Fat Necrosis Research Articles

Estimation of Programed Death Ligand_1 Concentrations in Serum and Tissue Among Iraqi Breast Diseases

Abstract Background: A programed death ligand L1 is the particular PD-1 ligand that is primarily found in lymphoid, epithelial, and myeloid cells. In order to activate the PD-1/PD-L1 pathway, which suppresses the production of cytokines and controls immune function, PD-1 must bind to PD-L1. Objectives: Estimating the concentration of PDL_1 in serum and breast tissue of patients with breast tumors. Materials and Methods: Case–control study included 100 women (17–60 years old) undergoing breast surgery at Babylon Province’s Al-Hilla Teaching Hospital and Al-Fayhaa Al Ahly Hospital provided blood and breast tissue samples. Hospital histology lab performed histological confirmation of breast diseases, including benign and malignant tumors. Twenty blood samples were taken as controls from women and men who appeared to be in good health. The enzyme-linked immunosorbent assay was used to determine PDL_1 in both patient and control serum and in the cell supernatant from the patient’s breast tissues. Results: The mean level of PDL_1 in serum of patient was 549.37 ng/L while control was 594.22 ng/L with found significant differences where P value was 0.05. While tissue of patients was 464.97 ng/L. The results appeared concentrations of PDL-L1 were significantly higher in serum compared with tissues at P ≥ 0.05. The results found no significantly differences in concentrations of PDL_1 among types of diseases in sera of patients except in fat necrosis patients. Perhaps as a result of our small sample size, the difference in PD-L1 expression between the various subtypes was not statistically significant. Conclusion: This study found concentration of PDL-1 decreased with primary breast diseases and it might be diagnostic marker.

The effect of telang flower extract on kidney function and histopathological features of obese rat kidneys

This study aims to determine the effect of oral administration of telang flower extract in several doses on histopathological changes in kidney organs. This study used a post test only control group design. Researchers used 6 Wistar rats for each experimental group, so that the total number of test animals in this study was 24. Grouping of test animals was done randomly into 4 test groups. Histopathological observations of kidney tissue were made by comparing the control and treatment groups. Changes observed will be the presence of fatty degeneration (vacuolization), necrosis and hydrophic degeneration. To obtain quantitative data, scoring was performed on each change found. The data from the study were then analyzed with the help of SPSS. Data normality test was analyzed by Kolmogorov-Smirnov test (p > 0.05). To test the significance between test groups, one-way analysis of variance or One Way ANOVA technique was conducted at 95% confidence level (p < 0.05). Further analysis or test was conducted using Post Hoc Test with LSD technique. The results showed that the administration of telang flower extract at a dose of 600mg/KgBB was effective in improving kidney function in obese Wistar white rats. This improvement is seen through increased levels of ureum, creatinine, and improved renal histological structure. Histopathological observation of kidney tissue showed that treatment group 3, which received telang flower extract at a dose of 600mg/KgBB, experienced significant improvement and was closer to the control group than the other groups.

Deciphering the pathogenesis of melanized focal changes in the white skeletal muscle of farmed Atlantic salmon (Salmo salar).

Melanized focal changes (MFCs) in the fillet of farmed Atlantic salmon is a major quality concern. The changes are thought to initially appear as acute red focal changes (RFCs) that progress into chronic MFCs. Recent findings have indicated that hypoxia may be important in their development, possibly leading to necrosis affecting not only myocytes but also adipocytes. Thus, the aim of this study was to investigate possible hypoxic conditions in RFCs and the subsequent inflammatory responses and lesions in the adipose tissue in RFCs and MFCs. A collection of RFCs, MFCs and control muscle samples from several groups of farmed salmon was studied. Using immunohistochemistry, we found induction of the hypoxia-inducible factor 1 pathway in RFCs. Histological investigations of RFCs and MFCs revealed different stages of fat necrosis, including necrotic adipocytes, a myospherulosis-like reaction and the formation of pseudocystic spaces. Accumulations of foamy macrophages were detected in MFCs, indicating degradation and phagocytosis of lipids. Using insitu hybridization, we showed the presence of tyrosinase- and tyrosinase-related protein-1-expressing amelanotic cells in RFCs, which in turn became melanized in MFCs. In conclusion, we propose a sequence of events leading to the formation of MFCs, highlighting the pivotal role of adiposity, hypoxia and fat necrosis.

Gigantic Macromastia: Modified Superomedial Pedicle is a Good Solution

Abstract Background Reduction of very huge breast—gigantic macromastia—is a challenge to breast surgeons in choosing the right procedure to obtain an optimal outcome. The feasibility of a superomedial pedicle (SMP) with some modifications proves to be a good option to achieve a viable nipple areolar complex (NAC) with good size and shape after good resection above 800 g. Materials and Methods Out of the 35 patients with 70 breast reductions, 15 can be considered gigantic macromastia with reductions above 800 g. A retrospective analysis of 30 breast reductions in these 15 patients from 2010 to 2023 was done. All cases were done using SMP with some modifications. The sternal notch to the nipple, the new NAC site, pedicle length, resection weight, and complications were analyzed. The modifications followed were lowering the new NAC, narrowing the distance between medial and lateral pillar width, medializing the pedicle, and lengthening the vertical limb. Results There was no total necrosis of the NAC. Partial necrosis occurred in three patients that were managed conservatively and one case of fat necrosis needed debridement. All of them had a good size, shape, and form. Conclusion SMP is a versatile technique with flexibility to modify the dimensions to get a robust blood supply to the NAC, after obtaining an adequate resection.

Hepatoprotective effects of Juglans regia on carbon tetrachloride‐induced hepatotoxicity: In silico/in vivo approach

AbstractJuglans regia L. is a well‐known therapeutic plant in Nepal, employed in traditional medicine for treating liver ailments. This study aimed to evaluate the in vivo and in silico liver‐protective effects of J. regia extract using a carbon tetrachloride (CCl4)‐induced hepatic damage rat model. Healthy male rats were randomly divided into six groups: normal control (distilled water 10 mL/kg), toxic control (distilled water 10 mL/kg), standard test (silymarin 100 mg/kg), and three groups receiving oral J. regia extracts (125, 250, and 500 mg/kg/day) for seven days. On the eighth day, carbon tetrachloride (CCl4) was administered intraperitoneally (i.p.) (1.5 mL/kg in 1:1 olive oil ratio for all groups, except the normal control). Rats were sacrificed on the ninth day, and blood was collected retro‐orbitally for liver blood injury tests and histopathological studies. Molecular docking was performed against cytochrome P450 2E1 (CYP450 2E1) enzyme for 16 selected phytoconstituents. J. regia, at doses of 125, 250, and 500 mg/kg, significantly reduced liver enzyme levels (alanine aminotransferase, alkaline phosphatase, direct bilirubin, and total bilirubin), while increasing serum albumin. Histological analysis revealed mitigation of carbon tetrachloride (CCl4)‐induced liver injury, reducing fatty degeneration and necrosis. Molecular docking supported the findings, with Beta‐sitosterol and Betulinic acid exhibiting the best binding affinity of −9.2 and −9.1 kcal/mol, respectively. In conclusion, result suggests that J. regia showed dose‐dependent hepatoprotective activity in CCl4‐induced hepatotoxicity and it could be utilized as a promising hepatoprotective agent. This study suggests the hepatoprotective potential of J. regia bark extracts, emphasizing the need for further clinical validation.

(135) DYSORGASMIA IN A FEMALE PATIENT FOLLOWING TRAM RECONSTRUCTIVE SURGERY

Abstract Introduction Many women struggle with sexual dysfunction, either in desire, arousal, orgasm, and/or pain. Despite the incidence of dysorgasmia in the general population, there is a paucity of literature focusing on its causes and treatment, especially when attributed to medical conditions and surgery. Objective This case report describes an unusual presentation of post-orgasmic pain following breast reconstruction surgery using abdominal tissue. Methods A 73-year old woman presented with chronic orgasmic pain in the deep pelvic area following transverse rectus abdominal muscle (TRAM) flap reconstruction for a mastectomy in the setting of breast cancer treatment. The patient was diagnosed with ductal carcinoma breast cancer in 2011, where she received a lumpectomy with radiation. After 2 years, in 2013, she was diagnosed with a recurrence of breast cancer. She underwent a mastectomy with no complications, with a transverse rectus abdominal muscle flap reconstruction surgery conducted five days later. Following the TRAM reconstruction, the patient consistently began to observe pain with orgasm. Results Prior to this surgery, the patient had experienced normal sexual intercourse and orgasm throughout her life. The patient describes pain with orgasm associated with self-stimulation, manual stimulation, oral stimulation, and vaginal penetration. The patient describes the pain associated with orgasm as a “deep, dull pain” causing nausea and is often associated with abdominal spasms. The pain lasts 2-3 minutes following orgasm and is rated as a 5-6/10 on the pain scale. The pain is not associated with urinary incontinence, urinary fullness, or bowel dysfunction. Physical exam revealed a tense abdominal wall consistent with TRAM reconstruction, well healed incisions, a normal clitoris in terms of appearance and sensation and normal pelvic floor muscles. Conclusions An orgasm is a complex process which involves interplays between the clitoris, the glans pubis, and the sympathetic activation system. A four-phase model for orgasm has been explored, which separates the orgasm response into: desire (the urge to participate in sexual activities), arousal (increased genital blood flow and clitorial erection), orgasm (after the threshold for stimulation has been reached), and resolution. Dysorgasmia can be multifactorial, and while still unclear, etiologies include pelvic floor dysfunction and/or spasm. While the pathophysiology of how the pelvic floor is connected to orgasm is not exactly understood, it is theorized to be due to dysregulated coordination of pelvic floor muscles. A transverse rectus abdominis muscle (TRAM) flap is a common breast reconstructive procedure following mastectomy. The most common complications of a TRAM flap surgery are hernias/abdominal bulges, fat necrosis, and loco-regional occurance. Interestingly, TRAM surgeries have previously been associated with pelvic floor dysfunction in women due to an increase in abdominal pressure. Since the pelvic floor is tightly connected to the mechanism of an orgasm, it is possible that disruptions to the pelvic floor may lead to painful spasms during orgasms. This is also consistent with the patient’s sensation of abdominal “spasms” during/after orgasm. While not all TRAM surgeries cause dysorgasmia, this patient’s dysorgasmia may be postulated to be secondary to pelvic floor dysfunction. Disclosure No.

Mediating effect of adiponectin between free fatty acid and tumor necrosis factor-α in patients with diabetes

Background/ObjectivesIncreased free fatty acid (FFA) promotes adiponectin secretion in healthy subjects and induces inflammation in diabetes. Given the potential pro-inflammatory role of adiponectin in “adiponectin paradox”, we performed this study in patients with type 2 diabetes mellitus (T2DM) to assess the association of FFA with adiponectin and to investigate whether adiponectin mediates FFA-related inflammation.MethodsThis cross-sectional study consisted of adult patients with T2DM. FFA, adiponectin, and tumor necrosis factor-α (TNF-α) were assayed from fasting venous blood after overnight fasting for at least 8 h. Multivariable linear regression analysis and restricted cubic splines (RCS) analysis were performed to identify the association between FFA and adiponectin. Mediation analysis was performed to determine the mediating effect of adiponectin on the association between FFA and TNF-α.ResultsThis study included 495 participants, with 332 males (67.1%) and a mean age of 47.0 ± 11.2 years. FFA was positively associated with adiponectin (b = 0.126, 95%CI: 0.036–0.215, P = 0.006) and was the main contributor to the increase of adiponectin (standardized b = 0.141). The RCS analysis demonstrated that adiponectin increased with FFA when FFA was less than 0.7 mmol/L but did not further increase thereafter (Poverall < 0.001 and Pnon-linear < 0.001). In addition, adiponectin mediated the association between FFA and TNF-α. The mediating effect was 0.08 (95%CI: 0.03–0.13, P = 0.003) and the mediating effect percentage was 26.8% (95%CI: 4.5–49.2, P = 0.02).ConclusionsIn patients with T2DM, FFA was positively associated with adiponectin when FFA was less than 0.7 mmol/L. Elevated adiponectin mediated FFA-related inflammation. This study may provide insights into the pro-inflammatory effect of adiponectin in T2DM.

Use of Ambient Light Compatible Fluorescence-Guided Surgical Technology for Objective Assessment of Flap Perfusion in Autologous Breast Reconstruction.

Decreased autologous flap vascular perfusion can lead to secondary procedures. Fluorescence angiography during surgery reduces the probability of repeat surgery but suffers from interpretation variability. Recently, the OnLume Avata System was developed, which evaluates real-time vascular perfusion in ambient light. This study aims to predict complications in autologous breast reconstruction using measures of relative intensity (RI) and relative area (RA). Patients undergoing autologous breast reconstruction underwent intraoperative tissue perfusion assessment using the OnLume Avata System. Post-hoc image annotation was completed by labeling areas of the flap interpreted to be "Well Perfused," "Questionably Perfused," and "Under Perfused." RIs and RAs were calculated for the marked areas. Primary complications of interest were overall complication rate, fat and mastectomy skin flap necrosis, and surgical revision. Logistic regression was applied to determine the odds of developing a complication based on RI and RA for each image. A total of 25 patients (45 flaps) were included. In total, 17 patients (68%) developed at least one complication. Patients who developed any complication (p = 0.02) or underwent a surgical revision for complications (p = 0.02) had statistically lower RI of under-perfused portions of the flap. Patients with greater areas of under-perfused flap had a significantly higher risk of developing fat necrosis (odds ratio [OR]: 5.71, p = 0.03) and required a revision operation (OR: 1.10, p = 0.01). Image-based interpretation using the OnLume Avata System correlated with the risk of developing postoperative complications that standard fluorescence imaging systems may not appreciate. This information can benefit surgeons to improve perfusion assessment and intraoperative decision-making.

HISTOPATHOLOGICAL PICTURE OF WHITE RATS LIVER DUE TO THE ADMINISTRATION OF MIMOSIN FROM SIMPLISIA LEUCAENA LEAF

Leucaena leaves (Leucaena leucocephala) are widely used as cattle feed because they contain high protein, flavonoids, tannins and other beneficial substances. In addition to containing good animal feed ingredients, it turns out that leucaena leaves contain toxic ingredients called mimosin. This study aims to study the impact of mimosin on the liver of experimental animals. The study used white rats (Rattus norvegicus) male wistar, aged 2 months with a body weight of 300-350 g, as many as 20 heads divided into 4 treatment groups. The 4 treatment groups were negative control (P0), positive control was given pure mimosin 5 mg/head/day (P1), group was given mimosin from leucaena leaf simplisia 50 mg/head/day (P2), group was given mimosin from leucaena leaf simplisia 150 mg/head/day (P3). Each treatment was given orally for 14 days. On day 15, a necropsy was performed and then the liver was taken and then put into neutral 10% formalin buffer (NBF) for further histopathology using Hematoxylin and Eosin (HE) staining. Histopathological examination is carried out covering five lesion variables, namely fatty degeneration, congestion, bleeding, inflammation, and necrosis. The severity of the lesion was scored, namely score 0 (normal), score 1 (mild), score 2 (medium) and score 3 (severe). The histopathological examination data were then analyzed using the Kruskal-Wallis non-parametic test and the Mann-Withney follow-up test. Based on the results of the study, administration of pure mimosin 5 mg and simplisia of leucaena leaves 50 mg and 150 mg caused histopathological lesions of rat liver (Rattus norvegicus) in the form of fatty degeneration, congestion, bleeding and inflammation that were significant compared to controls, except necrosis lesions. There was no significant lesion difference between mimosin from leucaena leaf simplisia between doses of 50 mg/head/day and 150 mg/head/day. It is necessary to carry out further research on the administration of mimosine in leucaena leaf simplicia at higher doses and given over a longer period, so that the factors of acute and chronic toxicity due to mimosine from leucaena leaves are known.

Ultrasound-guided cryoablation: Our experience in percutaneous treatment as an alternative to surgery for fibroadenomas of the breast lesions

ObjectivesTo review the tolerance to and medium-term efficacy of ultrasound-guided cryoablation as an alternative to surgical treatment of fibroadenomas of the breast in our hospital. MethodsWe analyzed data from the 12 patients with fibroadenomas treated with ultrasound-guided cryoablation in our hospital between November 2020 and July 2022. Cryoablation was performed with a system using argon gas (Galil Boston Scientific®) or liquid nitrogen (Prosense Ice Cure®) following a triple-phase (freeze-thaw-freeze) protocol of variable duration depending on the size of the lesion. Patients were followed up with ultrasonography at 3, 6, 12, and 18 months. ResultsAll patients tolerated the procedure well. Two patients reported moderate pain in the hours immediately after the procedure; no other complications occurred. The findings during follow-up included decreased volume of the fibroadenoma (47.07% at 3 months, 77.79% at 6 months, 81.77% at 12 months, and 88.81% at 18 months), blurring of the nodule’s margins, a significantly reduced or absent signal within the lesion in the Doppler study, an echogenic band (representing edema, hemorrhage, and fat necrosis), and hypoechoic areas suggestive of fibrosis surrounding the fibroadenoma. ConclusionsCryoablation is done on an outpatient basis, avoiding general anesthesia, thus making it less expensive. Cryoablation yields better cosmetic results than surgery.

Alternatives to the Gold Standard: A Systematic Review of Profunda Artery Perforator and Lumbar Artery Perforator Flaps for Breast Reconstruction.

Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap is the current gold-standard autologous option. The profunda artery perforator (PAP) and lumbar artery perforator (LAP) flaps have more recently been described as alternatives for patients who are not candidates for a DIEP flap. The aim of this study was to review the survival and complication rates of PAP and LAP flaps, using the DIEP flap as a benchmark. A literature search was conducted using PubMed, MEDLINE, Embase, BIOSIS, Web of Science, and Cochrane databases. Papers were screened by title and abstract, and full texts reviewed by three independent blinded reviewers. Quality was assessed using MINORS criteria. Sixty-three studies were included, for a total of 745 PAP, 62 stacked PAP, 187 LAP, and 23,748 DIEP flap breast reconstructions. The PAP (98.3%) had comparable success rate to DIEP (98.4%), and the stacked PAP (88.7%) and LAP (92.5%) success rate was significantly lower (P < 0.0001). The PAP and LAP groups both had a low incidence of fat necrosis. However, the revision rate for the LAP group was 16.1% whereas the PAP group was 3.3%. Donor site wound dehiscence rate was 2.9 in the LAP group and 9.1% in the PAP group. Profunda artery perforator and DIEP flaps demonstrate very high rates of overall survival. The LAP flap has a lower survival rate. This review highlights the survival and complication rates of these alternative flaps, which may help clinicians in guiding autologous reconstruction technique when a DIEP flap is unavailable.

An institutional experience of a rare diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

e19073 Background: Subcutaneous Panniculitis-like T-cell lymphoma (SPTCL) is a rare diagnosis making up &lt; 1% of Non-Hodgkin lymphomas. Data from Surveillance Epidemiology and End Results (SEER) identified a total of 204 cases from 2000-2020. Clinically, SPTCL presents as subcutaneous nodules and is difficult to distinguish from other more common conditions such as lupus erythematosus panniculitis. Most of our understanding on presentation, diagnosis and treatment on SPTCL is limited to small case series. Methods: Following IRB approval, a multi-center retrospective clinical and pathological review identified patients diagnosed with SPTCL from 1/1/2013-10/24/23. The study was conducted at Baylor Scott &amp; White system (CTX). Inclusion criteria included ≥ 18 years old, SPTCL AB sub-type. Patients were seen for &gt; 2 visits during time of active treatment. Cases of SPTCL y8 sub-type were excluded from the study. A descriptive analysis of the clinical presentation, treatment choice/duration, and clinical outcomes was generated. Results: A total of 5 patients met criteria for inclusion during the previously defined time period. The median age at diagnosis was 39 with a median follow up of 6 years. Patients presented with multiple nodular lesions affecting the chest, trunk, axilla, arms, and legs. Sixty percent of patients received misdiagnosis and experienced delay in appropriate treatment with a maximum delay of 10 years. Histopathology showed panniculitis-like lymphoid infiltrate composed predominantly of T lymphocytes, with areas of adipocyte rimming and a background of fat necrosis. No patients developed hemophagocytic syndrome. Patients were treated with steroids alone or in combination with cyclosporine, methotrexate, and/or romdespin. Sixty percent of patients achieved a complete response, and 40% remain in remission. The 5-year disease specific survival rate was 100%. Conclusions: SPTCL showed an indolent course in the patient population studied. All patients treated with systemic steroids as first line therapy responded favorably. When tolerated cyclosporine and methotrexate controlled disease in patients that showed progression following the completion of steroid taper.

Monitoring for Breast Cancer Recurrence Following Goldilocks Breast Reconstruction

Background The Goldilocks breast reconstruction utilizes redundant mastectomy skin flaps to fashion a breast mound; however, there is concern that imbrication of these skin flaps may predispose to fat necrosis and make detection of local breast cancer recurrence more difficult. Goldilocks patients follow a traditional postmastectomy screening pathway that includes clinical examination for locoregional recurrence, but it is unclear if this is sufficient. We evaluate our Goldilocks reconstruction case series to determine rates of diagnostic imaging, biopsy, and locoregional and distant recurrence. Methods Sixty-six patients (94 breasts) undergoing Goldilocks breast reconstruction were retrospectively reviewed. Any diagnostic postoperative imaging/biopsies performed and that confirmed local or distant breast cancer recurrence were noted. Results Average time of follow-up was 45 months. Most patients in this cohort had stage 0 (27.3%) or stage I (40.9%) breast cancer. There were a total of 11 (11.7%) concerning breast masses identified. Seven (7.4%) masses were biopsied, of which 5 were benign and 2 were invasive cancer recurrence. Four masses (4.3%) underwent diagnostic imaging only, all with benign findings. Five patients in this series were found to have either distant disease or a second primary cancer in the nonoperative contralateral breast. Conclusions Rates of local recurrence following Goldilocks are not higher than expected after other types of postmastectomy reconstruction. Clinical monitoring successfully detected local recurrence in all affected patients in this series. More definite guidelines around the routine screening of Goldilocks mastectomy patients may aid in early detection of local breast cancer recurrence.

No Skin Paddle, No Problem: Burying Deep Inferior Epigastric Artery Flaps in the Immediate Setting is Safe in Select Patient Populations.

In appropriately selected patients, it may be possible to fully bury breast free flaps deep to the mastectomy skin flaps. Because this practice forgoes the incorporation of a monitoring skin paddle for the flap, and thus limits the ability for physical exam, it may be associated with an increased risk of flap loss or other perfusion-related complications, such as fat necrosis. We hypothesized that fully de-epithelialized breast free flaps were not associated with an increased complication rate and reduced the need for future revision surgery. A single-institution retrospective review of 206 deep inferior epigastric artery (DIEP) flaps in 142 patients was performed between June 2016 and September 2021. Flaps were grouped into buried or nonburied categories based on the absence or presence of a monitoring paddle. Patient-reported outcomes were assessed postoperatively using the BREAST-Q breast reconstruction module. Electronic medical record data included demographics, comorbidities, flap characteristics, complications, and revision surgery. The buried flap patients (N = 46) had a lower median body mass index (26.9 vs 30.3, p = 0.04) and a lower rate of hypertension (19.5 vs. 37.5%, p = 0.04) compared with nonburied flap patients (N = 160). Burying flaps was more likely to be adopted in skin-sparing mastectomy or nipple-sparing mastectomy (p = 0.001) and in an immediate or a delayed-immediate fashion (p = 0.009). There was one flap loss in the nonburied group; complication rates were similar. There was a significantly greater revision rate in the nonburied flap patients (92 vs. 70%; p = 0.002). Buried flap patients exhibited a greater satisfaction with breasts (84.5 ± 13.4 vs. 73.9 ± 21.4; p = 0.04) and sexual satisfaction (73.1 ± 22.4 vs. 53.7 ± 29.7; p = 0.01) compared with nonburied flap patients. Burying breast free flaps in appropriately selected patients does not appear to have a higher complication rate when compared with flaps with an externalized monitoring paddle. Furthermore, this modification may be associated with a better immediate aesthetic outcome and improved patient satisfaction, as evidenced by a lower rate of revision surgery and superior BREAST-Q scores among buried DIEP flaps.

Inhibition of Adipocyte Necroptosis Alleviates Fat Necrosis and Fibrosis After Grafting in a Murine Model.

Because of the delicate structure of the adipose tissue, fat necrosis accounts for 43.7% of all complications after autologous fat grafting; however, its regulation remains unclear. The purpose of this study was to examine the role of necroptosis in fat graft remodeling after grafting. Clinical fat graft necrosis samples were collected, and the expression levels of the necroptosis marker phosphorylated(p)-MLKL were analyzed. Transcriptome analysis was performed on fat grafts before and 1 week after transplantation in C57BL/6 mouse fat grafting models. Additionally, the in vivo effects of RIPK1 inhibitor Nec-1s or RIPK3 inhibitor GSK'872 on the fat grafting complications, including fat necrosis and fibrosis, were investigated. Necroptosis markers were observed and associated with higher occurrence of fibrosis in clinical fat graft necrosis samples compared to normal fat tissue. Amplification and RNA-Seq were conducted on RNA isolated from fat grafts before and after grafting. MLKL, RIPK1, and RIPK3's expression levels were significantly upregulated in comparison to controls. Higher expression levels of necroptotic RNAs were associated with higher levels of DAMPs, including Cxcl2, HMGB1, S100a8, S100a9, Nlrp3, and IL33, and activated proinflammatory signaling pathways, including the TNF, NF-kappa B, and chemokine signaling pathways. Necroptotic inhibitor Nec-1s and GSK'872 robustly suppressed the p-MLKL expression level and significantly inhibited necroptotic cell death, especially in adipocytes. Moreover, administration of Nec-1s and GSK'872 significantly alleviated fat necrosis and subsequent fibrosis in fat grafts. Collectively, our study findings highlight the potential therapeutic applications of necroptosis inhibitors in preventing fat necrosis and fibrosis after grafting.

The articulated dual-supply pedicle for reduction mammoplasty.

Breast reduction surgery achieves symptomatic relief and improved quality of life for patients with excessive breast enlargement. Reduction mammoplasty has evolved over the last century with the introduction of multiple new pedicles and skin excision patterns utilizing the ample blood supply of the breasts. The superior pedicle is a relatively safe technique in small resections, while the superomedial pedicle, supplied by the internal mammary perforators, serves as a proper alternative in broader resections. We aim to introduce the dual-supply pedicle technique, taking advantage of the two efficient workhorse pedicles-the superior and superomedial. A retrospective study of 48 bilateral reduction mammoplasty patients operated over a 2-year period between 2017 and 2019 by a single surgeon (Y.W). Patient characteristics and postoperative outcome data were collected and evaluated. The novel surgical technique showed compatibility with different types of patients and breasts, forming excellent aesthetic outcomes. Complication rates were comparable or lower than previously published series. Major complications requiring revision surgery were encountered in 2 patients (2.08%) and minor complications in 11 patients (11.5%); 4 moderate surgical wound dehiscence, 6 minor surgical wound dehiscence and 1 fat necrosis. The Dual-Supply Pedicle Reduction Mammoplasty is a safe, reproducible technique, with a short learning curve, excellent aesthetical results, and an acceptable complication rate. Level of Evidence is Level III.

Effectiveness and Safety of Different Methods of Assisted Fat Grafting: A Network Meta-Analysis.

Numerous studies have proposed the utilization of stromal vascular fraction (SVF), adipose-derived stem cells (ADSCs), and platelet products as auxiliary grafting techniques to improve the survival rate of fat grafts. This study aimed to evaluate the efficacy and safety of various fat grafting methods since 2010 through a network meta-analysis, aiming to identify the most effective technique for fat grafting. Clinic trials on assisted fat grafting were searched from Pubmed, Embase, Web of Science, and the Cochrane Library, spanning the period from January 1, 2010 to March 2024. The risk of bias in the included trials was meticulously assessed using the Cochrane risk of bias tool. The survival rate of fat grafts served as the primary evaluation metric for effectiveness, while complications were employed as the indicator for safety. The study incorporated 31 clinic trials, involving a total of 1656 patients. The findings indicated that the survival rate with assisted fat grafting significantly surpassed that of simple fat grafting (SUCRA, 10.43%). Notably, ADSC-assisted fat grafting exhibited the highest survival rate (SUCRA, 82.17%), followed by Salvia miltiorrhiza (SM)-assisted fat grafting (SUCRA, 69.76%). In terms of safety, the most prevalent complications associated with fat grafting were fat sclerosis and fat necrosis. Adc-assisted fat grafting was correlated with the lowest incidence of complications (SUCRA, 41.00%), followed by simple fat grafting (SUCRA, 40.99%). However, PRP-assisted (SUCRA, 52.86%) and SVF-assisted fat grafting (SUCRA, 65.14%) showed higher complication rates. Various methods of assisted fat grafting can significantly enhance the survival rate, but they often fail to effectively mitigate the incidence of complications. Compared to other methods, adipose mesenchymal stem cells-assisted fat grafting consistently yielded a higher survival rate of grafts and fewer complications. Consequently, this approach represents a relatively effective method for assisting in fat grafting at present. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Gross and Histopathological Dermal Changes at Sites of Snakebite – Report from Autopsy Series

Background: Snake bite remains a significant cause of accidental death, its occurrence usually underestimated because of under reporting.Objective: To report on gross and microscopic changes at sites of snakebite in autopsy.Methods: A cross-sectional, descriptive study was conducted on thirty cadavers of snake bite for study duration of one year based on inclusion and exclusion criteria. Skin was collected from sites of bite. Gross examination was carried out on formalin fixed specimens. Microscopic examination was performed on dermal biopsy of formalin fixed paraffin embedded sections stained with haematoxylene and eosin (H&amp;E).Results: 53.4% of deceased were in the age group of 41-50 years. Males were predominant in the study (90%) where 63.3% were agriculture workers. Lower limb bite was commonly seen (83.3%) in outdoor locales (90%). Snakes identified were cobra and viper. Death occurred within 48 hours of admission in 80% cases. Bite mark was visualised in ten cases and ulceration in three. Microscopic examination revealed normal epidermis in 53.3% cases. Abnormalities seen included acantholysis in 36.7% and ulceration in 10%cases. Dermal changes were coagulative necrosis (26.7%), fibrinoid necrosis (16.7%), haemorrhagic necrosis (20%), oedema (13.3%). Combination of changes in a particular case also observed. Vascular changes comprised of extravasation (30%), fibrinoid necrosis with microvascular damage (23.4%), vasculitis (13.3%), microvascular damage (26.7%). Perineural fibrosis, subcutaneous gangrenous and haemorrhagic fat necrosis were other observations.Conclusion: This study highlights histological profile of dermal changes by snake venom at site of bite that can enlighten its pathophysiologic effects on cutaneous tissue.International Journal of Human and Health Sciences Vol. 08 No. 02 Apr’24 Page: 132-139

Analysis of Vascular Anatomy in Deep Inferior Epigastric Perforator Flap

Abstract Objectives The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard in autologous breast reconstruction. One of the existing challenges of the procedure is maintaining a pedicle of suitable length and diameter for flap survival. In this study, we analyzed the vascular anatomy of bi-pedicle DIEP flap cases in terms of the vessel diameter, the rate of secondary venae comitantes, and pedicle length to determine the efficacy of microvascular anastomosis and venous drainage. Methods We retrospectively evaluated 108 patients who underwent immediate breast reconstruction using free bi-pedicle DIEP flaps between 2012 and 2019. The patient characteristics, diameters of the deep inferior epigastric artery (DIEA) and accompanying veins (DIEVs), DIEA pedicle length, vessel re-anastomosis rate, flap failure rate, and fat necrosis were recorded. Results Comparison of the right side and left side diameters and pedicle lengths obtained showed no significant differences (p &gt; 0.05). A total of 148 sides (68.52%) of flaps had double venous drainage, whereas 68 sides (31.48%) of flaps had one. Vein congestion occurred in 5 cases, and all involved with just one DIEV anastomosis. No arterial occlusions were observed. Conclusions This is an analysis of extensive clinical data in terms of DIEA, DIEV, and pedicle length. The low vein congestion rate observed reveals adequate venous drainage was achieved in the DIEV system for DIEP reconstruction. Adequate deep inferior epigastric vessel pedicle length and vessel size, as well as greater than 60% of flaps with secondary DIEV, may allow comfortable microsurgery with reduced complications.

Cooling Under a Blanketrol System Versus Cooling With an Arctic Sun Thermoregulation System (CATS) for Neonates Undergoing Therapeutic Hypothermia.

Background Despite evidence suggesting improved outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH), data on the impact of temperature variability during cooling and its association with clinical outcomes remain limited. Objective To compare the efficacy and ease of use of two different cooling systems, the Arctic Sun (Medivance, Inc., Louisville, CO) vs. the Blanketrol III (Gentherm Medical, Cincinnati, OH) on achieving TH, temperature variability, and clinical outcomes in neonates with HIE undergoing TH. Methods This study was conducted at the Baylor Scott and White Medical Center's Level IV NICU. The study employed a retrospective cohort design, comparing infants treated with the Arctic Sun device (from December 2020 to August 2021) to a historical cohort treated with the Blanketrol system (from January 2017 to November 2020). Both groups were evaluated for clinical characteristics, patients' outcomes, and ease of use of the cooling devices. Ease of use was assessed through a self-developed survey administered to NICU nurses. Core body temperatures throughout the cooling course were documented at four-hour intervals, including induction, maintenance, and rewarming phases. Results Twenty-two infants were cooled using the Arctic Sun system, and 44 infants were cooled with the Blanketrol device. Median birth weight and gestational age were comparable. There were no significant differences in one-minute and five-minute appearance, pulse, grimace, activity, and respiration (APGAR) scores. The Arctic Sun group had a significantly higher rate of maternal morbidities, including diabetes and placental abruption. Although the median temperature achieved with both devices was 33.5°C, temperature variability was significantly greater with the Blanketrol device (p = 0.03). Thrombocytopenia rates were statistically different between the groups (9% in Arctic Sun vs. 38% in Blanketrol, p = 0.001). Although the Blanketrol group had higher rates of disseminated intravascular coagulation (48% vs. 37%), hypercalcemia (23% vs. 5%), and subcutaneous fat necrosis (7% vs. 5%), these differences were not statistically significant. A nurses' survey on ease of use revealed a strong preference for the Arctic Sun cooling system. Over 85% of nurses found it easier to learn and set up and required less manual intervention than the Blanketrol device. Conclusions Gel adhesive pad-based TH is a potentially superior modality to traditional water-circulating cooling devices. These pads offer advantages in user-friendliness, improved temperature control precision, and potentially reduced adverse event profiles.