Faculty Bibliography

Oral cancer patients experience pain at the site of the primary cancer. Patients with metastatic oral cancers report greater pain. Lack of pain identifies patients at low risk of metastasis with sensitivity = 0.94 and negative predictive value = 0.89. In the same cohort, sensitivity and negative predictive value of depth of invasion, currently the best predictor, were 0.95 and 0.92, respectively. Cancer pain is attributed to cancer-derived mediators that sensitize neurons and is associated with increased neuronal density. We hypothesized that pain mediators would be overexpressed in metastatic cancers from patients reporting high pain. We identified 40 genes overexpressed in metastatic cancers from patients reporting high pain (n=5) compared to N0 cancers (n=10) and normal tissue (n=5). The genes are enriched for functions in extracellular matrix organization and angiogenesis. They have oncogenic and neuronal functions and are reported in exosomes. Hierarchical clustering according to expression of neurotrophic and axon guidance genes also separated cancers according to pain and nodal status. Depletion of exosomes from cancer cell line supernatant reduced nociceptive behavior in a paw withdrawal assay, supporting a role for exosomes in cancer pain. The identified genes and exosomes are potential therapeutic targets for stopping cancer and attenuating pain.

BACKGROUND:The purpose of this study was to compare the commonly used fat grafting techniques-Telfa rolling and a closed washing system-in breast reconstruction patients. METHODS:Consecutive patients undergoing fat grafting were retrospectively reviewed and grouped by technique. Patients with less than 180 days of follow-up were excluded. Demographics, operative details, and complications were compared using univariate analysis with significance set at p < 0.05. RESULTS:Between January of 2013 and September of 2017, 186 women underwent a total of 319 fat grafting procedures. There was no difference in demographics, number of procedures performed, volume of fat grafted, and number of days after reconstruction that fat grafting was performed between groups (p > 0.05). Telfa rolling patients had longer operative times for second fat grafting procedures (implant exchange often completed prior) [100.0 minutes (range, 60.0 to 150.0 minutes) versus 79.0 minutes (range, 64.0 to 94.0 minutes); p = 0.03]. Telfa rolling breasts had more palpable masses requiring imaging (26.0 percent versus 14.4 percent; p = 0.01) and an increased incidence of fat necrosis (20.6 percent versus 8.0 percent; p < 0.01). The closed washing system was found to be an independent predictor of decreased rates of imaging-confirmed fat necrosis (OR, 0.29; p = 0.048). There was no difference in fat necrosis excision or cancer recurrence between the groups. CONCLUSION/CONCLUSIONS:The closed washing system was independently associated with decreased rates of imaging-confirmed fat necrosis compared to Telfa rolling without an increase in other complications. CLINICAL QUESTION/LEVEL OF EVIDENCE/METHODS:Therapeutic, III.

PURPOSE/OBJECTIVE:The purpose of the present study was to compare the severity of craniomaxillofacial injuries between accidents involving motorized and nonmotorized standup scooters. MATERIALS AND METHODS/METHODS:We performed a 20-year cross-sectional study of the National Electronic Injury Surveillance System. Injuries from powered and unpowered standup scooters were included in the present study if they had involved the head, face, eyeball, mouth, or ear. Study predictors were obtained from both patient and injury characteristics. The study outcome was the probability of hospital admission from the emergency department. A multiple logistic regression model was created to model the probability of admission using all significant univariate predictors. RESULTS:A total of 11,916 records were included in the present study, of which 9.5% had involved motorized scooters. The proportion of motorized injuries more than tripled from 2014 (5.8%) to 2018 (22.1%). Motorized injuries had occurred more often in older individuals (24.0 vs 8.5 years; P < .01). A greater proportion of motorized injuries involved the head (55.0 vs 36.9%; P < .01) and had resulted in concussion (11.5 vs 5.6%; P < .01), fractures (6.7 vs 2.0%; P < .01), and other nonspecified internal organ injuries (31.1 vs 19.6%; P < .01). Motorized scooters had resulted in more than triple the admission rate compared with nonmotorized scooters (13.9 vs 3.7%; P < .01). After controlling for potential confounders, injuries from motorized scooters still had double odds of hospital admission (odds ratio, 2.03; P < .01). CONCLUSIONS:Motorized standup scooters appear to cause more severe injuries than conventional nonmotorized scooters. The recent growth of rentable electric scooters could pose a future public health concern. Ride-sharing companies should ensure that customers are capable of safely and responsibly operating these vehicles.

We present a case report of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) that was mistaken as disseminated silicosis after multiple percutaneous biopsies. The correct diagnosis of BIA-ALCL was confirmed only after a pathologic examination of the capsulectomy specimens. A review of the literature of percutaneous biopsies of ALCL showed a diagnostic yield of only 63%. Although percutaneous biopsies may be facile to obtain and may be diagnostic, in our case, biopsies were not sufficient to exclude the diagnosis of BIA-ALCL.

BACKGROUND:Previous studies have provided recommendations for increasing female leadership in academic plastic surgery. This study quantifies the extent to which these recommendations have been met in plastic surgery residency programs and identifies remaining institutional barriers to the advancement of women in academic plastic surgery. METHODS:An electronic survey was designed to quantify select recommendations for promoting female leadership in academic plastic surgery. The survey was distributed to either a female faculty member or a male program director at each academic plastic surgery program. An optional phone interview discussing current barriers to women's advancement followed the survey. RESULTS:Forty-nine of 92 survey recipients participated (52.7 percent response rate). Women constituted 25 percent of faculty, 22 percent of program directors, and 20 percent of program leaders of participating programs. Programs on average provided three of 11 resources. Programs with female leaders provided 6.20 resources versus 2.28 resources at departments with male chairs (p = 0.015). Programs with female program directors provided 5.50 resources versus 2.18 resources at programs with male program directors (p = 0.008). Of the 49 survey respondents, nine completed the interview (18.4 percent completion rate). The most frequently identified barriers to aspiring women leaders were opaque promotion criteria (cited by 77.8 percent of interviewees), motherhood bias (77.8 percent), and unequal recruitment practices (55.6 percent). CONCLUSIONS:The presence of a female chair or program director is associated with a greater quantity of resources for promoting female leaders. Remaining barriers to women seeking academic leadership positions include compensation and promotion disparities, motherhood bias, and unequal recruitment practices.

OBJECTIVE:To synthesize a zirconia toughened alumina (ZTA) composite with 70% alumina reinforced by 30% zirconia for dental applications and to characterize its microstructure and optical properties for comparison with the isolated counterpart materials and a first-generation 3Y-TZP. METHODS:Disc-shaped specimens were divided in four groups (n = 70/material): (1) 3YSB-E (first generation 3Y-TZP), (2) Zpex (second generation 3Y-TZP), (3) alumina, and (4) ZTA-Zpex 70/30. After synthesis, ceramic powders were pressed, and green-body samples sintered following a predetermined protocol. Specimens were polished to obtain a mirror surface finish. Apparent density was measured by Archimedes principle. X-ray diffraction (XRD) and scanning electron microscope (SEM) were used to characterize the crystalline content and microstructure. Reflectance tests were performed to determine the contrast-ratio (CR) and translucency-parameter (TP). Mechanical properties were assessed by biaxial flexural strength (BFS) test. All analyses were conducted before and after artificial aging (20 h, 134 °C, 2.2 bar). Optical parameters were evaluated through repeated-measures analysis of variance and Tukey tests (p < 0.05). BFS data were analyzed using Weibull statistics (95% CI). RESULTS:High density values (95-99%) were found for all ceramic materials and SEM images exhibited a dense microstructure. While XRD patterns revealed the preservation of crystalline content in the ZTA composite, an increase in the monoclinic peak was observed for pure zirconias after aging. Significantly higher CR and lower TP values were observed for the ZTA composite, followed by alumina, 3YSB-E, and Zpex. The highest characteristic stress was recorded for 3YSB-E, followed by intermediate values between ZTA and Zpex, and the lowest for alumina. Aging affected the optical and mechanical properties of both zirconias, while remained stable for ZTA composite and alumina. SIGNIFICANCE/CONCLUSIONS:The synthesis of experimental 70-30% ZTA composite was successful and its relevance for dental applications relies on its higher masking ability, aging resistance, and strength similar to zirconia.