The elastography of distal ulnar nerve branches in cyclists.

INTRODUCTION: Forced elbow flexion and pressure during bicycling result in ulnar nerve traction and pressure exerted in Guyon's canal or the nerve's distal branches. The compression of the nerves causes a change in their stiffness related to edema and eventually gradual fibrosis. PURPOSE: This study aimed to evaluate the elastography of terminal branches of the ulnar nerve in cyclists. STUDY DESIGN: Cross-sectional study. METHODS: Thirty cyclists, 32 healthy individuals, and 32 volunteers with ulnar nerve entrapment neuropathies participated in the study. Each participant underwent a nerve examination of the cubital tunnel, Guyon's canal and the deep and superficial branches of the ulnar nerve using shear wave elastography. The cyclist group was tested before and after a 2-hour-long workout. RESULTS: Before cycling workouts, the ulnar nerve stiffness in the cubital tunnel and Guyon's canal remained below pathological estimates. Cycling workouts altered nerve stiffness in the cubital tunnel only. Notably, the stiffness of the ulnar terminal branches in cyclists was increased even before training. The mean deep branch stiffness was 50.85 ± 7.60 kPa versus 20.43 ± 5.95 kPa (p < 0.001) in the cyclist and healthy groups, respectively, and the mean superficial branch stiffness was 44 ± 12.45 kPa versus 24.55 ± 8.05 kPa (p < 0.001), respectively. Cycling contributed to a further shift in all observed values. DISCUSSION: These observations indicate the existence of persistent anatomical changes in the distal ulnar branches in resting cyclists that result in increased stiffness of these nerves. The severity of these changes remains, however, to be determined. CONCLUSIONS: These data show elastography values of the ulnar terminal branches in healthy individuals and cyclists where despite lack of clinical symptoms that they seem to be elevated twice above the healthy range.

The Impact of N-Acetylcysteine on Autologous Fat Graft: First-in-Human Pilot Study.

BACKGROUND: Our goal was to determine whether N-acetylcysteine (NAC) administered to the tumescent solution can reduce oxidative stress and increase autologous fat graft (AFG) viability. METHODS: The study included 15 women with a mean age of 31.8 years (range 23-39 years) who underwent breast asymmetry correction with AFG harvested from both thighs. One thigh was infiltrated with a standard tumescent fluid (control graft) and other with a NAC-enriched tumescent fluid (NAC-treated graft). Each participant had breast MRI imaging before and 6 months after the procedure. Also, adipose tissue samples from each graft were subjected to biochemical analysis, flow cytometric assay and qRT-PCR to determine the markers of oxidative stress, angiogenesis and adipogenesis. RESULTS: Concentration and activity of superoxide dismutase in the NAC-treated grafts turned out to be significantly higher than in the control grafts, in both fresh (p = 0.041 and p = 0.023, respectively) and frozen samples (p = 0.004 and p = 0.003, respectively). The level of nitric oxide in frozen samples from the control grafts was significantly higher than in the NAC-treated grafts (p = 0.009). iNOS was the only qRT-PCR target showing significant intergroup differences, with higher transcription levels observed in the control grafts (p = 0.027). Breast volumetric analysis demonstrated that the NAC-treated group had a 12.19% lower resorption rate than the control group, although it was found to be statistically insignificant (p = 0.149). No postoperative complications were observed during a 6-month follow-up. CONCLUSIONS: Some results of this study are promising. Further studies on larger groups are needed to determine NAC impact on AFG. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . TRIAL REGISTRY NAME: The Impact of N-Acetylcysteine on Volumetric Retention of Autologous Fat Graft for Breast Asymmetry Correction. REGISTRATION IDENTIFICATION NUMBER: NCT03197103. URL FOR THE REGISTRY: https://clinicaltrials.gov/ct2/show/NCT03197103?term=acetylcysteine&rank=6.

Role of Magnetic Resonance Spectroscopy in Evaluation of Cerebral Metabolic Status Before and After Carotid Endarterectomy/Thromboendarterectomy and Carotid Artery Stenting in Patients with Asymptomatic Critical Internal Carotid Artery Stenosis.

BACKGROUND The relative efficacy of carotid endarterectomy (CEA)/thromboendarterectomy (TEA) and carotid artery stenting (CAS) already has been compared in randomized controlled trials and a meta-analysis, but only limited data exist describing the status of cerebral metabolism before and after these interventions. The aim of the present study was to compare metabolic changes before and after treatment of carotid stenosis and assess their potential clinical implications.   MATERIAL AND METHODS Patients with asymptomatic unilateral critical internal CAS were imaged with proton 3T magnetic resonance spectroscopy (H-MRS) because the technique is more sensitive than regular magnetic resonance imaging for detection of the early signs of ischemic events. Abnormal metabolite ratios detected with H-MRS may precede actual morphological changes associated with hypoperfusion as well as reperfusion changes. Ipsilateral and contralateral middle cerebral artery vascular territories were both evaluated before and after vascular intervention. H-MRS was performed within 24 h before and after surgery. Correlations in the metabolic data from H-MRS for N-acetylaspartic acid (NAA)+N-acetylaspartylglutamate, creatinine (Cr)+phosphocreatinine, and phosphocholine+glycerophosphocholine (Cho) were sought. RESULTS H-MRS voxels from 11 subjects were analyzed. Values for dCho/CrI, dCho/CrC and Cho/Naal (P<0.001) were significantly higher ipsilaterally than contralaterally. Ratios for dNaa/ChoC and Cho/NaaC were significantly higher on the non-operated side (P<0.001). CONCLUSIONS H-MRS may be helpful for assessment of patients with CAS, particularly because unlike other modalities, it reveals postoperative changes in metabolic brain status. Initial results indicate the important role of perioperative neuroprotective treatment.

The Impact of N-Acetylcysteine on Autologous Fat Graft: First-in-Human Pilot Study.

BACKGROUND: Our goal was to determine whether N-acetylcysteine (NAC) administered to the tumescent solution can reduce oxidative stress and increase autologous fat graft (AFG) viability. METHODS: The study included 15 women with a mean age of 31.8 years (range 23-39 years) who underwent breast asymmetry correction with AFG harvested from both thighs. One thigh was infiltrated with a standard tumescent fluid (control graft) and other with a NAC-enriched tumescent fluid (NAC-treated graft). Each participant had breast MRI imaging before and 6 months after the procedure. Also, adipose tissue samples from each graft were subjected to biochemical analysis, flow cytometric assay and qRT-PCR to determine the markers of oxidative stress, angiogenesis and adipogenesis. RESULTS: Concentration and activity of superoxide dismutase in the NAC-treated grafts turned out to be significantly higher than in the control grafts, in both fresh (p = 0.041 and p = 0.023, respectively) and frozen samples (p = 0.004 and p = 0.003, respectively). The level of nitric oxide in frozen samples from the control grafts was significantly higher than in the NAC-treated grafts (p = 0.009). iNOS was the only qRT-PCR target showing significant intergroup differences, with higher transcription levels observed in the control grafts (p = 0.027). Breast volumetric analysis demonstrated that the NAC-treated group had a 12.19% lower resorption rate than the control group, although it was found to be statistically insignificant (p = 0.149). No postoperative complications were observed during a 6-month follow-up. CONCLUSIONS: Some results of this study are promising. Further studies on larger groups are needed to determine NAC impact on AFG. TRIAL REGISTRY NAME: The Impact of N-Acetylcysteine on Volumetric Retention of Autologous Fat Graft for Breast Asymmetry Correction. REGISTRATION IDENTIFICATION NUMBER: NCT03197103. URL FOR THE REGISTRY: https://clinicaltrials.gov/ct2/show/NCT03197103?term=acetylcysteine&rank=6 LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Impact of Mastectomy on Women's Visual Perception of Breast Aesthetics and Symmetry: A Pilot Eye-Tracking Study.

BACKGROUND: Little is known about breast cancer survivors' perception of breast attractiveness. A better understanding of this subjective concept could contribute to the improvement of patient-reported outcomes after reconstructive surgeries and facilitate the development of new methods for assessing breast reconstruction outcomes. OBJECTIVES: The aim of this eye-tracking (ET)-based study was to verify whether mastectomy altered women's visual perception of breast aesthetics and symmetry. METHODS: A group of 30 women after unilateral mastectomy and 30 healthy controls evaluated the aesthetics and symmetry of various types of female breasts displayed as highly standardized digital images. Gaze patterns of women from the study groups were recorded using an ET system and subjected to a comparative analysis. RESULTS: Regardless of the study group, the longest fixation duration and the highest fixation number were found in the nipple-areola complex. This area was also the most common region of the initial fixation. Several significant between-group differences were identified; the gaze patterns of women after mastectomy were generally characterized by longer fixation times for the inframammary fold, lower pole, and upper half of the breast. CONCLUSIONS: Mastectomy might affect women's visual perception patterns during the evaluation of breast aesthetics and symmetry. ET data might improve our understanding of breast attractiveness and constitute the basis for a new reliable method for the evaluation of outcomes of reconstructive breast surgeries.

Analysis of the Visual Perception of Female Breast Aesthetics and Symmetry: An Eye-Tracking Study.

BACKGROUND: Because of its subjective character, the term "breast attractiveness" is poorly defined and thus its reliable standardized assessment can be particularly challenging. Because of objective analysis of the observer's gaze pattern, eye-tracking technology may provide a better insight into the visual perception of breast aesthetics and symmetry. METHODS: One hundred observers, 50 women and 50 men, assessed the aesthetics and symmetry of eight types of female breasts displayed as digital images on frontal, lateral, and oblique projections. The gaze pattern of each observer was recorded using eye-tracking technology, and gaze data were subsequently analyzed. RESULTS: Although sex and breast type exerted an effect on attention capturing by some areas of interest, key characteristics of gaze patterns in female and male observers were essentially the same. Irrespective of observers' sex, the longest fixation duration and the highest fixation number were recorded for lower breast regions, in particular, for the nipple-areola complex. Mean fixation duration in this area corresponded to 58 and 57 percent of overall observation time for female and male observers, respectively, during the assessment of breast aesthetics; and to 56 and 52 percent of overall observation time for female and male observers, respectively, during the assessment of breast symmetry. CONCLUSIONS: Nipple-areola complex and lower breast are key focus areas for the assessment of breast aesthetics and symmetry. Gaze data collected during this study may constitute a valuable source of reference values for future eye-tracking research on various patient groups' visual perception of breast attractiveness and deformities.

Shear Wave Elastography in the Evaluation of Facial Skin Stiffness After Focused Ultrasound Treatment.

BACKGROUND: No objective method for the evaluation of facial aesthetic procedures has been proposed thus far. The authors hypothesized that shear wave elastography may be an appropriate method to evaluate the outcomes of some aesthetic treatments. OBJECTIVE: The aim of the study was to compare elastographic parameters of facial skin, subcutaneous fat, and superficial musculoaponeurotic system before high-intensity focused ultrasound treatment and 60 days after this procedure. METHODS AND MATERIALS: The study included 57 female patients aged 51.5 ± 7.3 years. Shear wave elastography of facial skin was performed before the aesthetic procedure and 2 months thereafter. RESULTS: Baseline stiffness of all examined layers correlated inversely with patients' age. Sixty days after the aesthetic treatment, the stiffness of all tissues improved significantly. The extent of the improvement correlated inversely with patients' body mass index. CONCLUSION: Shear wave elastography can accurately assess the outcomes of facial treatment with high-intensity focused ultrasound. Using this method, the authors documented improved stiffness of facial skin as early as 60 days after the procedure. The beneficial effect of the aesthetic treatment was observed regardless of patients' age but was less evident in women with excess body weight.

Predictive value of dermoscopy for the treatment of port-wine stains with large spot 532 nm laser.

OBJECTIVE: We wanted to evaluate dermoscopy as a tool to predict the efficacy of port-wine stain (PWS) laser treatment. STUDY DESIGN AND METHODS: Large spot 532 nm laser was used for the treatment of 67 PWS. Efficacy was assessed with an objective 3D digital imaging analysis. Dermoscopy images were taken before the treatment and analyzed semi quantitatively for features and patterns. RESULTS: The following dermoscopic features: "superficial vessels," "deep vessels," "deep lakes," "superficial lakes," and "thick vessels total" were identified as positive determinants of maximal global clearance effect (GCEmax), whereas "thin long vessels," "bright background total," "whitish veil," "white circles," and "perifollicular erythema" were found to be negative determinants. Rapid response correlated positively with "superficial vessels," "superficial lakes," and "thick vessels total" scores and showed inverse correlations with "bright-red background," "bright background total," "white circles," "peacock eyes," and "perifollicular erythema" scores. "Superficial vessels," "thick vessels total," and "pale-pink patchy background" were predictors of the lack of response. Dominance of "deep vessels" was a predictor of 75% of responses and dominance of "brown areas" feature was the predictor of clearance. Patients responded to treatment differently, depending on the dermoscopic pattern of PWS. CONCLUSION: Dermoscopy may be useful to predict the response of PWS to laser treatment: its rapidity, the risk of no response, and 75% response and clearance. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Ultrasonographic elastography in the evaluation of normal and pathological skin - a review.

The aim of this review article is to discuss the role of ultrasonographic elastography, a technique used to quantify tissue stiffness, in the evaluation of normal and pathological skin. A growing body of evidence suggests that elastography may be used for the diagnosis and monitoring of skin pathologies, in particular tumors, and fibrotic and sclerotic processes. Our knowledge about the elastographic parameters of normal skin is sparse, which together with the lack of reference values for cutaneous stiffness constitutes a serious limitation to the use of elastography in some medical disciplines, including aesthetic medicine.