The Dieffenbach Flap for Reconstruction of Auricular Defects After Mohs Micrographic Surgery.

Auricle reconstruction is a challenging problem in plastic surgery due to the ear's prominent location, complex anatomy, and limited local tissue availability. The Dieffenbach flap, a folded postauricular flap, offers a viable flap for reconstruction of larger ear defects. Although the technique has been well defined in previous literature, there are few studies evaluating its outcomes and complications. The authors conducted a retrospective review of patients who underwent auricle reconstruction with the Dieffenbach flap by a single surgeon between 2016 and 2022. Data collection included demographics, medical history, cancer type, defect characteristics, postoperative care, outcomes, and complications. Univariable analyses using the Fischer exact test assessed the association between risk factors (smoking, anticoagulation use, and age) and complication rates, with P ≤ 0.05 considered statistically significant. A total of 40 patients were included in this study, with a mean age of 67.6 and a male prevalence of 77.5%. The mean defect size was 6.5 cm2, with most defects located on the superior helix. The most common complication was postoperative cellulitis (3 patients, 7.5%), followed by contour abnormality that required revision surgery (2 patients, 5.0%). History of smoking had a statistically significant association with complications (P = 0.013). Use of anticoagulants, or older age (defined as >70 years), had no significant association with complication risk. The Dieffenbach flap remains a reliable method for reconstruction of various auricle defects. It is low maintenance, well tolerated by patients, and involves minimal donor site morbidity without the need for cartilage.

Aesthetic Auricle Reconstruction with the Dieffenbach Flap: A Retrospective Case Review.

The Dieffenbach flap is often used for post-Mohs reconstruction of auricle defects, effectively restoring the auricle rim. However, its impact on auricle projection and length after division and inset is not well-documented. This study evaluates auricle projection and length following defect repair with the Dieffenbach flap, comparing results to the nonoperative ear. We conducted a retrospective review of patients who underwent a Dieffenbach flap repair surgery at a single institution from 2016 to 2023. Auricle projection and length of the reconstructed ear were measured within the first month following division and inset of the flap and compared with the contralateral ear. A subset of patients had additional measurements > 1 month following division and inset, and these measurements were compared with the contralateral ear. Our study included 23 patients with an average age 67.4 years and 78.3% male. Within 1 month following division and inset, the Dieffenbach flap resulted in a significant decrease in auricle projection (16.5 vs. 18.6 mm, p < 0.05) and length (67.0 vs. 69.7 mm, p < 0.05) compared with the contralateral ear. Subsequent follow-up showed no significant differences in projection (18.5 vs. 18.5 mm, p = 0.98) or length (68.0 vs. 68.7 mm, p = 0.54). Following division and inset of the Dieffenbach flap, auricle projection and length experience initial reduction but subsequently self-correct to match the contralateral ear.

Funneling modulatory peptide design with generative models: Discovery and characterization of disruptors of calcineurin protein-protein interactions.

Design of peptide binders is an attractive strategy for targeting "undruggable" protein-protein interfaces. Current design protocols rely on the extraction of an initial sequence from one known protein interactor of the target protein, followed by in-silico or in-vitro mutagenesis-based optimization of its binding affinity. Wet lab protocols can explore only a minor portion of the vast sequence space and cannot efficiently screen for other desirable properties such as high specificity and low toxicity, while in-silico design requires intensive computational resources and often relies on simplified binding models. Yet, for a multivalent protein target, dozens to hundreds of natural protein partners already exist in the cellular environment. Here, we describe a peptide design protocol that harnesses this diversity via a machine learning generative model. After identifying putative natural binding fragments by literature and homology search, a compositional Restricted Boltzmann Machine is trained and sampled to yield hundreds of diverse candidate peptides. The latter are further filtered via flexible molecular docking and an in-vitro microchip-based binding assay. We validate and test our protocol on calcineurin, a calcium-dependent protein phosphatase involved in various cellular pathways in health and disease. In a single screening round, we identified multiple 16-length peptides with up to six mutations from their closest natural sequence that successfully interfere with the binding of calcineurin to its substrates. In summary, integrating protein interaction and sequence databases, generative modeling, molecular docking and interaction assays enables the discovery of novel protein-protein interaction modulators.

All I Have Learned, I Have Learned from Google: Why Today's Facial Rejuvenation Patients are Prone to Misinformation, and the Steps We can take to Contend with Unreliable Information.

A growing number of patients are seeking answers for their health concerns online. This study assesses the reliability, quality, and readability of online materials patients have access to through the Internet and evaluates the social media presence of information providers. An online search was conducted for facial rejuvenation by utilizing three ubiquitously used web search engines: Google, Bing, and Yahoo. The first 25 result pages were collected from each search engine, and exclusionary criteria were applied to exclude online stores and advertisements. Website reliability and quality were assessed via the DISCERN method. Readability was measured through six measurements: Flesch-Kincaid Grade Level (FKGL), Gunning Fox score, SMOG index, Coleman Liau index, and automated readability index. Social media presence and profile followers on Facebook, Twitter, and Instagram were determined to gauge social media presence. Exclusionary criteria yielded 41 unique websites, with the majority of websites authored by physicians (54%) followed by professional organizations (19%). The DISCERN method demonstrated that journal websites yielded the highest overall quality (4.00) and physician websites yielded the lowest (2.72). Readability analysis demonstrated that online forums proved the most challenging to read, and encyclopedia articles were the least challenging. Physician websites maintained the highest social media presence (95%) followed by professional organizations (75%). However, professional organizations had more social media followers in comparison to physician websites. Physician websites and professional organizations overwhelmingly command social media presence compared to other information providers and provide information with serious deficits in reliability and quality. A strong majority of online information also surpasses the health care literacy of patients. This poses a serious concern for physicians who need to provide and guide patients to high quality and reliable information.

Otoplasty Online Information: A Comprehensive Analysis of the Websites and Videos that Patients View Regarding Cosmetic Ear Surgery.

Physicians should be aware of both websites and videos available online regarding the otoplasty procedure to provide quality care. This study systematically analyzes the authorships, reliability, quality, and readability of the websites, as well as the authorships and primary objectives of the videos regarding otoplasty. Validated instruments were used to analyze the reliability, quality, and readability of websites, and videos were systematically categorized and analyzed. A Google search was conducted, and the first five pages of results were included in this study. After excluding unrelated websites, the remaining 44 websites were categorized by authorship (physician, patient, academic, or unaffiliated) and were analyzed using the validated DISCERN instrument for reliability and quality, as well as various other validated instruments to measure readability. A YouTube search was also conducted, and the first 50 relevant videos were included in the study. These videos were categorized by authorship and their primary objective. Website authorships were physician-dominated. Reliability, quality, and overall DISCERN score differ between the four authorship groups by a statistically significant margin (Kruskall-Wallis test, p < 0.05). Unaffiliated websites were the most reliable, and physician websites were the least reliable. Academic websites were of the highest quality, and patient websites were of the lowest quality. Readability did not differ significantly between the groups, though the readability measurements made showed a general lack of material easily readable by the general public. YouTube was likewise dominated by physician-authored videos. While the physician-authored videos sought mainly to inform and to advertise, patient-authored videos sought mainly to provide the patient's perspective. Academic organizations showed very little representation on YouTube, and the YouTube views on otoplasty videos were dominated by the top 20 videos, which represented over 93% of the total views of videos included in this study.

Oropharyngeal lymphoma: A US population based analysis.

OBJECTIVES: To describe the epidemiology and analyze factors determinant of survival in patients with oropharyngeal lymphoma, using the Surveillance Epidemiology and End Results (SEER) database. METHODS: 2504 patients with oropharyngeal lymphoma were identified using the most recent SEER database entry from 1976 to 2016. Demographic information, Ann Arbor stage, tumor histopathology and location were collected. Multivariate analysis was used to analyze patient and tumor characteristics associated with survival. RESULTS: The mean age of the patients studied was 60.5years, 58.4% of the subjects were male and 81% were white. Diffuse large B cell lymphoma (DLBCL) was the most common histologic subtype involving 56.9% of cases. The most common subsite of origin was the tonsil, with 71% of lymphomas originating from there. The association of survival with stage, age, tumor location, presence of B symptoms, tumor pathology, gender and race was analyzed using multivariate regression. Decreased survival was significantly associated with patient age p<0.0001, Ann Arbor staging p=0.005, the presence of B symptoms p=0.003 and tumor histopathology (T cell tumors) p=0.01. Patients with tumors originating from the soft palate were significantly more likely to die asa result of their disease p=0.03. CONCLUSION: Oropharyngeal lymphoma most commonly originates from the tonsil. DLBCL is the most common subtype and has a good prognosis. The presence of B symptoms, tumors originating from the soft palate and patients with T cell tumors have the worst prognosis. This information can potentially be of great utility to the head and neck surgeon discussing prognosis with patients suffering from oropharyngeal lymphoma.