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Leto Barone AA, Farley G, Vieira Alves VP, Bredemeier NO, Hogan E, Madzia J, Woodyard K, Schwentker AR, Fleck RJ. Characterization of Auricular Growth within the Pediatric Population Using Computed Tomography Scan Measurements. Plast Reconstr Surg Glob Open 2023; 11:e5210. [PMID: 37593699 PMCID: PMC10431552 DOI: 10.1097/gox.0000000000005210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023]
Abstract
Background In patients with microtia, auricular reconstruction is ideally performed promptly to prevent impaired socialization during formative childhood years. The earliest viable age for reconstruction is widely accepted from 7-10 years of age, as full auricular size is achieved around age 8, with some variability dependent on sex. This retrospective study aims to provide an auricular growth curve that accounts for age and sex, enhancing the individualized approach to ear reconstruction. Methods A total of 319 images of unaffected patients who underwent computed tomography angiography of the head and neck were reviewed, with bilateral cartilage height and width measured according to a consensus-standardized image measurement protocol. Means and SDs of cartilage height and width were calculated for both sexes, and analysis of ear growth was performed through plotting the mean cartilage height, width, and width:height ratio over time. Results Cartilage height and width differed significantly between male and female groups. Maximum cartilage height was reached at age 11 for female and at age 12 for male patients, whereas maximum cartilage width was reached at ages 10 and 8, respectively. On average, the width:height ratio for female group was 0.58. For male group, the average width:height ratio was 0.59. Conclusions An auricular growth map was designed using computed tomography measurements demonstrating maximum auricular size at age 11 and 12 respectively for female and male patients, with both sexes having a width:height ratio maintained at approximately 0.6 throughout growth.
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Affiliation(s)
- Angelo A Leto Barone
- From the Division of Plastic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio
- Division of Plastic Surgery, Nemours Children's Hospital, Orlando, Fla
| | | | | | | | - Elise Hogan
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jules Madzia
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Ann R Schwentker
- From the Division of Plastic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Robert J Fleck
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio
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Hoover ML, Karram MM, Farley G, Shah A. Subjective Efficacy of Suburothelial Versus Intradetrusor Botulinum Toxin for Overactive Bladder: A Retrospective Cohort Study. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Farley G, Sauer M, Brandt J, Ananth C. P–776 Singleton pregnancies conceived with infertility treatments and the risk of
neonatal and infant mortality. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is maternal infertility treatment associated with an increased risk of neonatal and infant mortality when compared to natural conception?
Summary answer
Infertility treatment is associated with a 70% increased adjusted risk of neonatal mortality. This association is strongly mediated by preterm delivery.
What is known already
The number of assisted reproduction technology (ART) cycles performed in the United States (US) increased by 39% from 142,435 cycles in 2007 to 197,737 in 2016. Within this growing experience, several studies described an increased risk of preterm delivery, low birth weight, congenital malformations, neonatal intensive care unit admission, stillbirth, and perinatal mortality among singletons conceived through ART compared to those conceived naturally. Experts have called for ART patients to be advised of potential increased risk for adverse perinatal outcomes and for obstetricians to manage these pregnancies as high risk.
Study design, size, duration
This is a cross-sectional study of 11,289,466 pregnancies in the United States (US) from 2015–2017 that resulted in a non-malformed singleton live birth. The exposure group includes births resulting from any infertility treatment method, including ART and fertility-enhancing drugs. The control group includes births resulting from natural conceptions. The primary outcomes measured were neonatal (within 1 month), post-neonatal (1 month to a year), and infant (up to 1 year) mortality.
Participants/materials, setting, methods
Pregnancies (n = 11,289,466) resulting in a non-malformed singleton live birth in the US from 2015–2017. Associations were estimated from log-linear Poisson regression models with robust variance. Risk ratio (RR) and 95% confidence interval (CI) were derived as the effect measure with adjustments for confounders. The impact of exposure misclassification and unmeasured confounding biases were assessed. A causal mediation analysis of the infertility treatment-mortality association with preterm delivery (<37 weeks) was performed.
Main results and the role of chance
Any infertility treatment was documented in 1.3% (n = 142,215) of singleton live births during the study period. Any infertility treatment was associated with a 70% increased adjusted risk of neonatal mortality (RR 1.70, 95% CI 1.54–1.88), with an even higher risk for early neonatal (RR 1.82, 95% CI 1.63–2.05) than late neonatal (RR 1.37, 95% CI 1.11–1.69) mortality. These risks were similar among pregnancies conceived through ART and treatment with fertility-enhancing drugs. The mediation analysis showed that 68% (95% CI 59–81) of the total effect of infertility treatment on neonatal mortality was mediated through preterm delivery. In a sensitivity analysis, following corrections for exposure misclassification and unmeasured confounding biases, these risks were higher for early neonatal (bias-corrected RR [RRbc] 2.94 95% CIbc 2.16–4.01), but not for late neonatal (RRbc 1.04, 95% CIbc 0.68–1.59) mortality.
Limitations, reasons for caution
Limitations of the study include the potential underreporting of infertility treatment on birth certificates and potential confounding from sociodemographic characteristics that were not accounted for in this study.
Wider implications of the findings: Pregnancies conceived with infertility treatment are associated with increased neonatal mortality and this association is mediated by the increased risk of preterm delivery. Knowledge of this risk should be shared with prospective couples consulting for fertility care in order to best provide adequate informed consent.
Trial registration number
Not applicable
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Affiliation(s)
- G Farley
- Rutgers Robert Wood Johnson Medical School, MD Candidate, New Brunswick, USA
| | - M Sauer
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics Gynecology and Reproductive Sciences, New Brunswick, USA
| | - J Brandt
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics Gynecology and Reproductive Sciences, New Brunswick, USA
| | - C Ananth
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics Gynecology and Reproductive Sciences, New Brunswick, USA
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Farley G, Riggs DW, Bhatnagar A, Hellmann J. Omega-3 polyunsaturated fatty acids modify the inverse association between systemic inflammation and cardiovascular fitness. Clin Nutr 2021; 40:4097-4105. [PMID: 33618966 DOI: 10.1016/j.clnu.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Exercise increases quality of life and lowers all-cause mortality, likely by preventing cardiovascular disease. Although the beneficial effects of exercise are linked with reductions in chronic inflammation, individual responses vary and factors that contribute to the anti-inflammatory effects of cardiovascular fitness remain largely undefined. We sought to investigate the role of fatty acids in the inverse relationship between inflammation and cardiovascular fitness. APPROACH AND RESULTS In this cross-sectional study using data from 435 participants in NHANES and linear regression models with CRP as the outcome, we observed significant negative interactions between VO2max and omega-3 polyunsaturated fatty acids (PUFAs) but not saturated, monounsaturated, or omega-6 PUFAs. When stratified by omega-3 PUFA tertiles, participants in the medium tertile, but not low tertile, show an enhanced negative association between VO2max and CRP, with a -32.0% difference (95% CI: -44.95, -15.9%) per 10 mL/kg/min of VO2max. Exploratory factor analysis identified five unique dietary fatty acid (FA) profiles. The FA profile consisting predominantly of omega-3 PUFA had the strongest negative association for VO2max and CRP, with a -28.2% difference in CRP (95% CI: -43.4, -8.9) per 10 mL/kg/min of VO2max. We also found that alpha-linolenic acid (ALA) and docosahexaenoic acid (DHA) enhanced the negative association between VO2max and CRP, suggesting that the anti-inflammatory response to VO2max capacity is associated with ALA and DHA levels. Males, Whites, and individuals with lower BMI were more sensitive to the effects of omega-3 PUFAs, while having high SFA levels attenuated the benefit. CONCLUSIONS This study suggests that omega-3 PUFAs are effect modifiers for VO2max and CRP and that the anti-inflammatory benefits of increasing cardiovascular fitness are associated with omega-3 PUFAs.
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Affiliation(s)
- Gabrielle Farley
- Diabetes and Obesity Center, Christina Lee Brown Envirome Institute, Division of Environmental Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA; School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Daniel W Riggs
- Diabetes and Obesity Center, Christina Lee Brown Envirome Institute, Division of Environmental Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA; Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, USA
| | - Aruni Bhatnagar
- Diabetes and Obesity Center, Christina Lee Brown Envirome Institute, Division of Environmental Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jason Hellmann
- Diabetes and Obesity Center, Christina Lee Brown Envirome Institute, Division of Environmental Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
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Costa F, Christensen NJ, Farley G, Biaggioni I. NO modulates norepinephrine release in human skeletal muscle: implications for neural preconditioning. Am J Physiol Regul Integr Comp Physiol 2001; 280:R1494-8. [PMID: 11294774 DOI: 10.1152/ajpregu.2001.280.5.r1494] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to estimate muscle interstitial norepinephrine (NE) levels during exercise and to determine whether nitric oxide (NO) modulates NE release in the skeletal muscle in humans. We measured interstitial dialysate concentrations of NE with two microdialysis probes inserted into the forearm. Probes were perfused with saline and the NO synthesis inhibitor N(G)-monomethyl-L-arginine (L-NMMA), respectively. Dialysate samples were collected during two sequential 20-min intense dynamic handgrip periods, preceded by 40-min baseline periods. On a different day, forearm ischemia was performed instead of the first exercise period. Exercise increased dialysate NE from 172 +/- 42 to 270 +/- 45 pg/ml (83% increase, P < 0.02, n = 6). Probes perfused with L-NMMA had a 136 +/- 39% greater dialysate NE compared with probes perfused with saline (225 +/- 25 vs. 125 +/- 25 pg/ml, P < 0.001, n = 9). The exercise-induced increase in NE (125 +/- 52%) was attenuated if preceded by exercise (34 +/- 34%) or ischemia (40 +/- 36%; P = 0.06, n = 6), suggesting a neural preconditioning effect. This attenuation was not observed in probes perfused with L-NMMA. We propose that NO modulates NE release in skeletal muscle, that ischemic exercise increases muscle interstitial NE, and that this increase can be attenuated by a preconditioning effect mediated in part by NO.
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Affiliation(s)
- F Costa
- Division of Clinical Pharmacology, Departments of Medicine and Pharmacology, Vanderbilt University, Nashville, Tennessee 37212-8210, USA
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Abstract
There is substantial evidence that adenosine activates muscle afferent nerve fibers leading to sympathetic stimulation, but the issue remains controversial. To further test this hypothesis, we used local injections of adenosine into the brachial artery while monitoring systemic muscle sympathetic nerve activity (MSNA) with peroneal microneurography. The increase in MSNA induced by 3 mg intrabrachial adenosine (106+/-32%) was abolished if forearm afferent traffic was interrupted by axillary ganglionic blockade (21+/-19%, n=5, P:<0.05). Furthermore, the increase in MSNA induced by intravenous adenosine was 3.7-fold lower and later (onset latency 20.9+/-4.8 seconds versus 8.5+/-1 seconds) than intrabrachial adenosine. Finally, we used forearm exercise (dynamic handgrip at 50% and 15% maximal voluntary contraction, MVC), with or without superimposed ischemia, to modulate interstitial levels of adenosine (estimated with microdialysis) while monitoring MSNA. Fifteen minutes of intense (50% MVC) and moderate (15% MVC) exercise increased adenosine dialysate concentrations from 0.31+/-0.1 to 1.24+/-0.4 micromol/L (528+/-292%) and from 0.1+/-0.02 to 0.419+/-0.16 micromol/L (303+/-99%), respectively (n=7, P:<0.01). MSNA increased 88+/-25% and 38+/-28%, respectively. Five minutes of moderate exercise increased adenosine from 0.095+/-0.02 to 0.25+/-0.12 micromol/L, and from 0.095+/-0.02 to 0.48+/-0.19 micromol/L when ischemia was superimposed on exercise (n=7, P:=0.01). The percent increase in MSNA induced by the various interventions correlated with the percent increase in dialysate adenosine levels (r=0.96). We conclude that adenosine activates muscle afferent nerves, triggering reflex sympathetic activation.
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Affiliation(s)
- F Costa
- Department of Medicine, Vanderbilt University, Nashville, TN 37212-8210, USA
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Bonchek LI, Geiss DM, Farley G. Emergency thrombectomy for acute thrombosis of superior vena cava. J Thorac Cardiovasc Surg 1979; 77:922-4. [PMID: 439927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Farley G. How to start to stop. J Tenn Med Assoc 1978; 71:452-3. [PMID: 755938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Radiographic findings previously thought pathognomonic for juvenile nasopharyngeal angiofibroma are anterior bowing of the posterior wall of the maxillary antrum on plain films or tomography, and a dense homogeneous blush on angiography. Two patients presented with nasopharyngeal masses which mimicked angiofibroma radiographically: one mass was a lymphoepithelioma and the other was a fibrous tumor. Constitutional symptoms and atypical physical findings should alert the physician to a diagnosis other than juvenile nasopharyngeal angiofibroma.
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