Double-bubble deformity in breast augmentation: correction with percutaneous barbed sutures.

The double-bubble deformity is a complication after breast augmentation that often requires additional treatment such as elevation and restoration of the inframammary fold (IMF), parenchymal scoring or fat grafting. We describe a percutaneous technique that combines dual plane pocket dissection, parenchymal scoring and placement of a percutaneous barbed suture to create a new IMF. This technique takes approximately 10 minutes per breast to complete, and the resulting breast has an immediately noticeable double-bubble free surface. This technique can both prevent and treat a double-bubble deformity after dual plane breast augmentation. LEVEL OF EVIDENCE V: 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 Double Bubble Sign: Duodenal Atresia and Associated Genetic Etiologies.

BACKGROUND: The "double bubble" sign is an ultrasonographic finding that commonly represents duodenal atresia and is associated with trisomy 21. OBJECTIVES: We sought to evaluate the positive predictive value of a prenatally identified double bubble sign for duodenal atresia and the genetic etiologies associated with it. METHODS: We examined a retrospective cohort with prenatal double bubble sign between January 1, 2008, and June 30, 2017. Postnatal diagnoses were determined by review of operative reports and additional postnatal evaluation including cytogenetic analysis, molecular analysis, and/or clinical genetic evaluation. RESULTS: All live births at our institution with a prenatal double bubble sign had confirmed duodenal atresia. Additional anatomic anomalies and/or genetic abnormalities were identified in 62% of cases. Out of 21 cases, 6 had trisomy 21. Of the remaining 15 cases, 8 were nonisolated duodenal atresia, 3 of which had a heterotaxy syndrome. In the 7 isolated cases, 1 likely pathogenic chromosomal microdeletion was identified. CONCLUSIONS: Prenatal double bubble sign is a reliable predictor of duodenal atresia. In addition to trisomy 21, heterotaxy may be encountered. ZIC3 mutations as well as microdeletion of 4q22.3 may be underlying genetic etiologies to be considered in the diagnostic evaluation of a prenatal double bubble sign.

D-SUN Method to Prevent Double-Bubble Deformity in Broad Base Breasts with High-Rising Inframammary Fold.

Breast augmentation is the most commonly performed plastic surgery among women worldwide. With time, implant selection shifted from arbitrary implantation to precise planning. Different methods address the dimensional planning process. Many of them are complex to put into practice, focusing mainly on the breast base. Constricted, short lower pole breasts are morphologically predisposed to complication such as double-bubble deformity. Yet, by focusing on the distance between the nipple on stretch and the inframammary fold, the D-SUN method guides the surgeon to find the most appropriate implant volume for anatomical form-stable silicon implants and IMF incision to avoid complications.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.

Clinical outcome of pregnancies with the prenatal double bubble sign - a five-year experience from one single centre in mainland China.

The aim of this study was to describe the risk of aneuploidy, associated structural anomalies and clinical outcome in pregnancies with the prenatal double bubble sign. A retrospective study on ultrasound reports and pregnancy outcomes was performed in 71 foetuses with double bubble sign, who were examined at the Guangzhou Women and Children Medical Center during a five-year period. Forty-nine patients had the regular prenatal care since first trimester; of these, 20 had the sonographic sign before 24 weeks and the remaining 29 had the sonographic diagnosis after 24 weeks. Twenty-two patients presented beyond 24 weeks and the sonographic diagnosis was late. Fetal trisomy 21 was found in one of the 49 patients who had early and regular prenatal visits, but was confirmed in six out of the 22 patients who had late prenatal care. Only one out of the 49 cases had additional malformation. In the 22 subset cases, seven had additional malformations. Two pregnancies ended in intrauterine foetal demise and five patients opted for termination of pregnancy because of additional anomalies or abnormal karyotype. There were 63 live births. Postnatal verification revealed duodenal obstruction secondary to intrinsic or extrinsic cause in 60 cases; three cases excluded duodenal obstruction. The implementation of first trimester screening programme has significantly reduced the number of duodenal obstruction cases with trisomy 21 and associated malformations. Impact statement What is already known on this subject: The double bubble sign is strongly indicative of duodenal atresia. More than one-half of foetuses with duodenal atresia have associated anomalies, especially trisomy 21. What the results of this study add: The clinical outcome of foetuses with double bubble sign was first reported in mainland China. The implementation of first trimester screening programme has significantly reduced the number of duodenal atresia cases with trisomy 21 and associated malformations. What the implications are of these findings for clinical practice and/or further research: The early diagnosis of duodenal obstruction, as well as of other associated anomalies, will allow complementary investigation, immediate and proper care at birth and family counselling.

Shoelace Breast Cast.

Implant malposition after breast augmentation surgery remains a common complication. Several surgical options exist to correct the resultant deformity; however, all involve additional risks, costs, and the increased potential for patient dissatisfaction. In my practice, I have developed a nonsurgical therapy using shoelaces, which, when tied and placed in a certain fashion, can correct this deformity. When worn continuously, the shoelaces act as an external breast cast that allows the inframammary fold to be set and heal in the correct position. I have achieved great success in using this nonsurgical technique, and it allows me to be aggressive in cases where I need to raise the inframammary fold because I know that I can easily correct if the fold is lowered too much.

Imaging the Double Bubble: A Case of Duodenal Atresia Detected in Late Pregnancy.

Duodenal atresia is a rare congenital gastrointestinal obstruction, usually recognized by a prominent "double bubble" sign on prenatal imaging. This case report presents a diagnosis of duodenal atresia in a fetus in the third trimester. The mother presented late for an antenatal ultrasound, which revealed the classic "double bubble" sign. Postpartum abdominal radiographs confirmed the diagnosis, showing an air-filled, dilated abdomen and proximal duodenum with no distal bowel without any gas. A successful surgical operation was performed. This case highlights the importance of imaging in the diagnosis and timeliness of management of duodenal atresia.

Jejunal Atresia With a Rare Association: A Case Report and Literature Review.

Jejunoileal atresia, a common cause of neonatal intestinal obstruction, typically manifests shortly after birth. This case report highlights a rare instance of a late preterm female neonate presenting with type 4 jejunoileal atresia along with proximal rectal atresia, an exceedingly uncommon combination. Initial symptoms included bilious emesis and failure to pass meconium, leading to surgical correction of jejunoileal atresia. However, postoperative complications, including vomiting and jaundice, prompted further investigation, revealing rectal atresia during a fluoroscopic study on day 29. Subsequent surgery was required to address the rectal atresia, resulting in additional challenges such as short bowel syndrome and infection. The complexity of diagnosis and management underscores the importance of thorough evaluation of the lower gastrointestinal tract in neonates with jejunoileal atresia to prevent misdiagnosis and reduce the need for multiple surgeries. Rectal atresia, which is a very rare anorectal abnormality, in combination with jejunoileal atresia is considered an incredibly unusual, exceptionally unique case; as to our knowledge, no similar presentation had previously occurred. Prompt identification and simultaneous treatment of both conditions can help mitigate complications, minimize the risk of necrosis and perforation, and improve overall outcomes. Comprehensive management strategies that encompass thorough diagnostic evaluation and coordinated surgical interventions are crucial for optimizing the care of neonates with complex intestinal malformations, ensuring timely resolution of symptoms, and reducing long-term morbidity.

Prenatal Sonography in Suspected Proximal Gastrointestinal Obstructions: Diagnostic Accuracy and Neonatal Outcomes.

BACKGROUND: The purpose of this study was to assess diagnostic accuracy and neonatal outcomes in fetuses with a suspected proximal gastrointestinal obstruction (GIO). METHODS: After IRB approval, a retrospective chart review was conducted on prenatally suspected and/or postnatally confirmed cases of proximal GIO at a tertiary care facility (2012-2022). Maternal-fetal records were queried for presence of a double bubble ± polyhydramnios, and neonatal outcomes were assessed to calculate the diagnostic accuracy of fetal sonography. RESULTS: Among 56 confirmed cases, the median birthweight and gestational age at birth were 2550 g [interquartile range (IQR) 2028-3012] and 37 weeks (IQR 34-38), respectively. There was one (2%) false-positive and three (6%) false-negatives by ultrasound. Double bubble had a sensitivity, specificity, positive predictive value, and negative predictive value for proximal GIO of 85%, 98%, 98%, and 83%, respectively. Pathologies included 49 (88%) with duodenal obstruction/annular pancreas, three (5%) with malrotation, and three (5%) with jejunal atresia. The median postoperative length of stay was 27 days (IQR 19-42). Cardiac anomalies were associated with significantly higher complications (45% vs 17%, p = 0.030). CONCLUSIONS: In this contemporary series, fetal sonography has high diagnostic accuracy for detecting proximal gastrointestinal obstruction. These data are informative for pediatric surgeons in prenatal counseling and preoperative discussions with families. LEVEL OF EVIDENCE: Diagnostic Study, Level III.

A Triboelectric Sensor with Double Bubble Structure Applied in a High Security Double Lock System.

With more attention on personal privacy and the need for a security defense, it is necessary to design an intelligent lock system with a higher security performance. Here, a novel high security double lock system integrating triboelectric nanogenerators (TENGs) with a double bubble structure (DB-TENG) and deep learning models is proposed. The TENG as a self-powered sensor is developed using silicone rubber and copper foil. By optimizing the thickness of the top layer film, surface microstructure, the size of the air bubble, and design of the double bubble structure, the sensitivity of the DB-TENG reaches 19.08 V/kPa. For the feasibility study, the sensor is fabricated to a smart belt to collect respiratory behaviors as a respiratory code. A Long Short-Term Memory network is adopted to identify four typical respiratory signals with an average accuracy of 97.00%. The system is deployed on a Raspberry Pi to determine whether the user is permitted through both the collected respiratory code and the related face image and will send an alarm message if one of the two does not match. It is worth mentioning that users can send alarm signals undiscovered by controlling their respiratory signals. Therefore, the proposed system has superb potential in security demanding environments.

Double Bubble Electrospinning: Patents and Nanoscale Interface.

BACKGROUND: Bipolymeric nanofibers have gained significant attention in various fields due to their enhanced functionality, improved mechanical properties, and controlled release capabilities. However, the fabrication of these composite fibers with a well-defined polymer-polymer interface remains a challenging task. METHODS: The double bubble electrospinning setup was developed and simulated using Maxwell 3D to analyze the electric field. PVP and PVA polymers were electrospun simultaneously to create bipolymer nanofibers with an interface. The resulting nanofibers were compared with nanofibers made from pure PVA, PVP, and a PVA/PVP blend. The characterization of the nanofibers was performed using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and thermogravimetric analysis (TGA). RESULTS: The SEM images showed the formation of PVA/PVP interfacial nanofibers aligned side by side, with a diameter of a few thousand nanometers on each side. By increasing the voltage from 20 kV to 40 kV during electrospinning, the diameter of the nanofibers on the PVA and PVP sides was successfully reduced by 60.8% and 66.3%, respectively. FTIR analysis confirmed the presence of both PVA and PVP in the bipolymeric interfacial nanofibers. TGA analysis demonstrated a weight retention of 14.28% compared to PVA, PVP, and the PVA/PVP blend even after degradation at 500°C. The Maxwell simulation of double bubble electrospinning revealed a stronger and more uniform electric field pattern at 40 kV compared to 20 kV. CONCLUSION: The study has demonstrated the potential of double bubble electrospinning for the fabrication of bipolymer nanofibers with an interface, opening new avenues for the development of functional nanofibers.

Dynamics of double bubbles under the driving of burst ultrasound.

This paper investigates the pulsations and translation of bubbles in a double-bubble system driven by burst ultrasound. Results illustrate that for two identical bubbles, decreasing the frequency of burst or increasing its amplitude can enhance the pulsations and improve the translation velocities of bubbles. In a certain scope, large bubble brings about fast translation velocity, but the velocity will fall down for too large bubble, such as the bubble with ambient radius over about its resonance radius. When the ambient radii of two bubbles are different, translation of the large bubble is smaller than that of the small bubble. In addition, the effect of initial distance between bubbles is described as well. If burst serials are used, shortening the time interval between each burst and improving the acoustic amplitude of bursts are beneficial for the translations of bubbles.

Clinical significance of prenatal double bubble sign on perinatal outcome and literature review.

OBJECTIVE: To determine the diagnostic accuracy of the double bubble sign in predicting duedonal obstruction, the prevalence of anomalies associated with congenital duedonal obstruction, and to evaluate the outcome of these pregnancies and review the literature. METHODS: We analyzed that the cases with double bubble sign were detected in prenatal ultrasonography between January 2014 and December 2019. Ultrasound reports, karyotyping results, surgical confirmed diagnoses and long-term results were extracted from the hospital database. RESULTS: Duodenal obstruction was detected in all operated cases with double bubble sign detected in prenatal ultrasonography. Karyotype anomaly was found in 63.9% and additional congenital anomaly was found in 69.4%. Adverse perinatal outcome was seen in 51.1% of cases. Adverse perinatal outcome was found significantly higher in abnormal karyotype and congenital anomaly groups than isolated group. 81.8% of the isolated cases lived after the operation. Only two isolated cases died. CONCLUSION: The prenatal double bubble sign is a highly reliable predictor for duodenal obstruction and structural anomalies and/or genetic abnormalities are present in the majority of cases. Duodenal obstruction is isolated, the outcomes appear favorable.

Another "double bubble" sign or "double bladder" sign: fetal intra-abdominal umbilical vein varix.

Fetal intra-abdominal umbilical vein varix increases the incidence of fetal/neonatal morbidity and mortality. Its early diagnosis may be clinically important. For a case of this disorder, we have proposed the new name of "double bladder" sign; "another double bubble" sign may also illustrate this disorder.

Pyloric atresia and Down's syndrome: prenatal double bubble false sign. / Atresia pilórica y síndrome de Down: falso signo de la doble burbuja prenatal.

Pyloric atresia is a rare malformation, with an incidence of 1:100,000 live newborns. Male to female ratio is 1/1. Typically, it is an isolated malformation, with a good prognosis, but 20-40% of cases present epidermolysis bullosa, and to a lesser extent, multiple intestinal atresias. We present the case of a pre-term newborn prenatally diagnosed with polyhydramnios, duodenal atresia with "double bubble" sign, and suspected Down's syndrome, who eventually had pyloric atresia.

La atresia pilórica es una malformación rara, presenta una incidencia de 1:100.000 recién nacidos vivos y la ratio hombre/mujer es de 1/1. Generalmente es una malformación aislada, con buen pronóstico, pero entre el 20-40% de los casos se asocia a epidermólisis bullosa y en menor frecuencia a otras atresias intestinales múltiples. Presentamos un caso de recién nacido pretérmino con atresia pilórica con el diagnóstico prenatal de polihidramnios, atresia duodenal con signo de 'doble burbuja' y sospecha de síndrome de Down.

Improved SARS-CoV-2 PCR detection and genotyping with double-bubble primers.

A new approach for improved RT-PCR is described. It is based on primers designed to form controlled stem-loop and homodimer configurations, hence the name 'double-bubble' primers. The primers contain three main regions for efficient RT-PCR: a 3' short overhang to allow reverse transcription, a stem region for hot start and a template-specific region for PCR amplification. As proof of principle, GAPDH, SARS-CoV-2 synthetic RNA and SARS-CoV-2 virus-positive nasopharyngeal swabs were used as templates. Additionally, these primers were used to positively confirm the N501Y mutation from nasopharyngeal swabs. Evidence is presented that the double-bubble primers offer fast, specific, robust and cost-effective improvement in RT-PCR amplification for detection of gene expression in general and for diagnostic detection and genotyping of SARS-CoV-2 in particular.

Beak Sign:A New Sign of Prenatal Ultrasound in the Diagnosis of Annular Pancreas / 中国医学影像学杂志

Purpose To explore the diagnostic value of beak sign in fetal annular pancreas by analyzing the ultrasonographic features of fetal annular pancreas.Materials and Methods The ultrasound images and clinical data of 13 cases of fetal annular pancreas diagnosed by prenatal ultrasound in Shandong Provincial Maternal and Child Health Hospital from September 2019 to December 2021 and confirmed by surgery after birth were retrospectively analyzed.The degree of duodenal stenosis at the obstruction site was observed,especially whether the angle formed by the intestinal wall could identify the fetal annular pancreas,and the ultrasonic characteristics were summarized and analyzed.Results A total of 13 fetuses with annular pancreas showed double bubble sign,3 cases showed clamp sign,and 7 cases showed beak sign at the end of duodenal dilatation.All the 13 cases underwent surgical treatment after birth,including 2 cases with duodenal atresia and 1 case with atypical intestinal malrotation.All the children had good prognosis after operation.Conclusion By observing the dilated end of duodenum and the relationship with pancreatic head,prenatal ultrasound combined with beak sign and double bubble sign could improve the diagnostic accuracy of fetal annular pancreas,which has significant value in prenatal diagnosis of fetal annular pancreas.

Annular Pancreas in an Adult Presenting with Acute Pancreatitis.

Annular pancreas is a rare congenital condition in which tissue from the head of the pancreas partially or completely surrounds the second part of the duodenum. This condition has a variable clinical presentation in adults and children. Radiologists should be aware of the imaging findings in adults as an annular pancreas can be overlooked or misdiagnosed in this patient population. In this case report we describe an adult patient with pancreatitis associated with the computed tomography findings of a complete annular pancreas and discuss additional imaging techniques and findings for differential diagnoses of this condition.

Etiology and treatment of adrenoleukodystrophy: new insights from Drosophila.

Adrenoleukodystrophy (ALD) is a fatal progressive neurodegenerative disorder affecting brain white matter. The most common form of ALD is X-linked (X-ALD) and results from mutation of the ABCD1-encoded very-long-chain fatty acid (VLCFA) transporter. X-ALD is clinically heterogeneous, with the cerebral form being the most severe. Diagnosed in boys usually between the ages of 4 and 8 years, cerebral X-ALD symptoms progress rapidly (in as little as 2 years) through declines in cognition, learning and behavior, to paralysis and ultimately to a vegetative state and death. Currently, there are no good treatments for X-ALD. Here, we exploit the Drosophila bubblegum (bgm) double bubble (dbb) model of neurometabolic disease to expand diagnostic power and therapeutic potential for ALD. We show that loss of the Drosophila long-/very-long-chain acyl-CoA synthetase genes bgm and/or dbb is indistinguishable from loss of the Drosophila ABC transporter gene ABCD Shared loss-of-function phenotypes for synthetase and transporter mutants point to a lipid metabolic pathway association with ALD-like neurodegenerative disease in Drosophila; a pathway association that has yet to be established in humans. We also show that manipulation of environment increases the severity of neurodegeneration in bgm and dbb mutant flies, adding even further to a suite of new candidate ALD disease-causing genes and pathways in humans. Finally, we show that it is a lack of lipid metabolic pathway product and not (as commonly thought) an accumulation of pathway precursor that is causative of neurometabolic disease: addition of medium-chain fatty acids to the diet of bgm or dbb mutant flies prevents the onset of neurodegeneration. Taken together, our data provide new foundations both for diagnosing ALD and for designing effective, mechanism-based treatment protocols.This article has an associated First Person interview with the first author of the paper.