limb transplants.

Introduction: Prolonged or recurrent cough in children has different underlying causes, which vary across settings and age. We assessed diagnostic testing and final diagnosis given to children visiting respiratory outpatient clinics in Switzerland. Methods: We analysed data from the multicentre Swiss Paediatric Airway cohort study. We included 363 children (median age 6 years, range 0-16, 60% male) referred for prolonged or recurrent cough. We extracted information on diagnostic investigations, final diagnoses proposed by paediatric pulmonologists, and treatment prescribed from outpatient records. Results: Final diagnosis was asthma and asthma-like conditions in 133 (37%), respiratory tract infections (RTI) including protracted bacterial bronchitis in 50 (14%), upper airway cough syndrome (UACS) in 45 (12%), post-infectious cough in 36 (10%), and unknown or other diagnoses in 99 (27%). Among children aged < 5 years, 27% had asthma, 24% RTI, and 14% UACS while among those aged ≥ 5 years, 42% had asthma, 12% UACS and 8% RTI. Fractional exhaled nitric oxide was measured in 73%, lung function in 71%, and chest X-rays were done in 25%. Most children (83%) diagnosed with asthma were prescribed inhaled corticosteroids, alone or in combination with long-acting beta agonists, 42% of the children with RTI were prescribed antibiotics and 82% of those diagnosed with UACS were prescribed nasal corticosteroids. Conclusion: Asthma was the most common diagnosis, in a third of the children. Final diagnoses differed strongly by age. The cause of cough was unknown in 20% of the children, highlighting the diagnostic challenge and the need for further research to improve diagnosis of prolonged and recurrent cough. Funding: SNSF 320030_212519

The Unified Astronomy Thesaurus (UAT) is a living resource, with regular updates and opportunities for integration that ensure its place as a critical tool that meets the needs of the astronomy community, including researchers, authors, publishers, observatories, data centers, and librarians.The UAT has been integrated into multiple systems and institutions in recent years.We share the latest integrations with LISA participants and engage in a discussion on how we can work together to continue to build and leverage the UAT as a community.Future integrations and areas of exploration, such as ADS integration, applying the UAT as a controlled vocabulary for your institution's needs, and the UAT's potential as a testbed for Natural Language Processing, are also discussed.

Background: Cell-based therapies in vascularized composite tissue allotransplantation (VCA) have demonstrated promising results with the potential to modify life-long conventional immunosuppression. Dendritic cells (DCs) promote pro-inflammatory, alloimmune responses. Of particular interest is the role of DCs as antigen-presenting cells and potential tolerogenic effects as immature DCs. Material and Methods: Diphteria Toxin Receptor (DTR) transgenic or wild-type (WT) donor mice were used to deplete subsets of DCs or APCs respectively in a fully histoincompatible murine hind limb and skin transplant models; prior to procurement, all donors were either treated with diphteria toxin (DT; at -15 hours) or with clodronate (CL; 8 days prior to Tx). DBA/2J mice served as recipients. Study endpoint was on POD 6. Alloimmune response was assessed sequentially; graft survival, intragraft structural and inflammatory changes were tested serially. Results: The total number of dendritic cells (CD11b- CD11c+ DC) had markedly increased in recipients of skin WT grafts compared to recipients of VCA WT grafts (p<0.0001). The treatment with CL or DT significantly reduced the numbers of maturated and activated DC in the spleen, blood, and LN of mice receiving a skin graft, whereas numbers of CD11b-CD11c+MHCII+ and CD11b-CD11c+CD40+ DC were exclusively reduced in the spleen of VCA recipients after donor pretreatment with DT. cDC 1 subtypes were significantly higher in VCA WT vs. skin WT recipients (p<0.001). Donor pretreatment with DT decreased cDC1 counts only in recipients of VCA grafts (p<0.001).Luminex analysis revealed significantly higher TNF-alpha serum levels in the VCA WT vs. skin WT group (p<0.01). TNF-beta serum levels were significantly decreased in VCA depletion groups vs VCA WT group (p<0.001). Clinical signs of acute rejection among the VCA groups revealed higher rejection grades in the WT compared to the DC depletion group according to the BANFF criteria (grade III vs. grade II). Additional injection of immature DCs did not show any difference in allograft survival (p=ns).Conclusion: This is to our knowledge the first systematic study delineating the role of mature and immature DCs tested across and skin transplants. Those data may help explaining split-tolerance phenomenon in VCA while providing a basic concept for the utilization of mature and immature DCs in modifying alloimmune responses in VCA transplants.

Library leaders at academic institutions in the United States at the level of University Librarians, Library Directors, and Library Deans were surveyed about their predictions for the future of science liaison librarianship and the importance of science subject specialization. Responses from 71 library leaders at institutions ranging from community colleges through large, research intensive universities provide insight into evolving roles for academic science librarians. Key findings include that library leaders perceive functional roles such as data management and scholarly communication growing in importance, yet they are rarely seen as replacing traditional subject-based ones. Subject specialization is still seen by many as a desirable qualification for science librarians, even though smaller institutional size and budget constraints may necessitate a more generalist approach. While there was no consensus on the necessity of science subject specialization, and whether or not science liaison librarianship would retain this characteristic in the future, there was a widespread acknowledgement of the value of liaison relationships with science faculty and others at their institutions.

Background: Animal-based research addresses many important questions in reconstructive transplantation. The mouse hind limb transplant model is a highly sophisticated, but powerful research tool. Unfortunately, success of this model is limited due to graft failure mainly because of vascular thrombosis. In consideration of the 3R principle, introduced to improve handling of laboratory animals and ensure quality of data obtained, a novel anticoagulation protocol was used to enhance animal und graft survival. Methods: A total of fifty murine hind limb transplantations were performed. Animals were assigned to five groups with different anticoagulation regimens. All grafts were flushed with a heparin-saline solution of different concentrations. Recipient and donor animals of two groups received an additional low-molecular-weight heparin (LMWH) injection protocol. Results: Graft failure due to vascular thrombosis was observed in groups where grafts were flushed with a solution containing 75 IU/cc of heparin and below or using a 50 IU/cc heparin solution in combination with a low dose LMWH injection protocol (p=0.03).Bleeding episodes with lethal outcomes through the osteotomy were significantly higher in groups where solutions with heparin concentrations of 75 IU/cc and above were administered compared to all other groups (p<000.1). Animals treated with a moderate LMWH injection protocol in combination with 50 IU/cc heparin solution for graft flush demonstrated the best outcome with no animal or graft loss and an overall survival of 100% (p<0.0001).Conclusion: In regards of the 3R principle, this is the first mouse transplant model utilizing an effective anticoagulation protocol to successfully perform a high-demanding microsurgical procedure.

Contributor Role Ontologies and Taxonomies (CROTs) are standard vocabularies to describe individual contributions to a scholarly project or research output. Contributor Roles Taxonomy (CRediT) is one of the most widely used CROTs, and has been adopted by numerous journals to describe author's contributions, and recently formalized as a ANSI/NISO standard. Despite these developments, there is still much work left to be done to improve how CROTs are used across different research domains, research output types, and scholarly workflows. In this paper, we describe how CROTs could be extended to include roles from various disciplines in an ethical and inclusive manner. We explore potential approaches to apply CROTs to diverse research objects and various disciplines; as well as envision their integration into various scholarly workflows, such as promotion and tenure in academic institutions. Lastly, we discuss potential mechanisms for wide adoption and use. While acknowledging that improving current systems of attribution is a slow and iterative process, we believe that engaging the community in the evolution of CROTs will ultimately enhance the ethical attribution of credit and responsibilities in scholarly publications.

Through a survey of more than 200 US academic science librarians, we investigated the perceived value of subject specialization; looked for trends toward or away from science subject specialization; and analyzed predictions about the future of science liaison librarianship. Results showed that science librarians perceive subject specialization positively and predict it will continue to be necessary in the future. They also perceive that liaison relationships will remain crucial. While functional roles appear to be growing, they were not seen as replacing traditional subject responsibilities. Results suggest a shift toward a more generalist approach; however, additional research is needed before stating this conclusively.

Assigning authorship and recognizing contributions to scholarly works is challenging on many levels. Here we discuss ethical, social, and technical challenges to the concept of authorship that may impede the recognition of contributions to a scholarly work. Recent work in the field of authorship shows that shifting to a more inclusive contributorship approach may address these challenges. Recent efforts to enable better recognition of contributions to scholarship include the development of the Contributor Role Ontology (CRO), which extends the CRediT taxonomy and can be used in information systems for structuring contributions. We also introduce the Contributor Attribution Model (CAM), which provides a simple data model that relates the contributor to research objects via the role that they played, as well as the provenance of the information. Finally, requirements for the adoption of a contributorship-based approach are discussed.

OBJECTIVE Inadequate diversity in clinical trials is widely recognized as a significant contributing factor to health disparities experienced by racial/ethnic minorities and other diverse populations in the US. To address this in a scalable way, we sought to develop a web tool that could help enhance underserved minority participation in clinical research. METHODS We used our research literacy support flashcard tool as the initial prototype for human-centered design and usability testing of the web tool Health for All in public library settings. After forming partnerships with leadership from Chicago Public Libraries (CPL), local medical libraries, and the Chicago Department of Public Health, we conducted seven iterative design sessions with focus groups of library patrons and library staff from six CPL branches serving underserved communities followed by two rounds of usability testing and website modification. RESULTS Based on the qualitative research findings from Design Sessions 1-7, we enacted the design decision of a website that was a hybrid of fact-filled and vignette (personal stories) paper prototypes divided into 4 modules (trust, diversity, healthy volunteers, pros/cons), each with their own outcome metrics. The website was thus constructed, and navigation issues identified in two rounds of usability testing by library patrons were addressed through further website modification, followed by the launch of a beta version of a hybridized single-scrolling and guided module prototype to allow further development with website analytics. CONCLUSIONS We report the development of Health for All, a website designed to enhance racial/ethnic minority participation in clinical trials by imparting research literacy, mitigating distrust engendered by longstanding racism and discrimination, and providing connections to clinical trials recruiting participants.

Sixteen out of 720 patients with carpal tunnel syndrome who had undergone surgery since 1979 were reoperated for a "recurrence" (2.2%). Twelve of these patients had been originally operated on in our department. Thus, our own recurrence rate is 1.7%. Three patients deteriorated following surgery, 6 had an unsatisfactory improvement, and in 7 the symptoms recurred after initial improvement. Eight of the reoperated patients had a predisposing disease (terminal renal insufficiency, insulin-dependent diabetes mellitus, acromegaly). In 10 of the 16 cases the initial operation had been carried out by surgeons in the first three years of training. Reoperation revealed incomplete splitting of the transverse carpal ligament in 10 cases, compression of the median nerve by the scar in 4, injury of the muscular branch in 1, and an anatomical variant as cause of incomplete decompression in 1 patient. "Recurrences" after carpal tunnel surgery are predominantly due to inadequacies of the first procedure. A remarkable number of patients (50%) has predisposing diseases. Interfascicular or epineural neurolysis and complete exposure and neurolysis of the median nerve and its branches is necessary only in cases of recurrence. Their omission at the first surgery does not result in an increased recurrence rate. Our observations indicate that the number of operations for recurrent carpal tunnel syndrome can probably be reduced when the first operation is performed with care and experience. Patients with carpal tunnel syndrome secondary to a systemic disease are particularly at risk.