The Upper Third in Facial Gender Confirmation Surgery: Forehead and Hairline.

The upper third of the face contains 2 features that are particularly important for facial gender recognition: the frontonasoorbital region and the hairline. The supraorbital ridge, which determines the position and exposure of the eyebrows, is almost invariably more developed in the male than in the female. Surgical modification of the frontonasoorbital complex, considered a standard procedure in facial feminization, is reliable and predictable, and also delivers satisfactory results that are stable over time.A prototypical male hairline has an M-shaped pattern compared to the more rounded shape often seen in female hairlines. Feminization of the hairline requires minimizing the temples as well as rounding out the overall shape, optimizing hair density, and occasionally changing the height of the hairline.This article provides an update on our forehead reconstruction technique and our experience in the treatment of hairline redefinition.

Propargylsilanes as Reagents for Synergistic Gold(I)-Catalyzed Propargylation of Carbonyl Compounds: Isolation and Characterization of σ-Gold(I) Allenyl Intermediates.

Reported herein is the isolation and characterization, for the first time, of a σ-gold allenyl complex as an intermediate in gold catalysis. This intermediate was captured during the study of a novel gold(I)-catalyzed propargylation of carbonyl compounds with propargylsilanes. Notably, the gold-catalyzed propargylation reaction, which proceeds with aldehydes and ketones, can be driven to the formation of either homopropargyl silyl ethers or the in situ synthesis of corresponding 2-silyl-4,5-dihydrofurans.

Understanding the Mechanism of the Divergent Reactivity of Non-Heteroatom-Stabilized Chromium Carbene Complexes with Furfural Imines: Formation of Benzofurans and Azetines.

The mechanisms of the reaction between non-heteroatom-stabilized alkynyl chromium carbene complexes prepared in situ and furfural imines to yield benzofurans and/or azetines have been explored by means of density functional theory method calculations. The reaction proceeds through a complex cascade of steps triggered by a nucleophilic addition of the imine nitrogen atom. The formation of two benzofuran regioisomers has been explained in terms of competitive nucleophilic attacks to different positions of the carbene complex. Each of these regioisomers can be obtained as the major product depending on the starting materials. The overall sequence could be controlled to yield benzofurans or azetines by adjusting the substituents present in the initial carbene complex. This mechanistic information allowed for the preparation of new benzofurans and azetinylcarbenes in good yields.

Dioxin receptor regulates aldehyde dehydrogenase to block melanoma tumorigenesis and metastasis.

BACKGROUND: The dioxin (AhR) receptor can have oncogenic or tumor suppressor activities depending on the phenotype of the target cell. We have shown that AhR knockdown promotes melanoma primary tumorigenesis and lung metastasis in the mouse and that human metastatic melanomas had reduced AhR levels with respect to benign nevi. METHODS: Mouse melanoma B16F10 cells were engineered by retroviral transduction to stably downregulate AhR expression, Aldh1a1 expression or both. They were characterized for Aldh1a1 activity, stem cell markers and migration and invasion in vitro. Their tumorigenicity in vivo was analyzed using xenografts and lung metastasis assays as well as in vivo imaging. RESULTS: Depletion of aldehyde dehydrogenase 1a1 (Aldh1a1) impairs the pro-tumorigenic and pro-metastatic advantage of melanoma cells lacking AhR expression (sh-AhR). Thus, Aldh1a1 knockdown in sh-AhR cells (sh-AhR + sh-Aldh1a1) diminished their migration and invasion potentials and blocked tumor growth and metastasis to the lungs in immunocompetent AhR+/+ recipient mice. However, Aldh1a1 downmodulation in AhR-expressing B16F10 cells did not significantly affect tumor growth in vivo. Aldh1a1 knockdown reduced the high levels of CD133(+)/CD29(+)/CD44(+) cells, melanosphere size and the expression of the pluripotency marker Sox2 in sh-AhR cells. Interestingly, Sox2 increased Aldh1a1 expression in sh-AhR but not in sh-AhR + sh-Aldh1a1 cells, suggesting that Aldh1a1 and Sox2 may be co-regulated in melanoma cells. In vivo imaging revealed that mice inoculated with AhR + Aldh1a1 knockdown cells had reduced tumor burden and enhanced survival than those receiving Aldh1a1-expressing sh-AhR cells. CONCLUSIONS: Aldh1a1 overactivation in an AhR-deficient background enhances melanoma progression. Since AhR may antagonize the protumoral effects of Aldh1a1, the AhR(low)-Aldh1a1(high) phenotype could be indicative of bad outcome in melanoma.

Gold(I)-Catalyzed Addition of Silylacetylenes to Acylsilanes: Synthesis of Indanones by C-H Functionalization through a Gold(I) Carbenoid.

A gold(I)-catalyzed synthesis of indanones from trimethylsilylacetylenes and acylsilanes is presented. The reaction is initiated through a synergistic acylsilane activation-gold acetylide formation and involves consecutive alkyne σ-gold(I) addition, π-activation, and 1,2-migration of a silyl group. Studies performed on the reaction mechanism allowed to establish the nature of the silyl migrating group and invoke the participation of a gold(I) carbenoid intermediate. The reaction is completed by a gold(I) C-H functionalization step.

Intermolecular and regioselective access to polysubstituted benzo- and dihydrobenzo[c]azepine derivatives: modulating the reactivity of group 6 non-heteroatom-stabilized alkynyl carbene complexes.

We highlight the versatility of non-heteroatom-stabilized tungsten-carbene complexes 3 synthesized in situ, which have been used in a modular approach to access 2-benzazepinium isolable intermediates 5. By employing very mild conditions, benzazepinium derivatives 5 have been obtained in high yield from simple compounds, such as acetylides 2, Fischer-type alkoxycarbenes 1, and phenylimines 4. The process, involving a formal [4+3] heterocycloaddition, occurs in a totally regioselective manner, which differs from the approach previously observed in similar procedures for other carbene analogues. This work, which involves three components, reveals a control of the reactivity of non-heteroatom-stabilized carbene complexes 3 ([4+3] vs. [2+2]-heterocycloaddition reactions) depending on the acetylide substitution pattern. The influence of the substitution pattern in the behavior of the complexes has been computationally analyzed and rationalized. Finally, elaboration of the 2-benzazepinium intermediates allows access to 3H-benzo[c]azepines 6 and 3H-1,2-dihydrobenzo[c]azepines 7-9 with high control of the substitution of the nine positions of the heterocycle.

Mechanistic studies on the rearrangement of 1-alkenyl-2-alkynylcyclopropanes: from allylic gold(I) cations to stable carbocations.

An allylic gold(I) cation, proposed as key intermediate in the gold-promoted rearrangement of 1,5-enynes bearing a fixed conformation, has been detected and characterized by NMR spectroscopy. Moreover, its participation in the overall transformation was confirmed. Computational studies indicate that the gold-catalyzed transformation occurs through an uncommon rearrangement. Additionally, this study led us to isolate and characterize a stable homoantiaromatic carbocation.

The dioxin receptor has tumor suppressor activity in melanoma growth and metastasis.

Melanoma is a highly metastatic and malignant skin cancer having poor rates of patient survival. Since the incidence of melanoma is steadily increasing in the population, finding prognostic and therapeutic targets are crucial tasks in cancer. The dioxin receptor (AhR) is required for xenobiotic-induced toxicity and carcinogenesis and for cell physiology and organ homeostasis. Yet, the mechanisms by which AhR affects tumor growth and dissemination are largely uncharacterized. We report here that AhR contributes to the tumor-stroma interaction, blocking melanoma growth and metastasis when expressed in the tumor cell but supporting melanoma when expressed in the stroma. B16F10 cells engineered to lack AhR (small hairpin RNA for AhR) exacerbated melanoma primary tumorigenesis and lung metastasis when injected in AhR+/+ recipient mice but not when injected in AhR- /- mice or when co-injected with AhR-/- fibroblasts in an AhR+/+ stroma. Contrary, B16F10 cells expressing a constitutively active AhR had reduced tumorigenicity and invasiveness in either AhR genetic background. The tumor suppressor role of AhR in melanoma cells correlated with reduced migration and invasion, with lower numbers of cancer stem-like cells and with altered levels of ß1-integrin and caveolin1. Human melanoma cell lines with highest AHR expression also had lowest migration and invasion. Moreover, AHR expression was reduced in human melanomas with respect to nevi lesions. We conclude that AhR knockdown in melanoma cells requires stromal AhR for maximal tumor progression and metastasis. Thus, AhR can be a molecular marker in melanoma and its activity in both tumor and stromal compartments should be considered.

Polymorphous low-grade adenocarcinoma in the upper lip: a well-described but infrequently recognized tumor.

Polymorphous low-grade adenocarcinoma (PLGA) is a rare malignant neoplasm arising almost exclusively in the minor salivary glands. PLGA occurs primarily in the oral cavity, especially in the palate, followed by the oral mucosa and upper lip [1,2]. Conditions involving these locations are often presented at dermatological clinics. Therefore, dermatologists should consider this entity in the differential diagnosis of the oral cavity tumors. We present a case of PLGA in the upper lip.

RECALSEEN 2021. Resources and quality in the Endocrinology and Nutrition units of the National Health System of Spain.

OBJECTIVES: RECALSEEN project aims to analyze the structure, activity, and outcomes of the departments of endocrinology and nutrition (S-U_EyN) of the Spanish National Health System (SNHS). Based on the results obtained, the challenges for the specialty are analyzed and proposals for improvement policies are made. In this paper 2021 survey data and activity data from the 2007-2019 from the Minimum Basic Data Set (MBDS) are presented. MATERIAL AND METHODS: Cross-sectional descriptive study of the S-U_EyN of acute general hospitals of the NHS in 2020. Data were obtained through: 1. an "ad hoc" survey answered by the S-U_EyN' consultants; and 2. analysing the acute general hospital discharges from S-U_EyN and discharges with endocrine-metabolic comorbidities registered in the minimum basis data set (MBDS) of the SNHS. RESULTS: 112 responses from S-U_EyN were obtained from a total of 154 general acute hospitals of the NHS (73%). The 2021 S-U_EyN sample includes 24 more centers than in 2017. 54% of the S-U_EyN were endocrinology departments. The median number of endocrinologists per S-U_EyN was 7. The estimated rate of endocrinologists was 2.5 per 100,000 inhabitants. S-U_EyN showed a high level of collaboration with primary care teams and other hospital units. Use of telemedicine by S-U_EyN experienced a high increase in 2020. Notable differences in resources and activity have been found between hospitals and Autonomous Communities. There was a wide margin for improvement in quality management. CONCLUSIONS: RECALSEEN is a useful project for the analysis of S-U_EyN. The remarkable variability found in the indicators of structure, activity and management probably indicates a wide margin for improvement.

Outcomes Following Autologous Fat Grafting in Patients with Sequelae of Head and Neck Cancer Treatment.

A single-center retrospective study was designed to assess the outcomes of autologous fat grafting for improving surgery- and radiotherapy-related sequelae in 40 patients with head and neck cancer. All patients underwent surgical resection of primary tumors and radiotherapy (50-70 Gy) and were followed over 12 months after fat grafting. Eligibility for fat grafting procedures included complete remission after at least 3 years of oncological treatment. The cervical and paramandibular regions were the most frequently treated areas. Injected fat volumes ranged between 7.5 and 120 mL (mean: 23 mL). Esthetic improvement was obtained in 77.5% of patients, being significant in 17.5%, and functional improvement in 89.2%, being significant in 29.7% of patients. Minor complications occurred in three patients. There was a high degree of satisfaction regarding esthetic improvement, global satisfaction, and 92.5% of patients would recommend the procedure. This study confirms the benefits of fat grafting as a volumetric correction reconstructive strategy with successful cosmetic and functional outcomes in patients suffering from sequelae after head and neck cancer treatment.

Secondary Facial Gender Surgery: Causes of Poor Outcomes and Strategies for Avoidance and Correction.

SUMMARY: Facial feminization surgery covers a broad spectrum of procedures across both hard and soft tissues. Despite the fact that this is a decidedly predictable surgery, because of the high demand for the procedures, a growing number of patients are requiring revision surgery, whether to correct unexpected results or to treat mid-term to long-term functional and aesthetic complications. This Special Topic article categorizes unsatisfactory outcomes encountered after forehead surgery, lower jaw surgery, and thyroid chondroplasty; key steps to avoid these pitfalls; and strategies for structured analysis and operative planning in revision cases.

An Analysis of the Self-Healing and Mechanical Properties as well as Shape Memory of 3D-Printed Surlyn® Nanocomposites Reinforced with Multiwall Carbon Nanotubes.

This research work studies the self-healing ability, mechanical properties, and shape memory of the polymer Surlyn® 8940 with and without multiwall carbon nanotubes (MWCNTs) as a nanoreinforcement. This polymer comes from a partially neutralized poly(ethylene-co-methacrylic acid) (EMAA) ionomer copolymer. MWCNTs and the polymer went through a mixing process aimed at achieving an excellent dispersion. Later, an optimized extrusion method was used to produce a uniform reinforced filament, which was the input for the 3D-printing process that was used to create the final test samples. Various concentrations of MWCNTs (0.0, 0.1, 0.5, and 1.0 wt.%) were used to evaluate and compare the mechanical properties, self-healing ability, and shape memory of unreinforced and nanoreinforced materials. Results show an enhancement of the mechanical properties and self-healing ability through the addition of MWCNTs to the matrix of polymer, and the specimens showed shape memory events.

Shaping the Lower Jaw Border with Customized Cutting Guides: Development, Validation, and Application in Facial Gender-Affirming Surgery.

Importance: Three-dimensional planning software is not standardized in facial gender-affirming surgery. Objective: To develop and validate surgical planning software to create cutting guides to contour the lower jaw border. Design, Setting, and Participants: A 3-year prospective case series study done in three phases: software development, validation, and surgical guide application. Ethics committee approval was obtained to enroll the patients (Clinical Research Ethics Committee, Hospital Costa del Sol, Marbella, Spain). Main Outcomes and Measures: Validation phase: degree of agreement between the planned and obtained results, modification of cephalometric parameters, and surgical times. Application phase: surgical technique description, complications, and patient-reported outcome measures. Results: The degree of agreement between the planned and obtained results was inframillimetric (0.31 ± 0.70 mm). The guides reduced the mandible to within feminine parameters (p < 0.05). Surgical times decreased by 10.96% with chin ostectomies (p < 0.05) and 23.06% with lower jaw border (angle-to-angle) surgeries (p < 0.001). In the application phase, revision surgery was required for 11 patients out of 260 (4.23%). Conclusions and Relevance: The use of cutting guides on the lower jaw border is effective, helps reach standard feminine parameters, and decreases surgical times.

Facial Gender Confirmation Surgery: The Lower Jaw. Description of Surgical Techniques and Presentation of Results.

BACKGROUND: Of the primary procedures associated with facial gender confirmation surgery, those involving the mentomandibular complex have received the least attention in the literature. METHODS: The authors present their experience with 837 trans feminine patients operated on for facial gender confirmation surgery who underwent mandibular bone contouring procedures, including bone contouring, chin and mandibular body and angle ostectomies, and osteotomies to reposition the chin. The authors describe the surgical techniques and materials used, and present a customized lower border-supported cutting guide designed by their team and used with 205 patients. A femininity perception score was calculated preoperatively and 12 months postoperatively, and satisfaction with the results was measured 12 months postoperatively. RESULTS: The postoperative follow-up ranged from 12 to 110 months. The mean femininity perception score increased from 47.86 preoperatively to 76.41 at 12 months postoperatively (p < 0.001). No emergency surgical operations were required. In no case was there any permanent damage to the mental or inferior dental nerve. The reoperation percentage because of problems detected during the postoperative period was 2.63 percent (22 patients). CONCLUSIONS: With facial gender confirmation surgery of the jawline and chin, it is possible to modify the transverse and vertical components of the jaw; soften the gonial angles; change the format, bone volume, and position of the chin; and harmonize the entire mandibular line. The facial feminization achieved high satisfaction scores regarding the results and feminine gender appearance 12 months after surgery. The future of mandibular bone contouring techniques includes planning with virtual software and surgical support with patient-specific cutting guides.

Gold(I)-Catalyzed One-Pot and Diastereoselective Synthesis of trans-2-Silyl-4,5-dihydrofurans from Propargylsilanes and Aldehydes.

A diastereoselective and high-yielding gold-catalyzed synthesis of trans-2-silyl-4,5-dihydrofurans is described. In addition to a sequential manner, this reaction could be performed in a one-pot procedure from propargylsilanes and aldehydes. A mechanistic proposal for the cis-trans isomerization step is formulated. To provide experimental support for this proposal, which involves ring opening/ring closing steps of the dihydrofuran, several isotopically labeled experiments, intramolecular capture of a proposed intermediate, and construction of a Hammett plot have been performed.

Facial Gender Confirmation Surgery: A Protocol for Diagnosis, Surgical Planning, and Postoperative Management.

During the past 10 years, academic publications that address facial feminization surgery have largely examined the technical aspects of the different surgical procedures involved and clinical evaluations of postoperative results. This Special Topic article focuses on aspects that are underdeveloped to date but useful with regard to taking the correct therapeutic approach to transgender patients who are candidates for facial gender confirmation surgery. The authors propose a protocolized sequence, from the clinical evaluation to the postoperative period, based on a sample size of more than 1300 trans feminine patients, offering facial gender confirmation surgery specialists standardized guidelines to handle their patients' needs in a way that is both objective and reproducible.

Hole-in-one: simple non-surgical technique for the management of anterior chamber migrated Ozurdex® implant.

Introduction: The migration of a dexamethasone implant to the anterior chamber is a vision-threatening complication which can happen in non-compartmentalized eyes treated with this device. Previous literature suggests that the solution to this complication is almost always surgical and in most cases cannot be delayed. Case description: We present the case of a 78-year-old woman with a scleral-fixated IOL and macular edema treated with Ozurdex®. She came to us complaining of blurred vision and was subsequently diagnosed with an anterior-chamber migration of her dexamethasone implant. Postural manoeuvres were performed until the dexamethasone implant returned to the vitreous cavity through the pupil. Pilocarpine drops were prescribed with a positive outcome and no further migrations were described. Discussion: This case shows a practical and efficient way of managing a potentially vision-threatening complication without placing the patient onto an operating table. It is interesting to see how it is possible to relocate a dexamethasone implant despite the presence of a scleral-fixated IOL. Conclusion: Postural manoeuvres are an interesting option in patients with a dexamethasone implant migrated to the anterior chamber. This approach can have very positive outcomes, in addition to avoiding surgery, with all the risks and complications involved.

Regioselective synthesis of 4,6,7-trisubstituted benzofurans from furfural imines and nonheteroatom stabilized alkynylcarbene complexes.

Nonheteroatom stabilized chromium alkynylcarbene complexes 3,6, generated in situ from Fischer cabene complexes 1, smoothly react with furan-2-ylmethanimines 4 to provide substituted 7-aminobenzofurans 5 in moderate to good yields. The procedure involves the construction of the arene ring by a regioselective [3+3] carbocyclization reaction.

Lines of cell differentiation in solitary fibrous tumor: an ultrastructural and immunohistochemical study of 10 cases.

BACKGROUND: Solitary fibrous tumor (SFT) is a rare ubiquitous mesenchymal neoplasm of probable fibroblastic type with a prominent hemangiopericytoma-like vascular pattern. Since their initial description as arising from the pleura, SFTs have been reported in many extraserosal sites. It is now accepted that this neoplasm is derived from mesenchymal cells but its histogenesis is still not known. METHODS: The authors gathered clinical data on 10 patients with SFT. Tissue microarrays were constructed to perform inmunohistochemical tests and we reviewed hematoxilin-eosin-stained slides. Electron-microscopically collected samples were fixed with formalin or Karnovsky reactive and embedded in epoxy resin. RESULTS: The histopathological review showed varying degrees of cell density and mitotic activity, which correlated with clinical behavior. Immunohistochemically most tumors stained positively for vimentin, CD99, and CD34. Ultrastructural study showed some degree of myofibroblastic differentiation in all cases and focal smooth muscle features. In addition, 9 cases showed perivascular undifferentiated cells. CONCLUSION: SFT is an uncommon neoplasm with different histological patterns and clinical behavior. The authors hypothesize that the perivascular undifferentiated cells that most cases showed might correspond to a quiescent stage of adult stem mesenchymal cell and could be the target of the molecular aberrations implied in its pathogenesis.