Defining "Ideal Abs" Through a Crowdsourcing-Based Assessment.

BACKGROUND: There were almost 12 million nonsurgical cosmetic procedures performed in the United States in 2016, which represented a 12% increase from the previous year, and popularity is expected to continue rising. Furthermore, nonsurgical fat reduction and body contouring have experienced a dramatic increase in popularity among both men and women. However, there has been very little work focused on the public's perception of the ideal abdominal muscles. OBJECTIVES: The authors sought to analyze patient perspectives on ideal abdominal contours and attitudes towards methods of improving the appearance of the abdomen. METHODS: A prospective cross-sectional study of 718 random volunteers recruited through Amazon Mechanical Turk was conducted. A survey instrument was administered to all study participants to assess the importance of ab symmetry, pec muscle definition, serratus muscle definition, and natural feel. RESULTS: Study participants across all ages, gender, ethnicity, and marital status indicated that a 6-pack was the ideal abdominal muscle count. They also rated the symmetry (61.06 ± 1.87) and natural feel of abs (60.72 ± 1.75) as the 2 most important aesthetic features in consideration of ideal abs. Study participants who reported exercising more than twice a week expressed a greater interest in nonsurgical procedures to achieve ideal abs (P = 0.007). CONCLUSIONS: "Ideal abs" are 6 in number, symmetric, and feel natural. Millennials are much more willing to consider nonsurgical options to achieve ideal abs instead of surgery. Individuals who maintain a high level of fitness are, interestingly, more likely to want ideal abs and nonsurgical methods to achieve them.

Why Should Young Aesthetic Plastic Surgeons Care About Aesthetic Medicine?

Young aesthetic surgeons may wonder, "Why care about aesthetic medicine?" The answer is based on the "five principles" of aesthetic medicine: patient acquisition, patient retention, patient optimization, patient education, and patient conversion. The explosion in new nonsurgical technologies and treatments combined with patients' demands behoove young plastic surgeons to look at incorporating aesthetic medicine into their practice to help them grow and deliver the best results possible. Beyond injectables, nonsurgical treatments like fat reduction and skin care can help growing surgical practices acquire new patients by offering diverse services at a range of price points.

Leaderless mRNAs are circularized in Chlamydomonas reinhardtii mitochondria.

The mitochondrial genome of Chlamydomonas reinhardtii encodes eight protein coding genes transcribed on two polycistronic primary transcripts. The mRNAs are endonucleolytically cleaved from these transcripts directly upstream of their AUG start codons, creating leaderless mRNAs with 3' untranslated regions (UTR) comprised of most or all of their downstream intergenic regions. In this report, we provide evidence that these processed linear mRNAs are circularized, which places the 3' UTR upstream of the 5' start codon, creating a leader sequence ex post facto. The circular mRNAs were found to be ribosome associate by polysome profiling experiments suggesting they are translated. Sequencing of the 3'-5' junctions of the circularized mRNAs found the intra-molecular ligations occurred between fully processed 5' ends (the start AUG) and a variable 3' terminus. For five genes (cob, cox, nd2, nd4, and nd6), some of the 3' ends maintained an oligonucleotide addition during ligation, and for two of them, cob and nd6, these 3' termini were the most commonly recovered sequence. Previous reports have shown that after cleavage, three untemplated oligonucleotide additions may occur on the 3' termini of these mRNAs-adenylation, uridylylation, or cytidylation. These results suggest oligo(U) and oligo(C) additions may be part of the maturation process since they are maintained in the circular mRNAs. Circular RNAs occur in organisms across the biological spectrum, but their purpose in some systems, such as organelles (mitochondria and chloroplasts) is unclear. We hypothesize, that in C. reinhardtii mitochondria it may create a leader sequence to facilitate translation initiation, which may negate the need for an alternative translation initiation mechanism in this system, as previously speculated. In addition, circularization may play a protective role against exonucleases, and/or increase translational productivity.

Nonsurgical Vulvovaginal Rejuvenation With Radiofrequency and Laser Devices: A Literature Review and Comprehensive Update for Aesthetic Surgeons.

Nonsurgical vulvovaginal rejuvenation (NVR) is growing in popularity as a treatment for restoration of youthful female genitalia. Numerous radiofrequency (RF) and laser devices have entered the market claiming improvement in vaginal laxity and genitourinary syndrome of menopause. There is a paucity of evidence existing concerning the effectiveness of these devices for both pre- and postmenopausal women with laxity and/or atrophy at the histologic and clinical level. Therefore, the goal of this review is to scrutinize the peer-reviewed data on NVR with RF and laser devices, identify gaps in existing literature, and propose opportunities for further investigation.

Mastopexy and Mastopexy-Augmentation.

Mastopexy and mastopexy-augmentation are aesthetic breast surgeries that seek to create youthful, beautiful appearing breasts. Age, hormonal changes, or weight loss can lead to alterations that require addressing the skin envelope and breast parenchyma. Many surgical approaches have been described including periareolar, vertical, and Wise pattern techniques, but most modern mastopexies include manipulation of the breast parenchyma to improve the longevity of breast ptosis correction. Mesh support of the ptotic breast is an extension of this paradigm shift and seeks to restore the lost strength of the support structures of the breast. Despite initial controversy, single stage mastopexy-augmentation has been demonstrated to be a safe option for appropriately selected and informed patients who desire both correction of shape and volume. Revisions may still be necessary based on patient and surgeon goals for correction. Evolving technologies will likely continue to enhance the ability of aesthetic plastic surgeons to provide pleasing, durable correction of breast ptosis.

Vaginal Laxity, Sexual Distress, and Sexual Dysfunction: A Cross-Sectional Study in a Plastic Surgery Practice.

BACKGROUND: Sexual health issues can be characterized by vaginal laxity (VL), sexual distress, and sexual dysfunction. The epidemiology of these issues in plastic surgery patients, and especially breast cancer survivors, remains poorly understood. OBJECTIVES: To prospectively assess sexual health issues in a plastic surgery patient population with and without breast cancer. METHODS: A prospective cohort study was created in our practice from June to August 2017 with administration of a survey including the vaginal laxity questionnaire (VLQ), female sexual distress scale-revised (FSDS-R), and female sexual function index (FSFI). Multivariate logistic regression identified the controlled effect of patient variables on development of sexual health issues. RESULTS: Of 291 patients solicited, 239 completed the survey (37.7% breast cancer survivors vs 62.3% without). Prevalence of VL was nearly 1 in 6 women. Of these, 46.0% met criteria for sexual distress (FSDS-R ≥ 11.0) and 64.8% had sexual dysfunction (FSFI ≤ 26.5). Breast cancer survivors exhibited significantly greater overall sexual dysfunction (P < 0.001) and greater dysfunction within all FSFI domains of desire, arousal, lubrication, orgasm, satisfaction, and pain (all P < 0.02). On multivariate regression, number of vaginal deliveries predicted development of VL (OR 1.87, P < 0.001), presence of VL predicted sexual distress (OR 3.01, P = 0.007), while history of breast cancer predicted sexual dysfunction (OR 1.87, P < 0.05). CONCLUSIONS: Sexual health issues are prevalent amongst plastic surgery patients. Aesthetic practices can improve patients' quality of life by focusing on these areas. Potential therapeutic options to address sexual health issues should consider addressing vaginal laxity.

Salvage of Implant-Based Breast Reconstruction in Nipple-Sparing Mastectomies With Autologous Flaps.

BACKGROUND: Implant-based breast reconstruction (IBR) after nipple-sparing mastectomies (NSM) can have complications that require explantation of a tissue expander or permanent prosthesis. When complications occur, preservation of the nipple-areola complex (NAC) remains critical to ensure aesthetic breast reconstruction. To date, there are minimal data on outcomes for patients experiencing unplanned explantations in IBR after NSM. OBJECTIVES: To evaluate final reconstructive outcomes for NSM patients who undergo IBR and have an unplanned explanation and to separately analyze the outcome of the NAC aesthetic subunit. METHODS: We analyzed a prospectively maintained database of NSM patients undergoing IBR reconstruction at a single institution to identify patients who had complications resulting in unplanned explanation. Demographics, covariates, and reconstructive outcomes, including salvage with IBR or autologous flaps, were assessed. Final outcomes of the NAC were also evaluated. RESULTS: A total of 213 patients underwent 382 NSM with IBR with either direct-to-implant (DTI) or tissue expander/implant (TE/I) reconstructions. The complication rate was 15.2% (N = 58) and 33 (8.6%) unplanned explantations occurred: 23 (69.8%) of whom ultimately completed reconstruction with either IBR (30.4%) or autologous flaps (69.6%). NACs were preserved in 62.5% of breasts with unplanned explantations. Only 8 NACs were lost in the entire cohort (2.1%). CONCLUSIONS: Following unplanned explantations in IBR after NSM, salvage can be performed with either IBR or autologous flaps. However, the majority of salvage procedures in IBR after NSM will be with autologous flaps that bring in healthy soft tissue to restore location specific defects caused by complications. The NAC can ultimately be preserved as an aesthetic subunit in most patients despite the occurrence of initial complications.

Nonsurgical Facial Rejuvenation: Outcomes and Safety of Neuromodulator and Soft-Tissue Filler Procedures Performed in a Resident Cosmetic Clinic.

BACKGROUND: The ability to perform nonsurgical facial rejuvenation procedures is a core competency requirement for plastic surgery residents. However, limited data exist on training models to achieve competency in nonsurgical facial rejuvenation and on outcomes of these procedures performed by residents. The purpose here is to evaluate patient-reported outcomes and safety of nonsurgical facial rejuvenation procedures performed by plastic surgery residents. METHODS: We prospectively enrolled 50 patients undergoing neuromodulator and/or soft-tissue filler injections in a resident cosmetic clinic between April and August 2016. Patients completed FACE-Q modules pre-procedure, and at 1 week and 1 month post-procedure. Paired t-tests were used to calculate statistical significance of changes between pre- and post-procedure scores. Effect sizes were calculated to assess clinical improvement from pre- to post-procedure. The magnitude of change was interpreted using Cohen's arbitrary criteria (small 0.20, moderate 0.50, large 0.80). RESULTS: Forty-five patients completed the study. Patients experienced significant improvements (p < 0.001) in all FACE-Q domains, including aging appearance appraisal (improved from 49.7 ± 29.4 to 70.1 ± 21.6, effect size 0.79), psychological well-being (44.0 ± 14.6-78.6 ± 20.7, effect size 1.93), social functioning (48.6 ± 16.6-75.5 ± 21.7, effect size 1.20), and satisfaction with facial appearance (50.1 ± 13.7-66.2 ± 19.7, effect size 0.95). At 1 month, overall satisfaction with outcome and decision were 75.8 ± 20.7 and 81.1 ± 20.4, respectively. No patients experienced complications. CONCLUSIONS: Nonsurgical facial rejuvenation procedures performed by residents can improve patients' quality of life and provide high satisfaction without compromising safety. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Impact of Time Interval between Radiation and Free Autologous Breast Reconstruction.

Background To evaluate whether the timing of surgery after radiation in autologous breast reconstruction affects major complications. Methods We performed a retrospective review of 454 free flaps (331 patients) for breast reconstruction at a single institution from 2003 to 2014. Charts were reviewed for age, BMI, laterality, flap type (TRAM, msTRAM, DIEP), surgeon, donor vessels (IMA, TD), chemotherapy, smoking, diabetes, hypertension, DVT, venous anastomoses, vein size, and time from radiation (none, < 12 months, or ≥ 12 months). The primary outcome of major complications was defined as partial/total flap loss, thrombosis, ischemia, or hematoma requiring return to the operating room. To identify independent predictors of major complications, a multivariate logistic regression was constructed. Alpha = 0.05 indicated significance in all tests. Results Average age was 47.4 ± 8.4. Free flaps consisted of msTRAM (41.1%), TRAM (29.6%), or DIEP (29.3%). The donor vessel was IMA in 66.9% of flaps or TD in 33.0% of patients with 90.7% using only one vein and 9.3% with two veins. The average IMA/TDV size was 2.5 cm ± 0.5. Preoperative radiation occurred in 31.2% of flaps. There were 54 flaps with at least one major complication (11.7%). On multivariate regression, only flap type (OR =4.04, p < .01) and vein size (OR = 0.13, p = 0.02) independently predicted major complications. Conclusion There was no significant difference in major complications between flaps who had reconstruction within 12 months and greater than 12 months after radiation. Only having a more muscle sparing technique or smaller vein size were independent risk factors for major complications.

Patient-Reported Outcomes of Aesthetics and Satisfaction in Immediate Breast Reconstruction After Nipple-Sparing Mastectomy With Implants and Fat Grafting.

Background: Direct-to-implant (DTI) and tissue expander/implant (TE/I) reconstructions are the most common implant-based reconstructions after nipple-sparing mastectomy (NSM). However, there are little data beyond complication rates comparing these options. Fat grafting has emerged as an adjunct in NSM reconstructions to improve aesthetic results; however, its impact on patient perceptions of aesthetic outcomes remain unknown. To improve patient-centered care, aesthetic outcomes must be considered from the patients' perspective. Objectives: To evaluate patient-reported outcomes of aesthetic satisfaction and quality of life in patients undergoing immediate DTI vs TE/I reconstruction after NSM and to assess the role of fat grafting on these outcomes. Methods: This is a prospective cohort study comparing NSM patients undergoing DTI or TE/I reconstruction. Patient-reported outcomes were evaluated using the BREAST-Q. Continuous and categorical variables were analyzed using t test and Fisher's exact test, respectively. Results: Fifty-nine patients underwent 113 reconstructions with either DTI (n = 41) or TE/I (n = 18). Mean follow up was 12.1 months. DTI and TE/I patients had comparable satisfaction with outcome, though TE/I patients had significantly larger final implant sizes. TE/I who underwent fat grafting also had significantly higher satisfaction with outcome and psychosocial wellbeing. Conclusions: Patient-reported outcomes are comparable between DTI and TE/I reconstructions after NSM. In order for TE/I patients to achieve a similar level of satisfaction, they may require a larger final implant and additional operations compared to DTI patients. Additionally, fat grafting improves overall satisfaction. TE/I patients may have different aesthetic expectations than DTI patients, emphasizing patient-centered discussions are essential to optimizing outcomes after NSM. Level of Evidence: 3.

Resident Cosmetic Clinic: Practice Patterns, Safety, and Outcomes at an Academic Plastic Surgery Institution.

BACKGROUND: Comprehensive aesthetic surgery education is an integral part of plastic surgery residency training. Recently, the ACGME increased minimum requirements for aesthetic procedures in residency. To expand aesthetic education and prepare residents for independent practice, our institution has supported a resident cosmetic clinic for over 25 years. OBJECTIVES: To evaluate the safety of procedures performed through a resident clinic by comparing outcomes to benchmarked national aesthetic surgery outcomes and to provide a model for resident clinics in academic plastic surgery institutions. METHODS: We identified a consecutive cohort of patients who underwent procedures through our resident cosmetic clinic between 2010 and 2015. Major complications, as defined by CosmetAssure database, were recorded and compared to published aesthetic surgery complication rates from the CosmetAssure database for outcomes benchmarking. Fisher's exact test was used to compare sample proportions. RESULTS: Two hundred and seventy-one new patients were evaluated and 112 patients (41.3%) booked surgery for 175 different aesthetic procedures. There were 55 breast, 19 head and neck, and 101 trunk or extremity aesthetic procedures performed. The median number of preoperative and postoperative visits was 2 and 4 respectively with a mean follow-up time of 35 weeks. There were 3 major complications (2 hematomas and 1 infection requiring IV antibiotics) with an overall complication rate of 1.7% compared to 2.0% for patients in the CosmetAssure database (P = .45). CONCLUSIONS: Surgical outcomes for procedures performed through a resident cosmetic clinic are comparable to national outcomes for aesthetic surgery procedures, suggesting this experience can enhance comprehensive aesthetic surgery education without compromising patient safety or quality of care. LEVEL OF EVIDENCE: 4 Risk.

Exploring the Clinical Features, Management of Hypertension, and Predictors of Severity in Hospitalized Hypertensive COVID-19 Patients.

Background Hypertension significantly contributes to the severity, prolonged hospitalization, the need for intensive care, and mortality of COVID-19 patients. However, the data is still evolving. This study investigated the predictors of severity among hypertensive COVID-19 patients. Methodology This cohort study included 333 hospitalized hypertensive COVID-19 patients at the Indus Hospital, Karachi, Pakistan, from April 2021 to October 2021. The study evaluated the clinical features, antihypertensive therapy, and predictors of severity. A multivariable binary logistic regression model was used to determine severity predictors using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, NY, USA). Results The majority of hypertensive COVID-19 patients were females (54.7%), aged <65 years (55.8%), and coexisted with diabetes mellitus (56.5%). The independent predictors of severity were male (aOR 2.65, 95% CI, 1.08-6.51; p < 0.033), fever (aOR 3.52, 95% CI, 1.24-9.92; p = 0.017), shortness of breath (aOR 4.49, 95% CI, 1.73-11.63; p = 0.002), oxygen saturation (<90%) (aOR 87.39, 95% CI, 19.15-398.75; p < 0.001), and D-dimer (>0.5 mcg/ml) (aOR 3.03, 95% CI, 1.19-7.71; p = 0.020). Conclusions Our study concluded that males with fever before admission, shortness of breath, lower oxygen saturation, and elevated D-dimer are the predictors of severity among hypertensive COVID-19 patients.

Predictors of mortality among hospitalized hypertensive patients with COVID-19 during third and fourth waves in Pakistan.

INTRODUCTION: Hypertension significantly contributes to the severity and mortality of COVID-19 patients. It has also been a risk factor for prolonged hospitalization and the need for intensive care. However, the data is still evolving. Therefore, this study investigated the predictors of mortality among hypertensive COVID-19 patients. METHODOLOGY: A single-center cohort study was performed at Indus Hospital and Health Network, Karachi, Pakistan, between April 1, 2021, and October 31, 2021. This study included 333 hospitalized hypertensive COVID-19 patients and evaluated their clinical characteristics and survival outcomes. A multivariate logistic regression model was applied in IBM SPSS 27.0 to determine the predictors of mortality. RESULTS: The majority of patients were females (54.7%), the median age was 62 [55-70] years, with co-existing diabetes (56.5%) and severely ill (52.6%). The independent predictors of mortality identified were age ≥ 65 years (aOR 20.89, 95% CI, 5.81-75.15; p < 0.001), pulse rate (aOR 1.03, 95% CI 1.01-1.63; p = 0.006), serum creatinine (aOR 1.34, 95% CI 1.11-1.63; p = 0.002), use of antibiotics (aOR 3.40, 95% CI 1.29-8.98; p = 0.014)), corticosteroid (aOR 49.68, 95% CI 1.83-1350.31; p = 0.020), and who needed high flow oxygen supply (aOR 13.08, 95% CI 1.70-100.54; p < 0.001), non-invasive mechanical ventilation (aOR 229.01, 95% CI 29.30-1789.71; p < 0.001) and invasive mechanical ventilation (aOR 379.54, 95% CI 36.60-3935.87; p < 0.001). CONCLUSIONS: Our study suggests that older age, elevated pulse rate, serum creatinine, use of antibiotics and corticosteroids, and the need for mechanical ventilation predict mortality among hypertensive COVID-19.

Intramuscular perforator dissection with the hydrodissection technique.

BACKGROUND: Perforator flap breast reconstruction requires increased time for safe perforator dissection, especially the intramuscular course. We describe an adjunctive technique using hydrodissection to assist with the intramuscular perforator dissection. METHODS: Hydrodissection techniques were used for perforator dissection in 45 consecutive patients (64 flaps) undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. These patients were compared with 39 patients (55 flaps) immediately prior to the use of this technique. The study time frame was between March 2008 and March 2010. Patient demographics, complications, and operative times were collected through an extensive chart review. RESULTS: There were no major differences in complications between groups; there were no flap losses encountered during this series, and fat necrosis rates were similar (9.4% with hydrodissection and 14.5% without, p = 0.41). Total operative time for bilateral reconstructions decreased by 59 minutes (p = 0.13) and 21 minutes (p = 0.57) for unilateral reconstructions with the utilization of hydrodissection, though this was not statistically significant. CONCLUSIONS: The use of hydrodissection to assist with intramuscular perforator vessel dissection is safe to perform, as there was no increase in complications. The procedures utilizing hydrodissection were faster, and surgeons using this technique found it easier to visualize the perforators and dissect through the intramuscular course.

Performance evaluation of machine learning models on large dataset of android applications reviews.

With an ever-increasing number of mobile users, the development of mobile applications (apps) has become a potential market during the past decade. Billions of users download mobile apps for divergent use from Google Play Store, fulfill tasks and leave comments about their experience. Such reviews are replete with a variety of feedback that serves as a guide for the improvement of existing apps and intuition for novel mobile apps. However, application reviews are challenging and very broad to approach. Such reviews, when segregated into different classes guide the user in the selection of suitable apps. This study proposes a framework for analyzing the sentiment of reviews for apps of eight different categories like shopping, sports, casual, etc. A large dataset is scrapped comprising 251661 user reviews with the help of 'Regular Expression' and 'Beautiful Soup'. The framework follows the use of different machine learning models along with the term frequency-inverse document frequency (TF-IDF) for feature extraction. Extensive experiments are performed using preprocessing steps, as well as, the stats feature of app reviews to evaluate the performance of the models. Results indicate that combining the stats feature with TF-IDF shows better performance and the support vector machine obtains the highest accuracy. Experimental results can potentially be used by other researchers to select appropriate models for the analysis of app reviews. In addition, the provided dataset is large, diverse, and balanced with eight categories and 59 app reviews and provides the opportunity to analyze reviews using state-of-the-art approaches.