Michelle Y. Seu’s research while affiliated with Rush University Medical Center and other places

Abstract Introduction: Selecting candidates for plastic and reconstructive surgery (PRS) residency is complex, involving academic metrics and intrinsic personal qualities. "Grit"-perseverance and passion for long-term goals may be one of these valued qualities. This study investigates how grit scores relate to securing a PRS residency, hypothesizing that higher grit correlates with greater matching success. Methods: After match day, an email survey was distributed to all the applicants of Rush University Medical Center's integrated PRS program during the academic years 2021-2022 and 2022-2023. This survey included items regarding match results and a validated grit questionnaire. We calculated baseline differences among the study participants. Correlation between grit score, academic achievements, and match was performed with univariate analyses using the Spearman correlation for continuous variables and the Wilcoxon rank sum test. Results: The program received 616 applications, of which 132 (21%) responded to the grit survey. Among the responders, 97 (74%) reported matching into PRS, versus 35 (27%) who did not. After adjusting for multiple confounders, higher grit score was found to be associated with significantly lower odds of matching into PRS residency (OR 0.13, p-value 0.03). Higher Step 1 and 2 CK scores, number of publications, and female gender were associated with greater odds of matching. Conclusion: Our study did not identify any association between higher grit and matching successfully in PRS. After adjusting for confounders, we observed significantly higher grit scores among applicants who did not match into PRS, which may be related to the psychological phenomenon of increased perseverance as people reflect on their perceived failures. Level of evidence: IV (Cross-sectional study). Keywords: academia; grit; medical students, plastic surgery, professionalism; residency applicants.

Background Chylous leakage is a rare surgical complication most frequently encountered following operations involving the neck and thorax. Even more rare are axillary chyle leaks secondary to breast cancer involving the axillary lymph nodes. Anatomic variability in the termination of the thoracic duct may play a role in the susceptibility some individuals may have to this type of leakage. There is no consensus on the definitive management of these complications, especially in the context of breast reconstruction. Methods Here, we report our experience in the management of chylous leakage in three patients who underwent left axillary lymph node dissection and immediate breast reconstruction with the use of tissue expanders and acellular dermal matrix. Descriptions of each case are followed by a review of the relevant literature. We also present an original treatment algorithm. Results Two of three patients with suspected chylous leakage secondary to intraoperative injury to the axillary region underwent definitive diagnosis by clinical examination and drain fluid triglyceride analysis, followed by conservative management with a low-fat diet. The third patient was diagnosed clinically with no fluid analysis. All leakages resolved through conservative means, with no need to return to the operating room for surgical exploration and repair. Conclusions Based on our experience, we believe that patients with suspected chylous leakage secondary to axillary lymph node dissection in the context of breast reconstruction can be safely and effectively managed by conservative management in the acute postoperative period. If these measures are insufficient, surgical management may be necessary.

Background Machine learning (ML) is a form of artificial intelligence that has been used to create better predictive models in medicine. Using ML algorithms, we sought to create a predictive model for breast resection weight based on anthropometric measurements. Methods We analyzed 237 patients (474 individual breasts) who underwent reduction mammoplasty at our institution. Anthropometric variables included body surface area (BSA), body mass index, sternal notch–to–nipple (SN-N), and nipple–to–inframammary fold values. Four different ML algorithms (linear regression, ridge regression, support vector regression, and random forest regression) either including or excluding the Schnur Scale prediction for the same data were trained and tested on their ability to recognize the relationship between the anthropometric variables and total resection weights. Resection weight prediction accuracy for each model and the Schnur scale alone were evaluated based on using mean absolute error (MAE). Results In our cohort, mean age was 40.36 years. Most patients (71.61%) were African American. Mean BSA was 2.0 m ² , mean body mass index was 33.045 kg/m ² , mean SN-N was 35.0 cm, and mean nipple–to–inframammary fold was 16.0 cm. Mean SN-N was found to have the greatest variable importance. All 4 models made resection weight predictions with MAE lower than that of the Schnur Scale alone in both the training and testing datasets. Overall, the random forest regression model without Schnur scale weight had the lowest MAE at 186.20. Conclusion Our ML resection weight prediction model represents an accurate and promising alternative to the Schnur Scale in the setting of reduction mammaplasty consultations.

Introduction Prior studies have shown a decrease in Medicare reimbursements in some surgical disciplines; however, it is unclear as to how the reimbursement of breast cancer surgeons and the hospitals they operate in have been affected by changes in the healthcare economy over time. This study evaluated trends in Medicare reimbursement for breast oncologic and reconstructive surgery. Methods We identified the CPT codes representing a wide variety of breast oncologic and reconstructive procedures performed at our institution from 2010–2021. These CPT codes were used to identify relevant information within the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid. Average national relative value units (RVUs) for physician-based work, facilities, and malpractice were collected along with the corresponding conversion factors for each year. Consumer price index and general inflation for each year were used to adjust values. Results From 2010 to 2021, there was an overall average decrease of 14.76% in Medicare reimbursement for both breast oncology (-11.41%) and reconstructive procedures (-16.38%). During this period there was an adjusted compound annual growth rate (CAGR) of -1.49, indicating an average annual decrease in reimbursement for the selected procedures. Meanwhile, there was a 2.34% increase of physician-based work RVUs, an 8.01% increase of facility-based RVUs, and a 33.11% increase of malpractice-based RVUs on average per procedure. Conclusion Over the past decade, Medicare reimbursement rates for breast surgeries have decreased. Based on these findings, breast and reconstructive surgeons should advocate for reimbursement that better reflects the costs of their practice.

Unlabelled: Studies have linked bibliometric indices with the academic level of plastic surgeons, but this relationship has not been explored with residency program directors (PDs). As teachers of the next generation, PDs' academic performance is an important component of residency program success. We sought to identify distinguishing characteristics of integrated plastic surgery programs, focusing on their PD bibliometric indices. Methods: We identified plastic surgery programs based on 2021 Doximity reputation and research output rankings, respectively, and then divided them into four quartiles (Q1-Q4). PD academic history and bibliometric indices (h-index, the number of publications, and citations) were collected through Doximity profiles and program websites: PubMed, Scopus, Google Scholar, American Society of Plastic Surgeons, and Accreditation Council for Graduate Medical Education. Results: Eighty-four programs were identified. There was a significant positive relationship between h-index, the number of publications, and type of research with reputation ranking (P < 0.05). After adjusting for years of experience post-training, h-index (OR = 1.24; P < 0.001) and the number of publications (OR = 1.05, P < 0.001) were significantly associated with reputation ranking. There was a statistically significant relationship between PD research fellowship completion and research output ranking (P < 0.01). After adjusting for years of experience post-training, h-index (OR = 1.05; P = 0.047) and the number of publications (OR = 1.01; P = 0.04) were significantly associated with research output ranking. Conclusion: Higher ranked programs tend to have PDs who have a strong record of scholarly activity, as evidenced by certain bibliometric indices.

Pseudomonas aeruginosa is one of the most virulent opportunistic Gram-negative bacterial pathogens in humans. It causes many acute and chronic infections with morbidity and mortality rates as high as 40%. P. aeruginosa owes its pathogenic versatility to a large arsenal of cell-associated and secreted virulence factors which enable this pathogen to colonize various niches within hosts and protect it from host innate immune defenses. Induction of cytotoxicity in target host cells is a major virulence strategy for P. aeruginosa during the course of infection. P. aeruginosa has invested heavily in this strategy, as manifested by a plethora of cytotoxins that can induce various forms of cell death in target host cells. In this review, we provide an in-depth review of P. aeruginosa cytotoxins based on their mechanisms of cytotoxicity and the possible consequences of their cytotoxicity on host immune responses.

Infantile cranial development typically occurs in a predictable sequence of events; however, less is known about how the development occurs in isolated, nonsyndromic congenital craniofacial anomalies. Furthermore, the timing of pediatric cranioplasty has been extrapolated from adult studies. Thus, the management of nonsyndromic congenital craniofacial anomalies presents with unique challenges to the craniofacial surgeon. The authors describe the case of a baby girl who was born with right Tessier 3 cleft, cleft palate, anophthalmos, and severe left craniofacial microsomia with Pruzansky grade III left mandibular anomaly. By analyzing 3-dimensional chronological models of the patient, the authors found that her abnormal fontanelle initially increased in size until 22 weeks of age, with subsequent spontaneous closure at a rate of 60.53 mm2/y. Although similar cranial anomalies are typically surgically corrected early in life, delaying treatment until after 2 years of age may be appropriate in some patients, obviating surgical morbidity in the newborn period.