Online Instructions Research Articles

The Impact of Exemplars On The Academic Outcomes For Master’s In Education Online Graduate Students

Annotated exemplars have recently been scrutinized as an academic support strategy in the context of Higher Education Institutes (HEIs). The idea is that using exemplars may front-load the system regarding student academic performance through the provision of meaningful feedback and task-specific comments before formal student submissions. More specifically, The Scholarship of Teaching and Learning (SoTL) research regarding exemplar use has called for the investigation of these exemplars on academic performance for the online graduate student. The purpose of this quantitative, quasi-experimental study was to determine if and to what extent the integration of annotated exemplars impacted the academic outcomes for Masters in Education online graduate students. Academic outcomes were designated as assessment grades and overall course grades. The study methodology and design were quantitative quasi-experimental using traditional pre-/post- techniques regarding this exemplar implementation with a convenience sample. The sample size of the experimental group is n = 17. The control group ranges from n = 25 to n = 27. The objective stated explicitly is to investigate if and to what extent the use of annotated exemplars impacts overarching student outcomes for graduate students at a university in the southwestern United States. The results showed no statistically significant difference between the control group and the experimental group for assignment grades, resulting in a retention of the null hypothesis. The results also indicated that there was a statistically significant difference between the control group and the experimental group for overall course grades, resulting in a rejection of the null hypothesis. Potential areas of future research might include brick-and-mortar settings, larger sample sizes, other student populations, or a qualitative examination of student perceptions about exemplars.

Conceptualizing Extended Reality Metaverse-based Pedagogy Model: A Hospitality and Tourism Education Perspective

The prevalence of online learning has significantly increased, particularly in light of the COVID-19 pandemic. Nevertheless, the shift to online education has presented numerous obstacles and concerns. The correlation between a lack of enthusiasm towards online learning and subpar academic achievements suggests the necessity to tackle the issues that impact students' involvement. Educators need to address obstacles encountered by students in online learning, including diminished concentration and inadequate learning delivery. Metaverse technologies have attracted growing interest among academia and practitioners for their possibilities in online education. Although metaverse technologies show promise for online education, there is a lack of research on their suitability for hospitality education. Comprehending how metaverse technologies can be seamlessly incorporated into online hospitality educational environments is crucial for the progression of such technology. Therefore, this study aims to conceptualize an extended reality metaverse-based pedagogy model for online hospitality education. The conceptual paper is a great resource for stakeholders who are interested in investigating the possibilities of metaverse technologies for hospitality education. This work also establishes a basis for future research that investigates the application of metaverse technologies in online educational environments.

Dry Liposculpture of the Calves and Ankles-A Novel Technique for Sculpting the Lower Legs.

Liposuction of the calves and ankles was historically described as a "taboo" procedure and linked with higher postoperative pain and unpleasing aesthetic results. This study presents a Novel technique for dry liposculpture of the calves and ankles using a tourniquet, as a safe and less painful procedure, which achieves better aesthetic results. This single surgeon, retrospective study included 70 women who underwent surgery based on the technique described. Details regarding the surgical outcomes and pain levels were collected, and patients completed 2 years of follow-up. A mean of 1395 cc fat was aspirated from both legs, combined, and the mean duration of surgery was 98 minutes. No major complications were observed, and postoperative pain levels were low. Pre- and post-surgery pictures were evaluated by 8 certified senior plastic surgeons for aesthetic results. The findings suggest that dry liposculpture is suitable for reshaping the calves and ankles. This technique is safe, with precise and satisfactory aesthetic results, low levels of postoperative pain, and may take less time to perform than wet liposuction. 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 .

Advancing Reduction Mammaplasty Surgery: Advancements and Outcomes with Tumescent Local Anaesthesia.

Tumescent local anaesthesia (TLA) is a method of anaesthesia used for surgical procedures that involves the infusion of a saline solution containing lidocaine, sodium bicarbonate, and epinephrine. This anaesthetic technique is designed to achieve both vasoconstriction and anaesthesia. In this article, we present a modified TLA protocol specifically adapted for reduction mammaplasty, based on an analysis of clinical case histories collected over the past few years. During the period from 2012 to 2022, we performed a reduction mammaplasty procedure in 120 patients employing tumescent local anaesthesia (TLA). The composition of the tumescent solution included 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000mL of 0.9% saline solution. The solution was injected diffusely throughout the mammary gland. The average volume of tumescent solution infiltrated during TLA was 350mL per breast. There were no cases of adrenaline or lidocaine toxicity, and no patients required conversion to general anaesthesia. No patient received sedation. Patients reported no pain or discomfort during pre-operative infiltration or during surgery. No reinterventions were necessary because of short-term complications. Among the complications, there were 4 cases of hematoma (3,3%), 3 cases of seroma (2,55%), 10 cases of wound dehiscence (8,3%), 5 cases of asymmetry (4,1%), 9 cases of T-junction breakdown (7,5%), 2 cases of (partial) nipple necrosis (1,6%), and 3 cases of liponecrosis (2,5%). No cases of infection or total nipple-areola loss were reported. The follow-up period was between 30 days and 1year. Reduction mammaplasty is a viable surgical option for women with macromastia seeking to enhance their physiognomy. It is imperative that patients fully understand the potential benefits and risks associated with the procedure and consult with healthcare professionals specialising in this field. The use of tumescent local anaesthesia (TLA) has been confirmed as a safe and effective methodology to perform reduction mammaplasty, ensuring adequate pain control with minimal post-operative complications and resulting in a high degree of patient satisfaction. 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 .

Utilising a Co-Design Approach to Strategically Plan Dementia Education for Diverse Populations in Ireland

Abstract Background In Ireland, the number of people living with dementia is projected to treble by 2050. National dementia education programmes span all care groups and areas of work, and include a 4-hour, a 2-day programme and HSEland modules. However, there is concern that these programmes often adopt a pedagogical approach that does not meet the needs of modern learners. Adopting a coproduction approach in designing dementia education initiatives is essential to ensuring that these programmes effectively impact healthcare professional’s attitudes, beliefs and care practices, meeting the needs of people from diverse populations and cultural backgrounds. Methods Methods included three key components: Firstly, a dementia education online survey for facilitators of national programmes to ascertain the benefits, challenges and impact on care practices. Secondly, a national event using World Café methodology to share insights and ideas and co-produce a vision for advancing dementia education in Ireland. Primary stakeholders included individuals living with dementia, their advocates, and delegates from various demographics and cultural backgrounds. Thirdly, a review of literature relating to dementia education in other jurisdictions. Results Key themes that emerged include the significance of understanding the lived experience and recognising diversity and cultural differences. Additionally, there is a need to explore various teaching and delivery methods, such as incorporating technology, simulation, and a tiered approach. There was general agreement that co designing a more adaptable, interactive national programme, including the lived experience of people with dementia would be more impactful. Challenges identified include staff turnover, difficulties releasing staff from clinical areas and organisational culture. Conclusion Through establishing an inclusive and collaborative platform, we can collectively shape a future where dementia education and care practices are compassionate, rights based and supportive. Crucially, people living with dementia and their supporters are at the heart of planning and decision-making processes in co-designing dementia education initiatives.

Enhanced Transconjunctival Lower Blepharoplasty: A Novel Method for Intraorbital Fat Transposition and Stabilization.

The evolution of lower blepharoplasty has shifted from simply removing of orbital septum fat to smoothing of the lid-cheek junction through fat repositioning. This paper adopts a novel technique to transpose and stabilize intraorbital fat during transconjunctival lower blepharoplasty. The tear trough and nasal alar base were filled to correct the pouch while ensuring the blood supply of the fat flap. Between September 2019 and June 2022, 104 patients aged between 22 and 49 who underwent bilateral fat flap transposition-nasal alar base filling lower blepharoplasty were selected. The surgical results were assessed by non-operative plastic surgeons according to the Hirmand grading system. Moreover, a self-satisfaction survey was conducted and patients were followed up for at least 6months to evaluate any complications and surgical outcomes. A high-frequency ultrasound imaging system was used to assess the degree of filling of the tear trough and nasal alar base. All 104 patients were followed up for at least 6months. The postoperative Hirmand grade was 0 for 96 out of 104 (92.3%) patients. In terms of self-satisfaction assessment, there were 92 out of 104 (88.5%) patients reported satisfaction. Dermatologic ultrasound showed no obvious gaps 6months after surgery. Transconjunctival fat flap transposition combined with nasal alar base filling during lower blepharoplasty has been shown to have a positive postoperative effect and high patient satisfaction. This procedure can preserve the blood supply of the fat flap, reduce the rates of fat absorption and denaturation, and improve facial contour, resulting in a satisfactory repairing effect. 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 .

A Novel Laboratory-Based Strategy for Single Adipocyte and Adipose-Derived Stem Cells Extraction for Transplantation: An Experimental Research.

Autologous fat grafting is widely used in plastic surgery. However, its main limitation is the low survival rate of fat grafts after transplantation. Transplantation of single adipocytes in combination with adipose-derived stem cells (ADSCs) could largely preserve the activity of the fat and improve graft survival. To verify the long-term survival rate of single adipocyte graft in vivo and its viable fat morphology for future fat grafting. Healthy adipose tissue was harvested and disassociated using fat dissociation solution, the Single-cell Suspension Preparation System (SSPS) was used to obtain a mixture of single adipocytes, ADSCs and stromal vascular fraction (SVF), and the structure of single adipocytes was verified by cell mask red and DAPI double staining. Nine male Balb/c nude mice were used, and three different graft volumes were established (0.05, 0.1 and 0.2ml). For each mouse, four sites were selected for transplantation, one for macrofat and the other three for single adipocytes, and different transplant volumes 30, 60 and 90days after transplantation. In each period, 3mice were selected to measure the volume of fat graft. Double staining with cell mask red and DAPI confirmed that the nucleus was identified intracellularly, which also indicated that the adipocytes in the single-cell suspension were structurally complete. When evaluating the transplantation, the groups with a volume of 0.05 ml and 0.2ml performed better in the single-cell fat group in all transplantation periods, the group with a volume of 0.1ml performed better in the single-cell group in the 30- and 60-day transplantation, and the differences were significant (P<0.05). In this study, the SSPS was used to obtain a new transplant material containing single adipocytes and ADSCs by enzymatic hydrolysis of adipose tissue and converted into single cells. It effectively improved the survival rate of fat grafting and the long-term effect of transplantation. 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.

A Multicenter, Randomized, Double-Blind, Parallel-Grouped, Positive-Controlled, Non-Inferiority Clinical Study to Evaluate the Efficacy and Safety of Injectable Calcium Hydroxylapatite Microsphere Hydrogel Fillers in the Correction of Nasolabial Fold in Chinese Subjects.

Soft tissue fillers are used to improve the appearance of nasolabial folds (NLFs). This study aimed to compare the efficacy and safety of a new calcium hydroxylapatite microsphere hydrogel filler (Aphranel) versus Restylane for correcting NLFs. In this multicenter, randomized, double-blind, parallel-grouped, positive-controlled, non-inferiority trial, 210 subjects were randomized to bilateral NLF treatment with Aphranel and Restylane on either side of the NLF. NLF was assessed before and right after injection and at the first week, first month, third, sixth, and 12 months. The primary efficacy endpoint was the WSRS improvement rate for the NLF, defined as ≥ 1 point improvement at Week 24. The secondary efficacy endpoints include the WSRS score assessed by investigators and the independent review committee (IRC) and the Global Aesthetic Improvement Scale (GAIS) evaluated by the subjects, investigators, and IRC over time. Randomization was performed using a computer-generated randomization list. To ensure the double-blind nature of the study, neither the physicians administering the injections nor the patients receiving them were aware of the specific product being used. All syringes were identical in appearance, with labels coded instead of indicating the product name. The preparation of the injection products was handled by nurses who were not involved in the treatment process, thereby maintaining the blinding of both the physicians and the patients to the treatment assignment. A total of 188 subjects (168 women and 20 men) completed the 12-month follow-up. The investigator-evaluated improvement rates using WSRS at 24 weeks were 84.04% for Aphranel and 78.72% for Restylane. The IRC-evaluated improvement rates using WSRS at 24 weeks were 72.34% for Aphranel and 70.21% for Restylane. Aphranel was shown to be statistically non-inferior to Restylane (P>0.05). Both the investigator and IRC-assessed WSRS scores over time showed that the mean scores for Aphranel were non-inferior to the mean scores for Restylane (all P>0.05). There was no difference between the Aphranel and Restylane groups according to the subjects, investigators, and IRC-assessed GAIS score at any time point (all P>0.05). Both devices' most frequently reported adverse events were injection site swelling and procedural pain. This study confirms that Aphranel is an effective and safe treatment for correcting NLFs in Chinese subjects. 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 Jigsaw Puzzle Locking Technique" to Augment the Stabilization between the Septal Cartilage and Extension Graft in End-to-End Suture Fixation.

Nasal tip stability is crucial for long-lasting results. Usage of the extension graft is one of the most reliable stabilization techniques. With a septum in the midline, the extension graft is fixed end to end. The "jig-saw puzzle technique" reinforces this end-to-end fixation. The specific protrusion on one piece of the puzzle is inserted in a groove on adjacent piece. This settlement provides stabilization between the pieces. Application of this philosophy between the nasal septum and extension graft may provide a long-term fixation. Between April 2022 and March 2024, the "jig-saw puzzle technique" was applied in 26 female patients. Trapezoid-shaped protrusion was created at the septum. Similar indentation was created at the extension grafts. The protrusion is then settled in the indentation. The preop, immediate postoperative and one-year postoperative pictures are compared to assess the rotations and projections with Adobe Photoshop Program. All 26 patients were females with mean age 27.5 years (20-32). Satisfactory graft stabilization was obtained without loss of projection and rotation in all patients. Statistically significant difference was found between the preoperative, immediate postoperative and postoperative 1-year projection and rotation assessments of the patients (p=0.001; p<0.01). The results were evaluated at a 95% confidence interval and significance was evaluated at p<0.05 level. These statistical analyses verify that both projection and rotation were preserved with jig-saw puzzle technique. The jigsaw puzzle technique may provide suture-independent, long-term end-to-end fixation opportunity of the septal cartilage and the extension graft. 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 .

Full-Incision Double-Eyelid Blepharoplasty with Selective Sensory Nerve Preservation.

Full-incision double-eyelid blepharoplasty can result in upper eyelid skin numbness postoperatively. However, few studies have examined sensory loss after eyelid surgery. We propose a novel surgical approach with selective sensory nerve preservation to prevent postoperative upper eyelid numbness. We enrolled 90 patients who underwent full-incision double-eyelid blepharoplasty with selective sensory nerve preservation from March 2021 to February 2022. Major longitudinal nerves that spread vertically to the palpebral margin under the orbicularis oculi muscle in the medial portion of the upper eyelid were dissected and carefully preserved. Eyelid sensation was measured using a Cochet-Bonnet filament-type esthesiometer at four predetermined anatomical locations in the upper eyelid. The mean esthesiometry reading was calculated at the preoperative and 2-week and final postoperative visits. The follow-up duration was 2-4 months (mean, 3 months). The mean esthesiometry readings at the inferonasal location were 5.22 cm (n=170, SD=0.28) preoperatively, 5.21 cm (n=170, SD=0.31) at 2 weeks postoperatively, and 5.22 cm (n=170, SD=0.29) at the final postoperative visits. Sensation was not significantly different between the second visit and the baseline (P=0.014) or between the final visit and the baseline (P=0.158). None of the patients reported a reduction in their subjective eyelid sensation. Full-incision double-eyelid blepharoplasty with selective sensory nerve preservation can prevent postoperative upper eyelid numbness while producing reliable and dynamic palpebral creases. The vital nerve branches of the upper eyelid can be preserved, thereby retaining skin sensation near the margin of the eyelid. We propose a novel full-incision double-eyelid blepharoplasty technique that incorporates selective sensory nerve preservation to prevent postoperative upper eyelid numbness. Full-incision double-eyelid blepharoplasty with selective sensory nerve preservation can prevent postoperative upper eyelid numbness while producing reliable and dynamic palpebral creases. The vital nerve branches of the upper eyelid can be preserved, thereby retaining skin sensation near the margin of the eyelid. 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 .

Combined Stromal Vascular Fraction and Fractional CO2 Laser Therapy for Hypertrophic Scar Treatment: A Systematic Review and Meta-Analysis.

Hypertrophic scars (HTSs) result from aberrant wound healing processes, leading to raised, thickened tissue with functional discomfort and cosmetic concerns. Current treatments, including corticosteroid injections and laser therapy, have limitations. Stromal vascular fraction (SVF) therapy and CO2 laser treatment offer promising avenues, with SVF therapy showing regenerative potential and CO2 laser therapy promoting precise tissue removal and wound healing. This study aims to investigate the combined application of SVF therapy and CO2 laser treatment for HTS, aiming to enhance treatment efficacy, tissue remodeling, and aesthetic outcomes, ultimately improving patient satisfaction in HTS management. PubMed, Scopus, Embase, and Web of Science databases have been searched for relevant studies. The "R" software (version 4.3.1) along with the "tidyverse" and "meta" statistical packages utilized to analyze data related to the efficiency of this combined method. A random-effects model was fitted to the data. For each study, continuous outcomes were pooled by calculating the standardized mean difference, along with their 95% confidence intervals. The assessment of heterogeneity utilized the I2 and chi-squared tests, applying the random effect model. Six articles fulfilled our inclusion criteria and were included in our review. Results from the pooled analysis of Vancouver Scar Scale (VSS) scores across three included studies indicated a significant impact of the SVF+CO2 method on VSS scores post-treatment (SMD=-3.0144; 95% CI:-4.3706 to -1.6583, p<0.0001). However, analysis of transepidermal water loss levels before and after treatment showed no significant difference (SMD=-2.7603; 95% CI: -6.8729 to 1.3522; p=0.1883). Comparatively, in a pooled analysis of two studies, the combined SVF+CO2 method demonstrated superior efficacy in VSS scores compared to other methods (SMD= -1.3573; 95% CI: -2.2475 to -0.4672, p = 0.0028), with moderate heterogeneity across studies (I^2=23.0%, p = 0.2545). The combined application of SVF and CO2 laser treatment shows significant promise in improving hypertrophic scars' appearance and texture. The SVF+CO2 method demonstrates superior efficacy compared to other modalities, suggesting its potential as a valuable therapeutic approach for hypertrophic scar management. 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 Hybrid Filler Technique: A 5-Year Retrospective Analysis.

The combination of calcium hydroxylapatite (CaHA) and hyaluronic acid fillers (CPM-HA, cohesive polydensified matrix-based hyaluronic acid fillers, Belotero® range, Merz Pharmaceuticals GmbH, Frankfurt, Germany), known as hybrid fillers, has emerged as a popular approach in aesthetic medicine. Premixed CaHA with CPM-HA offers several advantages, including enhanced tissue elevation and reduced early volume loss after injection. The objective of the present study is to assess the safety of premixing CaHA and CPM-HA fillers for rejuvenation purposes or as an aesthetic harmonization treatment. This retrospective study presents the clinical experience of two expert injectors who consistently used premixed CaHA and CPM-HA fillers for aesthetic treatments between March 2018 and December 2023. The premixed hybrid formulation was standardized and administered following a published protocol. A total of 2112 patients were treated, with meticulous follow-up over a minimum of one year. In the 2112 patients treated, only 5 minor adverse events (0.24%) were reported. The adverse events consisted of 4 non-inflammatory nodules of which 2 completely resolved with hyaluronidase, and 1 case of transient edema. Secondary findings consist of the treated areas, type of CPM-HA used and mixing ratios that were applied. The results from the current retrospective study, with the largest published cohort so far, are consistent with prior publications and strongly support a good safety profile of the CaHA:CPM-HA hybrid blend. 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 .

Does the Surgeon's Handedness Affect the Complications Rate in the Inframammary Approach Breast Augmentation?

Humans show a preference for left or right handedness in most cases. For this reason, surgeons might find it more difficult to operate on the "nondominant breast", i.e. the breast opposite to the surgeon´s dominant hand (left breast for right-handed surgeons and right breast for left-handed surgeons). The nondominant breast might therefore potentially be prone to a higher complication rate. Retrospective data of all consecutive patients who underwent breast augmentations by the first author over the past 15years was reviewed. In all cases, the entire operation was carried out with the surgeon standing on the right side of the table. All the complications of the right and left breasts were analyzed individually. 1707 patients with a minimum follow-up of sixmonths were reviewed. Mean breast implant volume was 305.6 cc and mean follow-up was 16.12months. A total of 151 complications were found (8.8%), including rotational deformity, capsular contracture, hematoma, seroma, bottoming out, high riding implant, double bubble deformity, implant rupture and infection. Of these complications, 77 (4.51%) affected the left breast, 48 (2.87%) were found on the right breast and 25 (1.46%) were bilateral. This difference was statistically significant. Surgeons´ handedness seem to have an impact on the rate of complications after breast augmentation. As a result of some sort of unease when operating on the nondominant breast, this side might be prone to less precision during the dissection and, consequently, to more complications. Our study found that the rate of complications was higher in the nondominant breast. 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 .

Our 40 Years' Experience on Face and Neck Lift Procedures with High-SMAS Flap Techniques: How to Manage Secondary and Tertiary Surgeries.

Facial aging drives a growing demand for esthetic procedures, with nonsurgical options often falling short in longevity compared to surgery. Despite primary face and neck lift techniques receiving substantial attention, revision procedures have been relatively overlooked in terms of their unique surgical management, complication incidence, and preventive strategies. The authors present a 40-year experience with revision face and neck lifts, comprising 283 cases. The primary focus was on the high-SMAS flap technique in revision surgeries, with data collected on complications compared to primary procedures and existing literature. Secondary analysis investigated the time-lapse between primary and revision surgeries in the author's series (secondary and tertiary rhytidectomy) compared to the literature findings. Out of 283 cases, 232 were secondary and 51 were tertiary procedures. Overall complication rates in secondary cases mirrored those of primary procedures, with no statistically significant difference observed (p > 0.05). The mean interval between procedures was 9.0years (range: 3.4-28.8years), with a significant statistical difference (p < 0.05) observed between the first and second procedures (10.7years, range: 3.8-18.8years) and the second and third procedures (7.8years, range: 3.5-10.8years). Results indicate that high-SMAS flaps yield consistent and satisfying outcomes, even in secondary and tertiary cases. Complication rates are comparable to primary surgeries, underscoring the importance of meticulous attention to detail in managing the complexities associated with previous surgeries and the aging process. 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 .

Premaxillary Graft with Costal Cartilage in Rhinoplasty: A Technique to Support the Nasal Tip.

Rhinoplasty is an ever-evolving field, with innovative techniques continually being developed to enhance both aesthetic and functional outcomes for patients. Increasingly, research has focused on the integral role of the facial skeleton in providing nasal support and projection. Central to the structural integrity of the nose is the maxillary bone, which occupies a pivotal position in the midface. The objective of this study is to assess the outcomes of patients who underwent rhinoplasty involving the placement of a premaxillary graft fashioned from costal cartilage. The study aims to evaluate the graft's tolerance, stability, and potential complications. The patient cohort comprised individuals who underwent open approach rhinoplasty with premaxillary insufficiency, necessitating the placement of a costal cartilage graft anterior to the nasal spine, performed by the same surgeon between 2021 and 2022. A total of 38 patients, consisting of 5 men and 33 women aged between 18 and 58years, were operated on during this period. Consistent maintenance of tip support was observed across all cases. Among the 33 patients, 20 were randomly chosen for a comparative assessment of the nasolabial angle in preoperative and postoperative profile photographs, demonstrating a statistically significant improvement. No complications such as graft displacement, scarring, extrusion, or infections were reported. The use of a premaxillary graft with costal cartilage appears to be a viable, well-tolerated option with favorable long-term outcomes. 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 .

Efficacy of Mixed Model Instruction to Improve English Language Skills of Business Management Students: An Experimental Study

Aim. The current study explored and compared the efficacy of technology-based instructions, specifically web-mediated, blended, and online instructions, on the enhancement of English language skills among students pursuing Business management (BM) in Prince Sattam Bin Abdulaziz University, Saudi Arabia. Method. A total of two hundred and four participants were chosen randomly and divided into four groups. The control group, comprising 51 individuals, received general English instruction utilizing the communicative language teaching (CLT) approach, and engaged in exercises that focused on developing their general English skills. On the other hand, the web-mediated learning experimental group, also consisting of 51 participants, received general English instruction through the Duolingo educational model. Similarly, the blended experimental group, comprised of 51 individuals, received general English instruction through the Enriched Virtual Blended Learning Model. Lastly, the online learning group, consisting of 51 participants, received general English instruction through the LMS instructional model. Results. Prior to the intervention, all students underwent a pretest, and subsequently, a posttest and a delayed posttest were administered to evaluate their proficiency in standard general English, as measured by the TOEFL exam. The study's results indicated that all groups displayed progress in their English language skills. However, the Duolingo and Enriched Virtual learning models demonstrated superior performance in enhancing English language skills compared to the other groups. Conclusion. These findings hold significant pedagogical implications for curriculum designers, the development of training programs for future HR professionals, material producers, and all stakeholders involved in the field of BM education.

Didactic possibilities of scientific and educational LabXchange online platforms for genetics learning in the pedagogical ZVO

Aim. Highlight the possibilities of the scientific and educational platform LabXchange for distance learning of genetics for students of higher education in the specialties 014 Secondary Education (Biology and Human Health) and 091 Biology. Methods. Content analysis, survey, generalization. Results. LabXchange, an online educational platform created by scientists, provides users with free access to high-quality scientific education through a variety of online tools. LabXchange's Comprehensive General Genetics Curriculum for Higher Education Students includes content types that transform standard science material into engaging interactive visualizations that promote better understanding of complex concepts, provide the opportunity to conduct genetic experiments in virtual laboratories with state-of-the-art equipment, help personalize the learning process, making it interesting and accessible opens up new opportunities for developing critical thinking skills, creativity and independence. Conclusions. The LabXchange online scientific and educational platform is an innovative resource for the study of genetics for students of higher education, as it performs important didactic functions. The experience of its use by students of a pedagogical university is useful for the formation of their professional competences.

Losartan in Situ Forming Gel as a New Treatment for Hypertrophic Scars.

Hypertrophic scars are defined as visible lesions formed by excessive wound healing that cause cosmetic and, in some cases, functional challenges in patients. This study aimed to assess the efficacy of intralesional injections of losartan-loaded in situ forming gel and compare it with the common treatment (triamcinolone) in preventing scar formation. The formulation was prepared using a thermosensitive PLGA-PEG-PLGA triblock copolymer. Ear scar tissue in rabbits represented the hypertrophic scar, and the animals were treated with three treatments in three groups. Nine weeks following the single treatment, images of the scars were obtained and quantitatively analyzed using ImageJ and light microscopy was used to evaluate the fibroblast cell number, vascularization, inflammation and collagen deposition and fibrosis in H&E-stained sample tissue. According to the results based on the ImageJ and the Vancouver criteria, the losartan in situ forming gel (F-LG) indicated significantly higher improving effects on decreased vascularity and pigmentation in comparison with triamcinolone (F-TA) and placebo as a control (F-Ctl), although the effect F-LG was almost similar to F-TA on pliability and scar height, and they were better than the control. Histological findings showed F-LG and F-TA have less inflammatory and fibroblast cells compared to F-Ctl. Also, results indicated the dermal layers of the F-TA and F-LG groups' scar were thinner, and the deposition of collagens was reduced compared to the control. Consequently, F-LG was found to be an effective treatment in reducing scarring and promoting wound healing.No Level Assigned 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 .

Optimizing Gynecomastia Correction Surgery: Efficacy and Safety of Tumescent Local Anesthesia Approach.

Tumescent local anesthesia (TLA) involves infusing a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While liposuction under general anesthesia remains the most used treatment, we introduce a novel TLA approach for gynecomastia surgery, drawing from our extensive experience in recent years. Between the years 2010 and 2023, we performed gynecomastia surgery on 60 male patients under TLA. The gynecomastia was treated by liposuction plus periareolar excision technique. Liposuction was carried out on both breasts in every case, regardless of whether the gynecomastia was bilateral or unilateral. The tumescent solution consisted of 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated between the pectoral fascia and the mammary gland, and then the surgery was carried out. The average volume of tumescent solution infiltrated during TLA was 300mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure. We observed a major postoperative complications rate of 6.7%, represented by three incident of hematoma and one case of seroma. A minor complication rate of 5% was observed: two cases of retraction of the NAC and one case of gynecomastia recurrence, the latter undergoing an additional combination procedure with liposuction and subcutaneous mastectomy. Follow-up time ranged from 30 days to 1 year. We developed a new outpatient surgical method for gynecomastia using liposuction and periareolar excision under tumescent local anesthesia. This technique, supported by a comprehensive rehabilitation plan, proved a successful and quick recovery, and high patient satisfaction. Our results suggest it is a feasible and effective option, warranting further consideration in gynecomastia treatment strategies. 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.

Advancement of Generative Pre-trained Transformer Chatbots in Answering Clinical Questions in the Practical Rhinoplasty Guideline.

The Generative Pre-trained Transformer (GPT) series, which includes ChatGPT, is an artificial large language model that provides human-like text dialogue. This study aimed to evaluate the performance of artificial intelligence chatbots in answering clinical questions based on practical rhinoplasty guidelines. Clinical questions (CQs) developed from the guidelines were used as question sources. For each question, we asked GPT-4 and GPT-3.5 (ChatGPT), developed by OpenAI, to provide answers for the CQs, Policy Level, Aggregate Evidence Quality, Level of Confidence in Evidence, and References. We compared the performance of the two types of artificial intelligence (AI) chatbots. A total of 10 questions were included in the final analysis, and the AI chatbots correctly answered 90.0% of these. GPT-4 demonstrated a lower accuracy rate than GPT-3.5 in answering CQs, although without statistically significant difference (86.0% vs. 94.0%; p = 0.05), whereas GPT-4 showed significantly higher accuracy for the level of confidence in Evidence than GPT-3.5 (52.0% vs. 28.0%; p < 0.01). No statistical differences were observed in Policy Level, Aggregate Evidence Quality, and Reference Match. In addition, GPT-4 rated significantly higher in presenting existing references than GPT-3.5 (36.9% vs. 24.1%; p = 0.01). The overall performance of GPT-4 was similar to that of GPT-3.5. However, GPT-4 provided existing references at a higher rate than GPT-3.5. GPT-4 has the potential to provide a more accurate reference in professional fields, including rhinoplasty. 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 .