Restoration Of Volume Research Articles

Аналіз результатів реконструктивно-відновних операцій при посттравматичних дефектах орбіти за методами комп’ютерного моделювання

Treatment of patients with post-traumatic orbital defects is relevant problem of ophthalmology and maxillofacial surgery. Residual diplopia or dislocation of the eyeball leads to disability, social maladaptation and development of psychoemotional disorders in patients. In this paper, we present an evaluation of treatment of patients with posttraumatic orbital wall defects based on the retrospective comparative analysis of CT data by computer simulation before and after reconstruction. When comparing the volume of the injured orbits before and after the operation (average volume difference was 2.7 ± 0.9 cm3), a significant improvement was found in terms of recovery of the orbital volume. The factors influencing the treatment effectiveness were determined based on the calculation of the volume of the orbits on the healthy and injured side in the software environment before and after the reconstruction. The causes of the detected cases of incomplete recovery of the orbital volume were analyzed. The solution to the problem of restoring the orbital volume is in the plane of restoring the geometry of the orbit because previous adaptation of the shape of the standard plate to its anatomical structure with overlapping defect on the stereolithographic model provided the best end result. Conclusions. Personalized adaptation of the implants to the shape of the orbit or individual production thereof can increase the accuracy of the orbital volume restoration, which can increase the effectiveness of eliminating complications such as enophthalmos and diplopia. The effectiveness of treatment of post-traumatic orbital defects by traditional methods directly depends on the severity of the damage, the degree of which determines the magnitude of the change in the orbital volume. However, the greater is the volume of the orbit changes as a result of the injury, the worse is the prognosis for its recovery. Development of the ways to individualize implants and evaluate their effectiveness is an important area for further research. Keywords: post-traumatic orbital defects, reconstructive surgery, computer simulation.

Improvement of Facial Skin Laxity by a Combined Technique With Hyaluronic Acid and Calcium Hydroxylapatite Fillers: A Clinical and Ultrasonography Analysis

Background: Facial aging involves skeletal changes, loss of volume in the fat compartment, and skin component changes. The current objective of cosmetic facial filling is to reestablish the overall aspect that was lost during the aging process. Hyaluronic acid (HA) and calcium hydroxyapatite (CaHA) fillers are indicated for facial rejuvenation, and these agents promote dissimilar effects regarding volume restoration and dermal biostimulation. Objective: This study aimed to assess clinical and ultrasonographic improvements in facial skin laxity using a technique that combines the injection of HA and CaHA. Methods: A 120-day follow-up, quasi-experimental study was conducted based on the enrollment of fifteen women (36–47 years old) with mild face flaccidity scores who underwent subcutaneous injection of up to 3 mL of HA (zygomatic-malar region, pyriform aperture, temporal region, and jaw) followed by 3 mL of 1:1 diluted CaHA using a fan technique (temporal, zygomatic-malar, and jaw regions). Objective: Adverse effects were registered, and the monthly assessed outcomes included clinical improvement, satisfaction, and high-frequency ultrasonography (dermal thickness) parameters. Results: At 120 days of follow-up, clinical assessment by blinded physicians yielded six (40%) very improved patients and nine (60%) exceptionally improved patients. All the participants were highly satisfied with the results and reported exceptional improvement. Dermal thickness increased 11.1% (8.8–13.4%), and augmented dermal homogeneity was evidenced by ultrasonography. Local adverse effects were mild and transient. Conclusion: In conclusion, the combined technique with HA and CaHA fillers was well-tolerated and yielded high satisfaction and safe improve in facial skin laxity and dermal thickness in women with mild midface aging. J Drugs Dermatol. 2022;21(1): 102-106. doi:10.36849/JDD.633Hyaluronic Acid and Calcium Hydroxylapatite Fillers

Osteogenic Capacity of the Prefabricated Periosteofascial Flap using Vascular Induction with Skeletonized Pedicle Transfer in Rabbit Calvarium

The study investigated the osteogenic capacity of a prefabricated periosteal flap created using only skeletonized pedicle transfer without fascia or muscle for vascular induction in rabbit calvarium. A critical-sized bone defect was made in the parietal bone centered on the sagittal suture, and the demineralized bone matrix was implanted. The periosteofascia over the defect was used as a form of prefabricated periosteofascial flap (PPF group, N=10), conventional periosteofascial flap (CPF group, N=10), and nonvascularized free periosteofascial graft (FPG group, N=6). The prefabricated flap was designed via vascular induction by transferring the central artery and vein of the right auricle onto the periosteofascia for 4 weeks prior to flap elevation. A quantitative comparison of volume restoration and radiodensity in the bone defect and a histological study were performed after 6 weeks of covering the bone defect with periosteofascia. The volume restoration of the bone defect covered with the PPF (43.4%) was not different from that of the CPF (46.2%), but significantly increased compared with that of the FPG (24.6%). The radiodensity of the bone defect covered with the PPF (-186.3 HU) was not different from that of the CPF (-153.6 HU), but significantly increased compared with that of the FPG (-329.8 HU). The results were based on adequate vascular development of the periosteum and were closely related to the osteogenic changes in the implanted demineralized bone matrix (DBM). In conclusion, even in the PPF created by transferring only skeletonized vascular pedicles, the osteogenic capacity of the periosteofascial flap is well maintained.

Enamel Remineralization Competence of a Novel Fluoride-Incorporated Bioactive Glass Toothpaste-A Surface Micro-Hardness, Profilometric, and Micro-Computed Tomographic Analysis.

This study aimed to analyze the enamel remineralization efficacy of a novel fluoridated bioactive glass (F-BG) toothpaste compared to a standard fluoride toothpaste. Seventy-two enamel blocks (N = 72) were divided into groups of twenty-four blocks according to the toothpaste exposure—group 1: brushed with distilled water, group 2: brushed with fluoride toothpaste (ColgateTM), and group 3: brushed with F-BG toothpaste (BioMinFTM). Pre-brushing, enamel blocks were demineralized using 6 wt.% citric acid (pH = 2.4). Tooth brushing was performed using a mixture of respective toothpaste and artificial saliva (AS), and each enamel block received 5000 linear strokes. The samples were assessed for surface micro-hardness (to estimate Vickers hardness number, VHN), surface roughness (Ra), and volume loss/gain using micro-computed tomography (micro-CT). The highest increase in the VHN was noticed for group 3 (117.81) followed by group 2 (61.13), and all the intragroup comparisons were statistically significant (p < 0.05). Demineralization increased the Ra values, and a decrease was observed post-remineralization for all the groups. The maximum Ra decrease was observed for group 3 (−223.2 nm) followed by group 2 (−55.6 nm), and all the intragroup comparisons were again statistically significant (p < 0.05). Micro-CT investigation revealed that the enamel volume decreased after demineralization and increased after remineralization among all groups. The F-BG toothpaste showed greater enamel surface micro-hardness (increased VHN), smoother surface (low roughness), and better volume restoration (remineralization) in comparison to the fluoride toothpaste.

Experimental evaluation of a pressure related analytical method (PRAM), a pulse contour analysis method, to calculate cardiac output during progressive hypovolemia and volume restoration in Beagle dogs

Experimental evaluation of a pressure related analytical method (PRAM), a pulse contour analysis method, to calculate cardiac output during progressive hypovolemia and volume restoration in Beagle dogs

Exertional heat stress and sodium balance: Leaders, followers, and adaptations.

Exertional heat stress presents a different acute challenge to salt balance compared to at rest. Sodium (Na+) and chloride (Cl-) losses during exercise are overwhelmingly driven by eccrine sweat glands (the "leader"), with minimal urinary excretion. Total salt losses are therefore largely influenced by thermoregulatory need, although adaptations from prior heat exposure or altered dietary intake influences sweat gland ion reabsorption, and therefore sweat Na+ ([Na+]sweat) and Cl- concentrations. The hypotheses that body Na+ and Cl- conservation, or their release from osmotically inactive stores, can occur during the timeframe of a single bout of exertional heat stress, has not been studied to date. The consequences of unreplaced Na+ and Cl- losses during exertional heat stress appear limited primarily to their interactions with water balance. However, the water volume ingested is substantially more influential than salt intake on total body water, plasma volume, osmolality, and thermoregulation during exercise. Acute salt and water loading 1-3h prior to exercise can induce isosmotic hyperhydration in situations where this is deemed beneficial. During exercise, only scenarios of whole body [Na+]sweat>75th centile, combined with fluid replacement >80% of losses, are likely to require significant replacement to prevent hyponatremia. Post-exercise, natriuresis resumes as the main regulator of salt losses, with the kidneys (the "follower") working to restore salt balance incurred from any exercise-induced deficit. If such a deficit exceeds usual dietary intake, and rapid restoration of hydration status is desirable, a deliberate increase in salt intake may assist in volume restoration.

Hyaluronic acid fillers in facial contouring:The “Less is More” concept

Background: Aesthetic dermatology is a rapidly evolving field of medicine that allows for minimally invasive procedures, little to no recovery time and cost-effective techniques. Hyaluronic Acid (HA) fillers are used for facial contouring, the treatment of facial volume loss &amp; enhancing the natural light reflecting areas of the face. Aims: HA fillers are safe and generally well tolerated yet using more of the product exposes the patient to an added risk of inflammation as well as higher cost. We aim to detail the “less is more” technique that limits the number of injections and maximises natural aesthetic results. The secondary aim of this study is to point out that younger patients consult for a different motive; namely the use of HA fillers for enhancing the natural light reflecting points of the face. Materials &amp; Methods: The “less is more” technique distinguishes between static and dynamic facial planes, allowing for natural expressions, positive patient image, an artistic analysis that encompasses the entire face including untreated facial units. This study was conducted over a period of 30 months on 162 patients divided into two age groups. Results/Conclusions: The “less is more” technique for HA fillers in facial contouring optimizes natural results by selectively diminishing negative facial expressions and allowing for natural looking volume restoration. HA fillers are also effective as a durable tool for enhancing the natural light reflecting areas of the face in patients aged 20-50.

Clinical case of combined diabetes insipidus and cerebral salt-wasting syndrome in a patient with craniocerebral and spinal injury

Introduction. Cerebral salt-wasting syndrome and diabetes insipidus are serious complications of craniocerebral injury and spinal cord injuries. Each of the syndromes in some cases causes a life-threatening condition. This determines the importance of timely diagnosis and emergency intensive care measures. In the literature, there are only single descriptions of combinations of these symptoms in one patient.Clinical case report. A victim with craniocerebral injury and cervical spinal cord injury underwent, according to emergency indications, emptying and drainage of a tense subgaleal hematoma of the fronto-parieto-occipital region, spinal cord decompression, and stabilization of the spine. Postoperative follow-up and intensive care: on the 1st day the rate of diuresis was 2.5 mL/kg/h, blood glucose level – 14.18 mmol/L, and sodium level – 148–158 mmol/L. The patient was diagnosed with diabetes insipidus, and a therapy with desmopressin at a dose of 0.6 mg/day, restoration of fluid volume with hypotonic solutions, and correction of hyperglycemia was started. On the 4th day blood sodium level was 133 mmol/L, and blood glucose level – 8.67 mmol/L. On the 5th day, hyponatremia of 126–115 mmol/L was noted with a diuresis rate of 4 mL/kg/h and glicemya level of 7.86 mmol/L. The development of cerebral salt-wasting syndrome was diagnosed, and the infusion of hydrocortisone 400 mg/day and of 10% NaCl solution was started. On the 6th day glucose level returned to normal. On the 9th day of follow-up, an increase in the volume of diuresis was again observed, and desmopressin therapy was continued. Stable normalization of water-electrolyte balance, urine output, and glucose levels were observed on the 16th day of follow-up.Conclusion. Monitoring of fluid balance and electrolyte composition of blood serum, and adequate replacement therapy were the conditions for successful treatment of a rare combination of diabetes insipidus and cerebral salt-wasting syndrome in patients with concomitant craniocerebral and spinal cord injuries.

Comparison of Isotonic Activation of Cell Volume Regulation in Rat Peritoneal Mesothelial Cells and in Kidney Outer Medullary Collecting Duct Principal Cells.

In disease states, mesothelial cells are exposed to variable osmotic conditions, with high osmotic stress exerted by peritoneal dialysis (PD) fluids. They contain unphysiologically high concentrations of glucose and result in major peritoneal membrane transformation and PD function loss. The effects of isotonic entry of urea and myo-inositol in hypertonic (380 mOsm/kg) medium on the cell volume of primary cultures of rat peritoneal mesothelial cells and rat kidney outer medullary collecting duct (OMCD) principal cells were studied. In hypertonic medium, rat peritoneal mesothelial cells activated a different mechanism of cell volume regulation in the presence of isotonic urea (100 mM) in comparison to rat kidney OMCD principal cells. In kidney OMCD cells inflow of urea into the shrunken cell results in restoration of cell volume. In the shrunken peritoneal mesothelial cells, isotonic urea inflow caused a small volume increase and activated regulatory volume decrease (RVD). Isotonic myo-inositol activated RVD in hypertonic medium in both cell types. Isotonic application of both osmolytes caused a sharp increase of intracellular calcium both in peritoneal mesothelial cells and in kidney OMCD principal cells. In conclusion, peritoneal mesothelial cells exhibit RVD mechanisms when challenged with myo-inositol and urea under hyperosmolar isotonic switch from mannitol through involvement of calcium-dependent control. Myo-inositol effects were identical with the ones in OMCD principal cells whereas urea effects in OMCD principal cells led to no RVD induction.

Early diagnosis and prevention of acute kidney injury in elderly patients after urgent abdominal surgery

Due to the rapidly aging of the population, the number of elderly patients is boosting. Elderly patients are a special cohort of patients due to their typical physiological and anatomical age-related changes, fragility, and comorbidity. One of the threatening perioperative complications is acute kidney injury (AKI), which is associated with a longer hospital stay, increased short-term and long-term mortality. Despite constant efforts to standardize the determination of AKI using serum creatinine, this method has several disadvantages, which makes the search for other diagnostic criteria for kidney damage urgent. Recently, the determination of biomarkers (lipocalin-2, interleukin-18, cystatin C), which can be useful in the early diagnosis of AKI, has become increasingly popular. Even though the filtration capacity of the kidneys is the only factor determining the serum cystatin C concentration, this marker is the most valuable. The use of ultrasound for the early diagnosis of AKI is also considered promising. Several studies show that the renal resistance index and semi-quantitative assessment of renal blood flow work are well for diagnosing persistent AKI. The high mortality rate and the lack of special treatment increase the need for AKI prevention in the elderly, the main one of which is careful clinical monitoring with timely correction of hypovolemia and hypotension. With invasive procedures, the risk of AKI can be reduced by maintaining mean arterial pressure &gt; 80 mmHg and hematocrit &gt; 30 %, as well as providing adequate oxygenation and volume restoration. Prescription of drugs should be individualized by adjusting doses based on the glomerular filtration rate and the patient’s age. However, the question of specific drug prevention of AKI remains open. Several studies have confirmed the renoprotective properties of dexmedetomidine in cardiac surgery, and some positive effects of pentoxifylline for the treatment of renal pathology are also described in the literature. This review explores the topic of AKI in elderly patients undergoing abdominal surgery and focuses on the early diagnosis and prevention of this syndrome.

Modern Fat Grafting Techniques to the Face and Neck.

After studying this article, the participant should be able to: 1. Understand age-related changes to the face and neck and pertinent anatomy and discuss important aspects of fat graft harvesting, processing, and infiltration. 2. Recognize key differences between common techniques for fat processing and infiltration and develop a plan for patients based on site-specific facial anatomical zones. 3. Appreciate the utility of fat grafting as an adjunct to other facial rejuvenating procedures such as face lift and blepharoplasty procedures and list the potential complications from fat grafting to the face and neck. Fat grafting to the face and neck aids in volume restoration, thereby addressing soft-tissue atrophy associated with the aging face, acquired conditions, or congenital malformations. Often, fat grafting may sufficiently restore facial volume alone or in conjunction with other facial rejuvenation procedures. Facial/neck fat grafting requires a systematic and thoughtful approach, with special care to atraumatic technique. This CME article covers the principles and techniques for modern facial fat grafting to the face and neck. Increasing data support the ability of autologous fat to produce significant and sustainable appearance-related changes. The authors follow the general principles of the Coleman technique for facial fat grafting and have observed tremendous success over the years. Other techniques for facial fat grafting are also discussed including microfat and nanofat processing. As the understanding of facial fat compartments continues to evolve, the authors may better predict fat grafting outcomes following augmentation. Finally, the technique described as "lipotumescence" has been successfully used in the breast and other regions of the body that have radiation damage and is discussed in this article specifically for the face and neck.

Effect of corneal stromal lenticule customization on neurite distribution and excitatory property

IntroductionRefractive stromal lenticules from Small Incision Lenticule Extraction (SMILE), though usually discarded, hold a potential for various ophthalmic applications, including refractive correction, stromal volume expansion, and biomechanical strengthening of the cornea. ObjectivesTo investigate the effect of lenticule customization on lenticule neurite length profile and the excitatory response (calcium signaling) and the potential of reinnervation. MethodsHuman and porcine stromal lenticules were treated by (1) excimer laser reshaping, (2) ultraviolet A-riboflavin crosslinking (CXL), and (3) decellularization by sodium dodecyl sulfate (SDS), respectively. The overall neurite scaffold immuno-positive to TuJ1 (neuron-specific class III β-tubulin) expression and population of active neurite fragments with calcium response revealed by L-glutamate-induced Fluo-4-acetoxymethyl ester reaction were captured by wide-field laser-scanning confocal microscopy, followed by z-stack image construction. The NeuronJ plugin was used to measure neurite lengths for TuJ1 (NL-TuJ1) and calcium signal (NL-Ca). Reinnervation of lenticules was examined by the ex vivo grafting of chick dorsal root ganglia (DRG) to the decellularized human lenticules. Differences between groups and controls were analyzed with ANOVA and Mann-Whitney U test. ResultsThe customization methods significantly eliminated neurites inside the lenticules. NL-TuJ1 was significantly reduced by 84% after excimer laser reshaping, 54% after CXL, and 96% after decellularization. The neurite remnants from reshaping and CXL exhibited calcium signaling, indicative of residual excitatory response. Re-innervation occurred in the decellularized lenticules upon stimulation of the grafted chick embryo DRG with nerve growth factor (NGF 2.5S). ConclusionAll of the lenticule customization procedures reduced lenticule neurites, but the residual neurites still showed excitatory potential. Even though these neurite remnants seemed minimal, they could be advantageous to reinnervation with axon growth and guidance after lenticule reimplantation for refractive and volume restoration of the cornea.

Comparison of Efficacy between Three-Dimensional Printing and Manual-Bending Implants for Inferomedial Orbital Fracture: A Retrospective Study

The purpose of reconstruction of an orbital fracture is restoration of normal structure and volume without visible or functional complications. In a previous study, orbital implants were created using three-dimensional (3D) printing technology to restore orbital fractures. In the present study, the authors compared the efficacy of the conventional manual-bending implant and the 3D-printed standardized implant in order to verify the clinical utility of the fabricated 3D printed orbital implant. In this single-center, retrospective study, the authors evaluated medical records and 3D-CT scans of patients with inferomedial orbital fracture. Selected patients were divided into two groups. Group A underwent surgery with the 3D-printed standardized implant, while group B was treated using a manual technique to mold and trim the implant. A total of 32 patients was included in this study, 16 in each group. The volume of the preoperative lesion side was significantly different from that of the normal side or postoperative lesion side within each group. The volume of the postoperative lesion side was not statistically different from that of the normal side in Group A, but this volume was significantly different from that of the normal side in Group B. The 3D-printed standardized implant provides surgical efficacy to restore inferomedial orbital fracture and has superior surgical outcomes to the manual-bending implant.

The Versatility of the Free Vastus Lateralis Muscle Flap: Orbital Reconstruction After Removal of Complex Vascular Malformation in a Pediatric Patient.

Introduction: Vascular orbital lesions in pediatric population represent a demanding therapeutic challenge which requires a multidisciplinary team. In severe cases, orbital enucleation can be considered. Surgical management of enucleated orbital region in children, differently from the adults, represents a challenging procedure owing to the intrinsic relation between volume replacement and normal orbital growth. Many reconstructive options have been proposed, and many donor sites have been utilized for this purpose but each one have demonstrated potential disadvantages. Despite its well-known versatility, no report of the vastus lateralis free flap in children requiring orbital reconstruction exists in literature. Herein, we propose this surgical strategy as a valid option for the reconstruction of an extended orbital defect in a pediatric patient suffering from a mixed type of vascular malformation.Material and Methods: A patient was referred from a foreign country with an unclear medical history, presenting exorbitism and exophthalmos, proptosis of the eyeball, visus 4/10, and limited ocular motility. We made clinical-instrumental investigations with a diagnosis of complex vascular malformation. It expanded in intraorbital and retrorbital space with bulb anterior dislocation and optic nerve involvement. We performed an emptying of the orbital content via transconjunctival and via coronal incision with eyelid preservation. A free vastus lateralis muscle flap was used for reconstruction, filling the orbital cavity. We anastomosed the flap on the superficial temporal artery. An ocular conformator was then positioned.Results: We report the result at 12 months, showing a good orbital rehabilitation with an adequate prosthetic cavity, a good recovery of volume and facial symmetry, guaranteeing balanced orbital and periorbital growth. There were no major or minor complications associated with the procedure.Discussion: The reconstruction of the orbit remains a “surgical challenge” both in adults, whose goal is the restoration of volume, adequate symmetry and facial esthetics, and children, in which correcting the asymmetry has the additional objective to balance orbital growth. Many reconstructive techniques have been proposed, including the use of free flaps. The versatility of the free vastus lateralis muscle flap is well-known. It offers adequate amount of tissue with minimal morbidity to the donor site, provides a long pedicle, gives the possibility of simultaneous work in a double team, and has a constant anatomy and a safe and rapid dissection. There are no descriptions of its use for pediatric orbital reconstructions.Conclusions: In our opinion, the free vastus lateralis flap should be included as one of the best option for orbital pediatric reconstruction after enucleation.

A Multi-Criteria Assessment Strategy for 3D Printed Porous Polyetheretherketone (PEEK) Patient-Specific Implants for Orbital Wall Reconstruction.

Pure orbital blowout fractures occur within the confines of the internal orbital wall. Restoration of orbital form and volume is paramount to prevent functional and esthetic impairment. The anatomical peculiarity of the orbit has encouraged surgeons to develop implants with customized features to restore its architecture. This has resulted in worldwide clinical demand for patient-specific implants (PSIs) designed to fit precisely in the patient’s unique anatomy. Material extrusion or Fused filament fabrication (FFF) three-dimensional (3D) printing technology has enabled the fabrication of implant-grade polymers such as Polyetheretherketone (PEEK), paving the way for a more sophisticated generation of biomaterials. This study evaluates the FFF 3D printed PEEK orbital mesh customized implants with a metric considering the relevant design, biomechanical, and morphological parameters. The performance of the implants is studied as a function of varying thicknesses and porous design constructs through a finite element (FE) based computational model and a decision matrix based statistical approach. The maximum stress values achieved in our results predict the high durability of the implants, and the maximum deformation values were under one-tenth of a millimeter (mm) domain in all the implant profile configurations. The circular patterned implant (0.9 mm) had the best performance score. The study demonstrates that compounding multi-design computational analysis with 3D printing can be beneficial for the optimal restoration of the orbital floor.

Effect of electroacupuncture at Baliao points on intrauterine residue and uterine volume restoration after uterine curettage of incomplete abortion

To observe the clinical therapeutic effect of the combination of electroacupuncture (EA) at Baliao points (bilateral Shangliao [BL 31], Ciliao [BL 32], Zhongliao [BL 33] and Xialiao [BL 34]) and oral administration of mifepristone tablets and its influence on uterine volume restoration after uterine curettage of incomplete abortion as compared with simple oral administration of mifeprstone tablets. A total of 58 patients after uterine curettage of incomplete abortion were randomized into an EA group and a western medication group, 29 cases in each one. In the western medication group, mifepristone tablets were administered orally, 2 tablets each time, once daily. In the EA group, on the base of the treatment as the western medication group, EA was applied to Baliao points, with disperse-dense wave, once daily, 50 min each time. The treatment for 3 days was as one course and 2 courses of treatment were required, at the interval of 1 day in the two courses. Before and after treatment, the area of intrauterine residue and blood flow signal positive rate of color Doppler flow imaging (CDFI) were recorded in patients of the two groups respectively. The days of vaginal bleeding and the rate of second operation were recorded after treatment in patients of the two groups. Using the three-dimensional ultrasound B reconstruction, the uterine endometrial volume after menstruation resumption was measured in patients of the two groups, and the clinical therapeutic effect was evaluated. After treatment, the intrauterine residue area and CDFI blood flow signal positive rate were all reduced as compared with the values before treatment in patients of the two groups (P<0.05). After treatment, the intrauterine residue area and CDFI blood flow signal positive rate in the EA group were less than those in the western medication group (P<0.05). After treatment, the days of vaginal bleeding in patients of the EA group were less than that in the western medication group and the rate of second operation was lower than the western medication group (P<0.05). The uterine endomentrial volume after menstruation resumption in the EA group was larger than that in the western medication group after treatment (P<0.05). The total effective rate was 55.2% (16/29) in the EA group, higher than 37.9% (11/29) in the western medication group (P<0.05). The combined treatment of electroacupuncture at Baliao points and oral administration of mifepristone tablets effectively promotes uterine contraction, softens and discharges intrauterine residue and contributes to uterine volume restoration in the patients after uterine curettage of incomplete abortion. The therapeutic effect of this combined therapy is better than simple oral administration of mifepristone tablets.

Hyaluronic acid injections in post-enucleation or evisceration socket syndrome: a case series

BackgroundOne of the primary goals of enucleation and evisceration surgery is the restoration of an adequate orbital volume through the use of appropriately sized alloplastic or autogenous tissues. In patients inadequately treated, post-enucleation or evisceration socket syndrome occurs. Fillers are an ideal alternative for eyelid and eyebrow arcade volume enhancement since their injection is easily performed in an outpatient setting avoiding several complications. The aim of this study is to report the use of hyaluronic acid (HA) fillers to treat volume deficits of the upper and lower eyelids, projecting the brow arcade and reducing the asymmetry.MethodsThirteen patients (2 male, 11 female, mean age 32.7 years) were treated from June 2012 to May 2020. Non-surgical treatment by HA filler injection for aesthetic rehabilitation of deep superior sulcus, inferior tear trough deformity, and scleral show was performed.ResultsNo complications as orbital-ache and/or vasovagal response were reported during the injections. Minor complications such as light swelling at the site of injection, self-resolved within 2 days, were recorded. Stable results were observed at follow-ups. In two cases, two successive treatments were required at 3 and 6 years from the first injection.ConclusionsHyaluronic acid fillers offer a versatile and safe method for replacing soft tissue lost from the upper eyelid/brow complex in cases of post-enucleation or evisceration socket syndrome.Level of evidence: Level IV, therapeutic study.

Do Racial Differences in Orbital Volume Influence the Reconstruction of Orbital Trauma

Successful orbital reconstruction relies on an accurate restoration of orbital volume (OV). The purpose of this study was to determine if the OV of African American (AA) subjects differs from that of Caucasian subjects. The authors implemented a retrospective observational study of successive subjects who received a maxillofacial computed tomography (CT) scan at a level I trauma center between 2017 and 2020. The primary predictor variable was race (AA/Caucasian). The primary outcome variable was orbital volume. Two independent examiners calculated OV with an open access OsiriX MD software version 10.0.5 (Pixmeo, Switzerland). Inter-rater reliability was calculated. Differences between races, genders, and sides were tested using independent samples t test with a significance of P < .05. Sixty subjects (120 orbits) were included in the study. The mean age was 36.7 (SD ± 13.2) years with a range of 22 to 78 years. Gender distribution was equal with 30 male (50%) and 30 female (50%) subjects. Inter-examiner reliability was 0.973. The mean OV of AA and Caucasians was 22.38 and 23.23 cm3, respectively (P=.07). The mean OV of AA and Caucasian males was 23.92, and 24.17cm3, respectively (P=.71). The mean OV in AA and Caucasian females was 20.84 and 22.28cm3, respectively (P=.013). African-American female subjects appear to have a smaller OV when compared with Caucasians which may influence orbital reconstruction. Laterality does not appear to be associated with any differences in OV.

Expert consensus on the use of human serum albumin in critically ill patients.

Expert consensus on the use of human serum albumin in critically ill patients.

Pharmacological Activation of Nrf2 Enhances Functional Liver Regeneration.

The transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) regulates an array of cytoprotective genes, yet studies in transgenic mice have led to conflicting reports on its role in liver regeneration. We aimed to test the hypothesis that pharmacological activation of Nrf2 would enhance liver regeneration. Wild-type and Nrf2 null mice were administered bardoxolone methyl (CDDO-Me), a potent activator of Nrf2 that has entered clinical development, and then subjected to two-thirds partial hepatectomy. Using translational noninvasive imaging techniques, CDDO-Me was shown to enhance the rate of restoration of liver volume (MRI) and improve liver function (multispectral optoacoustic imaging of indocyanine green clearance) in wild-type, but not Nrf2 null, mice following partial hepatectomy. Using immunofluorescence imaging and whole transcriptome analysis, these effects were found to be associated with an increase in hepatocyte hypertrophy and proliferation, the suppression of immune and inflammatory signals, and metabolic adaptation in the remnant liver tissue. Similar processes were modulated following exposure of primary human hepatocytes to CDDO-Me, highlighting the potential relevance of our findings to patients. Our results indicate that pharmacological activation of Nrf2 is a promising strategy for enhancing functional liver regeneration. Such an approach could therefore aid the recovery of patients undergoing liver surgery and support the treatment of acute and chronic liver disease.