Placental superoxide dismutase 3 mediates benefits of maternal exercise on offspring health.

Poor maternal diet increases the risk of obesity and type 2 diabetes in offspring, adding to the ever-increasing prevalence of these diseases. In contrast, we find that maternal exercise improves the metabolic health of offspring, and here, we demonstrate that this occurs through a vitamin D receptor-mediated increase in placental superoxide dismutase 3 (SOD3) expression and secretion. SOD3 activates an AMPK/TET signaling axis in fetal offspring liver, resulting in DNA demethylation at the promoters of glucose metabolic genes, enhancing liver function, and improving glucose tolerance. In humans, SOD3 is upregulated in serum and placenta from physically active pregnant women. The discovery of maternal exercise-induced cross talk between placenta-derived SOD3 and offspring liver provides a central mechanism for improved offspring metabolic health. These findings may lead to novel therapeutic approaches to limit the transmission of metabolic disease to the next generation.

Autologous Fat Transfer for Scar Prevention and Remodeling: A Randomized, Blinded, Placebo-controlled Trial.

Autologous fat transfer-also referred to as fat grafting-has been reported to provide beneficial effects to overlying scar and skin. Despite procedural frequency, there is a paucity of high-level evidence guiding the surgeon in technique, patient selection, and efficacy. METHODS: A multicenter, double-blinded, randomized, internally placebo-controlled trial was performed with an aim to qualitatively and quantitatively evaluate the impact of autologous fat transfer on the quality of overlying scar tissue. Fat-grafted scars were evaluated and compared with paired, saline-injected "control" scars. Subjective and objective metrics were evaluated in treated sites for 12 months after treatment. RESULTS: Blinded qualitative results demonstrated a statistically significant improvement in scar quality over time in fat-grafted scars. However, these improvements were not found to be statistically different from changes noted in scars treated with saline. In addition, objective metrics did not statistically differ between saline-injected and autologous fat-grafted scars. CONCLUSIONS: Our results demonstrate that autologous fat grafting can improve the qualitative profile of a scar from both the patient and observer perspectives. However, there was no difference in improvement when compared with scars that were treated with saline in a randomized and blinded fashion. These results demonstrate that any improvements in scar quality related to fat grafting are also achieved using saline and suggest that mechanisms other than cell activity may be at play. Additional randomized, blinded, placebo-controlled trials are required to either corroborate or contest the putative beneficial effect(s) of adipose tissue on scar remodeling.

Analgesic Efficacy of Nerve Blocks After Abdominoplasty: A Systematic Review.

BACKGROUND: A variety of regional nerve blocks have been utilized in abdominoplasty procedures, including transversus abdominis plane (TAP), intercostal, rectus sheath (RS), pararectus + ilioinguinal/iliohypogastric, quadratus lumborum, and paravertebral blocks. No consensus exists regarding the most effective nerve block modality in optimizing postprocedural comfort levels. OBJECTIVES: The purpose of this systematic review was to explore the efficacy of the various abdominal nerve blocks employed in abdominoplasty surgery and to draw attention to any modality that may be superior in regards to effectiveness and/or administration. METHODS: Utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed to identify studies that have employed regional nerve blocks in abdominoplasty procedures. Opioid consumption, pain scores, time to ambulation, time in the recovery room, and time to first analgesia request were extracted when available. RESULTS: A total of 191 articles were reviewed, of which 8 met inclusion criteria. The nerve blocks represented included TAP, RS, pararectus + ilioinguinal/iliohypogastric, intercostal, and quadratus lumborum. All modalities were effective in reducing opioid consumption except quadratus lumborum. CONCLUSIONS: TAP, RS, pararectus + ilioinguinal/iliohypogastric, and intercostal regional nerve blocks have been shown to optimize postoperative pain management in abdominoplasty procedures. The existing literature suggests that when studied against one another, TAP is more efficacious than RS and pararectus + ilioinguinal/iliohypogastric. When ultrasound guidance is unavailable, consideration should be given to TAP employing the direct visualization approach.

Vacuum-assisted closure therapy to the brain: a safe method for wound temporization in composite scalp and calvarial defects.

BACKGROUND: When composite scalp and calvarial defects with dural or cortical brain exposure are encountered, active infection or indeterminate oncologic margins complicate the timing of scalp reconstruction. The purpose of this study was to evaluate the safety and efficacy of vacuum-assisted closure (VAC) therapy as a temporizing measure in these complex scalp defects with dural or cortical brain exposure and a hostile local wound environment. METHODS: From December 2012 to December 2013, all composite scalp and calvarial defects reconstructed by the senior author (D.S.) were reviewed and 10 cases were identified. Five of these cases were temporized with VAC therapy. The medical records of these patients were reviewed. RESULTS: Five patients (mean age, 66.2 years) with composite scalp and calvarial defects were temporized with VAC therapy. The indications for delay included gross wound infection in 4 patients and an indeterminate intraoperative oncologic margin. The average size of the scalp and calvarial defects measured 123 and 49 cm, respectively. One patient underwent VAC therapy over exposed cortical brain with a dural defect measuring 25 cm. The average time between the initial operation and definitive reconstruction was 4.8 days. The average daily VAC output was 74 mL. Reconstructive methods included 1 free flap, 2 scalp rotational advancement flaps, and readvancement of 2 prior free flaps. At an average follow-up of 32 weeks, 1 patient developed a subcentimeter postoperative wound breakdown that was treated successfully with an incisional VAC. CONCLUSIONS: We found the use of VAC therapy applied directly to the dura or cortical brain as a safe and effective technique for short-term wound temporization in the setting of indeterminate oncologic margins or active infection.

What Made Them Successful: An Introspective Survey of AAPS Members.

BACKGROUND: The purpose of this study is to assess which personal characteristics and external factors are important contributors to eventual success. METHODS: The authors distributed a survey to all members of the American Association of Plastic Surgeons and asked responders to rate the importance of 10 preselected qualities in contributing to their personal success. Survey outcomes were analyzed across different demographic groups. RESULTS: Of the 580 American Association of Plastic Surgeons members who were surveyed, 295 returned completed surveys. Overall analysis indicates that hard work, compassion, and manual dexterity are the 3 most important attributes. Many significant differences are observed across demographic groups, indicating potential biases among the survey responders. Notably, we find that male surgeons attribute mentorship to success much more so than female surgeons (Column Trend Exact [CTE], P = 0.021), whereas female surgeons are more likely to attribute their success to hard work (CTE, P = 0.023). Similarly, those who have been program directors credit their success to mentoring more so than nonprogram directors (CTE, P < 0.00001). The authors also found that senior surgeons, as measured by years in practice, place greater emphasis on mentoring and career opportunities than younger surgeons (Mantel-Haenszel Trend, P = 0.003 and 0.0009, respectively). It is also interesting to note that individual talent qualities tend to be favored by more senior surgeons and those with more distant ties to academia. CONCLUSION: The authors believe that recognizing the relative importance of such factors, and their associated biases, is essential for the process of selecting and developing future successful plastic surgeons.

An evaluation of plastic surgery resident selection factors.

OBJECTIVE: Our purpose was to provide a metric by which evaluation criteria are prioritized during resident selection. In this study, we assessed which residency applicant qualities are deemed important by members of the American Association of Plastic Surgeons (AAPS). METHODS: A survey was distributed to all 580 AAPS members, and 295 responded to rate the importance of resident metrics, including measures of competency and personal characteristics. Demographic information, background training, and interaction with residents were also noted. Using SAS v9.2 (SAS Institute, Cary, NC), outcomes were analyzed across demographic groups with column trend exact (CTE) test for ordinal variables, Mantel-Haenszel trend test for interval variables, and Fisher exact test for discrete variables. RESULTS: Regarding competency metrics, letters of recommendation from known sources is the most important factor, whereas letters from unknown sources ranks the lowest. Character evaluations identified honesty as the most desirable trait; dishonesty was the most despised. Across demographic groups, academic surgeons and program directors value letters from known sources more than nonacademicians or nonprogram directors (CTE p = 0.005 and 0.002, respectively). Academicians and current program directors regard research more highly than their counterparts do (CTE p = 0.022 and 0.022, respectively). Currently, practicing surgeons, academicians, and program directors value hard work more than others (CTE p = 0.008, 0.033, and 0.029, respectively). Program directors emphasize maturity and patient commitment and are less tolerant of narcissism (CTE p = 0.002, 0.005, and 0.003, respectively). Lastly, academic surgeons and program directors look more favorably upon strong team players (CTE p < 0.00001 and p = 0.008, respectively), but less so over time (Mantel-Haenszel trend p = 0.006). CONCLUSIONS: We have examined applicant metrics that were deemed important by AAPS members and assessed their demographic interpretation. We hope this article provides a framework for plastic surgery resident selection and a guide for applicants to ascertain which qualities are highly regarded by programs. Although these attributes are highly desirable, future studies could identify if they are predictive of successful and productive plastic surgery residencies and careers.