Search

Summary:. This article discusses a novel approach to immediate nipple reconstruction during skin-sparing mastectomy with Wise-pattern design, a common procedure in direct-to-implant breast reconstruction. Traditionally, nipple reconstruction is performed as a second procedure, incurring additional costs and potential complications. This novel technique involves a simple modification to the Wise-pattern flap during the initial mastectomy, allowing for one-step reconstruction. The procedure includes preoperative markings of the Wise-pattern design, with a U-shaped flap added at the top angle to create the nipple position. This U-shaped flap, containing both skin and subcutaneous tissue, is then folded over itself and sutured, resulting in an inverted T-shaped incision with the reconstructed nipple at the apex. This article emphasizes the avoidance of a secondary operation for nipple reconstruction, avoiding additional costs and potential complications associated with flap loss, especially in postradiation patients. The technique was applied to five consecutive cases, with patient satisfaction reported as very high. Follow-up at 6 months showed no venous congestion or flap loss, and in patients without adjuvant radiation, the reconstructed nipple maintained almost all its initial postoperative height. Minor loss of nipple protrusion over time was comparable to traditional nipple reconstruction (eg, skate flap), and the construction of the new nipple required only an average of 10 extra minutes. Although larger-scale studies are needed for a comprehensive evaluation, the preliminary results suggest promising outcomes and encourage larger-scale safety and outcomes studies of this technique in Wise-pattern skin-sparing reconstructions.

Abstract Objective This article presents the dataset titled “Do you know how to Stop The Bleed®? [1]” The dataset contains the survey responses of 200 US persons aged 16 years and above regarding their knowledge of hemorrhage control, based on the American College of Surgeons Stop The Bleed® (STB) course [2]. Results Two hundred adults in the United States completed this web-based survey, which consisted of a quiz to assess STB knowledge. Factors that were not statistically correlated to STB knowledge retention included age, sex, race and education level up to college level. On the other hand, resuscitation coursework (p = 0.004) and income (p = 0.049) were important determinants of Stop the Bleed® knowledge. In particular, participants with CPR certification (p = 0.020) and/or a postgraduate degree (p = 0.015) scored higher than their counterparts in this sample cohort.

Abstract This is a clinical image submission depicting hemithorax white-out due to massive pleural effusion.

# Background Dysmenorrhea, or painful menstrual periods, is one of the most common gynecological complaints. Most reports of uterine contractions range between moderate to severe pain, and patients often elect to cope with their discomfort without assistance from a physician. In the process, women experiencing dysmenorrhea are more likely to report absenteeism from work and school. # Objectives This study measures the reported impact of dysmenorrhea on patients' lives and elucidates a relationship between income and access to oral contraceptives. # Methods Two hundred women completed a survey about their symptoms, level of pain, treatments, and the extent to which dysmenorrhea affected day-to-day obligations. Most questions were multiple-choice while others permitted several answer selections or were free response. The data was analyzed using JMP statistical software. # Results Eighty-four percent of respondents reported moderate to severe pain during menstruation. This discomfort has caused 65.5% of the cohort to miss work and 68% to avoid participating in social gatherings. Pain relief medications are most often used as treatment - 143 respondents took ibuprofen, 93 took acetaminophen, and 51 took naproxen. 29.5% of respondents are prescribed birth control for cramps and blood flow. Income (p = 0.049), age (p = 0.002), and education (p = 0.002) were significant predictors for oral contraceptive pill (OCP) use. The lowest income groups were found to use OCPs at less than half the rate as the highest income respondents. # Conclusion Dysmenorrhea affected most participants in the cohort with an impact that extends beyond professional obligations. Income was found to be positively correlated with increased OCP use, whereas education level was inversely correlated. Clinicians should consider how patients' backgrounds influence their access to OCP options. An improvement on this study's findings would be to establish a causal relationship between these demographic factors and access to OCPs.

# Background Sleep deprivation is a condition in which an individual does not get enough sleep, leading to a variety of negative effects on their physical and mental health. In the United States, sleep deprivation is a common problem, with many people not getting the recommended 7-9 hours of sleep per night. Excessive daytime sleepiness is also a common condition in the United States. It is characterized by a persistent feeling of fatigue or drowsiness during the day, despite getting enough sleep at night. The current study aims to document the frequency of sleepiness symptoms amongst the general US population. # Methods A web-based survey was conducted to assess the frequency of daily anxiety symptoms amongst adults residing in the United States. Questions from the Epworth Sleepiness Scale were used to quantify the burden of daytime sleepiness. JMP 16.0 for Mac OS was used to perform statistical analyses. Our Institutional Review Board gave the study an exempt determination (#2022-569). # Results In total, 9% of people qualified as having lower normal daytime sleepiness, 34% qualified as having higher normal daytime sleepiness, 26% qualified as having mild excessive daytime sleepiness, 17% qualified as having moderate excessive daytime sleepiness, and 17% qualified as having severe excessive daytime sleepiness. # Limitations The present findings are based on cross-sectional survey data. # Conclusion Although sleep is one of the most crucial bodily activities, our study of young adults found that more than 60% had moderate to severe sleep deprivation/daytime sleepiness as reported on the Epworth Sleepiness scale.

General Anxiety Disorder has become an increasing problem in the youth population. The authors conducted a survey of youth ages 16-24, on what life is like for those who are living with anxiety. In this cohort of 200, the youngest participants were the least likely to be diagnosed, see a professional, and take medication for their anxiety. A significant number said that anxiety affects their day-to-day lives and also causes many physical side effects.

Abstract Objective This article presents the dataset titled “Nutrition habits amongst college students in the United States. [1]” The dataset contains the survey responses of 200 US college students aged 18–24 years regarding their knowledge, attitudes, and challenges with regard to nutrition. The recommended USDA (US daily allowance) is 200 calories, comprised of 2 cups fruits, 2.5 cups vegetables, 5.5 ounces of protein, 6 ounces of grains, and 3 cups of dairy [2]. Adhering to these nutritional guidelines however can be complicated by rising tuition prices, food insecurity, and inability to make one’s own food. Data description The data in the dataset attempt to estimate the incidence of these barriers. These data could be useful to understand the barriers to healthy eating amongst young adults, and design targeted solutions.

The COVID-19 pandemic introduced lockdown and social distancing measures that made new methods of healthcare essential. Telehealth was introduced as a temporary measure but is being considered as a more permanent form of healthcare, particularly in rural areas, to provide more equitable healthcare. A survey was conducted on 200 rural dwellers (residents) regarding their experience with rural healthcare, any barriers to adequate healthcare, and openness to telehealth. The results demonstrated interest in telehealth and predominately positive experiences with telehealth in the areas where there was need and lack of access to healthcare, more commonly expressed in the younger age group. Quality healthcare should be equitable and available for every individual irrespective of zip code or the county they live. Telehealth is capable of bridging the gap of lack of access and transportation for individuals in rural areas to meet their healthcare needs in a timely fashion in the coming years.

Activation of the μ-opioid receptor (μOR) is responsible for the efficacy of the most effective analgesics. To shed light on the structural basis for μOR activation, here we report a 2.1 Å X-ray crystal structure of the murine μOR bound to the morphinan agonist BU72 and a G protein mimetic camelid antibody fragment. The BU72-stabilized changes in the μOR binding pocket are subtle and differ from those observed for agonist-bound structures of the β2-adrenergic receptor (β2AR) and the M2 muscarinic receptor. Comparison with active β2AR reveals a common rearrangement in the packing of three conserved amino acids in the core of the μOR, and molecular dynamics simulations illustrate how the ligand-binding pocket is conformationally linked to this conserved triad. Additionally, an extensive polar network between the ligand-binding pocket and the cytoplasmic domains appears to play a similar role in signal propagation for all three G-protein-coupled receptors.

The kainate receptors GluK1‐3 (glutamate receptor ionotropic, kainate receptors 1–3) belong to the family of ionotropic glutamate receptors and are essential for fast excitatory neurotransmission in the brain, and are associated with neurological and psychiatric diseases. How these receptors can be modulated by small‐molecule agents is not well understood, especially for GluK3. We show that the positive allosteric modulator BPAM344 can be used to establish robust calcium‐sensitive fluorescence‐based assays to test agonists, antagonists, and positive allosteric modulators of GluK1‐3. The half‐maximal effective concentration (EC50) of BPAM344 for potentiating the response of 100 μm kainate was determined to be 26.3 μm for GluK1, 75.4 μm for GluK2, and 639 μm for GluK3. Domoate was found to be a potent agonist for GluK1 and GluK2, with an EC50 of 0.77 and 1.33 μm, respectively, upon co‐application of 150 μm BPAM344. At GluK3, domoate acts as a very weak agonist or antagonist with a half‐maximal inhibitory concentration (IC50) of 14.5 μm, in presence of 500 μm BPAM344 and 100 μm kainate for competition binding. Using H523A‐mutated GluK3, we determined the first dimeric structure of the ligand‐binding domain by X‐ray crystallography, allowing location of BPAM344, as well as zinc‐, sodium‐, and chloride‐ion binding sites at the dimer interface. Molecular dynamics simulations support the stability of the ion sites as well as the involvement of Asp761, Asp790, and Glu797 in the binding of zinc ions. Using electron microscopy, we show that, in presence of glutamate and BPAM344, full‐length GluK3 adopts a dimer‐of‐dimers arrangement. [ABSTRACT FROM AUTHOR]

Background: As the obesity crisis in the United States continues, some renal transplantation centers have liberalized their BMI criteria necessary for transplant eligibility. More individuals with larger body‐habitus related comorbidities with End‐Stage Renal Disease (ESRD) now qualify for renal transplantation (RT). Surgical modalities from other fields also interact with this patient population. Methods: In order to assess surgical outcomes of panniculectomy in the context of renal transplantation and ESRD, the authors performed a systematic review following the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) 2020 guidelines. Due to a paucity of existing primary studies, we retrospectively collected data on patients with ESRD undergoing panniculectomy from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) to evaluate outcomes of body contouring in this patient population. Results: From the systematic review, a total of 783 ESRD patients underwent panniculectomy among the studies identified. Of these, 91 patients underwent panniculectomy simultaneously to RT while 692 had their pannus resected prior to kidney transplant. The most common complication was hematoma followed by wound dehiscence. From the NSQIP database, 24 868 patients met the inclusion criteria for analysis. In the setting of renal transplant status, patients with diabetes, hypertension requiring medication, and requiring dialysis were more likely to suffer postoperative complications (OR 1.31, 1.15, and 2.2, respectively). However, upon sub‐analysis of specific types of complications, the only retained association was between diabetes and wound complication. Conclusion: Preliminary data show that panniculectomy in ESRD patients appears to be safe, though with a nominal increased risk for complications. Pannus resection does not appear to impact post‐transplantation outcomes, including long‐term allograft survival. Larger, higher powered, randomized studies are needed to confirm the safety, utility, and medical benefit of panniculectomy in the context of renal transplantation. [ABSTRACT FROM AUTHOR]