Excessive Tissue Research Articles

Hypothesis: Platelet-rich plasma accelerate diabetic wound healing via dynamic modulation of multiple signaling pathways

Diabetic wounds are a prevalent complication in patients with diabetes. Incremental platelet-rich plasma (PRP) administration has recently been used as an adjunct therapy for the treatment of diabetic ulcers. However, the exact signaling pathways involved in PRP-induced healing remain unclear. We speculated that PRP could mediate diabetic wound healing by dynamic modulation of signaling pathways including TGF-β/Smad, Wnt/β-catenin, Notch, NF-κB, MAPK, and PI3K/Akt, at different levels. PRP may have different effects (activation or inhibition) on different or even the same signal pathways depending on the stage of the healing process and concentration of growth factors within the PRP preparation. In the early stages of wound healing, some signaling pathways are initiated to reduce wound inflammation and oxidative stress, and promote angiogenesis and collagen regeneration. In the late stages of wound healing and scar formation, PRP may inhibit some signal pathways to prevent excessive fibroblast proliferation and deposition of extracellular matrix proteins such as collagen, thereby controlling excessive tissue proliferation at the wound site and minimizing scars. The various signaling pathways exhibit complex and context-dependent interactions; crosstalk between these pathways can lead to synergistic or antagonistic effects and regulate various cellular responses. This knowledge could be used to develop targeted therapies to optimize healing and reduce the risk of subsequent complications.

Hemophagocytic Lymphohistiocytosis Possibly Triggered by Craniotomy Surgery: A Rare Association with Uplifting Ending

Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive inflammationand tissue destruction due to abnormal immune activation. HLH can occur as a familial or sporadic disorder, as wellas can be triggered by a variety of events that disrupt immune homeostasis. In HLH, natural killer cells and cytotoxiclymphocytes fail to eliminate activated macrophages resulting in excessive CD8+ T cell and activation of moremacrophages with highly elevated levels of interferon-gamma and other cytokines, which drive the pathology of HLH.Here, we present a case of 15 years old boy with HLH, which possibly was triggered after surgical intervention forarachnoid cyst in the right parietal lobe. It was a daunting challenge for us to evaluate and diagnose the patientpromptly since he was critically ill and developed pancytopenia, along with grossly altered liver function test andmarkedly raised ferritin in a short period of time. But it was even more crucial to start treatment in the form ofchemotherapy in such a patient who had very severe neutropenia as well as thrombocytopenia.
 Bangladesh Crit Care J March 2023; 11 (1): 39-42

174. Autologous Breast Reconstruction With Simultaneous Bilateral Lumbar Artery Perforator Flaps Improves Waistline Definition

PURPOSE: The lumbar artery perforator (LAP) flap is a valuable secondary option for autologous breast reconstruction when traditional abdominal donor sites are not available. Sociodemographic morphometric analyses have shown that the ideal waistline is characterized by a waist-to-hip ratio (WHR) of 0.7. How the LAP donor site affects truncal proportions and whether LAP flaps may lead to potential secondary benefits concerning waistline definition has never been systematically investigated. METHODS: A retrospective review of 50 patients who underwent bilateral breast reconstruction with lumbar artery perforator flaps (100 flaps) from 2018 - 2022 was performed. Patient characteristics and postoperative complications were recorded. Pre- and postoperative standardized patient photographs were analyzed to identify postoperative changes in WHR to assess waistline definition. The patients’ individual perception of postoperative aesthetic changes to their waistline was determined by an electronic survey. RESULTS: The patients had a mean age of 51 (24 - 63 years) and a mean BMI of 26.9 kg/m2 (19.3 - 37.4 kg/m2). Postoperative donor site complications included seromas (n = 10), wound dehiscence requiring operative revision (n = 5), hematomas (n = 4), and wound infections requiring oral antibiotic therapy (n = 2). Flap loss rate was 2%. After reconstruction, patients were found to have an improved waistline definition, indicated by a significantly decreased WHR (0.85 vs. 0.80, P = 0.005). Patient reported outcomes were obtained from 53% of patients. Among those, 81% of patients felt that their waistline had aesthetically improved after reconstruction, 14% reported no changes to their waistline aesthetics, and only 5% reported that their waistline had aesthetically worsened. CONCLUSION: Bilateral LAP flap breast reconstruction leads to improved waistline definition bringing patients closer to ideal aesthetic proportions. This reconstructive approach is ideal for patients that are not candidates for abdominal free flaps, however, demonstrate excess flank tissue and seek a more defined waistline.

78 Improvement of Cell Viability in Temporary Storage of Split Thickness Skin Grafts

Abstract Introduction Autologous split thickness skin grafts (STSGs) are the preferred donor tissue for restoration of large tissue deficits. Although grafting should be done at the time of donor harvest, various factors necessitate tissue storage, traditionally in saline solution (SS) at 4oC. However, STSGs often expire before grafting in these conditions. Patients then require further excision procedures or die due to inadequate skin coverage. For patients’ wellbeing, establishing a new storage protocol is imperative. This study sought to determine an effective storage media for prolongation of graft viability for subsequent incorporation into excision and grafting practice. Methods Following patient consent, excess tissue >1cm2 was collected after grafting procedures. Tissue was stored at 4oC in RPMI, DMEM, and SS with penicillin/streptomycin. Samples were evaluated at 2, 5, 7, and 14 days. Cell viability was measured by Trypan blue dye exclusion test in an automated cell counter yielding percentage of viable keratinocytes (PVK). An unbiased pathologist assessed tissue integrity by epidermal-dermal junction, perinuclear keratinocyte halos, and collagen organization with higher scores denoting deterioration. Data were evaluated by ANOVA and Effect size. Results A total of 155 sets of two specimens each were collected from 13 patients. Mean PVK values at day 2, 5, 7, and 14: SS (57.38, 36.96, 38.38, 27.50), RPMI (69.46, 69.92, 70.33, 62.67), DMEM (63.17, 53.50, 54.83, 37.92). By pairwise comparison, RPMI preserved PVK better than SS at days 5, 7, and 14 (p = 0.001 for each day). DMEM preserved PVK better than SS when comparing all days (p = 0.011) but failed to produce a statistically significant difference at any specific day. RPMI preserved PVK greater than DMEM each day. However, statistically significant differences were only revealed at day 14 (p = 0.017) and when comparing all days (p < 0.001). Effect size was large for overall group differences of PVK at day 5, 7, and 14 (Cohen’s f = 0.72, 0.73, and 0.75). Tissue integrity scores at day 2, 5, 7, and 14: SS (0.69, 1.0, 1.38, 2.0), RPMI (0.54, 0.92, 0.85, 1.54), DMEM (0.77, 0.92, 0.77, 1.15). Although culture media preserved tissue integrity greater than SS, no statistically significant differences were found. Conclusions RPMI preserved cell viability better than DMEM and SS. This suggests that STSGs stored in RPMI may prolong the time of which tissue could be stored and successfully amalgamated with skin. Applicability of Research to Practice Storing tissue in RPMI could benefit burn patients by decreasing tissue disposal therefore reducing future donor site area or eliminating repetitious excision procedures entirely. These effects decrease inpatient days and healthcare costs. Most importantly, successful tissue storage will save patients’ lives, especially those of large surface area burns who lack sufficient donor sites.

Prevalence of overweight/obesity in South Asia: A narrative review

IntroductionOverweight (ov) and obesity (ob) are conditions associated with excess adipose tissue mass. Overweight and obese (ov/ob) individuals are at an increased risk for chronic complications like diabetes mellitus, cardiovascular disease, liver disease, malignancies, sleep apnoea, osteoarthritis, urinary incontinence, and psychosocial issues. The prevalence of ov/ob is increasing globally and in South Asia. This review provides an overview of prevalence of ov/ob in South Asia in adults and children 0–5 years of age. MethodsData were retrieved from literature search including all national surveys published up to 1st January 2023, for South Asian countries (Afghanistan, Bangladesh, Bhutan, India, Maldives, Myanmar, Nepal, Pakistan, Sri Lanka). Specifically, national surveys conducted within the last 10 years were included. ResultsThe prevalence of ov/ob in adults and children 0–5 years of age ranged from 22.4 to 52.4%, and 1.3–7.6%, respectively. There was a higher prevalence seen in women, urban population, and higher socioeconomic status. ConclusionThe prevalence of ov/ob in South Asia is high and it may be even higher if Asian BMI cut-offs are applied to the surveyed population. Preventive strategies need to be tailored to the unique characteristics of ov/ob in South Asia.

Analysis of CDR3 Sequences from T-Cell Receptor β in Acute Respiratory Distress Syndrome.

Acute Respiratory Distress Syndrome (ARDS) is an illness that typically develops in people who are significantly ill or have serious injuries. ARDS is characterized by fluid build-up that occurs in the alveoli. T-cells are implicated as playing a role in the modulation of the aberrant response leading to excessive tissue damage and, eventually, ARDS. Complementarity Determining Region 3 (CDR3) sequences derived from T-cells are key players in the adaptive immune response. This response is governed by an elaborate specificity for distinct molecules and the ability to recognize and vigorously respond to repeated exposures to the same molecules. Most of the diversity in T-cell receptors (TCRs) is contained in the CDR3 regions of the heterodimeric cell-surface receptors. For this study, we employed the novel technology of immune sequencing to assess lung edema fluid. Our goal was to explore the landscape of CDR3 clonal sequences found within these samples. We obtained more than 3615 CDR3 sequences across samples in the study. Our data demonstrate that: (1) CDR3 sequences from lung edema fluid exhibit distinct clonal populations, and (2) CDR3 sequences can be further characterized based on biochemical features. Analysis of these CDR3 sequences offers insight into the CDR3-driven T-cell repertoire of ARDS. These findings represent the first step towards applications of this technology with these types of biological samples in the context of ARDS.

Tissue Dielectric Constant and Skin Stiffness Relationships in Lower Extremity Lymphedema.

Background: Lower extremity lymphedema or edema (LELE) may progressively transition from a state of excess tissue fluid to increased fat accumulation and collagen deposition, with tissue fibrosis and hardening. Such changes may lead to altered tissue water holding and thereby impact tissue dielectric constant (TDC). This study seeks to evaluate the relationship between TDC and tissue indentation force (TIF) in patients with LELE and assess the utility of the leg/arm TDC ratio (LAR) as an indicator of LELE. Methods and Results: Thirty females (49-91 years) with previously diagnosed LELE were evaluated during a scheduled session. TDC and TIF were measured 8 cm proximal to the medial malleolus on the medial and lateral aspects of both legs and on one forearm 8 cm distal to the antecubital fossa. The TDC-TIC relationship and the LAR were subsequently determined. Main results showed an absence of a significant correlation between TDC and TIF on medial or lateral leg sites but a positive correlation on the normal forearm site. Further, LAR values exceeded the published proposed threshold of 1.35 for 29/30 patients when using medial-side TDC values and 28/30 patients when using lateral-side TDC values. Conclusions: Findings suggest that for patients with LELE, TDC values are significantly elevated on medial and lateral standardized sites. The LAR determined using either medial or lateral sites that are similar to each other and have values consistent with a lymphedema threshold of 1.35. In edematous legs of the type evaluated herein, there is no apparent relationship between TDC values and indentation force.

Collagens Regulating Adipose Tissue Formation and Functions.

The globally increasing prevalence of obesity is associated with the development of metabolic diseases such as type 2 diabetes, dyslipidemia, and fatty liver. Excess adipose tissue (AT) often leads to its malfunction and to a systemic metabolic dysfunction because, in addition to storing lipids, AT is an active endocrine system. Adipocytes are embedded in a unique extracellular matrix (ECM), which provides structural support to the cells as well as participating in the regulation of their functions, such as proliferation and differentiation. Adipocytes have a thin pericellular layer of a specialized ECM, referred to as the basement membrane (BM), which is an important functional unit that lies between cells and tissue stroma. Collagens form a major group of proteins in the ECM, and some of them, especially the BM-associated collagens, support AT functions and participate in the regulation of adipocyte differentiation. In pathological conditions such as obesity, AT often proceeds to fibrosis, characterized by the accumulation of large collagen bundles, which disturbs the natural functions of the AT. In this review, we summarize the current knowledge on the vertebrate collagens that are important for AT development and function and include basic information on some other important ECM components, principally fibronectin, of the AT. We also briefly discuss the function of AT collagens in certain metabolic diseases in which they have been shown to play central roles.

Dendritic cells: Pivotal antigen presenting cells in periodontal disease

Periodontal disease is a common oral health condition that is characterized by chronic inflammation, tissue destruction, and bone loss. Dendritic cells (DCs) play a critical role in the pathogenesis of periodontal disease by recognizing and capturing antigens from bacterial biofilms, initiating and regulating the immune response, promoting inflammation and tissue destruction, and regulating bone resorption. Dysregulation of DC function can lead to excessive inflammation and tissue destruction, which are characteristic features of periodontal disease. However, targeting DCs and their interactions with other immune cells may provide novel therapeutic approaches for the treatment of periodontal disease. These approaches may include DC-based vaccines or immunotherapies, inhibition of cytokines and chemokines produced by DCs, and targeting the interactions between DCs and other immune cells. Further research is needed to better understand the complex interactions between DCs and other immune cells in the pathogenesis of periodontal disease and to develop effective and safe therapeutic strategies that target DC function. A better understanding of the role of DCs in periodontal disease may lead to the development of new diagnostic tools and treatments for this common and serious oral health condition.

Programming Mechanism of Adipose Tissue Expansion in the Rat Offspring of Obese Mothers Occurs in a Sex-Specific Manner.

We investigated whether excessive retroperitoneal adipose tissue (AT) expansion programmed by maternal obesity (MO) affects adipocyte size distribution and gene expression in relation to adipocyte proliferation and differentiation in male and female offspring (F1) from control (F1C) and obese (F1MO) mothers. Female Wistar rats (F0) ate a control or high-fat diet from weaning through pregnancy and lactation. F1 were weaned onto a control diet and euthanized at 110 postnatal days. Fat depots were weighed to estimate the total AT. Serum glucose, triglyceride, leptin, insulin, and the insulin resistance index (HOMA-IR) were determined. Adipocyte size and adipogenic gene expression were examined in retroperitoneal fat. Body weight, retroperitoneal AT and adipogenesis differed between male and female F1Cs. Retroperitoneal AT, glucose, triglyceride, insulin, HOMA-IR and leptin were higher in male and female F1MO vs. F1C. Small adipocytes were reduced in F1MO females and absent in F1MO males; large adipocytes were increased in F1MO males and females vs. F1C. Wnt, PI3K-Akt, and insulin signaling pathways in F1MO males and Egr2 in F1MO females were downregulated vs. F1C. MO induced metabolic dysfunction in F1 through different sex dimorphism mechanisms, including the decreased expression of pro-adipogenic genes and reduced insulin signaling in males and lipid mobilization-related genes in females.

An arginase 2 promoter transgenic illuminates immune cell polarisation in zebrafish.

The innate immune response to inflammation and infections are complex and represent major challenges for developing much needed new treatments for chronic inflammatory diseases and drug resistant infections. To be ultimately successful, the immune response must be balanced to allow pathogen clearance without excess tissue damage, processes controlled by pro- and anti-inflammatory signals. The roles of anti-inflammatory signalling in raising an appropriate immune response are underappreciated, representing overlooked potential drugs targets. This is especially true in neutrophils, a difficult cell type to study ex vivo due to a short lifespan, dogmatically seen as being highly pro-inflammatory. Here, we have generated and describe the first zebrafish transgenic line that labels expression of an anti-inflammatory gene (TgBAC(arg2:eGFP)sh571) and show that a subpopulation of neutrophils upregulate arginase early after immune challenge with injury and infection. At wound healing stages, arg2:GFP is expressed in subsets of neutrophils and macrophages, potentially representing anti-inflammatory, polarised immune cell populations. Our findings identify nuanced responses to immune challenge in vivo, responses that represent new opportunities for therapeutic interventions during inflammation and infection.

Toenail Paronychium Flap: Novel Surgical Approach for Ingrowing Toenail and Review of the Literature of Conventional Surgical Methods

Ingrown toenails are most common among school-age children and adolescents though they can be observed at any age. Causes of ingrown toenails are increased curvature, trauma, and external pressure. Treatment of ingrown toenails can be broadly characterized as conservative and surgical. Conservative treatment can be performed using various methods, such as a gutter splint, dental floss, and cotton. Surgical treatments may be divided into two main approaches; narrowing of the nail plate and debulking of periungual tissues. However, these various conservative and surgical treatments have high recurrence rates, and thus, the author used a permanent surgical method based on the use of a paronychium flap to treat a 15-year-old male adolescent with excessive periungual tissues and curved ingrown toenails who did not improve despite conservative and several surgical treatments over 4 years. Subsequently, toenail shape was maintained without recurrence 22 months after surgery, and there were no complaints of inflammation or pain while walking. This simple surgical method can be performed on patients with advanced ingrown toenails due to excessive periungual tissues and nail curvature and can be expected to have permanent effects.

Abstract 655: Protecting The Saphenous Vein Endothelium During Bypass Surgery

Coronary artery bypass graft surgeries commonly use saphenous vein grafts to revascularize diseased coronary arteries. Despite surgical and pharmacological advancements, graft failure rates remain high. Loss of endothelial cells (EC) during saphenous vein harvest and preservation likely contributes to the high incidence of graft failure. Standard methods of saphenous vein preparation and preservation during surgery include perfusion with heparinized saline solutions, a practice known to induce EC damage. As such, improved methods of saphenous vein storage may be the key to preserving EC and reducing graft failure rates. Here, we assessed the hypothesis that maintaining saphenous veins in autologous heparinized blood would preserve EC coverage and reduce cellular damage compared to standard of care, heparinized saline. To investigate this, saphenous vein tissues from 12 patients undergoing coronary artery bypass graft surgery were split into 2 treatment groups, 1) standard maintenance in heparin-saline (n=6) and 2) maintenance in heparin-blood (n=6). At the end of the surgeries, excess saphenous vein tissues were immediately fixed in 4% PFA to analyze endothelial coverage and DNA damage. In heparin-saline veins, histological analysis by H&E and Movat pentachrome staining revealed a broken or absent luminal layer and exposed lamina matrix, suggesting a loss of endothelial cell coverage. Luminal cell coverage was notably increased in heparin-blood samples. Immunofluorescent staining of endothelial markers VE-cadherin and endothelial nitric oxide identified a significant improvement in endothelial coverage in the heparin-blood group compared to heparin-saline. To determine the health of remaining endothelial cells, DNA damage was measured using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. Our data show that most of the endothelium (VE-cadherin positive) in heparin-saline tissues was TUNEL positive compared with heparin-blood. In conclusion, our data indicate that maintaining saphenous vein tissues in solutions containing autologous heparinized blood helps preserve the endothelium and maintains vein graft health which has the potential to improve vein graft patency rates in patients.

Abstract 650: Disrupting Neointimal Formation In Mouse And Human Vascular Tissues Through Targeting Connexin 43

Vascular damage caused by stent placement triggers smooth muscle cell (SMC) de-differentiation, leading to an aggressively proliferating phenotype that thickens the vessel wall and blocks the artery, which contributes to stent failure. We have identified the gap junction protein connexin 43 (Cx43) as a significant contributor to neointima progression. Phosphorylation of Cx43 by mitogen-activated protein kinase (MAPK) promotes its binding to the cell cycle regulator cyclin E and its kinase CDK2, promoting SMC proliferation. Beyond this, we do not know how these proteins regulate SMC proliferation in humans. We tested the hypothesis that disrupting Cx43-cyclin E binding could reduce neointima formation in human blood vessels. We used peptide arrays to identify cyclin E binding sites on Cx43 and to define critical Cx43 MAPK-phosphorylation residues that control their interactions. Based on this, we created a 15 amino acid, stearate-linked, cell-permeable, connexin mimetic peptide termed CycliCx that binds cyclin E. Experiments were controlled using Cx43 mimetic peptides designed against regions not bound by cyclin E. In cultured human coronary artery SMC, the CycliCx peptide reduces Cx43 MAPK-phosphorylation, disrupts Cx43-cyclin E interactions, and prevents PDGF-induced SMC proliferation. Application of the CycliCx peptide to mouse carotid arteries inhibits neointima formation in a 14-day ligation-induced neointima model (n=8, male and female). We developed an ex vivo model of PDGF-induced neointimal formation in excess human saphenous vein tissues recovered after CABG surgery. In the human saphenous vein preparations treated with PDGF, the CycliCx peptide disrupts neointima formation after 14 days (n=9). In conclusion, our data suggest that disrupting Cx43-cyclin E interactions provides protection against pathological SMC proliferation. These data highlight Cx43 as a potential drug target to prevent human neointima development.

Rectus Muscle Plication in Mini-abdominoplasty with Umbilicus Preservation.

Diastasis recti is a frequent problem that women, particularly, experience after pregnancy. It is an abdominal wall defect in which there is more than 2 cm separation between the abdominal rectus muscles. Aside from being repaired most commonly with a full abdominoplasty, in some cases, diastasis might present with minimal excessive adipocutaneous tissue, thus requiring a mini-abdominoplasty. Because umbilical transposition is not needed in that latter scenario, diastasis repair is only possible by ligating and cutting the existing umbilical stalk to be able to have a direct clear access to the supraumbilical linea alba. However, detaching the umbilical stalk will most certainly lead to the displacement of the umbilicus inferiorly. To overcome this problem, we performed a modified mini-abdominoplasty technique, which repairs the recti diastasis, keeps the umbilical stalk in place, and leaves behind a mini-abdominoplasty scar, thus providing a more cosmetically appealing result in addition to a radical solution to the defect. Moreover, this technique can be performed by any qualified plastic surgeon under basic operating settings.

Leukocyte associated immunoglobulin-like receptor 1 modulates immune response to Staphylococcus aureusinfection

Abstract Immunity is a balance of maximal pathogen defense with minimal host damage. Inhibitory immune receptors are important for maintaining this balance. We recently identified elevated levels of leukocyte-associated immunoglobulin (Ig)-like receptor protein1 (LAIR1), an inhibitory immune receptor, in cutaneous lymphoma patients, in whom invasive Staphylococcus aureus (S. aureus) infections are frequent. We therefore tested Lair1 knock-out (KO) mice in two models of invasive S. aureus infection: pneumonia and subcutaneous skin infection. In WT mice, skin infections resolve by 14 days post-infection (dpi), while pneumonia infections cause >50% lethality by 2dpi. In both models, Lair1 KO mice showed consistent patterns of myeloid hyper-activation. Lair1 KO had consistently larger skin lesions than WT throughout the 14 days, but no difference in bacterial clearance. Lair1 KO with pneumonia had higher survival (100% KO vs. 33% WT) despite comparable measures of lung injury and immune cell recruitment. In both models, KO mice produced higher levels of proinflammatory cytokines (IL-6, IL-1b) and neutrophil chemokines (CCL2, 3, 4) in lung, bronchoalveolar lavage, and skin by multiplex cytokine array. KO bone marrow-derived macrophages infected with S. aureus in vitro also secreted higher levels of proinflammatory cytokines (IL-6) and neutrophil chemokines (CCL2, 3, 4). Together, our results demonstrate that LAIR1 loss enhances myeloid activation, resulting in excessive tissue damage in skin infection, yet is protective against death in pneumonia. We posit that LAIR1 plays a crucial role in balancing myeloid immune response; LAIR1 activity can be beneficial or detrimental to the host depending on the site and type of infection.

Evaluation of Reducing the Excess Abdominal Skin, Subcutaneous Tissue and Anterior Abdominal Wall Laxity: A Prospective Observational Study at Dhaka Medical College Hospital

Background: Lax abdominal muscles cause laxity or bulging. This is generally a consequence of age or post-pregnancy, causing the abdominal rectus muscles and fascia that overlies and divides them to weaken. Abdominoplasty, a popular cosmetic surgery, has improved in recent years. helped minimize abdominal fat and skin. Medical institutions are diagnosing and treating obesity at an increasing pace. Objective: The purpose of the study was reduce the excess abdominal skin,subcutaneous tissue and anterior abdominal wall laxity. Methods: The duration of this prospective observational research was from July 2014 to April 2015. The research population consisted of patients hospitalized to the Plastic Surgery Department of Dhaka Medical College Hospital and numerous private hospitals in Dhaka with extra abdominal skin and abdominal wall laxity owing to various causes, such as past pregnancy or severe weight loss. From the study population, 30 instances that satisfied the enrollment requirements were chosen. Results: The majority of patients (26, or 86.67 %) were female, and 76 % were married. At the time of surgery, the average age was 41.3 years. The total complication rate was 40%, with just four serious complications (13.33%) and the most being mild (9, 30 % ). Seroma (3, 10%), infection (2, 6.67%), hematoma (2, 6.67%), wound dehiscence (1, 3.33%), partial flap loss (2, 6.67%), umbilical stenosis (1, 3.33%), epidermolysis (1, 3.33%), DVT (1, 3.33%) were the most prevalent complications (1, 3.33 % ). Very excellent (19, 66.3%), good (9, 30%), and adequate were patients' ratings of satisfaction (2, 6 % ). No patient reported low or extremely bad satisfaction. Conclusion: Abdominoplasty may be done with little risk and provides excellent results. Patients reported relief from their symptoms and satisfaction with the result. However, there was a high rate of mild problems, most of which involved wound healing. At most cases, problems were mild and quickly treated in a doctor's office.

Association of abdominal adiposity, hepatic shear stiffness with subclinical left-ventricular remodeling evaluated by magnetic resonance in adults free of overt cardiovascular diseases: a prospective study

BackgroundAbdominal ectopic fat deposition and excess visceral fat depots in obesity may be related to cardiovascular disease (CVD) as both are involved in the metabolic syndrome (MetS). The awareness of the link between abdominal adiposity and subclinical cardiac remodeling would help improve treatment and outcome. Besides, liver fibrosis has also shown a potential relationship with cardiac dysfunction. Thus, we aimed to investigate the associations of magnetic resonance (MR)-based abdominal adiposity and hepatic shear stiffness with subclinical left ventricular (LV) remodeling while taking account of MetS-related confounders in adults free of overt CVD.MethodsThis was an exploratory, prospective study of 88 adults (46 subjects with obesity, 42 healthy controls) who underwent 3 T cardiac and body MR exams. Measures of abdominal MR included hepatic and pancreatic proton density fat fraction (H-PDFF and P-PDFF), hepatic shear stiffness by MR elastography, and subcutaneous and visceral adipose tissue (SAT and VAT). Cardiac measures included epicardial adipose tissue (EAT) and parameters of LV geometry and function. Associations were assessed using Pearson correlation and multivariable linear regression analyses, in which age, sex, and MetS-related confounders were adjusted for.ResultsThe LV ejection fractions of all participants were within the normal range. Higher H-PDFF, P-PDFF, SAT and VAT were independently associated with lower LV global myocardial strain parameters (radial, circumferential and longitudinal peak strain [PS], longitudinal peak systolic strain rate and diastolic strain rate) (β = − 0.001 to − 0.41, p < 0.05), and P-PDFF, SAT and VAT were independently and positively associated with LV end-diastolic volume and stroke volume (β = 0.09 to 3.08, p ≤ 0.02) in the over-all cohort. In the obesity subgroup, higher P-PDFF and VAT were independently associated with lower circumferential and longitudinal PS, respectively (β = − 0.29 to − 0.05, p ≤ 0.01). No independent correlation between hepatic shear stiffness and EAT or LV remodeling was found (all p ≥ 0.05).ConclusionsEctopic fat depositions in the liver and pancreas, and excess abdominal adipose tissue pose a risk of subclinical LV remodeling beyond MetS-related CVD risk factors in adults without overt CVD. VAT may play a more considerable role as a risk factor for subclinical LV dysfunction than does SAT in individuals with obesity. The underlying mechanisms of these associations and their longitudinal clinical implications need further investigation.

Liposuction for Advanced Lymphedema in a Multidisciplinary Team Setting in Australia: 5-Year Follow-Up.

Liposuction for International Society of Lymphology late stage 2 or 3 limb lymphedema is an established surgical option to remove excessive adipose tissue deposition and has been performed in Australia since 2012 at the Australian Lymphoedema Education, Research, and Treatment (ALERT) Program of Macquarie University. Between May of 2012 and May of 2017, 72 patients with unilateral primary or secondary lymphedema of the arm or leg underwent suction-assisted lipectomy using the Brorson protocol. This prospective study presents 59 of these patients who had consented to research with a 5-year follow-up. Of the 59 patients, 54 (92%) were women, 30 (51%) had leg lymphedema, and 29 (49%) had arm lymphedema. For patients with arm lymphedema, the median preoperative volume difference between the lymphedematous and the contralateral arm was 1061 mL, which was reduced to 79 mL 1 year after surgery and to 22 mL 5 years after surgery. For patients with leg lymphedema, the median preoperative volume difference was 3447 mL, which was reduced to 263 mL 1 year after surgery but increased to 669 mL 5 years after surgery. Suction-assisted lipectomy is a long-term option for the management of selected patients with International Society of Lymphology late stage 2 or 3 limb lymphedema when conservative management can offer no further improvement. Therapeutic, IV.

Assessment of Healing after Diode Laser Gingivectomy Prior to Prosthetic Procedures

The current pilot study investigates the effects following removal of excessive gingival tissue, which is often necessary in fixed prosthodontic cases. The aim of the study is to assess gingival healing after diode laser gingivectomy prior to prosthetic procedures. Materials and methods: The healing process of the gingiva after the diode laser gingivectomy of 41 teeth was assessed. The following parameters were examined: recovery time of the gingiva, possibility to take the impression at the same visit, duration of the manipulation, bleeding during the procedure, tissue adherence to the instrument, postoperative hemorrhage on probing, postoperative pain, and wound healing in regard to tissue color, tissue contour, and appearance of the wound. Results: At the 24th hour, all gingival wounds were covered with fibrinous plaque and an erythematous halo. At the 72nd hour, in two cases (4.9%), this wound’s characteristic had already passed through to the next healing stage—granulated surface and normal pale pink color. A granulated surface in the 1st week was reported in 10 (24.4%) cases, and in all of the other 31 (75.6%) cases, complete healing was reported. In the second week, all wound surfaces had a normal pale pink color. Bleeding was self-limiting in most of the cases and negligible from a clinical point of view. The postoperative pain levels were low or nonexistent. There was lack of postoperative hemorrhage on probing after the first week in all examined cases. Tissue recovery in terms of tissue contour, color, and appearance of the wound was asymptomatic. Conclusion: within the limitations of this pilot study, the outcomes of the wound healing after laser gingivectomy aided the clinicians to perform the prosthetic procedures in the same visit.