Tissue Thickness Research Articles

Evaluation of risk factors associated with epicardial fat tissue thickness in patients with stage 4 and stage 5 chronic kidney disease.

Chronic kidney disease (CKD) is a global public health issue, often associated with high mortality and morbidity, especially due to cardiovascular diseases. Epicardial adipose tissue (EAT), the visceral fat surrounding the heart, has been recognized as a significant factor in cardiovascular risk. This study aims to assess the relationship between EAT and body composition in patients with stage 4 and 5 CKD using bioelectrical impedance analysis (BIA). The study included 80 patients with stage 4 and 5 CKD who were not on dialysis. Body composition was measured using BIA, and EAT was assessed using transthoracic echocardiography(ECHO). Exclusion criteria included heart failure, morbid obesity, pregnancy, and pacemaker use, among others. Various demographic, clinical, and biochemical parameters were also recorded. Patients with stage 5 CKD (6.7 ± 0.12) had significantly higher EAT compared to stage 4 CKD (5.9 ± 0.09) patients. EAT showed a positive correlation with age, BMI, blood pressure, C-reactive protein (CRP), and triglyceride levels, and a negative correlation with albumin and HDL levels. Multivariate analysis revealed that increased systolic blood pressure(SBP)(p:0.019),fat tissue mass (FTM)(p < 0.001), low HDL(p: 0.027), and low albumin(p < 0.001) were independent predictors of EAT. EAT is higher in advanced CKD patients and is associated with several cardiovascular risk factors. Measuring EAT in CKD patients using non-invasive methods like ECHO could be valuable in predicting cardiovascular risks. Addressing the factors that contribute to increased EAT may improve clinical outcomes for CKD patients.

Disodium hydrogen phosphate facilitates the gold enhancement reaction of nanogold in the pre-embedding immunoelectron microscopy.

Immunoelectron microscopy is a technique for analyzing molecular localization at the ultrastructural level. In the pre-embedding immunoelectron microscopy, samples are immunolabeled with extremely small gold particles. Gold enhancement then enlarges the gold particles to an easily visible size. During the examination of the optimal conditions, we found that phosphate buffer accelerates the enhancement reaction. Furthermore, disodium hydrogen phosphate was identified as responsible for this effect. Disodium hydrogen phosphate enabled the gold labeling of deep regions within thick tissue samples. In conclusion, our method is useful for increasing the sensitivity, especially in the deeper region of the sample.

Epicardial adipose tissue thickness - a new predictive factor for coronary artery disease

Abstract Introduction The role of pericardial adipose tissue has been investigated in numerous studies in relation to the development of coronary artery disease (CAD) and other cardiac pathologies. Total pericardial fat (TPF) consists of epicardial adipose tissue (EAT), which is located between the myocardium and the visceral pericardium, and pericardial fat (PCF), which adheres to the parietal pericardium. The suspected mechanisms are complex and include the acceleration of inflammation and oxidative stress as well as proximity to the coronary arteries. Purpose The aim of the study was to investigate the existence of a correlation between the thickness of epicardial and pericardial adipose tissue and the presence of CAD, with the hope of using this marker in the future for risk stratification of cardiovascular disease. Methods This study enrolled 264 patients with a mean age of 59,9 +/- 10.6 years, 60,6% (160 pts) male, with cardiovascular risk factors who were investigated for suspected CAD. In all patients, the thickness of the TPF, EAT, and the PCF were measured echocardiographically during end-diastole, at the anterior atrioventricular groove. Intra- and interobserver variability was excellent (ICC 0.995-0.998 and ICC 0.992-0.995 for all three layers). Results Out of the total patients included, 54,2% (142 pts) had lesions on conventional angiography, of which 46% had hemodynamically significant lesions requiring revascularization. There were no statistically significant differences in the thickness of the three layers according to the presence of cardiovascular risk factors (diabetes mellitus, smoking, hypertension) and there was no correlation with body mass index. There were statistically significant differences in the dimensions of the pericardial adipose tissue layers between the group of patients with CAD and the group of patients without CAD (EAT 7,1 +/-2,34 vs 5,07+/-2,36 mm, PCF 9.3+/-3,01 vs 7,2+/-2,9 mm and TPF 16,7+/-3,8 vs 12.59+/-4,3 mm, p=0.001 for all cases). There were no statistically significant differences between patients who had one, two, or all three coronary arteries affected (p=0.5). There is a significant correlation between EAT and TPF (r 0.81), PCF and TPF (r 0.83), but no significant correlation between the two substrates (r 0.44). Women without CAD had a lower epicardial layer thickness than men without CAD (4,8+/-0,26 vs 5,4+/-0,29,p &amp;lt;0,001), but this difference did not exist in those with CAD (6.9+/-0.47 vs 7.2+/-0.24). Conclusions The study shows that echocardiographic measurement of the thickness of pericardial adipose tissue layers is a feasible method, easy to perform with good intra- and interobserver reproducibility. The data presented suggest that the thickness of the pericardial adipose tissue layers (EAT and TPF) may represent an independent risk factor for CAD and could be included in the pre-test risk assessment of patients with suspected CAD.

Predictors of the Efficacy of Lymphedema Decongestive Therapy

Lymphedema is a chronic condition characterized by the accumulation of lymphatic fluid in the tissues, causing swelling primarily in the limbs, though other body parts can also be affected. It commonly develops after lymph node removal, or radiation therapy, or due to congenital lymphatic system defects. Effective management is essential due to its significant impact on physical function and quality of life. Complete Decongestive Therapy (CDT) is the primary treatment for lymphedema. This comprehensive approach combines manual lymphatic drainage (MLD), compression bandaging, skincare, and exercise. An early diagnosis and initiation of CDT are critical to preventing irreversible damage to the lymphatic system and worsening symptoms. Successful outcomes depend on timely treatment, patient adherence, and the consistent use of all CDT components, with compression therapy and exercise playing particularly vital roles. Recent research highlights how skin and fat tissue characteristics, such as increased skin thickness and adipose tissue accumulation, complicate lymphedema management, especially in advanced stages. In these cases, where fibrosis and fat deposition are more prominent, traditional CDT may need to be supplemented with advanced treatments like liposuction or enhanced compression techniques. This study explores the factors influencing the success of decongestive therapy, including the stage of lymphedema at the diagnosis, treatment protocols, and individual patient characteristics like skin and fat tissue properties.

P-40 A RARE PRESENTATION OF PROLONGED HYPOGLYCEMIA: CONGENITAL LEPTIN DEFICIENCY AND INSULIN INTOXICATION

Abstract Introduction Congenital leptin deficiency (CLD) is caused by mutations in the LEP gene with an incidence of 1 in 4.4 million, presenting with symptoms such as hyperphagia, obesity. Insulin intoxication is also a rare condition that usually occurs as a result of a suicide attempt or, a medication error. There is not an algorithm for the management of insulin intoxication. Here, we report the only case in the literature presenting with congenital leptin deficiency and insulin intoxication. Clinical Case A 33-year-old woman was admitted to the hospital with dizziness, nausea, and unconsciousness. She had applied nearly 300 IU insulin aspart of committing suicide. She had congenital leptin deficiency, hypothyroidism, and prediabetes. She had leptin replacement during 2020-2021 and didn’t have a replacement since then. Her body mass index was 62.2. Her blood pressure was 95/60 mm/Hg, Sp02 was 88 %, and heart rate was 120 per minute. Her blood glucose was 29 mg/dl, and there was respiratory acidosis. Liver and renal function tests, electrolytes, coagulation parameters, and thyroid hormones were normal. Chest x-ray and brain tomography were normal. Despite subsequent infusion of 20% dextrose solution via central catheter, serum glucose could only be kept at 70-80 mg/dl. In the following hours patient’s consciousness, pH level, and oxygen saturation returned to normal. We had to follow the patient with a high concentration of glucose (150-200cc/h %10 dextrose) for ten days because of reappearing hypoglycemia. On the 10th day of follow-up, we stopped IV glucose for a short time and measured the fasting hormones shown in Table 1. at 7.00 a.m. As there was hypocortisolemia, we applied 5mg prednisolone twice daily in the following days. Twenty-four hours after cortisol administration, we could easily stop the IV glucose. We followed the patient with 5mg prednisolone twice daily and oral carbohydrate intake for three days and didn’t observe hypoglycemia. Afterwards, we stopped prednisolone and the patient was normoglycemic for the following days. We again measured the fasting hormones shown in Table 2. At 7.00 a.m. three days after the last dose of prednisolone. The patient was not hypoglycemic or hypocortisolemic since then; vital parameters were all normal and we discharged the patient. Conclusion Prolonged hypoglycemia may have occurred in different mechanisms. Our patient had a thick subcutaneous fat tissue because of CLD; therefore, absorption of insulin may have increased and half life may be prolonged. Also, high dose exogenous insulin may have triggered the production of insulin antibodies causing prolonged duration of insulin action and hypoglycemia. Moreover, deep hypoglycemia may have affected the pituitary-adrenal cortisol axis causing relative adrenal insufficiency. The steroid decreased the insulin antibodies and also corrected the relative cortisol deficiency. More cases and data are needed to shed light on this subject.Table 1: Table 2:

A Cone-beam Computed Tomography Study Evaluating Soft Tissue Thickness for Midline and Bilateral Landmarks in Adult Patients with Different Vertical Skeletal Patterns

A Cone-beam Computed Tomography Study Evaluating Soft Tissue Thickness for Midline and Bilateral Landmarks in Adult Patients with Different Vertical Skeletal Patterns

Analysis of influencing factors on the height of gingival papilla around implants

The anatomical structure of the gingival papilla around the implant is special, and it is difficult to recover after injury. The reduction of its height will have a negative impact on function and esthetics, and it is one of the many problems in implant treatment at present. This paper analyzes the influencing factors of implant gingival papilla height from three aspects: anatomical factors, implant surgical design and implant restorative design, including the classical influencing factors such as the shape of natural teeth, interproximal distance between the implant and the adjacent tooth, soft tissue grafting, and contour of implant restorations, as well as the hot and controversial influencing factors in recent years such as the thickness of soft tissues around the implant, the implant surgical timing, the flap design, and the surgical incision, in order to provide reference for clinicians in the process of implant treatment for gingival papilla preservation and reconstruction.

Risk factors and prognosis analysis of dysphagia after occipitocervical fusion surgery: a retrospective study of 43 cases

ObjectivesTo analyze the risk factors for developing dysphagia after occipitocervical fusion (OCF) and investigate possible mechanisms and prognosis.MethodsThe case data of 43 patients who underwent OCF were retrospectively reviewed. Patients were divided into group A (dysphagia group) and group B (non-dysphagia group) based on Bazaz scoring criteria. Baseline data and imaging parameters were collected: O-C2 angle, C2-7 angle, pharyngeal inlet angle (PIA), posterior occipital cervical angle (POCA), O-EA angle, Oc-Ax angle, Atlas-dens interval, C2-7 sagittal vertical axis (SVA), T1 slope, narrowest oropharyngeal airway space (nPAS), and thickness of the prevertebral soft tissue. Potential risk factors were identified via one-way intergroup comparisons and included in multivariable logistic regression analysis. Pearson or Spearman correlation analysis was performed to assess associations between dnPAS% and each parameter and inter-parameter correlations. Predictors were selected to plot receiver operating characteristic (ROC) curves for diagnostic evaluation. Prognosis was analyzed using the Kaplan-Meier method and curvilinear regression.ResultsDysphagia occurred in 17 of 43 patients (39.53%). By the final follow-up (≥ 12 months), 11 patients (25.58%) had residual symptoms. Baseline factors, including dyspnea (P = 0.028), operative segment (P = 0.021), operative time (P = 0.006), anesthesia time (P = 0.025), solitude (P = 0.019), and satisfaction (P < 0.001), differed significantly between groups. Imaging parameters dO-C2a (P < 0.001), dPOCA (P < 0.001), PoPIA (P = 0.036), dPIA (P < 0.001), dOc-Axa (P = 0.001), dC2-7 SVA (P = 0.040), PonPAS (P = 0.004), dnPAS (P = 0.005), and dnPAS% (P < 0.001) were also significantly different. Multivariable regression analysis identified dPIA (OR = 0.870, P = 0.008) as an independent protective factor. ROC analysis showed dPIA had good diagnostic value (AUC = 0.855) with a cutoff of -8°. Prognostic analysis indicated rapid recovery was possible by 3 months postoperatively, with full recovery achieved in ~ 30% of patients by 1 year, after which recovery plateaued.ConclusionPostoperative dysphagia after OCF appears to result from multiple factors involving both “static + dynamic” elements. dPIA is a reliable predictor, with patients having a dPIA >-8° being less likely to develop dysphagia. However, only ~ 30% of patients achieve full recovery.

Nephronectin Is Required for Vascularization in Zebrafish and Sufficient to Promote Mammalian Vessel-Like Structures in Hydrogels for Tissue Engineering.

Organs and tissues need to be vascularized during development. Similarly, vascularization is required to engineer thick tissues. How vessels are formed during organogenesis is not fully understood, and vascularization of engineered tissues remains a significant challenge. Here, we show that the extracellular matrix protein nephronectin is required for vascularization during zebrafish development as well as adult fin regeneration and is sufficient to promote mammalian vessel formation and maturation. Nephronectin a morphants and mutants exhibit diminished axial vein sprouting and posterior intersegmental vessel growth. Notably, the angiogenesis-associated integrins itgav and itgb3.1 are coexpressed with nephronectin a in the region of the caudal vein plexus and posterior somites; nephronectin binds to integrin alpha-V/integrin beta-3.1 (ITGAV/ITGB3.1), and itgav morphants phenocopy nephronectin a mutants. In addition, nephronectin a mutants showed decreased vessel maturation compared with wild-type siblings during caudal fin regeneration in adult zebrafish. Moreover, nephronectin promotes mammalian endothelial cell migration and tube formation in 2D and 3-dimensional invitro tissue culture. Further, nephronectin enhances vascular endothelial growth factor-induced periaortic vascular capillary interconnectivity, vessel diameter, and vessel stability. Collectively, our results identify nephronectin as a proangiogenic factor during embryonic development, which can be used to improve the vascularization of engineered tissues.

Innovative therapeutic strategies for intrauterine adhesions: Role of umbilical cord mesenchymal stem cells in rat models.

Intrauterine adhesions (IUAs) represent a considerable impediment to female reproductive health. Despite ongoing debate regarding the optimally efficacious route of administration and dosage of stem cells for IUA treatment, human umbilical cord-derived mesenchymal stem cells (UCMSCs) have emerged as a promising avenue for regenerative therapy. The present study aimed to investigate the potential effects of UCMSCs on IUAs and to further explore the most effective treatment route and dosages. In the present study, the therapeutic potential of UCMSCs in a constructed rat model of IUAs was evaluated. The efficacy of UCMSC administration through three different routes, namely intraperitoneal injection, in-site injection and caudal vein injection, was compared at three different doses of cells (0.5x106, 1x106 and 5x106). The assessment parameters included endometrial thickness, glandular density and extent of fibrotic tissue, which were measured using HE staining and Masson staining and numbers of offspring. The IUA model group compared with the control group endometrial thickness decreased, glandular density decreased and the extent of fibrotic tissue increased, suggesting the IUA rat model had been successfully established. At 4 weeks post-treatment, an intraperitoneal injection of 1x106 UCMSCs (the middle dose) was found to have led to a significant increase in endometrial thickness and glandular count, approaching the levels that were observed in the normal group. This dosage also notably reduced the level of fibrosis compared with that in both the higher and the lower doses, although this remained slightly higher compared with that observed in the normal group. Furthermore, the reproductive capability of the rats in the higher and middle dosage IUA rat model exhibited partial recovery post-treatment. In conclusion, the results of the present study suggest that the intraperitoneal administration of 1x106 UCMSCs can provide a viable strategy for promoting endometrial regeneration and reducing fibrosis in IUA. In addition, this highlights the potential of UCMSC therapy as a means of clinical intervention for severe IUA, ultimately improving fertility outcomes, especially with regard to the specific dosage and intraperitoneal injection method.

Impact of Head Position on Facial Soft Tissue Thickness: An Ultrasound Study in the Slovak Population

Impact of Head Position on Facial Soft Tissue Thickness: An Ultrasound Study in the Slovak Population

Correction of Peri-Implant Buccal Bone Dehiscence Following Sub-Periosteal Peri-Implant Augmented Layer Technique With Either Block or Particulate Xenograft: A Retrospective Study.

To evaluate the effectiveness of Sub-periosteal Peri-implant Augmented Layer (SPAL) technique performed with deproteinized bovine bone mineral (DBBM), delivered either as particulate (pDBBM) or block (bDBBM), in correcting a peri implant bone dehiscence (PIBD). Implants showing a thick (≥ 2 mm) peri-implant buccal bone plate (PBBP) at placement were also examined. Patients with a PIBD ≥ 1 mm, treated with SPAL with either pDBBM (SPALparticulate) or bDBBM (SPALblock), and patients with an implant showing a PBBP ≥ 2 mm at insertion (CONTROL) were included. Re-entry was performed either at 6 months (SPAL groups) or 3 months (CONTROL). The rate of patients presenting no PIBD at re-entry was the primary outcome. Bone dehiscence height (BDH) and width (BDW), thickness of buccal tissues (BTT) and marginal bone level (MBL) were secondary outcomes. Thirty-nine implants in 39 patients (14 in SPALparticulate,14 in SPALblock and 11 in CONTROL) were analyzed. No PIBD were found in SPALparticulate whereas in SPALblock one PIBD was present. Two patients in CONTROL presented a PIBD. A reduction in both BDH and BDW was observed in both SPALparticulate (2.7 ± 1.6 mm for BDH and 3.9 ± 0.2 mm for BDW) and SPALblock (2.5 ± 1.8 mm for BDH and 3.8 ± 1.1 mm for BDW). SPALblock showed a higher BTT than SPALparticulate at re-entry (3.6 ± 1.3 mm for SPALblock and 2.6 ± 0.6 mm for SPALparticulate, p = 0.0160). All groups showed similar MBL. SPAL performed with either a pDBBM or bDBBM is similarly effective in correcting a PIBD as well as in increasingBTT.

Utility of 3D facial reconstruction for forensic identification: a focus on facial soft tissue thickness and customized techniques.

Facial reconstruction, a crucial method in forensic identification, finds particular significance in cases where conventional means of identification are unavailable. This study addresses a significant gap in the field of forensic facial reconstruction focusing on facial soft tissue thickness (FSTT) and facial reconstruction techniques specifically tailored to the Thai population. By developing and implementing the 3D (three-dimensional) facial reconstruction program and compiling an extensive dataset of FSTT, this research makes substantial progress in advancing forensic facial reconstruction methodologies employing the combination Manchester Method, 3D skull images obtained through cone beam computed tomography (CBCT) scans were reconstructed using Autodesk Maya software. A dataset comprising 100 Thai cadavers underwent FSTT measurements via ultrasound (US) for 53 landmarks, with subsequent facial comparisons of 10 samples between reconstructed faces and real photographs conducted using the facial pool comparison and the structural similarity index (SSIM). The accuracy of facial pool comparison ranged from 30 to 80%, reflecting a wide range due to human errors. Thus, incorporating computerized assessment is necessary to minimize human bias. SSIM values ranged from 0.76 to 0.89, indicating strong similarity between reconstructed and real faces and validating the reconstruction process's accuracy. These findings suggest that the facial soft tissue thickness database of the Thai population used in this study can effectively support 3D computerized facial reconstruction. Moreover, this study sets the stage for future advancements in facial reconstruction methodologies tailored to diverse populations, emphasizing the ongoing need for comprehensive data gathering and technique refinement to enhance accuracy and applicability in forensic investigations.

Relationship of Soft Tissue Thickness With Body Mass Index and Perioperative Factors in Patients Undergoing Total Hip Arthroplasty: A Retrospective Cross-Sectional Study

Relationship of Soft Tissue Thickness With Body Mass Index and Perioperative Factors in Patients Undergoing Total Hip Arthroplasty: A Retrospective Cross-Sectional Study

PREDICTING DIFFICULT INTUBATION IN ELECTIVE SURGICAL PATIENTS: THE ROLE OF BEDSIDE SONOGRAPHIC MEASUREMENTS

Objective: Predicting difficult intubation remains a pivotal challenge in anesthesia, with traditional methods often failing to identify all at-risk patients. This study investigates the efficacy of bedside sonographic measurements as predictors of intubation difficulty in elective surgical patients. Methods: A prospective observational study was conducted at Gulbarga Institute of Medical Sciences, Kalaburagi, involving 60 adult elective surgery patients. Sonographic measurements, including hyomental distance, pre-epiglottic space, anterior soft tissue distance, and neck circumference were evaluated for their ability to predict difficult intubation. Results: The study found significant associations between all measured parameters and intubation difficulty. Specifically, shorter hyomental and pre-epiglottic spaces were strongly predictive of difficult intubations. Increased anterior soft tissue thickness and larger neck circumference were also linked to higher intubation difficulty. Conclusion: Bedside sonographic measurements provide a reliable method for predicting difficult intubations in elective surgical patients. Their integration into preoperative evaluations can significantly enhance the prediction and management of difficult airways.

Hidden blood loss and risk factors after percutaneous endoscopic transforaminal lumbar interbody fusion.

In this study, we aimed to assess the occurrence of hidden blood loss (HBL) and its associated risk factors in patients with lumbar degenerative diseases who underwent percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF). Sex, age, height, weight, body mass index, and medical history including hypertension, diabetes, and osteoporosis were recorded. The duration of symptoms, preoperative lumbar subcutaneous fat tissue thickness (measured using midsagittal T2-weighted magnetic resonance imaging), lumbar disc degeneration grade, and other basic patient information were also documented. The levels of fibrinogen, activated partial thromboplastin time, prothrombin time, thrombin time, and platelet count as well as the pre- and postoperative hematocrit and hemoglobin levels were collected. In addition, the number of fusion levels, surgical time, and intraoperative blood loss were recorded. Total blood loss (TBL) was calculated using the gross formula, and HBL was calculated based on the TBL and visible blood loss. The risk factors were analyzed using single-factor correlation and multivariate linear regression analyses. Of the 83 patients, there were 42 males and 41 females. Hypertension (P = 0.003), fusion level (P < 0.001), and surgery time (P < 0.001) were significantly correlated with HBL via a single-factor correlation analysis. Multiple linear regression analysis showed that the fusion level (P < 0.001) and surgery time (P < 0.001) were independent risk factors for HBL. In patients with lumbar degenerative diseases treated with Endo-TLIF, HBL accounts for a large proportion of TBL. A large number of fusion segments and prolonged operation time are risk factors for increased perioperative HBL during Endo-TLIF. Increased attention should be paid to the presence of HBL to ensure the safety of perioperative patients.

High-Frequency Ultrasound for Detecting Periodontal Inflammation: A Preclinical Diagnostic Accuracy Study.

Ultrasonography (US) has shown accuracy in imaging healthy periodontium. This study aims to evaluate the feasibility and accuracy of US for estimating dimensions of inflamed periodontium induced by ligature and bacteria. Periodontal tissues of maxillary as well as mandibular premolars and molars in six female mini pigs were treated with ligature and three strains of bacteria for 4-10 weeks. Before euthanization, the periodontium was imaged with US. After euthanization, cone-beam computed tomography (CBCT) scans and histology were performed. Soft and hard tissue measurements by calibrated and masked examiners from US, CBCT, and histology were statistically compared. Seventy-one histological samples with corresponding CBCT and US scans were available for analysis. Overall, there was a good to excellent agreement between histology and US (ICC: 0.77-0.96) for parameters such as Soft Tissue Thickness (STT), Gingival Recession, Crestal Bone Thickness (CBT), and the bone-to-cemento-enamel junction (B-CEJ) distance. However, discrepancies were observed for STT at 3 mm below the CEJ and Soft Tissue Height (STH) (ICC: 0.44 and 0.54, respectively). CBCT showed lower agreement with histology, particularly for thin CBT (< 1 mm), with an ICC of 0.20, compared to 0.90 for US vs. histology. CBCT failed to identify crestal bone in 14 cases when the crestal bone was thin. Notably, CBCT results differed more from histological measurements than US in assessing B-CEJ and thin CBT. US demonstrated substantial potential as a transformative tool for periodontal diagnostics, exhibiting high agreement with histology in determining critical parameters. Compared to CBCT, US offered advantages, particularly in cases with thin crestal bone.

Guidelines to minimize risk when dry needling the rectus capitus posterior major muscle.

Headache disorders are prevalent often leading to disability. The rectus capitus posterior major muscle (RCPMaj) may contribute to headache symptoms via nociceptive convergence and myodural bridging. To establish guidelines for needle length and needle angle to mitigate risks during dry needling RCPMaj. Cadaveric investigation. Twenty-five cadavers (mean age: 80.1±13.2 years) were placed in prone. Depth measurements from the skin to the C2 spinous process were taken following midline incision. Dissection continued exposing the RCPMaj for three measures including: 1) posterior angle from the frontal plane, 2) lateral angle from midline, and 3) distance from the external occipital protuberance to the lateral most RCPMaj. Mean values for tissue thickness overlying C2 spinous process (37±7.3mm), RCPMaj posterior angle from the frontal plane (65.2° ±10°), RCPMaj lateral angle from midline (34.7° ±12.9°), and distance from the external occipital protuberance to the lateral most RCPMaj (30.6mm±9.3mm) were used to calculate a needle inclination of ≤45° and a needle length <40mm to reach the occipital portion of RCPMaj with an a priori insertion point of midway between the C2 spinous process and the C1 transverse process. Inserting a dry needle <40mm in length midway between the C2 spinous process and the C1 transverse process with a cranial angle of ≤45° relative to the frontal plane would increase the likelihood of reaching the RCPMaj and mitigate penetrating deeper structures.

Repeated Autologous Fat Grafting Significantly Increases Mastectomy Flap Thickness in Pre-Pectoral Multi-Stage Composite Expander-to-Implant Breast Reconstruction: Exploring the Concept of a Reverse Expansion.

Background/Objectives: Combining autologous fat grafting with implant placement is meant to improve the quality of implant-based breast reconstruction. The present study explores the concept of multi-stage composite breast reconstruction with repeated sessions of autologous fat grafting to increase mastectomy flap thickness and provide better pre-pectoral implant coverage. Methods: Twenty-five consecutive patients underwent bilateral multi-stage composite expander-to-implant breast reconstruction and reverse expansion from August 2020 to April 2024. Subcutaneous thickness of the mastectomy flap was evaluated in predefined regions of interests of the breast on standardized MR images at two timepoints (before the first fat grafting session, with the tissue expander fully inflated, and 3 months after implant placement). Furthermore, the incidence of complications requiring surgery and implant-related complications were evaluated. All values are expressed as mean ± standard deviation, accepting statistical significance for a p-value < 0.05. Results: Patients underwent an average of 2.5 ± 0.6 fat grafting sessions, with a fat injection volume of 170 ± 60 mL per breast per session. The mean duration of the reconstructive process from mastectomy to final implant placement was 12 ± 5 months and the mean follow-up was 17 ± 8 months. The overall thickness of both breasts amounted to 190% of baseline thickness and was significantly higher in the upper breast quadrants than in the lower quadrants (p < 0.05). Tissue thickness increase correlated well with the number of fat grafting sessions and was independent of the patient's weight gain. Complications requiring surgery occurred in eight breasts during the reconstruction, with iatrogenic expander puncture being the most frequent (three cases, 6%). During follow-up, only one implant-related complication was observed (one case of bilateral rippling, 4%). No breast animation or symptomatic capsular contracture were observed. Conclusions: Multi-stage pre-pectoral composite expander-to-implant breast reconstruction using autologous fat grafting is an effective concept for breast reconstruction. Despite the need for multiple surgeries, the significant increase in subcutaneous tissue thickness, resulting in better soft tissue coverage, compensates for the longer reconstructive process.

Enhanced Endothelialization Using Resveratrol-Loaded Polylactic Acid-Coated Left Atrial Appendage Occluders in a Canine Model.

Left atrial appendage occlusion (LAAO) is a well-established alternative to anticoagulation therapy for patients with atrial fibrillation who have a high bleeding risk. After occluder implantation, anticoagulation therapy is still required for at least 45 days until complete LAAO is achieved by neoendocardial coverage of the device. We applied a polylactic acid-resveratrol coating to the LAAO membrane to enhance endothelialization with the goal of shortening the anticoagulation therapy duration. Eighteen dogs were randomly divided into the experimental group (coated occluders) or the control group (noncoated occluders). The dogs were sacrificed in cohorts at days 14, 28, and 90 for anatomical and pathological examination to evaluate endothelialization and thrombus formation. Transesophageal echocardiography (TEE) was performed before sacrifice to evaluate device-related adverse events. According to the anatomical and pathological examinations, all except one LAAO cover exhibited larger or thicker tissue or neoendocardial coverage in the experimental group compared with the control group at the same sacrifice time points. All connection hubs were densely covered by endothelial cells at 90 days and completely covered at 28 days in the experimental group, while all connection hubs were thinly covered at 90 days and two connection hubs were exposed at 28 days in the control group. Pathological examination revealed no thrombus formation in the experimental group, while a small amount of thrombus was observed in one dog at 90 days and in two dogs at 28 days in the control group. Finally, TEE showed no peri-device leakage (PDL) in the experimental group, whereas a small amount of PDL was detected in one dog (3.2 mm) at 28 days and in one dog (3.7 mm) at 14 days in the control group. The resveratrol-loaded polylactic acid-covered LAAO device enhanced endothelialization and reduced thrombus formation and PDL. This effect could possibly reduce the anticoagulation therapy duration.