Periorbital Rejuvenation

The periorbital region, consisting of the eyebrows, upper and lower eyelids, glabella, and pericanthal region, is particularly susceptible to early signs of aging. Overall, this process is influenced by both genetic and environmental factors. Periorbital rejuvenation continues to be an area of advancement with evolution in both noninvasive and invasive techniques. In this article, we will review minimally invasive and surgical procedures in the treatment of periorbital aging.

INTRODUCTION

The orbital structures function to protect our visual system, arguably the most important sense in today's visual and digital world. Any interruption or imbalance of the binocular visual system will have profound impact upon every aspect of a patient's life. Add to this the obvious cosmetic impact facial appearance and symmetry plays, and one soon realizes that any surgical intervention within and around the orbit requires intimate knowledge of the anatomy and physiology of the tissues contained therein.

Interleukin-1beta in synergism gabapentin with tramadol in murine model of diabetic neuropathy

Abstract

Neuropathic pain is a complication of cancer and diabetes mellitus and the most commonly used drugs in the treatment of the diabetic neuropathic pain have only limited efficacy. The aim of this study was to evaluate the role of the biomarker interleukin-1beta (IL-1ß) in the pharmacological interaction of gabapentin with tramadol in a model of diabetic neuropathic pain. CF-1 male mice, pretreated with 200 mg/kg i.p. of streptozocin (STZ), were used and at day 3 and 7 were evaluated by the hot plate test and the spinal cord level of IL-1ß was determined. Antinociceptive interaction of the coadministration i.p. of gabapentin with tramadol, in basic of the fixed the ratio 1:1 of their ED50 values alone, was ascertained by isobolographic analysis. Tramadol was 1.13 times more potent than gabapentin in saline control mice, 1.40 times in STZ mice at 3 days and 1.28 times in STZ at 7 days. The interaction between gabapentin and tramadol was synergic, with an interaction index of 0.30 and 0.22 for mice pretreated with STZ at 3 and 7 days. The combination of gabapentin with tramadol reversed the increased concentration of IL-1β induced by STZ in diabetic neuropathic mice. These findings could help clarify the mechanism of diabetic neuropathy.

Usefulness of dermoscopy/dermatoscopy to improve the clinical and histopathologic diagnosis of skin cancers

Publication date: Available online 13 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Oriol Yélamos, Ralph P. Braun, Konstantinos Liopyris, Zachary J. Wolner, Katrin Kerl, Pedram Gerami, Ashfaq A. Marghoob

Abstract

Multiple studies have shown that dermoscopy increases the sensitivity and specificity for the detection of skin cancers compared to naked-eye examination. Dermoscopy can also lead to the detection of thinner and smaller cancers. Furthermore, dermoscopy leads to more precise selection of lesions requiring excision. In essence, dermoscopy helps clinicians differentiate benign from malignant lesions through the presence or absence of specific dermoscopic structures. Therefore, since most dermoscopic structures have direct histopathologic correlates, dermoscopy can allow the prediction of certain histologic findings present in skin cancers, thus helping select management and treatment options for select types of skin cancers. Visualizing dermoscopic structures in the ex vivo specimens can also be beneficial. It can improve the histologic diagnostic accuracy by targeted step-sectioning in areas of concern, which can be marked by the clinician before sending the specimen to the pathologist, or by the pathologist on the excised specimen in the laboratory. In addition, ex vivo dermoscopy can also be used to select tumor areas with genetic importance since some dermoscopic structures have been related to mutations with theragnostic relevance. In the second article of this continuing medical education series we review the impact of dermoscopy on the diagnostic accuracy of skin cancer, how can dermoscopy affect the histopathologic examination, and which dermoscopic features may be more relevant in terms of histological and genetic prediction.

Dermoscopy/dermatoscopy and dermatopathology correlates of cutaneous neoplasms

Publication date: Available online 13 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Oriol Yélamos, Ralph P. Braun, Konstantinos Liopyris, Zachary J. Wolner, Katrin Kerl, Pedram Gerami, Ashfaq A. Marghoob

Abstract

Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, podiatrists, doctors of osteopathic medicine, etc.) to inform clinical management decisions. Dermoscopic findings and/or images provided to pathologists offer an important insight into the clinician's diagnostic and management thought process. However, with limited dermoscopic training in dermatopathology, dermoscopic descriptions and images provided in the requisition form will provide little value to pathologists. Since most dermoscopic structures have direct histopathological correlates, dermoscopy can act as an excellent communication bridge between the clinician and the pathologist. In the first article of this continuing medical education series we review dermoscopic features and their histopathologic correlates.

Health shocks in sub-Saharan Africa: are the poor and uninsured households more vulnerable?

In developing countries, health shock is one of the most common idiosyncratic income shock and the main reason why households fall into poverty. Empirical research has shown that in these countries, households...

Encuesta sobre las características y honorarios de la práctica dermatológica privada española en 2018

Publication date: Available online 12 October 2018

Source: Actas Dermo-Sifiliográficas

Author(s): A. Martin-Gorgojo, I. García-Doval, E. del Río de la Torre

Resumen

Antecedentes y objetivo

Las tarifas por acto médico y los hábitos de asistencia privada de los dermatólogos apenas han sido objeto de estudio, al menos en nuestro entorno inmediato. Con el presente trabajo pretendemos describir hábitos de prestación de servicios, medios de cobro, promoción y fijación de tarifas de los dermatólogos que realizan asistencia privada en España. Secundariamente, buscamos analizar las diferencias por sección territorial, edad y sexo.

Materiales y métodos

Estudio descriptivo transversal a partir de un cuestionario on-line con un total de 31 preguntas dirigido exclusivamente a dermatólogos con asistencia privada en España, abierto a respuestas del 17 de mayo al 5 de junio de 2018. Los datos fueron analizados comparando por sección territorial, sexo y edad.

Resultados

Se recibió un total de 234 respuestas, paritarias en cuanto a sexo y proporcionadas en cuanto a las secciones territoriales de la Academia Española de Dermatología y Venereología (AEDV). Pudieron constatarse algunas diferencias por sección territorial, edad y sexo. Destacaban las tarifas sistemáticamente menores de las dermatólogas, incluso tras ajustar por factores de confusión mediante modelos de regresión.

Conclusiones

Quedan descritas características de la asistencia privada en Dermatología en España. El hecho de que haya tarifas más baratas entre las dermatólogas requiere de un estudio más detallado, probablemente mediante técnicas de investigación cualitativa.

Abstract

Background and objective

Per-visit fees and the characteristics of private practice in dermatology have been studied very little, at least in Spain. This study aims to describe how dermatologists in private practice in Spain provide services, collect payment, promote their services, and establish fees. We also analyze differences by region, age, and sex.

Materials and methods

We performed a descriptive, cross-sectional study based on an online questionnaire with a total of 31 questions aimed exclusively at dermatologists in private practice in Spain. The questionnaire was open for responses from May 17 to June 5, 2018. The data were analyzed by comparing region, sex, and age.

Results

A total of 234 questionnaires were returned, with equal numbers of male and female respondents and proportional numbers in terms of the regional sections of the Spanish Academy of Dermatology and Venereology (AEDV). Some differences were found for region, age, and sex. The fees of female dermatologists were consistently lower, even after adjusting for confounding factors by means of regression models.

Conclusions

We have described the characteristics of private dermatology practice in Spain. Charging of lower fees by female dermatologists requires more detailed study, probably using qualitative research techniques.

Graphical abstract

Photoprotective potential of medicinal plants from Cerrado biome (Brazil) in relation to phenolic content and antioxidant activity

Publication date: Available online 13 October 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Alesandra Ricardo Nunes, Ana Livya Moreira Rodrigues, Dinalva Brito de Queiróz, Icaro Gusmão Pinto Vieira, João Francisco Câmara Neto, João Tavares Calixto Junior, Saulo Relison Tintino, Selene Maia de Morais, Henrique Douglas Melo Coutinho

Abstract

Photooxidative damage affects cellular lipids, proteins and DNA in addition to being involved in the pathobiochemistry of erythema formation, premature skin aging, photodermatoses development and skin cancer. Phenolic compounds, flavonoids and hydroxycinnamic acid esters protect plant tissues against harmful UV-radiation. This study aimed to evaluate the sun protection factor of several Brazilian plant extracts in relation to UVB radiation absorption, which causes skin cancer, and to correlate the findings with their antioxidant activity, as well as with total phenol and flavonoid content. The antioxidant activity of the extracts were evaluated using the DPPH radical scavenging test. The photoprotective effect was evaluated using the methodology developed by Mansur. The antioxidant activity from the extracts showed IC₅₀ values ranging from 4.91 to 132.24 μg/mL when compared to the standard quercetin with an IC₅₀ of 5.01 μg/mL; the phenolic content varied from 3.77 to 57.14 mg GAE/g extract while flavonoid content varied from 1.80 to 5.89 mg EQ/g extract. Almost all extracts showed a potential for UVB radiation absorption in accordance with the ANVISA (Agência Nacional de Vigilância Sanitária) technical regulation for cosmetic sunscreens. The extracts with greater sun protection factors were those originating from Lippia microphylla (SPF = 26.82) and Dimorphandra gardneriana (SPF = 20.12). A sun protection factor of 15 or higher contributes to protect the skin, where the presence of sakuranetin flavonoids and quercetin glycosides contribute to this action.

Synthesis, characterization and unravelling the binding interaction of new bioactive 4-hydroxycoumarin derivative with calf thymus DNA: Insights from spectroscopic and theoretical aspect

Publication date: Available online 13 October 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Abhijit Mukherjee, Suvranil Ghosh, Rudraditya Sarkar, Satyajit Samanta, Sudipto Ghosh, Mahadeb Pal, Adinath Majee, Sukanta Kumar Sen, Bula Singh

Abstract

In the progress of small molecule drug candidates, 4-hydroxycoumarin based compounds bearing a crucial place as potent antibiotic agents with appreciable safety in drug invention. Being synthetically and easily obtainable, 4-hydroxycoumarin related compounds with planar structure have been promoted predominantly as DNA targeting agent. Nevertheless, here we elucidate the synthesis, characterization and theoretical study of bio-active small molecule 4-hydroxy-3,4′-bichromenyl-2,2′-dione (4HBD). Then we have illuminated the binding interactions of 4HBD with calf thymus DNA (ctDNA), which is particularly designed for biological application. Extensive investigations of the binding of 4HBD with ctDNA are provided by utilizing multi-spectroscopic and molecular docking approaches, including UV–vis absorbance, steady-state, time-resolved fluorescence spectroscopy and circular dichroism study. The calculated binding and quenching constant value from quantitative data analysis of absorption and emission spectroscopy shows that 4HBD binds to the ctDNA groove. Further confirmation of the same is found by comparative displacement and iodide quenching studies. Negative enthalpy, negative free energy and positive entropy change imply a hydrophobic force monitors the association of 4HBD with the biomacromolecule. Interestingly the small molecule (4HBD) shows potential anti-bacterial activity against the model pathogenic gram-negative (Escherichia coli and Pseudomonas aeruginosa) and gram-positive (Bacillus subtilis and Staphylococcus aureus) bacteria. The noncytotoxic nature of the 4HBD is demonstrated in vitro with the help of MTT assay by normal kidney epithelial (NKE), breast cancer cells (MCF-7) and human prostate cancer cell (PC3) lines. Hemolytic assay exhibits insignificant hemolysis of human erythrocyte cells at the minimum inhibitory concentration (MIC) of these tested bacteria. In this regard the present invention of 4-hydroxycoumarin based antimicrobial and noncytotoxic 4HBD molecule holds future promise in the development of new antibiotics.

Evaluating the role of small particle hyaluronic acid fillers using micro-droplet technique in the face, neck and hands: a retrospective chart review

A machine learning pipeline for internal anatomical landmark embedding based on a patient surface model

Abstract

Purpose

With the recent introduction of fully assisting scanner technologies by Siemens Healthineers (Erlangen, Germany), a patient surface model was introduced to the diagnostic imaging device market. Such a patient representation can be used to automate and accelerate the clinical imaging workflow, manage patient dose, and provide navigation assistance for computed tomography diagnostic imaging. In addition to diagnostic imaging, a patient surface model has also tremendous potential to simplify interventional imaging. For example, if the anatomy of a patient was known, a robotic angiography system could be automatically positioned such that the organ of interest is positioned in the system's iso-center offering a good and flexible view on the underlying patient anatomy quickly and without any additional X-ray dose.

Method

To enable such functionality in a clinical context with sufficiently high accuracy, we present an extension of our previous patient surface model by adding internal anatomical landmarks associated with certain (main) bones of the human skeleton, in particular the spine. We also investigate different approaches to positioning of these landmarks employing CT datasets with annotated internal landmarks as training data. The general pipeline of our proposed method comprises the following steps: First, we train an active shape model using an existing avatar database and segmented CT surfaces. This stage also includes a gravity correction procedure, which accounts for shape changes due to the fact that the avatar models were obtained in standing position, while the CT data were acquired with patients in supine position. Second, we match the gravity-corrected avatar patient surface models to surfaces segmented from the CT datasets. In the last step, we derive the spatial relationships between the patient surface model and internal anatomical landmarks.

Result

We trained and evaluated our method using cross-validation using 20 datasets, each containing 50 internal landmarks. We further compared the performance of four different generalized linear models' setups to describe the positioning of the internal landmarks relative to the patient surface. The best mean estimation error over all the landmarks was achieved using lasso regression with a mean error of \(12.19 \pm 6.98\ \hbox {mm}\) .

Conclusion

Considering that interventional X-ray imaging systems can have detectors covering an area of about \(200\ \hbox {mm} \times 266\ \hbox {mm}\) ( \(20\ \hbox {cm} \times 27\ \hbox {cm}\) ) at iso-center, this accuracy is sufficient to facilitate automatic positioning of the X-ray system.

Allergic contact dermatitis caused by nickel in an eyebrow pencil

Contact Dermatitis, EarlyView.

Allergic contact dermatitis caused by mupirocin and pimecrolimus

Contact Dermatitis, EarlyView.

Allergic contact dermatitis caused by clindamycin

Contact Dermatitis, EarlyView.

Management of Incidental Hernia Discovered During Abdominal Contouring in Post–Bariatric Surgery Patients

Purpose An increase in bariatric surgery has led to a rise in postbariatric contouring procedures. Despite a comprehensive preoperative assessment, body habitus in these patients may significantly limit the abdominal exam. Abdominal contouring procedures typically elevate large portions of the skin and fat off the abdominal wall, and unexpected hernia may be discovered intraoperatively. No study to date has characterized such hernia discovery at the time of body contouring surgery. We reviewed our experience of management of incidental hernia found during abdominoplasty or panniculectomy after laparoscopic bariatric surgery. Methods Records of all post–bariatric surgery patients undergoing abdominal contouring procedures between 2007 and 2017 were reviewed to identify patients with incidental hernias discovered intraoperatively. These patients were further examined by reviewing operative details, patient-specific factors, and outcomes. Results Six hundred eighty-one post–bariatric surgery patients underwent abdominal body contouring procedures with incidental ventral hernia discovered in 36 patients (5.3% [45 hernias]). At the time of plastic surgery, average age was 49 years (range, 25–64 years), and body mass index was 30.7 kg/m2 (range 25–43 kg/m2). Of 36 patients with incidental hernia, 26 patients (72.2%) had a single hernia, and the remainder had multiple (27.8%). Mean hernia size was 4.1 cm2 (range, 0.25–24 cm2). Most hernias were located paraumbilical/umbilical (46.7%) or epigastric (37.8%). Ninety-eight percent of hernias were repaired primarily (n = 44) by the plastic surgeon, and in 1 case (2%), mesh repair was performed by a consulting general surgeon. Average follow-up was 1.9 ± 0.3 years. Only 1 patient (2.8%) developed hernia recurrence after 48 months. Other postoperative complications included superficial wound healing problems (19.4%), seroma (16.7%), suture abscess (5.6%), and cellulitis that resolved with antibiotics (5.6%). Conclusions This is the first study to characterize incidental hernia discovered at the time of body contouring in the post–bariatric surgery patient. The body contouring surgeon should be aware of this common finding. Hernias typically discovered during panniculectomy or abdominoplasty arise in umbilical or epigastric regions, likely from prior laparoscopic port sites, and can be safely repaired by the plastic surgeon with low overall complication rates.

The Regenerative Capability of the Urodele Amphibians and Its Potential for Plastic Surgery

Newts and salamanders, both urodele amphibians, are the only vertebrates with tremendous regenerative potency throughout their lifetime. In contrast to the limited regenerative potential of most mammals, including humans, they can regenerate an entire limb after amputation and many other structures of their bodies, whereas humans mainly respond to injury by the formation of a scar. The intention of plastic surgery is to restore function of injured body parts, with the highest principle to replace "like with like." Despite tremendous improvements in surgical techniques over the last century, the remaining drawbacks include the availability of autologous tissue for transfer to restore extensive tissue loss. Here, some regenerative features of the urodeles are reviewed, in particular wound healing, nerve and limb regeneration, and their potential impact for reconstructive surgery are discussed. With a detailed molecular and cellular understanding of the urodele regeneration processes in combination with recent advances in tissue engineering, new perspectives for plastic surgery and especially improvements in regards to tissue regeneration are opened.

Diversity, Transgender, Vulnerable, Fetus, Entitlement, Evidence-Based, and Science-Based

No abstract available

Understanding the Anatomy of the Transverse Nasalis Aponeurotic Fibers and Its Importance in Asian Rhinoplasty

Background A complete release of the transverse nasalis aponeurotic fibers (TNAFs) during Asian rhinoplasty is critical for accurate positioning of the nasal implant and lengthening of the short nose. The objectives of this article are to clarify the anatomy of the TNAFs using cadaveric dissections and to present the clinical results after complete TNAF release in Asian rhinoplasty. Methods An anatomical dissection was performed in 8 cadavers to study the TNAFs, specifically the origin, insertion, and boundary of the TNAFs and the effect of the TNAF release on nasal length. Between January 2012 and December 2014, 2314 open implant augmentation rhinoplasties (1777 primary and 537 secondary) were performed by the senior author (J.J.). The records of these patients were retrospectively reviewed for results of TNAF release. A separately designed prospective clinical study was performed to document the nasal envelope extension after TNAF release in 52 consecutive patients. Results In the cadaver study, the anatomy and the boundaries of the TNAFs were clearly visualized and documented. With accurate release of the TNAFs, the ideal pocket for nasal implant can be defined, and the effect of the release of the TNAFs recorded. Release of the TNAFs also allows extension of the nasal envelope. However, measurements of the nasal envelope were not studied in the cadaver because the skin was degloved. From the clinical study with a follow-up ranging from 6 months to 1.5 years, the overall complication of open rhinoplasty using silicone implants incorporating TNAF release was 6%. In this group, 3.4% of patients required revision rhinoplasty. Releasing the TNAFs ensures an accurate implant pocket reducing the risk of implant deviation and implant visibility and increases the nasal length by 2.1 mm. Conclusions Complete release of the TNAFs is especially important in Asian rhinoplasty to facilitate accurate pocket dissection, allowing the extension of the nasal envelope in order to correct short nose or secondary contracted nose.

Acceptance of Vascularized Composite Allotransplantation (Face and Hand Transplant) in Singapore

Recent advancements and innovations in the burgeoning field of vascularized composite allotransplantation has enabled face and hand transplant to become a reality in the Western world. Plastic surgeons from the United States, France, and Spain have since performed vascularized composite allotransplantation as a novel therapeutic option in patients suffering from severe facial disfigurement and limb loss. Results have demonstrated remarkable functional and esthetic outcomes with improvements in the immense psychological, social, and emotional burdens that can arise in these patients. Despite the success of existing national solid organ transplant programs, face and hand transplant has yet to be established in this region. The specific aims of this study were to assess the attitudes and amount of risk Singaporeans are willing to accept towards receiving or donating face and hand transplants; and hence ultimately evaluate the feasibility of establishing such a program in Singapore.

Quality of Life of Patients After Immediate or Delayed Autologous Breast Reconstruction: A Multicenter Study

Introduction It is known that breast reconstruction improves quality of life (QoL) in women who underwent mastectomy. Previous studies showed that autologous immediate breast reconstruction is as safe as delayed breast reconstruction. However, there is not much known about the influence of the timing of the breast reconstruction on QoL. Therefore, this study aims to assess the effect of timing of the breast reconstruction on QoL, using the BREAST-Q questionnaire. Methods A total of 543 patients aged 18 years or older who underwent deep inferior epigastric perforator flap reconstruction after mastectomy (for prophylactic or oncological reasons) at least 12 months ago were selected in 3 hospitals in the Netherlands and invited to complete the BREAST-Q. Mean QoL outcomes were compared between patients who underwent immediate or delayed breast reconstruction. Furthermore, QoL outcomes were compared with recently published normative data of the BREAST-Q. Results Patients who underwent immediate reconstruction reported higher scores on satisfaction with psychosocial well-being, sexual well-being, physical well-being of the chest, and physical well-being of the abdomen. Patients who underwent delayed reconstruction reported higher scores on satisfaction with breasts, outcome, and nipples. However, after adjusting for potentially influencing factors, none of the differences were significant. Compared with the normative BREAST-Q data, both of our patient groups reported higher scores on satisfaction with breasts, psychological well-being, and sexual well-being, whereas they reported lower scores on satisfaction with physical well-being of the chest and the abdomen. Conclusions This study suggests that patients who underwent immediate or delayed deep inferior epigastric perforator flap breast reconstruction have comparable QoL more than 1 year after surgery, irrespective of the timing of the breast reconstruction.