Caudal resection of the upper lateral cartilages and its measured effect on tip rotation.

BACKGROUND: Commonly used maneuvers for upward tip rotation include cephalic trim of the lateral alar cartilages, caudal resection of the septum, and shortening of the upper lateral cartilages (ULCs). Few techniques for surgical manipulation of the ULCs are found in the literature, and none accurately describe the measured effect of the caudal resection on tip rotation. The purpose of this study is to predict the change in upward rotation of the nasal tip for a measured incremental resection of the ULCs. METHODS: Ten fresh cadaveric noses were dissected with the aid of loupe magnification via an open rhinoplasty approach. The ULCs were sectioned in 20% increments, and measurements of the nasolabial angle (NLA) were recorded with the use of a goniometer. True lateral photographs were obtained for the photographic analysis of the specimens. RESULTS: The average length of the ULC was 16.8 ± 1.6 mm. Serial reduction of the ULC length by 4 sequential 20% increments resulted in a mean NLA change of 3.6, 2.7, 2.1, and 1.9 degrees, respectively. The average incremental change in NLA for the 4 resections was 2.6 degrees. CONCLUSIONS: Caudal resection of the ULC has a measurable effect on the upward rotation of the nasal tip. A 20% resection correlates with an average change in the NLA of 2.6 degrees. Because caudal resection of the ULC is a powerful tool in the armamentarium of the rhinoplasty surgeon that can cause narrowing of the internal nasal valve and hallowing of the lower nasal sidewalls, it should be used with caution in a selected group of patients when attempting to elevate the "droopy" tip.

The Oxymoron of Financial Illiteracy in a Highly Educated Population: Are We Appropriately Equipping Trainees?

Medical professionals often incur a significant financial burden in pursuit of a medical education. Despite rigorous medical education, financial education appears to be lacking during training. This study intended to explore the financial preparedness and education of 2 cohorts of medical professionals-alumni graduates of a single institution and current plastic surgery residency trainees. METHODS: An electronic survey of the residency alumni at a single institution across all specialties over a 50-year period was conducted. This was conducted concurrent with a survey to current plastic surgery residency trainees across the country. The survey explored several core financially relevant areas, including financial education at various levels of training, fiscal goals, debt profile, spending and saving habits, investment management, financial and family obligations, estate planning, and retirement preparedness. RESULTS: A total of 521 alumni and 84 residents completed the survey from the residency alumni cohort and plastic surgery training programs cohort, respectively. Results from both groups demonstrated that although the large majority considered financial education a priority, this was not prioritized in medical or residency training. Most were introduced to financial education either by a family member or by self-directed learning. Data on investments, savings, finances, and retirement planning are also presented. CONCLUSIONS: As a very literate group, there is an unacceptably high level of "illiteracy" concerning financial education at an early stage. Practicing physicians and current trainees believe that a more directed approach to financial education should be adopted, rather than the current laissez-faire climate during medical education and residency training.

Protein glycosylation in Helicobacter pylori: beyond the flagellins?

Glycosylation of flagellins by pseudaminic acid is required for virulence in Helicobacter pylori. We demonstrate that, in H. pylori, glycosylation extends to proteins other than flagellins and to sugars other than pseudaminic acid. Several candidate glycoproteins distinct from the flagellins were detected via ProQ-emerald staining and DIG- or biotin- hydrazide labeling of the soluble and outer membrane fractions of wild-type H. pylori, suggesting that protein glycosylation is not limited to the flagellins. DIG-hydrazide labeling of proteins from pseudaminic acid biosynthesis pathway mutants showed that the glycosylation of some glycoproteins is not dependent on the pseudaminic acid glycosylation pathway, indicating the existence of a novel glycosylation pathway. Fractions enriched in glycoprotein candidates by ion exchange chromatography were used to extract the sugars by acid hydrolysis. High performance anion exchange chromatography with pulsed amperometric detection revealed characteristic monosaccharide peaks in these extracts. The monosaccharides were then identified by LC-ESI-MS/MS. The spectra are consistent with sugars such as 5,7-diacetamido-3,5,7,9-tetradeoxy-L-glycero-L-manno-nonulosonic acid (Pse5Ac7Ac) previously described on flagellins, 5-acetamidino-7-acetamido-3,5,7,9-tetradeoxy-L-glycero-L-manno-nonulosonic acid (Pse5Am7Ac), bacillosamine derivatives and a potential legionaminic acid derivative (Leg5AmNMe7Ac) which were not previously identified in H. pylori. These data open the way to the study of the mechanism and role of protein glycosylation on protein function and virulence in H. pylori.