Rhinoplasty Outcomes in Patients with Symptoms of Body Dysmorphia.

BACKGROUND: Patients with symptoms of body dysmorphia often seek consultation for aesthetic rhinoplasty. While body dysmorphic disorder is a formal psychiatric diagnosis, recent evidence indicates that patients with symptoms of this condition who seek rhinoplasty may experience increased satisfaction with their appearance following surgery. OBJECTIVES: To determine the psychological impact of rhinoplasty in patients screened pre-/postoperatively with a body dysmorphia screening questionnaire. METHODS: Retrospective chart review of patients who underwent aesthetic and/or functional rhinoplasty by a single surgeon (S.P.M.) from 6/2021- 4/2023. Adult patients with a complete pre- and postoperative body dysmorphic disorder-aesthetic surgery questionnaire (BDDQ-AS), Standardized Cosmesis and Health Nasal Outcomes Survey-Obstruction and Cosmesis (SCHNOS), and Visual Analog Scale (VAS) were included. Patient characteristics and outcomes were analyzed stratifying by BDDQ-AS screen. RESULTS: One-hundred fifteen patients (88% female) met criteria for inclusion. There was an 83% resolution rate in BDDQ-AS positive screening following rhinoplasty. Positive BDDQ-AS screening status pre- and postoperatively correlated with worse aesthetic satisfaction (all p<0.002). No patient reported outcome measures were indicative of which patients with a BDDQ-AS positive screen preoperatively would experience 'resolution' postoperatively. CONCLUSIONS: Body dysmorphia screening resolution following surgical intervention correlated with improved patient aesthetic satisfaction, pointing to a potential positive psychological impact of undergoing rhinoplasty.

Outcomes of Diced Cartilage Dorsal Augmentation in Dorsal Aesthetic Deformities.

Objective: To investigate the effectiveness of diced cartilage graft for dorsal augmentation in rhinoplasty. Methods: In a retrospective study, patients who underwent rhinoplasty with dorsal augmentation using diced cartilage graft from June 2017 to December 2021 were identified. Patients with complete preoperative and at least one postoperative Standardized Cosmesis and Health Nasal Outcomes Survey-Cosmesis (SCHNOS-C) and visual analogue scale (VAS) scores were included in the study. Postoperative periods were classified into ≤6 and >6 months. Mean preoperative outcome scores were compared with postoperative scores utilizing a Paired t-test, and postoperative scores were compared utilizing a Wilcoxon rank-sum test. Results: A total of 71 patients with a median age of 36 years, range (18-74) fit inclusion criteria. Majority were female patients 49 (69%). The postoperative period ranged from 17 days to 3.5 years. The mean follow-up period (standard deviation) for ≤6 and >6 months was 2.8 (1.5) and 14.2 (6.3) months, respectively. A decrease in mean SCHNOS-C, SCHNOS item 8, and an increase in VAS scores (p < 0.0001) were seen at both postoperative time periods compared with preoperative levels. Conclusion: This study demonstrates that dorsal augmentation with diced cartilage graft is an effective technique in correcting dorsal aesthetic deformities.

Patient Outcomes in Lateral Crural Repositioning and Reconstruction in Revision Rhinoplasty.

Background: In revision rhinoplasty, lateral crural repositioning/reconstruction is considered a complex maneuver. The aim of this study is to measure patient outcomes after lateral crural repositioning/reconstruction in revision rhinoplasty. Methods: In this retrospective case series, patients who underwent revision rhinoplasty with lateral crural repositioning/reconstruction for functional, cosmetic, or combined purposes were reviewed. Preoperative Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scores, functional and cosmetic visual analog scales (VAS-functional [F] and VAS-cosmetic [C]), and lateral wall insufficiency (LWI) grades were compared with their respective postoperative scores. Results: Forty-two patients were identified who underwent lateral crural repositioning. The mean postoperative follow-up for ≤6 months (PO1) and >6 months (PO2) was 3.1 (standard deviation [SD] 1.7) and 11.5 (SD 5.3) months, respectively. At both postoperative periods, significant improvement (p < 0.05) in patient-reported outcomes was observed in mean SCHNOS-Obstruction, SCHNOS-Cosmesis, VAS-F, and VAS-C scores. The postoperative changes in LWI scores (Δ) were significant on both sides at zone 1 at PO1 (p < 0.05) and PO2 (p < 0.05), and at PO2 on the left side (p < 0.05) only, for zone 2. Conclusion: Lateral crural repositioning with reconstruction is an effective maneuver in revision rhinoplasty in a subset of patients and specifically helps to improve nasal tip aesthetics while preserving function.

Prevalence and Characteristics Associated with Positive Body Dysmorphic Disorder Screening Among Patients Presenting for Cosmetic Facial Plastic Surgery.

Background: Many patients with body dysmorphic disorder (BDD) seek out cosmetic surgery to alleviate their symptoms of distress related to a perceived defect in their appearance; however, the prevalence and risk factors for BDD among patients with cosmetic concerns have not been well characterized. Methods: We screened adult patients presenting to the clinic from June 2021 through September 2022 for BDD using the BDD Questionnaire-Aesthetic Surgery (BDDQ-AS) who were seen in consultation for rhinoplasty, aging face, and injectables. Results: Among 488 patients, the prevalence of screening positive for BDD was 41.0%. The prevalence of a positive BDD screen was highest among patients who were younger (p = 0.02), and those who had a positive self-reported psychiatric history (p = 0.02). Among rhinoplasty patients, those with aesthetic/cosmetic motivations, and those seeking revision rhinoplasty had higher rates of positive BDD screen. Higher scores on the Standardized Cosmesis and Health Nasal Outcomes Survey-Nasal Obstruction Score (SCHNOS-O) (p = 0.01) and Standardized Cosmesis and Health Nasal Outcomes Survey-Nasal Obstruction Score-Nasal Cosmesis Score (SCHNOS-C) (p < 0.0001) were predictive of a positive BDD screen, while question 5 of the SCHNOS was highly predictive of positive BDD screening (p < 0.0001). Conclusions: Our study characterizes relationships between positive BDD screening and age, gender, self-reported psychiatric history, and motivations for consultation, among patients seen for cosmetic surgery evaluation in a facial plastic and reconstructive surgery setting.

Combined Cancer Immunotheranostic Nanomedicines: Delivery Technologies and Therapeutic Outcomes.

Cancer is among the main causes of mortality all over the world. The delayed diagnosis is directly related to the decrease in survival rate. The use of immunotherapy has dramatically changed the treatment outcomes of different types of cancers. However, many patients still do not respond to immunotherapies, and many also suffer from severe immune-related side effects. Recent advances in the fields of nanomedicine bioengineering and in particular imaging offered new approaches which can enhance not only the safety but also the efficacy of immunotherapy. Theranostics has showed great progress as a branch of medicine which integrates both diagnosis and therapy in a single system. The outcomes from animal studies demonstrated an improvement in the diagnostic and immunotherapeutic potential of nanoparticles within the theranostic framework. Herein, we discuss the most recent developments in the application of nanotheranostics for combining tumor imaging and cancer immunotherapies.

Arabic translation, cultural adaptation, and validation of the BDDQ-AS for rhinoplasty patients.

BACKGROUND: Body Dysmorphic Disorder (BDD) is a significant aspect that compromises patient satisfaction after rhinoplasty. BDDQ-AS (Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery) is a validated, simple, reliable patient-reported outcome measure. It is a screening tool to detect body dysmorphic disorder in rhinoplasty patients. This study aimed to translate, culturally adapt, and validate BDDQ-AS to Arabic as a novel tool for screening and detecting BDD in Arabic rhinoplasty individuals. METHODS: BDDQ-AS was translated from English to Arabic following the international consensus guidelines. We tested the translation on ten Arabic-speaking rhinoplasty patients to ensure that the final version was understandable and acceptable. The proposed Arabic version was then completed by 112 patients whose average age was 28.79 ± 9.32 years. The screening is assumed positive if the patients expressed bother and preoccupation about their appearance (questions 1 and 2 "yes"), as well as a moderately disrupted everyday life (question 7 "yes" or questions 3, 4, 5, or 6 are equal to or greater than "3''). The internal consistency, test-retest reliability, and item-response theory (IRT) were used to evaluate psychometric validations. RESULTS: The Arabic BDDQ had a high level of internal consistency, as measured by Cronbach's alpha 0.995. The A-BDDQ-AS was deemed reliable with an Intraclass Correlation Coefficient (ICC) of 0.989. A-BDDQ had good discrimination scores (above 2.0) with adequate difficulty parameters. The overall scale content validity average was 0.83, affirming that all items were relevant, clear, and straightforward. CONCLUSION: The Arabic version of the BDDQ-AS is reliable, culturally adapted, and psychometrically validated to be readily used and incorporated into clinical practice. It is a beneficial tool that can guide the screening of Arabic rhinoplasty patients suffering from body dysmorphic disorder and be utilized in further studies to optimize patient outcomes.

Matched Cohort Comparison of Dorsal Preservation and Conventional Hump Resection Rhinoplasty.

BACKGROUND: Structural preservation techniques (SPR) minimize disruption of the dorsal aesthetic lines, with potential aesthetic and functional benefits over conventional hump resection techniques (CHR). The goal of this study is to compare patient reported outcomes between these techniques. METHODS: This study was a retrospective matched cohort analysis of patients undergoing rhinoplasty with dorsal hump reduction using patient-reported outcomes measures: Standardized Cosmesis and Health Nasal Outcomes Survey (obstructive: SCHNOS-O, cosmetic: SCHNOS-C) and visual analog scale (functional: VAS-F, cosmetic: VAS-C). A cohort of patients undergoing SPR were matched to a cohort undergoing CHR based on age, gender, and preoperative SCHNOS scores. Intraoperative techniques and patient-reported outcomes were compared between groups. RESULTS: There were no significant differences in the dorsal height between groups. While radix grafting was more common in SPR, dorsal onlay grafting and midvault reconstructive techniques (e.g. autospreader flaps) were more common in CHR. Within both groups, post-operative SCHNOS and VAS improved significantly at short- and long-term follow-up. There were no differences between SCHNOS or VAS scores preoperatively. Post-operative SCHNOS-O and SCHNOS-C scores were similar between groups at both short-term and long-term follow-up. Post-operative VAS-F scores were not different; however, VAS-C scores at short-term follow-up were statistically greater in the SPR group compared to the CHR group (8.92 vs 8.20, p = 0.03). At long-term follow-up, the difference was not significant. CONCLUSION: While there are theoretical functional and aesthetic benefits of SPR techniques, the patient reported benefits may be minimal when compared to CHR techniques with appropriate midvault reconstruction. LEVEL OF EVIDENCE III: 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 .

Effect of postoperative high load long duration inspiratory muscle training on pulmonary function and functional capacity after mitral valve replacement surgery: A randomized controlled trial with follow-up.

OBJECTIVES: Although, pre-operative inspiratory muscle training has been investigated and reported to be an effective strategy to reduce postoperative pulmonary complications, the efficacy of postoperative inspiratory muscle training as well as the proper load, frequency, and duration necessary to reduce the postoperative pulmonary complications has not been fully investigated. This study was designed to investigate the effect of postoperative high-load long-duration inspiratory muscle training on pulmonary function, inspiratory muscle strength, and functional capacity after mitral valve replacement surgeries. DESIGN: Prospective randomized controlled trial. METHODS: A total of one hundred patients (mean age 38.3±3.29years) underwent mitral valve replacement surgery were randomized into experimental (n = 50) and control (n = 50) groups. The control group received conventional physiotherapy care, while experimental group received conventional care in addition to inspiratory muscle training, with 40% of the baseline maximal inspiratory pressure targeting a load of 80% by the end of the 8 weeks intervention protocol. Inspiratory muscle training started on the patient's first day in the inpatient ward. Lung functions, inspiratory muscle strength, and functional capacity were evaluated using a computer-based spirometry system, maximal inspiratory pressure measurement and 6MWT respectively at 5 time points and a follow-up assessment was performed 6 months after surgery. Repeated measure ANOVA and post-hoc analyses were used (p <0.05). RESULTS: Group-time interactions were detected for all the studied variables (p<0.001). Between-group analysis revealed statistically significant postoperative improvements in all studied variables in the experimental group compared to the control group (p <0.001) with large effect size of η2 ˃0.14. Within-group analysis indicated substantial improvements in lung function, inspiratory pressure and functional capacity in the experimental group (p <0.05) over time, and these improvements were maintained at follow-up. CONCLUSION: High intensity, long-duration postoperative inspiratory muscle training is highly effective in improving lung function, inspiratory muscle strength, and functional capacity after mitral valve replacement surgeries.

Recent advances in polymer shell oily-core nanocapsules for drug-delivery applications.

Polymeric nanocapsules are vesicular drug-delivery systems composed of an inner oily reservoir surrounded by polymeric membranes. Nanocapsules have various advantages over other nanovesicular systems such as providing controlled drug release properties. We discuss the recent advances in polymeric shell oily-core nanocapsules, illustrating the different types of polymers used and their implementation. Nanocapsules can be utilized for many purposes, especially encapsulation of highly lipophilic drugs. They have been shown to have variable applications, especially in cancer therapy, due to the ability of the polymeric shell to direct the loaded drugs to their target sites, as well as their high internalization efficacy. Those productive applications guaranteed their high potential as drug-delivery systems. However, their clinical development is still in an early stage.

Measurement of maternal serum amyloid A as a novel marker of preterm birth.

OBJECTIVE: To study the association between maternal serum amyloid A (mSAA) levels and preterm birth (PTB). METHODS: This prospective observational nested case control study was conducted at Ain Shams University Maternity Hospital, Cairo, Egypt, between May 2017 and December 2017. The study recruited pregnant women at 26-34 weeks presented with threatened preterm labor (PTL). Women with PTB were included in cases group while control group included women who continued pregnancy and delivered at term. Serum samples were collected to measure mSAA levels. The main outcome of the study was the association between mSAA levels and PTB. Secondary outcomes included neonatal intensive care unit admissions and neonatal mortality. RESULTS: Fifty-eight women were included in the final analysis (29 in each group). Women with PTB had a statistically significant higher mSAA levels [5.1 (4.5-7.7) vs. 1.2 (0.0-2.5) mg/l, for cases and controls respectively, p < .001]. Higher mSAA levels were also observed among women whose babies were admitted to NICU, but there was no significant relation between mSAA level and neonatal death. A statistically significant negative correlation was found between mSAA and gestational age at delivery and neonatal birth weight. mSAA had an excellent value to predict PTB (AUC = 0.972 [95% CI, 0.891-0.998], p < .0001), fair value to predict admission to NICU and a poor value to predict neonatal death. CONCLUSIONS: mSAA level was found to be elevated among women with threatened PTL who end with PTB; mSAA is a potentially useful predictive marker of PTB that warrant further study. CLINICALTRIALS.GOV: NCT01639027.

Lactoferrin-tagged quantum dots-based theranostic nanocapsules for combined COX-2 inhibitor/herbal therapy of breast cancer.

AIM: Herein, tumor-targeted quantum dots (QDs)-based theranostic nanocapsules (NCs) coloaded with celecoxib and honokiol were developed. Materials & methodology: The anionic CD44-targeting chondroitin sulfate and cationic low density lipoprotein (LDL)-targeting lactoferrin (LF) were sequentially assembled onto the surface of the positively charged oily core. As an imaging probe, highly fluorescent mercaptopropionic acid-capped cadmium telluride QDs were coupled to LF. RESULTS: In vitro, fluorescence of QDs was quenched (OFF state) due to combined electron/energy transfer-mediated processes involving LF. After intracellular uptake of NCs, fluorescence was restored (ON state), thus enabled tracing their internalization. The NCs demonstrated enhanced cytotoxicity against breast cancer cells as well as superior in vivo antitumor efficacy. CONCLUSION: We propose these multifunctional nanotheranostics for imaging and targeted therapy of breast cancer.

Layer-by-layer gelatin/chondroitin quantum dots-based nanotheranostics: combined rapamycin/celecoxib delivery and cancer imaging.

Aim: Nanotheranostics consisting of highly-fluorescent quantum dots coupled with gelatin/chondroitin layer-by-layer assembled nanocapsules were developed. Materials & methods: The hydrophobic drugs celecoxib (CXB) and rapamycin (RAP) were co-loaded into the oily core of nanocapsules (NCs) to enable synergistic growth inhibition of breast cancer cells. To overcome the nonspecific binding of actively targeted CS-NCs with normal cells, a matrix metalloproteinase (MMP-2)-degradable cationic gelatin layer was electrostatically deposited onto the surface of the negatively-charged CS-NCs. Results: The prepared nanocarriers displayed strong fluorescence which enabled tracing their internalization into cancer cells. An enhanced cytotoxicity of the NCs against breast cancer cells was demonstrated. In vivo, the nanoplatforms displayed superior antitumor efficacy as well as nonimmunogenic response. Conclusion: Therefore, these multifunctional nanoplatforms could be used as potential cancer theranostics.

Maternal serum amyloid A level as a novel marker of primary unexplained recurrent early pregnancy loss.

OBJECTIVE: To assess maternal serum amyloid A (SAA) levels among women with primary unexplained recurrent early pregnancy loss (REPL). METHODS: A prospective study was conducted among women with missed spontaneous abortion in the first trimester at Ain Shams University Maternity Hospital, Cairo, Egypt, between January 21 and December 25, 2014. Women with at least two consecutive primary unexplained REPLs and no previous live births were enrolled. A control group was formed of women with no history of REPL who had at least one previous uneventful pregnancy with no adverse outcomes. Serum samples were collected to measure SAA levels. The main outcome was the association between SAA and primary unexplained REPL. RESULTS: Each group contained 96 participants. Median SAA level was significantly higher among women with REPL (50.0 µg/mL, interquartile range 26.0-69.0) than among women in the control group (11.6 µg/mL, interquartile range 6.2-15.5; P<0.001). The SAA level was an independent indicator of primary unexplained REPL, after adjusting for maternal age and gestational age (odds ratio 1.12, 95% confidence interval 1.06-1.19; P<0.001). CONCLUSION: Elevated SAA levels found among women with primary unexplained REPL could represent a novel biomarker for this complication of pregnancy.