Alternatives to the Gold Standard: A Systematic Review of Profunda Artery Perforator and Lumbar Artery Perforator Flaps for Breast Reconstruction.

INTRODUCTION: Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap is the current gold-standard autologous option. The profunda artery perforator (PAP) and lumbar artery perforator (LAP) flaps have more recently been described as alternatives for patients who are not candidates for a DIEP flap. The aim of this study was to review the survival and complication rates of PAP and LAP flaps, using the DIEP flap as a benchmark. METHODS: A literature search was conducted using PubMed, MEDLINE, Embase, BIOSIS, Web of Science, and Cochrane databases. Papers were screened by title and abstract, and full texts reviewed by three independent blinded reviewers. Quality was assessed using MINORS criteria. RESULTS: Sixty-three studies were included, for a total of 745 PAP, 62 stacked PAP, 187 LAP, and 23,748 DIEP flap breast reconstructions. The PAP (98.3%) had comparable success rate to DIEP (98.4%), and the stacked PAP (88.7%) and LAP (92.5%) success rate was significantly lower (P < 0.0001). The PAP and LAP groups both had a low incidence of fat necrosis. However, the revision rate for the LAP group was 16.1% whereas the PAP group was 3.3%. Donor site wound dehiscence rate was 2.9 in the LAP group and 9.1% in the PAP group. CONCLUSIONS: Profunda artery perforator and DIEP flaps demonstrate very high rates of overall survival. The LAP flap has a lower survival rate. This review highlights the survival and complication rates of these alternative flaps, which may help clinicians in guiding autologous reconstruction technique when a DIEP flap is unavailable.

Fresh Frozen Cartilage in Rhinoplasty Surgery: A Systematic Review of Outcomes.

INTRODUCTION: Cadaveric fresh frozen cartilage provides an enticing alternative to traditional autologous cartilage grafts. This review provides a systematic analysis of existing literature on the use of fresh frozen rib for in rhinoplasties and focuses on clinical and aesthetic outcomes. METHODS: The methodology was designed and registered in the PROSPERO database (CRD42023447166). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was used to perform this systematic review. RESULTS: Four articles were included, with a total of 554 patients. A total of 477 patients were female (86%). Mean age ranged between 35.8 and 40.6. Mean follow-up ranged from 12.2 to 20.3 months. Only one article had a suitable control (with autologous rib graft). Pooled complications rates were low. Infection occurred in 12 patients (2%), warping in 8 patients (1.4%) and resorption in 3 patients (0.5%). CONCLUSION: Fresh frozen cartilage may be a safe and reliable alternative to autologous rib grafts. Complication rates were comparable to previous systematic reviews of autologous graft and irradiated allograft. Overall, patients reported high satisfaction rates with low rates of revision procedures. Further studies are required to assess both clinical and cost effectiveness against the current gold standard (autologous graft). LEVEL OF EVIDENCE III: Rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Overview of The the Clinician Investigator Trainees' Research Presented at The 2022 CSCI-CITAC Joint Meeting.

The 2022 Annual Joint Meeting (AJM) and Young Investigators' Forum of the Canadian Society for Clinical Investigation / Société Canadienne de recherches clinique (CSCI/SCRC) and Clinician Investigator Trainee Association of Canada/Association des cliniciens-chercheurs en formation du Canada (CITAC/ACCFC) was held in Montréal, November 13-14, 2022. The theme of this year's AJM was "Strength in Perseverance" and focused on highlighting clinician-investigator trainee achievements and resilience in research engagement through recent challenging and unprecedented times. The opening remarks were given by Nicola Jones (president of CSCI/SCRC) and Heather Whittaker (past president of CITAC/ACCFC). The keynote speaker was Dr. Michael Strong, who delivered the presentation "The Future of Clinician Scientists in Canada." Dr. Caroline Quach (Université de Montréal) received the CSCI Distinguished Scientist Award and Dr. Amy Metcalfe (University of Calgary) received the CSCI Joe Doupe Young Investigator Award. Each of the clinician-scientists delivered presentations on their award-winning research. The four interactive workshops included "Social Media in Science and Medicine," "Diversity in Science and Medicine," "Running a Successful Research Program," and "Mentorship in Action." The AJM also included presentations from clinician investigator trainees from across the country. Over 90 abstracts were showcased at this year's meeting, most of which are summarized in this review. Six outstanding abstracts were selected for oral presentations during the President's Forum.

Young Investigator Interview with CSCI Distinguished Scientist Awardee Dr. Caroline Quach-Thanh.

Dr. Caroline Quach-Thanh is a Professor in the Departments of Microbiology, Infectious Diseases and Immunology and of Pediatrics at University of Montreal. She is in charge of Infection Prevention and Control at CHU Sainte-Justine where she works as a pediatric infectious diseases specialist and medical microbiologist. Dr. Quach is a clinician-scientist and the Canada Research Chair, Tier 1 in Infection Prevention and Control. In 2022, Dr. Quach-Thanh received the Distinguished Scientist Award 2022 from the Canadian Society for Clinical Investigation. In the same year, she received a Women of Distinction Award-for public service-from the Women's Y Foundation. Dr. Quach-Thanh is the former president from the Association for Medical Microbiology and Infectious Diseases Canada (AMMI), a past Chair of the National Advisory Committee on Immunization (NACI) and is the current chair of the Quebec Immunization Committee. She was named Fellow of the Canadian Academy of Health Sciences and of the Society for Healthcare Epidemiology of America. Dr. QuachThanh was selected as one of the 2019 most Powerful Women in Canada. In 2021, she received the Order of Merit from Université de Montréal and was made Officière de l'Ordre national du Québec in 2022.

Fall 2022: Clinician Investigator Trainee Association of Canada (CITAC).

On behalf of the Clinical Investigator Trainee Association of Canada (CITAC) Board of Directors, I would like to extend an enthusiastic welcome to our new MD+ trainee members! I hope you soaked up all that summer had to offer and are in good back-to-school spirits. A new academic year is upon us, and opportunities abound for the Canadian physician scientist trainee community.

Overview of The Canadian Clinician Investigator Trainees' Research Presented at CSCI-CITAC Joint Meeting.

The 2021 Annual Joint Meeting (AJM) and Young Investigators' Forum of the Canadian Society for Clinical Investigation / Société Canadienne de Recherches Clinique (CSCI/SCRC) and Clinician Investigator Trainee Association of Canada/Association des Cliniciens-Chercheurs en Formation du Canada (CITAC/ACCFC) was hosted virtually on November 14-16th, 2021. The theme of the AJM was "Communication, Collaboration, and Tools for the Next Generation of Clinician Scientists", and emphasized lectures, panels and interactive workshops designed to provide knowledge and skills for professional development of clinician investigator trainees. The opening remarks were given by Nicola Jones (President of CSCI/SCRC) and Adam Pietrobon (Past President of CITAC/ACCFC). The keynote speaker was Dr. Timothy Caulfield, who delivered the presentation titled "Communication in the Era of Misinformation". Dr. Michael Hill (University of Calgary) received the CSCI Distinguished Scientist Award and Dr. Philippe Campeau (Université de Montréal) received the CSCI Joe Doupe Young Investigator Award. Each of the scientists delivered award winning talks during the symposium titled "All the King's Horses and All the King's Men" and "Understanding Growth Plate Disorders to Better Treat Them", respectively. The three interactive workshops included "Data Visualization", "Science Communication on Social Media" and "Mentorship in Action". The two panels were "CIHR Engagement: Challenges and Opportunities in the Clinician Investigator Career Path" and "Early Career Investigator Panel". The AJM also included presentations from clinician investigator trainees from across the country. Over 60 abstracts were showcased at this year's meeting, most of which are summarized in this review. Six outstanding abstracts were selected for oral presentations during the President's Forum.

Spring 2022: Clinician Investigator Trainee Association Of Canada (CITAC).

Over the past two years, physician-scientist trainees have persevered in the face of evolving challenges presented by the ongoing coronavirus disease 2019 (COVID-19) pandemic. Research and healthcare institutions across the country continue to feel the impacts of the public health emergency. As scientists and physicians generate evidence to inform the prevention and treatment of COVID-19, physician-scientist trainees in all disciplines have adapted to the changing conditions of their education.

Optimizing the Timing of Peripheral Nerve Transfers for Functional Re-Animation in Cervical Spinal Cord Injury: A Conceptual Framework.

Loss of upper extremity function following spinal cord injury (SCI) can have devastating consequences on quality of life. Peripheral nerve transfer surgery aims to restore motor control of upper extremities following cervical SCI and is poised to revolutionize surgical management in this population. The surgery involves dividing an expendable donor nerve above the level of the spinal lesion and coapting it to a recipient nerve arising from the lesional or infralesional segment of the injured cord. In order to maximize outcomes in this complex patient population, refinements in surgical technique need to be integrated with principles of spinal cord medicine and basic science. Deciding on the ideal timing of nerve transfer surgery is one aspect of care that is critical to maximizing recovery and has received very little attention to date in the literature. This complex topic is reviewed, with a focus on expectations for spontaneous recovery within upper motor neuron components of the injury, balanced against the need for expeditious re-innervation for lower motor neuron elements of the injury. The discussion also considers the case of a patient with C6 motor complete SCI in whom myotomes without electrodiagnostic evidence of denervation spontaneously improved by 6 months post-injury, thereby adjusting the surgical plan. The relevant concepts are integrated into a clinical algorithm with recommendations that consider maximal opportunity for spontaneous clinical improvement post-injury while avoiding excessive delays that may adversely affect patient outcomes.

Fall 2021: Clinician Investigator Trainee Association Of Canada (CITAC).

I hope you're taking care and found some time to relax this summer. A new semester may mean a big transition­some folks are starting their graduate studies, re-entering clerkship, starting residency or entering a fellowship. For some, there will be little or no change at all; but just a continuation of one of the many phases of the physician-scientist training pathway. Whatever stage you're at, the Clinical Investigator Trainee Association of Canada (CITAC) community is here to support and advocate for you!

Overview Of The Canadian Clinician Investigator Trainees' Research Presented At The 2020 CSCI-CITAC Joint Meeting.

The 2020 Annual General Meeting (AGM) and Young Investigators' Forum of the Canadian Society for Clinical Investigation / Société Canadienne de Recherches Clinique (CSCI/SCRC) and Clinician Investigator Trainee Association of Canada/Association des Cliniciens-Chercheurs en Formation du Canada (CITAC/ACCFC) was the first meeting to be hosted virtually. The theme was "Navigating Uncertainty, Embracing Change and Empowering the Next Generation of Clinician-Scientists", and the meeting featured lectures and workshops that were designed to provide knowledge and skills for professional development of clinician investigator trainees. The opening remarks were given by Jason Berman (President of CSCI/SCRC), Tina Marvasti (President of CITAC/ACCFC) and Nicola Jones (University of Toronto Clinician Investigator Program Symposium Chair). Dr. Michael Strong, President of the Canadian Institutes of Health Research, delivered the keynote presentation titled "CIHR's COVID-19 Response and Strategic Planning". Dr. John Bell (University of Ottawa) received the CSCI Distinguished Scientist Award, Dr. Stanley Nattel (Université de Montréal) received the CSCI-RCPSC Henry Friesen Award (RCPSC; Royal College of Physicians and Surgeons of Canada) and Dr. Meghan Azad (University of Manitoba) received the CSCI Joe Doupe Young Investigator Award. Each scientist delivered talks on their award-winning research. The interactive workshops were "Developing Strategies to Maintain Wellness", "Understanding the Hidden Curriculum: Power and Privilege in Science and Medicine", "Hiring a Clinician Scientist Trainee: What Leaders Are Looking For" and "COVID-19: A Case Study for Pivoting Your Research". The AGM included presentations from clinician investigator trainees nationwide. Over 70 abstracts were showcased, most are summarized in this review, and six were selected for oral presentations.

Spring 2021: Clinician Investigator Trainee Association Of Canada (CITAC).

The Clinician Investigator Trainee Association of Canada (CI) trainees across the country around the common goal of improving training conditions for those pursuing a career at the junction of research and medicine. Since then, the CI training landscape has shifted dramatically. The number of Canadian CI trainees enrolled totaling 289 MD-PhD trainees and 389 Clinical Investigator Program (CIP) trainees as of 2019 [1]. Alumni outcome data have presented conclusive evidence that MD-PhD training programs are effective in producing CI careers [2-4].

Overview of the Canadian Clinician Investigator Trainees' research presented at the 2019 CSCI-CITAC Joint Meeting.

The 2019 Annual General Meeting and Young Investigators' Forum of the Canadian Society for Clinical Investigation / Société Canadienne de Recherche Clinique (CSCI/SCRC) and Clinician Investigator Trainee Association of Canada / Association des Cliniciens-Chercheurs en Formation du Canada (CITAC/ACCFC) was held in Banff, Alberta on November 8-10th, 2019. The theme was "Positioning Early Career Investigators for Success: Strategy and Resilience". Lectures and workshops provided knowledge and tools to facilitate the attendees' development as clinician investigators. Dr. Jason Berman (President of CSCI/SCRC), Elina Cook (President of CITAC/ACCFC) and Drs. Doreen Rabi and Zelma Kiss (University of Calgary Organizing Co-Chairs) gave opening presentations. The keynote speakers were Dr. William Foulkes (McGill University) (Distinguished Scientist Award winner) and Dr. Andrés Finzi (Université de Montréal) (Joe Doupe Young Investigator Award winner). Dr. Robert Bortolussi (Dalhousie University) received the Distinguished Service Award for his work as the Editor-in-Chief of Clinical and Investigative Medicine and for being instrumental in the development of the Canadian Child Health Clinician Scientist Program. This meeting was the first to host a panel discussion with Drs. Stephen Robbins and Marcello Tonelli from the Canadian Institutes of Health Research. Workshops on communication, career planning and work-life balance were hosted by André Picard and Drs. Todd Anderson, Karen Tang, William Ghali, May Lynn Quan, Alicia Polachek and Shannon Ruzycki. The AGM showcased 90 presentations from clinician investigator trainees from across Canada. Most of the abstracts are summarized in this review. Eight outstanding abstracts were selected for oral presentation at the President's Forum.

Newsletter Fall 2020: Clinician Investigator Trainee Association of Canada (CITAC).

Message from the CITAC president To say that 2020 has been an unprecedented year is an understatement. The coronavirus disease 2019 (COVID-19) global pandemic and the major societal awakening on racial equity and justice have led us to reflect on our direction, goals and mission. Thanks to our talented and dedicated executive team, we were able to pivot our efforts and adapt to the changing landscape of research and advocacy. In April, we provided our members with a list of resources to help facilitate a smooth transition to working from home. In June, we published Clinician Investigator Trainee Association of Canada's (CITAC) press release on our role in combating anti-Black discrimination and racial injustice and have outlined specific advocacy efforts that we will be committing to over the next years (the full statement can be found on our website, https://www.citac-accfc.org).

Scientific Impact and Clinical Influence: Identifying Landmark Studies in Burns.

Although many reviews describe significant advances in burn care, no studies have yet examined why these papers had such profound impact. Our objective was to identify the most highly cited, as well as the most clinically influential studies in burns, and describe their characteristics, to inform future research in the field. Web of Science was searched using keywords related to burns to identify the 100 most-cited burns papers. Study design, year and journal of publication, and subject of the paper were recorded. A mixed-methods approach was used to identify papers in burn research leading to change in clinical practice. Characteristics of these papers were compared with identify any factors predictive of future citations or clinical influence. The 100 highly cited papers were cited between 159 and 907 times. There was no correlation between total citations and journal impact factor, year of publication, or subject area. Level of evidence did not predict future citations or influence, but may be influenced by evolving research standards. Of 23 clinically influential studies, 6 were not among 100 most-cited. Using papers only from the 100 most-cited list was not sufficient to identify leading researchers in burns. Citation analysis is a beneficial, however not alone sufficient to identify landmark papers, particularly for multidisciplinary fields such as burns.

Newsletter Spring 2019: Clinician Investigator Trainee Association of Canada (CITAC).

Message from the President: Demystifying and promoting the MD-PhD/MD+ world Since its inception in 2006, the Clinician-Investigator Trainee Association of Canada (CITAC) has investigated, supported and promoted the needs of Canadian trainees on track to building a career in research and medicine. Membership in CITAC signals interest in such a career as a physician/clinician/surgeon-scientist. MD+ trainees (e.g., those in Clinician Investigator Programs (CIP), MD-PhD and MD-MSc programs) are involved in discussions surrounding this dual career often enough to have a sense of what it entails. Trainees assume and trust that the training they receive, and the opportunities they seize, can lead them to the dual career. Yet, when considering practical questions about this career outcome, such as what is the success rate in landing a faculty position with that job description, we realize that much is unknown.

Muscle architecture of vastus medialis obliquus and longus and its functional implications: A three-dimensional investigation.

Vastus medialis (VM) has two partitions, longus (VML), and obliquus (VMO), which have been implicated in knee pathologies. However, muscle architecture of VMO and VML has not been documented volumetrically. The aims of this study were to determine and compare the muscle architecture of VMO and VML in three-dimensional (3D) space, and to elucidate their relative functional capabilities. Twelve embalmed specimens were used in this study. Each specimen was serially dissected, digitized (Microscribe™ MX), and modeled in 3D (Autodesk Maya®). Architectural parameters: fiber bundle length (FBL), proximal (PPA)/distal (DPA) pennation angle, and physiological cross-sectional area (PCSA) were compared using descriptive statistics/t-tests. Sarcomere lengths (SLs) were measured and compared from six biopsy sites of VM. VMO and VML were found to have superficial and deep parts based on fiber bundle attachments to aponeuroses, medial patellar retinaculum, and adductor magnus tendon. The superficial part of VMO was further subdivided into superior and inferior partitions. Architecturally, VMO was found to have significantly shorter mean FBL, greater mean PPA and DPA, and smaller mean PCSA than VML. VML was found to be connected to the fascia lata by thin fascial bands, not present in VMO. SLs of VMO and VML were comparable. VMO and VML are architecturally and functionally distinct, as evidenced by marked differences in their musculoaponeurotic geometry, attachment sites, and architectural parameters. VMO likely contributes greater to medial patellar stabilization, whereas VML, with a larger relative excursion and force-generating capability, to the extension of the knee. Clin. Anat. 32:515-523, 2019. © 2019 Wiley Periodicals, Inc.

Serratus Plane Block: A Cadaveric Study to Evaluate Optimal Injectate Spread.

BACKGROUND AND OBJECTIVES: Although serratus plane block reportedly provides satisfactory analgesia for breast and thoracic surgeries, the optimal technique for consistent success has not been studied. The goal of this anatomical study was to evaluate the impact of volume, level, and site of injection on the extent of injectate spread that can influence anesthetic coverage. METHODS: Ultrasound-guided dye injection and subsequent dissection were performed in 39 cadaveric hemithoraces. Methylene blue was injected according to 1 of 4 injection protocols as follows: one 20-mL bolus, either superficial or deep to the serratus anterior muscle (SAM), at the fifth rib level (groups SUP-20 and DEEP-20, respectively), or two 20-mL boluses, either superior or deep to the SAM, one at the third rib and one at the fifth rib level (group SUP-40 and group DEEP-40, respectively). Following injection, dissection and 3-dimensional digitization were performed to map the area of dye spread. RESULTS: We found that the extent of dye spread was mostly influenced by the volume of injection rather than the plane of injection (superficial vs deep to SAM). Increasing the volume from 20 to 40 mL doubled the area of injectate spread and promoted dye spread preferentially to the anterior chest wall, with some impact on cephalad-to-caudad spread and no impact on posterior spread. Dye was found most consistently in the axilla when a separate injection was performed at the third rib level. CONCLUSIONS: Our data showed that a high-volume double-injection technique provides extensive and consistent dye spread in the anterior chest wall and axilla, regardless of the plane of injection relative to the SAM. This technique likely provides more reliable analgesic coverage for breast procedures especially those that involve the axilla, pending confirmation in future clinical studies.

Integration of Th17- and Lymphotoxin-Derived Signals Initiates Meningeal-Resident Stromal Cell Remodeling to Propagate Neuroinflammation.

Tertiary lymphoid tissues (TLTs) have been observed in the meninges of multiple sclerosis (MS) patients, but the stromal cells and molecular signals that support TLTs remain unclear. Here, we show that T helper 17 (Th17) cells induced robust TLTs within the brain meninges that were associated with local demyelination during experimental autoimmune encephalitis (EAE). Th17-cell-induced TLTs were underpinned by a network of stromal cells producing extracellular matrix proteins and chemokines, enabling leukocytes to reside within, rather than simply transit through, the meninges. Within the CNS, interactions between lymphotoxin αß (LTαß) on Th17 cells and LTßR on meningeal radio-resistant cells were necessary for the propagation of de novo interleukin-17 responses, and activated T cells from MS patients expressed elevated levels of LTßR ligands. Therefore, input from both Th17 cells and the lymphotoxin pathway induce the formation of an immune-competent stromal cell niche in the meninges.