Citations

Abstract Classically described repairs for helical rim defects include granulation, linear closure, wedge repair, full-thickness skin grafts, helical rim advancement flaps, and two-stage interpolation flaps. The bilateral bidirectional O to Z rotation flap (O to Z flap) is commonly used for large defects on the scalp. The purpose of this study is to examine the clinical and cosmetic outcomes of O to Z flap repairs to the helical rim. The flap was created by incising above and below the defect along the helical rim on opposite sides of the defect to the depth of the perichondrium. Back cuts were performed to facilitate movement along with extensive undermining. The bilateral flaps were rotated into the defect from either end meeting in the defect middle and sutured into place with a running 5–0 FAG. In total, 50 O to Z flap repairs for helical rim defects following Mohs micrographic surgery were performed. Defect depths ranged from subcutaneous fat to through cartilage. The defect size ranged from 0.9 × 0.7 cm to 2.5 × 1.4 cm. The flap repair size ranged from 1.5 × 1.2 cm to 5.1 × 2.1 cm (average size 5.1 cm2). The median follow-up was 6 weeks (range 2 weeks to 2 years). Complications were as follows: 4% (2 of 50) of cases had bleeding requiring intervention, 16% (8 of 50) of cases had partial superficial flap necrosis, and 22% (11 of 50) of cases had mild persistent tenderness at 6 weeks. Cosmetic outcomes were graded on a scale of poor, acceptable, good or excellent. Overall, 78% (39 of 50) were rated good to excellent, 20% (10 of 50) were rated acceptable, and 2% (1 of 50) were rated poor, but did not require revision. The O to Z flap is a reliable repair for helical rim defects. Flap downsides include persistent cartilage tenderness and risk of minor flap necrosis.

Objectives: To summarize the current evidence for radiation therapy (RT) in the prevention and treatment of heterotopic ossification (HO), including patient selection, optimal RT technique, and associated risks. Methods: This multispecialty-led committee includes radiation oncologists, rheumatologists, orthopedic surgeons, and physical medicine/rehabilitation physicians. Using the population, intervention, comparator, outcome, timing and study design (PICOTS) framework, evidence regarding treatment outcomes was assessed using Cochrane and PRISMA methodology. Eligible studies included prospective and retrospective studies published between January 1, 1980, and November 1, 2025, from Embase, Medline, and PubMed databases. Of the 197 articles identified using the search strategy, 83 were selected for inclusion as evidence, including 27 well-designed studies (phase II randomized and phase III), 16 moderately well-designed studies that account for most common biases (matched cohort and phase II studies), 31 studies with design limitations (retrospective reviews), 2 supplemental studies (not useful as primary evidence), and 7 meta-analyses. Additional studies were included to provide context and were not used to guide recommendations. Well-established RAND-UCLA consensus methodology (modified Delphi) was used to rate the appropriateness of the treatment options. Results: The results of this analysis demonstrate that in appropriately selected patients, RT is an effective and safe therapy for prophylaxis of HO formation. Conclusions: This systematic review provides consensus guidelines for the use of RT as prophylaxis of HO based on current peer-reviewed evidence in the literature.

Through a Delphi process, all 33 panelists reached consensus on topics relating to MRI reporting of knee meniscus lesions, demonstrating that interdisciplinary and multi-institutional standardization is possible.

Abstract Workplace stress is one of the main sources of stress for adults, although physiological and cognitive factors may impact each person's stress response. Numerous studies have shown heart rate, heart rate variability, neural activity, and cognitive performance are affected by stress. Additionally, visual and auditory stimuli in one's environment have been shown to affect individuals' reaction to stressful events. To our knowledge, few studies have examined how each of these physiological and cognitive measures relate to one's perception of stress, the ability to recover from stress, and what environmental factors may help with stress recovery. Here, 80 healthy adults performed a laboratory-controlled stress induction task where they experienced and recovered from an acute psychological stressor (Trier Social Stress Test, TSST, using verbal math skills and a public presentation that was videotaped). Throughout the assessment, heart rate, heart rate variability, and neural activity were measured using wearable devices to assess changes before, during, and after the stressor. Additionally, participants were assessed their perceived stress levels at specific times throughout the assessment. After the psychological stressor, participants were randomly assigned to one of four recovery conditions within a multisensory relaxation room: Control (C), Auditory Only (A), Visual Only (V), or Combined Auditory and Visual (AV). During the stressor, anxiety, heart rate, and beta EEG power increased and high-frequency power and heart rate variability decreased, confirming participants reactivity to the stressor ( P < 0.01 for all vs. baseline). Only the V and AV conditions led to notable reductions in anxiety (15 and 17%, respectively) vs. the C condition, but these did not reach statistical significance. There was no difference between V and AV, suggesting a stronger impact of V. We observed no differences between conditions during recovery for HR and HRV. Overall, these findings suggest the visual features of the relaxation room impacted self-reported anxiety, however physiological and neurological effects did not demonstrate a statistically meaningful response.

Apply It! By reading this article, you will: • Understand how commonly used cardiorespiratory fitness prediction equations can misclassify fitness in both high-performance and clinical populations. • Learn how common prediction equations were developed and why the population of prediction equation studies matters when interpreting estimated cardiorespiratory fitness and percent-predicted values. • Recognize how to critically assess the suitability of a given cardiorespiratory fitness equation based on your client’s or patient’s characteristics.

Abstract Spatial transcriptomics has been widely applied to study the spatial distribution of cell types, cell states, and specific gene expression in tissue samples. However, we show that there is a prevalent transcript leakage problem in spatial transcriptomics data, where transcripts expressed by a cell diffuse to its neighborhood and are recurrently detected in the nearby cells. By analyzing published data sets, we show that this problem is general across data produced from different tissues and different species using different imaging-based and sequencing-based spatial transcriptomics platforms. It affects both upstream tasks such as expression quantification as well as downstream tasks such as cell-type annotation and detection of spatially-dependent gene expression. To tackle the transcript leakage problem, we propose a reference-free Bayesian model-based method, DeLeakage, which cleans up the data much more effectively than existing denoising methods. DeLeakage also improves cell-type annotation and avoids false detection of spatially dependent expression.