Influence of Large-Volume Liposuction on Metabolic and Cardiovascular Health: A Systematic Review.

BACKGROUND: Evidence suggesting that adipose tissue is a metabolically active tissue has generated debate on the effects of large-volume liposuction (LVL) on metabolic and cardiovascular health. Given the inconsistency in the literature, the authors performed a systematic review to identify available evidence in order to elucidate the potential impact of LVL on metabolic markers and cardiovascular risk factors. METHODS: A PubMed search using relevant keywords was conducted. Articles were screened using predetermined inclusion and exclusion criteria. Large-volume liposuction was defined as greater than 3.5 L of lipoaspirate. All studies included evaluation of patients' preoperative and postoperative cardiovascular risk factors, inflammatory cytokines, and/or insulin resistance/sensitivity. Relevant studies were evaluated and assigned a level of evidence. RESULTS: A total of 12 studies that met the inclusion criteria were reviewed, of which 1 was a continuation of a previous study. All reports were prospective studies, 2 were randomized control trials, and 3 included a control group. A total of 364 patients were pooled for analysis. The mean volume of lipoaspirate was 7440 ± 1934.9 mL. The mean body mass index at baseline and postliposuction was 30.7 and 28.4, respectively. Seven studies reported a trend toward decrease in total cholesterol levels with an overall mean reduction of 0.21 ± 0.05 mmol/L from 4.6 ± 0.79 mmol/L to 4.4 ± 0.74 mmol/L. After LVL, leptin was reported to significantly decrease in 4 studies, and TNF-α was reported to significantly decrease in 2. Adiponectin was reported to significantly increase in 2 studies. IL-6 decreased significantly in 2 studies. Two studies included participants with type II diabetes mellitus, whereas 10 studies evaluated insulin sensitivity. Of these, 6 studies reported improvement in insulin sensitivity. Six studies represented level IV and 6 represented level II evidence. CONCLUSIONS: Liposuction is among the most common aesthetic procedures performed with advances that make it possible to remove considerable amount of adipose tissue within a short period. Current data, although conflicting, appear to support the notion that LVL can affect cardiovascular risk factors, metabolic balance, and insulin resistance in positive ways. Future research with prospective studies is needed to clarify the role of LVL in improving overall health.

A Closer Look at the 2013 to 2014 Integrated Plastic Surgery Match.

BACKGROUND: Plastic surgery has become an increasingly competitive, yet limited information is available in the literature on successfully matched plastic surgery applicants. The goal of this study was to analyze which factors predicted a successful National Residency Match Program match during the 2013 to 2014 cycle. METHODS: An electronic questionnaire was distributed to successfully matched medical students in plastic surgery. Information obtained included (1) academic performance, (2) medical school criteria, (3) visiting subinternship rotation criteria, and (4) research performance. Match "success" was defined as matching into one of the applicant's top three ranked programs RESULTS: Data were available for 127 matched students. Average Step 1 score was 247.93 (95 percent CI, 244.3 to 251.56). Step 1 scores correlated with the number of interviews received (r(2) = 0.355; p = 0.039). An odds ratio of 2.2 was observed for residents who had a plastic surgery residency program affiliated with their medical school and match success. Step 1 score (r(2) = 0.045; p = 0.798), Step 2 score (r(2) = 0.131; p = 0.505), Alpha Omega Alpha membership (r(2) = 0.011; p = 0.905), and number of publications (r(2) = 0.121; p = 0.458) did not correlate significantly with match success. CONCLUSIONS: Successful applicants had a Step 1 score that was 1 SD greater than the U.S. mean. Having a plastic surgery residency program affiliated with an applicant's medical school was an important predictor of match success. Objective measures (step scores, Alpha Omega Alpha membership, and number of publications) were not predictive of match success.

Ten-year experience of more than 35,000 orofacial clefts in Africa.

BACKGROUND: Surgical correction of orofacial clefts greatly mitigates negative outcomes. However, access to reconstructive surgery is limited in developing countries. The present study reviews epidemiological data from a single charitable organization, Smile Train, with a database of surgical cases from 33 African countries from 2001-2011. METHODS: Demographic and clinical patient data were collected from questionnaires completed by the participating surgeons. These data were recorded in Excel, analyzed using SPSS and compared with previously reported data. RESULTS: Questionnaires were completed for 36,384 patients by 389 African surgeons. The distribution of clefts was: 34.44% clefts of the lip (CL), 58.87% clefts of the lip and palate (CLP), and 6.69% clefts of the palate only (CP). The male to female ratio was 1.46:1, and the unilateral: bilateral ratio 2.93:1, with left-sided predominance 1.69:1. Associated anomalies were found in 4.18% of patients. The most frequent surgeries included primary lip/nose repairs, unilateral (68.36%) and bilateral (11.84%). There was seasonal variation in the frequency of oral cleft births with the highest in January and lowest by December. The average age at surgery was 9.34 years and increased in countries with lower gross domestic products. The average hospital stay was 4.5 days. The reported complication rate was 1.92%. CONCLUSIONS: With the exception of cleft palates, results follow trends of worldwide epidemiologic reports of 25% CL, 50% CLP, and 25% CP, 2:1 unilateral:bilateral and left:right ratios, and male predominance. Fewer than expected patients, especially females, presented with isolated cleft palates, suggesting that limitations in economic resources and cultural aesthetics of the obvious lip deformity may outweigh functional concerns and access to treatment for females. A fewer than expected associated anomalies suggests either true ethnic variation, or that more severely-affected patients are not presenting for treatment. The epidemiology of orofacial clefting in Africa has been difficult to assess due to the diversity of the continent and the considerable variation among study designs. The large sample size of the data collected provides a basis for further study of the epidemiology of orofacial clefting in Africa.

Oral clefting in china over the last decade: 205,679 patients.

BACKGROUND: China is the most populated country and has one of the highest prevalences of oral clefting. The present study reports the epidemiology and surgical procedures performed on the largest reported cohort of individuals with clefting in China. METHODS: A retrospective review of patients who received cleft repair through Smile Train in China from 2000 to 2011 was conducted. Data on demographics, cleft characteristics, associated malformations, pregnancy and family history, and surgical technique were analyzed using SPSS (IBM, Chicago, Ill.). RESULTS: A total of 205,679 patients underwent 209,169 cleft procedures. Cleft lip and palate (42.7%) was most common followed by isolated cleft palate (32.4%) and isolated cleft lip (24.9%). Males accounted for 63.5% of cases. The average age at initial surgery was 6.12 years. By 2011, this decreased to 1.8 years of age for lip repair and to 5.9 years of age for palate repair. The preferred techniques were rotation-advancement (55%) for unilateral lip repair and Von-Langenbeck (38%) and pushback (39%) for palate repair. The percentages of cases with associated anomalies and surgical complications were 12.8% and 0.36%, respectively. CONCLUSIONS: This study provides insight into cleft care in China as it reports the largest cohort of cleft patients treated by surgeons to date. Our results generally follow trends previously reported in China and developed countries. The male:female ratio for cleft palate patients was higher than expected. The average age at primary repair is higher than recommended, but seems to be decreasing.

Cleft lip and/or palate: one organization's experience with more than a quarter million surgeries during the past decade.

BACKGROUND: A charitable surgical relief organization (Smile Train) enables local physicians in developing countries to provide surgical treatment of cleft lip and/or palate. The following study reviews the epidemiological data from more than 260,000 surgeries performed in India through this organization from 2000 until January 1, 2012. METHODS: Demographic and clinical patient data were collected from the participating surgeons, recorded in Excel (Microsoft, Redmond, WA), and analyzed using Software Package for the Social Sciences (IBM, Armonk, NY). RESULTS: The distribution of clefts treated was 20.2% of cleft lip, 13.9% of cleft palate (CP), and 65.9% of cleft lip and palate. The overall unilateral-bilateral ratio was 2.49:1 with a left-right ratio of 2.03:1. The male-female ratio was 1.58:1. Of the total patients, 2.67% had associated anomalies. The most frequently performed surgeries included primary repair of a unilateral cleft lip (41.62%), followed by primary repair of a CP (31.15%). The mean age at surgery was 7.91 years. The reported complication rate was 0.88%. CONCLUSIONS: The data collected are from the largest reported cohort of orofacial cleft patients in India. The cleft type, sex distribution, and overall male predominance resemble previously reported distributions; however, fewer CP patients and greater cleft lip and palate patients presented than would be expected. The frequency of associated anomalies was lower than in previous reports. Although there is significant selection bias to milder cases from lower socioeconomic groups in this study, the large sample size is unique, and the data collected can provide a valuable framework to further study the epidemiology of cleft lip and/or palate in India.