Ultrasound-Assisted Liposuction for Top Surgery in Transgender Men: Clinical Experience and Evaluation of Satisfaction and Quality of Life with TRANS-Q and BREAST-Q.

BACKGROUND: During the last decade, the demand for top surgery in female-to-male transgender (FMT) has increased worldwide. This study aims to present our initial experience with the novel use of ultrasound-assisted liposuction (UAL) in top surgery. Additionally, we evaluate the satisfaction and quality of life with TRANS-Q and BREAST-Q. METHODS: We conducted a retrospective study analyzing FMT undergoing UAL in top surgery from 2019 to 2021 at a single institution. We analyzed demographic variables, comorbidities, surgical techniques, operative time, complications, and follow-up time. We used TRANS-Q and BREAST-Q to evaluate patient-reported outcomes. A p value < 0.05 was considered significant. RESULTS: We performed 34 UAL combined subcutaneous mastectomies in 17 patients. Twelve patients (70.6%) underwent mastectomy double incision with free nipple grafting (DIFNG), and 29.4% underwent concentric circular mastectomy. In the DIFNG group, BMI (p < 0.02), the weight of each mammary gland (p < 0.001), and use of chest binder (p < 0.03) were significantly higher. The mean operative time was 115 min. The complication rate was 11.7% (one hematoma and three hypertrophic scars). The mean follow-up was 29.4 months, and no aesthetic revision surgeries was reported. The response rate for TRANS-Q and BREAST-Q was 76.5%, and high satisfaction with the results and significant improvement in quality of life were reported. CONCLUSIONS: We present the first cohort of transgender men who underwent UAL in top surgery. With proper training, the use of UAL could be a feasible and safe technique, offering good long-term esthetic results. Additionally, TRANS-Q and BREAST-Q demonstrated improved satisfaction and quality of life. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Differential Exudation Creates Biogeochemically Distinct Microenvironments during Rhizosphere Evolution.

Plant roots and associated microbes release a diverse range of functionally distinct exudates into the surrounding rhizosphere with direct impacts on soil carbon storage, nutrient availability, and contaminant dynamics. Yet mechanistic linkages between root exudation and emergent biogeochemical processes remain challenging to measure nondestructively, in real soil, over time. Here we used a novel combination of in situ microsensors with high-resolution mass spectrometry to measure, nondestructively, changing exudation and associated biogeochemical dynamics along single growing plant roots (Avena sativa). We found that metabolite and dissolved organic carbon (DOC) concentrations as well as microbial growth, redox potential (EH), and pH dynamics vary significantly among bulk soil, root tip, and more mature root zones. Surprisingly, the significant spike of rhizosphere DOC upon root tip emergence did not significantly correlate with any biogeochemical parameters. However, the presence of sugars significantly correlated with declines in EH following the arrival of the root tip, likely due to enhanced microbial oxygen demand. Similarly, the presence of organic acids significantly correlated to declines in pH upon root tip emergence. Overall, our in situ measurements highlight how different exudates released along growing roots create functionally distinct soil microenvironments that evolve over time.

The ATTO 565 Dye and Its Applications in Microscopy.

ATTO 565, a Rhodamine-type dye, has garnered significant attention due to its remarkable optical properties, such as a high fluorescence quantum yield, and the fact that it is a relatively stable structure and has low biotoxicity. ATTO 565 has found extensive applications in combination with microscopy technology. In this review, the chemical and optical properties of ATTO 565 are introduced, along with the principles behind them. The functionality of ATTO 565 in confocal microscopy, stimulated emission depletion (STED) microscopy, single-molecule tracking (SMT) techniques, two-photon excitation-stimulated emission depletion microscopy (TPE-STED) and fluorescence correlation spectroscopy (FCS) is discussed. These studies demonstrate that ATTO 565 plays a crucial role in areas such as biological imaging and single-molecule localization, thus warranting further in-depth investigations. Finally, we present some prospects and concepts for the future applications of ATTO 565 in the fields of biocompatibility and metal ion detection. This review does not include theoretical calculations for the ATTO 565 molecule.

Evaluation of magnetic resonance imaging derived synthetic computed tomography for proton therapy planning in prostate cancer.

Background and purpose: Magnetic resonance imaging (MRI)-only workflow is used in photon radiotherapy (RT) today, but not yet for protons. To bring MRI-only proton RT into clinical use, proton dose calculation on MRI-derived synthetic CT (sCT) must be validated. We evaluated proton dose calculation accuracy of prostate cancer proton plans using a commercially available sCT generator already validated for photon planning. Materials and methods: The retrospective planning study included 10 prostate cancer patients who underwent MRI and planning CT (pCT) before RT. sCT were generated from the MRI with MRI Planner v2.3, and compared to pCT using structural mean absolute error (MAE). The pCT was used to create one-arc volumetric modulated arc therapy (VMAT) photon plan and two-field intensity modulated proton therapy (IMPT) proton plan. Each plan was recalculated on the sCT and compared to pCT doses. Dose volume histogram parameters, gamma analyses and range differences were evaluated. Results: Median MAE for the body contour was 71 HU. Dose differences between pCT and sCT were small and similar for VMAT and IMPT plans. Median (range) gamma pass rates were lower for IMPT plans with 95.8 (89.3-98.7) % compared to VMAT plans with 99.4 (91.2-99.6) %. The proton range difference was 1.0 (interquartile range -0.1 - 0.2) mm deeper for sCT compared to the reference. Conclusion: MRI-only IMPT planning for prostate cancer seems feasible in a clinical setting for the evaluated beam arrangement and sCT generator. More patients and evaluation of other beam arrangements are needed for a more general conclusion.

Decreasing Patient Visit Length at a Student-Run Free Clinic via a Continuous Quality Improvement Project.

INTRODUCTION: The University of Florida Equal Access Clinic Network (EACN) is the largest student-run free clinic (SRFC) network in Florida. This student-driven, continuous quality improvement (CQI) project is intended to decrease total patient visit length at Eastside clinic, one of EACN's primary care sites. The original median visit length of 126.25 minutes represented a significant time burden for patients, especially those with limited transportation or inflexible schedules. METHODS: Over six months, four Plan-Do-Study-Act (PDSA) cycles were implemented. PDSA cycle 1 increased personnel and space for taking vitals. PDSA cycle 2 reduced redundancy in the intake process. PDSA cycle 3 triaged patients to match patient complexity with student experience level. PDSA cycle 4 introduced "nudge" interventions to reinforce clinic flow. Total patient visit length and time spent at each step of clinic flow were recorded anonymously for each patient visit. The median visit length per week was tracked on a run chart. RESULTS: From PDSA cycle 1 through PDSA cycle 4, the median visit length decreased from 126 minutes to 114 minutes. This shift was primarily driven by a decrease in the length of patient intake from a median of 19 minutes to 9 minutes. The run chart did not show clear trends until PDSA cycle 4, which demonstrated a strong downward trend. CONCLUSION: This study demonstrated the ability of a student-driven CQI model to decrease patient visit length in an SRFC setting. Similar models could be used to address this and other contributors to patient experience across SRFCs nationwide.

Spin States Matter─from Fundamentals toward Synthetic Methodology Development and Drug Discovery.

ConspectusThe potent reactivity of carbenes and nitrenes has been traditionally harnessed by the employment of a transition-metal catalyst in which the reactivity of the metal carbene/nitrene intermediates can be controlled via the judicious tuning of the metal catalyst. In recent years, progress made in this research area has unveiled novel strategies to directly access free carbenes or nitrenes under visible-light-mediated conditions without the necessity of a metal catalyst for stabilization of the carbene/nitrene intermediate. Such photochemical approaches present new opportunities to leverage orthogonal reactions with classic metal-catalyzed transformations.In this Account, we describe the major contributions from our group over the past years pushing the boundaries of light-mediated carbene and nitrene transfer reactions. In the first section, the development from purely singlet carbene chemistry toward methods that allow access to triplet carbene intermediates will be dissected. We describe how the triplet spin state of reagents provides a rich array of novel synthetic methods that build on the fundamentals of spin conservation. We lay out the different strategies in accessing the triplet spin state of carbenes (i.e., via electronic stabilization, via triplet sensitization with suitable photocatalysts, or via exploitation of geometric features of these intermediates), followed by an analysis of how the triplet spin state can be employed to leverage reactions distinct to the classic singlet carbene chemistry.The second part focuses on free nitrene intermediates, whereby both photochemical and photocatalytic strategies are analyzed and compared. We initiate with a discussion of the reactivity of iminoiodinanes as nitrene precursors in the presence of a photocatalyst or under photochemical conditions and how these two approaches result in fundamentally distinct nitrogen-based intermediates. While a nitrene radical anion is formed under photocatalytic conditions, triplet nitrene is generated under photochemical conditions. We commence with an outline of the basic reactivity of nitrene transfer reactions under both conditions, with a focus on the reaction with substrates containing double bonds. Finally, the latest developments in advanced cycloaddition chemistry beyond classic aziridination reactions are examined, with a special emphasis on the relay of the triplet nitrene reactivity to enable a Pauson-Khand-like (2 + 2 + 1) cycloaddition reaction that offers convenient access to high value bioisosteres in drug discovery.The work from our group on spin-dependent reactivities offers insight into important fundamentals in synthesis, where the spin state of the reactive intermediate will dictate the reaction outcome. We hope this may inspire others to widen the scope of applications of light-mediated carbene and/or nitrene transfer reactions, and furthermore, we anticipate that these understandings may also enable the development of advanced catalytic systems featuring triplet metal carbene/nitrene intermediates.

On the glow of cremated remains: long-lived green photo-luminescence of heat-treated human bones.

The long-lived green luminescence of human bone (that has been heated to 600 °C for a short duration) is attributed to a carbon quantum dot material (derived from collagen) encapsulated and protected by an inorganic matrix (derived from bone apatite) and is more intense in dense rigid and crystalline parts of (healthy) human bones. The strong collagen-apatite interaction results (upon decomposition) in a protective inorganic environment of the luminescent centers allowing long-lived triplet-based emission of a carbon (quantum) dot-like material at room temperature, as well as resilience against oxidation between 550 and 650 °C. The graphitic black phase (obtained upon heating around 400 °C) is a precursor to the luminescent carbon-based material, that is strongly interacting with the crystalline inorganic matrix. Human bone samples that have been heated to 600 °C were subjected to steady-state and time-resolved spectroscopy. Excitation-emission matrix (EEM) luminescence spectroscopy revealed a broad range of excitation and emission wavelengths, indicating a heterogeneous system with a broad density of emissive states. The effect of low temperature on the heat-treated bone was studied with Cryogenic Steady State Luminescence Spectroscopy. Cooling the bone to 80 K leads to a slight increase in total emission intensity as well as an intensity increase towards to red part of the spectrum, incompatible with a defect state model displaying luminescent charge recombination in the inorganic matrix. Time-resolved spectroscopy with an Optical Multichannel Analyzer (OMA) and Time Correlated Single Photon Counting (TCSPC) of these samples showed that the decay could be fitted with a multi-exponential decay model as well as with second-order decay kinetics. Confocal Microscopy revealed distinct (plywood type) structures in the bone and high intensity-fast decay areas as well as a spatially heterogeneous distribution of green and (fewer) red emissive species. The use of the ATTO 565 dye aided in bone-structure visualization by chemical adsorption. Conceptually our data interpretation corresponds to previous reports from the material science field on luminescent powders.

Enhancing stroke rehabilitation with whole-hand haptic rendering: development and clinical usability evaluation of a novel upper-limb rehabilitation device.

INTRODUCTION: There is currently a lack of easy-to-use and effective robotic devices for upper-limb rehabilitation after stroke. Importantly, most current systems lack the provision of somatosensory information that is congruent with the virtual training task. This paper introduces a novel haptic robotic system designed for upper-limb rehabilitation, focusing on enhancing sensorimotor rehabilitation through comprehensive haptic rendering. METHODS: We developed a novel haptic rehabilitation device with a unique combination of degrees of freedom that allows the virtual training of functional reach and grasp tasks, where we use a physics engine-based haptic rendering method to render whole-hand interactions between the patients' hands and virtual tangible objects. To evaluate the feasibility of our system, we performed a clinical mixed-method usability study with seven patients and seven therapists working in neurorehabilitation. We employed standardized questionnaires to gather quantitative data and performed semi-structured interviews with all participants to gain qualitative insights into the perceived usability and usefulness of our technological solution. RESULTS: The device demonstrated ease of use and adaptability to various hand sizes without extensive setup. Therapists and patients reported high satisfaction levels, with the system facilitating engaging and meaningful rehabilitation exercises. Participants provided notably positive feedback, particularly emphasizing the system's available degrees of freedom and its haptic rendering capabilities. Therapists expressed confidence in the transferability of sensorimotor skills learned with our system to activities of daily living, although further investigation is needed to confirm this. CONCLUSION: The novel haptic robotic system effectively supports upper-limb rehabilitation post-stroke, offering high-fidelity haptic feedback and engaging training tasks. Its clinical usability, combined with positive feedback from both therapists and patients, underscores its potential to enhance robotic neurorehabilitation.

Common variants increase risk for congenital diaphragmatic hernia within the context of de novo variants.

Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly often accompanied by other structural anomalies and/or neurobehavioral manifestations. Rare de novo protein-coding variants and copy-number variations contribute to CDH in the population. However, most individuals with CDH remain genetically undiagnosed. Here, we perform integrated de novo and common-variant analyses using 1,469 CDH individuals, including 1,064 child-parent trios and 6,133 ancestry-matched, unaffected controls for the genome-wide association study. We identify candidate CDH variants in 15 genes, including eight novel genes, through deleterious de novo variants. We further identify two genomic loci contributing to CDH risk through common variants with similar effect sizes among Europeans and Latinx. Both loci are in putative transcriptional regulatory regions of developmental patterning genes. Estimated heritability in common variants is ∼19%. Strikingly, there is no significant difference in estimated polygenic risk scores between isolated and complex CDH or between individuals harboring deleterious de novo variants and individuals without these variants. The data support a polygenic model as part of the CDH genetic architecture.

Microbial iron limitation in the ocean's twilight zone.

Primary production in the sunlit surface ocean is regulated by the supply of key nutrients, primarily nitrate, phosphate and iron (Fe), required by phytoplankton to fix carbon dioxide into biomass1-3. Below the surface ocean, remineralization of sinking organic matter rapidly regenerates nutrients, and microbial metabolism in the upper mesopelagic 'twilight zone' (200-500 m) is thought to be limited by the delivery of labile organic carbon4,5. However, few studies have examined the role of nutrients in shaping microbial production in the mesopelagic6-8. Here we report the distribution and uptake of siderophores, biomarkers for microbial Fe deficiency9 across a meridional section of the eastern Pacific Ocean. Siderophore concentrations are high not only in chronically Fe-limited surface waters but also in the twilight zone underlying the North and South Pacific subtropical gyres, two key ecosystems for the marine carbon cycle. Our findings suggest that bacterial Fe deficiency owing to low Fe availability is probably characteristic of the twilight zone in several large ocean basins, greatly expanding the region of the marine water column in which nutrients limit microbial metabolism, with potential implications for ocean carbon storage.

Single-colony MALDI mass spectrometry imaging reveals spatial differences in metabolite abundance between natural and cultured Trichodesmium morphotypes.

Trichodesmium, a globally significant N2-fixing marine cyanobacterium, forms extensive surface blooms in nutrient-poor ocean regions. These blooms consist of a dynamic assemblage of Trichodesmium species that form distinct colony morphotypes and are inhabited by diverse microorganisms. Trichodesmium colony morphotypes vary in ecological niche, nutrient uptake, and organic molecule release, differentially impacting ocean carbon and nitrogen biogeochemical cycles. Here, we assessed the poorly studied spatial abundance of metabolites within and between three morphologically distinct Trichodesmium colonies collected from the Red Sea. We also compared these results with two morphotypes of the cultivable Trichodesmium strain IMS101. Using matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging (MSI) coupled with liquid extraction surface analysis (LESA) tandem mass spectrometry (MS2), we identified and localized a wide range of small metabolites associated with single-colony Trichodesmium morphotypes. Our untargeted MALDI-MSI approach revealed 80 unique features (metabolites) shared between Trichodesmium morphotypes. Discrimination analysis showed spatial variations in 57 shared metabolites, accounting for 62% of the observed variation between morphotypes. The greatest variations in metabolite abundance were observed between the cultured morphotypes compared to the natural colony morphotypes, suggesting substantial differences in metabolite production between the cultivable strain IMS101 and the naturally occurring colony morphotypes that the cultivable strain is meant to represent. This study highlights the variations in metabolite abundance between natural and cultured Trichodesmium morphotypes and provides valuable insights into metabolites common to morphologically distinct Trichodesmium colonies, offering a foundation for future targeted metabolomic investigations.IMPORTANCEThis work demonstrates that the application of spatial mass spectrometry imaging at single-colony resolution can successfully resolve metabolite differences between natural and cultured Trichodesmium morphotypes, shedding light on their distinct biochemical profiles. Understanding the morphological differences between Trichodesmium colonies is crucial because they impact nutrient uptake, organic molecule production, and carbon and nitrogen export, and subsequently influence ocean biogeochemical cycles. As such, our study serves as an important initial assessment of metabolite differences between distinct Trichodesmium colony types, identifying features that can serve as ideal candidates for future targeted metabolomic studies.

Venous thromboembolism after aesthetic surgeries in low-risk patients without hypercoagulability.

Venous thromboembolism (VTE) is a serious but rare complication of aesthetic surgery, with an incidence of 0.017% for liposuction and 0.01%-0.02% for augmentation mammoplasty. Despite the low incidence and appropriate patient selection, we present two cases of VTE in low-risk patients without hypercoagulability undergoing aesthetic procedures. In the first case, a 45-year-old woman with a history of anemia developed bilateral pulmonary embolism after ultrasound-assisted liposuction. In the second case, a 33-year-old woman with a history of oral contraceptive use developed deep vein thrombosis in the right upper extremity after augmentation mammoplasty. The patients were treated early and fully recovered after 12 months. This report highlights the importance of early diagnosis and treatment of VTE in aesthetic surgery, even in low-risk patients.

iNav-based, Automated Coronary Magnetic Resonance Angiography for the Detection of Coronary Artery Stenosis (iNav-AUTO CMRA).

BACKGROUND: Coronary computed tomography angiography (CCTA) is recommended as the first line diagnostic imaging modality in low to intermediate risk individuals suspected of stable coronary artery disease (CAD). However, CCTA exposes patients to ionising radiation and potentially nephrotoxic contrast agents. Invasive coronary angiography (ICA) is the gold-standard investigation to guide coronary revascularisation strategy, however, invasive procedures incur an inherent risk to the patient. Coronary magnetic resonance angiography (Coronary MRA) avoids these issues. Nevertheless, clinical implementation is currently limited due to extended scanning durations, inconsistent image quality, and consequent lack of diagnostic accuracy. Several technical Coronary MRA innovations including advanced respiratory motion correction with 100% scan efficiency (no data rejection), fast image acquisition with motion-corrected undersampled image reconstruction and deep-learning (DL)-based automated planning have been implemented and now await clinical validation in multi-centre trials. METHODS: The objective of the iNav-AUTO CMRA prospective multi-centre study is to evaluate the diagnostic accuracy of a newly developed, state-of-the-art, standardised, and automated Coronary MRA framework compared to CCTA in 230 patients undergoing clinical investigation for CAD. The study protocol mandates the administration of oral beta-blockers to decrease heart rate to below 60bpm and the use of sublingual nitroglycerine spray to induce vasodilation. Additionally, the study incorporates the utilisation of standardised postprocessing with sliding-thin-slab multiplanar reformatting, in combination with evaluation of the source images, to optimize the visualisation of coronary artery stenosis. DISCUSSION: If proven effective, Coronary MRA could provide a non-invasive, needle-free, yet also clinically viable, alternative to CCTA. TRIAL REGISTRATION: This study is registered at clinicaltrials.gov (NCT05473117).

Non-invasive in vivo imaging of changes in Collagen III turnover in myocardial fibrosis.

Heart failure (HF) affects 64 million people globally with enormous societal and healthcare costs. Myocardial fibrosis, characterised by changes in collagen content drives HF. Despite evidence that collagen type III (COL3) content changes during myocardial fibrosis, in vivo imaging of COL3 has not been achieved. Here, we discovered the first imaging probe that binds to COL3 with high affinity and specificity, by screening candidate peptide-based probes. Characterisation of the probe showed favourable magnetic and biodistribution properties. The probe's potential for in vivo molecular cardiac magnetic resonance imaging was evaluated in a murine model of myocardial infarction. Using the new probe, we were able to map and quantify, previously undetectable, spatiotemporal changes in COL3 after myocardial infarction and monitor response to treatment. This innovative probe provides a promising tool to non-invasively study the unexplored roles of COL3 in cardiac fibrosis and other cardiovascular conditions marked by changes in COL3.

Photochemical α-amination of carbonyl groups with iodinanes.

We report on a photochemical reaction of silyl enol ethers with iminoiodinanes. This aza Rubottom reaction provides a direct access towards α-amino carbonyl compounds under catalyst free reaction conditions with light as the sole source of energy. Control experiments suggest the participation of triplet nitrene intermediates.

Trends in Surgical and Nonsurgical Aesthetic Procedures: A 14-Year Analysis of the International Society of Aesthetic Plastic Surgery-ISAPS.

INTRODUCTION: As part of the International Society of Aesthetic Plastic Surgery, we present an analysis of our global aesthetic statistics, fulfilling the role of a worldwide organization of plastic surgeons with a clear mission to disseminate aesthetic education worldwide, promote patient safety, protect high ethical standards, and communicate. MATERIAL AND METHODS: A retrospective analysis of the ISAPS Global Aesthetic Statistics was conducted annually from 2010 to 2023. The design and analysis of each survey was carefully developed and validated by Industry Insights, Inc. prior to distribution. Participants were recruited using an anonymous online questionnaire that focused primarily on the number of surgical and nonsurgical procedures performed in the previous year, as well as questions related to surgeon demographics and the prevalence of medical tourism. ISAPS invited all physicians in their data base who were board-certified plastic surgeons or equivalent and suggested National Societies to encourage their members to participate. RESULTS: The latest survey reported a global increase in 3.4%, including 34.9 million surgical and nonsurgical aesthetic procedures performed by plastic surgeons in 2023. More than 15.8 million surgical procedures and more than 19.1 million nonsurgical procedures were performed worldwide. During the past decade, a steady increase in aesthetic procedures has been observed, which has been more pronounced since 2021. In the last 4 years, the overall increase in procedures was 40%. SURGICAL PROCEDURES: The top five surgical procedures were liposuction, breast augmentation, eyelid surgery, abdominoplasty, and rhinoplasty. This trend has been stable for 14 years, with the exception of 2022, when breast lift surgery temporarily replaced rhinoplasty. FACE AND HEAD PROCEDURES: These procedures continue to be the most popular. This group included brow lift, ear surgery, eyelid surgery, facelift, facial bone contouring, facial fat grafting, lip augmentation or frontal surgery, neck lift, and rhinoplasty. BODY AND EXTREMITIES PROCEDURES: This group included abdominoplasty, buttock augmentation, buttock lift, liposuction, lower body lift, thigh lift, arm lift, upper body lift, labiaplasty, and vaginal rejuvenation. Over the past 14 years, body and extremity procedures have increased, with more than 5.1 million procedures in 2023 compared to 2.6 million in 2009. NONSURGICAL PROCEDURES: The five most popular nonsurgical procedures are botulinum toxin, hyaluronic acid, hair removal, chemical peels, and nonsurgical fat reduction. In 2022, chemical peels will replace nonsurgical skin tightening in the top five. MALE AESTHETIC SURGERY: Procedures performed on men continue to grow, with minimally invasive procedures dominating. The most recent survey reported that they represented 14.5% of the total. The top five surgical procedures were eyelid surgery, gynecomastia, liposuction, rhinoplasty, and facial fat grafting. The most popular nonsurgical procedures for men were botulinum toxin, hyaluronic acid, hair removal, nonsurgical skin tightening, and nonsurgical fat reduction. This trend has held steady for more than a decade. DISCUSSION: This study analyzes the most recent data and experience of board-certified aesthetic plastic surgeons in surgical and nonsurgical procedures worldwide over 14 years and provides insight into future trends. More than 60 years have passed since the introduction of liposuction, being one of the most performed aesthetic procedures worldwide over the past 14 years and currently number one procedure performed by plastic surgeons. New trends and technologies have evolved over the years, however, plastic surgeons must be cautious, as history has shown that risks increase when new technologies are introduced. With the popularity of liposuction, other body contouring procedures began to gain interest, and in 2015, gluteal lipoinjections were added to the ISAPS global aesthetic statistics and with them complications arise. In 2018 and 2019, the major patient safety societies, ISAPS, ASERF, ASPS, and ASAPS, began a systematic educational campaign to inform their members about the inherent risks of performing gluteal fat transfer surgery and what techniques or equipment can be used to minimize risks. Another procedure added to the ISAPS statistics in 2010 was vaginal aesthetic surgery. With the new trend of vaginal aesthetics, many believed that they were just changing the appearance of the area, but today it is clear that they are here for much more, to truly empower women with their sexuality. Breast augmentation showed a decline for the first-time last year. However, breast augmentation and liposuction have been the most performed procedures by plastic surgeons worldwide for more than a decade. On the other hand, implant removal has been the fastest growing procedure since 2015, with an overall increase in 46.3% over the past 5 years. In relation to male aesthetic surgery, the number of men undergoing aesthetic procedures has remained stable in recent years at around 14%. Male aesthetics is certainly a growing trend, and our practices should be more inclusive. Another prominent field is regenerative medicine. In relation to plastic surgery, regenerative surgery strategies often involve adipose tissue with stem cells and preadipocytes, alone or in combination with scaffolds. In terms of prevention, regenerative medicine aims to improve the quality of the skin by improving our outcomes and would make it possible to avoid the need for facelifts in the future. Finally, given the increasing popularity of medical procedures abroad ("medical tourism") and the fact that safety regulations and guidelines vary widely from place to place, we encourage patients to choose a board-certified, specialized, trained and experienced plastic surgeon for their procedure and an accredited surgical facility to ensure the procedure in done under the highest patient safety standards. CONCLUSIONS: Despite the obvious cultural and social differences from country to country that make certain procedures more desirable in some geographic areas and less so in other parts of the world, the results of this study show a significant overall increase in all surgical and nonsurgical procedures aimed at improving the aesthetic appearance of the body during14 years. As plastic surgeons, we are open to new possibilities in aesthetic procedures and are responsible for patient safety protocols and procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Postnatal chest X-ray in children with asymptomatic congenital lung malformations.

OBJECTIVE: The clinical implications of a postnatal chest X-ray (CXR) in asymptomatic children with a prenatally diagnosed congenital lung malformation (CLM) are uncertain. We assessed the justification for the postnatal use of CXR in these children. METHODS: We included patients with CLM confirmed through chest computed tomography angiography or histopathological analysis who were asymptomatic at birth, underwent routine postnatal CXR, and participated in our standard of care prospective structured longitudinal follow-up program. Children with major associated morbidities were excluded. Primary outcomes were the positive and negative predictive values (PPV and NPV) of CXR findings for symptom development at 4 weeks and 6 months of age. Secondarily, we sought to establish whether CXR findings were associated with undergoing additional diagnostics during the initial observational hospital stay or prolonged postnatal hospital admission. RESULTS: Among 121 included patients, CXR showed no abnormalities in 35 (29%), nonspecific abnormalities in 23 (19%), and probable CLM in 63 (52%). The PPV of CXR in relation to symptom development at 4 weeks and 6 months was 0.05 and 0.25, respectively. Corresponding NPVs were 0.96 and 0.91. An association was identified between CXR findings and undergoing further diagnostics during the initial observational hospital stay (p = .047). Additional diagnostic findings did not influence clinical management. CXR findings were not associated with prolonged initial hospital stay (p = .40). CONCLUSION: The routine practice of postnatal CXR in asymptomatic patients with prenatally diagnosed CLM can be omitted, as CXR findings do not influence subsequent clinical management.

The Value of Preoperative Rigid Tracheobronchoscopy for the Diagnosis of Tracheomalacia in Oesophageal Atresia Patients.

BACKGROUND: Oesophageal atresia (OA) is often accompanied by tracheomalacia (TM). The aim of this study was to evaluate its presence in OA patients during routine rigid tracheobronchoscopy (TBS) before primary correction and compare this to postoperative TBS and clinical signs of TM. METHODS: This retrospective cohort study included patients born with OA between June 2013 and December 2022 who had received a TBS before OA correction and had been followed for at least twelve months. Definite TM was postoperatively diagnosed through TBS, and probable TM was defined as having symptoms of TM. RESULTS: We analysed data from 79 patients, of whom 87% with OA type C. Preoperatively, TM was observed in 33 patients (42% of all patients), seven of whom had severe TM. Definite TM was observed in 21 patients (27%), of whom 15 had severe TM. Forty-one patients (52% of all patients) had developed symptoms of TM within twelve months, including harsh barking cough (n = 15), stridor and/or wheezing (n = 20), recurrent respiratory insufficiency (n = 11), or needing airway surgery (n = 7). The sensitivity of preoperative TBS for the presence of postoperative (definite and probable combined) TM is 50.0%, 95% CI [35.2-64.8], and the specificity 67.6%, 95% CI [51.7-81.1]. Clinical characteristics did not differ between the patients with or without postoperative TM. CONCLUSIONS: More than half of the studied patients with OA experienced symptoms of TM. While preoperative TBS is routinely performed prior to surgical OA correction, its predictive value for the presence of postoperative TM remains limited. LEVEL OF EVIDENCE: Level II. TYPE OF STUDY: Study of Diagnostics Test.

Presentation and outcomes of Lassa fever in children in Nigeria: a prospective cohort study (LASCOPE).

BACKGROUND: Data on the presentation, management and outcomes of Lassa fever (LF) in children are limited. METHODS: Description of the clinical and biological features, treatment and outcomes of RT-PCR-confirmed LF in children aged under 15, enrolled in the LASCOPE prospective cohort study in Nigeria between April 2018 and February 2023. RESULTS: 124 children (aged under 12 months: 19; over 12 months: 105) were hospitalized with RT-PCR-confirmed LF. All received intravenous ribavirin. During follow-up, 99/124 (80%) had fever; 71/124 (57%) had digestive symptoms, vomiting (n = 56/122, 46%) and abdominal pain (n = 34/78 aged ≥ 5 years, 44%) more often than diarrhea (n = 19/124, 15%); 17/124 (14%) had hemorrhagic signs; 44/112 (39%) had a hematocrit lower than 25%, of whom 32/44 (73%) received transfusions; 44/88 (50%) developed hypotension; 18/112 (16.1%) developed KDIGO ≥ 2 acute kidney injury; 10/112 (8.9%) had KDIGO 3 acute kidney failure; 4/124 (3.2%) underwent renal replacement therapy. 7 children died, including 4 aged under 12 months (case fatality rate: under 12 months - 22%, 95% CI 7 - 48%; over 12 months - 2.9%, 95% CI 0.7 - 8.7%). In univariable analysis, age (p=0.003), impaired consciousness (p=0.026), and Lassa RT-PCR Ct value (p=0.006) were associated to Day 30 mortality. CONCLUSIONS: The fatality rate for children over 12 months hospitalized with LF was lower than that previously reported for adults. Hypotension and acute kidney injury were the most frequent organ dysfunctions. Bleeding was relatively infrequent. Anemia and the need for transfusion were common, the relative contribution of ribavirin-induced hemolysis being unknown.