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Soft-tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin and account for only 1% of adult malignancies. They tend to occur most commonly in the lower extremities. Reconstruction after sarcoma resection can be challenging, especially when important structures are involved and recurrences occur. Additionally, more attention is now being paid to reconstructing the lymphatic system to prevent lymphatic complications. In this case report, we presented the management of recurrent medial thigh sarcoma that necessitated multiple challenging reconstructions to provide valuable insights for lectures on similar cases. A 50-year-old male patient was diagnosed with an undifferentiated pleomorphic cell sarcoma (UPS) of the anteromedial thigh. After preoperative radiotherapy, a mass of 23 × 15 cm was removed, and reconstruction with a pedicled deep inferior epigastric artery perforator (p-DIEP) flap-based lymphatic flow through (LyFT) was performed. Six months later, the patient developed the first local recurrence with the presence of a distant metastasis. Following the tumor resection, the medial part of the DIEP flap was de-epithelized and buried in the defect for dead space obliteration. Another local recurrence arose 7 months after the second surgery. Therefore, a major debulking surgery involving the femoral neurovascular bundle was performed. The femoral artery was reconstructed with a synthetic graft, and the femoral vein with the great saphenous vein harvested from the contralateral thigh. A composite myocutaneous neurotized anterolateral thigh (ALT) flap from the contralateral thigh was used to obliterate the defect and restore the loss of function of the quadriceps femoris. Two lymphaticovenular anastomoses (LVAs) were performed at the ankle to reduce the risk of lymphatic sequelae. This case report highlights the importance of integrating various techniques to create a tailored approach that effectively addresses complex surgical requirements to avoid limb amputation and maintain functionality.

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INTRODUCTION: The lympho-venous shunt using the distal vein of ALT flap pedicle allowed at the same time the coverage of the inguinal defects and to perform lymphovenous shunt into a run-in vein of the descending branch of the lateral circumflex femoral pedicle, draining the lymph through the flap pedicle. Surgical technique, complications and final outcomes (both clinical and lymphoscintigraphic) are reported. METHODS: Five patients (45.8 y.o.[22-70]) with groin soft tissue loss with lymphatic leakage or lower limb lymphedema, benefited of the described technique. The ALT flap was used to cover the defect and, at the same time, we could perform a lymphovenous shunt between afferent lymphatics to the thigh and the descending branch of the lateral circumflex femoral pedicle, distal to the perforator nourishing the flap. Clinical and lymphoscintigraphic assessment of the limbs, cease of lymphorrhea or cellulitis/lymphangitis episodes, eventual downstaging of physiologic/physical therapy were recorded. LYMphatic Quality Of Life in leg (LYMQoLLeg) and patient satisfaction were evaluated. RESULTS: Average flap size was 88.8cm2 (range 84-126). The mean number of multi-lymphovenous anastomosis (MLVA) performed was 1.8 (range 1-3) per patient with 1-3 lymphatics shunted into each vein. Only one hemato-seroma requiring surgical revision. Mean improvement of perometer values was 48.2% (range 27.7-67.7) with an average follow-up of 13.6 months (range 12-17). Lymphoscintigraphy showed disappearing of the lymphatic leak and lymphedema with a high satisfaction of LYMQoL score. DISCUSSION: The combination of pedicle flap with lympho-venous bypass as lymphatic derivation concept, improving the chronic morbidity scenarios of lymphatic complications.

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BACKGROUND: With aging, four major facial retaining ligaments become elongated, leading to facial sagging and wrinkling. Even though synthetic fillers are popular, however, it cannot address the problems of soft tissue descent alone, and injection of these fillers requires knowledge of the injection technique including the selection of injection sites, the amount of filler, and the dosage used per injection site. CASE SUMMARY: This report aimed to assess the safety and efficacy of a nonsurgical retightening technique to lift and tighten the true ligaments of the face, to improve age-related skin sagging and wrinkling. We objectively quantified the aesthetic lifting effect of a nonsurgical facial retightening procedure that strategically injected high G' fillers into the base of the true retaining ligaments of the face in two female patients. Facial images were recorded with a three-dimensional facial imaging system for comparison of the clinical outcome. The primary efficacy outcome was the change in facial anthropometric measurements obtained prior to and after injection. The patients were followed for 6 mo after the procedure. Skin retightening was observed, with an evident lift in the orbital, zygomatic, and mandibular regions, and the lifting effect was still observable at the 6-mo follow-up. Few mild adverse events, such as mild-to-moderate pain, tenderness, and itching, occurred during the 1st week after the procedure. No adverse events were reported 1 mo post-procedure. CONCLUSION: The results of this study demonstrated that our nonsurgical retightening procedure with strategically placed high G' fillers achieved quantifiable aesthetic improvements in the orbital, zygomatic, and mandibular regions of two patients. Future research with a larger sample could provide a more in-depth evaluation and validation of the aesthetic improvements observed in this study.

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Scaffolds are crucial elements for dental pulp regeneration. Most of the currently used scaffolds in regenerative endodontic procedures (REPs) are unsuitable for chairside clinical use. This study aimed to evaluate the effect of an injectable synthetic scaffold (Restylane Lyft) on human bone marrow mesenchymal stem cell (hBMSC) viability, proliferation, and osteo/dentinogenic differentiation in a regenerative endodontic organotype model (REM). hBMSC were loaded in an REM either alone (hBMSC group) or mixed with the Restylane Lyft scaffold (Restylane/hBMSC group) and cultured in basal culture medium (n = 9/group). hMSC on culture plates served as controls. Cell viability and proliferation were measured using AlamarBlue assay. The loaded REM was cultured in an osteogenic differentiation medium to measure alkaline phosphatase activity (ALP) and examine the expression of the osteo/dentinogenic markers using real-time reverse transcriptase polymerase chain reaction. Cell viability in all groups increased significantly over 5 days. The Restylane/hBMSC group showed significantly higher ALP activity and dentin sialophosphoprotein, osteocalcin, and bone sialoprotein genes expression than the hBMSC and the control groups. Restylane Lyft, a hyaluronic acid (HA) injectable, FDA-approved hydrogel, maintained cell viability and proliferation and promoted osteo/dentinogenic differentiation of hBMSC when cultured in an REM. Henceforth, it could be a promising chairside scaffold material for REPs.

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On-demand ridesourcing services from transportation network companies (TNCs), such as Uber and Lyft, have reshaped urban travel and changed externality costs from vehicle emissions, congestion, crashes, and noise. To quantify these changes, we simulate replacing private vehicle travel with TNCs in six U.S. cities. On average, we find a 50-60% decline in air pollutant emission externalities from NOx, PM2.5, and VOCs due to avoided "cold starts" and relatively newer, lower-emitting TNC vehicles. However, increased vehicle travel from deadheading creates a ∼20% increase in fuel consumption and associated greenhouse gas emissions and a ∼60% increase in external costs from congestion, crashes, and noise. Overall, shifting private travel to TNCs increases external costs by 30-35% (adding 32-37 ¢ of external costs per trip, on average). This change in externalities increases threefold when TNCs displace transit or active transport, drops by 16-17% when TNC vehicles are zero-emission electric, and potentially results in reduced externalities when TNC rides are pooled.

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BACKGROUND: Nonsurgical injectable treatments, including hyaluronic acid (HA) fillers, are increasingly used in Asian patients. AIMS: To demonstrate the efficacy and safety of Restylane Lyft compared to Restylane for the correction of nasolabial folds (NLFs). PATIENTS/METHODS: This was a randomized, evaluator-blinded, split-face, 12-month study conducted in China using Restylane Lyft in the aesthetic correction of moderate to severe NLFs among adult subjects. One NLF was treated with Restylane Lyft, and the opposite NLF with the comparator Restylane. Efficacy outcomes included improvement in the Wrinkle Severity Rating Scale (WSRS) and aesthetic improvement (using the Global Aesthetic Improvement Scale [GAIS] assessed by the subject and blinded evaluator) for each treatment at Months 3, 6 (primary objective based on WSRS), 9, and 12. Safety was evaluated by the incidence of injection site reactions and adverse events (AEs). RESULTS: A total of 100 subjects were randomized to the treatments. Noninferiority for Restylane Lyft was established according to blinded evaluation of WSRS at 6 months after last treatment. Similarly, the WSRS improved throughout the study, and the responder rate (improvement in WSRS of ≥1 grade from Baseline) was sustained after 6 months (64% and 65% for NLFs treated with Restylane and Restylane Lyft, respectively). For GAIS after 6 months, improvement was approximately 80% in both groups. No treatment-related serious AEs were reported. The safety profiles were similar between the two treatments. CONCLUSIONS: Similar to Restylane, Restylane Lyft was effective and well tolerated for treatment of moderate to severe NLFs in this Chinese population.

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Americans spend trillions of minutes in cars annually, tens of billions of minutes traveling to health care providers, and hundreds of millions of minutes ridesharing (e.g., with Uber or Lyft). From July to October 2017, we recruited rideshare users (e.g., Uber or Lyft) to participate in a survey about health messaging during rides. Responses were collected anonymously on tablet devices. We interviewed 170 ridesharers and assessed their interest in health messaging delivered during rides. Participants ranged from 19 to 79 years of age, and most (87%) reported using their smartphones to search for health information. More than 70% expressed interest in health messaging during rides, and 55% of current smokers expressed interest in quit-smoking messaging. The most popular of suggested health topics included healthy eating (61.8%), exercise (60.6%), and weight loss (40.0%), and the preferred message formats were video (33.5%), smartphone apps (33.5%), and online social network (25.3%). Free time spent riding in cars represents an enormous untapped resource, and our findings suggest that riders are receptive to the idea of health messaging delivered during rideshare trips.

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The goals of this study were to explore e-hail (e.g., Uber/Lyft) knowledge, use, reliance, and future expectations among older adults. Specifically, we aimed to identify factors that were related to e-hail, and how older adults view this mode as a potential future transportation option. Data were collected from a sample of older adults using a pencil-and-paper mailed survey. Univariate, bivariate, and regression techniques were used to assess the relationships among e-hail and several demographic and other factors. Almost three-quarters of the sample (74%) reported no e-hail knowledge. Only 1.7% had used e-hail to arrange a ride,andonly 3.3% reported that they relied on e-hail for any of their transportation needs. Younger age, male gender, more education, higher transportation satisfaction, and discussing transportation options with others were all independently associated with greater e-hail knowledge. Male gender also predicted e-hail use. E-hail was the mode least relied upon by older adults. Current e-hail knowledge was the biggest predictor of anticipated future use. E-hail may be a viable future option for older adults who have limited or stopped driving. More exposure to e-hail and continued evolution of these services is required to overcome older adults' lower internet/smartphone use. Policies could be implemented at departments of motor vehicles to pair information or training on transportation alternatives (like e-hail) with elimination of driving privileges, or at doctors' offices, senior centers, or hospitals. Potential underlying reasons for the findings are also discussed.