The Problem of Diagnostic Criteria of Breast Implant Illness in Women After Breast Reconstruction: Review and Discussion of a Case.

INTRODUCTION: There has been a rising trend in the use of silicone breast implants for breast reconstructions after breast cancer treatment, as well as in the aesthetic breast procedures. A cluster of non-specific symptoms related to the presence of silicone implant has been called breast implant illness (BII). However, there are no strict criteria of BII which would specifically define this term. The increasing interest in BII among patients and physicians urges verifying own cases of "on-demand" explantations. MATERIAL AND METHODS: In this paper, we discussed a case of a patient with initial BII diagnosis, after breast reconstruction, and reviewed the literature on the BII symptoms and aetiology. A decision for aesthetic revision, not explantation, was made as the diagnosis of BII was questioned, and somatisation due to dissatisfaction with the aesthetic result of breast reconstruction was diagnosed. RESULTS: Improving aesthetics by implant exchange and contralateral mastopexy caused a full recovery from patient's symptoms. CONCLUSION: Based on our case, we point on the fact that BII diagnosis in patients after breast reconstruction is challenging. We suggest that while considering such a diagnosis and further proceedings, e.g. explantation, especially in patients after breast reconstruction, some exclusion criteria should be considered. Dissatisfaction with the result of the surgery can also lead to somatisation and the presence of real clinical symptoms, which should not be confused with the possible autoimmune reaction to silicone particles. 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 .

Do Intraoperative Platelet-Rich Plasma Injections Influence the Final Appearance of Vertical Scars after Breast Reduction? Spectrophotometric Analysis.

Background: Platelet-rich plasma (PRP) has been shown to support wound healing and tissue regeneration due to its high concentration of growth factors and cytokines. This study aims to investigate the effect of intraoperative PRP injections on the final appearance of vertical scars after breast reduction, as well as to identify potential predictors of a scar's aesthetic assessment using spectrophotometric parameters. Methods: In this prospective, randomized trial, 82 scars from 41 women who underwent bilateral breast reduction with an inverted T pattern were analyzed. PRP or a placebo substance (0.9% sodium chloride solution) was injected intraoperatively into the edges of vertical wounds. Spectrophotometric measurements of scar pigmentation were performed 3 and 6 months after surgery; additionally, two independent observers evaluated the aesthetic appearance of scars based on photographs. Results: The results showed that the use of intraoperative PRP injections did not significantly influence the final appearance of vertical scars after breast reduction. Conclusions: We indicated spectrophotometric variables (b) in the early stages of wound healing (after 3 months) that can be predictors of the final scar's aesthetic outcome. This can be helpful in detecting scars that may need additional interventions to optimize the healing process.

Understanding Covid-19: Digit ratios and duration of oxygen therapy in hospitalized Covid-19 patients.

BACKGROUND: Covid-19 severity shows a sex difference (males>females) and progressive hypoxia among the most seriously affected. Digit ratios are sexually dimorphic and may be negatively-related to prenatal (2nd-to-4th digits' ratio; 2D:4D) and pubertal (3rd-to-5th digits' ratio; 3D:5D) testosterone. Oxygen therapy is important in Covid-19 treatment and low 2D:4D is linked to efficient oxygen metabolism. We consider relationships between digit ratios and duration of oxygen treatment in hospitalized Covid-19 patients. METHODS: Digit lengths were measured from photographs of the patient's hands. Age, Sex, BMI, vaccination status and number of days of O2 treatment, were recorded. RESULTS: There were 100 (58 women) patients. Sex differences (males

First trimester maternal sex steroids and the digit ratios of mothers and children.

BACKGROUND: It is thought that digit ratios (2D:4D) are a correlate of 1st trimester maternal and foetal sex steroids. Here we consider the relationship of 2D:4D to the former. METHOD: Digit lengths were directly measured with a calliper at infant age 13 months. Measures of T and E were obtained from mother's blood at 6-8 weeks, 10-11 weeks and 1st trimester means were calculated. RESULTS: There were 69 mother-infant pairs (33 boys). Sex differences in 2D:4D (boysboys) were found. For mothers of girls: there were negative relationships between 2D:4D and T at 6-8 weeks, 10-11 weeks and 1st trimester means. For infants: girls showed more correlations between 2D:4D and hormones than boys. For boys, there was one positive association between 2D:4D and E and two positive associations for E/T. For girls, 2D:4D was negatively related to T (four correlations) and positively related to E/T (four correlations). Considering associations in the total sample and controlling for sex, at 6-8 weeks right and left 2D:4D were positively related to E. At 10-11 weeks, right and left 2D:4D were negatively related to T. For 1st trimester means, 2D:4D's were positively related to E (right and left) and negatively related to T (right). CONCLUSION: Infant 2D:4D was correlated with first trimester maternal sex steroids, particularly at 10-11 weeks. The correlations were negative for T, and positive for E and E/T with weaker effects for male infants. The latter pattern may arise because in boys T produced by foetal testes masks the effect of maternal T.

The Immunohistochemical Profile of Mammary Tissue in Women With Macromastia and Its Potential Clinical Implications.

Macromastia is an excessive, rapid, or slow growth of breast tissue in 1 or both breasts. While macromastia represents a benign lesion, it may cause breast, shoulder, back, and neck pain, poor posture, infections, and loss of nipple sensation. The pathogenesis of macromastia or hypertrophy of mammary tissue remains poorly understood. The purpose of this study is to investigate the immunohistochemical expression of several hormone receptors that may potentially influence the growth of breast tissue in women with macromastia. Immunohistochemical studies performed on representative sections of breast tissue from 63 patients diagnosed with macromastia included estrogen receptor, progesterone receptor, androgen receptor (AR), prolactin receptor, growth hormone receptor, and vascular endothelial growth factor. The expression of each stain was evaluated separately in the glandular epithelium and adipose tissue and calculated as an H-score. We observed that AR expression in breast glandular and adipose tissue in women with macromastia was significantly lower than benign, nonhypertrophic breast tissue of a control group. Although the analyses were controlled for the age, the fact the mean age and hormonal status differed between the patients and the controls could have affected the results. Additional large studies will be required to further verify this finding and increase the knowledge about the etiology of this condition and then guide pharmacological treatment of juvenile and/or idiopathic gigantomastia.

The "Central Tendency Bias" in the assessment of facial attractiveness in group-based and individual ratings-A survey-based study in 727 volunteers.

BACKGROUND: The increasing number of esthetic procedures emphasizes the need for effective evaluation methods of outcomes. Current practices include the individual practitioners' judgment in conjunction with standardized scales, often relying on the comparison of before and after photographs. This study investigates whether comparative evaluations influence the perception of beauty and aims to enhance the accuracy of esthetic assessments in clinical and research settings. OBJECTIVE: To compare the evaluation of attractiveness and gender characteristics of faces in group-based versus individual ratings. METHODS: A sample of 727 volunteers (average age of 29.5 years) assessed 40 facial photographs (20 male, 20 female) for attractiveness, masculinity, and femininity using a 5-point Likert scale. Each face was digitally edited to display varying ratios in four lip-related proportions: vertical lip position, lip width, upper lip esthetics, and lower lip esthetics. Participants rated these images both in an image series (group-based) and individually. RESULTS: Differences in the perception of the most attractive/masculine/feminine ratios for each lip proportion were found in both the group-based and individual ratings. Group ratings exhibited a significant central tendency bias, with a preference for more average outcomes compared with individual ratings, with an average difference of 0.50 versus 1.00. (p = 0.033) CONCLUSION: A central tendency bias was noted in evaluations of attractiveness, masculinity, and femininity in group-based image presentation, indicating a bias toward more "average" features. Conversely, individual assessments displayed a preference for more pronounced, "non-average" appearances, thereby possibly pointing toward a malleable "intrinsic esthetic blueprint" shaped by comparative context.

Influence of ethnicity on aesthetic preferences for lip characteristics in Caucasian male and female faces.

BACKGROUND: In an era where globalization and social media significantly reshape beauty standards, it is imperative to delve into the subjectivity of beauty and attractiveness. The lips, a key element in facial aesthetics, contribute significantly to the perception of attractiveness, and also have a profound impact on an individual's self-esteem. OBJECTIVE: To analyze the influence of ethnicity on the aesthetic preferences for lip characteristics, among male and female faces. MATERIALS AND METHODS: This study encompassed a sample of 231 study participants (153 women and 78 men) with an average age of 23.2 ±â€¯2.8 years, representing ethnicities such as African, Caucasian, Middle Eastern, and South Asian. Participants were asked to rate a series of images showcasing various lip variants, providing insights into their aesthetic preferences. RESULTS: Demographic analysis revealed gender and ethnic variations in aesthetic preferences for all the investigated lip parameters. Women were 2.42 times more likely than men to prefer no Cupid's indentation on a female model (p = 0.0019). CONCLUSIONS: The study underscores the importance of understanding cultural influences on beauty standards and challenges the notion of a universal beauty ideal. The evolving role of social media trends, such as Cupid's bow indentation elimination, raises questions about the dynamic nature of aesthetic preferences among different ethnicities.

Digit ratios and hospitalization for COVID-19: A test of the low-androgen-driven and high-androgen-driven theories of COVID-19 severity.

BACKGROUND: Sex hormones are likely to be important determinants of COVID-19 severity, and two opposing explanations regarding severity, the low-androgen-driven and high-androgen-driven theories, seek to explain this pattern. Digit ratios are sex dependent (males < females) and are claimed to be markers for both prenatal and postnatal testosterone. OBJECTIVES: Here, we use a measure of COVID-19severity (hospitalization), compare digit ratios in patients and controls and consider whether vaccination status changed these associations. MATERIAL AND METHODS: Four digits were measured (2D, 3D, 4D, 5D). There were 194 participants (94 hospitalized patients [45 men] and 100 controls [53 men]) in Sample I and 162 participants (100 hospitalized [42 men], including 40 vaccinated and 62 controls [32 men]) in Sample II. Six ratios were calculated (2D:3D; 2D:4D; 2D:5D; 3D:4D; 3D:5D, 4D:5D) and compared between COVID-19 hospitalized and non-hospitalized patients and vaccinated and non-vaccinated. RESULTS: In comparison to controls, we found higher ("feminized") means in patient ratios that included 5D (2D:5D; 3D:5D; 4D:5D) in both samples. The differences were independent of sex and age. Hospitalized patients with COVID-19 have higher (feminized) means and higher standard deviations (SDs) for 5D digit ratios. DISCUSSION: Digit ratios are sex dependent (males < females) and are considered as markers for both prenatal and postnatal testosterone. If verified in future studies, the results will be helpful in regard to targeting mortality-reducing therapies for COVID-19 in certain groups of patients. CONCLUSION: We conclude that the association between high (feminized) 5D ratios and hospitalization supports the low-androgen-driven theory of COVID-19 severity.

Variability of anterolateral thigh flap perforator locations - clinical implications.

<b><br>Introduction:</b> The anterolateral thigh flap is an example of a free flap widely applied for reconstruction of tissues within various areas of the body.</br> <b><br>Aim:</b> The aim of the study was to determine the most common locations of the ALT flap perforators in men and women as well as to clarify any potential differences in the location of the vessel in male vs. female subjects.</br> <b><br>Material and method:</b> In years 2021-2022, a study was conducted at the Plastic, Reconstructive, and Aesthetic Surgery Clinic in a group of 90 volunteers (45 women and 45 men, a total of 180 lower extremities) to determine the location of the anterolateral thigh flap perforator against the flap surface using a portable Doppler probe.</br> <b><br>Results:</b> Variable locations were revealed for the anterolateral thigh flap perforator within the study. In women, the perforator is located more distally from the anterior superior iliac spine, most frequently within the inferolateral quadrant, while being located closer to the anterior superior iliac spine, and most frequently within the superolateral quadrant, in men. No perforator was found in 3.3% of the examined limbs. No statistically significant differences were observed between the course of the perforators within the left and right lower limbs in individual patients.</br> <b><br>Conclusions:</b> The location of the ALT flap perforator is subject to sexual dimorphism, which facilitates the investigation area being narrowed down to the well-defined locations of its most frequent occurrence when planning anterolateral thigh flap reconstructive procedures.</br>.

Servicios médicos en helicópteros de emergencias para pacientes con ictus cerebral / Helicopter emergency medical services for patients with cerebral stroke

Objetivo: El objetivo de este estudio transversal es analizar los transportes en helicóptero de pacientes con ictus isquémico en Polonia durante los años 2011-12. Se procuró evaluar el papel del servicio médico de helicópteros en reducir tiempos prehospitalarios y analizar la evolución de los pacientes durante el transporte. Método: Estudio retrospectivo de todas las atenciones realizadas por el servicio polaco de helicópteros medicalizados durante un periodo de dos años. Los datos recogidos de cada atención y paciente incluyeron el tiempo desde la activación hasta la llegada al lugar de atención, tiempo en el lugar de la atención, tiempo de transporte, escala del National Advisory Committee for Aeronautics (NACA), ETR (Escala de Trauma Revisada) y ECG (Escala de Coma de Glasgow) en el lugar de atención y en el momento de transferencia del paciente a los servicios de emergencias o al hospital. Resultados: Se analizaron 1.191 atenciones. Los valores medios de las escalas ETR y ECG en el lugar de atención eran 11,1 (DE 1,36) y de 11,8 (DE 3,39). Después del transporte en helicóptero medicalizado, los valores medios eran: 11,0 (1,5) y 11,7 (3,5), respectivamente. Se observó que el tiempo de transporte no influyó en el estado del paciente, mientras que más tiempo en el lugar de atención produce una disminución estadísticamente significativa en los valores medios de las escalas. Conclusiones: El helicóptero es un modo seguro de transporte para pacientes con ictus y asegura su transferencia al hospital/ambulancia más cercano en el tiempo apropiado para la iniciación de tratamiento. La atención en el lugar de atención en caso de ictus debería ser tan corta como sea posible (AU)

Objective: The aim of this cross-sectional study was to analyze transport by helicopter emergency medical services (HEMS) in cases of ischemic cerebral stroke in Poland in 2011 and 2012. We assessed the role of the HEMS in reducing prehospital times and analyzed changes in patients’ status during transport. Methods: Retrospective study of all missions flown by the Polish HEMS to attend stroke patients over the 2-year period. The following data were collected for each mission and patient: time from activation of the HEMS until arrival at the scene, time spent at the scene; and scores on the National Advisory Committee for Aeronautics scale, the Revised Trauma Scale (ETR), and the Glasgow Coma Scale (ECG) at the scene and on transfer of the patient to the hospital or ambulance. Results: A total of 1191 patients were analyzed. The mean (SD) ETR and ECG scores on the scene were 11.1 (1.36) and 11.8 (3.39), respectively. After HEMS transport the means were 11.0 (1.5) and 11.7 (3.5). In-flight transport did not affect the patient’s condition, but more time spent at the scene was associated with significantly lower scores on the scales. Conclusions: Helicopter transport of these patients is safe and ensures their transfer to the nearest hospital or ambulance within the treatment time window. Time spent on care at the scene of the emergency should probably be as short as posible (AU)