Spontaneous Rupture of a Non-scarring Gravid Uterus: A Late and Haphazard Diagnosis in the Postpartum Period.

This paper reports the case of a spontaneous rupture of a non-scarring gravid uterus seen four days after vaginal delivery and provides an update on this rare pathology, which can be functionally and vitally life-threatening. Uterine rupture of a healthy gravid uterus can occur as a result of structural abnormalities of the uterine tissue framework or uterine parietal fragility due to pathological phenomena such as septic states. On admission, the clinical picture is generally that of an acute abdomen with a hypogastric origin, with or without hemodynamic instability and an altered general condition, depending on the presence of an underlying advanced uterine infection. Medical imaging, mainly ultrasound and CT scan with iodine contrast, enables visualization of the uterine breach and a precise assessment of the damage. Surgery is the treatment of choice for repairing the breach and ensuring hemostasis. This case study sheds light on this pathology, familiarizing us with its clinical and radiological picture, as well as its post-treatment prognosis.

A historical syndemic? The impact of synergistic epidemics of measles and scarlet fever on life expectancy in Victoria, Australia (1860s-1870s).

OBJECTIVES: To explore whether synergistic epidemics of measles and scarlet fever in 1860s-1870s Victoria, Australia could be characterized as syndemics, we apply the methods of Sawchuk, Tripp, and Samakaroon (Social Science & Medicine 2022, 295, 112956) to quantify the impact of each of the two major co-occurring epidemic events (1867, 1875) in terms of life expectancy (LE) changes. Sawchuk et al. posit the presence of a harvesting effect, indicated by a statistically significant increase in LE in the immediate post-epidemic "fallow period", as a criterion for identification of a historical syndemic. We test an alternate hypothesis that the same methods can identify a short-term scarring effect. MATERIALS AND METHODS: Using annual age- and cause-specific death statistics and census population data, we constructed abridged period life tables for baseline period, potential syndemic year, and "fallow" year for each of the two periods (1860s and 1870s). We compared LE at birth using Z-tests. We decomposed age-cause-specific mortality according to Arriaga's method to identify age-and cause-specific contributions to LE change. RESULTS: LE was significantly lower than baseline (1864-1865) in 1867 but not in the "fallow" year (1869). LE in 1875 and the 1878 "fallow" year were both significantly below baseline (1871-1873). Age-cause-specific decomposition showed similar patterns for 1867 and 1875 for measles and scarlet fever combined effects. DISCUSSION: Evidence of a scarring effect following the 1875 measles/scarlet fever combined peak supports the interpretation of this event as a syndemic. We suggest the short-term scarring effect can be a useful additional criterion for identifying historical syndemics.

Serial Excision Technique to Reduce Cicatricial Alopecia.

Introduction: Cicatricial alopecia (CA) poses a challenge for dermatologists due to irreversible hair follicle damage. While pharmacological treatments offer limited efficacy, surgical interventions aim to improve aesthetic outcomes. This article explores the serial excision technique (SET) as a viable option for stable cases of inflammatory CA. Case Report/Case Presentation: Three adult females with different forms of CA underwent staged surgeries to correct CA patches. Procedures included different incision and closure methods based on individual characteristics such as age, type and extent of alopecia, location, and tissue mobility in the scarred area. Discussion: CA significantly impacts patients' quality of life, demanding comprehensive treatment approaches. SET emerges as an encouraging possibility for stable cases, providing notable cosmetic improvements and enhancing patients' well-being. This technique offers cost-effective benefits with potential standalone efficacy or in combination with hair transplantation, providing promising outcomes for individuals with CA.

Inviscision: A Futuristic Alternative to Endaural Incision for TMJ Surgeries.

Background: As TMJ surgery incisions have evolved, there has been a decrease in facial deformity and adequate surgical access. Even though the traditional preauricular and endaural incisions offer great exposure, they heal with a noticeable scar; in contrast, the Inviscision becomes invisible. Aim: To compare and evaluate both the approaches for TMJ surgeries in terms of surgical exposure, VII nerve injury and postoperative aesthetics. Methods: 60 TMJ surgery cases were randomly divided into two groups: Group A-30 Inviscision and Group B-30 Endaural incision and assessed for the amount of time from the incision to the exposure, ample access for surgery and postoperative nerve injury, scarring, cartilage injury/necrosis and ear deformity. All the patients were followed up for an average of six months. Results: Surgical exposure time was average 12 and 10 min via Inviscision and endaural incision, respectively. In Inviscision, scar becomes invisible after 40 days and in endaural incision, scar becomes a thin but visible line after 35 days. No cases of hypertrophic scar, keloid formation, cartilage injury/necrosis/ear deformity in either group. Transient temporal branch of VII nerve weakness seen in 33% of Inviscision and 40% of endaural cases which improved after average 3 and 3.4 months, respectively. Likert's patient satisfaction score was average 4 and 2, and POSAS score for scarring was 1.5 and 3, in Inviscision and endaural incision, respectively. Conclusion: Inviscision gives adequate exposure, avoids all related anatomic structures, other than causing transient retraction neuropraxia, along with outstanding aesthetic outcomes by hiding the scar in the anatomical folds of the ear auricle. Although, endaural incision provides better surgical time management and equivalent surgical exposure, Inviscision proves to be a better alternative for TMJ surgeries through all other parameters.

Stented endoscopic third ventriculostomy: technique, safety, and indications-a multicenter multinational study.

PURPOSE: Endoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus. Secondary stoma closure may be life threatening and is the most common reason for late ETV failure, mostly secondary to local scarring. Local stents intended to maintain patency are rarely used. In this study, we summarize our experience using stented ETV (sETV), efficacy, and safety. MATERIAL AND METHODS: Data was retrospectively collected from all consecutive patients who underwent ETV with stenting at four centers. Collected data included indications for using sETV, hydrocephalic history, surgical technique, outcomes, and complications. RESULTS: Sixty-seven cases were included. Forty had a primary sETV, and 27 had a secondary sETV (following a prior shunt, ETV, or both). The average age during surgery was 22 years. Main indications for sETV included an adjacent tumor (n = 15), thick or redundant tuber cinereum (n = 24), and prior ETV failure (n = 16). Fifty-nine patients (88%) had a successful sETV. Eight patients failed 11 ± 8 months following surgery. Reasons for failure included obstruction of the stent, reabsorption insufficiency, and CSF leak (n = 2 each), and massive hygroma and tumor spread (n = 1 each). Complications included subdural hygroma (n = 4), CSF leak (n = 2), and stent malposition (n = 1). There were no complications associated with two stent removals. CONCLUSION: Stented ETV appears to be feasible and safe. It may be indicated in selected cases such as patients with prior ETV failure, or as a primary treatment in cases with anatomical alterations caused by tumors or thickened tuber cinereum. Future investigations are needed to further elucidate its role in non-communicating hydrocephalus.

Using the SCAR-Q to Evaluate Morbidity of Scars in Craniosynostosis Repair.

OBJECTIVE: While previous literature has investigated the psychosocial impact and aesthetic satisfaction associated with post-operative scarring for certain pediatric craniofacial conditions, the impact of the scar burden resulting from craniosynostosis surgery has not been adequately studied. PARTICIPANTS: SCAR-Q was shared with patients ages 8 and older. Thirty-two complete patient responses were recorded. INTERVENTIONS: SCAR-Q is a PROM that consists of three independent scales - appearance, symptoms, and psychosocial impact - associated with a scar. MAIN OUTCOME MEASURES: Mann-Whitney U, linear regression, and Pearson correlation tests were used to evaluate associations between the scales, in addition to patient characteristics such as sex and suture involvement. RESULTS: Mean ages at time of surgery and survey completion were 9.65 ± 10.10 months and 12.10 ± 3.92 years, respectively. Mean scale scores were 81.5 ± 17.9 for appearance, 86.8 ± 12.4 for symptoms, and 79.3 ± 25.7 for psychosocial impact. Higher patient dissatisfaction with scar appearance correlated with more scar-related symptoms (r = 0.389; p = 0.028) and a greater psychosocial impact (r = 0.725; p < 0.001). SCAR-Q scales did not significantly correlate with age at surgery, age at survey completion, type of synostosis, or type of surgery; however, female patients reported lower mean appearance (65.4 vs. 86.0; p = 0.012) and psychosocial impact (57.3 vs. 85.5; p = 0.010) scores when compared to their male counterparts. CONCLUSIONS: It is vital that surgeons discuss patients' aesthetic satisfaction following craniosynostosis surgery in order to appropriately address and limit deleterious, long-term physical and psychosocial outcomes.

Pruritus in Lichen Planopilaris and Frontal Fibrosing Alopecia-Clinical Characteristics and Dermoscopic Correlations.

Background: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are the most common causes of lymphocytic scarring alopecia. Itching of the scalp is a common accompanying symptom. The aim of the study was the clinical assessment of pruritus and its correlation with dermoscopic features. Methods: Sixty-one patients with scarring alopecia were analyzed (LPP = 16; FFA = 33; coexisting LPP-FFA = 12). Each patient underwent a trichoscopic examination. Itch severity and characteristics were assessed using a Visual Analogue Scale (VAS), 4-item Itch Questionnaire and 12-item Descriptive Pruritus Assessment Questionnaire. Results: Itching of the scalp occurred in 73.8% of the patients (mean maximal VAS 5.3 ± 3.1 points). Pruritus was most frequently accompanied by tingling (19.7%) or burning (14.8%) sensations. The following factors most frequently increased the severity of pruritus: sweating, heat, stress and hot water. On the other hand, cold water and cold air often relieved symptoms. There was a significant relationship between itch and perifollicular scaling (p = 0.011), hair diameter diversity (p = 0.008) and white halo (p = 0.016). Conclusions: Pruritus was the main subjective complaint reported by patients suffering from LPP and FFA. A better understanding of pruritic features may help in the selection of an effective therapeutic strategy.

Astrocyte-Neuron Interactions in Spinal Cord Injury.

Spinal cord injuries cause irreversible loss of sensory and motor functions. In mammals, intrinsic and extrinsic inhibitions of neuronal regeneration obstruct neural repair after spinal cord injury. Although astrocytes have been involved in a growing list of vital homeostatic functions in the nervous system, their roles after injury have fascinated and puzzled scientists for decades. Astrocytes undergo long-lasting morphological and functional changes after injury, referred to as reactive astrogliosis. Although reactive astrogliosis is required to contain spinal cord lesions and restore the blood-spinal cord barrier, reactive astrocytes have detrimental effects that inhibit neuronal repair and remyelination. Intriguingly, elevated regenerative capacity is preserved in some non-mammalian vertebrates, where astrocyte-like glial cells display exclusively pro-regenerative effects after injury. A detailed molecular and phenotypic catalog of the continuum of astrocyte reactivity states is an essential first step toward the development of glial cell manipulations for spinal cord repair.

Anterior Labrum Periosteal Sleeve Avulsion Lesions of the Shoulder: A Scoping Review.

Background: Anterior labrum periosteal sleeve avulsion (ALPSA) lesion of the shoulder is defined as a labral avulsion with an intact periosteum of the glenoid neck resulting in medial malattachment of the labrum, which is both nonanatomic and nonfunctional. It is relatively rare compared with Bankart lesions, and its results are usually reported in combination with other anterior labroligamentous lesions in the literature. Purpose: To (1) assess the size and scope of the literature on ALPSA lesions, (2) highlight the importance of this lesion, and (3) distinguish between ALPSA and Bankart lesions in diagnostic and treatment strategies. Study Design: Scoping review; Level of evidence, 4. Methods: The PubMed, Scopus, Embase, and Google Scholar databases were searched with the keywords "ALPSA,""anterior labrum periosteal sleeve avulsion,""anterior labral periosteal sleeve avulsion," and "anterior labroligamentous periosteal sleeve avulsion" lesion. Duplicate articles and those that did not meet the inclusion criteria were excluded, resulting in the identification of 42 relevant articles. Their references were analyzed for further data curation. Results: This scoping review demonstrated that ALPSA lesions are difficult to clinically identify. Magnetic resonance angiography in the adduction internal rotation position is the most sensitive and specific imaging modality for identification. Optimal views are the anterosuperior portal for accurate identification and the anteroinferior portal for surgical repair during arthroscopy. Treatment begins with correctly identifying the labrum, in contradistinction to dense reactive fibrous tissue, and reattaching the labrum to the correct anatomic glenoid footprint. Chronic lesions with bone loss require either bone block or soft tissue augmentation procedures. Conclusion: There is paucity of exclusive literature on ALPSA lesions. It is important to distinguish this lesion from the Bankart lesion as it is associated with worse outcomes. The higher failure rates of ALPSA lesion repair indicate that the current repair techniques require further refinement to improve the outcomes to the standard of Bankart lesions.

Treating scars after burns with pulsed electric fields in the rat model.

Reducing scar size after severe burn injuries is an important and challenging medical, technology and social problem. We have developed a battery-powered pulsed electric field (PEF) device and surface needle electrode applicator to deliver pulsed electric fields to the healing dorsal burn wound in rats. PEF was used to treat residual burn wounds caused by metal contact in rats starting 10 days after the injury for 4 months every 11 or 22 days for 4 months using varying time applied voltages at 250-350V range, 400mA current, 40 pulses, 70 µs duration each, delivered at pulse repetition frequency 10 Hz at 5 locations inside the wound. We found 40-45% reduction in the scar size in comparison with untreated controls in both upper and lower dorsal locations on rats' backs two months after the last PEF application. We have not detected significant histopathological differences in the center of the scars besides the thickness of the newly generated epidermis, which was thicker in the PEF treated group.We showed that minimally invasively applied pulsed electric fields through needle electrodes are effective method and device for treating residual burn wounds in the rat model, reducing the size of the resulting scars, without any adverse reaction.

Insights into Pathogenesis of Trachoma.

Trachoma is the most common infectious cause of blindness worldwide. This review investigates the pathogenesis of trachoma, focusing on its causative agent, transmission pathways, disease progression, and immune responses. Trachoma is caused by serovars A-C of the bacterium Chlamydia trachomatis (Ct). Transmission occurs through direct or indirect exchanges of ocular and nasal secretions, especially in regions with poor hygiene and overcrowded living conditions. The disease is initiated in early childhood by repeated infection of the ocular surface by Ct. This triggers recurrent chronic inflammatory episodes, leading to the development of conjunctival scarring and potentially to trichiasis, corneal opacity, and visual impairment. Exploring the pathogenesis of trachoma not only unveils the intricate pathways and mechanisms underlying this devastating eye disease but also underscores the multifaceted dimensions that must be considered in its management.

Keratosis Follicularis Spinulosa Decalvans Associated With Woolly Hair: A Case Report.

Keratosis follicularis spinulosa decalvans X-linked (KFSDX) is part of the spectrum of a rare disorder known as keratosis pilaris atrophicans. Here, we report the case of a 14-year-old boy who presented with a history of abnormal hair since birth. He also had a history of skin lesions and hair loss. There was no similar condition in the family, and the parents were not consanguine. Scalp examination revealed woolly hair, a solitary scarring alopecia patch, and follicular papules. There were also patches of scarring alopecia on the lateral portion of the eyebrows and whole eyelashes bilaterally. His nose showed multiple, skin-colored, non-scaly follicular papules. The differential diagnosis included lichen planopilaris, Graham Little-Piccardi-Lassueur syndrome, KFSDX, keratosis follicularis spinulosa decalvans, and structural hair anomalies. Hair examination under light microscopy was normal. Skin biopsy from the follicular papule on the nose revealed follicular plugging with normal epidermis and dermis. Based on the above clinicopathological findings, the patient was diagnosed with KFSDX associated with woolly hair. He was reassured, but he did not show up for further treatment during the follow-up.

WRN Nuclease-Mediated EcDNA Clearance Enhances Antitumor Therapy in Conjunction with Trehalose Dimycolate/Mesoporous Silica Nanoparticles.

Current research on tumor fibrosis has focused on cancer-associated fibroblasts, which may exert dual functions of tumor promotion and inhibition. Little attention has been paid to whether tumor cells themselves can undergo fibrotic transformation and whether they can inhibit parenchymal cells similar to pulmonary fibrosis, thus achieving the goal of inhibiting the malignant progression of tumors. To explore the significance of inducing tumor fibrosis for cancer treatment. This study utilizes mesoporous silica nanoparticles (MSN) loaded with Trehalose dimycolate (TDM) to induce tumor cell fibrosis through the dual effects of TDM-induced inflammatory granuloma and MSN-induced foreign body granuloma. The results show that TDM/MSN (TM) can effectively induce tumor fibrosis, manifested specifically by collagen internalization, and suppression of proliferation and invasion capabilities, suggesting the potential role of tumor fibrosis therapy. However, further investigation reveals that extrachromosomal DNA (ecDNA) mediates resistance to fibrosis induction. To comprehensively enhance the efficacy, WRN exonuclease is conjugated to TM to form new nanoparticles (TMW) capable of effectively eliminating ecDNA, globally promoting tumor cell fibroblast-like transformation, and validated in a PDX model to inhibit cancer progression. Therefore, TMW, through inducing tumor cell fibrosis to inhibit its malignant progression, holds great potential as a clinical treatment strategy.

Liposuction Through an Axillary Fold Incision Combined with a Small Areola Incision to Treat Gynecomastia.

BACKGROUND: Gynecomastia is a progressive disease characterized by enlarged breasts, affecting a significant proportion of men. Persistent gynecomastia negatively affects the psychological and emotional development of patients; therefore, surgical intervention is required. In this article, we describe a surgical technique, where liposuction through an axillary incision is used in combination with a single small periareolar incision, to obtain the most minimal scars in the treatment of gynecomastia. METHODS: Between June 2021 and June 2023, 125 patients with different Simon grades of gynecomastia were enrolled. The patients' basic conditions and operation processes were recorded. Following surgery, a score was assigned according to the five main aesthetic aspects of the surgical procedure. RESULTS: In total, 125 patients with gynecomastia were treated with a pre-axillary fold incision combined with a small areolar incision. There were 17 cases of Simon grade I, 46 grade IIA, 42 grade IIB, and 20 grade III. The average operation time was 45.8 min, the average liposuction volume was 250.5 mL, the average glandular tissue volume was 50.5 g, intraoperative blood loss ranged from 15 to 60 mL, and the average hospital stay was 3.2 days. Regarding the postoperative aesthetic effect, doctors scored > 4 points, and the patient satisfaction score was > 7.5, which fully affirmed the aesthetic effect of this method. CONCLUSIONS: Treatment of gynecomastia through an anterior axillary fold incision combined with a small areolar incision is safe and feasible, involving a simple procedure, short operation time, and few complications. Its efficacy and cosmetic effects could lead to its use as a primary surgical method to treat gynecomastia. LEVEL OF EVIDENCE IV: 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Surgical Management of Chronic Morel-Lavallée Lesion with Minimal Cosmetic Scarring: A Case Report.

Introduction: Morel-Lavallée lesion (MLL) is a closed degloving injury that occurs after traumatic damage to soft tissue, leading to the formation of an encapsulated serosanguinous collection of fluid. Although some MLLs resolve spontaneously, chronic MLLs present with a significant risk of infection and may impede patients' quality of life. Chronic lesions require surgical intervention to evacuate and debride the hematoma, often resulting in severe cosmetic damage postoperatively. Case Report: We documented a large 19.4 cm × 4.2 cm × 15.10 cm MLL on the right lateral hip that presented a significant impediment to the patient's daily functions. After the failure of conservative management, the patient was treated surgically through a minimal incision debridement procedure, utilizing a wound drain and vacuum-assisted compressional dressing upon closure. Excellent 1-year post-operative outcomes were achieved with no recurrence of the lesion and limited cosmetic evidence of the MLL. Conclusion: This case highlights the value of a limited incisional debridement procedure for the management of a chronic Morel-Lavellée lesion. When using this technique, surgeons can effectively treat these lesions with promising short-term outcomes and minimal wound scarring.

Sexual dimorphism of pelvic scarring: A new method of adult biological sex estimation.

Estimating biological sex is a crucial aspect of forensic anthropology, and is pivotal in forensic investigations. Presently, the most frequently adopted osteological sex estimation methods focus on the anterior pelvis, which is easily susceptible to postmortem damage, revealing a need for additional accurate methods. This study introduces a novel method for estimating adult sex through metric pelvic scar analysis, using a known skeletal sample (169 females; 51 males). Relationships between sex and scar dimensions were subjected to Kendall's tau-B testing, and the strongest associated measurements were further analyzed using binary logistic regression to determine their predictive capacity. The final estimation method was tested on an additional known-sex sample of 43 males and 43 females from the Spitalfields skeletal collection. All associations between biological sex and scar measurements were significant, with the preauricular sulcus and newly defined inferior interosseous cavity presenting the strongest relationships (τb 0.223-0.504). Individual regression models using the approximate volume of each feature predicted sex with over 80% accuracy, but when combined in a single regression model, the accuracy increased to an impressive 97.1%. When then applied to the validation sample, the final estimation model achieved an accuracy of 90.7%. These results highlight the high estimation accuracy achieved by simultaneously utilizing the approximate volume of the sulcus and the inferior cavity. This is not only highly accurate but also utilizes the sturdier posterior pelvis, making it a promising tool for forensic investigations and the wider field of osteology.