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Plast Reconstr Surg ; 144(2): 499-504, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348367


BACKGROUND: The use of social media to discuss topics related to and within plastic surgery has become widespread in recent years; however, it remains unclear how to use this abundance of largely untapped data to propagate educational research in the field of plastic surgery. In this prospective, observational study, the authors aimed to delineate which plastic surgery-related topics evoked a significant emotional response within the study population and to assess the utility of motivational artificial intelligence within the field of plastic surgery. METHODS: Over a 4-month period (January to April of 2018), Cognovi Lab's artificial intelligence technology was used to search and analyze emotional reactions to several commonly hashtagged words. This innovative software uses several key metrics to describe its findings, including awareness, engagement, and motivation. RESULTS: Of the search terms examined, "nose job" had the most awareness during the study period, and the topic that most engaged consumers emotionally was "liposuction." Interestingly, "liposuction" ranked only fifth in terms of awareness. Consumers showed the strongest positive motivation toward the subjects of "plastic surgery" and "cosmetic surgery," and the lowest motivation toward the topic of "tummy tucks." CONCLUSIONS: This analysis by Cognovi Labs is the first quantitative effort to use the plethora of data on social media to interpret patient motivations and subsequent behavior. Moving forward, artificial intelligence technology will make it possible to predict which plastic surgery products, procedures, and practices will be successful. The findings presented in this article describe the unique viewpoint and power that this technology can deliver.

Inteligência Artificial/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Mídias Sociais/estatística & dados numéricos , Cirurgia Plástica/métodos , Bases de Dados Factuais , Inteligência Emocional , Estética , Feminino , Humanos , Aprendizado de Máquina , Masculino , Estudos Prospectivos , Cirurgia Plástica/psicologia , Resultado do Tratamento
Plast Reconstr Surg ; 144(1): 24-33, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246794


BACKGROUND: Revision procedures address contour irregularities and aesthetic concerns following autologous breast reconstruction. Mental health diagnoses are known to influence patient satisfaction with reconstruction. The authors aimed to identify oncologic, reconstructive, and demographic factors, including mental health diagnoses, associated with the number of revisions after autologous breast reconstruction. METHODS: The medical records of all adult women undergoing abdominal free flap-based breast reconstruction at a major academic institution between 2011 and 2016 were reviewed. Multivariate logistic regression was used to identify factors associated with receipt of revisions. Negative binomial regression was used to identify characteristics associated with number of revisions received. RESULTS: Of 272 patients identified, 55.2 percent received one revision, 23.2 percent received two revisions, and 10.3 percent received three or more revisions after autologous breast reconstruction (median, one; range, zero to five). After adjustment on multivariate analysis, anxiety (OR, 4.34; p = 0.016) and bilateral reconstruction (OR, 3.10; p = 0.017) were associated with receipt of any revisions; other oncologic and reconstructive factors including breast cancer stage, receipt of radiation therapy, and type or timing of free flap reconstruction were not associated with revisions. Using univariate negative binomial regression, anxiety (incidence rate ratio, 1.34; p = 0.006), Caucasian race (incidence rate ratio, 1.24; p = 0.02), and bilateral reconstruction (incidence rate ratio, 1.39; p = 0.04) were predictive of increased numbers of revisions received. After stepwise selection on multivariate analysis, anxiety remained the only significant predictor of increased numbers of revisions. CONCLUSIONS: Preoperative anxiety significantly influences the number of revisions after autologous breast reconstruction. Further research is necessary to better understand the interplay among mental health, patient preference, and outcomes in breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Transtornos de Ansiedade/complicações , Neoplasias da Mama/cirurgia , Retalhos de Tecido Biológico , Mamoplastia/psicologia , Adulto , Neoplasias da Mama/psicologia , Transtorno Depressivo/complicações , Feminino , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Satisfação do Paciente , Cuidados Pré-Operatórios , Reto do Abdome/transplante , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Transplante Autólogo
Plast Reconstr Surg ; 143(5): 1109e-1117e, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033841


BACKGROUND: This study described the prevalence of bleeding complications necessitating blood transfusion across plastic surgery procedures and identified those procedures that may be associated with higher rates of bleeding. METHODS: The authors retrospectively identified patients who suffered from postoperative bleeding complications from 2010 to 2015 using the National Surgical Quality Improvement Program database. This is defined by the National Surgical Quality Improvement Program as the need for transfusion of at least one unit of packed or whole red blood cells. Patient characteristics were described using summary statistics, and National Surgical Quality Improvement Program and univariate analysis of patient characteristics and bleeding complications was performed. RESULTS: Overall, 1955 of 95,687 patients experienced bleeding complications. Patients with bleeding complications were more likely to be diagnosed with hypertension, have a longer total operative time, and have a previously diagnosed bleeding disorder. The most common primary plastic surgery procedure associated with bleeding complications was breast reconstruction with a free flap, and breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap had the highest rate of bleeding. A return to the operating room was required in 539 patients (27.6 percent) who suffered a postoperative bleeding complication. Patients with a preexisting bleeding disorder [n = 1407 (1.5 percent)] were more likely to be diabetic, have a lower preoperative hematocrit, and have a longer operative time. In addition, these patients were more likely to suffer from other nonbleeding complications (1.29 percent versus 0.35 percent; p < 0.01). CONCLUSIONS: Complex procedures (i.e., free flap breast reconstruction) have a higher prevalence of bleeding requiring a transfusion. Furthermore, patients undergoing combined procedures-specifically, breast oncologic and reconstructive cases-may be at a higher risk for experiencing bleeding-related complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Perda Sanguínea Cirúrgica/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Mamoplastia/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adulto , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Mamoplastia/métodos , Pessoa de Meia-Idade , Duração da Cirurgia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Prevalência , Melhoria de Qualidade/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos
J Reconstr Microsurg ; 35(6): 417-424, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30616243


BACKGROUND: Despite limited oncologic benefit for women without an increased risk for breast cancer, the rates of contralateral prophylactic mastectomy (CPM) have increased. Patients undergoing CPM are more likely to undergo bilateral and immediate breast reconstruction. This study assessed the relationship between the timing and laterality of free flap-based breast reconstruction and the risk of postoperative bleeding complications. METHODS: Women undergoing postmastectomy free-flap based breast reconstruction from 2010 to 2015 were identified using the National Surgical Quality Improvement Program (NSQIP) dataset. Patients were categorized according to reconstructive laterality and timing. Modified Poisson regression was used to assess the risk of postoperative bleeding and complications across reconstructive procedures. RESULTS: Of the 4,133 patients undergoing free flap-based breast reconstruction, 12% (n = 494) experienced postoperative bleeding complications. Bilateral immediate reconstruction was associated with the highest incidence of bleeding (16.6%, n = 188), followed by bilateral delayed (12.8%, n = 58), unilateral immediate (10%, n = 142), and unilateral delayed reconstruction (9.4%, n = 106). Among patients undergoing immediate reconstruction, bilateral, rather than unilateral, reconstruction was associated with a significantly elevated risk of bleeding complications (RR [rate ratio] = 1.58; 95% CI [confidence interval] =1.19, 2.10; p = 0.0002). Furthermore, immediate bilateral reconstruction was associated with a significantly higher rate of return to the operating room (RR =1.39; 95% CI =1.06, 1.82; adjusted p = 0.009) when compared with a unilateral procedure. CONCLUSION: Patients undergoing immediate bilateral free flap-based breast reconstruction may be at an increased risk for experiencing acute postoperative bleeding complications and a return to the operating room. Patients undergoing CPM and considering immediate reconstruction should be counseled regarding the increased morbidity of a bilateral reconstructive procedure.

Neoplasias da Mama/cirurgia , Retalhos de Tecido Biológico/transplante , Mamoplastia/métodos , Hemorragia Pós-Operatória/epidemiologia , Feminino , Humanos , Incidência , Mastectomia , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos , Medição de Risco
Plast Reconstr Surg Glob Open ; 6(8): e1849, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30254827


Distant silicone migration and late postoperative hematoma are rare but serious complications following breast implant rupture. This study describes a case report of both these complications occurring in the same patient. After a review of pertinent literature, the authors found 19 other case reports (20 total patients) with distant silicone migration following breast implant rupture. Median age at the time of presentation was 48 years (range, 21-76), and median time between initial breast augmentation and presentation with silicone migration was 10 years (range, 1-30 years). Sites of migrated silicone included arm/forearm (n = 11), thoracic cavity (n = 4), abdominal wall (n = 3), legs (n = 2), and back (n = 1). A total of 67% of patients had documented trauma to the chest before presentation. Our study highlights the need to consider distant silicone migration in the differential diagnosis when extracapsular implant rupture is suspected.

Diabetes ; 66(1): 127-133, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27797908


Overcoming the immune response to establish durable immune tolerance in type 1 diabetes remains a substantial challenge. The ongoing effector immune response involves numerous immune cell types but is ultimately orchestrated and sustained by the hematopoietic stem cell (HSC) niche. We therefore hypothesized that tolerance induction also requires these pluripotent precursors. In this study, we determined that the tolerance-inducing agent anti-CD45RB induces HSC mobilization in nonautoimmune B6 mice but not in diabetes-prone NOD mice. Ablation of HSCs impaired tolerance to allogeneic islet transplants in B6 recipients. Mobilization of HSCs resulted in part from decreasing osteoblast expression of HSC retention factors. Furthermore, HSC mobilization required a functioning sympathetic nervous system; sympathectomy prevented HSC mobilization and completely abrogated tolerance induction. NOD HSCs were held in their niche by excess expression of CXCR4, which, when blocked, led to HSC mobilization and prolonged islet allograft survival. Overall, these findings indicate that the HSC compartment plays an underrecognized role in the establishment and maintenance of immune tolerance, and this role is disrupted in diabetes-prone NOD mice. Understanding the stem cell response to immune therapies in ongoing human clinical studies may help identify and maximize the effect of immune interventions for type 1 diabetes.

Mobilização de Células-Tronco Hematopoéticas , Transplante de Células-Tronco Hematopoéticas/métodos , Aloenxertos/imunologia , Aloenxertos/metabolismo , Animais , Feminino , Citometria de Fluxo , Transplante das Ilhotas Pancreáticas/imunologia , Antígenos Comuns de Leucócito/metabolismo , Camundongos , Camundongos Endogâmicos NOD , Osteoblastos/metabolismo