Availability and Readability Level of Online Patient Education Materials Provided by Cleft Lip and Palate Teams.

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.

Reduction Mammoplasty in the Pediatric Population: An Analysis of Pediatric NSQIP Data From 2012 to 2019.

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/m2. 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.

Introduction: La mammoplastie de réduction devient plus couramment pratiquée dans la population pédiatrique; toutefois les facteurs de risque de complications n'ont pas été bien étudiés. L'objectif de cette étude était d'évaluer la relation entre les caractéristiques préopératoires des patients et les complications postopératoires dans une grande population de patients pédiatriques subissant une mammoplastie de réduction. méthodes: Les patients pédiatriques subissant une mammoplastie de réduction ont été identifiés dans la base de données NSQIP 2012­2019 pour une étude transversale. Les variables prédictives étaient l'âge, l'indice de masse corporelle (IMC), le diabète, l'utilisation chronique de stéroïdes, la durée de l'anesthésie et la durée de l'intervention. Le principal critère d'évaluation était une complication liée au site opératoire à 30 jours. Une analyse de régression logistique multifactorielle a été réalisée pour identifier un lien entre une valeur prédictive et le critère d'évaluation. Résultats: Un total de 1216 patients pédiatriques d'âge moyen 16,6 ans a été identifié; l'IMC moyen de cette population était de 30,8 kg/m2. L'incidence globale des complications postopératoires a été de 4,6 %. Une infection superficielle du site opératoire a été la complication la plus fréquente (29/1216; 2,4 %). L'IMC a été associé de manière significative avec ces infections superficielles (rapport de cotes : 1,03, IC à 95 % : 1,00 à 1,05; P = 0,02). Seize (16) patientes (1,32 %) ont dû subir une deuxième intervention, le plus souvent pour résoudre un problème d'hématome/sérome (7/16; 43.8 %). Conclusion: La mammoplastie de réduction chez les patients pédiatriques s'est avérée une procédure sécuritaire avec un faible taux de complications dans une grande série de patients. L'IMC a été associé de manière significative à l'incidence des infections superficielles du foyer chirurgical et la cause de réintervention la plus fréquente était l'existence d'un hématome/sérome. Cette étude peut contribuer à la discussion entre médecins et patients sur les risques potentiels associés à la mammoplastie de réduction pédiatrique.

A Spectrum of Age- and Gender-Dependent Lower Urinary Tract Phenotypes in Three Mouse Models of Type 2 Diabetes.

Lower urinary tract symptoms are extremely common in people with diabetes and obesity, but the causes are unclear. Furthermore, it has proven difficult to reliably demonstrate bladder dysfunction in diabetic mouse models, thus limiting the ability to gain mechanistic insights. Therefore, the main objective of this experimental study was to characterize diabetic bladder dysfunction in three promising polygenic mouse models of type 2 diabetes. We performed periodic assessments of glucose tolerance and micturition (void spot assay) for eight to twelve months. Males and females and high-fat diets were tested. NONcNZO10/LtJ mice did not develop bladder dysfunction over twelve months. TALLYHO/JngJ males were severely hyperglycemic from two months of age (fasted blood glucose ~550 mg/dL), while females were moderately so. Although males exhibited polyuria, neither they nor the females exhibited bladder dysfunction over nine months. KK.Cg-Ay/J males and females were extremely glucose intolerant. Males exhibited polyuria, a significant increase in voiding frequency at four months (compensation), followed by a rapid drop in voiding frequency by six months (decompensation) which was accompanied by a dramatic increase in urine leakage, indicating loss of outlet control. At eight months, male bladders were dilated. Females also developed polyuria but compensated with larger voids. We conclude KK.Cg-Ay/J male mice recapitulate key symptoms noted in patients and are the best model of the three to study diabetic bladder dysfunction.

Deletion of Mechanosensory ß1-integrin From Bladder Smooth Muscle Results in Voiding Dysfunction and Tissue Remodeling.

The bladder undergoes large shape changes as it fills and empties and experiences complex mechanical forces. These forces become abnormal in diseases of the lower urinary tract such as overactive bladder, neurogenic bladder, and urinary retention. As the primary mechanosensors linking the actin cytoskeleton to the extracellular matrix (ECM), integrins are likely to play vital roles in maintaining bladder smooth muscle (BSM) homeostasis. In a tamoxifen-inducible smooth muscle conditional knockout of ß1-integrin, there was concomitant loss of α1- and α3-integrins from BSM and upregulation of αV- and ß3-integrins. Masson's staining showed a reduction in smooth muscle with an increase in collagenous ECM. Functionally, mice exhibited a changing pattern of urination by voiding spot assay up to 8 wk after tamoxifen. By 8 wk, there was increased frequency with reductions in voided volume, consistent with overactivity. Cystometrograms confirmed that there was a significant reduction in intercontractile interval with reduced maximal bladder pressure. Muscle strip myography revealed a loss of contraction force in response to electrical field stimulation, that was entirely due to the loss of muscarinic contractility. Quantitative western blotting showed a loss of M3 receptor and no change in P2X1. qPCR on ECM and interstitial genes revealed loss of Ntpd2, a marker of an interstitial cell subpopulation; and an upregulation of S100A4, which is often associated with fibroblasts. Collectively, the data show that the loss of appropriate mechanosensation through integrins results in cellular and extracellular remodeling, and concomitant bladder dysfunction that resembles lower urinary tract symptoms seen in older people.