The presence of lymph node metastases is a well-studied prognostic factor for cutaneous melanoma. Characterization of melanoma lymph node metastases and their association with survival in multiple, large observational studies has led to recognition of the following high-risk features: quantity of lymph node metastases (number of nodes), size of the nodal tumor deposit (in mm), and extracapsular extension. Despite increasing utilization of these features in the design of randomized clinical trials, in addition to their role in contemporary clinical decision-making, current staging systems lag behind, only accounting for the quantity of lymph nodes with metastases. Herein, we review the prognostic role of melanoma lymph node metastases and their high-risk features, current reporting standards, how such features have been utilized in practice-changing trials, and best practices for future clinical trial design and clinical decision-making.
Objective To critically appraise the body of scientific literature supporting the risks and efficacy of nasoalveolar molding (NAM), specifically in contrast to alternative methods of presurgical infant orthopedics (PSIO) or to treatment without PSIO. Main Outcome Measures Five outcome domains were considered: nasolabial aesthetics; dentoalveolar relationship; midfacial growth; cost and burden of care; and number of anesthetic events. Design MEDLINE, Embase, and Scopus were queried for articles from the first description of the Grayson-Santiago NAM technique (1993) through December 13, 2021. After the application of inclusionary and exclusionary criteria, selected articles were critically appraised using a systematic framework that included risk of bias assessment using the Cochrane RoB 2.0 and ROBINS-I tools. Results A total of 88 studies were included. Level-I and -II evidence showed on par or better approximation and alveolar alignment achieved by NAM compared to other PSIO. Level-II and -III evidence showed improved nasolabial aesthetics compared to other PSIOs. Level-II and -III evidence supported no harm to maxillofacial skeletal growth through age 12. Sparse level-III evidence supported a reduced number of labial or nasal revisions following NAM. Level-II and -III evidence showed NAM requiring upfront cost and frequent appointments but reducing caregiver psychosocial burden and reducing long-term costs compared to select alternatives. Many studies carried a high risk of bias. Conclusions Current evidence supports the overall efficacy of NAM regarding short/mid-term outcomes, with a low risk of negative effects on midfacial growth or dental development. The high risk of bias discovered in many papers underscores the need for robust study design in future research.
Despite the increasing prevalence of Longitudinal Integrated Clerkships (LICs), there is a paucity of published LIC models which directly integrate radiology into longitudinal clinical experiences, instead favoring protected time for radiology didactics or a more traditional block rotation (BR). [1][2][3] Such models miss the opportunity to better capture longitudinal clinical and professional relationships and the integration of system-based care which defines LICs. We sought to explore if the core constructs of LICs could be expanded to incorporate radiology learning objectives in a pilot LIC Radiology program.
were subcutaneously implanted in rats using a CV flap technique. P4HB scaffolds without the internal latticework and Cook Biodesign® Nipple Cylinder were implanted as controls.
RESULTS:The projection of 3D-P4HB nipples were well maintained over 3 months (>90%, p>0.05) and nipple stiffness slowly declined as the polymer was gradually replaced by tissue. In contrast, the Cook Biodesign® nipple lost 25% and 50% projection at 1-and 3-month respectively (p<0.05).
CONCLUSION:We have successfully engineered neonipples that maintain projection over time, while simultaneously allowing for tissue ingrowth that is biomechanically similar to that of native nipples. Long-term observation will be warranted to verify the translatability of this novel 3D-P4HB nipple scaffold.
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