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Digital Papillary Adenocarcinoma: An Updated Review of Epidemiology, Pathogenesis, and Management
No full textBACKGROUND: Digital papillary adenocarcinoma (DPAc) is an uncommon sweat gland malignancy. OBJECTIVE: To review recent updates in epidemiology, pathogenesis, and treatment of DPAc. MATERIALS AND METHODS: A PubMed/MEDLINE search of DPAc, with an emphasis on articles published after 2010. RESULTS: DPAc has an incidence of approximately one in 10 million person-years. Males are more commonly affected than women, and the tumor is commonly diagnosed in the fifth and sixth decades of life. Recent studies have detected human papillomavirus 42 DNA in DPAc, leading to a paradigm shift in the authors\u27 understanding of DPAc oncogenesis. Additional studies also suggest BRAF V600E polymorphisms and fibroblast growth factor receptor dysregulation to be potential drivers of DPAc pathogenesis. Regarding treatment, wide local excision or amputation both appear to afford similar rates of recurrence-free survival; Mohs micrographic surgery is an emerging but understudied modality for DPAc. At present, there are insufficient data to strongly recommend the utilization of sentinel lymph node biopsy. CONCLUSION: Recent molecular advances in DPAc have paved the way for enhanced diagnosis and treatment. Further research on the utility of Mohs micrographic surgery and sentinel lymph node biopsy would be helpful in clarifying the optimal treatment approach for DPAc
Cholesterol crystal embolization induced kidney disease
Get PDFCholesterol crystal embolization (CCE) results from the release of cholesterol crystals from ruptured atherosclerotic plaques into circulation, resulting in the occlusion of small arteries and arterioles in various organs. Ischemia triggers a systemic inflammatory response resulting in vascular obstruction and organ dysfunction. Kidneys are often involved because of the proximity to the aorta and CCE in the kidneys can result in acute, sub-acute, or chronic kidney disease. There are many known risk factors for renal involvement of CCE, including iatrogenic and spontaneous causes. The pathophysiology of CCE includes complex pathways that lead to acute and chronic effects that can have direct deleterious effects on the kidney. The diagnosis entails numerous lab studies and potential need for tissue biopsy. Treatment is often supportive but can also include more novel therapies. This paper reviews the pathophysiology, clinical manifestations, diagnostic approaches, and management strategies for CCE affecting the kidneys
Superficial Cervical Plexus Block for Postoperative Pain Management in Occipital Craniotomies: A Narrative Review
Get PDFPost-craniotomy pain is common yet often sub-optimally managed because systemic opioids can obscure postoperative neurologic examinations. The superficial cervical plexus block (SCPB) has, therefore, emerged as a targeted regional anesthesia option for occipital craniotomies. The SCPB targets the C2-C4 nerves to anesthetize the occipital scalp region, covering the lesser occipital nerve territory that lies within typical posterior scalp incisions. Clinical evidence shows the block is effective in reducing acute postoperative pain after occipital craniotomy and diminishes opioid requirements. Studies have demonstrated successful and long-lasting analgesia, reductions in 24-h opioid consumption, and a lower incidence of severe pain. Moreover, the technique exhibits a low complication rate and is safer than a deep cervical plexus block because the injection remains superficial and avoids critical vascular and neural structures. When delivered under ultrasound guidance, major adverse events are exceedingly rare. By reducing opioid use, the SCPB can help reduce postoperative complications, allowing earlier neurological assessments and fewer opioid-related side effects. Incorporation of the SCPB into multimodal analgesia regimens can, therefore, accelerate postoperative recovery by providing regionally focused, opioid-sparing pain control without clinically significant sedation. Overall, current data support the SCPB as a dependable, well-tolerated, and clinically practical approach for managing post-craniotomy pain in patients undergoing occipital approaches. In this narrative review, we will discuss the mechanism of action and anatomy, the clinical application, safety and tolerability, patient outcomes, and emerging future directions of the superficial cervical plexus block and how it mitigates post-occipital craniotomy pain
Impact of Race on Admission, Clinical Outcomes, and Disposition in Cholangiocarcinoma: Insights from the National Inpatient Database
Get PDFBACKGROUND: Cholangiocarcinoma, malignancies arising from the intrahepatic and extrahepatic bile ducts, has increased in incidence in the United States over the past few decades. The reported incidence of cholangiocarcinomas is high, particularly in specific racial groups such as Asian and Pacific Islander patients. Race also significantly impacts disparities in healthcare utilization and clinical outcomes. Our study focused on the impact of race on admission, clinical outcomes, and disposition of cholangiocarcinoma. METHODS: We performed a retrospective analysis of cholangiocarcinoma-related hospital admissions, using the National Inpatient Sample for the year 2022. Patients were stratified according to race into the following groups: White, African American, Hispanic, Asian or Pacific Islander, Native American, and Other. The data analysis was performed using STATA/BE version 18.5. Univariable and multivariable logistic regression models were applied to evaluate the relationship between race and clinical and healthcare utilization outcomes. RESULTS: In 2022, 7479 hospitalizations were recorded for cholangiocarcinoma in the United States. Among these, 65.99% were White, 13.27% Hispanic, and 10.13% African American. There was a statistically significant difference in gender distribution across racial groups (p \u3c 0.001), with males comprising the majority in all groups. Males outnumbered females in all racial groups except among the Hispanic group. Significant racial disparities in mortality were observed, with White patients showing a mortality rate of 6.69%, compared to higher rates among African American (9.76%), Native American (8.51%), and Asian or Pacific Islander (8.09%) patients, while Hispanic (5.04%) and Other (5.88%) groups had lower rates (p \u3c 0.001). CONCLUSIONS: The study underscores the racial disparities among cholangiocarcinoma hospitalizations, with African American, Native American, and Asian patients facing disproportionately higher mortality and poorer in-hospital outcomes compared to White patients. This analysis highlights the healthcare strategies and policy reforms to promote equitable treatment by mitigating these disparities and to improve cholangiocarcinoma outcomes
Diedra Brewer-Hohensee Interview
Get PDFThis interview of Diedra Brewer-Hohensee was conducted by Chandler Smith on September 9, 2025. Interview transcribed by Sam Howat.https://digitalscholar.lsuhsc.edu/oral_hist/1016/thumbnail.jp
Mike Brauninger Interview
Get PDFThis interview of Mike Brauninger was conducted by Chandler Smith on August 15, 2025. Interview transcribed by Sam Howat. Mike worked at LSU Health Sciences Center - New Orleans from 2004-2006.https://digitalscholar.lsuhsc.edu/oral_hist/1010/thumbnail.jp
The effect of occlusal morphology of implant-supported prosthesis, support configuration, and build angulation on the number of isolated islands in a 3D printing slicing software
No full textPURPOSE: To evaluate the impact of posterior occlusal morphology, build angulation, and support configuration on the occurrence of isolated islands in a three-dimensional (3D) printing slicing software when printing a full arch implant-supported prosthesis. MATERIALS AND METHODS: Three maxillary implant-supported full-arch prostheses were designed with similar intaglio and anterior teeth and different posterior morphology based on cusp angulations, including shallow (10°), medium (20°), and steep (33°). Each digital file was transferred to slicing software and nested in different angulations (0°, 15°, 30°, 45°, and 90°), and supports were created using different configurations (thin, standard, and thick). The sliced file from each configuration was evaluated for the presence of isolated islands of print where the printed material was left unsupported. The effect of independent variables and number of isolated islands, time to print, number of layers, and volume of the resin to print were analyzed with a three-way ANOVA test with a significance level set at 5%. RESULTS: The mean number of isolated islands (minimum 0 and maximum 11.9) in the slicing software was significantly affected by all three investigated variables (p \u3c 0.05). Steep occlusal morphology reduced the chance of developing islands after slicing. The standard and thick support configuration reduced the number of islands when compared with the thin support configuration. In terms of build angulation, 0° resulted in the highest number of islands, and 90° build angulation resulted in no islands. Increasing the thickness of support and steeper cusp angulation significantly increased the amount of resin required to print (p \u3c 0.05). Increasing the build angulation significantly increased the time to print, number of layers, and amount of resin to print (p \u3c 0.05). CONCLUSIONS: Slicing software can produce isolated unsupported areas that have the potential to cause print failure of a full arch implant-supported prosthesis. Based on the present findings, shallower posterior occlusal anatomy, thinner supports, and 0° build angulation increased the chance of developing isolated islands in a slicing software
Effect of margin thickness and cement gap on the fabrication and fit accuracy of additively manufactured crowns in definitive resins with different filler content
Get PDFPURPOSE: To evaluate how commercially available composite resins in varying filler content affect the fabrication and fit accuracy (trueness and precision) of additively manufactured (AM) definitive crowns with different margin thickness and cement gaps by comparing them to subtractively manufactured (SM) polymer-infiltrated ceramic crowns. MATERIALS AND METHODS: Two identical unprepared mandibular right first molars were prepared by an experienced prosthodontist for crowns with either 0.5 mm or 1.0 mm chamfer margins, verified using silicone indexes and a periodontal probe, and then digitized with an industrial-grade scanner. These scan files were used to design reference crowns with either 50-µm or 80-µm cement gaps in standard tessellation language (STL) format. These reference STLs were used to manufacture a total of 112 crowns, 28 crowns for each crown margin thickness-cement gap pair, using three additively manufactured resins with different filler ratios (AM-20-40%, AM-50%, AM-60%) and one SM polymer-infiltrated ceramic network (n = 7). After fabrication, an intraoral scanner was used to obtain STL files of each crown, the prepared typodont teeth, and each crown seated on its corresponding typodont. All STLs were imported into a metrology-grade 3-dimensional (3D) analysis software program to quantify the surface deviations (overall, external, intaglio, and marginal) of the crowns using the root mean square method and their fit with the average gap measurements. Precision was defined as the average of how much each measurement differed from the overall mean. All data were analyzed using generalized linear model analysis and Bonferroni-corrected post-hoc tests (Minitab Software, Version 17) with a significance level set at α = 0.05. RESULTS: The accuracy of external surface deviations and the precision of the average gaps were affected by the interaction among all main factors. The interaction between material type and margin thickness influenced the accuracy of intaglio surface deviations, while the interaction between material type and cement gap affected the accuracy of marginal surface deviations; both interactions impacted the average gaps. In addition, the accuracy of overall deviations was affected by the interaction between margin thickness and cement gap (p ≤ 0.040). AM-20-40% crowns mostly had higher overall accuracy and SM crowns mostly had higher external and intaglio surface accuracy (p ≤ 0.033). AM-20-40% crowns mostly had higher fit accuracy, while the crowns with 0.5 mm-thick margins or 50-µm cement gap had lower average gaps (p ≤ 0.044). CONCLUSIONS: AM crowns in resin with low filler ratio (AM-20-40%) and SM crowns mostly had higher fabrication accuracy, which may enable fewer clinical adjustments and more reliable fabrication than AM crowns in resins with higher filler ratios (AM-50% and AM-60%). Only AM-20-40% and SM crowns with 0.5 mm-thick margins or 50-µm cement gap had average gap values similar to previously reported clinical thresholds
