1
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Falade IO, Murphy AI, Switalla KM, Yin RR, Rose JA. Functional donor-site morbidity following reconstruction with pectoralis major flaps: A systematic review. JPRAS Open 2024; 39:278-290. [PMID: 38370000 PMCID: PMC10874169 DOI: 10.1016/j.jpra.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Background Pectoralis major muscle/myocutaneous flaps (PMMFs) are commonly used in reconstructive surgery, but may result in shoulder disability on the donor side. A systematic review evaluating this morbidity could be beneficial for guiding patients and providers considering this procedure. Methods In October 2022, a systematic review of studies evaluating quantitative/qualitative measures of functional morbidity after PMMF was conducted. The results were categorized into PMMF's effect on range of motion (ROM), strength, and ability to complete shoulder-related activities/quality of life. Results Eleven studies were included for analysis, which analyzed standard PMMF and two PMMF variants that spared portions of the muscle. Three of five studies demonstrated reduced shoulder ROM for standard PMMF versus controls lasting at least 4 months after head and neck reconstruction. Two of five studies, including two prospective studies demonstrated reduced shoulder strength for standard PMMF versus controls lasting at least 3 months after surgery. Five of nine studies found significant impairment in the ability to conduct shoulder-related activities, including work, up to one year postoperatively for standard PMMF versus controls. Muscle-sparing PMMF variants exhibited more promising outcomes in some categories. Conclusion Standard PMMF results in prolonged reductions in shoulder ROM and strength, which may impair patients in shoulder-related activities. Other reconstructive options should be considered in patients who frequently participate in such activities. For patients requiring PMMF, muscle-sparing PMMF variants should be considered as alternatives to the standard PMMF.
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Affiliation(s)
- Israel O. Falade
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alexander I. Murphy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kayla M. Switalla
- Medical School, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Raymond R. Yin
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - John A. Rose
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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2
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Murphy AI, O'Connell GM, Ishtihar S, Levy AS, Rohde CH. Reply: Lymphatic Microsurgical Preventative Healing Approach for the Primary Prevention of Lymphedema: A 4-Year Follow-Up. Plast Reconstr Surg 2024; 153:492e-493e. [PMID: 38266143 DOI: 10.1097/prs.0000000000011039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Alexander I Murphy
- Division of Plastic Surgery Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Gillian M O'Connell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Sherene Ishtihar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Adam S Levy
- Precision Plastic and Hand Surgery, Golden, CO
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
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3
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Clapp A, Murphy AI, Ascherman JA, Rohde CH. Contralateral prophylactic mastectomy: Weighing the risks of delayed chemotherapy, radiotherapy, and hormonal therapy. J Plast Reconstr Aesthet Surg 2024; 89:7-13. [PMID: 38118362 DOI: 10.1016/j.bjps.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/18/2023] [Accepted: 11/26/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Many patients with unilateral breast cancer opt for contralateral prophylactic mastectomy (CPM) at the time of therapeutic mastectomy (immediate CPM) or following completion of adjuvant therapy. Studies show that immediate CPM increases the risk of surgical complications related to unilateral mastectomy (UM) alone, which may lead to delays in adjuvant therapy initiation. However, it is unclear if these complications cause clinically significant delays in initiating adjuvant chemotherapy, radiotherapy, or hormonal therapy. METHODS A retrospective chart review was conducted on patients with breast cancer who underwent immediate CPM versus UM alone at Columbia University Medical Center from January 2000 to December 2020. Patient demographic and oncologic characteristics; complications; and timing of adjuvant chemotherapy, radiotherapy, and/or hormonal therapy relative to therapeutic mastectomy were collected. RESULTS In this study, 239 UM alone patients were propensity score matched to 239 immediate CPM patients. No significant difference in complication rates was found between the index and contralateral breasts in CPM patients. A similar percentage of CPM and UM patients experienced postoperative complications (19% vs. 17%, p = 0.64). No significant difference in time to adjuvant chemotherapy, radiotherapy, or hormonal therapy was found between CPM patients with complications and all CPM patients or all UM patients. CONCLUSIONS There is a lack of clear guidance for clinical decision-making regarding timing of CPM relative to adjuvant therapy. Our study suggests that immediate CPM does not significantly increase the risks of postoperative complications or complication-related delays in the initiation of adjuvant chemotherapy, radiotherapy, or hormonal therapy. This information may help patients and providers to plan, select, and schedule breast cancer treatment options.
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Affiliation(s)
- Averill Clapp
- Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Alexander I Murphy
- Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey A Ascherman
- Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Vagelos College of Physicians & Surgeons/Columbia University Irving Medical Center, New York, NY, USA
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Vagelos College of Physicians & Surgeons/Columbia University Irving Medical Center, New York, NY, USA.
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4
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Asadourian PA, Murphy AI, Diaddigo SE, LaValley MN, Marano AA, Rohde CH, Wu JK. And Then There Was One: 2021-2022 COVID-19 Single Away Rotation Policy's Impact on the Geography of the Integrated Plastic Surgery Match. Plast Reconstr Surg 2023; 151:1057e-1058e. [PMID: 37163457 DOI: 10.1097/prs.0000000000010178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Paul A Asadourian
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center New York Presbyterian Hospital, New York, NY
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5
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Levy AS, Murphy AI, Ishtihar S, Peysakhovich A, Taback B, Grant RT, Ascherman JA, Feldman S, Rohde CH. Lymphatic Microsurgical Preventive Healing Approach for the Primary Prevention of Lymphedema: A 4-Year Follow-Up. Plast Reconstr Surg 2023; 151:413-420. [PMID: 36696330 DOI: 10.1097/prs.0000000000009857] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Axillary lymph node dissection (ALND) remains the leading cause of lymphedema nationally, and there is still no cure for the disease. The lymphatic microsurgical preventive healing approach (LYMPHA) is a promising option for lymphedema prophylaxis in patients undergoing ALND, but long-term outcomes of the LYMPHA are not well established. METHODS The authors conducted a retrospective review of patients undergoing ALND at their center from November of 2012 to November of 2016 and assembled two cohorts, those who received the LYMPHA and those who did not (non-LYMPHA). Patient data were collected to evaluate lymphedema risk and long-term lymphedema incidence of each group. RESULTS Forty-five women were included in both our LYMPHA and non-LYMPHA cohorts. Mean body mass index (27.7 kg/m2 versus 29.9 kg/m2; P = 0.15) and radiation therapy rates (60.0% versus 68.9%; P = 0.51) did not differ between groups. Non-LYMPHA patients underwent complete mastectomy more frequently than LYMPHA patients (97.8% versus 77.8%; P = 0.007), but had a similar number of nodes removed during ALND (14.4 versus 15.8; P = 0.32). Median follow-up time was greater than 4 years for both LYMPHA and non-LYMPHA groups (57.0 months versus 63.0 months; P = 0.07). Overall, lymphedema incidence was 31.1% in the LYMPHA group and 33.3% in the non-LYMPHA group (P > 0.99). No significant differences in lymphedema incidences were observed between the LYMPHA and non-LYMPHA groups for patients with obesity, patients who received radiation therapy, or patients with obesity who also received radiation therapy (P > 0.05 for all subgroups). CONCLUSIONS The LYMPHA may not prevent lymphedema long-term in patients who undergo ALND. More long-term studies are needed to determine the true potential of the procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Adam S Levy
- From the Division of Plastic Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | | | | | | | - Bret Taback
- Breast Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospitaland
| | | | | | - Sheldon Feldman
- Division of Breast Surgery, Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine
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6
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Christopher AN, Patel V, Mellia JA, Morris MP, Diatta F, Murphy AI, Fischer JP. Leadership Roles, Academic Appointments, and Scholarly Activity—Does a Fellowship after Plastic Surgery Training Make a Difference? Arch Plast Surg 2022; 49:207-214. [PMID: 35832666 PMCID: PMC9045523 DOI: 10.1055/s-0042-1744418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background
Fellowship training is becoming more popular in plastic surgery, with over half of residents pursuing advanced training. Here, we investigate how clinical and research fellowship training impacts career trajectory and scholastic achievement in academic plastic surgery.
Methods
Plastic surgery faculty members, from programs recognized by the American Council of Academic Plastic Surgeons, were identified using institutional Web sites. Data extracted included faculty demographics, training history, academic positions, and research productivity. Continuous and categorical variables were compared using
t
-tests and chi-square, respectively.
Results
In total, 949 faculty members were included, with 657 (69%) having completed fellowship training. Integrated program residents were more likely to complete a fellowship when compared with independent residents (
p
< 0.0001). Fellowship trained faculty were more likely to have graduated from a higher ranked residency program, in terms of both overall and research reputation (
p
= 0.005 and
p
= 0.016, respectively). When controlling for years in practice, there was no difference found in number of publications, Hirsch index (h-index), or National Institutes of Health funding between faculty between the two cohorts (
p
> 0.05). In a subanalysis comparing hand, craniofacial, microsurgery, and research fellowships, those who completed a research fellowship had higher h-indices and were more likely to reach full professor status (
p
< 0.001 and
p
= 0.001, respectively). Fellowship training had no effect on being promoted to Chief/Chair of departments (
p
= 0.16).
Conclusion
Fellowship training is common among academic plastic surgeons. In this study, both clinical and research fellowships were associated with various aspects of academic success. However, fellowship training alone did not affect attainment of leadership positions.
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Affiliation(s)
- Adrienne N. Christopher
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Viren Patel
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph A. Mellia
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Martin P. Morris
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fortunay Diatta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander I. Murphy
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - John P. Fischer
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Asadourian PA, Murphy AI, Marano AA, Rohde CH, Wu JK. Home Field Advantage: Assessing the Geographic Trends of the Plastic Surgery Residency Match during the COVID-19 Pandemic. J Surg Educ 2021; 78:1923-1929. [PMID: 34210645 PMCID: PMC8635498 DOI: 10.1016/j.jsurg.2021.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/01/2021] [Accepted: 06/06/2021] [Indexed: 05/22/2023]
Abstract
OBJECTIVE In previous plastic surgery residency match cycles, in-person activities at other institutions, such as away rotations, have facilitated matches outside of an applicant's home program or region. The COVID-19 pandemic, however, limited these in-person opportunities. Therefore, we hypothesized that applicants of the 2021 cycle would be more likely to match into programs with which they have existing geographic connections when compared to previous years. DESIGN Residency websites and social media accounts were searched for resident names and educational information for those matching in 2021 and 2015 to 2020. Outcomes included proportion of applicants matching at the program affiliated with their medical school ("home program"), or matching in the same state or United States Census Map region as their medical school or undergraduate institution. Subgroup analyses were stratified by program region, incoming resident class size, and Doximity residency reputation ranking. SETTING Columbia University (New York). PARTICIPANTS For the 2015 to 2020 residency cycles, 963 residents were identified from 78 (95.1%) programs. For 2021, 159 incoming interns were identified from 70 (82.3%) programs. RESULTS 2021 applicants matched into their home program at higher rates than 2015-2020 applicants (36.0% vs. 24.1%, p = 0.019). This trend was similar regardless of program region or size. This increase was significant for programs ranked outside of the top 30 (41.5% vs. 26.4%, p = 0.032), but not for the top 30 programs (32.1% vs. 22.3%, p = 0.128). Excluding those who matched at their home program, 2015 to 2020 and 2021 applicants matched in the same state or region of their medical school or undergraduate institution at similar rates (p > 0.05 for all). CONCLUSIONS During the COVID-19 pandemic, plastic surgery residency programs matched more applicants from affiliated medical schools than in previous years. This may result from lack of in-person opportunities for applicants at other programs. Alternative relationship-building opportunities may facilitate broader geographic connections in the 2022 cycle.
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Affiliation(s)
- Paul A Asadourian
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York.
| | - Alexander I Murphy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York
| | - Andrew A Marano
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York
| | - June K Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York
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8
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Klifto KM, Mellia J, Murphy AI, Diatta F, Fischer JP, Kovach SJ. The 2020 Evidence-Based Promotion Ladder of Academic Plastic Surgery. Cureus 2021; 13:e15221. [PMID: 34188975 PMCID: PMC8232926 DOI: 10.7759/cureus.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Metrics were evaluated between academic plastic surgeons from different tiered training programs to determine promotion predictors within tiers and between tiers for those seeking promotion from assistant professor, associate professor, to full professors. Methodology We performed a retrospective, cross-sectional study by collecting 61 variables from full-time plastic surgery faculty affiliated with United States residency training programs during the 2020-2021 academic year. Surgeons were stratified into nine cohorts for comparison by professorship (assistant, associate, professor) and Doximity-ranked institution program tiers (Tier 1 = T1, Tier 2 = T2, Tier 3 = T3). Univariate followed by multivariate regressions with reciprocal transformation were performed to determine predictors more likely associated with promotion or lateral movement. Results A total of 98 programs listed 851 surgeons. T1/T2/T3 surgeon promotion predictors included more years in practice (p = 0.002; p < 0.001; p < 0.001) and greater number of last-author publications (p < 0.001; p < 0.001; p = 0.007). T1/T3 surgeon promotion predictors included higher h-indexes (p = 0.001; p = 0.002). T1 surgeon promotion predictors included being on journal editorial board (p = 0.040). T2 surgeon promotion predictors from assistant to associate included non-white race (p = 0.010). T3 surgeon promotion predictors included residency director (p = 0.009) and greater number of citations (p = 0.026). Promotion predictors from assistant, associate, and professors for T3/T2/T1 programs included greater number of last-author publications (p = 0.007; p = 0.002; p < 0.001). Movement from assistant and associate between T3/T2/T1 programs included plastic surgery department (p = 0.002; p < 0.001). Movement from assistant between programs included attending Top 10 US News medical schools (p = 0.012), attending more favorable Doximity-ranked research programs (p < 0.001), greater number of first-author publications (p = 0.017), and greater number of citations (p = 0.023). Movement from associate between programs included attending more favorable Doximity-ranked reputation programs (p = 0.017) and higher h-indexes (p = 0.017). Movement from professor between programs included receiving any American Association of Plastic Surgeons (AAPS) award (p = 0.039) and greater number of AAPS awards (p = 0.012). Conclusions Promotion predictors provided evidence to synthesize the Doximity-tiered Promotion Ladder of Academic Plastic Surgery.
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Affiliation(s)
- Kevin M Klifto
- Plastic and Reconstructive Surgery, University of Missouri, Columbia, USA.,Plastic Surgery, University of Pennsylvania, Philadelphia, USA
| | - Joseph Mellia
- Plastic Surgery, Stony Brook University, Long Island, USA
| | | | - Fortunay Diatta
- Plastic Surgery, University of Pennsylvania, Philadelphia, USA
| | - John P Fischer
- Plastic Surgery, University of Pennsylvania, Philadelphia, USA
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9
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Roark RS, Li H, Williams WB, Chug H, Mason RD, Gorman J, Wang S, Lee FH, Rando J, Bonsignori M, Hwang KK, Saunders KO, Wiehe K, Moody MA, Hraber PT, Wagh K, Giorgi EE, Russell RM, Bibollet-Ruche F, Liu W, Connell J, Smith AG, DeVoto J, Murphy AI, Smith J, Ding W, Zhao C, Chohan N, Okumura M, Rosario C, Ding Y, Lindemuth E, Bauer AM, Bar KJ, Ambrozak D, Chao CW, Chuang GY, Geng H, Lin BC, Louder MK, Nguyen R, Zhang B, Lewis MG, Raymond DD, Doria-Rose NA, Schramm CA, Douek DC, Roederer M, Kepler TB, Kelsoe G, Mascola JR, Kwong PD, Korber BT, Harrison SC, Haynes BF, Hahn BH, Shaw GM. Recapitulation of HIV-1 Env-antibody coevolution in macaques leading to neutralization breadth. Science 2021; 371:eabd2638. [PMID: 33214287 PMCID: PMC8040783 DOI: 10.1126/science.abd2638] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/09/2020] [Indexed: 12/21/2022]
Abstract
Neutralizing antibodies elicited by HIV-1 coevolve with viral envelope proteins (Env) in distinctive patterns, in some cases acquiring substantial breadth. We report that primary HIV-1 envelope proteins-when expressed by simian-human immunodeficiency viruses in rhesus macaques-elicited patterns of Env-antibody coevolution very similar to those in humans, including conserved immunogenetic, structural, and chemical solutions to epitope recognition and precise Env-amino acid substitutions, insertions, and deletions leading to virus persistence. The structure of one rhesus antibody, capable of neutralizing 49% of a 208-strain panel, revealed a V2 apex mode of recognition like that of human broadly neutralizing antibodies (bNAbs) PGT145 and PCT64-35S. Another rhesus antibody bound the CD4 binding site by CD4 mimicry, mirroring human bNAbs 8ANC131, CH235, and VRC01. Virus-antibody coevolution in macaques can thus recapitulate developmental features of human bNAbs, thereby guiding HIV-1 immunogen design.
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Affiliation(s)
- Ryan S Roark
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hui Li
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Wilton B Williams
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Hema Chug
- Laboratory of Molecular Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Rosemarie D Mason
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jason Gorman
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Shuyi Wang
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Fang-Hua Lee
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Juliette Rando
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mattia Bonsignori
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Kwan-Ki Hwang
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC 27710, USA
| | - Kevin O Saunders
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC 27710, USA
- Departments of Immunology and Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Kevin Wiehe
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - M Anthony Moody
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC 27710, USA
- Departments of Pediatrics and Immunology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Peter T Hraber
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - Kshitij Wagh
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - Elena E Giorgi
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - Ronnie M Russell
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Frederic Bibollet-Ruche
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Weimin Liu
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jesse Connell
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Andrew G Smith
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Julia DeVoto
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alexander I Murphy
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jessica Smith
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Wenge Ding
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chengyan Zhao
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Neha Chohan
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maho Okumura
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christina Rosario
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yu Ding
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Emily Lindemuth
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anya M Bauer
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Katharine J Bar
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David Ambrozak
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Cara W Chao
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Gwo-Yu Chuang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Hui Geng
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bob C Lin
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mark K Louder
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Richard Nguyen
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Baoshan Zhang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Donald D Raymond
- Laboratory of Molecular Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Nicole A Doria-Rose
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Chaim A Schramm
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Daniel C Douek
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mario Roederer
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Thomas B Kepler
- Department of Microbiology, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Mathematics and Statistics, Boston University, Boston, MA 02215, USA
| | - Garnett Kelsoe
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC 27710, USA
- Departments of Immunology and Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - John R Mascola
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Peter D Kwong
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bette T Korber
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - Stephen C Harrison
- Laboratory of Molecular Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
- Howard Hughes Medical Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Barton F Haynes
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Beatrice H Hahn
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - George M Shaw
- Departments of Medicine and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Chen AZ, Shen TS, Bovonratwet P, Pain KJ, Murphy AI, Su EP. Total Joint Arthroplasty During the COVID-19 Pandemic: A Scoping Review with Implications for Future Practice. Arthroplast Today 2021; 8:15-23. [PMID: 33521188 PMCID: PMC7836630 DOI: 10.1016/j.artd.2020.12.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Recent studies have examined the impact of the COVID-19 pandemic on the practice of total joint arthroplasty. A scoping review of the literature with compiled recommendations is a useful tool for arthroplasty surgeons as they resume their orthopedic practices during the pandemic. Methods In June 2020, PubMed, Embase (Ovid), Cochrane Library (Wiley), Scopus, LitCovid, CINAHL, medRxiv, and bioRxiv were queried for articles using controlled vocabulary and keywords pertaining to COVID-19 and total joint arthroplasty. Studies were characterized by their region of origin, design, and Center of Evidence Based Medicine level of evidence. The identified relevant studies were grouped into 6 categories: changes to future clinical workflow, education, impact on patients, impact on surgeons, technology, and surgical volume. Results The COVID-19 pandemic has had a significant impact on arthroplasty practice, including the disruption of the clinical teaching environment, personal and financial consequences for patients and physicians, and the drastic reduction in surgical volume. New pathways for clinical workflow have emerged, along with novel technologies with applications for both patients and trainees. Conclusions The COVID-19 pandemic emphasizes the recent trend in arthroplasty toward risk stratification and outpatient surgery, which may result in improved clinical outcomes and significant cost-savings. Furthermore, virtual technologies are a promising area of future focus that may ultimately improve upon previous existing inefficiencies in the education and clinical environments.
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Affiliation(s)
- Aaron Z Chen
- Weill Cornell Medical College, New York, NY, USA
| | - Tony S Shen
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Patawut Bovonratwet
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Kevin J Pain
- Weill Cornell Medicine, Samuel J. Wood Library & C.V Starr Biomedical Information Center, New York, NY, USA
| | - Alexander I Murphy
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Edwin P Su
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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11
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Yakulis R, Manack L, Murphy AI. Postradiation malignant triton tumor. A case report and review of the literature. Arch Pathol Lab Med 1996; 120:541-8. [PMID: 8651855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To report the third case of postradiation malignant triton tumor and to review the literature on malignant triton tumor with regard to features of possible prognostic significance. DATA SOURCES Published articles were retrieved through MEDLINE, and additional articles were obtained through searches of the bibliographies. STUDY SELECTION Cases were selected on the basis of histologic, immunohistochemical, and ultrastructural studies of malignancies showing both neurogenic and myogenic differentiation. Only those cases with survival data were selected for analysis. DATA EXTRACTION The relationship between survival time and the possible prognostic variables of sex, presence or absence of von Recklinghausen's disease, age, and tumor location were evaluated by Cox regression analysis. RESULTS Kaplan-Meier analysis showed a 5-year specific survival of 26%. Tumor location showed a statistically significant association with survival time (P = .01). CONCLUSIONS This study suggests that malignant triton tumors occurring in the upper extremities, lower extremities, and head and neck have a better prognosis than tumors located in the retroperitoneum, buttock, or trunk. It is not clear if this variation is due to a difference in tumor grade, tumor stage, or resectability, or if it is a consequence of therapy.
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Affiliation(s)
- R Yakulis
- Department of Pathology and Laboratory Medicine, Medical College of Pennsylvania, Allegheny General Hospital, Pittsburgh 15212, USA
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12
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Abstract
Twenty-one tension headache sufferers and 21 control subjects were exposed to a series of psychological stressors and an ischemic pain task, involving a tourniquet around the arm. Compared to control subjects, headache patients showed higher heart rates and evidence of more prolonged vasoconstriction in the hands and the ear lobe. No between-group differences in EMG were found, however. Headache patients rated the tourniquet as more painful than did control subjects, and described themselves as more anxious, angry, and depressed. The pattern of results is consistent with the interpretation that headache patients are emotionally and autonomically hyperreactive to pain and to psychological stress.
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Affiliation(s)
- P M Lehrer
- UMDNJ-R.W. Johnson Medical School, Piscataway 08854-5635
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13
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Abstract
Seventeen carefully screened muscle contraction headache sufferers were tested in both the headache and the nonheadache state. At baseline, forehead and trapezius EMG were higher, whereas finger temperature and finger blood volume were lower in the headache than the nonheadache state. At a borderline level, physiological reactivity was greater during the headache than the nonheadache state in response to a reaction-time stressor. During the headache state, subjects also reported themselves to be more anxious, depressed, and angry than they were in the nonheadache state and said they felt themselves to be more hassled by external stressors and less able to cope with, prevent, and control their headaches. The findings are consistent with the notion that shoulder/neck tension and emotional arousal contribute to tension headaches. Evidence is less clear for the contribution of vasomotor factors and general physiological reactivity.
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14
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Murphy AI, Lehrer PM, Karlin R, Swartzman L, Hochron S, McCann B. Hypnotic susceptibility and its relationship to outcome in the behavioral treatment of asthma: some preliminary data. Psychol Rep 1989; 65:691-8. [PMID: 2678205 DOI: 10.2466/pr0.1989.65.2.691] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
12 subjects from an experiment on relaxation therapy for asthma were given the Harvard Group Scale of Hypnotic Susceptibility, Form A. Full scale hypnotic susceptibility scores were positively correlated, at a borderline significance, with improvement in the methacholine challenge test, a measure of asthma severity. Performance on the amnesia item of the Harvard Group Scale was correlated with improvement in self-reported symptoms of asthma.
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Abstract
Spontaneous release of a taut, fibrotic subretinal strand was observed in a patient with rhegmatogenous retinal detachment. This strand had been elevating the retina, and its release led to partial reattachment. Whereas spontaneous resolution of preretinal membrane contraction in retinal detachment has been reported, this is the first report of spontaneous release of such a subretinal fibrotic strand. The manner in which the strand released raised the question of whether efforts should be made to rupture such strands with transcleral pressure prior to considering retinotomy.
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Abstract
Pigmented lesions of the vagina are very rare. A benign blue nevus of the vagina in a 73-year-old woman, diagnosed clinically as malignant melanoma, is presented. Although 15 cases of blue nevi of the uterine cervix have been reported, this is the first case of blue nevus located exclusively in the vagina.
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17
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Tobon H, Amortegui AJ, Murphy AI. Alveolar soft part sarcoma of the vagina. Pa Med 1976; 79:55-7. [PMID: 967485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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18
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19
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