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This retrospective study utilized the National Electronic Injury Surveillance System (NEISS) database to identify pediatric emergency department (ED) patients with playground-associated craniofacial injuries between January 2012 and December 2021. A total of 25 414 patients were identified. The majority of injuries occurred in preschool and elementary school–age children (90.3%) and patients were more commonly boys (59.3%). Injuries most often involved the head/scalp (52.4%), face (30.4%), and mouth (11.9%). Infant (32.7%) and teen (40.0%) injuries most commonly involved swings, whereas preschool (23.1%) and elementary school (28.1%) injuries were mostly associated with slides and climbers, respectively. Most patients were treated in the ED and discharged to home (96.5%), a small portion required hospitalization (1.6%), and one death was reported. Although the majority of the injuries were relatively minor and resulted in same-day discharges, these injuries can result in serious physical harm, emotional stress, and unexpected financial burdens. Proper education and supervision regarding safe play is important to prevent these injuries. [ABSTRACT FROM AUTHOR]

Background: Opioid drugs have been a mainstay medication for the management of postoperative pain for several decades; however, in recent years there has been a push towards investigating alternative treatment options. Although ketorolac has been widely used by other medical and surgical specialties for analgesia, its utilization in plastic surgery has been widely debated.Objectives: The purpose of this study was to investigate the efficacy of ketorolac as an adjunct in postoperative pain management.Methods: The authors performed a retrospective review of patients who underwent implant-based breast reconstruction after mastectomy between January 2012 and December 2016. Other risk factors, such as chronic anticoagulation, aspirin, or coagulopathies, were documented as well.Results: There were 198 patients who met the inclusion criteria. The results demonstrated that patients who received ketorolac utilized significantly fewer narcotics than patients who did not: 80 mg vs 108.8 mg (P = 0.002), respectively. The results showed that patients who received ketorolac had a decreased length of hospitalization: 1.9 days vs 2.1 days (P = 0.04), respectively.Conclusions: Generous narcotic prescribing has received greater scrutiny in recent years. Aside from the risk of increased narcotic availability in the community, the side effects of nausea, puritis, and constipation delay patient recovery. These data show that patients who received ketorolac have a decreased length of hospital stay and lower narcotic use, suggesting ketorolac may be a safe and cost-effective adjustment to a multi-modal pain control regimen postoperatively.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

The article presents a detailed description of the calcaneus osteocutaneous filet flap operative technique along with a report on the outcomes of a small consecutive series of patients undergoing this procedure. It explains that operative technique is best used for patients with devastating injury variants to the proximal or middle third of the leg. Topics discussed include contraindications to the procedure, the mobilization of the pedicle flap and the transection of the plantar skin flap.

Collections of parasitoids attacking the soybean aphid, Aphis glycines Matsumura (Hemiptera: Aphididae), in South Korea yielded specimens that were originally identified as Binodoxys communis (Gahan) (Hymenoptera: Braconidae). We report here on laboratory studies indicating that this population is actually a previously unknown species of Binodoxys. Four classes of comparisons were made between the Korean population and a Chinese population that also had been identified as B. communis. The comparisons included 1) mating trials coupled with behavioral observations and spermathecal examinations, 2) assessment of nucleotide divergence at two mitochondrial and two nuclear gene loci, 3) patterns of host use, and 4) reassessment of morphological characters. These studies revealed premating reproductive isolation of the two populations and minor nucleotide differences in mitochondrial cytochrome oxidase I sequences and nuclear internal transcriber spacer 1 sequences, providing strong indications that they are different species. Subtle morphological differences also were discovered that confirmed that the Chinese population corresponds to B. communis, whereas the Korean population does not. We propose the name Binodoxys koreanus Starý, sp. n. for the Korean population. The two species exhibited similar host ranges in the laboratory, the most notable exception being that B. koreanus, sp. n. is better able to develop in a population of Aphis craccivora Koch that harbors the bacterial endosymbiont Hamiltonella defensa Moran, which seems to strongly interfere with the development of B. communis. We discuss the implications of our results for biological control introductions against the soybean aphid in North America. [ABSTRACT FROM AUTHOR]

Abstract: The term ‘idiobiont’ refers to those parasitoid species that permanently paralyse their hosts during parasitism, causing the cessation of host growth and development. This is in contrast to koinobiont parasitoids, which allow their hosts to continue developing after being parasitized. While no koinobiont species induce permanent paralysis in their hosts, a minority of koinobionts induce a temporary paralysis that does not interfere with overall host growth and development. We characterized transient paralysis induction in two koinobiont aphid parasitoids in the genus Binodoxys (Hymenoptera: Aphidiinae). Both Binodoxys species induced transient paralysis in Aphis glycines, with paralysis time ranging between 4.5 and 8min (depending upon parasitoid species and host instar). In a separate experiment, B. communis was capable of inducing transient paralysis in nine aphid species. We addressed two hypotheses potentially explaining the adaptive value of temporary host paralysis in experiments using A. nerii, which is readily accepted but engages in strong defensive behaviour. The first hypothesis is that paralysis increases oviposition success by interfering with host defences and the second is that it aids in the avoidance of self-superparasitism. Paralysed aphids were more likely to be rejected by B. communis than were aphids that had never been stung or that had recovered from paralysis. This result supports the avoidance-of-self-superparasitism hypothesis and is inconsistent with the hypothesis that transient paralysis increases oviposition success of B. communis. [Copyright &y& Elsevier]

Introduction: Reduction mammoplasty is becoming more commonly performed in the pediatric population yet the risk factors for complications have not been well-studied. The purpose of this study was to assess the relationship between preoperative patient characteristics and postoperative complications in a large population of pediatric patients undergoing reduction mammoplasty. Methods: Pediatric patients undergoing reduction mammoplasty were identified within the 2012 to 2019 National Surgical Quality Improvement Program database for cross-sectional study. The predictor variables were age, body mass index (BMI), diabetes, chronic steroid use, time under anesthesia, and operative time, and the primary outcome was a 30-day postoperative surgical site-related complication. Multivariate logistic regression was performed to identify a relationship between predictor variable and primary outcome. Results: A total of 1216 pediatric patients were identified with a mean age of 16.6 years and mean BMI of 30.8 kg/m 2 . The incidence of overall postoperative complications was 4.6%. Superficial surgical site infection (SSI) was the most common complication (29/1216; 2.4%). BMI was significantly associated with superficial SSI (odds ratio: 1.03, 95% confidence interval: 1.00-1.05, P  = .02) . Sixteen patients (1.32%) underwent a second operation, most commonly to address hematoma/seroma (7/16; 43.8%). Conclusion: In a large series of patients, pediatric reduction mammoplasty is a safe procedure with a low complication rate. BMI was significantly associated with the incidence of superficial SSIs with the most common cause for reoperation being a hematoma/seroma. This study can help guide the discussion between physicians and patients regarding potential risks associated with pediatric reduction mammoplasty., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2022 The Author(s).)

Objectives: Evaluate the readability of online English and Spanish cleft lip and palate patient education materials., Design: Review of free online materials., Setting: English and Spanish language online patient education materials on cleft lip and palate were collected from American Cleft Palate-Craniofacial Association (ACPA) approved teams., Participants: American Cleft Palate-Craniofacial Association (ACPA) approved teams., Interventions: English materials were analyzed using the Flesch-Kincaid, SMOG, and Coleman-Liau readability calculators. Spanish materials were analyzed using the Fry Graph, Fernandez Huerta, and INFLESZ calculators. A one-way analysis of variance (ANOVA) was used to test for variability between the readability tools., Outcomes: Readability levels were examined for both sets of materials., Results: 171 (90.5%) teams provided English language materials online, with an average readability score calculated as 10.5 ± 2.9 (10th-11th grade). A total of 44 (23.2%) teams listed Spanish language materials online, with average readability score of 7.9 ± 1.2 (8th grade). ANOVA demonstrated statistically significant variability between the readability assessment tools ( P  < .01)., Conclusion: Online cleft lip and palate patient education material provided by ACPA craniofacial teams were more available in English than in Spanish. Both sets of materials demonstrated readability levels above the recommended 6th-7th grade. Refining readability is associated with lowered healthcare costs and increased patient satisfaction., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The integrated plastic surgery residency match is a highly competitive process. If performed wisely, medical research is an opportunity to differentiate applications from peers, and productivity is closely evaluated by residency programs. In this study, the authors aimed to characterize medical student research productivity for integrated plastic surgery residency programs and their respective medical schools. To this end, the authors performed a retrospective review of senior author publications from the 81 integrated plastic surgery programs from January 1, 2016, to December 31, 2020. The primary outcome was a publication with a medical student as the first author. Secondary outcomes included the number of faculty from each program, the geographic region of the program, and the ranking of associated medical schools. It was found that the average number of medical student first-author publications and faculty members per institution were 14.0 and 11.0, respectively. There was a positive correlation between the number of faculty members and several medical student first-author publications for a program ( R = 0.54, P < 0.0001). The average number of medical student first-author publications was higher in the top 25 programs than for the remaining programs ( P < 0.001), and most medical student first-author publications in the United States were produced by 10 plastic surgery programs. From these findings, it was concluded that these programs associated with higher-ranking medical schools produce greater numbers of medical student first-author publications. These analyses of medical student academic productivity should be a highly useful guide for current and future medical students as they strategize their successful match into plastic surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Lamba et al.)

COVID-19 is an emerging viral illness that has rapidly transmitted throughout the world. Its impact on society and the health care system has compelled hospitals to quickly adapt and innovate as new information about the disease is uncovered. During this pandemic, essential medical and surgical services must be carried out while minimizing the risk of disease transmission to health care workers. There is an elevated risk of COVID-19 viral transmission to health care workers during surgical procedures of the head and neck due to potential aerosolization of viral particles from the oral cavity/naso-oropharynx mucosa. Thus, patients with facial fractures pose unique challenges to the variety of injuries and special considerations, including triaging injuries and protective measures against infection. The proximity to the oral cavity/naso-oropharyngeal mucosa, and potential for aerosolization of secretions containing viral particles during surgical procedures make most patients undergoing operative interventions for facial fractures high risk for COVID-19 transmission. Our proposed algorithm aims to balance patient care with patient/medical personnel protection as well as judicious health care utilization. It stratifies facial trauma procedures by urgency and assigns a recommended level of personal protective equipment, extreme or enhanced, incorporating current best practices and existing data on viral transmission. As this pandemic continues to evolve and more information is obtained, the protocol can be further refined and individualized to each institution.

Purpose: There is a paucity of literature regarding the use of chaperones by surgeons when examining patients. Use of a chaperone not only makes the patient comfortable but also potentially protects the surgeon from perceived misconduct. This is especially true for plastic surgeons who examine sensitive areas commonly. The purpose of this study was to determine the current trends in chaperone use by plastic surgeons when examining patients., Materials and Methods: A 23-question online survey was sent to all members of the American Society of Plastic Surgeons. Data collected online were analyzed using Student t test and Pearson χ test. A P < 0.05 was considered significant., Results: Of the 4990 surgeons polled, 830 (16.6%) responded to some or all of the questions (707 [85%] male; 117 [14%] female). The overall chaperone use by plastic surgeons during all examinations of patients was 30%. This rate increased up to 60% while examining sensitive areas. Male surgeons reported a higher frequency of chaperone use than female surgeons (P < 0.001). Cosmetic surgeons had a higher rate of chaperone use compared to reconstructive surgeons (P = 0.001). Similarly, surgeons who had been in practice for more than 20 years reported a higher rate of chaperone use compared to surgeons in practice for less than 20 years (P = 0.032). Sixty-one (7.6%; 56 male and 5 female) surgeons reported being accused of inappropriate behavior by patients, of whom 49 (80%) did not have a chaperone present. There was no significant difference among male and female surgeons in rates of being accused of inappropriate behavior (7.9% vs 4.2%, P = 0.19)., Conclusions: There was a higher rate of chaperone use by male plastic surgeons, surgeons with more than 20 years experience, and cosmetic surgeons. Despite the difference in chaperone use between the sexes, both had similar rates of being accused of inappropriate behavior during examinations by patients, and although these incidents were quite low, most had no chaperone present during those examinations.