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Background: Secondary Furlow (Furlow) and buccal myomucosal flaps (BMMF) treat velopharyngeal insufficiency by lengthening the palate and retropositioning the levator veli palatini muscles. The criteria for choosing one operation over the other remain unclear., Methods: A single-center retrospective cohort study was conducted. Thirty-two patients with nonsyndromic, repaired cleft palate were included. All patients underwent a Furlow or BMMF. Outcome measures included (1) resolution of hypernasality 12 months postoperatively, (2) degree of improvement of hypernasality severity; and (3) change in velar length, as measured on magnetic resonance imaging scans obtained preoperatively and 12 months postoperatively. All measures were performed by raters blinded to participants' medical and surgical history., Results: Hypernasality was corrected to normal in 80% of the Furlow group and in 56% of the BMMF group. Patients receiving BMMF had more severe hypernasality during preoperative speech evaluation. Both groups had a median decrease of two scalar rating points for severity of hypernasality ( P = 0.58). On postoperative magnetic resonance imaging, patients who underwent Furlow had a median increased velar length of 6.9 mm. Patients who received BMMF had a median increased velar length of 7.5 mm. There was no statistically significant difference between groups regarding increase in velar length ( P = 0.95)., Conclusions: Furlow and BMMF procedures increase velar length with favorable speech outcomes. The same degree of improvement for hypernasality was observed across groups, likely explained by the similar increase in velar length achieved. Anatomic changes in palate length and levator veli palatini retropositioning persist 1 year after surgery., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. This study was supported by the National Institute of Dental & Craniofacial Research of the National Institutes of Health under award numbers K23DE025023 and U01DE029750., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Targeted muscle reinnervation (TMR) has shown promise in reducing postsurgical limb pain in amputees. However, there has been little evidence on the increased risk of complications and cost as compared with traditional amputations. This study was designed to assess the rate of complications and healthcare costs between those treated with TMR and traditional amputations., Methods: Patients undergoing amputation were selected from the PearlDiver Mariner dataset and categorized into one of two treatment groups depending on the use of TMR versus traditional amputation. Rates of postsurgical complications and overall healthcare costs were compared between the two groups, while controlling for differences in patient demographics and comorbidities., Results: One hundred sixteen TMR procedures and 76,412 traditional amputations were included in the study. The rate of complications did not differ between groups, with a complication rate of 77% in the TMR and 87% in the traditional amputation groups. Overall healthcare costs also did not differ 1 year after surgery, with an average cost of $32,632 in the TMR group and $36,219 in the traditional amputation group., Conclusions: Amputees experience high rates of postsurgical complications, morbidity, and mortality. However, there is no increased risk of complications or cost with the use of TMR. TMR has the potential benefits of reducing overall postsurgical pain and reestablishing activities of daily living. Although TMR is more expensive up front, it may reduce the overall healthcare costs by reducing the need for subsequent care. Further work is needed in large, randomized trials to examine these findings., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background Improving diagnosis of ductal carcinoma in situ (DCIS) before surgery is important in choosing optimal patient management strategies. However, patients may harbor occult invasive disease not detected until definitive surgery. Purpose To assess the performance and clinical utility of mammographic radiomic features in the prediction of occult invasive cancer among women diagnosed with DCIS on the basis of core biopsy findings. Materials and Methods In this Health Insurance Portability and Accountability Act-compliant retrospective study, digital magnification mammographic images were collected from women who underwent breast core-needle biopsy for calcifications that was performed at a single institution between September 2008 and April 2017 and yielded a diagnosis of DCIS. The database query was directed at asymptomatic women with calcifications without a mass, architectural distortion, asymmetric density, or palpable disease. Logistic regression with regularization was used. Differences across training and internal test set by upstaging rate, age, lesion size, and estrogen and progesterone receptor status were assessed by using the Kruskal-Wallis or χ 2 test. Results The study consisted of 700 women with DCIS (age range, 40-89 years; mean age, 59 years ± 10 [standard deviation]), including 114 with lesions (16.3%) upstaged to invasive cancer at subsequent surgery. The sample was split randomly into 400 women for the training set and 300 for the testing set (mean ages: training set, 59 years ± 10; test set, 59 years ± 10; P = .85). A total of 109 radiomic and four clinical features were extracted. The best model on the test set by using all radiomic and clinical features helped predict upstaging with an area under the receiver operating characteristic curve of 0.71 (95% CI: 0.62, 0.79). For a fixed high sensitivity (90%), the model yielded a specificity of 22%, a negative predictive value of 92%, and an odds ratio of 2.4 (95% CI: 1.8, 3.2). High specificity (90%) corresponded to a sensitivity of 37%, positive predictive value of 41%, and odds ratio of 5.0 (95% CI: 2.8, 9.0). Conclusion Machine learning models that use radiomic features applied to mammographic calcifications may help predict upstaging of ductal carcinoma in situ, which can refine clinical decision making and treatment planning. © RSNA, 2022.

Background: The Superficial Femoral Artery-Popliteal EvidencE Development Study Group developed contemporary objective performance goals (OPGs) for peripheral vascular interventions (PVI) for superficial femoral artery (SFA)-popliteal artery disease using the Registry Assessment of Peripheral Interventional Devices., Methods: The Society for Vascular Surgery Vascular Quality Initiative PVI registry from January 2010 to October 2016 was used to develop OPGs based on SFA-popliteal procedures (n = 21,377) for intermittent claudication and critical limb ischemia (CLI). OPGs included 1-year rates for target lesion revascularization (TLR), major amputation, and 1 and 4-year survival rates. OPGs were calculated for the SFA and popliteal arteries and stratified by four treatments: angioplasty alone (percutaneous transluminal angioplasty [PTA]), self-expanding stenting, atherectomy, and any treatment type. Outcomes were illustrated by unadjusted Kaplan-Meier analyses., Results: Cohorts included PTA (n = 7505), stenting (n = 9217), atherectomy (n = 2510) and any treatment (n = 21,377). The mean age was 69 years, 58% were male, 79% were White, and 52% had CLI. The freedom from TLR OPGs at 1 year in the SFA were 80.3% (PTA), 83.2% (stenting), 83.9% (atherectomy), and 81.9% (any treatments). The freedom from TLR OPGs at 1 year in the popliteal were 81.3% (PTA), 81.3% (stenting), 80.2% (atherectomy), and 81.1% (any treatments). The freedom from major amputation OPGs at 1 year after SFA PVI were 93.4% (PTA), 95.7% (stenting), 95.1% (atherectomy), and 94.8% (any treatments). The freedom from major amputation OPG at 1 year after popliteal PVI were 90.5% (PTA), 93.7% (stenting), 91.8% (atherectomy), and 91.8%, (any treatments). The 4-year survival OPGs after SFA PVI were 76% (PTA), 80% (stenting), 82% (atherectomy), and 79% (any treatments), and for the popliteal artery were 72% (PTA), 77% (stenting), 82% (atherectomy), and 75% (any treatment). On a multivariable analysis, which included patient-level, leg-level, and lesion-level covariates, CLI was the single independent factor associated with increased TLR, amputation, and mortality., Conclusions: The Superficial Femoral Artery-Popliteal EvidencE Development OPGs define a new, contemporary benchmark for SFA-popliteal interventions using a large subset of real-world evidence to inform more efficient peripheral device clinical trial designs to support regulatory and clinical decision-making. It is appropriate to discuss proposals intended for regulatory approval with the US Food and Drug Administration to refine the OPG to match the specific trial population. The OPGs may be updated using coordinated registry networks to assess long-term real-world device performance., (Copyright © 2020 Society for Vascular Surgery. All rights reserved.)

Morbihan's disease is classically defined as primarily a Caucasian disease of chronic, recurrent erythema and nonpitting edema of the middle and upper thirds of the face. The disease is often difficult to diagnose and challenging to treat. Medical management is the primary treatment modality; however, if there is progression of the disease that causes visual impairment, surgical debulking is often required. We present the first reported case of Morbihan's disease in a Navajo patient in conjunction with a review of the literature on surgical management of this challenging disease., Competing Interests: Disclosure: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

A membrane potential change in cells is accompanied with mechanical deformation. This electromechanical response can play a significant role in regulating action potential in neurons and in controlling voltage-gated ion channels. However, measuring this subtle deformation in mammalian cells has been a difficult task. We show a plasmonic imaging method to image mechanical deformation in single cells upon a change in the membrane potential. Using this method, we have studied the electromechanical response in mammalian cells and have observed the local deformation within the cells that are associated with cell-substrate interactions. By analyzing frequency dependence of the response, we have further examined the electromechanical deformation in terms of mechanical properties of cytoplasm and cytoskeleton. We demonstrate a plasmonic imaging approach to quantify the electromechanical responses of single mammalian cells and determine local variability related to cell-substrate interactions.

Background: Clinical, pathological, and molecular information combined with cancer stage in prognostication algorithms can offer more personalized estimates of survival, which might guide treatment choices. Our aim was to evaluate the quality of prognostication tools in esophageal cancer., Methods: We systematically searched MedLine and Embase from 2005 to 2017 for studies reporting development or validation of models predicting long-term survival in esophageal cancer. We evaluated tools using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies guidelines and the American Joint Committee on Cancer acceptance criteria for risk models., Results: We identified 16 prognostication tools for patients treated with curative intent and 1 for patients with metastatic disease. These tools frequently excluded adenocarcinoma, contained outdated data, and were developed with a limited sample size. Nine tools were developed in China for squamous cell cancer, and 11 used data on patients diagnosed before 2010. Most tools excluded key prognostic factors such as age and sex. Tumor stage and grade were the most commonly, but not universally, included factors. Twelve tools were designed to predict overall survival; 5 predicted cancer-specific survival. Bootstrap internal validation was performed for most tools; c-statistics ranged from 0.63 to 0.77 and graphically evaluated calibration was "good." Five tools were externally validated; c-statistics ranged from 0.70 to 0.77., Conclusions: Existing tools cannot be confidently used for esophageal cancer prognostication in current clinical practice. Better-quality tools might help to more individually and accurately estimate disease course, select further treatments, and risk-stratify for future clinical trials., (Copyright © 2018. Published by Elsevier Inc.)

Objective: The current state of evaluating patients with peripheral artery disease and more specifically of evaluating medical devices used for peripheral vascular intervention (PVI) remains challenging because of the heterogeneity of the disease process, the multiple physician specialties that perform PVI, the multitude of devices available to treat peripheral artery disease, and the lack of consensus about the best treatment approaches. Because PVI core data elements are not standardized across clinical care, clinical trials, and registries, aggregation of data across different data sources and physician specialties is currently not feasible., Methods: Under the auspices of the U.S. Food and Drug Administration's Medical Device Epidemiology Network initiative-and its PASSION (Predictable and Sustainable Implementation of the National Registries) program, in conjunction with other efforts to align clinical data standards-the Registry Assessment of Peripheral Interventional Devices (RAPID) workgroup was convened. RAPID is a collaborative, multidisciplinary effort to develop a consensus lexicon and to promote interoperability across clinical care, clinical trials, and national and international registries of PVI., Results: The current manuscript presents the initial work from RAPID to standardize clinical data elements and definitions, to establish a framework within electronic health records and health information technology procedural reporting systems, and to implement an informatics-based approach to promote the conduct of pragmatic clinical trials and registry efforts in PVI., Conclusions: Ultimately, we hope this work will facilitate and improve device evaluation and surveillance for patients, clinicians, health outcomes researchers, industry, policymakers, and regulators., (Copyright © 2017 Society for Vascular Surgery. All rights reserved.)

Managed care organizations face distrust from public policy-makers, the media, and other public stakeholders. To succeed, the managed care industry must work to restore trust in their approach to healthcare delivery. A variety of strategies are presented as ways to mitigate the public's distrust of the managed care industry.

Physicians have lost their trust in managed care plans because of perceived deficits in competency, concern, choice, confidentiality, and communications. To succeed in a market-driven healthcare system, managed care plans must work to restore that trust. A variety of strategies are proposed to address physician concerns related to these 5 domains of trust. Although no single strategy will restore trust, a combination can improve the relationship with these important stakeholders.

Managed care organizations face distrust from patients, many of whom believe the organizations disregard their interests. To succeed in a market-driven healthcare system, managed care plans must work to restore that trust. A variety of strategies are presented to restore patient trust. The next 2 articles of this 3-part series will examine trust-building strategies targeted at physicians and public stakeholders.

Using the Born-Oppenheimer parameter lambda = (m/M)(1/4) as a perturbation parameter, we find that for allowed transitions, the zeroth order approximation of the spectral intensity gives rise to the Condon approximation, the first order vibronic coupling and anharmonic effect appear in the first order approximation of the spectral intensity, which gives us the non-Condon scheme, and only the intensity of the transitions of totally-symmetric modes with nonvanishing normal coordinate displacements is affected by the inclusion of the first order vibronic coupling and anharmonic effect. For symmetry-forbidden but vibronic-allowed transitions, the first nonvanishing term of the spectral intensity is second order with respect to lambda and the B-O couplings do not appear in the calculation of the spectral intensity until the fourth order approximation with respect to lambda; in this case, other high order vibronic couplings and anharmonic effect are competing with the B-O couplings.

The purpose of this paper has been to investigate the effect of solvent on radiationless transitions. Two types of the solvent effect have been studied: one is the so-called medium-induced radiationless transition, i.e., the radiationless transition induced by the interaction between the solute and solvent, and the other is the effect of solvent on the radiationless transition through the change in energy gap induced by the solute-solvent interaction.

It has been the purpose of the present paper to investigate and explore the conditions under which the linear relation between Delta/C(D) (0) and Delta in the Hanna-Ashbaugh-Foster-Fyfe equation for the evaluation of equilibrium constants holds, (C(D) (0) is initial concentration of a donor and Delta is the observed chemical shift relative to the chemical shift of the acceptor) to obtain the equation representing the exact linear relation between Delta/C(D) (0) and Delta, when the linear relation between Delta/C(D) (0) and Delta holds, and to discuss how to use the Job method in nuclear magnetic resonance measurements to determine the stoichiometry of molecular complexes. We have found that the conventional belief that C(D) (0) should always be chosen to be much greater than C(A) (0) (initial concentration of acceptor) is not necessarily always true and the exact linear relation between Delta/C(D) (0) and Delta is represented by the equation Delta/C(D) (0) = K(1)Delta(0)/(1 + K(1)C(A) (0)) - K(1)Delta/(1 + K(1)C(A) (0))(2), where K(1) is the formation constant of the complex. It is shown that in the Job method of nuclear magnetic resonance measurements one has to plot DeltaC(A) (0) against the mole fraction, and the mole fraction at the maximum should give us the composition of the complex. Theoretical results have been verified experimentally on the weak interaction between naphthalene and methyl iodide.

The purpose of this paper has been to develop a systematic approach for classifying and distinguishing the relative orders of approximation of various types of couplings like the vibronic (Herzberg-Teller) couplings and Born-Oppenheimer couplings, and for studying the importance of the anharmonicity in the quantitative calculation of the spectral intensity and electronic relaxation. It will be shown that the perturbation parameter introduced by Born and Oppenheimer in separating the electronic and nuclear motion involved in the molecular Schrödinger equation, lambda = (m/M)(1/4), can be used for this purpose by expanding wavefunctions and energies in power series of lambda.

The purpose of this paper has been to explore in a preliminary way the nature and mechanism of collisional energy transfer and quenching of electronic excitation. For this purpose, the Born approximation has been used, and the triplet-triplet and singlet-singlet transfer, and the triplet-triplet and singlet-singlet quenching have been studied. It has been shown theoretically that (i) the singlet-singlet transfer constants (or cross sections) are always larger than the triplet-triplet transfer constants (or cross sections) for the same system of donor and acceptor; (ii) for the singlet-singlet transfer, the observed cross section varies linearly with respect to the spectral overlap between the donor emission and the acceptor absorption; (iii) the reason that the quenching constants (or cross sections) are always smaller than the energy transfer constants (or cross sections) is due to the fact that for the quenching the vibration of the acceptor hardly participates in accepting the electronic excitation and for the energy transfer only part of the excited electron energy of the donor is converted into the energy of nuclear motion; and (iv) the polar acceptor molecules are better quenchers than nonpolar acceptor molecules.

A general quantum mechanical approach for treating a great number of rate processes is developed and the temperature dependence of the rate constants is discussed.

The purpose of this paper is to investigate the nature of band shapes of emission spectra and their relation to the rate of nonradiative processes. Two cases are discussed, one in which the Franck-Condon principle applies and the other in which the electronic transition is symmetry-forbidden but vibronic-allowed. The moment relations of emission spectra have been derived and their applications demonstrated.The vibrational structuring in emission spectra is discussed and empirical equations for calculation of the shapes of vibrational bands are derived. It is found that from the shapes of vibrational bands one can obtain the information of intermolecular vibration and from the areas under vibrational bands one can determine the Franck-Condon factors of intramolecular vibration.