Gender-Affirmation Hair Transplantation Techniques.

Hair restoration can play an important role for transgender patients seeking gender-affirmation procedures. In our clinic, we have seen an increase in transgender patients seeking hair restoration. The most common hair restoration procedures performed in our clinic for the transgender patient are hairline lowering procedures, facial hair restoration procedures including eyebrow and beard transplantation, and body hair transplantation.

Paths to postsecondary education enrollment among adolescents with and without childhood attention-deficit/hyperactivity disorder (ADHD): A longitudinal analysis of symptom and academic trajectories.

We examined developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non-Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (Mage = 25 at final follow-up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in PSE compared to those who did not. Overall, school performance mattered more than academic achievement for understanding eventual enrollment of adolescents with ADHD.

Odd Diffusivity of Chiral Random Motion.

Diffusive transport is characterized by a diffusivity tensor which may, in general, contain both a symmetric and an antisymmetric component. Although the latter is often neglected, we derive Green-Kubo relations showing it to be a general characteristic of random motion breaking time-reversal and parity symmetries, as encountered in chiral active matter. In analogy with the odd viscosity appearing in chiral active fluids, we term this component the odd diffusivity. We show how odd diffusivity emerges in a chiral random walk model, and demonstrate the applicability of the Green-Kubo relations through molecular dynamics simulations of a passive tracer particle diffusing in a chiral active bath.

Time reversal symmetry breaking and odd viscosity in active fluids: Green-Kubo and NEMD results.

Active fluids, which are driven at the microscale by non-conservative forces, are known to exhibit novel transport phenomena due to the breaking of time reversal symmetry. Recently, Epstein and Mandadapu [arXiv:1907.10041 (2019)] obtained Green-Kubo relations for the full set of viscous coefficients governing isotropic chiral active fluids, including the so-called odd viscosity, invoking Onsager's regression hypothesis for the decay of fluctuations in active non-equilibrium steady states. In this Communication, we test these Green-Kubo relations using molecular dynamics simulations of a canonical model system consisting of actively torqued dumbbells. We find the resulting odd and shear viscosity values from the Green-Kubo relations to be in good agreement with values measured independently through non-equilibrium molecular dynamics flow simulations. This provides a test of the Green-Kubo relations and lends support to the application of the Onsager regression hypothesis in relation to viscous behaviors of active matter systems.

Time-reversal symmetry breaking in two-dimensional nonequilibrium viscous fluids.

We study the rheological signatures of departure from equilibrium in two-dimensional viscous fluids with and without internal spin. Under the assumption of isotropy, we provide the most general linear constitutive relations for stress and couple stress in terms of the velocity and spin fields. Invoking Onsager's regression hypothesis for fluctuations about steady states, we derive the Green-Kubo formulas relating the transport coefficients to time-correlation functions of the fluctuating stress. In doing so, we show that one of the nonequilibrium transport coefficients, the odd viscosity, requires time-reversal symmetry breaking in the case of systems without internal spin. However, the Green-Kubo relations for systems with internal spin also show that there is a possibility for nonvanishing odd viscosity even when time-reversal symmetry is preserved. Furthermore, we find that breakdown of equipartition in nonequilibrium steady states results in the decoupling of the two rotational viscosities relating the vorticity and the internal spin.

Follicular Unit Excision: Current Practice and Future Developments.

Hair transplantation, or hair restoration surgery (HRS) remains the only method to consistently restore hair in those experiencing pattern hair loss as well as hair loss from most other causes. HRS has been significantly improved with the development of follicular unit extraction, later renamed follicular unit excision, or FUE. This allows the surgeon to harvest grafts from the donor area without leaving a scar. FUE can also be used to harvest grafts from other areas of the body. When performed properly using the most technically advanced devices, the transection of the grafts with FUE remains under 4%.

Hairline-Lowering Surgery.

As an alternative to hair transplantation for lowering the overly high hairline, hairline-lowering/forehead-reduction surgery has several advantages, including unsurpassed density and immediate results. Appropriate candidates for this surgery must have a stable frontal hairline (thus excluding most men) and a fairly to very mobile scalp that will permit sufficient advancement to warrant this more "invasive" approach. The main objective of this surgery is the lowering of the hairline. The authors' surgical approach, which was developed over the performance of more than 90 of these procedures and produces consistent results with low rates of complications, is described.

Cell Enriched Autologous Fat Grafts to Follicular Niche Improves Hair Regrowth in Early Androgenetic Alopecia.

BACKGROUND: Adipose and adipose derived regenerative cells (ADRCs) play an increasing role in androgenetic alopecia. OBJECTIVES: The authors sought to evaluate the safety and feasibility of fat grafts enriched with ADRCs in early androgenetic alopecia. METHODS: Seventy-one patients were treated: 16 with Puregraft fat and 1.0 × 106 ADRCs/cm2 scalp; 22 with Puregraft fat and 0.5 × 106 ADRCs/cm2 scalp, 24 with Puregraft fat alone, and 9 with saline control. Treatments were delivered into the skin and subcutaneous layer of the scalp. A total of 40 cm2 of scalp was treated and macrophotography and global photography were obtained at baseline and at 6, 24, and 52 weeks. RESULTS: A total of 71 patients tolerated the procedures well. No unanticipated associated adverse events were reported. When evaluating all patients at 24 weeks, there were no statistical differences between any of the treatment groups with respect to nonvellus (terminal) hair counts or width. There were increases (mean change from baseline) in terminal hair count for the low-dose ADRC group in the Norwood Hamilton 3 subgroup at week 6 (13.90 ±â€…16.68), week 12 (11.75 ±â€…19.42), week 24 (16.56 ±â€…14.68), and week 52 (2.78 ±â€…16.15). For this subgroup, the difference in hair count between the low-dose ADRC group and no-fat saline control was statistically significant (P = 0.0318) at week 24. CONCLUSIONS: Puregraft fat and ADRCs are safe and well tolerated. In early male hair loss, this therapy demonstrated a statistically significant increase in terminal hair counts relative to the control population at 24 weeks and represents a promising approach for early androgenetic alopecia.

Statistical mechanics of transport processes in active fluids. II. Equations of hydrodynamics for active Brownian particles.

We perform a coarse-graining analysis of the paradigmatic active matter model, active Brownian particles, yielding a continuum description in terms of balance laws for mass, linear and angular momentum, and energy. The derivation of the balance of linear momentum reveals that the active force manifests itself directly as a continuum-level body force proportional to an order parameter-like director field, which therefore requires its own evolution equation to complete the continuum description of the system. We derive this equation, demonstrating in the process that bulk currents may be sustained in homogeneous systems only in the presence of interparticle aligning interactions. Furthermore, we perform a second coarse-graining of the balance of linear momentum and derive the expression for active or swim pressure in the case of mechanical equilibrium.

Hair Transplantation Techniques for the Transgender Patient.

Hair transplantation can play a complementary role in the spectrum of gender transformation procedures sought by transgender patients undergoing gender transformation surgery. The authors' clinic has seen an increase in the demand for hair restoration in transgender patients. Hairline lowering, eyebrow transplantation, and pubic hair transplantation can play roles for male-to-female transgender patients whereas beard hair transplantation and body hair transplantation can play integral roles for female-to-male patients seeking gender transformation surgery. This article delineates an experience in the role hair restoration plays for transgender patients and outlines a surgical approach for these hair restoration procedures.

Alopecia and techniques in hair restoration: an overview for the cosmetic surgeon.

PURPOSE: Alopecia is a debilitating disorder affecting millions of individuals worldwide. Although challenging to treat, advances in hair restoration technologies have led to multiple viable options with excellent clinical results. This paper seeks to provide an overview of hair loss and the currently utilized techniques in hair transplantation in order to serve as a reference source for the facial plastic surgeon. METHODS: A comprehensive review of recent literature regarding the evaluation of, and management modalities for, alopecia was performed. RESULTS: The follicular unit extraction technique and the strip harvest technique are both widely used for patients desiring transplantation. While both techniques can lead to successful outcomes, each has pros and cons that are important to understand prior to engaging in the procedure. CONCLUSION: Advancements in hair restoration technologies implementing robotics, manual, or motorized follicular unit extraction have facilitated optimization of outcomes. Adjuvant treatment modalities including robotics and platelet-rich plasma injections have shown utility in augmenting transplantation.

Clinical Implications of Extensive Lymph Node Metastases for Resected Pancreatic Cancer.

BACKGROUND: Outcomes of patients with resected pancreatic ductal adenocarcinoma (PDA) and extensive lymph node metastases have not been fully characterized. METHODS: A total of 637 patients underwent resection for pancreatic ductal adenocarcinoma (PDA) between 2002 and 2014 at the Thomas Jefferson University. Positive lymph node count (LNC) and positive lymph node ratio (LNR) were analyzed as predictors of cancer-specific outcomes, with a focus on outcomes of patients with extensive lymph node burden. RESULTS: Resected patients with regional lymph node metastases had a median survival of 17.1 months (n = 425, 70%) compared with 25.5 months (n = 185, 30%) for patients without lymph node spread (N0) (hazard ratio [HR] = 1.9, p < 0.001). Overall survival decremented with increased lymph node spread, but plateaued for LNC ≥ 4 (HR 2.4 vs. N0, p < 0.001) and LNR ≥ 0.4 (HR 2.2, p < 0.001). Compared with historical cohorts with macroscopic metastatic disease, as opposed to microscopic, superior long-term survival was achieved in patients with extensive lymph node metastases (LNC ≥ 4); 24- and 36-month survivals were 25% (vs. 16%, p < 0.001) and 12% (vs. 6%, p < 0.001), respectively. Extensive lymph node burden was associated with increased baseline postoperative serum CA 19-9 (p = 0.044) and systemic recurrence (p < 0.001). CONCLUSIONS: The prognostic impact of extensive lymph node spread after resection for PDA plateaus above a specific threshold (LNC ≥ 4 or LNR ≥ 0.4), supporting the new 8th edition AJCC criteria for N2 disease. Clinically, lymph node spread above this threshold seems to correlate with occult systemic disease (elevated postoperative CA 19-9 and systemic pattern of failure).

Mesenchymal Stem Cells and Stromal Vascular Fraction for Hair Loss: Current Status.

The current state of the applicability of cell therapy for the treatment of various conditions of hair loss reveals a promising and potentially effective role. Further research, based on published work to date, is indicated to further explore the potential roles of autologous fat grafting, mesenchymal stem cells, and stromal vascular fraction therapy. The authors' evolving experience matches these promising scientific findings.

Common Hepatic Artery Abutment or Encasement Is an Adverse Prognostic Factor in Patients with Borderline and Unresectable Pancreatic Cancer.

BACKGROUND: Localized and unresectable pancreatic ductal adenocarcinoma (PDA) comprises one third of new diagnoses and includes borderline resectable (BR) and locally advanced (LA) unresectable disease. In a cohort of patients who were treated and followed at a single institution, we assessed clinical and radiographic predictors of outcome. METHODS: The study included 69 consecutive patients with BR or LA PDA. Serial imaging studies were reviewed by both a pancreatic surgeon and a radiologist for vascular abutment or encasement by cancer, and they were recorded. RESULTS: The cohort included 25 patients with BR and 44 patients with LA PDA, with median overall survivals (OS) of 15 and 14 months, respectively (p = 0.802). Fifteen patients were resected (22%), with a median OS of 21 months from diagnosis (HR 2.50, p = 0.006) and 13 months from resection. Median OS from diagnosis was 33 months in patients without lymph node metastases at resection (n = 10), but just 17 months with lymph node metastases (n = 5, HR = 8.95, p = 0.011). There were 12 two-year survivors in the total cohort (17%), and seven of them never underwent resection. First-line treatments consisted of gemcitabine (n = 13), modern first-line combinations (FOLFIRNOX or gemcitabine/nab-paclitaxel, n = 24), or alternative multi-agent therapies (n = 32); there were no statistical differences between treatment subgroups (OS of 10, 13, and 16 months, respectively). Common hepatic artery (CHA) abutment or encasement at diagnosis was associated with poor survival (adjusted hazard ratio, CHA abutment = 2.47 (p = 0.015) and CHA encasement = 2.16 (p = 0.036)). CONCLUSION: In this cohort, common hepatic arterial abutment or encasement and residual lymph node disease at resection portended a particularly poor outcome in patients with localized, unresectable PDA.

Microscopic lymphovascular invasion is an independent predictor of survival in resected pancreatic ductal adenocarcinoma.

Background and Objectives Despite routine inclusion of lymphovascular invasion (LVI) status in pathologic reports of resected pancreatic ductal adenocarcinomas (PDA), the clinical implications of LVI have not been well characterized. Methods This study is a retrospective review of 2640 patients who underwent a pancreatectomy for PDA at Thomas Jefferson University Hospital, Massachusetts General Hospital, or Johns Hopkins Hospital (2003-2014). Clinical and pathologic records were extracted from institutional databases. Results The median post-resection survival for the total cohort was 19.2 months with a 5-year survival rate of 15.2%. In a multivariate Cox proportional hazards model including conventional pathologic features, LVI was an independent predictor of survival (HR = 1.14, P = 0.017). In a stratified Kaplan-Meier survival analysis, patients with N0, LVI- PDA had a significantly improved overall survival compared to those with N0, LVI+ PDA (median 31 vs 24 mo, P = 0.020). Similarly, patients with N1, LVI- PDA had superior survival to patients with N1, LVI+ disease (18.6 vs 16.5 mo, P = 0.001). Conclusions As the first large scale study focused on the clinical impact of LVI status in PDA, these data indicate that this routinely reported pathologic feature is a bona fide and independent adverse prognostic factor.