Microsurgical Breast Reconstruction: Maximizing Success

alexandrossfakianakis shared this article with you from Inoreader Microsurgical Breast Reconstruction: Maximizing Success via Seminars in Plastic Surgery Semin Plast Surg 2022; 36: 253-259 DOI: 10.1055/s-0042-1759573 Breast reconstruction is becoming increasingly recognized as a fundamental component in comprehensive breast cancer treatment. The primary goal for any reconstruction is to safely restore a natural appearing breast. When it comes to achieving the elements of size, shape, symmetry, and softness, the use of autologous tissue has many advantages. The approach to autologous breast reconstruction has changed substantia lly over the years as microsurgical free tissue transplants become more routine and accessible. While a variety of flap donor sites exist, careful flap selection based on surgical history and the availability of donor tissue is critical in achieving reliable results. This article reviews the clinical considerations in patient evaluation, donor site selection, and surgical approach taken at the Buncke Clinic. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Free Flap Donor-Site Complications and Management

alexandrossfakianakis shared this article with you from Inoreader Free Flap Donor-Site Complications and Management via Seminars in Plastic Surgery Semin Plast Surg DOI: 10.1055/s-0042-1759795 Free flap harvest will occasionally result in donor-site complications and morbidity. Most of these complications are managed simply without producing lingering effects on activities of daily living. However, some patients will sustain limb weakness, gait issues, chronic pain, and nonhealing wounds. Frank preoperative discussion between surgeon and patient is essential to maximize postoperative outcome and manage expectations. Fast idious surgical technique will help minimize the risks of hematoma, seroma, and infection, while newer techniques can help prevent some issues with wound healing, limb weakness, and sensory changes. In this article, we describe the rates of common and rare complications at free flap donor sites, as well as techniques to prevent and manage them. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of Transnasal Esophagoscopy and Sedated Esophagogastroduodenoscopy in the Assessment of Laryngopharyngeal Reflux

alexandrossfakianakis shared this article with you from Inoreader Comparison of Transnasal Esophagoscopy and Sedated Esophagogastroduodenoscopy in the Assessment of Laryngopharyngeal Reflux via Clinical Otolaryngology Abstract Objective Transnasal esophagoscopy (TNE) in the awake patient and esophagogastroduodenoscopy (EGD) in sedation are both used in the assessment of laryngopharyngeal reflux (LPR). The objective of this study was to compare these two endoscopic methods in contributing to the diagnosis of LPR. Methods This study included 54 patients presenting with signs and symptoms suspicious for LPR, which were examined both by TNE and EGD. The contribution of each method to the diagnosis of LPR was evaluated separately and then compared with each other. Results In detecting LPR, TNE showed a significant higher sensitivity (94% vs. 60%) and accuracy (93% vs. 59%) than EGD, but their specificity was equal (50% each). The most common pathologic findings in both methods were a hiatal hernia (70% vs 48%) and gaping cardia (69% vs 24%), followed by peptic esophagitis (41% vs 24%). Conclusion The value of EGD is limited in the workup of LPR, as sedation tends to mask the subtle findings in this kind of reflux disease. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta‐analysis of randomized placebo‐controlled trials

alexandrossfakianakis shared this article with you from Inoreader Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta‐analysis of randomized placebo‐controlled trials via Clinical Otolaryngology Abstract Aim To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that examined the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). Methods The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18-March-2022. The included studies were evaluated for risk of bias. The efficacy endpoints were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results Five RCTs comprising 380 patients (desmopressin=191 patients and placebo=189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n=5 RCTs, MD=–37.97 ml, 95% CI [–56.97, –18.96], p<0.001), 5-point Boezaart scores (n=2 RCTs, MD=–0.97, 95 CI [–1.21, –0.74], p<0.001), and 10-point Boezaart scores (n=2 RCTs, MD= –3.00, 95% CI [-3.61, -2.40], p<0.001) were significantly reduced in favor of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n=5 RCTs, MD=–3.73 min, 95% CI [–14.65, 7.18], p=0.50). No patient in both groups developed symptomatic hyponatremia (n=3 RCTs, 194 patients) or thromboembolic events (n=2 RCTs, 150 patients) Conclusion Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

higher female risk for adult glioma associated with variants in the region of CCDC26

alexandrossfakianakis shared this article with you from Inoreader Australian genome-wide association study confirms higher female risk for adult glioma associated with variants in the region of CCDC26 via Neuro-Oncology Advance Access Abstract Background Glioma accounts for approximately 80% of malignant adult brain cancer and its most common subtype, glioblastoma, has one of the lowest 5-year cancer survivals. Fifty risk-associated variants within 34 glioma genetic risk regions have been found by genome-wide association studies (GWAS) with a sex difference reported for 8q24.21 region. We conducted an Australian GWAS by glioma subtype and sex. Methods We analysed genome-wide data from the Australian Genomics and Clinical Outcomes of Glioma (AGOG) consortium for 7,573,692 single nucleotide polymorphisms (SNPs) for 560 glioma cases and 2,237 controls of European ancestry. Cases were classified as glioblastoma, non-glioblastoma, astrocytoma or oligodendroglioma Logistic regression analysis was used to assess the associations of SNPs with glioma risk by subtype and by sex. Results We replicated the previously reported glioma risk associations in the regions of 2 q33.3 C2orf80, 2q37.3 D2HGDH, 5p15.33 TERT, 7p11.2 EGFR, 8q24.21 CCDC26, 9p21.3 CDKN2BAS, 11q21 MAML2, 11q23.3 PHLDB1, 15q24.2 ETFA, 16p13.3 RHBDF1, 16p13.3 LMF1, 17p13.1 TP53, 20q13.33 RTEL and 20q13.33 GMEB2 (P<0.05). We also replicated the previously reported sex difference at 8q24.21 CCDC26 (P=0.0024) with the association being nominally significan t for both sexes (P<0.05). Conclusions Our study supports a stronger female risk association for the region 8q24.21 CCDC26 and highlights the importance of analysing glioma GWAS by sex. A better understanding of sex differences could provide biological insight into the cause of glioma with implications for prevention, risk prediction and treatment. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Molecular heterogeneity of pediatric choroid plexus carcinomas determines the distinctions in clinical course and prognosis

alexandrossfakianakis shared this article with you from Inoreader Molecular heterogeneity of pediatric choroid plexus carcinomas determines the distinctions in clinical course and prognosis via Neuro-Oncology Advance Access Abstract Background Choroid plexus carcinomas (CPCs) are rare aggressive pediatric tumors of the brain with no treatment standards. Genetic profiling of CPCs is often confined to possible association with Li–Fraumeni syndrome, though only about a half of CPCs develop from syndromic predispositions. Whole-chromosome gains and losses typical of CPCs reflect genomic instability of these tumors, but only partially explain the aggressive clinical course. Methods This retrospective study enrolled 25 pediatric patients with CPC, receiving treatment between January 2009 and June 2022. Molecular genetic testing was performed for 20 cases with available tumor tissue and encompassed mutational status, chromosomal aberrations and gene expression profiles. We analyzed several factors presumably influencing the outcomes, including molecular profiles and clinical parameters. The median follow-up constituted 5.2 years (absolute range 2.8–12.6 years ). Results All studied CPCs had smooth mutational profiles with the only recurrent event being TP53 variants, either germline or somatic, encountered in 13 cases. Unbalanced whole-chromosome aberrations, notably multiple monosomies, were highly typical. In seven tumors, chromosome losses were combined with complex genomic rearrangements: segmental gains and losses or signs of chromothripsis. This phenomenon was associated with extremely low 5-year survival: 20.0±17.9% vs. 85.7±13.2%; p=0.009. Transcriptomically, the cohort split into two polar clusters Ped_CPC1 and Ped_CPC2 differing by survival: 31.3±17.8% vs. 100%; p=0.012. Conclusion CPCs split into at least two molecular subtypes distinguished both genomically and transcriptomically. Clusterization of the tumors into Ped_CPC1 and Ped_CPC2 significantly correlates with survival. The distinct ion may prove relevant in clinical trials for dedicated and patient-oriented optimization of clinical protocols for these rare tumors. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of SARS-CoV-2 variants on inpatient clinical outcome

alexandrossfakianakis shared this article with you from Inoreader Impact of SARS-CoV-2 variants on inpatient clinical outcome via Clinical Infectious Diseases Advance Access Abstract Background Prior observation has shown differences in COVID-19 hospitalization risk between SARS-CoV-2 variants, but limited information describes hospitalization outcomes. Methods Inpatients with COVID-19 at five hospitals in the eastern United States were included if they had hypoxia, tachypnea, tachycardia, or fever, and SARS-CoV-2 variant data, determined from whole genome sequencing or local surveillance inference. Analyses were stratified by history of SARS-CoV-2 vaccination or infection. The average effect of SARS-CoV-2 variant on 28-day risk of severe disease, defined by advanced respiratory support needs, or death was evaluated using models weighted on propensity scores derived from baseline clinical features. Results Severe disease or death within 28 days occurred for 977 (29%) of 3,369 unvaccinated patients and 269 (22%) of 1,230 patients with history of vaccination or prior SARS-CoV-2 infection. Among unvac cinated patients, the relative risk of severe disease or death for Delta variant compared to ancestral lineages was 1.30 (95% confidence interval [CI] 1.11-1.49). Compared to Delta, this risk for Omicron patients was 0.72 (95% CI 0.59-0.88) and compared to ancestral lineages was 0.94 (95% CI 0.78-1.1). Among Omicron and Delta infections, patients with history of vaccination or prior SARS-CoV-2 infection had half the risk of severe disease or death (adjusted hazard ratio 0.40, 95% CI 0.30-0.54), but no significant outcome difference by variant. Conclusions Although risk of severe disease or death for unvaccinated inpatients with Omicron was lower than Delta, it was similar to ancestral lineages. Severe outcomes were less common in vaccinated inpatients, with no difference between Delta and Omicron infections. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Possible transmission of COVID‐19 epidemic by a dog as a passive mechanical carrier of SARS‐CoV‐2, Chongqing, China, 2022

alexandrossfakianakis shared this article with you from Inoreader Possible transmission of COVID‐19 epidemic by a dog as a passive mechanical carrier of SARS‐CoV‐2, Chongqing, China, 2022 via Journal of Medical Virology Abstract An outbreak of COVID-19 was reported in Yongchuan district of Chongqing, China in March 2022, while the source was unknown. We aimed to investigate the origin and transmission route of the virus in the outbreak. We conducted field investigations for all cases and collected their epidemiological and clinical data. We performed gene sequencing and phylogenetic analysis for the cases, and draw the epidemic curve and the case relationship chart to analyze interactions and possible transmission mode of the outbreak. A total of 11 cases of COVID-19, including 5 patients and 6 asymptomatic cases were laboratory-confirmed in the outbreak. The branch of the virus was Omicron BA.2 which was introduced into Yongchuan district by a traveler in early March. Patient F and asymptomatic case G had never contact with other positive infected individuals, but close contact with their pet dog that sniffed the discarded cigarette butts and stepped on the sputum of patient B. Laboratory test results sh owed that the dog hair and kennel were positive for SARS-CoV-2, and the ten isolates were highly homologous to an epidemic strain in a province of China. The investigation suggested that the contaminated dog by SARS-CoV-2 can act as a passive mechanical carrier of the virus and might transmit the virus to humans through close contact. Our findings suggest that during the COVID-19 pandemic, increasing hygiene measures and hand washing after close contact with pets is essential to minimize the risk of community spread of the virus. This article is protected by copyright. All rights reserved. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Synthetic Contrasts in Musculoskeletal MRI: A Review

alexandrossfakianakis shared this article with you from Inoreader Synthetic Contrasts in Musculoskeletal MRI: A Review via Investigative Radiology - Current Issue This review summarizes the existing techniques and methods used to generate synthetic contrasts from magnetic resonance imaging data focusing on musculoskeletal magnetic resonance imaging. To that end, the different approaches were categorized into 3 different methodological groups: mathematical image transformation, physics-based, and data-driven approaches. Each group is characterized, followed by examples and a brief overview of their clinical validation, if present. Finally, we will discuss the advantages, disadvantages, and caveats of synthetic contrasts, focusing on the preservation of im age information, validation, and aspects of the clinical workflow. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Modern Low-Field MRI of the Musculoskeletal System: Practice Considerations, Opportunities, and Challenges

alexandrossfakianakis shared this article with you from Inoreader Modern Low-Field MRI of the Musculoskeletal System: Practice Considerations, Opportunities, and Challenges via Investigative Radiology - Current Issue Magnetic resonance imaging (MRI) provides essential information for diagnosing and treating musculoskeletal disorders. Although most musculoskeletal MRI examinations are performed at 1.5 and 3.0 T, modern low-field MRI systems offer new opportunities for affordable MRI worldwide. In 2021, a 0.55 T modern low-field, whole-body MRI system with an 80-cm-wide bore was introduced for clinical use in the United States and Europe. Compared with current higher-field-strength MRI systems, the 0.55 T MRI system has a lower total ownership cost, including purchase price, installation, and maintenance. Althou gh signal-to-noise ratios scale with field strength, modern signal transmission and receiver chains improve signal yield compared with older low-field magnetic resonance scanner generations. Advanced radiofrequency coils permit short echo spacing and overall compacter echo trains than previously possible. Deep learning–based advanced image reconstruction algorithms provide substantial improvements in perceived signal-to-noise ratios, contrast, and spatial resolution. Musculoskeletal tissue contrast evolutions behave differently at 0.55 T, which requires careful consideration when designing pulse sequences. Similar to other field strengths, parallel imaging and simultaneous multislice acquisition techniques are vital for efficient musculoskeletal MRI acquisitions. Pliable receiver coils with a more cost-effective design offer a path to more affordable surface coils and improve image quality. Whereas fat suppression is inherently more challenging at lower field strengths, chemical s hift selective fat suppression is reliable and homogeneous with modern low-field MRI technology. Dixon-based gradient echo pulse sequences provide efficient and reliable multicontrast options, including postcontrast MRI. Metal artifact reduction MRI benefits substantially from the lower field strength, including slice encoding for metal artifact correction for effective metal artifact reduction of high-susceptibility metallic implants. Wide-bore scanner designs offer exciting opportunities for interventional MRI. This review provides an overview of the economical aspects, signal and image quality considerations, technological components and coils, musculoskeletal tissue relaxation times, and image contrast of modern low-field MRI and discusses the mainstream and new applications, challenges, and opportunities of musculoskeletal MRI. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.