To Serve Those Who Served: Advances in Plastic and Reconstructive Surgery During War and Peace.

The industrialization of modern warfare dating back to WWI led to an increase in combat-related injuries with unprecedented levels of severity. The necessity of addressing the clinical challenges that ensued led to the emergence of modern reconstructive surgery and subsequently a robust healthcare initiative for veterans in the form of the Department of Veterans Affairs. In the following article, a literature review was conducted to examine the interplay between combat injuries, veterans' care, and reconstructive surgery. We found that the relationship between military trauma and reconstructive surgery has led to an increase in survival rates and advances in mass casualty response while allowing the survivors to maintain a high quality of life. The relationship between the Veterans Affairs hospitals and plastic surgery has only strengthened over time as these hospitals play a major role in training the next generation of plastic surgeons throughout the nation. It is imperative to maintain this cooperative relationship to ensure a high level of care for our veterans and a comprehensive training experience for plastic surgery residents.

Face Off: 3D-Printed Masks as a Cost-Effective and Reusable Alternative to N95 Respirators: A Feasibility Study.

BACKGROUND: One of the best methods for protection against respiratory diseases is the use of an N95 mask. Supply shortages have demonstrated a significant need for effective alternatives to N95 masks. Benefits of 3D-printed respirators over N95s include reduced cost and ease of production, widespread availability, reusability/sterilizability, and customizability. 3D-printed mask designs have been downloaded thousands of times; however, there is little to no data on the efficacy of these potential alternatives. METHODS: Three of the most popular 3D-printed respirator designs were modified to allow for the Occupational Safety and Health Administration (OSHA) quantitative fit testing that disperses saline into the ambient air and determines concentrations within the mask during multiple trials. Five volunteers conducted standardized fit tests of these masks, as well as an N95 and a KN95, and the results were compared. RESULTS: One of the 3D-printed respirators, low poly COVID-19 face mask respirator (mask 2), achieved a fit factor greater than 100 in every trial, representing sufficient fit according to OSHA protocols. The N95 mask achieved a sufficient fit in 60% of the trials, and none of the remaining masks provided a suitable fit factor reliably according to the OSHA fit test. Further trials showed no change in fit factor when different 3D-printable plastics are used or when a widely available high efficiency particulate air (HEPA) filter was used. CONCLUSION: 3D-printed respirators provide a possible alternative to N95 masks to protect against respiratory pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Fit testing results demonstrate that certain 3D-printed mask designs may exceed the fit of N95 masks.

BreastImplantAnalyzer: An easy-to-use, validated tool for calculating breast implant volume from MRI data.

BACKGROUND: Given the prevalence of breast augmentation and prosthetic-based breast reconstruction, it is common for the plastic surgeon to see patients presenting for revisional implant surgery. A frequent issue encountered in such procedures is uncertainty of implant size, which presents numerous challenges and may lead to undesired outcomes for both the patient and the surgeon. There is currently no tool available with the purpose of measuring implant volume from magnetic resonance imaging (MRI) data. In this study, such a program was designed and tested. METHODS: An open-source software was developed that provides volume measurement of a chosen breast implant with minimal interaction from the user, allowing for precision in the planning of breast implant revisional surgery. It was developed to be as easy to use as possible for clinicians who may not have experience with imaging analysis platforms. The program was tested on patients who underwent revisional implant surgery and had documented implant volumes and pre-operative breast MRIs. Twenty-two implants were tested in total, including saline and both smooth and textured silicone implants. RESULTS: The software has shown to be highly accurate with an average accuracy of 98.6%. A Spearman correlation coefficient of 0.967 was obtained. The software also performed faster than previously proposed methods. CONCLUSION: Plastic surgeons can easily calculate breast implant volume pre-operatively using BreastImplantAnalyzer, which is available to download for free from www.BreastImplantAnalyzer.com or as an extension for the popular medical imaging platform 3D Slicer.

DRRGenerator: A Three-dimensional Slicer Extension for the Rapid and Easy Development of Digitally Reconstructed Radiographs.

As the interest in image-guided medical interventions has increased, so too has the necessity for open-source software tools to provide the required capabilities without exorbitant costs. A common issue encountered in these procedures is the need to compare computed tomography (CT) data with X-ray data, for example, to compare pre-operative CT imaging with intraoperative X-rays. A software approach to solve this dilemma is the production of digitally reconstructed radiographs (DRRs) which computationally simulate an X-ray-type image from CT data. The resultant image can be easily compared to an X-ray image and can provide valuable clinical information, such as small anatomical changes that have occurred between the pre-operative and operative imaging (i.e., vertebral positioning). To provide an easy way for clinicians to make their own DRRs, we propose DRR generator, a customizable extension for the open-source medical imaging application three-dimensional (3D) Slicer. DRR generator provides rapid computation of DRRs through a highly customizable user interface. This extension provides end-users a free, open-source, and reliable way of generating DRRs. This program is integrated within 3D Slicer and thus can utilize its powerful imaging tools to provide a comprehensive segmentation and registration application for clinicians and researchers. DRR generator is available for download through 3D Slicer's in-app extension manager and requires no additional software.

Anabolic action of parathyroid hormone is skeletal site specific at the tissue and cellular levels in mice.

The cellular and molecular events triggering the anabolic response of the skeleton to exogenous parathyroid hormone (PTH) are not well understood. Despite the numerous bone mass studies in rats, few data are available for mice. Therefore, we treated 10-week-old female intact C57BL/6J mice with human PTH(1-34) delivered subcutaneously at a dose of 40 microg/kg per day 5 days a week for 3 weeks and 7 weeks. Bone mineral density (BMD) of total bone, femur, tibia, and lumbar vertebrae was measured weekly by PIXImus. Bone turnover was examined by histomorphometry, and gene expression of bone formation and resorption markers and osteoclastogenesis regulators in the excised femur and tibia was assessed by reverse-transcription polymerase chain reaction (RT-PCR) at 3 weeks and 7 weeks. The PTH-stimulated increase in BMD was more prominent in the tibia and femur than in the lumbar vertebrae, with an anabolic effect detected within 1-2 weeks and BMD continuing to increase. The appearance of a detectable PTH-stimulated increase in BMD was slower in the lumbar vertebrae where the increase was only significant after 7 weeks of treatment. Histomorphometric analysis of the proximal tibia at both 3 weeks and 7 weeks indicated significant time-dependent increases in trabecular area, trabecular number, trabecular and cortical widths, and osteoblast and osteoid perimeters. In the lumbar vertebrae, these stimulatory effects of PTH on trabecular area, trabecular number, and cortical width were smaller and not detected until 7 weeks. PTH-stimulated increases in bone turnover were evident by increased gene expression of osteocalcin (OC), tartrate-resistant acid phosphatase (TRAP), and receptor of activator nuclear factor kappaB (NF-kappaB) ligand (RANKL) in the tibia and femur. No significant difference in gene expression was observed between the two long bone sites. In conclusion, PTH exerts an anabolic action at the tissue and cellular levels in intact mice and the magnitude and temporal pattern of this anabolic action, as assessed by densitometry and histomorphometry, are skeletal site specific.