Skin Markers Research Articles

Hyperkeratosis in Skin Dimples in Children With Down Syndrome.

Down syndrome (DS) is a common chromosomal disorder with distinct phenotypes and skin markers. This study reports39DSpatients, aged 1-44 months, who presented from birth with rough, brownish skin in the dimples of theirkneesand/or elbows.Dermoscopy revealed hyperkeratosis with brownish scales, and biopsies in six cases showedpapillomatosis andmildhyperkeratosis. In the cases followed, the condition resolved spontaneously. Hyperkeratosisintheskindimplesonthe knees and elbows seems to be a congenital and perhaps characteristic finding in patients withDS.

Clinical implementation of Cone-beam CT guided online adaptive radiotherapy in whole breast irradiation

PurposeIn postoperative breast irradiation, changes in the breast contour and arm positioning can result in patient positioning errors and offline re-planning. This can lead to increased treatment burden, and strain on departmental logistics due to the need for additional cone-beam CT images or even a new radiotherapy treatment plan (TP). Online daily adaptive radiotherapy (oART) could provide a solution to these challenges. We have clinically implemented and evaluated the feasibility of oART for whole breast irradiation. Methods and MaterialsTwenty patients treated with postoperative whole breast right irradiation (5 × 5.2 Gy) were included in BREAST-ART, a prospective single-arm trial. Dosimetry of the reference TP calculated on the daily anatomy and adaptive TP were compared. Duration of the oART workflow, in-house satisfaction questionnaires, and acute toxicity (CTCAE v5.0) was collected. The oART workflow was evaluated by investigating the impact of manual corrections of influencer and target contours on treatment time and quality. ResultsIn the first 17 patients (85 fractions), the on-couch time, i.e. time between the end of CBCT1 and CBCT3, was median 13.8 minutes (range=11–25). Retrospective evaluation of the use of the influencer (i.e. breast) in 4 patients (20 fractions) and manual correction of the most cranial and caudal target contours (i.e. 4 mm) in 10 patients (36 fractions) was done. This resulted in a reduced on-couch time in the last 3 clinical patients to a median of 13.0 minutes (range=11–19). No grade 3 or higher toxicity was observed, and 19/20 patients indicated to prefer the same treatment again. Skin marks for patient positioning during treatment were no longer necessary. ConclusionsThis study showed the feasibility, challenges, and practical solutions for the implementation of oART for breast cancer patients. Future work will focus on more complex breast indications such as whole breast including axillary nodes, to further investigate benefits and challenges of oART in breast cancer.

K. Dauge-Roth and C. Koslofsky (eds.), Stigma: Marking Skin in the Early Modern World (University Park: Pennsylvania State University Press, 2023). Pages xii + 294, and there are illustrations. $29.95 paperback.

K. Dauge-Roth and C. Koslofsky (eds.), Stigma: Marking Skin in the Early Modern World (University Park: Pennsylvania State University Press, 2023). Pages xii + 294, and there are illustrations. $29.95 paperback.

Intelligent Verification Tool for Surgical Information of Ophthalmic Patients-A Study Based on Artificial Intelligence Technology.

With the development of day surgery, the characteristics of "short, frequent and fast" ophthalmic surgery are becoming more prominent. However, nurses are not efficient in verifying patients' surgical information, and problems such as patient privacy leakage are becoming more prominent. To improve the situation, we developed a new augmented reality (AR)-based tool for visual recognition and artificial intelligent (AI) interpretation of the pattern and location of patient surgical skin markings for the verification of the correct surgical site and procedure. The tool can also display a variety of other verbally requested patient information. The purpose of this proposal is to evaluate its feasibility of use by surgical nurses in a real clinical setting. We developed a tool with image recognition technologies to interpretation patient surgical skin markings and match the information obtained with the patients surgical records, thus, verify the patient's surgical information. Verification includes the proper surgical site and type of procedure to be performed. Nurses can interact with the device through its speech recognition capabilities and the device provides them with a variety of other requested patient information via a heads-up display. Three hundred patients in an outpatient ophthalmology clinic were divided into an AR intelligent verification experimental group and a manual verification control group. The accuracy of information verification, work time consumption, and economic cost data were compared between the 2 groups to evaluate the effectiveness of the AR Surgical Information Intelligent Verification Tool in clinical patient surgical information verification. There was no statistically difference in the correct rates of patient surgical information review between the experimental group (95.33%) and the control group (98.67%) (χ2 = 2.934, P = 0.087). The median time for information verification was 10.00 (10.00, 11.00) seconds in the experimental group and 21.00 (20.00, 24.00) seconds in the control group, a statistically difference (Z = 0.000, P < 0.001). The experimental group saved 11 seconds per patient per review compared with the control group. Considering 10,531 surgeries in 2023, printing 1 page of surgical information per 9 patients and requiring 4 copies, 4680 pages of printing paper could be saved. The AR Surgical Information Intelligent Verification Tool has advantages in assisting medical staff in patient surgical information verification, improving nursing efficiency, preventing surgical mark errors or nonstandardization, protecting patient privacy, and saving costs. It has certain research and application value in the scenario of patient surgical information verification in ophthalmic day ward.

Managing Complicated Nontuberculous Mycobacteria Infections in Plastic Surgery.

Nontuberculous mycobacteria (NTM) infections after cosmetic surgery have become an increasing concern. These infections are often initially misdiagnosed and treated with standard antibiotic regimens, which fail to resolve the underlying infection, leading to prolonged patient suffering. In this case study, we describe a chronic wound infection caused by Mycobacterium abscessus subsp. bolletii after a muscle-repair abdominoplasty. This case illustrates the diagnostic and therapeutic challenges plastic surgeons face in successfully treating such infections. Initial obstacles included the isolation of co-contaminating bacteria that masked the NTM infection, the use of antibiotics ineffective against the specific NTM species, and the failure to identify the infection source. In this instance, contaminated skin marker ink used to mark the rectus muscle, combined with a nonabsorbable (permanent) suture for muscle repair, led to the development of a biofilm that acted as a persistent reservoir for the infection, resistant to antibiotic treatments. Complete resolution was achieved only after evaluation by a plastic surgeon experienced in treating NTM infections and the subsequent removal of the permanent suture. The delayed suture removal contributed to a 15-month recovery period. This case underscores the importance of early recognition of NTM infections after cosmetic procedures. By sharing this case, we aim to raise awareness of NTM infections and help prevent future cases of misdiagnosis and prolonged antibiotic treatments. Key points regarding the diagnosis, sources of infection, and treatment options for NTM infections are highlighted in this article using "text boxes" to emphasize the most important information and provide concise summaries of critical insights.

Walking in a controlled ankle motion (CAM) boot: In-boot measurement of joint kinematics and kinetics

Research investigating ankle function during walking in a controlled ankle motion (CAM) boot has either placed markers on the outside of the boot or made major alterations to the structure of the CAM boot to uncover key landmarks. The aim of this study was to quantify joint kinematics and kinetics using “in-boot” skin markers whilst making only minimal structural alterations. Seventeen healthy participants walked at their preferred walking speed in two conditions: (1) in standard athletic trainers (ASICS patriot 8, ASICS Oceania Pty Ltd, USA), and (2) using a hard-cased CAM boot (Rebound® Air Walker, Össur, Iceland) fitted on the right foot. Kinematic measurements revealed that CAM boots restrict sagittal plane ankle range of motion to less than 5°, and to ∼3° in the frontal plane, which is a reduction of 85% and 73% compared to standard footwear, respectively (p < 0.001). This ankle restriction resulted in a reduction of ankle joint total limb work contribution from 38 ± 5% in normal footwear to 13 ± 4% in the CAM boot (p < 0.001). This study suggests that CAM boots do restrict the ankle joint’s ability to effectively perform work during walking, which leads to compensatory mechanisms at the ipsilateral and contralateral hip and knee joints. Our findings align with previous research that employed “on-boot” kinematic measurements, so we conclude that in-boot approaches do not offer any benefit to the researcher and instead, on-boot measurements are suitable.

ThP1.11 - Harnessing digital consent analytics to highlight multicentre operative and consent trends in breast surgery

Abstract Introduction Paper-based consent is difficult to audit at scale, therefore hospital episode statistics data is used to provide insights into national breast surgical practice. However, as digital consent is becoming routine, analysis of amalgamated data is possible to provide a better understanding of consent practice. Methods Between 22/04/2020-29/11/23, patient anonymised digital consent data was analysed retrospectively using Concentric Health analytics (Audit ID:1123ABS). Inclusion criteria required the responsible clinician to be a breast surgeon, with non-breast surgical procedures excluded. Results n=6860 digital consent episodes were performed across 10 NHS Trusts and 4 private institutions (n=890 unique operations. n=82 unique responsible clinicians, n=191 consenting clinicians). 45.6% (n=3125/6860) of the cases were consented by consultants. 18.7% (n=1286/6860) underwent a mastectomy; 78.5% simple &amp; 21.5% reconstruction (of which 82.6% implant and 17.4% autologous reconstruction). 40.1% (n=2750/6860) underwent breast conserving surgery (79.2% WLE, 18.9% therapeutic mammoplasty, 1.9% Intercostal perforator). Re-excision of margins accounted for 16% of BCS cases (n=441/2750). SLNB was performed in 40.6% and ANC in 11.5% of all breast surgery cases. Regarding localisation; 44.5% Seed, 30.6% Wire, 21.7% palpable/other, 3.2% USS skin mark. Conclusion As well as providing benefits in terms of information sharing and improved patient satisfaction, digital consent also provides an opportunity to provide high-level data, regarding which operations are being consented to, when and by whom.

Propolis suppresses atopic dermatitis through targeting the MKK4 pathway.

Propolis is a natural resinous substance made by bees through mixing various plant sources. Propolis has been widely recognized as a functional food due to its diverse range of beneficial bioactivities. However, the therapeutic effects of consuming propolis against atopic dermatitis (AD) remain largely unknown. The current study aimed to investigate the potential efficacy of propolis against AD and explore the active compound as well as the direct molecular target. In HaCaT keratinocytes, propolis inhibited TNF-α-induced interleukin (IL)-6 and IL-8 secretion. It also led to a reduction in chemokines such as monocyte chemoattractant protein-1 (MCP-1) and macrophage-derived chemokine (MDC), while restoring the levels of barrier proteins, filaggrin and involucrin. Propolis exhibited similar effects in AD-like human skin, leading to the suppression of AD markers and the restoration of barrier proteins. In DNCB-induced mice, oral administration of propolis attenuated AD symptoms, improved barrier function, and reduced scratching frequency and transepidermal water loss (TEWL). In addition, propolis reversed the mRNA levels of AD-related markers in mouse dorsal skin. These effects were attributed to caffeic acid phenethyl ester (CAPE), the active compound identified by comparing major components of propolis. Mechanistic studies revealed that CAPE as well as propolis could directly and selectively target MKK4. Collectively, these findings demonstrate that propolis may be used as a functional food agent for the treatment of AD.

Topical ABT-263 treatment reduces aged skin senescence and improves subsequent wound healing.

Senescent cells (SnC) accumulate in aging tissues, impairing their ability to undergo repair and regeneration following injury. Previous research has demonstrated that targeting tissue senescence with senolytics can enhance tissue regeneration and repair by selectively eliminating SnCs in specific aged tissues. In this study, we focused on eliminating SnC skin cells in aged mice to assess the effects on subsequent wound healing. We applied ABT-263 directly to the skin of 24-month-old mice over a 5-day period. Following topical ABT-263, aged skin demonstrated decreased gene expression of senescent markers p16 and p21, accompanied by reductions in SA-β-gal and p21-positive cells compared to DMSO controls. However, ABT-263 also triggered a temporary inflammatory response and macrophage infiltration in the skin. Bulk RNA sequencing of ABT-263-treated skin revealed prompt upregulation of genes associated with wound healing pathways, including hemostasis, inflammation, cell proliferation, angiogenesis, collagen synthesis, and extracellular matrix organization. Aged mice skin pre-treated with topical ABT-263 exhibited accelerated wound closure. In conclusion, topical ABT-263 effectively reduced several senescence markers in aged skin, thereby priming the skin for improved subsequent wound healing. This enhancement may be attributed to ABT-263-induced senolysis which in turn stimulates the expression of genes involved in extracellular matrix remodeling and wound repair pathways.

Estimating three-dimensional foot bone kinematics from skin markers using a deep learning neural network model

The human foot is a complex structure comprising 26 bones, whose coordinated movements facilitate proper deformation of the foot, ensuring stable and efficient locomotion. Despite their critical role, the kinematics of foot bones during movement remain largely unexplored, primarily due to the absence of non-invasive methods for measuring foot bone kinematics. This study addresses this gap by proposing a neural network model for estimating foot bone movements using surface markers. To establish a mapping between the positions and orientations of the foot bones and 41 skin markers attached on the human foot, computed tomography scans of the foot with the markers were obtained with eleven healthy adults and thirteen cadaver specimens in different foot postures. The neural network architecture comprises four layers, with input and output layers containing the 41 marker positions and the positions and orientations of the nine foot bones, respectively. The mean errors between estimated and true foot bone position and orientation were 0.5 mm and 0.6 degrees, respectively, indicating that the neural network can provide 3D kinematics of the foot bones with sufficient accuracy in a non-invasive manner, thereby contributing to a better understanding of foot function and the pathogenetic mechanisms underlying foot disorders.

Adverse Effects of Gefitinib on Skin and Colon in a Lung Cancer Mouse Model.

Gefitinib, an Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor (EGFR-TKI), frequently causes side effects when used to treat non-small cell lung cancer. The purpose of this experiment was to investigate the side effect of gefitinib on the skin and colon of mice. Male Balb/c nu-nu nude mice aged 4-5 weeks were used as xenograft tumor models, and gefitinib at 150 mg/kg and 225 mg/kg was started at 9 days after the xenograft tumor grew out. The mice's weights and tumor volumes were tracked concurrently, and the mouse skin adverse reactions and diarrhea were observed during the treatment. The animal tissues were subjected to biochemical and pathological evaluations after 14 days. Gefitinib effectively decreased the size and weight of transplanted tumors in nude mice, while also lowering body weight and raising indexes of the liver and spleen. Gefitinib could cause skin adverse reactions and diarrhea in mice. Further pathological investigation revealed tight junction- related markers in the mice's skin and colon to be reduced and macrophages and neutrophils to be increased after gefitinib treatment. The findings imply that gefitinib has negative effects on the skin and colon. Gefitinib- induced skin and colon adverse reactions in mice have been successfully modeled in this study.

Permanent Indian ink tattoos for breast cancer radiotherapy: A United Kingdom study of the emotional impact on patients following radiotherapy

IntroductionPost-operative radiotherapy for early breast cancer is recommended for over 30,000 people every year in the United Kingdom. The majority of these patients will be advised to have radiotherapy alignment tattoos; permanent skin marks applied with Indian ink and a lancing needle, black/green/blue in colour and approximately 2 mm in diameter. The tattoos assist the therapeutic radiographers to position the patient accurately and reproducibly for each treatment fraction. The aim of this study was to investigate the emotional impact of radiotherapy tattoos on people following breast cancer radiotherapy. MethodsAn electronic questionnaire was distributed by the charitable organisation, Breast Cancer Now, to their members who had undergone radiotherapy for early breast cancer. Based on the responses to the open and closed questions, an overall impact score was assigned to each respondent, and representative quotes extracted to contextualise the themes identified. Statistical tests were performed to evaluate the relationship between overall impact scores and several variables such as age at the time of radiotherapy, skin type, and age at the time of completing the questionnaire. Results204 people responded to the questionnaire. 100% had permanent Indian ink tattoos during breast cancer radiotherapy. 95% could still see the midline tattoo. 22 subthemes were identified; 4 positive, 4 neutral and 14 negative. Radiotherapy tattoos served as a constant negative reminder for 27% and affected clothing choices in 14% of respondents. 11% described feelings of ‘hating’ them. 6% were assigned positive overall impact scores, 43% neutral, and 51% had negative overall impact scores. The black/green/blue ink pigment used was commonly described as unnatural; contributing strongly to the negative appearance of the tattoos. ConclusionPermanent Indian ink tattoos have a negative impact on emotional well-being in the months and years following radiotherapy for early breast cancer for many people. In contrast, a very small minority feel positively about the tattoos. Implications for practiceOur findings are unlikely to be unique to this diagnostic cohort and supports the need to offer alternatives that are less-impactful to the recipient, accessible for people of all skin colours, and fit-for-purpose in terms of radiotherapy set-up. Acknowledgement of the significant negative impact and collaboration between industry, healthcare professionals and patient representatives is key to identifying and implementing suitable alternatives as standard of care.

The application of methylene blue location technique in deep-seated benign breast tumor resection under endoscopy: a retrospective, single-institution analysis.

Endoscopic curative excision of benign breast diseases (BBDs) can preserve the cosmetic appearance of the breast. However, endoscopic surgery is not feasible, and some challenges still need to be addressed. Traditional line marker localization methods cannot visualize tumors, and the exploration of deep tumors may lead to certain risks of accidental injury. This study aimed to investigate the value of the methylene blue location (MBL) technique in endoscopic resection of deep-seated benign breast tumors. A total of 217 patients with benign deep breast tumors admitted to the Sixth Affiliated Hospital of Sun Yat-sen University between November 2017 and June 2023 met the inclusion criteria. Among them, 107 patients underwent endoscopic resection with a MBL, in which methylene blue was injected to guide the tumor resection endoscopically, whereas 110 patients underwent endoscopic resection with a skin mark location (SML), in which the tumor was located by a marking line on the skin. We compared patient characteristics, surgery-related data, complications, and cosmetic outcomes between the two groups. Endoscopic breast tumor resection was successfully performed in 217 patients, none of whom had undergone open surgery. The mean operation time was significantly different between the MBL and SML groups (45.70±12.508 and 49.59±10.997 min, respectively; P=0.008<0.05), and blood loss in the MBL group was significantly reduced compared with that in the SML group (11.07±5.665 and 13.83±7.918 mL, respectively; P=0.004<0.05). There were no significant differences in drainage volume, length of hospital stay, or postoperative complications between the MBL and SML groups (P>0.05). The postoperative cosmetic outcomes of the patients were noteworthy, with no statistically significant differences between the two groups. The methylene blue positioning technique is safe and effective for the endoscopic treatment of deep breast tumors. It shortens operation time, reduces surgical complications, and is worthy of clinical promotion.

HoloDIEP-Faster and More Accurate Intraoperative DIEA Perforator Mapping Using a Novel Mixed Reality Tool.

Microsurgical breast reconstruction using abdominal tissue is a complex procedure, in part, due to variable vascular/perforator anatomy. Preoperative computed tomography angiography (CTA) has mitigated this challenge to some degree; yet it continues to pose certain challenges. The ability to map perforators with Mixed Reality has been demonstrated in case studies, but its accuracy has not been studied intraoperatively. Here, we compare the accuracy of "HoloDIEP" in identifying perforator location (vs. Doppler ultrasound) by using holographic 3D models derived from preoperative CTA. Using a custom application on HoloLens, the deep inferior epigastric artery vascular tree was traced in 15 patients who underwent microsurgical breast reconstruction. Perforator markings were compared against the 3D model in a coordinate system centered on the umbilicus. Holographic- and Doppler-identified markings were compared using a perspective-corrected photo technique against the 3D model along with measurement of duration of perforator mapping for each technique. Vascular points in HoloDIEP skin markings were -0.97 ± 6.2 mm (perforators: -0.62 ± 6.13 mm) away from 3D-model ground-truth in radial length from the umbilicus at a true distance of 10.81 ± 6.14 mm (perforators: 11.40 ± 6.15 mm). Absolute difference in radial distance was twice as high for Doppler markings compared with Holo-markings (9.71 ± 6.16 and 4.02 ± 3.20 mm, respectively). Only in half of all cases (7/14), more than 50% of the Doppler-identified points were reasonably close (<30 mm) to 3D-model ground-truth. HoloDIEP was twice as fast as Doppler ultrasound (76.9s vs. 150.4 s per abdomen). HoloDIEP allows for faster and more accurate intraoperative perforator mapping than Doppler ultrasound.

Trunk kinematics and limb movement of horses walking backwards and forwards in hand and lifting a single limb

Equine physiotherapy commonly includes basic exercises such as walking backward (BW) and voluntary lifting of single limbs (SLL), but trunk movements during these have not been studied. In order to compare the trunk kinematics during BW and SLL with forward walking (FW), nine horses were measured in FW, BW and during SLL triggered by tactile cue. Kinematics were obtained from skin markers captured by ten high-speed video cameras. Trunk angles were calculated in sagittal and horizontal planes from withers, dorsal to spinous processes of the 16th thoracic vertebra (T16), 2nd and 4th sacral vertebrae (S2, S4), WT16S2 and T16S2S4 respectively. From the hooves, maximum hoof height during swing phase and horizontal distance between hoof and median body plane during swing and stance phases were determined.Dorsoventral range of motion (ROM) and maximum flexion of WT16S2 was significantly larger in BW than in FW, while laterolateral ROM was significantly smaller during hindlimb swing phase in BW and SLL than in FW. In contrast, dorsoventral ROM of T16S2S4 was significantly smaller during stance and swing phases of hindlimbs in BW compared to FW, and throughout the movement. During forelimb swing phase, T16S2S4 ROM was significantly larger in BW than SLL. Hindhoof height in SLL was significantly higher than in FW. Distance between median body plane and hooves was significantly larger in BW than in FW, and significantly larger in BW than in SLL for hindlimb swing phase. In BW, increased lumbosacral stabilisation and the larger area of support created by fore- and hindlimbs may represent a strategy to enhance body stabilisation, as BW entails some insecurity.

A Novel Transforaminal Approach for Upmigrated Lumbar Disc Herniations in the Hidden Zone of MacNab: A Surgical Technical Note

Objective: Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive surgical procedure used to treat herniated disc fragments in the hidden zone of MacNab. This study aimed to investigate the efficacy, advantages, and safety of TPED for superiorly migrated lumbar disc herniation in the hidden zone of MacNab, focusing on patients with isolated causative factors such as prolapsed discs.Methods: A cohort of patients with clinical conditions involving isolated causative factors of herniated discs in the hidden zone of MacNab were selected for TPED. Patients with conditions contributing to clinical symptoms were excluded. Twelve patients with hidden-zone disc herniations underwent TPED. Under fluoroscopic guidance, precise skin markings were performed, followed by chromodiscography and epidurography. A nonstandard floating approach was utilized for TPED. The assessment of patients included visual analogue scale and Oswestry Disability Index scores. The outcomes were evaluated based on the modified MacNab criteria after 12 months.Results: Successful removal of the herniated fragments was achieved in all 12 cases of hidden-zone disc herniations that underwent TPED. According to the modified MacNab criteria, 11 out of 12 patients achieved excellent outcomes, while one patient attained a good outcome.Conclusions: The transforaminal approach in TPED was confirmed to be a highly effective and minimally invasive technique for managing hidden-zone disc herniations. The procedure yielded satisfactory to excellent results, accompanied by a significantly shorter rehabilitation period and minimal blood loss. Importantly, the pars interarticularis and lamina remain fully intact with the transforaminal approach.

Ashy Dermatosis: Suatu Laporan Kasus Jarang

Background: Ashy dermatosis is a rare, acquired, benign, and idiopathic hypermelanotic disease. It is manifested asashy-colored lesion with no signs of inflammation. Commonly affected sites of the body include the trunk, neck, face, also proximal and distal extremities. Case: A 33-year-old woman came to Dr. Moewardi Hospital, Surakarta, with chief complaints asymptomatic, ashy colored macule that appear on her right arm. Physical examination in general region shows ashy-colored macule and multiple discrete patches of hyperpigmentation with irregular border. Dermoscopy examinationmacules showed bluish-gray skin markings over bluish background. Histopathological examination showed thin epidermis layer, hyperkeratosis, incontinentia pigmenti, dropping melanin resembles the basal layer civatte bodies. At dermis focal fibrosis was found with infiltrates, incontinentia pigmenti, and dropping melanin. Discussion: Ashy dermatosis or known as erythema dyschromicum perstans is a rare hyperpigmentation disorder that started with reddish, active-bordered lesions, then disappear, leaving a round or oval shape, polycyclic, and ashy macule on the proximal region of the trunk andneck. Onset of symptoms usually at young adult, between first and second decade of life. Etiology of ashy dermatosis is still unclear, and many factors were thought to be involved. Dermoscopy examination showed bluish-gray macules overbluish background. Histopathological examination showed lichenoid reactions and an increase melanin on the dermis. This report aims to describe the diagnosis a rare condition based on anamnesis, physical examination, dermoscopy, and histopathological examination. Clinical findings in this patient were in accordance with the result of previous studies.

An Indian Expert Group Review of Acanthosis Nigricans with Recommendations for Early Detection and Timely Management.

Acanthosis nigricans (AN) is a visible cutaneous manifestation of several underlying systemic conditions, such as prediabetes, diabetes mellitus (DM), polycystic ovarian syndrome (PCOS), metabolic syndrome (MS), and malignancy. AN is commonly seen in obese individuals and is a proven skin marker of insulin resistance (IR). Its typical clinical presentation and location, especially on the nape of the neck, allows for easy visual identification. Obesity, IR, and other noncommunicable diseases (NCD) are on the rise in India, with many cases being undiagnosed or missed. Every sixth diabetic in the world is Indian. AN can thus play a vital role in screening, early identification, and reduction of morbidity, especially of IR-related disorders. Currently, there are no national or international multidisciplinary guidelines or recommendations for AN. To review published current literature and evidence on AN, its associations, and management. To recommend an approach to clinical identification of AN, associated/underlying disorders, investigations, and management, including lifestyle modifications. To sensitize and familiarize clinicians and healthcare workers across India with AN presentations. This will enable early detection of conditions such as IR, prediabetes, DM, PCOS, malignancy, etc., in practice and in the community. The PCOS Society of India constituted a multispecialty Expert Working Group with representation from various national societies to review all published scientific evidence. Expert group meetings were conducted to provide recommendations. Acanthosis nigricans is a simple, non-invasive, cost-effective screening tool for early identification of IR. It is important to integrate and disseminate information and training on AN across medical specialties. The government of India has launched several National Health Programmes to help address the rising burden of NCD in the population. AN would provide a simple screening tool to pick up undiagnosed or missed cases.

A Novel Surgical Approach For Upper Eyelid Blepharoplasty

Purpose: To report the surgical results of the patients with dermatochalasis (DC) who underwent upper eyelid blepharoplasty (UEB) with the cautery method was aimed. Materials and Methods: UEB surgery was performed by cautery method in 36 eyes of 18 patients due to DC. Pencil-tipped cautery was used to cut to sagging and marked skin area and was removed. Patients were examined preoperatively and postoperatively on the 1st day, 3rd day, 2nd week, 3rd month and 6th month. Results: The mean age was 54.6±7.9 years (range, 46 to 67 years) and 10 of were female and 8 were male. Mean operation time (1 session for 2 upper eyelid (UE)) was 36.7 ± 5.8 minutes (range, 28 to 46 minutes). Mean wound healing time was 7.7 ± 1.6 days (range, 5 to 12 days). Skin ecchymosis persisted for approximately 24.8±3.7 days (range, 19 to 38 days). Suture marks did not appear in 34 patients (%94), they were present in 2 patients 6 months after surgery. Statistically significant change was detected in the 6-month period in terms of skin ecchymosis and suture scar disappearance (p

An exploratory clinical trial of preoperative non-invasive localization before breast-conserving surgery using augmented reality technology

PurposeThis single-center, randomized, prospective, exploratory clinical trial was conducted to assess the clinical efficacy of an augmented reality (AR)—based breast cancer localization imaging solution for patients with breast cancer.MethodsThis clinical trial enrolled 20 women who were diagnosed with invasive breast cancer between the ages of 19 and 80, had a single lesion with a diameter ≥ 5 mm but ≤ 30 mm, had no metastases to other organs, and had not received prior chemotherapy. All patients underwent mammography, ultrasound, computed tomography, and magnetic resonance imaging for preoperative assessment. Patients were randomly assigned to ultrasound-guided skin marking localization (USL) and AR-based localization (ARL) groups (n = 10 in each group). Statistical comparisons between USL and ARL groups were made based on demographics, radiologic features, pathological outcomes, and surgical outcomes using chi-square and Student t-tests.ResultsTwo surgeons performed breast-conserving surgery on 20 patients. Histopathologic evaluation of all patients confirmed negative margins. Two independent pathologists evaluated the marginal distances, and there were no intergroup differences in the readers' estimates (R1, 6.20 ± 4.37 vs. 5.04 ± 3.47, P = 0.519; R2, 5.10 ± 4.31 vs. 4.10 ± 2.38, P = 0.970) or the readers' average values (5.65 ± 4.19 vs. 4.57 ± 2.84, P = 0.509). In comparing the tumor plane area ratio, there was no statistically significant difference between the two groups in terms of either reader's mean values (R1, 15.90 ± 9.52 vs. 19.38 ± 14.05, P = 0.525; R2, 15.32 ± 9.48 vs. 20.83 ± 12.85, P = 0.290) or the overall mean values of two readers combined (15.56 ± 9.11 vs. 20.09 ± 13.38, P = 0.388). Convenience, safety, satisfaction, and reusability were all superior in the AR localization group (P < 0.001) based on the two surgeons' responses.ConclusionAR localization is an acceptable alternative to ultrasound-guided skin marking with no significant differences in surgical outcomes.