Christine H. Rohde

In 2020, the Food and Drug Administration mandated a black box warning on all breast implants, warning of an association with anaplastic large cell lymphoma (ALCL). The World Health Organization recently introduced breast implant–associated anaplastic large cell lymphoma as a new provisional entity. We identified breast implant–associated anaplastic large cell lymphoma cases diagnosed in adult women, from January 1, 2021, to December 31, 2022, following the inaugural use of the new diagnostic code within the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Age-adjusted incidence was calculated to the 2000 US standard population. The age-adjusted incidence rate of breast implant–associated anaplastic large cell lymphoma in 2021 and 2022 was 17.2 (95% confidence interval [CI] = 7.6 to 33.8) and 26.9 (95% CI = 14.8 to 45.5) per 100 million person-years, respectively, which increased compared with our prior estimate for 2012-2018 (14.5 to 19.6 cases per 100 million person-years) and substantially exceeded the US Food and Drug Administration’s earlier estimate for 2001-2007 (3 cases per 100 million persons-years). This study presents the first population-based incidence rate estimations of breast implant–associated anaplastic large cell lymphoma, which is increasing rapidly in the United States.

Background.: We previously reported a porcine model of vascularized composite allograft (VCA) transplantation with concurrent hematopoietic cell transplantation (HCT). Tolerance developed when major histocompatibility complex (MHC) class I was matched in the absence of class II matching but not when class II was matched without class I matching. We investigated whether rejection resulted from a mismatch between class I and class II. Methods.: Recipient pigs were either mismatched from donors by a single class I haplotype or matched by a single class II haplotype. They received CD3 immunotoxin and total-body irradiation followed by HCT and VCA transplantation from the same donor. Cyclosporine immunosuppression was discontinued after 45 d. Results.: Pigs mismatched for only 1 MHC class I haplotype maintained peripheral chimerism and accepted the VCA graft, except for 1 animal that rejected the epidermis. Pigs matched for only 1 MHC class II haplotype lost bone marrow engraftment and rejected the VCA graft. Conclusions.: When combined with our prior experiments, our results suggest that some degree of MHC class I matching is necessary for tolerance induction to HCT/VCA, but this is dependent on the degree of class II matching. Full class I matching reliably generates VCA tolerance, regardless of the degree of class II matching. VCA tolerance fails to develop reliably when MHC class I is fully mismatched, regardless of the degree of class II matching. When a single class I haplotype is matched, VCA tolerance depends on the degree of class II matching.

Introduction: Attrition from academic research, defined as cessation of publication, may be influenced by access barriers to professional and academic development. It is currently unknown how these considerations affect plastic surgeons, despite trends of increasing research demands in the field. This study quantifies trends in academic attrition among currently practicing plastic surgeons across three decades. Methods: A longitudinal cohort study was conducted with a cohort of American plastic surgeons with academic publications since 2000. The main outcome of interest was attrition, quantified as a lack of academic publication in the last three years or more. The probability of attrition over time was measured with Kaplan-Meier curves, and predictors of attrition were evaluated with a Cox proportional hazards model (pppp<0.05) independently predicted a lower likelihood of attrition over time. In a sensitivity analysis that included only those who began publishing in 2010 or later, gender was no longer a significant predictor of attrition (HR: 0.98, 95% CI: 0.75-1.29, p = 0.90). Conclusion: Attrition rates are predicted by surgeon gender, academic affiliation, and fellowship training. These trends highlight continued gender imbalances in the field of plastic surgery and the need for organizational shifts that foster growth for all physicians who desire to continue academic research.