Comparison of blind deconvolution- and Patlak analysis-based methods for determining vascular permeability.

This study describes a computational algorithm to determine vascular permeability constants from time-lapse imaging data without concurrent knowledge of the arterial input function. The algorithm is based on "blind" deconvolution of imaging data, which were generated with analytical and finite-element models of bidirectional solute transport between a capillary and its surrounding tissue. Compared to the commonly used Patlak analysis, the blind algorithm is substantially more accurate in the presence of solute delay and dispersion. We also compared the performance of the blind algorithm with that of a simpler one that assumed unidirectional transport from capillary to tissue [as described in Truslow et al., Microvasc. Res. 90, 117-120 (2013)]. The algorithm based on bidirectional transport was more accurate than the one based on unidirectional transport for more permeable vessels and smaller extravascular distribution volumes, and less accurate for less permeable vessels and larger extravascular distribution volumes. Our results indicate that blind deconvolution is superior to Patlak analysis for permeability mapping under clinically relevant conditions, and can thus potentially improve the detection of tissue regions with a compromised vascular barrier.

Quantitation of Mitochondrial DNA Deletions Via Restriction Digestion/Long-Range Single-Molecule PCR.

Quantification of deletions in mtDNA is a long-standing problem in mutational analysis. We describe here an approach that combines the power of single-molecule PCR of the entire mitochondrial genome with the enrichment of the deletions by restriction digestion. This approach is indispensable if information about wide range of deletion types in a sample is critical, such as in studies concerning distribution of deletion breakpoints (as opposed to approaches where fraction of a single deletion or a limited set of deletions is used as a proxy for total deletion load). Because deletions in a sample are quantified almost exhaustively, the other important application of this approach involves studies where only small amounts of tissue, such as biopsies, are available.

Effect of dietary zinc and phytase supplementation on botulinum toxin treatments.

PURPOSE: To determine whether oral zinc supplementation might affect the efficacy and duration of botulinum toxin treatments. METHODS: In a double-blind, placebo-controlled, crossover pilot study, we examined the efficacy of three botulinum toxin preparations (onabotulinumtoxinA, abobotulinumtoxinA, and rimabotulinumtoxinB) following oral supplementation with zinc citrate 50 mg and phytase 3,000 PU, zinc gluconate 10 mg, or lactulose placebo in individuals treated for cosmetic facial rhytids, benign essential blepharospasm, and hemifacial spasm. RESULTS: In seventy-seven patients, 92% of subjects supplemented with zinc 50 mg and phytase experienced an average increase in toxin effect duration of nearly 30%, and 84% of participants reported a subjective increase in toxin effect, whereas no significant increase in duration or effect was reported by patients following supplementation with lactulose placebo or 10 mg of zinc gluconate. The dramatic impact of the zinc/phytase supplementation on some patients' lives clinically unmasked the study and prompted an early termination. CONCLUSIONS: This study suggests a potentially meaningful role for zinc and/or phytase supplementation in increasing the degree and duration of botulinum toxin effect in the treatment of cosmetic facial rhytids, benign essential blepharospasm, and hemifacial spasm.

The subtarsal incision: where should it be placed?

PURPOSE: The subtarsal incision is a frequently used approach to orbital floor fractures. Compared with the subciliary incision, there is a lower rate of lower lid retraction. Unlike the transconjunctival incision, there is no need to perform a lateral canthoplasty to restore canthal integrity. Despite its widespread use, the exact location of the subtarsal incision is not uniform among surgeons. MATERIALS AND METHODS: Twenty patients underwent open reduction and internal fixation of orbital floor fractures by a single surgeon over a 4-month period, using the subtarsal incision. Postoperative photographs of the first 7 consecutive patients were analyzed by 4 nonmedical personnel and 4 plastic surgeons regarding scar visibility. Pearson correlation coefficients were calculated to determine if a correlation existed between more inferior placement of the scar and scar visibility. RESULTS: No patients in the series developed any complications such as lower lid retraction or enophthalmos. One patient developed transient facial palsy. The results of the survey showed a positive correlation between distance from lash line to scar and scar visibility at the level of the lateral limbus (Pearson r coefficient, 0.73) and at the level of the lateral canthal angle (Pearson r coefficient, 0.65). CONCLUSIONS: The results of this study indicate that the optimal placement of the subtarsal incision is as close as possible to the inferior border of the tarsal plate. The incision should be placed within an existing skin crease, if possible, and should be made with the knowledge that the more inferior the incision is placed, the greater the visualization of the fracture, but the more visible the scar.

Insurance but not race is associated with diverticulitis mortality in a statewide database.

OBJECTIVES: Racial identity and health insurance have been associated with differential health care outcomes for many diseases, but not for diverticulitis. We examined the association of racial identity and insurance with admission, treatment, and mortality for patients admitted to inpatient care for acute diverticulitis. METHODS: Data on adult inpatients with nonelective diverticulitis admissions between 1985 and 2006 were extracted from the New York Statewide Planning and Cooperative Systems Database. Race categories were white non-Hispanic, black non-Hispanic, Hispanic, Asian, other race, and unknown race. A multivariable logistic regression model adjusted for insurance, year, patient factors, community factors, and hospital factors was used to examine the association of racial identity and insurance with presentation, treatment, and mortality. Five outcomes were considered: 1) admission via the emergency department, 2) complicated disease presentation, 3) surgical intervention, 4) colostomy creation, and 5) mortality. White race and private insurance were reference groups. RESULTS: We identified 253,655 admissions. Race distribution included 77.7% white, 8.1% black, and 7.2% Hispanic. Medicare was the most commonly held insurance (52.7%), and 73.7% of patients were admitted through the emergency department. Of 36,190 surgeries, 20,650 (57.1%) included colostomies, and 3.0% of all patients died. Race other than white and Medicaid insurance were the strongest predictors of admission via the emergency department (OR 1.34, 95% CI 1.12-1.60; OR 1.60, 95% CI 1.44-1.78). Patients categorized as black, Hispanic, Asian, or other were less likely to have complicated disease, surgery, and colostomy creation (OR 0.81, 95% CI 0.76-0.85; OR 0.87, 95% CI 0.81-0.94; and OR 0.67, 95% CI 0.61-0.74). Insurance was associated with higher rates of mortality; having Medicaid or no insurance were the strongest predictors (OR 1.61, 95% CI 1.36-1.89; OR 1.34, 95% CI 1.06-1.69). CONCLUSIONS: In acute diverticulitis, race and insurance were associated with differential admission patterns, and patients categorized as black, Hispanic, Asian, or other were less likely to receive surgical treatment or colostomy. Insurance status, but not race, was associated with mortality. Future research is needed to further explore these differences in admission, treatment, and mortality.

Contemporary techniques in inferior turbinate reduction: survey results of the American Society for Aesthetic Plastic Surgery.

BACKGROUND: Nasal airway obstruction is a frequently-encountered problem, often secondary to inferior turbinate hypertrophy. Medical treatment can be beneficial but is inadequate for many individuals. For these refractory cases, surgical intervention plays a key role in management. OBJECTIVE: The authors evaluate the current trends in surgical management of inferior turbinate hypertrophy and review the senior author's (SS) preferred technique. METHODS: A questionnaire was devised and sent to members of the American Society for Aesthetic Plastic Surgery (ASAPS) to determine their preferred methods for assessment and treatment of inferior turbinate hypertrophy. RESULTS: One hundred and twenty-seven physicians responded to the survey, with 85% of surveys completed fully. Of the responses, 117 (92%) respondents were trained solely in plastic surgery and 108 (86.4%) were in private practice. Roughly 81.6% of respondents employ a clinical exam alone to evaluate for airway issues. The most commonly-preferred techniques to treat inferior turbinate hypertrophy were a limited turbinate excision (61.9%) and turbinate outfracture (35.2%). CONCLUSIONS: Based on the results of this study, it appears that limited turbinate excision and turbinate outfracture are the most commonly-used techniques in private practice by plastic surgeons. Newer techniques such as radiofrequency coblation have yet to become prevalent in terms of application, despite their current prevalence within the medical literature. The optimal method of management for inferior turbinate reduction should take into consideration the surgeon's skill and preference, access to surgical instruments, mode of anesthesia, and the current literature.

Breast implant infections: is cefazolin enough?

BACKGROUND: Bacterial infection is a well-known risk of breast implant surgery, occurring in 2.0 to 2.5 percent of cosmetic cases and up to 20 percent of reconstructive cases. The Centers for Disease Control and Prevention recommends a first-generation cephalosporin for perioperative prophylaxis; however, no guidelines exist for the empiric treatment of established breast implant infections. A recent increase in methicillin-resistant Staphylococcus aureus infections has prompted interest in using alternative antibiotics with anti-methicillin-resistant S. aureus activity for both prophylactic and empiric therapy. The goal of the present study was to assess the bacteriology and antibiotic susceptibility of breast implant-related infections at two tertiary care hospitals in the Texas Medical Center to determine whether a baseline for empiric therapy for breast implant infections could be established. METHODS: A retrospective review of patients who developed periprosthetic infections within 1 month after breast implant placement between 2001 and 2006 was completed. One hundred six patients with 116 infected breasts were identified. Patients were included in the study only if they had documented culture data. RESULTS: Thirty-one breasts in 26 patients met inclusion criteria. Sixty-seven percent of the infected breasts had S. aureus infections; of these, 68 percent were methicillin-resistant S. aureus infections and 32 percent were methicillin-susceptible S. aureus infections. We noted Gram-negative rods and sterile cultures in 6 percent and 26 percent of breasts, respectively. CONCLUSIONS: Because of the high incidence of methicillin-resistant S. aureus infections in breast implant recipients, we believe that choosing an antibiotic with anti-methicillin-resistant S. aureus activity is justified for empiric treatment of breast implant infections, until culture and sensitivity data, if obtained, become available.

Pearls of mandibular trauma management.

Mandibular trauma is a common problem seen by plastic surgeons. When fractures occur, they have the ability to affect the patient's occlusion significantly, cause infection, and lead to considerable pain. Interventions to prevent these sequelae require either closed or open forms of reduction and fixation. Physicians determining how to manage these injuries should take into consideration the nature of the injury, background information regarding the patient's health, and the patient's comorbidities. Whereas general principles guide the management of the majority of injuries, special consideration must be paid to the edentulous patient, complex and comminuted fractures, and pediatric patients. These topics are discussed in this article, with a special emphasis on pearls of mandibular trauma management.

Mycobacterium abscessus infection after breast augmentation: a case of contaminated implants?

Infections after breast augmentation are uncommon, occurring in 1-3% of cases. Treatment often requires additional surgeries and may yield a sub-optimal cosmetic result. For this reason, post implant infection remains a serious concern among plastic surgeons. A 48-year-old female presented to our clinic with bilateral breast implant infections 3 months after primary augmentation in China. Cultures grew Mycobacterium abscessus, a previously undescribed infectious aetiology after breast augmentation. The fastidious nature of the organism often results in a negative acid fast stain and initially sterile cultures. For these reasons, clinical signs of infection in the face of sterile cultures should raise suspicion of Mycobacterium infection among clinicians. While the overall incidence of Mycobacterium infection after breast augmentation is low, it remains an important and often overlooked aetiology for patients with a lack of systemic symptoms and initial sterile cultures.

Nonsynostotic occipital plagiocephaly: radiographic diagnosis of the "sticky suture".

BACKGROUND: While the clinical differences between nonsynostotic occipital plagiocephaly and lambdoid craniosynostosis have been described, the radiographic differentiation between the two remains obscure. The aim of this study was to characterize morphological differences in the lambdoid suture between nonsynostotic occipital plagiocephaly and lambdoid craniosynostosis. METHODS: Computed tomography scans of children clinically diagnosed with nonsynostotic occipital plagiocephaly (n = 26) were compared with computed tomography scans from children diagnosed with lambdoid craniosynostosis (n = 7). Suture and cranial morphology, ear position, and endocranial base angles were qualitatively and quantitatively compared. RESULTS: Nonsynostotic occipital plagiocephaly sutures demonstrated areas of focal fusion (25 percent), endocranial ridging (78 percent), narrowing (59 percent), sclerosis (19 percent), and changes from overlapping to end-to-end orientation (100 percent). No sutures demonstrated ectocranial ridging. All cases of nonsynostotic occipital plagiocephaly presented with ipsilateral occipital flattening, 85 percent with ipsilateral frontal, and 95 percent with contralateral occipital bossing producing parallelogram morphology. In contrast, a greater frequency of sutures in lambdoid craniosynostosis patients demonstrated nearly complete obliteration (p < 0.001) with ectocranial ridging (p < 0.001); significantly more of these patients presented with ipsilateral occipital flattening with compensatory ipsilateral mastoid (p < 0.001) and contralateral parietal (p < 0.01) bossing, producing a trapezoid morphology. Sutures from nonsynostotic occipital plagiocephaly patients showed endocranial ridging, focal fusions, and narrowing, previously reported as lambdoid craniosynostosis. CONCLUSIONS: In contradiction to previous reports, lambdoid craniosynostosis is not radiographically unique among suture fusions. This work establishes the radiographic diagnosis of nonsynostotic occipital plagiocephaly.