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1. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author: Naghavi, M, Ong, KL, Aali, A, Ababneh, HS, Abate, YH, Abbafati, C, Abbasgholizadeh, R, Abbasian, M, Abbasi-Kangevari, M, Abbastabar, H, Abd ElHafeez, S, Abdelmasseh, M, Abd-Elsalam, S, Abdelwahab, A, Abdollahi, M, Abdollahifar, M-A, Abdoun, M, Abdulah, DM, Abdullahi, A, Abebe, M, Abebe, SS, Abedi, A, Abegaz, KH, Abhilash, ES, Abidi, H, Abiodun, O, Aboagye, RG, Abolhassani, H, Abolmaali, M, Abouzid, M, Aboye, GB, Abreu, LG, Abrha, WA, Abtahi, D, Abu Rumeileh, S, Abualruz, H, Abubakar, B, Abu-Gharbieh, E, Abu-Rmeileh, NME, Aburuz, S, Abu-Zaid, A, Accrombessi, MMK, Adal, TG, Adamu, AA, Addo, IY, Addolorato, G, Adebiyi, AO, Adekanmbi, V, Adepoju, AV, Adetunji, CO, Adetunji, JB, Adeyeoluwa, TE, Adeyinka, DA, Adeyomoye, OI, Admass, BAA, Adnani, QES, Adra, S, Afolabi, AA, Afzal, MS, Afzal, S, Agampodi, SB, Agasthi, P, Aggarwal, M, Aghamiri, S, Agide, FD, Agodi, A, Agrawal, A, Agyemang-Duah, W, Ahinkorah, BO, Ahmad, A, Ahmad, D, Ahmad, F, Ahmad, MM, Ahmad, S, Ahmad, T, Ahmadi, K, Ahmadzade, AM, Ahmed, A, Ahmed, H, Ahmed, LA, Ahmed, MS, Ahmed, MB, Ahmed, SA, Ajami, M, Aji, B, Akara, EM, Akbarialiabad, H, Akinosoglou, K, Akinyemiju, T, Akkaif, MA, Akyirem, S, Al Hamad, H, Al Hasan, SM, Alahdab, F, Alalalmeh, SO, Alalwan, TA, Al-Aly, Z, Alam, K, Alam, M, Alam, N, Al-amer, RM, Alanezi, FM, Alanzi, TM, Al-Azzam, S, Albakri, A, Albashtawy, M, AlBataineh, MT, Alcalde-Rabanal, JE, Aldawsari, KA, Aldhaleei, WA, Aldridge, RW, Alema, HB, Alemayohu, MA, Alemi, S, Alemu, YM, Al-Gheethi, AAS, Alhabib, KF, Alhalaiqa, FAN, Al-Hanawi, MK, Ali, A, Ali, L, Ali, MU, Ali, R, Ali, S, Ali, SSS, Alicandro, G, Alif, SM, Alikhani, R, Alimohamadi, Y, Aliyi, AA, Aljasir, MAM, Aljunid, SM, Alla, F, Allebeck, P, Al-Marwani, S, Al-Maweri, SAA, Almazan, JU, Al-Mekhlafi, HM, Almidani, L, Almidani, O, Alomari, MA, Al-Omari, B, Alonso, J, Alqahtani, JS, Alqalyoobi, S, Alqutaibi, AY, Al-Sabah, SK, Altaany, Z, Altaf, A, Al-Tawfiq, JA, Altirkawi, KA, Aluh, DO, Alvis-Guzman, N, Alwafi, H, Al-Worafi, YM, Aly, H, Aly, S, Alzoubi, KH, Amani, R, Amare, AT, Amegbor, PM, Ameyaw, EK, Amin, TT, Amindarolzarbi, A, Amiri, S, Amirzade-Iranaq, MH, Amu, H, Amugsi, DA, Amusa, GA, Ancuceanu, R, Anderlini, D, Anderson, DB, Andrade, PP, Andrei, CL, Andrei, T, Angus, C, Anil, A, Anil, S, Anoushiravani, A, Ansari, H, Ansariadi, A, Ansari-Moghaddam, A, Antony, CM, Antriyandarti, E, Anvari, D, Anvari, S, Anwar, S, Anwar, SL, Anwer, R, Anyasodor, AE, Aqeel, M, Arab, JP, Arabloo, J, Arafat, M, Aravkin, AY, Areda, D, Aremu, A, Aremu, O, Ariffin, H, Arkew, M, Armocida, B, Arndt, MB, Ärnlöv, J, Arooj, M, Artamonov, AA, Arulappan, J, Aruleba, RT, Arumugam, A, Asaad, M, Asadi-Lari, M, Asgedom, AA, Asghariahmadabad, M, Asghari-Jafarabadi, M, Ashraf, M, Aslani, A, Astell-Burt, T, Athar, M, Athari, SS, Atinafu, BTT, Atlaw, HW, Atorkey, P, Atout, MMW, Atreya, A, Aujayeb, A, Ausloos, M, Avan, A, Awedew, AF, Aweke, AM, Ayala Quintanilla, BP, Ayatollahi, H, Ayuso-Mateos, JL, Ayyoubzadeh, SM, Azadnajafabad, S, Azevedo, RMS, Azzam, AY, B, DB, Babu, AS, Badar, M, Badiye, AD, Baghdadi, S, Bagheri, N, Bagherieh, S, Bah, S, Bahadorikhalili, S, Bahmanziari, N, Bai, R, Baig, AA, Baker, JL, Bako, AT, Bakshi, RK, Balakrishnan, S, Balasubramanian, M, Baltatu, OC, Bam, K, Banach, M, Bandyopadhyay, S, Banik, PC, Bansal, H, Bansal, K, Barbic, F, Barchitta, M, Bardhan, M, Bardideh, E, Barker-Collo, SL, Bärnighausen, TW, Barone-Adesi, F, Barqawi, HJ, Barrero, LH, Barrow, A, Barteit, S, Barua, L, Basharat, Z, Bashiri, A, Basiru, A, Baskaran, P, Basnyat, B, Bassat, Q, Basso, JD, Basting, AVL, Basu, S, Batra, K, Baune, BT, Bayati, M, Bayileyegn, NS, Beaney, T, Bedi, N, Beghi, M, Behboudi, E, Behera, P, Behnoush, AH, Behzadifar, M, Beiranvand, M, Bejarano Ramirez, DF, Béjot, Y, Belay, SA, Belete, CM, Bell, ML, Bello, MB, Bello, OO, Belo, L, Beloukas, A, Bender, RG, Bensenor, IM, Beran, A, Berezvai, Z, Berhie, AY, Berice, BN, Bernstein, RS, Bertolacci, GJ, Bettencourt, PJG, Beyene, KA, Bhagat, DS, Bhagavathula, AS, Bhala, N, Bhalla, A, Bhandari, D, Bhangdia, K, Bhardwaj, N, Bhardwaj, P, Bhardwaj, PV, Bhargava, A, Bhaskar, S, Bhat, V, Bhatti, GK, Bhatti, JS, Bhatti, MS, Bhatti, R, Bhutta, ZA, Bikbov, B, Bishai, JD, Bisignano, C, Bisulli, F, Biswas, A, Biswas, B, Bitaraf, S, Bitew, BD, Bitra, VR, Bjørge, T, Boachie, MK, Boampong, MS, Bobirca, AV, Bodolica, V, Bodunrin, AO, Bogale, EK, Bogale, KA, Bohlouli, S, Bolarinwa, OA, Boloor, A, Bonakdar Hashemi, M, Bonny, A, Bora, K, Bora Basara, B, Borhany, H, Borzutzky, A, Bouaoud, S, Boustany, A, Boxe, C, Boyko, EJ, Brady, OJ, Braithwaite, D, Brant, LC, Brauer, M, Brazinova, A, Brazo-Sayavera, J, Breitborde, NJK, Breitner, S, Brenner, H, Briko, AN, Briko, NI, Britton, G, Brown, J, Brugha, T, Bulamu, NB, Bulto, LN, Buonsenso, D, Burns, RA, Busse, R, Bustanji, Y, Butt, NS, Butt, ZA, Caetano dos Santos, FL, Calina, D, Cámera, LA, Campos, LA, Campos-Nonato, IR, Cao, C, Cao, Y, Capodici, A, Cárdenas, R, Carr, S, Carreras, G, Carrero, JJ, Carugno, A, Carvalheiro, CG, Carvalho, F, Carvalho, M, Castaldelli-Maia, JM, Castañeda-Orjuela, CA, Castelpietra, G, Catalá-López, F, Catapano, AL, Cattaruzza, MS, Cederroth, CR, Cegolon, L, Cembranel, F, Cenderadewi, M, Cercy, KM, Cerin, E, Cevik, M, Chadwick, J, Chahine, Y, Chakraborty, C, Chakraborty, PA, Chan, JSK, Chan, RNC, Chandika, RM, Chandrasekar, EK, Chang, C-K, Chang, J-C, Chanie, GS, Charalampous, P, Chattu, VK, Chaturvedi, P, Chatzimavridou-Grigoriadou, V, Chaurasia, A, Chen, AW, Chen, A-T, Chen, CS, Chen, H, Chen, MX, Chen, S, Cheng, C-Y, Cheng, ETW, Cherbuin, N, Cheru, WA, Chien, J-H, Chimed-Ochir, O, Chimoriya, R, Ching, PR, Chirinos-Caceres, JL, Chitheer, A, Cho, WCS, Chong, B, Chopra, H, Choudhari, SG, Chowdhury, R, Christopher, DJ, Chukwu, IS, Chung, E, Chung, S-C, Chutiyami, M, Cindi, Z, Cioffi, I, Claassens, MM, Claro, RM, Coberly, K, Cogen, RM, Columbus, A, Comfort, H, Conde, J, Cortese, S, Cortesi, PA, Costa, VM, Costanzo, S, Cousin, E, Couto, RAS, Cowden, RG, Cramer, KM, Criqui, MH, Cruz-Martins, N, Cuadra-Hernández, SM, Culbreth, GT, Cullen, P, Cunningham, M, Curado, MP, Dadana, S, Dadras, O, Dai, S, Dai, X, Dai, Z, Dalli, LL, Damiani, G, Darega Gela, J, Das, JK, Das, S, Dascalu, AM, Dash, NR, Dashti, M, Dastiridou, A, Davey, G, Dávila-Cervantes, CA, Davis Weaver, N, Davletov, K, De Leo, D, de Luca, K, Debele, AT, Debopadhaya, S, Degenhardt, L, Dehghan, A, Deitesfeld, L, Del Bo', C, Delgado-Enciso, I, Demessa, BH, Demetriades, AK, Deng, K, Deng, X, Denova-Gutiérrez, E, Deravi, N, Dereje, N, Dervenis, N, Dervišević, E, Des Jarlais, DC, Desai, HD, Desai, R, Devanbu, VGC, Dewan, SMR, Dhali, A, Dhama, K, Dhimal, M, Dhingra, S, Dhulipala, VR, Dias da Silva, D, Diaz, D, Diaz, MJ, Dima, A, Ding, DD, Ding, H, Dinis-Oliveira, RJ, Dirac, MA, Djalalinia, S, Do, THP, do Prado, CB, Doaei, S, Dodangeh, M, Dohare, S, Dokova, KG, Dolecek, C, Dominguez, R-MV, Dong, W, Dongarwar, D, D'Oria, M, Dorostkar, F, Dorsey, ER, dos Santos, WM, Doshi, R, Doshmangir, L, Dowou, RK, Driscoll, TR, Dsouza, HL, Dsouza, V, Du, M, Dube, J, Duncan, BB, Duraes, AR, Duraisamy, S, Durojaiye, OC, Dwyer-Lindgren, L, Dzianach, PA, Dziedzic, AM, E'mar, AR, Eboreime, E, Ebrahimi, A, Echieh, CP, Edinur, HA, Edvardsson, D, Edvardsson, K, Efendi, D, Efendi, F, Effendi, DE, Eikemo, TA, Eini, E, Ekholuenetale, M, Ekundayo, TC, El Sayed, I, Elbarazi, I, Elema, TB, Elemam, NM, Elgar, FJ, Elgendy, IY, ElGohary, GMT, Elhabashy, HR, Elhadi, M, El-Huneidi, W, Elilo, LT, Elmeligy, OAA, Elmonem, MA, Elshaer, M, Elsohaby, I, Emeto, TI, Engelbert Bain, L, Erkhembayar, R, Esezobor, CI, Eshrati, B, Eskandarieh, S, Espinosa-Montero, J, Esubalew, H, Etaee, F, Fabin, N, Fadaka, AO, Fagbamigbe, AF, Fahim, A, Fahimi, S, Fakhri-Demeshghieh, A, Falzone, L, Fareed, M, Farinha, CSES, Faris, MEM, Faris, PS, Faro, A, Fasanmi, AO, Fatehizadeh, A, Fattahi, H, Fauk, NK, Fazeli, P, Feigin, VL, Feizkhah, A, Fekadu, G, Feng, X, Fereshtehnejad, S-M, Feroze, AH, Ferrante, D, Ferrari, AJ, Ferreira, N, Fetensa, G, Feyisa, BR, Filip, I, Fischer, F, Flavel, J, Flood, D, Florin, BT, Foigt, NA, Folayan, MO, Fomenkov, AA, Foroutan, B, Foroutan, M, Forthun, I, Fortuna, D, Foschi, M, Fowobaje, KR, Francis, KL, Franklin, RC, Freitas, A, Friedman, J, Friedman, SD, Fukumoto, T, Fuller, JE, Fux, B, Gaal, PA, Gadanya, MA, Gaidhane, AM, Gaihre, S, Gakidou, E, Galali, Y, Galles, NC, Gallus, S, Ganbat, M, Gandhi, AP, Ganesan, B, Ganiyani, MA, Garcia-Gordillo, MA, Gardner, WM, Garg, J, Garg, N, Gautam, RK, Gbadamosi, SO, Gebi, TG, Gebregergis, MW, Gebrehiwot, M, Gebremeskel, TG, Georgescu, SR, Getachew, T, Gething, PW, Getie, M, Ghadiri, K, Ghahramani, S, Ghailan, KY, Ghasemi, M-R, Ghasempour Dabaghi, G, Ghasemzadeh, A, Ghashghaee, A, Ghassemi, F, Ghazy, RM, Ghimire, A, Ghoba, S, Gholamalizadeh, M, Gholamian, A, Gholamrezanezhad, A, Gholizadeh, N, Ghorbani, M, Ghorbani Vajargah, P, Ghoshal, AG, Gill, PS, Gill, TK, Gillum, RF, Ginindza, TG, Girmay, A, Glasbey, JC, Gnedovskaya, EV, Göbölös, L, Godinho, MA, Goel, A, Golchin, A, Goldust, M, Golechha, M, Goleij, P, Gomes, NGM, Gona, PN, Gopalani, SV, Gorini, G, Goudarzi, H, Goulart, AC, Goulart, BNG, Goyal, A, Grada, A, Graham, SM, Grivna, M, Grosso, G, Guan, S-Y, Guarducci, G, Gubari, MIM, Gudeta, MD, Guha, A, Guicciardi, S, Guimarães, RA, Gulati, S, Gunawardane, DA, Gunturu, S, Guo, C, Gupta, AK, Gupta, B, Gupta, MK, Gupta, M, Gupta, RD, Gupta, R, Gupta, S, Gupta, VB, Gupta, VK, Gurmessa, L, Gutiérrez, RA, Habibzadeh, F, Habibzadeh, P, Haddadi, R, Hadei, M, Hadi, NR, Haep, N, Hafezi-Nejad, N, Hailu, A, Haj-Mirzaian, A, Halboub, ES, Hall, BJ, Haller, S, Halwani, R, Hamadeh, RR, Hameed, S, Hamidi, S, Hamilton, EB, Han, C, Han, Q, Hanif, A, Hanifi, N, Hankey, GJ, Hanna, F, Hannan, MA, Haque, MN, Harapan, H, Hargono, A, Haro, JM, Hasaballah, AI, Hasan, I, Hasan, MT, Hasani, H, Hasanian, M, Hashi, A, Hasnain, MS, Hassan, I, Hassanipour, S, Hassankhani, H, Haubold, J, Havmoeller, RJ, Hay, SI, He, J, Hebert, JJ, Hegazi, OE, Heidari, G, Heidari, M, Heidari-Foroozan, M, Helfer, B, Hendrie, D, Herrera-Serna, BY, Herteliu, C, Hesami, H, Hezam, K, Hill, CL, Hiraike, Y, Holla, R, Horita, N, Hossain, MM, Hossain, S, Hosseini, M-S, Hosseinzadeh, H, Hosseinzadeh, M, Hosseinzadeh Adli, A, Hostiuc, M, Hostiuc, S, Hsairi, M, Hsieh, VC-R, Hsu, RL, Hu, C, Huang, J, Hultström, M, Humayun, A, Hundie, TG, Hussain, J, Hussain, MA, Hussein, NR, Hussien, FM, Huynh, H-H, Hwang, B-F, Ibitoye, SE, Ibrahim, KS, Iftikhar, PM, Ijo, D, Ikiroma, AI, Ikuta, KS, Ikwegbue, PC, Ilesanmi, OS, Ilic, IM, Ilic, MD, Imam, MT, Immurana, M, Inamdar, S, Indriasih, E, Iqhrammullah, M, Iradukunda, A, Iregbu, KC, Islam, MR, Islam, SMS, Islami, F, Ismail, F, Ismail, NE, Iso, H, Isola, G, Iwagami, M, Iwu, CCD, Iyamu, IO, Iyer, M, J, LM, Jaafari, J, Jacob, L, Jacobsen, KH, Jadidi-Niaragh, F, Jafarinia, M, Jafarzadeh, A, Jaggi, K, Jahankhani, K, Jahanmehr, N, Jahrami, H, Jain, N, Jairoun, AA, Jaiswal, A, Jamshidi, E, Janko, MM, Jatau, AI, Javadov, S, Javaheri, T, Jayapal, SK, Jayaram, S, Jebai, R, Jee, SH, Jeganathan, J, Jha, AK, Jha, RP, Jiang, H, Jin, Y, Johnson, O, Jokar, M, Jonas, JB, Joo, T, Joseph, A, Joseph, N, Joshua, CE, Joshy, G, Jozwiak, JJ, Jürisson, M, K, V, Kaambwa, B, Kabir, A, Kabir, Z, Kadashetti, V, Kadir, DH, Kalani, R, Kalankesh, LR, Kaliyadan, F, Kalra, S, Kamal, VK, Kamarajah, SK, Kamath, R, Kamiab, Z, Kamyari, N, Kanagasabai, T, Kanchan, T, Kandel, H, Kanmanthareddy, AR, Kanmiki, EW, Kanmodi, KK, Kannan S, S, Kansal, SK, Kantar, RS, Kapoor, N, Karajizadeh, M, Karanth, SD, Karasneh, RA, Karaye, IM, Karch, A, Karim, A, Karimi, SE, Karimi Behnagh, A, Kashoo, FZ, Kasnazani, QHA, Kasraei, H, Kassebaum, NJ, Kassel, MB, Kauppila, JH, Kaur, N, Kawakami, N, Kayode, GA, Kazemi, F, Kazemian, S, Kazmi, TH, Kebebew, GM, Kebede, AD, Kebede, F, Keflie, TS, Keiyoro, PN, Keller, C, Kelly, JT, Kempen, JH, Kerr, JA, Kesse-Guyot, E, Khajuria, H, Khalaji, A, Khalid, N, Khalil, AA, Khalilian, A, Khamesipour, F, Khan, A, Khan, G, Khan, I, Khan, IA, Khan, MN, Khan, M, Khan, MJ, Khan, MAB, Khan, ZA, Khan suheb, MZ, Khanmohammadi, S, Khatab, K, Khatami, F, Khatatbeh, H, Khatatbeh, MM, Khavandegar, A, Khayat Kashani, HR, Khidri, FF, Khodadoust, E, Khorgamphar, M, Khormali, M, Khorrami, Z, Khosravi, A, Khosravi, MA, Kifle, ZD, Kim, G, Kim, J, Kim, K, Kim, MS, Kim, YJ, Kimokoti, RW, Kinzel, KE, Kisa, A, Kisa, S, Klu, D, Knudsen, AKS, Kocarnik, JM, Kochhar, S, Kocsis, T, Koh, DSQ, Kolahi, A-A, Kolves, K, Kompani, F, Koren, G, Kosen, S, Kostev, K, Koul, PA, Koulmane Laxminarayana, SL, Krishan, K, Krishna, H, Krishna, V, Krishnamoorthy, V, Krishnamoorthy, Y, Krohn, KJ, Kuate Defo, B, Kucuk Bicer, B, Kuddus, MA, Kuddus, M, Kuitunen, I, Kulimbet, M, Kulkarni, V, Kumar, A, Kumar, H, Kumar, M, Kumar, R, Kumari, M, Kumie, FT, Kundu, S, Kurmi, OP, Kusnali, A, Kusuma, D, Kwarteng, A, Kyriopoulos, I, Kyu, HH, La Vecchia, C, Lacey, B, Ladan, MA, Laflamme, L, Lagat, AK, Lager, ACJ, Lahmar, A, Lai, DTC, Lal, DK, Lalloo, R, Lallukka, T, Lam, H, Lám, J, Landrum, KR, Lanfranchi, F, Lang, JJ, Langguth, B, Lansingh, VC, Laplante-Lévesque, A, Larijani, B, Larsson, AO, Lasrado, S, Lassi, ZS, Latief, K, Latifinaibin, K, Lauriola, P, Le, NHH, Le, TTT, Le, TDT, Ledda, C, Ledesma, JR, Lee, M, Lee, PH, Lee, SW, Lee, SWH, Lee, W-C, Lee, YH, LeGrand, KE, Leigh, J, Leong, E, Lerango, TL, Li, M-C, Li, W, Li, X, Li, Y, Li, Z, Ligade, VS, Likaka, ATM, Lim, L-L, Lim, SS, Lindstrom, M, Linehan, C, Liu, C, Liu, G, Liu, J, Liu, R, Liu, S, Liu, X, Llanaj, E, Loftus, MJ, López-Bueno, R, Lopukhov, PD, Loreche, AM, Lorkowski, S, Lotufo, PA, Lozano, R, Lubinda, J, Lucchetti, G, Lugo, A, Lunevicius, R, Ma, ZF, Maass, KL, Machairas, N, Machoy, M, Madadizadeh, F, Madsen, C, Madureira-Carvalho, ÁM, Maghazachi, AA, Maharaj, SB, Mahjoub, S, Mahmoud, MA, Mahmoudi, A, Mahmoudi, E, Mahmoudi, R, Majeed, A, Makhdoom, IF, Malakan Rad, E, Maled, V, Malekzadeh, R, Malhotra, AK, Malhotra, K, Malik, AA, Malik, I, Malta, DC, Mamun, AA, Mansouri, P, Mansournia, MA, Mantovani, LG, Maqsood, S, Marasini, BP, Marateb, HR, Maravilla, JC, Marconi, AM, Mardi, P, Marino, M, Marjani, A, Martinez, G, Martinez-Guerra, BA, Martinez-Piedra, R, Martini, D, Martini, S, Martins-Melo, FR, Martorell, M, Marx, W, Maryam, S, Marzo, RR, Masaka, A, Masrie, A, Mathieson, S, Mathioudakis, AG, Mathur, MR, Mattumpuram, J, Matzopoulos, R, Maude, RJ, Maugeri, A, Maulik, PK, Mayeli, M, Mazaheri, M, Mazidi, M, McGrath, JJ, McKee, M, McKowen, ALW, McLaughlin, SA, McPhail, SM, Mechili, EA, Medina, JRC, Mediratta, RP, Meena, JK, Mehra, R, Mehrabani-Zeinabad, K, Mehrabi Nasab, E, Mekene Meto, T, Meles, GG, Mendez-Lopez, MAM, Mendoza, W, Menezes, RG, Mengist, B, Mentis, A-FA, Meo, SA, Meresa, HA, Meretoja, A, Meretoja, TJ, Mersha, AM, Mesfin, BA, Mestrovic, T, Mettananda, KCD, Mettananda, S, Meylakhs, P, Mhlanga, A, Mhlanga, L, Mi, T, Miazgowski, T, Micha, G, Michalek, IM, Miller, TR, Mills, EJ, Minh, LHN, Mini, GK, Mir Mohammad Sadeghi, P, Mirica, A, Mirijello, A, Mirrakhimov, EM, Mirutse, MK, Mirzaei, M, Misganaw, A, Mishra, A, Misra, S, Mitchell, PB, Mithra, P, Mittal, C, Mobayen, M, Moberg, ME, Mohamadkhani, A, Mohamed, J, Mohamed, MFH, Mohamed, NS, Mohammad-Alizadeh-Charandabi, S, Mohammadi, S, Mohammadian-Hafshejani, A, Mohammadifard, N, Mohammed, H, Mohammed, M, Mohammed, S, Mohan, V, Mojiri-Forushani, H, Mokari, A, Mokdad, AH, Molinaro, S, Molokhia, M, Momtazmanesh, S, Monasta, L, Mondello, S, Moni, MA, Moodi Ghalibaf, A, Moradi, M, Moradi, Y, Moradi-Lakeh, M, Moradzadeh, M, Moraga, P, Morawska, L, Moreira, RS, Morovatdar, N, Morrison, SD, Morze, J, Mosser, JF, Motappa, R, Mougin, V, Mouodi, S, Mousavi, P, Mousavi, SE, Mousavi Khaneghah, A, Mpolya, EA, Mrejen, M, Mubarik, S, Muccioli, L, Mueller, UO, Mughal, F, Mukherjee, S, Mulita, F, Munjal, K, Murillo-Zamora, E, Musaigwa, F, Musallam, KM, Mustafa, A, Mustafa, G, Muthupandian, S, Muthusamy, R, Muzaffar, M, Myung, W, Nagarajan, AJ, Nagel, G, Naghavi, P, Naheed, A, Naik, 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Zhu, L, Ziafati, M, Zielińska, M, Zitoun, OA, Zoladl, M, Zou, Z, Zuhlke, LJ, Zumla, A, Zweck, E, Zyoud, SH, Wool, EE, and Murray, CJL
Published: 2024

2. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author: Ferrari, AJ, Santomauro, DF, Aali, A, Abate, YH, Abbafati, C, Abbastabar, H, Abd ElHafeez, S, Abdelmasseh, M, Abd-Elsalam, S, Abdollahi, A, Abdullahi, A, Abegaz, KH, Abeldaño Zuñiga, RA, Aboagye, RG, Abolhassani, H, Abreu, LG, Abualruz, H, Abu-Gharbieh, E, Abu-Rmeileh, NME, Ackerman, IN, Addo, IY, Addolorato, G, Adebiyi, AO, Adepoju, AV, Adewuyi, HO, Afyouni, S, Afzal, S, Agodi, A, Ahmad, A, Ahmad, D, Ahmad, F, Ahmad, S, Ahmed, A, Ahmed, LA, Ahmed, MB, Ajami, M, Akinosoglou, K, Akkaif, MA, Al Hasan, SM, Alalalmeh, SO, Al-Aly, Z, Albashtawy, M, Aldridge, RW, Alemu, MD, Alemu, YM, Alene, KA, Al-Gheethi, AAS, Alharrasi, M, Alhassan, RK, Ali, MU, Ali, R, Ali, SSS, Alif, SM, Aljunid, SM, Al-Marwani, S, Almazan, JU, Alomari, MA, Al-Omari, B, Altaany, Z, Alvis-Guzman, N, Alvis-Zakzuk, NJ, Alwafi, H, Al-Wardat, MS, Al-Worafi, YM, Aly, S, Alzoubi, KH, Amare, AT, Amegbor, PM, Ameyaw, EK, Amin, TT, Amindarolzarbi, A, Amiri, S, Amugsi, DA, Ancuceanu, R, Anderlini, D, Anderson, DB, Andrade, PP, Andrei, CL, Ansari, H, Antony, CM, Anwar, S, Anwar, SL, Anwer, R, Anyanwu, PE, Arab, JP, Arabloo, J, Arafat, M, Araki, DT, Aravkin, AY, Arkew, M, Armocida, B, Arndt, MB, Arooj, M, Artamonov, AA, Aruleba, RT, Arumugam, A, Ashbaugh, C, Ashemo, MY, Ashraf, M, Asika, MO, Askari, E, Astell-Burt, T, Athari, SS, Atorkey, P, Atout, MMW, Atreya, A, Aujayeb, A, Ausloos, M, Avan, A, Awotidebe, AW, Awuviry-Newton, K, Ayala Quintanilla, BP, Ayuso-Mateos, JL, Azadnajafabad, S, Azevedo, RMS, Babu, AS, Badar, M, Badiye, AD, Baghdadi, S, Bagheri, N, Bah, S, Bai, R, Baker, JL, Bakkannavar, SM, Bako, AT, Balakrishnan, S, Bam, K, Banik, PC, Barchitta, M, Bardhan, M, Bardideh, E, Barker-Collo, SL, Barqawi, HJ, Barrow, A, Barteit, S, Barua, L, Bashiri Aliabadi, S, Basiru, A, Basu, S, Bathini, PP, Batra, K, Baune, BT, Bayileyegn, NS, Behnam, B, Behnoush, AH, Beiranvand, M, Bejarano Ramirez, DF, Bell, ML, Bello, OO, Beloukas, A, Bensenor, IM, Berezvai, Z, Bernabe, E, Bernstein, RS, Bettencourt, PJG, Bhagavathula, AS, Bhala, N, Bhandari, D, Bhargava, A, Bhaskar, S, Bhat, V, Bhatti, GK, Bhatti, JS, Bhatti, MS, Bhatti, R, Bhutta, ZA, Bikbov, B, Bishai, JD, Bisignano, C, Bitra, VR, Bjørge, T, Bodolica, V, Bodunrin, AO, Bogale, EK, Bonakdar Hashemi, M, Bonny, A, Bora Basara, B, Borhany, H, Boxe, C, Brady, OJ, Bragazzi, NL, Braithwaite, D, Brant, LC, Brauer, M, Breitner, S, Brenner, H, Brown, J, Brugha, T, Bulamu, NB, Buonsenso, D, Burkart, K, Burns, RA, Busse, R, Bustanji, Y, Butt, ZA, Byun, J, Caetano dos Santos, FL, Calina, D, Cámera, LA, Campos-Nonato, IR, Cao, C, Capodici, A, Carr, S, Carreras, G, Carugno, A, Carvalho, M, Castaldelli-Maia, JM, Castañeda-Orjuela, CA, Castelpietra, G, Catapano, AL, Cattaruzza, MS, Caye, A, Cegolon, L, Cembranel, F, Cenderadewi, M, Cerin, E, Chakraborty, PA, Chan, JSK, Chan, RNC, Chandika, RM, Chandrasekar, EK, Charalampous, P, Chattu, VK, Chatzimavridou-Grigoriadou, V, Chen, AW, Chen, A-T, Chen, CS, Chen, H, Chen, NM, Cheng, ETW, Chimed-Ochir, O, Chimoriya, R, Ching, PR, Cho, WCS, Choi, S, Chong, B, Chong, YY, Choudhari, SG, Chowdhury, R, Christensen, SWM, Chu, D-T, Chukwu, IS, Chung, E, Chutiyami, M, Claassens, MM, Cogen, RM, Columbus, A, Conde, J, Cortesi, PA, Cousin, E, Criqui, MH, Cruz-Martins, N, Dadras, O, Dai, S, Dai, X, Dai, Z, Dalaba, MA, Damiani, G, Das, JK, Das, S, Dashti, M, Dávila-Cervantes, CA, Davletov, K, De Leo, D, Debele, AT, Debopadhaya, S, DeCleene, NK, Deeba, F, Degenhardt, L, Del Bo', C, Delgado-Enciso, I, Demetriades, AK, Denova-Gutiérrez, E, Dervenis, N, Desai, HD, Desai, R, Deuba, K, Dhama, K, Dharmaratne, SD, Dhingra, S, Dias da Silva, D, Diaz, D, Diaz, LA, Diaz, MJ, Dima, A, Ding, DD, Dirac, MA, Do, THP, do Prado, CB, Dohare, S, Dominguez, R-MV, Dong, W, Dongarwar, D, D'Oria, M, Dorsey, ER, Doshmangir, L, Dowou, RK, Driscoll, TR, Dsouza, HL, Dsouza, V, Dube, J, Dumith, SC, Duncan, BB, Duraes, AR, Duraisamy, S, Durojaiye, OC, Dzianach, PA, Dziedzic, AM, Eboreime, E, Ebrahimi, A, Edinur, HA, 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S, Hsu, JM, Huang, J, Hugo, FN, Hushmandi, K, Hussain, J, Hussein, NR, Huynh, CK, Huynh, H-H, Hwang, B-F, Iannucci, VC, Ihler, AL, Ikiroma, AI, Ikuta, KS, Ilesanmi, OS, Ilic, IM, Ilic, MD, Imam, MT, Immurana, M, Irham, LM, Islam, MR, Islam, SMS, Islami, F, Ismail, F, Ismail, NE, Isola, G, Iwagami, M, Iwu, CCD, Iyer, M, Jaafari, J, Jacobsen, KH, Jadidi-Niaragh, F, Jafarinia, M, Jaggi, K, Jahankhani, K, Jahanmehr, N, Jahrami, H, Jain, A, Jain, N, Jairoun, AA, Jaiswal, A, Jakovljevic, M, Jatau, AI, Javadov, S, Javaheri, T, Jayapal, SK, Jayaram, S, Jee, SH, Jeganathan, J, Jeyakumar, A, Jha, AK, Jiang, H, Jin, Y, Jonas, JB, Joo, T, Joseph, A, Joseph, N, Joshua, CE, Jozwiak, JJ, Jürisson, M, K, V, Kaambwa, B, Kabir, A, Kabir, Z, Kadashetti, V, Kalani, R, Kalankesh, LR, Kaliyadan, F, Kalra, S, Kamenov, K, Kamyari, N, Kanagasabai, T, Kandel, H, Kanmanthareddy, AR, Kanmodi, KK, Kantar, RS, Karaye, IM, Karim, A, Karimi, SE, Karimi, Y, Kasraei, H, Kassel, MB, Kauppila, JH, Kawakami, N, Kayode, 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Y, Yusuf, H, Zahid, MH, Zakham, F, Zaki, L, Zaki, N, Zaman, BA, Zamora, N, Zand, R, Zandieh, GGZ, Zar, HJ, Zarrintan, A, Zastrozhin, MS, Zhang, H, Zhang, N, Zhang, Y, Zhao, H, Zhong, C, Zhong, P, Zhou, J, Zhu, Z, Ziafati, M, Zielińska, M, Zimsen, SRM, Zoladl, M, Zumla, A, Zyoud, SH, Vos, T, and Murray, CJL
Published: 2024

3. Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Sheena, BS, Hiebert, L, Han, H, Ippolito, H, Abbasi-Kangevari, M, Abbasi-Kangevari, Z, Abbastabar, H, Abdoli, A, Ali, HA, Adane, MM, Adegboye, OA, Adnani, QES, Advani, SM, Afzal, MS, Afzal, S, Meybodi, MA, Ahadinezhad, B, Ahinkorah, BO, Ahmad, S, Ahmad, T, Ahmadi, S, Ahmed, H, Ahmed, MB, Rashid, TA, Akalu, GT, Aklilu, A, Akram, T, Al Hamad, H, Alahdab, F, Alem, AZ, Alem, DT, Alhalaiqa, FAN, Alhassan, RK, Ali, L, Ali, MA, Alimohamadi, Y, Alipour, V, Alkhayyat, M, Almustanyir, S, Al-Raddadi, RM, Altawalah, H, Amini, S, Amu, H, Ancuceanu, R, Andrei, CL, Andrei, T, Anoushiravani, A, Ansar, A, Anyasodor, AE, Arabloo, J, Arab-Zozani, M, Argaw, AM, Argaw, ZG, Arshad, M, Artamonov, AA, Ashraf, T, Atlaw, D, Ausloos, F, Ausloos, M, Azadnajafabad, S, Azangou-Khyavy, M, Jafari, AA, Azarian, G, Bagheri, S, Bahadory, S, Baig, AA, Banach, M, Barati, N, Barrow, A, Batiha, A-MM, Ramirez, DFB, Belgaumi, UI, Berhie, AY, Bhagat, DS, Bhardwaj, N, Bhardwaj, P, Bhattacharyya, K, Bhojaraja, VS, Bijani, A, Biondi, A, Bodicha, BBA, Bojia, HA, Boloor, A, Bosetti, C, Braithwaite, D, Briko, NI, Butt, ZA, Camera, LA, Chakinala, RC, Chakraborty, PA, Charan, J, Chen, S, Choi, J-YJ, Choudhari, SG, Chowdhury, FR, Chu, D-T, Chung, S-C, Cortesi, PA, Cowie, BC, Culbreth, GT, Dadras, O, Dai, X, Dandona, L, Dandona, R, De la Hoz, FP, Debela, SA, Dedefo, MG, Demeke, FM, Demie, TGG, Demissie, GD, Molla, MD, Desta, AA, Dhamnetiya, D, Dhimal, ML, Dhimal, M, Didehdar, M, Doan, LP, Dorostkar, F, Drake, TM, Eghbalian, F, Ekholuenetale, M, El Sayed, I, Zaki, MES, Elhadi, M, Elmonem, MA, Elsharkawy, A, Enany, S, Enyew, DB, Erkhembayar, R, Eskandarieh, S, Esmaeilzadeh, F, Ezzikouri, S, Farrokhpour, H, Fetensa, G, Fischer, F, Foroutan, M, Gad, MM, Gaidhane, AM, Gaidhane, S, Galles, NC, Gallus, S, Gebremeskel, TG, Gebreyohannes, EA, Ghadiri, K, Ghaffari, K, Ghafourifard, M, Ghamari, S-H, Ghashghaee, A, Gholami, A, Gholizadeh, A, Gilani, A, Goel, A, Golechha, M, Goleij, P, Golinelli, D, Gorini, G, Goshu, YA, Griswold, MG, Gubari, MIM, Gupta, B, Gupta, S, Gupta, VB, Gupta, VK, Haddadi, R, Halwani, R, Hamid, SS, Hamidi, S, Hanif, A, Haque, S, Harapan, H, Hargono, A, Hariri, S, Hasaballah, A, Hasan, SMM, Hassanipour, S, Hassankhani, H, Hay, S, Hayat, K, Heidari, G, Herteliu, C, Heyi, DZ, Hezam, K, Holla, R, Hosseini, M-S, Hosseini, M, Hosseinzadeh, M, Hostiuc, M, Househ, M, Huang, J, Hussein, NR, Iavicoli, I, Ibitoye, SE, Ilesanmi, OS, Ilic, IM, Ilic, MD, Irham, LM, Islam, JY, Ismail, NE, Jacobsen, KH, Jadidi-Niaragh, F, Mamaghani, AJ, Jayaram, S, Jayawardena, R, Jebai, R, Jha, RP, Joseph, N, Joukar, F, Kaambwa, B, Kabir, A, Kabir, Z, Kalhor, R, Kandel, H, Kanko, TKT, Kantar, RS, Karaye, IM, Kassa, BG, Bohan, PMK, Keykhaei, M, Khader, YS, Khajuria, H, Khan, G, Khan, IA, Khan, J, Ab Khan, M, Khanali, J, Khater, AM, Khatib, MN, Khodadost, M, Khoja, AT, Khosravizadeh, O, Khubchandani, J, Kim, GR, Kim, H, Kim, MS, Kim, YJ, Kocarnik, JM, Kolahi, A-A, Koteeswaran, R, Kumar, GA, La Vecchia, C, Lal, DK, Landires, I, Lasrado, S, Lazarus, J, Ledda, C, Lee, DW, Lee, S-W, Lee, YY, Levi, M, Li, J, Lim, SS, Lobo, SW, Lopukhov, PD, Loureiro, JA, MacLachlan, JH, Razek, HMAE, Razek, MMAE, Majeed, A, Makki, A, Malekpour, M-R, Malekzadeh, R, Malik, AA, Mansour-Ghanaei, F, Mansournia, MA, Martins-Melo, FR, Matthews, PC, Mendoza, W, Menezes, RG, Meretoja, TJ, Mersha, AG, Mestrovic, T, Miller, TR, Minh, LHN, Mirica, A, Mirmoeeni, S, Mirrakhimov, EM, Misra, S, Mithra, P, Moazen, B, Mohamadkhani, A, Mohammadi, M, Mohammed, S, Moka, N, Mokdad, AH, Moludi, J, Momtazmanesh, S, Monasta, L, Moradi, G, Moradzadeh, M, Moradzadeh, R, Moraga, P, Mostafavi, E, Mubarik, S, Muniyandi, M, Murray, CJL, Naghavi, M, Naimzada, MD, Swamy, SN, Natto, ZS, Nayak, BP, Nazari, J, Negoi, I, Negru, SM, Nejadghaderi, SA, Kandel, SN, Nguyen, HLT, Ngwa, CH, Niazi, RK, Nnaji, CA, Noubiap, JJ, Nowroozi, A, Nunez-Samudio, V, Oancea, B, Ochir, C, Odukoya, OO, Oh, I-H, Olagunju, AT, Olakunde, BO, Bali, AO, Omer, 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Abstract: BACKGROUND: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. METHODS: The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. FINDINGS: In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 0
Published: 2022

4. Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Author: Peden, AE, Cullen, P, Francis, KL, Moeller, H, Peden, MM, Ye, P, Tian, M, Zou, Z, Sawyer, SM, Aali, A, Abbasi-Kangevari, Z, Abbasi-Kangevari, M, Abdelmasseh, M, Abdoun, M, Abd-Rabu, R, Abdulah, DM, Abdurehman, AM, Abebe, G, Abebe, AM, Abedi, A, Abidi, H, Aboagye, RG, Ali, HA, Abu-Gharbieh, E, Adane, DE, Adane, TD, Addo, IY, Adewole, OG, Adhikari, S, Adnan, M, Adnani, QES, Afolabi, AAB, Afzal, S, Afzal, MS, Aghdam, ZB, Ahinkorah, BO, Ahmad, AR, Ahmad, T, Ahmad, S, Ahmadi, A, Ahmed, H, Ahmed, MB, Ahmed, A, Ahmed, JQ, Rashid, TA, Aithala, JP, Aji, B, Akhlaghdoust, M, Alahdab, F, Alanezi, FM, Alemayehu, A, Al Hamad, H, Ali, SS, Ali, L, Alimohamadi, Y, Alipour, V, Aljunid, SM, Almidani, L, Almustanyir, S, Altirkawi, KA, Alvis-Zakzuk, NJ, Ameyaw, EK, Amin, TT, Amir-Behghadami, M, Amiri, S, Amiri, H, Anagaw, TF, Andrei, T, Andrei, CL, Anvari, D, Anwar, SL, Anyasodor, AE, Arabloo, J, Arab-Zozani, M, Arja, A, Arulappan, J, Arumugam, A, Aryannejad, A, Asgary, S, Ashraf, T, Athari, SS, Atreya, A, Attia, S, Aujayeb, A, Awedew, AF, Azadnajafabad, S, Azangou-Khyavy, M, Azari, S, Jafari, AA, Azizi, H, Azzam, AY, Badiye, AD, Baghcheghi, N, Bagherieh, S, Baig, AA, Bakkannavar, SM, Balta, AB, Banach, M, Banik, PC, Bansal, H, Bardhan, M, Barone-Adesi, F, Barrow, A, Bashiri, A, Baskaran, P, Basu, S, Bayileyegn, NS, Bekel, AA, Bekele, AB, Bendak, S, Bensenor, IM, Berhie, AY, Bhagat, DS, Bhagavathula, AS, Bhardwaj, P, Bhardwaj, N, Bhaskar, S, Bhat, AN, Bhattacharyya, K, Bhutta, ZA, Bibi, S, Bintoro, BS, Bitaraf, S, Bodicha, BBA, Boloor, A, Bouaoud, S, Brown, J, Burkart, K, Butt, NS, Butt, MH, Camera, LA, Rincon, JCC, Cao, C, Carvalho, AF, Carvalho, M, Chakraborty, PA, Chandrasekar, EK, Chang, J-C, Charalampous, P, Charan, J, Chattu, VK, Chekole, BM, Chitheer, A, Cho, DY, Chopra, H, Christopher, DJ, Chukwu, IS, Cruz-Martins, N, Dadras, O, Dahlawi, SMA, Dai, X, Damiani, G, Darmstadt, GL, Soltani, RDC, Darwesh, AM, Das, S, Dastiridou, A, Debela, SA, Dehghan, A, Demeke, GM, 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Rafiee, A, Raghav, PR, Rahim, F, Rahman, MA, Rahman, FS, Rahman, M, Rahmani, AM, Rahmani, S, Moolambally, SR, Ramazanu, S, Ramezanzadeh, K, Rana, J, Rana, SM, Rao, CR, Rao, SJ, Rashedi, V, Rashidi, M-M, Rastogi, P, Rasul, A, Rawaf, S, Rawaf, DL, Rawal, L, Rawassizadeh, R, Rezaei, N, Rezaeian, M, Rezapour, A, Riad, A, Riaz, M, Rickard, J, Buendia Rodriguez, JA, Roever, L, Ronfani, L, Roy, B, Manjula, S, Saad, AMA, Sabour, S, Sabzmakan, L, Saddik, B, Sadeghi, M, Saeb, MR, Saeed, U, Moghaddam, SS, Safi, SZ, Sahiledengle, B, Sahoo, H, Sahraian, MA, Saki, M, Salamati, P, Salehi, S, Salem, MR, Samy, AM, Sanabria, J, Santric-Milicevic, MM, Saqib, MAN, Sarikhani, Y, Sarveazad, A, Sathian, B, Satpathy, M, Saya, GK, Ceola Schneider, IJ, Schwebel, DC, Seddighi, H, Senthilkumaran, S, Seylani, A, Shabaninejad, H, Shafeghat, M, Shah, PA, Shahabi, S, Shahbandi, A, Shahraki-Sanavi, F, Shaikh, MA, Shaker, E, Shams-Beyranvand, M, Shanawaz, M, Shannawaz, M, Sharew, MMS, Sharma, N, Shashamo, BB, Shayan, M, Sheikhi, RA, Shen, J, Shetty, BSK, Shetty, PH, Shin, JI, Shitaye, NA, Shivakumar, KM, Shobeiri, P, Shorofi, SA, Shrestha, S, Siabani, S, Sidemo, NB, Simegn, W, Sinaei, E, Singh, P, Sinto, R, Siraj, MS, Skryabin, VY, Skryabina, AA, Sleet, DA, Chandan, SN, Socea, B, Solmi, M, Solomon, Y, Song, Y, Sousa, RARC, Soyiri, IN, Stokes, MA, Suleman, M, Abdulkader, RS, Sun, J, Tabares-Seisdedos, R, Tabatabaei, SM, Tabish, M, Taheri, E, Soodejani, MT, Tampa, M, Tan, K-K, Tarigan, IU, Tariqujjaman, M, Tat, NY, Tat, VY, Tavakoli, A, Tefera, BN, Tefera, YM, Temesgen, G, Temsah, M-H, Thangaraju, P, Thapar, R, Thomas, NK, Ticoalu, JHV, Tincho, MB, Tiyuri, A, Togtmol, M, Tovani-Palone, MR, Mai, TNT, Ullah, S, Ullah, I, Umakanthan, S, Unnikrishnan, B, Upadhyay, E, Tahbaz, SV, Valdez, PR, Vasankari, TJ, Vaziri, S, Veroux, M, Vervoort, D, Violante, FS, Vlassov, V, Linh, GV, Waheed, Y, Wang, Y, Wang, Y-P, Wang, C, Wiangkham, T, Wickramasinghe, ND, Woday, AT, Wu, A-M, Yahya, GAT, Jabbari, SHY, Yang, L, Yaya, S, Yigit, A, Yigit, V, Yisihak, E, Yonemoto, N, You, Y, Younis, MZ, Yu, C, Yunusa, I, Yusefi, H, Zahir, M, Bin Zaman, S, Zare, I, Zarea, K, Zastrozhin, MS, Zhang, Z-J, Zhang, Y, Ziapour, A, Zodpey, S, Zoladl, M, Patton, GC, Ivers, RQ, Peden, AE, Cullen, P, Francis, KL, Moeller, H, Peden, MM, Ye, P, Tian, M, Zou, Z, Sawyer, SM, Aali, A, Abbasi-Kangevari, Z, Abbasi-Kangevari, M, Abdelmasseh, M, Abdoun, M, Abd-Rabu, R, Abdulah, DM, Abdurehman, AM, Abebe, G, Abebe, AM, Abedi, A, Abidi, H, Aboagye, RG, Ali, HA, Abu-Gharbieh, E, Adane, DE, Adane, TD, Addo, IY, Adewole, OG, Adhikari, S, Adnan, M, Adnani, QES, Afolabi, AAB, Afzal, S, Afzal, MS, Aghdam, ZB, Ahinkorah, BO, Ahmad, AR, Ahmad, T, Ahmad, S, Ahmadi, A, Ahmed, H, Ahmed, MB, Ahmed, A, Ahmed, JQ, Rashid, TA, Aithala, JP, Aji, B, Akhlaghdoust, M, Alahdab, F, Alanezi, FM, Alemayehu, A, Al Hamad, H, Ali, SS, Ali, L, Alimohamadi, Y, Alipour, V, Aljunid, SM, Almidani, L, Almustanyir, S, Altirkawi, KA, Alvis-Zakzuk, NJ, Ameyaw, EK, Amin, TT, Amir-Behghadami, M, Amiri, S, Amiri, H, Anagaw, TF, Andrei, T, Andrei, CL, Anvari, D, Anwar, SL, Anyasodor, AE, Arabloo, J, Arab-Zozani, M, Arja, A, Arulappan, J, Arumugam, A, Aryannejad, A, Asgary, S, Ashraf, T, Athari, SS, Atreya, A, Attia, S, Aujayeb, A, Awedew, AF, Azadnajafabad, S, Azangou-Khyavy, M, Azari, S, Jafari, AA, Azizi, H, Azzam, AY, Badiye, AD, Baghcheghi, N, Bagherieh, S, Baig, AA, Bakkannavar, SM, Balta, AB, Banach, M, Banik, PC, Bansal, H, Bardhan, M, Barone-Adesi, F, Barrow, A, Bashiri, A, Baskaran, P, Basu, S, Bayileyegn, NS, Bekel, AA, Bekele, AB, Bendak, S, Bensenor, IM, Berhie, AY, Bhagat, DS, Bhagavathula, AS, Bhardwaj, P, Bhardwaj, N, Bhaskar, S, Bhat, AN, Bhattacharyya, K, Bhutta, ZA, Bibi, S, Bintoro, BS, Bitaraf, S, Bodicha, BBA, Boloor, A, Bouaoud, S, Brown, J, Burkart, K, Butt, NS, Butt, MH, Camera, LA, Rincon, JCC, Cao, C, Carvalho, AF, Carvalho, M, Chakraborty, PA, Chandrasekar, EK, Chang, J-C, Charalampous, P, Charan, J, Chattu, VK, Chekole, BM, Chitheer, A, Cho, DY, Chopra, H, Christopher, DJ, Chukwu, IS, Cruz-Martins, N, Dadras, O, Dahlawi, SMA, Dai, X, Damiani, G, Darmstadt, GL, Soltani, RDC, Darwesh, AM, Das, S, Dastiridou, A, Debela, SA, Dehghan, A, Demeke, GM, Demetriades, AK, Demissie, S, Dessalegn, FN, Desta, AA, Dianatinasab, M, Diao, N, da Silva, DD, Diaz, D, Digesa, LE, Diress, M, Djalalinia, S, Linh, PD, Dodangeh, M, Doku, PN, Dongarwar, D, Dsouza, HL, Eini, E, Ekholuenetale, M, Ekundayo, TC, Elagali, AEM, Elbahnasawy, MA, Elhabashy, HR, Elhadi, M, Zaki, MES, Enyew, DB, Erkhembayar, R, Eskandarieh, S, Etaee, F, Fagbamigbe, AF, Faris, PS, Farmany, A, Faro, A, Farzadfar, F, Fatehizadeh, A, Fereshtehnejad, S-M, Feroze, AH, Fetensa, G, Feyisa, BR, Filip, I, Fischer, F, Foroutan, B, Foroutan, M, Fowobaje, KR, Franklin, RC, Fukumoto, T, Gaal, PA, Gadanya, MA, Galali, Y, Galehdar, N, Ganesan, B, Garg, T, Gebrehiwot, MGD, Gebremariam, YH, Gela, YY, Gerema, U, Ghafourifard, M, Ghamari, S-H, Ghanbari, R, Nour, MG, Gholamalizadeh, M, Gholami, A, Gholamrezanezhad, A, Ghozy, S, Gilani, SA, Gill, TK, Gine-Vazquez, I, Girma, ZA, Glasbey, JC, Glozah, FN, Golechha, M, Goleij, P, Grivna, M, Guadie, HA, Gunawardane, DA, Guo, Y, Gupta, VB, Gupta, S, Gupta, B, Gupta, VK, Haj-Mirzaian, A, Halwani, R, Hamadeh, RR, Hameed, S, Hanfore, LK, Hanif, A, Hargono, A, Harlianto, NI, Harorani, M, Hasaballah, AI, Hasan, SMM, Hassan, A, Hassanipour, S, Hassankhani, H, Havmoeller, RJ, Hay, SI, Heidari, M, Hendrie, D, Heyi, DZ, Hiraike, Y, Holla, R, Horita, N, Hossain, SJ, Hossain, MBH, Shabanan, SH, Hosseinzadeh, M, Hostiuc, S, Hoveidaei, AH, Hsiao, AK, Hussain, S, Hussein, A, Ibitoye, SE, Ilesanmi, OS, Ilic, IM, Ilic, MD, Imani, B, Immurana, M, Inbaraj, LR, Islam, SMS, Islam, RM, Islam, MM, Ismail, NE, Merin, LJ, Jahrami, H, Jakovljevic, M, Janodia, MD, Javaheri, T, Jayapal, SK, Jayarajah, UU, Jayaraman, S, Jeganathan, J, Jemal, B, Jha, RP, Jonas, JB, Joo, T, Joseph, N, Jozwiak, JJ, Jurisson, M, Kabir, A, Kadashetti, V, Kadir, DH, Kalankesh, LR, Kalhor, R, Kamal, VK, Kamath, R, Kandel, H, Kantar, RS, Kapoor, N, Karami, H, Karaye, IM, Karkhah, S, Katoto, PDMC, Kauppila, JH, Kayode, GA, Keikavoosi-Arani, L, Keskin, C, Khader, YS, Khajuria, H, Khammarnia, M, Khan, EA, Khan, MN, Khan, M, Khan, YH, Khan, IA, Khan, A, Khan, MAB, Khanali, J, Khatatbeh, MM, Kashani, HRK, Khazaie, H, Khubchandani, J, Kifle, ZD, Kim, J, Kim, YJ, Kisa, S, Kisa, A, Kneib, CJ, Kompani, F, Koohestani, HR, Koul, PA, Laxminarayana, SLK, Koyanagi, A, Krishan, K, Krishnamoorthy, V, Bicer, BK, Kumar, N, Kumar, M, Kurmi, OP, Laflamme, L, Lam, J, Landires, I, Larijani, B, Lasrado, S, Lauriola, P, La Vecchia, C, Lee, SWH, Lee, YH, Lee, S-W, Lee, W-C, Legesse, SM, Li, S, Lim, SS, Lorenzovici, L, Luke, AO, Madadizadeh, F, Madureira-Carvalho, AM, Abd El Razek, MM, Mahjoub, S, Mahmoodpoor, A, Mahmoudi, R, Mahmoudimanesh, M, Majeed, A, Makki, A, Rad, EM, Malekpour, M-R, Malik, AA, Mallhi, TH, Malta, DC, Mansouri, B, Mansournia, MA, Mathews, E, Maulud, SQ, Mazingi, D, Nasab, EM, Mendoza-Cano, O, Menezes, RG, Mengistu, DA, Mentis, A-FA, Meretoja, A, Mesregah, MK, Mestrovic, T, Gomide Nogueira de Sa, ACM, Miller, TR, Mirghaderi, SP, Mirica, A, Mirmoeeni, S, Mirrakhimov, EM, Mirza, M, Misra, S, Mithra, P, Mittal, C, Moberg, ME, Mohammadi, M, Mohammadi, S, Mohammadi, E, Mohammadpourhodki, R, Mohammed, S, Mohammed, TA, Mohseni, M, Mokdad, AH, Momtazmanesh, S, Monasta, L, Moni, MA, Moreira, RS, Morrison, SD, Mostafavi, E, Isfahani, HM, Mubarik, S, Muccioli, L, Mukherjee, S, Mulita, F, Mustafa, G, Nagarajan, AJ, Naimzada, MD, Nangia, V, Nassereldine, H, Natto, ZS, Nayak, BP, Negoi, I, Nejadghaderi, SA, Nepal, S, Kandel, SN, Noroozi, N, Nunez-Samudio, V, Nzoputam, OJ, Nzoputam, CI, Ochir, C, Odhiambo, JN, Odukoya, OO, Okati-Aliabad, H, Okonji, OC, Olagunju, AT, Bali, AO, Omer, E, Otoiu, A, Otstavnov, SS, Otstavnov, N, Oumer, B, Owolabi, MO, Mahesh, PA, Padron-Monedero, A, Padubidri, JR, Fallahy, MTP, Panda-Jonas, S, Pandi-Perumal, SR, Pardhan, S, Park, E-K, Patel, SK, Pathan, AR, Pati, S, Paudel, U, Pawar, S, Pedersini, P, Peres, MFP, Petcu, I-R, Phillips, MR, Pillay, JD, Piracha, ZZ, Poursadeqiyan, M, Pourtaheri, N, Qattea, I, Radfar, A, Rafiee, A, Raghav, PR, Rahim, F, Rahman, MA, Rahman, FS, Rahman, M, Rahmani, AM, Rahmani, S, Moolambally, SR, Ramazanu, S, Ramezanzadeh, K, Rana, J, Rana, SM, Rao, CR, Rao, SJ, Rashedi, V, Rashidi, M-M, Rastogi, P, Rasul, A, Rawaf, S, Rawaf, DL, Rawal, L, Rawassizadeh, R, Rezaei, N, Rezaeian, M, Rezapour, A, Riad, A, Riaz, M, Rickard, J, Buendia Rodriguez, JA, Roever, L, Ronfani, L, Roy, B, Manjula, S, Saad, AMA, Sabour, S, Sabzmakan, L, Saddik, B, Sadeghi, M, Saeb, MR, Saeed, U, Moghaddam, SS, Safi, SZ, Sahiledengle, B, Sahoo, H, Sahraian, MA, Saki, M, Salamati, P, Salehi, S, Salem, MR, Samy, AM, Sanabria, J, Santric-Milicevic, MM, Saqib, MAN, Sarikhani, Y, Sarveazad, A, Sathian, B, Satpathy, M, Saya, GK, Ceola Schneider, IJ, Schwebel, DC, Seddighi, H, Senthilkumaran, S, Seylani, A, Shabaninejad, H, Shafeghat, M, Shah, PA, Shahabi, S, Shahbandi, A, Shahraki-Sanavi, F, Shaikh, MA, Shaker, E, Shams-Beyranvand, M, Shanawaz, M, Shannawaz, M, Sharew, MMS, Sharma, N, Shashamo, BB, Shayan, M, Sheikhi, RA, Shen, J, Shetty, BSK, Shetty, PH, Shin, JI, Shitaye, NA, Shivakumar, KM, Shobeiri, P, Shorofi, SA, Shrestha, S, Siabani, S, Sidemo, NB, Simegn, W, Sinaei, E, Singh, P, Sinto, R, Siraj, MS, Skryabin, VY, Skryabina, AA, Sleet, DA, Chandan, SN, Socea, B, Solmi, M, Solomon, Y, Song, Y, Sousa, RARC, Soyiri, IN, Stokes, MA, Suleman, M, Abdulkader, RS, Sun, J, Tabares-Seisdedos, R, Tabatabaei, SM, Tabish, M, Taheri, E, Soodejani, MT, Tampa, M, Tan, K-K, Tarigan, IU, Tariqujjaman, M, Tat, NY, Tat, VY, Tavakoli, A, Tefera, BN, Tefera, YM, Temesgen, G, Temsah, M-H, Thangaraju, P, Thapar, R, Thomas, NK, Ticoalu, JHV, Tincho, MB, Tiyuri, A, Togtmol, M, Tovani-Palone, MR, Mai, TNT, Ullah, S, Ullah, I, Umakanthan, S, Unnikrishnan, B, Upadhyay, E, Tahbaz, SV, Valdez, PR, Vasankari, TJ, Vaziri, S, Veroux, M, Vervoort, D, Violante, FS, Vlassov, V, Linh, GV, Waheed, Y, Wang, Y, Wang, Y-P, Wang, C, Wiangkham, T, Wickramasinghe, ND, Woday, AT, Wu, A-M, Yahya, GAT, Jabbari, SHY, Yang, L, Yaya, S, Yigit, A, Yigit, V, Yisihak, E, Yonemoto, N, You, Y, Younis, MZ, Yu, C, Yunusa, I, Yusefi, H, Zahir, M, Bin Zaman, S, Zare, I, Zarea, K, Zastrozhin, MS, Zhang, Z-J, Zhang, Y, Ziapour, A, Zodpey, S, Zoladl, M, Patton, GC, and Ivers, RQ
Abstract: BACKGROUND: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. METHODS: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. FINDINGS: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19
Published: 2022

5. Bioluminescence Imaging of Tumor Vascularity and Response to Anti-Angiogenic Therapy

Author: Kantar RS, Lashgari G, Lewandrowski GK, and Tannous BA
Published: 2015
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6. Etiology and Management of 800 Patients With Facial Palsy at a Private Practice Setting Over a 5-Year Period.

Author: Melhem AM, Leshgold N, Pokress H, Younan RA, Haddad M, Kantar RS, and Azizzadeh B
Subjects: Humans, Female, Male, Adult, Middle Aged, Retrospective Studies, Neuroma, Acoustic complications, Neuroma, Acoustic therapy, Antiviral Agents therapeutic use, Adolescent, Aged, Electric Stimulation Therapy, Child, Young Adult, Facial Paralysis etiology, Bell Palsy therapy, Private Practice
Abstract: Introduction: Very few papers investigated the etiologic breakdown and demographic characteristics of patients with facial nerve (FN) palsy. Our paper aims to present the etiologic breakdown and demographic characteristics of patients with FN palsy, presenting at a private care center between 2014 and 2019, along with the treatment modalities that were offered to them., Methods: Charts of 800 patients with facial palsy (FP) were reviewed. Data included the etiology of their diagnosis, family history, recurrent FP, demographic information, and treatment provided before and after presentation., Results: Seventy-five percent of our study population were females. The average period between diagnosis with FP and presentation at our center was 10.8 years. The most commonly identified etiology was Bell's palsy, followed by acoustic neuroma. Eighty-one percent of the study subjects were prescribed steroids and/or antivirals. Facial neuromuscular retraining, electrical stimulation, chemodenervation, and surgical intervention were also part of some treatment plans for our population., Discussion: Recommendations for the treatment of idiopathic FP include steroids with adjuvant antiviral medications. Data remains uncertain whether the combination therapy of steroids and antivirals has better results compared to steroids alone. Electrical stimulation is still a controversial therapeutic tool for facial paralysis with a potential role in exacerbating synkinesis. The difference in referral patterns between tertiary and private care centers can explain the disparity in the ranking of the etiologies between our study and what has been published., Conclusion: Management of FP is a complex process. The FN community must develop a common database to improve its understanding of the different presentations., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)
Published: 2024
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7. Single-Stage Posterior Vomerine Ostectomy and Primary Cheiloplasty in Patients with Bilateral Cleft Lip & Palate and Protuberant Premaxilla.

Author: Hamdan US, Younan RA, Haddad M, Melhem AM, Najjar W, Hussein S, Kantar RS, Annan B, Johnson A, and Liau J
Subjects: Humans, Male, Female, Retrospective Studies, Child, Infant, Child, Preschool, Osteotomy methods, Longitudinal Studies, Maxilla abnormalities, Maxilla surgery, Peru, Plastic Surgery Procedures methods, Ecuador, Lebanon, Treatment Outcome, Cleft Lip surgery, Cleft Palate surgery, Vomer surgery
Abstract: Objective: A protruded premaxilla has always been challenging to care for by cleft care professionals. This study aims to fortify the use of a single-stage premaxillary setback, with posterior vomerine ostectomy and primary cheiloplasty to achieve proper care for patients with bilateral cleft lip and palate (BCLP) and protruded premaxilla., Design: Longitudinal retrospective analysis., Setting: Twenty-three outreach programs to four countries (Ecuador, Lebanon, Peru, and El-Salvador) between 2016-2022., Patients/participants: Sixty-five patients between the ages of 3 months and 6 years and 5 months, with BCLP and severely protruded premaxilla underwent premaxillary setback via posterior vomerine ostectomy and primary cheiloplasty. Patients with diagnosed syndromes and inaccessible vomer bone due to fused palates were excluded from the study., Interventions: Premaxillary setback with posterior vomerine ostectomy, bilateral gingivoperiosteoplasties (GPP), and primary cheiloplasty., Main Outcome Measure(s): Postoperative complications and aesthetic outcomes., Results: The mean age at surgery was 13.17 ± 14.1 months, with an average follow-up time of 26 ± 17 months. Patients underwent their procedures in Ecuador (72%), Peru (9%), Lebanon (8%) and El-Salvador (1%). The majority of patients were aged 1 year or less (66.7%) and were males (58.5%). All patients were operated on successfully and had good aesthetic outcomes. Only one patient developed partial necrosis., Conclusion: Patients with BCLP and severe premaxillary protrusion have always carried immense social, psychological, and financial burdens, especially in outreach settings. Our described single-stage technique has proven to be safe and effective with good aesthetic results. Further follow-up after primary repair should be done to document and ensure proper facial growth and normal nasolabial maturation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Published: 2024
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8. Reshaping Faces, Redefining Risks: A Systematic Review of Orthognathic Surgery Outcomes in Cleft Lip and Palate Patients.

Author: Chinta SR, Segrera S, Friedman R, Shah AR, Kantar RS, Volk AS, Staffenberg D, and Rodriguez ED
Abstract: Background: This study aims to determine a generalized outcome and risk profile for patients undergoing orthognathic surgery for the definitive treatment of cleft lip and palate. Furthermore, we hope to determine the key risk factors that cause increased risk for cleft lip and palate patients undergoing orthognathic surgery. Methods: This study includes a systematic review using PubMed, MEDLINE, Cochrane, and Scopus. Data curation utilized Covidence software, with dual-reviewer screening and conflict resolution by a third party, focusing on publications with the full texts available. Results: The initial search yielded 1697 articles. Following title, abstract, and full-text screening, a total of 62 articles were included in this review. A total of 70.9% of included articles had moderate bias, with the rest having low risk of bias. The sample consisted of 2550 patients with an average age of about 20 years and an average follow-up of 16.8 months. The most employed procedure was Le Fort I osteotomy (99%). In terms of velopharyngeal function, there were notable increases in insufficiency and severity scores, with an average 63% worsening score from the baseline. That being said, patients experienced an average 33% improvement in speech articulation. Furthermore, the average horizontal movement was reported to be 6.09 mm with a subsequent relapse of 0.98 mm overall. Conclusions: This systematic review distills data from 62 articles and 2550 patients. It highlights the efficacy of orthognathic surgery in addressing oropharyngeal and aesthetic deficits. This study identifies relapse and velopharyngeal insufficiency as recurrent complications. These insights inform surgical refinement and patient counseling, laying a foundation for enhanced clinical protocols.
Published: 2024
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9. Single-Stage Posterior Vomerine Ostectomy, Premaxillary Setback, Bilateral Gingivoperiosteoplasties and Primary Bilateral Cheiloplasty in Patients with Protuberant Premaxilla.

Author: Hamdan US, Garcia Garcia JA, Haddad MS, Younan RA, Melhem AM, Kantar RS, and Najjar WW
Abstract: Various patients with complete bilateral cleft lip and palate present with a protruded premaxilla. Several techniques have been described for correctional repair of the projection with a plethora of unsatisfactory outcomes. This poses a challenge not only for the cleft team providing care but also for the patients and their respective families. Multiple patients suffer from residual deformities after inadequate primary repair, which increase surgical, financial, and psychological burden. Premaxillary setback with posterior vomerine ostectomy and complete bilateral cleft lip repair can promote alignment of the premaxilla with the maxillary prominences. To effectively address this challenging deformity, we describe a single-stage surgical technique that includes vomerine ostectomy posterior to the vomero-premaxillary suture, bilateral gingivoperiosteoplasties with complete bilateral cleft lip repair, and primary cleft rhinoplasty. Careful surgical planning is essential for adequate matching between the length of the protruded premaxilla and the extent of ostectomy. The described technique offers several advantages for the management of complete bilateral cleft lip with a projected premaxilla. It can be applied anywhere around the world and is most beneficial in underprivileged areas where patients suffer from restricted access to healthcare, absence of presurgical orthodontics and lack of sufficient resources.
Published: 2024
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10. The First Hybrid International Educational Comprehensive Cleft Care Workshop.

Author: Kantar RS, Esenlik E, Al Abyad OS, Melhem A, Younan RA, Haddad M, Keith K, Kassam S, Annan B, Vijayakumar C, Picard A, Padwa BL, Sommerlad B, Raposo-Amaral CE, Forrest CR, Gillett DA, Steinbacher DM, Runyan CM, Tanikawa DYS, Chong DK, Fisher DM, Mark H, Canter HI, Losee JE, Patel KG, Hartzell LD, Johnson AB, Collares MVM, Alonso N, Chen PK, Tse R, Mann RJ, Prada-Madrid JR, Kobayashi S, Hussain SA, Kummer A, Sell DA, Pereira VJ, Mabry K, Gonsoulin CK, Persson M, Davies G, Sethna NF, Munoz-Pareja JC, Kuijpers-Jagtman AM, Grayson BH, Grollemund B, Garib DG, Meazzini MC, Kharbanda OP, Santiago PE, Nalabothu P, Batra P, Stieber E, Prasad D, Brewster H, Ayala R, Erbay E, Akcam MO, Don Griot JPW, Vyas RM, Flores RL, Breugem CC, and Hamdan US
Subjects: Humans, Cross-Sectional Studies, Head, Personal Satisfaction, Cleft Palate therapy, Cleft Lip therapy
Abstract: Objective: Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance., Design: Cross-sectional survey-based evaluation., Setting: International comprehensive cleft care workshop., Participants: Total of 489 participants., Interventions: Three-day simulation-based hybrid comprehensive cleft care workshop., Main Outcome Measures: Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance., Results: The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 ± 3.08 vs 27.63 ± 3.93; P = .04) and perceived impact on their clinical practice (22.37 ± 3.42 vs 21.02 ± 3.45 P = .01)., Conclusion: Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.
Published: 2023
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11. Global Prevalence and Burden of Orofacial Clefts: A Systematic Analysis for the Global Burden of Disease Study 2019.

Author: Kantar RS, Hamdan US, Muller JN, Hemal K, Younan RA, Haddad M, Melhem AM, Don Griot JPW, Breugem CC, and Mokdad AH
Abstract: Orofacial clefts, in particular cleft lip and cleft palate, are among the most common congenital anomalies. Despite guidelines recommending early surgical correction, a global backlog of untreated patients persists. This has made orofacial clefts an attractive target for global cleft care initiatives. The most recent global burden of orofacial clefts was estimated to be 529,758.92 disability-adjusted life years (95% uncertainty interval: 362,492.88-798,419.69 disability-adjusted life years), whereas the global prevalence of orofacial clefts was estimated to be 4.6 million (95% uncertainty interval: 3.8-5.7 million). An inverse relationship exists between the Sociodemographic Index and the burden of orofacial clefts. Sub-Saharan Africa, Middle East/North Africa, and South Asia are the regions carrying the most significant burden of orofacial clefts. This manuscript provides updated estimates of the global burden and prevalence of orofacial clefts, acting as a guide to direct future investments, resources, and initiatives from individuals and organizations engaged in global cleft care delivery with the goal of building sustainable cleft care capacity where it is needed the most., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)
Published: 2023
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12. Global Smile Foundation's Cleft Surgical Outreach Program: Clinical and Economic Impact During the Past 14 Years.

Author: Younan RA, Melhem AM, Haddad M, Annan B, Najjar W, Kantar RS, and Hamdan US
Subjects: Humans, Cost-Benefit Analysis, Morbidity, Cleft Palate surgery, Cleft Lip surgery, Plastic Surgery Procedures
Abstract: Clefts of the lip and/or palate can result in significant morbidity as well as economic and psychosocial distress for patients and families. Global Smile Foundation is a non-profit organization committed to providing comprehensive cleft care to patients with cleft of the lip/palate around the world. Primary cleft lip and primary cleft palate repairs performed by the Global Smile Foundation in the last decade were reviewed. Averted disability-adjusted life years were estimated and assessed for their economic value. A total of 15,310 disability-adjusted life years were averted. The financial gain was estimated between $78,323,624 and $152,906,604, with an average financial benefit of $48,021 to $93,750 per patient., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)
Published: 2023
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13. Quality Assurance Standards for Outreach Cleft Lip and Cleft Palate Repair Programs in Low-Resource Settings.

Author: Chahine EM, Ramly EP, Marston AP, Teng SN, Nader M, Kassam SN, Kantar RS, and Hamdan US
Subjects: Humans, Ecosystem, Delivery of Health Care, Outcome Assessment, Health Care, Cleft Lip surgery, Cleft Palate surgery
Abstract: Background: Comprehensive cleft care is a multidisciplinary team endeavor. While untreated craniofacial conditions have multiple undue repercussions, cleft care in outreach settings can be fraught with significant perioperative morbidity risks., Aim: Propose updated quality assurance standards addressing logistic and operational considerations essential for the delivery of safe and effective cleft lip and /or palate (CL/P) care in low and middle-income countries (LMICs) settings., Methods: Based on American Cleft Palate-Craniofacial Association (ACPA) quality standards, published literature, published protocols by Global Smile Foundation (GSF), and the senior author's three-decade experience, updated standards for outreach cleft care were synthesized., Results: Ten axes for safe, effective, and sustainable cleft lip and palate care delivery in underserved settings were generated: 1) site assessment, 2) establishment of community partnerships, 3) team composition and credentialing, 4) team training and mission preparation, 5) implementation of quality assurance guidelines, operative safety checklists, and emergency response protocols, 6) immediate and long-term postoperative care, 7) medical record keeping, 8) outcomes evaluation, 9) education, and 10) capacity building and sustainability. Subsequent analysis further characterized essential components of each of those ten axes to delineate experience derived and evidence-based recommendations., Discussion: Quality assurance guidelines are essential for the safe delivery of comprehensive cleft care to patients with CL/P in any setting. Properly designed surgical outreach programs relying on honest community partnerships can be effectively used as vehicles for local capacity building and the establishment of sustainable cleft care ecosystems.
Published: 2023
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14. Re-cognizing the new self: The neurocognitive plasticity of self-processing following facial transplantation.

Author: Azevedo RT, Diaz-Siso JR, Alfonso AR, Ramly EP, Kantar RS, Berman ZP, Diep GK, Rifkin WJ, Rodriguez ED, and Tsakiris M
Subjects: Face, Individuality, Pattern Recognition, Visual, Facial Expression, Facial Transplantation, Facial Recognition
Abstract: The face is a defining feature of our individuality, crucial for our social interactions. But what happens when the face connected to the self is radically altered or replaced? We address the plasticity of self-face recognition in the context of facial transplantation. While the acquisition of a new face following facial transplantation is a medical fact, the experience of a new identity is an unexplored psychological outcome. We traced the changes in self-face recognition before and after facial transplantation to understand if and how the transplanted face gradually comes to be perceived and recognized as the recipient's own new face. Neurobehavioral evidence documents a strong representation of the pre-injury appearance pre-operatively, while following the transplantation, the recipient incorporates the new face into his self-identity. The acquisition of this new facial identity is supported by neural activity in medial frontal regions that are considered to integrate psychological and perceptual aspects of the self.
Published: 2023
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15. An urgent plea for surgical care in Lebanon.

Author: Kantar RS, Habib JR, Nassereldine H, Hoballah JJ, and Mokdad AH
Subjects: Humans, Lebanon, Refugees
Published: 2022
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16. Less Operating and More Overtriage: National Trends in Interfacility Transfer of Facial Fracture Patients.

Author: Wasicek PJ, Kantar RS, Gebran S, Yoon J, Kalsi R, Morrison JJ, and Nam AJ
Subjects: Adolescent, Adult, Child, Child, Preschool, Emergency Service, Hospital, Humans, Infant, Infant, Newborn, Injury Severity Score, Patient Transfer, Retrospective Studies, Trauma Centers, Young Adult, Facial Injuries surgery, Skull Fractures surgery
Abstract: Background: The purpose of this study was to characterize demographics, injury patterns, and initial management trends of facial fracture patients who were subject to interfacility transfer., Methods: Using the National Trauma Data Bank from 2007 to 2015, facial fracture patients arriving by interfacility transfer were included in the study., Results: Over 9 years, 171,618 patients were included, with 37.5 percent having an isolated facial injury. Isolated facial injury patients tended to be younger, less frequently white, more frequently assaulted, and more frequently underwent facial fracture operative repair during the index admission (all, p < 0.001). From 2007 to 2015, insurance coverage increased from 54.6 to 79.0 percent (R2 = 0.90, p < 0.001). In addition, there was a 45 percent proportional increase in patients 50 to 89 years of age compared to a 20 percent decrease in patients 0 to 39 years of age (both, R2 = 0.99, p < 0.001). The proportion of transfer patients with isolated facial injury increased over the study period (32.0 to 39.4 percent, R2 = 0.90, p < 0.001); however, there was a decline in operative intervention (29.5 to 22.1 percent, R2 = 0.94, p < 0.001) and a 151 percent increase in the proportion discharged from the emergency department upon transfer arrival (R2 = 0.99, p < 0.001)., Conclusions: Facial fracture patients subject to interfacility transfer comprise a wide array of demographics and injury patterns, with most having concomitant injuries and only a minority undergoing immediate operative intervention. Over time, this demographic has become older, sustained more isolated facial injury, and undergone fewer immediate operative interventions and is more frequently insured and more frequently discharged from the emergency department upon transfer arrival, reflecting increasing rates of secondary overtriage., (Copyright © 2022 by the American Society of Plastic Surgeons.)
Published: 2022
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17. Dangle Protocols in Lower Extremity Reconstruction.

Author: Lee ZH, Ramly EP, Alfonso AR, Daar DA, Kaoutzanis C, Kantar RS, Thanik V, Saadeh PB, and Levine JP
Subjects: Clinical Protocols, Free Tissue Flaps blood supply, Humans, Outcome Assessment, Health Care, Free Tissue Flaps surgery, Lower Extremity surgery, Microsurgery methods, Plastic Surgery Procedures methods, Vascular Surgical Procedures methods
Abstract: Introduction: Dangling protocols are known to vary by surgeon and center, and their specific regimen is often largely based on single surgeon or institutional experience. A systematic review was conducted to derive evidence-based recommendations for dangling protocols according to patient-specific and flap-specific considerations., Methods: A systematic review was performed using PubMed, Embase-OVID and Cochrane-CENTRAL. Study design, patient and flap characteristics, protocol details, dangling-related complications, and flap success rate were recorded. Studies were graded using the Oxford Center for Evidence-Based Medicine Levels of Evidence Scale. Data heterogeneity precluded quantitative analysis., Results: Eleven articles were included (level of evidence (range):IIb-IV; N (range):8-150; age (range):6-89). Dangling initiation, time, and frequency varied considerably. Flap success rate ranged from 94 to 100%. Active smoking, diabetes, and hypertension are associated with characteristic physiologic changes that require vigilance and potential protocol modification. Early dangling appears to be safe across a variety of free flap locations, sizes, and indications. Axial fasciocutaneous flaps may tolerate more aggressive protocols than muscular flaps. While flaps with single venous anastomosis tolerate dangling, double venous or flow-through anastomoses may provide additional benefit. Major limitations included small sample sizes, uncontrolled study designs, and heterogeneous patient selection, dangling practices, monitoring methods, and outcome measures., Conclusions: Significant heterogeneity persists in postoperative dangling protocols after lower extremity microvascular reconstruction. Patient comorbidities and flap characteristics appear to affect tolerance to dangling. We propose two different standardized pathways based on risk factors. Clinical vigilance should be exercised in tailoring lower extremity protocols to patients' individual characteristics and postoperative course., (Copyright © 2021 Elsevier Inc. All rights reserved.)
Published: 2021
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18. Survival Following Self-Inflicted Gunshot Injuries to the Face Using the National Trauma Data Bank.

Author: Wasicek PJ, Kantar RS, Yoon J, Elegbede A, and Nam AJ
Subjects: Aged, Databases, Factual, Hospital Mortality, Humans, Male, Retrospective Studies, Trauma Centers, Facial Injuries epidemiology, Facial Injuries etiology, Firearms, Wounds, Gunshot epidemiology
Abstract: Introduction: Self-inflicted gunshot wounds to the face frequently result in devastating injuries; however, there is a paucity of large experiences describing determinants of mortality and outcomes., Methods: Using the National Trauma Databank from 2007 to 2015, patients suffering self-inflicted firearm facial injuries were included., Results: Over 9 years 7869 patients were included: 87.7% were male, 46.4% suffered traumatic brain injury (TBI) and overall in-hospital mortality was 44.7%. The majority (67.8%) of in-hospital mortality occurred within the first 24 hours. Using multiple regression, advanced age (>65 years), presence of TBI, admission hypotension, and decreased Glasgow coma score were each independently associated with increased odds of mortality (all P < 0.001). Mandible or combined mandible/midface fracture injury patterns were most likely to survive (P < 0.001). Of those surviving to hospital discharge, the median [interquartile range] length of stay was 13 [6, 23] days, 86.6% required an intensive care unit stay with 67% requiring intubation and 42.5% tracheostomy. Among survivors, the combined mandible and midface fracture pattern resulted in the highest rates of tracheostomy (70.5%), gastrostomy tube placement (50.5%), and facial operations (87.0%) with a median [interquartile range] of 5 [3, 7] operative trips (all P < 0.001)., Conclusions: Self-inflicted facial firearm injuries are highly morbid injuries with the majority of in-hospital deaths occurring the first hospital day. Differences including concomitant TBI, facial injury pattern, neurologic status, and presence of hypotension on admission were independently associated with survival/death. More extensive facial injuries (combined mandible and midface fracture patterns) were more likely to survive and required more intensive interventions., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)
Published: 2021
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19. Comprehensive Cleft Care Delivery in Developing Countries: Impact of Geographic and Demographic Factors.

Author: Kantar RS, Abyad OA, Melhem A, Chahine EM, Kassam SN, Annan B, Nader MK, Keith K, Breugem CC, and Hamdan US
Subjects: Adult, Comprehensive Health Care, Demography, Developing Countries, Humans, Cleft Lip epidemiology, Cleft Lip therapy, Cleft Palate epidemiology, Cleft Palate surgery
Abstract: Introduction: The authors analyzed the insights of participants and faculty members of Global Smile Foundation's Comprehensive Cleft Care Workshops concerning the barriers and interventions to multidisciplinary cleft care delivery, after stratification based on demographic and geographic factors., Methods: During 2 simulation-based Comprehensive Cleft Care Workshops organized by Global Smile Foundation, participants and faculty members filled a survey. Surveys included demographic and geographic data and investigated the most relevant barrier to multidisciplinary cleft care and the most significant intervention to deliver comprehensive cleft care in outreach settings, as perceived by participants., Results: The total response rate was 57.8%. Respondents reported that the greatest barrier to comprehensive cleft care was financial, and the most relevant intervention to deliver multidisciplinary cleft care was building multidisciplinary teams. Stratification by age, gender, and geographical area showed no statistical difference in reporting that the greatest barrier to cleft care was financial. However, lack of multidisciplinary teams was the most important barrier according to respondents with less than 5 years of experience (P = 0.03). Stratification by gender, years in practice, specialty, and geographical area showed no statistical difference, with building multidisciplinary teams reported as the most significant intervention. However, increased training was reported as the main intervention to cleft care for those aged less than 30 years old (P = 0.04)., Conclusions: Our study delivers an assessment for barriers facing multidisciplinary cleft care delivery and interventions required to improve cleft care delivery. The authors are hoping that stratification by demographic and geographic factors will help them delineate community-specific road maps to refine cleft care delivery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)
Published: 2021
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20. Perceived Barriers to Comprehensive Cleft Care Delivery: Results From A Capacity-Building Educational Initiative and Implications.

Author: Kantar RS, Breugem CC, Alfonso AR, Keith K, Kassam S, Annan B, Chahine EM, Wasicek PJ, Patel KG, Flores RL, and Hamdan US
Subjects: Humans, Surveys and Questionnaires, Cleft Lip surgery, Cleft Palate surgery
Abstract: Introduction: We analyzed the perceptions of participants and faculty members in simulation-based comprehensive cleft care workshops regarding comprehensive cleft care delivery in developing countries., Methods: Data were collected from participants and faculty members in 2 simulation-based comprehensive cleft care workshops organized by Global Smile Foundation. We collected demographic data and surveyed what they believed was the most significant barrier to comprehensive cleft care delivery and the most important intervention to deliver comprehensive cleft care in developing countries. We also compared participant and faculty responses., Results: The total number of participants and faculty members was 313 from 44 countries. The response rate was 57.8%. The majority reported that the most significant barrier facing the delivery of comprehensive cleft care in developing countries was financial (35.0%), followed by the absence of multidisciplinary cleft teams (30.8%). The majority reported that the most important intervention to deliver comprehensive cleft care was creating multidisciplinary cleft teams (32.2%), followed by providing cleft training (22.6%). We found no significant differences in what participants and faculty perceived as the greatest barrier to comprehensive cleft care delivery (P = 0.46), or most important intervention to deliver comprehensive cleft care in developing countries (P = 0.38)., Conclusions: Our study provides an appraisal of barriers facing comprehensive cleft care delivery and interventions required to overcome these barriers in developing countries. Future studies will be critical to validate or refute our findings, as well as determine country-specific roadmaps for delivering comprehensive cleft care to those who need it the most., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
Published: 2021
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21. Predicting postoperative complications following mastectomy in the elderly: Evidence for the 5-factor frailty index.

Author: Dammeyer K, Alfonso AR, Diep GK, Kantar RS, Berman ZP, Daar DA, Ramly EP, Sosin M, and Ceradini DJ
Subjects: Aged, Female, Humans, Mastectomy, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Risk Assessment, Risk Factors, Breast Neoplasms surgery, Frailty
Abstract: Understanding the risk factors that contribute to post-mastectomy complications can better inform preoperative discussions. Here, we assess the impact of the 5-Factor Frailty Index Score (mFI-5) in predicting 30-day postoperative complications in patients undergoing mastectomy. A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data base was conducted for patients older than 65 undergoing mastectomy between 2010 and 2015. We assessed each patient's Frailty Index Score using the mFI-5. Primary outcomes included wound complications and overall complications. Multivariate logistic and linear regression analyses were used to determine the ability of the mFI-5 to predict postoperative outcomes. A total of 13,783 patients were analyzed. The rate of wound complications was 3.0%, while the rate of overall complications was 6.0%. An mFI-5 score greater than 2 was an independent risk factor for wound complications and overall complications. Overall, patients undergoing mastectomy with an mFI-5 of 2 or greater experienced higher rates of postoperative complications. The mFI-5 is an accessible tool that can be used to risk-stratify patients undergoing mastectomy and can positively contribute to the informed consent and shared decision-making process., (© 2021 Wiley Periodicals LLC.)
Published: 2021
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22. Facial Transplantation: Principles and Evolving Concepts.

Author: Kantar RS, Alfonso AR, Diep GK, Berman ZP, Rifkin WJ, Diaz-Siso JR, Sosin M, Gelb BE, Ceradini DJ, and Rodriguez ED
Subjects: Donor Selection, Esthetics, Face diagnostic imaging, Face surgery, Facial Transplantation adverse effects, Facial Transplantation history, Graft Rejection etiology, History, 21st Century, Humans, Imaging, Three-Dimensional, Models, Anatomic, Printing, Three-Dimensional, Transplantation, Homologous adverse effects, Transplantation, Homologous history, Transplantation, Homologous methods, Treatment Outcome, Facial Injuries surgery, Facial Transplantation methods, Graft Rejection prevention & control, Patient Care Planning
Abstract: Learning Objectives: After studying this article, the participant should be able to: 1. Appreciate the evolution and increasing complexity of transplanted facial allografts over the past two decades. 2. Discuss indications and contraindications for facial transplantation, and donor and recipient selection criteria and considerations. 3. Discuss logistical, immunologic, and cost considerations in facial transplantation, in addition to emerging technologies used. 4. Understand surgical approaches and anatomical and technical nuances of the procedure. 5. Describe aesthetic, functional, and psychosocial outcomes of facial transplantation reported to date., Summary: This CME article highlights principles and evolving concepts in facial transplantation. The field has witnessed significant advances over the past two decades, with more than 40 face transplants reported to date. The procedure now occupies the highest rung on the reconstructive ladder for patients with extensive facial disfigurement who are not amenable to autologous reconstructive approaches, in pursuit of optimal functional and aesthetic outcomes. Indications, contraindications, and donor and recipient considerations for the procedure are discussed. The authors also review logistical, immunologic, and cost considerations of facial transplantation. Surgical approaches to allograft procurement and transplantation, in addition to technical and anatomical nuances of the procedure, are provided. Finally, the authors review aesthetic, functional, and psychosocial outcomes that have been reported to date., (Copyright © 2021 by the American Society of Plastic Surgeons.)
Published: 2021
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23. Sustainable Cleft Care: A Comprehensive Model Based on the Global Smile Foundation Experience.

Author: Chahine EM, Kantar RS, Kassam SN, Vyas RM, Ghotmi LH, Haddad AG, and Hamdan US
Subjects: Humans, Cleft Lip surgery, Cleft Palate surgery
Abstract: Introduction: Clefts of the lip and palate are leading congenital facial anomalies. Underserved patients with these facial differences lack access to medical care, surgical expertise, prenatal care, or psychological support. Moreover, the disease results in significant economic strains on patients and their families. While surgical outreach programs have attempted to fill this void, significant challenges facing international comprehensive cleft care persist., Objective: Propose a path toward international sustainable cleft care based on the Global Smile Foundation experience., Results: International sustainable comprehensive cleft care can be achieved by regulating surgical outreach programs. Regulation of these missions would ensure standardized care and encourage stakeholders to cooperate and adequately allocate funding and resources. Capacity building can be achieved through "diagonal" cleft care delivery models, multidisciplinary workshops, fellowship programs, research and quality assurance, as well as leveraging emerging technologies such as Augmented Reality., Conclusion: International comprehensive cleft care requires continuous collaborative efforts between visiting and local teams as well as international and national organizations. Standardizing and regulating current practices as well as promoting capacity building initiatives can contribute to sustainable cleft care.
Published: 2021
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24. Reply: Knowledge and Skills Acquisition by Plastic Surgery Residents through Digital Simulation Training: A Prospective, Randomized, Blinded Trial.

Author: Kantar RS and Flores RL
Subjects: Humans, Prospective Studies, Internship and Residency, Simulation Training, Surgery, Plastic education
Published: 2021
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25. The Effects of Nasoalveolar Molding on Nasal Proportions at the Time of Nasal Maturity.

Author: Maliha SG, Kantar RS, Gonchar MN, Eisemann BS, Staffenberg DA, Shetye PR, Grayson BH, and Flores RL
Subjects: Humans, Nasoalveolar Molding, Nose, Reproducibility of Results, Retrospective Studies, Treatment Outcome, Cleft Lip surgery, Cleft Palate surgery
Abstract: Background: The aim of this study is to assess the effect of nasoalveolar molding (NAM) versus no-NAM on nasal morphology in patients with unilateral cleft lip and palate (UCLP) at the time of nasal maturity., Methods: A retrospective, single-institution review was conducted on all non-syndromic patients with UCLP. Inclusion criteria included age 14 years or above, unilateral cleft repair at the time of infancy, and adequate photography taken at nasal maturity and prior to rhinoplasty. Exclusion criteria included age less than 14 years, syndromic diagnosis, and rhinoplasty prior to nasal maturity. Ten parameters were measured twice from standardized clinical photographs using the Dolphin Imaging Software for establishment of intrarater reliability. Subjective analysis was achieved through completion of the Asher McDade grading scale by 3 expert cleft practitioners., Results: Nostril height, columellar angle, alar cant, vertical alar height, alar height angle, nasofacial angle, and nasolabial angle were found to be significantly less severe in patients who had undergone NAM in conjunction with surgical repair when compared with those who had undergone surgical repair alone. Asher McDade grading revealed significant improvement in nasal form, nasal symmetry/deviation, nasal profile, vermillion border, and overall score in patients who underwent NAM compared to no-NAM., Conclusion: The use of presurgical NAM during infancy can improve nasal symmetry and nasal proportions at the time of nasal maturity.
Published: 2021
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26. A Comparison of Immunosuppression Regimens in Hand, Face, and Kidney Transplantation.

Author: Rifkin WJ, Manjunath AK, Kantar RS, Jacoby A, Kimberly LL, Gelb BE, Diaz-Siso JR, and Rodriguez ED
Subjects: Humans, Immunosuppression Therapy trends, Retrospective Studies, Immunosuppression Therapy methods, Immunosuppressive Agents administration & dosage, Kidney Transplantation, Vascularized Composite Allotransplantation
Abstract: Background: Authors have speculated that vascularized composite allotransplantation (VCA) recipients may require greater maintenance immunosuppression than solid organ transplant (SOT) recipients due to the higher antigenicity of skin. However, detailed comparisons of VCA and SOT immunosuppression regimens have been limited., Methods: Hand and face VCA recipient immunosuppression data were collected through a systematic literature review. Kidney recipient data were obtained through a retrospective chart review of the authors' institution. Prednisone and mycophenolate mofetil (MMF) doses were compared between VCA and kidney recipients at predefined follow-up intervals (<1, 1-5, and >5 y). Tacrolimus target trough levels (TTTL) were compared at follow-up intervals of 1-5 and >5 y, and stratified into our institution's kidney transplant risk-based target ranges (4-6 ng/mL, 6-8 ng/mL) or higher (>8 ng/mL)., Results: Immunosuppression data were available for 57 VCA and 98 kidney recipients. There were no significant differences in prednisone doses between groups at all follow-up intervals. VCA recipient mean MMF dose was significantly greater at <1-y (1.71 ± 0.58 versus 1.16 ± 0.55 gm/d; P = 0.01). For VCA recipients, there was a significant difference (P = 0.02) in TTTL distribution over the three predefined therapeutic ranges (4-6 ng/mL, 6-8 ng/mL, and >8 ng/mL) between 1 and 5 y (24.0%, 20.0%, 56.0%, respectively) and >5 y (28.6%, 42.9%, 28.6%)., Conclusions: At longer follow-up, VCA and kidney recipients receive comparable MMF/prednisone doses, and most VCA recipients are treated with TTTL similar to kidney recipients. Further research may improve our understanding of VCA's complex risk/benefit ratio, and enhance informed consent., (Copyright © 2020. Published by Elsevier Inc.)
Published: 2021
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27. Hepatic Artery Microvascular Anastomosis in Liver Transplantation: A Systematic Review of the Literature.

Author: Kantar RS, Berman ZP, Diep GK, Ramly EP, Alfonso AR, Sosin M, Lee ZH, Rifkin WJ, Kaoutzanis C, Yu JW, Ceradini DJ, Dagher NN, and Levine JP
Subjects: Adult, Anastomosis, Surgical, Child, Hepatic Artery surgery, Humans, Living Donors, Retrospective Studies, Liver Transplantation
Abstract: Background: The operating microscope is used in many centers for microvascular hepatic arterial reconstruction in living as well as deceased donor liver transplantation in adult and pediatric recipients. To date, a systematic review of the literature examining this topic is lacking., Methods: This systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Three different electronic databases (PubMed, Embase OVID, and Cochrane CENTRAL) were queried., Results: A total of 34 studies were included. The rate of hepatic artery thrombosis (HAT) in noncomparative studies (28) ranged from 0% to 10%, with 8 studies reporting patient deaths resulting from HAT. Within comparative studies, the rate of HAT in patients who underwent arterial reconstruction using the operating microscope ranged from 0% to 5.3%, whereas the rate of HAT in patients who underwent arterial reconstruction using loupe magnification ranged from 0% up to 28.6%, and 2 studies reported patient deaths resulting from HAT. Two comparative studies did not find statistically significant differences between the 2 groups., Conclusions: Our comprehensive systematic review of the literature seems to suggest that overall, rates of HAT may be lower when the operating microscope is used for hepatic arterial reconstruction in liver transplantation. However, matched comparisons are lacking and surgical teams need to be mindful of the learning curve associated with the use of the operating microscope as compared with loupe magnification, as well as the logistical and time constraints associated with setup of the operating microscope.
Published: 2021
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28. Congestive Heart Failure Predicts Major Complications and Increased Length of Stay in Lower Extremity Pedicled Flap Reconstruction.

Author: Levy-Lambert D, Ramly EP, Kantar RS, Alfonso AR, and Levine JP
Subjects: Adult, Age Factors, Aged, Databases, Factual, Female, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Postoperative Complications etiology, Plastic Surgery Procedures methods, Reoperation statistics & numerical data, Risk Assessment statistics & numerical data, Risk Factors, Surgical Flaps transplantation, United States epidemiology, Heart Failure epidemiology, Lower Extremity surgery, Postoperative Complications epidemiology, Plastic Surgery Procedures adverse effects, Surgical Flaps adverse effects
Abstract: Background: Congestive heart failure affects 6.2 million people in the United States. Patients have a decreased cardiopulmonary reserve and often suffer from peripheral edema, important considerations in lower extremity reconstructive surgery. In this study, the authors sought to determine the impact of congestive heart failure on postoperative outcomes following lower extremity pedicled flap reconstruction using a national multi-institutional database., Methods: The authors isolated all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent lower extremity pedicled flap reconstruction from 2010 to 2016. Preoperative, intraoperative, and postoperative variables were compared between patients with and without congestive heart failure. Multivariable regressions were performed to determine the independent effect of congestive heart failure on postoperative outcomes., Results: The authors identified 1895 patients who underwent lower extremity pedicled flap reconstruction, of whom 34 suffered from congestive heart failure. No significant difference was observed between patients with versus without congestive heart failure in postoperative wound complications (superficial wound infection, deep wound infection, and wound dehiscence), renal failure, or readmission. On multivariable analysis, congestive heart failure was independently associated with increased cardiopulmonary complications (i.e., myocardial infarction, cardiac arrest, pneumonia, reintubation, and failed ventilator weaning) (OR, 3.92; 95 percent CI, 1.53 to 9.12), septic events (OR, 4.65; 95 percent CI, 2.05 to 10.02), and length of hospital stay (β, 0.37; 95 percent CI, 0.01 to 0.72)., Conclusions: In patients undergoing lower extremity pedicled flap reconstruction, congestive heart failure independently predicts a four-fold increase in postoperative sepsis and cardiopulmonary complications and a significantly increased length of hospital stay. The authors' findings highlight the need for heightened perioperative vigilance and medical optimization in this high-risk population., Clinical Question/level of Evidence: Risk, II.
Published: 2020
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29. International Cleft Surgery Educational Initiatives: Ethical Challenges and Solutions.

Author: Kantar RS, Chahine EM, Alfonso AR, Nader MK, Annan B, Haddad AG, and Hamdan US
Published: 2020
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30. Clinical and Economic Impact of The Global Smile Foundation Surgical Program.

Author: Kantar RS, Chahine EM, Ghotmi LH, McAleer CM, Mera DF, Annan B, Haddad AG, Johnson AB, and Hamdan US
Published: 2020
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31. Simulation-Based Comprehensive Cleft Care Workshops: A Reproducible Model for Sustainable Education.

Author: Kantar RS, Breugem CC, Keith K, Kassam S, Vijayakumar C, Bow M, Alfonso AR, Chahine EM, Ghotmi LH, Patel KG, Shetye PR, Santiago PE, Losee JE, Steinbacher DM, Rossell-Perry P, Garib DG, Alonso N, Mann RJ, Prada-Madrid JR, Esenlik E, Pamplona MDC, Collares MVM, Bennun RD, Kummer A, Giugliano C, Padwa BL, Raposo-Amaral CE, Tse R, Sommerlad B, Flores RL, and Hamdan US
Subjects: Computer Simulation, Cross-Sectional Studies, Humans, Cleft Lip surgery, Cleft Palate surgery
Abstract: Objective: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact., Design: Cross-sectional survey-based evaluation., Setting: Simulation-based comprehensive cleft care workshop., Participants: Total of 180 participants., Interventions: Three-day simulation-based comprehensive cleft care workshop., Main Outcome Measures: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice., Results: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; P < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; P < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices., Conclusion: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants' clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.
Published: 2020
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32. The Latest Evolution in Virtual Surgical Planning: Customized Reconstruction Plates in Free Fibula Flap Mandibular Reconstruction.

Author: Lee ZH, Alfonso AR, Ramly EP, Kantar RS, Yu JW, Daar D, Hirsch DL, Jacobson A, and Levine JP
Subjects: Adult, Aged, Female, Humans, Male, Middle Aged, Patient Care Planning, Retrospective Studies, User-Computer Interface, Bone Plates, Fibula transplantation, Free Tissue Flaps, Mandibular Reconstruction methods, Surgery, Computer-Assisted methods
Abstract: Background: Virtual surgical planning has contributed to technical advancements in free fibula flap mandible reconstruction. The authors present the largest comparative study on the latest modification of this technology: the use of patient-specific, preoperatively customized reconstruction plates for fixation., Methods: A retrospective chart review was performed on all patients undergoing mandibular reconstruction with virtually planned free fibula flaps at a single institution between 2008 and 2018. Patient demographics, perioperative characteristics, and postoperative outcomes were reviewed. Reconstructions using traditional fixation methods were compared to those using prefabricated, patient-specific reconstruction plates., Results: A total of 126 patients (mean age, 48.5 ± 20.3 years; 61.1 percent male) underwent mandibular reconstruction with a free fibula flap. Mean follow-up time was 23.5 months. A customized plate was used in 43.7 percent of cases. Reconstructions with patient-specific plates had significantly shorter total operative times compared with noncustomized fixation methods (643.0 minutes versus 741.7 minutes; p = 0.001). Hardware complications occurred in 11.1 percent of patients, with a trend toward a lower rate in the customized plate group (5.5 percent versus 15.5 percent; p = 0.091). Multivariate regression showed that the use of customized plates was a significant independent predictor of fewer overall complications (p = 0.03), shorter operative time (p = 0.014), and shorter length of stay (p = 0.001)., Conclusions: Compared to traditional fixation methods, patient-specific plates are associated with fewer complications, shorter operative times, and reduced length of stay. The use of customized reconstruction plates increases efficiency and represents the latest technological innovation in mandibular reconstruction., Clinical Question/level of Evidence: Therapeutic, III.
Published: 2020
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33. Technical Pearls in Frontal and Periorbital Bone Contouring in Gender-Affirmation Surgery.

Author: Eisemann BS, Wilson SC, Ramly EP, Kantar RS, Alfonso AR, Frey JD, Bluebond-Langer R, and Rodriguez ED
Subjects: Female, Humans, Male, Orbit, Facial Bones surgery, Frontal Bone surgery, Plastic Surgery Procedures methods, Sex Reassignment Surgery methods
Abstract: Changes made to the forehead and periorbital region can have dramatic effects in gender-affirmation surgery. Removal of frontal bossing and alteration of orbital shape can result in significant facial feminization. This elective surgical intervention must be safe, reliable, and aesthetically effective. The described technique of frontal and periorbital bone contouring allows for a safe and consistent surgical outcome in properly selected patients. Nuances in specific technical maneuvers in this operation can have profound effects on safety and aesthetic outcomes. In this article, specific points are detailed in text and video describing the senior author's (E.D.R) surgical approach.
Published: 2020
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34. What Is the Burden of Care of Nasoalveolar Molding?

Author: Alfonso AR, Ramly EP, Kantar RS, Wang MM, Eisemann BS, Staffenberg DA, Shetye PR, and Flores RL
Subjects: Alveolar Process, Female, Humans, Nasoalveolar Molding, Nose, Cleft Lip therapy, Cleft Palate therapy
Abstract: Objective: This systematic review aims to evaluate nasoalveolar molding (NAM) in the context of burden of care defined as physical, psychosocial, or financial burden on caregivers., Search Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 5 databases were searched from inception through December 24, 2019, for keywords and subject headings pertaining to cleft lip and/or palate and NAM., Eligibility Criteria: Clinical studies on NAM with reference to physical (access to care, number of visits, distance traveled), psychosocial (caregiver perceptions, family interactions, breast milk feeding), and financial (direct and indirect costs) burden were included., Data Collection and Analysis: Study selection was performed by 2 independent reviewers., Results: The search identified 1107 articles and 114 articles remained for qualitative synthesis. Burden of care domains were discussed but not measured in 43% of articles and only 25% assessed burden of care through a primary outcome. Of these, 20 articles reported on physical, 8 articles on psychosocial, and 12 articles on financial burden. Quality of evidence is limited by study design and risk of bias., Conclusion: Nasoalveolar molding has been indiscriminately associated with burden of care in the literature. Although NAM may not be the ideal treatment option for all patients and families, the physical considerations are limited when accounting for the observed psychosocial advantages. Financial burden appears to be offset, but further research is required. Teams should directly assess the impact of this early intervention on the well-being of caregivers and advance strategies that improve access to care.
Published: 2020
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35. Communication Efficiency in a Face Transplant Recipient: Determinants and Therapeutic Implications.

Author: Levy-Lambert D, Grigos MI, LeBlanc É, DeMitchell-Rodriguez EM, Noel DY, Alfonso AR, Ramly EP, Rifkin WJ, Diaz-Siso JR, Ceradini DJ, Kantar RS, and Rodriguez ED
Subjects: Adult, Humans, Male, Speech Intelligibility, Speech Production Measurement, Transplant Recipients, Facial Transplantation
Abstract: We longitudinally assessed speech intelligibility (percent words correct/pwc), communication efficiency (intelligible words per minute/iwpm), temporal control markers (speech and pause coefficients of variation), and formant frequencies associated with lip motion in a 41-year-old face transplant recipient. Pwc and iwpm at 13 months post-transplantation were both higher than preoperative values. Multivariate regression demonstrated that temporal markers and all formant frequencies associated with lip motion were significant predictors (P < 0.05) of communication efficiency, highlighting the interplay of these variables in generating intelligible and effective speech. These findings can guide us in developing personalized rehabilitative approaches in face transplant recipients for optimal speech outcomes.
Published: 2020
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36. Anesthetic Considerations in Facial Transplantation: Experience at NYU Langone Health and Systematic Review.

Author: Alfonso AR, Ramly EP, Kantar RS, Rifkin WJ, Diaz-Siso JR, Gelb BE, Yeh JS, Espina MF, Jain SK, Piper GL, and Rodriguez ED
Abstract: Anesthetic considerations are integral to the success of facial transplantation (FT), yet limited evidence exists to guide quality improvement. This study presents an institutional anesthesia protocol, defines reported anesthetic considerations, and provides a comprehensive update to inform future directions of the field., Methods: An institutional "FT Anesthesia Protocol" was developed and applied to 2 face transplants. A systematic review of 3 databases captured FTs in the peer-reviewed literature up to February 2020. Two reviewers independently screened titles and abstracts to include all clinical articles with FT recipient and/or donor-specific preoperative, intraoperative, and relevant postoperative anesthetic variables. Data charting guided a narrative synthesis, and quantitative synthesis reported variables as median (range)., Results: Our institutional experience emphasizes the importance of on-site rehearsals, anticipation of patient-specific anesthetic and resuscitative requirements, and long-term pain management. Systematic search identified 1092 unique records, and 129 met inclusion criteria. Reports of 37 FTs in the literature informed the following anesthetic axes: donor pre- and intraoperative management during facial allograft procurement, recipient perioperative care, immunotherapy, antimicrobial prophylaxis, and pain management. Quantitative synthesis of 30 articles showed a median operative time of 18 hours (range, 9-28) and fluid replacement with 13 L (5-18) of crystalloids, 13 units (0-66) of packed red blood cells, 10 units (0-63) of fresh frozen plasma, and 1 unit (0-9) of platelets., Conclusions: Anesthetic considerations in FT span the continuum of care. Future efforts should guide standard reporting to establish evidence-based strategies that promote quality improvement and patient safety., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Published: 2020
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37. Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly.

Author: Lee J, Alfonso AR, Kantar RS, Diep GK, Berman ZP, Ramly EP, Daar DA, Levine JP, and Ceradini DJ
Abstract: Due to the high complication rate of panniculectomies, preoperative risk stratification is imperative. This study aimed to assess the predictive value of the 5-item modified frailty index (mFI-5) for postoperative complications in the elderly following panniculectomy., Methods: A retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database for patients over the age of 65 years who underwent a panniculectomy between 2010 and 2015 was conducted. The mFI-5 score was calculated for each patient based on the presence of diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status, and an mFI-5 score of 2 was used as a cutoff. Multivariate logistic and linear regression analysis was used to determine the validity of the mFI-5 as a predictor of postoperative complications., Results: A total of 575 patients were analyzed. Patients with an mFI-5 score of 2 or more (421; 73.2%) had significantly higher rates of wound complications (19.5% versus 12.8%; P = 0.03), overall complications (33.8% versus 19.5%; P < 0.001), and significantly longer hospital length of stay (3.6±5.0 versus 1.9±3.0; P < 0.001). mFI-5 score of 2 or more was an independent risk factor for wound complications (odds ratio, 1.26; 95% confidence interval, 1.08-2.20; P = 0.04) and overall complications (odds ratio, 1.34; 95% confidence interval, 1.09-2.15; P = 0.02)., Conclusions: Frailty, as measured by the mFI-5, holds a predictive value regarding outcomes of wound complications and overall complications in elderly patients after panniculectomy. The mFI-5 score can be used to identify high-risk patients before surgery., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Published: 2020
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38. Temporomandibular Joint Ankylosis in Pediatric Patients With Craniofacial Differences: Causes, Recurrence and Clinical Outcomes.

Author: Ramly EP, Yu JW, Eisemann BS, Yue O, Alfonso AR, Kantar RS, Staffenberg DA, Shetye PR, and Flores RL
Subjects: Adolescent, Ankylosis diagnostic imaging, Arthroplasty, Child, Child, Preschool, Humans, Infant, Infant, Newborn, Mandibular Reconstruction, Osteogenesis, Distraction, Recurrence, Retrospective Studies, Temporomandibular Joint diagnostic imaging, Temporomandibular Joint Disorders diagnostic imaging, Tracheostomy, Treatment Outcome, Ankylosis surgery, Temporomandibular Joint surgery, Temporomandibular Joint Disorders surgery
Abstract: Background: The authors present an institutional experience treating congenital and acquired temporomandibular joint (TMJ) ankylosis, detailing outcomes and potential risk factors of recurrence., Methods: Retrospective chart review identified patients with TMJ ankylosis (1976-2019). Clinical records, operative reports, and imaging studies were reviewed for demographics, surgical operations, and ankylosis including maximal interincisal opening (MIO) and re-ankylosis., Results: Forty-four TMJs with bony ankylosis were identified in 28 patients (mean age at any initial mandibular surgery: 3.7; range:0-14 years). Follow-up was 13.7 ± 5.9 years. Sixteen (57.1%) patients had bilateral ankylosis; 27(96.4%) had syndromes. Nine patients had congenital ankylosis, 16 had iatrogenic ankylosis (4.5 ± 3.7 years from initial distraction osteogenesis or autologous mandibular reconstruction) referred from outside institutions in 6 instances, and 3 had post-infectious ankylosis. Patients having their first mandibular operation at a younger age had more frequent reoperations for recurrent TMJ ankylosis, although this did not reach statistical significance. Mean improvement in MIO was 21.4 ± 7.3 mm. Ankylosis recurred in 21 (75%) patients. Five patients with congenital TMJ ankylosis required gastrostomy and remained at least partially dependent. Five patients had tracheostomy at the time of TMJ ankylosis surgery: 2 were eventually decannulated and 3 required repeat tracheostomy after ankylosis recurrence and remained tracheostomy-dependent., Conclusion: The clinical course of TMJ ankylosis in children affected by craniofacial differences is complex and typically involves a high rate of recurrence and multiple reoperations despite initial improvement in postoperative MIO. Younger age at initial mandibular surgery and number of operations require further investigation as potential predictors of recurrent TMJ ankylosis as well as tracheostomy and gastrostomy dependence.
Published: 2020
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39. Reply re: "Facial Transplantation and Ocular Considerations".

Author: Greenfield JA, Kantar RS, Rifkin WJ, Sosin M, Diaz-Siso JR, Patel P, Fleming JC, Iliff NT, Lee BW, and Rodriguez ED
Subjects: Eye, Face, Humans, Facial Transplantation
Published: 2020
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40. Educational Resources in Craniofacial Surgery: The Case for User-Friendly Digital Simulators.

Author: Kantar RS, Alfonso AR, Ramly EP, Diaz-Siso JR, and Flores RL
Subjects: Humans, New York, Plastic Surgery Procedures, Surgery, Plastic, Face surgery, Jaw Diseases surgery
Abstract: Introduction: Digital simulators are potential solutions to challenges facing surgical education. The authors sought to evaluate the reach and utilization of a freely-accessible craniofacial surgery digital educational simulator. More importantly, we compare usage patterns between web-based and mobile-based platforms., Methods: A 3-way collaboration between academic, non-profit (myFace, New York, NY), and biotechnology (Biodigital, New York, NY) stakeholders in 2015 produced the Craniofacial Interactive Virtual Assistant Pro (CIVA-Pro). CIVA-Pro is a freely-accessible craniofacial surgery digital educational simulator. In addition to the web-based platform, a mobile-based platform was launched in 2017. Usage analytics were collected and analyzed., Results: Since its launch, 751 registered users from 117 countries had accessed CIVA-Pro. The total number of sessions was 9531, including 7500 web and 2031 mobile sessions. The total screen time was 403.9 hours, 290.3 for the web and 113.6 for the mobile platform. Comparison of the mean monthly screen time and number of monthly sessions between platforms since 2017 demonstrated a significantly higher mean monthly screen time (60.1 ± 33.2 versus 29.4 ± 16.5 hours; P = 0.002) and number of sessions (110.2 ± 36.1 versus 58.1 ± 31.9; P < 0.0001) for the mobile-based platform. The mean screen time per session was comparable (P = 0.86)., Conclusion: A freely available digital craniofacial surgery educational simulator designed for surgical trainees can achieve significant global reach. Significantly higher utilization of the mobile-based platform of the simulator as compared to the web-based platform reinforces the need to invest in user-friendly, easily accessible, and widely available digital educational resources by key stakeholders to ensure optimal plastic surgery trainee education.
Published: 2020
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41. The Left-handed Plastic Surgery Trainee: Perspectives and Recommendations.

Author: Savetsky IL, Cammarata MJ, Kantar RS, Diaz-Siso JR, Avashia YJ, Rohrich RJ, and Saadeh PB
Abstract: Left-handed surgeons experience difficulty with tools designed for use in the right hand. The purpose of this study was to examine instrument laterality and to survey the experiences of left-handed plastic surgery trainees., Methods: Count sheets for plastic surgery trays (reconstructive, microsurgery, rhinoplasty, craniofacial) were acquired from Tisch Hospital, NYU Langone Health. Instruments with right-handed laterality were tallied. A survey was also distributed to plastic surgery residents and fellows to determine hand preference for surgical tasks, and those who identified as left-handed described how handedness impacted their training., Results: Right-handed laterality was seen in 15 (31.3%) of the 48 reconstructive instruments, 17 (22.7%) of the 75 rhinoplasty instruments, and 22 (31.0%) of the 71 craniofacial instruments. One-hundred percent of the 25 microsurgery instruments were ambidextrous. There were 97 survey responses. Trainees (17.5%) were identified as left-handed and were more likely than right-handed trainees to report operating with both hands equally or with the opposite hand (47.1% versus 1.3%; P < 0.001). Left-handed trainees were significantly more likely than right-handed trainees to use their nondominant hand with scissors ( P < 0.001), electrocautery ( P = 0.03), and needle drivers ( P < 0.001) and when performing tissue dissection ( P < 0.001) and microsurgery ( P = 0.008). There was no difference in use of the nondominant hand between right and left-handed trainees for knot tying ( P = 0.83) and in use of the scalpel ( P = 0.41)., Conclusions: Left-handed plastic surgery trainees frequently encounter instruments designed for the nondominant hand, with which they adaptively perform several surgical tasks. Mentoring may help trainees overcome the laterality-related challenges of residency., Competing Interests: Disclosure: Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from Thieme Medical Publishing. The other authors have no financial interest to declare., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Published: 2020
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42. Levels of Evidence in Plastic Surgery Research: A 10-Year Bibliometric Analysis of 18,889 Publications From 4 Major Journals.

Author: Rifkin WJ, Yang JH, DeMitchell-Rodriguez E, Kantar RS, Diaz-Siso JR, and Rodriguez ED
Subjects: Bibliometrics, Humans, Research Design, Periodicals as Topic statistics & numerical data, Plastic Surgery Procedures, Surgery, Plastic
Abstract: Background: Improving the quality of research published in plastic surgery literature has been recognized as a difficult and time-intensive process. Despite significant progress over the last decade, leaders in the field continue to advocate for higher-quality studies to better inform clinical practice., Objectives: The aim of this study was to evaluate and analyze trends in the levels of evidence (LOEs) of the plastic surgery literature over the last decade in 4 major journals., Methods: After systematic review of all articles published between 2008 and 2017 in Plastic and Reconstructive Surgery, Annals of Plastic Surgery, Journal of Plastic, Reconstructive, and Aesthetic Surgery, and Aesthetic Surgery Journal (ASJ), included articles were assigned an LOE and classified according to study design and category., Results: In total, 8211 articles were included. Case series and reports represented 36.1% and 13.6% of studies, respectively. Additionally, 27.2% were retrospective cohort studies, 8.2% prospective cohort studies, 3.9% systematic reviews, and 2.9% randomized controlled trials (RCTs). Overall, the percentage of Level I/II studies has increased from 10.9% in 2008 to 17.3% in 2017. ASJ published the greatest proportion of Level I/II studies (23.2%) and RCTs (5.1%) of all the journals. There were significant differences in the distribution of Level I/II studies by journal (P < 0.001) and category (P < 0.001)., Conclusions: Over the past decade, plastic surgery journals have published higher-quality research and a significantly greater proportion of Level I and II studies. The field must continue to strive for robust study designs, while also recognizing the importance of lower-LOE research., (© 2019 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.)
Published: 2020
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43. Total Eyelid Transplantation in a Face Transplant: Analysis of Postoperative Periorbital Function.

Author: Grigos MI, LeBlanc É, Rifkin WJ, Kantar RS, Greenfield J, Diaz-Siso JR, and Rodriguez ED
Subjects: Adult, Biomechanical Phenomena, Eyelids physiology, Humans, Male, Eyelids transplantation, Facial Transplantation
Abstract: Background: Prolonged impairment of protective ocular functions can compromise vision and lead to blindness if uncorrected. Several facial transplants have incorporated periorbital structures with variable eyelid preservation, but objective assessment of post-transplant periorbital function has been limited., Materials and Methods: Kinematic data were collected from a full-face recipient that included the fist total eyelid transplantation at 5 separate pre-transplant (PRE) and post-transplant time points (T1-T4). Using optical facial tracking, eyelid movements were tracked during involuntary blinking and compared with controls., Results: There was significant improvement in right eye aperture from PRE to T1 (β = 5.54, P < 0.001), with no change between T1 and T4. Aperture fluctuated in the left eye, with a temporary decrease between T2 and T3 corresponding with revision brow lift (β = -4.57, P < 0.001). Although improved from the pre-transplantation, right and left eye apertures remained significantly smaller than controls at T1 and T4 (P < 0.001). Similarly, spatial coupling increased from PRE to T1 (β = 0.63, P < 0.001) and remained high at T4, albeit significantly less than controls (P < 0.001). Temporal coupling improved from PRE to T2 (β = 2.29, P < 0.02) and was sustained at subsequent time points, with no difference relative to controls at T4. Considerable improvement was observed on clinical examination, with full functional status., Conclusions: Application of a novel method for assessing functional eyelid recovery using facial tracking technology to the first total eyelid transplantation in the setting of a full facial transplant shows clear functional improvement after transplantation and suggests revisions can be performed safely to optimize aesthetic outcomes without permanent negative functional impact., (Copyright © 2019 Elsevier Inc. All rights reserved.)
Published: 2020
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44. Knowledge and Skills Acquisition by Plastic Surgery Residents through Digital Simulation Training: A Prospective, Randomized, Blinded Trial.

Author: Kantar RS, Alfonso AR, Ramly EP, Cohen O, Rifkin WJ, Maliha SG, Diaz-Siso JR, Eisemann BS, Saadeh PB, and Flores RL
Subjects: Academic Performance statistics & numerical data, Adult, Cleft Lip surgery, Clinical Competence statistics & numerical data, Female, Humans, Internship and Residency statistics & numerical data, Male, Program Evaluation, Prospective Studies, Plastic Surgery Procedures methods, Reproducibility of Results, Computer-Assisted Instruction methods, Internship and Residency methods, Plastic Surgery Procedures education, Simulation Training methods, Surgery, Plastic education
Abstract: Background: Simulation is a standard component of residency training in many surgical subspecialties, yet its impact on knowledge and skills acquisition in plastic surgery training remains poorly defined. The authors evaluated the potential benefits of simulation-based cleft surgery learning in plastic surgery resident education through a prospective, randomized, blinded trial., Methods: Thirteen plastic surgery residents were randomized to a digital simulator or textbook demonstrating unilateral cleft lip repair. The following parameters were evaluated before and after randomization: knowledge of surgical steps, procedural confidence, markings performance on a three-dimensional stone model, and surgical performance using a hands-on/high-fidelity three-dimensional haptic model. Participant satisfaction with either educational tool was also assessed. Two expert reviewers blindly graded markings and surgical performance. Intraclass correlation coefficients were calculated. Wilcoxon signed rank and Mann-Whitney U tests were used., Results: Interrater reliability was strong for preintervention and postintervention grading of markings [preintervention intraclass correlation coefficient, 0.97 (p < 0.001); postintervention intraclass correlation coefficient, 0.96 (p < 0.001)] and surgical [preintervention intraclass correlation coefficient, 0.83 (p = 0.002); postintervention intraclass correlation coefficient, 0.81 (p = 0.004)] performance. Postintervention surgical knowledge (40.3 ± 4.4 versus 33.5 ± 3.7; p = 0.03), procedural confidence (24.0 ± 7.0 versus 14.7 ± 2.3; p = 0.03), markings performance (8.0 ± 2.5 versus 2.9 ± 3.1; p = 0.03), and surgical performance (12.3 ± 2.5 versus 8.2 ± 2.3; p = 0.04) significantly improved in the digital simulation group compared with before intervention, but not in the textbook group. All participants were more satisfied with the digital simulator as an educational tool (27.7 ± 2.5 versus 14.4 ± 4.4; p < 0.001)., Conclusion: The authors present evidence suggesting that digital cognitive simulators lead to significant improvement in surgical knowledge, procedural confidence, markings performance, and surgical performance.
Published: 2020
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45. Unilateral Cleft Lip Repair: A Quantitative Scale Assessment of Postoperative Lip and Nose Scars Across 2 Operative Techniques.

Author: Ramly EP, Eisemann BS, Kantar RS, Alfonso AR, Wang M, Diaz-Siso JR, Staffenberg DA, and Flores RL
Subjects: Cicatrix etiology, Cohort Studies, Evaluation Studies as Topic, Female, Humans, Infant, Male, Nose pathology, Observer Variation, Photography, Postoperative Care, Plastic Surgery Procedures adverse effects, Reproducibility of Results, Retrospective Studies, Severity of Illness Index, Treatment Outcome, Cicatrix pathology, Cleft Lip diagnosis, Cleft Lip surgery, Plastic Surgery Procedures methods
Abstract: Background: There is no quantitative evidence supporting one unilateral cleft lip (UCL) repair technique over the other with regard to scarring. We sought to evaluate the difference between the extended Mohler and Millard techniques, using 3 scar assessment scales., Methods: Postoperative frontal and basal photographs of patients undergoing UCL repair were reviewed. Three validated scar assessment scales were used: the Manchester Scar Scale (MSS), modified scar-rating scale (MSRS), and Stony Brook Scar Evaluation Scale. Lip and nose scars were rated by 5 independent raters using each of the scales. Interrater reliability was assessed using the intraclass correlation coefficient (ICC)., Results: Assessment of 116 images for 58 consecutive patients undergoing UCL repair (36 extended Mohler, 22 Millard) was performed. Interrater reliability was excellent for lip scars (ICCs, 0.903 [0.857-0.938] for MSS, 0.913 [0.872-0.944] for MSRS, and 0.850 [0.775-0.902] for SBES) and moderate for nose scar assessment (ICCs, 0.714 [0.579-0.816] for MSS, 0.693 [0.548-0.802] for MSRS, and 0.565 [0.359-0.720] for SBES). No statistically significant difference was found between the extended Mohler and Millard repairs in mean lip scar scores (MSS, 6.983 ± 1.469 vs 6.772 ± 1.175, P = 0.571; MSRS, 5.433 ± 1.530 vs 5.481 ± 1.290, P = 0.902; SBES, 3.633 ± 0.977 vs 3.446 ± 0.995, P = 0.483) or nose scar scores (MSS, 5.644 ± 1.131 vs 5.491 ± 0.689, P = 0.523; MSRS, 4.233 ± 0.987 vs 3.991 ± 0.705, P = 0.320; SBES, 3.933 ± 0.750 vs 4.018 ± 0.486, P = 0.603)., Conclusions: Using 3 validated scar assessment scales, no significant difference was found between the extended Mohler and Millard techniques in terms of lip or nose scars.
Published: 2019
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46. Effect on Facial Growth of the Management of Cleft Lip and Palate.

Author: Farber SJ, Maliha SG, Gonchar MN, Kantar RS, Shetye PR, and Flores RL
Subjects: Adult, Age Factors, Child, Child, Preschool, Cleft Lip diagnosis, Cleft Palate diagnosis, Face, Female, Humans, Infant, Infant, Newborn, Male, Plastic Surgery Procedures adverse effects, Reoperation methods, Risk Assessment, Treatment Outcome, Child Development physiology, Cleft Lip surgery, Cleft Palate surgery, Growth physiology, Plastic Surgery Procedures methods
Abstract: Treatment of cleft lip and palate ordinarily requires multiple interventions spanning the time of birth to adulthood. Restriction of facial growth, a common occurrence in affected children, is due to multiple factors. There are multiple surgical and therapeutic options, which may have influence on facial growth in these patients. As restriction to facial development can have significant implications to form, function, and psychological well-being, practitioners should have an appreciation for the effects of the different cleft therapies to facial growth. We have outlined and thoroughly reviewed in chronological order all of the interventions from birth to adulthood necessary in the comprehensive care of the patient with cleft lip and palate, along with the effects they may or may not have on facial growth.
Published: 2019
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47. Beyond Stopping the Bleed: Opportunities for Plastic Surgeons in the Response to Mass Casualty Events.

Author: Ramly EP, Alfonso AR, Kantar RS, Diaz-Siso JR, and Rodriguez ED
Published: 2019
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48. Magnetic Resonance Imaging Volumetry of Facial Muscles in a Face Transplant Recipient.

Author: Kantar RS, Wake N, Alfonso AR, Rifkin WJ, Ramly EP, Diaz-Siso JR, and Rodriguez ED
Abstract: Face transplantation has evolved into a viable reconstructive option for patients with extensive facial disfigurement. Because the first face transplant procedure was described in 2005, the safety and feasibility of the procedure have been validated, and the focus of the field has shifted toward refining functional and esthetic outcomes. Recovery of muscle function following facial transplantation is critical to achieving optimal facial function and restoring facial expression. Assessment of facial muscle function in face transplant recipients has traditionally relied on clinical evaluation. In this study, we describe longitudinal changes in facial muscle volumes captured through quantitative magnetic resonance imaging in a face transplant recipient and compare these findings with functional outcomes evaluated through clinical assessment., (Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Published: 2019
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49. How to Integrate Lived Experience Into Quality-of-Life Assessment in Patients Considering Facial Transplantation.

Author: Kimberly LL, Alfonso AR, Ramly EP, Kantar RS, Caplan AL, and Rodriguez ED
Subjects: Humans, Decision Making ethics, Facial Transplantation psychology, Life Change Events, Patient Reported Outcome Measures, Quality of Life psychology, Surveys and Questionnaires standards
Abstract: Facial transplantation has gained increasing acceptance as a treatment option to improve quality of life (QoL) for persons suffering from severe facial disfigurement. Despite its growth, the field has yet to establish a consistent approach to assessing QoL in face transplant candidates and recipients that includes integration of meaningful patient-reported outcomes. The published literature suggests that face transplant programs currently use a wide variety of assessment tools and strategies. Moreover, confusion remains as to how best to weigh patients' lived experiences and incorporate them into QoL assessments. Qualitative research can illuminate the dimensions of QoL that are meaningful to face transplant candidates and recipients. Coupled with collaboration and data sharing across face transplant programs, qualitative research will help to bring conceptual clarity and transparency to the assessment process., (© 2019 American Medical Association. All Rights Reserved.)
Published: 2019
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50. Risk Factors for Wound Complications Following Transmetatarsal Amputation in Patients With Diabetes.

Author: Kantar RS, Alfonso AR, Rifkin WJ, Ramly EP, Sharma S, Diaz-Siso JR, Levine JP, and Ceradini DJ
Subjects: Aged, Diabetic Foot complications, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Surgical Wound Dehiscence etiology, Surgical Wound Infection etiology, United States epidemiology, Amputation, Surgical adverse effects, Diabetic Foot surgery, Metatarsal Bones surgery, Surgical Wound Dehiscence epidemiology, Surgical Wound Infection epidemiology
Abstract: Background: The goal of our study was to evaluate risk factors for wound complications in patients with diabetes mellitus undergoing transmetatarsal amputations (TMAs), given the paucity of research on this subject., Materials and Methods: We used the American College of Surgeons National Surgical Quality Improvement Program database. In this retrospective analysis, all surgical cases with a primary Current Procedural Terminology code for TMA from 2009 to 2015 were reviewed., Results: A total of 2316 patients with diabetes mellitus who underwent TMA were identified. Overall wound complications occurred in 276 (11.9%) of patients. Univariate analysis showed that the operative time was significantly longer in patients who developed complications than those who did not (58.3 ± 39.5 versus 50.6 ± 39.4; P = 0.003). Furthermore, the rate of obesity was significantly higher among patients who developed wound complications than those who did not (47.1% versus 41.5%; P = 0.04). Multivariate analysis demonstrated that a longer operative time (odds ratio = 1.02; 95% confidence interval: 1.01-1.04; P = 0.01) and obesity (odds ratio = 1.60; 95% confidence interval: 1.06-2.40; P = 0.03) were independent risk factors for wound complications in our cohort., Conclusions: These findings emphasize the importance of having heightened clinical vigilance in obese patients with diabetes mellitus undergoing this procedure, close postoperative follow-up, and limiting operative time when possible., (Copyright © 2019. Published by Elsevier Inc.)
Published: 2019
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