Summary
Multiple myeloma (MM) accounts for 10% of haematological malignancies. Overall survival (OS) has improved in recent years due to increased use of autologous stem cell transplantation (ASCT) ...in the treatment of newly diagnosed MM and the advent of novel agents, including proteasome inhibitors, immunomodulatory drugs and monoclonal antibodies. To assess trends in ASCT including patient selection, choice of induction regimen, depth of response and survival, we performed a retrospective analysis of all patients undergoing first ASCT for MM in European Society for Blood and Marrow Transplantation centres between 1995 and 2019. A total of 117 711 patients across 575 centres were included. The number of transplants performed increased sevenfold across the study period. The median age increased from 55 to 61 years, and the percentage of patients aged >65 years rose from 7% to 30%. Use of chemotherapy‐based induction fell significantly, being largely replaced by bortezomib‐based regimens. The two‐year complete response rate increased from 22% to 42%. The five‐year progression‐free survival and OS rates increased from 28% to 31% and from 52% to 69%, respectively. Transplant mortality fell from 5.9% to 1.5%. Ongoing advances in MM treatment may challenge the future role of ASCT. However, at the current time, ASCT remains central to the MM treatment paradigm.
Plant growth and food security depend heavily on phosphorus (P). Recovering and recycling P from animal, municipal, and food waste streams can significantly reduce dependency on traditional mineral ...P. This is particularly pertinent in the EU regions with limited native P supplies. The agronomic performance of including P-based recycling-derived fertilisers (two struvite and two ashes) or cattle slurry was compared to a conventional mineral P fertilisation programme along with no P and no fertiliser controls over three years. A field-scale experiment was set up to evaluate the perennial ryegrass dry matter yield (DMY), P uptake, and soil test P effects. Struvite, ash, and cattle slurry proved effective in replacing P mineral fertiliser and produced yields similar to those of the mineral fertiliser programme. Differences were observed in plant P recovery, with struvite-based programmes achieving a significantly higher P recovery than ash-based programmes, which had the lowest plant P recovery. Differences in Morgan’s soil test P were also noted, with potato waste struvite (PWS) and poultry litter ash (PLA) showing significantly higher soil test P values. The findings strongly indicate that a range of recycled bio-based fertilisers from the bioeconomy can be used to reduce reliance on conventional imported mineral P fertiliser, with some programmes based on recycled fertilisers even surpassing the performance of conventional linear economy mineral fertilisers.
Objectives/Hypothesis
Objectively measure the ability of facial reanimation surgery to normalize the appearance of facial paralysis using eye‐tracking technology.
Study Design
Prospective randomized ...controlled experiment.
Methods
An eye‐tracker system was used to record the eye‐movement patterns, called scanpaths, of 86 naïve observers gazing at pictures of paralyzed faces (House‐Brackmann IV–VI), smiling and in repose; before and after facial reanimation surgery; as well as normal, nonparalyzed faces. Observers gazed at each face for 10 seconds. Fixation durations for all predefined facial areas of interest were analyzed using mixed‐effects linear regression.
Results
Observers spent the majority of time (6.6 of 10 seconds) gazing in the central triangle region (eyes, nose, and mouth) of normal faces and paralyzed faces. There were significant deviations in fixation within the central triangle of paralyzed faces as compared to normal faces. Total fixation on the eyes remained conserved. However, total nose fixation decreased and mouth fixation increased on paralyzed faces. Facial reanimation surgery normalized many of the hemifacial gaze asymmetries caused by unilateral facial paralysis, and restored a normal distribution of gaze between the functional and paralyzed sides of the face and mouth.
Conclusion
There were objective differences in the way observers directed their attention to facial features when viewing normal and paralyzed faces. After facial reanimation surgery, the attentional distraction caused by facial feature irregularities was reduced. These findings are important additions to the emerging body of objective evidence indicating the effectiveness of reanimation surgery; they also suggest opportunities to optimize reconstruction.
Level of Evidence
N/A. Laryngoscope, 124:2489–2497, 2014
The masseteric nerve is a valuable donor nerve in the management of facial paralysis; however, its location is less familiar to surgeons because this motor nerve is not commonly exposed in other head ...and neck procedures. Current techniques for masseteric nerve identification rely on physical measurements from surface or bony landmarks that may be unpredictable across patient age, ethnicity, and size. The authors sought to identify a rapid and minimally invasive technique based on surgical anatomy independent of intraoperative physical measurements.
A two-phase, fresh-frozen cadaver study was performed followed by a clinical application that included 11 consecutive patients undergoing facial reanimation procedures between May of 2012 and October of 2012.
Ten cadavers were dissected and 11 clinical applications are reported. In all dissections, the masseteric nerve was identified through the newly described "subzygomatic triangle." This triangle is formed by the zygomatic arch superiorly, the temporomandibular joint posteriorly, and the frontal branch of the facial nerve inferiorly and anteriorly. This finding was consistent across patient ages (8 to 49 years) and ethnicities. By using the short-scar, minimal dissection approach described in the study, average time to nerve identification was 10.2 minutes during the clinical application.
The subzygomatic triangle is a consistent anatomic landmark for rapid, reliable, and minimally invasive identification of the masseteric nerve. Use of the subzygomatic triangle obviates the need for extensive dissection and surgeon reliance on soft-tissue measurements that may vary among patients of different size, sex, or ethnicity.
Therapeutic, IV.
Numerous biomolecular markers have been studied to improve the accuracy of fine needle aspiration biopsy (FNAB) in the diagnostic and prognostic evaluation of thyroid tumors, but none of them has yet ...become clinically useful. The recently discovered BRAF mutation, which occurs specifically in papillary thyroid cancers (PTC) with a high prevalence and is associated with poor clinicopathological outcomes, has the potential to be a useful diagnostic and prognostic marker for PTC. In the present study, we investigated whether detection of BRAF mutation on FNAB specimens was technically possible and could be used as an adjunct diagnostic tool with routine FNAB. Evaluation of a new colorimetric mutation detection method demonstrated 100% sensitivity and 100% specificity in comparison with conventional DNA sequencing as the “gold standard” in a large pool of DNA samples from various primary thyroid tumor specimens and cell lines. We found this novel technique even more sensitive in detecting BRAF mutation on FNAB specimens than conventional sequencing. In a series of 48 patients undergoing thyroidectomy, mostly for thyroid cancer or for suspicion of cancer, we performed preoperative FNAB and, using the colorimetric mutation detection method, identified BRAF mutation on the cytological specimens. Prospective analysis showed that 50% of the nodules that proved to be PTC on surgical histopathology were correctly diagnosed by BRAF mutation analysis on FNAB specimens; there were no false positive findings. Thus, we have demonstrated the usefulness of BRAF mutation detection on FNAB specimens that can help diagnose and identify those PTC patients who may need more aggressive surgical treatment and vigilant clinical monitoring.
Objectives/Hypothesis:
There is a paucity of data showing the perception penalty caused by facial paralysis. Our objective was to measure society's perception of facial paralysis on the ...characteristic of beauty. We hypothesized that patients with paralysis would be considered by society as less attractive than normals, a difference amplified by smiling.
Study Design:
Randomized controlled experiment.
Methods:
Forty subjects viewed photographs of normal and paralyzed faces. They rated attractiveness, identified paralysis if present, its severity, and the feature most affected.
Results:
There were significant differences in attractiveness scores for normal and paralyzed faces (Wilcoxon rank sum test, z = 16.912; P < .001). A mixed effects regression model was used to explain differences in the scores. The fixed portion of the model shows paralyzed faces were 1 standard deviation less attractive than normal faces. Smiling increased attractiveness for normals (constant, 5.9; smile effect, 0.735; P < .001). The smile × paralysis interaction term was −0.892; P < .001, but not significantly different from the smile term (χ2(1) = 0.87; P = .352). The random effects model showed an intersubject rating variability of 1.32.
Conclusions:
The attractiveness penalty imposed by facial paralysis is significant, with paralyzed faces considered markedly less attractive than normals. However, the ratings did not change significantly when patients smiled, despite the increased asymmetry that occurs through smiling. Observers were moderately good at identifying the presence of facial paralysis, but less good at distinguishing side of involvement. These results have important implications for patient counseling and management of facial paralysis patients in an evidence‐based manner.
A quality-control Internet-based study using recognized quality scoring systems.
To evaluate the quality of information available on the Internet.
The quality of information available is of poor ...quality and unreliable, and this study was to determine if it has improved in line with the exponential increase in Internet-based information since the last time it was reviewed in 2005.
To identify potential Web sites, the 5 most commonly accessed search engines were identified and a search for "scoliosis" was performed on each. The top 100 Web sites were reviewed. Each Web site was categorized according to its authorship and assessed using recognized scoring systems (Journal of American Medical Association JAMA and DISCERN criteria, scoliosis-specific content quality). The presence of the Health on the Net code, a reported quality-assurance marker, was noted.
Forty-one unique Web sites were identified and analyzed. Five were academic, 11 were produced by physicians, 5 were commercial, 3 were nonphysician sites, 6 were attached to discussion groups or social media sites, 3 were media related, and 8 were not otherwise classifiable. There were significant differences noted between the authorship categories on the DISCERN score, JAMA benchmark criteria, and scoliosis-specific content quality score, (P = 0.001, <0.0001, and 0.009, respectively) with academic- and physician-related Web sites containing better-quality information. Internet sites with a Health on the Net code demonstrated higher-quality scoliosis-specific information than those without the code (P = 0.1368).
The overall quality of information regarding scoliosis remains poor despite an exponential increase in the number of sites available. Patients need to be educated about appropriate Internet use-academic- and physician-provided sites have been shown to contain better-quality information. We have a potential role as clinicians to not only direct patients to appropriate sites but also to help in developing content on the Internet.
Mare Crisium is composed of a set of volcanic deposits situated in an impact basin on the Moon's near side. The topography of the mare is dominated by an annulus of elevated topography, the inner ...edge of which is delineated by basin-concentric wrinkle ridges. From a combination of remotely sensed image and topographic data and numerical modeling, we show that the thrust faults that underlie these ridges penetrate up to 20 km in depth, considerably below the base of the mare deposits themselves. Thrust faults of this scale have not heretofore been recognized on the Moon. Mare Crisium sits above a region of uplifted mantle, which contributes to a mass excess beneath the basin, and we demonstrate by comparison with free-air gravity anomaly and derived crustal thickness data for Crisium that the thrust faults structurally bound this elevated mantle material. By means of finite-element models of stresses induced by lithospheric loading within the basin, we argue that the deep-seated thrusts may have been localized by the boundary between the superisostatic mantle material and a sub-isostatic collar of thickened crust that resulted from basin formation and modification shortly after impact. Importantly, numerous other mare-filled mascon basins on the Moon share the same topographic and tectonic characteristics as Crisium, suggesting that they, too, are underlain by deep-seated thrust faults that formed in a similar manner.
•Mare Crisium hosts a set of concentric wrinkle ridges that border a raised “bench”.•These ridges overlie thrust faults that penetrate to depths of 18–20 km.•The faults structurally bound the uplifted mantle beneath the Crisium basin.•These deep-seated structures likely formed early and were later reactivated.•This structural arrangement likely exists elsewhere on the Moon and other bodies.
The relationship between the value of reconstructive surgery and the visual attention drawn by facial deformity has not been studied.
We hypothesized that willingness to pay (WTP) for reconstructive ...surgery would increase as visual attention to deformity increased in a Mohs defect eye-tracking model.
We conducted a randomized observational study. Eighty casual observers participated in timed eye-tracking trials utilizing preoperative and postoperative photographs from 32 patients with facial Mohs defects. Fixation on each defect was quantified in milliseconds. For each photograph, casual observers reported how much they would be willing to pay for a perfect reconstruction and rated defect severity and patient attractiveness. The associations between defect fixation time and WTP, attractiveness, and severity were modeled using a multivariate mixed-effects model.
Increased defect fixation time was associated with increased WTP (regression coefficient = 0.332651,
< 0.001), decreased attractiveness (regression coefficient = -0.221779,
< 0.001), and increased severity (regression coefficient = 0.363111,
< 0.001). As defect fixation time increased, WTP increased exponentially.
Observer WTP for facial reconstruction increases exponentially as defects become more distracting. These findings justify the dedication of health care resources to reconstructive procedures that decrease attentional distraction to the greatest extent possible.
This article presents an overview of surgical management for complex midfacial fractures for the practicing otolaryngologist-head and neck surgeon. Discussion includes the important anatomic ...relationships; pathophysiology; clinical features; pertinent physical examination findings; imaging; surgical approaches; and techniques for repair of zygomaticomaxillary complex, orbital, naso-orbital-ethmoid, and Le Fort fractures.
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