Laser scanning as a tool for assessment of HIV-related facial lipoatrophy: evaluation of accuracy and reproducibility

Plasticine Model: An Useful Surgical Training in Plastic Surgery

OBJECTIVE

To help surgical trainees reach a deep understanding of plastic operations, we developed and evaluated an economical and convenient model using plasticine for plastic surgical training.

METHODS

From Sep of 2012 to Dec of 2014, we invited 57 medical interns to participate in a program designed for the qualitative evaluation of this model. In this program, 57 interns were asked to simulate certain surgical operations under guidance of the experienced staff of our department using the plasticine model. The value of the plasticine model was evaluated through questionnaire surveys. Their acceptance of the plasticine model, as well as the benefits and the flaws, was evaluated by the questionnaire survey.

RESULTS

All the participants completed the training session as well as the questionnaire, all of whom felt that the plasticine model had increased their familiarity with the surgical procedure they were assigned. By remodeling plasticine, the trainees understood either the brief surgical procedures or some confusing operative details in plastic surgery. In the questionnaire surveys, the trainees showed considerable consensus with the training program. The flaws of this method were also listed. The flaws generally reflected that "it is difficult to model into a vivid image" and "it is not suitable for all the operation".

CONCLUSIONS

Overall, the plasticine model is accepted by the participants in this survey. This model is economical and versatile, and could be used as a complementary training tool for novices in simulated operation training of plastic surgery.

NO LEVEL ASSIGNED

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Improvements in cheek volume in lipoatrophic individuals switching away from thymidine nucleoside reverse transcriptase inhibitors

BACKGROUND

Thymidine nucleoside reverse transcriptase inhibitors (NRTIs) are associated with subcutaneous fat loss. Facial changes cannot be assessed by dual-energy X-ray absorptiometry (DEXA) scans. There are limited objective data on the reversibility of facial lipoatrophy.

METHODS

We performed a facial volume substudy of a randomized thymidine NRTI replacement study carried out in HIV-infected subjects with moderate to severe lipoatrophy. Facial volume changes were assessed using validated 3D laser imaging. Changes in body composition were measured using DEXA scans. The association between changes in facial volume and body composition parameters at 48 weeks was measured using Spearman's rank correlation.

RESULTS

Forty-seven individuals (46 male), 11 receiving zidovudine and 36 receiving stavudine, switched to either tenofovir disoproxil fumarate (DF) (n=23) or abacavir (ABC) (n=24). Thirty-nine of these 47 patients (84.8%) reported facial lipoatrophy at baseline. The median volume increase in both cheeks from baseline was 1857.3 mm(3). These volume changes and increases in limb fat at 48 weeks were similar in the two groups and correlated significantly (Spearman's r=0.41, P=0.004).

CONCLUSIONS

Facial volume in lipoatrophic individuals was found to increase after thymidine NRTI replacement. We demonstrated a significant correlation between improvements in facial and limb fat parameters. Switching from thymidine NRTIs in patients with facial lipoatrophy could potentially reduce the need for cosmetic interventions.

Therapy insight: Body-shape changes and metabolic complications associated with HIV and highly active antiretroviral therapy

Increasingly effective therapies for HIV infection are now available. These treatments, referred to collectively as highly active antiretroviral therapy, comprise various combinations of anti-HIV drugs from different drug classes. Recently, a range of metabolic complications have emerged as important toxicities in treated patients. Complications present as abnormalities of body-fat mass distribution in association with an often significant dyslipidemia and glucose homeostasis dysregulation. The body-shape changes, manifesting as peripheral lipoatrophy or central lipohypertrophy, can have a negative impact on quality of life and consequently on adherence to treatment. The combination of central lipohypertrophy, dyslipidemia and insulin resistance is associated with accelerated rates of atherosclerosis and other potentially significant long-term effects. The pathogenesis of these effects is complex and is still being actively investigated. Possible contributing factors relate to host characteristics, HIV viral parameters and specific effects of anti-HIV drugs on adipose-tissue biology and on intermediary metabolism. Management of these complications involves manipulation of the anti-HIV drugs using an understanding of their particular effects on lipid and glucose metabolism, in association with standard therapeutic interventions. Individualized approaches, taking into consideration quality-of-life issues, and assessment of potential cardiovascular risks, are now an important component of effective care of HIV-infected patients.

Three-dimensional face shape in Fabry disease

Facial dysmorphology is an important feature in several lysosomal storage disorders. Although in Fabry disease facial dysmorphism is not a prominent sign, minor facial abnormalities have been previously reported. By analysing three-dimensional images of faces, we quantified facial dysmorphology in a cohort of both male and female Fabry patients. Morphometric analysis of different regions of the face revealed significant differences in face shape in male patients and to a lesser extent in female patients. In male patients, the most prominent abnormalities were located in the peri-orbital region. Pattern recognition techniques achieved a discrimination accuracy of up to 85% for male patients compared with healthy controls. The discrimination accuracy in female patients achieved only 67%. This objective method for facial dysmorphology assessment provided evidence for significant differences in face shape in both male and female Fabry patients compared with controls. However, because discrimination from healthy controls is too low, no key role in the diagnostic process can be expected.