Defining Ideal Pretarsal Rolls Through a Morphometric Analysis in Asians.

BACKGROUND: Pretarsal rolls are a crucial aesthetic feature. Despite numerous studies conducted on periorbital aesthetics, there remains a dearth of research on the ideal pretarsal rolls. OBJECTIVES: This study aimed to investigate 4 aesthetic characteristics of ideal pretarsal rolls: presence, width, proportion, and morphology. METHODS: Respondents (385, including 80 aesthetic specialists) were presented with 7 series of images of pretarsal rolls, including 2 series of pretarsal roll existence, 2 series of varying widths, 2 series of different ratios between pretarsal roll and palpebral fissure height, and 1 series about morphology. Participants were asked to rank each image within a given series from most attractive to least attractive. The rankings were then analyzed according to population demographics. RESULTS: The majority of respondents deemed images with pretarsal rolls to be more aesthetically pleasing (P < .001) than those without such features. Additionally, pretarsal rolls with a width of 5 mm (P < .001), a ratio to palpebral fissure height of 0.5:1 (P < .001), and a crescent shape (P < .001) were perceived as the most attractive. Moreover, individuals aged 40 or younger exhibited a significant preference for images with pretarsal rolls compared to older groups (P < .001), and females displayed a greater inclination toward a medium ratio of pretarsal roll to palpebral fissure height than males did (0.5:1 P = .003, 0.618:1 P < .001). CONCLUSIONS: This study validates the optimal characteristics of pretarsal rolls, which provides insight into pretarsal roll aesthetics and holds significant implications for surgical planning and effect assessment in future periocular procedures involving pretarsal rolls.

Botulinum Toxin Treatment for Calf Contouring Based on the Study of Combined Injection of Gastrocnemius and Soleus.

BACKGROUND: Botulinum toxin is administered to paralyze the gastrocnemius muscle and reduce its size, thereby improving the calf contour and reducing the leg circumference of the calf. OBJECTIVES: In pursuit of better efficacy, we designed a new injection protocol that targeted both the gastrocnemius and soleus. An algorithm of botulinum toxin injection for calf contouring was proposed based on the results of the study and ultrasonographic data. METHODS: A prospective, self-controlled, double-blind study was conducted. The gastronemius muscle (GM) group (n = 17) included the patients whose gastrocnemius muscles were treated, and the GM + soleus muscle (SM) group (n = 17) included the patients who had both the gastrocnemius and soleus treated. Parameters including the maximum leg circumference and the subcutaneous fat, gastrocnemius muscle, and soleus muscle thicknesses were collected before and after injection. RESULTS: Both GM and GM + SM injection helped improve calf contour. Although the thickness of the gastrocnemius muscle was reduced, reducing the leg circumference, the subcutaneous fat and soleus muscle had compensatory thickening after injection, especially over the long term, which may affect the efficacy. Compared with the GM group, the GM + SM group effectively reduced the tendency of the soleus muscle to thicken. Calf muscle thickness could be roughly estimated by constructing a fitting equation and measuring height, weight, and leg circumference. CONCLUSIONS: Two injection methods achieved the effect of improving calf contour and reducing the leg circumference with equivalent patient satisfaction. The GM + SM injection group did not show any obvious extra clinical benefit when compared with the GM injection group.

Protocol Establishment and Reliability Verification of Three-Dimensional Digital Stereophotogrammetry in Lower Eyelid Anthropometry.

BACKGROUND: Three-dimensional (3D) stereophotogrammetry has been widely used in anthropometry for both medical and esthetic purposes. However, no studies have assessed its reliability on measuring the lower eyelid by 3D imaging. This study aimed to establish a standardized 3D anthropometric protocol for lower eyelid region and validate its reliability. METHODS: Fifty-eight participants (116 eyes) were recruited with mean age of 39.14 ± 11.25 years. Two sets of VECTRA 3D images were taken for each subject, and each set of images was individually measured twice by two raters. Twenty-seven landmarks were identified in the lower eyelid region, and then 19 linear, 4 curvilinear, 7 angular and 2 areal metrics were assessed for intrarater, interrater and intramethod reliability. RESULTS: High reliability was found in this 3D imaging-based lower eyelid anthropometry. The mean absolute difference within 2 intrarater measurement were 0.22 and 0.08 units, the technical errors measurement were 0.31 and 0.15 units, the relative errors of measurement were 0.90% and 0.31%, the relative technical errors of measurement were 1.53% and 0.64%, and the intra-group correlation coefficient was 0.99 and 0.99. The results for interrater measurement were 0.53 units, 0.59 units, 2.94%, 3.41% and 0.96, and for intramethod measurement were 0.71 units, 0.77 units, 4.12%, 4.05% and 0.95 units, respectively. CONCLUSION: 3D stereophotogrammetry is reliable for lower eyelid anthropometry. The standardized protocol can be further applied for many purposes such as lower eyelid aging evaluation, surgical related assessment and periocular rejuvenation plan. 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 .

Development and Validation of a Comprehensive Perioral Evaluation Method Using Three-Dimensional Stereophotogrammetry.

BACKGROUND: The non-invasive three-dimensional (3D) stereophotogrammetry is widely used in anthropometry for medical purpose. Yet, few studies have assessed its reliability on measuring the perioral region. OBJECTIVES: This study aimed to provide a standardized 3D anthropometric protocol for the perioral region. METHODS: 38 female and 12 male Asians were recruited (mean age 31.6 ± 9.6 years). Two sets of 3D images using the VECTRA 3D imaging system were acquired for each subject, and two measurement sessions for each image were performed independently by two raters. 25 landmarks were identified, and 28 linear, 2 curvilinear, 9 angular and 4 areal measurements were evaluated for intrarater, interrater, and intramethod reliability. RESULTS: Our results showed high reliability of 3D imaging-based perioral anthropometry by mean absolute difference (0.57 and 0.57 unit), technical error measurement (0.51 and 0.55 unit), relative error of measurement (2.18% and 2.44%), relative technical error of measurement (2.02% and 2.34%), and intraclass correlation coefficient (0.98 and 0.98) for intrarater 1 and intrarater 2 reliability; respectively 0.78 unit, 0.74 unit, 3.26%, 3.06% and 0.97 for interrater reliability; and respectively 1.01 unit, 0.97 unit, 4.74%, 4.57% and 0.95 for intramethod reliability. CONCLUSIONS: This standardized protocol utilizing 3D surface imaging technologies are feasible and highly reliable in perioral assessment. It could be further applied for diagnostic purpose, surgical planning and therapeutic effect evaluation in clinical practice in relation to perioral morphologies. 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 .

A Quantitative Three-Dimensional Tear Trough Deformity Assessment and Its Application in Orbital Septum Fat Transposition.

BACKGROUND: Existing evaluation tools of tear trough deformity are based on subjective impression of clinicians. More accurate quantitative assessment methods are needed. This study aimed to propose a quantitative three-dimensional assessment method for the tear trough deformity in comparison with the Barton's grading system and apply it to the efficacy evaluation of orbital septum fat transposition. METHODS: 117 healthy Chinese adults (234 eyes) were enrolled and divided into four groups according to the Barton's grading system. Three-dimensional facial images were captured using Vectra H1 handheld camera. 6 anthropometric landmarks were identified on each eye and 8 linear measurements were generated accordingly. Intra-observer reliability was determined and measurements were compared between groups. Pre- and post-operative three-dimensional measurements were compared in 19 patients who received lower blepharoplasty with orbital septum fat transposition. RESULTS: The severity of tear trough was positively correlated with age (P < 0.001) but not BMI (P = 0.145) or gender (P = 0.280). Intra-rater reliability of the 8 linear measurements was excellent except for the vertical distance between the palpebrale inferioris margin and the tear trough below the pupillary center. Intergroup comparison showed that the horizontal distance between the lateral end of tear trough (P < 0.001) and medial canthus and the sagittal vector from tear trough point toward eyelid bag point (P = 0.009) increased with grade, while the vertical distance from mid-pupil to palpebrale inferioris margin decreased gradually (P = 0.001). Orbital septum fat transposition significantly improved the tear trough deformity as assessed by these three-dimensional measurements. CONCLUSIONS: We demonstrated a novel quantitative evaluation method of the tear trough deformity using three-dimensional stereophotogrammetry and proved it to be valid and reliable. It showed good value of clinical application and might help with periorbital rejuvenation planning and outcome assessment. 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 .

Does Double-Eyelid Blepharoplasty Improve Forehead Wrinkles? A Prospective Study Using FACE-Q Scale and Anthropometric Measurements.

BACKGROUND: Single eyelids are common among Asians. It is not uncommon to see people with single eyelids raise their eyebrows to wide open their eyes. This results in frequent compensatory contraction of the frontalis muscle and thus leads to deep forehead wrinkles. Double-eyelid blepharoplasty creates a larger visual field. In theory, patients who receive the surgery will stop overusing the frontalis muscle. Therefore, the forehead wrinkles can be improved. METHODS: 35 patients who underwent double-eyelid blepharoplasty were enrolled. FACE-Q forehead wrinkle assessment scale was adopted to evaluate the forehead wrinkles preoperatively and postoperatively. In addition, anthropometric measurements were taken to indirectly evaluate frontalis muscle contraction in maximum eye-opening position. RESULTS: According to the FACE-Q scale, forehead wrinkles were improved after double-eyelid blepharoplasty, and the improvement was long-lasting in the 3-month follow-up. This was because the frontalis muscle contraction reduced after the surgery, as shown by the anthropometric measurements. CONCLUSION: This study used subjective and objective methods to prove that double-eyelid surgery improves forehead wrinkles. 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 .

Ultrasonographic Analysis of Trapezius Muscle for Efficient Botulinum Toxin Type A Injection.

BACKGROUND: Patients nowadays seek medical reduction of the upper trapezius muscle to achieve aesthetic pleasing necklines. Botulinum toxin type A (BoNT-A), a neurotoxin that reduces the force of muscle contraction, is widely used for shoulder contouring. However, detailed metrical data are lacking to guide clinical injection. METHODS: Forty healthy young women were enrolled. All subjects were seated for point marking and measuring of trapezius muscle (TM) anatomical data. At marked locations, the thickness of the subcutaneous tissue, the thickness of the TM, the TM's anterior border, and the depth from the skin surface to the middle of TM were measured using a real-time ultrasound scanner. In addition, photos were taken to assess the shoulder area proportion and shoulder angle. RESULTS: The shoulder area size among participants was 90 ± 15.2 cm2, the average area proportion was 0.55 ± 0.1, and the shoulder angle was 23.12° ± 2.9°. Ultrasonography data reveal that the thickness of the subcutaneous tissue, the thickness of the TM, and the depth from the skin surface to the middle of TM all thickened from the anterior line to the posterior line (P < 0.001). The length of the TM extending forward was 1.47 ± 0.4 cm (range 0.51-1.31 cm). To better evaluate the appearance of the trapezius muscle, we constructed a grading system correlated to shoulder angle. CONCLUSION: In this study, ultrasonography and photos were applied to assess the TM's anatomical features. Trapezius hypertrophy was described on a scale from 0 to 2 based on the shoulder angle. The findings of the present study provide a practical clinical guidance for precise and efficient BoNT-A administration. 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 .

Risk of second primary malignancies associated with radiotherapy in prostate cancer patients: competing risk analysis.

Background: The effect of radiotherapy (RT) for second primary malignancies (SPMs) among prostate cancer survivors is controversial. Methods: Applying logistic regression, competing risk analysis and propensity score matching method, this study analyzed clinical data from the Surveillance, Epidemiology, and End Results program to compare the risk for SPMs between patients receiving RT and non-RT. Results: In this study, prostate cancer patients treated with RT developed more SPMs in the anus, bladder, rectum, liver, lung and bronchus and lymphoma than non-RT groups. Conclusion: More intensive surveillance should be adopted for these cancers among prostate cancer survivors.

Plain language summary Patients with prostate cancer have the highest 5-year survival rate, which increases the risk for developing second primary malignancies (SPMs). The effect of radiotherapy (RT) for SPMs is controversial among prostate cancer survivors. This study analyzed a mass of prostate cancer patients from a public database to compare risk for SPMs between RT and non-RT groups. RT indeed increased certain categories of SPM and intensive surveillance should be considered.

The "Visible" Muscles on Ultrasound Imaging Make Botulinum Toxin Injection More Precise: A Systematic Review.

BACKGROUND: Botulinum toxin (BoNT) injection is the most commonly performed procedure in cosmetic surgery. However, blind injection is unable to take individual anatomical variations into consideration, which is the main contributing factor to complications. Ultrasound (US) imaging was introduced to reduce complications and improve effects. This article will review uses of US in aesthetic BoNT injection. METHOD: A systematic electronic search was performed using the PubMed, MEDLINE, Web of science. Search terms were set to focus on aesthetic BoNT injection. Two independent reviewers subsequently reviewed the resultant articles based on strict inclusion and exclusion criteria. Selected manuscripts were analysed and grouped by procedure categories. Clinical cases were all performed by one plastic surgeon in our department. RESULTS: The search finally retained 24 articles. Five procedural categories were identified, including masseter (n = 16), frontalis (n = 2), glabella complex (n = 2), trapezius (n=1), and gastrocnemius (n = 3). US imaging is practical and instructive for pre-operative assessments as in needle-type selection, injection point localization and depth setting, as well as post-operative follow-ups regarding injection feedback (for instance, the extent of muscle volume decreases). What's more, ultrasound-guided injection makes needle trajectory visualized so as for the needle to reach the target muscle in avoidance of potential damage to neurovascular bundle, gland or adjacent muscle. CONCLUSION: Muscles, such as masseter, frontalis, glabella complex, trapezius and gastrocnemius, and their adjacent structures can be well visualized using US, and as such, US can be a useful tool for a variety of pre-operative, intra-operative and post-operative procedures. 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 .

Stereophotogrammetry to reveal age-related changes of labial morphology among Chinese women aging from 20 to 60.

BACKGROUND: The lip is of important aesthetic value and highly subjected to aging. Collecting anthropometric baseline data and understanding age-related changes of labial morphology can help with diagnosis of deformity, assessment of aging, and planning of cosmetic procedures. Many studies have focused on Caucasians, while there is a lack of anthropometric data on Chinese women. METHODS: A total of 169 women were enrolled in this cross-sectional study and divided into four consecutive age groups. Linear distances, angles, and surface area data were obtained via stereophotogrammetry. Intergroup comparisons between different age groups were performed to find age-related differences. RESULTS: Lip width significantly increased with age while philtrum width seemed to show no obvious change. Cutaneous upper and lower lip height increased, lengthening the lip in the vertical dimension. Decrease of upper vermilion height and changes in angles indicated that aging process shortened the upper vermilion and flattened the vermilion border. Surface area also showed age-related changes. Intergroup comparison showed no statistical significance in most variables between 20s and 30s or 30s and 40s, while age-related changes in some variables were significant between 40s and 50s. CONCLUSION: This study provided anthropometric data of labial morphology across a wide age range. Aging process affected a variety of labial anthropometric variables. Age-related changes accelerated after 40 among Chinese women.

Case report: Macrophage activation syndrome in a patient with Kabuki syndrome.

Macrophage activation syndrome (MAS), is a severe and fatal complication of various pediatric inflammatory disorders. Kabuki syndrome (KS), mainly caused by lysine methyltransferase 2D (KMT2D; OMIM 602113) variants, is a rare congenital disorder with multi-organ deficiencies. To date, there have been no reported cases of MAS in patients with KS. This report describes a case of a 22-year-old male with Kabuki syndrome (KS) who developed MAS. This unique case not only deepens the understanding of the involvement of KMT2D in immune regulation and disease, but expands the phenotype of the adult patient to better understand the natural history, disease burden, and management of patients with KS complicated with autoimmune disorders.

Development and evaluation of a deep learning framework for the diagnosis of malnutrition using a 3D facial points cloud: A cross-sectional study.

BACKGROUND: The feasibility of diagnosing malnutrition using facial features has been validated. A tool to integrate all facial features associated with malnutrition for disease screening is still demanded. This work aims to develop and evaluate a deep learning (DL) framework to accurately determine malnutrition based on a 3D facial points cloud. METHODS: A group of 482 patients were studied in this perspective work. The 3D facial data were obtained using a 3D camera and represented as a 3D facial points cloud. A DL model, PointNet++, was trained and evaluated using the points cloud as inputs and classified the malnutrition states. The performance was evaluated with the area under the receiver operating characteristic curve, accuracy, specificity, sensitivity, and F1 score. RESULTS: Among the 482 patients, 150 patients (31.1%) were diagnosed as having moderate malnutrition and 54 patients (11.2%) as having severe malnutrition. The DL model achieved the performance with an area under the receiver operating characteristic curve of 0.7240 ± 0.0416. CONCLUSION: The DL model achieved encouraging performance in accurately classifying nutrition states based on a points cloud of 3D facial information of patients with malnutrition.

Automated anatomical landmark detection on 3D facial images using U-NET-based deep learning algorithm.

Background: Facial anthropometry based on 3-dimensional (3D) imaging technology, or 3D photogrammetry, has gained increasing popularity among surgeons. It outperforms direct measurement and 2-dimensional (2D) photogrammetry because of many advantages. However, a main limitation of 3D photogrammetry is the time-consuming process of manual landmark localization. To address this problem, this study developed a U-NET-based deep learning algorithm to enable automated and accurate anatomical landmark detection on 3D facial models. Methods: The main structure of the algorithm stacked 2 U-NETs. In each U-NET block, we used 3×3 convolution kernel and rectified linear unit (ReLU) as activation function. A total of 200 3D images of healthy cases, acromegaly patients, and localized scleroderma patients were captured by Vectra H1 handheld 3D camera and input for algorithm training. The algorithm was tested to detect 20 landmarks on 3D images. Percentage of correct key points (PCK) and normalized mean error (NME) were used to evaluate facial landmark detection accuracy. Results: Among healthy cases, the average NME was 1.4 mm. The PCK reached 90% when the threshold was set to the clinically acceptable limit of 2 mm. The average NME was 2.8 and 2.2 mm among acromegaly patients and localized scleroderma patients, respectively. Conclusions: This study developed a deep learning algorithm for automated facial landmark detection on 3D images. The algorithm was innovatively validated in 3 different groups of participants. It achieved accurate landmark detection and improved the efficiency of 3D image analysis.

Introduction and validation of an automatic and low-cost three-dimensional facial imaging system: a comparison to direct anthropometry and Vectra H1.

Background: Three-dimensional (3D) imaging is a powerful tool for the analysis of soft tissue morphology. 3D photogrammetry outperforms conventional photogrammetric methods and gains popularity among plastic surgeons. However, commercial 3D imaging systems bundled with analytical software are costly. This study intends to introduce and validate an automatic, low-cost, and user-friendly 3D facial scanner. Methods: An automatic and low-cost 3D facial scanning system was developed. The system consisted of a 3D facial scanner running automatically on a sliding track and a 3D data processing tool. Fifteen human subjects underwent 3D facial imaging by the novel scanner. Eighteen anthropometric parameters were measured on the 3D virtual models and compared with caliper measurements (the gold standard). Further, the novel 3D scanner was compared to the commonly used commercial 3D facial scanner Vectra H1. Heat map analysis was used to evaluate the deviation between the 3D models obtained by the two imaging systems. Results: The 3D photogrammetric results were highly correlated with the direct measurement results (P<0.001). The mean absolute differences (MADs) were less than 2 mm. Bland-Altman analysis indicated that, for 17 of the 18 parameters, the largest differences within the 95% limits of agreement margin were within the 2.0 mm clinical acceptance. Heat map analysis showed the average distance between the 3D virtual models was 0.15 mm, with a root mean square of 0.71 mm. Conclusions: The novel 3D facial scanning system is proven to be highly reliable. It provides a good alternative to commercial 3D facial scanners.

Ultrasonographic analysis of the calves for efficient botulinum toxin type A injection.

BACKGROUND: Large calves are considered unattractive. Botulinum toxin type A (BoNT-A), acting as a neurotoxin that reduces muscle contraction, is widely used in calf contouring. However, there lacks detailed anatomical data to guide clinical injection. OBJECTIVES: This study aims to use ultrasonography to provide depth information of the calf muscles and determine the morphological types of the gastrocnemius muscle. METHODS: Ultrasound scanning was performed at six sites on 40 Chinese adults. A real-time ultrasound scannerwas used to detect the depth of the gastrocnemius muscle and the soleus muscle. RESULTS: The thickness of the gastrocnemius muscle and the soleus muscle was measured. The depth from the skin to the surface, the middle, and the bottom of the gastrocnemius muscle was measured. The morphology of gastrocnemius muscle was classified into four different types under ultrasound according to the muscle bulge pattern. CONCLUSION: This study took ultrasonic measurements of Asian calves to guide accurate and effective BoNT-A injection in real clinical practice.

Scientific landscape and trend analysis of keloid research: a 30-year bibliometric review.

BACKGROUND: Keloids remain troublesome for clinicians because of the lack of standard therapy, and the underlying mechanisms are still unclear. Bibliometric analysis could be a powerful tool to comprehensively review research trends, evaluate publication performances and provide future perspectives. There is no bibliometric analysis focusing on keloid research. METHODS: Keloid related publications were searched in Web of Science Core Collection from the publication year 1990 to 2019. Bibliometric data were provided on document type, annual publication number, most productive journals, publication geography, top potential authors, and highly cited articles. The distribution of single words in article titles was analyzed to evaluate the main research focuses and determine their development trends. Word cluster analysis was further performed to detect emerging trends in keloid research. RESULTS: The number of annual articles increased from 24 in 1990 to 63 in 2006 and then increased sharply, reaching 139 in 2019. Dermatologic Surgery published the highest number of articles followed by Plastic and Reconstructive Surgery. The USA ranked top with six publication indicators and China had a dramatic increase in the annual number of articles since 2012. Recent research hotspots include underlying pathogenetic mechanisms, keloid treatment, and therapeutic effect evaluation. DISCUSSION: Keloids remain a research focus. Efforts will be continuously made to understand the underlying mechanism of keloid formation. Despite many treatment modalities, there is no gold standard for keloid treatment, and many efforts are being made in the exploration of new therapies. Moreover, it is foreseeable that objective measurement tools will have a higher status in the assessment of keloids and scars.

The use of botulinum toxin A in upper lip augmentation.

BACKGROUND: Full lips are beauty standards. Botulinum toxin A (BTA) paralyzes the orbicularis oris muscle to achieve the eversion of the lip, and thus makes the lip look plump. AIMS: This study presents three cases of BTA injection to the lip and evaluates the possible changes in the labial morphology and the lip surface area. METHODS: Three patients received a total of 4U BTA injection at the vermilion border of the upper lip. Vectra® H1 3D imaging system was used to capture 3D photographs of the lips before injection and two weeks after injection. Eight linear distances and the upper lip surface area were measured. Anthropometric measurements before and after injection were compared. RESULTS: Patients displayed a larger upper vermillion height (P = .038) and a smaller cutaneous upper lip height (P = .024). There was a trend for a larger upper lip surface area, but not statistically significant (P = .109). Symptoms of slight perioral muscular palsy and mouth incompetence lasted about one month in three patients. CONCLUSION: BTA helps to enlarge the upper lip and shorten the philtrum. The BTA injection can be an option for lip enhancement with caution.

Outcome of Non-small Cell Lung Cancer Patients With N3 Stage: Survival Analysis of Propensity Score Matching With a Validated Predictive Nomogram.

Background and Objectives: N3-positive non-small cell lung cancer (NSCLC) is usually regarded as inoperable. There were very few studies that focused on N3-NSCLC patients. This study aims to analyze prognosis of NSCLC patients with N3 disease and provides retrospective indications. Methods: NSCLC patients staged as N3 were retrospectively reviewed from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox regression were used for identifying prognostic factors. The selected predictive parameters by the least absolute shrinkage and selection operator (LASSO) regression were used to develop predictive nomogram models for overall survival (OS) and lung cancer-specific survival (CSS). The C-index values were calculated to assess the models' predictive ability, while calibration curves were plotted to evaluate the agreement between the predicted and the actual survival. Survival curves were plotted by Kaplan-Meier method and were compared by log-rank test. Propensity score matching (PSM) was used to balance the baseline characteristics between treatment groups. Results: A total of 24,747 N3-NSCLC patients were enrolled. The 1-, 3-, and 5-year OS rates were 35.8, 6.8, and 1.7%, respectively, while the corresponding CSS rates was 36.6, 6.9, and 1.8%, respectively. The nomogram models were developed using 11 significant prognostic parameters, including age, sex, race, histology, stage, T stage, bone, brain and liver metastases, surgery, and chemotherapy. Both of them demonstrated great predictive ability and performed well in the calibration curves. After PSM, patients receiving surgery demonstrated significantly better survival than those who did not. Besides, there was no significant difference of survival between patients receiving chemotherapy with and without radiotherapy. Conclusions: The nomogram models for predicting survival outcome of N3-NSCLC patients can be clinically used. Surgery may be beneficial to the survival for these patients, while radiotherapy may not have additional survival benefits in patients receiving chemotherapy.

To Predict the Length of Hospital Stay After Total Knee Arthroplasty in an Orthopedic Center in China: The Use of Machine Learning Algorithms.

Background and Objectives: Total knee arthroplasty (TKA) is widely performed to improve mobility and quality of life for symptomatic knee osteoarthritis patients. The accurate prediction of patients' length of hospital stay (LOS) can help clinicians for rehabilitation decision-making and bed assignment planning, which thus makes full use of medical resources. Methods: Clinical characteristics were retrospectively collected from 1,298 patients who received TKA. A total of 36 variables were included to develop predictive models for LOS by multiple machine learning (ML) algorithms. The models were evaluated by the receiver operating characteristic (ROC) curve for predictive performance and decision curve analysis (DCA) for clinical values. A feature selection approach was used to identify optimal predictive factors. Results: The areas under the ROC curve (AUCs) of the nine models ranged from 0.710 to 0.766. All the ML-based models performed better than models using conventional statistical methods in both ROC curves and decision curves. The random forest classifier (RFC) model with 10 variables introduced was identified as the best predictive model. The feature selection indicated the top five predictors: tourniquet time, distal femoral osteotomy thickness, osteoporosis, tibia component size, and post-operative values of Hb within 24 h. Conclusions: By analyzing clinical characteristics, it is feasible to develop ML-based models for the preoperative prediction of LOS for patients who received TKA, and the RFC model performed the best.

Three-dimensional anthropometric analysis of eyelid aging among Chinese women.

BACKGROUND: Eyelid morphology is highly susceptible to aging. Previous studies have described the process of eyelid aging in Caucasians; however, anthropometric data describing aging in Chinese eyelids are lacking. Therefore, this study aimed to quantitatively analyze the effect of aging on the eyelids of Chinese women through a three-dimensional (3D) anthropometry. METHODS: In this prospective, cross-sectional study, 3D photos were captured from 188 healthy Chinese Han women, who were categorized into four age groups. Anthropometric landmarks were identified for the measurement of eyelid parameters, and a unified coordinate system was built into each subject. Linear and angular measurements were computed from the coordinates and were compared between the groups. RESULTS: An age-related decrease was observed in the ocular width, outer canthal width, palpebral fissure height, and multiple angular measurements. This indicated upper eyelid ptosis, which reduced the lateral and superior visual field. Lateral shift of the upper eyelid arc was not observed. The lower eyelid underwent slight elevation with increasing age. Aging rendered the periorbital region esthetically less pleasing, as shown by changes in the multiple proportion indices computed. Furthermore, an intergroup comparison indicated that eyelid aging was accelerated after the age of 40 years among Chinese women. CONCLUSION: This study used 3D photography to quantitatively analyze how eyelids in Chinese women changed with age. The anthropometric data collected could help with antiaging cosmetic surgery planning and postoperative assessment.