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Preoperative Predictors of Length of Hospitalization Following Head and Neck Free Flap Reconstruction
No full textPostoperative Outcomes and Survivorship After Lateral Temporal Bone Resection: A Single Center Retrospective Chart Review
No full textTrisomy 21 Children With Duodenal Atresia or Anorectal Malformation: NSQIP-P Surgical Outcomes Study
No full textINTRODUCTION: Patients with Trisomy 21 (T21) have significantly different surgical outcomes when compared to their non-T21 counterparts. Using a national database, we sought to determine if operative complications are increased in T21 patients undergoing duodenal atresia (DA) or anorectal malformation (ARM) surgery, two commonly associated congenital surgical conditions in T21, compared to their non-T21 counterparts. MATERIALS AND METHODS: We used the deidentified National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database to identify children under 18 with an ICD-9 diagnosis of congenital malformations related to DA or ARM from 2012 to 2020. We stratified patients based on T21 ICD-9 diagnosis. CPT codes were used to identify all surgical procedures related to DA or ARM. Primary outcomes were clinical outcomes (operative time, readmission, reoperation, length of stay [LOS], death) and complications (infectious, cardiac, respiratory, renal, neurological, and hematologic). Unadjusted and adjusted analyses were used for statistical analysis. RESULTS: Of 2242 patients with DA, 17.5% had T21. The most common procedure overall was enterectomy (38.7%). DA patients with T21 were more likely to be neonates or small children (P = 0.0002), White or Hispanic (P \u3c 0.0001), with cardiac risk factors (P \u3c 0.0001), previous cardiac surgery (P \u3c 0.0001), hematologic disorders (P = 0.0045), underwent elective cases (P \u3c 0.0001), and had higher ASA class (P \u3c 0.0001), compared to non-T21 counterparts. In unadjusted analyses, T21 patients with DA were less likely to have hematologic complications (P \u3c 0.0001). T21 patients with DA were also less likely to have any complications in adjusted analyses (P \u3c 0.0001). Of 2532 patients with ARM, 112 had T21 (4.4%). The most common procedure performed was the perineal/sacroperineal approach repair of a high imperforate anus with a fistula (32.3%). T21 patients with ARM were more likely to be infants (P = 0.0188), older gestational age (P = 0.0008), Hispanic (P \u3c 0.0001), with major or minor cardiac risk factors (P \u3c 0.0001), and higher ASA class (P \u3c 0.0001). In unadjusted analysis, T21 patients with ARM were more likely to have superficial surgical site infections (SSI) (P = 0.0057), organ/space SSI (P = 0.0456), and sepsis (P = 0.0364), compared to their non-T21 counterparts. In adjusted analyses, T21 was not a significant risk factor for any complication (OR 1.79 [0.92, 3.47], P = 0.0866). No differences were found in operative time, unplanned reoperations, readmissions, LOS of more than 30 d, death, or LOS in both DA and ARM patients with and without T21. CONCLUSIONS: This study reveals that T21 patients are less likely to have postoperative complications following DA surgical treatment. However, patients with T21 and ARM have more postoperative complications related to wound healing and infection. Further investigation into these differences may provide insight into how to improve outcomes for T21 patients undergoing other surgical procedures
A Single Surgeon\u27s Long-Term Experience With Full-Thickness Skin Grafts for Nasal Defect Reconstruction
No full textNasal reconstruction is a constantly evolving area of plastic surgery. Many nasal defects are managed with staged local or regional flaps, which often impart significant donor site morbidity and may place psychosocial stress on patients. Full-thickness skin grafts (FTSGs) are a viable option for reconstruction. When FTSGs are used, the skin is typically taken from behind or in front of the ear, though this skin does not always match the nasal skin well. This study examines the use of FTSGs taken from the forehead, specifically from the widow\u27s peak area, to reconstruct nasal defects. This is a retrospective study of nasal reconstructions performed by one surgeon from 2014 to 2019. After receiving IRB approval, patient charts were reviewed. Eligible patients had shallow nasal defects (skin and subcutaneous tissue only) with good blood supply in the wound bed. All FTSGs were taken from the widow\u27s peak area of the forehead. Grafts were thinned, placed into the defect, and secured with sutures and a bolster dressing for one week. Donor sites were closed directly if small or repaired with Yin Yang flaps if larger. Patients were followed until the site was fully healed, and outcomes focused on graft survival, cosmetic appearance, and complications. Twenty patients met the criteria for the study; 60% were male with an average age of 74. Most (65%) had basal cell carcinoma, and the nasal tip was the most common site repaired (12 cases). The average defect size was 1.69 cm (range 0.5-4.5 cm). Cosmetic results were generally favorable, with good color, thickness, and texture matching. This study shows that FTSGs from the forehead\u27s widow\u27s peak offer a reliable and cosmetically favorable option for nasal reconstruction, especially for lower third defects of the nose. Compared to traditional flaps or ear skin grafts, forehead FTSGs provide better skin thickness and contour match and avoid the need for multiple surgeries. This makes them an appealing option for patients who want a single-stage procedure with a quick recovery
Wrist Extension Reconstruction Using Distal Anterior Interosseous to Extensor Carpi Radialis Brevis Nerve Transfer in Brachial Plexus Injuries
No full textPurpose: Reconstruction of wrist extension in C5–C8 root brachial plexus injuries (BPIs) is challenging, because of limited nerve and tendon donors. The purpose of this study was to report outcomes relating to the pronator quadratus branch of the anterior interosseous nerve (AIN) to extensor carpi radialis brevis (ECRB) nerve transfer from three BP surgeons. Methods: Ten patients with C5–C8 BPI underwent AIN to ECRB nerve transfer. The mean age of the patients was 30.5 ± 15.9 years. All patients were men. The mean time to nerve surgery following initial injury was 4.5 ± 1.2 months. In all patients, wrist extension was absent at baseline. All patients had a minimum follow-up of 12 months (mean: 28.1 months) after surgery. Results: Seven of 10 patients achieved Medical Research Council (M) grading system 4 wrist extension. In these patients, mean time to M2 was 12.7 ± 10.1 months, and mean time to M4 was 19.9 ± 10.0 months. The three patients who did not achieve M4 wrist extension had double fascicular transfer and relied strongly on the “Oberlin effect” where wrist flexion was required to initiate and achieve antigravity elbow flexion. Additionally, the three patients who did not achieve M4 wrist extension also had longer recovery to achieve antigravity (M3) elbow flexion, all presenting with poorer ability to initiate and achieve elbow flexion independent of the Oberlin effect. None of the patients had loss of forearm pronation after AIN to ECRB nerve transfer. Conclusions: The AIN to ECRB nerve transfer can effectively reconstruct wrist extension in BPI patients with C5–C8 root injuries. Single fascicular transfer with the ulnar nerve as a donor and avoidance of multiple muscle targets for reinnervation from the median nerve may result in more consistent recovery through this nerve transfer. Type of study/level of evidence: Therapeutic V
Increased risk of type 2 diabetes in patients with atopic dermatitis: An age-stratified analysis using TriNetX
No full textImpact of Janus Kinase Inhibitors on Psychiatric and Sleep Outcomes in Alopecia Areata: A Real-World Multicenter Cohort Study
No full textRiding the Wave of Progress: Examining the Current Landscape and Future Potential of MicroRNAs in Cancer Gene Therapy
No full textMicroRNAs, commonly referred to as miRNAs, exert a significant impact on cellular processes by coordinating post-transcriptional gene regulation. These non-coding RNAs, which are only 22 nucleotides long, form a part of the RNA-induced silencing complex (RISC) and play a crucial role in regulating gene expression. Their complex participation in cell proliferation, differentiation, and death highlights their crucial role in maintaining cellular balance. MicroRNAs have become significant contributors in the complex field of cancer biology, operating beyond the usual tasks of cells. Their dysregulation is closely intertwined with cancer initiation and development. miRNAs act as cellular regulators and regulate complex processes of gene expression. Disruption of this regulation can result in tumor development. This review article explores the intricate process of miRNA biosynthesis and its mechanisms, providing insights into its complex interactions with cancer. It also discusses the exciting field of miRNA-based cancer treatment. Exploring the therapeutic possibilities of these small RNA molecules presents opportunities for precision medicine, introducing a new age where miRNAs can be utilized to create targeted therapeutic interventions that mainly address the abnormal genetic characteristics that cause tumor formation. miRNAs provide a harmonious balance between understanding their biology and utilizing their therapeutic potential in cancer treatment. However, they also serve as conductors and possible therapeutic instruments in the symphony of molecular biology for gene therapy
Human endogenous retroviruses (HERVs) associated with glioblastoma risk and prognosis
Get PDFEmerging evidence suggests expression from human endogenous retrovirus (HERV) loci likely contributes to, or is a biomarker of, glioblastoma multiforme (GBM) disease progression. However, the relationship between HERV expression and GBM malignant phenotype is unclear. Applying several in silico analyses based on data from The Cancer Genome Atlas (TCGA), we derived a locus-specific HERV transcriptome for glioma that revealed 211 HERVs significantly dysregulated in the comparisons of GBM vs. normal brain (NB), GBM vs. low-grade glioma (LGG), and LGG vs. NB. Our analysis supported development of a unique HERV scoring algorithm that segregated GBM, LGG, and NB. Interestingly, lower HERV scores showed correlation with lower survival in GBM. However, HERV scores were less robust in predicting LGG survival or LGG progression to GBM. Functional prediction analysis linked the 211 HERV loci with 18 voltage-gated potassium channel genes. The functional link between dysregulated HERVs and specific potassium channel genes may contribute to better understanding of GBM pathogenesis, disease progression, and possibly drug resistance