Late Hematoma After Feminizing Augmentation Mammoplasty Mimicking Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).

We report the case of an Asian transgender patient with late hematoma after feminizing mammoplasty. Bilateral silicone breast implants were inserted into the patient 25 years previously. The right breast gradually became swollen without any specific cause, along with erythema and pain. Positron emission tomography showed right axillary lymphadenopathy. The mass and the axillary lymph node were surgically removed. Pathologic examination of the excised specimen revealed only hematoma formation and inflammatory granulation. At follow-up at 6 months postoperatively there was no reformation of hematoma. The presented symptoms are similar to those of breast implant-associated anaplastic large cell lymphoma, so there can be difficulty in differentiating between these 2 complications. We compared the clinical characteristics between our case of late hematoma and reported breast implant-associated anaplastic large cell lymphoma after feminizing mammoplasty. Life-threatening breast implant-associated anaplastic large cell lymphoma should be ruled out from late hematoma according to the National Comprehensive Cancer Network screening guidelines.

Practicality and Hemodynamic Advantage of Microvascularly Augmented Pectoralis Major Musculocutaneous Flap: Technical Approach and Evidence Based on Indocyanine Green Angiography.

ABSTRACT: We have recently shown that including the blood flow from the lateral thoracic artery (LTA) in addition to the thoracoacromial artery in the pectoralis major muscle musculocutaneous (PMMC) flap (bipedicle PMMC flap) can increase the perfusion of the flap. We also developed the concept of the supercharged PMMC flap, in which the LTA included in the flap was once cut and anastomosed to a cervical artery under a microscope. It is an effective solution to maintain the additional blood flow from the LTA, when the length of the LTA is compromised for reconstruction. The mandibular reconstruction of an oral cancer patient was performed with a supercharged PMMC flap. Intraoperative indocyanine green angiography was performed in a single pedicle, bipedicle, and supercharged conditions, and the videos were analyzed with a quantitative assessment system of perfusion using some parameters. As a result, blood supply from the LTA was essential for flap survival in this patient, and supercharging from the cervical artery improved flap perfusion compared with the perfusion in the bipedicle condition. The supercharged PMMC flap can resolve the compromise of pedicle length and be also hemodynamically advantageous, thus making the reconstruction more reliable than the conventional technique.

Induction for Self-Propelled Motion of Artificial Objects with/without Shape Anisotropy.

Motion is an essential feature of living systems. Microorganisms autonomously change their nature in response to slight changes in the surrounding environment induced by external stimuli and exhibit unique motion modes. Various self-propelled objects have been constructed to understand these behaviors. Towards achievement of such purpose, the precise settings of experimental conditions including fabrication of objects with a shape anisotropy have been made attempts in the field of active matter and supramolecular chemistry. This review describes the recent progress in inducing the self-propelled motion of artificial objects. If life-like dynamic behavior such as self-propelled motion can be designed and experimentally induced from molecular properties, it will be easier to control functions expressed as outputs. This will lead to not only a better understanding of the complex functions in living systems, but also the fabrication of exotic materials with life-like properties.

Identification of 1-(thiophene-2-carbonyl)-LSD from blotter paper falsely labeled "1D-LSD".

PURPOSE: Since the mid-2010s, lysergic acid diethylamide (LSD) analogs made for substance abuse have periodically emerged. In this case, three pieces of blotter paper labeled "1D-LSD" and presumably impregnated with this LSD analog, were seized. Several websites indicate that 1D-LSD is 1-(1,2-dimethylcyclobutane-1-carbonyl)-LSD. Because this analog is much more difficult to synthesize than previously reported LSD analogs, we doubted that the blotter paper contained 1D-LSD. Herein, we determined the structure of the absorbed compound. METHODS: One of the seized specimens was extracted and analyzed using gas chromatography/mass spectrometry (GC/MS), liquid chromatography/mass spectrometry (LC/MS), high-resolution mass spectrometry (HRMS), and nuclear magnetic resonance (NMR) spectroscopy to estimate the extract components. The estimated compound was then synthesized, yielding an authentic standard. The contents of the seized specimens were identified using authentic standard analysis with GC/MS, LC/MS, and NMR spectroscopy. RESULTS: Instrumental analyses confirmed the active compound to be 1-(thiophene-2-carbonyl)-LSD, which was inconsistent with the labeling on drug-infused blotter paper. CONCLUSION: As in this case, similar blotter paper analyses should consider the possibility of a mismatch between the label and ingredient. To the authors' knowledge, this is the first case report in which 1-(thiophene-2-carbonyl)-LSD was seized and the first seizure of an LSD analog in which an aromatic carboxylic acid had been condensed to LSD. This type of lysergamide may become prevalent in the near future, and we should remain alert for newly appearing lysergamides.

Surgical results of retroauricular fascia graft in frontalis suspension surgery: A case series study.

Frontalis suspension surgery is commonly used for the repair of congenital ptosis and involutional blepharoptosis with poor levator function. Grafts for this procedure have been developed using a variety of different materials, each with advantages and disadvantages. The retroauricular fascia graft might be beneficial in this surgery. This article reports the surgical results of blepharoptosis, who were treated with the retroauricular fascia, which is a new autologous graft for the frontalis suspension technique. This case series study targeted patients with ptosis who underwent frontalis suspension surgery with the retroauricular fascia graft at Wakayama Medical University in Japan between May 2016 and May 2023. Patients with insufficient follow-up (<6 months) were excluded from the study. Eligible patients were categorized into one of the following three assessment groups: "good" (improvement of palpebral fissure height without laterality, Margin reflex distance-1 gap between right and left side <0.5 mm), "fair" (improvement of palpebral fissure height with laterality), or "poor" (poor improvement of palpebral fissure height). Thirty-five eyes in 25 patients were treated with the retroauricular fascia graft. The mean postoperative follow-up was 27 months. Eight patients were classified as good (32%), 15 as fair (60%), and two as poor (8%). Two patients (8%) had postoperative lagophthalmos. No patients had eyelash inversion, tarsal deformity, or recurrence of ptosis. Scars along the edge of the hairline were inconspicuous and there were no hypertrophic scars. Functional reconstruction of the eyelids using the retroauricular fascia graft technique is described here for the first time. This grafting technique may be a useful alternative for frontalis suspension surgery because it can be harvested with easy access and without leaving conspicuous scars.

Safety and Pitfalls of Blepharoptosis Surgery in Elderly People.

Background Elderly patients often have complications of blepharoptosis surgery that can result in the appearance or exacerbation of superficial punctate keratopathy (SPK). However, postoperative changes to SPK status have not been previously reported. We used subjective assessment of symptoms and measurement of SPK scale classification to investigate the safety and efficacy of blepharoptosis surgery in elderly patients. Methods Included in this prospective study were 22 patients (44 eyes) with bilateral blepharoptosis that underwent surgery. Patients comprised 8 males and 14 females with a mean (±standard deviation) age of 75.7 ± 8.2 years (range: 61-89). Blepharoptosis surgery consisted of transcutaneous levator advancement and blepharoplasty including resection of soft tissue (skin, subcutaneous tissue, and the orbicularis oculi muscle). Margin reflex distance-1 (MRD-1) measurement, a questionnaire survey of symptoms and SPK scale classification, was administered preoperatively and 3 months postoperatively for evaluation. Results The median MRD-1 was 1 mm preoperatively and 2.5 mm postoperatively, representing a significant postoperative improvement. SPK area and density scores were found to increase when the MRD-1 increase was more than 2.5 mm with surgery. All 10 items on the questionnaire tended have increased scores after surgery, and significant differences were observed in 7 items (poor visibility, ocular fatigue, heavy eyelid, foreign body sensation, difficulty in focusing, headaches, and stiff shoulders). Conclusion Blepharoptosis surgery was found to be a safe and effective way to maintain the increase in MRD-1 within 2.0 mm. Despite the benefits, surgeons must nonetheless be aware that blepharoptosis surgery is a delicate procedure in elderly people.

Glycoprotein M6A upregulation detected by transcriptome analysis controls the proliferation of keloidal fibroblasts.

Hypertrophic scars and keloids are fibroproliferative disorders caused by abnormal wound healing. Their exact cause has not been found, but abnormalities during the wound healing process including inflammatory, immune, genetic, and other factors are thought to predispose an individual to excessive scarring. In the present study, we performed transcriptome analysis of established keloid cell lines (KEL FIB), focusing on gene expression analysis and fusion gene detection for the first time. For gene expression analysis, fragments per kilobase per million map read values were calculated, which were validated by real-time PCR and immunohistochemistry. Fusion genes were predicted by transcriptome sequence, and validated by Sanger sequence and G-banding. As a result, GPM6A was shown in the expression analysis to be upregulated in KEL FIB compared with normal fibroblasts. The GPM6A upregulation in KEL FIB was confirmed by real-time PCR, and GPM6A messenger ribonucleic acid expression was consistently significantly elevated in the tissues of hypertrophic scar and keloid compared to normal skin. Immunohistochemistry also revealed that the number of fibroblast-like spindle-shaped cells positive for GPM6A was significantly increased in keloidal tissues. GPM6A inhibition by small interfering ribonucleic acid significantly reduced the number of KEL FIB. On the other hand, although we hypothesized that fusion genes are involved in the pathogenesis of keloids, the transcriptome analysis could not prove the presence of fusion genes in KEL FIB. Taken together, GPM6A upregulation may have an inducible effect on cell proliferation in keloidal fibroblasts. GPM6A can be a novel therapeutic target in hypertrophic scars and keloids. The inflammatory nature may be more prominent in the pathogenesis of keloids, rather than being skin tumors, as proposed by Ogawa et al. Future studies using several cell lines will be required.

The 'Invisible Lazy-T' Procedure for Correction of Medial Ectropion.

No accepted standard for the correction of medial ectropion has been established. The most critical part of the surgical treatment for medial ectropion is the tightening of both horizontal and vertical laxity. To correct this ectropion, we have applied a combination procedure which includes tightening of the conjunctiva and the eyelid retractors (posterior lamellae) and the lateral tarsal strip procedure. Our imitation of the 'Lazy-T', a surgical operation performed on the medial ectropion, is tentatively named 'Invisible Lazy-T'. It is a versatile technique with a less visible scar than alternative techniques because skin incision is made along the crease line of the 'the crow's feet'. Results suggest a satisfactory solution to this problem and with better outcomes than by other techniques. We propose this novel combination technique is the best strategy for the medial ectropion, and it does not require specialized surgical skill, so ectropion can be managed by craniofacial surgeons.

Reliable and safe salivary duct repositioning technique with partial transection and intraductal stenting: Technical notes.

Salivary duct repositioning is often performed after excision of malignant tumors or removal of sialoliths to maintain salivary function and minimize the risk of swelling or pain due to the obstruction of the gland. However, there is risk of intraoperative tissue damage due to traumatic manipulation, leading to stenosis; in addition, the small diameter of the duct also renders this procedure difficult. Recently, we improved our method of salivary duct repositioning as follows. In the first technique, partial transection is made on the lateral wall of the duct ligated with thread at the end. Pulling the thread provides a view of the lumen, and appropriate tension enables a reliable and non-invasive procedure without requiring the operator to grasp the edge of the duct directly. When the diameter of the duct is small, intraductal stenting, the second technique, can be combined with the former technique by probe insertion to expand the lumen. Our approach is technically easy and simple which can be accepted by any clinicians and it could also be a promising technique that can serve as a less invasive and effective treatment.

Impaired healing of cutaneous wound in a Trpv1 deficient mouse.

Transient Receptor Potential (TRP) ion channels mediate the influx of cations into cells responding to chemical or physical stimuli. TRP vanilloid 1 (TRPV1) regulates cutaneous functions. Its function in cutaneous wound healing, however, has not been clarified. The current study elucidated the role of TRPV1 in cutaneous wound healing of dorsal circular excisional injury using Trpv1-null (KO) and wild type (WT) male/female C57BL/6 mice. Macroscopic observation showed that the remaining cutaneous lesion was significantly larger in KO than that of WT at postoperative days (POD) 7 and 10. Histological analysis showed significantly delayed re-epithelialization in KO at POD7. The number of macrophages in KO and WT similarly returned to the reduced state from POD4 to POD7. Whereas, the number of neutrophils in KO did not significantly return to the reduced state, in contrast to WT. Of note, The H3Cit-labeled NETs (Neutrophil Extracellular Traps) formation of KO was prominently increased both in POD4 and 7. The current results suggest that the loss of TRPV1 induces prolonged neutrophilic inflammation and NETs formation, retarding murine cutaneous wound healing in vivo. This study provides a possible link with TRPV1 and neutrophilic regulation in cutaneous wound healing.

Modeling the effect of rainfall changes to predict population dynamics of the Asian tiger mosquito Aedes albopictus under future climate conditions.

The population dynamics of mosquitoes in temperate regions are not as well understood as those in tropical and subtropical regions, despite concerns that vector-borne diseases may be prevalent in future climates. Aedes albopictus, a vector mosquito in temperate regions, undergoes egg diapause while overwintering. To assess the prevalence of mosquito-borne diseases in the future, this study aimed to simulate and predict mosquito population dynamics under estimated future climatic conditions. In this study, we tailored the physiology-based climate-driven mosquito population (PCMP) model for temperate mosquitoes to incorporate egg diapauses for overwintering. We also investigated how the incorporation of the effect of rainfall on larval carrying capacity (into a model) changes the population dynamics of this species under future climate conditions. The PCMP model was constructed to simulate mosquito population dynamics, and the parameters of egg diapause and rainfall effects were estimated for each model to fit the observed data in Tokyo. We applied the global climate model data to the PCMP model and observed an increase in the mosquito population under future climate conditions. By applying the PCMP models (with or without the rainfall effect on the carrying capacity of the A. albopictus), our projections indicated that mosquito population dynamics in the future could experience changes in the patterns of their active season and population abundance. According to our results, the peak population number simulated using the highest CO2 emission scenario, while incorporating the rainfall effect on the carrying capacity, was approximately 1.35 times larger than that predicted using the model that did not consider the rainfall effect. This implies that the inclusion of rainfall effects on mosquito population dynamics has a major impact on the risk assessments of mosquito-borne diseases in the future.

Lateral Thoracic Artery Can Stabilize Circulation in the Pectoralis Major Myocutaneous Pedicle Flap: Single-center, Prospective, Uncontrolled Case Series.

BACKGROUND: Head and neck reconstructions using the pectoralis major myocutaneous pedicle flap (PMMF) with thoracoacromial artery alone are prone to hemodynamic instability, possibly leading to infection, prolapse, hematoma, seroma, and partial or total flap failure (6%-71%). Aside from unstable blood circulation, reported risk factors for these complications include feminine gender, smoking, and having diabetes mellitus. Preservation of the lateral thoracic artery in addition to the thoracoacromial artery has been suggested as a way to improve unstable blood circulation in the PMMF. METHODS: This is a single-center, prospective, uncontrolled case series. Circulation to the PMMF was studied intraoperatively with and without lateral thoracic artery clamping after harvest. Indocyanine green (ICG) angiopathy, a quantitative hemodynamic assessment method, was used to analyze three parameters: maximum intensity (Imax), time from start of ICG to maximum intensity (Tmax), and slope of intensity (Smax = Imax/Tmax). Hemodynamic parameters, such as pulse rate and blood pressure, were all within normal ranges. Allergy to contrast media was criterion for exclusion. RESULTS: Six patients all had oral cancer as their primary disease. Their background was characterized by established risk factors: four patients had a history of smoking, two had diabetes mellitus, and two were women. Postoperatively, no patients had complications at the recipient or donor sites. Mean results of the analysis were Imax: 60 ± 47, Tmax: 91 ± 55, Smax: 0.8 ± 0.5 in the clamped group and Imax: 85 ± 40, Tmax: 73 ± 42, Smax: 1.8 ± 1.5 in the un-clamped group. Significant difference was observed in Imax (P = 0.03) and Smax (P = 0.03). CONCLUSION: Lateral thoracic artery preservation appears to be useful for stabilizing blood circulation to the PMMF, including in patients considered to be at high-risk for complications, such as women, smokers, and patients with diabetes mellitus.

Anatomic Approximation Approach to Bilateral Macrostomia Repair.

ABSTRACT: In principle, reconstruction in macrostomia requires symmetry and accurate positioning of the newly reconstructed commissure. The proper position of the new commissure can be determined by several methods. In the determination of the new commissure of bilateral cases, generally the average length of the lips or the distance from anatomical landmarks other than the lips, such as the pupils or tragi, has been used. A new approach was reported by Tse et al in 2018: the anatomic approximation approach. Macrostomia repair refers to anatomical landmarks in the lips to determine the new commissure. The authors performed surgery using this anatomic approximation approach for bilateral macrostomia and achieved the good results.

Bilateral Eyebrow Sclerosis: A New Clinical Entity.

We report a man with sparse eyebrows and recurrent bilateral subcutaneous nodules beneath the eyebrows. Their histopathologic features were sclerosis of a subcutaneous lesion. The proliferation of muscle was not obvious and inflammatory cell infiltration was inconspicuous, but some dilated capillaries were noted. Collagen was regularly interlaced, thickened, and hyalinized with dispersed fibroblasts. Various skin tumors can occur on adult faces, but this presentation, to our knowledge, was unique and could not be characterized as a known condition. Plastic surgeons, dermatologists, and pathologists may encounter similar conditions, so it should be considered as a new clinical entity called bilateral eyebrow sclerosis. This may be of comfort to patients with similar conditions. Moreover, we propose enlarged resection to include the skin surface and underlying muscles as an effective treatment for recovery of the eyebrows and prevention of recurrence.

Fabrication of Carbon Nanotube Thin Films for Flexible Transistors by Using a Cross-Linked Amine Polymer.

Owing to their remarkable properties, single-walled carbon nanotube thin-film transistors (SWCNT-TFTs) are expected to be used in various flexible electronics applications. To fabricate SWCNT channel layers for TFTs, solution-based film formation on a self-assembled monolayer (SAM) covered with amino groups is commonly used. However, this method uses highly oxidized surfaces, which is not suitable for flexible polymeric substrates. In this work, a solution-based SWCNT film fabrication using methoxycarbonyl polyallylamine (Moc-PAA) is reported. The NH2 -terminated surface of the cross-linked Moc-PAA layer enables the formation of highly dense and uniform SWCNT networks on both rigid and flexible substrates. TFTs that use the fabricated SWCNT thin film exhibited excellent performance with small variations. The presented simple method to access SWCNT thin film accelerates the realization of flexible nanoelectronics.

Swinging Eyelid Approach to Zygomaticomaxillary Complex Fracture.

A surgical approach to zygomaticomaxillary complex (ZMC) fracture has not been standardized. The authors reviewed 15 cases of ZMC fractures treated with the swinging eyelid approach and evaluated the effectiveness of the technique by an observational study of Japanese patients. Results were assessed from authentic and functional perspectives: the presence of entropion/ectropion, external canthal malposition and chemosis of the conjunctiva. After a minimum follow-up of 10 months, no patients had lower eyelid ectropion, entropion or retraction. Wounds appeared inconspicuous, and a lateral canthal shape was preserved. No post-operative chemosis of the conjunctiva was observed. Each case was evaluated based on patient satisfaction about their aesthetic outcomes. Patient self-assessment is classified into 4 groups (excellent, good, fair, and unsatisfactory). Thirteen patients were assessed to have an "excellent" outcome, and 2 patients were assessed to have a "good" outcome. No patients had "fair" or "unsatisfactory" outcomes. Avoidance of scarring is a goal of every craniofacial surgeon. The swinging eyelid approach to ZMC fractures offers a simple alternative to the conventional technique. It is versatile and provides sufficient exposure to surgical fields with less visible scar because skin incision is made along the natural crease line, "the crow's feet."

Photocatalytic Reduction of Low Concentration of CO2.

A novel molecular photocatalytic system with not only high reduction ability of CO2 but also high capture ability of CO2 has been developed using a Ru(II)-Re(I) dinuclear complex as a photocatalyst. By using this photocatalytic system, CO2 of 10% concentration could be selectively converted to CO with almost same photocatalysis to that under a pure CO2 atmosphere (TONCO > 1000, ΦCO > 0.4). Even 0.5% concentration of CO2 was reduced with 60% initial efficiency of CO formation by using the same system compared to that using pure CO2 (TONCO > 200). The Re(I) catalyst unit in the photocatalyst can efficiently capture CO2, which proceeds CO2 insertion to the Re-O bond, and then reduce the captured CO2 by using an electron supplied from the photochemically reduced Ru photosensitizer unit.