Efficacy of Vascularized Submental Lymph Node Transfer with Decongestive Therapy and Antibiotics for Early-Stage Lower Limb Filarial Lymphedema.

BACKGROUND: Filarial lymphedema (FLE) is the most common cause of secondary lymphedema, with endemic prevalence in developing countries. FLE traditionally has been managed with antibiotics and decongestive therapy (DCT) in the early stage or excisional surgery at the late stage. Results of vascularized lymph node transfer (VLNT) in postoncologic lymphedema have been encouraging, and VLNT is a widely accepted surgical treatment. The authors advocate that the combined treatment of antibiotics, DCT, and vascularized submental lymph node (VSLN) transfer could produce objective and subjective improvement of early-stage lower limb FLE. METHODS: Between January of 2019 and January of 2020, patients with early-stage lower-limb FLE who underwent VLNT were retrospectively reviewed. VLNT was harvested from the submental region in all patients. Outcomes were assessed using volume improvement, frequency of cellulitis, and lymphoscintigraphy, along with subjective scoring questionnaire. RESULTS: Three men and one woman with an average age of 27 years (range, 25 to 29 years) were included. Two patients presented bilateral lymphedema. One patient was lost at 3-month follow-up and not included in the analysis. Patients showed an initial decrease in circumferential measurements after antibiotics and DCT of 2074 ± 471 cc (39% ± 9%). At a mean follow-up of 12.3 ± 6.2 months, further improvement of limb volume of 2389 ± 576 cc (45% ± 10%) was achieved following VSLN transfer. Lymphoscintigraphy demonstrated dye uptake by the VLNT with reduced dermal backflow and none of the patients had episodes of postoperative cellulitis. Patients reported excellent outcome on subjective scoring (average score, 9 ± 1) and returned to their daily activities without wearing compression garments. CONCLUSION: The authors' early experience showed that VSLN transfer may represent an effective treatment option in the multimodal approach to early-stage lower limb FLE.

circMbl functions in cis and in trans to regulate gene expression and physiology in a tissue-specific fashion.

Muscleblind (mbl) is an essential muscle and neuronal splicing regulator. Mbl hosts multiple circular RNAs (circRNAs), including circMbl, which is conserved from flies to humans. Here, we show that mbl-derived circRNAs are key regulators of MBL by cis- and trans-acting mechanisms. By generating fly lines to specifically modulate the levels of all mbl RNA isoforms, including circMbl, we demonstrate that the two major mbl protein isoforms, MBL-O/P and MBL-C, buffer their own levels by producing different types of circRNA isoforms in the eye and fly brain, respectively. Moreover, we show that circMbl has unique functions in trans, as knockdown of circMbl results in specific morphological and physiological phenotypes. In addition, depletion of MBL-C or circMbl results in opposite behavioral phenotypes, showing that they also regulate each other in trans. Together, our results illuminate key aspects of mbl regulation and uncover cis and trans functions of circMbl in vivo.

Polyacrylamide hydrogel injection in the management of human immunodeficiency virus-related facial lipoatrophy: a 2-year clinical experience.

BACKGROUND: Facial lipoatrophy is defined as the reduction in buccal and orbital fat pads along with a more global loss of fat within the subcutaneous tissue. It is the most common and distressing sign of human immunodeficiency virus-associated lipodystrophy. Injectable polyacrylamide hydrogel (Aquamid) is a synthetic nonbiodegradable polymer consisting of a minor backbone of 2.5 percent cross-linked polyacrylamide and 97.5 percent nonpyrogenic water and is used for cosmetic facial contour correction. Favorable results with maximum aesthetic gains with the use of polyacrylamide hydrogel for reconstruction of facial lipoatrophy on the face in significantly immunocompromised individuals are being reported. These results are attributable to its use in limited volume injected at multiple sites and in multiple sittings. METHODS: Aquamid has been used for the correction of severe nasolabial folds and mid and lower facial volume loss in patients affected by human immunodeficiency virus-associated lipodystrophy. Fifty patients were enrolled and treated, with a mean follow-up of 13.1 months. Results were evaluated clinically, by standardized ultrasonography, and by psychological tests (visual analogue scale, Beck Depression Inventory, and Assessment of Body Change and Distress questionnaire) to quantify patient satisfaction. RESULTS: No significant side effects or issues such as swelling, infections, allergies, or nodule formation were noted over the follow-up period. CONCLUSION: Aquamid has provided a minimally invasive, effective, long-lasting facial contour correction that significantly improves the quality of life in human immunodeficiency virus-infected patients.

An absolute vascular milieu for primary bone graft in aesthetic nasal reconstruction.

Restoration of a composite nasal defect with an aesthetically acceptable vascularized full-thickness soft tissue cover and a primary bone graft in a surgically unscarred area at the same stage requires that the flap have a complete formal inset from all the sides, for enhancement of the milieu interior. This article addresses such a situation, which required the use of a cantilever bone graft simultaneously with an interpolated midline forehead flap based on the supratrochlear vessel and transferred on a deepithelialized bridge segment, which allowed an absolute inset from all the sides. The eventual aesthetic outcome was satisfactory after a secondary surgery for nasal tip correction using conchal cartilage graft for tip framework. The procedure has allowed placement of the bone graft in an unscarred bed, with a complete inset of the vascularized full-thickness soft tissue cover. This provided the graft with the ideal vascular milieu for survival and consolidation and achieved an aesthetically acceptable soft tissue reconstruction of the nose with minimal donor-site morbidity. It obviated the need for the staged procedures and provided a secure vascular milieu for the primary bone graft.