Prevalence of clonal hematopoiesis of indeterminate potential in patients with severe chronic graft-versus-host disease
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Functional assessment of autologous tissue expansion grafts for vaginal reconstruction in a rabbit model
This study explores a novel approach to vaginal reconstructive surgery using autologous tissue grafts, which may provide new therapeutic options for women with congenital or acquired vaginal anomalies. Using a small autologous vaginal tissue segment, we engineered a six-fold expanded graft perioperatively, leveraging the body as a bioreactor and avoiding preoperative tissue culture. In adolescent White New Zealand rabbits, a vaginal defect was created and repaired using a PLATE graft (perioperative, layered, autologous, tissue-expansion graft) containing mucosa, smooth muscle, collagen, and surgical mesh. After seven months, PLATE grafts were well integrated with native tissues, exhibited reduced fibrosis, and enhanced muscle regeneration compared to acellular grafts. Gene analysis revealed upregulation of smooth muscle and ECM organisation markers. Functional validation included successful breeding and vaginal delivery of live pups. PLATE grafts proved safe for vaginal reconstruction in rabbits, presenting a new direction in tissue engineering and expanding surgical options for women.
The significance of free light-chain ratio in light-chain monoclonal gammopathy of undetermined significance: a flow cytometry sub-study of the iStopMM screening study
Light-chain (LC) monoclonal gammopathy of undetermined significance (MGUS) is a precursor of multiple myeloma (MM) and related conditions. LC-MGUS is characterized by free light-chain (FLC) levels outside defined reference intervals, indirectly indicating underlying plasma cell (PC) monoclonality. Next-generation flow cytometry (NGF) was used to evaluate clonal PC presence in bone marrow (BM) samples from individuals with LC-MGUS in the iStopMM study, aiming to assess the predictive value of the FLC ratio for clonal PC presence and its prognostic implications. BM samples from 61 individuals with LC monoclonal gammopathy were analyzed. Clonal plasma cells were detected in 53.6% of LC-MGUS samples (n = 28) and in all samples from individuals with more advanced conditions (n = 33). The FLC ratio was predictive of clonal PC presence for kappa-involved FLC ratios (p < 0.05; n = 42), with an optimal cutoff of 3.15 (96.7% sensitivity, 91.7% specificity). Of 195 individuals with kappa-involved LC-MGUS in follow-up within the iStopMM study, none with FLC ratios >1.65 to 3.15 progressed to MM (n = 124), whereas 4/71 (5.6%) with FLC ratios >3.15 progressed over median follow-up of 55 months. These findings support using a kappa-involved FLC ratio cutoff of >3.15 to more accurately identify individuals at increased risk of developing symptomatic PC disorders.
Advancements in bioengineering for descemet membrane endothelial keratoplasty (DMEK)
Corneal diseases are the third leading cause of blindness worldwide. Descemet’s Membrane Endothelial Keratoplasty (DMEK) is the preferred surgical technique for treating corneal endothelial disorders, relying heavily on high-quality donor tissue. However, the scarcity of suitable donor tissue and the sensitivity of endothelial cells remain significant challenges. This review explores the current state of DMEK, focusing on advancements in tissue engineering as a promising solution to improve outcomes and address donor limitations.
Bayesian p-curve mixture models as a tool to dissociate effect size and effect prevalence
Much research in the behavioral sciences aims to characterize the “typical” person. A statistically significant group-averaged effect size is often interpreted as evidence that the typical person shows an effect, but that is only true under certain distributional assumptions for which explicit evidence is rarely presented. Mean effect size varies with both within-participant effect size and population prevalence (proportion of population showing effect). Few studies consider how prevalence affects mean effect size estimates and existing estimators of prevalence are, conversely, confounded by uncertainty about effect size. We introduce a widely applicable Bayesian method, the p-curve mixture model, that jointly estimates prevalence and effect size by probabilistically clustering participant-level data based on their likelihood under a null distribution. Our approach, for which we provide a software tool, outperforms existing prevalence estimation methods when effect size is uncertain and is sensitive to differences in prevalence or effect size across groups or conditions.
Evolution of temporomandibular joint reconstruction: from autologous tissue transplantation to alloplastic joint replacement
The reconstruction of the temporomandibular joint presents a multifaceted clinical challenge in the realm of head and neck surgery, underscored by its relatively infrequent occurrence and the lack of comprehensive clinical guidelines. This review aims to elucidate the available approaches for TMJ reconstruction, with a particular emphasis on recent groundbreaking advancements. The current spectrum of TMJ reconstruction integrates diverse surgical techniques, such as costochondral grafting, coronoid process grafting, revascularized fibula transfer, transport distraction osteogenesis, and alloplastic TMJ replacement. Despite the available options, a singular, universally accepted ‘gold standard’ for reconstructive techniques or materials remains elusive in this field. Our review comprehensively summarizes the current available methods of TMJ reconstruction, focusing on both autologous and alloplastic prostheses. It delves into the differences of each surgical technique and outlines the implications of recent technological advances, such as 3D printing, which hold the promise of enhancing surgical precision and patient outcomes. This evolutionary progress aims not only to improve the immediate results of reconstruction but also to ensure the long-term health and functionality of the TMJ, thereby improving the quality of life for patients with end-stage TMJ disorders.
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