Faculty Bibliography

PURPOSE/OBJECTIVE:Hemorrhagic radiation cystitis (HRC), a complication of pelvic radiation therapy, results from hypoxic and ischemic injury and causes urinary symptoms like hematuria, dysuria, frequency, urgency, and retention. Hyperbaric Oxygen Therapy (HBOT), where patients breathe 100% oxygen at increased atmospheric pressure, enhances tissue oxygenation, promoting neovascularization and reducing inflammation. The optimal pressure remains unclear, though pressures above 1.41 ATA are efficacious, with higher pressures increasing side effect risks. This study compares the efficacy and side effects of 2.0 versus 2.5 ATA therapy at two sites. MATERIALS AND METHODS/METHODS:A retrospective chart review of 93 patients treated for HRC at two sites was conducted. Data on demographics, efficacy (symptom reduction), and side effects were analyzed using GraphPad Prism. Chi-squared and Mann-Whitney tests were used for statistical analysis. Mixed effects logistic regression models were used. RESULTS AND CONCLUSIONS/CONCLUSIONS:Fewer patients treated at 2.5 ATA experienced gross hematuria within 1-year post-therapy compared to those treated at 2.0 ATA (p < 0.05). However, time to hematuria recurrence showed no difference between the groups (10.2 vs. 9.6 months). No difference was observed in other urinary symptoms. Adverse events were increased at 2.5 ATA when analyzed with a mixed effects logistic regression model. Other treatment parameters, including treatment number and duration, were similar across groups. These findings suggest an association between 2.5 ATA treatment and lower rates of hematuria recurrence, but further randomized studies are necessary to determine causality. Future studies should also assess quality of life and explore variations in treatment protocol for efficacy and safety. CLINICAL TRIAL REGISTRATION/BACKGROUND:As this is a retrospective study, no clinical trial registration is necessary.

BACKGROUND:Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition often requiring surgical intervention for definitive treatment. Previous studies evaluated post-surgical outcomes, but no standardization exists for collection and nomenclature for HS surgical outcomes. OBJECTIVE:To characterize and define surgical outcome terminology. METHODS:A modified Delphi protocol was used to reach consensus on data to collect and terms to describe outcomes following HS surgical procedures. A five-member steering committee created preliminary definitions and surveys which were distributed via Qualtrics to a group of international HS experts. A nine-point Likert scale was used and a score of at least 7 was needed for an item to reach agreement. RESULTS:Twenty-five dermatologists and general and plastic surgeons participated in the Delphi study. Following two rounds of surveys and feedback, the consensus terminology to describe outcomes included surgical site and regional persistence and progression. Consensus was also reached on key features to report as part of each outcome. LIMITATIONS/CONCLUSIONS:Limitations include narrow scope and small number of participants from limited geographical areas. CONCLUSION/CONCLUSIONS:Surgery persistence and progression definitions were agreed upon by a group of international HS experts. This consensus is a first step towards standardizing terminology and reporting for HS surgical outcomes.

GENERAL PURPOSE/OBJECTIVE:To provide an evidence-based review of strategies for the prevention and management of wounds and postoperative scars following microsurgical autologous breast reconstruction. TARGET AUDIENCE/BACKGROUND:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES/OBJECTIVE:After participating in this educational activity, the participant will: 1. Identify operative considerations to promote wound healing in microsurgical autologous breast reconstruction. 2. Synthesize management strategies for major flap complications following microsurgical autologous breast reconstruction. 3. Explain features in the assessment, prevention, and treatment of scars following microsurgical autologous breast reconstruction.

INTRODUCTION/BACKGROUND:Wound care is an essential discipline in plastic surgery, especially as the prevalence of chronic wounds, such as pressure injuries, is increasing. The escalating volume of patient data and the numerous variables influencing wound outcomes are making traditional manual chart reviews in wound care and research increasingly complex and burdensome. The emergence of Natural Language Processing (NLP) software based on large language models (LLMs) such as ChatGPT presents an opportunity to automate the data extraction process. This study harnesses the capabilities of ChatGPT, hosted by our medical center's secure, private Azure OpenAI service, to automatically extract and process variables from patient charts following sacral wound visits. We assess ChatGPT's potential to revolutionize chart review through improved data retrieval accuracy and efficiency. METHODS:We evaluated the use of the medical center's internal ChatGPT in chart review. ChatGPT and a Python script were integrated into the existing chart review process for patients with sacral wounds from 2 hospital cohorts to extract and format variables related to wound care. Metrics include time taken for review, accuracy of extracted information, and assessment of ChatGPT-generated insights. RESULTS:ChatGPT reduced the average time per chart review from 7.56 minutes with the manual method to 1.03 minutes using ChatGPT. Furthermore, it achieved a 0.957 overall accuracy rate compared to manual chart review, ranging from 0.747 to 0.986 across extracted data elements. ChatGPT was also able to synthesize accurate narrative descriptions of patient wounds. CONCLUSIONS:We highlight ChatGPT's potential to enhance speed and precision of chart review in the context of both clinical care and wound care research, offering valuable implications for integration of artificial intelligence in healthcare workflows.

OBJECTIVES/UNASSIGNED:Hyperbaric Oxygen (HBO₂) Therapy has been associated with some risks and adverse events. Previous studies examining otologic complications from HBO₂ therapy vary in their reported incidence of adverse events. This study aims to systematically review the otologic complications associated with HBO₂ therapy and investigate contributing risk and protective factors. REVIEW METHOD/UNASSIGNED:A systematic review was conducted to identify studies reporting otologic adverse effects due to HBO₂ therapy. Utilizing PRISMA 2020 guidelines, titles and abstracts were screened before conducting a full-text analysis. Studies reporting the incidence of otologic complications and studies reporting risk or protective factors for otologic complications were included. RESULTS/UNASSIGNED:A search for articles on HBO₂ therapy otologic complications yielded 2,027 articles, of which 183 were relevant to the research question. Ultimately, 54 studies met the inclusion criteria. Fifteen percent of the 18,284 patients treated with HBO₂ therapy experienced adverse events. Of the middle ear barotrauma (MEB) that occurred, 42.8% was mild, and 6.4% was severe. The major risk factors were increasing age, female sex, head and neck pathology, sensory neuropathy, and pre-treatment difficulty equalizing ear pressure. The main protective factor was experience with effective equalization techniques. CONCLUSIONS/UNASSIGNED:15% of patients experienced otologic complications due to HBO₂ therapy. Older age, female sex, and a history of head and neck or neurological conditions may increase the risk for MEB. Increased monitoring of higher-risk patients during initial treatment sessions and proper equalization techniques may help prevent MEB during HBO₂ therapy. This is the most comprehensive systematic review on the topic to date.

Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin disease characterized by keratinized epithelial tunnels that grow deeply into the dermis. Here, we examined the immune microenvironment within human HS lesions. Multi-omics profiling and multiplexed imaging identified tertiary lymphoid structures (TLSs) near HS tunnels. These TLSs were enriched with proliferative T cells, including follicular helper (Tfh), regulatory (Treg), and pathogenic T cells (IL17A+ and IFNG+), alongside extensive clonal expansion of plasma cells producing antibodies reactive to keratinocytes. HS fibroblasts express CXCL13 or CCL19 in response to immune cytokines. Using a microfluidic system to mimic TLS on a chip, we found that HS fibroblasts critically orchestrated lymphocyte aggregation via tumor necrosis factor alpha (TNF-α)-CXCL13 and TNF-α-CCL19 feedback loops with B and T cells, respectively; early TNF-α blockade suppressed aggregate initiation. Our findings provide insights into TLS formation in the skin, suggest therapeutic avenues for HS, and reveal mechanisms that may apply to other autoimmune settings, including Crohn's disease.

BACKGROUND/UNASSIGNED:Our objective is to evaluate the utilization fraction (UF) of surgical instruments during a commonly performed ambulatory hand surgery case as an avenue for cost reduction, increased operating room efficiency, and systems quality improvement. METHODS/UNASSIGNED:The total number of instruments opened at the start of the case was recorded followed by instruments being divided into those used and not used during the procedure. Total sterile processing costs were estimated at $1.56 per instrument according to data from our institution's central sterilization processing (CSP) department. RESULTS/UNASSIGNED:Nineteen hand procedures performed by 2 surgeons were included in this study. An average of 120.1 ± 10.9 instruments were opened at the start of each case, while an average of 12.6 ± 5.4 instruments were used per case (Figure 1). This yielded an UF of 10.7% ± 4.8%. Using our internal CSP estimate, we calculated an annual cost of $16 863 to reprocess the current hand tray (Figure 2). Using literature data, this cost ranged from $5 513 to $34 484 annually. The same cost calculations were performed for the theoretical optimized tray (incorporating instruments used at least 20% of the time when opened) containing 23.2 instruments. The annual reprocessing cost of this new tray according to CSP data was $3 260, demonstrating a cost-reduction of $13 603 or 80.7% (Figure 2). CONCLUSIONS/UNASSIGNED:Evaluation of pre- and peri-operative processes is a valuable technique to mitigate increasing healthcare costs and reduce unnecessary healthcare spending, with broad applicability to multiple surgical subspecialties and procedures.