Citations

ABSTRACTBackgroundTactile sensory recovery in autologous breast reconstruction (ABR) has been shown to prevent injuries and improve quality of life. However, the studies comparing neurotized versus non‐neurotized outcomes are still controversial due to methodological heterogeneity. This review uses consistent and objective outcomes to evaluate the current evidence's qualitative characteristics and quantitative tactile sensory recovery.MethodsWe conducted a systematic electronic literature search from database inception through 10 February 2024, of the following databases: PubMed, Ovid MEDLINE, Embase, SCOPUS, and CINAHL to identify all studies reporting outcomes of tactile sensory recovery using the Semmes‐Weinstein Measuring scale in free‐flap ABR comparing neurotization versus non‐neurotization. The SWM scale score, demographic characteristics, and surgical features were extracted from each study. Due to the data heterogeneity within the studies, we transformed the data into means and pooled the qualitative information.ResultsWe identified 264 articles. After thorough screening, 12 fulfilled the inclusion criteria and were included in the qualitative synthesis. Finally, 7 were quantitatively analyzed with a total of 251 breasts that underwent ABR with free flap neurotization and 244 breasts without neurotization. This revealed a mean SWM score difference of −0.67 and a significant p‐value < 0.05. A subgroup DIEP flap analysis performed for 177 neurotized compared to 175 non‐eurotized flaps yielded a significant mean difference of −0.86 p < 0.05. There were no significant differences between groups in age (48.8 vs. 49.8, p = 0.5), history of chemotherapy (72 vs. 74, p = 0.91), radiotherapy (61 vs. 56, p = 0.84), or follow‐up time (21.85 vs. 25.09 months, p = < 0.05) that could have influenced tactile sensory recovery.ConclusionNeurotization in free‐flap ABR could allow better tactile sensory recovery than the spontaneous sensation gained without it. The additional surgical time required for coaptation is short, and no studies have reported associated complications, making it a safe procedure that can potentially improve patients´ quality of life. Nonetheless, higher‐quality studies, such as randomized control trials with standardized sensation testing and more rigorous methodologies, are needed before making final clinical recommendations.

Abstract Craniopharyngiomas are rare parasellar tumors, and papillary craniopharyngiomas (PCPs) represent 8 to 20% of cases. Interim analysis of retrospective data collected from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID). Fourteen U.S.-based academic skull base centers between 2011 and 2023. Patients with PCPs. Demographic, imaging, surgical, and outcome variables. Ninety-nine patients with PCPs were included. The mean age was 51.8 ± 14.7, and 57.6% were male. Most tumors showed mixed cystic/solid components (67.5%), were transinfundibular (50.0%), and were treated with an endoscopic endonasal approach (74.5%), with 51.1% demonstrating gross total resection (GTR). Pituitary stalk was preserved in 51.9%. Permanent arginine vasopressin deficiency was seen in 67.1% and was associated with pituitary stalk sacrifice (p = 0.003). Cerebrospinal fluid leak was the most common nonendocrine postsurgical, 30-day complication (9.1%), reason for return to the operating room (3.1%), and reason for 90-day readmission (8.1%). Most patients (63.9%) received no adjuvant therapy; GTR was associated with decreased radiotherapy use (p = 0.0001). BRAFV600E mutation was detected in 64/69 tumors tested, although only one patient was treated with a BRAF inhibitor. A mean follow-up of 12.3 ± 14.6 months was seen for the group. RAPID consortium enabled the largest real-world clinical information dataset for PCPs. Early findings support that GTR and stalk preservation are important to outcomes. Iterative analysis and discussion of data led to the generation of a framework for future studies to fully leverage the capabilities of multicenter registries.

Background Dermatofibrosarcoma protuberans (DFSP) arising in the vulvar and perivulvar region poses unique challenges to the dermatologic surgeon. The potential for broad subclinical extension and involvement of deeper and high-risk functional structures requires a strong knowledge of relevant anatomy. Careful considerations are required for preoperative arrangements, surgical day preparations, and postoperative surveillance to improve treatment outcomes and patient experiences. Objective The authors aim to provide a practical guide for the dermatologic surgeon, which outlines surgical planning and management recommendations for vulvar DFSP. Emphasis on pelvic anatomy through cadaveric and patient images as well as anatomical illustrations will be included. Materials and Methods A literature review was performed to identify evidence-based management recommendations for vulvar DFSP. Authors share anecdotal perioperative recommendations for optimizing the patient experience. A detailed pelvic dissection of a female cadaver was performed for anatomical depiction of relevant high-risk structures. Illustrations of sensory nerve distributions were created for reference. Conclusion Vulvar DFSP is a challenging cutaneous tumor in a sensitive anatomical location. As Mohs surgery offers clear advantages over wide local excision, the authors provide dermatologic surgeons with detailed anatomy review resources as well as recommendations and considerations for management and perioperative planning for this specialized site.

Abstract Rationale Pulmonary hypertension (PH) is associated with significant morbidity and mortality. Ground-glass opacities (GGOs) are common in Group 1 PH, but their clinical significance is unclear. Objectives We sought to characterize the clinical features and outcomes of patients with Group 1 PH with and without GGOs in the PVDOMICS study, a prospective multicenter cohort study aimed at deep phenotyping PH. Methods Patients with incident and prevalent PH were enrolled across seven U.S. centers. We included patients with Group 1 PH and excluded those with parenchymal lung disease or without chest imaging, resulting in a cohort of 242 patients. Results GGOs were common among patients with Group 1 PH (43% prevalence), associated with female sex, younger age, prostanoid use, and longer disease duration. GGOs were more common among patients with familial pulmonary arterial hypertension and pulmonary veno-occlusive disease. GGOs were associated with established markers of disease severity, including echocardiographic (right ventricular systolic pressure and tricuspid annular plane systolic excursion), biomarkers (N-terminal pro B-type natriuretic peptide), and worse hemodynamics (higher mean pulmonary artery pressure, pulmonary vascular resistance, and pulmonary artery wedge pressure). GGOs were associated with worse transplant-free survival (hazard ratio, 2.49; 95% confidence interval = 1.43–4.32; P = 0.001) and had independent prognostic value for predicting transplant-free survival after adjusting for European Society of Cardiology and European Respiratory Society risk stratification (hazard ratio, 2.19; 95% confidence interval = 1.20–3.99; P = 0.01). Conclusions Overall, GGOs were associated with specific clinical characteristics and disease phenotypes, as well as worse hemodynamics, longer disease duration, prostanoid use, and worse survival. Future studies evaluating the pathophysiology and “omic” correlates of GGOs are warranted. Clinical trial registered with www.clinicaltrials.gov (NCT02980887).

BACKGROUND: Older adults value the maintenance of function as an outcome of surgery, which can be evaluated by subjective perception and objective performance. The aims of this study were to explore whether these perceptions correlate with a decline in function, as measured by decreased ability to perform activities of daily living (ADLs), and to identify risk factors associated with worsened 30-day postoperative perceived physical function (PPF) in patients aged 80 years and older. STUDY DESIGN: American College of Surgeons NSQIP Geriatric Surgery Verification Pilot Program data (2015 to 2017) were used for patients aged 80 years and older. Chi-square tests were used to examine the concordance between 30-day outcomes of PPF and the quantified performance of ADLs. Multivariable logistic regression models identified risks associated with worsened PPF 30 days postoperatively. RESULTS: A total of 5,464 patients from 16 hospitals were included. The mean age was 85.7 years and 63% of participants were women. At 30 days postoperatively, 33% reported functional decline, whereas 28% had worsened quantified ADL performance (K = 0.25). Twenty-one percent of patients without quantified decline reported worsened PPF. Risk factors for worsened PPF were found for patient (eg American Society of Anesthesiologists class IV and V (odds ratio [OR] 2.2, 95% CI 1.5 to 3.2)), procedure (eg orthopaedic [OR 1.7, 95% CI 1.2 to 2.4]), and older adult-specific characteristics (eg preoperative fall [OR 1.9, 95% CI 1.2 to 2.9]). CONCLUSIONS: At 30 days postsurgery, there was discordance between quantified ADL performance and PPF in patients aged 80 years and older. Although assessing ADLs is a common approach to detect functional decline and loss of independence, directly asking patients about their PPF can serve as an additional important method for identifying functional decline, ensuring that the evaluation remains patient centered.

The Doppler twinkling artifact (TA) plays a crucial role in detecting some biopsy markers including those made of polymethyl methacrylate (PMMA), facilitating precise lymph node localization in diagnostic and therapeutic procedures. This study presents comprehensive signal processing analysis methods to quantify and characterize the TA phenomenon using raw, per-channel radiofrequency (RF) data acquired from PMMA markers scanned with an L7-4 linear array transducer. We evaluated signals at different stages along the image reconstruction pipeline including (1) beamforming, (2) beamformed RF signal conversion into in-phase/quadrature (IQ) signals, and (3) Doppler velocity calculations and image reconstruction. We analyzed changes of pulses within an ensemble and between ensembles (i.e., frames). We also evaluated the impact of wall filters with various cutoff frequencies on color and power Doppler image reconstruction. Comparative analysis between PMMA markers and a non-twinkling control sample demonstrated distinct TA signatures or lack thereof in color and power Doppler images. The IQ data from PMMA marker locations exhibiting TA signatures showed substantially higher variability compared to non-twinkling samples, with standard deviations approximately 20 times higher between ensembles and 5 times higher within ensembles. This quantitative analysis framework provides valuable insight into the TA signal, potentially leading to more reliable and accurate diagnostic interpretations.

The color Doppler twinkling artifact has been attributed to existing microbubbles or cavitation has been reported for objects with rough surfaces like kidney stones, sandpaper, and polymethyl methacrylate (PMMA) bone cement. Passive cavitation detection (PCD) is a method for determining the presence of bubble oscillation from subharmonic, ultraharmonic, and inharmonic components in the Fourier domain. We evaluated multiple PMMA samples with varying twinkling amounts as well as a non-twinkling metal rod. Ultrasound scans were conducted using a Verasonics L11-4v probe on a V1 system from 3–9 MHz Doppler transmit frequency. A Sonic Concepts Y-107 PCD probe connected to a JSR DPR300 pulser/receiver collected data during Doppler ultrasound transmission. The Fourier spectra showed increased magnitude trends in the midband frequency range between the fundamental, f, and second harmonic, 2f, on the twinkling samples compared to non-twinkling metal rod. The midband increase was highest at frequencies that showed the most twinkling. This work indicates that the presence of color Doppler twinkling signal on PMMA gives rise to additional peaks in the Fourier domain, particularly in the midband range. Additionally, as there were no distinct subharmonic peaks, the increased midband magnitudes could be due to cavitation on the rough surfaces of the PMMA.

Abstract Background: Understanding of the diagnosis and treatment of adults with community-acquired pneumonia (CAP) has evolved thanks to new evidence, experience, and emerging technologies. This document updates evidence-based clinical practice guidelines on four key questions for the diagnosis and management of adult patients with CAP. Methods: A multidisciplinary panel integrated systematic reviews of comparative evidence with other relevant research and clinical experience, then applied Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology to produce recommendations using the Evidence to Decision Framework. Results: The panel formulated clinical recommendations that address questions related to CAP, including lung ultrasound for diagnosis, empiric antibacterial therapy if a test for a respiratory virus is positive, antibiotic duration, and the use of systemic corticosteroids. Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with CAP.