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Dorsal preservation rhinoplasty in cases of a convex or overprojected noses has significant advantages over resection and reconstruction of the dorsum. Analysis of the subdorsal septum in relation to the radix osteotomy to achieve a drop or hinge of the natural dorsum is important in avoiding possible complications involving the skull base, frontal sinus, and subsequent radix position. In the majority of patients, simple cut release of the perpendicular plate rather than resection superiorly may be necessary where the quadrangular cartilage junction with the perpendicular plate is caudal to the radix osteotomy. Computed tomography is helpful in delineating this position as well as providing information on the frontal sinus and position of the cribriform plate prerhinoplasty.
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Rinoplastia , Hueso Etmoides , Humanos , Tabique Nasal/cirugía , Osteotomía , Base del CráneoRESUMEN
Cell sorters play important roles in biological and medical applications, such as cellular behavior study and disease diagnosis and therapy. This work presents a label-free microfluidic sorter that has a downstream-pointing magnetic elastic diverter. Different with most existing magnetic sorters, the proposed device does not require the target microobjects to be intrinsically magnetic or coated with magnetic particles, giving users more flexibility in sorting criteria. The diverter is wirelessly deformed by an applied magnetic field, and its deformation induces a fluid vortex that sorts incoming microobjects, e.g., cells, to the collection outlet. The diverter does not touch samples in this process, reducing the sample contamination and damage risks. This sorter uses a magnetic field generated by off-chip electromagnetic coils that are centimeters away from the device. With simple structure and no on-chip circuits or coils, this device can be integrated with other lab-on-a-chip instruments in a sealed chip, ameliorating the safety concerns in handling hazardous samples. The parallel and independent control of two such diverters on a single chip were demonstrated, showing the potential of doubling the overall throughput or forming a two-stage cascaded sorter. The sorter was modeled based on the Euler-Bernoulli beam theory and its reliability was demonstrated by achieving a raw success rate of 96.68% in sorting 1506 registered microbeads. With a simple structure, the sorter is easy and cheap to fabricate. The advantages of the proposed sorter make it a promising multi-purpose sorting tool in both academic and industrial applications.
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Separación Celular/instrumentación , Elasticidad , Dispositivos Laboratorio en un Chip , Fenómenos Magnéticos , Diseño de EquipoRESUMEN
BACKGROUND: Pyoderma gangrenosum is a rare noninfectious cutaneous disease characterized by expanding areas of skin ulceration around necrotic centers with purulent debris. Exceptionally, it can be precipitated by surgery alone, and this entity has been described as postsurgical pyoderma gangrenosum (PSPG). Cases of PSPG in the literature are rare. METHODS: We performed a retrospective review of the current literature on PSPG and highlight some observed differences between these conditions. We also present our experience of PSPG imitating an infectious process post reduction mammoplasty. RESULTS: Although PSPG can demonstrate fever, malaise, systemic signs, and serology that mimic the sepsis of necrotizing fasciitis, we identify some features that can aid diagnosis of pyoderma gangrenosum in the absence of pathergy (which is pathognomonic). These include premorbid inflammatory bowel disease, hematological malignancy, or inflammatory polyarthritis; the exquisite and disproportionate pain associated (in particular within surrounding normal skin); symmetrical changes on both breasts; specific histopathological changes with absence of microorganisms; cutaneous wounds demonstrating an ulcerated, violaceous, and undermined edge; and, in this case, bilaterally spared nipple-areola complexes suggesting progression within continuous skin up to but not across incision lines. CONCLUSIONS: We hope that, in encouraging a higher index of suspicion, prompt diagnosis, and accurate treatment, a better outcome for both patient and surgeon can be achieved in future cases.
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Fascitis Necrotizante/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Piodermia Gangrenosa/diagnóstico , Diagnóstico Diferencial , HumanosRESUMEN
Cancer-related lymphedema is a progressive, chronic condition that impairs quality of life. Its pathophysiology and the mechanisms of action of current reconstructive surgical treatments are not fully understood but lymphaticovenous communications may play a key role. We review the available literature on lymphaticovenous communications and their implications in lymphedema surgery, and propose a subclassification of lymphaticovenous communications. J. Surg. Oncol. 2016;113:374-380. © 2016 Wiley Periodicals, Inc.
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Sistema Linfático/patología , Linfedema/patología , Linfedema/cirugía , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Sistema Linfático/anatomía & histología , Sistema Linfático/cirugíaRESUMEN
BACKGROUND: Classic teaching of ear anatomy in the context of otoplasty states that if the antihelical fold is more prominent than the helical fold after surgery then the ear is "overcorrected." We set out to explore the role of the antihelix in normal ear anatomy, its relevance to aesthetic perceptions of the ear, and a snapshot of its incidence in nonoperated ears. METHODS: To readily identify junior staff in our department, their color photographs, names, and contact details are posted on every ward. Using digital methods, we cropped the left ear out of the source images, making them unidentifiable. Clinical and nonclinical staff in our unit were asked to choose their favorite and their least favorite ears based on their aesthetic appeal. Responses were tabulated and the 2 most popular ears were compared. RESULTS: The preferred ear did not conform to the traditional dogma because it had a prominent antihelix and was statistically significant when compared to other choices. We also noted that a prominent antihelix is common among the general population and among colleagues within the department, and hence "normal." Also interesting was that the helix of the ear chosen as the most aesthetic was also the ear where the helix was almost touching the side of the head. CONCLUSIONS: We found that when judging the aesthetic nature of the "virgin" ear, antihelical fold prominence did not appear to be a negative attribute. Indeed, we noted that a prominent antihelix was a common attribute, and we conclude that this was a normal variant without undue negative aesthetic stigma. A surgically corrected ear should not necessarily be regarded as a poor outcome simply on the basis of antihelical prominence. Furthermore, we postulate that patients who have a prominent antihelix might be part of a spectrum of individuals who might have had the subtype of prominent ears featuring a deep conchal bowl. Finally, although not tested directly, it appears that we do not have an idea of our own ear shape, as none of the participants was able to recognize their own ear from the photographs.
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Actitud del Personal de Salud , Pabellón Auricular/anatomía & histología , Estética , Procedimientos Quirúrgicos Otológicos/psicología , Pabellón Auricular/cirugía , HumanosRESUMEN
INTRODUCTION: Various postauricular incision sites can be used for prominent ear correction depending on technique and surgeon preference. No study has previously looked at the most aesthetic (least visible) location for the postauricular scar. We investigated the visibility of various scar locations on the posterior ear from a third person perspective through a "Visibility Arc"-a formal assessment of the range of degrees where a particular scar is visible. The objective was to determine the least visible incision-that is, the scar with the shortest visibility arc. METHODS: Normal ears were marked with 3 different color markers to simulate postoperative scar position, namely, (1) black in auriculocephalic sulcus, (2) blue in the sulcus of the antihelical fold/groove, and (3) green between black and blue. Starting laterally from the right ear toward the left ear, each head was photographed across 180 degrees posteriorly, at 10-degree intervals to determine which colored line (corresponding to a particular scar location) was visible over what "visibility arc." RESULTS: Forty individual ears were analyzed. Scars located in the sulcus of the antihelical fold had the shortest average visible arc, which was a 70-degree arc. The auriculocephalic sulcus had the largest visibility arc, and was most obvious of all of the scar locations-a 100-degree arc. The scar location in between these 2 locations had an 80-degree arc. CONCLUSIONS: The least visible scar for pinnaplasty rests in the groove of the antihelix posteriorly, with scars slightly medial to this almost as discrete. The most visible scars when viewed from behind will be those in the "traditional" location of the auriculocephalic sulcus.
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Cicatriz/etiología , Técnicas Cosméticas , Oído Externo/cirugía , Estética , Complicaciones Posoperatorias , Cicatriz/diagnóstico , Humanos , Imagenología Tridimensional , Complicaciones Posoperatorias/diagnóstico , Cuidados PreoperatoriosRESUMEN
Background: Resection of additional tissue circumferentially around the cavity left by lumpectomy (cavity shave) was suggested to reduce rates of positive margins and re-excision. Methods: A single center retrospective study which analyzed margins status, re-excision, and surgical time in patients who underwent breast conserving surgery and cavity shave or intraoperative evaluation of resection margins. Results: Between 2021 and 2023, 594 patients were enrolled in the study. In patients subjected to cavity shave, a significant reduction in positive, focally positive, or closer margins was reported 8.9% vs. 18.5% (p = 0.003). No difference was reported in terms of surgical re-excision (p < 0.846) (5% vs. 5.5%). Surgical time was lower in patients subjected to cavity shave (<0.001). The multivariate analysis intraoperative evaluation of sentinel lymph node OR 1.816 and cavity shave OR 2.909 were predictive factors for a shorter surgical time. Excluding patients subjected to intraoperative evaluation of sentinel lymph node and patients with ductal carcinoma in situ, patients that underwent the cavity shave presented a reduced surgical time (67.9 + 3.8 min vs. 81.6 + 2.8 min) (p = 0.006). Conclusions: Cavity shaving after lumpectomy reduced the rate of positive margins and it was associated with a significant reduction in surgical time compared to intraoperative evaluation of resection margins.
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Carcinoma Intraductal no Infiltrante , Márgenes de Escisión , Mastectomía Segmentaria , Humanos , Carcinoma Intraductal no Infiltrante/cirugía , Linfadenopatía , Tempo Operativo , Estudios RetrospectivosRESUMEN
Among children with multiple congenital melanocytic nevi, 25% have no established genetic cause, of whom many develop a hyperproliferative and severely pruritic phenotype resistant to treatment. Gene fusions have been reported in individual cases of congenital melanocytic nevi. We studied 169 patients with congenital melanocytic nevi in this study, 38 of whom were double wild type for pathogenic NRAS/BRAF variants. Nineteen of these 38 patients had sufficient tissue to undergo RNA sequencing, which revealed mosaic BRAF fusions in 11 of 19 patients and mosaic RAF1 fusions in 1 of 19. Recurrently, fusions involved the loss of the 5´ regulatory domain of BRAF or RAF1 but preserved the kinase domain. We validated all cases and detected the fusions in two separate nevi in 5 of 12 patients, confirming clonality. The absence of the fusion in blood in 8 of 12 patients indicated mosaicism. Primary culture of BRAF-fusion nevus cells from 3 of 12 patients demonstrated highly increased MAPK activation, despite only mildly increased BRAF expression, suggesting additional mechanisms of kinase activation. Trametinib quenched MAPK hyperactivation in vitro, and treatment of two patients caused rapid improvement in bulk tissue, improving bodily movement and reducing inflammation and severe pruritus. These findings offer a genetic diagnosis to an additional group of patients and trametinib as a treatment option for the severe associated phenotypes.
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Nevo de Células Epitelioides y Fusiformes , Nevo Pigmentado , Neoplasias Cutáneas , Niño , Humanos , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/metabolismo , Proteínas Proto-Oncogénicas B-raf/genética , Mutación , Nevo Pigmentado/tratamiento farmacológico , Nevo Pigmentado/genética , Nevo Pigmentado/congénitoRESUMEN
Many lacerations involve degloving, a form of avulsion in which skin is torn off the underlying tissue. Patients with lacerations involving degloving must be managed appropriately so that they do not experience too much pain and to ensure that wound healing is not delayed. This article presents a case study involving a patient with a degloving injury of the leg. It examines the important features of her journey of care, and discusses factors that influence wound healing and outcomes.
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Traumatismos de la Pierna/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Accidentes por Caídas , Vendajes , Femenino , Humanos , Laceraciones/cirugía , Persona de Mediana Edad , Procedimientos de Cirugía Plástica , Tatuaje , Cicatrización de HeridasRESUMEN
Introduction: A congenital cervical mass is a considerable health problem worldwide; however, accessory tragus (AT) in the neck is extremely rare. The cervical variant of AT or congenital cartilaginous rest of the neck (CCRN) is a rare anomaly related to the branchial arch located at the lateral of the neck that typically presents as an asymptomatic papule or nodule along the anterior border of sternocleidomastoid (SCM) muscle. It is detected since birth or in the first few years of life. Diagnosis is based on the clinical characteristics of the lesion, surgical findings, and histopathologic studies. Case Report: A young man with no underlying diseases or known congenital anomaly was referred by a dermatologist for an asymptomatic pedunculated papule in the left mid-cervical area. Physical examination reveals a firm and mobile papule with a size of 1*1 cm on the anterior middle 1/3 border of the SCM. Radiologic findings illustrated a mass nearby the SCM with a long tract beneath it extending upward. The lesion was finally resected, and during surgery, a long tract was discovered, and histopathologic examination confirmed the diagnosis of a CCRN. Conclusions: Although rare, the cervical variant of AT or CCRN should be considered in a differential diagnosis of benign masses in the neck.
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Salinity seriously constrains growth and fertility of rice worldwide. Long non-coding RNAs (lncRNAs) play crucial roles in plant abiotic stress response. However, salt responsive lncRNAs are poorly understood in rice. Herein, salt responsive lncRNAs (DE-lncRNAs) were identified in FL478 (salt tolerant) compared to its susceptible parent (IR29) using RNA-seq in root tissues at seedling stage. In FL478 and IR29, 8724 and 9235 transcripts with length of > 200 bp were nominated as potential lncRNAs, respectively. Rigorous filtering left four (in FL478) and nine (in IR29) DE-lncRNAs with only 2 DE-lncRNAs in common. ATAC-seq data showed that the genomic regions of all four lncRNAs in FL478 and 6/9 in IR29 are significantly accessible for transcription. Weighted correlation network analysis (WGCNA) revealed that lncRNA.2-FL was highly correlated with 173 mRNAs as trans-targets and a gene encoding pentatricopeptide repeat (PPR) protein was predicted as cis-target of lncRNA.2-FL. In silico mutagenesis analysis proposed the same transcription factor binding sites (TFBSs) in vicinity of the trans- and cis-regulatory target genes of lncRNA.2-FL, which significantly affect their transcription start site (TSS). This study provides new insights into involvement of the DE-lncRNAs in rice response to salt stress. Among them, lncRNA.2-FL may play a significant regulatory role in the salt stress tolerance of FL478.
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Oryza , ARN Largo no Codificante , ARN Largo no Codificante/genética , ARN Largo no Codificante/metabolismo , Estrés Salino/genética , Estrés Fisiológico/genética , ARN Mensajero/genéticaRESUMEN
We present a new design of an imaging cytometer for high content bioanalysis, which is equipped with a low-cost linear complementary metal oxide semiconductor (CMOS) imager (running at ≥40kHz). The fluorescent signals are encoded in a series of line scans across the cellular body, while it streams through a precisely defined line-shaped focus spot. This bioanalysis platform enables the concurrent collection of multiple fluorescence channels, while maintaining both high resolution and excellent throughput (1000 cells/s). We develop several image processing routines for the on-the-fly quantitative analysis of subcellular structures. Finally, we characterize our prototype system by imaging both adherent cells (plate format) and suspended cells (microfluidics format).
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Citometría de Flujo/instrumentación , Fluorescencia , MicrofluídicaRESUMEN
Anterior cruciate ligament (ACL) disruptions are common injuries that currently hold a fearsome reputation among athletes of all abilities and disciplines. Indeed, if the diagnosis is missed at first presentation, it is difficult to attribute ongoing instability and recurrent injury to an ACL tear. Classically, patients then often improve shortly before repeatedly reinjuring their knee. At some point, the knee may lock, necessitating an arthroscopic meniscectomy. Tragically, this then hastens the progression of joint arthrosis and the decline of the joint function. While the burden of responsibility does not lie solely with the junior doctor or the general practitioner, it is often at the first consultation that the natural history of this devastating injury is decided. The ability to recognise, institute early management and reassure patients with ACL tears about the future is an invaluable asset to the non-specialist junior doctor. Once diagnosed, the responsibility of advising and further counselling of patients with ACL injuries is best left to the orthopaedic knee specialist. Family practitioners and emergency room doctors should not feel pressured to offer advice on specialist areas such as return to sports without reconstruction or indeed the need for reconstruction. Indeed, decisions to return to sports with ACL-deficient knees have all too often led to disastrous reinjury events to the articular cartilage and/or the menisci.
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Lesiones del Ligamento Cruzado Anterior , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/terapia , Articulación de la Rodilla/anatomía & histología , Rotura/diagnóstico , Rotura/terapiaRESUMEN
BACKGROUND/AIM: Reduction of postoperative stress is a modern tenet in surgical oncology with the aim of reducing early postoperative lymphopenia. Our prospective study evaluated post-operative immune response at baseline and postoperative day (POD) 1 and 2 after direct-to-implant pre-pectoral (PP) breast reconstruction with titanium-coated polypropylene mesh versus subpectoral (SP) breast reconstruction. PATIENTS AND METHODS: Between January and December 2020, 37 patients were randomized between PP (n=17) or SP (n=16) reconstruction. Baseline and operative data were analyzed. Postoperative pain assessment using numeric pain rating scale (NPRS), and a full blood count with lymphocyte subsets were collected before surgery, and on POD1 and POD2. Data were evaluated by two-way analysis of variance test. RESULTS: Baseline data did not demonstrate any statistical difference. Inter-group analysis did not provide any statistically significant difference in leukocytes, total lymphocytes, and lymphocytes subsets among SP and PP reconstruction groups (p>0.05). However, compared to specificity, the PP group experienced shorter operative time, with a mean difference 30.19 min, lower blood loss (p=0.017), lower rate of postoperative anemia (p=0.039), and a more favorable profile in inter-group pain analysis (p<0.001). CONCLUSION: PP reconstruction with titanium-coated polypropylene mesh does not increase immunological impairment in the early postoperative period when compared with SP reconstruction and provides lower postoperative pain, reduction of operative time, and lower rate of postoperative anemia.
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Implantación de Mama/instrumentación , Implantes de Mama , Neoplasias de la Mama/cirugía , Mastectomía , Complicaciones Posoperatorias/inmunología , Anciano , Anemia/etiología , Anemia/prevención & control , Implantación de Mama/efectos adversos , Neoplasias de la Mama/patología , Femenino , Humanos , Italia , Persona de Mediana Edad , Tempo Operativo , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Polipropilenos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Diseño de Prótesis , Factores de Riesgo , Propiedades de Superficie , Mallas Quirúrgicas , Factores de Tiempo , Titanio , Resultado del TratamientoRESUMEN
Day surgery breast-conserving surgery (DS-BCS) is a surgical approach applied in many specialized breast surgery departments. This study demonstrates the benefits of this approach from the perspectives of patients and of the Hospital/National Health System compared to ordinary breast-conserving surgery (ORD-BCS) under general anesthetic. A comparison of costs and diagnosis-related group (DRG) reimbursement demonstrated improved cost-effectiveness in DS-BCS compared to ORD-BCS.
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Breast reconstruction plays a fundamental role in the therapeutic process of breast cancer treatment and breast implants represents the leading breast reconstruction strategy. Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL), locoregional recurrence in the skin flap, and skin flap necrosis are well-known complications following mastectomy and immediate breast reconstruction (IBR). We report a case of locoregional cancer recurrence in the mastectomy flap mimicking BIA-ALCL, in a patient who underwent 6 breast procedures in four facilities across 15 years including immediate breast reconstruction with macrotextured breast implants. Despite the rate and onset of the disease, clinicians should be aware of BIA-ALCL. Due to the risk of false negative results of fine needle aspiration, clinical suspicion of BIA-ALCL should drive clinicians' choices, aside from cytological results. In the present case, surgical capsulectomy of the abnormal periprosthesic tissue revealed locoregional recurrence.
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This article portrays the authors' clinical experience of a complex case of lower extremity reconstruction using a recycled pedicle from 10 years old free latissimus dorsi musculocutaneous flap to supply a new free anterolateral thigh flap for proximal tibia wound defect reconstruction. It provides clinical evidence that muscle neovascularization occurs and supports the dogma peripheral tissue neovascularization. This case stipulates that recycling of pedicle is feasible, when used with appropriate strategy and safety and also provides evidence for the long-term survival of greater saphenous vein grafts in lower extremity reconstruction.
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PURPOSE: There is an increasing availability of large imaging cohorts [such as through The Cancer Imaging Archive (TCIA)] for computational model development and imaging research. To ensure development of generalizable computerized models, there is a need to quickly determine relative quality differences in these cohorts, especially when considering MRI datasets which can exhibit wide variations in image appearance. The purpose of this study is to present a quantitative quality control tool, MRQy, to help interrogate MR imaging datasets for: (a) site- or scanner-specific variations in image resolution or image contrast, and (b) imaging artifacts such as noise or inhomogeneity; which need correction prior to model development. METHODS: Unlike existing imaging quality control tools, MRQy has been generalized to work with images from any body region to efficiently extract a series of quality measures (e.g., noise ratios, variation metrics) and MR image metadata (e.g., voxel resolution and image dimensions). MRQy also offers a specialized HTML5-based front-end designed for real-time filtering and trend visualization of quality measures. RESULTS: MRQy was used to evaluate (a) n = 133 brain MRIs from TCIA (7 sites) and (b) n = 104 rectal MRIs (3 local sites). MRQy measures revealed significant site-specific variations in both cohorts, indicating potential batch effects. Before processing, MRQy measures could be used to identify each of the seven sites within the TCIA cohort with 87.5%, 86.4%, 90%, 93%, 90%, 60%, and 92.9% accuracy and the three sites within the rectal cohort with 91%, 82.8%, and 88.9% accuracy using unsupervised clustering. After processing, none of the sites could be distinctively clustered via MRQy measures in either cohort; suggesting that batch effects had been largely accounted for. Marked differences in specific MRQy measures were also able to identify outlier MRI datasets that needed to be corrected for common acquisition artifacts. CONCLUSIONS: MRQy is designed to be a standalone, unsupervised tool that can be efficiently run on a standard desktop computer. It has been made freely accessible and open-source at http://github.com/ccipd/MRQy for community use and feedback.
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Artefactos , Imagen por Resonancia Magnética , Estudios de Cohortes , Humanos , Procesamiento de Imagen Asistido por Computador , Control de CalidadRESUMEN
Bilateral posterior fracture-dislocations of the shoulders are a rare injury that usually occurs secondary to a tonic-clonic seizure, electrocution or a high energy trauma. In this unique case, we present the first case of this injury resulting from a simple syncope in a 49 year old man with no history of epilepsy. He was fully investigated and no cause was found for his syncope. His shoulder fracture dislocations were reduced acutely and treated conservatively with full functional recovery.