The pixie ear: How to prevent and correct it-a review of the literature.

As the life expectancy of the population continues to increase, more facial-rejuvenating procedures are sought. As the number of facelift procedures increases, it is mandatory to acknowledge, and most importantly prevent, any possible associated complications. One of the complications after rhytidectomy, and a sign of facelift, is the so-called "pixie ear deformity" or "bat ear." This is regarded as a telltale sign of a facelift procedure and appears to be identified in 5% of earlobe inset cases. The ear's location is a crucial hallmark of an aesthetically pleasing face, not only by itself but also in relation with other aesthetic units. When performing a facelift procedure, tension vectors of the rhytidectomy flap could cause alterations in ear's position and appearance: the ear loses its great mobility and becomes more fixed in its acquired position, resulting in a "stuck-on" appearance. The auricle is displaced following an anteroinferior direction, with the otobasion inferius (the most caudal anterior attachment of the earlobe to the cheek) being dislocated from its original more posterior and upper position to a new more anterior and caudal location. The displacement of the auricle is usually accompanied by distortion of the earlobe rotating forward and becoming more anterior than the rest of the ear. In recent decades, many techniques and procedures have been described to prevent and correct the pixie ear; in this review, we aim to analyze and describe them comprehensively.

Radiomic Gradient in Peritumoural Tissue of Liver Metastases: A Biomarker for Clinical Practice? Analysing Density, Entropy, and Uniformity Variations with Distance from the Tumour.

The radiomic analysis of the tissue surrounding colorectal liver metastases (CRLM) enhances the prediction accuracy of pathology data and survival. We explored the variation of the textural features in the peritumoural tissue as the distance from CRLM increases. We considered patients with hypodense CRLMs >10 mm and high-quality computed tomography (CT). In the portal phase, we segmented (1) the tumour, (2) a series of concentric rims at a progressively increasing distance from CRLM (from one to ten millimetres), and (3) a cylinder of normal parenchyma (Liver-VOI). Sixty-three CRLMs in 51 patients were analysed. Median peritumoural HU values were similar to Liver-VOI, except for the first millimetre around the CRLM. Entropy progressively decreased (from 3.11 of CRLM to 2.54 of Liver-VOI), while uniformity increased (from 0.135 to 0.199, p < 0.001). At 10 mm from CRLM, entropy was similar to the Liver-VOI in 62% of cases and uniformity in 46%. In small CRLMs (≤30 mm) and responders to chemotherapy, normalisation of entropy and uniformity values occurred in a higher proportion of cases and at a shorter distance. The radiomic analysis of the parenchyma surrounding CRLMs unveiled a wide halo of progressively decreasing entropy and increasing uniformity despite a normal radiological aspect. Underlying pathology data should be investigated.

CT-based radiogenomics of intrahepatic cholangiocarcinoma.

BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is an aggressive disease with increasing incidence and its genetic alterations could be the target of systemic therapies. AIMS: To elucidate if radiomics extracted from computed tomography (CT) may non-invasively predict ICC genetic alterations. METHODS: All consecutive patients with a diagnosis of a mass-forming ICC (01/2016-06/2022) were considered. Inclusion criteria were availability of a high-quality contrast-enhanced CT and molecular profiling by NGS or FISH for FGFR2 fusion/rearrangement. The CT scan at diagnosis was considered. Genetic analyses were performed on surgical specimens (resectable patients) or biopsies (unresectable ones). The radiomic features were extracted using the LifeX software. Multivariate predictive models of the commonest genetic alterations were built. RESULTS: In the 90 enrolled patients (58 NGS/32 FISH, median age 65 years), the most common genetic alterations were FGFR2 (20/90), IDH1 (10/58), and KRAS (9/58). At internal validation, the combined clinical-radiomic models achieved the best performance for the prediction of FGFR2 (AUC = 0.892) and IDH1 status (AUC = 0.819), outperforming the pure clinical and radiomic models. The radiomic model for predicting KRAS mutations achieved an AUC = 0.767 (vs. 0.660 of the clinical model) without further improvements with the addition of clinical features. CONCLUSIONS: CT-based radiomics provides a reliable non-invasive prediction of ICC genetic status with a major impact on therapeutic strategies.

Novel Therapies and Approaches to Inflammatory Bowel Disease (IBD).

Inflammatory bowel diseases (IBDs), divided into two predominant groups, Crohn's disease (CD) and ulcerative colitis (UC), are chronic relapsing inflammatory diseases of the gastrointestinal tract, resulting from an aberrant immune response to microbes in the gut, in genetically susceptible patients [...].

Contrast-Enhanced Mammography versus Breast Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis.

BACKGROUND: Contrast-enhanced mammography (CEM) and contrast-enhanced magnetic resonance imaging (CE-MRI) are commonly used in the screening of breast cancer. The present systematic review aimed to summarize, critically analyse, and meta-analyse the available evidence regarding the role of CE-MRI and CEM in the early detection, diagnosis, and preoperative assessment of breast cancer. METHODS: The search was performed on PubMed, Google Scholar, and Web of Science on 28 July 2021 using the following terms "breast cancer", "preoperative staging", "contrast-enhanced mammography", "contrast-enhanced spectral mammography", "contrast enhanced digital mammography", "contrast-enhanced breast magnetic resonance imaging" "CEM", "CESM", "CEDM", and "CE-MRI". We selected only those papers comparing the clinical efficacy of CEM and CE-MRI. The study quality was assessed using the QUADAS-2 criteria. The pooled sensitivities and specificity of CEM and CE-MRI were computed using a random-effects model directly from the STATA "metaprop" command. The between-study statistical heterogeneity was tested (I2-statistics). RESULTS: Nineteen studies were selected for this systematic review. Fifteen studies (1315 patients) were included in the metanalysis. Both CEM and CE-MRI detect breast lesions with a high sensitivity, without a significant difference in performance (97% and 96%, respectively). CONCLUSIONS: Our findings confirm the potential of CEM as a supplemental screening imaging modality, even for intermediate-risk women, including females with dense breasts and a history of breast cancer.

Evaluating Upadacitinib in the Treatment of Moderate-to-Severe Active Ulcerative Colitis: Design, Development, and Potential Position in Therapy.

Upadacitinib is a selective small molecule that inhibits Janus kinase (JAK) type 1. This molecule is administrated orally and is currently approved for the treatment of rheumatoid arthritis, atopic dermatitis, and psoriatic arthritis. Upadacitinib has been approved by the United States Food and Drug Administration for the induction and maintenance therapy of moderate-to-severe ulcerative colitis (UC) and is under investigation by the European Medicines Agency. Data from two induction and two maintenance Phase III randomized controlled trials (RCTs) proved the efficacy of upadacitinib in achieving clinical and endoscopic remission in patients with moderate-to-severe UC, regardless of previous inadequate response to other biologic therapies. The most frequently reported adverse events in the induction trials were acne, creatine phosphokinase increase, nasopharyngitis, headache, and anemia, while in the maintenance studies nasopharyngitis, elevation of creatine phosphokinase, UC exacerbation, upper respiratory tract infection, arthralgia, and anemia were reported. A limited proportion of upadacitinib-treated patients experienced adverse events of special interest, like herpes zoster infections or thromboembolic events, indicating a reliable safety profile. The aim of this review is to summarize the available evidence on upadacitinib in UC providing useful insights about the positioning of this drug in the therapeutic algorithm.

Anti-integrin drugs in clinical trials for inflammatory bowel disease (IBD): insights into promising agents.

INTRODUCTION: Despite huge and increasing developments in the treatment of inflammatory bowel disease (IBD), a significant percentage of patients with Crohn's disease (CD) and ulcerative colitis (UC) is still in need of an effective and safe therapeutic option. Tackling the trafficking of leukocytes specifically within or directed to the inflamed gut appears to be a particularly promising strategy, and several new anti-integrin agents are currently under investigation in clinical trials. AREAS COVERED: This review summarizes efficacy and safety data from phase 1, 2 and 3 clinical trials on investigational drugs, including monoclonal antibodies (etrolizumab, abrilumab, ontamalimab) and oral small molecules (AJM300, PTG-100). It also discusses the future perspectives for the treatment of IBD patients with this class of agents. EXPERT OPINION: The pipeline of anti-integrin agents is well assorted, and it is reasonable to expect that some will be introduced in the market soon. Among the most exciting features of this class are the gut selectivity, the convenient subcutaneous and oral administrations and the reassuring safety profiles. Most of the new anti-integrins seem to improve outcomes in UC but not in CD, however these data are far from definitive and several pivotal trials are still under way.