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Neoadjuvant therapy is recommended for patients with locally advanced breast cancer. Here the authors report the results of a phase 2 clinical trial of oral neoadjuvant therapy with pyrotinib (pan-HER tyrosine kinase inhibitor), letrozole (aromatase inhibitor) and dalpiciclib (CDK4/6 inhibitor) in patients with treatment-naïve and stage II-III triple positive breast cancer.

Background:. In the past 5 years, social media use among plastic surgeons has grown to become a common modality used to promote one’s practice. However, surgeons lack the necessary ethical training to understand how their published content impacts patient opinions and behavior. Social media trends among plastic surgeons may contribute to the reduced rate of Black (non-White) patients accessing gender affirming surgery. Methods:. In total, 250 gender affirming surgeons and 51,698 individual posts from social media platform, Instagram, were manually extracted and analyzed. Posts were assessed for inclusion and categorized by the subject’s skin color (White versus non-White) using the Fitzpatrick scale. Results:. Of the 3101 included posts, 375 (12.1%) portrayed non-White subjects. Of the 56 included surgeons, White surgeons were found to be 2.3 times less likely to include non-White subjects in their posts, compared with non-White surgeons. Regionally, surgeons practicing in the Northeast had the most racially diverse social media accounts, with over 20% of all posts including a non-White subject. Analyzing data over the past 5 years demonstrated no relative increase in the amount of non-White subjects being displayed on social media, while social media use by gender affirming surgeons had increased by over 200%. Conclusions:. The low number of non-White individuals portrayed by surgeons on social media perpetuates the racial disparity seen in patients accessing gender affirming surgery. Surgeons must be conscious of the demographic they portray on social media, as a lack of representation may influence patients’ self-identify and decision to utilize gender affirming surgical treatment.

Abstract Objective Chronic spontaneous urticaria (CSU) is defined as urticaria with an unknown etiology which persists for more than 6 weeks. CSU is an uncomfortable cutaneous condition that occurs due to an immune-mediated inflammatory reaction. Many studies have demonstrated that vitamin D deficiency and single-nucleotide polymorphisms in the vitamin D receptor (VDR) impact the immune response. In the current study, the frequency of the Taq1 polymorphism in the VDR gene were compared between patients with CSU and individuals without CSU. Methods In a case–control study, a group of CSU patients (n = 100) was compared with a group of healthy age- and gender-matched individuals as a control group (n =100) who visited our center between 2015 and 2017. After DNA extraction from EDTA-containing blood, polymerase chain reaction (PCR–RFLP) was used to determine the presence of the Taq1 polymorphism. Serum vitamin D levels were measured using ELISA method (Abcam, Cambridge, USA). Results Genotyping for Taq1 polymorphism showed that TT, Tt and tt genes frequency in the CSU group were 36%, 54%, and 10% respectively. The TT, Tt and tt genotypes had a distribution of 50%, 47% and 3% respectively in the control group. The mean serum vitamin D level in the CSU group was 19.88 ± 8.14 ng/ml, which was not significantly correlated with the Taq1 polymorphism (P = 0.841). There was a significant relationship between Taq1 gene polymorphism (tt genotype) and CSU (P = 0.038). Tt genotype increased the risk of CSU (odds ratio = 1.596), and inheritance of tt genotype increased the risk even further (odds ratio = 4.630). Conclusion The frequency of Taq1 genotype polymorphism in the VDR gene was significantly higher in patients with CSU compared to the control group. The tt genotype polymorphism may be a risk factor for CSU.

Introduction: Vaginoplasty is performed to create a neovagina for transgender individuals who seek surgical transition or for cisgender individuals with congenital or acquired absence of a vagina (or "cisvagina"). The current knowledge of the bacterial microenvironment of the neovagina is limited. The objective of this study was to conduct a systematic review of current knowledge regarding the microbiome of the neovagina in transgender women. Methods: A systematic review of three medical databases (PubMed, MEDLINE, Web of Science) was performed in December 2021. Articles were included if they discussed the bacterial flora of the post-surgical neovagina in transgender women. Articles were excluded if their primary focus was pathogenic disease of the neovagina. Articles were summarized qualitatively and organized into a table. Results: Ten articles were identified for the review. Surgical techniques included penile inversion vaginoplasty (PIV) and intestinal/sigmoid vaginoplasty. PIV neovaginas were most similar to cisvaginas with bacterial vaginosis, whereas intestinal vaginoplasty resulted in microbiomes comparable to that of the colorectum. Oral probiotic supplements may be able to encourage the growth of Lactobacillus in the neovagina. Maintenance protocols relating to cleaning are largely surgeon- and institution-dependent, and evidence regarding the use of estrogen and its effect on the neovagina is limited. Conclusions: The microbiome of the neovagina is distinct from that of the cisvagina, and it differs based on surgical technique. Further research is warranted to better characterize the effect of different surgical techniques, patient characteristics, estrogen use, and cleaning habits on the health of the neovaginal microbiome. [ABSTRACT FROM AUTHOR]

BackgroundMindfulness-based cognitive therapy and isometric exercise training (IET) interventions are relatively new approaches to maintain physical functioning, alleviate pain, prevent joint stiffness and muscular atrophy, and positively influence other postoperative care outcomes. ObjectiveThe aim of this review was to identify the impacts of mindfulness-based interventions (MBIs) and IET and, more specifically, their combination, which have not previously been assessed to our knowledge. MethodsStudies were identified by searching the PubMed and Cochrane databases within the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) algorithm format and using relevant keyword combinations, which resulted in 39 studies meeting the inclusion criteria. ResultsIn general, MBI was shown to positively impact both pain relief and physical functioning, while IET positively impacted physical functioning. Numerous other benefits, including improved quality of life and decreased postoperative opioid use, were also described from both interventions; however, further research is needed to confirm these findings as well as to determine other possible benefits. No studies were found that combined MBI and IET. ConclusionsDespite many positive results from each individual intervention, there is a lack of information about how the combination of MBI and IET might impact postoperative care. The combination of these two interventions might prove to be more effective than each individual intervention alone, and the findings from this review show that they could even be complementary. Going forward, research should be expanded to study the possible benefits of the combination of MBI and IET in postoperative care routines as well as other possible combinations.

Nurses caring for patients who contract coronavirus disease 2019 (COVID-19) have experienced significant traumas in the form of increased workloads, negative patient outcomes, and less social support system access. Nurses should be provided with information regarding early detection, coping skills and treatment for anxiety, depression, post-traumatic stress syndrome (PTSS)/post-traumatic stress disorder (PTSD), and other mental health disorders. Early intervention is important as mental health disorders can cause dysfunction, internal suffering, and in the most extreme situations, lead to death if not properly cared for. Healthcare corporations should consider providing coverage for mental health treatment for employees who experience COVID-19 traumas. With the implementation of healthy coping skills and therapeutic intervention, nurses will be able to let go of the negative impacts that the COVID-19 pandemic has caused and reintegrate into their roles as caring and entrusted health care providers. The current paper evaluates the mental health disorders encountered by nurses in the COVID-19 era based on the current medical literature and aims to provide practical coping strategies.

Surgical treatment of trigger finger involves release of A1 pulley. Some authors have theorized that the loss of A1 pulley can lead to ulnar subluxation of flexor tendons, which can be prevented by release of A1 pulley radially, even in a nonrheumatoid hand. However, there is no evidence in literature to either support or oppose this hypothesis. Occasionally, difficulty is encountered to precisely identify where A1 ends and A2 begins. While incomplete release of A1 can cause relapse of triggering, release of substantial A2 can cause bowstringing. Knowledge of the safe limit of concomitant A2 release is beneficial. The study was conducted in 12 cadaver upper extremity specimens. A1 pulleys of 48 fingers were divided at the radial (24 fingers) or ulnar (24 fingers) attachment. A 20lb traction force was applied on the flexor tendons. Any subluxation or bowstringing was noted. The experiment was repeated following serial release of the A2—initially 25%, followed by 50% and 100%. No bowstringing or subluxation was noted when A1 pulley was opened, either by radial or ulnar incision. The same was true for A1 + 25% A2 release. When A1 + 50% A2 pulley were released, bowstringing was observed in 3/48 fingers. When A1 + 100% of the A2 pulley were released, bowstringing occurred in all cases. The location of incision for release of the A1 pulley has no effect on bowstringing or tendon subluxation. Release of additional 25% of the A2 pulley can be performed safely, which corresponds to the level of palmar digital crease.

Summary:. The COVID-19 pandemic limited the ability of medical students to participate in plastic surgery sub-internships and to attend residency interviews in person during the 2020–2021 match cycle. A podcast and accompanying online directory were created to introduce integrated plastic surgery residency programs to medical students from the perspective of current residents. Since July 2020, a total of 49 plastic surgery residents representing 42 programs have participated in the podcast. Topics of discussion included program logistics, faculty leadership, and aspects of resident lifestyle of interest to medical students and future residency candidates. The podcast has had a total of 5072 downloads (mean 121 downloads per episode). The majority of listeners (90%) were in the United States. Twenty-five plastic surgery applicants who participated in the 2020–2021 National Resident Matching Program match cycle responded to a feedback survey. Listeners reported that the podcast was useful for preparing for interviews, making rank lists, and learning about programs that they otherwise would not have considered. Most listeners (90%) ranked the podcast as one of their top three resources for learning about plastic surgery programs during the application and interview process. Future directions include completion of episodes for all integrated plastic surgery programs and expansion to other surgical subspecialties and plastic surgery fellowships.

The current COVID-19 pandemic has vastly impacted the health care system in the United States, and it is continuing to dictate its unprecedented influence on the education systems, especially the residency and fellowship training programs. The impact of COVID-19 on these training programs has not been uniform across the board, with plastic surgery residency and fellowship programs among the hardest hit specialties. Implementation of social distancing regulations has affected departmental educational activities, including preoperative, morbidity and mortality conferences and journal clubs; operating room educational activities; as well as the overall education of plastic surgery trainees in the United States. Almost all elective and semielective surgeries across the United States were suspended for a few months during the COVID-19 pandemic; this constitutes a significant portion of plastic surgery cases. Considering the current staged reopening policies, it may be a long time, if ever, before restrictions are completely lifted. In this paper, we review the multidimensional impact of the current COVID-19 pandemic on the training programs of plastic surgery residents and fellows in the United States and worldwide, along with some potential solutions on how to address existing challenges.

Summary:. Edwardsiella tarda (ET), a Gram-negative bacterium, causes an extremely uncommon, yet highly aggressive, soft tissue infection. Although plastic surgeons are frequently involved in the primary care, debridement, and secondary reconstruction of difficult soft tissue infections, infections caused by ET have received scant attention in the plastic surgery literature, perhaps because of the rarity of occurrence. We present a case of a 58-year-old man with alcohol abuse and hepatitis C who developed an upper extremity soft tissue infection after a catfish injury, which rapidly deteriorated to cause multiorgan failure and death within 5 days of admission. We will discuss the management of this rare but potentially lethal infection as well as the review of the current literature.

Since the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic, significant changes have occurred in the United States as the infection spread reached and passed its exponential phase. A stringent analysis of COVID-19 epidemiologic data requires time and would generally be expected to happen with significant delay after the exponential phase of the disease is over and when the focus of the health care system is diverted away from crisis management. Although much has been said about high-risk groups and the vulnerability of the elderly and patients with underlying comorbidities, the impact of race on the susceptibility of ethnic minorities living in indigent communities has not been discussed in detail worldwide and specifically in the United States. There are currently some data on disparities between African American and Caucasian populations for COVID-19 infection and mortality. While health care authorities are reorganizing resources and infrastructure to provide care for symptomatic COVID-19 patients, they should not shy away from protecting the general public as a whole and specifically the most vulnerable members of society, such as the elderly, ethnic minorities, and people with underlying comorbidities.