Online Instructions Research Articles

Aesthetic Surgical Treatment of Large Xanthelasma palpebrarum.

Xanthelasma palpebrarum (XP) is a common eyelid condition. Various treatment modalities exist, each with its own merits and drawbacks. Managing larger lesions poses increased challenges. This study aims to explore the aesthetic surgical management of large xanthelasma palpebrarum. Patients with xanthelasma palpebrarum presenting to our department underwent partial excision of the lesion and debridement of the medullary nucleus under local anesthesia for lesions with a diameter of 6mm or more. Microsurgical scissors were utilized to remove residual subcutaneous lesions. Postoperatively, tie-over bolster dressings were applied. Patients with lipid and glucose abnormalities received corresponding therapy. Bolster dressings were removed on the third postoperative day, with suture removal seven days later. All flaps subjected to subcutaneous medullary debridement exhibited complete viability, with minimal localized eyelid depression early postoperatively and inconspicuous scarring three months post-surgery. No instances of lid ectropion were observed. The eyelid maintained a natural appearance, with a low recurrence rate of xanthelasma palpebrarum. Surgical intervention involving partial excision of the lesion and medullary nucleus debridement offers a satisfactory approach for managing large xanthelasma palpebrarum. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ultrasound and Helium Plasma-Assisted Liposuction for Body Contouring: A Single-Retrospective Cohort Study of 639 Patients.

Over the past two decades, liposuction techniques have significantly evolved, moving from basic fat removal to sophisticated methods aimed at improving safety, efficiency, and cosmetic outcomes. This study evaluates the efficacy and safety of a combined approach using ultrasound-assisted liposuction (UAL) and helium plasma radiofrequency (HPRF) technology to enhance skin tightening without the need for extensive surgical interventions. We conducted a retrospective analysis of 639 patients who underwent the combined UAL and HPRF liposuction technique. The patient cohort had an average age of 31.5 years and a mean BMI of 27.9 kg/m2. The procedure predominantly targeted the abdomen, with an average of 2.4 body areas treated per patient. Surgical duration averaged 118 minutes, with a mean aspirate volume of 1698 mL. Minimal residual skin laxity was observed in 87% of patients, and 91% achieved excellent improvement in body contouring. The complication rates were low, with minor occurrences of seroma (5.6%) and a very low incidence of infection (0.3%). This combined technique demonstrated safety and efficacy, providing significant skin tightening and reducing recovery time compared to more invasive procedures. The combined use of UAL and HPRF technology offers a safe and effective method for enhancing skin tightening and improving body contouring outcomes. Despite the promising results, this study acknowledges the limitations of its retrospective design. Future prospective, multicenter studies are recommended to further validate these findings. This technique represents a significant advancement in the field of cosmetic surgery, emphasizing minimally invasive solutions with substantial esthetic benefits. 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 .

The Impact of Body Contouring Following Bariatric Surgery: A Prospective Examination of Psychosocial and Medical Impairment.

Body contouring surgery (BCS) to remove loose skin is often desired following bariatric surgery. This study prospectively examined psychosocial and medical functioning based on BCS status after bariatric surgery. N=56 adults who sought a BCS consultation following bariatric surgery completed measures of impairment, depression, and medical (e.g., rashes, infections) and psychosocial concerns due to loose skin. Assessments were repeated at 1- and 3-month follow-ups. Most did not undergo BCS due to insurance coverage denial/finances; n = 24 (42.9%) underwent BCS. The groups with and without BCS did not differ significantly in BMI, weight loss, impairment, or depression at any assessment; however, a significantly greater proportion of non-BCS patients reported several medical and psychosocial concerns due to loose skin relative to BCS patients at follow-up assessments. Greater loose skin concerns were associated significantly with greater impairment and depression at all assessments. Over half who sought BCS did not undergo BCS, mostly due to insurance/financial reasons. The BCS group had significantly fewer medical and psychosocial concerns related to loose skin at follow-ups. Greater loose skin concerns were associated with heightened levels of broad psychosocial impairments suggesting that loose skin and psychological concerns warrant greater clinical attention after bariatric surgery. 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 .

Scarless Enhanced Body Contouring.

A helium-based plasma device with minimal invasiveness selectively heats tissues via joule heating, ensuring safe external temperatures and eliminating the need to monitor the epidermal temperature. From December 2022 to January 2024, Forty-six patients without prior bariatric surgery, who had localized lipodystrophy and mild-to-moderate skin laxity in various body areas, were enrolled in this prospective work. Liposuction was paired with a helium-based plasma radiofrequency device used for all patients. Data on demographics and postoperative complications were disclosed. A patient evaluation was conducted objectively and subjectively, using an independent plastic surgeon assessment and a patient satisfaction survey, respectively. Our technique was performed on 40 females (87%) and six males (13%), in various body areas: arm (fourteen cases: 30.4%), neck (ten: 21.7%), thigh (nine: 19.6%), abdomen (seven: 15.2%), back (three: 6.5%), gynecomastia (three: 6.5%), their age ranges from 23 to 57years, and their body mass index (BMI) ranges from 24 to 34.6kg/m2. Patients' satisfaction at 6months after surgery was 82.6% (38) satisfied, 15.2% (7) borderline, and 2.2% (1) unsatisfied. Individual plastic surgeon evaluation was 69.6% (32) excellent, 28.3% (13) good, and 2.1% (1) fair. The overall complications rates were postoperative edema in 22 cases (47.8%), ecchymosis in 11 cases (23.9%), persistent skin laxity in one case (11.1%), mild seroma in three cases (6.5%), pain and tingling in six cases (13%), and mild subcutaneous emphysema in four cases (8.7%). Combined liposuction and helium-based plasma radiofrequency device usage are a safe, efficient, and minimally invasive substitute for excisional procedures in non-bariatric patients with localized lipodystrophy and mild-to-moderate skin laxity. 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 .

PTB Regulates Keloid Fibroblast Migration and Proliferation Through Autophagy.

Keloid disease is a chronic fibroproliferative disease that occurs after tissue injury, and the currently available treatments are unsatisfactory. We aimed to explore the level of autophagy in keloid fibroblasts (KFbs) and adjacent normal fibroblasts (NFbs). In addition, whether polypyrimidine tract-binding protein (PTB) regulates the biological functions of KFbs via autophagy was also investigated. The morphology of fibroblasts in normal skin and keloids was observed transmission electron microscopy. We silenced PTB with PTB-specific siRNA to determine whether PTB-regulated KFb proliferation. Acridine orange and LysoTracker Red staining was performed to label acidic compartments. Interestingly, when autophagy was inhibited by wortmannin, the PTB knockdown-mediated decrease in KFb migration and proliferation was abolished, while the collagen I and III levels were not altered; these results indicated that PTB regulated the migration and proliferation of KFbs via autophagy, while collagen synthesis occurred independently of PTB regulation. Many activities related to the survival and function of KFbs are controlled by PTB. Transmission electron microscopy revealed more autophagosomes and autolysosomes in KFbs than in NFbs. PTB induced autophagy in KFbs, as demonstrated by the significantly greater number of autophagosomes in KFbs after PTB knockdown, which was revealed by acridine orange and LysoTracker staining. Our study is the first to show that PTB regulates the migration and proliferation of KFbs via autophagy and that PTB regulates collagen synthesis in KFbs in an autophagy-independent manner. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Current Knowledge on Breast Implant-Associated Anaplastic Large Cell Lymphoma: Evidence from Italian Ministry of Health Registry Data.

Accurate estimation of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) incidence is crucial for assessing breast-implant-associated risk. However, the size of the implanted population worldwide is unknown, making it challenging to appropriately estimate this figure. This study aims to provide a new reliable and reproducible method to estimate the breast-implanted-population (BIP), reporting a reliable annual BIA-ALCL incidence estimate. Moreover, we discuss all activities performed over the past decade in collecting complete histories, managing, and monitoring outcomes of each Italian case. Data from the National Breast Implant Registry and from manufacturers have been used to define a new formula to estimate the BIP at risk of developing a breast-implant-related event. From the BIA-ALCL registry, complete information on Italian cases has been collected and analysed. Overall survival is estimated by the Kaplan-Meier curve. From 2010 to June 2024, 111 BIA-ALCL cases were recorded in Italy. The estimated incidence rate showed an upward trend, ranging from 2.68 to 6.35 cases per 100,000 patient-years. Thanks to newly promoted disease awareness, most patients had a complete response to treatment, resulting in a three-year overall survival rate estimate of 98.2%. The BIP formula showed to be an innovative, effective and reproducible tool to make a reliable estimation of the implanted population, confirming that BIA-ALCL is a rare disease with an incidence rate estimate varying from 2.7 to 6.3 cases/100.000 patient-years in the last five years. Eleven-year experience in this field also confirmed that this disease has a favorable prognosis if properly treated. 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 .

Enrichment of Fat Graft with Association of ASC and Nanofat in an Animal Model.

Fat graft (FG) absorption rate varies from 20 to 80% in two years. Recently, several bioengineering techniques were applied to improve FG retention rate. Numerous studies investigated the use of adipocyte-derived stem cells (ASC) as FG enrichment. However, ASC production is costly, complex, and time-consuming. In contrast, Nanofat, a combination of lipids, stem cells and growth factors, offers a faster, simpler, and more cost-effective alternative for FG enrichment. This study aims to compare the effects of ASC with those of Nanofat, as a viable option in FG enrichment. Animals were allocated in three groups: Control group (1mL fat), ASC group (1mL fat +1x106ASC), andNnF group (1mL of fat + 0.3mL NnF). These groups were subdivided in three subgroups (4, 8, and 12 weeks, n = 6/group). We performed ultrasound and macroscopic measurements for FG volume, histology and expression of healing and inflammation genes. At week 12, ASC and NnF groups showed a higher retention of FG when compared to the Control group (51%, 46%, 12% respectively, p < 0.01). Fibrosis was similar in ASC and Nanofat groups. The Nanofat group showed a higher vascular density then the Control group (p < 0.05). Il-10 gene expression was higher, and Mmp9 was lower in the Nanofat group when compared to the ASC and Control groups. This study indicates that enriching FG with both ASC and Nanofat led to an increased retention rate of the FG, suggesting that Nanofat might be a promising alternative for FG enrichment. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Effectiveness and Safety of IPN-20-SENSE LIDOCAINE for Lip Volume Augmentation and/or Redefinition (SMILE Study): A Non-inferiority Randomized Double-Blinded Controlled Study.

Hyaluronic acid (HA) is a widely used dermal filler for lip augmentation. IPN-20-SENSE LIDOCAINE (Laboratoires VIVACY) is a monophasic gel consisting of cross-linked HA and includes lidocaine hydrochloride for the reduction of injection-associated pain. The SMILE study was designed to assess the non-inferiority of IPN-20-SENSE LIDOCAINE compared to HA-RK-Lido in improving aesthetic lip appearance. The secondary objectives were to evaluate the effectiveness and safety of IPN-20-SENSE LIDOCAINE against the chosen similar active control device. This was a prospective, multicenter, double-blinded, randomized active controlled parallel group study undertaken in two investigational sites between May 2021 and July 2022 (14 months). The primary endpoint of this study was the proportion of subjects reporting an improvement on the Global Aesthetic Improvement Scale (GAIS) 3 months after treatment initiation. Regarding the primary endpoint, the difference between the treatment arms in the proportion of improved subjects was +7.0[-2.2;17.7]. The lower limit of this 90%CI, being above the non-inferiority margin of -15 and below zero, demonstrated the non-inferiority of IPN-20-SENSE LIDOCAINE vs. HA-RK-Lido. The secondary outcomes reported by subjects and the blinded live evaluators supported this result. All injection site reactions and device-related adverse events reported in this study were expected, already described and were mostly mild and transient. The study demonstrated the non-inferiority of IPN-20-SENSE LIDOCAINE to HA-RK-Lido in the aesthetic improvement of the lips. The effect of both treatments decreased over time. Nonetheless, aesthetic improvement was sustained longer in the IPN-20-SENSE LIDOCAINE arm. 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 .

Effect of Hyperbaric Oxygen Therapy and Adipocyte Stem Cell on the Viability of Degloving Injury: A Murine Model.

Degloving soft tissue injuries (DSTIs) involve skin and tissue detachment from muscle or fascia. Surgical treatments exist, but they cannot prevent necrosis. Our aim was to investigate the effects of hyperbaric oxygen therapy (HOT) and adipocyte stem cell (ASC) treatment on tissue viability in degloving injuries in a murine model. 32 animals were submitted to a degloving flap surgery in the dorsal region and were allocated in four groups (n=8/group): Control: suture only; HOT: 2-hour daily therapy in 100% oxygen at 2.0 ATA for 7 days; ASC: injected with 1x106 stem cells; ASC+HOT: stem cells injection plus HOT therapy. We performed macroscopic measurements, blood flow, histology, and expression of inflammation genes. After 7days, HOT, ASC, and ASC+HOT groups had significantly more viable tissue compared to Control (97%, 90%, 81% vs. 6%). Viable area ratios were higher in HOT and ASC than Control. Blood flow in the injury's distal region was higher in HOT, ASC, and ASC+HOT compared to Control. Vascular density was higher in HOT and ASC+HOT than Control. Inflammatory cells decreased by 40% in HOT, 50% in ASC+HOT, and 75% in ASC. Gene Cd68 expression was lower in HOT than Control. Il10 expression was lower in HOT but higher in ASC and ASC+HOT than Control. This study suggests that the HOT can benefit the degloving injury flap model in the early phase of wound healing, and the association of ASC with HOT could benefit the wound healing in a later phase. This journal requires that authors assign a level of evidence to each submission to which evidence-based medicine rankings are applicable. This excludes review articles, book reviews, and manuscripts that concern basic science, animal studies, cadaver studies, and experimental studies. 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 .

EPortfolio-based Professional Development: Insights from a Southeast Asian Online Educators’ Community of Practice

This study examines the implementation and impacts of an ePortfolio-based professional learning initiative within a Southeast Asian online community of practice (CoP), part of the SEAMEO-AUS EduLink Project. Targeting the development of educators' competencies in ePortfolio pedagogy, the project engaged 541 educators from various Southeast Asian countries in two online self-paced courses and a series of four expert-led webinars, culminating in a final project webinar. The research utilised course analytics and post-webinar surveys to analyse participant engagement, satisfaction, and perceived learning outcomes. The findings indicate substantial engagement with the courses and positive reception of the webinar series. About 75% of participants completed the asynchronous courses, while 64% found the webinar content immediately applicable to their practice. The webinars, focusing on diverse aspects of ePortfolio use, successfully complement the online courses, with 91% of participants expressing intent to attend future events. This study underscores the effectiveness of combining asynchronous and synchronous learning modalities in professional development, particularly in the context of ePortfolios. It highlights the role of ePortfolios in promoting reflective practice, collaborative learning, and authentic assessment. Additionally, the project's success in fostering a supportive CoP model illustrates the potential of online communities in professional development, especially in regions with emerging ePortfolio practices. The paper concludes by emphasising the value of ePortfolio-based initiatives in enhancing educators' skills and fostering cross-cultural educational collaborations. It offers recommendations for educators and policymakers on implementing similar initiatives, underlining the need for sustainable and contextually sensitive approaches in professional development.

Evaluating Surgical Accuracy in Bimaxillary Surgery: A Systematic Review and Meta-Analysis of Mandible-First versus Maxilla-First Approaches.

Mandible-first surgery (MdFS) has gained attention as an alternative to the traditional maxilla-first surgery (MxFS) in bimaxillary procedures. Given the distinct sequence of operations between these approaches, evaluating the clinical advantages of MdFS compared to MxFS is crucial for optimizing surgical decision-making. This systematic review and meta-analysis examine intraoperative achievability and postoperative stability between these two surgical approaches. A thorough literature search was performed using PubMed, Embase, Web of Science, and MEDLINE, covering articles published from 2013 to 2023. Studies included were retrospective, prospective, and randomized trials that compared the accuracy and/or stability of MdFS with MxFS. The primary endpoint for the meta-analysis was the standardized mean difference in surgical accuracy for translational movements, with a secondary focus on rotational accuracy. A total of 11 studies encompassing 712 patients met the inclusion criteria. The analysis suggested that MdFS might reduce accuracy in the sagittal dimension (CI, 0.05 to 0.74) but offered greater achievability in the vertical direction (CI, - 0.47 to - 0.07). Additionally, MdFS was associated with a relatively posterior (CI, - 1.18 to - 0.60) and inferior (CI, - 0.64 to - 0.07) positioning of the maxillomandibular complex. Despite certain limitations, our findings indicate that MdFS can achieve clinical outcomes similar to MxFS in terms of both accuracy and stability. However, further researches with larger sample sizes and more rigorous study designs are necessary to validate these conclusions. 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 .

Reduced Injection Site Pain with Altered pH in 24-h Reconstituted Botulinum Toxin: Findings from a Randomized Controlled Study on Cosmetic Applications.

Botulinum toxin (BTX) injections are widely recognized for many cosmetic applications, but still commonly encounter a challenge: injection site pain (ISP). This discomfort can impact the overall patient experience and satisfaction, highlighting a need for innovative solutions to this problem. This randomized controlled study aimed to determine whether adjusting the pH levels in a 24-h reconstituted botulinum toxin can serve as a strategy to mitigate ISP. A controlled trial involving 24 volunteers was executed. Participants received incobotulinum toxin A. One side of each participant's face was treated with fresh toxin, while the other received a 24-h reconstituted version. Pain perceptions post-injection were assessed using the visual analogue scale (VAS). pH values of the fresh toxin were more acidic (6.17) than the 24-h reconstituted toxin (7.17). Out of 24 patients, 13 reported reduced ISP with the 24-h reconstituted toxin. The mean VAS score for the fresh toxin was 5.92, in contrast to 4.17 for the reconstituted toxin, indicating a significant difference (p<0.01). Limitations include the use of a VAS and a relatively small sample size. Altering the pH of BTX demonstrates potential in ISP reduction. However, broader, large-scale investigations are important for comprehensive validation. 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.

Correction of Infraorbital Dark Circles Using Autologous Adipose-Derived Collagen Filler: A Novel Regenerative Option.

Numerous intrinsic and extrinsic factors, notably the aging process, contribute to the development of infraorbital dark circles. These features, commonly associated with old age and fatigue, are caused by a disruption of dermal melanin and impairment of skin barrier function. Common aesthetic concerns affecting patients with infraorbital dark circles are primarily owing to lean and translucent lower eyelid skin overlying the orbicularis oculi muscle. This study aimed to present a novel technique for correcting infraorbital dark circles utilizing an adipose-derived extracellular matrix concentrate-adipose collagen fragment (ACF)-to correct infraorbital dark circles. Female patients (n = 94) aged 20-38 who presented infraorbital dark circles were enrolled to assess the efficacy of this technique for an eight-month follow-up. Following intradermal injections with ACF filler, the clinical outcome was determined by responses to GAIS and patient satisfaction surveys. Statistical analysis was performed with the one-way ANOVA test, and a p value of < 0.05 was considered statistically significant. Patients (n = 92) completed a single treatment session and underwent an eight-month follow-up. Eighty patients (86%) reported being "highly satisfied" or "satisfied" with the outcome and responded that the technique resulted in brighter, tighter, and smoother infraorbital skin. Over 97% of patients were rated as "improved," "much improved" and "Very much improved" throughout the follow-up on GAIS by three independent surgeons (p < 0.05). The statistical analyses demonstrated the percentage differences among groups are highly significant (p < 0.0001). No irregularity or lump was observed during the follow-up. Two patients were excluded from the study due to having undergone cosmetic eyelid surgery. Intradermal ACF filler represents a novel approach to addressing infraorbital dark circles and yields significantly high patient satisfaction. ACF fillers provide a degree of bio-stimulation, and adipose-derived concentrate is a natural filler with regenerative effects used in periorbital rejuvenation. 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 .

Unveiling the Teacher Identities of Online EFL Pre-service Teachers

The remote education modality inherited from the global pandemic in early 2020 and the emergence of online schools worldwide led different universities in Colombia to establish pedagogical practicum online as a permanent option. These shifts impact the delivery of FL education and the positioning and self-perception of pre-service teachers as online educators in the post-pandemic landscape. Some previous research has examined how graduate and college in-service teachers developed their identities as online instructors during the global pandemic in early 2020, graduate and college in-service teachers’ construction of their transitional identities as online instructors and compared such newly-constructed roles with their already-established identities in face-to-face (f2f) scenarios; overlooking thus a complete examination of the experiences and factors that shape student-teachers online teacher identity in planned remote training settings in post-pandemic realities. This qualitative case study intended to address the research gap by unveiling the online teacher identities that 16 EFL pre-service teachers constructed throughout their online pedagogical practicum at a public university in Colombia. Data were collected employing whole-class discussions, recorded class observations, focus groups, teacher’s journals, and surveys. The results showed that the student-teachers constructed multiple online teacher identities based on their experiences as technology users and educational software course students. The pre-service teachers also drew on their recent experiences and interactions with their students and the online factors and events themselves present during the synchronous EFL classes in their pedagogical practicum. These results posed noteworthy implications for FL teacher education programs, practicum supervisors, and teacher development. The study's limitations entailed the relatively short timeframe of data collection and the selection of participants not based on a carefully designed and checked test on ICT and software-specific skills that could have played a role in the resulting online teacher identities.

Comparisons of the Clinical Outcomes of Mandible Contouring Surgery With or Without the Use of Intraoral Drains.

Mandible contouring surgery is a common cosmetic procedure aimed at reducing the width of the lower face or correcting chin-related issues by contouring the mandible. Typically, an intraoral drain is placed during procedures involving the reduction of the mandible angle portion to mitigate seroma or hematoma formation. Despite this standard practice, anecdotal evidence suggests that the omission of drains does not significantly impact complication rates or surgical outcomes. A retrospective study was conducted to compare surgical outcomes and complication rates between patients who received intraoral drains (n = 338) and those who did not (n = 132) during mandible contouring surgery. The primary outcomes measured included the incidence of seroma, hematoma, and infection by counting the number of post-operative interventions required to address these complications. Statistical analysis was performed using chi-square tests for categorical variables. A p-value of < 0.05 was considered statistically significant. The incidence of post-operative surgical interventions for bleeding control or hematoma evacuation in the drain group was 0.59% compared to 0% in the no-drain group (p = 0.922). Minimally invasive interventions were required in 2.37% of patients with drains and 3.03% without drains (p = 0.933). Infection rates were 1.18% in the drain group versus 0.76% in the no-drain group (p = 1.0). The study demonstrates no statistically significant difference in complication rates between mandible contouring surgeries performed with or without intraoral drains. These findings suggest that the routine use of drains may be unnecessary, potentially simplifying post-operative care and reducing patient discomfort. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Machine Learning, Deep Learning, Artificial Intelligence and Aesthetic Plastic Surgery: A Qualitative Systematic Review.

This systematic review aims to assess the use of machine learning, deep learning, and artificial intelligence in aesthetic plastic surgery. This qualitative systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. To analyze quality risk-of-bias assessment of all included articles, we used the ROBINS-I tool for non-randomized studies. We searched for studies with the following MeSH terms: Machine Learning OR Deep Learning OR Artificial intelligence AND Plastic surgery on MEDLINE/PubMed, EMBASE, and Cochrane Library, from inception until July 2024 without any filter applied. A total of 2,148 studies were screened and 41 were fully reviewed. We conducted article extraction, screening, and full text review using the rayyan tool. Eighteen studies were ultimately included in this review, describing the use of machine learning, deep learning and artificial intelligence in aesthetic plastic surgery. All studies were published from 2019 to 2024. Articles varied regarding the population studied, type of machine learning (ML), Deep Learning Model (DLM), Artificial Intelligence (AI) used, and aesthetic plastic surgery type. Of the eighteen studies, we included the following aesthetic plastic surgeries: augmentation mastopexy, breast augmentation, reduction mammoplasty, rhinoplasty, facial rejuvenation surgery, including facelift surgery; blepharoplasty, and body contouring. Image-based with AI, ML, and DLMs algorithms were used in these studies to improve human decision-making and identified factors associated with postoperative complications. AI, ML, and DL algorithms offer immense potential to transform the aesthetic plastic surgery field. By meticulously analyzing patient data, these technologies may, in the future, help optimize treatment plans, predict potential complications, and more clearly elucidate patient concerns, improving their ability to make informed decisions. The drawback, as with preoperative surgical simulation, is that patients may see an AI-generated image that is to their liking, but impossible to achieve; great care is needed when using such tools in order to not create unrealistic expectations. Ultimately, the old plastic surgery adage of ''under-promise and over-deliver'' will continue to hold true, at least for the foreseeable future. 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 . Study registration A review protocol for this systematic review was registered at PROSPERO CRD42024567461.

Structural Mastopexy: Volume Displacement in Breast Reshaping.

Although in breast reshaping, the restoration of a suitable mammary cone is the main goal of the procedure, long-lasting upper pole fullness preservation is the most common weak point of all mastopexy. Mastopexy is a challenging procedure, and a surgical procedure to create desirable long-lasting results has not been well standardized. In this paper, the authors report their experiences in structural mastopexy procedures, describing three different adipo-glandular flaps, each repositioned as auto-prosthesis to reshape upper pole contour in patients affected by a severe degree of breast ptosis. A 6-year retrospective iconographic-chart and review was performed on 89 patients undergoing mastopexy between January 2016 and December 2021. Surgical candidates reported grades 2 and 3 of ptosis following Regnault classification. Minimum follow-up was 24 months. Pre- and postoperative data for all patients were collected in the same standard conditions. 89 patients affected with bilateral breast ptosis were included in the study, for a total of 178 breasts. Patients' mean age at the time of surgery was 40.45 years, ranging between 28 and 59 years. Follow-up ranged between 2 and 6 years with an average of 47.13 months. Out of 89 patients, 50 underwent general anesthesia, and the remaining 39 underwent local anesthesia. Among the 178 treated breasts, 10 (17.8%) experienced minor complications: No major complications were reported. Autologous tissue displacement, collecting parenchyma wherever surplus can be recruited, permits the transfer of extra tissue to the lack of volume, recontouring satisfactory breast shape and ensuring long-lasting results. 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 .

Developing Digital Skills in Students through Blended Learning

The conditions that provoked changes in the system of education and its receiving by students are mentioned. Traditional, distance and hybrid forms of education their features, advantages and disadvantages are considered from the point of view of modern education. The pandemic of COVID-19 necessitated the search for conditions for further implementation of education with minimal omissions. Solving that problem remote learning was invented for the quarantine period, while providing this format, some organizations had to develop a system of educational resources and online platforms for interaction between teachers and students in a short time. There was also a need for technical support for both students and teachers in need of mastering new technologies and competencies. Despite the difficulties encountered, the conditions of the pandemic made it possible to open up new online education opportunities that could not be ignored after all restrictions were lifted. Returning to the traditional form of education there is a crucial question how can the developed online resources and platforms be used in teaching students. Hybrid form of education has been recognized as an effective innovation with a number of conditions and requirements that act as an obstacle to the organization of the educational process, including for teachers, the role of the teaching staff in this system is changing and expanding. The information and technical resources and conditions that allow for the implementation of blended learning, and some of its types, are indicated. In conclusion, the effectiveness of hybrid education is outlined, as well as the basic requirements for students studying in this form.

Development of ethical codes for instructors engaged in distance education: a Delphi study

ABSTRACT Ethical codes are written documents that delineate a set of rules and principles that guide the duties and responsibilities of professionals within a professional organization from an ethical perspective. The research aims to develop an ethical code framework for instructors engaged in distance education. The Delphi, a qualitative research method, was employed to achieve this aim. The study included 22 distance education experts, selected via purposive sampling. The Delphi technique, conducted in three rounds, commenced with an evaluation of the ethical dimensions of distance education. In the study’s second phase, we invited participants to suggest additional ethical codes for the agreed-upon dimensions. We collected the suggestions and agreed on specific ethical code items in the third round. The researchers thus established the final form of the ethical code list. This process resulted in developing an ethical code framework for instructors engaged in distance education. The framework comprises sixdimensions: Instructional Design (ID), Social Interaction (SI), Content Provision (CP), Technology Usage (TU), Management (M), and Assessment and Evaluation (AE). It includes 62 ethical code items. The study demonstrates that the ethical code dimensions align with the roles of online instructors, as described in the relevant literature. This alignment substantiates the ethical code framework's validity and reliability.

Summary of Best Evidence for Perioperative Management Practices in Hair Transplantation Patients : Facial Skeleton.

To integrate and summarize the best evidence on perioperative management practices for hair transplantation patients, providing an evidence-based reference for clinical. An exhaustive literature search was conducted to identify the best evidence for managing patients undergoing hair transplantation during the perioperative period. The databases searched included Up To Date, BMJ Best Practice, UK National Institute for Health and Care Excellence, National Guideline Clearing House, Scottish Intercollegiate Guidelines Network, Guidelines International Network, Cochrane Library, JBI Database of Systematic Reviews and Implementation Reports, PubMed, Web of Science, European Dermatology Forum, China National Knowledge Infrastructure, Wanfang Data, Medlive Guideline Network, and Sinomed. The search spanned publications from February 2013 to February 2024, focusing on clinical decisions, evidence summaries, guidelines, and expert consensus. We finally identified 22 articles with high-quality results (consisting of 9 clinical decisions, 6 guidelines, 7 expert consensuses), providing 41 pieces of evidence across seven categories: assessment of transplantation conditions, transplant planning and preoperative preparation, anesthetic preparations, surgical methods and operation skills, postoperative wound management, medication-related guidance, optimization of nursing and treatment strategies. Special emphasis has been placed on the sections covering anesthesia preparation, surgical methods, and operational techniques, with detailed explanations provided. The summarized best evidence on perioperative management practices for hair transplantation patients can serve as evidence-based guidelines for clinical. It is recommended that clinical staff adopt evidence-based recommendations to improve and optimize patient outcomes and promote postoperative recovery. As these evidences came from different countries, factors such as the clinical environment should be evaluated before application. 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 .