Hairline Lowering Surgery With Bone Tunneling Suture Fixation: Effectiveness and Safety in 91 Patients.

BACKGROUND: People with a wide forehead often look older. Hairline lowering surgery is a good treatment option, which is generally performed utilizing Endotine. OBJECTIVES: We describe our hairline lowering surgical technique involving bone tunneling without Endotine, a method designed to produce comparable outcomes with fewer side effects. We evaluated the effectiveness and safety of our technique. METHODS: Charts of 91 patients who underwent hairline lowering surgery without Endotine were reviewed retrospectively. We utilized standardized preoperative and postoperative photographs to measure the proportions of 3 face parts and the length of the forehead. We also determined changes in forehead length at various times after surgery, occurrence of postoperative complications, and overall patient satisfaction with their surgical results. RESULTS: Of the 91 patients, 80 were female and the mean age was 28.67 ± 7.15 years. Preoperatively, the mean forehead length was 8.09 ± 0.69 cm and ratio of facial part lengths was 1.08:1:0.99 (cranial to caudal). The hairline was advanced 18.37 ± 2.90 mm. One month postoperatively, the mean forehead length was 6.57 ± 0.52 cm and facial parts ratio was 1:1:0.99. Compared with preoperatively, forehead length was significantly reduced at 1, 3, 6, and 12 months postoperatively. Forehead length was not significantly different at 1 and 12 months postoperatively. All patients were satisfied or very satisfied with their overall surgical results. CONCLUSIONS: Hairline lowering surgery with bone tunneling was effective and safe, and patients were satisfied with the results. The effects appeared immediately following surgery and were sustained over time.

Activated platelet-rich plasma improves fat graft survival in nude mice: a pilot study.

BACKGROUND: Numerous processing methods have been proposed to enhance the survival of fat grafts, but no definitive treatment protocol is available. Platelet-rich plasma (PRP) contains a high concentration of platelets with neovascularization properties and has the potential to promote fat graft survival. OBJECTIVE: To evaluate the effect of activated PRP on human graft quality and survival. MATERIALS AND METHODS: Using the scalp model, nude mice received fat mixed with PRP followed by injection of thrombin and calcium chloride to activate the PRP (PRP group) or fat mixed with saline (control group). After 10 weeks, mice were killed, the volume and weight of the fat graft were determined, and graft sections were examined using light microscopy. RESULTS: Fat graft volume and weight were significantly higher in the PRP group than in the control group, and histologic evaluation revealed greater vascularity, fewer cysts and vacuoles, and less fibrosis in the PRP group than in the control group. The cellular integrity and inflammation were not statistically different between the two groups. CONCLUSION: PRP treatment improved the survival and quality of fat grafts. Safer methods of PRP activation and preparation should be further investigated for potential application in humans.

Genetic Polymorphisms rs699947, rs1570360, and rs3025039 on the VEGF Gene Are Correlated with Extracranial Internal Carotid Artery Stenosis and Ischemic Stroke.

Extracranial internal carotid artery (ECICA) stenosis is a modifiable risk factor of ischemic stroke. VEGF plays a crucial role in the maintenance of endothelial integrity and physiological function. This study was designed to assess the correlations of VEGF polymorphisms with ECICA stenosis in ischemic stroke and to explore the relationships between these polymorphisms and different biochemical parameters. This study included a total of 650 ischemic stroke patients, 232 with ECICA stenosis while 418 had no ECICA stenosis as assessed by magnetic resonance angiography. Three SNPs in the VEGF gene, rs699947, rs1570360, and rs3025039, were assessed by real-time PCR coupled with melting curve analysis. Serum samples were analyzed for biochemical parameters in an automated clinical chemistry analyzer in the Laboratory Medicine Department. The CA and CA+AA (A allele bearing) genotype frequencies of the rs699947 polymorphism (AOR=1.46 and 1.47, respectively) and the GA genotype frequency of the rs1570360 polymorphism (AOR=7.33) showed a significant association with ECICA stenosis. However, the haplotype frequencies of C-A-A, T-A-C, and T-A-A (rs302503-rs1570360-rs699947) were significantly different between patients who experienced stroke with and stroke without ECICA stenosis. We found that the total homocysteine (tHcy) levels of stroke patients with ECICA stenosis with rs1570360 and rs699947 SNPs were significantly different compared to the wild-type reference genotype. In conclusion, VEGF rs699947 and rs3025039 polymorphisms were associated with increased risk of stroke, while rs1570360 and rs699947 were associated with stroke and ECICA stenosis.

To do or not to do; dilemma of intra-arterial revascularization in acute ischemic stroke.

BACKGROUND: There has still been lack of evidence for definite imaging criteria of intra-arterial revascularization (IAR). Therefore, IAR selection is left largely to individual clinicians. In this study, we sought to investigate the overall agreement of IAR selection among different stroke clinicians and factors associated with good agreement of IAR selection. METHODS: From the prospectively registered data base of a tertiary hospital, we identified consecutive patients with acute ischemic stroke. IAR selection based on the provided magnetic resonance imaging (MRI) results and clinical information were independently performed by 5 independent stroke physicians currently working at 4 different university hospitals. MRI results were also reviewed by 2 independent experienced neurologists blinded to clinical data and physicians' IAR selection. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was calculated on initial DWI and MTT. We arbitrarily used ASPECTS differences between DWI and MTT (D-M ASPECTS) to quantitatively evaluate mismatch. RESULTS: The overall interobserver agreement of IAR selection was fair (kappa = 0.398). In patients with DWI-ASPECTS >6, interobserver agreement was moderate to substantial (0.398-0.620). In patients with D-M ASPECTS >4, interobserver agreement was moderate to almost perfect (0.532-1.000). Patients with higher DWI or D-M ASPECTS had better agreement of IAR selection. CONCLUSION: Our study showed that DWI-ASPSECTS >6 and D-M ASPECTS >4 had moderate to substantial agreement of IAR selection among different stroke physicians. However, there is still poor agreement as to whether IAR should not be performed in patients with lower DWI and D-M ASPECTS.

Two different clinical entities of small vessel occlusion in TOAST classification.

BACKGROUND: Small deep infarcts might be classified into 2 types: lacunar and branchatheromatous infarcts. However, since their initial description, small deep infarcts were still regarded as the same category of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, small vessel occlusion (SVO). We hypothesized that the 2 types of small deep infarcts would be distinct clinical entities. This study was conducted to investigate the clinical characteristics in the 2 groups of patients according to lesion pattern and combined atherosclerotic diseases. METHODS: We included patients with small deep infarcts in the subcortical area. The patients were divided into 2 groups: (1) island lesions and (2) linear lesions on coronal diffusion weighted imaging. The status of the relevant artery was categorized as no stenosis, non-significant (<50% of luminal narrowing) and significant (≥ 50% of luminal narrowing). We compared the clinical and imaging characteristics of two lesion types according to various arterial status. RESULTS: This study analyzed a total of 248 patients. Independent factors for island lesions on coronal DWI were male, severe leukoaraiosis, microbleeds, abnormal glycated hemoglobin (HbA1C), and abnormal estimated glomerular filtration ratio (eGFR) adjusted by age, sex, and initial National Institutes of Health Stroke Scale. In addition, in patients without significant relevant arterial stenosis, island lesion patterns were more frequently associated with severe periventricular white matter hyperintensity, diabetes mellitus, abnormal eGFR and abnormal HbA1C than linear lesion patterns. CONCLUSION: This study demonstrated that SVO of TOAST classifications had different imaging and clinical characteristics according to the lesion patterns of coronal imaging. It suggests that two types of SVO should be regarded as the different categories of stroke classification.

Oromandibular dyskinesia as the initial manifestation of late-onset huntington disease.

Huntington's disease (HD) is a neurodegenerative disorder characterized by a triad of choreoathetosis, dementia and dominant inheritance. The cause of HD is an expansion of CAG trinucleotide repeats in the HD gene. Typical age at onset of symptoms is in the 40s, but the disorder can manifest at any time. Late-onset (≥ 60 years) HD is clinically different from other adult or juvenile onset HD and characterized by mild motor problem as the initial symptoms, shorter disease duration, frequent lack of family history, and relatively low CAG repeats expansion. We report a case of an 80-year-old female with oromandibular dyskinesia as an initial manifestation of HD and 40 CAG repeats.