西北大学费恩伯格医学院

Purpose Tendon transfers and nerve transfers are two techniques available for reconstruction of elbow extension, grip, pinch, and release after spinal cord injury. This systematic review was aimed at assessing and comparing the strength outcomes of tendon and nerve transfers for functional reconstruction of the upper extremity to better guide surgical discussion. Methods This review was registered with PROSPERO ID: CRD42024595503 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Scopus, and MEDLINE were queried for citations that presented strength outcomes for patients having undergone tendon and/or nerve transfers to restore upper-extremity function after a spinal cord injury. Weighted averages were used to report patient demographic data. A pooled estimate of strength outcomes was completed for the brachialis-to-anterior interosseous nerve transfer using a random-effects model. Results Five hundred and ninety-four citations were screened for 51 included studies with a total of 959 patients who were, on average, 31.8 years old (range, 5−76). For elbow extension reconstruction, strength of M3 or greater was reported in 68% of patients who underwent nerve transfers, 79% of patients who underwent a biceps-to-triceps tendon transfer, and 70% of patients who underwent a deltoid-to-triceps transfer. The pooled proportion of patients achieving M3 or better strength after a brachialis-to-anterior interosseous nerve transfer was 0.5 (0.31−0.7), with better outcomes in younger patients. For the supinator-to-posterior interosseous nerve transfer, 78% of patients reported achieving M3 strength or better. Conclusions There is no gold standard for the functional reconstruction of the upper extremity after a spinal cord injury. The choice of procedure(s) remains patient-specific. Several options are available to surgeons treating tetraplegia, and patients have achieved considerable strength recovery from both nerve and tendon transfers. Current evidence demonstrates poor outcomes after brachialis-to-anterior interosseous nerve transfers. More homogeneous follow-up protocols are needed for strength measurement and patient-reported outcome measures for both nerve and tendon transfers. Type of study/level of evidence Therapeutic III.

Chronic rhinosinusitis (CRS) is a heterogeneous and often debilitating disease characterized by persistent sinonasal symptoms and inflammation and is phenotypically classified as CRS with nasal polyps (CRSwNP) or without nasal polyps (CRSsNP). Although CRSsNP is the more prevalent phenotype (approximately 80

Hepatoid adenocarcinoma of the lung (HAL) is a rare subtype of non–small cell lung carcinoma characterized by morphologic and immunophenotypic overlap with hepatocellular carcinoma (HCC), creating diagnostic challenges for practicing pathologists. Because of its rarity, only limited information exists regarding its molecular profile and biologic behavior. We retrospectively analyzed 17 HAL cases diagnosed at Northwestern Memorial Hospital and describe their clinical presentation, morphologic features, immunohistochemical and molecular profiles, and clinical outcomes. Histologically, HAL is composed of polygonal to columnar epithelioid cells with abundant lightly eosinophilic, finely granular cytoplasm and predominantly solid and/or complex glandular growth patterns. Foci of mucinous differentiation may be present. Cytologic atypia, brisk mitotic activity, and tumor necrosis are common findings. Immunohistochemically, HAL is characterized by strong and diffuse HepPar1 expression, positivity for adenocarcinoma markers such as MOC31, and cytoplasmic immunoreactivity for TTF-1. Across the 17 cases, STK11 alterations were most frequent (52.9

Physical activity (PA) is crucial in adolescents and young adults (AYA) for the promotion of long-term cardiovascular health. In transgender and non-binary (TGNB) AYA who were assigned female at birth (AFAB), chest dysphoria may lead to avoidance of sports and exercise. Thus, it is important to understand the impact of gender-affirming top surgery on PA in TGNB AFAB AYA. In this pilot study, we conducted a qualitative analysis of the associations among chest dysphoria, top surgery, and the relationship with PA. Two focus groups, each consisting of five TGNB AFAB patients who were 13–25 years old at the time of top surgery, were conducted to elicit perspectives on factors impacting PA, including top surgery. Focus group transcripts were analyzed using grounded theory coupled with situational analysis. Identified themes were grouped into barriers, facilitators, and complicating factors of PA. Most barriers, including structural accessibility, passing, binding/clothing restrictions, and physical safety, were prominent prior to top surgery. Several facilitators to PA arose after top surgery, including top surgery improving PA, social acceptance, and PA to augment the post-op chest. Complicating factors included mental health, which impacted PA both before and after surgery, and the post-op healing process, which impacted PA for up to 6 months post-surgery. Conclusion: In TGNB AFAB adolescents and young adults, chest dysphoria poses several barriers to PA, many of which are resolved by top surgery. These findings suggest that alleviation of chest dysphoria via gender-affirming care has implications for the long-term cardiovascular health of TGNB patients.