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Background: Inguinal hernia repair is a common surgical procedure, with more than 20 million cases yearly. Choice between mesh types varies in clinical practice. To compare light-weight polypropylene (LW-PP, 34-36 g/m2) and heavy-weight polypropylene (HW-PP, 95 ​g/m2) meshes., Methods: Data from patients who underwent open inguinal hernia repair between 2020 and 2022. Selection criteria ensured homogeneity. Endpoints were to assess the impact of different mesh weights on overall health-related quality of life (HRQoL), using Short Form 36 (SF-36), and to monitor postoperative complications., Results: Two hundred patients were included in both groups. Lateral and direct hernias occurred in 60.5 ​% and 39.5 ​%. According to EHS, 31.5 ​%, 22.3 ​% and 46.2 ​% were classified as size 1, 2, 3. Follow-up showed similar HRQoL at 30-days, with a favorable trend towards LW-PP mesh offering fewer limitations, better comfort, and improved general health after 12-months. No difference in postoperative paresthesia, wound hematoma, and interference with daily activities., Conclusion: 1-year after surgery HRQoL evaluation highlights the non-inferiority of LW-PP. Mesh selection should be tailored, aiming at improving outcomes and postoperative comfort., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Colonic diverticulosis and diverticular disease are among the most common gastrointestinal disorders encountered in clinical practice. These Italian guidelines focus on the diagnosis and management of diverticulosis and diverticular disease in the adult population, providing practical and evidence-based recommendations for clinicians. Experts from five Italian scientific societies, constituting a multidisciplinary panel, conducted a comprehensive review of meta-analyses, systematic reviews, randomised controlled trials, and observational studies to formulate 14 PICO questions. The assessment of the quality of the evidence and the formulation of the recommendations were carried out using an adaptation of the GRADE methodology. The guidelines covered the following topics: i) Management of diverticulosis; ii) Symptomatic uncomplicated diverticular disease: diagnosis and treatment; iii) Acute diverticulitis: diagnosis and treatment; iv) Management of diverticular disease complications; v) Prevention of recurrent acute diverticulitis; vi) Interventional management of diverticular disease., Competing Interests: Declaration of competing interest No conflict of interest to declare., (Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Rhinoplasty traditionally presents a challenge for plastic surgeons. The aim of this article is to describe a new alar base lining graft (ABLG) in augmentation rhinoplasty to prevent and treat alar retraction., Methods: In this study, the authors retrospectively reviewed patients treated with ABLG at their institution between July of 2019 and April of 2022. The authors describe their technique and graft. At a minimum follow-up time of 1 year, postoperative photographs were taken, and patients were reassessed, evaluating aspects such as global symmetry, shape, and contour of the nose. Patient satisfaction was investigated according to the rhinoplasty outcomes evaluation questionnaire., Results: A total of 42 patients were included in the study. They reported significant satisfaction with the aesthetic results, as demonstrated by the mean postoperative rhinoplasty outcomes evaluation score. Alar contracture in secondary rhinoplasty was treated successfully. None of the grafts was extruded or collapsed. Wounds healed without reported major infection., Conclusion: This study demonstrates that ABLG is safe, contributes to improved functional and aesthetic outcomes, results in a high patient satisfaction rate, and has a low rate of postoperative complications., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a potentially life-threatening autoimmune disorder which is strongly associated with ovarian teratomas in young female patients. The primary aim is to highlight the importance of considering NMDAR encephalitis in the differential diagnosis of young female patients presenting with acute or subacute neuropsychiatric symptoms, especially when accompanied by ovarian teratomas., Case Description: This case report and literature review detail the presentation, diagnosis, and treatment of a 35-year-old G4P3 Indigenous woman who initially presented with neuropsychiatric symptoms and fever, having a history of extensive drug and alcohol use. Misdiagnosed initially, the patient's lack of response to standard treatments led to further investigations, revealing paraneoplastic anti-NMDAR encephalitis secondary to a left ovarian teratoma. The report examines the treatment regimen followed, including prednisolone, intravenous immunoglobulin, rituximab injections, and laparoscopic bilateral salpingo-oophorectomy., Conclusions: This case underscores the critical need for increased clinical vigilance for anti-NMDAR encephalitis in patients, particularly young females, presenting with neuropsychiatric symptoms and potential ovarian teratomas. The literature review accompanying the case report provides valuable insights into the presentation, diagnosis, and management of this complex condition. Lastly, this study emphasised the diagnostic challenges inherent in paraneoplastic neuropsychiatric syndromes, advocating for a multidisciplinary approach in similar clinical scenarios., (© 2024. Crown.)

Background : Deep inferior epigastric perforator (DIEP) flap breast reconstruction is an increasingly popular technique, but controversy exists regarding the optimal use of closed suction drains (CSD) at the abdominal donor site. This narrative review synthesizes current evidence on CSD application, criteria for placement/removal, and complications in DIEP flap procedures. Alternative techniques and implications for postoperative care are also discussed. Methods : A systematic search was conducted in August 2024 across several databases to identify English language studies related to CSD use in DIEP flap breast reconstruction. Inclusion criteria consisted of original research on aspects such as CSD volume criteria, timing, complications, alternatives like progressive tension sutures, and impact on showering and patient outcomes. References from relevant papers were hand-searched. Results : The review found a lack of consensus on CSD protocols, with drainage volume triggering removal varying widely from 5 mL to 80 mL daily. While CSD may reduce seroma/hematoma formation, earlier removal (≤3 days) did not increase complications and shortened hospital stay. Progressive tension sutures show promise as an alternative, with evidence of comparable or reduced complications and improved recovery versus CSD. The safety of early showering with drains remains unclear. Conclusions : Although CSD aims to minimize postoperative complications, more rigorous randomized trials are needed to establish evidence-based practices for the timing of removal and demonstrate the efficacy of emerging drain-free techniques on patient-centered outcomes. Standardized criteria could reduce practice variability. Further research should also explore the long-term impact of drainage strategies on aesthetic and functional results.

Background: Thigh lift, first described by Lewis in 1957, consists of thigh recontouring by various strategies. In post-bariatric thigh lift (PBTL), the technical details become fundamental due to both patient comorbidities and increased risk of complications. Moreover, post-bariatric weight loss affects the thighs, resulting in significant tissue redundancy, inner excess, lower thigh deformity, later excess, and buttocks ptosis. With the present paper, a systematic review of PBTL procedures is reported and a comprehensive classification system is proposed, aiming to improve their medical and surgical management., Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was carried out by searching the PubMed (MEDLINE) database from May 2004 to May 2024 using the search string "thighplasty OR thigh lift OR post-bariatric thighplasty OR (thigh lift AND weight loss) OR (thigh lift AND liposuction)". Original studies discussing PBTL with a minimum of three clinical cases were eligible for inclusion., Results: The final synthesis included 17 articles and 496 patients. The articles were published in the last 20 years. Several papers discussed significant PBTL surgical strategies and technical measures., Conclusions: PBTL is challenging because of both technical factors and complex comorbidities of post-bariatric patients. This comprehensive assessment of PBTL may help in choosing the appropriate treatment based on a patient's individual needs. Liposuction-assisted inner thigh lift with combined horizontal-vertical scars and skin-only excision is effective and versatile for most patients. However, select cases may benefit from alternative and more invasive strategies. Artificial intelligence is a topic of growing interest, and it will probably become increasingly relevant in PBTL., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background/Objectives : Abdominoplasties are prevalent surgical procedures for improving lower abdominal contours, necessitating effective pain management. Insufficient management can increase opioid usage, dependency risks, and adverse effects. This review investigates various strategies in abdominoplasty pain management, aiming to reduce opioid dependence and improve patient care. Methods : A comprehensive systematic literature search (MEDLINE, Cochrane, PubMed, Web of Science, EMBASE) was conducted, spanning from their inception to January 2024, using keywords such as 'abdominoplasty' and 'postoperative pain management'. Included studies focused on nonopioid interventions in adults, encompassing various study designs. Non-English publications and those not meeting outcome criteria were excluded. Bias in studies was assessed using specific tools for randomized and non-randomized trials. Results : Thirty-five studies, published between 2005 and 2024, were included, involving 3636 patients with an average age of 41.8. Key findings highlighted the effectiveness of transversus abdominis plane blocks in reducing opioid use and pain. Pain pump catheters also showed promise in improving pain management and reducing opioid dependency. Local anesthetics demonstrated varying degrees of efficacy, while other alternatives like ketamine and NSAIDs successfully reduced postoperative pain and opioid requirements. The bias assessment of the RCTs revealed "low" and "some concerns" ratings, indicating a need for more detailed methodology reporting and management of missing data. The cohort studies generally attained "moderate" risks of bias, primarily due to confounding variables and outcome data reporting. Conclusions : Nonopioid analgesics show potential in postoperative pain management for abdominoplasties, but further research is needed to confirm their effectiveness and optimize patient care.

Autologous breast reconstruction, especially using the deep inferior epigastric artery perforator (DIEP) flap, is increasingly seen as a reliable, safe, and long-term alternative to implant-based reconstruction. Despite the recognized advantages of the DIEP flap for breast reconstruction, successful realization demands excellent anatomical knowledge, a thorough understanding of autologous breast reconstruction concepts and advanced microsurgical skills. Given that the porcine model is widely employed in microsurgical training, our study aims to assess this model using validated outcomes, with the objective of evaluating the enhancement in a surgeon's learning curve following training with this model. Forty DIEP flaps were harvested on 20 swines by a single surgeon in "Pius Branzeu Center" (Timisoara, RO) and "Drazan Institute" (University of veterinary of Brno, CZ) laboratories for microsurgical training in 6months (January 2015-June 2015). Then we analyzed data from 40 DIEP flaps harvested by the same surgeon on first 20 consecutive patients undergoing DIEP flap breast reconstruction. Perforator dissection time, surgeon-determined dissection difficulty score (DDS) and venous congestion rate were collected for each flap in porcine model and in patients, then compared and analyzed. The mean of DDS score analysis in first and second swines group dissection resulted as statistically significant (P-value 0.0001), while it was not statistically significant between those analyzed in the second group of swines dissected and patients (P-value 0.8037). Reduction in perforator dissection time between the two swines' groups and in venous congestion rates from the first swines groups to the second to the human group resulted statistically significant too (P-value respectively 0.0001 and 0.0079). The porcine model has been used for a long time together with other animal models for microsurgical training. Our study confirms and objective by validated scores that it is a valid and reliable model, comparable to the human one and which mimics the dissection of human perforating vessels., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background : Tumescent local anesthesia (TLA) is widely used in esthetic surgery due to its ability to reduce complications, eliminate the need for general anesthesia, provide effective pain control, and shorten hospitalization times. Methods : This study evaluates the use of TLA in 80 patients who underwent augmentation mastopexy between 2010 and 2022. A tumescent solution containing 500 mg lidocaine, 672 mg sodium bicarbonate, and 1 mg epinephrine in 1000 mL of saline was infiltrated, with an average of 300 mL per breast. The surgical technique involved creating a subpectoral pocket for textured round implants (250-400 cc), followed by careful hemostasis. Results : No patients required conversion to general anesthesia, and there were no signs of toxicity or major complications. Minor complications included wound dehiscence (6.2%), hematoma (2.5%), and capsular contracture (2.5%). Pain management satisfaction at 3 months post-surgery was rated as "outstanding" by 12.5% of patients, "excellent" by 67.5%, and "good" by 20%. The longest follow-up was 6 years, with no implant ruptures except one (1.2%). Conclusions : While the study did not include a control group or statistical analysis, the findings suggest that TLA is a safe and effective alternative to general anesthesia for augmentation mastopexy, providing excellent pain control and a low rate of complications.

Eyelid melanoma (EM) is a malignant neoplasm accounting for around 1% of eyelid malignancies. Because of its rarity, most of our knowledge of EM is currently based on studies of cutaneous melanomas located elsewhere. Accordingly, this study aimed to specifically evaluate EM characteristics, management strategies, and prognosis. A retrospective study was carried out on patients diagnosed with EM at Careggi University Hospital, Florence between May 2012 and May 2022. In addition, a systematic review of relevant literature was conducted, encompassing studies published from 2013 to 2023. Clinical, histopathological, therapeutical, and prognostic data were analyzed to assess the metastasis rate and the 5-year survival rate of patients with EM. Separate data were extracted for in situ and invasive disease. Our original study included 19 patients diagnosed with EM with a 5-year survival rate of 100% for in situ and 83.3% for invasive EM. The literature review identified five poorly detailed large database reviews and 14 original studies on EM with an overall 5-year survival rate of 79.7%. The present research indicates that EM is a challenging malignancy, but has a relatively better prognosis and easier management than other melanomas of the head and neck region. These are probably related to the anatomical location which leads to early diagnosis. Therefore, EM should be considered as a specific disease requiring dedicated treatment. Based on the personal authors' experience and comprehensive overview of the current knowledge, a dedicated protocol is proposed., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives : Despite CTAs being critical for preoperative planning in autologous breast reconstruction, experienced plastic surgeons may have differing preferences for which side of the abdomen to use for unilateral breast reconstruction. Large language models (LLMs) have the potential to assist medical imaging interpretation. This study compares the perforator selection preferences of experienced plastic surgeons with four popular LLMs based on CTA images for breast reconstruction. Materials and Methods : Six experienced plastic surgeons from Australia, the US, Italy, Denmark, and Argentina reviewed ten CTA images, indicated their preferred side of the abdomen for unilateral breast reconstruction and recommended the type of autologous reconstruction. The LLMs were prompted to do the same. The average decisions were calculated, recorded in suitable tables, and compared. Results : The six consultants predominantly recommend the DIEP procedure (83%). This suggests experienced surgeons feel more comfortable raising DIEP than TRAM flaps, which they recommended only 3% of the time. They also favoured MS TRAM and SIEA less frequently (11% and 2%, respectively). Three LLMs-ChatGPT-4o, ChatGPT-4, and Bing CoPilot-exclusively recommended DIEP (100%), while Claude suggested DIEP 90% and MS TRAM 10%. Despite minor variations in side recommendations, consultants and AI models clearly preferred DIEP. Conclusions : Consultants and LLMs consistently preferred DIEP procedures, indicating strong confidence among experienced surgeons, though LLMs occasionally deviated in recommendations, highlighting limitations in their image interpretation capabilities. This emphasises the need for ongoing refinement of AI-assisted decision support systems to ensure they align more closely with expert clinical judgment and enhance their reliability in clinical practice.

Background: The regulatory landscape for plastic and cosmetic surgery across the country plays a crucial role in shaping the practices within its premises, ensuring patient safety, and maintaining ethical standards in the medical community. This review examines the distinct regulatory frameworks that govern Australia, United Kingdom (UK), and Italy practices, focusing on the nuances that influence the professional accountability and safety measures in place., Methods: A comprehensive scoping review was conducted, exploring the legal and regulatory frameworks governing plastic and reconstructive surgery in Australia, the UK, and Italy. Databases such as PubMed, Scopus, and Google Scholar were searched for relevant studies from infinity to May 2024, which were then analyzed to compare regulatory practices, qualification requirements, and their implications on patient safety and professional accountability., Results: Each country presents a unique set of regulations that reflect their individual medical, legal, and cultural contexts. In Australia, the Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia impose stringent criteria for differentiating between "cosmetic surgeons" and "plastic surgeons". The UK's approach, governed by the General Medical Council (GMC), emphasizes ethical conduct, informed consent, and transparent advertising. Italy's regulatory framework varies slightly with a specific focus on the qualifications and titles of practitioners., Conclusions: The study underscores the importance of stringent regulations in plastic and cosmetic surgery, advocating for enhanced regulatory measures and comprehensive education on the qualifications of practitioners. It is imperative that these standards are maintained and adapted as necessary to protect patients in the rapidly evolving landscape of cosmetic and plastic surgery across the different regions., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-24-244/coif). W.M.R. serves as an unpaid associate editor of Gland Surgery from March 2023 to February 2028. I.S. serves as an unpaid editorial board member of Gland Surgery from September 2023 to August 2025. The other authors have no conflicts of interest to declare., (2024 Gland Surgery. All rights reserved.)

Abdominal pain in patients with diverticular disease (DD) can be challenging in clinical practice. Patients with symptomatic uncomplicated diverticular disease (SUDD) and patients with a previous acute diverticulitis (PD) may share a similar clinical pattern, difficult to differentiate from irritable bowel syndrome (IBS). We used standardized questionnaires for DD (short and long lasting abdominal pain) and IBS (following Rome III Criteria) to assess clinical features of abdominal pain, in terms of presence, severity and length, in SUDD and PD patients. One hundred and forty-eight SUDD and 118 PD patients completed all questionnaires. Short-lasting pain was more frequent in SUDD than PD patients (p = 0.007). Number of long-lasting pain episodes was higher in SUDD (6.6 ± 11.9) compared to PD patients (3.4 ± 6.9) (p < 0.001). PD patients reported long-lasting pain more frequently in the lower left abdomen (p < 0.001), while in SUDD it was more frequently diffuse (p = 0.002) or localized in the lower right quadrant (p = 0.009). Features associated with long-lasting pain (fever, confinement to bed, consultations, antibiotic therapy, hospitalization) were more often reported in PD patients. IBS criteria were reported in 28.2% of patients and were more frequent in SUDD than PD patients (37.2% vs 17.1%, p < 0.001). SUDD and PD patients presented different pattern of abdominal pain (length, number of long lasting episodes, site and associated features), with a third reporting overlap with IBS. Further observational studies are needed to better characterize abdominal symptoms in DD patients, especially in those not fulfilling IBS criteria.Trial registration: The REMAD Registry is registered as an observational study in ClinicalTrial.gov (ID: NCT03325829)., (© 2024. The Author(s).)

Background: Amyloidosis is characterized by extracellular amyloid protein deposition. When amyloidosis intersects with basal cell carcinoma (BCC), it introduces complex diagnostic challenges. This study explored the overlap between primary localized cutaneous amyloidosis (PLCA) and BCC, examining amyloid deposits in BCC, systemic amyloidosis risk in PLCA, and various treatment methods., Methods: Two case studies were discussed, followed by a literature review, in which PubMed, Web of Science, EMBASE, and the Cochrane Library databases were utilized. The search, covering studies from infinity up to January 2024, focused on "cutaneous amyloidosis," "basal cell carcinoma," and related terms. Articles in English detailing the clinical presentation, diagnostic methods, treatment, and outcomes of cutaneous amyloidosis mimicking BCC were included. Data extraction and synthesis were performed by two independent reviewers., Case Series: This study highlighted two cases exemplifying the complexity of diagnosing BCC and PLCA. The first case (a 64-year-old with a nodule on the cheek) and the second (a 67-year-old with a nodular lesion on the upper lip cheek) were initially suspected as BCC and were later identified as PLCA upon histopathological examination., Discussion: The diagnosis of amyloidosis within BCC nodules remains a diagnostic challenge. Although their coexistence is relatively prevalent, their local recurrence rates remain debatable. Various diagnostic and therapeutic approaches have been suggested, such as topical creams and phototherapy. However, none have garnered conclusive and consistent evidence to establish reliable clinical application., Conclusion: The findings emphasized the importance of considering alternative pathologies in differential diagnoses. Future research should focus on understanding systemic amyloidosis risks and optimizing care for both conditions., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The integration of neck liposuction with FaceTite Manipulus Radiofrequency (RF) technology and buccal fat pad excision for enhanced neck rejuvenation promise heightened precision and efficacy in sculpting the neck and jawline. Neck liposuction, coupled with RF technology, provides controlled thermal energy for adipose tissue treatment and collagen remodeling, while buccal fat pad excision offers refined contouring of the lower face and neck. This integrated approach aims to optimize patient outcomes and advance the field of esthetic plastic surgery., Methods: A prospective study was conducted from 2016 to 2023 on 80 consecutive patients who presented to the author's private clinic and required neck remodeling surgery for esthetic purposes. Patients were monitored and clinic appointments were scheduled at intervals of 0, 1, 3, 6 and 12 months post-treatment for evaluation. A tape measure recorded submental length at 1 and 6 months, and a satisfaction survey was administered one week before surgery and after six months. Physicians assessed improvement using a five-point scale for patient satisfaction and a four-point scale for overall improvement., Results: All patients underwent successful RFAL treatment, consistently achieving satisfaction with the outcomes. The average reduction in submental length measured 23 mm during the 6-month follow-up period. Additionally, the removal of buccal fat pads played a pivotal role in facial slimming and enhancing the esthetics of the upper cheek region., Conclusions: The integration of neck liposuction with FaceTite RF technology and buccal fat pad excision offers a promising approach for enhanced neck rejuvenation and facial contouring. This combined method demonstrates heightened precision and efficacy in sculpting the neck and jawline, aiming to optimize patient outcomes and advance the field of esthetic plastic surgery., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2024. The Author(s).)

Fournier's gangrene (FG) is a rare form of necrotizing fasciitis of the perineal, genital, or perianal region. It is characterized by an aggressive course and high mortality rate, over 20%. FG demands immediate treatment including resuscitation maneuvers, intravenous antibiotic therapy and early surgical debridement. Background/Objectives : The gold-standard treatment for FG is surgical reconstruction. However, up to date, no precise guidelines exist. Thus, we decided to systematically review the literature, focusing on FG contemporary approaches to reconstructive surgery, aiming to analyze the various reconstructive strategies and their specific indications. Methods : A systematic review was carried out according to the PRISMA statement by searching various databases from April 2014 to April 2024, using the terms ''Fournier Gangrene OR Fournier Gangrene Reconstruction OR Fournier Gangrene Treatment OR Fournier Gangrene Plastic Surgery OR Necrotizing Fasciitis OR Necrotizing Fasciitis AND Reconstruction". The eligibility criteria included original studies aimed at discussing FG reconstruction with at least three clinical cases. Results : The final synthesis included 38 articles, and 576 reconstructions were described. Of these, 77.6% were minimally invasive strategies (direct closure, secondary healing, grafts, and local random flaps), while more invasive reconstructions (loco-regional flaps based on known vascular anatomy) were adopted in 22.4%. No free flaps were reported. Conclusions : FG requires immediate medical interventions including broad-spectrum antibiotic therapy, surgical debridement, adjuvant therapies, and reconstructive surgeries. Taking into account the anatomical characteristics of the inguinal-crural region, skin grafts and local random flaps could offer versatile and effective reconstructions for most FG cases, while the more invasive strategies should be reserved for very few cases. Future research is warranted to define an FG dedicated reconstruction protocol.

Background: Artificial intelligence (AI) has emerged as a powerful tool in various medical fields, including plastic surgery. This study aims to evaluate the performance of ChatGPT, an AI language model, in elucidating historical aspects of plastic surgery and identifying potential avenues for innovation., Methods: A comprehensive analysis of ChatGPT's responses to a diverse range of plastic surgery-related inquiries was performed. The quality of the AI-generated responses was assessed based on their relevance, accuracy, and novelty. Additionally, the study examined the AI's ability to recognize gaps in existing knowledge and propose innovative solutions. ChatGPT's responses were analysed by specialist plastic surgeons with extensive research experience, and quantitatively analysed with a Likert scale., Results: ChatGPT demonstrated a high degree of proficiency in addressing a wide array of plastic surgery-related topics. The AI-generated responses were found to be relevant and accurate in most cases. However, it demonstrated convergent thinking and failed to generate genuinely novel ideas to revolutionize plastic surgery. Instead, it suggested currently popular trends that demonstrate great potential for further advancements. Some of the references presented were also erroneous as they cannot be validated against the existing literature., Conclusion: Although ChatGPT requires major improvements, this study highlights its potential as an effective tool for uncovering novel aspects of plastic surgery and identifying areas for future innovation. By leveraging the capabilities of AI language models, plastic surgeons may drive advancements in the field. Further studies are needed to cautiously explore the integration of AI-driven insights into clinical practice and to evaluate their impact on patient outcomes., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266., (© 2024. The Author(s).)

Background: Abdominoplasty is a critical aesthetic and functional procedure for individuals who have undergone massive weight loss. Numerous techniques have been proposed to optimize aesthetic results while minimizing complications., Methods: This prospective study examined 500 patients who underwent abdominoplasty during body-contouring procedures between 1 January 2018 and 31 December 2021 at a tertiary center. The Skin-Adipose Tissue-Muscle (SAM) protocol was employed to analyze the operative strategies and complication rates and compare them with the existing literature. Furthermore, patient satisfaction and aesthetic outcomes were measured one year post-operation using a comprehensive four-point questionnaire evaluated by the patients themselves and two independent surgeons., Results: Participants had an average age of 34.8 years and a mean BMI of 31.1 kg/m 2 . The surgeries included 328 full abdominoplasties and 172 T-inverted abdominoplasties. Notable complications included wound infection (4%), wound dehiscence (8.6%), tissue necrosis (0.6%), seroma (8.4%), and hematoma (2.6%). A higher BMI was correlated with an increased risk of complications and lower patient satisfaction. Data analysis was performed using Stata version 18 software., Conclusions: The increasing prevalence of obesity highlights an urgent need for more bariatric surgeries and subsequent abdominoplasties to mitigate the effects of massive weight loss. A crucial link between elevated BMI and a heightened risk of postoperative complications, emphasizing the necessity for standardized surgical protocols tailored to individuals with higher BMI, was noted. Innovatively, future studies must further investigate the intricate dynamics between BMI and surgical risks. Exploring and establishing uniform, adaptive surgical guidelines promise to revolutionize patient care by significantly reducing complications and enhancing recovery and satisfaction following abdominoplasty.

Background: Abdominoplasty is a common operation, used for a range of cosmetic and functional issues, often in the context of divarication of recti, significant weight loss, and after pregnancy. Despite this, patient-surgeon communication gaps can hinder informed decision-making. The integration of large language models (LLMs) in healthcare offers potential for enhancing patient information. This study evaluated the feasibility of using LLMs for answering perioperative queries., Methods: This study assessed the efficacy of four leading LLMs-OpenAI's ChatGPT-3.5, Anthropic's Claude, Google's Gemini, and Bing's CoPilot-using fifteen unique prompts. All outputs were evaluated using the Flesch-Kincaid, Flesch Reading Ease score, and Coleman-Liau index for readability assessment. The DISCERN score and a Likert scale were utilized to evaluate quality. Scores were assigned by two plastic surgical residents and then reviewed and discussed until a consensus was reached by five plastic surgeon specialists., Results: ChatGPT-3.5 required the highest level for comprehension, followed by Gemini, Claude, then CoPilot. Claude provided the most appropriate and actionable advice. In terms of patient-friendliness, CoPilot outperformed the rest, enhancing engagement and information comprehensiveness. ChatGPT-3.5 and Gemini offered adequate, though unremarkable, advice, employing more professional language. CoPilot uniquely included visual aids and was the only model to use hyperlinks, although they were not very helpful and acceptable, and it faced limitations in responding to certain queries., Conclusion: ChatGPT-3.5, Gemini, Claude, and Bing's CoPilot showcased differences in readability and reliability. LLMs offer unique advantages for patient care but require careful selection. Future research should integrate LLM strengths and address weaknesses for optimal patient education., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2024. The Author(s).)

Periocular sebaceous carcinoma (PSC) is a rare, aggressive, and potentially metastatic adnexal malignancy. Due to the ability of PSC to resemble several benign and malignant conditions, diagnosis is often delayed or mistaken. In addition, even with a known diagnosis, choosing the right treatment is still an open debate. For this reason, we decided to review the most up-to-date literature on PSC and propose a dedicated procedural protocol to help clinicians when dealing with PSC. A PubMed search was carried out using the terms "Sebaceous Carcinoma", "Adnexal Periocular Cancer", "Sebaceous Carcinoma AND eyelid", "Periocular Sebaceous Carcinoma", and "Ocular Adnexa". Pertinent studies published in English from 1997 up to December 2022 were compared to the selection criteria and if suitable, included in this review. Through the initial search, 84 articles were selected. Of these, 36 were included in the final study. Several papers explored different diagnostic and therapeutic strategies regarding PSC diagnosis and management. In light of the current literature review and the multidisciplinary experience of three clinical centers, a dedicated procedural protocol is proposed. PSC diagnosis may be achieved through accurate clinical evaluation, but it requires histopathologic confirmation, which can be challenging. Dermoscopy, in vivo reflectance confocal microscopy, and optical coherence tomography may facilitate PSC clinical examination, while immunohistochemistry stains may support histological diagnosis. Appropriate disease staging is necessary before choosing the treatment, as local disease requires radically different treatment compared to advanced disease. In addition, recent innovations in nonsurgical treatments, including radio-chemotherapy, immunotherapy, and targeted therapy, may be a viable option in the most challenging cases., (© 2024 the International Society of Dermatology.)

Background: Diverticular disease (DD) represents a common gastrointestinal condition that poses a heavy burden on healthcare systems worldwide. A high degree of uncertainty surrounds the therapeutic approaches for the control of symptoms in patients with symptomatic uncomplicated diverticular disease (SUDD) and primary and secondary prevention of diverticulitis and its consequences., Objectives: To review the current knowledge and discuss the unmet needs regarding the management of SUDD and the prevention of acute diverticulitis., Eligibility Criteria: Randomized trials, observational studies, and systematic reviews on lifestyle/dietary interventions and medical treatment (rifaximin, mesalazine, and probiotics) of SUDD or prevention of acute diverticulitis., Sources of Evidence: The literature search was performed from inception to April 2023, without language restriction, following the modified Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) reporting guidelines. References of the papers selected were checked to identify additional papers of potential interest. The final list of references was evaluated by a panel of experts, who were asked to check for any lack of relevant studies., Charting Methods: Information on patient population, study design, intervention, control group, duration of the observation, and outcomes assessed was collected by two authors independently., Results: The review shows a high degree of uncertainty about therapeutic interventions, both dietary/lifestyle and pharmacological, in patients with SUDD, because of the scarcity and weakness of existing evidence. Available studies are generally of low quality, heterogeneous, and outdated, precluding the possibility to draw robust conclusions. Similarly, acute diverticulitis prevention has been seldom investigated, and there is a substantial lack of evidence supporting the role of dietary/lifestyle or pharmacological approaches to reduce the risk of diverticulitis., Conclusion: The lack of robust evidence regarding therapeutic options for gastrointestinal symptoms in SUDD patients and for primary and secondary prevention of acute diverticulitis remains an important unmet need in the management of DD., Competing Interests: R. C. has served as a speaker and consultant for Alfasigma/Alfa Wassermann, Allergan, Malesci, Almirall, Fresystem, Shire, Sofar, Biocure, Co.GE.DI, and Valeas, and has received research funding from Alfasigma/Alfa Wassermann, Fresystem, Sofar, and CO.GE.DI. G. M. Served as an advisory board member for AlfaSigma, EG Pharma, Monteresearch srl, Recordati, and Cineca. Received lecture grants from Agave, AlfaSigma, Bromatech, Clorofilla, Echosens, Ferring, Mayoly Spindler, Menarini, and Schwabe Pharma. G. B. has served as a speaker and consultant for Alfasigma/Alfa Wassermann, Allergan, CaDiGroup, Danone, Ironwood, Italchimici, Malesci, Menarini, Noos, Shire, Synergy, Sofar, Yakult, and Zespri, and has received research funding from Alfasigma/Alfa Wassermann, Cadigroup, Falk Pharma, IMA, Italchimici, Lorenzatto, Parmalat Sofar, Yakult, and Zespri. B. A. has served as a speaker and consultant for Alfasigma and Aboca. M. C. and F. R. none to declare., (© The Author(s), 2024.)

Introduction: Obesity is a chronic disease with significant health implications. Bariatric surgery is an effective treatment for obesity-related conditions. However, the timing of post-bariatric body contouring surgery remains uncertain., Materials and Methods: We conducted a retrospective study of 1336 patients who underwent bariatric surgery. We analyzed weight trends and variations after different types of bariatric procedures. The Pittsburgh Index was used to evaluate body contouring outcomes., Results: The majority of patients were women, and sleeve gastrectomy was the most common procedure. Weight loss varied depending on the surgery type, with different outcomes for male and female patients. The Pittsburgh Index remained stable in most cases., Conclusion: Our findings suggest that the timing of body contouring surgery should be tailored to the type of bariatric procedure performed. Abdominoplasty is recommended as a last procedure for sleeve gastrectomy patients, while gastric bypass patients are suitable candidates for early abdominoplasty. Biliopancreatic diversion patients should stabilize their weight before abdominoplasty. The Pittsburgh Index is a valuable tool for assessing the timing of post-bariatric plastic surgery. Further research is needed to optimize surgical planning and outcomes., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Purpose: The integration of artificial intelligence and machine learning technologies into the medical field has brought about remarkable advancements, particularly in the domain of clinical decision support systems. However, it is uncertain how they will perform as clinical decision-makers., Methods: This prospective cohort study evaluates the potential of incorporating ChatGPT-4 plus into the management of subcapital fifth metacarpal fractures. The treatment recommendations provided by ChatGPT-4 plus were compared with those of the two control groups-the attending clinic plastic surgeon and an independent expert panel. The primary outcome measures, operative or conservative, were compared between the groups. Intraclass correlation of 0.61 infers moderate reliability in the consistency of recommended management plans across all groups., Results: Key predictors for opting for operative management, regardless of the decision-maker, included clinical signs of scissoring, extension deficit, and radiographic evidence of intra-articular extension., Conclusions: These findings support the potential for artificial intelligence applications in enhancing diagnostic and treatment decisions., Type of Study/level of Evidence: Therapeutic IV., Competing Interests: No benefits in any form have been received or will be received related directly to this article., (© 2024 The Authors.)

Clear cell acanthoma (CCA) and squamous cell carcinoma (SCC) represent distinct entities within dermatological oncology, each posing unique diagnostic and therapeutic challenges. CCA is a rare, benign epidermal growth, often not associated with human papillomavirus (HPV) infection, whereas SCC, a more aggressive form of skin cancer, has been linked to both ultraviolet (UV) exposure and HPV. Understanding the co-occurrence of these conditions in a single patient can enhance diagnostic accuracy and therapeutic outcomes. We report a 64-year-old male who underwent an operation for a verruciform lesion in the right groin, which was diagnosed as HPV-positive CCA alongside keratinised SCC. A literature search across January 2024 revealed limited evidence directly linking HPV to CCA, suggesting a need for further investigation. The speculative association between HPV and CCA warrants deeper exploration, especially considering the potential for HPV to contribute to lesion development through indirect mechanisms. The coexistence of CCA and SCC in an elderly patient presents a unique clinical scenario. This emphasises the need for vigilant diagnosis and tailored treatment strategies, highlighting the gap in understanding the pathogenesis of CCA, particularly its potential association with HPV. Further research is crucial for elucidating the complex interactions governing these conditions and for developing targeted interventions.

Background: Atrophic scarring is a severe form-disfiguring sequela of acne, which can lead to negative effect on patients' life. Fractional microplasma radiofrequency (RF) has emerged as a promising modality, leveraging dermal fibroblast remodeling to enhance aesthetic results for scars and hyperpigmentation. This study evaluates the efficacy and safety of high-power fractional microplasma RF for atrophic acne scars, considering patient tolerance to procedural discomfort., Methods: In this prospective study, 95 Chinese patients with atrophic facial acne scars underwent three sessions of fractional microplasma RF treatment, with assessments at 1, 3, and 6 months post-treatment. Patients were categorized based on treatment power: Group A (50-70 W) and Group B (70-85 W). Efficacy was determined by three independent dermatologists using digital photographs and Echelle d'Evaluation Clinique des Cicatrices d'Acné (ECCA) scores, and patient-reported outcomes gauged satisfaction levels., Results: Eighty-six patients completed the study. Significant improvements were observed, with a reduction in ECCA scores from 107.21 to 42.27 (P<0.05), demonstrating notable scar amelioration across both groups, albeit with a superior outcome in Group B. All patients experienced transient side effects such as pain, erythema, and edema, deemed tolerable with no long-term adverse effects reported. The treatment was well-received, with high satisfaction rates, underscoring its efficacy and acceptable safety profile., Conclusion: Fractional microplasma RF therapy, particularly at higher power settings, is an effective and safe option for treating atrophic acne scars, offering significant aesthetic improvement with manageable discomfort. This modality presents a valuable addition to acne scar management strategies, especially for patients with darker skin tones seeking minimal downtime and reduced risk of hyperpigmentation., (© 2024 The Author(s).)

Background: Artificial intelligence (AI) has the potential to transform preoperative planning for breast reconstruction by enhancing the efficiency, accuracy, and reliability of radiology reporting through automatic interpretation and perforator identification. Large language models (LLMs) have recently advanced significantly in medicine. This study aimed to evaluate the proficiency of contemporary LLMs in interpreting computed tomography angiography (CTA) scans for deep inferior epigastric perforator (DIEP) flap preoperative planning., Methods: Four prominent LLMs, ChatGPT-4, BARD, Perplexity, and BingAI, answered six questions on CTA scan reporting. A panel of expert plastic surgeons with extensive experience in breast reconstruction assessed the responses using a Likert scale. In contrast, the responses' readability was evaluated using the Flesch Reading Ease score, the Flesch-Kincaid Grade level, and the Coleman-Liau Index. The DISCERN score was utilized to determine the responses' suitability. Statistical significance was identified through a t-test, and P-values < 0.05 were considered significant., Results: BingAI provided the most accurate and useful responses to prompts, followed by Perplexity, ChatGPT, and then BARD. BingAI had the greatest Flesh Reading Ease (34.7±5.5) and DISCERN (60.5±3.9) scores. Perplexity had higher Flesch-Kincaid Grade level (20.5±2.7) and Coleman-Liau Index (17.8±1.6) scores than other LLMs., Conclusion: LLMs exhibit limitations in their capabilities of reporting CTA for preoperative planning of breast reconstruction, yet the rapid advancements in technology hint at a promising future. AI stands poised to enhance the education of CTA reporting and aid preoperative planning. In the future, AI technology could provide automatic CTA interpretation, enhancing the efficiency, accuracy, and reliability of CTA reports., (© 2024 The Author(s).)

Introduction: The use of the dorsal hamate as a free osteochondral bone graft or vascularized bone flap has become the mainstay for large, comminuted middle phalanx volar lip fractures. To date, few studies have been conducted in the assessment of donor site morbidity for the hemi-hamate graft or flap, and none have discussed modes of repair or reconstruction of this donor site., Methods: A retrospective analysis of 14 hemi-hamate arthroplasty (HHA) procedures, including 6 vascularized and 8 non-vascularized grafts, from two surgeons was performed. Four hamate defect reconstruction techniques were utilized: no formal reconstruction, autologous bone grafting, gel foam, or synthetic bone substitute. The dorsal capsule was repaired with either extensor retinaculum grafting or by direct closure. Wrist range of motion, pain scores, and radiographic alignment were assessed., Results: At 6 months follow-up, all patients achieved full, pain-free wrist motion compared to the uninjured side, with visual analog scale pain scores of 0. Serial radiographs showed maintained carpal alignment without instability or subluxation. No differences based on the hamate defect reconstruction method or capsular repair technique was demonstrated., Conclusion: Safe return to pain free, unrestricted wrist function is achievable after HHA, regardless of hamate donor site management. Adequate dorsal capsular repair appears critical to prevent instability. Further study is needed to compare techniques, but choice may be guided by surgeon preference in the absence of clear evidence., Competing Interests: The authors declare no conflict of interests., (© 2024 The Author(s).)

Introduction: Augmentation rhinoplasty traditionally represents a serious challenge for plastic surgeons. The association with centrofacial lipofilling is a great approach to achieve harmonious, aesthetic results. The aim of this article is to describe our personal association between Augmentation Rhinoplasty and Centrofacial Lipofilling (ARCL) in non-Caucasian patients. Materials and Methods: In this study, we retrospectively reviewed patients treated with ARCL at our institution between January 2019 and December 2023. We described our personal approach and technique. At a minimum follow-up time of one year, post-operative pictures were taken, and patients were reassessed, evaluating aspects such as global symmetry, shape and contour of the nose, and facial harmony and rejuvenation; finally, patients' satisfaction was investigated according to the ROE questionnaire and the modified S-GAIS. Results: A total of 307 patients were included in the study. They reported a significant satisfactory aesthetic result in nasal image and facial harmony, as the mean postoperative ROE and S-GAIS score show. None of the grafts extruded or collapsed. Wounds healed without reported major infection. Conclusions: This study has demonstrated that ARCL is a safe approach that contributes to improve functional and aesthetic outcomes, has a high patient satisfaction rate, and limited post-operative complications.

Background: Breast cancer with about 2.3 million diagnoses and 685,000 deaths globally is the most frequent malignancy in the female population. Continuous research has led to oncological and reconstructive advances in the management of breast cancer, thus improving outcomes and decreasing patient morbidity. Nowadays, the submuscular expander and prosthesis (E/P) implant-based breast reconstruction (IBR) accounts for 73% of all reconstructions. Despite its widely accepted efficacy, the technique is not free from complications and up to 28% of cases require revision surgery for mechanical complications such as capsular contracture, implant displacement/rotation, and implant rupture. With this study, the authors report their experience in the management of E/P IBR revision surgery through the technique of Selective Capsulotomies (SCs) and Partial Capsulectomy (PC)., Methods: A retrospective study was conducted on patients who had previously undergone E/P IBR and presented for revision reconstruction between January 2013 and May 2023 at the Department of Plastic Surgery of the University of Siena, Italy. Reasons for revision included capsular contracture, implant displacement/rotation, and implant rupture. Revision reconstructions involved SC and PC with implant replacement. Fat grafting was also considered. The complication rate was evaluated by analysis of patients' medical records. Patients' satisfaction with the treatment was assessed through a specific questionnaire., Results: 32 patients underwent revision surgeries. No early complication occurred. Recurrence rate was assessed at 19% with average follow-up of 59 months (range: 13-114 months). The average time between revision surgery and recurrence was 3 years (range: 1-6 years). 23 patients answered the questionnaire and were overall satisfied with the treatments (8.29/10)., Conclusions: SC possibly associated to PC is a valuable option for E/P IBR revision surgery with minimal complications, reduced surgical trauma, short operating time, and relatively low recurrence risk. In addition, treated patients are overall satisfied with the results over time., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Pietro Susini et al.)

Background: The use of acellular dermal matrix (ADM) in breast reconstruction was described for the first time in 2000s. Recently, ADMs have been used not only in reconstructive surgery but also in cosmetic breast surgery for both primary and revision indications. Therefore, the matrices represent an important support to recent surgical techniques for breast augmentation in treatment or prevention of complications. Conversely, ADMs can affect operative times, costs, and additional complications related to their placement. A review of the literature was carried out to evaluate the efficacy, safety, and indication for the use of these matrices in cosmetic breast surgery., Methods: A literature review was conducted including manuscripts published up to April 2023 on breast augmentation using ADM. PubMed and MEDLINE were the databases used for research. The keywords used were "Breast augmentation" and "Acellular Dermal Matrix." Non-English language articles have been excluded., Results: The initial search for "breast augmentation" yielded 7900 results, which were further reviewed for "Acellular Dermal Matrices" in breast augmentation, selecting 74 articles. Following further screening, 12 articles were included in the review. A total of 787 patients were treated with breast augmentation and ADM placement. The main indication was capsular contracture (60%)., Conclusions: The current evidence from the published scientific literature, albeit limited, suggests the indication for the use of ADM in revision surgery, to support the prosthetic pocket, to minimize the risk of capsular contracture and its recurrence., (© 2024 The Author(s).)

Background : The integration of artificial intelligence in healthcare has led to the development of large language models that can address various medical queries, including intraoperatively. This study investigates the potential of ChatGPT in addressing intraoperative questions during the deep inferior epigastric perforator flap procedure. Methods : A series of six intraoperative questions specific to the DIEP flap procedure, derived from real-world clinical scenarios, were proposed to ChatGPT. A panel of four experienced board-certified plastic surgeons evaluated ChatGPT's performance in providing accurate, relevant, and comprehensible responses. Results : The Likert scale demonstrated to be medically accurate, systematic in presentation, and logical when providing alternative solutions. The mean readability score of the Flesch Reading Ease Score was 28.7 (±0.8), the Flesch-Kincaid Grade Level was 12.4 (±0.5), and the Coleman-Liau Index was 14.5 (±0.5). Suitability-wise, the DISCERN score of ChatGPT was 48 (±2.5) indicating suitable and comprehensible language for experts. Conclusions : Generative AI tools such as ChatGPT can serve as a supplementary tool for surgeons to offer valuable insights and foster intraoperative problem-solving abilities. However, it lacks consideration of individual patient factors and surgical nuances. Nevertheless, further refinement of its training data and rigorous scrutiny under experts to ensure the accuracy and up-to-date nature of the information holds the potential for it to be utilized in the surgical field.

Background: While current wound treatment strategies often focus on antimicrobials and topical agents, the role of nutrition in wound healing and aesthetic outcomes is crucial but frequently overlooked. This review assesses the impact of specific nutrients and preoperative nutritional status on surgical outcomes., Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library, from the inception of the study to October 2023. The study focused on the influence of macronutrients and micronutrients on aesthetic outcomes, the optimization of preoperative nutritional status, and the association between nutritional status and postoperative complications. Inclusion criteria were English language peer-reviewed articles, systematic reviews, meta-analyses, and clinical trials related to the impact of nutrition on skin wound healing and aesthetic outcomes. Exclusion criteria included non-English publications, non-peer-reviewed articles, opinion pieces, and animal studies., Results: Omega-3 fatty acids and specific amino acids were linked to enhanced wound-healing and immune function. Vitamins A, B, and C and zinc positively influenced healing stages, while vitamin E showed variable results. Polyphenolic compounds showed anti-inflammatory effects beneficial for recovery. Malnutrition was associated with increased postoperative complications and infections, whereas preoperative nutritional support correlated with reduced hospital stays and complications., Conclusion: Personalized nutritional plans are essential in surgical care, particularly for enhanced recovery after surgery protocols. Despite the demonstrated benefits of certain nutrients, gaps in research, particularly regarding elements such as iron, necessitate further studies. Nutritional assessments and interventions are vital for optimal preoperative care, underscoring the need for more comprehensive guidelines and research in nutritional management for surgical patients., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s).)

Breast cancer-related lymphedema (BCRL) affects approximately 20% of women after breast cancer therapy. Advances in treatment have increased the life expectancy; thus, the prevalence of BCRL will continue to rise with the number of cancer survivors, hence the need to develop strategies to prevent this condition. We provide a systematic review of the literature on the primary prevention of BCRL by prophylactic lymphatic surgery (PLS). Between June and August 2022, we conducted a search of PubMed, Google Scholar and Cochrane. In the end, a total of eighteen papers were selected. The eleven studies without a control group reported only 15 of 342 patients who developed lymphedema at least six months after PLS (4.59%). The seven studies with a control group included 569 patients, 328 cases and 241 controls. Among the cases, 36 (10%) developed lymphedema. In contrast, the incidence of lymphedema in the controls was 40% (98 of 241 patients). The formulation of definite recommendations in favor of PLS is hindered by low-quality studies. There is no consensus on which technique should be preferred, nor on whether adjuvant radiotherapy might affect the efficacy of PLS. Randomized controlled trials are mandatory to conceive evidence-based recommendations.

Background : Illicit substance sales facilitated by social media platforms are a growing public health issue given recent increases in overdose deaths, including an alarming rise in cases of fentanyl poisoning. However, little is known about how online users evaluate what features of social media posts convey safety, which can influence their intent to source illicit substances. Objectives : This study adapts conjoint analysis which assessed how attributes of social media posts (i.e., features) influence safety evaluations of mock posts selling illicit substances. 440 participants were recruited online for self-reporting use or purchase of controlled substances or prescription medicines recreationally. The following attributes were tested: drug packaging, drug offerings, profile photo of seller, payment info provided, and use of emojis. Results : Packaging was ranked the most important attribute (Average Importance =43.68, Offering=14.94, Profile=13.86, Payment=14.11, Emoji=13.41), with posts that displayed drugs in pill bottles assessed as the most safe. Attribute levels for advertising multiple drugs, having a blank profile photo, including payment information, and including emojis also ranked higher in perceived safety. Rankings were consistent across tested demographic factors (i.e., gender, age, and income). Survey results show that online pharmacies were most likely to be perceived as safe for purchasing drugs and medications. Additionally, those who were younger in age, had higher income, and identified as female were more likely to purchase from a greater number of platforms. Conclusions : These findings can assist in developing more precise content moderation for platforms seeking to address this ongoing threat to public safety.

The spread of misinformation and conspiracies has been an ongoing issue since the early stages of the internet era, resulting in the emergence of the field of infodemiology (i.e., information epidemiology), which investigates the transmission of health-related information. Due to the high volume of online misinformation in recent years, there is a need to continue advancing methodologies in order to effectively identify narratives and themes. While machine learning models can be used to detect misinformation and conspiracies, these models are limited in their generalizability to other datasets and misinformation phenomenon, and are often unable to detect implicit meanings in text that require contextual knowledge. To rapidly detect evolving conspiracist narratives within high volume online discourse while identifying nuanced themes requiring the comprehension of subtext, this study describes a hybrid methodology that combines natural language processing (i.e., topic modeling and sentiment analysis) with qualitative content coding approaches to characterize conspiracy discourse related to 5G wireless technology and COVID-19 on Twitter (currently known as 'X'). Discourse that focused on correcting 5G conspiracies was also analyzed for comparison. Sentiment analysis shows that conspiracy-related discourse was more likely to use language that was analytic, combative, past-oriented, referenced social status, and expressed negative emotions. Corrections discourse was more likely to use words reflecting cognitive processes, prosocial relations, health-related consequences, and future-oriented language. Inductive coding characterized conspiracist narratives related to global elites, anti-vax sentiment, medical authorities, religious figures, and false correlations between technology advancements and disease outbreaks. Further, the corrections discourse did not address many of the narratives prevalent in conspiracy conversations. This paper aims to further bridge the gap between computational and qualitative methodologies by demonstrating how both approaches can be used in tandem to emphasize the positive aspects of each methodology while minimizing their respective drawbacks., Competing Interests: Authors TKM and ZL are employees of the startup company S-3 Research LLC. S-3 Research is a startup funded and currently supported by the National Institutes of Health – National Institute of Drug Abuse through a Small Business Innovation and Research contract for opioid-related social media research and technology commercialization. TKM is also the CEO and a member of S-3 Research LLC with ownership. Author reports no other conflict of interest associated with this manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Haupt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Type 2 diabetes (T2D) has a complex pathophysiology which makes modeling the disease difficult. We aimed to develop a novel model for simulating T2D in vitro, including hyperglycemia, hyperlipidemia, and variably elevated insulin levels targeting muscle cells. We investigated insulin resistance (IR), cellular respiration, mitochondrial morphometry, and the associated function in different T2D-mimicking conditions in rodent skeletal (C2C12) and cardiac (H9C2) myotubes. The physiological controls included 5 mM of glucose with 20 mM of mannitol as osmotic controls. To mimic hyperglycemia, cells were exposed to 25 mM of glucose. Further treatments included insulin, palmitate, or both. After short-term (24 h) or long-term (96 h) exposure, we performed radioactive glucose uptake and mitochondrial function assays. The mitochondrial size and relative frequencies were assessed with morphometric analyses using electron micrographs. C2C12 and H9C2 cells that were treated short- or long-term with insulin and/or palmitate and HG showed IR. C2C12 myotubes exposed to T2D-mimicking conditions showed significantly decreased ATP-linked respiration and spare respiratory capacity and less cytoplasmic area occupied by mitochondria, implying mitochondrial dysfunction. In contrast, the H9C2 myotubes showed elevated ATP-linked and maximal respiration and increased cytoplasmic area occupied by mitochondria, indicating a better adaptation to stress and compensatory lipid oxidation in a T2D environment. Both cell lines displayed elevated fractions of swollen/vacuolated mitochondria after T2D-mimicking treatments. Our stable and reproducible in vitro model of T2D rapidly induced IR, changes in the ATP-linked respiration, shifts in energetic phenotypes, and mitochondrial morphology, which are comparable to the muscles of patients suffering from T2D. Thus, our model should allow for the study of disease mechanisms and potential new targets and allow for the screening of candidate therapeutic compounds.

Introduction: According to the American Society of Plastic Surgery, cosmetic surgery procedures for "ethnic patients" are annually increasing. Ethnic rhinoplasty traditionally represents a difficult challenge for plastic surgeons. Herein, we describe our personal technique to ethnic rhinoplasty to achieve a harmonious nose maintaining the characteristics of individual ethnicity and identity., Materials and Methods: In this study, we retrospectively reviewed ethnic patients treated with rhinoplasty at our institution between January 2019 and October 2022. We described our personal rhinoplasty technique step by step. At a minimum follow-up time of six months, postoperative pictures were taken, and patients were reassessed, evaluating aspects such as global symmetry and shape and contour of the nose. Finally, patient satisfaction was investigated according to rhinoplasty outcomes evaluation (ROE) questionnaire., Results: A total of 1321 patients were included in the study. They reported a significant satisfactory aesthetic result in nasal image, as indicated by the mean postoperative ROE score (92.12). No cases of nasal contracture were recorded. None of the grafts was extruded or collapsed. Wounds healed without reported major infection., Conclusion: This study demonstrated that our approach is a safe procedure that contributes to improved functional outcomes with a high patient satisfaction rate and a low rate of postoperative complication. The creation of a solid base structure, nasal skin preparation, and an integrated patient approach are key elements of this surgery., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Artificial intelligence (AI), notably Generative Adversarial Networks, has the potential to transform medical and patient education. Leveraging GANs in medical fields, especially cosmetic surgery, provides a plethora of benefits, including upholding patient confidentiality, ensuring broad exposure to diverse patient scenarios, and democratizing medical education. This study investigated the capacity of AI models, DALL-E 2, Midjourney, and Blue Willow, to generate realistic images pertinent to cosmetic surgery. We combined the generative powers of ChatGPT-4 and Google's BARD with these GANs to produce images of various noses, faces, and eyelids. Four board-certified plastic surgeons evaluated the generated images, eliminating the need for real patient photographs. Notably, generated images predominantly showcased female faces with lighter skin tones, lacking representation of males, older women, and those with a body mass index above 20. The integration of AI in cosmetic surgery offers enhanced patient education and training but demands careful and ethical incorporation to ensure comprehensive representation and uphold medical standards.

Background and Objectives : The use of oncoplastic techniques has spread widely in the last decade, with an expansion of the indications and demonstration of excellent oncological safety profiles. A potential downside may be the increased complication rates, which could influence the timing of adjuvant therapy. To date, there is increasing evidence that negative pressure therapy on closed wounds can reduce complication rates after surgery. From this perspective, we tested the use of portable negative pressure wound dressings (NPWDs) in oncoplastic surgery to minimize early post-operative admissions to the outpatient clinic and prevent surgical complications. Materials and Methods: An observational prospective cohort study was conducted on a population of patients who underwent quadrantectomy and wise-pattern reduction mammoplasty for breast cancer. The primary objective of the study is represented by the evaluation of the impact of NPWD on post-operative outcomes in an oncoplastic surgery setting. Patients enrolled between January 2021 and January 2023 were divided into two groups, the conventional dressing (CD) group and the NPWD group, by a simple randomization list. Results : A total of 100 patients were enrolled, with 52 in the CD group and 48 in the NPWD group. The use of NPWD significantly reduced the wound dehiscence rate (2.0% vs. 7.7% p = 0.002) and the number of one-month postoperative admissions to our clinic (3.8 ± 1.1 vs. 5.7 ± 1.3 p = 0.0009). Although not significant, it is possible to note a trend of reduction of clinically relevant postoperative total complications in patients treated with NPWDs. Conclusions : NPWDs may represent a useful tool in the post-surgical management of complex oncoplastic procedures, ensuring less wound dehiscence. Furthermore, the use of these dressings led to a significant reduction in admissions to the clinic, promoting a lower use of resources by hospitals and effective prevention of possible complications.

The use of hyaluronic acid (HA)-based aesthetic therapies is growing steadily, and according to the International Society of Aesthetic Plastic Surgery, more than 4.3 million aesthetic procedures using HA were performed in 2019, an increase of 15.7% than 2018. More people are offering these types of services, often without proper training or qualifications. Therefore, there is an increasing number of reports in the literature relating to possible adverse events, with subsequent therapeutic problems and more or less serious consequences for patients. The aim of this research is to carry out a review of the literature in order to evaluate the impact of hyaluronic acid-based fillers in patients with autoimmune inflammatory diseases, in particular scleroderma and Systemic Lupus Erythematosus (SLE). Although HA plays a central role in the inflammatory process, the use of HA-based fillers in patients with autoimmune inflammatory diseases is still controversial. HA, in fact, in inflamed tissues helps to propagate the inflammatory response and, injected in the form of a dermal filler, could potentially promote reactivation of the underlying disease. For this reason, many specialists do not perform HA-based aesthetic treatments in patients with scleroderma or SLE. However, recent scientific evidence suggests that the use of HA-based fillers in patients with scleroderma can lead to improvement of skin lesions, with satisfactory results. In the literature, there are no clinical studies that contraindicate the administration of HA-based dermal fillers in patients with inflammatory disease., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

The COVID-19 pandemic has resulted in significant morbidity and mortality worldwide. Management of the pandemic has relied mainly on SARS-CoV-2 vaccines, while alternative approaches such as meditation, shown to improve immunity, have been largely unexplored. Here, we probe the relationship between meditation and COVID-19 disease and directly test the impact of meditation on the induction of a blood environment that modulates viral infection. We found a significant inverse correlation between length of meditation practice and SARS-CoV-2 infection as well as accelerated resolution of symptomology of those infected. A meditation "dosing" effect was also observed. In cultured human lung cells, blood from experienced meditators induced factors that prevented entry of pseudotyped viruses for SARS-CoV-2 spike protein of both the wild-type Wuhan-1 virus and the Delta variant. We identified and validated SERPINA5, a serine protease inhibitor, as one possible protein factor in the blood of meditators that is necessary and sufficient for limiting pseudovirus entry into cells. In summary, we conclude that meditation can enhance resiliency to viral infection and may serve as a possible adjuvant therapy in the management of the COVID-19 pandemic., Competing Interests: Dr. Joe Dispenza's company, Encephalon, runs the meditation retreats. All other authors have no conflicts of interest., (Published by Elsevier Inc.)

Background: Increased public health and regulatory scrutiny concerning the youth vaping epidemic has led to greater attention to promotion and sales of vaping products on social media platforms., Objectives: We used unsupervised machine learning to identify and characterise sale offers of electronic nicotine delivery systems (ENDS) and associated products on Instagram. We examined types of sellers, geographic ENDS location and use of age verification., Methods: Our methodology was composed of three phases: data collection, topic modelling and content analysis. We used data mining approaches to query hashtags related to ENDS product use among young adults to collect Instagram posts. For topic modelling, we applied an unsupervised machine learning approach to thematically categorise and identify topic clusters associated with selling activity. Content analysis was then used to characterise offers for sale of ENDS products., Results: From 70 725 posts, we identified 3331 engaged in sale of ENDS products. Posts originated from 20 different countries and were roughly split between individual (46.3%) and retail sellers (43.4%), with linked online sellers (8.8%) representing a smaller volume. ENDS products most frequently offered for sale were flavoured e-liquids (53.0%) and vaping devices (20.5%). Online sellers offering flavoured e-liquids were less likely to use age verification at point of purchase (29% vs 64%) compared with other products., Conclusions: Instagram is a global venue for unregulated ENDS sales, including flavoured products, and access to websites lacking age verification. Such posts may violate Instagram's policies and US federal and state law, necessitating more robust review and enforcement to prevent ENDS uptake and access., Competing Interests: Competing interests: MN, CB, JL, and TKM are employees of the startup company S-3 Research LLC. S-3 Research is a startup funded and currently supported by the National Institutes of Health – National Institute of Drug Abuse through a Small Business Innovation and Research contract for opioid-related social media research and technology commercialisation. Author reports no other conflict of interest associated with this manuscript., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: In 2019, the state of Massachusetts signed into law the first statewide sales restrictions of flavored ENDS/tobacco products for both physical and online shops in response to a previous executive order to curb E-Cigarette, or Vaping Product, Use Associated Lung Injury (EVALI) cases that were surging throughout the nation., Methodology: This study obtained licensure data from the Massachusetts Department of Revenue, to observe the changes in retail licensure comparing the pre ban (October 2018-August 2019) and post ban periods (October 2020- August 2021). A series of linear regression tests were conducted on both periods using census tract data to explore potential associations with sociodemographic covariates, including median age, median household income, and population proportion by gender, age, and race/ethnicity groups., Results: Analysis of the Massachusetts post-ban period (October 2020-August 2021) found that new tobacco retail licenses issued decreased by 52.9% (n = 968) when compared to the pre-ban period (October 2018-August 2019) of 1831. A significant positive association was discovered between change in new retailer count and proportion male population (2.48 ± 1.05, P = .018) as well as proportion Hispanic population (1.19 ± .25, P < .001) at the census tract level., Conclusion/discussion: Our analysis indicates that, following the temporary MA flavor sales ban, the total number of licenses decreased, though decreases were more pronounced for new licenses when compared to continuing licenses. Higher increases in new tobacco retailer density were significantly associated with concentration of male and Hispanic populations., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MN, ZL, and TKM are employees of the startup company S-3 Research LLC. S-3 Research is a startup funded and currently supported by the National Institutes of Health – National Institute of Drug Abuse through a Small Business Innovation and Research contract for opioid-related social media research and technology commercialization. Author reports no other conflict of interest associated with this manuscript., (© The Author(s) 2023.)

Background: Acute Kidney Injury (AKI) incidence has continued to rise and is recognized as a major risk factor for kidney disease progression and cardiovascular complications. Early recognition of factors associated with post-AKI complications is fundamental to stratifying patients that could benefit from closer follow-up and management after an episode of AKI. Recent studies have shown that proteinuria is a prevalent sequela after AKI and a strong predictor of complications post-AKI. This study aims to evaluate the frequency and timing of the development of de-novo proteinuria after an AKI episode in patients with known kidney function and no prior history of proteinuria., Methods: We retrospectively analyzed data from adult AKI patients with pre- and post-kidney function information between Jan 2014 and March 2019. The presence of proteinuria determined before and after index AKI encounter was based on ICD-10 code and/or urine dipstick and UPCR during the follow-up period., Results: Of 9697 admissions with AKI diagnoses between Jan 2014 and March 2019, 2120 eligible patients with at least one assessment of Scr and proteinuria before AKI index admission were included in the analysis. The median age was 64 (IQR 54-75) years, and 57% were male. 58% (n-1712) patients had stage 1 AKI, 19% (n = 567) stage 2 AKI, and 22% (n = 650) developed stage 3 AKI. De novo proteinúria was found in 62% (n = 472) of patients and was already present by 90 days post-AKI in 59% (209/354). After adjusting for age and comorbidities, severe AKI (stage 2/3 AKI) and diabetes, were independently associated with increased risk for De novo proteinuria., Conclusion: Severe AKI is an independent risk factor for subsequent de novo proteinuria post-hospitalization. Further prospective studies are needed to determine whether strategies to detect AKI patients at risk of proteinuria and early therapeutics to modify proteinuria can delay the progression of kidney disease., (© 2023. The Author(s).)