Activated Plasmacytoid Dendritic Cells regulate Type 2 Innate Lymphoid Cells-mediated Airway Hyperreactivity

Capsule summary: pDCs suppress ILC2s through IFN-α

http://ift.tt/2qH3GsL

A New Measure to Assess Asthma’s Impact on Quality of Life from the Patient’s Perspective

The Asthma Impact on Quality of Life Scale (A-IQOLS) assesses the negative effect of asthma on quality of life (QoL) from the patient's perspective, using dimensions of Flanagan's Quality of Life Scale (QOLS), a measure of current QoL.

http://ift.tt/2s0ph3h

Dendritic cells conditioned by activin-A-induced regulatory T cells exhibit enhanced tolerogenic properties and protect against experimental asthma.

This study uncovers a novel biological function for act-A-iTreg cells in instructing the generation of DCs with enhanced tolerogenic properties that could be targeted for the re-establishment of tolerance and the amelioration of asthmatic disease.

http://ift.tt/2qHiZBs

Assessment of thunderstorm-induced asthma using Google Trends

An asthma outbreak of hospitalizations and deaths was noticed in Australia (November 2016) and in Kuwait (December 2016). This outbreak was clearly demonstrated using Google Trends (GT), a Web-based surveillance tool of interest in clinical practice.

http://ift.tt/2s0mLdf

Differential expression of transcription factors NF-κB and STAT3 in periodontal ligament fibroblasts and gingiva of healthy and diseased individuals

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): R. Ambili, Prasanthila Janam, P.S. Saneesh Babu, Manu Prasad, D. Vinod, P.R. Anil Kumar, T.V. Kumary, S. Asha Nair
ObjectivePathogens and host mediators can activate transcription factors in periodontal cells to bring about gene level alterations, thereby accentuating the periodontal disease process. Nuclear factor-kappa B (NF-κB) and signal transducers and activators of transcription 3 (STAT3) are two pivotal transcription factors implicated in chronic inflammatory diseases. But their importance in periodontal pathogenesis has not been investigated in detail. The aim of the present study was to evaluate the expression of activated transcription factors and their target genes in healthy and diseased periodontium.DesignPrimary culture of periodontal ligament fibroblasts (PDLF) were established from healthy and diseased periodontium using explant culture methods. NF-κB and STAT3 activation in these cells by Porphyromonas gingivalis LPS (lipopolysaccharide) was demonstrated using confocal microscopy and mRNA expression of target genes were evaluated by quantitative real time PCR. NF-κB and STAT3 expression in diseased and healthy gingival tissues were analyzed using immunohistochemistry.ResultsA basal upregulation of transcription factors and their target genes were noted in diseased PDLF compared to healthy ones. LPS challenge induced differential expression of NF-κB and STAT3 and their target genes in diseased PDLF compared to healthy ones. Immunohistochemical analysis revealed significant activation of transcription factors in diseased gingival tissues.ConclusionThe findings of the present study reveal the role of transcription factors NF-κB and STAT3 in periodontal pathogenesis and disease susceptibility of fibroblast subpopulations in periodontal disease could be mediated through activation of NF-κB and STAT3. Since genetic factors are nonmodifyable, transcription factors are promising targets for future host modulation therapy.



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Surrogate Outcome Measures for Corneal Neurotization in Infants and Children.

Background: Corneal anesthesia is a rare and challenging condition, particularly in young children. The insensate cornea leads to abnormal epithelial cell metabolism and loss of trophic influences supplied by the corneal nerve fibers. This results in recurrent spontaneous epithelia erosion and eventual loss of sight. Corneal reinnervation is a definitive treatment option for neuropathic keratitis. The outcome measures in young children following corneal sensitization are different to adults as esthesiometry is unachievable. Methods: The authors have undertaken corneal reinnervation in a young patient using a sural nerve graft. Surrogate measures suitable for pediatric patients were used for assessment of the outcome. Results: Postoperatively there was evidence of improved corneal healing and function after 8 weeks. At 10 months postprocedure, the cornea was completely free of vascularization. Conclusion: Resensitization of the cornea using nerve grafts has previously been reported in older children and adults. This is the first time the procedure has been undertaken in a young child. Although the technique is still in its infancy with only 4 patients reported worldwide including our report, it seems to hold promise of improvement to this challenging cohort of patients. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2rLoqns

Patient With Cleft Maxillary Hypoplasia Who Underwent Distraction Osteogenesis and Conservative Therapies to Postoperative Velopharyngeal Insufficiency.

The authors performed distraction osteogenesis using The Maxillary Distractor System (SYNTHES) to maxillary hypoplasia patient with cleft lip palate, and consequently improved the aesthetic complexion of the patient. Velopharyngeal insufficiency developed after bone elongation; the authors improved the insufficiency with conservative therapies such as articulatory training using the bulb attached palatal lift prosthesis. And then the authors got successful and accepted postoperative speech outcome. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2rLATHx

Genetic Factors Involved in Mandibular Prognathism.

Mandibular prognathism is defined as an abnormal forward projection of the mandible beyond the standard relation to the cranial base and it is usually categorized as both a skeletal Class III pattern and Angle Class III malocclusion. The etiology of mandibular prognathism is still uncertain, with various genetic, epigenetic, and environmental factors possibly involved. However, many reports on its coexistence in both twins and segregation in families suggest the importance of genetic influences. A multifactorial and polygenic background with a threshold for expression or an autosomal dominant mode with incomplete penetrance and variable expressivity are the most probable inheritance patterns. Linkage analyses have, thus far, shown the statistical significance of such loci as 1p22.1, 1p22.3, 1p32.2, 1p36, 3q26.2, 4p16.1, 6q25, 11q22, 12pter-p12.3, 12q13.13, 12q23, 12q24.11, 14q24.3 to 31.2, and 19p13.2. The following appear among candidate genes: MATN1, EPB41, growth hormone receptor, COL2A1, COL1A1, MYO1H, DUSP6, ARHGAP21, ADAMTS1, FGF23, FGFR2, TBX5, ALPL, HSPG2, EVC, EVC2, the HoxC gene cluster, insulin-like growth factor 1, PLXNA2, SSX2IP, TGFB3, LTBP2, MMP13/CLG3, KRT7, and FBN3. On the other hand, MYH1, MYH2, MYH3, MYH7, MYH8, FOXO3, NFATC1, PTGS2, KAT6B, HDAC4, and RUNX2 expression is suspected to be involved in the epigenetic regulations behind the mandibular prognathism phenotype. (C) 2017 by Mutaz B. Habal, MD.

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Coexistence of Lymphoepithelial Carcinoma of the Parotid Gland and Submandibular Gland Pleomorphic Adenoma.

Lymphoepithelial carcinoma is a variant of undifferentiated carcinoma with characteristic dense lymphoid stroma in which nasopharynx is site of predilection. Racial and geographic association and Epstein-Barr virus positivity in endemic areas are other characteristics of this rare neoplasm. Lymphoepithelial carcinoma accounts for only 0.4% of malignant salivary gland tumors. The authors present a patient with Epstein-Barr virus positive lymphoepithelial carcinoma of the parotid gland in a nonendemic region. Besides this, synchronous pleomorphic adenoma in the contralateral submandibular gland caused a challenge in making initial therapeutic decision. (C) 2017 by Mutaz B. Habal, MD.

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Canine Eruption After Secondary Alveolar Bone Graft in Unilateral Cleft Lip and Palate Patients.

Purpose: The aim of this article is to analyze dental abnormalities in unilateral cleft lip and palate patients by focusing on the role of the secondary alveolar bone graft (SABG) surgery and its outcomes on canine eruption/inclusion. Materials and Methods: A sample of 24 patients with unilateral cleft lip and palate were selected. Dental anomalies, canine eruption based on the existence of supernumeraries, agenesis elements, inclination of the major canine axis before and after surgery, distance from the occlusal plane before and after surgery, and sector classification were analyzed. Results: Out of the 24 patients, 87.5% presented a canine spontaneously erupted in the dental arch while 12.5% needed surgical-orthodontic traction. There is also no proof that inclination of the canine significantly influenced the eruption before (P = 0.5889) and after (P = 0.4029) surgery. Also, there is no any correlation between the 2 sides (P = 0.1257). The SABG surgery showed a significant correlation with canine eruption (P = 0.009242); moreover, SABG shows a positive relationship with the radicular development of the canine (P = 0.005163). Lateral incisive (P = 0.8493) and second premolar agenesis (P = 1) are not statistically correlated with the eruption of the canine. This does not happen with supernumerary elements that are correlated with the surgical-orthodontic traction (P = 0.0004464). Conclusions: Agenesis does not play any role in the process of canine eruption while supernumeraries do. There is no relationship between the inclination and eruption of the canine. The SABG surgery has a key role because it contributes to create an appropriate support for the erupting canine, the nasal base and the anterior maxilla. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2skT4kk

Fibrin Tissue Sealant as an Adjunct to Cleft Palate Repair.

Purpose: Fibrin glue is a common tissue sealant used to promote hemostasis, adhere tissues, and accelerate healing. Cleft palate repair can be technically challenging, creating dead space between tissue planes, and can be prone to complications such as would dehiscence or bleeding. The purpose of this study is to assess the role of fibrin glue as an adjunct to cleft palate repair. The authors hypothesize a beneficial impact on complication rates, including bleeding, dehiscence, and fistula formation, among others. Methods: Primary cleft palate repairs using fibrin glue were retrospectively analyzed. Demographic, intraoperative, perioperative, and postoperative data were combed for outcome variables. Complication rates were calculated in percentages and the results were compared to the published literature. Z-test statistics were performed for comparison. Results: A total of 45 patients, 21 females and 24 males, who underwent primary cleft palate repair with fibrin glue between 2011 and 2014, had sufficient data to be reviewed. There were no instances of bleeding, dehiscence, airway obstruction, infection, oronasal fistula, or return to the operating room in any patients. One patient exhibited mild postoperative coughing and secretions that resolved with conservative measures. Another patient displayed postoperative seizure activity due to a pre-existing condition. All complication rates in our fibrin glue series were lower than those reported without the use of fibrin glue. Overall complication rates with fibrin sealant are significantly lower than overall complication rates without. Conclusion: Our data suggest that fibrin sealant is a beneficial adjunct to cleft palate repair. Its application is well-tolerated and the complication profile in our cohort was much less than the reported rates. The results of this preliminary study should be vetted with a prospective analysis involving a control group. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2rLGVrS

Asymmetry of Preoperative Incision Design Markings for Upper Blepharoplasty.

Purpose: To compare preoperative incision design markings between both eyelids in upper blepharoplasty. Methods: This retrospective study examined 22 patients who underwent bilateral upper blepharoplasty surgery resulting from senile dermatochalasis and/or blepharoptosis. The initial preoperative incision design markings were drawn with the patient sitting upright. Then, with the patient in a supine position, preoperative design photographs were taken. The authors measured medial canthal excision angle, maximal lid excision height, maximal lid excision width, peak point angle, and peak point distance and compared measurements between both upper eyelids designs using Image J software. Results: The mean medial canthal excision angle, maximal lid excision height, and maximal lid excision width for the right side (30.68[degrees] +/- 10.16[degrees], 1.17 +/- 0.24 cm, and 0.72 +/- 0.19 cm) were significantly different from those for the left side (35.39[degrees] +/- 13.82[degrees]; P < 0.001, 1.24 +/- 0.25 cm; P = 0.002, and 0.77 +/- 0.21 cm; P = 0.011). The mean peak point angle and peak point distance for the right side (15.67[degrees] +/- 5.09[degrees], 2.41[degrees] +/- 0.31[degrees]) were significantly different from those for the left side (18.11[degrees] +/- 5.49[degrees]; P = 0.001, 2.22 +/- 0.28 cm; P = 0.001). Conclusions: In upper blepharoplasty, the preoperative incision marking design measurements of the left side were significantly greater than those of the right side. The symmetry can therefore be maximized by including the asymmetries in the preoperative design. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2sl1XKY

Nasolabial Growth in Individuals With Unilateral Cleft Lip and Palate: A Preliminary Study of Longitudinal Observation Using Three-Dimensional Stereophotogrammetry.

There are limited numbers of studies comparing the preoperative and postoperative facial features of infants with unilateral cleft lip and palate (UCLP) using three-dimensional (3D) stereophotogrammetry. The authors attempted an anthropometric analysis of nasolabial asymmetry 1 year after primary lip repair using a handheld 3D imaging system. Five different nasolabial dimensions in 24 infants with UCLP were measured using 3D images captured during primary lip repair and again, 1 year after the repair. The nasal and upper-lip elements of the cleft side were significantly changed after primary lip repair, and nasolabial asymmetry was anthropometrically improved. This is a preliminary longitudinal observation of nasolabial growth in individuals with UCLP using 3D stereophotogrammetric technique. The authors would like to follow these children until adulthood, capturing 3D images at every intervention. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2skXZSf

Coding Challenges in Craniofacial Surgery.

No abstract available

http://ift.tt/2rLQirt

Nasal Root Deviation in Unicoronal Craniosynostosis: A Craniometric Analysis of Early and Late Postoperative Outcomes.

Purpose: Current operative techniques for correcting unicoronal craniosynostosis (UCS) leave the nasal bones untouched, resulting in an unclear long-term impact on nasal root deviation. The purpose of this study is to quantify nasal root deviation in the preoperative and late postoperative setting in patients who have undergone conventional single-staged UCS correction. Methods: The authors performed a retrospective, craniometric analysis of nasal root deviation comparing preoperative computed tomography scans, with those of the early, and late postoperative period. Three vectors were analyzed to measure nasal root deviation, one extending from the nasion to the rhinion (nasal bone vector), the second from the rhinion to the anterior nasal spine (nasal aperture vector), and the third from the nasion to the anterior nasal spine (nasal longitudinal vector). Results: Twenty-five subjects were included in the study. Average ages at the time of preoperative, early, and late postoperative imaging were 0.6 +/- 0.3, 0.9 +/- 0.6, and 9.3 +/- 2.7 years, respectively. Improvement of angular deviation of both the nasal aperture vector and nasal longitudinal vector was observed. Mean angular deviation of the nasal aperture vector was 6.0 +/- 1.9 degrees preoperatively, 6.0 +/- 2.1 degrees early postoperatively (P = 0.952), and 2.4 +/- 2.1 in the late postoperative period (P = 0.013). Mean angular deviation of the nasal longitudinal vector was 5.7+2.0 degrees preoperatively, 5.8 +/- 2.3 degrees early postoperatively (P = 0.948), and 3.7 +/- 1.6 degrees in the late postoperative period (P = 0.019). Conclusion: Nasal root deviation decreased significantly only in the late postoperative period, lending credence to the notion that though UCS correction does not directly address nasal root deviation, this pathology improves significantly over time. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2skNhvh

A Modified External Fixator System in Treatment of Mandibular Condylar Fractures.

The purpose of this study is to evaluate patient's outcomes after condylar fractures treated with the modified external fixation system from 2008 to 2012. A group of 58 patients with unilateral and bilateral fractures of mandibular condyle was admitted in the authors' study. The final sample included a total of 44 patients, 24 males (54.6%) and 20 females (45.4%). The remaining 14 (24%) patients were excluded because they did not fulfill all the criteria requested. After 12 months from surgery, the functional-clinical evaluation of mouth's maximum opening and mostly extent of lateral excursion and of protrusion showed the following results: 8% of the sample showed a maximum mouth opening 40 mm lateral excursion (contralateral to fracture) and protrusion was respectively of 9.5 and 3.9 mm. Only 2 (4.5%) of the 44 evaluated patients reported headaches. 86.5% of the patients showed no postoperative temporomandibular joint dysfunction; 9% of them reported occasional clicking, while 4.5% reported recurrent disorders. The average satisfaction score of surgery outcome reported by patients was 94.5/100, and it ranged between 50/100 and 100/100. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2skzF31

Hidradenoma of the Chin.

Clear cell hidradenoma is a rare skin tumor in the head and neck. Clear cell hidradenoma of skin is an uncommon soft tissue tumor originating from the sweat glands. The authors report a case of clear cell hidradenoma developing in the chin in a 61-year-old woman, which occurred during the course of 8 months. The clinical and histologic findings of the tumor are documented. The lesion was totally removed by excision and revealed no evidence of recurrence. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2rLxZCP

How to Achieve Facial Balance by Mandibular Contouring Ostectomy in Hemimandibular Hyperplasia.

Hemimandibular hyperplasia is a rare type of condylar hyperplasia which leads to facial asymmetry. Its surgical correction may be challenging since it usually requires complex mandibular osteotomies. Mandibular inferior border ostectomy is poorly described in the literature. The aim of this report is to present a new surgical technique guided by a customized surgical splint manufactured using computer-aided design/computer-aided manufacturing technology. Very good aesthetic results are achieved as it is very precise. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2skJOg6

Microsurgical Decompression of Inferior Alveolar Nerve After Endodontic Treatment Complications.

Iatrogenic injury in oral surgery is the most frequent cause of sensory disturbance in the distribution of the inferior alveolar nerve (IAN) and mental nerve. Inferior alveolar nerve damage can occur during third molar extraction, implant location, orthognathic surgery, preprosthetic surgery, salivary gland surgery, local anesthetic injections or during the resection of benign or malignant tumors. Injuries to the IAN can be caused also by endodontic treatment of mandibular molars and premolars when filling material is forced into the tooth and mandibular canal. The sensory disturbances that could follow a damage of the IAN could be hypoesthesia, dysesthesia, hyperesthesia, anesthesia, and sometimes a painful anesthesia that strike ipsilateral lower lip, chin, and teeth. These can undermine life quality by affecting speech, chewing, and social interaction. Treatment of these complications is sometimes difficult and could consist in observation or in surgical decompression of the involved nerve to relieve the patient's symptoms and improve sensory recovery. The most debated points are the timing of intervention and the effective role of decompression in clinical outcome-improvement. The purpose of this article is to show authors' experience with 2 patients treated with microsurgical nerve decompression to remove endodontic material from the mandibular canal and providing also a comprehensive review of the literature. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2rLAp4c

Nasal Soft Tissue Change Following Bimaxillary Orthognathic Surgery.

Objective: The purpose of this study is to identify the correlation between maxillary movement and nasal soft tissue changes on three-dimensional reconstructed cone beam computed tomography (CBCT) images after Le Fort I osteotomy. Materials and Methods: The authors also investigate the long-term change of alar base width (ABW) to determine the effect of cinch suture. The authors retrospectively studied 52 subjects (14 males and 38 females) who were treated by bimaxillary orthognathic surgery including Le Fort I osteotomy and mandibular ramus surgery. The landmarks and planes were established on three-dimensional reconstructed CBCT images. The authors measured each parameters preoperatively, 1 month postoperatively, and 1 year postoperatively. Results: There was no significant correlation between the horizontal movement of A-point and the widening of ABW (P

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Review of "Medical Error-the Third Leading Cause of Death in the US" by Makary MA and Daniel M in BMJ 353: i2139, 2016.

No abstract available

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Pharmacotherapy of mast cell disorders.

Purpose of review: Mast cell disorders (MCDs) comprise mastocytosis and disorders referred to as mast cell activation syndrome and are caused by abnormal accumulation and/or activation of mast cells in tissues. Clinical signs and symptoms are protean; therefore, finding suitable treatment options for individual patients entails a challenge for clinicians. The purpose of this manuscript is to review the literature on the available therapeutic interventions in patients with MCD. Recent findings: Pharmacotherapy is mainly directed against the effects of mast cells and their mediators. The current recommendations are exclusively based on expert opinions due to the lack of controlled clinical trials. The targeted therapies aiming at blocking mutant KIT variants and/or downstream signaling pathways are currently being developed and may be considered in severely affected, therapy-refractory patients. Summary: There is currently no method for predicting the best available approach to control symptoms in individual patients with MCD. Therefore, a stepwise, individual-based approach in pharmacotherapy options appears to be most successful strategy and is recommended in all patients. The core component of the treatment in most patients is to control symptoms caused by mast cell mediator release, whereas cytoreductive therapies are mainly reserved for patients with advanced/aggressive systemic mastocytosis. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Combined spontaneous bacterial empyema and peritonitis in cirrhotic patients with ascites and hepatic hydrothorax

Publication date: Available online 1 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Anwar Mohamed, Mohammed Atef, Ayman Alsebaey, Mahmoud Musa Elhabshy, Mohsen Salama
Background and study aims: Spontaneous bacterial empyema (SBEM) is an underestimated condition in patients with ascites and hepatic hydrothorax with a high mortality. This study aimed to find whether spontaneous bacterial peritonitis (SBP) is a prerequisite for SBEM. Patients and methods: 3000 HCV-related cirrhotic patients with ascites and hydrothorax were screened for the presence of SBP (ascitic fluid neutrophils >250/mm³) and SBEM (positive pleural fluid culture and neutrophils >250/mm³ or negative pleural fluid culture and neutrophils >500/mm³ with no evidence of pneumonia/parapneumonic effusion on chest radiograph or CT). Results: The prevalence of SBEM in cirrhotic patients was 1.2% (36/3000) unlike SBP (1.6%; 48/3000). SBEM was detected in 51.4% of the patients with hepatic hydrothorax (36/70). A total of 70 patients had concomitant ascites and hydrothorax, namely SBP (n=17), SBEM (n=5), and dual SBP and SBEM (n=31), whereas 17 patients had sterile concomitant ascites and hydrothorax. Age, sex, liver function, kidney function tests, complete blood count, INR, MELD, MELD-Na, blood chemistry, and culture/sensitivity for ascitic and pleural fluid were statistically not different (p>0.05) between SBP and dual SBP and SBEM patients. Escherichia coli and Klebsiella pneumoniae were detected in the culture. From univariate analysis, no predictors of dual SBP and SBEM were detected. Conclusion: SBEM is a part of SBP in cirrhotic patients with ascites and hydrothorax.



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Relationship between liver injury and serum cytokeratin 18 levels in asymptomatic hepatitis B virus carriers and in patients with chronic hepatitis B infection

Publication date: Available online 1 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Ayhan Balkan, Nimet Yılmaz, Yasemin Balkan, Irfan Koruk, Mustafa Örkmez, Musa Aydınlı, Mehmet Koruk
Background and study aimsApoptosis represents a well-known mechanism of cell death involved in most chronic liver injuries. Our aim was to investigate the serum fragment level of cytokeratin 18 (CK18), M30, in asymptomatic hepatitis B virus (HBV) carriers and patients with chronic hepatitis B (CHB) and to evaluate the relationship between serum M30 levels and the severity of hepatic injury.Patients and methodsAsymptomatic HBV carriers (n=169), patients with CHB (n=100), and healthy control subjects (n=43) were enrolled in the study. Serum CK18 (M30) levels were analysed in all subjects. Liver biopsy for histopathological assessment was performed in asymptomatic HBV carriers and in patients with CHB infection.ResultsSerum CK18 (M30) levels were significantly higher in asymptomatic HBV carriers (198.77±77.62U/L) than in healthy control subjects (146.92±40.18U/L). Patients with CHB (283.02±147.45U/L) had significantly higher CK18 (M30) levels than asymptomatic HBV carriers (p=0.001). The diagnostic efficacy of CK18 (M30) levels in distinguishing patients with HBeAg-negative CHB from asymptomatic HBV carriers was found to be moderate (c-statistics: 0.695), and the diagnostic cut-off value of CK18 (M30) was 262U/L (specificity: 85%, sensitivity: 48%, positive likelihood ratio: 3.35, and negative likelihood ratio: 0.60). There was a positive correlation between serum CK18 (M30) levels and histological activity index scores in asymptomatic HBV carriers and patients with CHB.ConclusionsSerum CK18 (M30) levels may be a valuable indicator in distinguishing asymptomatic HBV carriers from patients with HBeAg-negative CHB when considered together with ALT and HBV-DNA levels.



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Chemotherapy for Resected Colorectal Cancer Pulmonary Metastases: Utilization and Outcomes in Routine Clinical Practice

Publication date: Available online 1 June 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Safiya Karim, Sulaiman Nanji, Kelly Brennan, C.S. Pramesh, Christopher M. Booth
BackgroundThe role of chemotherapy in the setting of resected colorectal cancer pulmonary metastases (CRCPM) is not well defined. Here we describe utilization of peri-operative chemotherapy and outcomes among patients with resected CRCPM in the general population.MethodsAll cases of CRCPM who underwent resection from 2002-2009 were identified using the Ontario Cancer Registry (OCR). Electronic treatment records identified peri-operative chemotherapy delivered within 16 weeks before or after pulmonary metastectomy (PM). Modified Poisson regression was used to evaluate factors associated with chemotherapy delivery. Cox proportional models were used to explore the association between post-operative chemotherapy and cancer-specific (CSS) and overall survival (OS).ResultsThe study population included 420 patients. Thirty-six percent of patients (151/420) received peri-operative chemotherapy. Among these patients, 75% (113/151) received post-operative chemotherapy. Factors that were independently associated with use of post-operative chemotherapy included higher socioeconomic status (SES) and no prior adjuvant chemotherapy (p<0.01). In adjusted analyses post-operative chemotherapy was not associated with improved CSS (HR 0.99, 95% CI 0.67-1.47) or OS (HR 0.93 95%CI 0.66-1.31). In exploratory analyses, among those patients who did not receive previous adjuvant therapy for the primary colorectal cancer, post-operative chemotherapy following lung metastatectomy was associated with HR 0.50 (95%CI 0.27-0.95) for OS and HR 0.59 (95%CI 0.27-1.27) for CSS.ConclusionOne third of patients with resected CRCPM in routine practice receive peri-operative chemotherapy. A randomized controlled trial is warranted to evaluate whether chemotherapy following resection of CRCPM is associated with improved survival.



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Percutaneous ultrasound-guided fiducial marker placement for liver cancer robotic stereotactic radio-surgery treatment: A comparative analysis of three types of markers and needles

Publication date: Available online 1 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Maria Marsico, Tommaso Gabbani, Sarah Lunardi, Andrea Galli, Maria Rosa Biagini, Vito Annese
Background and study aimsPercutaneous placement of fiducial markers is required to perform stereotactic body radiation therapy (SBRT) for liver neoplastic lesions. This prospective trial was designed to evaluate the feasibility and safety of percutaneous ultrasound-guided placement of three different types of markers in patients with liver cancer referred for SBRT.Patients and methodsFifty patients underwent percutaneous ultrasound-guided implantation of a fiducial marker in the liver. Three sizes of needles were used: 25 gauge (G), 22G, and 17G. The 25G and 22G needles contained gold anchor markers of 0.28×10mm and 0.4 ×10mm size, respectively. In contrast, the 17G needle contained a gold grain marker of 1×4mm. Each patient received 1–6 markers, depending on lesion size and numbers. Technical feasibility and the occurrence of adverse events were registered. Computed tomography scans were acquired prior to SBRT to evaluate the location, visibility, or complications related to the markers.ResultsA total of 163 needles were used to deliver 163 markers in 50 patients. No major complications occurred. Minor complication occurrence rate was 12%. The total complication occurrence for all type of markers was 8.5%. No complications were observed with the use of the gold anchor marker of 0.4 ×10mm size. Variance analysis of the three markers showed a significant difference in the frequency of complications amongst the three markers (p<0.01).ConclusionPercutaneous ultrasound-guided placement of fiducial markers for SBRT of liver neoplastic lesions is safe and feasible. In our series, the 22G needle showed some advantage in terms of handling and safety when compared with the 25G and 17G needles. In addition, the gold anchor marker of 0.4 ×10mm size displayed a lower percentage of displacement.



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Prevalence of hepatitis C virus genotypes and subtypes in Lebanese population and major high risk groups

Publication date: Available online 1 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Antoine Abou Rached, Cesar Yaghi, Leda Khalil, Jowana Saba, Walid Ammar
Background and study aimsThe prevalence of hepatitis C in Lebanon is low. It is estimated at 0.2% of the total population. The aim of our study is to evaluate the exact prevalence of each genotype on a large scale population and in each potential source of infection.Patients and methodsWe reviewed all the data in the Ministry of Public Health related to patients who have submitted their file for treatment during a period of 9years ranging from January 2005 till December 2013.ResultsThe genotype distribution in 1031 Lebanese patients was as following: Genotype 1 was the most predominant representing 47% followed by genotype 4 representing 34% then genotype 3 representing14%. Concerning sex distribution and routes of infection, there was a male predominance in intravenous drug users (IVDU), whereas approximately equal distribution was noted in haemodialysis and transfusion groups. A female predominance was noted in the "unknown" mode of infection. Concerning age distribution and routes of infection, a mean age of 27 was noted in the IVDU group, whereas mean age of 60 in the transfusion group and 50 in the haemodialysis group. In patients who acquired the infection post transfusion or during haemodialysis, genotype 1 was the most predominant, whereas in IVDU, genotype 3 was the most predominant. Concerning sub-genotyping: subtype 1b was the most predominant (84%) in genotype 1. in genotype 2 subtype b with 75%, all genotype 3 were subtype a, in genotype 4 subtype a represents 50% of genotype followed by subtype e in 30%.ConclusionOur data concerning Lebanese population demonstrate that genotype 1 is the most prevalent genotype followed by genotype 4. In IVU, we noted genotype-3 and -1 being the most prevalent in relation to clustering in this high risk group. This distribution differs from most surrounding countries and all other Arab countries.



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APRI test and hyaluronic acid as non-invasive diagnostic tools for post HCV liver fibrosis: Systematic review and meta-analysis

Publication date: Available online 1 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Magdy Amin El Serafy, Abdel Meguid Kassem, Heba Omar, Mohammad Shaaban Mahfouz, Maissa El Said EL Raziky
Background and study aimsHepatitis C virus (HCV) accounts for a sizable proportion of chronic liver disease cases and represents the most common indication for liver transplantation. Precise diagnosis of hepatic fibrosis stage is considered a funnel-neck in proper management and follow-up of HCV-infected patients. Given the possible complications of liver biopsy, a non-invasive method for assessing hepatic fibrosis is needed. This study aimed to evaluate the diagnostic accuracy of APRI and hyaluronic acid as non-invasive diagnostic assessment tools for post HCV liver fibrosis.Patients and methodsSystematic literature searching identified studies performed on Egyptian territory to evaluate APRI and hyaluronic acid as non-invasive tests of fibrosis and using liver biopsy as the reference standard. Meta-analysis was performed for areas with an adequate number of publications. Validation of meta- analysis on APRI was done on a subset of 150 treatment-naïve post-hepatitis C patients.ResultsBoth APRI and hyaluronic acid have superior predictive power for hepatic cirrhosis (F4) than for significant fibrosis (F2-F3). The pooled estimate for sensitivities and specificities of APRI and hyaluronic acid to diagnose F4 were (84% and 82%) and (83% and 89%) respectively. In the subgroup of treatment naïve post-hepatitis C patients, APRI had higher diagnostic performance to diagnose liver cirrhosis with 93.8% sensitivity and 72.4% specificity (AUC; 0.908, 95%CI; 0.851–0.965, p-value; <0.001) compared to its accuracy to diagnose significant hepatic fibrosis with 65.1% sensitivity and 77.8% (AUC; 0.685, 95% CI; 0.59–0.78, p-value; 0.001).ConclusionAPRI score and hyaluronic acid levels are simple and reliable non-invasive markers to detect advanced fibrosis among post-hepatitis C patients.



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Evaluation of gastro-oesophageal reflux disease in wheezy infants using 24-h oesophageal combined impedance and pH monitoring

Publication date: Available online 1 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Ahmed Abdallah, Tarek El-Desoky, Khalid Fathi, Wagdi Fawzi Elkashef, Ahmed Zaki
Background and study aimsGastro-oesophageal reflux disease (GERD) is incriminated as a cause of non-asthmatic infantile wheeze. To date, no diagnostic test is considered standard for GERD-related airway reflux diagnosis. Oesophageal combined multiple channel intraluminal impedance and pH (MII-pH) monitoring is proposed to be a sensitive tool for evaluation of all GERD including infantile wheeze. We aimed to determine the GERD prevalence amongst wheezy infants in the first year of life using combined MII-pH versus pH monitoring alone and evaluate the sensitivity and specificity of objective MII-pH monitoring parameters in GERD-associated infantile wheeze diagnosis compared to those of lipid-laden macrophage index (LLMI).Patients and methodsThirty-eight wheezy infants below 1year of age were evaluated for GERD using oesophageal combined MII-pH monitoring and LLMI.ResultsTotally, 60.5% of cases had abnormal MII-pH; only 7.9% of them had abnormal pH monitoring. LLMI was significantly higher in wheezy infants with abnormal MII-pH than infants with normal MII-pH monitoring (112±88 versus 70±48; P=0.036). The current definitions of abnormal MII-pH study, reflux index≥10% and distal reflux episodes≥100, had low sensitivity (23%) but high specificity (100% and 96%, respectively) in GERD-related aspiration diagnosis defined by LLMI≥100. Using ROC curves, bolus contact time≥2.4% and proximal reflux episodes≥46 had 61% and 54% sensitivity and 64% and 76% specificity, respectively, in GERD-related aspiration diagnosis.ConclusionCombined MII-pH is superior to pH monitoring in reflux-associated infantile wheeze diagnosis. Objective data including proximal reflux episodes and bolus contact time should be combined with the current parameters used in reflux-associated infantile wheeze diagnosis.



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Efficacy and safety of midazolam and ketamine in paediatric upper endoscopy

Publication date: Available online 1 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Ahmet Basturk, Reha Artan, Aygen Yılmaz
Background and study aimUpper endoscopy can be successfully carried out in children under deep sedation and anaesthesia. However, the best method of upper endoscopy for children who require gastrointestinal intervention has yet to be defined. The aim of this study is to investigate the efficacy and safety of the sedation induced by intravenous midazolam and ketamine during upper endoscopy in children.Patients and methodsThis study included patients ages 3–18years who had undergone upper endoscopy. All subjects received IV midazolam and ketamine. During the intervention, hypoxia, tachycardia, bradycardia, hypertension, and hypotension were recorded. After the intervention, euphoria, dysphoria, vertigo, visual problems (such as diplopia and nystagmus), and emergencies (such as arrhythmia, convulsion, and hallucination), among other findings, were recorded. Older children who were capable of expressing themselves were questioned to help determine these conditions.ResultsThe mean age of the study group was was 11.9±3.42years; 54% of the patients were females, and 46% were males. During the upper endoscopy, hypoxia occurred in 9% of patients, mild hypertension in 14%, hypotension in 5%, tachycardia in 23%, bradycardia in 8%, and flushing-urticaria in 2%. After the upper endoscopy, one of the most common complications was sore throat, which occurred in 24% of patients. Vomiting was observed in 14% of patients, dizziness in 24%, diplopia in 27%, euphoria in 3% (5 patients), dysphoria in 4%, and hallucination in 4%. Of the total patients, 4% required oxygen supply with a face mask.ConclusionThe results of our study showed that the use of IV midazolam and ketamine during upper endoscopy in children was safe and effective.



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A glycoproteomic approach reveals that the S-layer glycoprotein of Lactobacillus kefiri CIDCA 83111 is O- and N-glycosylated

Publication date: 6 June 2017
Source:Journal of Proteomics, Volume 162
Author(s): Gustavo J. Cavallero, Mariano Malamud, Adriana C. Casabuono, M. de los Ángeles Serradell, Alicia S. Couto
In Gram-positive bacteria, such as lactic acid bacteria, general glycosylation systems have not been documented so far. The aim of this work was to characterize in detail the glycosylation of the S-layer protein of Lactobacillus kefiri CIDCA 83111. A reductive β-elimination treatment followed by anion exchange high performance liquid chromatography analysis was useful to characterize the O-glycosidic structures. MALDI-TOF mass spectrometry analysis confirmed the presence of oligosaccharides bearing from 5 to 8 glucose units carrying galacturonic acid. Further nanoHPLC-ESI analysis of the glycopeptides showed two O-glycosylated peptides: the peptide sequence SSASSASSA already identified as a signature glycosylation motif in L. buchneri, substituted on average with eight glucose residues and decorated with galacturonic acid and another O-glycosylated site on peptide 471–476, with a Glc5–8GalA2 structure. As ten characteristic sequons (Asn-X-Ser/Thr) are present in the S-layer amino acid sequence, we performed a PNGase F digestion to release N-linked oligosaccharides. Anion exchange chromatography analysis showed mainly short N-linked chains. NanoHPLC-ESI in the positive and negative ion modes were useful to determine two different peptides substituted with short N-glycan structures. To our knowledge, this is the first description of the structure of N-glycans in S-layer glycoproteins from Lactobacillus species.SignificanceA detailed characterization of protein glycosylation is essential to establish the basis for understanding and investigating its biological role. It is known that S-layer proteins from kefir-isolated L. kefiri strains are involved in the interaction of bacterial cells with yeasts present in kefir grains and are also capable to antagonize the adverse effects of different enteric pathogens. Therefore, characterization of type and site of glycosidic chains in this protein may help to understand these important properties. Furthermore, this is the first description of N-glycosidic chains in S-layer glycoprotein from Lactobacillus spp.

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Proteomic and transcriptomic analysis of saliva components from the hematophagous reduviid Triatoma pallidipennis

Publication date: 6 June 2017
Source:Journal of Proteomics, Volume 162
Author(s): María J. Hernández-Vargas, Jeovanis Gil, Luis Lozano, Martha Pedraza-Escalona, Ernesto Ortiz, Sergio Encarnación-Guevara, Alejandro Alagón, Gerardo Corzo
Species belonging to the Triatominae subfamily are commonly associated with Chagas disease, as they are potential vectors of the parasite Trypanosoma cruzi. However, their saliva contains a cocktail of diverse anti-hemostatic proteins that prevent blood coagulation, vasodilation and platelet aggregation of blood; components with indisputable therapeutic potential. We performed a transcriptomic and proteomic analyses of salivary glands and protein spots from 2DE gels of milked saliva, respectively, from the Mexican Triatoma pallidipennis. Massive sequencing techniques were used to reveal this protein diversity. A total of 78 out of 233 transcripts were identified as proteins in the saliva, divided among 43 of 55 spots from 2DE gels of saliva, identified by LC-MS/MS analysis. Some of the annotated transcripts putatively code for anti-hemostatic proteins, which share sequence similarities with proteins previously described for South American triatomines. The most abundant as well as diverse transcripts and proteins in the saliva were the anti-hemostatic triabins. For the first time, a transcriptomic analysis uncovered other unrelated but relevant components in triatomines, including antimicrobial and thrombolytic polypeptides. Likewise, unique proteins such as the angiotensin-converting enzyme were identified not just in the salivary gland transcriptome but also at saliva proteome of this North American bloodsucking insect.Biological significanceThis manuscript is the first report of the correlation between proteome and transcriptome of Triatoma pallidipennis, which shows for the first time the presence of proteins in this insect that have not been characterized in other species of this family. This information contributes to a better understanding of the multiple host defense mechanisms that are being affected at the moment of blood ingestion by the insect. Furthermore, this report gives a repertoire of possible therapeutic proteins.

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Comparative proteome analysis of the hepatopancreas from the Pacific white shrimp Litopenaeus vannamei under long-term low salinity stress

Publication date: 6 June 2017
Source:Journal of Proteomics, Volume 162
Author(s): Chang Xu, Erchao Li, Yan Liu, Xiaodan Wang, Jian G. Qin, Liqiao Chen
Litopenaeus vannamei is a typical euryhaline decapod model to study the osmoregulation mechanism in crustaceans. The proteomic was undertaken using isobaric tags for relative and absolute quantification together with the reverse phase in high-performance liquid chromatography mass spectrometry to quantitatively identify the proteins differentially expressed in the hepatopancreas under low salinity stress (3psu) compared with the control salinity (25psu). 533 proteins and 84 differentially expressed proteins were identified including 58 proteins with the 1.2-fold cut-off value under chronically low salinity stress. Among these proteins, 26 were up-regulated while 32 were down-regulated. 48 out of 58 differentially expressed proteins were annotated in the Uniprot database and were mapped into 38 pathways by KEGG analysis. These proteins were categorized into the pathways for energy metabolism, signaling, immunization and detoxification, lipid and protein metabolism. A more active glycometabolism, positive response detoxification pathway, immunosuppression and positive osmoregulation were identified in L.vannamei under low salinity stress. This study suggests that under chronically low salinity stress, L. vannamei showed low immunity and high demand for energy especially from glycometabolism. Signaling transfer related pathways, especially the Wnt signaling pathways were involved in the process of salinity adaption, but the in-depth mechanism warrants further investigation.SignificanceIn this study, a comprehensive physiological response was studied using proteomics to reveal the underlying mechanism of adaptation to low salinity in L.vannamei, which was the first report on the proteomic response of crustacean to salinity stress. The extensive proteomic investigation on hepatopancreas under low salinity stress provides a new insight into the adaptive mechanism of this euryhaline crustacean species to low salinity.

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Proteome analysis of human embryonic stem cells organelles

Publication date: 6 June 2017
Source:Journal of Proteomics, Volume 162
Author(s): Faezeh Shekari, Hossein Nezari, Mehran Rezaei Larijani, Chia-Li Han, Hossein Baharvand, Yu-Ju Chen, Ghasem Hosseini Salekdeh
As the functions of proteins are associated with their cellular localization, the comprehensive sub-cellular proteome knowledge of human embryonic stem cells (hESCs) is indispensable for ensuring a therapeutic effect. Here, we have utilized a sub-cellular proteomics approach to analyze the localization of proteins in the nucleus, mitochondria, crude membrane, cytoplasm, heavy and light microsomes. Out of 2002 reproducibly identified proteins, we detected 762 proteins in a single organelle whereas 160 proteins were found in all sub-cellular fractions. We verified the localization of identified proteins through databases and discussed the consistency of the obtained results. With regards to the ambiguity in the definition of a membrane protein, we tried to clearly define the plasma membrane, peripheral membrane and membrane proteins by annotation of these proteins in databases, along with predictions of transmembrane helices. Among ten enriched signaling pathways highlighted in our results, non-canonical Wnt signaling were analyzed in greater detail. The functions of three novel hESC membrane proteins (ERBB4, GGT1 and ZDHHC13) have been assessed in terms of pluripotency. Our report is the most comprehensive for organellar proteomics of hESCs.SignificanceMass spectrometric identification of proteins using a TripleTOF 5600 from nucleus, mitochondria, crude membrane, cytoplasm, heavy and light microsomal fractions highlighted the significance of the non-canonical Wnt signaling in human embryonic stem cells.

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Editorial Board

Publication date: 6 June 2017
Source:Journal of Proteomics, Volume 162





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Organ-specific proteomics of soybean seedlings under flooding and drought stresses

Publication date: 6 June 2017
Source:Journal of Proteomics, Volume 162
Author(s): Xin Wang, Ehsaneh Khodadadi, Baratali Fakheri, Setsuko Komatsu
Organ-specific analyses enrich the understanding of plant growth and development under abiotic stresses. To elucidate the cellular responses in soybean seedlings exposed to flooding and drought stresses, organ-specific analysis was performed using a gel-free/label-free proteomic technique. Physiological analysis indicated that enzyme activities of alcohol dehydrogenase and delta-1-pyrroline-5-carboxylate synthase were markedly increased in leaf and root of plants treated with 6days of flooding and drought stresses, respectively. Proteins related to photosynthesis, RNA, DNA, signaling, and the tricarboxylic acid cycle were predominately affected in leaf, hypocotyl, and root in response to flooding and drought. Notably, the tricarboxylic acid cycle was suppressed in leaf and root under both stresses. Moreover, 17 proteins, including beta-glucosidase 31 and beta-amylase 5, were identified in soybean seedlings under both stresses. The protein abundances of beta-glucosidase 31 and beta-amylase 5 were increased in leaf and root under both stresses. Additionally, the gene expression of beta-amylase 5 was upregulated in leaf exposed to the flooding and drought, and the expression level was highly correlated with the protein abundance. These results suggest that beta-amylase 5 may be involved in carbohydrate mobilization to provide energy to the leaf of soybean seedlings exposed to flooding and drought.Biological significanceThis study examined the effects of flooding and drought on soybean seedlings in different organs using a gel-free/label-free proteomic approach. Physiological responses indicated that enzyme activities of alcohol dehydrogenase and delta-1-pyrroline-5-carboxylate synthase were increased in leaf and root of soybean seedlings exposed to flooding and drought for 6days. Functional analysis of acquired protein profiles exhibited that proteins related to photosynthesis, RNA, DNA, signaling, and the tricarboxylic acid cycle were predominated affected in leaf, hypocotyl, and root under both stresses. Moreover, the tricarboxylic acid cycle was suppressed in leaf and root of stressed soybean seedlings. Additionally, increased protein abundance of beta-amylase 5 was consistent with upregulated gene expression in the leaf under both stresses, suggesting that carbohydrate metabolism might be governed in response to flooding and drought of soybean seedlings.

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Semen proteomics and male infertility

Publication date: 6 June 2017
Source:Journal of Proteomics, Volume 162
Author(s): Meritxell Jodar, Ada Soler-Ventura, Rafael Oliva
Semen is a complex body fluid containing an admixture of spermatozoa suspended in secretions from the testes and epididymis which are mixed at the time of ejaculation with secretions from other accessory sex glands such as the prostate and seminal vesicles. High-throughput technologies have revealed that, contrary to the idea that sperm cells are simply a silent delivery vehicle of the male genome to the oocyte, the sperm cells in fact provide both a specific epigenetically marked DNA together with a complex population of proteins and RNAs crucial for embryogenesis. Similarly, –omic technologies have also enlightened that seminal fluid seems to play a much greater role than simply being a medium to carry the spermatozoa through the female reproductive tract. In the present review, we briefly overview the sperm cell biology, consider the key issues in sperm and seminal fluid sample preparation for high-throughput proteomic studies, describe the current state of the sperm and seminal fluid proteomes generated by high-throughput proteomic technologies and provide new insights into the potential communication between sperm and seminal fluid. In addition, comparative proteomic studies open a window to explore the potential pathogenic mechanisms of infertility and the discovery of potential biomarkers with clinical significance.SignificanceThe review updates the numerous proteomics studies performed on semen, including spermatozoa and seminal fluid. In addition, an integrative analysis of the testes, sperm and seminal fluid proteomes is also included providing insights into the molecular mechanisms that regulate the generation, maturation and transit of spermatozoa. Furthermore, the compilation of several differential proteomic studies focused on male infertility reveals potential pathways disturbed in specific subtypes of male infertility and points out towards future research directions in the field.



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Corrigendum to “Quantitative proteomics and integrative network analysis identified novel genes and pathways related to osteoporosis” [J. Proteomics 142 (16 June 2016) 45–52]

Publication date: 6 June 2017
Source:Journal of Proteomics, Volume 162
Author(s): Yong Zeng, Lan Zhang, Wei Zhu, Chao Xu, Hao He, Yu Zhou, Yao-Zhong Liu, Qing Tian, Ji-Gang Zhang, Fei-Yan Deng, Hong-Gang Hu, Li-Shu Zhang, Hong-Wen Deng




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Cutaneous T pseudolymphoma on the red pigmented areas of a tattoo

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Plasma-induced selectivity in bone cancer cells death

Publication date: September 2017
Source:Free Radical Biology and Medicine, Volume 110
Author(s): Cristina Canal, Raul Fontelo, Ines Hamouda, Jordi Guillem-Marti, Uros Cvelbar, Maria-Pau Ginebra
BackgroundCurrent therapies for bone cancers - either primary or metastatic – are difficult to implement and unfortunately not completely effective. An alternative therapy could be found in cold plasmas generated at atmospheric pressure which have already demonstrated selective anti-tumor action in a number of carcinomas and in more relatively rare brain tumors. However, its effects on bone cancer are still unknown.MethodsHerein, we employed an atmospheric pressure plasma jet (APPJ) to validate its selectivity towards osteosarcoma cell line vs. osteoblasts & human mesenchymal stem cells.ResultsCytotoxicity following direct interaction of APPJ with cells is comparable to indirect interaction when only liquid medium is treated and subsequently added to the cells, especially on the long-term (72h of cell culture). Moreover, following contact of the APPJ treated medium with cells, delayed effects are observed which lead to 100% bone cancer cell death through apoptosis (decreased cell viability with incubation time in contact with APPJ treated medium from 24h to 72h), while healthy cells remain fully viable and unaffected by the treatment.ConclusionsThe high efficiency of the indirect treatment indicates that an important role is played by the reactive oxygen species (ROS) and reactive nitrogen species (RNS) in the gaseous plasma stage and then transmitted to the liquid phase, which overall lead to lethal and selective action towards osteosarcoma cells. These findings open new pathways for treatment of metastatic bone disease with a minimally invasive approach.

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Prophylactic Midface Lift in Midfacial Trauma

Facial plast Surg 2017; 33: 347-351
DOI: 10.1055/s-0037-1602165

The objective was to review our favorable experience in the use of prophylactic midface lifts in the setting of severe midfacial trauma. A retrospective review of a consecutive series of patients undergoing prophylactic midface lifts at the time of definitive fracture repair in a County Hospital Level 1 trauma center was done. All patients undergoing midface lifts at the time of fracture repair by the senior author from July 1998 to July 2012 were included in this review. A total of 72 patients (58 males, 14 females, average age: 36.2 years) were available for review. Sixty-three patients had a minimal follow-up of at least 3 months. No complications felt to be related to the midfacial suspension were noted. There were no instances of frontal nerve paralysis or palsy. There were no patients with ectropion. Patient midfacial symmetry was evaluated by two blinded facial plastic surgeons. It was felt to be excellent in 53 patients, good in 9, fair in 1, and poor in none. The force of trauma necessary to elicit a severe midfacial fracture and the subsequent subperiosteal dissection required to expose the fractures for rigid fixation result in severe laxity of the midfacial soft tissue envelope. Failure to suspend and support these soft tissues will result in significant facial asymmetry. Prophylactic endoscopic midface suspension appears to be a safe and effective method of largely eliminating this problem and should be considered in the setting of severe midfacial fractures.
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The Horizontal Neck Lift

Facial plast Surg 2017; 33: 266-270
DOI: 10.1055/s-0037-1598054

The horizontal neck lift is a procedure involving direct excision of a horizontally oriented ellipse of skin from the neck. This procedure was developed for neck rejuvenation in patients with significant horizontal creases and excess skin of the middle and lower neck, areas that often cannot be adequately addressed with traditional techniques. This article describes the procedure, indications, patient counseling, and postoperative care in detail from the senior author's (H. M.) experience.
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The Superficial Musculoaponeurotic System Facelift: A Prudent Balance of Risks and Benefits

Facial plast Surg 2017; 33: 260-265
DOI: 10.1055/s-0037-1603316

Over the decades, facelifting has not escaped the natural history of trends and fads. And, as a profession, facial plastic surgery has not avoided falling into the trap of following corporate initiated technology, rather than leading common-sense methodologies to rejuvenating the aging face. The author is often reminded of a truism to which he was introduced in the 1980s. "When there are many ways of doing things, all of them work; or none of them work." Undeniably, any procedure that lifts and removes excessive skin of the face and neck "works." However, the questions that must be answered by leading teachers of facelifting surgery are: How well does a given technique work? How long-lasting are the results? Where does the risk–benefit curve cross over from optimal benefits to unacceptable risks? At what stage in a given patient's aging process are more aggressive techniques called for? At what stage in a surgeon's career should more invasive techniques be attempted, if ever? This article addresses the preceding questions as they relate to the contribution made by the superficial musculoaponeurotic fascia in repositioning sagging tissues of the face and neck.
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The History of Rhytidectomy

Facial plast Surg 2017; 33: 247-249
DOI: 10.1055/s-0037-1603347

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Skin Resurfacing in Combination with Facelift Surgery

Facial plast Surg 2017; 33: 299-310
DOI: 10.1055/s-0037-1602742

Facial aging is a combination of descent of facial tissues, atrophy of fat compartments, bony remodeling, and chronological and photoaging changes of the skin. A rhytidectomy will address the aging changes due to gravity on facial tissues but will do little to improve skin texture, thickness, and pigmentation. To address collagen loss, rhytids, and dyspigmentation, surgeons are incorporating resurfacing techniques including carbon dioxide/erbium ablative and fractionated lasers, 35% trichloroacetic acid chemical peel pretreated with Jessner's solution, phenol 88% chemical peel, Baker's solution chemical peel, and dermabrasion. More recently, surgeons are approaching facial aging with a more comprehensive approach to address both gravity and collagen changes by a combination of rhytidectomy with resurfacing. Technique and modality selection are keys to maximum single treatment results and therefore the greatest patient satisfaction.
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Revision Rhinoplasty: Retrospective Chart Review Analysis of Deformities and Surgical Maneuvers in Patients with Nasal Airway Obstruction—Five Years of Experience

Facial plast Surg 2017; 33: 334-338
DOI: 10.1055/s-0037-1598041

Nasal airway obstruction is one of the most frequent causes of revision rhinoplasty in patients after previous rhinoplasty procedure. Purpose of this study is to present the deformities and the surgical maneuvers conducted in revision rhinoplasty patients with functional complaint, anatomical sites at risk, and potential prophylactic maneuvers. This study is a retrospective chart review analysis of 46 consecutive revision rhinoplasty procedures in patients with nasal airway obstruction. Inclusion criteria were at least one previous rhinoplasty and nasal airway obstruction as the epicenter of patients' complaint. Thorough clinical examination to certify the obstruction was performed. Deformities noted were separated in three categories according to functional, cosmetic, and combination of functional and cosmetic implications. Surgical maneuvers conducted were reviewed. Deformities found were checked for statistically significant coexistences. The average patient age was 34.9 years. The mean number of previous septorhinoplasties was 1.33. Nasal ventilation obstruction mainly caused either by septum deviation or nasal valve dysfunction was identified in 91.3% of our patients. Surgical maneuvers conducted included placement of grafts in 89.1% of all cases, septoplasty in 76.1%, lateral wall support in 47.8%, and placement of spreader grafts in 39.1% of patients. The average preoperative Nasal Obstruction Symptom Evaluation (NOSE) score was 61 ± 15 and it improved substantially, even from month 1, postoperatively. Owing to high prevalence of nasal airway obstruction after primary or secondary rhinoplasty, we conducted the first retrospective chart review study to identify the most common deformities in revision rhinoplasty patients with nasal airway obstruction and the appropriate surgical maneuvers to address them. Septum deviation and nasal valve dysfunction were the two pillars of nasal airway obstruction in those patients.
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Lateral Crural Tensioning for Refinement of the Nasal Tip and Increasing Alar Stability: A Case Series

Facial plast Surg 2017; 33: 316-323
DOI: 10.1055/s-0037-1602143

The objective of this study was to discuss the technical details and our experiences with lateral crural tensioning (LCT) in both functional and aesthetic rhinoplasties. A retrospective medical review was completed for all patients who underwent rhinoplasty with LCT from the years 2011 to 2014. The indications for LCT included correction of lateral crural convexity, boxy tip geometry, and dynamic collapse of the external nasal valve. The details of the rhinoplasty procedure and complications were evaluated. A total of 114 LCT rhinoplasty cases were included in this series. The most common adjunctive maneuvers included placement of spreader grafts (92% of cases) and alar rim grafts (78% of cases). Conventional classic cephalic trim was not performed in any subjects and conservative paradomal cephalic trim was performed in 48% of cases. As experience with the technique progressed, the use of onlay tip grafts decreased and the use of articulated rim grafts increased. Indications for revision were dissatisfaction with cosmetic outcome (4.4% of cases) and nasal obstruction (0.9% of cases). LCT combines traditional lateral crural steal with the use of a caudal septal extension graft to refine the broad tip and increase stability of the alar lobule. This maneuver is essentially cartilage sparing and does not rely on extensive grafting maneuvers that can reduce airway area.
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Psychology of the Facelift Patient

Facial plast Surg 2017; 33: 252-259
DOI: 10.1055/s-0037-1598071

This paper presents an extensive literature review of the psychology of facelift patients as it has evolved over the past 50 years. Earlier studies revealed significant levels of pre and perioperative depression. Facelift patients generally exhibit emotional and social concerns about facial appearance that are higher than the general population. Many are undergoing midlife situational stresses and may lack the positive characteristics to deal with them. The most common diagnoses seen include depression, impulsivity, unstable personality, and passive dependence, albeit not necessarily serious. Improvement in body image is the major driver for surgery. Characteristics of female patients as defined by their age are described. These include the younger emotionally dependent group, the worker group of middle age, and the older grief group. Male patients are seen to have a higher level of psychological dysfunction, but a higher improvement in postoperative quality of life. Motivations for surgery include increasing self-esteem, making new friends, improving relationships, and getting better jobs. Overall patient satisfaction is more than 95%, with improvement seen in positive changes in their life, increased self-confidence and self-esteem, decreased self-consciousness about their appearance, and overall improvement in quality of life. Postoperative psychological reactions are seen in about half the patients, these primarily being anxiety and depression of varying degrees. Predictors of patient satisfaction include the desire for self-image improvement in contradistinction to a change in life situation. Negative predictors include male sex, young age, unrealistic expectations, relationship disturbances, and preexisting psychological pathology. The importance of good patient selection in achieving a satisfied patient is outlined and emphasized.
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Psychology of the Facelift Patient

Facial plast Surg 2017; 33: 252-259
DOI: 10.1055/s-0037-1598071

This paper presents an extensive literature review of the psychology of facelift patients as it has evolved over the past 50 years. Earlier studies revealed significant levels of pre and perioperative depression. Facelift patients generally exhibit emotional and social concerns about facial appearance that are higher than the general population. Many are undergoing midlife situational stresses and may lack the positive characteristics to deal with them. The most common diagnoses seen include depression, impulsivity, unstable personality, and passive dependence, albeit not necessarily serious. Improvement in body image is the major driver for surgery. Characteristics of female patients as defined by their age are described. These include the younger emotionally dependent group, the worker group of middle age, and the older grief group. Male patients are seen to have a higher level of psychological dysfunction, but a higher improvement in postoperative quality of life. Motivations for surgery include increasing self-esteem, making new friends, improving relationships, and getting better jobs. Overall patient satisfaction is more than 95%, with improvement seen in positive changes in their life, increased self-confidence and self-esteem, decreased self-consciousness about their appearance, and overall improvement in quality of life. Postoperative psychological reactions are seen in about half the patients, these primarily being anxiety and depression of varying degrees. Predictors of patient satisfaction include the desire for self-image improvement in contradistinction to a change in life situation. Negative predictors include male sex, young age, unrealistic expectations, relationship disturbances, and preexisting psychological pathology. The importance of good patient selection in achieving a satisfied patient is outlined and emphasized.
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Erratum: Rhytidoplasty: SMAS Imbrication Vector Comparison

Facial plast Surg 2017; 33: 352-352
DOI: 10.1055/s-0037-1602171

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Revision Rhinoplasty: Retrospective Chart Review Analysis of Deformities and Surgical Maneuvers in Patients with Nasal Airway Obstruction—Five Years of Experience

Facial plast Surg 2017; 33: 334-338
DOI: 10.1055/s-0037-1598041

Nasal airway obstruction is one of the most frequent causes of revision rhinoplasty in patients after previous rhinoplasty procedure. Purpose of this study is to present the deformities and the surgical maneuvers conducted in revision rhinoplasty patients with functional complaint, anatomical sites at risk, and potential prophylactic maneuvers. This study is a retrospective chart review analysis of 46 consecutive revision rhinoplasty procedures in patients with nasal airway obstruction. Inclusion criteria were at least one previous rhinoplasty and nasal airway obstruction as the epicenter of patients' complaint. Thorough clinical examination to certify the obstruction was performed. Deformities noted were separated in three categories according to functional, cosmetic, and combination of functional and cosmetic implications. Surgical maneuvers conducted were reviewed. Deformities found were checked for statistically significant coexistences. The average patient age was 34.9 years. The mean number of previous septorhinoplasties was 1.33. Nasal ventilation obstruction mainly caused either by septum deviation or nasal valve dysfunction was identified in 91.3% of our patients. Surgical maneuvers conducted included placement of grafts in 89.1% of all cases, septoplasty in 76.1%, lateral wall support in 47.8%, and placement of spreader grafts in 39.1% of patients. The average preoperative Nasal Obstruction Symptom Evaluation (NOSE) score was 61 ± 15 and it improved substantially, even from month 1, postoperatively. Owing to high prevalence of nasal airway obstruction after primary or secondary rhinoplasty, we conducted the first retrospective chart review study to identify the most common deformities in revision rhinoplasty patients with nasal airway obstruction and the appropriate surgical maneuvers to address them. Septum deviation and nasal valve dysfunction were the two pillars of nasal airway obstruction in those patients.
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Rhytidectomy: Analysis of Videos Available Online

Facial plast Surg 2017; 33: 311-315
DOI: 10.1055/s-0037-1602163

The objective of this study was to examine YouTube videos related to rhytidectomy created by both physicians and nonphysicians to determine the content of the videos, the selected topics of discussion, and other important parameters using a cross-sectional analysis study design. A YouTube search result for the keyword "facelift" was performed. Videos pertaining to the rhytidectomy procedure were included in this analysis. Authorship, length of video, primary objective, and total views were recorded. Total 80 videos (81%) were authored by physicians, 14 (14%) were authored by patients, and 5 (5%) were authored by a third party. Fifty-eight (59%) videos were shorter than 5 minutes, and 41 videos (41%) were longer than 5 minutes. Fifty-two (53%) videos were viewed fewer than 10,000 times, and 47 videos (47%) were viewed more than 10,000 times. Forty (40%) videos had a primary objective of providing information, 13 (13%) had a primary objective of providing the patient's perspective, and 46 (46%) had a primary objective of advertising a physician's practice. A chi-square test for independence with threshold of significance < 0.05 was used to compare whether or not the primary objective of the videos depended on the type of authorship. A significant difference was found between physician- and patient-authored videos. In addition, the 12 (12%) videos with the most views of videos included in this study were responsible for 75% of the total views of videos included in this study. Advertising was a goal of both physician- and patient-based videos, but physician-based videos were more likely to provide information about the procedure whereas patient-based videos more commonly presented a patient's personal perspective. The most popular 12% of videos were responsible for 75% of total views in this analysis, indicating that a small minority of perspectives dominates the YouTube viewership regarding rhytidectomy. The general public may be misled by information found by viewing these videos as the Internet generally lacks safeguards for quality or accuracy. It may be prudent for academic or professional organizations to provide videos intended to achieve a more neutral, well-informed perspective.
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Beyond the Facelift: Procedures to Enhance Rhytidectomy

Facial plast Surg 2017; 33: 245-246
DOI: 10.1055/s-0037-1603348

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Surgical Anatomy for Facelift

Facial plast Surg 2017; 33: 250-251
DOI: 10.1055/s-0037-1603528

Knowledge of surgical anatomy is of paramount importance during surgical dissection for facelift surgery, regardless of the type of facelift procedure performed. This article reviews the relevant surgical anatomy for facelift, including the superficial musculoaponeurotic system (SMAS), and course of the facial nerve relative to the SMAS, zygomatic arch, and mandible. Also, this article reviews the various retaining ligaments, and some types of facelift procedures recommend release of these ligaments to achieve a more effective aesthetic result.
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Preoperative Simulation in Planning Rhinoplasty: Evaluation from Patients' and Surgeons' Perspectives

Facial plast Surg 2017; 33: 324-328
DOI: 10.1055/s-0037-1601419

Among aesthetic surgery procedures, rhinoplasty is one of the most common. Preoperative simulations have become increasingly commonplace through the recent years along with a controversy regarding their use. Although capable of building a solid rapport between the surgeon and the patient by visualizing the end result, it can also prove to be a liability for a surgeon who is not confident about delivering the result which has been put on screen. The objective of this study is to evaluate the outlook of the surgeons and patients on preoperative simulations. Plastic surgeons who perform rhinoplasty and individuals who consider rhinoplasty were surveyed via an online questionnaire system. Their opinions about the practice of simulation were questioned and they were asked to distinguish between simulated and actual postoperative results. Statistical analyses were performed using SPSS software. Major factors influencing the decision-making process of patients were the availability of preoperative simulation, being shown appealing results of the surgeon's previous work and a personal reference from a patient with an appealing result. Within the health care professionals, it has been observed that experienced surgeons are more confident about using simulations, while inexperienced ones are daunted by being bound with a visual contract (p < 0.05). However, it has been noted that the preference of withholding the simulation or providing a copy to the patient was similar in all experience levels (p > 0.05). In conclusion, our findings suggest that the patients' self-consciousness regarding preoperative simulations seem to grow faster than the surgeons' confidence in their use. Level of evidence is Level V.
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Rhytidectomy: Analysis of Videos Available Online

Facial plast Surg 2017; 33: 311-315
DOI: 10.1055/s-0037-1602163

The objective of this study was to examine YouTube videos related to rhytidectomy created by both physicians and nonphysicians to determine the content of the videos, the selected topics of discussion, and other important parameters using a cross-sectional analysis study design. A YouTube search result for the keyword "facelift" was performed. Videos pertaining to the rhytidectomy procedure were included in this analysis. Authorship, length of video, primary objective, and total views were recorded. Total 80 videos (81%) were authored by physicians, 14 (14%) were authored by patients, and 5 (5%) were authored by a third party. Fifty-eight (59%) videos were shorter than 5 minutes, and 41 videos (41%) were longer than 5 minutes. Fifty-two (53%) videos were viewed fewer than 10,000 times, and 47 videos (47%) were viewed more than 10,000 times. Forty (40%) videos had a primary objective of providing information, 13 (13%) had a primary objective of providing the patient's perspective, and 46 (46%) had a primary objective of advertising a physician's practice. A chi-square test for independence with threshold of significance < 0.05 was used to compare whether or not the primary objective of the videos depended on the type of authorship. A significant difference was found between physician- and patient-authored videos. In addition, the 12 (12%) videos with the most views of videos included in this study were responsible for 75% of the total views of videos included in this study. Advertising was a goal of both physician- and patient-based videos, but physician-based videos were more likely to provide information about the procedure whereas patient-based videos more commonly presented a patient's personal perspective. The most popular 12% of videos were responsible for 75% of total views in this analysis, indicating that a small minority of perspectives dominates the YouTube viewership regarding rhytidectomy. The general public may be misled by information found by viewing these videos as the Internet generally lacks safeguards for quality or accuracy. It may be prudent for academic or professional organizations to provide videos intended to achieve a more neutral, well-informed perspective.
[...]

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The History of Rhytidectomy

Facial plast Surg 2017; 33: 247-249
DOI: 10.1055/s-0037-1603347

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Beyond the Facelift: Procedures to Enhance Rhytidectomy

Facial plast Surg 2017; 33: 245-246
DOI: 10.1055/s-0037-1603348

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Surgical Anatomy for Facelift

Facial plast Surg 2017; 33: 250-251
DOI: 10.1055/s-0037-1603528

Knowledge of surgical anatomy is of paramount importance during surgical dissection for facelift surgery, regardless of the type of facelift procedure performed. This article reviews the relevant surgical anatomy for facelift, including the superficial musculoaponeurotic system (SMAS), and course of the facial nerve relative to the SMAS, zygomatic arch, and mandible. Also, this article reviews the various retaining ligaments, and some types of facelift procedures recommend release of these ligaments to achieve a more effective aesthetic result.
[...]

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The Superficial Musculoaponeurotic System Facelift: A Prudent Balance of Risks and Benefits

Facial plast Surg 2017; 33: 260-265
DOI: 10.1055/s-0037-1603316

Over the decades, facelifting has not escaped the natural history of trends and fads. And, as a profession, facial plastic surgery has not avoided falling into the trap of following corporate initiated technology, rather than leading common-sense methodologies to rejuvenating the aging face. The author is often reminded of a truism to which he was introduced in the 1980s. "When there are many ways of doing things, all of them work; or none of them work." Undeniably, any procedure that lifts and removes excessive skin of the face and neck "works." However, the questions that must be answered by leading teachers of facelifting surgery are: How well does a given technique work? How long-lasting are the results? Where does the risk–benefit curve cross over from optimal benefits to unacceptable risks? At what stage in a given patient's aging process are more aggressive techniques called for? At what stage in a surgeon's career should more invasive techniques be attempted, if ever? This article addresses the preceding questions as they relate to the contribution made by the superficial musculoaponeurotic fascia in repositioning sagging tissues of the face and neck.
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Preoperative Simulation in Planning Rhinoplasty: Evaluation from Patients' and Surgeons' Perspectives

Facial plast Surg 2017; 33: 324-328
DOI: 10.1055/s-0037-1601419

Among aesthetic surgery procedures, rhinoplasty is one of the most common. Preoperative simulations have become increasingly commonplace through the recent years along with a controversy regarding their use. Although capable of building a solid rapport between the surgeon and the patient by visualizing the end result, it can also prove to be a liability for a surgeon who is not confident about delivering the result which has been put on screen. The objective of this study is to evaluate the outlook of the surgeons and patients on preoperative simulations. Plastic surgeons who perform rhinoplasty and individuals who consider rhinoplasty were surveyed via an online questionnaire system. Their opinions about the practice of simulation were questioned and they were asked to distinguish between simulated and actual postoperative results. Statistical analyses were performed using SPSS software. Major factors influencing the decision-making process of patients were the availability of preoperative simulation, being shown appealing results of the surgeon's previous work and a personal reference from a patient with an appealing result. Within the health care professionals, it has been observed that experienced surgeons are more confident about using simulations, while inexperienced ones are daunted by being bound with a visual contract (p < 0.05). However, it has been noted that the preference of withholding the simulation or providing a copy to the patient was similar in all experience levels (p > 0.05). In conclusion, our findings suggest that the patients' self-consciousness regarding preoperative simulations seem to grow faster than the surgeons' confidence in their use. Level of evidence is Level V.
[...]

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Prophylactic Midface Lift in Midfacial Trauma

Facial plast Surg 2017; 33: 347-351
DOI: 10.1055/s-0037-1602165

The objective was to review our favorable experience in the use of prophylactic midface lifts in the setting of severe midfacial trauma. A retrospective review of a consecutive series of patients undergoing prophylactic midface lifts at the time of definitive fracture repair in a County Hospital Level 1 trauma center was done. All patients undergoing midface lifts at the time of fracture repair by the senior author from July 1998 to July 2012 were included in this review. A total of 72 patients (58 males, 14 females, average age: 36.2 years) were available for review. Sixty-three patients had a minimal follow-up of at least 3 months. No complications felt to be related to the midfacial suspension were noted. There were no instances of frontal nerve paralysis or palsy. There were no patients with ectropion. Patient midfacial symmetry was evaluated by two blinded facial plastic surgeons. It was felt to be excellent in 53 patients, good in 9, fair in 1, and poor in none. The force of trauma necessary to elicit a severe midfacial fracture and the subsequent subperiosteal dissection required to expose the fractures for rigid fixation result in severe laxity of the midfacial soft tissue envelope. Failure to suspend and support these soft tissues will result in significant facial asymmetry. Prophylactic endoscopic midface suspension appears to be a safe and effective method of largely eliminating this problem and should be considered in the setting of severe midfacial fractures.
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Lateral Crural Tensioning for Refinement of the Nasal Tip and Increasing Alar Stability: A Case Series

Facial plast Surg 2017; 33: 316-323
DOI: 10.1055/s-0037-1602143

The objective of this study was to discuss the technical details and our experiences with lateral crural tensioning (LCT) in both functional and aesthetic rhinoplasties. A retrospective medical review was completed for all patients who underwent rhinoplasty with LCT from the years 2011 to 2014. The indications for LCT included correction of lateral crural convexity, boxy tip geometry, and dynamic collapse of the external nasal valve. The details of the rhinoplasty procedure and complications were evaluated. A total of 114 LCT rhinoplasty cases were included in this series. The most common adjunctive maneuvers included placement of spreader grafts (92% of cases) and alar rim grafts (78% of cases). Conventional classic cephalic trim was not performed in any subjects and conservative paradomal cephalic trim was performed in 48% of cases. As experience with the technique progressed, the use of onlay tip grafts decreased and the use of articulated rim grafts increased. Indications for revision were dissatisfaction with cosmetic outcome (4.4% of cases) and nasal obstruction (0.9% of cases). LCT combines traditional lateral crural steal with the use of a caudal septal extension graft to refine the broad tip and increase stability of the alar lobule. This maneuver is essentially cartilage sparing and does not rely on extensive grafting maneuvers that can reduce airway area.
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Skin Resurfacing in Combination with Facelift Surgery

Facial plast Surg 2017; 33: 299-310
DOI: 10.1055/s-0037-1602742

Facial aging is a combination of descent of facial tissues, atrophy of fat compartments, bony remodeling, and chronological and photoaging changes of the skin. A rhytidectomy will address the aging changes due to gravity on facial tissues but will do little to improve skin texture, thickness, and pigmentation. To address collagen loss, rhytids, and dyspigmentation, surgeons are incorporating resurfacing techniques including carbon dioxide/erbium ablative and fractionated lasers, 35% trichloroacetic acid chemical peel pretreated with Jessner's solution, phenol 88% chemical peel, Baker's solution chemical peel, and dermabrasion. More recently, surgeons are approaching facial aging with a more comprehensive approach to address both gravity and collagen changes by a combination of rhytidectomy with resurfacing. Technique and modality selection are keys to maximum single treatment results and therefore the greatest patient satisfaction.
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The Difficult Neck in Facelifting

Facial plast Surg 2017; 33: 271-278
DOI: 10.1055/s-0037-1598073

As the popularity and acceptance of facial and cervical rejuvenation procedures grows, surgeons are increasingly encountering patients with less favorable anatomical characteristics for rhytidectomy. These patients will typically display an obtuse cervicomental angle, underprojected chin, excess cervical adiposity, and platysmal banding, in addition to ptotic submandibular glands, tenacious jowls, and prejowl volume deficits. Recognition of these problems and the correct application of available techniques to address the difficult neck in facelifting are critical in maximizing success.
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The Horizontal Neck Lift

Facial plast Surg 2017; 33: 266-270
DOI: 10.1055/s-0037-1598054

The horizontal neck lift is a procedure involving direct excision of a horizontally oriented ellipse of skin from the neck. This procedure was developed for neck rejuvenation in patients with significant horizontal creases and excess skin of the middle and lower neck, areas that often cannot be adequately addressed with traditional techniques. This article describes the procedure, indications, patient counseling, and postoperative care in detail from the senior author's (H. M.) experience.
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V-Y Advancement Flap for Defects of the Lid–Cheek Junction

Facial plast Surg 2017; 33: 329-333
DOI: 10.1055/s-0037-1602144

We report a series of 10 patients who underwent inferolaterally based V-Y advancement flaps for reconstruction of defects involving the lower eyelid and infraorbital cheek junction. Defects ranged from 1.7 to 2.9 cm in largest diameter, and patients ranged from 59 to 84 years of age. All patients had excellent functional and cosmetic outcomes without subsequent surgical or laser revision. There were no instances of flap necrosis, hematoma, or ectropion. Vertically oriented V-Y flaps are often underused in this setting largely due to the perceived increase risk of ectropion. We describe a modification of the flap with lateral orientation that both diminishes the downward tension vector, which threatens ectropion, and conceals incision scars within resting tension lines, providing superior functional and aesthetic outcomes. Our series demonstrates that a properly designed and well-executed inferiorly based V-Y advancement flap can be used as a safe reconstructive modality for defects involving the lid–cheek junction.
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The Difficult Neck in Facelifting

Facial plast Surg 2017; 33: 271-278
DOI: 10.1055/s-0037-1598073

As the popularity and acceptance of facial and cervical rejuvenation procedures grows, surgeons are increasingly encountering patients with less favorable anatomical characteristics for rhytidectomy. These patients will typically display an obtuse cervicomental angle, underprojected chin, excess cervical adiposity, and platysmal banding, in addition to ptotic submandibular glands, tenacious jowls, and prejowl volume deficits. Recognition of these problems and the correct application of available techniques to address the difficult neck in facelifting are critical in maximizing success.
[...]

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