Multimodal ultrasonography evaluation in thyroid nodule characterization: what is the ideal algorithm?

AIMS: The aim of this study is to investigate the diagnostic performances of Ultrasonography (US), Shear-wave Elastography (SWE), and Superb Microvascular Imaging (SMI) findings in the diagnosis of malignant thyroid nodules (MTNs) and to determine the US algorithm with the best diagnostic performance. MATERIAL AND METHODS: Eighty-one nodules in 77 patients who had underwent multimodal US with biopsy results, were evaluated. Echogenicity, nodule components, contours, presence and type of calcification, and size were analyzed with US. Nodule stiffness and vascular index (VI) measurements were performed via SWE and SMI. The power of the US algorithm in predicting malignancy was evaluated. RESULTS: Hypoechogenicity, irregular contour, aspect ratio (anteroposterior (AP)/transvers diameter) >1, and >43.9 kPa were the characteristicshad significant efficacy in the diagnosis of MTNs. Sensitivity, specificity, and AUC values were respectively 100%, 48.5%, and 0.742 for hypoechogenicity; 80%, 90.1%, and 0.855 for irregular contour; 60%, 71.2%, and 0.656 for aspect ratio >1; 60%, 72.7%, and 0.671 for >43.9 kPa; and 93.3%, 90.9%, and 0.921 for the US algorithm. VI did not show significant efficacy in diagnosis. CONCLUSION: Some B-mode and SWE findings showed sufficient efficacy in differentiating benign and malign nodules on their own. However, diagnostic accuracy increased significantly when the US algorithm was applied.

On the durability of surgical masks after simulated handling and wear.

After the spread of COVID-19, surgical masks became highly recommended to the public. They tend to be handled and used multiple times, which may impact their performance. To evaluate this risk, surgical masks of Type IIR were submitted to four simulated treatments: folding, ageing with artificial saliva or sweat and washing cycles. The air permeability, mechanical integrity, electrostatic potential, and filtration efficiency (FE) of the masks were measured to quantify possible degradation. Overall, air permeability and mechanical integrity were not affected, except after washing, which slightly degraded the filtering layers. Electrostatic potential and FE showed a strong correlation, highlighting the role of electrostatic charges on small particle filtration. A slight decrease in FE for 100 nm particles was found, from 74.4% for the reference masks to 70.6% for the mask treated in saliva for 8 h. A strong effect was observed for washed masks, resulting in FE of 46.9% (± 9.5%), comparable to that of a control group with no electrostatic charges. A dry store and reuse strategy could thus be envisaged for the public if safety in terms of viral and bacterial charge is ensured, whereas washing strongly impacts FE and is not recommended.

Community Masks - from an Emergency Solution to an Innovation Booster for the Textile Industry.

The COVID-19 pandemic resulted in shortages of personal protective equipment and medical devices in the initial phase. Agile small and medium-sized enterprises from regional textile industries reacted quickly. They delivered alternative products such as textile-based community masks in collaboration with industrial partners and research institutes from various sectors. The current mask materials and designs were further improved by integrating textiles with antiviral and antimicrobial properties and enhanced protection and comfort by novel textile/membrane combinations, key factors to increase the acceptance and compliance of mask wearing. The innocuity and sustainability of masks, as well as taking into account particular needs of vulnerable persons in our society, are new fields for textile-based innovations. These innovations developed for the next generation of facemasks have a high adaptability to other product segments, which make textiles an attractive material for hygienic applications and beyond.

Correction of septal and midface hypoplasia in maxillonasal dysplasia (Binder's syndrome) using high-density porous polyethylene.

BACKGROUND: Maxillonasal dysplasia (Binder's syndrome) is a congenital malformation characterized by an extremely flat and retruded nose. METHODS: This report describes an 18-year-old woman with maxillonasal dysplasia (Binder's syndrome). The septal deficiencies and maxillary retrusion of the patient were corrected by using an L-shaped implant and a crescent-shaped high-density porous polyethylene implant through the oral vestibular sulcus via an external rhinoplasty approach. RESULTS: After the operation, the tip of the nose had moved 5.5 mm anteriorly in the sagittal plane and 11.9 mm coronally in the vertical plane. Also, the nasolabial angle had increased after the surgery. Follow-up evaluation at 24 months showed good correction of the nasal and midface projection. CONCLUSIONS: High-density porous polyethylene implants are a good alternative for patients with Binder's syndrome, especially those who will not accept costal cartilage grafts or orthognathic surgery and who have tendency for hypertrophic scarring.

7-plasty technique for the surgical treatment of congenital longitudinal ear lobe cleft.

The ear lobe plays an important part in the aesthetic appearance of the auricle. The clefts of the ear lobe may vary in a wide range of severity from a simple notching to extensive tissue deficiency. We have operated on a congenital longitudinal ear lobe cleft using an alternative surgical method and obtained a favorable result. This method consists of a 7-plasty (or inverted L-plasty) that was performed to correct the deformity. The inner edges of the lobes were excised, and a medial extension incision was added. This helped to drop the medial part inferiorly like a back-cut so that the length of that lobe was increased. Eversion of the lateral lobe was also done, and the edges were approximated so that the angle between the extension incision and the excision line was increased to produce an obtuse angle between the 2 lines. We report an alternative method of reconstruction that can be used in longitudinal ear lobe clefts that offers a favorable result.

"Reading man flap" design for reconstruction of circular infraorbital and malar skin defects.

BACKGROUND: Surgical complications such as lid retraction and ectropion from graft or flap scar contracture make reconstruction of skin defects in the malar and infraorbital regions challenging. OBJECTIVE: A new flap design, the reading man flap, was used to overcome these problems. The Limberg and bilobed flap were compared with the reading man flap. METHODS: The reading man flap consists mainly of a superiorly based quadrangular flap and an inferiorly based triangular flap. Malar and infraorbital circular skin defects measuring 14 x 14 to 40 x 40 mm were reconstructed with a reading man flap in 13 patients. The defects occurred after basal cell carcinoma in all patients. The Limberg flap, bilobed flap, and reading man flap were planned for same-sized defects on the abdominoplasty resection material. The results were compared in terms of total scar area, scar length, and total healthy skin area discarded. RESULTS: When comparing the 3 flap designs, the reading man flap was the most suitable flap in terms of total scar area and length. CONCLUSION: The reading man flap can be used to reconstruct malar and infraorbital circular defects with good cosmetic results and without creating any tractional forces to the eyelids.

Nicolau syndrome aggravated by cold application after i.m. diclofenac.

Nicolau syndrome is a rare but well-recognized cutaneous adverse drug reaction at the site of i.m. injection of certain drugs. Clinically, it is characterized by severe pain immediately after the injection followed by an erythematous reticular patch that may result in a necrotic ulcer and scarring at the injection site. We describe a 60-year-old woman with a painful, violaceous, crusted plaque after i.m. diclofenac administration to her right buttock. She had applied an ice pack to this area immediately after the injection to relieve the pain without any benefit. A clinical diagnosis of Nicolau syndrome due to diclofenac injection was made, and reconstructive surgery of the wound was performed. Although diclofenac is a widely used non-steroidal anti-inflammatory drug, Nicolau syndrome following i.m. diclofenac injection has rarely been reported in the published work. Application of a cold compress was considered an aggravating factor in our patient.

Variaciones múltiples de las ramas de la arteria axilar relevantes para la cirugía plástica: reporte de caso / Multiple variations in the axillary arterial tree relevant to plastic surgery: a case report

While dissecting the body of a 59 years old male cadaver we observed abnormal branching pattern of the axillary artery and unusual vascular pedicles of the serratus anterior muscle. The serratus anterior branch originated directly first part of the axillary artery as the first branch. The lateral thoracic and thoracodorsal arteries arose together from the third part of the axillary artery as a lateral thoracic- thoracodorsal common trunk. The superior thoracic artery was out of the position. The circumflex scapular artery originated directly the third part of the axillary artery. The subscapular artery was not present.

Durante la diección de un cadáver de un hombre de 59 años de edad observamos un padrón anormal de las ramas de la arteria axilar e inusual pedículo vascular para el músculo serrato anterior. La rama para el músculo serrato anterior se originaba directamente de la primera parte de la arteria axilar como la primera rama. Las arterias torácica lateral y toracodorsal se originaban juntas de tronco común de la tercera parte de la arteria axilar como arteria torácica lateral-toracodorsal. La arteria torácica superior estaba fuera de la posición. La arteria circunfleja escapular se originaba directamente de la tercera parte de la arteria axilar. La arteria subescapular no estaba presente.