Lateral Folds Research Articles

Newborn Filiform Periungual Hyperkeratosis: A Prospective Observational Study.

Newborn filiform periungual hyperkeratosis (NFPH) incidence and prevalence during the neonatal period remain unknown and have not been described in current literature. Timely diagnosis and treatment are essential to avoid complications during the neonatal period, such as acute paronychia. The aim of our prospective observational study was to describe the characteristics of NFPH in neonates born in a referral hospital in Buenos Aires. One hundred patients were included. Most of them were male (60%). NFPH consists of hard, filiform elements, mostly present bilaterally in lateral nail folds. It was found in 46% of included patients. Prevalence was higher in the right hand. Due to a trend towards easy detachment and fracture, erosions were seen in several cases. Two cases of acute paronychia secondary to NFPH were diagnosed, with favorable outcomes after topical antibiotic treatment. The importance of clinical examination for screening of this local predisposing factor for infection in neonatal patients is highlighted.

Evaluation of the Recurrence Rate of Ingrown Toenail After a 45-Second Matrix Cauterization With Phenol.

Ingrown toenail is a very common nail disorder, and partial matricectomy by phenolization is considered the most effective treatment technique. However, the contact time of the phenol with the nail matrix remains debatable. To evaluate the recurrence rate of ingrown toenail after partial matricectomy by phenol for 45 seconds. A total of 1,460 surgeries were performed, with a photographic record of 802 pictures for a period of 6 months. The presence of any nail spicule or sign of ingrowth during follow-up was considered a recurrence. A total of 802 surgeries were evaluated, with the most affected nails being the right (49.3%) and left (48%) big toes and most frequently the lateral fold (54.5%). The recurrence rate was 0.75% at 3 months and 1.87% at 6 months, and the medial nail fold had a higher recurrence rate than the lateral nail fold. Forty-five seconds of contact time of 88% phenol with the nail matrix was enough and effective, resulting in low recurrence rates. Prospective studies are needed to better assess postoperative morbidity.

Cutaneous adverse events to systemic anticancer therapies : Hand-foot syndrome and nail changes

Hand-foot syndrome (HFS) and nail changes are frequent adverse events of anticancer therapies. To provide areview of current evidence in HFS and nail disorders associated with medical tumor treatment. Basis is the current German S3guideline "Supportive therapy in oncologic patients" and literature on this topic published since the guideline was finalized. Two variants of HFS are distinguished: achemotherapy-associated and akinase-inhibitor-associated variant. In the first form, painful erythema, blisters and ulceration can occur, also in other areas with ahigh number of sweat glands such as axillary and inguinal regions. Thus, the secretion of toxic substances through sweat glands is aproposed pathogenetic mechanism. For the second form, which results in callus-like painful thickening of the horny layer on areas of mechanic pressure, avascular mechanism is proposed. For prophylaxis of HFS, avoidance of mechanical stress, regular cleaning of predisposed areas, and also urea- and diclofenac-containing ointments are recommended; in case of infusions (taxanes, doxorubicine), cooling of hands and feet during infusion is recommended. In case of manifest HFS, dose reduction or prolongation of intervals of the associated treatment are recommended. Nail changes often develop under therapy with chemotherapeutic agents but also under treatment with agents such as checkpoint inhibitors or under targeted therapy. Different components of the nail unit may be involved such as the nail matrix, nail bed, nail plate, hyponychium, lunula and proximal and lateral nail folds. This work gives insight into the pathophysiology of HFS and nail disorders that develop under systemic oncologic treatments and gives recommendations for prophylaxis and treatment.

The Application of Reverse Z-Plasty Design in Medial Canthal Skin Redundancy Reconstruction Surgery.

To investigate the clinical outcomes of reverse Z-plasty in the reconstruction of epicanthal fold. We conducted a retrospective analysis on clinical data from patients who underwent medial canthal skin redundancy reconstruction surgery from September 2019 to January 2023. The surgical procedure involved a preoperative design for the incision line, suborbicularis oculi dissection to create a muscle flap, and the use of a reverse Z-flap for the reconstruction of the lateral canthal fold. Postoperative follow-up assessments focused on the intercanthal distance, positional changes of the medial canthus point, alterations in the medial canthus angle, and patient satisfaction levels. The statistical evaluation was carried out utilizing paired t -tests, with a P -value of less than 0.05 denoting statistical significance. Postsurgery, the lacrimal prominences were less exposed, and inner canthal angles naturally reshaped. Inconspicuous scarring with diminished reverse Z-plasty marks was noted within 3 months. The average ICD has increased by 3 to 6mm, corresponding to elongation ratios of 9.09% to 28.30%. Preoperatively, the ICD averaged 31.25±2.32mm, expanding postoperatively to 35.19±2.26mm. The canthal angle enlarged significantly from 49.031±6.627 to 62.188±6.662. Inner canthal points shifted notably postsurgery, with a decrease in x-value and an increase in y-value, signalling a movement upwards and away from the nose. Patient satisfaction is high. The reverse Z-plasty technique has proven to be an effective approach for reconstructing the epicanthal fold. The clarity and precision of the incision design, coupled with the stability of postoperative results, demonstrate that this method can reliably achieve successful epicanthal fold reconstruction.

Onychocryptosis: A review of epidemiology, risk factors, classification, complications and effective therapeutic strategies.

Abstract: Ingrown toenails, clinically known as onychocryptosis, represent a prevalent nail pathology. The clinical manifestation involves symptoms typical for a foreign body reaction and in severe cases, tissue hypertrophy with complications may occur. Key risk factors include improper nail care, trauma, obesity, tight footwear, poor foot hygiene, and genetic predisposition. The condition predominantly affects individuals between the first and the third decades of life and older adults, with a predilection for the great toe, especially the lateral skin fold. The Heifetz and Scholz classifications delineate the stages of ingrown toenails based on severity. Therapeutic approaches range from conservative procedures, such as taping, dental floss, gutter treatment, cotton nail cast, braces and super elastic wire to surgical interventions like partial or total nail avulsion, matricectomy and advanced techniques like the Vandebos procedure or the Winograd procedure. Although many studies have analysed available treatment methods, there is no consensus among specialists regarding the best therapeutic strategy. Complications include paronychia, infection, and scarring. A comprehensive therapeutic approach should consider clinical severity, patient preferences, and both conservative and surgical interventions, emphasizing the importance of larger randomized clinical trials to establish definitive guidelines.

Effectiveness of the Sellick maneuver for painless gastroscopy in patients with esophageal hiatal hernia: A randomized, self‑control trial.

The Sellick maneuver is used for endotracheal intubation to prevent the occurrence of gastroesophageal reflux. The aim of the present study was to observe the effect of the Sellick maneuver on safety, esophageal closure status, gastric mucosal fold extension status, and positive detection rate of lesions in patients with esophageal hiatal hernia under painless gastroscopy. A total of 40 patients with esophageal hiatal hernia who underwent painless gastroscopy were screened for the use of the Sellick maneuver, in which the operator applied pressure to the cervical cricoid cartilage during the examination. The status of esophageal closure at the are pressed, examination time, gastric mucosal fold extension score, positive rate of lesion detection, and reflux of gastric juice or gastric contents, amongst other parameters were assessed. After using the Sellick maneuver, the state of esophageal closure during gastroscopy was significantly better than the no-Sellick maneuver group (P<0.05), and the extension scores of the greater curvature folds of the gastric body, the lateral folds of the lesser curvature of the gastric body, and the mucosal folds of the fundus were significantly higher than that of the no-Sellick maneuver (all P<0.05). The number of gastric polyps and gastric lesions (gastric ulcers and mucosal hyperplasia, amongst others) examined with the Sellick maneuver was significantly higher than the no-Sellick maneuver group (P<0.01). The Sellick maneuver effectively improved the extension of gastric mucosal folds during gastroscopy in patients with esophageal hiatal hernia, increased the positive detection rate of gastric lesions, and shortened the endoscopy time.

A median fin derived from the lateral plate mesoderm and the origin of paired fins

The development of paired appendages was a key innovation during evolution and facilitated the aquatic to terrestrial transition of vertebrates. Largely derived from the lateral plate mesoderm (LPM), one hypothesis for the evolution of paired fins invokes derivation from unpaired median fins via a pair of lateral fin folds located between pectoral and pelvic fin territories1. Whilst unpaired and paired fins exhibit similar structural and molecular characteristics, no definitive evidence exists for paired lateral fin folds in larvae or adults of any extant or extinct species. As unpaired fin core components are regarded as exclusively derived from paraxial mesoderm, any transition presumes both co-option of a fin developmental programme to the LPM and bilateral duplication2. Here, we identify that the larval zebrafish unpaired pre-anal fin fold (PAFF) is derived from the LPM and thus may represent a developmental intermediate between median and paired fins. We trace the contribution of LPM to the PAFF in both cyclostomes and gnathostomes, supporting the notion that this is an ancient trait of vertebrates. Finally, we observe that the PAFF can be bifurcated by increasing bone morphogenetic protein signalling, generating LPM-derived paired fin folds. Our work provides evidence that lateral fin folds may have existed as embryonic anlage for elaboration to paired fins.

Numerical examination of the geomorphic indicators for lateral fold growth

Fold-and-thrust belts (FTBs) develop widely in and around active orogenic belts on Earth. With the accumulation of structural shortening, thrust-related folds can grow by increasing their amplitudes and lengths, providing insights into the structural evolution of FTBs. Investigations of fold growth patterns and landscape responses through time and space have important implications for hydrocarbon exploration and geo-hazard assessment. Evidence for lateral fold propagation (i.e., increase in length) usually comes from geochronological constraints based on differences in onset timings along strike. However, these traditional methods are time consuming and economically costly. Alternatively, previous studies have proposed the use of geomorphic features to investigate the lateral fold propagation, including spatial variations in the patterns and densities of river channels, the configuration of the topographic profile along the fold crest, and the occurrence of wind gaps. However, such analyses are based on morphological features of present-day landscapes, which still need process-based validations. Here, we conduct a series of landscape evolution models to reproduce fold growth and their associated geomorphic adjustments. Our results show that deflected rivers and inflected fold-crest elevation profile with decreasing gradient are reliable evidence of lateral fold propagation. The location of propagation is in accordance with the distribution of crest-profile slope breaks and the position where river deflection began. Then, we apply these findings to two natural examples located at the deformation fronts of the Tian Shan (NW China). Results suggest that 1) the Kashi anticline has experienced lateral propagation both westwards and eastwards; and 2) that the Yaken anticline has experienced accelerated tectonic uplift as well as eastwards propagation. These findings are supported by the constraints from geochronological dating and quantitative structural analysis. Future work that integrates folding mechanisms may provide novel insights into landscape response to complex deformation in active FTBs.

Correction of the High Fold in Difficult Secondary Blepharoplasty Through Retro-Orbicularis Oculi Fat Transposition and Augmentation in Asians.

Secondary blepharoplasty to correct a high crease is considered challenging for most surgeons, especially in patients who show overly excessive removal of eyelid tissue in Asians. Therefore, we define a typical difficult secondary blepharoplasty as when patients present too high eyelid fold with excessive tissue resection and preaponeurotic fat deficiency. This study provides the technique of retro-orbicularis oculi fat (ROOF) transferring and volume augmentation to reconstruct eyelid anatomical structure on the base of a series of difficult secondary blepharoplasty cases in Asians and assess the effectiveness of the method in the meanwhile. This was a secondary blepharoplasty cases-based retrospective observational study. From October 2016 to May 2021, a total of 206 cases were performed blepharoplasty revision surgery to correct high folds. Among them, a total of 58 cases (6 men, 52 women) diagnosed with difficult blepharoplasty were applied ROOF transferring and volume augmentation to correct high folds and were followed up on time. Depending on the distribution of ROOF of different thicknesses, we designed 3 different methods of harvesting and transferring ROOF flaps. The mean follow-up for patients in our study was 9 months, a range of 6 to 18 months. The postoperative results were reviewed, graded, and analyzed. Most patients (89.66%) were satisfied. No postoperative complications were observed, such as infection, dehiscence of incision, tissue necrosis, levator dysfunction, or multiple creases. The mean height of the mid, medial, and lateral eyelid folds decreased from 8.96 ± 0.43, 8.21 ± 0.58, and 7.96 ± 0.53 mm to 6.77 ± 0.55, 6.27 ± 0.57, and 6.65 ± 0.61 mm, respectively. Retro-orbicularis oculi fat transposition or/and its enhancement contributes significantly to the reconstruction of the physiology of the eyelid structure and provides an available surgical option for the correction of too high folds in blepharoplasty.

The Utility of a Lateral Adipodermal Flap in Prepectoral Direct-to-implant Breast Reconstruction.

Prepectoral implant-based breast reconstruction has become more common given the reduced dissection, decreased postoperative pain, elimination of animation deformity, and improved aesthetics compared with subpectoral reconstructions. Despite these benefits, surgeons must contend with increased rates of implant rippling and more tenuous implant positioning and coverage, especially in direct-to-implant reconstructions. Although the use of an acellular dermal matrix can assist with both implant rippling and support/positioning, it does not protect against implant exposure, and rippling can still occur, despite its use, with significant additional cost. This article looks into the use of a lateral adipodermal flap that assists with reducing the mismatch between the excess skin and implant surface area, implant positioning (by helping secure the lateral mammary fold), and providing implant coverage. Twenty-two patients underwent 38 nipple-sparing mastectomies and prepectoral direct-to-implant reconstructions using a lateral adipodermal flap without acellular dermal matrix. No patients had evidence of implant malposition or exposure with at least 6 months follow-up. The author concludes that the lateral adipodermal flap may be helpful in securing the lateral mammary fold, reducing excess skin and providing viable tissue coverage in patients undergoing prepectoral direct-to-implant reconstruction.

ON THE POSSIBILITY OF INFLUENCE OF CELL SURFACE RELIEF ON STOMATAL MOVEMENTS

Folds are often present on the surface of stomatal complex cells. This allows us to assume that the folds influence stomatal movements. To evaluate the validity of this assumption, the stomatal complexes with various surface reliefs of their cells were studied, namely the complexes with lateral folds, with marginal stomatal rings, with rings of ledges, with peristomatal rims, as well as those with folds located on subsidiary and ordinary epidermal cells without any obvious order, in Acokanthera oblongifolia, Acokanthera oppositifolia, Prunus laurocerasus, Populus tremula, Osmanthus yunnanensis, Raphiolepis ×delacourii, and Ternstroemia gymnanthera. In all the studied species, stomatal deformations depending on the presence of microrelief folds were observed. Since deformation processes are the basis of stomatal movements, it is possible to conclude that surface folds of stomatal complex cells are structural features of these cells capable of influencing the mechanics of stomatal movements.

Surgical Correction of Massive Gynecomastia Using Power-Assisted Liposuction and Direct Gland Resection

Introduction: The surgical treatments of mild to moderate gynecomastia has evolved towards less invasive techniques, such as power-assisted liposuction, suction-assisted lipectomy or ultrasound-assisted liposuction. Excisional techniques are still indicated for the most severe cases characterized by skin excess and ptosis. The aim of this study was to present a method of using power-assisted liposuction combined with gland resection to treat gynecomastia with severe hypertrophy. Materials and Methods: We conducted a chart review of 27 consecutive patients treated for massive gynecomastia between 2014 and 2018. Power-assisted liposuction was performed to remove the fatty breast tissue. Incisions for liposuction were placed at lateral inframammary fold and upper anterior axillary pillar. An inferior hemiperiareolar incision was then performed to allow direct resection of fibroglaundular breast tissue. A final liposuction in all directions was performed again to recontour the breast. No skin was resected and drains were always inserted in each breast. Compression vest was worn for 6 weeks after surgery. Results: In average, 749 mg of fat and fibroglandular tissue were removed from each breast. No complications were reported. At 1 year follow-up, ideal aesthetic results, with minimal scars, adequate virilization of the chest contour and full satisfaction of surgeon and patient were observed in 24 patients, while 3 patients presented residual skin excess. Conclusion: In average, 749 mg of fat and fibroglandular tissue were removed from each breast. No complications were reported. At 1 year follow-up, ideal aesthetic results, with minimal scars, adequate virilization of the chest contour and full satisfaction of surgeon and patient were observed in 24 patients, while 3 patients presented residual skin excess.

Long-term outcomes of lateral vocal fold autologous fat injection for unilateral vocal fold paralysis

Objective: To investigate the long-term outcomes of patients with unilateral vocal fold paralysis resulting in dysphonia treated with lateral vocal fold autologous fat injection. To analyze the factors that may affect the long-term efficacy of the procedure. Methods: From July 2003 to June 2020, 163 patients (86 males and 77 females), aged 9-73 years (mean (34.50±12.94) years) with unilateral vocal fold paralysis resulting in dysphonia underwent transoral laryngoscopic injection of autologous fat into the lateral vocal folds. Subjective auditory perception assessment (GRBAS scale), objective acoustic assessment, voice handicap index (VHI) evaluation and stroboscopic laryngoscopy were compared before and after the surgery. Patients were followed up for 1 to 18 years, with median follow-up time of 6 years. SPSS 22.0 software was used for statistical analysis. Results: Of 163 patients, 17 patients (10.4%) had mild hoarseness (G1) and 146 patients (89.6%) had moderate to severe hoarseness (G2-3). Stroboscopic laryngoscopy revealed an arch-shaped vocal fold on the affected side, fixed in the paramedian position or abduction position, with obvious glottic closure fissure. Postoperatively, voice recovered to normal (G0) in 139 patients (85.3%), mild hoarseness (G1) in 18 patients (11.0%) and moderate hoarseness (G2) in 6 patients (3.7%). Of these, 131 patients (80.4%) showed significant improvement in hoarseness, 29 patients (17.8%) showed mild improvement and 3 patients (1.8%) showed no significant improvement in hoarseness. Objective acoustic parameters of Jitter, Shimmer, NHR and MPT improved significantly, as did VHI scores. Stroboscopic laryngoscopy showed medialization of the affected vocal folds, improved vocal fold closure and normal or nearly normal vocal fold mucosal waves. With a fat injection volume of 3.0-4.5 ml, the patient's subjective auditory perception scores of G, R, B and A improved more significantly within 3 months after surgery, and both VHI and MPT were significantly better since 1 year after surgery. With bilateral vocal fold injection, the B and A scores improved significantly from 1 month postoperatively compared to unilateral injections(unilateral vs. bilateral injection 1 month post-operation, tB scores=1.42,tA scores=1.51,P<0.05). Conclusions: The long-term efficacy of autologous fat injection in the paraglottic space for the treatment of unilateral vocal fold paralysis was stable. The efficacy of the surgery was related to the amount of fat injected, unilateral or bilateral of the injection.

Dermoscopy of Acrodermatitis Continua of Hallopeau.

A 29-year-old female presented with recurrent episodes of painful pustules over the right thumb for the past 8 months. She was treated with oral antibiotics along with avulsion of the nail plate, but it did not improve her condition. She had no history of other skin disorders. On examination, the nail plate was absent. Erythematous plaque with scaling and few areas of crusting were present involving the nail bed and pulp of the right thumb [Figure 1a] along with a single pustule on the right thumb [Figure 1b]. Dermoscopy (Polarized contact light dermoscopy; Dermlite DL4; 10×) revealed yellowish-white scales and linear blood vessels over the nail bed along with few hemorrhagic spots [Figure 2a]. Additionally, yellow globules were seen on the lateral nail fold and dotted vessels arranged in a regular pattern were seen over the pulp area [Figure 2b]. A Gram stain was done from the pustule, which was sterile and showed only neutrophils. A diagnosis of acrodermatitis continua of Hallopeau (ACH) was made based on the clinical and dermoscopic correlation. She was treated with oral cyclosporine and topical calcipotriol with good improvement in 2 weeks [Figure 3a and b].Figure 1: (a) The nail plate is absent. Erythematous plaque with scaling and few areas of crusting is seen involving the nail bed and pulp of the right thumb. (b) A single pustule is seen on the right thumbFigure 2: (a) Dermoscopic image showing yellowish-white scales (black arrow) and linear blood vessels over the nail bed (blue arrow) along with few hemorrhagic spots (red arrow). (b) Dermoscopic image showing dotted vessels arranged in a regular pattern (yellow arrows) over the pulp area. (Polarized contact light dermoscopy; Dermlite DL4; 10×)Figure 3: Clinical (a) and dermoscopic (b) images showing near-complete resolution of the lesions after 2 weeks. (Polarized contact light dermoscopy; Dermlite DL4; 10X)ACH, a variant of pustular psoriasis, is a rare, sterile pustular eruption of the distal fingers and/or toes. It is a chronic and progressive condition and can lead to irreversible complications including onychodystrophy and osteitis, which may result in anonychia and distal phalanx osteolysis, respectively; hence, an early and prompt diagnosis is required.[1] Dermoscopy of pustular psoriasis reveals yellow globules and regularly distributed dotted vessels which on histology correspond to nonfollicular superficial pustules and dilated vessels in homogenously elongated dermal papillae, respectively.[2] E. Errichetti et al. described dermoscopic findings in two cases of ACH which showed whitish-yellowish hyperkeratosis/scaling along with single or multiple pustules, dotted and linear vessels, and hemorrhagic spots.[3] These findings aid in differentiating ACH from other localized conditions such as onychomycosis, nail lichen planus, acral hand eczema, and psoriatic onychopathy.[3] We report our case to highlight the dermoscopic features of ACH which can help in the preliminary evaluation, thus reducing the diagnostic delay. As biopsy over the distal digits is often distressing and difficult, dermoscopy can be considered a valuable tool in such cases. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Modified chest wall lateral intercostal artery perforator (MCW‐LICAP) flap: a versatile flap in the era of oncoplastic breast surgery

Breast reconstruction following oncological resection is becoming more common in recent years. In some ladies, implant reconstruction is not ideal due to significant implant visibility or palpability. Autologous reconstruction addresses the limitations of implant reconstruction but results in potential donor site morbidities. To date, there is no clear advantage ascribed to any technique. With appropriate selection, patients with adequate lateral mammary fold have the option of reconstruction with MCW-LICAP flap. We present our techniques and outcomes from a series of 29 patients who underwent MCW-LICAP flap. A retrospective review of consecutive patients who underwent curative resection for breast cancer with immediate MCW-LICAP flap reconstruction, between July 2018 to April 2022 was conducted. The techniques used with its variations along with video demonstrations are presented. A total of 29 patients underwent 34 procedures. Nineteen breast conserving surgeries and 15 mastectomies were completed, and immediate reconstruction performed in all cases. Twenty-three patients had MCW-LICAP, 1 with a Stacked intercostal artery perforator (STICAP) flap, and 5 had MCW-LICAP combined with a Goldilocks mastectomy. There were no cases of complications requiring re-operation. All patients had acceptable time to adjuvant therapy with a median of 36 days. Learning curve analysis showed a significant reduction in operative time after the 6th case. In our preliminary experience, MCW-LICAP flap is a safe, reliable, and versatile oncoplastic reconstruction option.

Lateral Canthotomy/Cantholysis Performance Gap Analysis and Training Recommendations for Expeditionary Physicians.

Preservation of life, preservation of limb, and preservation of eyesight are the priorities for military medical personnel when attending to casualties. The incidences of eye injuries in modern warfare have increased significantly, despite personal eye equipment for service members. Serious eye injuries are often overlooked or discovered in a delayed fashion because they accompany other life- and limb-threatening injuries, which are assigned a higher priority. Prehospital military ocular trauma care is to shield the eye and evacuate the casualty to definitive ophthalmic care as soon as possible, with exceptions for treatment of ocular chemical injury and orbital compartment syndrome. Retrospective analysis of eye injuries in recent conflicts identified gaps in clinical capabilities with up to 96% of ocular injuries being suboptimally managed. Ocular compartment syndrome (OCS) is a complication associated with orbital hemorrhage, where significant morbidity occurs as a result of increasing intracompartment pressure. The ischemic tolerance of the retina and optic nerve is approximately 90 minutes, so OCS must be rapidly diagnosed and aggressively treated through lateral canthotomy/cantholysis (LC/C) to prevent permanent vision loss. LC/C procedures consist of using hemostats to crush the lateral canthal fold and cutting the lateral canthal tendon from the inferior crus to relieve increasing intracompartment pressure. The purpose of this study was to examine the baseline capabilities of military physicians and surgeons to accurately and independently perform the LC/C procedures and identify performance gaps that could be closed through focused professional development activities. This study received institutional review board approval at our institution. A total of 60 subjects voluntarily participated in the study from emergency medicine (15), general surgery (28), and ophthalmology (17). All procedural assessments were performed 1:1 by expert faculty ocular trauma specialists using a high-reliability eye trauma simulator (Sonalysts, Inc.). The competency standard was set at independent and accurate completion of all procedural components and all critical procedural components. Analyses were performed using descriptive statistics and analysis of variance to examine between-group differences (P < 0.05). There was a significant difference between the total score performance and the critical score performance for the three groups (P < 0.001). Outcomes indicate a significant linear relationship between the expertise level of the clinical provider and the procedural performance of LC/C. Outcomes demonstrate the baseline surgical capabilities of the general surgeons transferred to LC/C performance; however, they were unfamiliar with the anatomy and the procedural techniques and requirements. The group of emergency medicine participants demonstrated performance gaps not only in the same areas as the general surgeons but also in their baseline surgical abilities. This suggests that different professional development activities are necessary for surgeons and physicians tasked with performing LC/V procedures. We identified significant performance gaps among emergency medicine physicians, general surgeons, and ophthalmologists in their abilities to recognize and treat OCS through LC/C procedures. These sight-saving procedures are a critical competency for forward-situated clinicians in expeditionary contexts. We identified the need for targeted approaches to professional development for closing the performance gaps for both emergency medicine physicians and general surgeons.

Tentorium cerebelli formation during human embryonic and early fetal development.

The morphologies of the fetal tentorium cerebelli (TC) and brain influence each other during development. This study aimed to analyze and more comprehensively understand the three-dimensional morphogenesis of the TC and fetal brain. We examined magnetic resonance imaging from 64 embryonic and fetal specimens (crown-rump length range, 9.2-225 mm). During the embryonic period, the lateral folds of the TC elongated to traverse the middle part of the midbrain. The TC and falx cerebri appeared separated, and no invaginations at the parieto-occipital region were observed. In the early fetal period, the cerebrum covered approximately half of the midbrain. The separation of the dural limiting layer at the parieto-occipital region widened from the posterior cerebrum to the cranial cerebellum. The lateral folds of the TC were spread between its tip, continuous with the falx cerebri, and its base plane, located between the midbrain and rostral hindbrain. Differences in the TC components' growth directions gradually diminished as the cerebrum covered the midbrain. We observed rotation of the TC at its median section according to its growth, which ceased in the middle fetal period. The brainstem and cerebellum extended inferiorly via differential growth, with the cerebrum covering them superiorly. The morphology of the TC curved to conform to the cerebellar and cerebral surfaces. Our present study suggests that factors affecting TC morphology differ between the early and middle fetal periods. Present data provided a more comprehensive view of TC formation according to developmental stage.

Super-resolved Raman imaging via galvo-painted structured line illumination.

Traditional line-scan Raman imaging features a rapid imaging speed while preserving complete spectral information, yet has diffraction-limited resolution. Sinusoidally structured line excitation can yield an improvement in the lateral resolution of the Raman image along the line's direction. However, given the need for the line and spectrometer slit to be aligned, the resolution in the perpendicular direction remains diffraction limited. To overcome this, we present here a galvo-modulated structured line imaging system, where a system of three galvos can arbitrarily orient the structured line on the sample plane, while keeping the beam aligned to the spectrometer slit in the detection plane. Thus, a two-fold isotropic improvement in the lateral resolution fold is possible. We demonstrate the feasibility using mixtures of microspheres as chemical and size standards. The results prove an improvement in the lateral resolution of 1.8-fold (limited by line contrast at higher frequencies), while preserving complete spectral information of the sample.

Fold Flaps to the Rescue in Postmastectomy Breast Reconstruction.

Ischemic complications following postmastectomy breast reconstruction are not uncommon and can lead to reconstructive failure, especially with implant reconstruction. The authors propose a simple local flap for management of such complications. This flap is easily raised from the upper abdomen or lateral chest as a medially or laterally based fasciocutaneous flap, and the donor site is hidden in the inframammary or lateral mammary fold. The authors present a case series of these "fold flaps" that were used to manage complications following implant-based breast reconstruction. All patients between 2007 and 2021 who underwent a fold flap for breast reconstruction salvage were queried from a prospectively maintained database. Demographic variables, clinical factors, and surgical details were analyzed. Outcomes assessed included complications, appropriate wound healing, and reconstructive salvage. Fourteen patients underwent thoracoepigastric or thoracoabdominal fold flaps following breast reconstruction for soft-tissue coverage with an underlying prosthesis. The mean age was 54 years, mean body mass index was 30 kg/m 2 , and mean follow-up duration was 18.5 months. Fold flap indications included mastectomy skin flap necrosis ( n = 9), infection ( n = 4), and chronic seroma ( n = 1). Eleven reconstructions (79%) were salvaged and three (21%) required eventual prosthesis explantation secondary to infection or delayed wound healing. Fold flaps are a reliable option for managing ischemic complications following postmastectomy breast reconstruction. The benefits include improved soft-tissue coverage with a high salvage rate. These flaps are simple to raise, and their donor site is concealed within the folds. Furthermore, they provide a reliable early option to manage complications and potentially prevent reconstructive failure. Therapeutic, IV.

Facial skin ageing: Key concepts and overview of processes.

IntroductionThe face is a cosmetically sensitive region where the process of ageing is most clearly manifested. With increased focus on anti‐ageing and longevity, more anti‐senescent treatments are being proposed despite limited evidence. This study outlines the pathways and mechanisms underpinning the biological process of ageing in the face.MethodsComprehensive searches of MEDLINE, EMBASE, Cochrane Library and CINAHL from inception to 2020. Inclusion criteria included all empirical human research studies specific to facial ageing features, written in the English language.ResultsA total of 65 papers met inclusion criteria for analysis. Pathways were subdivided into intrinsic and extrinsic senescence mechanisms. Intrinsic pathways included genetics, generation of reactive oxygen species and hormonal changes. Extrinsic pathways included photoageing and damage to skin layers. The combined intrinsic and extrinsic pathway alterations result in wrinkles, higher laxity, slackness and thinning of the skin. Skin functions such as barrier immune function, wound healing, thermoregulation and sensory function are also impaired.ConclusionThe ageing process is unique to the individual and depends on the interplay between an individual's genetics and external environmental factors. Through understanding the molecular and cellular mechanisms, an appreciation of the consequent structural and functional changes can be achieved. Based on this knowledge, further research can focus on how to slow or impede the ageing process and identify specific targets to develop and evolve new treatment strategies.