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Pathogenic variants (PVs) in the SDHD gene increase risk for paragangliomas (PGL)/pheochromocytomas, renal cell carcinomas, and gastrointestinal stromal tumors. Penetrance in individuals with SDHD PVs varies in reported research from 40-70%, and there is limited evidence of specific genotype risks. This study aims to characterize a multi-generational family with SDHD p.Trp43* PVs and potential genotype-phenotype considerations for surveillance. Individuals with a paternally inherited SDHD p.Trp43*(c.129G > A) PV were identified. Genetic, medical and family histories were abstracted, including clinical characteristics, tumor histories, and treatment approaches. Eleven individuals with the SDHD PV in the same kindred were diagnosed with 41 SDHx-related tumors across all family members. Eight individuals developed 27 head and neck PGL of varying origins, and seven individuals developed tumors outside of the head and neck region. Many individuals had multiple tumors, and age of first tumor diagnosis ranged from age 10 to age 45 years old. Individuals with SDHD p.Trp43* variants may have higher risks for SDHx related tumors than other SDHD variants. Prioritizing identification of at-risk individuals and initiating surveillance tailored to family history is recommended given the rate of multiple tumors found in one familial branch of individuals under 18 years old. Individuals with strong family histories of PGL at young ages with this PV will benefit from tailored surveillance recommendations., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: Osteosynthetic treatment strategies of PHFs include MIPO or ORIF techniques. The aim of this study was to compare the 1 year outcome following either technique in type B PHFs., Methods: This study was designed as a retrospective cohort study of patients treated at one academic Level 1 trauma center. Patients from 2009 to 2019 who required surgical treatment of a type B PHF were eligible to be included in this study. Patients with A- or C-type fractures or patients requiring arthroplasty were excluded. All patients were treated with Proximal Humerus Interlocking System (PHILOS) and stratified according the approach into Group MIPO or Group ORIF. Outcome measures include local complications that occurred during hospitalization, nonunion after 12 months, and range of motion after 1 year follow-up., Results: This study included 149 (75.3%) patients in Group ORIF, and 49 (24.7%) in Group MIPO. The fracture morphology and concomitant injuries were comparable amongst these groups. When compared with Group MIPO, Group ORIF had a 2.6 (95% CI 0.6-11.7) higher risk of suffering from local complications. The rate of postoperative nerve lesions was comparable (OR 0.9, 95% CI 0.1-9.7) as was the rate of soft tissue complications (OR 2.0, 95% CI 0.2-17.2). The risk for nonunion was 4.5 times higher (95% 1.1-19.5) in Group ORIF when compared with Group MIPO. Group MIPO had a higher chance of flexion above 90° (OR 8.2, 95% CI 2.5-27.7)., Conclusion: This study provides indications that patients following surgical treatment of PHFs in MIPO technique might have favourable outcome. Large-scale and high-quality studies are warranted to confirm these results., (© 2021. The Author(s).)

Objective: The objective of this study is to describe the operative success of completely buried free flaps and to determine the safety/reliability of using implantable dopplers for postoperative monitoring in completely buried free flaps., Study Design: A retrospective chart review was conducted from 2014 to 2020. Patients were included who had implantable dopplers placed for monitoring a completely buried free flap without a visible skin paddle., Setting: Single academic cancer hospital., Methods: Patient charts were reviewed to determine flap viability after surgery, need for reoperation, and ability of implanted doppler probes to detected change in free flap status., Results: A total of 65 patients were included. Locations of flaps were as follows: pharynx, 76.9%; skull base, 7.7%; trachea, 6.2%; esophagus, 4.6%; and facial reanimation, 4.6%. Types of free flaps performed included radial forearm (50.8%), anterolateral thigh (44.6%), and gracilis (4.6%). One patient (1.5%) returned to the operating room for vascular compromise, which was accurately detected by the implantable doppler and salvaged. All free flaps were viable upon hospital discharge based on clinical examination and implantable doppler signals. There were no complications related to implantable doppler use., Conclusions: Implantable dopplers are an effective method for evaluating postoperative success of completely buried free flaps. In our series utilizing implantable dopplers, buried free flap survival was higher than traditionally thought. The use of implanted dopplers for monitoring buried free flaps allows for an effective, cosmetically appealing, and simplified reconstructive technique.

Purpose: Dislocated tibial avulsions of the posterior cruciate ligament (PCL) require surgical intervention. Several arthroscopic strategies are options to fix the fragment and restore posterior laxity, including two types of suspension button devices: adjustable (self-locking) and rigid knotted systems. Our hypothesis was that a rigid knotted button construct has superior biomechanical properties regarding laxity restoration compared with an adjustable system. Both techniques were compared with standard screw fixation and the native PCL., Methods: Sixty porcine knees were dissected. The constructs were tested for elongation, stiffness, yield force, load to failure force, and failure mode in a material testing machine. Group N (native, intact PCL) was used as a control group. In group DB (Dogbone™), TR (Tightrope™), and S (screw), a standardized block osteotomy with the osteotomized fragment attached to the PCL was set. The DB and TR groups simulated using a suspension button system with either a rigid knotted (DB) or adjustable system (TR). These groups were compared to a screw technique (S) simulating antegrade screw fixation from posterior., Results: Comparing the different techniques (DB, TR, S), no significant elongation was detected; all techniques achieved a sufficient posterior laxity restoration. Significant elongation in the DB and TR group was detected compared with the native PCL (N). In contrast, screw fixation did not lead to significant elongation. The stiffness, yield load, and load to failure force did not differ significantly between the techniques. None of the techniques reached the same level of yield load and load to failure force as the intact state., Conclusion: Arthroscopic suspension button techniques sufficiently restore the posterior laxity and gain a comparable construct strength as an open antegrade screw fixation., (© 2021. The Author(s).)

Nanosecond pulsed electric field (nsPEF) processing is gaining momentum as a physical means for single-cell bioconversion efficiency enhancement. The technology allows biomass yields per substrate (Y X/S ) to be leveraged and poses a viable option for stimulating intracellular compound production. NsPEF processing thus resonates with myriad domains spanning the pharmaceutical and medical sectors, as well as food and feed production. The exact working mechanisms underlying nsPEF-based enhancement of bioconversion efficiency, however, remain elusive, and a better understanding would be pivotal for leveraging process control to broaden the application of nsPEF and scale-up industrial implementation. To bridge this gap, the study provides the electrotechnological and metabolic fundamentals of nsPEF processing in the bio-based domain to enable a critical evaluation of pathways underlying the enhancement of single-cell bioconversion efficiency. Evidence suggests that treating cells during the rapid proliferating and thus the early to mid-exponential state of cellular growth is critical to promoting bioconversion efficiency. A combined effect of transient intracellular and sublethal stress induction and effects caused on the plasma membrane level result in an enhancement of cellular bioconversion efficiency. Congruency exists regarding the involvement of transient cytosolic Ca 2+ hubs in nsPEF treatment responses, as well as that of reactive oxygen species formation culminating in the onset of cellular response pathways. A distinct assignment of single effects and their contributions to enhancing bioconversion efficiency, however, remains challenging. Current applications of nsPEF processing comprise microalgae, bacteria, and yeast biorefineries, but these endeavors are in their infancies with limitations associated with a lack of understanding of the underlying treatment mechanisms, an incomplete reporting, insufficient characterization, and control of processing parameters. The study aids in fostering the upsurge of nsPEF applications in the bio-based domain by providing a basis to gain a better understanding of cellular mechanisms underlying an nsPEF-based enhancement of cellular bioconversion efficiency and suggests best practice guidelines for nsPEF documentation for improved knowledge transfer. Better understanding and reporting of processes parameters and consequently improved process control could foster industrial-scale nsPEF realization and ultimately aid in perpetuating nsPEF applicability within the bio-based domain., (Copyright © 2021. Published by Elsevier Inc.)

Background: Little is known about physician trust in patients with head and neck cancer. This study's aim is to evaluate trust pre- and post-treatment., Methods: A study was conducted of 50 patients with head and neck cancer at a tertiary referral center. Surveys administered before and after treatment included several validated survey tools including the Trust in Oncologist Scale Short Form., Results: There was an increase in overall trust scores (p < 0.001). Female patients (p = 0.034) and those who received chemotherapy (p = 0.001) were less trusting post-treatment. Patients with more comorbidities (p = 0.045) and progression of disease (p = 0.029) had higher final trust than those without. Patients with high initial distress scores showed a decrease in trust (p = 0.023)., Conclusions: Patients with head and neck cancer trust their surgeon more after completion of treatment, with specific characteristics having a variable impact on trust scores., (© 2021 Wiley Periodicals LLC.)

Objective: Patients with SDHx germline mutations (SDHA, AF2, B, C, D) are at risk for paragangliomas (PGLs), renal cell carcinoma and gastrointestinal stromal tumours. The aim of this study was to evaluate the age of SDHx tumour diagnosis in those with pathogenic variants (PVs), notably tumour detection after the age of 50 years., Study Design: Longitudinal retrospective observational analysis., Patients: Individuals with SDHx PVs., Measurements: Demographic, clinical, genetic, screening and tumour detection and treatment data were abstracted from the electronic medical record. Descriptive analysis was utilised., Results: A total of 165 patients with SDHx PVs from 34 families were evaluated. Sixty-eight patients (41.2%) had at least one known SDHx-related tumour in their history, identified through symptoms, screening or incidentally. The average age of SDHx-related tumour diagnosis was 32.0 years. Age of diagnosis varied by the gene. Nine patients (n = 50; 18.0%) were identified with a tumour after the age of 50, identified via baseline screening after PV identification, or due to symptoms before molecular SDHx diagnosis., Conclusions: Though tumours were identified in individuals above the age of 50; they were all identified on baseline screening or due to symptoms, confirming that baseline screening is essential. Given the slow-growing nature of PGLs, these tumours might have been discovered before age 50 if molecular diagnosis and baseline screening had occurred earlier. Considering discontinuing screening after age 50 may be warranted if baseline screen imaging is negative and the individual does not have a prior tumour history., (© 2021 John Wiley & Sons Ltd.)