Latest Updates

Epigenetics In Autoimmune Disease

Matlock A Jeffries, MD
    • Epigenetics is strongly linked with multiple autoimmune diseases.
    • Epigenetic modifications include DNA methylation, histone side-chain modifications, and noncoding RNA.
    • Epigenetic changes occur early in autoimmune disease; for example, in systemic lupus erythematosus, DNA methylation changes are present in naive T cells even before activation.
    • Technological advances have led to our ability to simultaneously map the epigenome of multiple tissue types across multiple autoimmune diseases, shedding light on common shared pathways.

Fenestrated and Branched Endografts

Mirza Shadman Baig, MD, Carlos H. Timaran, MD
    • Fenestrated and branched endografts versus standard EVAR
    • “Off-the-shelf” versus custom-made endografts for paravisceral aneurysms
    • Evidence indicates that the Z-FEN graft may be used in patients with less than the recommended infrarenal neck length of 4 mm

Reconstructive Approaches to Nasal Defects

Michael L. Bentz, MD, FAAP, FACS, Ravi K Garg, MD

    • Non-melanoma skin cancers are the most common cause of nasal defects necessitating reconstruction.

    • Nasal reconstructive strategies should ensure that there is adequate structural support of the nasal airway while also optimizing aesthetic outcomes.

    • While reconstruction of nasal aesthetic subunits may be a guiding principle for some patients, consideration of nasal texture, color, and contour may be more important for deciding which parts of the nose to resurface in other patients.
    • A comprehensive operative plan addresses restoration of nasal lining, support, and cover, based on the extent of the nasal defect.
    • Reconstruction of nasal cover may be as simple as allowing a small defect to heal by secondary intent or as complicated as a two or three stage forehead flap procedure. Prosthetic reconstruction may be a better option for patients who have failed previous autologous reconstruction or patients who are poor surgical candidates.

Tenosynovitis Disorders of the Hand and Wrist

Michael Aversano, MD, Nader Paksima, DO, MPH
    • The introduction of office-based, ultrasonography-guided injections has become an important part of the treatment algorithm for tenosynovitis disorders.

    • Surgical techniques using wide-awake local anesthesia and no tourniquet are becoming increasingly popular.

    • Use of corticosteroid injections in treatment has been shown to have higher rates of symptom-free resolution, decreased pain, and improved function.

Gender Dysphoria

Atef Bakhoum, MD, PhD, Waguih William IsHak, MD, FAPA
    • Gender identity disorder (DSM-IV) is now labeled as gender dysphoria (DSM-5).
    • Some potential genetic correlates have been found in gender dysphoria.

Pediatric Minimally Invasive Pyeloplasty

Pasquale Casale, MD, Julia Beth Finkelstein, MD
    • Pediatric robotic pyeloplasty is safe and effective, with comparative studies showing similar success and complication rates between minimally invasive and open pyeloplasty.
    • Anderson-Hynes dismembered pyeloplasty is the standard approach for repair, but robotic approaches can be tailored to the specific case when complex patient anatomy is encountered.
    • Several benefits of robotic pyeloplasty are intimated; previously unrecognized advantages include human capital gain, indirect benefits from shortened hospitalizations, and parental satisfaction. 

Cervical Dysplasia and Human Papillomavirus

Melissa K Frey, MD, Cathleen E Matrai, MD
    • Large randomized trials of Pap and HPV cotesting found that after extended follow-up, the incidence of invasive cervical cancer was significantly lower in women initially screened with HPV-based testing compared with cytology alone.
    • Screening that includes assessment of HPV status provides 60 to 70% greater protection against invasive cervical carcinomas compared with cytology alone.
    • Vaccination rates for the HPV vaccine, approved in the United States since 2006, are well below national goals, and provider recommendation has been found to be the most important factor influencing a patient’s or parent’s decision as to whether or not to accept the HPV vaccine.

Stress Fractures And The Reproductive System In The Female Athlete

Irfan M Asif, MD, Kimberly Harmon, MD, Mallory Shasteen, MD
    • Due to the radiation exposure involved with oblique radiography and CT, the recommended imaging modalities when spondylolysis is suspected include initial two-view radiography followed by MRI.
    • Surgery for spondylolysis is recommended only when bilateral spondylolysis is present and has progressed to significant spondylolisthesis.
    • Female athletes should have 1,500 mg/day of calcium and maintenance of vitamin D levels at 32 to 50 ng/mL, which may generally occur with 800 IU of vitamin D/day.
    • Female athletes should have baseline dual-energy x-ray absorptiometry if they have one or more “high-risk” triad risk factors or two or more “moderate-risk” triad risk factors. 
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