Notes

EPA-enriched phospholipids ameliorate cancer-associated cachexia mainly by means of suppressing lipolysis.
The significant effect of travel participation on life satisfaction is fully mediated by social integration. Income and self-perceived health status both significantly contribute to social integration and life satisfaction.

Travel participation should be considered as an independent domain that directly impacts the social integration of people with SCI, which in turn enhances their life satisfaction. Systematic interventions with standard protocols for travel-related skill training and assessments procedures are needed for people after SCI.
Travel participation should be considered as an independent domain that directly impacts the social integration of people with SCI, which in turn enhances their life satisfaction. Systematic interventions with standard protocols for travel-related skill training and assessments procedures are needed for people after SCI.
Using the subpectoral approach, animation deformity or breast distortion due to pectoralis muscle contraction is common. Although the anatomy of the pectoral nerves has been extensively studied, only few studies have related the location of these nerves to bony landmarks.

Our aim is to clarify the anatomy and possible variations of the innervation of the pectoralis major in relation to bony landmarks useful for surgery and to identify the preferred level for (selective) denervation by 1) transecting the nerves and 2) splitting the muscle in subpectoral breast implant surgery in cadavers.

Fourteen pectoral regions (both left and right side) were dissected on 7 formaldehyde-fixed cadavers. The origin, locations, and course were mapped and (distances to) landmarks were reported.

The lateral pectoral nerve, medial pectoral nerve, and ansa pectoralis were identified in all cadavers. Nerve branches pierce the pectoralis minor or run along its upper or lower border. The piercing nerves vary from one to three branches and were consistently located lateral to the midclavicular line. The horizontal and vertical distances to bony landmarks varied greatly and depended on the size and location of the pectoralis minor, except for the nerve running along the upper border of the PMin, which was located consistently around 30% of the clavicular line from the acromioclavicular joint to the sternoclavicular joint.

We were unable to define a fixed landmark to mark pre- or peroperatively. However, we could define guidelines that help to identify and excise or preserve nerves of interest.
We were unable to define a fixed landmark to mark pre- or peroperatively. However, we could define guidelines that help to identify and excise or preserve nerves of interest.
Ventral skin deficiency in complicated hypospadias is a difficult problem to treat. The aim of our study is to report our technique and outcomes of vascularized islanded scrotal raphe flap for ventral skin deficiency in complicated hypospadias.

A retrospective review was conducted at Northwest General Hospital & Research Centre, Peshawar, from January 2012 to January 2019. Complicated hypospadias patients who underwent two-stage surgery employing islanded scrotal flap were identified. Patients underwent surgery in two stages scar tissue removal, chordee correction and buccal mucosal graft in the first stage; neourethral tubularization, water proofing, and skin coverage with vascularized islanded scrotal raphe flap in the second stage. The primary outcome was 6-month flap survival rate. Secondary outcomes were 6-month complication rate (fistula, persistent chordee, distal stenosis) and end-of-follow-up patient self-reported satisfaction rate.

A total of 1845 patients underwent hypospadias surgery, ofable skin but also fascia as a waterproofing layer.
Sutureless microvascular anastomoses could simplify the microvascular field, shortening operative time and improving the final outcome. The use of thermosensitive poloxamers (TP407) together with the application of cyanoacrylate as an alternative method for conventional sutures was well-documented for arteries, but not for veins. The purpose of our study was to prove the feasibility of this technique for venous anastomoses and compare it with the traditional hand-sewn technique on a rat model.

Twenty male Sprague-Dawley rats that weighed between 265 and 310g were used. In the sutureless group (SG), 20 left external jugular veins (LEJV) end-to-end anastomoses were performed using a T704 and cyanoacrylate glue. They were compared to 20 right external jugular veins (REJV) anastomoses sutured with conventional 10-0 stitches (control group - CG). Cyclopamine Diameters of veins, anastomosis time, and patency rate at 15 days were reported. Foreign body reaction was assessed histologically.

The mean diameter of the LEJV was 0.94±0.1mm and 0.95±0.09mm for the REJV. The mean anastomosis time was 11.9±1.37min for the SG and 27.75±3.31min for the CG. In the latter group, the immediate patency rate was 95% and 90% at 15 days. For the SG group, 90% of the anastomoses were patent immediately and 85% at 15 days.

TP407 and cyanoacrylate could offer a fast and reliable technique for sutureless venous anastomoses. Before human application, effectiveness of this method remains to be confirmed in larger animals in a long-term follow-up.
TP407 and cyanoacrylate could offer a fast and reliable technique for sutureless venous anastomoses. Before human application, effectiveness of this method remains to be confirmed in larger animals in a long-term follow-up.
Cadaveric studies suggest that a thick part of the distal interosseous membrane (DIOM), known as the distal oblique bundle (DOB), contributes to the distal radioulnar joint (DRUJ)'s stability. We hypothesized that the DIOM thickness, measured through magnetic resonance imaging (MRI), has a clinically significant association with DRUJ stability.

We retrospectively reviewed patients, from February 2018 to April 2019, who underwent wrist MRI examination with physical examination for DRUJ stability. We evaluated the correlation between their MRI findings (i.e., triangular fibrocartilage complex [TFCC] tears and presence of the DOB) and DRUJ instability.

Out of 85 patients with an average age of 42 years, 45 (53%) had foveal TFCC tears, 29 (34%) had a DOB, and 38 patients (45%) had clinical DRUJ instability. Patients with DRUJ instability had a significantly higher incidence of foveal TFCC tears (30/38, vs 15/47, p < 0.001), while DOB was absent (36/38 vs. 20/47, p < 0.001). Among 45 patients with foveal TFCC tears, only 1 out of 13 patients with a DOB had DRUJ instability, whereas 29 out of 32 patients without a DOB had DRUJ instability (p < 0.001). The odds ratio for DRUJ instability was 11.7 (95% CI 2.9-47.5, p=0.001) for foveal TFCC tear and 54.2 (95% CI 8.2-358.2, p < 0.001) for the absent DOB.

Clinical DRUJ instability was less common when the DOB is present in patients with foveal TFCC tears, which supports DOB's role as a secondary DRUJ stabilizer.
Clinical DRUJ instability was less common when the DOB is present in patients with foveal TFCC tears, which supports DOB's role as a secondary DRUJ stabilizer.
Safety of reconstructive microsurgery in elderly patients is still a topic of debate, because no conclusive evidence exists that provides indications and risk evaluation in elderly patients. The purpose of this study, which the Italian Society for Plastic, Reconstructive, and Aesthetic Surgery (SICPRE) has promoted, is to evaluate the safety and the complication risk of elective reconstructive microsurgery in elderly patients as well as to identify patient- or procedure-related risk factors. The secondary aim is to evaluate the predictive role for complications of the Geriatric 8 score (G8).

A total of 194 consecutive patients from 18 centers, aged 65 or older, who received an elective microsurgical flap between April 2018 and April 2019 were prospectively evaluated. Patient-related, treatment-related, and outcomes data were recorded and statistically analyzed through multiple-adjusted logistic regression models.

Our study showed an increased risk of complications and a longer hospitalization in patients aged ≥75 years with the American Society of Anesthesiologists (ASA) score ≥3 (or G8 score ≤11) as compared to patients >65 years of age and <75 years of age who undergo reconstruction with a microsurgical flap. Instead, flap survival did not significantly vary with age, but was associated only with ASA score ≥3 (or G8 score ≤11) and surgeries that last longer than 480 min; however, flap survival (92.3%) was slightly lower than that commonly reported for in the general population.

Reconstructive microsurgery in the elderly is generally safe. The ASA score is easier and quicker than the G8 score and equally useful for risk stratification.
Reconstructive microsurgery in the elderly is generally safe. The ASA score is easier and quicker than the G8 score and equally useful for risk stratification.
Preservation rhinoplasty (PR) is considered to be an innovative approach with high patient satisfaction. However, little is known about its functional outcomes and radiological analyses.

In this prospective clinical study, 30 patients (20 female and 10 male patients, mean age 30.7 ±9.8 years) were operated on between 2017 and 2021. Radiological assessment was evaluated by cone beam computed tomography before surgery and at final follow-up. Patient assessment regarding their outcome was assessed at final follow-up using a validated questionnaire (rhinoplasty outcomes evaluation questionnaire=ROE).

After a mean follow-up of 8.4 ± 5 months (range=1 - 18 months), radiological analyses denoted an overall improved internal nasal valve (INV) angle after surgery (preoperative=20.77° ± 3.2° vs. postoperative=21.82° ± 5.7°, p=0.18). Those results are in accordance with an overall high patient satisfaction for both function and aesthetics (ROE score 18.4 ± 4.3).

Our study showed a preserved and widened INV angle after PR, along with high patient satisfaction.

III.
III.
An organic etiology underpinning post-finasteride syndrome, a constellation of persistent sexual, neuropsychiatric, and somatic symptoms reported by men exposed to 5-alpha-reductase inhibitors (5ARIs), is debated. Persistent changes in neurosteroid levels or androgen receptor expression have been implicated.

To determine whether differences in gene expression, especially in relevant biologic pathways, exist between patients reporting post-finasteride syndrome symptoms and healthy controls.

This was a single center, prospective case-control study taking place between March 2013 and September 2018. Men 18 years and older being evaluated for sexual dysfunction (study) or circumcision (control) were eligible for inclusion. Twenty-six men with a history of 5ARI use reporting symptoms consistent with post-finasteride syndrome were included in the patient group. Twenty-six men consented to inclusion in the control group.

The primary outcome measure is gene expression data for genes affecting neurosteroid levexual dysfunction. Howell S, Song W, Pastuszak A, et al. Differential Gene Expression in Post-Finasteride Syndrome Patients. J Sex Med 2021;XXXXX-XXX.
Transgender and gender-diverse (TGD) adolescents experience increased mental health risk compared to cisgender peers. Limited research suggests improved outcomes following gender-affirmation. This study examined mental healthcare and psychotropic medication utilization among TGD youth compared to their siblings without gender-related diagnoses and explored utilization patterns following gender-affirming care.

This retrospective cohort study used military healthcare data from 2010-2018 to identify mental healthcare diagnoses and visits, and psychotropic medication prescriptions among TGD youth who received care for gender dysphoria before age 18, and their siblings. Logistic and Poisson regression analyses compared mental health diagnosis, visits, and psychotropic prescriptions of TGD youth to their siblings, and compared healthcare utilization pre- and post-initiation of gender-affirming pharmaceuticals among TGD adolescents.

3,754 TGD adolescents and 6,603 cisgender siblings were included. TGD adolescents were more likely to have a mental health diagnosis (OR 5.
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