Jacobs Institute of Women's Health
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Robotic-assisted Supermicrosurgery in Plastic Surgery: A Systematic Literature Review
No full textBACKGROUND: Robotic microsurgery is rapidly changing the surgical landscape by mitigating conventional hand-surgical limitations such as physiological tremor while promoting increased precision in confined spaces through the provision of high-depth microoptics and motion-scaling. The innovation of specialized super microsurgical robotic platforms such as Medical Microinstruments\u27 Symani and Microsure\u27s MUSA-2 has further bolstered microsurgical toolkits by enabling high-precision microvascular anastomoses in vessels with a diameter of 0.8 mm of less. METHODS: Our team conducted a systematic literature review of the global uses of robotic-assisted supermicrosurgery in plastic and reconstructive surgery. Using Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 flow guidelines, our search yielded 107 articles, of which 16 were eligible based on our inclusion criteria. RESULTS: Our results showed that lymphaticovenous anastomoses represent 37% of reported plastic and reconstructive surgery supermicrosurgery robot clinical uses, whereas free flaps and nerve repairs comprised just 14% and 2%, respectively. These procedures were found to correspond with significant but short learning curves. Across studies, mean operating times were found to be up to 1.5 times greater than manual techniques and showed a downward trend in time spent. Our analysis revealed that robotic-assisted techniques decreased rates of microtrauma, with anastomotic patency rates of 99.38%. CONCLUSIONS: Although robotic technology represents a significant financial investment and includes training needs, current literature supports evidence of potential long-term net savings due to reliably high patency rates; decreased in-hospital recovery times; the promise of new, expanded surgical options and capabilities; and enhanced career longevity for surgeons
Chest wall injury surgeon, know thyself
No full textThe use of surgical stabilization of rib fractures (SSRF) for non-flail fracture patterns continues to rise. However, multiple, recent randomized controlled trials in this patient population have failed to show a clear benefit to surgery. Rather than widening the gap between research and practice, we must embrace these trials, learn from them, and continue to refine the indications for surgery. Approaching SSRF with an awareness of our own cognitive biases, as well as scientific rigor, will advance the discipline of chest wall injury surgery
Characterizing cannabis use among adolescents seeking treatment for their substance use
No full textINTRODUCTION: The evolving landscape of laws and policies related to cannabis can inform patterns and trends in adolescent cannabis use. Today, a wide variety of cannabis products and alternatives are available in the legal and illicit markets. Harms associated with their use may vary depending on the amount and type of tetrahydrocannabinol (THC) they contain. Few studies have examined the awareness of and use of these different cannabis products among adolescents. METHODS: Our study examined patterns of cannabis use in adolescent patients of an urban pediatric addiction clinic. RESULTS: Most adolescents seen at the clinic use multiple cannabis products, and many adolescents use cannabinoid derivatives such as delta-8 and delta-10 THC. DISCUSSION: These results highlight the need for providers to explore in depth the various cannabis products used by adolescents, educate adolescents on the products, especially due to unknown risks associated with cannabinoid derivatives, and advocate for further regulation of alternative cannabis products
Prophylactic and therapeutic neutralizing monoclonal antibody treatment prevents lethal yellow fever infection
No full textYellow Fever virus (YFV) infection is fatal in 5-10% of the 200,000 yearly cases. There is currently no available antiviral treatment. We showed previously that administration of 50 mg/kg of a YFV-specific neutralizing monoclonal antibody (nmAb) at 2 days post-infection (dpi), prior to the onset of severe disease, protected YFV-infected rhesus macaques from death. To further explore the clinical applicability of our nmAb MBL-YFV-01, we treated rhesus macaques with a lower dose (10 mg/kg) of this nmAb prophylactically or therapeutically at 3.5 dpi. We show that a single prophylactic or therapeutic intravenous dose of our nmAb protects rhesus macaques from death following challenge. A comprehensive analysis of 167 inflammatory cytokine and chemokines revealed that protection was associated with significantly reduced expression of 125 of these markers, including type I interferons, IL6, and CCL2. This study further expands the potential clinical use of our YFV-specific nmAb, which could be used during an outbreak for immediate prophylactic immunity or for patients with measurable serum viremia
Differential BACH1 Expression in Basal-like Breast Tumors of Black Women Identified via Immunohistochemistry
No full textBACH1 has been identified as a functional regulator of cancer metastasis and metabolic signaling in breast cancer cells. However, the clinical relevance of BACH1 expression in breast tumors remains poorly understood. Using a tissue microarray from a cohort of 130 patients, we assessed the expression of BACH1 and its known target gene, MCT1 (encoded by SLC16A1), through immunohistochemistry (IHC). The expression data were then analyzed in relation to clinical variables, including breast cancer subtypes, tissue types, tumor size and grade, patient racial background, and age group. We found positive associations between BACH1 expression and tumor size, tumor grade, and the basal-like subtype. Importantly, BACH1 expression was significantly higher in tumors from Black women compared to those from White women, as well as in the basal-like subtype of breast tumors from Black women. Additionally, a positive correlation was observed between BACH1 and MCT1 IHC scores in tumors from Black women, while a weak association was noted in tumors from White women. Our study provides compelling evidence that BACH1 expression is evident based on the race and subtypes of breast cancer patients
Age Stratification of 2-Year Revision Risk Following Reverse Total Shoulder Arthroplasty: A Retrospective, Multicenter Analysis
No full textINTRODUCTION: Reverse total shoulder arthroplasty (RTSA) is a valuable surgical modality for treating various shoulder pathologies including rotator cuff tear arthropathy, proximal humerus fracture, and glenohumeral osteoarthritis. As the incidence of this surgery increases, so does the burden associated with adverse complications, including revisions. Age has been recognized as an independent risk factor for revision; however, current literature lacks data-driven thresholds to guide surgical-decision making. Identifying such thresholds and understanding their varying indications for revision can help surgeons risk stratify, better educate patients, and create interventions to minimize these complications. Therefore, the aim of this study was to identify data-driven age thresholds that predict significant differences in 2-year revision rates following RTSA. METHODS: A retrospective cohort analysis of patients undergoing RTSA from 2010 to 2022 was conducted using the PearlDiver national administrative claims database. Stratum specific likelihood ratio (SSLR) analysis was conducted to determine data-driven age cut-offs associated with varying risks of revision surgery within 2-years following RTSA. To control for confounders, multivariable regression analysis was conducted to confirm the association of the identified data-driven cutoffs with 2-year all-cause revision rates. RESULTS: In total, 54,719 patients undergoing RTSA were included in this study. SSLR analysis identified four data-driven age cutoffs associated with varying risks of revision: 40-60 years, and 61-67 years, 68-77 years, and 78+ years at the time of surgery. As age increased, the incidence of all-cause revision decreased within each age stratum: 2.52% in the Age 40-60 cohort, 1.64% in the Age 61-67 cohort, 1.14% in the Age 68-77 cohort, and 0.49% in the Age 78+ cohort. Relative to the Age 78+ cohort, the odds of 2-year all-cause revision was significantly higher and sequentially increased as the age cohort decreased: Age 68-77 (OR: 2.31), Age 61-67 (OR: 3.29), Age 40-60 cohort (OR: 4.92) (P\u3c0.001 for all). CONCLUSION: This study not only demonstrates the clear association between patient age and 2-year revision following RTSA, but also successfully identified four unique data-driven age cutoffs which stratified the risk of early all-cause revision following RTSA: age 40-60, age 61-67, age 68-77, and age 78+. Surgeons should not only consider patient age as a significant risk factor for revision, but should also consider these age cutoffs when discussing the potential risks and benefits of RTSA. Patients younger than 60 years, in particular, should be informed of the higher likelihood of early revision surgery. LEVEL OF EVIDENCE: Level III; Retrospective Cohort Comparison using Large Database; Prognosis Study
Lung Cancers with Cystic Airspaces - an Overview
No full textThere is increased recognition that some lung cancers arise from or are associated with air-filled cystic spaces. Recognition of precursors is important because these are often overlooked and because some of these cancers progress rapidly once a solid component develops. A systematic review suggests that such precursors typically appear as irregular air cysts; these should be distinguished from bullae and smooth round cysts with paper-thin walls that are often seen incidentally with increasing age. Such irregular cysts usually enlarge slowly before developing a ground glass or small solid component or becoming multiloculated. Such change warrants careful surveillance; continued progression of a solid component justifies intervention. Early intervention is associated with good outcomes; survival markedly diminishes if resection occurs when a more substantial solid component has developed
Advancing Global Cancer Symptom Science: Insights and Strategies From the Inaugural Cancer Symptom Science Expert Meeting
No full textOBJECTIVES: The inaugural Cancer Symptom Science Expert Meeting, held in Lausanne Switzerland on October 11-12, 2023, brought together 40 nurse scientists from seven countries. The event aimed to enhance collaboration across the global symptom science community; identify common research interests, gaps in knowledge, and opportunities for research; and develop strategies to address challenges and accelerate symptom science research internationally. This white paper summarizes the discussions and recommendations deliberated during the meeting and introduces the Global Research Alliance in Symptom Science (GRASS). METHODS: This 2-day meeting featured presentations that highlighted critical issues and unanswered questions in cancer symptom science. Four core topic areas based on knowledge gaps were reflected throughout presentations. The co-occurrence of cancer with other chronic conditions (eg, cardiovascular disease, diabetes) that may share similar contributors and underlying mechanisms was included. Four working groups (WGs) were formed to identify gaps and opportunities associated with each topic and to outline strategic directions and essential actions to advance symptom science. RESULTS: Working groups developed four recommendations. WG1 explored optimal approaches to collect, analyze, and use symptom data for research and clinical purposes. WG2 addressed the development of a minimum dataset or common data model for symptom science. WG3 focused on enhancement of best practices in implementation science strategies to improve uptake of evidence-based symptom management in routine care. WG4 addressed capacity building and infrastructure for the creation of a global research alliance in symptom science (GRASS). CONCLUSIONS: The symposium established the groundwork for the development of GRASS, dedicated to symptom science in cancer and other chronic conditions. Future directions include establishing regular scientific meetings, fostering interdisciplinary collaboration, and engaging with symptom scientists. IMPLICATIONS FOR NURSING PRACTICE: The Global Research Alliance in Symptom Science is an alliance for symptom science and its implementation into clinical practice. Nurses are at the forefront of this work
Longitudinal evaluation of bone safety in children and adolescents with HIV-1 starting tenofovir alafenamide-containing antiretroviral therapy
No full textBACKGROUND: Adult participants taking tenofovir alafenamide (TAF) in clinical trials had a better bone safety profile than those taking tenofovir disoproxil fumarate. Herein, we report medium- to long-term effects of TAF-containing regimens on bone health in children and adolescents with human immunodeficiency virus (HIV). METHODS: This post hoc pooled analysis of data from two phase 2/3 clinical studies (NCT01854775 and NCT02285114) evaluated the pharmacokinetics, safety, and efficacy of TAF-based regimens in children and adolescents with HIV-1. Participants were categorized into Group 1 (aged 12-\u3c18 years, weighing ≥35 kg), Group 2 (aged 6-\u3c12 years, weighing ≥25 kg), and Group 3 (aged ≥2 years, weighing 14-\u3c25 kg). Evaluations included virologic suppression, height Z-score, Tanner stage, bone mineral density (BMD) of the spine and total body less head (TBLH; absolute and height-for-age Z-score adjusted [HAZ-adjusted] for both), bone serum markers, bone-related adverse events, and pharmacokinetic assessments. RESULTS: Overall, 169 participants were enrolled and treated (78, 61, and 30 in Group 1, 2, and 3, respectively). Median (range) exposure to study drug was 320.3 (8.3-492.3), 290.1 (24.0-393.9), and 168.3 (9.0-193.0) weeks in Groups 1, 2, and 3, respectively. Virologic suppression (HIV-1 RNA \u3c50 copies/mL) rates were high across all groups. Spine and TBLH absolute BMD increased over time in all groups, and spine and TBLH HAZ-adjusted BMD Z-scores increased or remained stable in all groups. There were no significant changes in bone serum markers, and no treatment-related fractures or bone-related adverse events. CONCLUSIONS: TAF-based regimens demonstrated acceptable medium- to long-term bone safety in children and adolescents with HIV
Profiles of cannabis use and expense-related factors among US young adults
No full textOBJECTIVES: Given the changing cannabis policy and retail environment, this study examined profiles of young adults with differing cannabis cost-related behaviors and perceptions (e.g., products used, impact of cost) and their associations with use-related outcomes. METHODS: Using 2024 survey data among 1,359 US young adults reporting past-month cannabis use (M = 26.95, 61.4 % female, 20.7 % Hispanic, 17.9 % Black, 7.7 % Asian), latent class analysis (LCA) was conducted; indicators were perceived cost of cheapest product (10), impact of cost on use (low; moderate; high), monthly cannabis expenditures (26-100, \u3e$100), past-month use days (1-5; 6-20; ≥21), and product type (bud/herb; edibles; oils/vape; concentrates/other). Multivariable analysis assessed sociodemographics in relation to class (multinomial logistic regression), then class in relation to use-related outcomes (next-year use intentions, problematic use; linear regression). RESULTS: LCA identified 4 classes: 1) \u27Price-insensitive, low-spend, low-level bud/edible use\u27 (36.1 %); 2) \u27Semi-price-sensitive, high-spend, high-level bud/oil/concentrate use\u27 (31.9 %); 3) \u27Semi-price-sensitive, moderate-spend, mid-level oil/other product use\u27 (24.1 %); and 4) \u27Price-sensitive, high-spend, mid-level mixed product use\u27 (7.9 %). Compared to Class 1 (referent): Class 2 was older, more likely \u3c bachelor\u27s (vs. ≥ bachelor\u27s) degree educated, cohabitating (vs. single/other), and parents, but less likely Asian (vs. White); Class 3 was more likely Black and \u3c bachelor\u27s degree educated, but less likely with other (vs. full-time) employment; and Class 4 was more likely Black and food insecure. In multivariable regression, relative to Class 1, other classes had higher use intentions and more problematic use. CONCLUSIONS: Regulatory and educational efforts must address young adults with higher risk indicators and potentially related disparities