Understanding Fatal Fat Embolism in Gluteal Lipoinjection: Analysis of 16 Autopsies Under the Loupe

Background: Deaths secondary to gluteal lipoinjection are relatively recent events of major importance. However, little is known in relation to their behavior and clinical evolution. Therefore, an analysis was performed of case records from clinical cases that encountered this problem, correlating the results with the findings during autopsies. Material and methods: An analysis was performed of records from patients who died secondary to gluteal lipoinjection. Patient-specific data, surgical procedure, clinical picture, evolution and outcome were analyzed. The findings of the autopsies and the involvement of other organs were also analyzed and correlated. Results: From 2000 to 2009, 16 files were obtained that fulfilled the indicated requirements. There were no statistically significant differences in the general characteristics of the patients, such as age, BMI or lipoinjected or liposuction volume. The clinical pictures were similar in all cases, and the autopsy findings showed the presence of microembolism in all cases and macroembolism in the most severe cases. CONCLUSIONS: The most significant parameter of severity in patients who undergo gluteal lipoinjection is the presence of fat in macroscopic form in the circulation. The volumes of liposuctioned or lipoinjected fat have little influence. Hypoxemia, hypotension and bradycardia are the characteristic clinical features. Although there is no specific treatment, immediate aggressive vital support to attempt to stabilize the patient is crucial. Financial disclosure and products: The authors have no conflict of interest to declare in relation to the content of this article Corresponding Author, Contact Information: Lázaro Cárdenas-Camarena MD, INNOVARE Cirugía Plástica Especializada, Av Verona 7412. Col Villa Verona, Zapopan, Jalisco, México 45019, drlazaro@drlazarocardenas.com ©2018American Society of Plastic Surgeons

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The Feasibility Determination of Risky Severe Complications of Arterial Vasculature Regarding to the Filler Injection Sites at the Tear Trough

Background: The tear trough is a significant sign of the eye and periorbital aging and has been usually corrected with filler injection. However, the arterial supply surrounding the tear trough could be inadvertently injured during injection; therefore, this study aimed to evaluate the nearest arterial locations related to the tear trough and investigate the possibility of severe complications following filler injection. Methods: Thirty hemi-faces of 15 Thai embalmed cadavers were utilized in this study. Results: The artery located closest to both the inferior margin (TT1) and mid pupil level (TT2) of tear trough was found to be the palpebral branch of the infraorbital artery. Furthermore, at 0.5 mm along the tear trough from the medial canthus (TT3), the angular artery was identified which was a found to be a branch of ophthalmic artery. The artery at TT1 and TT2 was located both of the zygomaticus major muscle and orbicularis oculi muscle. The distances from TT1 to the artery were measured as follows; laterally. 2.79 ± 1.08 mm along the X-axis and inferiorly 2.88 ± 1.57 mm along the Y-axis. For the TT2, the artery was located infero-medially from the landmark of 4.65 ± 1.83 mm along the X-axis and 7.13 ± 3.99 mm along the Y-axis. However, the distance along the X-axis at TT3 was located medially as 4.00 ± 2.37 mm. Conclusion: The high risky injured artery at the tear trough should be considered due to the numerous arterial supplies which accompany the facial artery and traverse at varying tissues depths to this area. Financial Disclosure Statement: All authors have nothing to disclose. No funding was received for this article. Acknowledgments: The 100th Anniversary Chulalongkorn University Fund for Doctoral Scholarship from the Graduate School, Chulalongkorn University Corresponding author: Tanvaa Tansatit, MD, MSc, Department of Anatomy, Faculty of Medicine, and The Chula Soft Cadaver Surgical Training Center, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok 10330 Thailand. E-Mail: orange_anatomist@hotmail.com ©2018American Society of Plastic Surgeons

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Clinical Implications of Gluteal Fat Graft Migration – A Dynamic Anatomic Study.

Background: The intraoperative mortality and overall complication rate for gluteal augmentation with fat transplantation is unacceptably high. The current controversy among experts regarding safety is whether fat should be placed within the gluteus muscle or only limited to the subcutaneous space. The purpose of the present study is to test the hypothesis that under certain pressures, fat injected within the gluteal muscle can actually migrate out of the muscle and into a deeper plane containing critical neurovascular structures, via the process of Deep Intramuscular Migration. Methods: A total of eight human cadaver dissections were performed. Four hemi-buttocks were selected for intramuscular fat injection. The patterns of sub-fascial fat migration were evaluated in three of these hemi-buttocks by direct visual inspection and in one hemi-buttock by endoscopic evaluation. Four other hemi-buttocks were selected for subcutaneous or supra-fascial fat injection. Results: Proxy fat was found to migrate through the muscle and into the deep submuscular space with each intramuscular injection. With subcutaneous injection, no proxy fat was found during dissection in the intramuscular septae or submuscular space. Conclusion: The intramuscular insertion of fat, which up to this point has been considered reasonable to perform in the superficial muscle and even recommended in the literature, is now deemed to be an inexact and risky surgical technique. This technique, because of its migratory nature, should be avoided from further use in fat transplantation to the gluteal region. Disclosures: Rod J. Rohrich, MD receives instrument royalties from Eriem Surgical, Inc and book royalties from Thieme Medical Publishing, he is a Clinical and Research Expert for Allergan, Inc and MTF Biologics, and the Owner of Medical Seminars of Texas, LLC. No funding was received for this article Dr. Del Vecchio is a founder of Surgistem Technologies, LLC; a device company involved in fat transplantation, receives royalties from Microaire, and is a founding member of Peninsula Partners, LLC a consulting firm in the plastic surgery sector. Acknowledgements: Dr. Rod Rohrich Research Fund from UT Southwestern Department of Plastic Surgery, Garret Adams of Stryker for compartment pressure monitor, Jourdan Carboy for illustrations and the Willed Body Program UTSW Corresponding Author: Daniel A. Del Vecchio, MD, 38 Newbury Street, Boston, MA 02116, Fatvsfiction@gmail.com ©2018American Society of Plastic Surgeons

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“The Impact of Upper Face Botulinum Toxin Injections on Eyebrow Height and Forehead Lines: A Randomized Controlled Trial and an Algorithmic Approach to Forehead Injection”

Background: No previous study has objectively evaluated the effect of different forehead injection patterns on the eyebrow height and forehead lines. Methods: The patients were divided into three groups. Botulinum toxin was injected in both the lateral and medial eyebrow depressors in all groups. The frontalis was injected using either a V-pattern (group1), a middle horizontal pattern (group 2) or a high horizontal pattern (group 3). Objective eyebrow measurements were performed using standardized pre-and- post injection photographs. Validated photonumeric scales were used to assess the forehead lines. Results: 15 patients (30 eyebrows) were included in each group. In all the groups, 2 weeks after the injection, the brow was lower at all the measured positions in the exception of the lateral brow edge that was higher in the 3 injection patterns. No difference was found when comparing group 1 to groups 2 and 3. The middle forehead injection pattern lowered the eyebrow more than the upper forehead injection pattern. The 3 techniques improved the forehead lines at rest and with contraction. The forehead lines with contraction were more improved in group 1 when compared to both groups 2 and 3. Conclusion: Each forehead injection pattern yielded different results on forehead lines and eyebrow position. Upper forehead injections were less effective on forehead lines but prevented eyebrow ptosis. Financial Disclosure Statement: All the authors have nothing to disclose. No funding was received for the article. List of product used: Dysport© (Ipsen Ltd, Berks, UK) Ethical approval was obtained from the institutional review board of Hotel Dieu de France Hospital, Beirut, Lebanon. All participating patients gave informed written consent. Clinical trial registration information: Name of trial database: ClinicalTrials.gov Registration number: NCT03186001 URL: https://ift.tt/2P4J7TC Corresponding author: Samer Jabbour, MD, Faculty of Medicine Saint-Joseph University Hotel Dieu de France Hospital, Alfred Naccash boulevard, samermed@gmail.Com ©2018American Society of Plastic Surgeons

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Familial Aggregation of Plastic Surgical Procedures

Summary: A growing number of patients seeking plastic surgical procedures in our practice are first-degree relatives of our previous surgical patients. Three possibilities exist as to the coalescence of procedures within a family unit: 1) the morphologic and anatomical patterns are conserved and passed on within relatives; 2) a captive "audience" (family members) appreciates firsthand the surgical result and positive difference, be it functional or aesthetic for their relative, or 3) the rapport established between surgeon and patient lead that patient to recommend his or her surgeon to others. The purpose of this study is to identify our recent cohort of family members undergoing similar or related procedures by the same surgeon (DMS), and understand the diagnoses, factors, and rationale for "passing the torch" to other family members to undergo surgery. Survey responses from 17 members of 10 families who sought elective procedures after an index family member indicated that both the result of the first surgery and rapport with the surgeon were important factors in their decision to undergo surgery (mean Likert response = 4.94; SD=0.24). 94% of family members (n=16/17) indicated that the result of the original procedure was the most important factor in their decision to undergo subsequent procedures with the same surgeon. 88% of family members (n=15/17) seeking subsequent procedures indicated that they were not considering undergoing surgery prior to observing the result of the first procedure in their family. The data demonstrate the importance of achieving an excellent surgical result in earning the trust of patients and establishing strong family referral patterns. ©2018American Society of Plastic Surgeons

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Role of gender in the treatment experiences of people with an eating disorder: a metasynthesis

Abstract

Background

Traditionally perceived as a disorder of women, Eating Disorders (EDs) are known to have impacts on people irrespective of their gender. This study is designed to synthesise the available qualitative research studies to more broadly understand the diverse experiences of ED and their treatment, specifically in relationship to issues of gender.

Methods

The methodology involved a systematic search and quality appraisal of the literature published after 1980 using terms that aimed to represent the primary concepts of "role of gender" and "treatment experiences" and "eating disorders". Nine qualitative studies met the inclusion criteria. Meta-themes were inductively generated through a synthesis of data across themes from the relevant included papers.

Results

Analysis of data was constructed around three meta-themes, each with subthemes. The first meta-theme "Out of sight, out of mind" depicted the experience of gender issues that were marginalised in treatment. More specifically for transgender people, when gender issues were ignored by treatment providers, this frequently led to non-disclosure of their gender identity. Furthermore, men were less likely to be assessed for an eating disorder and within this context; diagnosis of an ED and referral to specialist treatment was frequently hindered. The second meta-theme "Lack of literacy among health care providers" focused on issues related to misdiagnosis of EDs, and the question of whether this was related to a lack of health literacy amongst health professionals. The final theme "Pathways into treatment that address stigma and other barriers" highlighted the need for the development of future treatment interventions address the complex social reality of the experiencing person, including questions of gender.

Conclusion

Gender issues impact upon the ED experience and require broader consideration in the development and evaluation of ED treatment interventions, including the further development of gender-informed interventions.

Trial registration

Protocol registered on PROSPERO 2017 CRD42017082616.

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Bilateral breast reconstruction and pectus excavatum correction: a case and review of the literature

Abstract

Pectus excavatum is a chest wall malformation characterized by anterior chest wall depression. It is often associated with hypoplastic breasts, sternal rotation, and consequent breast asymmetry. We present here the case of a 52-year-old female with pectus excavatum, a bilateral nipple-sparing mastectomy for breast cancer, and immediate autologous breast reconstruction using bilateral deep inferior epigastric perforator flaps. To correct reconstructed breast deformities and pectus excavatum depression and to enhance breast volume to treat hypoplastic breasts, three sessions of Brava-assisted fat grafting were performed. These postoperative courses were uneventful and without any complications. The patient was satisfied with the final esthetic results. There are only two case reports to perform bilateral breast reconstruction and surgical correction of pectus excavatum, which were used with both pedicle musculocutaneous flap and breast implant, with or without a sternal implant. In this study, we discuss indications and surgical options for bilateral breast reconstruction, pectus excavatum, and breast augmentation.

Level of Evidence: Level V, therapeutic study.

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Scholar : International Journal of Oncology - Volume:53 Number:4

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TABLE OF CONTENTS October-2018 Volume 53 Issue 4

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Liquid biopsy and PCR-free ultrasensitive detection systems in oncology (Review) Alessia Finotti, Matteo Allegretti, Jessica Gasparello, Patrizio Giacomini, Demetrios A. Spandidos, Giuseppe Spoto, Roberto Gambari View Abstract ❯
Novel insights into ion channels in cancer stem cells (Review) Qijiao Cheng, Anhai Chen, Qian Du, Qiushi Liao, Zhangli Shuai, Changmei Chen, Xinrong Yang, Yaxia Hu, Ju Zhao, Songpo Liu, Guo Rong Wen, Jiaxin An, Hai Jing, Biguang Tuo, Rui Xie, Jingyu Xu View Abstract ❯
Cinnamtannin B-1 inhibits cell survival molecules and induces apoptosis in colon cancer Patrick P. Carriere, Neeraj Kapur, Hina Mir, Ashley B. Ward, Shailesh Singh View Abstract ❯
Upregulation of PD‑L1 expression by resveratrol and piceatannol in breast and colorectal cancer cells occurs via HDAC3/p300‑mediated NF‑κB signaling Justin Lucas, Tze-Chen Hsieh, H. Dorota Halicka, Zbigniew Darzynkiewicz, Joseph M. Wu View Abstract ❯
Translationally controlled tumor protein affects colorectal cancer metastasis through the high mobility group box 1-dependent pathway Maoliang Huang, Yan Geng, Qiaoting Deng, Ru Li, Xiangyang Shao, Zhigao Zhang, Weiwen Xu, Yingsong Wu, Qiang Ma View Abstract ❯
MicroRNA-488 inhibits proliferation, invasion and EMT in osteosarcoma cell lines by targeting aquaporin 3 Jing Qiu, Yongzhi Zhang, Hu Chen, Zhi Guo View Abstract ❯
miR‑92b promotes autophagy and suppresses viability and invasion in breast cancer by targeting EZH2 Fei Liu, Meixiang Sang, Lingjiao Meng, Lina Gu, Shina Liu, Juan Li, Cuizhi Geng View Abstract ❯
Establishment of three novel cell lines derived from African American patients with colorectal carcinoma: A unique tool for assessing racial health disparity Jenny Paredes, Ping Ji, Joseph F. Lacomb, Kenneth R. Shroyer, Laura A. Martello, Jennie L. Williams View Abstract ❯
Competing endogenous RNA analysis reveals the regulatory potency of circRNA_036186 in HNSCC Wen-Long Wang, Zhi Yang, Yi-Juan Zhang, Ping Lu, You-Kang Ni, Chang-Fu Sun, Fa-Yu Liu View Abstract ❯
CX3CL1/fractalkine enhances prostate cancer spinal metastasis by activating the Src/FAK pathway Peng Liu, Yun Liang, Libo Jiang, Houlei Wang, Shengxing Wang, Jian Dong View Abstract ❯
Downregulation of HOXA3 in lung adenocarcinoma and its relevant molecular mechanism analysed by RT-qPCR, TCGA and in silico analysis Bin-Liang Gan, Rong-Quan He, Yu Zhang, Dan-Ming Wei, Xiao-Hua Hu, Gang Chen View Abstract ❯
Intraperitoneal neutrophils activated by KRAS-induced ovarian cancer exert antitumor effects by modulating adaptive immunity Mitsuyo Yoshida, Ayumi Taguchi, Kei Kawana, Juri Ogishima, Katsuyuki Adachi, Akira Kawata, Hiroe Nakamura, Masakazu Sato, Asaha Fujimoto, Tomoko Inoue, Kensuke Tomio, Mayuyo Mori, Takeshi Nagamatsu, Takahide Arimoto, Kaori Koga, Osamu Wada Hiraike, Katsutoshi Oda, Tohru Kiyono, Yutaka Osuga, Tomoyuki Fujii View Abstract ❯
Upregulation of miR-96 promotes radioresistance in glioblastoma cells via targeting PDCD4 Pin Guo, Yanan Yu, Zibin Tian, Yingying Lin, Yongming Qiu, Weicheng Yao, Lijuan Zhang View Abstract ❯
A miR-26a/E2F7 feedback loop contributes to tamoxifen resistance in ER-positive breast cancer Jian Liu, Xiang Li, Meng Wang, Guodong Xiao, Ganghua Yang, Huangzhen Wang, Yanbo Li, Xin Sun, Sida Qin, Ning Du, Hong Ren, Yamei Pang View Abstract ❯
Effects of β-caryophyllene on arginine ADP-ribosyltransferase 1-mediated regulation of glycolysis in colorectal cancer under high-glucose conditions Li Zhou, Mu-Lu Zhan, Yi Tang, Ming Xiao, Ming Li, Qing-Shu Li, Lian Yang, Xian Li, Wen-Wen Chen, Ya-Lan Wang View Abstract ❯
Inositol hexaphosphate limits the migration and the invasiveness of colorectal carcinoma cells in vitro Ladislava Schröterová, Alena Ježková, Emil Rudolf, Kateřina Caltová, Věra Králová, Veronika Hanušová View Abstract ❯
Clinical significance of growth factor receptor EGFR and angiogenesis regulator VEGF‑R2 in patients with ovarian cancer at FIGO stages I-II Ingiridur Skirnisdottir, Helena Åkerud, Tomas Seidal View Abstract ❯
TRIM2 regulates the development and metastasis of tumorous cells of osteosarcoma Yi Qin, Jichao Ye, Fulan Zhao, Shaoyu Hu, Suwei Wang View Abstract ❯
2,3,7,8‑Tetrachlorodibenzo‑p‑dioxin suppresses the growth of human liver cancer HepG2 cells in vitro: Involvement of cell signaling factors Masayoshi Yamaguchi, Oliver Hankinson View Abstract ❯
Radiosensitization by irinotecan is attributed to G2/M phase arrest, followed by enhanced apoptosis, probably through the ATM/Chk/Cdc25C/Cdc2 pathway in p53-mutant colorectal cancer cells Yaqi Wang, Lifeng Yang, Jing Zhang, Menglong Zhou, Lijun Shen, Weijuan Deng, Liping Liang, Ran Hu, Wang Yang, Ye Yao, Hui Zhang, Zhen Zhang View Abstract ❯
Anti-adult T‑cell leukemia/lymphoma activity of cerdulatinib, a dual SYK/JAK kinase inhibitor Chie Ishikawa, Masachika Senba, Naoki Mori View Abstract ❯
Transcriptional activation of miR-320a by ATF2, ELK1 and YY1 induces cancer cell apoptosis under ionizing radiation conditions Zheng Hu, Yi Tie, Guixiang Lv, Jie Zhu, Hanjiang Fu, Xiaofei Zheng View Abstract ❯
Modulation of G6PD affects bladder cancer via ROS accumulation and the AKT pathway in vitro Xiaoyi Chen, Zhijie Xu, Zhijian Zhu, Anqi Chen, Guanghou Fu, Yimin Wang, Hao Pan, Baiye Jin View Abstract ❯
Anaplastic transition within the cancer microenvironment in early-stage oral tongue squamous cell carcinoma is associated with local recurrence Kohei Okuyama, Keiji Suzuki, Souichi Yanamoto, Tomofumi Naruse, Hiroki Tsuchihashi, Shunichi Yamashita, Masahiro Umeda View Abstract ❯
Identification of fatal outcome in a childhood nasopharyngeal carcinoma patient by protein expression profiling Mohamed E.M. Saeed, Rolf Mertens, Rupert Handgretinger, Thomas Efferth View Abstract ❯
miR-200b/c targets the expression of RhoE and inhibits the proliferation and invasion of non-small cell lung cancer cells Qiulin Tang, Mingxing Li, Liang Chen, Feng Bi, Hongwei Xia View Abstract ❯
The tumorigenic role of DSPP and its potential regulation of the unfolded protein response and ER stress in oral cancer cells Ioannis Gkouveris, Nikolaos G. Nikitakis, Jaya Aseervatham, Kalu U.E. Ogbureke View Abstract ❯
Circular RNA‑MTO1 suppresses breast cancer cell viability and reverses monastrol resistance through regulating the TRAF4/Eg5 axis Yunxiao Liu, Yanyan Dong, Liping Zhao, Lihong Su, Jin Luo View Abstract ❯
Knockdown of TWIST enhances the cytotoxicity of chemotherapeutic drugs in doxorubicin-resistant HepG2 cells by suppressing MDR1 and EMT Rong Li, Changli Wu, Hongying Liang, Yinghai Zhao, Chunyan Lin, Xiujuan Zhang, Caiguo Ye View Abstract ❯
Lewis(y) antigen-mediated positive feedback loop induces and promotes chemotherapeutic resistance in ovarian cancer Juanjuan Liu, Mingjun Zheng, Yue Qi, Huimin Wang, Miao Liu, Qing Liu, Bei Lin View Abstract ❯
Exogenous expression of miRNA-3613-3p causes APAF1 downregulation and affects several proteins involved in apoptosis in BE(2)-C human neuroblastoma cells Iwona Nowak, Elżbieta Boratyn, Małgorzata Durbas, Irena Horwacik, Hanna Rokita View Abstract ❯
MicroRNA-552 links Wnt signaling to p53 tumor suppressor in colorectal cancer Bomi Kwak, Dong Uk Kim, Tae Oh Kim, Heui-Soo Kim, Sang-Woo Kim View Abstract ❯
Interleukin‑17A and heparanase promote angiogenesis and cell proliferation and invasion in cervical cancer Qiongying Lv, Kejia Wu, Fulin Liu, Wanrong Wu, Yurou Chen, Wei Zhang View Abstract ❯

20-22 September, 2018, Metropolitan Hotel, Athens, Greece 23nd World Congress on Advances in Oncology & 22th International Symposium on Molecular Medicine 18-19 September 2018, Pre-Congress Workshop: 'MicroRNA Analysis'

28-30 March, 2019, Tawana Hotel, Bangkok, Thailand 23 rd International Symposium on Molecular Medicine

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Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers

J reconstr Microsurg
DOI: 10.1055/s-0038-1667363

Background Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation. The primary aim of this study was to examine reconstructive and functional outcomes in patients who underwent free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) at our tertiary referral center for advanced limb salvage. Methods Between June 2013 and June 2016, 29 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (K.K.E.). In all cases, microsurgical reconstruction was offered as an alternative to major amputation for the management of recalcitrant DFUs. Overall rates of flap survival, limb salvage, and postoperative ambulation were evaluated. The lower extremity functional scale (LEFS) score was used to assess functional outcomes after surgery. Results Overall rates of flap success and lower limb salvage were 93 and 79%, respectively. Flap failure occurred in two patients with delayed microvascular compromise. Seven patients in this series ultimately required below-knee amputation secondary to recalcitrant infection (n = 5), intractable pain (n = 1), and limb ischemia (n = 1). The average interval between FTT and major amputation was 8 months (r, 0.2–15 months). Postoperative ambulation was confirmed in 25 patients (86%) after a mean final follow-up of 25 months (r, 10–48 months). The average LEFS score for all patients was 46 out of 80 points (r, 12–80 points), indicating the ability to ambulate in the community with some limitations. Conclusions FTT for the management of recalcitrant DFUs is associated with high rates of reconstructive success and postoperative ambulation. However, several patients will eventually require major amputation for reasons unrelated to ultimate flap survival. These data should be used to counsel patients regarding the risks, functional implications, and prognosis of microvascular diabetic foot reconstruction.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

J reconstr Microsurg
DOI: 10.1055/s-0038-1667364

Background Indocyanine green (ICG) videoangiography is routinely used to evaluate skin and organ perfusion and to assess patency rates of microvascular anastomoses. This study uses ICG angiography as a novel approach to qualitatively and quantitatively evaluate bone perfusion of microvascular fibula grafts intraoperatively and to assess the effect of fibula segment length and number of osteotomies on bone perfusion. Methods All patients planned for mandible reconstruction using a microvascular fibula graft between January 2013 and May 2017 were considered for this study. ICG videoangiography of cancellous bone perfusion was performed using a handheld ICG camera. Videos were analyzed, and a perfusion curve was generated. Peak enhancement, time to peak, slope, and wash-in area under the curve were extracted; rise time, wash-in rate (WiR), and wash-in perfusion index were calculated. Results were statistically analyzed with regard to distal fibula segment length and number of osteotomy sites. Results Thirty-nine patients (age 59 ± 8 years) were included in the study. Mandible reconstruction was achieved with 1 (n = 15), 2 (n = 13), or 3 (n = 11) fibula segments. The WiR was 6.4 ± 2.3 and 4.4 ± 0.2 before and after proximal osteotomy, respectively. The wash-in perfusion index was 114.2 ± 48.4 before and 84.4 ± 20.0 after proximal osteotomy. Bone perfusion was significantly reduced after additional proximal osteotomies. Both the segment length and number of proximal osteotomies correlated with bone perfusion, with longer segments and fewer osteotomies showing higher perfusion. Conclusions This study demonstrates the feasibility of cancellous bone perfusion analysis using ICG and can serve as a basis for future bone perfusion studies. Additional osteotomies and short segment length negatively affects cancellous bone perfusion of the distal fibula segment in free fibula flaps. The extent to which the observed decrease in arterial inflow to the distal fibula segment affects the further course of healing needs to be addressed in future studies.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Cryogenic Numbing to Reduce Injection Discomfort during Indocyanine Green Lymphography

J reconstr Microsurg
DOI: 10.1055/s-0038-1667362

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Impact of Contralateral Symmetry Procedures on Long-Term Patient-Reported Outcomes following Unilateral Prosthetic Breast Reconstruction

J reconstr Microsurg
DOI: 10.1055/s-0038-1667365

Background One aim of unilateral postmastectomy breast reconstruction (BR) is to restore symmetry with the contralateral breast. As such, unilateral prosthetic reconstruction often requires a contralateral symmetry procedure (CSP). There is sparse literature on the impact of CSPs on long-term patient-reported outcomes (PROs) such as satisfaction and health-related quality of life (HRQoL). This study aims to describe PROs following CSPs, using a validated PRO tool, BREAST-Q. The hypothesis is that CSPs are associated with greater patient-reported satisfaction and HRQoL. Methods This study is a single institutional analysis of prospectively collected BREAST-Q scores of patients who underwent unilateral prosthetic BR during 2011 to 2015. Women 18 years and older with BREAST-Q scores measured ≥ 9months after BR with or without CSP(s) at the time of expander replacement were included. Patients were classified into four subcohorts: augmentation, mastopexy, reduction, and no symmetry procedure (controls). Sociodemographic, clinical characteristics, and BREAST-Q scores were analyzed. Multivariable linear regression was performed. Results Of 553 patients, 67 (12%) underwent contralateral augmentation, 68 (12%) mastopexy, 93(17%) reduction, and 325 (59%) were controls. Mean follow-up time was 52 months. Satisfaction with breast and outcomes were higher in the augmentation compared with the control groups (p = 0.01). On multivariable analysis, augmentation remained an independent predictor of satisfaction with breast (p = 0.04). Physical well-being scores were lower for contralateral mastopexy and reduction compared with the controls with a trend toward statistical significance on multivariable models. Psychological and sexual well-being was similar across groups. Conclusion Prosthetic reconstruction with contralateral breast augmentation was associated with greater satisfaction with breast and reconstructive outcome. In contrast, breast reduction and mastopexy procedures demonstrated equivalent satisfaction with breasts compared with controls but may be associated with lower physical well-being. Such information can be used to improve the shared decision-making process for women who choose unilateral prosthetic BR.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Outcome following Sternal Reconstruction with the Omental Flap

J reconstr Microsurg
DOI: 10.1055/s-0038-1668136

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A Hyperbaric Warm Perfusion System Preserves Tissue Composites Ex vivo and Delays the Onset of Acute Rejection

J reconstr Microsurg
DOI: 10.1055/s-0038-1667298

Background Ischemia–reperfusion injury (IRI) precipitates acute rejection of vascularized composite allografts (VCA). Hyperbaric preservation of tissues ex vivo, between harvest and revascularization, may reduce IRI and mitigate acute rejection of VCA. Methods A porcine heterotopic musculocutaneous gracilis flap model was used. In phase 1, control autografts (n = 5) were infused with University of Wisconsin Solution (UWS) and stored at 4°C for 3 hours. Intervention autografts (n = 5) were placed in a hyperbaric oxygen organ preservation system for 5 hours and infused with hyperoxygenated UWS at 20°C and 3 atm. Grafts were replanted into the animals' necks. In phase 2, similarly treated control (n = 8) and intervention grafts (n = 8) were allotransplanted into the necks of animals separated by a typed and standardized genetic mismatch. No systemic immunosuppression was given. Systemic markers of IRI, and clinical and histopathological assessments of necrosis and rejection were performed. Results Autotransplanted tissue composites preserved in the hyperbaric chamber showed histopathological evidence of less muscle necrosis at 3 hours (p = 0.05). Despite a longer period of ischemia, no evidence was found of a difference in systemic markers of IRI following revascularization in these groups. Allotransplanted tissues supported ex vivo within the hyperbaric perfusion device experienced acute rejection significantly later than corresponding controls. Conclusions Hyperbaric warm perfusion preserves musculocutaneous tissue composites ex vivo for longer than standard cold preservation in this model. This translates into a delay in acute rejection of allotransplanted tissue composites.
[...]

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Hand Perfusion in Patients with Physiological or Pathological Allen's Tests

J reconstr Microsurg
DOI: 10.1055/s-0038-1668159

Introduction The Allen test (AT) is a widely used clinical tool for the preoperative assessment of sufficient dual vessel hand perfusion although the impact of a pathological AT on tissue perfusion of the hand is not entirely clear. This study reveals perfusion changes of the hand in patients with pathological and physiological AT after terminating the dual blood supply. Methods Patients were distributed into 2 groups (physiological and pathological AT) that each contained 25 members. Perfusion of the thumb, middle, and small fingers was measured with a laser Doppler based ("oxygen-to-see" [O2C]) device. A steady state was measured and also values at 1, 3, 5, and 10 minutes after radial occlusion were measured. Results In patients with a physiological AT, only 1 out of 18 values differed significantly from the steady state measurements after 10 minutes, whereas patients with a pathological AT showed significant alterations in 8 out of 18 values. Oxygen saturation of the superficial and deep tissues appeared to be significantly worse in patients with a pathological AT. Conclusion Patients with a pathological AT suffered significantly more from the loss of dual hand perfusion than patients with a physiological AT. Patients with a pathological AT need more time to compensate for the altered perfusion pattern.
[...]

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Exercise-Loaded Indocyanine Green Fluorescence Lymphangiography for Diagnosing Lymphedema

J reconstr Microsurg
DOI: 10.1055/s-0038-1667366

Background Indocyanine green (ICG) fluorescence lymphography (ICGLG) that can visualize the lymphatic vessel and its flow noninvasively and dynamically was developed in 2007. It is frequently used to observe the function and pathway of the lymphatic vessels. ICGLG is simple and easy to perform, and it is useful for understanding the condition of the lymphatic system in real time. However, its protocol is not standardized. In addition, the lymphatic flow is enhanced by an exercise load such as walking. Till now, there is no report of exercise-loaded ICGLG. Therefore, we aimed to shorten the examination time and establish a standard ICGLG protocol. Methods We examined 63 patients (126 lower limbs) who visited our clinic for lower extremity edema. We observed detailed images of exercise-loaded ICGLG and examined the changes in findings over time in affected legs classified according to the International Society of Lymphedema. After ICG was injected, the participants exercised for 30 minutes. We observed the farthest proximal point where any ICG could be observed and the appearance of dermal backflow (DB), which is a specific finding of lymphedema, every 5 minutes. Results The proximal migration speed of ICG tended to slow as the disease stage worsened. For all disease stages, after 20 minutes of exercise, the DB appearance rate did not change further. The rates were 0% for legs with stage 0 lymphedema, 50% for legs with stage 1 lymphedema, and 100% for legs with stages 2a and 2b lymphedema. Conclusions The appropriate exercise duration after ICG injection is 20 minutes. ICGLG is useful for screening for lymphedema.
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Volume Change of Pedicled Latissimus Dorsi Muscle Flap after Partial Breast Reconstruction

J reconstr Microsurg
DOI: 10.1055/s-0038-1667176

Introduction Despite successful breast reconstruction with oversized latissimus dorsi muscle flap after breast-conserving surgery for breast cancer, esthetic problems continue to exist due to flap shrinkage. The purpose of this study was to evaluate the objective volume change of pedicled latissimus dorsi muscle flap when it is used in breast reconstruction. Methods Patients who were diagnosed with breast cancer and underwent a breast-conserving surgery with immediate breast reconstruction with pedicled latissimus dorsi myocutaneous flap between October 2009 and November 2015 were studied. Eleven patients who were followed up for more than 1 year after operation were included in the study. We evaluated the volume of muscle portion of the latissimus dorsi myocutaneous flap with computed tomography (CT) scan. We analyzed the rate of volume change of the latissimus dorsi muscle every year until 5 years after the operation. Result The latissimus dorsi muscle flaps of all 11 patients showed a volume decrease over time. The rate of volume change of the latissimus dorsi muscle flaps decreased 8.04% in the first year, 6.36% in the second year, 5.05% in the third year, 2.88% in the fourth year, and 2.56% in the fifth year after operation in average. Conclusion This research shows the possibility of objectively evaluating the volume change of pedicled latissimus dorsi muscle flaps after breast reconstruction. The findings will be helpful in designing the size of the flaps to use on defects after breast-conserving surgery.
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Laser Depigmentation in Extensive Vitiligo

No abstract available

https://ift.tt/2KNEA4q

Platelet-Rich Plasma Augments Subcision in Atrophic Acne Scars: A Split-Face Comparative Study

BACKGROUND Acne has a prevalence of 90% among adolescents. Facial scarring affects 75% of patients. Autologous platelet-rich plasma (PRP) is a novel treatment option for acne scar management and can be used as an adjuvant to acne scar revision procedures. Owing to its remodeling properties, PRP when used as an adjuvant reduces the total number of sittings. OBJECTIVE To compare efficacy of autologous PRP and subcision against subcision alone in acne scars. METHODOLOGY It was an experimental analytical study conducted over a period of 2 years. Forty patients successfully completed the trial. It was a split-face study in which the right side of the face was the study side where autologous PRP was injected into each scar after performing subcision. The left side of the face was the control side where only subcision was performed. Digital photographs were taken at every sitting. Analysis was performed using the Wilcoxon signed-rank test and Mann–Whitney tests in SPSS software. RESULTS Platelet-rich plasma and subcision showed greater improvement (32.08%) in postacne scars as compared to subcision alone (8.33%). Rolling acne scars responded greatest (39.27%) followed by box-type scars (33.88%). CONCLUSION Platelet-rich plasma and subcision act synergistically to improve the appearance of acne scars. Address correspondence and reprint requests to: Vasudha Belgaumkar, MBBS, MD (Skin VD), Department of Dermatology, B.J. Medical College, Pune-411001, India, or email: doc_vasudha@yahoo.co.in V.A. Belgaumkar is supported by the Fogarty International Center of the US National Institutes of Health (grant #D43TW00957). The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. V.A. Belgaumkar and N.S. Deshmukh contributed equally toward research design and implementation and manuscript preparation and should be considered as first authors. The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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The safety and efficacy of once-weekly glucagon-like peptide-1 receptor agonist semaglutide in patients with type 2 diabetes mellitus: a systemic review and meta-analysis

Abstract

Objectives

To investigate the safety and efficacy of once-weekly glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide as monotherapy or add-on to other antihyperglycaemic agents (AHAs) in patients with type 2 diabetes mellitus (T2DM).

Methods

PubMed, Embase, Cochrane library and ClinicalTrials.gov were searched from the inception to January 18, 2018. Randomised controlled trials (RCTs) comparing semaglutide with placebo or other AHAs in T2DM patients were included in our meta-analysis. Risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CI) were used to evaluate the outcomes.

Results

A total of 11 studies with 9519 patients were included in our meta-analysis. The results revealed that compared with placebo or other AHAs, semaglutide had further reduced the level of haemoglobin A1c (HbA1c) [MD 1.03%, 95% CI (0.85%, 1.22%), p < 0.00001], self-measured plasma glucose (SMPG) [MD 1.19 mmol/L, 95% CI (0.84 mmol/L, 1.53 mmol/L), p < 0.00001], fasting plasma glucose (FPG) [MD 1.33 mmol/L, 95% CI (0.97 mmol/L, 1.69 mmol/L), p < 0.00001] and weight [MD 3.61 kg, 95% CI (3.05 kg, 4.17 kg), p < 0.00001] and significantly increased participants who achieved HbA1c < 7.0% [RR 2.26, 95% CI (1.89, 2.70), p < 0.00001] in T2DM patients. Semaglutide had a significant increase in the incidence of adverse events (AEs) [RR 1.06, 95% CI (1.02, 1.11), p < 0.0001] and an analogous incidence in serious adverse events (SAEs) [RR 0.94, 95% CI (0.86, 1.02), p = 0.11] and hypoglycaemic events (severe or blood glucose (BG)-confirmed symptomatic) [RR 0.93, 95% CI (0.74, 1.16), p = 0.50] compared with the control group.

Conclusions

This article revealed that semaglutide had a favourable efficacy and safety in treating T2DM patients. It maybe a superior choice for T2DM patients who have obesity or a poor adherence to daily AHAs.

https://ift.tt/2Mhqu0c

The safety and efficacy of once-weekly glucagon-like peptide-1 receptor agonist semaglutide in patients with type 2 diabetes mellitus: a systemic review and meta-analysis

Abstract

Objectives

To investigate the safety and efficacy of once-weekly glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide as monotherapy or add-on to other antihyperglycaemic agents (AHAs) in patients with type 2 diabetes mellitus (T2DM).

Methods

PubMed, Embase, Cochrane library and ClinicalTrials.gov were searched from the inception to January 18, 2018. Randomised controlled trials (RCTs) comparing semaglutide with placebo or other AHAs in T2DM patients were included in our meta-analysis. Risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CI) were used to evaluate the outcomes.

Results

A total of 11 studies with 9519 patients were included in our meta-analysis. The results revealed that compared with placebo or other AHAs, semaglutide had further reduced the level of haemoglobin A1c (HbA1c) [MD 1.03%, 95% CI (0.85%, 1.22%), p < 0.00001], self-measured plasma glucose (SMPG) [MD 1.19 mmol/L, 95% CI (0.84 mmol/L, 1.53 mmol/L), p < 0.00001], fasting plasma glucose (FPG) [MD 1.33 mmol/L, 95% CI (0.97 mmol/L, 1.69 mmol/L), p < 0.00001] and weight [MD 3.61 kg, 95% CI (3.05 kg, 4.17 kg), p < 0.00001] and significantly increased participants who achieved HbA1c < 7.0% [RR 2.26, 95% CI (1.89, 2.70), p < 0.00001] in T2DM patients. Semaglutide had a significant increase in the incidence of adverse events (AEs) [RR 1.06, 95% CI (1.02, 1.11), p < 0.0001] and an analogous incidence in serious adverse events (SAEs) [RR 0.94, 95% CI (0.86, 1.02), p = 0.11] and hypoglycaemic events (severe or blood glucose (BG)-confirmed symptomatic) [RR 0.93, 95% CI (0.74, 1.16), p = 0.50] compared with the control group.

Conclusions

This article revealed that semaglutide had a favourable efficacy and safety in treating T2DM patients. It maybe a superior choice for T2DM patients who have obesity or a poor adherence to daily AHAs.

https://ift.tt/2Mhqu0c

Hyperinsulinemia precedes insulin resistance in offspring rats exposed to angiotensin II type 1 autoantibody in utero

Abstract

Objective

Insulin resistance is highly associated with an adverse intrauterine environment. We previously reported that fetal rats exposed to angiotensin II type 1 receptor (AT₁R) autoantibody (AT1-AA) displayed increased susceptibility to metabolic diseases during middle age. However, the timing of the onset of insulin resistance remains unknown. In this study, we examined the offspring of AT1-AA-positive rats, tracking the development of insulin resistance.

Methods

Pregnant rats were intravenously injected with AT1-AA. Afterwards, we collected serum samples and liver tissues of the offspring at various stages, including gestation day 18, 3 weeks (weaning period), 18 weeks (young adulthood), and 48 weeks (middle age) after birth.

Results

Compared with saline control group, hepatic vacuolar degeneration was visible in AT1-AA offspring rats as early as 3 weeks; hyperinsulinemia and impaired glucose tolerance occurred at 18 weeks of age, however, insulin resistance was not observed until 48 weeks. At 18 weeks we detected suppressed protein levels of insulin receptor (IR) but increased levels of IR substrate 1 (IRS1) in the liver of AT1-AA group rats. Interestingly, both IR and IRS1/2 were significantly decreased at 48 weeks. Liver proteomic analysis indicated that the differences in protein expression between the AT1-AA and control rats became more pronounced with age, particularly in terms of mitochondrial energy metabolism.

Conclusion

Rats exposed to AT1-AA in utero developed hyperinsulinemia from young adulthood which subsequently progressed to insulin resistance, and was linked with abnormal hepatic structure and impaired IR signaling. Additionally, dysregulation of energy metabolism may play a fundamental role in predisposing offspring to insulin resistance.

https://ift.tt/2B9Yozo

Does cyclophosphamide still play a role in glomerular diseases?

Publication date: Available online 11 August 2018

Source: Autoimmunity Reviews

Author(s): Claudio Ponticelli, Rachele Escoli, Gabriella Moroni

Abstract

Cyclophosphamide is a prodrug that is converted to inactive carboxy-cyclophosphamide, acrolein and phosphoramide mustard, an agent that adds alkyl groups to oxygen and nitrogen atoms of guanine, one of the four nitrogen bases that form the DNA nucleotides, causing DNA cross-links and introducing DNA breaks. These cytotoxic and mutagenic effects mainly occur in proliferating cells. Repair mechanisms may prevent DNA damage in quiescent cells, but they may be insufficient to contrast the side effects of cyclophosphamide if high doses of the drug are used. Most adverse events are dose- and age-dependent. Phosphoramide mustard can cause bone marrow toxicity, gonadal toxicity, and may favor the development of leukemia, bladder cancer and other types of malignancy. Acrolein can produce hemorrhagic cystitis and even bladder fibrosis when given for prolonged periods. A number of precautional measures should be taken to prevent these untoward events. In particular, long-term administration and high doses of cyclophosphamide should be avoided whenever possible.

Today the indications to cyclophosphamide in glomerular diseases are more restricted than in the past, but the drug is still used as a steroid-sparing agent in steroid-sensitive minimal change disease and focal segmental glomerulosclerosis. In membranous nephropathy, cyclophosphamide, alternated or associated with corticosteroids, proved to be beneficial in obtaining remission of nephrotic syndrome and preserving renal function. Cyclophosphamide is considered as a first-line treatment for rapidly progressive glomerulonephritis and the hectic phases of lupus nephritis. In conclusion, cyclophosphamide is a cheap drug that may be useful in a number of glomerular diseases but it may lead to severe side effects. A close monitoring of blood count and clinical conditions, as well as low cumulative doses of cyclophosphamide are strongly recommended when using the drug in patients with renal diseases.

https://ift.tt/2ntdQNz

Hyperinsulinemia precedes insulin resistance in offspring rats exposed to angiotensin II type 1 autoantibody in utero

Abstract

Objective

Insulin resistance is highly associated with an adverse intrauterine environment. We previously reported that fetal rats exposed to angiotensin II type 1 receptor (AT₁R) autoantibody (AT1-AA) displayed increased susceptibility to metabolic diseases during middle age. However, the timing of the onset of insulin resistance remains unknown. In this study, we examined the offspring of AT1-AA-positive rats, tracking the development of insulin resistance.

Methods

Pregnant rats were intravenously injected with AT1-AA. Afterwards, we collected serum samples and liver tissues of the offspring at various stages, including gestation day 18, 3 weeks (weaning period), 18 weeks (young adulthood), and 48 weeks (middle age) after birth.

Results

Compared with saline control group, hepatic vacuolar degeneration was visible in AT1-AA offspring rats as early as 3 weeks; hyperinsulinemia and impaired glucose tolerance occurred at 18 weeks of age, however, insulin resistance was not observed until 48 weeks. At 18 weeks we detected suppressed protein levels of insulin receptor (IR) but increased levels of IR substrate 1 (IRS1) in the liver of AT1-AA group rats. Interestingly, both IR and IRS1/2 were significantly decreased at 48 weeks. Liver proteomic analysis indicated that the differences in protein expression between the AT1-AA and control rats became more pronounced with age, particularly in terms of mitochondrial energy metabolism.

Conclusion

Rats exposed to AT1-AA in utero developed hyperinsulinemia from young adulthood which subsequently progressed to insulin resistance, and was linked with abnormal hepatic structure and impaired IR signaling. Additionally, dysregulation of energy metabolism may play a fundamental role in predisposing offspring to insulin resistance.

https://ift.tt/2B9Yozo