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Pecan is an important specialty crop that has experienced extensive interspecific hybridization and nearly-obligate outcrossing. Here, the authors assemble diploid genomes of four outbred genotypes, identify interspecific introgressions through comparative genomics analyses, and map QTLs associated with pest resistance.

Introduction: Meniscal injuries represent the most common pathology affecting the knee, often limiting return to sporting activities secondary to pain and disability. In meniscal deficient patients, meniscal allograft transplantation (MAT) procedure may be considered. Return to sport (RTS) rate, predictors of successful RTS, and patient-reported outcomes in athletic patients undergoing MAT are largely unknown. Objectives: To review the literature on RTS rates, predictors of RTS success or failure, and patient-reported outcomes following MAT in athletic patients. Methods: PubMed, Cochrane, and Scopus databases were reviewed for relevant literature using the following keywords: “meniscal allograft transplantation,” “meniscal transplant,” “meniscus transplant,” “return to sport,” “return to play,” and “patient-reported outcomes.” Results: RTS rates following MAT are generally favorable in the athletic population. Appropriate graft sizing, secure graft fixation, younger age, and the absence of articular cartilage injury are associated with improved RTS success. Meanwhile, the presence of focal chondral defects, osteoarthritic changes, limb malalignment, concomitant procedures performed at the time of MAT, and ligamentous instability are associated with failed RTS. Significant improvements in patient-reported outcomes were appreciated when compared to pre-operative values. Conclusions: MAT is a viable treatment option for athletic, meniscal deficient patients. Future investigations of high methodologic quality that evaluate long-term outcomes, graft survivorship, and athletic performance following MAT are warranted to better understand the influence and efficacy of MAT in athletic patients.

Objectives: Large language model (LLM)-based chatbots such as ChatGPT have been publicly available and increasingly utilized by the general public since late 2022. This study sought to investigate ChatGPT responses to common patient questions regarding Human Papilloma Virus (HPV) positive oropharyngeal cancer (OPC). Methods: This was a prospective, multi-institutional study, with data collected from high volume institutions that perform >50 transoral robotic surgery cases per year. The 100 most recent discussion threads including the term "HPV" on the American Cancer Society's Cancer Survivors Network's Head and Neck Cancer public discussion board were reviewed. The 11 most common questions were serially queried to ChatGPT 3.5; answers were recorded. A survey was distributed to fellowship trained head and neck oncologic surgeons at 3 institutions to evaluate the responses. Results: A total of 8 surgeons participated in the study. For questions regarding HPV contraction and transmission, ChatGPT answers were scored as clinically accurate and aligned with consensus in the head and neck surgical oncology community 84.4% and 90.6% of the time, respectively. For questions involving treatment of HPV+ OPC, ChatGPT was clinically accurate and aligned with consensus 87.5% and 91.7% of the time, respectively. For questions regarding the HPV vaccine, ChatGPT was clinically accurate and aligned with consensus 62.5% and 75% of the time, respectively. When asked about circulating tumor DNA testing, only 12.5% of surgeons thought responses were accurate or consistent with consensus. Conclusion: ChatGPT 3.5 performed poorly with questions involving evolving therapies and diagnostics—thus, caution should be used when using a platform like ChatGPT 3.5 to assess use of advanced technology. Patients should be counseled on the importance of consulting their surgeons to receive accurate and up to date recommendations, and use LLM's to augment their understanding of these important health-related topics. [ABSTRACT FROM AUTHOR]

Objectives Osseous microvascular free tissue transfer (MFTT) is the gold standard for reconstruction for most segmental mandibulectomy defects. The most common osseous MFTT utilized in reconstruction is the fibular, scapular, and osteocutaneous radial forearm (OCRF) free flap. We evaluated postoperative bone union as well as clinical complications following MFTT and the impact of various patient and reconstructive characteristics, including type of osseous MFTT. Study Design Retrospective cohort study. Setting Tertiary care academic hospital. Methods This study examined patients who underwent osseous MFTT for mandibular defects from January 2017 to January 2019. Results An overall 144 osteotomies in 58 patients were evaluated. Of the 144 junctions, 28 (19.4%) showed radiographic nonunion. Patients who underwent preoperative (odds ratio [OR] = 0.30, P = .027) and postoperative (OR = 0.28, P = .003) radiation had a significantly lower bone union score. Time from surgery to postoperative imaging was associated with higher bone union scores (OR = 1.07, P = .024). When bone union scores were compared among types of MFTT, fibular (OR = 5.62, P = .008) and scapular (OR = 4.69, P = .043) MFTT had significantly higher scores than OCRF MFTT. Twelve (20.7%) patients had postoperative complications. There was no statistically significant correlation between clinical complications and various variables, including type of osseous MFTT. Conclusion Pre- and postoperative radiation and time from surgery have an impact on bone union. Regarding the type of MFTT, fibular and scapular MFTT appeared to have higher bone union when compared with OCRF. There was no impact of bone union or type of osseous MFTT on clinical complications.

Background: Posterior instability is less common than anterior instability but can be seen in contact athletes and posttraumatically. Distal tibial allograft reconstruction for glenoid bone loss was first described by Provencher and colleagues in 2009 and an arthroscopic technique for posterior glenoid reconstruction using a distal tibial allograft was later described by Gupta et al in 2013. Indications: The primary indications for posterior distal tibial allograft include the failure of conservative management, recurrent instability after an arthroscopic stabilization, or glenoid bone loss > 20% to 25%. Technique Description: The patient is positioned in lateral decubitus, and examination under anesthesia is performed. Following arthroscopic evaluation, an incision is made medial to the posterolateral aspect of the acromion at the glenohumeral joint level. Electrocautery is carried to the deltoid, which is split in line with its fibers. A split between the infraspinatus and teres minor is performed. Vertical capsulotomy is performed, and deep retractors are placed. Attention is turned to the back table for graft preparation. The graft is measured, marked on the lateral aspect of the articular surface, and cut accordingly. Two 3.5-mm holes are drilled 1 cm apart, and the graft is thoroughly irrigated before being placed into the wound. A 2.5-mm drill is used in the 3.5-mm holes, and two 3.5-mm solid fully threaded screws are placed under power and tightened by hand. The wound is closed in the traditional fashion. Results: Graft nonunion and/or resorption are the primary concerns following posterior distal tibial allograft. Amar et al found no cases of nonunion or partial unions on 6-month computerized tomography (CT) scan, most patients having no or

Objective(s): Vismodegib, a unique hedgehog pathway inhibitor, has been demonstrated to be effective in the treatment of non-operable and metastatic basal cell carcinoma (BCC). While effective, concerns regarding its role in the development of cutaneous squamous cell carcinoma (CSCC) remain. The primary objective is to describe a unique case of locally advanced BCC of the face and subsequent transformation to CSCC following treatment with vismodegib. Methods: Case report. Results: A 64-year-old Caucasian female presented with a 3-year history of a progressive and erosive lesion involving the entirety of her forehead with involvement of the left medial canthus and upper eyelid. Biopsies performed at the periphery of the lesion demonstrated superficial and nodular BCC. As surgical management would result in significant morbidity, the patient elected for treatment with oral vismodegib, 150 mg daily, with curative intent. Dramatic tumor response was experienced over an 18-month period; however, surveillance MRI demonstrated concern for tumor progression at the periphery of the mass without evidence of intracranial extension or metastases. Subsequent biopsies at the superior and left supraorbital margins demonstrated invasive SCC. Following immunohistochemistry analysis, intravenous nivolumab, 480 mg monthly was initiated; the patient remains progression-free after 18 months of therapy. Conclusion: This case highlights the importance of close surveillance in patients treated with vismodegib for non-operable BCC. Serial biopsies of new or suspicious appearing tumors should be performed given the potential for CSCC transformation.

Resistance to rose rosette disease (RRD), a fatal disease of roses (Rosa spp.), is a high priority for rose breeding. As RRD resistance is time-consuming to phenotype, the identification of genetic markers for resistance could expedite breeding efforts. However, little is known about the genetics of RRD resistance. Therefore, we performed a quantitative trait locus (QTL) analysis on a set of inter-related diploid rose populations phenotyped for RRD resistance and identified four QTLs. Two QTLs were found in multiple years. The most consistent QTL is qRRV_TX2WSE_ch5, which explains approximately 20% and 40% of the phenotypic variation in virus quantity and severity of RRD symptoms, respectively. The second, a QTL on chromosome 1, qRRD_TX2WSE_ch1, accounts for approximately 16% of the phenotypic variation for severity. Finally, a third QTL on chromosome 3 was identified only in the multiyear analysis, and a fourth on chromosome 6 was identified in data from one year only. In addition, haplotypes associated with significant changes in virus quantity and severity were identified for qRRV_TX2WSE_ch5 and qRRD_TX2WSE_ch1. This research represents the first report of genetic determinants of resistance to RRD. In addition, marker trait associations discovered here will enable better parental selection when breeding for RRD resistance and pave the way for marker-assisted selection for RRD resistance.

Background/ObjectivesMicrovascular free tissue transfer has become essential to head and neck reconstruction and recent advancements in microvascular surgery have led to excellent surgical outcomes. However, there continues to be controversy and a stigma associated with the use of perioperative intravenous vasopressor agents among both surgeons and anesthesiologists. Due to concern for vasoconstriction of peripheral vasculature flowing to the denervated tissue flap, there remains concerns about potential thrombosis, decreased tissue perfusion and ultimately flap failure. This topic becomes even more important as vasopressors play an essential role in new Extended Recovery After Surgery (ERAS) protocols being put in place to optimize postoperative recovery for patients. The purpose of this study was to comprehensively review the role and safety as well as discuss current trends with intraoperative vasopressor agents in free tissue transfer for head and neck reconstruction.MethodsA scoping literature review was conducted of all studies that examined the use of vasopressor agents during head and neck free flap tissue transfer. Primary and secondary outcomes included free flap survival, arterial thrombosis, venous congestion, need for revision surgery, and other postoperative complications.ResultsOne prospective and nine retrospective studies were identified. Phenylephrine and ephedrine were the most common vasopressors reported; the rate of vasopressor use ranged from 53% to 85% and administration methods included both bolus and infusion. The included studies did not show any significant association between the use of vasopressors and free flap failure, pedicle thrombosis, or other flap complications.ConclusionThe administration of vasopressors during microvascular free tissue transfer for head and neck reconstruction does not seem to be associated with increased flap failure rates or other postoperative morbidities. Moreover, vasopressors may provide overall improved hemodynamic stability and help to limit overall fluid administration and subsequent postoperative complications. Additional prospective investigation is warranted to further elucidate and establish evidence-based recommendations regarding the type, timing, and dose of vasopressors to further enhance free flap survival and patient outcomes.

Objective: To identify factors influencing volume change in non-osseous oral free flap reconstruction using postoperative cross-sectional imaging and 3-dimensional segmentation of the free flap's muscular and adipose tissue content. Methods: Oral tongue free flap reconstruction cases (2014-2019) were reviewed with inclusion of patients with 3 postoperative, cross-sectional imaging studies with 1 within 6 months, 1 within 1 year, and 1 that spanned 2 years post-reconstruction. Exclusion criteria included recurrence, significant dental artifact, bony reconstruction, and flap failure. Demographics, risk factors, and surgical/clinical treatments were identified. Flap volumes were measured using Materialise MIMICS. Results: Twenty-two patients met strict inclusion criteria. Four flaps were anterolateral thighs and 18 radial forearms. Median percent volume loss greater than 2 years post-reconstruction was 53.2% overall, 58.1% for radial forearms, and 45.4% for ALTs (21.4% for adipose tissue and 57.4% for muscular tissue). Univariate analysis revealed glossectomy amount was associated with percent volume loss (P =.0417). Each successive postoperative month, the flap decreased by 1.54% (P <.0001). Checking for the interaction effect, the percent of flap loss across time was different for glossectomy amount (P =.0093), obesity status (P =.0431), and base of tongue involvement (P =.0472). Conclusion: Glossectomy type, and thus flap size, is a positive predictor for flap atrophy. Obesity and base of tongue involvement are negative predictors for flap atrophy. The amount of tissue loss may differ from classical teachings with median atrophy 53.2% greater than 2 years post-reconstruction. [ABSTRACT FROM AUTHOR]

There is intense interest and effort toward regenerating the brain after severe injury. Stem cell transplantation after insult to the central nervous system has been regarded as the most promising approach for repair; however, engrafting cells alone might not be sufficient for effective regeneration. In this study, we have compared neural progenitors (NPs) from the fetal ventricular zone (VZ), the postnatal subventricular zone, and an immortalized radial glia (RG) cell line engineered to conditionally secrete the trophic factor insulin-like growth factor 1 (IGF-1). Upon differentiation in vitro , the VZ cells were able to generate a greater number of neurons than subventricular zone cells. Furthermore, differentiated VZ cells generated pyramidal neurons . In vitro , doxycycline-driven secretion of IGF-1 strongly promoted neuronal differentiation of cells with hippocampal, interneuron and cortical specificity. Accordingly, VZ and engineered RG-IGF-1-hemagglutinin (HA) cells were selected for subsequent in vivo experiments. To increase cell survival, we delivered the NPs attached to a multifunctional chitosan-based scaffold. The microspheres containing adherent NPs were injected subacutely into the lesion cavity of adult rat brains that had sustained controlled cortical impact injury. At 2 weeks posttransplantation, the exogenously introduced cells showed a reduction in stem cell or progenitor markers and acquired mature neuronal and glial markers. In beam walking tests assessing sensorimotor recovery, transplanted RG cells secreting IGF-1 contributed significantly to functional improvement while native VZ or RG cells did not promote significant recovery. Altogether, these results support the therapeutic potential of chitosan-based multifunctional microsphere scaffolds seeded with genetically modified NPs expressing IGF-1 to promote repair and functional recovery after traumatic brain injuries.