The Challenges of Upper Extremity Intramuscular Hemangioma: A Case Study and Systematic Review.

BACKGROUND: Intramuscular hemangiomas are rare, benign vascular tumors, constituting 0.8 percent of all hemangiomas. Upper extremity intramuscular hemangiomas pose diagnostic and therapeutic challenges because of their rarity, invasive nature, and potential for neurovascular involvement. The authors report a comprehensive systematic review of upper extremity intramuscular hemangioma management and a challenging case report. METHODS: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases were used to identify articles describing upper extremity intramuscular hemangiomas through 2019. Patient demographics, clinical presentation, management, complications, and outcomes were reviewed. Based on operative timing, cases were categorized as either "primary" (excision performed at initial diagnosis) or "secondary" (excision performed after failure of conservative treatment). RESULTS: Eighteen articles encompassing 25 patients were included in the authors' systematic review. Of those, 18 underwent primary excision and seven underwent secondary excision. The majority involved the forearm or antecubital region. Complete excision, evaluated by gross examination or pathology, was reported in all primary cases and 71 percent of secondary cases. Primary excisions demonstrated smaller size of mass (19.4 cm 2 versus 165.3 cm 2 ) and superior reported functional outcomes (100 percent versus 33 percent). Complications were reported in 5 percent of the primary excisions compared to 71 percent of the secondary excisions, where one complication was a fatal hematoma. CONCLUSIONS: The literature concerning upper extremity intramuscular hemangioma is limited to mostly case reports and several case series with the potential risk of bias. With careful dissection and microsurgical technique, wide local excision followed by complete reconstruction can be successfully performed at initial diagnosis for upper extremity intramuscular hemangiomas. At early stages, smaller lesion size significantly reduces the risk of functional impairment and complications.

Indocyanine Green J Aggregates in Polymersomes for Near-Infrared Photoacoustic Imaging.

Clinical translation of photoacoustic imaging (PAI) has been limited by the lack of near-infrared (NIR) contrast agents with low toxicity required for regulatory approval. Herein, J aggregates of indocyanine green (ICG) with strong NIR absorbance were encapsulated at high loadings within small 77 nm polymersomes (nanocapsules) composed of poly(lactide-co-glycolide-b-poly(ethylene glycol)) (PLGA-b-PEG) bilayers, thus enabling PAI of of breast and ovarian cancer cells with high specificity and a sensitivity at the level of ∼100 total cells. All of the major components of the polymersomes are FDA approved and used in the clinic. During formation of polymersomes with a water-in-oil-in-water double emulsion process, loss of ICG from the ICG J aggregates was minimized by coating them with a layer of branched polyethylenimine and by providing excess "sacrificial" ICG to adsorb at the oil-water interfaces. The encapsulated J aggregates were protected against dissociation by the polymersome shell for 24 h in 100% fetal bovine serum, after which the polymersomes biodegraded and the J aggregates dissociated to ICG monomers.

Anxiety sensitivity as a predictor of acute subjective effects of smoking.

INTRODUCTION: Anxiety sensitivity (i.e., AS; the degree to which one believes that anxiety and its related sensations are harmful) is a stable trait that is associated with habitual smoking. Yet, the mechanisms linking AS and smoking are unclear. A promising hypothesis is that high-AS individuals are more sensitive to the acute subjective reinforcing effects of smoking and are, therefore, more prone to tobacco dependence. This study examined trait AS as a predictor of several subjective effects of cigarette smoking. METHODS: Adult non-treatment-seeking smokers (N = 87; 10+ cigarettes/day) completed a measure of AS during a baseline session. Prior to a subsequent experimental session, participants were asked to smoke normally before their appointment. At the outset of that visit, each participant smoked a single cigarette of their preferred brand in the laboratory. Self-report measures of affect and cigarette craving were completed before and after smoking, and post-cigarette subjective effect ratings were provided. RESULTS: AS predicted greater increases in positive affect from pre- to post-cigarette (ß = .30, p = .006) as well as greater smoking satisfaction and psychological reward (ß = .23 to .48, ps < .03). Each of these effects remained statistically significant after adjusting for anxiety symptom severity. AS did not predict the degree of negative affect and craving suppression or post-cigarette aversive effects. CONCLUSIONS: These findings suggest that positive reinforcement mechanisms may be particularly salient etiological processes that maintain smoking in high-AS individuals.