RESUMEN
BACKGROUND: Cryolipolysis nonsurgically targets and reduces subcutaneous fat through controlled cooling of skin and underlying fatty tissue. Although skin changes after cryolipolysis treatment have been observed clinically, the mechanisms by which these occur are not well understood. OBJECTIVES: The aim of this study was to investigate the expression of heat shock protein 70 (HSP70) in the epidermal and dermal layers of human skin following cryolipolysis treatment. METHODS: Subjects (N = 11; average age, 41.8 years; average BMI, 29.59 kg/m2) were recruited to receive cryolipolysis treatment with a vacuum cooling cup applicator (-11°C/35 minutes) prior to abdominoplasty surgery. Treated and untreated abdominal tissue samples were harvested immediately after surgery (average follow-up, 15 days; range, 3 days to 5 weeks). Immunohistochemistry for HSP70 was performed on all samples. Slides were digitized and quantified in epidermal and dermal layers. RESULTS: There was higher epidermal and dermal HSP70 expression in cryolipolysis-treated pre-abdominoplasty samples vs untreated samples. There was a 1.32-fold increase of HSP70 expression in the epidermis (P < .05) and a 1.92-fold increase in the dermis (P < .04) compared with untreated samples. CONCLUSIONS: We found significant induction of HSP70 after cryolipolysis treatment in epidermal and dermal layers. HSP70 has potential therapeutic benefits and is recognized to have a role in skin protection and adaption after thermal stress. Although cryolipolysis is popular for subcutaneous fat reduction, cryolipolytic HSP induction in the skin may prove valuable for additional therapeutic applications, including skin wound healing, remodeling, rejuvenation, and photoprotection.
RESUMEN
Importance: Military forces in the State of New York, comprising the Army National Guard, Air National Guard, Naval Militia, and State Guard, with contributions from the Army Corps of Engineers, have made major contributions to the state response to the COVID-19 pandemic. Observations: Operation COVID-19 began on March 10, 2020, and will continue uninterrupted at least through June 2022, making it the longest and largest domestic mobilization in state history. More than 7000 service members served across 200 COVID-19 mission sites, administering more than 4 million vaccines, producing more than 35 million testing kits, delivering more than 54 million meals, and administering more than 1.5 million tests. Conclusions and Relevance: Because of the role of states in delivering relief, testing, care, vaccination, and other community support during the COVID-19 pandemic, this article illuminates the role of New York military forces in responding to COVID-19. The aim is to provide details for the public health community, as well as to share lessons for the continued mission and future pandemic responses.
Asunto(s)
COVID-19 , Personal Militar , COVID-19/epidemiología , Humanos , New York/epidemiología , Pandemias/prevención & control , Salud PúblicaRESUMEN
BACKGROUND: Corneal protection is a priority in flaccid facial palsy patients. Denervation of the orbicularis oculi muscle results in weak palpebral closure and predisposes patients to severe corneal sequelae. While periorbital static procedures enhance corneal coverage in repose, voluntary closure is only regained through dynamic reinnervation of the muscle. This study aims to elucidate the added effect of dynamic reinnervation of the orbicularis oculi muscle on long-term corneal integrity as well as on dynamic closure of the palpebral aperture. METHODS: Retrospective review was performed on two groups of complete palsy patients: those who received solely periorbital static procedures and those who underwent concomitant orbicularis oculi muscle reinnervation and static lid procedures. Only patients with complete ophthalmic examinations were included. Corneal punctate epithelial erosions in addition to static and dynamic palpebral measurements were serially assessed preoperatively and postoperatively. RESULTS: Of 272 facial palsy patients, 26 fit the inclusion criteria. Eleven patients underwent combined muscle reinnervation involving facial-to-masseteric nerve coaptation in addition to static eye procedures, and 15 patients underwent solely static interventions. Analysis revealed a 65.3 percent lower mean punctate epithelial erosion score in reinnervation patients as compared with static patients when evaluated at more than 9 months postoperatively (p < 0.01). Reinnervation patients were also found to have 25.3 percent greater palpebral aperture closure (p < 0.05) and 32.8 percent higher closure velocity (p < 0.01) compared with static patients. CONCLUSION: In patients with subacute facial palsy, dynamic reanimation of the orbicularis oculi muscle with concomitant static interventions provides lasting corneal protection not seen in patients who receive solely static interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Asunto(s)
Enfermedades de la Córnea/prevención & control , Músculos Faciales/inervación , Enfermedades del Nervio Facial/cirugía , Parálisis Facial/cirugía , Transferencia de Nervios/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Parpadeo/fisiología , Niño , Córnea/diagnóstico por imagen , Córnea/patología , Enfermedades de la Córnea/diagnóstico , Enfermedades de la Córnea/etiología , Enfermedades de la Córnea/fisiopatología , Párpados/fisiopatología , Párpados/cirugía , Músculos Faciales/cirugía , Nervio Facial/cirugía , Enfermedades del Nervio Facial/complicaciones , Parálisis Facial/etiología , Femenino , Humanos , Masculino , Nervio Mandibular/trasplante , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Latinos are one of the fastest growing ethnic groups in the United States, and there is a growing demand for aesthetic rhinoplasty in these patients. The authors provide an individualized, systematic approach for evaluation and improvement of surgical outcomes in Latino patients. METHODS: A retrospective review of patients identified as Latino who underwent primary rhinoplasty and those who did not but had documented nasal photographs was performed. Photographs and operative records were reviewed in detail. Specific aesthetic nasal characteristics, individualized surgical techniques, and aesthetic results were recorded. RESULTS: The Latino nose has some characteristic nasal traits, including thick soft-tissue envelope, bulbous and underrotated tips, fatty hanging alae with propensity for anterior notching, weak underlying cartilaginous structures, and a propensity for alar flare worsened by depressor septi hyperactivity. Case review, however, demonstrates that there is moderate variability, with some patients demonstrating features more consistent with a European Caucasian nose and others displaying features more congruent with the black nose. CONCLUSIONS: Addressing the Latino nose requires a firm understanding of the racial heterogeneity that exists within this patient population, ranging from features more consistent with the black nose to features more congruent with a European Caucasian nose. A patient's aesthetic goals should be thoroughly discussed to avoid racial incongruity. The authors provide an individualized, component approach to improving aesthetic outcomes in Latino rhinoplasty.
Asunto(s)
Hispánicos o Latinos , Nariz/anatomía & histología , Rinoplastia , Adulto , Estética , Femenino , Humanos , Masculino , Grupos Raciales , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: The human smile is a complex coordinated activity of mimetic muscles predominantly recognizable by a superolateral pull at the commissure and elevation of the upper lip. The aim of this study was to revisit the muscles of facial expression responsible for these motions, evaluate their relational anatomy and orientation, and relate this to optimal positioning of free muscle transfer in smile reanimation. METHODS: Nineteen hemifaces from fresh cadaveric specimens were dissected. A subsuperficial muscular aponeurotic system skin flap was elevated to expose the zygomaticus major, zygomaticus minor, levator labii superioris, and levator labii superioris alaeque nasi. Muscle location, length, width, angle of pull, and any anatomic variation were noted. RESULTS: All specimens had zygomaticus major, levator labii superioris, and levator labii superioris alaeque nasi muscles present bilaterally. Conversely, the zygomaticus minor was present in only 10 of 19 hemifaces. There was no significant difference in muscle length, width, or line of pull between specimen sides. Of all the assessed muscles, the zygomaticus minor had the most transverse line of pull, at 31.6°; the zygomaticus major was more oblique with a line of pull of 55.5°; and the levator labii superioris and levator labii superioris alaeque nasi were oriented almost vertically with angles of 74.7° and 79.0°, respectively. CONCLUSIONS: The mimetic muscle vector is quite vertical in comparison to the angle obtained by traditional dynamic smile reconstruction surgeries. A more vertical vector, especially at the upper lip, should be considered in smile reconstruction.
Asunto(s)
Músculos Faciales/anatomía & histología , Músculos Faciales/cirugía , Sonrisa/fisiología , Anciano , Anciano de 80 o más Años , Músculos Faciales/fisiología , Parálisis Facial/cirugía , Femenino , Colgajos Tisulares Libres/trasplante , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Repeated evolution of similar phenotypes is a widespread phenomenon found throughout the living world and it can proceed through the same or different genetic mechanisms. Cave animals with their convergent traits such as eye and pigment loss, as well as elongated appendages, are a striking example of the evolution of similar phenotypes. Yet, few cave species are amenable to genetic crossing and mapping techniques making it challenging to determine the genetic mechanisms causing their similar phenotypes. To address this limitation, we have been developing Asellus aquaticus, a freshwater isopod crustacean, as a genetic model. Many of its cave populations originate from separate colonization events and thus independently evolved their similar cave-related phenotypes which differ from the still existent ancestral-like surface populations. In our prior work, we identified genomic regions responsible for eye and pigment loss in a single cave population from Slovenia. In this study we examined another, independently evolved cave population, also from Slovenia, and asked whether the same or different genomic regions are responsible for eye and pigment loss in the two cave populations. We generated F2 and backcross hybrids with a surface population, genotyped them for the previously identified genomic regions, and performed a complementation test by crossing individuals from the two cave populations. We found out that the same genomic regions are responsible for eye and pigment loss and that at least one of the genes causing pigment loss is the same in both cave populations. Future studies will identify the actual genes and mutations, as well as examine additional cave populations to see if the same genes are commonly associated with eye and pigment loss in this species.
Asunto(s)
Evolución Biológica , Variación Genética , Isópodos/fisiología , Fenómenos Fisiológicos Oculares/genética , Pigmentación/genética , Animales , Cuevas , Ojo/embriología , Ojo/crecimiento & desarrollo , Femenino , Isópodos/genética , Masculino , Fenotipo , EsloveniaRESUMEN
BACKGROUND: Scar management is critical for every plastic surgeon's practice and, ultimately, the patient's satisfaction with his or her aesthetic result. Despite the critical nature of this component of routine postoperative care, there has yet to be a comprehensive analysis of the available literature over the past decade to assess the best algorithmic approach to scar care. To this end, a systematic review of best practices in preventative scar management was conducted to elucidate the highest level of evidence available on this subject to date. METHODS: A computerized MEDLINE search was performed for clinical studies addressing scar management. The resulting publications were screened randomized clinical trials that met the authors' specified inclusion/exclusion criteria. RESULTS: This systematic review was performed in May of 2016. The initial search for the Medical Subject Headings term "cicatrix" and modifiers "therapy, radiotherapy, surgery, drug therapy, prevention, and control" yielded 13,101 initial articles. Applying the authors' inclusion/exclusion criteria resulted in 12 relevant articles. All included articles are randomized, controlled, clinical trials. CONCLUSIONS: Optimal scar care requires taking into account factors such as incisional tension, anatomical location, and Fitzpatrick skin type. The authors present a streamlined algorithm for scar prophylaxis based on contemporary level I and II evidence to guide clinical practice.
RESUMEN
BACKGROUND: Two-stage facial reanimation procedures with a cross-facial nerve graft often have unsatisfactory results in the older patient. Although the cause of result variability is likely multifactorial, some studies suggest that increased donor nerve axonal load improves function of a free muscle transfer after a cross-facial nerve graft. This study attempts to characterize the relationship between age and facial nerve axonal load. METHODS: Sixty-three fresh cadaveric heads were dissected to expose the facial nerve. For each hemiface, two facial nerve samples were taken: one proximal as the nerve exits the stylomastoid foramen, and one distal at the buccal branch (at a point 1 cm proximal to the anterior parotid border). Nerve samples were stained and quantified. Correlation analysis was completed using a Pearson correlation coefficient. RESULTS: Thirty-six female and 27 male cadavers were dissected; their average age was 71 years (range, 22 to 97 years). At the proximal (r = -0.26; p < 0.01; n = 104) and distal (r = -0.45; p < 0.0001; n = 114) sampling points, there was a significant negative correlation between age and axonal load. CONCLUSIONS: As age increases, the axonal load of the facial nerve decreases at the buccal and zygomatic branches approximately 1 cm proximal to the anterior parotid border. The authors previously suggested this location as significant for cross-facial nerve coaptation. These results propose that decreasing axonal load can be a factor in the unsatisfactory outcomes of cross-facial grafting in the aging population. Moreover, this underscores the importance of recruiting more donor axons in attempting to improve facial reanimation in the older patient.
Asunto(s)
Músculos Faciales/inervación , Nervio Facial/anatomía & histología , Colgajos Quirúrgicos/inervación , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Axones , Cadáver , Disección , Traumatismos Faciales/cirugía , Nervio Facial/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Colgajos Quirúrgicos/trasplante , Adulto JovenRESUMEN
BACKGROUND: As vascularization represents the rate-limiting step in permanent incorporation of hydrogel-based tissue-regeneration templates, the authors sought to identify the material chemistry that would optimize endothelial cell adhesion and invasion into custom hydrogel constructs. The authors further investigated induction of endothelial tubule formation by growth factor supplementation and paracrine stimulation. METHODS: Hydrogel scaffolds consisting of combinations of alginate, collagen type I, and chitosan were seeded with human umbilical vein endothelial cells and maintained under standard conditions for 14 days. Cell density and invasion were then evaluated. Tubule formation was evaluated following basic fibroblast growth factor addition or co-culture with human aortic smooth muscle cells. RESULTS: Human umbilical vein endothelial cells demonstrated greatest cell-surface density and invasion volumes with alginate and collagen (10:1 weight/weight) scaffolds (p < 0.05). Supplementation with basic fibroblast growth factor increased surface density but neither invasion nor tubule formation. A significant increase in tubule content/organization was observed with increasing human aortic smooth muscle cell-to-human umbilical vein endothelial cell ratio co-culture. CONCLUSIONS: Alginate and collagen 10:1 scaffolds allow for maximal cellularization compared with other combinations studied. Growth factor supplementation did not affect human umbilical vein endothelial cell invasion or morphology. Paracrine signaling by means of co-culture with human umbilical vein endothelial cells stimulated endothelial tubule formation and vascular protonetwork organization. These findings serve to guide future endeavors toward fabrication of prevascularized tissue constructs.
Asunto(s)
Células Endoteliales/citología , Hidrogel de Polietilenoglicol-Dimetacrilato/farmacología , Músculo Liso Vascular/citología , Neovascularización Fisiológica , Ingeniería de Tejidos/métodos , Andamios del Tejido , Alginatos/farmacología , Materiales Biocompatibles/farmacología , Adhesión Celular/fisiología , Quitosano/farmacología , Técnicas de Cocultivo , Colágeno Tipo I/farmacología , Factor 2 de Crecimiento de Fibroblastos/farmacología , Células Endoteliales de la Vena Umbilical Humana , Humanos , Inmunoglobulina G/farmacología , Melfalán/farmacología , Oligopéptidos/farmacología , Comunicación Paracrina/fisiologíaRESUMEN
INTRODUCTION: Autologous techniques for the reconstruction of pediatric microtia often result in suboptimal aesthetic outcomes and morbidity at the costal cartilage donor site. We therefore sought to combine digital photogrammetry with CAD/CAM techniques to develop collagen type I hydrogel scaffolds and their respective molds that would precisely mimic the normal anatomy of the patient-specific external ear as well as recapitulate the complex biomechanical properties of native auricular elastic cartilage while avoiding the morbidity of traditional autologous reconstructions. METHODS: Three-dimensional structures of normal pediatric ears were digitized and converted to virtual solids for mold design. Image-based synthetic reconstructions of these ears were fabricated from collagen type I hydrogels. Half were seeded with bovine auricular chondrocytes. Cellular and acellular constructs were implanted subcutaneously in the dorsa of nude rats and harvested after 1 and 3 months. RESULTS: Gross inspection revealed that acellular implants had significantly decreased in size by 1 month. Cellular constructs retained their contour/projection from the animals' dorsa, even after 3 months. Post-harvest weight of cellular constructs was significantly greater than that of acellular constructs after 1 and 3 months. Safranin O-staining revealed that cellular constructs demonstrated evidence of a self-assembled perichondrial layer and copious neocartilage deposition. Verhoeff staining of 1 month cellular constructs revealed de novo elastic cartilage deposition, which was even more extensive and robust after 3 months. The equilibrium modulus and hydraulic permeability of cellular constructs were not significantly different from native bovine auricular cartilage after 3 months. CONCLUSIONS: We have developed high-fidelity, biocompatible, patient-specific tissue-engineered constructs for auricular reconstruction which largely mimic the native auricle both biomechanically and histologically, even after an extended period of implantation. This strategy holds immense potential for durable patient-specific tissue-engineered anatomically proper auricular reconstructions in the future.
Asunto(s)
Colágeno Tipo I/fisiología , Pabellón Auricular/crecimiento & desarrollo , Cartílago Auricular/crecimiento & desarrollo , Hidrogel de Polietilenoglicol-Dimetacrilato , Procedimientos de Cirugía Plástica , Animales , Bovinos , Niño , Condrocitos/citología , Condrocitos/metabolismo , Colágeno Tipo I/química , Diseño Asistido por Computadora , Pabellón Auricular/anatomía & histología , Cartílago Auricular/cirugía , Oído Externo/crecimiento & desarrollo , Oído Externo/cirugía , Humanos , Masculino , Prótesis e Implantes , Ratas , Ingeniería de TejidosRESUMEN
Many gay men in the popular sectors of Lima, Peru participate in vóley callejero, or street volleyball. The ethnographic data presented in this article describes verbal and corporal mechanisms through which gay identity emerges within the particular context of the street volleyball game, ultimately highlighting the contextual nature of identity. The volleyball players are not just hitting a ball back and forth, they are engaging in a meaningful activity that illuminates intersections of language, sexuality, and identity. Through the manipulation of the street into a volleyball court, the volleyball players create a space conducive to the articulation of particular verbal and embodied practices that index gay identity. The challenge to the regulations of "proper" volleyball through the practice of ritual insulting and the cultivation of gay volleyball technique are playful reconfigurations of gendered practices prominent in the sites where fieldwork was carried out.