It's Hip to Go Home: An Evaluation of Outpatient Alveolar Bone Grafting in Patients With Cleft Palate.

INTRODUCTION: Secondary alveolar bone grafting (ABG) is a common procedure performed at cleft care centers used to fill the alveolar cleft. The advent of techniques such as minimally invasive trephine drill harvest and placement of continuous-infusion pain pumps at the donor site has made outpatient ABG an increasingly feasible and cost-effective procedure. However, enhanced recovery after surgery protocols to maximize pain control and recovery times for this patient population have not been well established. METHODS: A retrospective single-institution review was conducted of pediatric patients with cleft palate who underwent iliac crest bone graft ABG at a large urban academic children's hospital from 2017 to 2022. Patient age, alveolar cleft repair laterality, pain scores, surgery duration, hospital LOS, readmissions, and re-operations within 30 days were examined. RESULTS: Fifty-four patients met our inclusion criteria. Fifty patients (92.6%) received a pain pump during the operation. The median duration of surgery and LOS in the post-anesthesia care unit were 1.28 and 1.75 hours, respectively. Fifty-two patients (96.3%) were discharged on the same day as their surgery whereas 2 patients (3.7%) stayed in the hospital overnight. The median pain score at the time of discharge was 0 (interquartile range 0, 0). There were 6 (11.1%) minor complications including 5 pain pump malfunctions and 1 recipient site wound breakdown. There was 1 readmission (1.9%) for development of a surgical site infection at the hip and no re-operations within 30 days of surgery. CONCLUSION: The described outpatient ABG protocol demonstrates effective postoperative pain control, short hospital LOS, and few complications requiring hospital readmission or reoperation.

Monkeypox Presenting as a Hand Consult in the Emergency Department: Two Case Reports.

The ongoing outbreak of the monkeypox virus (now referred to as "mpox") was deemed a public health emergency by the World Health Organization in 2022. The United States now reports the highest number of mpox cases, with 29 980 cases and 21 deaths as of January 11, 2023. The most common presenting symptom is a pruritic, vesicular rash that commonly involves the hands. While covering hand call, our division has encountered 2 cases of mpox in the emergency department for which the chief complaint was a hand lesion. Because hand surgeons will be called upon to make an initial diagnosis, the purpose of these case reports is to describe the presentation, disease course, treatment, and outcomes of these mpox patients. These patients had both uncontrolled HIV as well as other sexually transmitted disease. Symptoms included painful vesicular hand lesions with ulceration and eventual central necrosis, followed by similar lesions on the face, trunk, and genital area. Diagnosis was made using nucleic acid amplification testing through polymerase chain reaction. The patients were treated with restoration of immunity through control of HIV as well as treatment of all secondary bacterial infections. One patient died in the hospital, and the other survived without any long-term defects.

Nurse practitioner scope of practice and the prevention of foot complications in rural diabetes patients.

PURPOSE: Diabetic foot ulcers afflict a quarter of type-2 diabetes mellitus patients and are associated with higher mortality rates among people with diabetes. Routine primary and preventive care is essential to both prevent and treat foot ulcers before they can contribute to further adverse outcomes. One approach for expanding this care to people with diabetes in rural communities is increasing the practice authority of nurse practitioners. This study examines whether the presence of nurse practitioner practice authority is associated with fewer foot ulcer complications in rural populations as measured through the incidence of foot debridement-a common procedure for addressing severe diabetic foot ulcers. METHODS: This study uses medical claims to estimate the incidence of foot debridement for US counties. A multivariable linear regression was performed to examine the association between nurse practitioner practice authority and the county incidence of foot debridement after adjusting for measures of local health care workforce and sociodemographics. FINDINGS: Nurse practitioner practice authority was associated with 219.4 fewer foot debridements per 10,000 enrollees (P < .001) in rural counties. Rural health clinics (P < .03) and skilled nursing facilities (P < .03) were also associated with fewer rural debridements. The number of nurse practitioners (P < .69) and primary care physicians (P < .69) per enrollee were not significant. No measure of health care workforce was associated with the incidence of foot debridement in urban counties. CONCLUSIONS: Expanding nurse practitioner practice authority may be an effective solution for preventing complications from diabetic foot ulcers in rural communities.

Gender Disparity in Abstract Presentation at Plastic Surgery Meetings.

BACKGROUND: Medical and surgical fields continue to be marred by gender disparities. The "leaky pipeline" effect, representing a gradual decline in female representation along the academic ladder, has been well documented in plastic surgery. However, gender differences in abstract presentation at national plastic surgery meetings and subsequent publications remains elusive. METHODS: We reviewed abstracts presented at the 2014 and 2015 annual meetings of the American Association of Plastic Surgeons (AAPS); American Society of Plastic Surgeons (ASPS), and the Plastic Surgery Research Council (PSRC). Several abstract characteristics including the names of the first and last authors were extracted. Genderize.io and Google search were used to identify the authors' gender. RESULTS: We identified 1174 abstracts presented at the three identified meetings. Females comprised 29% of the presenters and 16% of abstract senior authors (ASAs). No gender differences were identified between the meetings, type of presentation (oral versus poster), and year of presentation. The only difference was in the subspecialty of the abstracts. Successful conversion to full-text articles was similar for male and female presenters (68% versus 62%, P = 0.065) but higher for male ASAs (68% versus 59%, P = 0.01). When an author change occurred, female presenters and ASAs were more likely to be replaced by males (P < 0.001). CONCLUSION: Gender differences continue to be evident in academic plastic surgery with women constituting a minority of both presenters and senior authors on abstracts presented at national plastic surgery meetings. Future work should assess whether flexible and supportive work policies can foster greater female representation in academic plastic surgery.

Homocysteine level, body mass index and clinical correlates in Chinese Han patients with schizophrenia.

Obesity is common comorbidity in patients with schizophrenia. Previous studies have reported that homocysteine (Hcy) is increased in schizophrenia. However, no study has reported the association between BMI and Hcy levels in schizophrenia. This cross-sectional naturalistic study aimed to evaluate the relationship between BMI, Hcy and clinical symptoms in Chinese Han patients with chronic schizophrenia. Clinical and anthropometric data as well as plasma Hcy level and glycolipid parameters were collected. Psychopathology was measured with the Positive and Negative Syndrome Scale (PANSS). Our results showed that compared with the low BMI group, the high BMI group had a higher PANSS general psychopathology subscore, higher levels of blood glucose, total cholesterol and high-density lipoprotein (HDL) cholesterol (all p < 0.05). Hcy levels were negatively associated with BMI in patients (p < 0.001). Hcy level, the PANSS general psychopathology subscale, total cholesterol and education (all p < 0.05) were the influencing factors of high BMI. Our study suggest that Hcy level may be associated with BMI in patients with schizophrenia. Moreover, patients with high BMI show more severe clinical symptoms and higher glucose and lipid levels.

The Matter of Disability.

By ruling out questions of impairment from the social critique of disability, Disability Studies (DS) analyses establish a limit point in the field. Of course the setting of "limits" enables possibilities in multiple directions as well as fortifies boundaries of refusal. For instance, impairment (the biological conditions of an organism's inefficient attachment to the world) becomes in DS simultaneously a productive refusal to interpret disabled bodies as inferior to non-disabled bodies (i.e. pathologized) and a bar to thinking through more active engagements with disability as materiality. Disability materiality such as conditions produced by ecological toxicities serve as active switch-points for creative corporeal navigations of the interaction between bodies and environments.In fact in this paper we want to propose a more "lively" definition of disability materiality to existing definitions of impairment as limiting expressions of non-normative bodies. We have no useful ways of explaining disability as adaptation and it's time we begin the process of theorizing more active ideas of materiality that extend existing ideas of disability beyond simplistic conceptions of socially rejected biologies made available by social constructivist thought.

A ligand-gated ion-channel mimetic nanopore membrane with an on-board transmembrane microbattery.

We have been investigating synthetic nanopore membranes that mimic the function of ligand-gated ion channels. We showed previously that the transmembrane ion current in a hydrophobic alumina nanopore membrane can be switched from an "off" state to an "on" state by exposure of the membrane to hydrophobic ionic surfactants. In these prior experiments, external electrodes and an external power supply were used to drive the ion current when the membrane was in its "on" state. In biological channels there are no electrodes, and the ion current is driven by an electrochemical potential difference across the cell membrane. In this article we mimic this function of the ligand-gated ion channel by applying a porous battery cathode film to one face of the hydrophobic alumina membrane and a porous battery anode film to the other face. Hence, in analogy to the naturally occurring channel case, we have a membrane with a built in electrochemical potential difference across the membrane. We show here that in the absence of the ligand (again, a hydrophobic ionic surfactant), the membrane is in its "off" state, and the electrochemical potential difference cannot be utilized to drive a transmembrane ion current. In contrast, when the ligand is detected, the membrane switches to its "on" state and the transmembrane battery discharges, producing a corresponding transmembrane ion current.

Smart nanotubes for bioseparations and biocatalysis.

Tube-shaped nanostructures (nanotubes) have a number of attributes that make them potentially useful for biomedical applications such as drug delivery/detoxification and enzyme immobilization. Template synthesis provides a route for preparing monodisperse nanotubes of nearly any size and composed of nearly any material. We show here that template-synthesized silica nanotubes can be biochemically functionalized such that they act as biocatalysts and highly selective nano-phase extraction agents for bioseparations. For example, nanotubes containing an enantioselective antibody selectively extract the enantiomer of a drug molecule that binds to the antibody, relative to the enantiomer that has no specific interaction with the antibody. Nanotubes containing the enzyme glucose oxidase function as nanophase bioreactors to catalyze the oxidation of glucose.

Ion channel mimetic micropore and nanotube membrane sensors.

This paper describes synthetic micropore and nanotube membranes that mimic the function of a ligand-gated ion channel; that is, these membranes can be switched from an "off" state (no or low ion current through the membrane) to an "on" state (higher ion current) in response to the presence of a chemical stimulus. Ion channel mimics based on both microporous alumina and Au nanotube membranes were investigated. The off state was obtained by making the membranes hydrophobic by chemisorbing either a C18 silane (alumina membrane) or a C18 thiol (Au nanotube membrane). Water and electrolyte are forbidden from entering these very hydrophobic pores/nanotubes. The transition to the on state was induced by the partitioning of a hydrophobic ionic species (e.g., a drug or a surfactant) into the membrane. The membrane switches to the on state because at a sufficiently high concentration of this ionic analyte species, the pores/nanotubes flood with water and electrolyte. A pH-responsive membrane was also prepared by attaching a hydrophobic alkyl carboxylic acid silane to the alumina membrane.

Antibody-based bio-nanotube membranes for enantiomeric drug separations.

Synthetic bio-nanotube membranes were developed and used to separate two enantiomers of a chiral drug. These membranes are based on alumina films that have cylindrical pores with monodisperse nanoscopic diameters (for example, 20 nanometers). Silica nanotubes were chemically synthesized within the pores of these films, and an antibody that selectively binds one of the enantiomers of the drug was attached to the inner walls of the silica nanotubes. These membranes selectively transport the enantiomer that specifically binds to the antibody, relative to the enantiomer that has lower affinity for the antibody. The solvent dimethyl sulfoxide was used to tune the antibody binding affinity. The enantiomeric selectivity coefficient increases as the inside diameter of the silica nanotubes decreases.