81 results on '"Ryan M. Smith"'
Search Results
2. Radiographic Assessment of the Nasal Septum and Trends in Donor Cartilage Availability
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Matthew J. Urban, Michael Eggerstedt, Jessica Rhee, Ryan M. Smith, Dean M. Toriumi, Pete S. Batra, and Peter Revenaugh
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Logistic Models ,Nasal Cartilages ,Ethnicity ,Humans ,Female ,Surgery ,Rhinoplasty ,Nasal Septum - Published
- 2022
3. Hypoglossal and Masseteric Nerve Transfer for Facial Reanimation: A Systematic Review and Meta-Analysis
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Matthew J. Urban, Ryan M. Smith, Michael Eggerstedt, Eleni A Varelas, Adam J. Beer, Madeline J. Epsten, and Peter C. Revenaugh
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Hypoglossal Nerve ,business.industry ,Mandibular Nerve ,Facial Paralysis ,Masseteric nerve ,medicine.disease ,Facial nerve ,Facial paralysis ,Treatment Outcome ,medicine.anatomical_structure ,Facial reanimation ,Meta-analysis ,Nerve Transfer ,Anesthesia ,Humans ,Medicine ,Surgery ,Adverse effect ,business ,Reinnervation - Abstract
Background: Hypoglossal and masseteric nerve transfer are currently the most popular cranial nerve transfer techniques for patients with facial paralysis. The authors performed a systematic review and meta-analysis to compare functional outcomes and adverse effects of these procedures. Methods: A review of online databases was performed to include studies with four or more patients undergoing hypoglossal or masseter nerve transfer without muscle transfer or other cranial nerve transposition. Facial nerve outcomes, time to reinnervation, and adverse events were pooled and studied. Results: A total of 71 studies were included: 15 studies included 220 masseteric-facial transfers, and 60 studies included 1312 hypoglossal-facial transfers. Oral commissure symmetry at rest was better for hypoglossal transfer (2.22 ± 1.6 mm vs. 3.62 ± 2.7 mm, p = 0.047). The composite Sunnybrook Facial Nerve Grading Scale was better for masseteric transfer (47.7 ± 7.4 vs. 33.0 ± 6.4, p < 0.001). Time to first movement (in months) was significantly faster in masseteric transfer (4.6 ± 2.6 vs. 6.3 ± 1.3, p < 0.001). Adverse effects were rare (
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- 2022
4. PV Module Degradation Due to Frequent and Prolonged Inverter Clipping: A Preliminary Study
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Manjunath Matam, Ryan M. Smith, and Hubert Seigneur
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- 2022
5. Mismatch Losses in Simulated Commercial and Utility-scale PV Arrays due to Shortened Strings
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Ryan M. Smith, Manjunath Matam, and Hubert Seigneur
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- 2022
6. Management of the Clinical and Academic Mission in an Urban Otolaryngology Department During the COVID‐19 Global Crisis
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Peter Papagiannopoulos, Kerstin M. Stenson, Peter C. Revenaugh, Elias M. Michaelides, Ryan M. Smith, Inna Husain, Samer Al-Khudari, R. Mark Wiet, Phillip S. LoSavio, Bobby A. Tajudeen, and Pete S. Batra
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,telehealth ,Pneumonia, Viral ,novel coronavirus ,tracheostomy ,Telehealth ,Betacoronavirus ,Otolaryngology ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,Disease Transmission, Infectious ,Urban Health Services ,medicine ,Humans ,Disease management (health) ,030223 otorhinolaryngology ,Pandemics ,Retrospective Studies ,Original Research ,biology ,SARS-CoV-2 ,business.industry ,pandemic ,COVID-19 ,Disease Management ,Retrospective cohort study ,Safe delivery ,biology.organism_classification ,medicine.disease ,Telemedicine ,Otorhinolaryngologic Diseases ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Surgery ,Medical emergency ,Emergencies ,Coronavirus Infections ,business - Abstract
Objective The objective of this study was to assess the strategic changes implemented in the departmental mission to continue safe delivery of otolaryngology care and to support the broader institutional mission during the COVID-19 pandemic response. Study Design Retrospective assessment was performed to the response and management strategy developed to transform the clinical and academic enterprise. Setting Large urban tertiary care referral center. Results The departmental structure was reorganized along new clinical teams to effectively meet the system directives for provision of otolaryngology care and support for inpatient cases of COVID-19. A surge deployment schedule was developed to assist frontline colleagues with clinical support as needed. Outpatient otolaryngology was consolidated across the system with conversion of the majority of visits to telehealth. Operative procedures were prioritized to ensure throughput for emergent and time-critical urgent procedures. A tracheostomy protocol was developed to guide management of emergent and elective airways. Educational and research efforts were redirected to focus on otolaryngology care in the clinical context of the COVID-19 crisis. Conclusion Emergence of the COVID-19 global health crisis has challenged delivery of otolaryngology care in an unparalleled manner. The concerns for preserving health of the workforce while ethically addressing patient career needs in a timely manner has created significant dilemmas. A proactive, thoughtful approach that reorganizes the overall departmental effort through provider and staff engagement can facilitate the ability to meet the needs of otolaryngology patients and to support the greater institutional mission to combat the pandemic.
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- 2020
7. Level of Evidence in Facial Plastic Surgery Research: A Procedure-Level Analysis
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Peter C. Revenaugh, Aryan Shay, Ethan M. Ritz, Michael Eggerstedt, Ryan M. Smith, Jennifer Westrick, and Hannah J. Brown
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Facial trauma ,medicine.medical_specialty ,Facial rejuvenation ,medicine.medical_treatment ,030230 surgery ,Rhinoplasty ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Rejuvenation ,Surgery, Plastic ,Craniofacial ,Orthodontics ,business.industry ,Evidence-based medicine ,Plastic Surgery Procedures ,medicine.disease ,Facial paralysis ,Plastic surgery ,Critical appraisal ,Face ,Surgery ,business - Abstract
As evidence-based medicine has taken hold across medical specialties, the level of evidence within the facial plastic surgery literature has risen, but remains weak in comparison. There has not yet been a systematic, critical appraisal of the relative strength of evidence among subsets of the practice of facial plastic surgery. The current study is a systematic review, designed to evaluate the level of evidence observed in the facial plastic surgery literature. Five journals were queried using facial plastic surgery terms for four selected years over a 10-year period. Following screening, articles were assigned to a category regarding subject matter, assessed for the presence of various methodological traits, and evaluated for overall level of evidence. Comparisons were made in regard to level of evidence across the breadth of facial plastic surgery subject matter. A total of 826 articles were included for final review. Studies on operative facial rejuvenation and rhinoplasty had significantly fewer authors on average than studies on cancer reconstruction or craniofacial topics. Craniofacial studies demonstrated higher levels of evidence relative to all other categories, with the exception of facial paralysis and facial trauma studies, from which there was no significant difference. In general, reconstructive studies had significantly more authors and higher levels of evidence than did articles with an aesthetic focus. Level of evidence in facial plastic surgery remains relatively weak overall. Reconstructive and particularly craniofacial studies demonstrate higher mean level of evidence, relative to other subsets of facial plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266
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- 2020
8. An Update on Level of Evidence Trends in Facial Plastic Surgery Research
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Aryan Shay, Michael Eggerstedt, Eleni A Varelas, Peter C. Revenaugh, Ashwin Ganti, Ryan M. Smith, and Hannah J. Brown
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medicine.medical_specialty ,Biomedical Research ,Evidence-Based Medicine ,business.industry ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,MEDLINE ,Evidence-based medicine ,Plastic Surgery Procedures ,Quality of evidence ,Physical medicine and rehabilitation ,Face ,Facial plastic surgery ,Humans ,Medicine ,Surgery ,Surgery, Plastic ,business ,ComputingMethodologies_COMPUTERGRAPHICS - Abstract
Background: Knowledge of the quality of evidence in facial plastic surgery research is essential for the implementation of evidence-based practices. The purpose of this study is to provide an updat...
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- 2020
9. Setbacks in Forehead Feminization Cranioplasty: A Systematic Review of Complications and Patient-Reported Outcomes
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Young Soo Hong, Connor Wakefield, Jennifer Westrick, Ryan M. Smith, Peter C. Revenaugh, and Michael Eggerstedt
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,MEDLINE ,Prom ,CINAHL ,PsycINFO ,Evidence-based medicine ,030230 surgery ,Cranioplasty ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Systematic review ,Otorhinolaryngology ,Physical therapy ,Medicine ,Surgery ,business - Abstract
Forehead feminization cranioplasty (FFC) is an important component of gender-affirming surgery and has become increasingly popular in recent years. Little objective evidence exists for the procedure’s safety and clinical impact via patient-reported outcome measures (PROMs). To determine what complications are observed following FFC, the relative frequency of complications by surgical technique, and what impact the procedure has on patient’s quality of life. Database searches were performed in PubMed/MEDLINE, Scopus, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and PsycINFO. The search terms included variations of forehead setback/FFC. Both controlled vocabularies (i.e., MeSH and CINAHL’s Suggested Subject Terms) and keywords in the title or abstract fields were searched. Two independent reviewers screened the titles and abstracts of all articles. Two independent surgeon reviewers evaluated the full text of all included articles, and relevant data points were extracted. Complications and complication rate observed following FFC. Additional outcome measures were the approach utilized, concurrent procedures performed, and the use and findings of a PROM. Ten articles describing FFC were included, encompassing 673 patients. The overall pooled complication rate was 1.3%. PROMs were used in half of studies, with no standardization among studies. Complications following FFC are rare and infrequently require reoperation. Further studies into standardized and validated PROMs in facial feminization patients are warranted. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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- 2020
10. The Selfie View: Perioperative Photography in the Digital Age
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Michael Eggerstedt, Ryan M. Smith, Jane K. Schumacher, Matthew J. Urban, and Peter C. Revenaugh
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business.industry ,Photography ,Context (language use) ,Perioperative ,030230 surgery ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Facial analysis ,Optometry ,Medicine ,Surgery ,Table of contents ,Social media ,Selfie ,business ,Amateur - Abstract
The aesthetics of social media have become increasingly important to cosmetic surgery patients in recent years; however, aesthetic treatments have not kept pace with the desires of modern patients. The current study investigates the most common angles employed by various user cohorts when posting a selfie on social media platforms and proposes that aesthetic surgeons consider utilizing a selfie angle alongside standard pre- and postoperative photographic views. Full face photographs published on the social media platform Instagram™ with the tag #selfie were divided into three cohorts: female models/influencers, amateur females, and amateur males. Each cohort contained 100 photographs. The photographs were analyzed using cloud-based facial analysis software for facial pan, roll, and tilt relative to the camera. One hundred photographs from each cohort were analyzed and demonstrated that amateur females (AF) take photographs from higher angles than amateur males (AM) or model females (MF). Roll-off-midline was significantly greater for AF and MF as compared to AM. The MF group had significantly a greater pan-off-midline as compared to AF and AM, while AF had significantly a greater pan-off-midline than AM. Common photography practices employed within selfie photographs utilize angles not captured in standard perioperative photographs. This study supports the implementation of a selfie photograph into the standard set of pre- and postoperative photographs taken by aesthetic surgeons to evaluate the effects of interventions in the context of selfie photography. The angle employed can vary depending upon the demographic profile of the patient. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
- Published
- 2020
11. Quality-Based Evaluation of Patient-Facing Online Education Materials Regarding Facial Filler Procedures
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Adam J. Beer, Michael Eggerstedt, Matthew J. Urban, Ryan M. Smith, and Peter C. Revenaugh
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Education, Distance ,Internet ,Reading ,education ,Humans ,Surgery ,Comprehension ,Head - Abstract
Injectable facial fillers have become tremendously more popular in recent years, and the Internet offers a proportional amount of consumer-facing educational material. This study sought to explore the quality of these online materials. The top 20 Web sites offering educational materials about facial filler were identified via Google search and sorted by source: Medical Professional Boards, Hospitals and Providers, Medical News and Reference, and Fashion. The materials were assessed for overall quality with the validated DISCERN instrument. The authors also assessed understandability and actionability (Patient Education Material Assessment Tool - PEMAT), accuracy, comprehensiveness, and readability (Flesch-Kincaid Grade Level and Flesch Reading Ease). The mean DISCERN score was 46.9 ± 7.6, which is considered “fair” quality educational material; above “poor,” but below “good” and “excellent.” Understandability and actionability scores were low, particularly with respect to visual aids. The materials were generally accurate (76–99%), but scored poorly in comprehensiveness, as 15% failed to mention any risks/adverse effects and only 35% mentioned cost. On average, readability was at an 11th grade level, far more complex than ideal (< 6th grade level). Information disseminated from seemingly reputable sources such as professional boards and hospitals/providers were not of higher quality or superior in any of the above studied domains. In conclusion, online educational materials related to injectable facial fillers are of subpar quality, including those from academic and professional organizations. Visual aids were particularly weak. The facial rejuvenation community should make a concerted effort to set a higher standard for disseminating such information.
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- 2022
12. Abstract 12954: A Genotype-Phenotype Link Between Cardiac Monoamine Oxidase Activity and Arrhythmogenic Potential Using a Translational Approach
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Qian Shi, Alexander Hart, Andrew Jatis, Nathan Karlan, Shahab Akhter, Jean C Shih, Ryan M Smith, Long-sheng Song, and Ethan J Anderson
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Monoamine oxidase (MAO) has emerged as an intriguing drug target for heart disease because of the toxicity of the oxidative catechol metabolites produced. Our group has recently shown that a high rate of MAO activity in atrial myocardium is associated with a greater incidence of postoperative atrial fibrillation (POAF) following coronary artery bypass graft surgery (CABG). Hypothesis: Cardiac MAO deficiency lowers arrhythmogenic potential. Methods and Results: In a cohort of age-matched CABG patients (N=288, 26% female, 20% African-American), we performed DNA-sequencing analysis of maoA,B while assessing maximal MAO-A and -B enzyme activity with norepinephrine (NE) in fresh atrial tissue from a subset (N=110) of these patients. Patients homozygous for maoA synonymous variant rs1800464, and maoB intron variant rs5905512, had lower NE-supported MAO activity ( Figure 1 , 0 = ref, 1=het, 2=homoz) and lower incidence of POAF (OR 0.6 ± 0.1 and 0.9 ± 0.02, respectively). Mice with cardiomyocyte-specific MAO-A deficiency (cMAOA -/- ) had 2-fold lower rates of epinephrine/caffeine-induced ventricular tachycardia (VT) compared with wild-type ( Figure 2 , *P-/- mice had increased fractional shortening, faster relaxation and shorter Ca 2+ transient duration (P2+ handling in the cMAOA -/- mice were accompanied by decreased epinephrine-induced phosphorylation of CamKII and ryanodine receptor (P Conclusions: Collectively, these findings suggest that decreasing MAO activity lowers arrhythmogenic potential in the heart, and that cardiac MAO may be a therapeutic target for POAF.
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- 2021
13. Cyclical Consumer Search Trends Regarding Cosmetic Plastic Surgery of the Face: A Google Trends Analysis
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Matthew J. Urban, Ryan M. Smith, Michael Eggerstedt, and Peter C. Revenaugh
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medicine.medical_specialty ,Internet ,business.industry ,Information Seeking Behavior ,Face (sociological concept) ,Advertising ,Plastic Surgery Procedures ,Search Engine ,Plastic surgery ,Face ,Medicine ,Humans ,Surgery ,business - Published
- 2021
14. Estlander flap for lip reconstruction
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Michael Eggerstedt, Peter C. Revenaugh, and Ryan M. Smith
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medicine.medical_specialty ,business.industry ,Lower lip ,Local flap ,Anatomy ,Commissure ,eye diseases ,stomatognathic diseases ,03 medical and health sciences ,Estlander flap ,Plastic surgery ,0302 clinical medicine ,stomatognathic system ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Lip reconstruction ,Medicine ,Surgery ,030223 otorhinolaryngology ,business - Abstract
Lip reconstruction for defects which involve the commissure remains a significant challenge to the facial plastic surgeon. The Estlander flap is a hardy local flap which can be used to reconstruct defects of 1/3-2/3 of both the upper and lower lip. Herein, we describe the operative technique of the Estlander flap for lip reconstruction.
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- 2020
15. Association of Perioperative Opioid-Sparing Multimodal Analgesia With Narcotic Use and Pain Control After Head and Neck Free Flap Reconstruction
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Michael Eggerstedt, Ryan M. Smith, Peter C. Revenaugh, Deborah Vaughan, Hannah N. Kuhar, Danny Jandali, Emily A. Ramirez, Samer Al-Khudari, and Kerstin M. Stenson
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Male ,Narcotics ,Narcotic ,medicine.medical_treatment ,Free flap ,030230 surgery ,Free Tissue Flaps ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Medical prescription ,030223 otorhinolaryngology ,Head and neck ,Original Investigation ,Aged ,Pain Measurement ,Retrospective Studies ,Pain, Postoperative ,integumentary system ,business.industry ,Pain scale ,Perioperative ,Middle Aged ,Plastic Surgery Procedures ,Head and Neck Neoplasms ,Anesthesia ,Morphine ,Free flap reconstruction ,Female ,Surgery ,Analgesia ,business ,medicine.drug - Abstract
IMPORTANCE: An increase in narcotic prescription patterns has contributed to the current opioid epidemic in the United States. Opioid-sparing perioperative analgesia represents a means of mitigating the risk of opioid dependence while providing superior perioperative analgesia. OBJECTIVE: To assess whether multimodal analgesia (MMA) is associated with reduced narcotic use and improved pain control compared with traditional narcotic-based analgesics at discharge and in the immediate postoperative period after free flap reconstructive surgery. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study assessed a consecutive sample of 65 patients (28 MMA, 37 controls) undergoing free flap reconstruction of a through-and-through mucosal defect within the head and neck region at a tertiary academic referral center from June 1, 2017, to November 30, 2018. Patients and physicians were not blinded to the patients’ analgesic regimen. Patients’ clinical courses were followed up for 30 days postoperatively. INTERVENTIONS: Patients were administered a preoperative, intraoperative, and postoperative analgesia regimen consisting of scheduled and as-needed neuromodulating and anti-inflammatory medications, with narcotic medications reserved for refractory cases. Control patients were administered traditional narcotic-based analgesics as needed. MAIN OUTCOMES AND MEASURES: Narcotic doses administered during the perioperative period and at discharge were converted to morphine-equivalent doses (MEDs) for comparison. Postoperative Defense and Veterans Pain Rating Scale pain scores (ranging from 0 [no pain] to 10 [worst pain imaginable]) were collected for the first 72 hours postoperatively as a patient-reported means of analyzing effectiveness of analgesia. RESULTS: A total of 28 patients (mean [SD] age, 64.1 [12.3] years; 17 [61%] male) were included in the MMA group and 37 (mean [SD] age, 65.0 [11.0] years; 22 [59%] male) in the control group. The number of MEDs administered postoperatively was 10.0 (interquartile range [IQR], 2.7-23.1) in the MMA cohort and 89.6 (IQR, 60.0-104.5) in the control cohort (P
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- 2019
16. Enhanced recovery after surgery in head and neck surgery: Reduced opioid use and length of stay
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Michael Eggerstedt, Emily A. Ramirez, Ryan M. Smith, Danny Jandali, Peter C. Revenaugh, Holly Scheltens, Kerstin M. Stenson, Deborah Vaughan, Ashwin Ganti, and Samer Al-Khudari
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Male ,medicine.medical_specialty ,Narcotic ,medicine.medical_treatment ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030223 otorhinolaryngology ,Enhanced recovery after surgery ,Aged ,Retrospective Studies ,Morphine ,business.industry ,Head and neck cancer ,Retrospective cohort study ,Length of Stay ,Middle Aged ,medicine.disease ,Drug Utilization ,Colorectal surgery ,Analgesics, Opioid ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Anesthesia ,Cohort ,Head and neck surgery ,Female ,Enhanced Recovery After Surgery ,business ,Head ,Neck ,medicine.drug - Abstract
OBJECTIVES Enhanced recovery after surgery (ERAS) protocols were first developed in colorectal surgery and sought to standardize patient care. There have been several studies in the head and neck surgical literature looking at outcomes after ERAS protocol, but no studies focusing on narcotic use and length of stay. This study aimed to evaluate narcotic usage and length of stay, in addition to several other outcomes, following the implementation of an ERAS protocol. METHODS A head and neck-specific ERAS protocol was implemented at this tertiary care center beginning July 2017. A retrospective cohort study was performed comparing this cohort to that of a retrospective control group. Outcomes included mean morphine equivalent dose, mean pain score, and percentage of patients prescribed narcotics on discharge. Secondary outcomes included ICU and total length of stay. RESULTS The mean morphine equivalent dose (MED) administered within 72 hours postoperatively was significantly lower in the ERAS group (17.5 ± 46.0 mg vs. 82.7 ± 116.1 mg, P
- Published
- 2019
17. Spontaneous Otogenic Pneumocephalus: Case Series and Update on Management
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Michael Eggerstedt, R. Mark Wiet, Daniel B. Eddelman, Ryan M. Smith, Rich Byrne, Scott A. Hong, and Lorenzo F. Munoz
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Tegmen ,medicine.medical_specialty ,Disease entity ,business.industry ,Emergency department ,medicine.disease ,Middle cranial fossa ,Surgery ,Pneumocephalus ,Tegmen tympani ,medicine.anatomical_structure ,medicine ,Neurology (clinical) ,Presentation (obstetrics) ,business ,Rare disease - Abstract
Objectives This study is aimed to report the largest independent case series of spontaneous otogenic pneumocephalus (SOP) and review its pathophysiology, clinical presentation, and treatment. Design Four patients underwent a middle cranial fossa approach for repair of the tegmen tympani and tegmen mastoideum. A comprehensive review of the literature regarding this disease entity was performed. Setting U.S. tertiary academic medical center. Participants: Patients presenting to the lead author's clinic or to the emergency department with radiographic evidence of SOP. Symptoms included headache, otalgia, and neurologic deficits. Main Outcome Measures Patients were assessed for length of stay, postoperative length of stay, and neurologic outcome. Three of four patients returned to their neurologic baseline following repair. Results Four patients were successfully managed via a middle cranial fossa approach to repairing the tegmen mastoideum. Conclusion The middle cranial fossa approach is an effective strategy to repair defects of the tegmen mastoideum. SOP remains a clinically rare disease, with little published information on its diagnosis and treatment.
- Published
- 2018
18. Use of Objective Metrics in Dynamic Facial Reanimation
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Lisa Ishii, Max A. Plitt, Peter C. Revenaugh, Ryan M. Smith, Patrick J. Byrne, and Kofi D. O. Boahene
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medicine.medical_specialty ,business.industry ,Facial Paralysis ,MEDLINE ,Plastic Surgery Procedures ,030230 surgery ,medicine.disease ,Neurosurgical Procedures ,Facial paralysis ,03 medical and health sciences ,Outcome and Process Assessment, Health Care ,0302 clinical medicine ,Physical medicine and rehabilitation ,Facial reanimation ,Health care ,Humans ,Social consequence ,Medicine ,Surgery ,Facial nerve function ,030223 otorhinolaryngology ,business - Abstract
Facial nerve deficits cause significant functional and social consequences for those affected. Existing techniques for dynamic restoration of facial nerve function are imperfect and result in a wide variety of outcomes. Currently, there is no standard objective instrument for facial movement as it relates to restorative techniques.To determine what objective instruments of midface movement are used in outcome measurements for patients treated with dynamic methods for facial paralysis.Database searches from January 1970 to June 2017 were performed in PubMed, Embase, Cochrane Library, Web of Science, and Scopus. Only English-language articles on studies performed in humans were considered. The search terms used were ("Surgical Flaps"[Mesh] OR "Nerve Transfer"[Mesh] OR "nerve graft" OR "nerve grafts") AND (face [mh] OR facial paralysis [mh]) AND (innervation [sh]) OR ("Face"[Mesh] OR facial paralysis [mh]) AND (reanimation [tiab]).Two independent reviewers evaluated the titles and abstracts of all articles and included those that reported objective outcomes of a surgical technique in at least 2 patients.The presence or absence of an objective instrument for evaluating outcomes of midface reanimation. Additional outcome measures were reproducibility of the test, reporting of symmetry, measurement of multiple variables, and test validity.Of 241 articles describing dynamic facial reanimation techniques, 49 (20.3%) reported objective outcome measures for 1898 patients. Of those articles reporting objective measures, there were 29 different instruments, only 3 of which reported all outcome measures.Although instruments are available to objectively measure facial movement after reanimation techniques, most studies do not report objective outcomes. Of objective facial reanimation instruments, few are reproducible and able to measure symmetry and multiple data points. To accurately compare objective outcomes in facial reanimation, a reproducible, objective, and universally applied instrument is needed.
- Published
- 2018
19. Interest in Facial Cosmetic Surgery in the Time of COVID-19: A Google Trends Analysis
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Matthew J. Urban, Michael Eggerstedt, Peter C. Revenaugh, and Ryan M. Smith
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Blepharoplasty ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,General surgery ,medicine.medical_treatment ,MEDLINE ,COVID-19 ,Cosmetic Techniques ,Search Engine ,Face surgery ,Face ,medicine ,Humans ,Surgery ,Psychology - Published
- 2021
20. Genetic and epigenetic analysis of the serotonin 2A receptor in the context of cocaine abuse
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Ryan M. Smith and Aysheh Alrfooh
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Genetics ,Cancer Research ,Rs6313 ,Addiction ,media_common.quotation_subject ,Context (language use) ,Single-nucleotide polymorphism ,Methylation ,DNA ,Biology ,DNA Methylation ,Polymorphism, Single Nucleotide ,Epigenesis, Genetic ,Cocaine-Related Disorders ,Cocaine ,DNA methylation ,Humans ,Protein Isoforms ,Receptor, Serotonin, 5-HT2A ,Epigenetics ,RNA, Messenger ,Allele ,Molecular Biology ,media_common ,Research Paper - Abstract
Despite more than 2 million American cocaine users monthly, there is no approved drug for treating cocaine use disorder. Cocaine use disorder has a multifactorial aetiology, including both genetic and environmental factors. Both cocaine use and genetic variations demonstrably alter DNA methylation and gene expression in the brain in a complex manner. How these factors interact in the context of cocaine abuse in humans is unknown. We propose that we can identify potential drug targets for treating cocaine use disorders by examining genetic, epigenetic, and expression changes in the brains of individuals that abused cocaine. In this study, we identified the interaction between the epigenetics changes (DNA CpG methylation) and genetic variants (SNPs) in the HTR2A gene in the context of cocaine addiction by using brain tissue collected from individuals that overdosed on cocaine (N = 14) and healthy matched controls (N = 16). We generated DNA CpG methylation profiles in eight regions of HTR2A harbouring frequent SNPs, measuring both allelic and total methylation, and compared these methylation profiles with HTR2A mRNA expression. Furthermore, we examined the influence of common variants rs6311 and rs6313 on cocaine abuse, methylation, and gene expression. We found evidence that rs6311 regulates HTR2A methylation, consistent with earlier studies. Furthermore, the minor alleles for rs6311 and rs6313 are associated with significantly increased expression of a splice isoform in which exon 2 is truncated in both cocaine and control samples. These results reveal specific roles for HTR2A in the context of cocaine abuse, highlighting opportunities to modulate this target for treating cocaine use disorder.
- Published
- 2021
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21. Implementation of Preoperative Screening Protocols in Otolaryngology During the COVID-19 Pandemic
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Tirth R Patel, Bobby A. Tajudeen, Phillip S. LoSavio, Inna Husain, R. Mark Wiet, Kerstin M. Stenson, Matthew J. Urban, Ryan M. Smith, Thomas E. Nielsen, Peter C. Revenaugh, Peter Papagiannopoulos, Richard A. Raad, Samer Al-Khudari, and Pete S. Batra
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medicine.medical_specialty ,Point-of-care testing ,Pneumonia, Viral ,030230 surgery ,Preoperative care ,Tertiary Care Centers ,03 medical and health sciences ,Betacoronavirus ,Otolaryngology ,0302 clinical medicine ,COVID-19 Testing ,Pandemic ,Preoperative Care ,medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,Pandemics ,Mass screening ,Retrospective Studies ,Protocol (science) ,Chicago ,business.industry ,Clinical Laboratory Techniques ,SARS-CoV-2 ,COVID-19 ,Retrospective cohort study ,medicine.disease ,Workflow ,Otorhinolaryngology ,Point-of-Care Testing ,Surgery ,Medical emergency ,business ,Coronavirus Infections - Abstract
To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic.This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a "high-risk case protocol" was utilized to maximize available resources. As information and technology evolved, a "universal point-of-care protocol" was implemented.Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure (Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on "COVID-19 clinics" or other community testing facilities.Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays.
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- 2020
22. Beauty is in the eye of the follower: Facial aesthetics in the age of social media
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Matthew J. Urban, Jessica Rhee, Michael Eggerstedt, Ryan M. Smith, Peter C. Revenaugh, and Angelica Mangahas
- Subjects
Adult ,Esthetics ,Patients ,Cephalometry ,media_common.quotation_subject ,medicine.medical_treatment ,Nostril ,Health Behavior ,Nasofacial angle ,Rhinoplasty ,03 medical and health sciences ,Beauty ,Young Adult ,0302 clinical medicine ,Photography ,Medicine ,Humans ,Social media ,Surgery, Plastic ,030223 otorhinolaryngology ,media_common ,Orthodontics ,Motivation ,Physician-Patient Relations ,Anatomy, Cross-Sectional ,business.industry ,Patient Preference ,Nasal tip ,Preference ,Nasolabial angle ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Face ,Female ,business ,Social Media - Abstract
Background The advent of social media has influenced the relationship between aesthetic surgeons and their patients, as well as the motivations of such patients to seek cosmetic surgery. Aims & objectives To determine how the cephalometric proportions of modern social media models fit with historical canons of beauty. Materials & methods Frontal and lateral photographs of 20 high-influence female Instagram models were obtained and evaluated for cephalometric measures. The means of these measures were compared with previous reports in the literature. Results Cephalometric measurements of social media models were in agreement with historical ideals of beauty for Nostril axis (120.7°), Goode's ratio (0.6), Nasofacial angle (35.7°), Nasofrontal angle (130.9°), and the horizontal thirds. Results were discrepant from historical ideals for the Nasolabial angle (82.6°) and the vertical facial fifths. Conclusion Cephalometric measurements of social media models in the digital age closely resemble the ideal values proposed by previous authors. Due to a preference for larger or altered lip profiles, nostril axis is a more reliable measure of nasal tip rotation than nasolabial angle.
- Published
- 2020
23. Nasal Skin and Soft Tissue Thickness Variation Among Differing Races and Ethnicities: An Objective Radiographic Analysis
- Author
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Michael Eggerstedt, Bobby A. Tajudeen, Peter C. Revenaugh, Ryan M. Smith, Pete S. Batra, Megan Buranosky, and Jessica Rhee
- Subjects
Adult ,Male ,medicine.medical_specialty ,Biometry ,Radiography ,medicine.medical_treatment ,Dentistry ,Nose ,Surgical planning ,Tertiary care ,Patient Care Planning ,Rhinoplasty ,Ethnicity ,Medicine ,Humans ,In patient ,Retrospective Studies ,Skin ,business.industry ,Electronic medical record ,Soft tissue ,Middle Aged ,Cross-Sectional Studies ,Otorhinolaryngology ,Surgery ,Female ,business ,Tomography, X-Ray Computed - Abstract
Importance: Nasal skin and soft tissue envelope (SSTE) thickness has considerable effects on procedural planning and postoperative outcomes in rhinoplasty surgery. Objective understanding of relative SSTE thickness in patients is essential to optimal outcomes in rhinoplasty, and knowledge of its variation by demographic group is of aid to surgeons. Objective: To measure and compare nasal SSTE thickness across different races and nasal subsites and to determine whether objective variability exists for these parameters. Design, Setting, Participants: Retrospective cross-sectional radiographic analysis was carried out on 200 adult patients, without nasal deformity, presenting to an academic otolaryngology clinic at a tertiary care academic referral center. Blinded evaluators measured nasal SSTE thickness at six sites on maxillofacial computed tomography (CT) scans and comparisons were made based on patient-reported race/ethnicity categories available in the electronic medical record. Intervention: N/A Main Outcomes and Measures: Nasal SSTE thickness was measured at six predefined anatomic sites using high-resolution CT imaging. Statistical comparisons between races/ethnicities were made based on these measurements. Results: Mean age of patients was 48.8 years, and 47% were male. Nasal SSTE showed thicker soft tissue at the sellion in Latin American (LA; mean (SD) 6.1 (1.8) mm) and white (5.8 (1.8) mm) patients vs. African American (AfA) and Asian American (AsA) patients. The supratip was thicker in AfA patients (5.2 (1.3) mm) vs. all other races. The tip SSTE was thinner in white patients (2.4 (0.7) mm) vs. all other races. Composite nasal SSTE thickness was thinner in AsA patients (3.22 (0.8) mm) relative to AfA and LA patients. Conclusions and Relevance: SSTE thickness influences surgical planning and postoperative outcomes in rhinoplasty patients. This study supports varied thickness of the nasal SSTE among patients of different races. These data are foundational in providing a framework for developing treatment strategies specific to the SSTE properties of a multicultural patient population.
- Published
- 2020
24. Nasal Fractures
- Author
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Leslie Kim, Matthew G. Huddle, Ryan M. Smith, and Patrick Byrne
- Published
- 2020
25. List of Contributors
- Author
-
Bizhan Aarabi, Zahid Afzal, Majd Al Mardini, Brian Alpert, Oleh Antonyshyn, Krystal Archer-Arroyo, Said C Azoury, Craig Birgfeld, Kofi D.O. Boahene, Colin M. Brady, Steven R. Buchman, Patrick Byrne, Daniel Cantu, John P. Carey, Edward H. Davidson, Kristopher M. Day, A. Lee Dellon, Sarah W. DeParis, J. Rodrigo Diaz-Siso, Amir H. Dorafshar, Edward Ellis, Jeffrey Fialkov, Robert L. Flint, Christopher R. Forrest, Nils-Claudius Gellrich, Dane J. Genther, Jesse A. Goldstein, Chad R. Gordon, Michael Grant, Joseph S. Gruss, Corbett A. Haas, Alan S. Herford, Larry H. Hollier, Richard A. Hopper, Matthew G. Huddle, Lewis C. Jones, Bartlomiej Kachniarz, Leslie Kim, George M. Kushner, Matthew E. Lawler, Andrew Lee, Jeffrey Lee, Jonathan Y. Lee, Fan Liang, Joseph Lopez, Joseph E. Losee, Matthew R. Louis, Alexandra Macmillan, Paul N. Manson, Meagan Miller, Shannath L. Merbs, Stuart E. Mirvis, Corey M. Mossop, Gerhard S. Mundinger, Arthur J. Nam, Lauren T. Odono, Devin O'Brien-Coon, Ira D. Papel, Zachary S. Peacock, Daniel Perez, Christian Petropolis, David B. Powers, Andrew M. Read-Fuller, Richard J. Redett, Likith V. Reddy, Sashank Reddy, Douglas D. Reh, Isabel Robinson, Eduardo D. Rodriguez, Christopher R. Roxbury, Shai M. Rozen, Larry Sargent, Tatyana A. Shamliyan, David A. Shaye, Ghassan G. Sinada, Ryan M. Smith, Mark W. Stalder, E. Bradley Strong, Marcelo Suzuki, Jeffrey G. Trost, Anthony P. Tufaro, Mark Urata, Christian J. Vercler, Gary Warburton, Heather M. Weinreich, Tyler Wildey, S. Anthony Wolfe, Bradford A. Woodworth, Robin Yang, Michael J. Yaremchuk, Elizabeth Zellner, and Rüdiger M. Zimmerer
- Published
- 2020
26. Surgical Pearls and Pitfalls
- Author
-
Ryan M. Smith, Lisa Ishii, and Matthew J. Urban
- Subjects
Follicular unit transplantation ,medicine.medical_specialty ,integumentary system ,business.industry ,medicine.medical_treatment ,medicine.disease ,Surgery ,Hair loss ,Quality of life ,Hairline lowering ,medicine ,Hair transplantation ,business ,Follicular unit extraction ,Psychosocial ,Tissue expansion - Abstract
Alopecia is a common condition with varying levels of severity that affects both men and women. Hair loss can have a negative psychosocial effect with detriments to self-esteem, social success, and perceived attractiveness. Recent evidence has proven a significant reduction in the quality of life (QOL) in patients with this condition. Health-state utility studies have demonstrated the value of treating alopecia and reveal the motivations for patients seeking treatment [1]. Surgical hair restoration is now among the most highly sought cosmetic procedures. According to the International Society for Hair Restoration Surgery (ISHRS), the number of surgical hair restoration patients increased by 109% from 2012 to 2016 and by 67% from 2014 to 2016 alone [3]. Hair restoration aims to stimulate regrowth of lost hair and unlike many medical therapies, is not limited to prevention of hair loss [2]. Tremendous advancements in hair restoration techniques have led to greatly improved outcomes since restoration was first attempted in the early 1800s [2]. Procedures in the current era include hair transplantation with follicular unit extraction (FUE) or follicular unit transplant (FUT), use of platelet-rich plasma (PRP), tissue expansion, local tissue rearrangement, and hairline lowering surgery.
- Published
- 2020
27. Difficult Necks and Unresolved Problems in Neck Rejuvenation
- Author
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Ryan M. Smith and Ira D. Papel
- Subjects
Esthetics ,business.industry ,Patient Selection ,Patient characteristics ,Aging face ,030230 surgery ,Skin Aging ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Risk analysis (engineering) ,Neck Muscles ,Facial aging ,Rhytidoplasty ,Humans ,Rejuvenation ,Medicine ,Surgery ,030212 general & internal medicine ,business ,Neck - Abstract
Neck rejuvenation attempts to correct the unattractive features that result from the process of facial aging. The aesthetic goals of surgery include creating a well-defined jaw contour, optimal cervicomental angle, smooth-appearing skin, and a healthy redistribution of soft tissue volume. Unique patient characteristics create inherent challenges that may limit the degree to which improvement can be made. Psychological expectations and motivations influence patient satisfaction and must be understood through careful evaluation and counseling. This article describes common difficult situations encountered during neck rejuvenation and discusses unresolved problems. Several clinical examples along with specific surgical solutions are included.
- Published
- 2018
28. Resources That Improve Medical Board Licensing Examination Performance
- Author
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Ryan A Kollar, Frank I. Jackson, Robert Harmon, Ethan Duane, Ryan M Smith, and Nicole M Rainville
- Subjects
Self-assessment ,Medical education ,business.industry ,General Engineering ,Medical school ,Graduate medical education ,board examination ,030204 cardiovascular system & hematology ,comlex-usa level 1 ,medical school ,United States Medical Licensing Examination ,Quality Improvement ,usmle step 1 ,03 medical and health sciences ,0302 clinical medicine ,Medical Education ,Preparedness ,Medicine ,business ,030217 neurology & neurosurgery ,Accreditation - Abstract
Purpose Examine the factors improving performance on national medical licensing board examinations. Rationale Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs report the United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Licensing Examination-USA (COMLEX-USA) Level 1 scores as the most important criteria in selecting candidates to interview. Hypotheses (1) Certain resources are superior for exam preparation. (2) Certain practice tests better assess exam preparedness. (3) USMLE performance will correlate with the COMLEX-USA. Methods One-hundred and two (102) medical students were surveyed regarding preparation for and performance on COMLEX-USA Level 1 and USMLE Step 1. Results USMLE-specific question banks were positively correlated with performance on COMLEX-USA Level 1 and USMLE Step 1 while COMLEX-specific question banks showed no correlation. National Board of Medical Examiners (NBME) Comprehensive Basic Science Self Assessment (CBSSA) and National Board of Osteopathic Medical Examiners (NBOME) Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) practice examinations were positively correlated with performance on the USMLE Step 1 and the COMLEX-USA Level 1. Scores on USMLE Step 1 and COMLEX-USA Level 1 were highly correlated. Students who took USMLE Step 1 performed better on COMLEX-USA Level 1 than those who did not. Conclusion COMLEX-specific resources may not adequately prepare students for COMLEX-USA Level 1. Students studying for COMLEX-USA Level 1 may benefit by preparing for USMLE Step 1.
- Published
- 2019
29. Setbacks in Forehead Feminization Cranioplasty: A Systematic Review of Complications and Patient-Reported Outcomes
- Author
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Michael, Eggerstedt, Young Soo, Hong, Connor J, Wakefield, Jennifer, Westrick, Ryan M, Smith, and Peter C, Revenaugh
- Subjects
Male ,Treatment Outcome ,Patient Satisfaction ,Quality of Life ,Humans ,Feminization ,Forehead ,Patient Reported Outcome Measures - Abstract
Forehead feminization cranioplasty (FFC) is an important component of gender-affirming surgery and has become increasingly popular in recent years. Little objective evidence exists for the procedure's safety and clinical impact via patient-reported outcome measures (PROMs).To determine what complications are observed following FFC, the relative frequency of complications by surgical technique, and what impact the procedure has on patient's quality of life.Database searches were performed in PubMed/MEDLINE, Scopus, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and PsycINFO. The search terms included variations of forehead setback/FFC. Both controlled vocabularies (i.e., MeSH and CINAHL's Suggested Subject Terms) and keywords in the title or abstract fields were searched.Two independent reviewers screened the titles and abstracts of all articles. Two independent surgeon reviewers evaluated the full text of all included articles, and relevant data points were extracted.Complications and complication rate observed following FFC. Additional outcome measures were the approach utilized, concurrent procedures performed, and the use and findings of a PROM.Ten articles describing FFC were included, encompassing 673 patients. The overall pooled complication rate was 1.3%. PROMs were used in half of studies, with no standardization among studies.Complications following FFC are rare and infrequently require reoperation. Further studies into standardized and validated PROMs in facial feminization patients are warranted.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
- Published
- 2019
30. Mismatch losses in a PV system due to shortened strings
- Author
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Ryan M. Smith, Manjunath Matam, and Hubert Seigneur
- Subjects
Maximum power principle ,Renewable Energy, Sustainability and the Environment ,String (computer science) ,Photovoltaic system ,Emphasis (telecommunications) ,Energy Engineering and Power Technology ,Topology ,Blocking (statistics) ,Power (physics) ,Fuel Technology ,Nuclear Energy and Engineering ,Point (geometry) ,Mathematics ,Voltage - Abstract
Numerous events may require intentional removal of one or more photovoltaic modules from a string, shortening the length of the string relative to others within the array, resulting in a str ing length mismatch. The impact of such a mismatch is not well understood either in measurable operational effects (voltage, current, power) or in the potential effects on long-term module health. It is impractical to solely approach this problem experimentally due to the size and complexity of arrays that may experience string length shortening. This work presents simulations, validated through limited field experiments on a two string array, providing a basis from which more complex arrays and scenarios may be explored. Refinement of the simulation achieves an overall error in IMPP for the nominal ( S 1 ) and test strings ( S 2 ) between the simulation and experimental values, through all test conditions, of + 0.35 ± 1.46 % and - 0.36 ± 1.58 % respectively. Shortening one of two strings by one module results in a power loss greater than the power contribution of the module alone (1.29 module equivalents); the impact increases through the maximum test case of a six module mismatch with a power loss equivalent to more than 11 modules. The impact of using string-end blocking diodes is presented with an emphasis at the array maximum power point and at open circuit. Implications are discussed for arrays of higher complexity.
- Published
- 2021
31. Cytopathologic assessment of gloves and instruments after major head and neck surgery
- Author
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Samer Al-Khudari, Kerstin M. Stenson, Aryan Shay, Bobby A. Tajudeen, Paolo Gattuso, Ryan M. Smith, Peter C. Revenaugh, and Hannah N. Kuhar
- Subjects
Male ,medicine.medical_specialty ,Cytological Techniques ,Tumor resection ,Pilot Projects ,03 medical and health sciences ,Neoplasm Seeding ,0302 clinical medicine ,Cytology ,medicine ,Humans ,Gloves, Surgical ,Neoplasm Invasiveness ,Prospective Studies ,030223 otorhinolaryngology ,Prospective cohort study ,Aged ,Salvage Therapy ,business.industry ,Head and neck cancer ,Margins of Excision ,Sarcoma ,Surgical Instruments ,medicine.disease ,Otorhinolaryngologic Surgical Procedures ,Surgery ,Parotid gland ,medicine.anatomical_structure ,Otorhinolaryngology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Scalp ,Cancer cell ,Carcinoma, Squamous Cell ,Female ,Neoplasm Recurrence, Local ,business - Abstract
Purpose To investigate the potential for cancer cells to be transferred between anatomic sites via instruments and other materials. Materials and methods Pilot prospective study from April 2018–January 2019 at Rush University Medical Center. Glove and instrument washings were collected from 18 high-risk head and neck cancer resection cases (36 samples total). Each case maintained at least one of the following features in addition to a diagnosis of squamous cell carcinoma or sarcoma: palliative/salvage surgery, positive margins, extensive tumor burden, and/or extra capsular extension (ECE). Surgical gloves and four main instruments were placed through washings for blind cytological assessment (2 samples/case). Results 18 patients undergoing surgical tumor resection for biopsy-proven squamous cell carcinoma with at least one of the aforementioned characteristics were included. 26.7% of cases had ECE, 40.0% had positive final margins and 46.7% had close final margins. Tumor locations included: oral cavity (10), neck (4), parotid gland (2), and skin (2). Malignant cells were isolated on glove washings in 1 case (5.5%). No malignant cells were isolated from instrument washings. The single case of malignant cells on glove washings occurred in a recurrent, invasive squamous cell carcinoma of the scalp with intracranial extension. Anucleated squamous cells likely from surgeon skin were isolated from 94.4% of washings. Squamous cells were differentiated from mature cells by the absence of nuclei. Conclusions Malignant squamous cells can be isolated from surgical glove washings, supporting the practice of changing of gloves after gross tumor resection during major head and neck cancer resections.
- Published
- 2021
32. Anatomic relationship of the first olfactory neuron and trochlea: cadaveric study with surgical implications
- Author
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Peter Papagiannopoulos, Bobby A. Tajudeen, Ryan M. Smith, Max A. Plitt, and Philip H. Locker
- Subjects
Endoscope ,business.industry ,Anatomy ,Functional endoscopic sinus surgery ,Vector angle ,Olfactory neuron ,03 medical and health sciences ,0302 clinical medicine ,Frontal bone ,medicine.anatomical_structure ,Otorhinolaryngology ,Trochlear fovea ,Cadaver ,030221 ophthalmology & optometry ,Immunology and Allergy ,Medicine ,030223 otorhinolaryngology ,business ,Cadaveric spasm - Abstract
Background Iatrogenic injury to the trochlea is a potential complication of the Draf III or endoscopic modified Lothrop procedure; however, the location of the trochlea from within the sinus cavity has yet to be clearly characterized. We performed the first cadaveric study assessing the position of the trochlea in relation to the first olfactory neuron, a commonly identified landmark during the Draf III procedure. Methods Thirteen external dissections of the trochlea were performed on 7 disarticulated cadaveric heads via an extended Lynch type incision. An endoscopic Draf III procedure was then performed on all cadavers. A burr hole was then created at the trochlear fovea. A straight vector between the trochlear attachment and the ipsilateral first olfactory neuron was then created. The vector was then viewed from within the sinuses using a 30-degree endoscope. The endoscope was maneuvered to create an upright midline view centered on the olfactory neurons. An image was subsequently captured and analyzed using ImageJ software to calculate a vector angle. The linear distance between the 2 structures was also recorded. Results Relative to the first olfactory neuron, the trochlea was found to be 19.52 ± 4.68 mm away and at an angle of 39.42 ± 8.54 degrees in the anterolateral, superior direction along the frontal bone. Conclusion We report the first anatomical dissection characterizing the position of the trochlea relative to the ipsilateral first olfactory neuron. Intraoperative recognition of this relationship during Draf III procedures can prevent potential injury to the trochlea.
- Published
- 2017
33. Adverse Events Associated with Absorbable Implants for the Nasal Valve: A Review of the Manufacturer and User Facility Device Experience Database
- Author
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Bobby A. Tajudeen, Peter C. Revenaugh, Ryan M. Smith, Connor Wakefield, and Michael Eggerstedt
- Subjects
medicine.medical_specialty ,Nasal valve ,business.industry ,MEDLINE ,medicine ,Surgery ,User Facility ,Adverse effect ,business ,Absorbable Implants - Published
- 2020
34. Sexual Dimorphism of the Nasal Skin and Soft Tissue Envelope
- Author
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Ryan M. Smith, Michael Eggerstedt, and Peter C. Revenaugh
- Subjects
Sex Characteristics ,medicine.medical_specialty ,business.industry ,Soft tissue ,Anatomy ,Nose ,Sexual dimorphism ,Plastic surgery ,medicine ,Humans ,Surgery ,business ,Skin ,Envelope (waves) - Abstract
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
- Published
- 2020
35. The Selfie View: Perioperative Photography in the Digital Age
- Author
-
Michael, Eggerstedt, Jane, Schumacher, Matthew J, Urban, Ryan M, Smith, and Peter C, Revenaugh
- Subjects
Cohort Studies ,Male ,Esthetics ,Face ,Photography ,Humans ,Female ,Surgery, Plastic - Abstract
The aesthetics of social media have become increasingly important to cosmetic surgery patients in recent years; however, aesthetic treatments have not kept pace with the desires of modern patients. The current study investigates the most common angles employed by various user cohorts when posting a selfie on social media platforms and proposes that aesthetic surgeons consider utilizing a selfie angle alongside standard pre- and postoperative photographic views.Full face photographs published on the social media platform Instagram™ with the tag #selfie were divided into three cohorts: female models/influencers, amateur females, and amateur males. Each cohort contained 100 photographs. The photographs were analyzed using cloud-based facial analysis software for facial pan, roll, and tilt relative to the camera.One hundred photographs from each cohort were analyzed and demonstrated that amateur females (AF) take photographs from higher angles than amateur males (AM) or model females (MF). Roll-off-midline was significantly greater for AF and MF as compared to AM. The MF group had significantly a greater pan-off-midline as compared to AF and AM, while AF had significantly a greater pan-off-midline than AM.Common photography practices employed within selfie photographs utilize angles not captured in standard perioperative photographs. This study supports the implementation of a selfie photograph into the standard set of pre- and postoperative photographs taken by aesthetic surgeons to evaluate the effects of interventions in the context of selfie photography. The angle employed can vary depending upon the demographic profile of the patient.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
- Published
- 2019
36. Contributors
- Author
-
Jessica L. Ables, Yael Abreu-Villaça, Armando Alberola-Die, Tursun Alkam, M. Inês G.S. Almeida, Goel Ankit, Beatriz Antolin-Fontes, Insa Backhaus, Deniz Bagdas, Zsolt Bagosi, Dzejla Bajrektarevic, Luisa Barreiros, Elizabeth S. Barrie, Jeff A. Beeler, Ramon O. Bernabeu, Russell W. Brown, Adriaan W. Bruijnzeel, Beata Budzyńska, Barbara Budzyńska, S. Caille, Vince D. Calhoun, Yik Lung Chan, Gary C.K. Chan, Adriano José Maia Chaves Filho, Hui Chen, Chidera C. Chukwueke, Patrycja Chylińska-Wrzos, Kelly J. Clemens, Raúl Cobo, Robert D. Cole, John B. Correa, Silvia Corsini, Fiammetta Cosci, Luca Cucullo, Antonio Gomes de Castro-Neto, David Freitas de Lucena, Pollyanna Fausta Pimentel de Medeiros, Philip DeCicca, Armani P. Del Franco, Manuel Delgado-Vélez, Kataria Dinesh, David J. Drobes, Valentina Echeverria, Branden Eggan, Ulrich Ettinger, David E. Evans, Maria Paula Faillace, Fabrizio Ferretti, Lorra Garey, W. Drew Gill, Cassandra D. Gipson, Stanley D. Glick, Julianna G. Goenaga, Patrícia Xavier Lima Gomes, Britta Hahn, Meghan Harding, Brandon J. Henderson, David C. Hodgins, Lucian Hritcu, Yun Hu, Ines Ibañez-Tallon, M. Imad Damaj, Isabel Ivorra, Sari Izenwasser, Doris Clark Jackson, Hrvoje Jakovac, Barbara Jodłowska-Jędrych, Do-Un Jung, Adrian B. Kelly, Shaun Yon-Seng Khoo, Sungroul Kim, Sung-Jin Kim, Ari P. Kirshenbaum, Kristi A. Kohlmeier, Spas D. Kolev, Jessica L. Koranda, Veena Kumari, Giuseppe La Torre, José A. Lasalde-Dominicci, S. Lauren Kyte, Bernard Le Foll, Sung-Ha Lee, Edward D. Levin, Aldo Liccardi, Taylor Liles, Marta Lis-Sochocka, Yudan Liu, Danielle Macedo, Alex Christian Manhães, Alice Mannocci, John J. Maurer, Sarah McCallum, Daniel S. McGrath, Gavan P. McNally, Agnieszka Michalak, Marius Mihasan, Long Chiau Ming, Andrés Morales, Toshitaka Nabeshima, Sergej Nadalin, Mark D. Namba, Erik Nesson, Andrea Nistri, Brian G. Oliver, Jason A. Oliver, Oné R. Pagán, Vinay Parikh, Carol A. Pollock, Gregory L. Powell, Harry Prapavessis, Shikha Prasad, Victor R. Preedy, Kukreti Prerna, Rajkumar Rajendram, Rossana Carla Rameh-de-Albuquerque, Amir H. Rezvani, Anderson Ribeiro-Carvalho, Linda Richter, Emma V. Ritchie, Scott Rollo, Sonia Saad, Wolfgang Sadee, Lia Lira Olivier Sanders, Beate Saegesser Santos, Michael A. Sayette, Kyle Saylor, Heath D. Schmidt, Marcela A. Segundo, M. Sibel Gurun, Ryan M. Smith, Emily A. Stockings, Tiwari Sucheta, Sterling N. Sudweeks, Wuyou Sui, Chee Fai Sui, Taraneh Taghavi, S. Tannous, Christiane M. Thiel, Rebekah Thomas, Wisam Toma, Maria Tortora, Rachel F. Tyndale, Roberta Uchôa, Victor M. Vergara, Ewelina Wawryk-Gawda, Stephen J. Wilson, Paul Zammit, Ross Zeitlin, Chenming Zhang, Zongmin Zhao, and Michael J. Zvolensky
- Published
- 2019
37. Nicotine Dependence and the CHRNA5/CHRNA3/CHRNB4 Nicotinic Receptor Regulome
- Author
-
Sung-Ha Lee, Elizabeth S. Barrie, Wolfgang Sadee, and Ryan M. Smith
- Subjects
Genetics ,Nonsynonymous substitution ,Nicotinic agonist ,biology ,CHRNA5 ,Gene cluster ,biology.protein ,Regulome ,Single-nucleotide polymorphism ,Gene ,Phenotype - Abstract
The nicotinic receptor cluster, located on chromosome 15q25.1, contains genes encoding the α5, α3, and β4 subunits that combine to form ligand-gated ion channels, present throughout the periphery and in brain regions important for addiction. Clinical studies have identified strong associations between nicotine dependence (ND) phenotypes and polymorphisms in this gene cluster, notably with a nonsynonymous polymorphism rs16969968 in CHRNA5. Polymorphisms in a master regulatory element influence messenger RNA expression for several genes in the cluster, while additional regulatory variants modify tissue-specific expression of each individual gene. Significant interactions between these regulatory polymorphisms and rs16969968 modulate ND risk, which cannot be correctly estimated from additive effects of single SNPs. Taken together, multiple variants combine to exert genetic influence of the gene cluster “regulome” on clinical phenotypes, critical to understanding trait heritability.
- Published
- 2019
38. Reconstruction of the Ear
- Author
-
Ryan M. Smith and Patrick J. Byrne
- Subjects
Reconstructive surgery ,medicine.medical_specialty ,Reconstructive Surgeon ,Skin Neoplasms ,business.industry ,Dermatologic Surgical Procedures ,Ear reconstruction ,Surgical Flaps ,Surgery ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Form and function ,otorhinolaryngologic diseases ,medicine ,Humans ,sense organs ,Ear, External ,030223 otorhinolaryngology ,business ,Ear Neoplasms - Abstract
Skin cancer is a common indication for reconstructive surgery of the ear. The unique anatomy of the external ear makes the restoration of form and function challenging for the reconstructive surgeon. This article reviews the relevant anatomy of the ear, defines the goals of reconstruction, outlines the assessment of defects based on location, and describes specific surgical techniques useful in auricular reconstruction.
- Published
- 2018
39. BrainSeq: Neurogenomics to Drive Novel Target Discovery for Neuropsychiatric Disorders
- Author
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Patricio O'Donnell, Christian Schubert, Tony Kam-Thong, Wayne C. Drevets, Amy Deep-Soboslay, Nicholas J. Brandon, David C. Airey, Andrew E. Jaffe, Laurent Essioux, James E. Scherschel, Mitsuyuki Matsumoto, Thomas M. Hyde, David A. Collier, Philip J. Ebert, Hartmuth C. Kolb, Michael Didriksen, Yushi Liu, Hui-Rong Qian, Alan J. Cross, Joo Heon Shin, Daniel R. Weinberger, Qi Wang, Kalpana M. Merchant, Laura Nisenbaum, Jens R. Wendland, Hualin S. Xi, Maura L. Furey, Richard E. Straub, John N. Calley, Ryan M. Smith, Cara L. Ruble, Jie Quan, Enrico Domenici, Ashley R. Winslow, Joel E. Kleinman, Husseini K. Manji, Takeshi Saito, Brian J. Eastwood, Hong Wang, and Yankai Jia
- Subjects
Neurogenomics ,medicine.medical_specialty ,Mood Disorders ,Mental Disorders ,General Neuroscience ,Genomic data ,Brain ,Computational biology ,Medical research ,medicine.disease ,Epigenesis, Genetic ,Mood disorders ,Drug Discovery ,Gene Targeting ,medicine ,Animals ,Humans ,Psychiatry ,Psychology - Abstract
We outline an ambitious project to characterize the genetic and epigenetic regulation of multiple facets of transcription in distinct brain regions across the human lifespan in samples of major neuropsychiatric disorders and controls. Initially focused on schizophrenia and mood disorders, the goal of this consortium is to elucidate the underlying molecular mechanisms of genetic associations with the goal of identifying novel therapeutic targets. The consortium currently consists of seven pharmaceutical companies and a not-for-profit medical research institution working as a precompetitive team to generate and analyze publicly available archival brain genomic data related to neuropsychiatric illness.
- Published
- 2015
40. Considerations for Temporomandibular Joint Procurement in Vascularized Composite Allotransplantation
- Author
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Ryan M. Smith, Amir H. Dorafshar, Alexandra Macmillan, Patrick Byrne, Edward H. Davidson, and Nima Khavanin
- Subjects
Vascularized Composite Allotransplantation ,Condyle ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,Joint capsule ,Temporal bone ,medicine ,Cadaver ,Humans ,Range of Motion, Articular ,Orthodontics ,Temporomandibular Joint ,business.industry ,Mandible ,Mandibular Condyle ,Temporal Bone ,030206 dentistry ,General Medicine ,Temporomandibular joint ,Transplantation ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Tissue and Organ Harvesting ,Feasibility Studies ,Surgery ,Range of motion ,business ,Tomography, X-Ray Computed - Abstract
Methods for harvest of the temporomandibular joint (TMJ) for transplantation may involve several anatomic levels. The authors aim to assess the feasibility and identify challenges with 2 such methods, resuspending the donor condyles from the recipient glenoid fossae and en bloc harvest of the joint and surrounding temporal bone with plate-fixation to the recipient skull base. Two mock face transplantations were carried out using 4 fresh cadavers. Computed tomography imaging was obtained before and after the procedures to assess the technical success of each method. Both techniques were technically successful, allowing for full passive jaw range of motion following graft transfer and appropriate condyle positioning as assessed by computed tomography. En bloc TMJ harvest allowed for transfer of the entire joint without violating its capsule or altering its biomechanics. The authors found this technique better able to avoid issues with size mismatch between the donor mandible and recipient skull base width. When no such mismatch exists, graft harvest at the level of the mandibular condyle is technically easier and less time consuming. Although both methods of TMJ harvest are technically feasible with acceptable immediate postoperative jaw position and range of motion, the en bloc technique allows for more natural jaw function with less risk of postoperative joint immobility by preserving the joint capsule and its ligamentous support.
- Published
- 2018
41. Selectivity of Terahertz Gas-Phase Spectroscopy
- Author
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Mark A. Arnold and Ryan M. Smith
- Subjects
chemistry.chemical_compound ,chemistry ,Infrared ,Terahertz radiation ,Analytical chemistry ,Propionaldehyde ,Methanol ,Propionitrile ,Spectroscopy ,Selectivity ,Acetonitrile ,Analytical Chemistry - Abstract
Analytical potential of terahertz (THz) spectroscopy is assessed by comparing selectivity for a set of eight environmentally important gases over THz and infrared (IR) optical frequencies. Selectivity coefficients are determined over selected spectral regions for acetaldehyde, acetonitrile, ethanol, water, methanol, ammonia, propionaldehyde, and propionitrile. These selectivity coefficients quantify the magnitude of the net analyte signal for each test compound relative to the other seven. In addition to the THz spectral range (2-125 cm(-1)), selectivity coefficients are determined for the following IR regions 600-1300, 1300-2000, 2600-3100, 3100-4000, and 4000-6500 cm(-1). Highest selectivity is afforded over the THz frequencies for six of the eight test compounds and THz selectivity coefficients for the other two gases (water and acetonitrile) are acceptable for environmental measurements.
- Published
- 2015
42. Advancing psychiatric pharmacogenomics using drug development paradigms
- Author
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Ryan M. Smith
- Subjects
medicine.medical_specialty ,As Directed ,medicine.medical_treatment ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Drug Discovery ,Genetics ,medicine ,Humans ,Antipsychotic ,Psychiatry ,Pharmacology ,Risperidone ,business.industry ,Drug discovery ,Human genetics ,Drug development ,Psychotic Disorders ,Pharmacogenetics ,Pharmacogenomics ,Molecular Medicine ,business ,030217 neurology & neurosurgery ,medicine.drug ,Antipsychotic Agents - Abstract
Drugs used to treat psychiatric disorders, even when taken as directed, fail to provide adequate relief for a sizeable proportion of patients. Despite our advancements in understanding human genetics and development of high-throughput tools to probe variation, pharmacogenomics has yielded marginal ability to predict drug response for psychiatric disorders. Here, I review the current pharmacogenomics paradigm, identifying opportunities to incorporate drug development strategies designed to increase the probability of delivering a successful molecule to the clinic. This includes using in-depth pharmacokinetic profiles, clear measures of target engagement and target-specific pharmacodynamic responses orthogonal to clinical response. The complex pharmacological profiles psychiatric drugs require re-examination of simplified clinical response-oriented pharmacogenetic hypotheses, in favor of a more complete patient profile.
- Published
- 2017
43. Family-Based Clinical Associations and Functional Characterization of the Serotonin 2A Receptor Gene (HTR2A) in Autism Spectrum Disorder
- Author
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Ryan M. Smith, Wolfgang Sadee, Gail E. Herman, Emily Hansen, and Wesley Banks
- Subjects
Genetics ,Untranslated region ,rs6311 ,Rs6314 ,General Neuroscience ,Single-nucleotide polymorphism ,Context (language use) ,Biology ,medicine.disease ,Dorsolateral prefrontal cortex ,medicine.anatomical_structure ,medicine ,Autism ,Neurology (clinical) ,Allele frequency ,Genetics (clinical) - Abstract
The serotonin 2A receptor gene (HTR2A) harbors two functional single nucleotide polymorphisms (SNPs) that are frequent in populations of African and European descent; rs6311, which affects mRNA expression, and rs6314, which changes the amino acid sequence of the encoded protein and affects the signaling properties of the receptor. Multiple clinical associations support a role for these SNPs in cognitive and neuropsychiatric phenotypes, although studies in autism spectrum disorder (ASD) remain equivocal. Here, we tested transmission disequilibrium of rs6311 and rs6314 in a cohort of 158 ASD trios (simplex and multiplex), observing significant under-transmission of the minor "A" allele of rs6311 to offspring with ASD (permuted P = 0.0004). Consistent with our previous findings in the dorsolateral prefrontal cortex of unaffected individuals, rs6311/A decreases expression of HTR2A mRNA with an extended 5' untranslated region (UTR) in the frontopolar cortex in brain samples from 54 ASD patients and controls. Interpreting the clinical results in the context of our mRNA expression analysis, we speculate that any risk associated with rs6311 is conferred by greater expression of the long 5'UTR mRNA isoform. The current study corroborates earlier associations between rs6311 and ASD in a family study, supporting the hypothesis that rs6311 plays a modulatory role in ASD risk.
- Published
- 2014
44. Coronary CT angiography versus intravascular ultrasound for estimation of coronary stenosis and atherosclerotic plaque burden: A meta-analysis
- Author
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Collin Fischer, Edward Hulten, Szilard Voros, Todd C. Villines, Pallavi Belur, and Ryan M. Smith
- Subjects
medicine.medical_specialty ,Lumen (anatomy) ,Coronary stenosis ,Coronary Angiography ,Severity of Illness Index ,Predictive Value of Tests ,Internal medicine ,Multidetector Computed Tomography ,Intravascular ultrasound ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Ultrasonography, Interventional ,medicine.diagnostic_test ,business.industry ,Significant difference ,Coronary Stenosis ,Coronary ct angiography ,medicine.disease ,Coronary Vessels ,Plaque, Atherosclerotic ,Stenosis ,ROC Curve ,Area Under Curve ,Meta-analysis ,Angiography ,Cardiology ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Numerous studies have compared coronary CT angiography (CTA) with quantitativecoronary angiography. However, the ability of coronary CTA to identify atherosclerosis and to accurately measure plaque and coronary area and volume measurements as compared with intravascular ultrasound (IVUS) has not been fully defined. Objective We sought to assess the ability of coronary CTA to quantify coronary and plaque measurements commonly performed with IVUS. Methods We searched multiple databases for diagnostic studies that directly compared coronary CTA and IVUS for coronary plaque detection, vessel luminal area, percentage of area stenosis, plaque area, and plaque volume. We used a bivariate mixed-effects binomial regression model to pool test sensitivity and specificity for detection of any coronary plaque. Results Forty-two studies that evaluated 1360 patients (75% men; mean age, 59 years) were identified. No significant difference was found between coronary CTA and IVUS measurements of vessel lumen cross-sectional area, plaque area, percentage of area stenosis, or plaque volume within the overall cohort and no difference for the measurement of cross-sectional area (n = 5 studies) and plaque volume (n = 8 studies) among a subgroup that used automated or semiautomated measurement techniques. Sensitivity and specificity of coronary CTA to detect any plaque compared with IVUS were 93% and 92%, respectively, with an area under the receiver-operating curve of 0.97. Conclusions Compared with IVUS, coronary CTA appears to be highly accurate for estimation of luminal area, percentage of area stenosis, plaque volume, and plaque area and for detection of plaque. The use of automated vessel and stenosis measurements appears promising in limited studies to date.
- Published
- 2013
45. Changes in Preventive Medical Therapies and CV Risk Factors After CT Angiography
- Author
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Michael K. Cheezum, Ryan M. Smith, Todd C. Villines, Luke Surry, Allen J. Taylor, Matthew York, Edward Hulten, and Jacqueline N. Kircher
- Subjects
Male ,Blood Pressure ,Coronary Angiography ,Severity of Illness Index ,Coronary artery disease ,Risk Factors ,Preventive Health Services ,Odds Ratio ,Practice Patterns, Physicians' ,Aspirin ,medicine.diagnostic_test ,Middle Aged ,Cholesterol ,Treatment Outcome ,Radiology Nuclear Medicine and imaging ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,coronary artery disease ,medicine.drug ,Adult ,medicine.medical_specialty ,Statin ,hypertension ,medicine.drug_class ,aspirin ,Risk Assessment ,coronary CT angiography ,Decision Support Techniques ,Predictive Value of Tests ,Internal medicine ,Severity of illness ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Antihypertensive Agents ,Aged ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,dyslipidemia ,Retrospective cohort study ,Odds ratio ,medicine.disease ,Blood pressure ,Logistic Models ,Angiography ,Multivariate Analysis ,Linear Models ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Tomography, X-Ray Computed ,Biomarkers ,Platelet Aggregation Inhibitors - Abstract
ObjectivesThe aim of the study was to determine the association of coronary computed tomographic angiography (CTA)–identified coronary artery disease (CAD) with post-test aspirin, statin, and antihypertensive medication use and changes in cholesterol and blood pressure (BP).BackgroundThe relationship of CTA findings to subsequent changes in preventive cardiovascular medication prescribing patterns and risk factors is largely unknown.MethodsWe studied 1,125 consecutive patients without known CAD referred for coronary CTA. CAD was defined as none, nonobstructive (
- Published
- 2013
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46. Multiple Regulatory Variants Modulate Expression of 5-Hydroxytryptamine 2A Receptors in Human Cortex
- Author
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Joel E. Kleinman, Wolfgang Sadee, Barbara K. Lipska, Laura Nisenbaum, Leanne Munsie, Amy Webb, Audrey C. Papp, Cara L. Ruble, and Ryan M. Smith
- Subjects
Untranslated region ,Single-nucleotide polymorphism ,Biology ,Methylation ,Polymorphism, Single Nucleotide ,Article ,Transcriptome ,Exon ,Untranslated Regions ,Gene expression ,Humans ,Protein Isoforms ,Receptor, Serotonin, 5-HT2A ,Promoter Regions, Genetic ,Alleles ,Biological Psychiatry ,Cerebral Cortex ,Genetics ,Regulation of gene expression ,Clinical Trials as Topic ,Depression ,Alternative splicing ,Genetic Variation ,RNA ,Exons ,Gene Expression Regulation ,Selective Serotonin Reuptake Inhibitors - Abstract
Background The 5-hydroxytryptamine 2A receptor, encoded by HTR2A , is a major postsynaptic target for serotonin in the human brain and a therapeutic drug target. Despite hundreds of genetic associations investigating HTR2A polymorphisms in neuropsychiatric disorders and therapies, the role of genetic HTR2A variability in health and disease remains uncertain. Methods To discover and characterize regulatory HTR2A variants, we sequenced whole transcriptomes from 10 human brain regions with massively parallel RNA sequencing and measured allelic expression of multiple HTR2A messenger (m)RNA transcript variants. Following discovery of functional variants, we further characterized their impact on genetic expression in vitro. Results Three polymorphisms modulate the use of novel alternative exons and untranslated regions (UTRs), changing expression of RNA and protein. The frequent promoter variant rs6311, widely implicated in human neuropsychiatric disorders, decreases usage of an upstream transcription start site encoding a longer 5′UTR with greater translation efficiency. rs76665058, located in an extended 3′UTR and unique to individuals of African descent, modulates allelic HTR2A mRNA expression. The third single nucleotide polymorphism, unannotated and present in only a single subject, directs alternative splicing of exon 2. Targeted analysis of HTR2A in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study reveals associations between functional variants and depression severity or citalopram response. Conclusions Regulatory polymorphisms modulate HTR2A mRNA expression in an isoform-specific manner, directing the usage of novel untranslated regions and alternative exons. These results provide a foundation for delineating the role of HTR2A and serotonin signaling in central nervous system disorders.
- Published
- 2013
47. Prognostic Value of Coronary CT Angiography
- Author
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Ahmad M. Slim, Ryan M. Smith, Collin Fischer, Michael K. Cheezum, Todd C. Villines, and Edward Hulten
- Subjects
Male ,medicine.medical_specialty ,Clinical settings ,CAD ,Coronary Artery Disease ,Coronary Angiography ,Risk Assessment ,Severity of Illness Index ,Coronary artery disease ,Internal medicine ,medicine ,Humans ,Angina, Stable ,cardiovascular diseases ,Coronary Artery Bypass ,Vascular Calcification ,Aged ,business.industry ,musculoskeletal, neural, and ocular physiology ,Coronary Stenosis ,Graft Occlusion, Vascular ,Coronary computed tomography angiography ,Coronary ct angiography ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Plaque, Atherosclerotic ,Survival Rate ,Coronary artery calcification ,Exercise Test ,Cardiology ,Female ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Agatston score ,Risk assessment - Abstract
Coronary computed tomography angiography (CTA) is a highly accurate noninvasive test that is increasingly used in symptomatic patients primarily for the diagnosis of coronary artery disease (CAD). Beyond its proven accuracy, data have now clearly demonstrated the incremental prognostic information available from coronary CTA related to the presence, extent, and severity of obstructive and nonobstructive CAD across a variety of clinical settings and patient populations. Current evidence supports the use of coronary CTA not only for the diagnosis of CAD in appropriately selected symptomatic patients but also to further refine their cardiovascular risk assessment following testing.
- Published
- 2012
48. Terahertz Time-Domain Spectroscopy of Solid Samples: Principles, Applications, and Challenges
- Author
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Mark A. Arnold and Ryan M. Smith
- Subjects
Materials science ,Terahertz radiation ,business.industry ,Analytical chemistry ,Laser ,law.invention ,Imaging analysis ,law ,Optoelectronics ,Instrumentation (computer programming) ,Spectral data ,Spectroscopy ,business ,Terahertz time-domain spectroscopy ,Instrumentation ,Ultrashort pulse - Abstract
Advances in ultrafast lasers and semiconductor technologies have facilitated access to the terahertz (THz) frequency range for spectroscopic and imaging purposes. THz time-domain spectroscopy (TDS) is commonly used to acquire spectral data having high signal-to-noise ratios (SNRs) over a broad range of THz frequencies. THz-TDS instrumentation is commercially available, thereby enabling novel applications of THz time-domain (TD) imaging and spectroscopy in a myriad of applications. This review gives a general description of the instrumentation available for collecting THz-TD data and focuses on measurements of solid samples. Measurement geometries useful for collecting THz-TD data from solid samples are reviewed and a summary is presented of the major applications to the analysis of solid samples related to security issues, as well as samples originating from the pharmaceutical industry, dental sciences, biological samples, and polymer materials. Emphasis is also given to analytical applications i...
- Published
- 2011
49. Importance of animal/human health interface in potential Public Health Emergencies of International Concern in the Americas
- Author
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Matthew J. Moynihan, Ryan M. Smith, Sylvain Aldighieri, Maria Almiron, Ximena Aguilera, Jarbas Barbosa da Silva Jr., and Maria Cristina Schneider
- Subjects
medicine.medical_specialty ,Economic growth ,business.industry ,Public health ,education ,Public Health, Environmental and Occupational Health ,International community ,International health ,Global Health ,Communicable Diseases ,International Health Regulations ,Health promotion ,Zoonoses ,Environmental health ,Global health ,Animals ,Humans ,Medicine ,Veterinary public health ,Public Health ,Americas ,Emergencies ,business ,Legal instrument ,health care economics and organizations - Abstract
In today’s globalized world, diseases have the potential to transcend geopolitical boundaries through international travel and trade. It is now understood that the economies and livelihoods of the entire international community can be affected by a single health crisis in one country. With this concept in mind, a revised version of the World Health Organization (WHO) International Health Regulations (IHRs) was established in 2005 (effective 15 June 2007) to “help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide” (1). This binding legal instrument covers 194 countries across the globe, including all WHO Member States, and aims to protect public health through the prevention of the spread of diseases. For that purpose and as part of IHR implementation, WHO Member States are committed to strengthening their surveillance of and ability to rapidly detect, assess, notify, and report potential Public Health Emergencies of International Concern (PHEICs) in accordance with these regulations. A PHEIC is an extraordinary event that has been determined, as provided in the IHRs, to 1) “constitute a public health risk to other States through the international spread of disease” and 2) “potentially require a coordinated international response” (1).
- Published
- 2011
50. Intronic Polymorphisms Affecting Alternative Splicing of Human Dopamine D2 Receptor Are Associated with Cocaine Abuse
- Author
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Deborah C. Mash, Danxin Wang, Wolfgang Sadee, Ryan M. Smith, Audrey C. Papp, Linda Duque, and Robert A. Moyer
- Subjects
Adult ,Male ,Single-nucleotide polymorphism ,Biology ,Polymorphism, Single Nucleotide ,Cocaine-Related Disorders ,Young Adult ,Exon ,Dopamine receptor D2 ,Humans ,Genetic Predisposition to Disease ,Allele ,Genetic association ,Pharmacology ,Genetics ,Receptors, Dopamine D2 ,Alternative splicing ,Intron ,Brain ,Middle Aged ,Introns ,Alternative Splicing ,Psychiatry and Mental health ,HEK293 Cells ,RNA splicing ,Female ,Original Article - Abstract
The dopamine receptor D2 (encoded by DRD2) is implicated in susceptibility to mental disorders and cocaine abuse, but mechanisms responsible for this relationship remain uncertain. DRD2 mRNA exists in two main splice isoforms with distinct functions: D2 long (D2L) and D2 short (D2S, lacking exon 6), expressed mainly postsynaptically and presynaptically, respectively. Two intronic single-nucleotide polymorphisms (SNPs rs2283265 (intron 5) and rs1076560 (intron 6)) in high linkage disequilibrium (LD) with each other have been reported to alter D2S/D2L splicing and several behavioral traits in human subjects, such as memory processing. To assess the role of DRD2 variants in cocaine abuse, we measured levels of D2S and D2L mRNA in human brain autopsy tissues (prefrontal cortex and putamen) obtained from cocaine abusers and controls, and genotyped a panel of DRD2 SNPs (119 abusers and 95 controls). Robust effects of rs2283265 and rs1076560 on reducing formation of D2S relative to D2L were confirmed. The minor alleles of rs2283265/rs1076560 were considerably more frequent in Caucasians (18%) compared with African Americans (7%). Also, in Caucasians, rs2283265/rs1076560 minor alleles were significantly overrepresented in cocaine abusers compared with controls (rs2283265: 25 to 9%, respectively; p=0.001; OR=3.4 (1.7–7.1)). Several SNPs previously implicated in diverse clinical association studies are in high LD with rs2283265/rs1076560 and could have served as surrogate markers. Our results confirm the role of rs2283265/rs1076560 in D2 alternative splicing and support a strong role in susceptibility to cocaine abuse.
- Published
- 2010
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