Establishing a regional interdisciplinary resilience center: a bottom-up approach.

Both natural and manmade disasters have severely impacted the region of Southeast Texas over the past few decades, and this has negatively affected the socio-economic well-being of the region. The state of Texas has suffered 200-250 billion dollars in damages from natural and manmade disasters since 2010. Given the region's strategic importance to the nation's energy and security, developing resilience knowledge and multi-disaster resilience research focused on issues pertaining to the region is needed. This paper describes the structure and process of building a center for multi-disaster resilience at a regional public university. By utilizing a bottom-up approach, the Center's mission and design are broadly democratized through the participation of a variety of scholars and various stakeholders with whom they interact. Resilience needs specific to the Southeast Texas region are examined, as is the relationship between resilience and the academic disciplines of the stakeholders involved. The issues of resilience in the region are discussed as well as the future steps for the Center's continued growth and development for the study of resilience.

Serratus Anterior-Rib Composite Flap as a Novel Approach for Tracheal Reconstruction.

OBJECTIVE: To report a novel case of tracheal reconstruction using a serratus anterior-rib composite flap. METHODS: Case report and literature review. RESULTS: A 46-year-old male with a 4 cm anterior tracheal wall defect underwent reconstruction with a serratus anterior-rib composite flap. The patient experienced excellent results regarding phonation, swallowing, and cosmesis. CONCLUSION: The serratus anterior-rib composite flap appears to be a suitable candidate for tracheal reconstruction and merits further analysis in this context. The flap's intrinsic incorporation of a perfused rib segment allows for reliable reconstruction of the neotrachea and maintenance of proximal dynamic airway support.

Spondylolysis.

Spondylolysis is a bony defect of the pars interarticularis and most often results from repetitive stress. Although spondylolysis is usually asymptomatic, symptomatic spondylolysis is the most common cause of identifiable back pain in children and adolescent athletes. A thorough history and physical exam, as well as appropriate imaging studies are helpful in diagnosis. General first-ine therapy for spondylolysis is conservative and consists of rest from sports, core strengthening, as well as spinal bracing. Patients who have failed conservative therapy may consider surgical repair. This article aims to review the epidemiology, pathophysiology, presentation, and treatment options of spondylolysis.

Successfully treated acute adult T-cell leukemia with haploidentical stem cell transplantation.

Adult T-cell leukemia-lymphoma caused by human T-lymphotropic virus type 1 is a rare and aggressive tumor with high morbidity and mortality. Historically it has been treated with chemotherapy, but more recent studies suggest improvement in survival with the combination of chemotherapy and stem cell transplantation. Our case study reports a middle-aged African American woman with no other risk factors diagnosed with the acute form of adult T-cell leukemia-lymphoma and in remission after completing chemotherapy and a haploidentical stem cell transplantation.

A Case of Aplastic Anemia and Colon Cancer With Underlying Spliceosome Mutation: Is It an Incidental Finding or a Novel Association?

Alternative splicing is an epigenetic mechanism that plays a role in the development and function of antigen-specific lymphocytes. One such is the zinc-finger-RNA-binding-motif-and-serine/arginine-rich-2 (ZRSR2), which is clinically implicated in myelodysplastic syndrome and leukemia. Here, we present a case of a young male with myriad autoimmune conditions and adenocarcinoma of the colon in the setting of ZRSR2 mutation. A 28-year-old male with common variable immunodeficiency disease, atopic dermatitis, autoimmune gastroenteropathy, inflammatory polyarthropathy, primary bone marrow failure, colon cancer, and family history of Lynch syndrome was admitted to our hospital for an acute flare of autoimmune enteropathy secondary to subtherapeutic tacrolimus levels. He initially developed pancytopenia at the age of 26 years. Workup for HIV, hepatitis, cytomegalovirus, human-herpesvirus 6, parvovirus was negative. Partial thromboplastin time (PTT), international normalized ratio (INR), d-dimer, ferritin, iron profile, antinuclear antibodies (ANA) screen was unremarkable. Direct, indirect, and super-combs antibodies were undetectable. Chromosomal study for Fanconi-related chromosomal breakage and telomerase gene panel was negative. Flow cytometry did not reveal an abnormal clone. Bone marrow biopsy showed markedly hypocellular marrow with reduced trilineage hematopoiesis and 1% blasts with normal cytogenetics, immunohistochemistry, fluorescence in situ hybridization (FISH), and negative for myelodysplastic syndrome and paroxysmal nocturnal hemoglobinuria (PNH). Cincinnati inherited children's bone marrow transplant (BMT) panel was negative. He was diagnosed with aplastic anemia and was treated with antithymocyte globulin, cyclosporine, prednisone, and currently tacrolimus. At the age of 26 years, he was diagnosed with colon cancer. Immunohistochemistry was positive for MLH1, but the confirmatory genetic testing for Lynch syndrome was negative. He underwent total proctocolectomy and ileostomy and is currently in remission. Next-generation sequencing of bone marrow revealed a germline homozygous ZRSR2 mutation.  ZRSR2 spliceosome mutations are more common in males as it's an X-linked gene. They are seen in myelodysplastic syndrome, leukemia, increased autoimmune phenomenon, and 35 cases of colon cancer associated with this mutation are reported. In the setting of aplastic anemia and lynch negative colon cancer, we suspect our patient could have aplastic anemia due to an autoimmune phenomenon, underlying common variable immunodeficiency disease (CVID), or the new ZRSR2 mutation could be playing a role. Further studies and research is warranted to determine its true association with the disease entities. The underlying contributing factor is ZRSR2 mutation.

Infrahyoid myocutaneous flap: A systematic review.

INTRODUCTION: The infrahyoid myocutaneous flap (IHMCF) is an often-overlooked flap of the anterior neck used for reconstruction of oral cavity and laryngopharyngeal defects. The primary goal of this systematic review is to evaluate the postoperative outcomes and efficacy of this flap. METHODS: A comprehensive search of PubMed, Biological Abstracts, CINAHL Plus, and Web of Science was conducted. Two researchers independently scrutinized the studies to determine inclusions based on relevance, sample size, and English language publications. RESULTS: Twenty-eight studies containing 1027 IHMCF cases met the inclusion criteria. Primary outcomes included flap necrosis and postoperative functional outcomes. The rate of flap survival was 99%. Total skin necrosis and partial skin necrosis were minor complications that occurred in 2.5% and 5.8% of cases respectively. Poor speech and swallowing outcomes were reported in 6.4% and 6.5% of cases respectively. The included studies were predominantly retrospective. An average MINORS score of 9.6 suggests moderate bias among the studies. CONCLUSIONS: The IHMCF is both safe and effective for repairing medium sized mucosal lesions of the head and neck region in carefully selected patients. IHMCF use in oral cavity reconstruction is particularly appealing although functional outcomes remain difficult to statistically assess. Complications of IHMCFs are rare and often minor. To ensure the best outcome, pre-surgical planning needs to be conducted and all contraindications should be respected. Further large prospective multi-centered trials are needed for more accurate analysis.