The Emerging Role of Three-dimensional Technologies in Orthoplastic Surgery.

Three-dimensional (3D) planning and manufacturing technologies have become integral to head and neck reconstruction following tumor resection. These technologies facilitate the prototyping of patient-specific solutions in both digital and physical form. Three-dimensional tumor models and cutting guides help conceptualize and verify the surgical approach, as well as serve as a blueprint for reconstruction.

Systemic T-cell activation and IFN-γ activity in indeterminate severe hepatitis are reminiscent of hemophagocytic lymphohistiocytosis: Implications for T-cell- and IFN-γ-directed therapies.

Background: Severe hepatitis cases in children are increasingly recognized, but the exact etiology remains unknown in a significant proportion of patients. Cases of indeterminate severe hepatitis (iSH) may progress to indeterminate pediatric acute liver failure (iPALF), so understanding its immunobiology is critical to preventing disease progression. Hemophagocytic lymphohistiocytosis (HLH) is a systemic hyperinflammatory disorder associated with T-cell and macrophage activation with liver injury.

Clinical outcomes among patients with mitral valve regurgitation undergoing Impella-supported high-risk PCI.

Background: Mitral valve regurgitation (MR) is associated with worse outcomes in patients undergoing percutaneous coronary intervention (PCI). We sought to evaluate outcomes of Impella-supported high-risk PCI (HRPCI) patients according to MR severity.

Methods: Patients from the PROTECT III study undergoing Impella-supported HRPCI were stratified into 4 groups according to MR severity: No or trace MR, mild MR, moderate MR, and severe MR.

Utilizing an ultrasound guided 5-in-1 trigger point and hydrodissection technique for interscapular mid-thoracic myofascial pain: A retrospective review.

Poor posture can lead to excessive strain of the neck and upper back musculature, leading to irritation of the dorsal scapular nerve (DSN) and spinal accessory nerve (SAN). A 5-in-1 trigger point technique has been described that specifically target trapezius, rhomboids, levator scapulae, SAN and DSN in a single percutaneous injection. We modified the technique to include hydrodissecting the DSN and SAN to provide further pain relief from possible nerve entrapments.

Lifetime Management for Aortic Stenosis: Strategy and Decision-Making in the Current Era.

Aortic stenosis, the most common valvular disease in the Western world, has traditionally been treated with surgical aortic valve replacement (SAVR) but is increasingly treated by transcatheter aortic valve replacement (TAVR). Whereas patients older than 65 years are preferably treated with bioprosthetic tissue valves, there is considerable uncertainty in the choice between TAVR and SAVR. We present various considerations for optimizing the lifelong management of patients receiving bioprosthetic valves (SAVR or TAVR).

Outcomes and Cost of Donor Nephrectomy Across Surgical Specialties and Operative Approaches.

Introduction: Live donor nephrectomy (LDN) is performed by various specialty surgeons, including urologists, general surgeons, and transplant surgeons. However, national practice patterns and outcomes associated with surgeon specialty have not been previously explored. Here, we investigate surgeon specialty trends, perioperative complications, hospital length of stay, cost, and charge for LDN according to surgeon specialty.

Using Natural Language Processing on Expert Panel Discussions to Gain Insights for Recruitment, Retention and Intervention Adherence for Online Social Support Interventions on a Stage II-III Clinical Trial Among Hispanic and African American Dementia Caregivers.

We applied natural language processing (NLP) to a corpus extracted from 4 hours of expert panel discussion transcripts to determine the sustainability of a Stage II-III clinical trial of online social support interventions for Hispanic and African American dementia caregivers. Prominent topics included Technology/hard to reach populations, Training younger populations, Building trust, Privacy and security issues, Simplification of screening questions and recruitment procedures, Understanding participants' needs, Planning strategies and logistics, Potential recruitment places, Adjusting intervention size downwards to engage elderly participants, Targeting different generations, Internet-based interventions by age range, and Providing step-by-step instructions and an overview of the entire research process during recruitment. The application of NLP to qualitative data on a dementia caregiving clinical trial provides useful insights for recruitment, retention, and adherence to guidelines for such interventions serving Hispanic and African American dementia caregivers.

Spread Through Air Spaces: Interresponder Agreement and Comparison Between Pulmonary and General Pathologists.

Spread through air spaces (STAS), an important prognostic indicator included in the 2015 World Health Organization classification, is defined as micropapillary, solid, and/or single tumor cell clusters beyond the edge of the main mass and distinct from processing artifacts. This study aimed to assess the interresponder agreement on current STAS criteria vs artifacts, identify discrepancies, and compare responses between pulmonary and general pathologists. A multiple-choice online questionnaire illustrating multiple criteria for STAS vs artifacts was available internationally for 6 days to Pulmonary Pathology Society members, thoracic pathology course attendees, and International Association for the Study of Lung Cancer pathology committee members.

Association of Preprocedural SYNTAX Score With Outcomes in Impella-Assisted High-Risk Percutaneous Coronary Intervention.

Background: Patients with complex coronary artery disease, as defined by high SYNTAX scores, undergoing percutaneous coronary intervention (PCI) have poorer outcomes when compared with patients with lower SYNTAX I scores. This study aimed to assess if mechanical circulatory support using Impella mitigates the effect of the SYNTAX I score on outcomes after high-risk percutaneous coronary intervention (HRPCI).

Methods: Using data from the PROTECT III study, patients undergoing Impella-assisted HRPCI between March 2017 and March 2020 were divided into 3 cohorts based on SYNTAX I score-low (≤22), intermediate (23-32), and high (≥33).

Practical Guidance for Clinical Microbiology Laboratories: Updated guidance for processing respiratory tract samples from people with cystic fibrosis.

SUMMARYThis guidance presents recommendations for clinical microbiology laboratories for processing respiratory samples from people with cystic fibrosis (pwCF). Appropriate processing of respiratory samples is crucial to detect bacterial and fungal pathogens, guide treatment, monitor the epidemiology of cystic fibrosis (CF) pathogens, and assess therapeutic interventions. Thanks to CF transmembrane conductance regulator modulator therapy, the health of pwCF has improved, but as a result, fewer pwCF spontaneously expectorate sputum.

Approach to radical hysterectomy for cervical cancer after the Laparoscopic Approach to Cervical Cancer trial and associated complications: a National Surgical Quality Improvement Program study.

Background: The Laparoscopic Approach to Cervical Cancer study results revolutionized our understanding of the best surgical management for this disease. After its publication, the guidelines state that the standard and recommended approach for radical hysterectomy is an open abdominal approach. Nevertheless, the effect of the Laparoscopic Approach to Cervical Cancer trial on real-world changes in the surgical approach to radical hysterectomy remains elusive.

Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes.

Objective: Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically, and open repair is associated with high rates of incontinence. In recent years, there have been increasing reports of robotic-assisted bladder neck reconstruction in the literature. However, existing studies are small, heterogeneous case series.