Nonsurgical Rhinoplasty With Polydioxanone Threads and Fillers.

BACKGROUND: Absorbable wedge-shaped polydioxanone (PDO) sutures are currently available for facial rejuvenation, and they are extremely popular in the aesthetic clinics in Korea. Other than face lifting, threads also can be used for nonsurgical rhinoplasty. The Asian nose is typified by a flat nasal bridge, indistinct nasal dorsum, underprojected and broad nasal tip, and a short columella. In the past, Asian rhinoplasty mainly focused on dorsal augmentation. At present, augmentation of the nasal tip is very popular and is considered an important aspect of achieving a natural and balanced nose. OBJECTIVE: To describe a novel technique with PDO threads in nonsurgical rhinoplasty. In addition, the authors aimed to assess the overall safety and efficacy of nonsurgical rhinoplasty combining both fillers and threads. METHODS: A retrospective analysis was performed on Korean patients who received rhinoplasty with PDO threads and fillers. All participants underwent a single treatment session. The results were assessed objectively by 2 independent dermatologists using serial photography and subjectively based on the patients' satisfaction scores at 6-month follow-up. RESULTS: A total of 31 patients were evaluated, and 93.5% considered the results satisfactory. Consensus ratings at the 6-month follow-up were largely categorized as very much improved (38.7%), much improved (35.5%), and improved (25.8%). An average increase of 6.3° (percentage increase by 7.6) in the nasolabial angle (p < .05) was measured at follow-up. The incidence of the complications was low, and the ones reported were minor. CONCLUSION: Nonsurgical rhinoplasty combining PDO threads and fillers can be safe and effective, maintaining good results at 6 months after the procedure. Threads are especially useful for lifting-up the nasal tip, contributing to a more harmonious and pleasing nasal appearance by modifying the columella-labial angle.

Homozygosity for the toll-like receptor 2 R753Q single-nucleotide polymorphism is a risk factor for cytomegalovirus disease after liver transplantation.

Immunity against cytomegalovirus (CMV) is initiated after its recognition by Toll-like receptor 2 (TLR2). We assessed the association between a single-nucleotide polymorphism (SNP) that impairs TLR2 function and CMV disease in a cohort of 737 liver recipients. Ninety-two of 737 patients (7.1%, 10.9%, 12.3%, and 12.5% by 3, 6, 12, and 24 months, respectively) developed CMV disease. Kaplan-Meier estimation demonstrated an association between TLR2 R753Q SNP homozygosity and CMV disease (P = .044), especially tissue-invasive CMV disease (P = .001). A multivariate Cox proportional hazard model that accounted for other significant predictors demonstrated a significant association between TLR2 R753Q SNP homozygosity and tissue-invasive CMV disease (hazard ratio, 3.407; 95% confidence interval, 1.518-7.644; P = .0029). In conclusion, homozygosity for TLR2 R753Q SNP is a marker for CMV disease risk, especially for tissue-invasive disease, after liver transplantation. This observation supports the critical role of TLR2 in the pathogenesis of CMV disease in humans.

Toll-like receptor 2 polymorphism and Gram-positive bacterial infections after liver transplantation.

Toll-like receptor 2 (TLR2) is an immune sensor for gram-positive bacterial cell wall components. Single-nucleotide polymorphisms (SNPs) in the TLR2 gene that impair its function may, therefore, influence the risk and outcomes of gram-positive bacterial infections. In a cohort of 694 liver transplant recipients, we assessed the TLR2 SNP that is translated into an amino acid substitution of arginine for glutamine at position 753 (R753Q), and we found that its presence was associated with the clinical characteristics and outcomes of gram-positive bacterial infections. The proportions of patients with the TLR2 R753Q SNP did not significantly differ between those with gram-positive bacterial infections and those without gram-positive bacterial infections (9.6% versus 9.6%, P = 0.999). However, in patients with the TLR2 R753Q SNP, higher rates of infection recurrence (27.8% versus 11.8%, P = 0.07) and initial septic shock (11.1% versus 1.2%, P = 0.047) were observed. Chronic hepatitis C [relative risk (RR) = 3.37, 95% confidence interval (CI) = 1.24-9.13, P = 0.02], initial septic shock (RR = 15.13, 95% CI = 2.84-80.54, P = 0.001), and central venous catheter-related bacteremia (RR = 7.22, 95% CI = 2.54-20.51, P < 0.001) were significantly associated with 90-day all-cause mortality after gram-positive bacterial infections. In contrast, the presence of the TLR2 R753Q SNP was not significantly associated with mortality.

Spectrum of early-onset and late-onset bacteremias after liver transplantation: implications for management.

Bacteremia is a significant cause of morbidity and mortality after liver transplantation. The characterization of the microbiological spectrum of bacteremia after liver transplantation may help physicians in choosing the initial empirical antimicrobial therapy for patients presenting with sepsis. The clinical and microbiology records of patients who received liver transplantation from January 1997 to March 2006 were reviewed. One hundred twenty-three of the 737 liver recipients (16.7%) developed bacteremia during the median follow-up period of 5.8 years (interquartile range = 2.5-8.8 years); 92 patients (12.5%) had gram-positive bacteremia (GPB), whereas 47 (6.4%) had gram-negative bacteremia (GNB). Nosocomial bacteremia was significantly more frequent among patients with early-onset GPB or GNB versus patients with late-onset GPB (66.7% versus 23.7%, P < 0.001) or GNB (70.6% versus 20.0%, P = 0.001). Peritonitis (33.3% versus 7.9%, P = 0.004) and wound infections (13.0% versus 0%, P = 0.04) as sources were more common in patients with early-onset GPB versus patients with late-onset GPB. Likewise, peritonitis was a more common source of early-onset GNB than late-onset GNB (41.2% versus 6.7%, P = 0.007). Staphylococcus aureus and Enterococcus faecium were the most common pathogens in patients with early-onset GPB, whereas Enterococcus faecalis and Streptococcus species were most common in patients with late-onset GPB. Pseudomonas aeruginosa and anaerobes were the most common pathogens in patients with early-onset GNB, whereas Escherichia coli was most common in patients with late-onset GNB. In conclusion, the microbiological spectra of early-onset and late-onset bacteremias differ, and this should be considered by those determining the initial empirical treatment of liver transplant recipients suspected to have bacteremias.

Toll-like receptor 4 polymorphisms and the risk of gram-negative bacterial infections after liver transplantation.

BACKGROUND: Toll-like receptor 4 (TLR4) is the main immune molecule that recognizes lipopolysaccharide from gram-negative bacteria. Single-nucleotide polymorphisms (SNPs) in the TLR4 gene that impair lipopolysaccharide recognition may influence gram-negative bacterial infections after liver transplantation. METHODS: TLR4 D299G and T399I SNPs were assessed in a cohort of 706 liver transplant recipients and were associated with the clinical characteristics and outcome of gram-negative bacterial infections. Cox proportional hazard model was performed to determine covariates associated with outcomes after gram-negative bacterial infections. RESULTS: Of 706 patients, there were 108 with microbiologically confirmed gram-negative bacterial infections, 135 with clinically suspected but not confirmed infections, and 463 patients without gram-negative bacterial infections. The proportions of TLR4 D299G (5/108 [4.6%] vs. 32/463 [6.9%]; P=0.39) and T399I SNPs (19/108 [17.6%] vs. 68/463 [14.7%]; P=0.45) did not differ between those with or without microbiologically confirmed gram-negative bacterial infections. Female gender (odds ratio 2.30, 95% confidence interval [CI]1.50-3.53; P<0.001) and ulcerative colitis (odds ratio 2.18, 95% CI 1.08-4.38; P=0.03) were associated with gram-negative bacterial infections. Among 108 patients with gram-negative bacterial infections, alcoholic liver disease (relative risk [RR] 4.87, 95% CI 1.54-15.44; P=0.007), initial septic shock (RR 10.19, 95% CI 2.70-38.37; P=0.001), and nosocomially-acquired infection (RR 4.61, 95% CI 1.51-14.14; P=0.007) were significantly associated with 90-day mortality after gram-negative bacterial infections. In contrast, TLR4 D299G and T399I SNPs were not significantly associated with mortality after gram-negative bacterial infections. CONCLUSION: In this cohort of liver transplant recipients with long-term follow-up, no significant association was observed between TLR4 D299G and T399I SNPs and the risk and outcome of gram-negative bacterial infections.