Adipose-derived stem cell enrichment is counter-productive for the majority of women seeking primary aesthetic breast augmentation by autologous fat transfer: A systematic review.

BACKGROUND: Autologous lipotransfer (AL) is a popular method despite unpredictable retention rates. Higher retention rates have been reported when co-administering adipose-derived stem cells (ASCs), a process called cell-assisted lipotransfer (CAL). Our hypothesis is that CAL might indeed limit volume gain in most women seeking aesthetic breast augmentation because it doubles the amount of fat required without consistently improving the outcome. METHODS: Electronic databases were searched for articles published between January 2008 and October 2019 in English and German. All original articles evaluating fat viability following autologous breast augmentation in vivo were included. Based on the reported retention rates, potential volume gains were estimated for CAL and AL. RESULTS: A total of 23 studies were selected. The AL retention rate varied from 39% to 76%, whereas CAL increased this rate at best by 24%. The body mass index (BMI) ranged from 18.8 to 23.4 (20.4±1.6) in the study population, whereas the BMI of women in the same age group is 28.7 (±8.4). We calculated that, starting from 200 ml of harvested fat and after two sessions of AL of 100 ml each, the volume retained would be at most 152 ml. In contrast, after one session of CAL of 100 ml, while the remaining 100 ml are used to isolate ASCs, a maximum of 95 ml of fat would remain. CONCLUSION: The volume gain after two sessions of AL is far superior to that after one session of CAL for the same volume of harvested fat. This is an important practical consideration for women with low BMI, as the extra fat required to isolate ASCs is not counterbalanced by an increase in the retention rate. Therefore, two sessions of AL may be preferable to maximize the volume gain.

B-Technique with dermis suspension: A new approach toward reduction mammaplasty combining short-scar with durability of results.

BACKGROUND: Dermis suspensions (DM) have been introduced in reduction mammaplasties (RM) to extend the durability of the results and improve the quality of the scar. The authors present a new method of RM that consists of completing the B-method of Regnault with a well-vascularized DM. OBJECTIVE: Analyze the efficacy of a reduction mammaplasty technique proposed by the authors. METHODS: The authors propose a comparison of two mamma reduction techniques based on a superior pedicle performed on 233 patients at the Medical University of Vienna, Department of Obstetrics and Gynecology, from 2010 to 2019. A total of 102 patients (Group A) were treated with a mammaplasty using Regnault's B-technique with a superior pedicle; 131 patients (Group B) were treated through a similar technique with additional support from an inferior-based deepithelialized pedicle for extra support. The assessment of patient satisfaction was performed by using the BREAST-Q for breast reduction; scar quality assessment was performed using a Patient and Observer Scar Assessment Scale (POSAS). RESULTS: Group A/Group B: 74/97 patients were operated bilaterally and 28/24 unilaterally. The amount of resected tissue ranged from 102-620 g to 30-810 g. Average BREAST-Q score for satisfaction with outcome was 82.3/86.1. POSAS was scored 35.2/37.6 to 23.2/24.4. Bottoming out after surgery was observed in 12 of 102 patients in Group A and 6 of 131 in Group B in the follow-up visits at 12, 18, and 36 months. CONCLUSION: The described technique proved to be fast, safe, and reliable, with a high level of patient satisfaction, less bottoming out, and better scar quality.

Surgery of True Recurring Median Carpal Tunnel Syndrome with Synovial Flap by Wulle Plus Integument Enlargement Leads to a High Patient's Satisfaction and Improved Functionality.

This prospective study was conducted to investigate electrophysiological qualities and patient's satisfaction of a synovial gliding tissue flap in treating true recurring carpal tunnel syndrome. In 14 patients (11 women, three men), 15 median nerves were included in this retrospective study. For all 15 nerves, motor and sensory nerve conduction velocity, compound muscle action potential, a Visual Analogue Scale-score (VAS-score) questionnaire and an adapted Levine-Test were evaluated pre- and postoperatively. All participants underwent operative neurolysis of the median nerve, which was then enwrapped by a synovial gliding tissue flap. Eleven procedures were completed by integument enlargement. Follow-up period was 12 months. Postoperatively, distal latency decreased significantly by 15.6%. Compound muscle action potential and sensory nerve conduction velocity did not improve significantly. VAS score regarding pain reduced highly significantly with 74.1%. The adapted Levine-Test function score improved highly significantly with 39.2%. The synovial gliding tissue flap lead to an excellent patient's satisfaction for treating true recurring carpal tunnel syndrome. Primary wound closure should be completed with integument enlargement if needed.

Inhibition of Cellular Adhesion by Immunological Targeting of Osteopontin Neoepitopes Generated through Matrix Metalloproteinase and Thrombin Cleavage.

Osteopontin (OPN), a secreted protein involved in inflammatory processes and cancer, induces cell adhesion, migration, and activation of inflammatory pathways in various cell types. Cells bind OPN via integrins at a canonical RGD region in the full length form as well as to a contiguous cryptic site that some have shown is unmasked upon thrombin or matrix metalloproteinase cleavage. Thus, the adhesive capacity of osteopontin is enhanced by proteolytic cleavage that may occur in inflammatory conditions such as obesity, atherosclerosis, rheumatoid arthritis, tumor growth and metastasis. Our aim was to inhibit cellular adhesion to recombinant truncated proteins that correspond to the N-terminal cleavage products of thrombin- or matrix metalloproteinase-cleaved OPN in vitro. We specifically targeted the cryptic integrin binding site with monoclonal antibodies and antisera induced by peptide immunization of mice. HEK 293 cells adhered markedly stronger to truncated OPN proteins than to full length OPN. Without affecting cell binding to the full length form, the raised monoclonal antibodies specifically impeded cellular adhesion to the OPN fragments. Moreover, we show that the peptides used for immunization were able to induce antisera, which impeded adhesion either to all OPN forms, including the full-length form, or selectively to the corresponding truncated recombinant proteins. In conclusion, we developed immunological tools to selectively target functional properties of protease-cleaved OPN forms, which could find applications in treatment and prevention of various inflammatory diseases and cancers.

Motor evoked potentials enable differentiation between motor and sensory branches of peripheral nerves in animal experiments.

Differentiation between motor and sensory fascicles is frequently necessary in reconstructive peripheral nerve surgery. The goal of this experimental study was to verify if centrally motor evoked potentials (MEP) could be implemented to differentiate sensory from motor fascicles, despite the well-known intermingling between nerve fascicles along their course to their distant periphery. This new procedure would enable surgeons to use MEP for placing nerve grafts at corresponding fascicles in the proximal and distal stumps without the need to use time-consuming staining. In ten sheep, both ulnar nerves were exposed at the terminal bifurcation between the last sensory and motor branch. Animals were then relaxed to avoid volume conduction. On central stimulation, the evoked nerve compound action potentials were simultaneously recorded from both terminal branches. In all cases, neurogenic motor nerve action potentials were recorded only from the terminal motor branch. The conclusion was that MEPs can be used for intraoperative differentiation between sensory and motor nerves. Further studies are necessary to develop this method for in situ measurements on intact nerve trunks.

Reconstruction of cavernous nerves by nerve grafts to restore potency: contemporary review of technical principles and basic anatomy.

PURPOSE OF REVIEW: The review discusses the efficacy of reconstructing the neurovascular bundle to regain sexual function if nerve-sparing prostatectomy is unfeasible. RECENT FINDINGS: Eleven studies could be found describing the reconstruction of neurovascular bundles. All reconstructive procedures displayed technical inadequacies. The effectiveness of unilateral neurovascular bundle reconstruction remains statistically insignificant when compared with procedures without reconstruction. The efficacy of reconstructing both neurovascular bundles ranges between 0 and 43%. Concerning basic anatomy, the neurovascular bundle contains fibers innervating the cavernous nerves, prostate, rectum, and levator ani muscle. The terms cavernous nerve and neurovascular bundle have often been wrongly considered synonymous. The pelvic splanchnic nerves probably do not join the neurovascular bundle proximal to the bladder/prostate junction but rather at variable distances from 10 to 20 mm distal to it. Therefore, described proximal coaptation sites at the bladder/prostate junction possibly encompass only the hypogastric nerve. SUMMARY: Modest clinical results are partly due to inadequate surgical techniques and are mainly due to the anatomical and topographical complexity of the cavernous nerves. Contemporary nerve grafting techniques probably do not allow for the regeneration of all cavernous nerves.

Intrathecal temperature is closely reflected by the aortic, but not by the rectal, temperature in a rabbit model of spinal cord ischemia.

IMPLICATIONS: Experimental ischemic lesions in the lumbar spinal cord of the rabbit can be induced by inflating the balloon of a Swan-Ganz catheter in the abdominal aorta. The intrathecal temperature is significantly better reflected by the temperature from the thermistor of the catheter than by the rectal temperature.

Leprosy affects facial nerves in a scattered distribution from the main trunk to all peripheral branches and neurolysis improves muscle function of the face.

Current literature rejects nerve release in leprous facial neuropathy and states that lesions are restricted to the peripheral zygomatic branches. Since there are approximately 500,000 patients with this disease throughout the world, we wanted to clarify the precise location of facial nerve's affection and the benefit of neurolysis. Our study showed that in patients with leprosy, the facial nerve's main trunk, the peripheral zygomatic branches, and all other branches were affected. Follow-up showed improvement in lagophthalmos and in misreinnervation, with no improvement in the control cohort. Nerve release improves muscle function in leprous facial neuropathy, provided surgery is performed on all affected segments. Intraoperative electroneurodiagnostics is an effective tool for detecting the most proximal site of lesion and ensuring effective surgery.

Leprosy affects facial nerves in a scattered distribution from the main trunk to all peripheral branches and neurolysis improves muscle function of the face

Current literature rejects nerve release in leprous facial neuropathy and states that lesions are restricted to the peripheral zygomatic branches. Since there are approximately 500,000 patients with this disease throughout the world, we wanted to clarify the precise location of facial nerve's affection and the benefit of neurolysis. Our study showed that in patients with leprosy, the facial nerve's main trunk, the peripheral zygomatic branches, and all other branches were affected. Follow-up showed improvement in lagophthalmos and in misreinnervation, with no improvement in the control cohort. Nerve release improves muscle function in leprous facial neuropathy, provided surgery is performed on all affected segments. Intraoperative electroneurodiagnostics is an effective tool for detecting the most proximal site of lesion and ensuring effective surgery.