Evolving Role of Lymphedema Surgery on Breast Reconstruction: A Systematic Review and Multi-Institutional Algorithmic Approach.

: Recent advancements in breast cancer treatment have led to increased survival rates, prompting a shift towards addressing breast cancer-related lymphedema (BCRL). Despite the evolving role of lymphatic surgery in breast reconstruction, there is limited literature evaluating the current role of lymphatic surgery in breast reconstruction. This review aims to evaluate the state of lymphatic surgery in breast reconstruction, analyzing surgical techniques and proposing a multi-institutional algorithmic approach.

Updates in Immunotherapy for Pancreatic Cancer.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with limited effective therapeutic options. Due to a variety of cancer cell-intrinsic factors, including KRAS mutations, chemokine production, and other mechanisms that elicit a dysregulated host immune response, PDAC is often characterized by poor immune infiltration and an immune-privileged fibrotic stroma. As understanding of the tumor microenvironment (TME) evolves, novel therapies are being developed to target immunosuppressive mechanisms.

Atrial fibrillation in Black American patients: A review of genetics, risk factors, and outcomes.

Atrial fibrillation (AF), the most common arrhythmia in the United States, affects 6 million Americans, with numbers projected to increase to 12 million by 2030. A racial paradox difference in the incidence and prevalence of AF exists between Black and White Americans. Black Americans are less prone than White Americans to development of AF, but they display a higher burden of modifiable risk factors for cardiovascular disease and higher rates of ischemic stroke.

Use of Magnetic Resonance Imaging for Postoperative Radiation Therapy Planning in Patients with Carbon Fiber-Reinforced Polyetheretherketone Instrumentation.

Purpose: Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation is being used more frequently in the spinal oncology landscape. Better visualization with this material allows for more precise postoperative stereotactic body radiation therapy (SBRT) planning using either computed tomography (CT)-myelography or magnetic resonance imaging (MRI) studies. We compared the dosimetric planning equivalencies and outcomes.

Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study.

Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources.

"What Matters" in the Emergency Department: A Prospective Analysis of Older Adults' Concerns and Desired Outcomes.

Objective: To describe "What Matters" to older adults seeking emergency department (ED) care and to identify patient characteristics associated with meeting desired outcomes.

Background: As part of the 4Ms framework, identifying "What Matters" has been captured across healthcare settings, yet limited attention has been directed to older adults in the ED.

Methods: We performed a secondary analysis of a multicenter prospective observational study.

Improving Recurrence Prediction in Intrahepatic Cholangiocarcinoma: The Synergistic Impact of the FIB-4 Index and Tumor Burden Score on Post-hepatectomy Outcomes.

Background: The prognostic role of the fibrosis-4 (FIB-4) index relative to intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study sought to characterize the impact of the FIB-4 index and tumor burden score (TBS) on recurrence and overall survival (OS).

Methods: ICC patients undergoing hepatectomy (2000-2020) were identified using a multi-institutional database.

Optimization of Timing for Risk-Reducing Salpingectomy and Oophorectomy.

ClinicalTrials.gov , NCT04251052.

The Need for Higher Levels of Evidence in Plastic Surgery.

Background: Evidence-based medicine in plastic surgery is essential to provide optimal care to individual patients. Level of evidence (LOE) and number of citations are metrics used to gauge quality of research and impact within a field, respectively. The objective of this study was to determine an association between LOE and number of citations within recently published articles in (PRS).

Quantitative Assessment of Collagen Architecture to Determine Role of Tumor Stroma During Vestibular Schwannoma Progression.

Objective: The primary objective was to characterize the abundance and architecture of collagen in the extracellular matrix in vestibular schwannoma (VS). The secondary objective was to investigate the association between collagen architecture and tumor size.

Study Design: Retrospective cohort study.

Cannabinoids and General Anesthetics: Revisiting Molecular Mechanisms of Their Pharmacological Interactions.

Cannabis has been used for recreation and medical purposes for more than a millennium across the world; however, its use's consequences remain poorly understood. Although a growing number of surgical patients are regular cannabis consumers, little is known regarding the pharmacological interactions between cannabis and general anesthetics; consequently, there is not a solid consensus among anesthesiologists on the perioperative management of these patients. The existing evidence about the molecular mechanisms underlying pharmacological interactions between cannabinoids and anesthetic agents, both in animal models and in humans, shows divergent results.

Metabolic-associated steatotic liver disease and hepatocellular carcinoma.

Introduction: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has been introduced as a superior term to describe steatosis on a background of metabolic dysregulation and is slated to become the leading cause of HCC worldwide, as the incidence of metabolic comorbidities is increasing. As such, MASLD has evolved into an important public health issue, potentially leading to higher rates of liver mortality and end-stage liver disease. To this end, understanding the association between MASLD and HCC may allow for the identification of better interventions and novel therapeutic strategies.

Snaring via a Femoral Approach to Facilitate Transvenous Lead Extraction of an Infected Right Ventricular Lead Jailed by a Bioprosthetic Tricuspid Valve.

An 85-year-old woman presented with bacteremia complicated by infective endocarditis with vegetations on the prosthetic mitral valve and right ventricular (RV) lead. The patient had a single-chamber permanent pacemaker with two RV leads, one of which was previously trapped or "jailed" after a bioprosthetic tricuspid valve replacement. Complete transvenous lead extraction including the chronically retained jailed RV lead was achieved via laser extraction assisted by concomitant traction from a superior left subclavian and inferior right femoral venous approach.

Topical corticosteroid powder for peristomal pyoderma gangrenosum: a systematic review.

Background: Peristomal pyoderma gangrenosum (PPG) is a critical complication after surgical ileostomy or colostomy placement. While topical treatments are often effective, most of the available vehicles reduce ostomy pouch adhesion. There are no commercially available corticosteroid powders for topical application; however, using powder from crushed corticosteroid tablets or capsules may circumvent this issue.

Clinicopathologic Features and Digital Imaging Analysis of HER2 Protein in Breast Carcinomas With Different HER2 Fluorescence in Situ Hybridization Patterns.

Background: HER2-targeted therapies have significantly improved outcomes for patients with HER2-positive breast cancer (BC), which represents 15% to 20% of all BC cases. HER2 status is assessed via immunohistochemistry (IHC) and/or in situ hybridization (ISH), dividing BCs into five groups (G1-G5).

Patients And Methods: In a study of 2,702 primary BC cases, comprising 12.

Surgical opioid prescription and the risk of opioid initiation among opioid-naive households.

Background: We sought to investigate the association between surgical opioid prescriptions and the risk of opioid initiation among opioid-naive spouses.

Methods: Patients who underwent surgery for breast or gastrointestinal cancer were identified from the IBM Marketscan database. Multivariable regression analysis was performed to examine the association between surgical opioid prescription and opioid initiation among opioid-naïve patient spouses.

Risk-stratification tools for emergency department patients with syncope: A systematic review and meta-analysis of direct evidence for SAEM GRACE.

Objectives: Approximately 10% of patients with syncope have serious or life-threatening causes that may not be apparent during the initial emergency department (ED) assessment. Consequently, researchers have developed clinical decision rules (CDRs) to predict adverse outcomes and risk stratify ED syncope patients. This systematic review and meta-analysis (SRMA) aims to cohere and synthesize the best current evidence regarding the methodological quality and predictive accuracy of CDRs for developing an evidence-based ED syncope management guideline.