Christopher Alessandro

The expansion of robotic surgery has led to developments in robotic-assisted breast reconstruction techniques. Specifically, robotic flap harvest is being evaluated to help maximize operative reliability and reduce donor site morbidity without compromising flap success. Many publications are feasibility studies or technical descriptions; few cohort analyses exist. This systematic review aims to characterize trends in robotic autologous breast reconstruction and provide a summative analysis of their results. A systematic review was conducted using PubMed, Medline, Scopus, and Web of Science to evaluate robot use in breast reconstruction. Studies dated from 2006 to 2022 were identified and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Full-text, peer-reviewed, English-language, and human subject studies were included. Non-breast reconstruction articles, commentary, expert opinion, editor’s letter, and duplicate studies were excluded. A total of 17 full-text articles were analyzed. The two robotic breast procedures identified were the deep inferior epigastric perforator (DIEP) and the latissimus dorsi (LD) flap. Results showed comparable complication rates and increased operative times compared to NSQIP data on their corresponding open techniques. Additional findings reported in studies included patient reported outcomes, incision lengths, and downward trends in operative time with consecutive procedures. The available data in the literature confirms that robotic surgery is a promising alternative to traditional open methods of breast reconstruction following mastectomy.

SARS-CoV-2 is a rapidly evolving virus with many strains. Although vaccines have proven to be effective against earlier strains of the virus, the efficacy of vaccination status against later strains is still an area of active research. To determine if vaccination status was associated with symptomatology due to infection by later strains of SARS-CoV-2. This cross-sectional survey was sent to an adult Jewish population from December 2021 to March 2022. This is a population-based study of Jewish communities throughout the tristate area. The subjects were recruited by local Jewish not-for-profit and social service organizations. Surveys were sent to 14,714 adults who were recruited by local Jewish not-for-profit and social service organizations; 966 respondents completed the survey (6.57%). Only participants who received a positive COVID-19 nasal swab 10 weeks since December 1, 2021, were included in the main outcome. Participants were grouped by vaccine type (i.e., Johnson & Johnson {J&J}, Moderna, or Pfizer) and vaccination status (i.e., unvaccinated, single, full, or booster). The primary study outcome was an association between immunization status and somatological presentation. Symptom severity classes were built using latent class analysis (LCA). Out of 14,714 recipients, 966 completed the survey (6.57%). The participants were mainly self-described Ashkenazi Jewish (97%) with a median age of 41. The LCA resulted in four classes: highly symptomatic (HS), less symptomatic (LS), anosmia, and asymptomatic (AS). Vaccinated participants were less likely to be in symptomatic groups than the unvaccinated participants (odds ratio {OR}: 0.326; 95% confidence interval {CI}: 0.157-0.679; p=0.002). Boosted participants were less likely to be in symptomatic groups than fully vaccinated participants (OR: 0.267; 95% CI: 0.122-0.626; p=0.002). Additionally, there was no association between symptomatology and vaccination type (p=0.353). Participants who received COVID-19 vaccinations or booster shots were less likely to be symptomatic after Omicron infection compared to unvaccinated participants and vaccinated participants without boosters, respectively. There’s no association between vaccination type and symptomatology. These results enhance our understanding that COVID-19 vaccinations improve clinical symptomatology, even in an unforeseen COVID-19 strain.

Nephrolithiasis is universally understood to be a multifactorial disease resulting from genetic and environmental factors including gender, diet, calcium, and uric acid excretion. Notably, several of these factors may be related to body habitus. Because men are more likely to develop kidney stones and on average have a larger body size, height may be an important risk factor for stone formation. Several studies have demonstrated that short adult stature is associated with numerous conditions such as hypertension, hypercholesterolemia, and cardiovascular diseases. However, other studies have demonstrated otherwise. Additionally, stones have been shown to be correlated with a high body mass index (BMI). This is likely due to dietary factors. Although height is a component of BMI, there is minimal literature regarding the relationship of height to stone prevalence adjusting for weight. We aimed to examine whether short adult height is associated with the development of kidney stones using a population-based cohort of the National Center for Health Statistics. Data was gathered from National Health and Nutrition Examination Surveys (NHANES) “Kidney Conditions - Urology” and “Weight History” questionnaire datasets from March 2017 to March 2020 along with demographic data. Logistic regression analysis was used to determine an association between current self-reported height (inches) and if the participant has ever had kidney stones, controlling for weight, gender, age, race, educational level, and marital status. We found that those who were shorter had higher odds of reporting a history of stones (OR: 1.017; 95%CI: 1.005-1.028). This association was found after controlling for covariates such as age, gender, race, education, and weight. In addition, the male gender and Hispanic race had higher odds of reporting a history of stones (OR: 1.43 and 1.073, respectively). Our results suggest that short height is related to the prevalence of kidney stones independent of weight, age, gender, and race. This supports previous literature indicating height to be a component of renal disease.

Schools are a place for learning and education, and in a learning environment, everyone should feel safe. Gun violence is a serious concern for students and teachers alike in a school setting. There may be a multifaceted explanation for why a student would be carrying a firearm or any other weapon in school. Our research explores the association between being a victim of bullying and carrying a firearm. The national Youth Risk Behavior Surveillance System survey was utilized to assess the increased incidents of bully victims carrying firearms. Several efforts, including the passing of laws, have been made to prevent the carrying of firearms. However, additional attempts must be made to reduce bullying in schools as well, so that students do not feel the need to carry a weapon, and schools can be a safe environment for everyone.

Sleep plays a critical role in the development of adolescents. Identifying the factors influencing adolescent sleep duration is a critical public health concern. Our study was designed to look for associations that may affect sleep duration in adolescent students. A cross-sectional research method was used to evaluate a dataset of thousands of adolescent students who were polled. The study assessed whether there was a correlation between exercise and length of sleep. The research showed a statistically significant positive correlation between the studied variables. We found that while demographic variables modify this association, a positive correlation exists even after controlling for these confounders. Our findings suggest that promoting physical activity can increase the quantity of sleep among adolescents.