Systematic Surgical Approach to Alar Base Surgery in Rhinoplasty

In an era with smartphone photography and social media (specifically, "selfies"), basal view aesthetics is becoming increasingly important. Achieving balance between the nasal base and the remainder of the nose and face while preserving or restoring external valve function are essential to a successful rhinoplasty. Without a systematic approach to the nasal base, it is more difficult to achieve an ideal outcome from both aesthetic and functional standpoints. This article outlines an organized and systematic approach to the nasal base, beginning with comprehensive nasofacial analysis. The authors continue by describing idealized basal view aesthetics and provide a treatment algorithm for common deformities that include alar flaring and a wide nasal base. The authors attempt to provide a comprehensive approach to the treatment of the nasal base by discussing the implications of treating columellar deformities, tip positioning, or alar-columellar discrepancies on the overall aesthetics of the lower third of the nose. Furthermore, technical considerations are given for common surgical maneuvers addressing the alar base to help guide treatment and prevent complications such as poor scarring, notching, nostril asymmetry or stenosis (external valve obstruction), and alar deformities ("parenthesis" or "bowling pin"), to name a few.

Short communication: Molecular markers for epithelial cells across gastrointestinal tissues and fecal RNA in preweaning dairy calves

The objective of this study was to compare the transcription of gene markers for gastrointestinal (GI) epithelial cells, including fatty acid binding protein 2 (FABP2) and cytokeratin 8 (KRT8), and tight junction complex genes (TJP1, CLDN1, CLDN4) in fecal RNA against several GI tract tissue sections in dairy calves. Eight healthy Jersey calves were euthanized at 5 wk of age, and postmortem samples were collected from rumen, duodenum, jejunum, ileum, large intestine, cecum, and feces for total RNA isolation. Tissues and fecal samples were immediately frozen in liquid nitrogen until RNA isolation. A real-time quantitative PCR analysis was performed using a single standard curve composited of equal amounts of all samples, including cDNA from fecal and GI tract tissues. The mRNA expression of the tight junctions TJP1, CLDN1, and CLDN4 was greater in fecal RNA compared with lower GI tract tissues (i.e., duodenum, jejunum, ileum, large intestine, and cecum). Similar to fecal RNA, rumen tissue had greater expression of tight junctions CLDN1 and CLDN4 than lower GI tract tissues. Similarly, rumen tissue had greater expression of TPJ1 than all lower GI tract tissues except duodenum. The expression of TJP1 and CLDN4 was greater in fecal RNA than in rumen tissue; in contrast, CLDN1 mRNA expression was greater in rumen tissue than in the fecal RNA. The expression of FABP2 was greater in duodenum in comparison to all tissue except ileum. The mRNA expression of FABP2 in fecal samples was similar to jejunum and ileum. The expression of KRT8 in fecal samples was similar to duodenum, large intestine, and cecum. The fecal RNA had a greater expression of KRT8 in comparison to jejunum and ileum. The rumen tissue had the lowest mRNA expression of KRT8. The expression levels of FABP2, KRT8, and tight junction genes observed in fecal transcripts suggest that a considerable amount of RNA derived from GI tract epithelial cells can be detected in fecal RNA, which is in agreement with previous data in neonatal dairy calves and other biological models including humans, rodents, and primates. The greater expression of tight junctions in fecal RNA in comparison to sections of the low GI remains to be understood, and due to the importance of tight junctions in GI physiology, further clarification of this effect is warranted. The similarities in mRNA expression of FABP2 and KRT8 between fecal RNA and intestinal sections add up to the accumulating evidence that fecal RNA can be used to investigate molecular alterations in the GI tract of neonatal dairy calves. Further research in this area should include high-throughput transcriptomic analysis via RNA-seq to uncover novel molecular markers for specific sections of the GI tract of neonates.

Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients

OBJECTIVE

End stage heart failure is a lethal disease with a dismal 5 year survival. Heart transplantation has proven to be a highly effective modality of treatment in appropriately selected group of such patients. This is a retrospective analysis of medium term outcomes of heart transplantation in the setting of a private health facility in India. The objective of this study was two fold.

METHODS

The outcome of 257 heart transplants done at a single centre from October 2012 to October 2019 was analyzed. Patients with combined Heart and lung transplants and those whose complete medical records were unavailable were excluded from the study. Survival was tracked at 60 days, 90 days, one year and beyond for a maximum of 7 years. Preoperative patient risk profiles were characterized on the basis of INTERMACS category.

RESULTS

There were 176 male and 81 female patients. The age range was from 8 months to 78 years with a mean of 32.9 years. Survival at 2 months was 87%, at 90 days was 83%, at one year was 81%, 2 years was 75%, at 3 years was 72% and at 5 years and beyond was 62% for the whole series. Strong predictors of 90 day mortality included INTERMACS category (odd's ratio 0.289, p = 0.000) and creatinine more than 1.5 mg/dl (odd's ratio 2.48, p = 0.056). Recipient pulmonary vascular resistance and donor organ ischemic times were not found to be statistically significant factors affecting outcome. Medium term survival was influenced by INTERMACS category (Hazard ratio > 3 for INTERMACS category 1 compared to INTERMACS 4 or 5, p < 0.0001) and creatinine > 1.5 mg/dl (Hazard ratio 2.15, p = 0.003). This effect of creatinine was related to the age of the recipient. Hazard ratio 1.4, p = 0.524 if age <30 and Hazard ratio 4.78, p = 0.006, if age was >50.

CONCLUSION

Satisfactory medium term outcome is possible after heart transplantation even in resource constrained environment of a developing country.

Rhinoplasty Refinements: Addressing the Deviated, Overprojected Nose

Deprojection of an overprojected nose and correction of an infralobular deformity are very challenging for rhinoplasty surgeons because a systematic approach is needed to correct these problems. A deviated nose with a dorsal hump is a common deformity that is best treated using septal reconstruction and the component dorsal hump reduction technique using an open rhinoplasty approach. This article and its videos show how to correct a deviated nose with overprojection and a dorsal hump deformity.

Brachioplasty Refinements

With a growing massive weight loss population, upper arm contouring continues to rise in popularity. Refinements in technique, such as modification of skin excision patterns and the adjunct use of liposuction, have allowed for safe and reproducible results. This article helps to understand the evolution of upper arm contouring and provides an update on the limited-incision medial brachioplasty. Details of preoperative markings and operative technique are clearly illustrated in the video included.

Male Rhinoplasty: Update

Male rhinoplasty is unique in that it requires precise preoperative planning to achieve a successful result. Better communication and clarity are paramount with male rhinoplasty patients because the patients may be less attentive. It is important for the surgeon to screen the patients for any psychosocial disorders. Through a series of cases, male rhinoplasty techniques are highlighted. Masculine features should be preserved, and the nose should not be feminized or oversculpted. Another key component in any rhinoplasty case is proper skin care, especially during the postoperative period. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.

Effect of peroxomonosulfate, peroxodisulfate and hydrogen peroxide on graphene oxide photocatalytic performances in methyl orange dye degradation

Carbocatalyst GO photocatalytic mechanism and performances in the presence of an electron scavenger (ES) has been consciously discussed herein. Single layer GO photocatalyst has been synthesized by Hummer's method and photocatalyst characteristics are gathered by different analytical methods. Studies ensured the formation of a good crystalline GO that contains number of oxygenated functional groups, with average crystalline size of the sp² domain in 18.24 nm. Optical studies suggest that optical band gap of the GO nanosheet photocatalyst is found in the range of 3.19-4.4 eV. TEM analysis confirms the formation of a single layer GO nanosheet. Photocatalytic study justifies that in the absence of ES, 24% mineralization efficiency is achieved with GO as a photocatalyst, whereas in the presence of ES such as PMS, PDS and HP the mineralization efficiency is considerably enhanced up to 91%, 77% and 65% respectively. Moreover, photocatalytic degradation intermediate byproducts were also examined through LC-MS analysis. The study substantiates methyl orange dye degradation undergoes via the multiple degradation pathway such as (i) azo bond cleavage and hydroxylation, (ii), asymmetric cleavage followed by reduction of sulfonate group and aromatic ring removal and (iii) consecutive demethylation reactions and sulfonate group removal. Rationalized the contributing effects of process parameters towards the photocatalytic degradation of methyl orange using a RSM based on CCD validation. The validation reveals that most significant process parameter affects degradation process are the irradiation time, catalyst loading and choice of ES.

Fabrication and Characterization of Flexible Cotton Fabric/Carbon Nanotubes/MnO₂ Nanocomposite-Based Electrodes for Energy Storage Application

Flexible cotton fabric based electrodes were fabricated using multi-walled carbon nanotubes (MWCNTs) and manganese dioxide (MnO₂) nanocomposite which was prepared using wet chemical synthesis. Characterization of CNT/MnO₂ nanocomposite was done by Transmission electron microscopy (TEM), X-ray diffraction (XRD), X-ray photon spectroscopy (XPS), Raman spectroscopy and BET analysis. Their electrochemical properties were investigated using three electrode systems. The high specific capacitance of 634.35 F/g was obtained for the nanocomposite coated cotton fabric prepared via dipping method. The high capacitance was attributed to its high specific surface area 678.9 m₂/g. The electrode exhibited high cyclic performance showing retention of 84% of its initial capacity in 0.5 M sodium sulphate (Na₂SO₄) solution. The demonstrated high specific capacitance of CNT/MnO₂ nanocomposite makes it a promising electrode material for energy storage applications due to its low cost and flexibility.