Aesthetic Genioplasty Based on Strategic Categorization

BACKGROUND

Genioplasty is a popular procedure used for lower facial contour correction. Various osteotomy techniques enable us to perform advancement, setback, reduction, or narrowing procedures. Computed tomographic images facilitate preoperative planning in detail. The authors used a novel planning method based on strategic categorization. The analytic results are described.

METHODS

This retrospective study reviewed 208 patients who underwent genioplasty procedures for facial contouring from October of 2015 to April of 2020. During preoperative evaluation of the mandible, the operative procedure selected was one of three types: (1) horizontal segment osteotomy, (2) vertical and horizontal segment osteotomy, and (3) bone graft after repositioning. Adequate osteotomies were followed by rigid fixation using a titanium plate and screws. The follow-up period ranged from 8 to 24 months (average, 17 months). The results were assessed based on medical records, photographs, and facial bone computed tomographic images.

RESULTS

Overall, the patients were satisfied with the outcomes and had responder-based improvement in lower facial contour and balance. Chin point deviations were noted in 176 cases; left-side deviation ( n = 135) was more frequent than right-side deviation ( n = 41). Strategic osteotomies based on precise measurements led to correction of asymmetries. Temporary partial sensory losses reported in 12 cases resolved within an average of 6 months after surgery.

CONCLUSIONS

Each patient's chief complaint and bony structures should be carefully evaluated before genioplasty procedures are performed. During the operation, meticulous osteotomy, precise movement, and rigid fixation are necessary. The strategic process used for genioplasty resulted in aesthetic balance and predictable outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Integrase strand transfer inhibitor treatment does not increase the incidence of immune reconstitution inflammatory syndrome in HIV-infected Koreans

OBJECTIVES

Immune reconstitution inflammatory syndrome (IRIS) is a major concern when starting antiretroviral therapy (ART) in patients with advanced HIV infection. The aim of this study was to determine the incidence and risk factors of IRIS in HIV-infected Koreans initiating ART, and whether integrase strand transfer inhibitor (INSTI) treatment increases the risk of IRIS.

METHODS

This retrospective analysis included adults living with HIV, seen at four university-affiliated hospitals in South Korea, who were naïve to ART and had a CD4 T-cell count < 200 cells/μL between January 2004 and May 2019. IRIS was determined through a medical record review within 6 months of ART initiation. Propensity score-matched case-control study between the non-INSTI and INSTI groups was performed.

RESULTS

The study included 501 patients; 192 were assigned to the INSTI group, who started ART based on INSTIs as the initial treatment. There were opportunistic infections (OIs) in 253 (50.5%) cases before ART initiation. The three most common OIs were Pneumocystis jirovecii pneumonia, candidiasis and tuberculosis (TB). We identified 47 cases of IRIS; TB-IRIS was the most common type. The incidence of IRIS within 6 months of ART initiation was 9.4%, and there were no significant differences in baseline characteristics and incidence of IRIS between the matched groups. The risk factors for IRIS were pre-ART CD4 T-cell count (< 30 cells/μL), higher pre-ART viral load (≥ 75 000 copies/mL), and TB-OI.

CONCLUSIONS

The incidence of IRIS was 9.4% in Korean HIV patients. The INSTI regimen was not related to IRIS occurrence.

Twelve-day medium pumping into tubular cell-laden scaffold using a lab-made PDMS connector

In the current study, a method is proposed to supply culture medium into a two-layered cell-laden tubular scaffold in order to enhance cell proliferation, confluence, and viability. The two-layered cell-laden tubular scaffold was made of calcium-alginate mixed with fibroblast cells (NIH/3T3) using a lab-made double- coaxial laminar-flow generator. Afterwards, the tubular scaffold was connected to a syringe pump system using a polydimethylsiloxane (PDMS) micro-connector for long-term cell culture. Three medium pumping conditions were applied and compared: a heart-beat-mimicking pumping (20 µL/s, 1 s period, and 50 % pulse width), a continuous pumping (20 µL/s) and a non-pumping. Non-leaky connections between the tubular scaffolds and the micro-connector outlet were sustained for 13.5 ± 0.83 d in heartbeat-mimicking pumping and 11.8 ± 0.33 d in continuous pumping condition, due to the elasticity of the tubular scaffolds. Importantly, the two pumping conditions resulted in more cell proliferation, confluence, and viability than the non-pumping condition. Furthermore, analysis of newly-produced type-I collagen matrix indicated that the cells under the two pumping conditions formed a tissue-like structure. The proposed technique could further be applied to vascular co-culturing for vascular engineered tissue.

Revision malarplasty guided by strategic categorization

BACKGROUND

Esthetic reduction malarplasty is popular in East Asia, where a small and balanced facial profile is considered a desirable characteristic. Various surgical techniques have been applied; however, several complications can impact the bony structure and final esthetic appearance. We examined the outcomes of revision malarplasty with regard to strategic assessments to achieve facial balance and skeletal stability.

METHODS

This retrospective study reviewed 97 patients who underwent revision malarplasty between December 2014 and November 2016. We analyzed the indications of revision and categorized the patients into three surgical groups. Dual bone flap procedures utilizing new osteotomies were performed to achieve a natural malar contour in certain cases. In addition, zygomatic arches were fixed in a lifted position to revise both bony dehiscence and soft tissue drooping. Postoperative results were assessed using medical records, photographs, and facial bone computerized tomography images.

RESULTS

The major reason for revision malarplasty was undercorrection that required additional repositioning. The zygomatic body and arch with a bony gap (5-7 mm) necessitated additional osteotomy and repositioning to achieve zygomatic continuity and natural curvature. Significant bony defects and segmental resorption were addressed with reconstructive bone grafts.

CONCLUSION

The causes of complications after malarplasty should be cautiously evaluated before revision procedures. We categorized patients on the basis of strategic analysis considering reposition vector and the necessity of additional osteotomy. Unstable zygomatic segments were revised to obtain structural stability, and the zygomatic arch lifting technique using an intraoral approach can be used to achieve promising and predictable outcomes in revision malarplasty.

Developmental hemispheric asymmetry of interregional metabolic correlation of the auditory cortex in deaf subjects

The functional connectivity of the auditory cortex might be altered in deaf subjects due to the loss of auditory input. We studied the developmental changes of functional connectivity of the primary auditory cortex (A1) in deaf children, deaf adults, and normal hearing adults by examining interregional metabolic correlation with (18)F-FDG PET. The mean activity of FDG uptake in the cytoarchitectonically defined A1 region served as a covariate in the interregional and interhemispheric correlation analysis. A1 metabolic rate was correlated with that of the ipsilateral superior temporal lobe in both normal and deaf subjects. This correlated area was larger in deaf children than in deaf or normal hearing adults. Concerning the functional connectivity of A1, a hemispheric asymmetry was found in that the extent of interregional correlation was clearly larger in the right than in the left hemisphere. This asymmetry was particularly pronounced in the younger deaf children. Both extent and asymmetry of the functional connectivity of A1 subsided with age. Contrary to this, a correlation between the left and the right primary auditory cortices was absent in younger deaf children but became apparent as they grew older.

Discoid lateral meniscus in children: clinical manifestations and morphology

The authors investigated the correlation between the clinical manifestations and the morphology of discoid lateral meniscus. Thirty-eight children, age 5 to 17 years, with 39 cases of discoid lateral meniscus underwent an arthroscopic procedure and magnetic resonance imaging. The two most frequent preoperative clinical manifestations were pain and extension block. In 19 cases without surface tear, the most frequent clinical manifestation was extension block. In the sagittal magnetic resonance images, the mean thickness of the anterior portion of the discoid lateral meniscus (7.77 mm) in the group with extension block exceeded that (4.02 mm) in the group without extension block. Extension block was significantly more common in patients with the anterior hypertrophy type and the slab (anterior-posterior diffusely hypertrophic) type than in the posterior hypertrophy type by the modified Hall classification. As a result, extension block was significantly correlated with the morphology of the menisci. Also, the thickened anterior portion of the discoid lateral meniscus may be considered one of the mechanical factors that limit knee extension.

Cystic left atrium myxoma--a rare case report

Myxoma is the most common primary tumor of heart. The typical picture of myxoma under echocardiography is a solid, dense echo mass and left atrium is the most common site to find it. The cystic form of myxoma is vary rare. We report a patient who received echocardiographic examination under impression of mitral valve stenosis. A multilobulated cystic mass which was like a hydatid cyst was found in the left atrium and atrioventricular flow was affected by this mass. After tumor resection, myxoma with internal hemorrhage was proved by pathology. No further recurrent myxoma was found during follow-up echocardiographic examination.

Sclerotherapy with picibanil (OK-432) for congenital lymphatic malformation in the head and neck

HYPOTHESIS/OBJECTIVES

Congenital lymphatic malformations of the head and neck (LMHN) present special challenges to the otolaryngologist-head and neck surgeon. Recently, a number of sclerotherapy trials have shown promising results. In this study, we present our experiences with picibanil (OK-432) sclerotherapy for this lesion.

STUDY DESIGN

Retrospectively review.

METHODS

We retrospectively reviewed 21 patients who have undergone sclerotherapy with picibanil for LMHN.

RESULTS

Satisfactory response with complete or nearly complete shrinkage of the lesions was observed in 15 cases after repeated sclerotherapy (average, two times). We did not observe any significant morbidity or complications in the patients treated with picibanil. Reduction in size of the mass was achieved in weeks to months. Some of the patients who had not had any other previous treatment showed remarkable reductions in size even after the first therapy. When we used picibanil sclerotherapy as a primary treatment for the LMHN, most of our patients showed satisfactory results regardless of the size or location of the lesions.

CONCLUSION

Given with our experience and the reports that failure of picibanil sclerotherapy does not hinder subsequent surgical salvage procedures, we recommend trying picibanil sclerotherapy as a primary treatment for the LMHN and performing surgical excision as a secondary modality if the response to the sclerotherapy is not satisfactory.

Necrotizing fasciitis of the head and neck: an analysis of 47 cases

Necrotizing fasciitis is an overwhelming infection common to the perineum, abdominal wall, and extremities. It is a surgical emergency related to a high mortality rate that is more often seen in elderly and immunocompromised patients. Necrotizing fasciitis occurs uncommonly in the head and neck region. Over a 12-year period, 47 cases of necrotizing fasciitis of the head and neck region were collected at this hospital. The demographics, predisposing factors, clinical presentation and courses, management, complications, and outcomes were analyzed. The cases were divided into two groups: survivors and nonsurvivors. Statistical comparisons were made of the parameters age, gender, smoking or drinking habit, underlying medical problems, laboratory data, and treatments used. Forty-two patients (89.4 percent) had associated systemic disease; most of these patients had diabetes (72.3 percent). The clinical manifestations are nonspecific but are often typical for diagnosis. The necessity of computed tomographic scans is not conclusive in this study. Presentation of septic shock (p = 0.004) and association with underlying malignancy (p = 0.03) were the only statistically significant factors that led to a poor prognosis. The cornerstones of proper management include early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and intensive supportive care.

Atrioventricular block in Kearns-Sayre syndrome: a case report

The Kearns-Sayre (K-S) syndrome which includes the triad of progressive external ophthalmoplegia, pigment retinopathy, and disorder of cardiac conduction was first described in 1958. The mitochondria disorder is believed to be the cause of this syndrome. Involvement of the cardiac conduction system is the most importent prognostic factor in K-S syndrome. A 34-year-old male K-S syndrome patient, manifesting as ptosis and weakness of limbs since the age of 15 years, suffered from dizziness and weakness. Twelve-lead eletrocardiography (ECG) showed a 2:1 atrioventricular (AV) block with slow ventricular rate. Intermittent complete AV block, complete left bundle branch block and torsades de pointes were noted in Holter ECG. The electrophysiology study demonstrated prolonged HV interval (85 ms) on conduction beat and infra-His block on non-conduction beat. A VVIR mode of permanent pacemaker was implanted and the patient's condition was stable during this period of follow-up.

Healing of superior vena cava defect in mediastinal seminoma with invasion

We present an unusual case of mediastinal seminoma with direct intraluminal invasion into the superior vena cava (SVC) and extension to the right atrium. Magnetic resonance imaging demonstration of the SVC defect due to tumor invasion was important for determining treatment strategy because rapid posttherapeutic tumor regression may increase the risk of SVC rupture. Gradual healing of the SVC defect at the tumor entrance site was attained using a tailored treatment plan with radiotherapy and chemotherapy.

Survey of the Korean population for 9 short tandem repeat loci

The short tandem repeats with repeat units ranging from two to several nucleotides became a powerful tool in the field of forensic identification and paternity determination as well as for research in human gene mapping. Allele and genotype frequencies for 9 short tandem repeats including HUMCSF1PO, HUMTH01, HUMPLA2A1, HUMF13A01, HUMCYAR04, HUMLIPOL, HUMHPRTB, HUMCD4, and HUMFABP were determined using PCR and subsequent analysis of the PCR products by denaturing polyacrylamide gel electrophoresis followed by silver-staining. DNA samples were obtained from about 100 Korean people and amplified in a thermocycler adopting glass capillaries rather than traditional tubes. We found that the bovine serum albumin was an essential additive for the capillary PCR, presumably to coat the inner surface of the capillary which may adsorb Taq DNA polymerase. The capillary thermocycler was very effective in reducing the cycling time such that most of the amplification reactions could be finished within 30 min albeit the PCR product was less than that for the tube systems. All loci except HUMHPRTB met the Hardy-Weinberg expectations according to the exact test. The cumulative power of discrimination (PD) was 0.9999998 and the power of exclusion (POE) for the paternity test was a little low, being 0.9873989.

Modified expression of a carrot small heat shock protein gene, hsp17. 7, results in increased or decreased thermotolerancedouble dagger

We have determined that one small heat shock protein gene, encoding Hsp17.7, plays an important role in the ability of carrot cells and plants to survive thermal stress. Transgenic cells and regenerated plants were generated in which the carrot Hsp17.7 gene was either constitutively expressed (denoted CaS lines) or expressed as a heat inducible antisense RNA (denoted AH lines). Thermotolerance measurements demonstrated that CaS lines were more thermotolerant than vector controls and AH antisense lines were less thermo- tolerant than vector controls. RNA analysis demonstrated that Hsp17. 7 mRNA was detectable, but not abundant, prior to heat shock in CaS cells, but not in vector control cells. Conversely, RNA analysis of antisense cells showed that, after heat shock, the amounts of mRNA for Hsp17.7 was moderately less abundant in AH cells than in vector controls. Analysis of protein synthesis in CaS cells did not indicate substantial synthesis or accumulation of Hsp17.7, or any small Hsp, at 23 degrees C. However, in the most thermotolerant line, protein synthesis was maintained at a higher rate than in other cell lines at a more extreme heat shock (42 degrees C). In contrast, antisense AH cells showed reduced synthesis of many Hsp, large and small. These results suggest that the Hsp17.7 gene plays a critical, although as yet not understood, role in thermotolerance in carrot. This represents the first demonstration of the ability to both increase and decrease thermotolerance by the manipulation of expression of a single gene.

Survey on the distribution of Vibrionaceae at the seaport areas in Taiwan, 1991-1994

A monthly survey on the distribution of human-pathogenic Vibrionaceae of the seawater from five principal harbors in Taiwan was conducted by National Quarantine Service from July, 1991 to February, 1994. Of the total 1,167 Vibrionaceae isolates, strains of Vibrio alginolyticus (449 strains) were the most frequently isolated, followed by Vibrio parahaemolyticus (262) , Aeromonas hydrophila (153), Vibrio cholerae non-O1 (86), and Vibrio vulnificus (67). None of Vibrio cholerae O1 was isolated. The pH, salinity, and water temperature in this study ranged from 5.8 to 8.6, 0.1 to 4.2% , and 15 to 34 degrees C, respectively. It is concluded that the family Vibrionaceae exists autochthonously around the coastal waters in Taiwan.

Vibration measurement by the time-averaged electronic speckle pattern interferometry methods

Three different image-processing methods based on the time-averaged technique were compared by the electronic speckle pattern interferometry (ESPI) technique for vibration measurement. The three methods are the video-signal-addition method, the video-signal-subtraction method, and the amplitude-fluctuation method. Also, errors introduced by using the zero-order Bessel function directly into the analysis of the fringe pattern were investigated. The video-signal-addition method has been the most generally used ESPI technique for vibration measurement. However, without additional image and/or signal-processing procedures, the fringe pattern obtained directly by the video-signal-addition method is rather difficult to observe. The reason for poor visibility of the experimentally obtained fringe pattern with this method is explained. To increase the fringe pattern's visibility without additional image and/or signal processes, we tried two video-signal-subtraction methods. One of the two methods is the video-signal-subtraction method that has normally been used in the static applications. The other method, called the amplitude-fluctuation method, and its associated theory are reported here.

Extracorporeal shockwave lithotripsy for treatment of intrahepatic stones: in vitro and in vivo studies

In vitro, bile duct stones, mostly comprising calcium bilirubinate, are readily fragmented by extracorporeal shockwave lithotripsy (ESWL). In the case of intrahepatic stones, ESWL is effective if the stones float freely in the bile, but if the stones completely fill, or are impacted within, the hepatic duct or bile duct, attempts at fragmentation will end in failure. Three patients with intrahepatic stones were treated with ESWL, and effectively fragmented. The stone fragments passed out spontaneously through T-tube sinus tract, PTDC sinus tract and the sphincter of Oddi as shown in the second cholangiogram. No specific complication was noted in our experimental and clinical experience. We believe that ESWL for fragmentation of biliary stones is technically reliable. The problem of the passage of these fragmented stones is considered; if necessary, it can be overcome by endoscopic means.

Sunlight exposure, antioxidant status, and cataract in Hong Kong fishermen

STUDY OBJECTIVES

The aim was to test whether cataract is associated with higher lifetime exposure to sunlight, and whether antioxidants protect against cataract.

DESIGN

This was a cross sectional survey of eye disease, with assessment of antioxidant status in a subgroup.

SETTING

Hong Kong fishing communities in 1989.

PARTICIPANTS

685 men and women aged 55 to 74 years old were included in the study, of whom 367 (54%) attended hospital for detailed examination.

MEASUREMENTS AND MAIN RESULTS

At a mobile clinic visual acuity and lens opacities were assessed, and using a questionnaire, occupational history and lifetime exposure to sunlight. At hospital ophthalmic measurements were repeated and blood was taken for measurement of plasma vitamin C, vitamin E, and total carotenoids, and red cell activities of glucose-6-phosphate dehydrogenase, glutathione peroxidase, superoxide dismutase, and catalase. Higher grades of cataract (particularly nuclear cataract) tended to be more common in subjects with the most sun exposure, although not to the point of statistical significance. In contrast to earlier studies, no association was found with antioxidant status.

CONCLUSIONS

The findings give some support to the hypothesis that sunlight causes cataract. The absence of a relation to antioxidant status may be because blood levels of antioxidants at one point in time do not adequately reflect a subject's past metabolic state, and particularly the past activity of antioxidants in the lens.

Education, reading, and familial tendency as risk factors for myopia in Hong Kong fishermen

STUDY OBJECTIVE

The aim was to assess the influence of childhood reading on the development of myopia after allowance for familial differences in susceptibility.

DESIGN

The study was a cross sectional survey.

SETTING

Four fishing harbours in Hong Kong in 1989.

SUBJECTS

Participants were 408 men and women aged 15-39 years old from 159 families.

MAIN RESULTS

Histories of school attendance and reading habits in childhood were obtained at interview. Myopia was assessed by retinoscopy. Associations between myopia (defined as a refractive error of at least -1.0D in one or both eyes) and indices of reading in childhood were explored. Myopia was more common in subjects who had attended school (odds ratio = 1.7, 95% CI 1.0-3.0), with the highest risks in those who had started school at the earliest ages and who had spent the most time reading and writing while at primary school. Allowance for familial tendency to myopia produced no diminution in the risks associated with reading.

CONCLUSIONS

These data support the hypothesis that reading in childhood is a cause of short sight.

Mondor's disease of the breast--three cases report

Mondor's disease is a rare and relatively little known clinical entity. Clinical features include sudden development of localized pain in the breast, followed by visible and papable, tender, cordlike, branching cutaneous grooves. It involves superficial thrombophlebitis of the thoracoepigastric or lateral thoracic vein occurring mostly in middle-age women. The etiology of Mondor's disease is unknown, and it may be related to trauma, operation, infection, bandaging, or tight clothes. The mammogram of most cases showed no abnormality, but the ultrasonography revealed hyperechoic cordlike pattern in the lesions. The symptomatic treatment is required and surgery will be indicated when it is associated with malignancy or severe painful cord due to pain and traction. It usually resolves over a period of 2 to 8 weeks. We report three cases of Mondor's disease and that we believe to be the first reported cases in Taiwan.

The Heat Shock Response of Carrot : Protein Variations between Cultured Cell Lines

We have defined several parameters surrounding the heat shock response of cultured cells of carrot (Daucus carota L.) and have found that these cells exhibit a typical "higher plant" heat shock response. In particular, the resolution of the heat shock proteins (hsps) by two-dimensional polyacrylamide gel electrophoresis (PAGE) has revealed a pattern of proteins very similar to the hsps from soybean; specifically, the low molecular weight class is composed of approximately 15 to 20 different polypeptides which likely represent different members of a small gene family. In addition, we have compared the (2-D) PAGE profiles of hsps isolated from several different cultured cell lines currently maintained in our laboratory and have found notable differences in the low molecular weight hsps between cell lines. Some of the differences appear to be quantitative, while others may be qualitative. Each of the cell lines was derived from a different seedling of the same seed stock of the same cultivar; thus, genetic differences should be minimized. In addition, two of the cell lines, which show clear differences, were initially derived from a single parental line, and thus arose from a single genetic stock. Possible explanations for the cell line differences observed here are either partial aneuploidy or modified gene regulation resulting from molecular changes during the time in culture (i.e. somaclonal variation). These observations serve to highlight the potential for variation that exists in cells in culture even for such a highly conserved response and gene set as the heat shock genes.

[Urethral injuries: analysis of 24 cases]

Cases analysis of 24 operations for the anterior urethral injuries is presented. 7 patients were treated one-stage transperineal end-to-end anastomosis and 17 underwent an immediate urethral realignment over a fenestrated catheter. Hospital stays were generally short and the rate of complication was low as well as the number of blood transfusions needed in both groups. The operating time however was longer in patients in the anastomosis group. Postoperatively, urethral strictures occurred in 71% of the patients who underwent one-stage transperineal end-to-end anastomosis and in 65% of those treated by realignment over a fenestrated catheter. The high incidence of postoperative stricture formation caused both techniques indicated neither procedure as a valuable modality for the primary and early treatment of anterior urethral injuries. According to the authors the suprapubic cystostomy and delayed urethroplasty offer a better choice of therapy.