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Aesthetic Plastic Surgery Apr 2024As a new-generation collagen stimulator, polycaprolactone (PCL) containing filler has been extensively applied in facial dermal fillers and other medical aesthetic...
BACKGROUND
As a new-generation collagen stimulator, polycaprolactone (PCL) containing filler has been extensively applied in facial dermal fillers and other medical aesthetic fields. However, inadvertent intravascular injection of PCL may result in complications such as tissue edema, flap necrosis, and even blindness. To date, there is no effective treatment for PCL-induced intravascular embolism.
OBJECTIVES
The aim of this study was to identify a viable resolution for the embolism resulting from intravascular administration of PCL-containing fillers.
METHODS
Two different animal experiments were performed: (1) PCL-induced rat inferior epigastric arteries embolism, followed by gross observation, histological evaluation, and cytokines analysis from serum; and (2) PCL-induced rabbit auricular artery embolism, immediately treated with heparin and nitroglycerin. The ears were then evaluated by gross observation, Laser speckle imaging, in vivo imaging system (IVIS) imaging, and histological evaluation. Saline and hyaluronic acids (HA) were used as controls, hyaluronidase was used as a positive drug.
RESULTS
In a rat model of inferior epigastric arteries embolism, both intravascular injection of HA and PCL resulted in flap necrosis, indicating that the filler-induced intravascular embolism can lead to serious complications. In a rabbit model of auricular artery embolism, the combination treatment of heparin and nitroglycerin resulted in a relative blood reperfusion recovery of 80% in the ischemic area of the PCL group on day 7 post-operation, which was comparable to that of the HA group treated with hyaluronidase. Histological analysis revealed that the administration of heparin and nitroglycerin significantly attenuated intravascular thrombosis formation and inflammatory cell aggregation.
CONCLUSIONS
The combination of heparin and nitroglycerin effectively restores blood flow reperfusion in the intravascular embolization caused by PCL filler injection, alleviates local tissue edema and flap necrosis. These findings offer a novel approach for future clinical management of intravascular embolization with PCL-containing filler injection.
NO LEVEL ASSIGNED
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .
PubMed: 38594353
DOI: 10.1007/s00266-024-03969-4 -
Asian Journal of Surgery Jun 2024Ex vivo liver resection and autotransplantation (ERAT) can be used to treat locally advanced tumors that are conventionally unresectable. Because the procedure is rare,...
PURPOSE
Ex vivo liver resection and autotransplantation (ERAT) can be used to treat locally advanced tumors that are conventionally unresectable. Because the procedure is rare, there are very few reports in the literature. Recently, we performed ERAT for two cases of cholangiocarcinoma invading caudate lobe, the retrohepatic vena cava and hepatic veins, and investigated technical variations of this procedure.
METHODS
One patient was a 57-year-old man with liver caudate lobe metastasis from cholangiocarcinoma after pancreaticoduodenal resection five years ago, and the other patient was a 68-year-old man with caudate lobe cholangiocarcinoma. Both cases were considered to be unresectable by conventional resection due to the critical invasion of the retrohepatic vena cava along with the three hepatic veins. Therefore, ERAT was indicated in these two cases.
RESULTS
The liver along with the retrohepatic vena cava was removed, which was replaced by GORE-TEX synthetic artificial vessel grafts with angioplasty to reconstruct the inferior vena cava (IVC), and the GORE-TEX synthetic artificial vessel anastomosed to the right auricular appendage or the IVC to build the continuity of the IVC. Ex vivo caudate lobe hepatectomy was performed, along with the retrohepatic vena cava and hepatic veins, and subsequently the reconstruction outflow of hepatic venous was established using cold-preserved allogeneic vessels and falciform ligament. Finally, remnant of the liver was implanted by Piggyback liver transplantation. The hepatic vein, portal vein, hepatic artery and bile duct were anastomosed, and autotransplantation of the liver was completed. The patients were followed-up for 18 months and showed good liver function, with no recurrence of cancer.
CONCLUSIONS
ERAT should be considered as a therapeutic option for selected patients with cholangiocarcinoma invading caudate lobe, the retrohepatic vena cava and hepatic veins. It is crucial to reconstruct the outflow of hepatic venous according to different situations.
Topics: Humans; Cholangiocarcinoma; Male; Bile Duct Neoplasms; Middle Aged; Aged; Transplantation, Autologous; Liver Transplantation; Hepatectomy; Vena Cava, Inferior; Hepatic Veins; Plastic Surgery Procedures; Liver Neoplasms
PubMed: 38555210
DOI: 10.1016/j.asjsur.2024.03.001 -
DWI scrolling artery sign for the diagnosis of giant cell arteritis: a pattern recognition approach.RMD Open Mar 2024To investigate the diagnostic accuracy of a pattern recognition approach for the evaluation of MRI scans of the head with diffusion-weighted imaging (DWI) in suspected...
OBJECTIVES
To investigate the diagnostic accuracy of a pattern recognition approach for the evaluation of MRI scans of the head with diffusion-weighted imaging (DWI) in suspected giant cell arteritis (GCA).
METHODS
Retrospectively, 156 patients with suspected GCA were included. The 'DWI-Scrolling-Artery-Sign' (DSAS) was defined as hyperintense DWI signals in the cranial subcutaneous tissue that gives the impression of a blood vessel when scrolling through a stack of images. The DSAS was rated by experts and a novice in four regions (frontotemporal and occipital, bilaterally). The temporal, occipital and posterior auricular arteries were assessed in the T1-weighted black-blood sequence (T1-BB). The diagnostic reference was the clinical diagnosis after ≥6 months of follow-up.
RESULTS
The population consisted of 87 patients with and 69 without GCA; median age was 71 years and 59% were women. The DSAS showed a sensitivity of 73.6% and specificity of 94.2% (experts) and 59.8% and 95.7% (novice), respectively. Agreement between DSAS and T1-BB was 80% for the region level (499/624; kappa(κ)=0.59) and 86.5% for the patient level (135/156; κ=0.73). Inter-reader agreement was 95% (19/20; κ=0.90) for DSAS on the patient level and 91.3% (73/80; κ=0.81) on the region level for experts. For expert versus novice, inter-reader agreement for DSAS was 87.8% on the patient level (137/156; κ=0.75) and 91.2% on the region level (569/624; κ=0.77).
CONCLUSIONS
The DSAS can be assessed in less than 1 min and has a good diagnostic accuracy and reliability for the diagnosis of GCA. The DSAS can be used immediately in clinical practice.
Topics: Humans; Female; Aged; Male; Giant Cell Arteritis; Temporal Arteries; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Arteries
PubMed: 38519109
DOI: 10.1136/rmdopen-2023-003652 -
Clinica E Investigacion En... 2024One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading...
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.
Topics: Humans; Vascular Diseases; Spain; Atherosclerosis; Global Health; Risk Factors; Heart Disease Risk Factors; Cardiovascular Diseases; Societies, Medical
PubMed: 38490888
DOI: 10.1016/j.arteri.2024.02.001 -
Journal of Plastic, Reconstructive &... Apr 2024Single-stage microtia auricular reconstruction is becoming more relevant. The determining factor is a temporoparietal fascia flap (TPF) with both branches of the...
BACKGROUND
Single-stage microtia auricular reconstruction is becoming more relevant. The determining factor is a temporoparietal fascia flap (TPF) with both branches of the superficial temporal artery (STA). There are not many studies regarding vascular branching in people with microtia.
METHODS
We conducted an anatomical study on the TPF flap harvested during single-stage endoscopic-assisted microtia auricular reconstruction from May 2018 to July 2021. We observed the flaps under endoscopic and surgical microscopes to determine several variables (vascular size, number of frontal/parietal branches, distance from the branching location to the estimated external ear canal, distance from the frontal artery to projected course of facial nerve's frontal branch, etc.).
RESULTS
The study included 55 flaps from 54 patients. Of the 55 flaps, 50 (90.9%) had a parietal branch, and all 55 (100%) had a frontal branch with a mean diameter of 0.98 and 0.91 mm, respectively. Regarding the frontal artery, 1.8%, 25.5%, 50.9%, 16.35% and 5.45% had 0-4 traverse frontal branch(es), respectively. The mean distance from the frontal artery to the estimated course of the frontal nerve was 10.56 mm. Parietal artery absence is more likely in patients with severe hemifacial microsomia or STA trunk go under the auricular cartilage remnants (p < 0.05). Either frontal or parietal artery absence or small diameter can cause necrosis. Frontal arteries travelling near the frontal nerve may result in post-operative nerve palsy.
CONCLUSIONS
Microtia auricular reconstructive surgery is always a big challenge for plastic surgeons. Anatomical variants are common. A detailed anatomical description of the STA, with the help of microsurgery and endoscopy, allows arterial-based flap designing and harvest, which tremendously improves surgical success rate by diminishing flap necrosis and nerve damage.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Humans; Congenital Microtia; Temporal Arteries; Surgical Flaps; Fascia; Necrosis
PubMed: 38412600
DOI: 10.1016/j.bjps.2024.01.029 -
Aesthetic Plastic Surgery Feb 2024Ophthalmic artery occlusion caused by facial hyaluronic acid filler injection has always been a rare but devastating complication. With the pursuit of beauty, people...
Ophthalmic artery occlusion caused by facial hyaluronic acid filler injection has always been a rare but devastating complication. With the pursuit of beauty, people have become more interested in ears and hyaluronic acid fillers. Herein, we report the case of a more serious rare complication of ophthalmic artery occlusion caused by ear filler injection. A 45-year-old woman developed vision loss on the left side immediately after receiving cosmetic hyaluronic acid injection in the ear, with only the visual field at the inferior temporal side remaining. She was diagnosed with central retinal artery occlusion in the left eye. After treatment with hyaluronidase injection, dexamethasone, hyperbaric oxygen, and oral alprostadil, blood flow was partially restored in the left ophthalmic artery, and her vision improved. Vascular complications after ear injections are rare. However, as the demand for ear filler injections increases, the probability of serious vascular complications is predicted to increase. The potential mechanism by which occlusion occurred involved the filler reaching the superficial temporal artery system through the superior auricular artery, thus occluding the ophthalmic artery. Having an understanding of anatomy is an important measure to avoid complications.Level of Evidence IV 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 .
PubMed: 38388798
DOI: 10.1007/s00266-024-03903-8 -
Archivos de Cardiologia de Mexico Feb 2024Atrial fibrillation (AF) is the most prevalent arrhythmia and is related with significant morbidity, mortality and costs. In spite of relevant advances in the prevention...
Atrial fibrillation (AF) is the most prevalent arrhythmia and is related with significant morbidity, mortality and costs. In spite of relevant advances in the prevention of embolic events and rhythm control, little has been done to reduce its prevalence, progression and impact, since it increases with ageing as well as with common risk factors such as alcohol intake, tobacco use and stress as well as with arterial hypertension, diabetes mellitus, heart failure, sleep apnea, kidney failure, chronic pulmonary obstructive disease, ischemic heart disease and stroke, among other important comorbidities. Fortunately, new evidence suggests that lifestyle modifications and adequate risk factors and comorbidities control could be effective in primary and secondary AF prevention, especially in its paroxysmal presentations. This is why a multidisciplinary approach integrating lifestyle modifications, risk factors and comorbidities control, is necessary in conjunction with rhythm or rate control and anticoagulation. Unfortunately, that holistic approach strategy is not considered, is scarcely studied or is subtilized in general clinical practice. The present statement's objectives are to: 1) review the relationship between habits, risk factors and illnesses with AF, 2) review the individual and common physiopathology mechanisms of each one of those conditions that may lead to AF, 3) review the effect of control of habits, risk factors and co-morbidities on the control and impact of AF, and 4) supply guidelines and recommendations to start multidisciplinary and integrative AF treatment.
PubMed: 38382332
DOI: 10.24875/ACM.22000236 -
Pilot and Feasibility Studies Feb 2024Temporomandibular disorders (TMD) are a collective term for pain and dysfunction of the masticatory muscles and the temporomandibular joints. The most common types of...
Transcutaneous auricular vagus nerve stimulation for the treatment of myoarthropatic symptoms in patients with craniomandibular dysfunction - a protocol for a randomized and controlled pilot trial.
BACKGROUND
Temporomandibular disorders (TMD) are a collective term for pain and dysfunction of the masticatory muscles and the temporomandibular joints. The most common types of TMD are pain-related, which may impact the psychological behavior and quality of life. Currently, the most popular methods for the treatment of TMD patients are occlusal splint therapy, often in combination with physical- and/or pharmacotherapy. However, due to the complexity of etiology, the treatment of chronic TMD remains a challenge. Recently, CE-certified systems for non-invasive VNS (transcutaneous auricular vagus nerve stimulation, taVNS) have become available and show positive effects in the treatment of chronic pain conditions, like migraine or fibromyalgia, with which TMD shares similarities. Therefore, it is the main purpose of the study to evaluate the feasibility of daily taVNS against chronic TMD and to assess whether there is an improvement in pain severity, quality of life, and kinetic parameters.
METHODS
This study is designed as a single-blinded, double-arm randomized controlled trial (RCT) in a 1:1 allocation ratio. Twenty adult patients with chronical TMD symptoms will be enrolled and randomized to stimulation or sham group. In the stimulation group, taVNS is performed on the left tragus (25 Hz, pulse width 250 µs, 28 s on/32 s off, 4 h/day). The sham group will receive no stimulation via a non-functional identical-looking electrode. Validated questionnaire data and clinical parameters will be collected at the beginning of the study and after 4 and 8 weeks. The compliance of a daily taVNS of patients with chronical TMD will be evaluated via a smartphone app recording daily stimulation time and average intensity. Additionally, the treatment impact on pain severity and quality of life will be assessed with different questionnaires, and the effect on the mandibular mobility and muscle activity will be analyzed.
DISCUSSION
This is the first clinical trial to assess the feasibility of taVNS in patients with chronic TMD symptoms. If taVNS improves the symptoms of TMD, it will be a significant gain in quality of life for these chronic pain patients. The results of this pilot study will help to determine the feasibility of a large-scale RCT.
TRIAL REGISTRATION
This study has been registered in the DRKS database (DRKS00029724).
PubMed: 38331976
DOI: 10.1186/s40814-024-01447-x -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... Jan 2024To create a novel chitosan antibacterial hemostatic sponge (NCAHS) and to evaluate its material and biological properties.
OBJECTIVE
To create a novel chitosan antibacterial hemostatic sponge (NCAHS) and to evaluate its material and biological properties.
METHODS
Chitosan, a polysaccharide, was used as the sponge substrate and different proportions of sodium tripolyphosphate (STPP), glycerol, and phenol sulfonyl ethylamine were added to prepare the sponges through the freeze-drying method. The whole-blood coagulation index (BCI) was used as the screening criterion to determine the optimal concentrations of chitosan and the other additives and the hemostatic sponges were prepared accordingly. Zein/calcium carbonate (Zein/CaCO) composite microspheres loaded with ciprofloxacin hydrochloride were prepared and added to the hemostatic sponges to obtain NCAHS. Scanning electron microscope was used to observe the microscopic morphology and porosity of the NCAHS. The water absorption rate, antibacterial susceptibility rate against () and (), coagulation performance, and hemocompatibility of NCAHS were examined. The coagulation performance of NCAHS was evaluated by using rabbit liver injury and rabbit auricular artery hemorrhageear models and commercial hemostatic sponge (CHS) was used as a control. The biocompatibility, including such aspects as cytotoxicity, skin irritation in animals, and acute toxicity, of the NCAHS extracts was examined by using as a reference the national standards for biological evaluation of medical devices.
RESULTS
The NCAHS prepared with 1.5% chitosan (/), 0.01% STPP (/), 0% glycerol (/), 0.15% phenol-sulfonyl-ethylamine (/), Zein and CaCO at the mixing ratio of 5∶1 (/), Zein at the final mass concentration of 2.5 g/L, and ethanol at the final concentration of 17.5% (/) were fine and homogeneous, possessing a honeycomb-like porous structure with a pore size of about 200 μm. The NCAHS thus prepared had the lowest BCI value. The water absorption ([2362.16±201.15] % vs. [1102.56±91.79]%) and coagulation performance (31.338% vs. 1.591%) of NCAHS were significantly better than those of CHS (<0.01). Tests with the auricular artery hemorrhage model ([36.00±13.42] s vs. [80.00±17.32] s) and rabbit liver bleeding model ([30.00±0] s vs. [70.00±17.32] s) showed that the hemostasis time of NCAHS was significantly shorter than that of CHS (<0.01). NCAHS had significant inhibitory ability against and . In addition, NCAHS showed good and biocompatibility.
CONCLUSION
NCAHS is a composite sponge that shows excellent antimicrobial properties, hemostatic effect, and biocompatibility. Therefore, its extensive application in clinical settings is warranted.
Topics: Animals; Rabbits; Chitosan; Hemostatics; Escherichia coli; Glycerol; Staphylococcus aureus; Zein; Hemostasis; Anti-Bacterial Agents; Hemorrhage; Water; Ethylamines; Phenols
PubMed: 38322514
DOI: 10.12182/20240160403 -
Cureus Dec 2023Relapsing polychondritis is a rare disease that causes progressive and recurrent destruction of cartilage in the auricles, eyes, nose, and airways. A 90-year-old man was...
Relapsing polychondritis is a rare disease that causes progressive and recurrent destruction of cartilage in the auricles, eyes, nose, and airways. A 90-year-old man was brought to the emergency department with fever, low SpO, and effortful breathing. Arterial blood gas analysis showed that PaCO levels had accumulated to 120 mmHg. Although CT showed marked thickening of the bronchial wall from the central to the peripheral region, the cause was unknown. At the family's request, the patient was not placed on a ventilator, and treatment was started with steroids alone. After admission, the patient's condition improved with only intravenous steroids, and he was discharged to the facility with continued oral steroid medication. After a short treatment period, the possibility of relapsing polychondritis was considered and confirmed. The patient met Levine's diagnostic criteria, with findings of destruction of the bilateral auricular cartilage and the airway and a response to steroid administration. Although it is very difficult to diagnose relapsing polychondritis at the initial emergency department visit, early administration of steroids is worth trying in patients with asphyxia with extensive thickening of the airway on CT findings, as relapsing polychondritis may be considered, and early steroid administration may improve patient symptoms.
PubMed: 38274918
DOI: 10.7759/cureus.51101