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In transabdominal histotripsy, ultrasound pulses are focused into the body to noninvasively destroy soft tissues via cavitation. However, the ability to focus is limited by phase aberration, or decorrelation of the ultrasound pulses due to spatial variation in the speed of sound throughout heterogeneous tissue. Phase aberration shifts, broadens, and weakens the focus, thereby reducing the safety and efficacy of histotripsy therapy. This paper reviews and discusses aberration effects in histotripsy and in related therapeutic ultrasound techniques (e.g., high intensity focused ultrasound), with an emphasis on aberration by soft tissues. Methods for aberration correction are reviewed and can be classified into two groups: model-based methods, which use segmented images of the tissue as input to an acoustic propagation model to predict and compensate phase differences, and signal-based methods, which use a receive-capable therapy array to detect phase differences by sensing acoustic signals backpropagating from the focus. The relative advantages and disadvantages of both groups of methods are discussed. Importantly, model-based methods can correct focal shift, while signal-based methods can restore substantial focal pressure, suggesting that both methods should be combined in a 2-step approach. Aberration correction will be critical to improving histotripsy treatments and expanding the histotripsy treatment envelope to enable non-invasive, non-thermal histotripsy therapy for more patients. [ABSTRACT FROM AUTHOR]

Objective: This article describes an updated step‐by‐step protocol for transmucosal abutment selection and treatment sequencing after immediate implant placement in the esthetic zone. Clinical Considerations: Current surgical and prosthetic concepts strive to preserve hard and soft‐tissues to provide optimal esthetics at the implant‐abutment interface. Consequently, restoring implants in the esthetic zone with transmucosal abutments presents a great challenge and must take into consideration implant depth, angulation, and bucco‐lingual position as well as transmucosal height and space for an optimized emergence profile of the restoration and the dimensions of the anterior tooth to be restored. The proper selection of the type, shape, and dimensions of implant components and connections, determined by the product portfolio offered by the implant manufacturer, play a critical role in the ability to adequately address these challenges. This article provides an update on surgical and prosthetic workflows for single implant restorations in the esthetic zone. Conclusions: Following esthetic, mechanical, and biologic principles, the long‐term success of implant‐supported restorations in the esthetic zone is directly correlated to proper execution and sequencing of surgical and prosthetic treatment steps, especially after immediate implant placement. These steps must be critically assessed based on the current scientific evidence to achieve the desired clinical outcomes on a predictable and consistent basis. Clinical Significance: Selection of surgical and prosthetic treatment protocols to achieve ideal esthetic outcomes and emergence profiles in implant dentistry is often a great challenge, not only determined by technical and clinical skills of the provider but also by the type and dimensions of implant components and connections offered by the manufacturer. Following certain decision‐making principles and workflows are key for clinical success with implant‐supported restorations after immediate implant placement the esthetic zone. [ABSTRACT FROM AUTHOR]

The problem of constitutive model calibration has traditionally been addressed using least squares-based curve-fitting approaches. In recent years, Bayesian approaches have been proposed to calibrate constitutive models with an eye on accounting for the variability in experimental data. Generally, the likelihood function in this approach focuses only on the data and any correlations between neighboring data-points are ignored. In this work, we demonstrate a straightforward approach to incorporating data correlations into the likelihood function that harnesses gradient information. This approach leads to improved fits and better identifiability of the constitutive model parameters. [ABSTRACT FROM AUTHOR]

A study by Tsvetkov et al. recently published a proposed novel form of copper-induced cell death in Science; however, few studies have looked into the possible mechanism in soft tissue sarcoma (STS). Herein, this study sought to investigate the function of cuproptosis-related genes (CRGs) in the development of tumor-associated immune cells and the prognosis of sarcoma. Herein, this study aimed to explore the role of cuproptosis-related genes (CRGs) in the development, tumor-associated immune cells, and the prognosis of sarcoma. Methods: The prognostic model was established via the least absolute shrinkage and selection operator (LASSO) algorithm as well as multivariate Cox regression analysis. The stromal scores, immune scores, ESTIMA scores, and tumor purity of sarcoma patients were evaluated by the ESTIMATE algorithm. Functional analyses were performed to investigate the underlying mechanisms of immune cell infiltration and the prognosis of CRGs in sarcoma. Results: Two molecular subgroups with different CRG expression patterns were recognized, which showed that patients with a higher immune score and more active immune status were prone to have better prognostic survival. Moreover, GO and KEGG analyses showed that these differentially expressed CRGs were mainly enriched in metabolic/ions-related signaling pathways, indicating that CRGs may have impacts on the immune cell infiltration and prognosis of sarcoma via regulating the bioprocess of mitochondria and consequently affecting the immune microenvironment. The expression levels of CRGs were closely correlated to the immunity condition and prognostic survival of sarcoma patients. Conclusions: The interaction between cuproptosis and immunity in sarcoma may provide a novel insight into the study of molecular mechanisms and candidate biomarkers for the prognosis, resulting in effective treatments for sarcoma patients. [ABSTRACT FROM AUTHOR]

Purpose: Intrathecal baclofen (ITB) is a well-known treatment option for cerebral palsy (CP) spasticity. The combination of soft-tissue release and ITB for spasticity is common. This study compared patients who had soft-tissue release before ITB (PRE-ITB), soft-tissue release at the same time as ITB (ST-ITB), and no ITB (NON-ITB) but had soft-tissue release at a similar age as PRE-ITB. Methods: Inclusion criteria were a spastic or mixed nonambulatory CP diagnosis, prior hip adductor surgery, no prior reconstructive surgery, and at least a five-year post-operative follow-up. Thirty hips were identified as PRE-ITB, 20 hips as ST-ITB, and 43 hips as NON-ITB. The primary outcome variables were the subsequent hip surgery during the study period and/or a migration percentage ≥ 50% at the final follow-up defined as "unsuccessful hip." Results: The mean follow-up duration was 9.0 years (SD 2.4) for PRE-ITB, 9.4 (SD 3.6) for ST-ITB, and 9.3 (SD 3) for NON-ITB. The odds of unsuccessful outcomes were not different between NON-ITB and PRE-ITB but were lower for the ST-ITB group. The need for subsequent osteotomies or revision adductor surgery was significantly higher in ST-ITB compared with PRE-ITB (p = 0.02) or NON-ITB (p = 0.015). The incidence of surgical site infection over the whole follow-up period was higher in ST-ITB (40%) compared with PRE-ITB (13.3%, p = 0.035) and NON-ITB (0, p < 0.001). Conclusion: The addition of tone management with ITB did not reduce the need for later hip surgery but did increase the risk for surgical site infection. [ABSTRACT FROM AUTHOR]

Background: Sarcomas are a heterogeneous group of rare malignant tumors with more than 100 subtypes. Accurate diagnosis remains challenging due to a lack of characteristic molecular or histomorphological hallmarks. A DNA methylation-based tumor profiling classifier for sarcomas (known as sarcoma classifier) from the German Cancer Research Center (Deutsches Krebsforschungszentrum) is now employed in selected cases to guide tumor classification and treatment decisions at our institution. Data on the usage of the classifier in daily clinical routine are lacking. Methods: In this single-center experience, we describe the clinical course of five sarcoma cases undergoing thorough pathological and reference pathological examination as well as DNA methylation-based profiling and their impact on subsequent treatment decisions. We collected data on the clinical course, DNA methylation analysis, histopathology, radiological imaging, and next-generation sequencing. Results: Five clinical cases involving DNA methylation-based profiling in 2021 at our institution were included. All patients' DNA methylation profiles were successfully matched to a methylation profile cluster of the sarcoma classifier's dataset. In three patients, the classifier reassured diagnosis or aided in finding the correct diagnosis in light of contradictory data and differential diagnoses. In two patients with intracranial tumors, the classifier changed the diagnosis to a novel diagnostic tumor group. Conclusions: The sarcoma classifier is a valuable diagnostic tool that should be used after comprehensive clinical and histopathological evaluation. It may help to reassure the histopathological diagnosis or indicate the need for thorough reassessment in cases where it contradicts previous findings. However, certain limitations (non-classifiable cases, misclassifications, unclear degree of sample purity for analysis and others) currently preclude wide clinical application. The current sarcoma classifier is therefore not yet ready for a broad clinical routine. With further refinements, this promising tool may be implemented in daily clinical practice in selected cases. [ABSTRACT FROM AUTHOR]

Facial soft tissue trauma is a common case in the emergency department. Handling this case requires special attention because the face is a prominent part and a marker of identity. Thalassemia is a blood disorder that causes the sufferer to experience anemia, where thalassemia patients must undergo blood transfusions for life. This case will describe a 14- year-old girl who came to the Emergency Department of Hasan Sadikin Hospital Bandung with complaints of bleeding on the eyelids due to a motorcycle accident, from the patient's history it is known that the patient is a thalassemia patient who routinely undergoes transfusions every month. As a result of this hemorrhage caused a significant decrease in hemoglobin value in the patient, so that emergency management was carried out, namely suturing the patient's traumatized eyelid and blood transfusion. Emergency management of facial soft tissue trauma in children with thalassemia must be done carefully to control bleeding and restore the function and aesthetics of traumatized facial tissues, besides that we also collaborate with pediatric colleagues for the management of anemia due to thalassemia in this patient. [ABSTRACT FROM AUTHOR]

Angiomatoid fibrous histiocytoma (AFH) is a rare neoplasm described for the first time by Enzinger in 1979, and classified by World Health Organization 2020 as intermediate malignant potential neoplasm. It mostly occurs in the subcutis and is characterized by varying proportions of epithelioid, ovoid and spindle cells in a nodular and syncytial growth pattern, with some hemorrhagic pseudovascular spaces. In this paper, we report the clinical case of a 62-year-old man who presented with AFH on the right arm, and relapsed three years after first surgical excision. After a further three years, the patient presented with an intramuscular localization of AFH, and 12 months after this, a pulmonary metastasis of AFH was diagnosed. Given the rarity of the spreading of AFH, we performed Fluorescence In Situ Hybridization (FISH) and we detected EWSR1::CREB1 gene fusion. [ABSTRACT FROM AUTHOR]

Background: Most authors cite that an ingrown toenail is caused by an ingress of the nail plate into the periungual soft tissues, though a minority of authors believe that soft tissue pathology is primarily responsible. Consequently, when nail surgery is indicated, there is a dichotomy in the treatment approach aimed at either nail/nail matrix resection or soft tissue debridement. Aim: The aim of this research is to collate, code and chart data regarding ingrown toenails managed with soft tissue procedures - without nail or nail matrix resection. Methods: A scoping review of the literature on soft tissue resection techniques for the management of ingrown toenails without nail or nail matrix resection was carried out using current scoping review practice and PRISMA-ScR guidelines. Results: 25 articles were included in the review. Most of these papers were case studies or case series. Multiple surgical techniques were found but with no clear best technique identified due to low-quality research using heterogeneous methodologies. Conclusions: The evidence for the soft tissue management of ingrown nails is lacking in quality but warrants further consideration. High quality, perspective studies need to be performed to be eligible for future Cochrane reviews. [ABSTRACT FROM AUTHOR]

Background: Patients with Arnold-Chiari Malformation I (CM-I) treated with foramen magnum decompression (FMD) can have ongoing neck pain, headaches, and other symptoms complicated by persistent syringomyelia, yet there is little research regarding treatment of these symptoms. Case Report: A 62-year-old woman with a history of residual syringomyelia following FMD and ventriculoperitoneal shunt for CM-I presented to a chiropractor with progressively worsening neck pain, occipital headache, upper extremity numbness and weakness, and gait abnormality, with a World Health Organization Quality of Life score (WHO-QOL) of 52%. Symptoms were improved by FMD 16 years prior, then progressively worsened, and had resisted other forms of treatment, including exercises, acupuncture, and medications. Examination by the chiropractor revealed upper extremity neurologic deficits, including grip strength. The chiropractor ordered whole spine magnetic resonance imaging, which demonstrated a persistent cervico-thoracic syrinx and findings of cervical spondylosis, and treated the patient using a multimodal approach, with gentle cervical spine mobilization, soft tissue manipulation, and core and finger muscle rehabilitative exercises. The patient responded positively, and at the 6-month follow-up her WHO-QOL score was 80%, her grip strength and forward head position had improved, and she was now able to eat using chopsticks. Conclusions: This case highlights a patient with neck pain, headaches, and persistent syringomyelia after FMD for CM-I who improved following multimodal chiropractic and rehabilitative therapies. Given the limited, low-level evidence for these interventions in patients with persistent symptoms and syringomyelia after FMD, these therapies cannot be broadly recommended, yet could be considered on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Simple Summary: Soft tissue sarcomas are a common form of cancer arising in the skin and connective tissues of domestic cats. Soft tissue sarcomas encompass a group of different histological subtypes of tumours, which can behave in a range of different ways in the patient. In dogs and in humans, this group of tumours can be given a histological score ("grade") at the time of diagnosis, which is prognostic, but there is no equivalent, well-established grading system for these tumours in cats. This review looks at soft tissue sarcomas in terms of which histological subtypes of tumour should be included in this group, and how pathologists approach their grading, comparing feline tumours with their human and canine counterparts. Soft tissue sarcomas are one of the most commonly diagnosed tumours arising in the skin and subcutis of our domestic cats, and are malignant neoplasms with a range of histological presentations and potential biological behaviours. However, unlike their canine and human counterparts, there is no well-established histological grading system for pathologists to apply to these tumours, in order to provide a more accurate and refined prognosis. The situation is further complicated by the presence of feline injection site sarcomas as an entity, as well as confusion over terminology for this group of tumours and which histological types should be included. There is also an absence of large scale studies. This review looks at these tumours in domestic cats, their classification and histological grading, with comparisons to the human and canine grading system. [ABSTRACT FROM AUTHOR]

16 Mentzel T, Reisshauer S, Rütten A, Hantschke M, Soares de Almeida LM, Kutzner H. Cutaneous clear cell myomelanocytic tumour: a new member of the growing family of perivascular epithelioid cell tumours (PEComas). Keywords: clear cell; mesenchymal; neoplasm; soft tissue EN clear cell mesenchymal neoplasm soft tissue 835 838 4 09/21/22 20221001 NES 221001 INTRODUCTION Distinctive dermal clear cell mesenchymal neoplasm (DDCCMN) is a very rare entity. The clinical presentation of a solitary, exophytic nodular tumor and histopathologic findings of large cells with abundant clear cytoplasm and characteristic staining pattern were compatible with distinctive dermal clear cell mesenchymal neoplasm. Primary clear cell sarcoma of the skin is rare, most often affecting tendons and aponeurosis of the limbs.7-11 Sharing similar pathologic properties, clear cell sarcoma is considered the soft tissue counterpart of malignant melanoma. [Extracted from the article]

Alveolar soft part sarcoma (ASPS) is a rarely diagnosed tumour of deep soft tissue origin. This tumour is more common in adolescents and young adults and has a slowly progressive clinical course, which often leads to delayed diagnosis and treatment. It is highly vascular, can be confused with other entities like haemangiomas and arteriovenous malformations clinically and radiologically and is thus challenging to report on fine needle aspiration cytology (FNAC). Diagnosing the tumour is difficult on cytology, so knowledge of this entity and the differentials with its morphological mimics on cytology is required for timely diagnosis and early management of the patient. We report a case of ASPS in a young female who presented with a large, painless swelling in the thigh, diagnosed on cytology combined with ancillary testing with immunohistochemical markers. [ABSTRACT FROM AUTHOR]

The evaluation of pediatric patients with subcutaneous nodules remains a diagnostic challenge. Pediatric dermatologists are regularly confronted with patients who have a nonspecific nodule. Though most masses that require evaluation are ultimately benign, the possibility of a more aggressive process, including borderline or malignant neoplasms, underscores the pivotal role of the pediatric dermatologist in recognizing these lesions. The aim of this review is to provide an overview of lumps and bumps that are important to recognize to prevent delay in diagnosis or treatment of a serious underlying condition. Clinical clues that may lead the pediatric dermatologist to have a higher index of suspicion for more aggressive lesions are reviewed. Suggestions for evaluation and workup, as well as tips for the difficult to discern lesion, are proposed. [ABSTRACT FROM AUTHOR]

Aim: To compare connective tissue graft (CTG) with collagen matrix (CMX) in terms of increase in buccal soft tissue profile (BSP) at 1 year when applied at single implant sites. Materials and Methods: Patients with a single tooth gap in the anterior maxilla and horizontal mucosa defect were enrolled in a multi‐centre randomized controlled trial. All sites had a bucco‐palatal bone dimension of at least 6 mm, received a single implant and an immediate implant restoration using a full digital workflow. Sites were randomly allocated to the control (CTG) or test group (CMX) to increase buccal soft tissue thickness. The primary outcome was the increase in BSP at 1 year when compared with the pre‐operative situation based on superimposed digital surface models. The changes in BSP over time were registered at a buccal area of interest reaching from 0.5 mm below the soft tissue margin to 4 mm more apical. Secondary outcomes included patient‐reported, clinical and aesthetic outcomes. Results: Thirty patients were included per group (control: 50% females, mean age 50.1; test: 53% females, mean age 48.2). The increase in BSP at 1 year was 0.98 mm (98.3% confidence interval [CI]: 0.75–1.20) for CTG and 0.57 mm (98.3% CI: 0.34 to 0.79) for CMX. The mean difference of 0.41 mm (98.3% CI: 0.12 to 0.69) in favour of CTG was significant (p <.001). Based on an arbitrarily chosen threshold for success of 0.75 mm increase in BSP, 89.7% of the patients in the control group and 10% of the patients in the test group were successfully treated (odds ratio = 77.90; 95% CI: 13.52 to 448.80; p <.001). Sites treated with CMX demonstrated 0.89 mm (98.3% CI: 0.49 to 1.30) more shrinkage between postop and 1 year than sites treated with CTG. In addition, CMX resulted in significantly more marginal bone loss (0.39 mm; 95% CI: 0.05 to 0.74; p =.026) than CTG. There were no significant differences between the groups in terms of patients' aesthetic satisfaction (p =.938), probing depth (p =.917), plaque (p =.354), bleeding on probing (p =.783), midfacial recession (p =.915), Pink Esthetic Score (p =.121) and Mucosal Scarring Index (p =.965). Conclusions: CTG remains the gold standard to increase soft tissue thickness at implant sites. Clinicians need to outweigh the benefits of CMX against considerable resorption of the graft. This study was registered in ClinicalTrials.gov (NCT04210596). [ABSTRACT FROM AUTHOR]

Objective: In dentistry, patient and physician adoption of diode lasers and light-emitting diodes (LEDs) continues to increase as research indicates that diode lasers and LEDs may be used for surgical and nonsurgical procedures. The goal of this literature review was to critically analyze randomized controlled trials and experimental trials to provide evidence-based recommendations on the therapeutic uses of diode lasers and LEDs in oral applications based on published efficacy and safety data. Methods: A literature review was performed of published literature on patients receiving periodontal and oral surgery treatment that included the use of diode lasers and/or the use of LED phototherapy to determine if the outcomes of phototherapy were superior to conventional therapy and if one form of phototherapy was superior to the other. Results: Eighteen original clinical trials and experimental studies were suitable for review. The diode laser was presented as an effective tool in soft tissue management due to its cutting precision, incision depth, analgesic effects, and elimination of bacterial load and in periodontal applications for probing depth reduction when used as an adjunct to scaling and root planing (SRP). LEDs also served as an effective tool for pain management, wound healing, and efficacy when used as an adjunct to SRP. Other than one study, all the available studies reviewed were either evaluating the efficacy of diode lasers or LEDs, but not both. Therefore, the results for determining the more effective tool were inconclusive. Conclusions: According to existent data, diode lasers and LEDs are equally effective tools for the phototherapy in periodontology and oral surgery. Although fewer studies exist examining the use of LED for phototherapy, the studies all revealed positive results. Further clinical comparative investigations utilizing both diode lasers and LED are needed to determine superiority of this application for periodontal management and oral surgery. [ABSTRACT FROM AUTHOR]

Steerable needles are a promising technology to provide safe deployment of tools through complex anatomy in minimally invasive surgery, including tumor-related diagnoses and therapies. For the 3-D localization of these instruments in soft tissue, fiber Bragg gratings (FBGs) based reconstruction methods have gained in popularity because of the inherent advantages of optical fibers in a clinical setting, such as flexibility, immunity to electromagnetic interference, nontoxicity, and the absence of line-of-sight issues. However, methods proposed thus far focus on shape reconstruction of the steerable needle itself, where accuracy is susceptible to errors in interpolation and curve fitting methods used to estimate the curvature vectors along the needle. In this study, we propose reconstructing the shape of the path created by the steerable needle tip based on the follow-the-leader nature of many of its variants. By assuming that the path made by the tip is equivalent to the shape of the needle, this novel approach paves the way for shape reconstruction through a single set of FBGs at the needle tip, which provides curvature information about every section of the path during navigation. We propose a Kalman-filter-based sensor fusion method to update the curvature information about the sections as they are continually estimated during the insertion process. The proposed method is validated through simulation, in vitro and ex vivo experiments employing a programmable bevel-tip steerable needle (PBN). The results show clinically acceptable accuracy, with 2.87-mm mean PBN tip position error, and a standard deviation of 1.63 mm for a 120-mm 3-D insertion. [ABSTRACT FROM AUTHOR]

Soft-tissue lumps and bumps are a common referral for imaging in children and adolescents. The etiology of these lesions includes benign non-tumorous lesions, as well as benign and malignant tumors. Some of these lesions have a characteristic imaging appearance but others do not and require tissue sampling to make a diagnosis. MRI typically provides the best overall characterization of soft-tissue masses; however, in some cases US provides complementary information to that provided by MRI that can help make a diagnosis. [ABSTRACT FROM AUTHOR]

Orbital fractures are a common finding in facial trauma, and serious complications may arise when orbital reconstruction is not performed properly. The virtual planning can be used to print stereolithographic models or to manufacture patient-specific titanium orbital implants (PSIs) through the process of selective laser melting. This method is currently considered the most accurate technique for orbital reconstruction. Even with the most accurate techniques of bone reconstruction, there are still situations where enophthalmos is present postoperatively, and it may be produced by intraorbital soft tissue atrophy. The aim of this paper was to evaluate the orbital soft tissue after posttraumatic reconstruction of the orbital walls' fractures. Ten patients diagnosed and treated for unilateral orbital fractures were included in this prospective study. A postoperative CT scan of the head region with thin slices (0.6 mm) and soft and bone tissue windows was performed after at least 6 months. After data processing, the STL files were exported, and the bony volume, intraorbital fat tissue volume, and the muscular tissue volume were measured. The volumes of the reconstructed orbit tissues were compared with the volumes of the healthy orbit tissues for each patient. Our findings conclude that a higher or a lower grade of fat and muscular tissue loss is present in all cases of reconstructed orbital fractures. This can stand as a guide for primary or secondary soft tissue augmentation in orbital reconstruction. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVE: Post-burn contracture is the tightening of the skin after a second or third-degree burn with the formation of contracture. Post-burn contractures result in the limitation of movement around a burn area. Burns contractures, if left untreated, may cause limitations in the range of motion and daily living tasks. The purpose of this study was to compare the effects of soft tissue mobilization versus static stretching in post-burn contractures at the elbow and wrist. METHODOLOGY: A pilot study was conducted, and 36 patients were enrolled. Patients with post-burn contracture were divided randomly into two groups. Allocation of patients in both groups was done by computerized generated list. The treatment frequency was 3 times a week. Numeric pain rating scale (NPRS) and Katz index ADLS scale were used for scoring. Paired t-test was applied to evaluate the data. RESULTS: The mean age in group A and B were 26.16±7.46 and 28.05±1.27, respectively. Mean score for pre-Katz Index of Group A and B (2.47±0.87, 2.16±0.98), post-Katz Index group A and B (3.29±1.68, 3.05±1.47) with a p-value 0.12 and 0.03 group A and B respectively. The mean score group A and B for pre-NPRS (7.61±1.37, 7.94±1.10), post-NPRS (2.27±1.01, 1.72±1.22) with a p-value<0.001. CONCLUSION: It was concluded that static stretching is more effective than soft tissue mobilization. [ABSTRACT FROM AUTHOR]

Many different pulsed electromagnetic field (PEMF) devises have been clinically used to stimulate healing processes, but many procedures are still without supporting basic research data. The aim of this study was to investigate a new modified pulsed electromagnetic field therapy: electromagnetic transduction therapy (EMTT). EMTT is technically based on high-intensive PEMFs with a magnetic field strength between 80 and 150 mT. The effect of EMTT for a 10-min session three times a week on human bone marrow mesenchymal stem cells (MSCs) was evaluated by assessing cell viability, gene expression of bone regenerative factors and VEGF-A (vascular endothelial growth factor) secretion after 7 and 14 days of treatment. No negative or toxic effects of EMTT on MSCs in vitro were observed in the applied test frame. The VEGF-ELISA at day 7 of EMTT treatment with 80 mT showed a significant higher VEGF concentration compared to untreated control group. In conclusion, high-intensive electromagnetic impulses showed no harmful effects on MSC cultures in our study. The enhancement of the proangiogenic factor VEGF in MSCs on day 7 indicates a substantial role in cell-stimulating effect of EMTT. Further in vitro and in vivo studies should differentiate specific stimulating and regenerating effects of EMTT impulses in soft tissue engineering. Specific electromagnetic characteristics have to be determined to optimize electromagnetic treatment options in orthopedic surgery and traumatology and soft tissue treatment options. [ABSTRACT FROM AUTHOR]

Introduction: Soft tissue sarcomas are a group of malignancies that commonly occur in the extremities. As deep lesions may exist within the confines of the muscular fascia, we postulate that local recurrence rates are higher for superficial soft tissue sarcomas managed by the standard of care.A retrospective review was performed on 90 patients who underwent surgical resection of soft tissue sarcomas of the extremity from 2007 to 2015. Patients with minimum 2-year follow-up and adequate operative, pathologic, and clinical outcomes data were included.Mean age was 54 ± 18 years with 49 (54.4%) patients being male. Lesions in 77.8% of cases were deep, and 22.2% were superficial to fascia. Following the index surgical resection, a total of 33 (36.7%) patients had positive margins. A total of 17 (18.9%) patients had a local recurrence. Overall, 3-year survival was 92.7%, and 5-year survival was 79.0%. Five-year recurrence-free survival of deep sarcomas was 91.1% versus 58.2% of superficial lesions (p = 0.006). Patients with higher tumor depth had lower odds of experiencing a local recurrence (HR 0.26 [95% CI 0.09–0.72]). Local recurence rates was also associated with positive surgical margins on initial resection (33.3% versus 12.3%) (p = 0.027).In this series, superficial tumor depth was associated with local recurrence of soft tissue sarcomas of the extremity following surgical resection. Positive surgical margins was also associated with local recurrence.Materials and methods: Soft tissue sarcomas are a group of malignancies that commonly occur in the extremities. As deep lesions may exist within the confines of the muscular fascia, we postulate that local recurrence rates are higher for superficial soft tissue sarcomas managed by the standard of care.A retrospective review was performed on 90 patients who underwent surgical resection of soft tissue sarcomas of the extremity from 2007 to 2015. Patients with minimum 2-year follow-up and adequate operative, pathologic, and clinical outcomes data were included.Mean age was 54 ± 18 years with 49 (54.4%) patients being male. Lesions in 77.8% of cases were deep, and 22.2% were superficial to fascia. Following the index surgical resection, a total of 33 (36.7%) patients had positive margins. A total of 17 (18.9%) patients had a local recurrence. Overall, 3-year survival was 92.7%, and 5-year survival was 79.0%. Five-year recurrence-free survival of deep sarcomas was 91.1% versus 58.2% of superficial lesions (p = 0.006). Patients with higher tumor depth had lower odds of experiencing a local recurrence (HR 0.26 [95% CI 0.09–0.72]). Local recurence rates was also associated with positive surgical margins on initial resection (33.3% versus 12.3%) (p = 0.027).In this series, superficial tumor depth was associated with local recurrence of soft tissue sarcomas of the extremity following surgical resection. Positive surgical margins was also associated with local recurrence.Results: Soft tissue sarcomas are a group of malignancies that commonly occur in the extremities. As deep lesions may exist within the confines of the muscular fascia, we postulate that local recurrence rates are higher for superficial soft tissue sarcomas managed by the standard of care.A retrospective review was performed on 90 patients who underwent surgical resection of soft tissue sarcomas of the extremity from 2007 to 2015. Patients with minimum 2-year follow-up and adequate operative, pathologic, and clinical outcomes data were included.Mean age was 54 ± 18 years with 49 (54.4%) patients being male. Lesions in 77.8% of cases were deep, and 22.2% were superficial to fascia. Following the index surgical resection, a total of 33 (36.7%) patients had positive margins. A total of 17 (18.9%) patients had a local recurrence. Overall, 3-year survival was 92.7%, and 5-year survival was 79.0%. Five-year recurrence-free survival of deep sarcomas was 91.1% versus 58.2% of superficial lesions (p = 0.006). Patients with higher tumor depth had lower odds of experiencing a local recurrence (HR 0.26 [95% CI 0.09–0.72]). Local recurence rates was also associated with positive surgical margins on initial resection (33.3% versus 12.3%) (p = 0.027).In this series, superficial tumor depth was associated with local recurrence of soft tissue sarcomas of the extremity following surgical resection. Positive surgical margins was also associated with local recurrence.Conclusions: Soft tissue sarcomas are a group of malignancies that commonly occur in the extremities. As deep lesions may exist within the confines of the muscular fascia, we postulate that local recurrence rates are higher for superficial soft tissue sarcomas managed by the standard of care.A retrospective review was performed on 90 patients who underwent surgical resection of soft tissue sarcomas of the extremity from 2007 to 2015. Patients with minimum 2-year follow-up and adequate operative, pathologic, and clinical outcomes data were included.Mean age was 54 ± 18 years with 49 (54.4%) patients being male. Lesions in 77.8% of cases were deep, and 22.2% were superficial to fascia. Following the index surgical resection, a total of 33 (36.7%) patients had positive margins. A total of 17 (18.9%) patients had a local recurrence. Overall, 3-year survival was 92.7%, and 5-year survival was 79.0%. Five-year recurrence-free survival of deep sarcomas was 91.1% versus 58.2% of superficial lesions (p = 0.006). Patients with higher tumor depth had lower odds of experiencing a local recurrence (HR 0.26 [95% CI 0.09–0.72]). Local recurence rates was also associated with positive surgical margins on initial resection (33.3% versus 12.3%) (p = 0.027).In this series, superficial tumor depth was associated with local recurrence of soft tissue sarcomas of the extremity following surgical resection. Positive surgical margins was also associated with local recurrence. [ABSTRACT FROM AUTHOR]

• Gustilo grades IIIB/C open tibial fractures are severe and require aggressive, multidisciplinary management. • Large tibial defects combined with large soft tissue defects are challenging problems in clinical practice. • This study compared the effects of MFFT and IBTT by retrospectively analysing clinical data. • For open tibial and soft tissue defects in Gustilo IIIB/C fractures, MFFT should be the first treatment choice if the surgeon has a high level of microsurgical skills. • MFFT achieves faster healing, less discomfort, and may be better appearance within the bone and soft tissue defect. The treatment of bone and soft-tissue defects after open fractures remains challenging. This study aimed to evaluate the clinical efficacy of the Masquelet technique combined with the free-flap technique (MFFT) versus the Ilizarov bone transport technique (IBTT) for the treatment of severe composite tibial and soft-tissue defects. We retrospectively analysed the data of 65 patients with tibial and soft-tissue defects and Gustilo type IIIB/C open fractures treated at our hospital between April 2015 and December 2021. The patients were divided into two groups based on the treatment method: group A (n = 35) was treated with the MFFT and internal fixation, and group B (n = 30) was treated with the IBTT. The mean follow-up period was 28 months (range 13–133 months). Complete union of both soft-tissue and bone defects was achieved in all cases. The mean bone-union times were 6 months (range 3–12 months) in group A and 11 months (range 6–23 month) in group B, with a significant difference between the two groups (Z = –4.11, P = 0.001). The mean hospital stay was 28 days (range 14–67 d) in group A which was significantly longer than the mean stay of 18 days (range 10–43 d) in group B (Z = –2.608, P = 0.009). There were no significant differences in the infection rate between group A (17.1 %) and group B (26.7%) (χ2 = 0.867, P = 0.352). The Total Physical Health Scores were 81.51 ± 6.86 (range 67–90) in group A and 75.83±16.14 (range 44–98) in group B, with no significant difference between the two groups (t = 1.894, P = 0.063). The Total Mental Health Scores were significantly higher in group A (90.49 ± 6.37; range 78–98) than in group B (84.70 ± 13.72; range 60–98) (t = 2.232, P = 0.029). Compared with IBTT, MFFT is a better choice of treatment for open tibial and soft-tissue defects with Gustilo IIIB/C fractures. IBTT is the preferred option when the tibial bone defect is large or if the surgeon's expertise in microsurgery is limited. [ABSTRACT FROM AUTHOR]

Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management. [ABSTRACT FROM AUTHOR]

There is an alarming increase in the incidence of both oral and base of the tongue squamous cell carcinoma during the past decades, especially in women and younger patients without the traditional risk factors of alcohol or tobacco use. Locoregional spread of tumor via lymphatics to submandibular and jugulodigastric lymph nodes is common. Soft-tissue metastasis (STM) in the neck of oral tongue squamous cell carcinoma is very rare and represents nonnodal-based metastasis. It has a significant adverse impact on the survival of patients. STM in the neck as a presenting symptom of oral tongue carcinoma is very unusual and extremely rare. [ABSTRACT FROM AUTHOR]

Background: Displaced patella fracture is commonly treated with open reduction and internal fixation (ORIF). Wound complications after surgery often lead to prolonged hospitalization and dissatisfaction of patients. Periarticular adiposity and swelling may be associated with wound complications. The purpose of this study is to determine the relationship between periarticular soft tissue thickness and wound complications after ORIF of patella fractures.Methods: We retrospectively studied 237 patients undergoing ORIF for patella fractures from June 2017 to February 2021 at our institution. We established periarticular soft tissue thickness ratio (PSTTR) to evaluate soft tissue status on lateral knee X-ray radiographs. Univariate analysis was performed to identify the association between PSTTR and postoperative wound complication. A receiver-operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of PSTTR.Results: The incidence of postoperative wound complication was 10.5%. Minor wound complication occurred in 24 patients, and major wound complication occurred in one patient. The average femoral PSTTR (fPSTTR) was 0.94 ± 0.17 and the average tibial PSTTR (tPSTTR) was 0.66 ± 0.16. fPSTTR proved to be associated with postoperative wound complication. In the ROC analysis of fPSTTR predicting postoperative wound complication, the area under curve (AUC) was 0.676, which indicated a moderate predictive value.Conclusions: PSTTR was a feasible method to assess periarticular soft tissue. The increased fPSTTR was associated with wound complications after ORIF of patella fractures. [ABSTRACT FROM AUTHOR]

The aim of this article is to provide a short review of the literature concerning the basic principles, usefulness and limitations of ultrasound-guided biopsy of musculoskeletal softtissue tumors, with particular focus on core needle biopsies. Musculoskeletal soft-tissue tumors represent a rare and complex group of heterogeneous lesions. Prompt diagnosis of these uncommon lesions can improve the outcome and increase the patient survival rate. A biopsy examination of soft-tissue tumors with imaging modalities is necessary in all cases of aggressive or undetermined lesions. Although fine needle aspiration can be helpful for the biopsy of certain tumor types, core needle biopsy is a standard procedure in most tertiary sarcoma centers. It has a high diagnostic accuracy, low complication rate and lower price in comparison to open biopsy, and can replace it in the majority of cases of soft-tissue tumor assessment. However, the examining physician has to be familiar with the technique, and the strengths and potential difficulties in performing ultrasound-guided biopsy, as well as possible solutions to obstacles. Several recently developed ultrasound techniques can be helpful and improve the outcome of imaging-guided biopsies of musculoskeletal lesions. [ABSTRACT FROM AUTHOR]

Purpose: The reconstruction of defects resulting from spinal surgery poses a challenge to plastic surgeons due to the curved contour and strong skin tension of the back. Implant and metal exposure can also increase the difficulty of covering such defects. This study presents our experiences of covering defects after spinal surgery using dorsal intercostal artery perforator (DICAP) flaps. Methods: From November 2018 to August 2021, 14 patients with spinal soft tissue defects underwent DICAP flap reconstructive surgery at our department. The mean age of the patients was 54.3 years (range, 35--70 years). Age, sex, etiology, the dimensions of the defect and the flap, the site of the defect, surgical technique, and postoperative complications were recorded. Results: All flaps survived, with no major complications such as total flap necrosis. Minor complications were observed in four cases. One patient developed an infection with erythematous changes and another developed partial flap necrosis. Two patients experienced wound dehiscence. These minor complications were all resolved with conservative treatment. No additional complications occurred during the follow-up period. Conclusion: The use of DICAP flaps was successful in all cases. DICAP flaps can adequately cover defects following spinal surgery and have a low complication rate. Thus, DICAP flaps are a good choice for covering defects resulting from spinal surgery. [ABSTRACT FROM AUTHOR]

Due to its sensitivity to geometrical and mechanical properties of waveguides, ultrasonic guided waves (UGWs) propagating in cortical bones play an important role in the early diagnosis of osteoporosis. However, as impacts of overlaid soft tissues are complex, it remains challenging to retrieve bone properties accurately. Meta-learning, i.e., learning to learn, is capable of extracting transferable features from a few data and, thus, suitable to capture potential characteristics, leading to accurate bone assessment. In this study, we investigate the feasibility to apply the multichannel identification neural network (MCINN) to estimate the thickness and bulk velocities of coated cortical bone. It minimizes the effects of soft tissue by extracting specific features of UGW, which shares the same cortical properties, while the overlaid soft tissue varies. Distinguished from most reported methods, this work moves from the hand-design inversion scheme to data-driven assessment by automatically mapping features of UGW to the space of bone properties. The MCINN was trained and validated using simulated datasets produced by the finite-difference time-domain (FDTD) method and then applied to experimental data obtained from cortical bovine bone plates overlaid with soft tissue mimics. A good match was found between experimental trajectories and theoretical dispersion curves. The results demonstrated that the proposed method was feasible to assess the thickness of coated cortical bone plates. [ABSTRACT FROM AUTHOR]

Introduction: Applying proper tension to collateral ligaments during total knee arthroplasty surgery is fundamental to achieve optimal implant performance: low tension could lead to joint instability, over-tensioning leads to pain and stiffness. A "functional stability" must be defined and achieved during surgery to guarantee optimal results. In this study, an experimental cadaveric activity was performed to measure the minimum tension required to achieve knee functional stability. Materials and methods: Ten knee specimens were investigated; femur and tibia were fixed in specifically designed fixtures and clamped to a loading frame; constant displacement rate was applied and resulting tension force was measured. Joint stability was determined as the slope change in the force/displacement curve, representing the activation of both collateral ligaments elastic region; the tension required to reach joint functional stability is then the span between ligaments toe region and this point. Intact, ACL (anterior cruciate ligament)-resected and ACL & PCL (posterior cruciate ligament)-resected knees were tested. The test was performed at different flexion angles; each configuration was analyzed three times. Results: Results demonstrated an overall tension of 40–50 N to be enough to reach stability in intact knees. Similar values are sufficient in ACL-resected knees, while significantly higher tension is required (up to 60 N) after cruciate ligaments resection. The tension required was slightly higher at 60° of flexion. Conclusion: Results agree with other experimental studies, showing that the tensions required to stabilize a knee joint are lower than the ones applied nowadays via surgical tensioners. To reach functional stability, surgeons should consider such results intraoperatively and avoid ligament laxity or over-tension. [ABSTRACT FROM AUTHOR]

To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type headache (TTH). Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized controlled trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis. Fifteen studies were included with a total sample of 1131 individuals. High velocity and low amplitude techniques were not superior to no treatment on reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = −0.27, moderate evidence). Soft tissue interventions were superior to no treatment on reducing pain intensity (SMD = −0.86, low evidence) and frequency of pain (SMD = −1.45, low evidence). Dry needling was superior to no treatment on reducing pain intensity (SMD = −5.16, moderate evidence) and frequency (SMD = −2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache. Manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache. Soft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache. High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache. Manual therapy was not effective for improving the impact of headache in patients with tension type headache. [ABSTRACT FROM AUTHOR]

Gastropods comprise approximately 80% of molluscans, of which land snails are used variably as food and traditional medicines due to their high protein content. Moreover, different components from land snails exhibit antimicrobial activities. In this study, we evaluated the antifungal activity of soft tissue extracts from Helix aspersa against Candida albicans, Aspergillus flavus, and Aspergillus brasiliensis by identifying extract components using liquid chromatography-tandem mass spectrometry (LC-MS-MS). Two concentrations of three extracts (methanol, acetone, and acetic acid) showed antifungal activity. Both acetone (1 g/3 mL) and acetic acid extracts (1 g/mL) significantly inhibited C.albicans growth (p = 0.0001, 5.2 ± 0.2 mm and p = 0.02, 69.7 ± 0.6 mm, respectively). A. flavus and A. brasiliensis growth were inhibited by all extracts at 1 g/mL, while inhibition was observed for acetic acid extracts against A. brasiliensis (p = 0.02, 50.3 ± 3.5 mm). The highest growth inhibition was observed for A. flavus using acetic acid and acetone extracts (inhibition zones = 38 ± 1.7 mm and 3.1 ± 0.7 mm, respectively). LC-MS-MS studies on methanol and acetone extracts identified 11-α-acetoxyprogesterone with a parent mass of 372.50800 m/z and 287.43500 m/z for luteolin. Methanol extracts contained hesperidin with a parent mass of 611.25400 m/z, whereas linoleic acid and genistein (parent mass = 280.4 and 271.48900 m/z, respectively) were the main metabolites. [ABSTRACT FROM AUTHOR]

Purpose: Image guidance is used to improve the accuracy of radiation therapy delivery but results in increased dose to patients. This is of particular concern in children who need be treated per Pediatric Image Gently Protocols due to long‐term risks from radiation exposure. The purpose of this study is to design a deep neural network architecture and loss function for improving soft‐tissue contrast and preserving small anatomical features in ultra‐low‐dose cone‐beam CTs (CBCT) of head and neck cancer (HNC) imaging. Methods: A 2D compound U‐Net architecture (modified U‐Net++) with different depths was proposed to enhance the network capability of capturing small‐volume structures. A mask weighted loss function (Mask‐Loss) was applied to enhance soft‐tissue contrast. Fifty‐five paired CBCT and CT images of HNC patients were retrospectively collected for network training and testing. The output enhanced CBCT images from the present study were evaluated with quantitative metrics including mean absolute error (MAE), signal‐to‐noise ratio (SNR), and structural similarity (SSIM), and compared with those from the previously proposed network architectures (U‐Net and wide U‐Net) using MAE loss functions. A visual assessment of ten selected structures in the enhanced CBCT images of each patient was performed to evaluate image quality improvement, blindly scored by an experienced radiation oncologist specialized in HN cancer. Results: All the enhanced CBCT images showed reduced artifactual distortion and image noise. U‐Net++ outperformed the U‐Net and wide U‐Net in terms of MAE, contrast near structure boundaries, and small structures. The proposed Mask‐Loss improved image contrast and accuracy of the soft‐tissue regions. The enhanced CBCT images predicted by U‐Net++ and Mask‐Loss demonstrated improvement compared to the U‐Net in terms of average MAE (52.41 vs 42.85 HU), SNR (14.14 vs 15.07 dB), and SSIM (0.84 vs 0.87), respectively (p<0.01$p < 0.01$, in all paired t‐tests). The visual assessment showed that the proposed U‐Net++ and Mask‐Loss significantly improved original CBCTs (p<0.01$p < 0.01$), compared to the U‐Net and MAE loss. Conclusions: The proposed network architecture and loss function effectively improved image quality in soft‐tissue contrast, organ boundary, and small structure preservation for ultra‐low‐dose CBCT following Image Gently Protocol. This method has potential to provide sufficient anatomical representation on the enhanced CBCT images for accurate treatment delivery and potentially fast online‐adaptive re‐planning for HN cancer patients. [ABSTRACT FROM AUTHOR]

Background: Leiomyosarcomas are aggressive malignancies which can occur on the trunk and extremities whose pathogenesis is poorly understood. We aim to quantify the prognostic impact of various clinical and pathological markers on survival and recurrence of leiomyosarcomas. Methods: We conducted a systematic review as per PRISMA protocol. Survival, local recurrence, and metastasis were the outcome measures. Data were extracted from the studies for the outcome variables; the resultant odds ratios (OR) and 95% confidence interval (CI) were used for the synthesis of a forest plot. Results: Our search revealed thirteen studies comprising 1380 patients. Seven of these 13 publications were since 2012. Our analysis showed that tumor size larger than 5 cm adversely affected the outcome with an OR 3.39 (2.26–5.10, p < 0.01). Other factors which reduced the overall survival were positive margins of excision OR 2.12 (1.36–3.32, p < 0.01). A reduced risk of metastasis has strongly associated the use of radiotherapy with OR 10.84 (4.41–26.61, p < 0.01). Only a few studies analyzed the impact of factors on local recurrence. Conclusions: Size larger than 5 cm and positive margins of excision are associated with poor overall survival. In comparison, the use of adjuvant radiotherapy was associated with a lower metastatic rate. There is a need for methodically high-quality studies with more uniform study design and reporting to evaluate the impact of various risk factors on local recurrence and metastases. Level of evidence: Level 1 Prognostic [ABSTRACT FROM AUTHOR]

BACKGROUND: As the latest generation of autologous platelet concentrate biologics, concentrated growth factor has become a research hotspot in the field of tissue repair and regeneration due to its natural fibrin scaffold and abundant endogenous growth factors. OBJECTIVE: To summarize the research progress of concentrated growth factors in the field of tissue repair and regeneration, as well as discuss the existing problems in the current research stage, in order to provide new reference ideas for the follow-up research of concentrated growth factors. METHODS: This article used “concentrated growth factor, CGF, stem cells, tissue repair, tissue regeneration” as search terms. A comprehensive search was conducted on PubMed, EMbase, Medline, and CNKI. The relevant research evidence of the application of concentrated growth factor in the field of tissue repair and regeneration in the past 10 years were collected and summarized. The literature was screened based on strict inclusion and exclusion criteria. Finally, 96 articles were included. RESULTS AND CONCLUSION: (1) This article summarized the research progress of concentrated growth factor from four aspects: the specific method of preparation and application of concentrated growth factor, the principle of concentrated growth factor promoting tissue repair and regeneration, the effect on cell proliferation and differentiation in vitro, and the repair and reconstruction of tissue in vivo, and discussed the current research the existing problems. (2) Concentrated growth factor is an autologous bioactive factor with potential in the field of tissue repair and regeneration. The preparation method is simple and the application method is flexible and changeable. It is completely taken from autologous blood, so that it has great biocompatibility and few immune rejection reactions. (3) The core structure of concentrated growth factor includes a natural fibrin scaffold and a variety of endogenous growth factors, which can promote the proliferation, migration and differentiation of a variety of stem cells in vitro. (4) Concentrated growth factors can promote the repair of bone defects in vivo, and the local growth factor slow-release system constructed by combining it with tissue engineering materials is an effective way to extend the slow-release time of growth factors. (5) Concentrated growth factors have shown great effects in promoting soft tissue repairing, anti-skin photoaging, and reducing postoperative complications. It has become one of the preferred options for personalized treatment of autologous bioactive preparations. [ABSTRACT FROM AUTHOR]

Background: Maxillofacial soft tissue injuries (STIs) are common and frequent in emergency departments. The aim of this study was to analyze factors causing infection of maxillofacial STIs. Patients and Methods: Patients with maxillofacial STIs who received sutures and had complete medical records were evaluated. Gender, age, American Society of Anesthesiologists (ASA) grade, diabetes mellitus, wound age, wound length, wound contamination, wound type, and sites were analyzed using univariable analysis and binary logistic regression. Results: There were 3,276 cases included. In the univariable analysis, there was no significant difference in the infection rate between genders or between the wound age groups. In binary logistic regression, age, wound length, wound type, and physician level were risk factors for infection: age of 18-44 years (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7-2.9), 44-64 years (OR, 3.1; 95% CI, 2.3-4.3), and ≥65 years (OR, 2.6; 95% CI, 1.7-4.1); wound length of 4-8 cm (OR, 1.7; 95% CI, 1.3-2.2) and >8 cm (OR, 2.4; 95% CI, 1.1-5.1); intra-oral wounds (OR, 1.6; 95% CI, 1.1-2.4) and communicating wounds (OR, 3.2; 95% CI, 2.3-4.4); junior specialists (OR, 1.6; 95% CI, 1.2-2.2); and lip (OR, 3.7; 95% CI, 1.1-12.0) and cheek (OR, 4.7; 95% CI, 2.3-17.1) sites. Wound contamination, ASA grade, and diabetes mellitus were not significantly different from wound infection in binary regression analysis. Conclusions: Age (>18 years old), wound length (>4 cm), intra-oral wounds, communicating wounds, suturing by junior surgeons, and lip or cheek injuries may be risk factors for maxillofacial STI infection. Even if the penetrating wound age exceeds 24 hours, it is meaningful to suture if there is no serious infection. For wounds at high risk of infection, further measures should be considered to reduce the possibility of infection, such as improving the surgical training of junior surgeons and improving the patient's wound care. [ABSTRACT FROM AUTHOR]

Background: Primary tumor resection is the mainstay of treatment for undifferentiated pleomorphic sarcoma (UPS); however, the necessity of adjuvant chemotherapy has been debated. We aimed to clarify the effect of adjuvant chemotherapy on survival rates in patients with UPS with localized and resectable primary lesions. Methods: This retrospective analysis included data of 2112 patients with localized UPS arising in the extremities and trunk, extracted from a registry in Japan. We estimated overall survival (OS), identified prognostic factors, and adjusted patient characteristics in the two groups treated with or without chemotherapy using propensity score matching (PSM). Results: The 5-year OS rate was 79.4%. In multivariate OS analysis, adjuvant chemotherapy was a good prognostic factor (hazard ratio 0.65; 95% confidence interval 0.48–0.9, P = 0.009). Large tumor size was the poorest prognostic factor, and OS decreased with the tumor size (P < 0.0001). In all patients, adjuvant chemotherapy prolonged OS (5-year OS: 82.3% vs. 78.6%, P = 0.03). Adjuvant chemotherapy did not affect OS in patients with tumor size < 5 cm; the benefit was strong in patients with tumor size 10 to < 15 cm (5-year OS: 79.5% vs. 66.8%, P = 0.003). Adjuvant chemotherapy efficacy was not pronounced in patients with tumor size 5 to < 10 cm (5-year OS: 87% vs. 80%, P = 0.06) and ≥ 15 cm (5-year OS: 60.7% vs. 49.5%, P = 0.08). After PSM, adjuvant chemotherapy was significantly associated with improved OS (P = 0.02). Conclusions: In patients with localized UPS, adjuvant chemotherapy tended to improve OS when tumors were ≥ 5 cm, especially when they were 10 to < 15 cm. [ABSTRACT FROM AUTHOR]

Background: Facial is different among various populations, However, none of the available studies had assessed nasal morphology in Sudaneses with different skeletal malocclusions. Objectives: The aim of the present study was to compare nasal morphology among Sudanese sample, with skeletal class I, II and III relationship, to study gender difference in nasal morphology, and to compare the results with other study results on other populations. Materials and Methods: All patients were of Sudanese background and had a lateral cephalogram as part of orthodontic records. 233 cephalogram was included in the study, Upper and lower facial height, nosal height, length and tip projection, were measured by the main investigator. Conclusions: Sudanese males have increased facial heights with more prominent nose than females, also the nasal parameters are correlated to the underlying craniofacial structure, are larger in patients with class III skeletal occlusion than those with class II skeletal occlusion. Ethnical variety has been observed and the results were comparable to other studies on different populations. The nose, the most prominent facial feature, is related to gender, upper facial height, skeletal occlusion and ethnical group, so should be considered during diagnosis and treatment planning. [ABSTRACT FROM AUTHOR]

The broad and heterogeneous spectrum of vascular anomalies ranges from an innocuous localized cutaneous discoloration to complex, extensive and life-threatening diagnoses. While many of these lesions are present at birth, smaller and deeper lesions might be clinically occult for months or years. Certain vascular anomalies commonly manifest in the prenatal or neonatal period and often have suggestive clinical and imaging features that can aid the radiologist in making a correct diagnosis. The characteristics of such lesions presenting very early in life, particularly those manifesting as soft-tissue masses, are the focus of this review. [ABSTRACT FROM AUTHOR]

Introduction: Myxoid sarcomas are a rare and heterogeneous group of tumours exhibiting overlapping histomorphological features with varied biological behaviour. Hence, additional ancillary techniques like Immunohistochemistry (IHC) are necessary for definite diagnosis and categorisation of the myxoid sarcomas. Aim: To identify the distribution of myxoid sarcomas among patients and also to evaluate the utility of basic IHC in the diagnosis of myxoid sarcomas. Materials and Methods: This was six years retrospective observational cross-sectional study carried out in the Department of Pathology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India, during the period of January 2008-December 2013. Relevant pathological data of all the myxoid sarcomas reported during the study period were retrieved from the medical records. Corresponding Haematoxylin and Eosin (H&E) stained slides were reviewed and IHC was done using a panel of markers for confirmation. Results: Among the 57 myxoid sarcomas, 46% occurred in the age group of 41-60 years with a striking male preponderance (74%). Myxofibrosarcoma was the most common histological type (33.33%). All cases of myxofibrosarcoma were positive for vimentin while two cases showed focal Smooth Muscle Actin (SMA) positivity and one case showed focal CD34 positivity. Low grade fibromyxoid sarcomas were positive for only vimentin. Myxoid liposarcomas and extra-skeletal myxoid chondrosarcomas showed vimentin and S100 positivity. Myxoid Dermato Fibrosarcoma Protuberans (DFSP) was positive for vimentin and CD34 while synovial sarcoma with myxoid change was positive for vimentin and Pancytokeratin (Pan CK). Myxoid Malignant Peripheral Nerve Sheath Tumour (MPNST) showed 100% vimentin and S100 positivity while CD34 was positive in 12.5% of cases. Leiomyosarcoma with myxoid change was positive for vimentin, SMA, desmin and Pan CK. Conclusion: The IHC is a valuable adjunct to light microscopy for the diagnosis of myxoid sarcomas and can provide as a judicious tool for diagnosis of this uncommon and challenging group of malignant soft tissue tumours. [ABSTRACT FROM AUTHOR]

Background: Soft tissue sarcomas (STS) are rare, and little is known about the factors that affect the delays in the initial treatment. The aim of this study is to quantify the period between onset of symptoms and start of treatment of STS and determine the factors affecting delays in initial treatment. Methods: This is a retrospective study of all STS treated in our institution between October 2009 and March 2019. We analysed patient record to determine the period from onset of symptoms to start of initial treatment. We also collected data with regard to patient characteristics and features of the tumour. Tumours were classified into upper extremity, lower extremity, trunk and others based on location of the tumour. Statistical tests were done to identify factors that affected delay in initial treatment. Results: The study included 134 patients (76 male and 58 female) with STS with an average age of 56.6 years. The tumours involved the upper extremity in 20 patients, lower extremity and trunk in 50 patients each and other areas in 14 patients. The most frequent histological subtypes were liposarcomas (n = 31, 23.5%) and undifferentiated pleomorphic sarcomas (n = 24, 18.2%). Initial treatment was delayed by an average of 9.9 months for all groups. The period of treatment delay for tumours involving the upper extremity was shorter (7.9 months) and these tumours were smaller at initial presentation (57.6 mm) compared to tumours in other locations (p < 0.05). Other factors that were positively associated with treatment delays were a history of diabetes mellitus (p = 0.037) and smoking (p = 0.026). Conclusion: Patients with upper-extremity STS may have the benefit of a relatively better prognosis as they present earlier and with a smaller tumour. In addition, factors, such as diabetes and smoking, which indicate a low interest in health also influenced the delay in the initial treatment. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]

Soft tissue modeling is a challenging issue in tissue engineering. Tissue is a complex environment. It is assumed to represent viscoelastic behavior. Therefore, a complicated process is required to model its stress-strain relationship. In this paper, a non-integer order model is considered for the tissue’s mechanical behavior. The order indicates the amount that the tissue tends to behave as a pure viscous or pure elastic material. The main goal of the paper and the main contribution is to interpret the order as a function of the state of the material. To this aim, an experimental estimated model is used in which the order is considered as a function of time. Stress and strain signals are also available as functions of time. Then, an identification process is used to obtain the direct functionality of the order with respect to the state of the material (i.e. the momentary stress and strain). Data are gathered through an experimental setup. The stress signal calculated using a force sensor is highly noisy. Hence, de-noising is necessary. However, noise elimination may cause losing meaningful data. Also, a slight amount of noise enhances the generalization of the trained network in the identification process. Accordingly, a multi-level noise reduction method is used. The method is based on Empirical Mode Decomposition (EMD). To obtain the optimal noise reduction level, the noise reduction process is performed level by level and the best levels in train and test stages are chosen. Results show that supposing an explicit functionality between the order (as the amount of viscoelasticity) and the state of the tissue is reasonable. Also, it is verified that multi-level de-noising significantly improves the identification process. [ABSTRACT FROM AUTHOR]

Myositis ossificans is a benign, ossifying, soft-tissue pseudotumor that most commonly occurs in men ages 30–40 years after trauma. Myositis ossificans may also occur in children, but it is extremely rare in those younger than 10 years of age. While myositis ossificans can often mimic malignant soft-tissue tumors, it has many unique findings that can aid in diagnostic differentiation. This differentiation is critical to avoid unnecessary risk with potentially harmful procedures. We present a very unusual presentation of myositis ossificans in the immediate post-birth perinatal period, as well as a review of key imaging findings. [ABSTRACT FROM AUTHOR]

Giant cell tumor of soft tissue (GCT-ST), histologically resembling the GCT of the bone, is a rare tumor. The tumor has been categorized to have low malignancy. Few reports of local recurrence or distant metastasis and the use of chemotherapeutic agents for metastatic GCT-ST exist. Herein, we report the efficacy of pazopanib in a 78-year-old Japanese woman with GCT in the intrinsic back musculature with both post-operative local recurrence and lung metastasis. The patient visited the hospital with a three-month history of a palpable mass in the intrinsic back musculature. Following magnetic resonance imaging, the tumor predominantly exhibited slight hyperintensity on T2-weighted images and intense heterogeneous enhancement on contrast-enhanced T1-weighted images. A percutaneous needle biopsy was performed, and the pathological diagnosis was GCT-ST. The patient underwent surgery, and three months later she presented with not only local recurrence but also multiple lung metastases. The patient was immediately treated with pazopanib 400 mg once daily. One month after initiating treatment, a partial response in the pulmonary lesions was observed, and stable disease (SD) effects lasted for 11 months without severe adverse effects. Therefore, pazopanib treatment for metastatic malignant giant cell tumor of soft tissue achieved reasonable success. [ABSTRACT FROM AUTHOR]

Myofibroblastoma is a rare tumor that was originally described in the breast but has since been found in extra-mammary locations, where it been renamed mammary-type myofibroblastoma (MTM). We describe a case of MTM occurring in the anterior compartment of the thigh, which was initially interpreted as a possible a liposarcoma on MRI. Two subsequent biopsy samples and eventual excision revealed the tumor to have the characteristic pathology of MTM. This benign tumor, albeit rare, needs to be considered in the imaging differential diagnosis of fat containing deep soft tissue masses of the extremity. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Adductor canal block and femoral nerve block are common analgesic methods after anterior cruciate ligament reconstruction. This article systematically evaluates the analgesic effect of adductor tube block and femoral nerve block after anterior cruciate ligament reconstruction with autogenous bone-tendon-bone reconstruction. METHODS: A computer-based search was performed in PubMed, EMbase, Cochrane Library, Web of Science, Google Scholar, CNKI, WanFang, VIP and CBM databases for clinical randomized controlled trials on the analgesic effect of femoral nerve block and adductor canal block from the establishment of the database to October 31, 2020 A randomized controlled clinical trial in analgesia after ligament reconstruction. The Cochrane risk bias table was used to assess the quality of the included literature. Meta-analysis was performed with RevMan 5.3 software, and the evaluation indicators included the main visual analog scale scores, opioid consumption and complications. RESULTS: A total of 6 randomized controlled trials involving 506 patients were included, 251 patients in the control group received femoral nerve block, and 255 patients in the intervention group received adductor tube block. The quality of the literature was higher. Meta-analysis showed that compared with the control group, the intervention group only had a slight advantage in reducing the visual analog scale score at 48 hours after surgery (mean difference=0.65, 95% confidence interval: 0.10-1.20, P < 0.05), but there was no significant difference between the two groups in terms of visual analog scores at 0, 6, 12, 18, and 24 hours postoperatively and morphine consumption at 0, 24, and 48 hours postoperatively (P > 0.05). Fewer complications, such as deep vein thrombosis, re-rupture of the anterior cruciate ligament, pain in the anterior knee area, defective knee extension function, decreased quadriceps muscle strength, and risk of falling, occurred in both two groups, indicating a high safety of two methods. CONCLUSION: There is basically no significant difference between femoral nerve block and adductor canal block in terms of postoperative analgesia, but largesample randomized controlled trials are needed in the future to confirm the results. Adductor canal block is recommended in clinical practice due to its small inhibitory effects on the muscle strength of quadriceps muscle and no obvious complications. [ABSTRACT FROM AUTHOR]

Background: The degree of contamination of healthy tissue with tumor cells during a biopsy in bone or soft tissue sarcomas is clearly dependant on the type of biopsy. Some studies have confirmed a clinically relevant contamination of the biopsy tract after incisional biopsies, as opposed to core-needle biopsies. The aim of our prospective study was to evaluate the risk of local recurrence depending on the biopsy type in extremity and pelvis sarcomas. Methods: We included 162 patients with a minimum follow-up of 6 months after wide resection of extremity sarcomas. All diagnostic and therapeutic procedures were performed at a single, dedicated sarcoma center. The excision of the biopsy tract after an incisional biopsy was performed as a standard with all tumor resections. All patients received their follow-up after the conclusion of therapy at our center by means of regional MRI studies and, at a minimum, CT of the thorax to rule out pulmonary metastatic disease. The aim of the study was the evaluation of the influence of the biopsy type and of several other clinical factors on the rate of local recurrence and on the time of local recurrence-free survival. Results: One hundred sixty-two patients with bone or soft tissue tumors of the extremities and the pelvis underwent either an incisional or a core-needle biopsy of their tumor, with 70 sarcomas (43.2%) being located in the bone. 84.6% of all biopsies were performed as core-needle biopsies. The median follow-up time was 55.6 months, and 22 patients (13.6%) developed a local recurrence after a median time of 22.4 months. There were no significant differences between incisional and core-needle biopsy regarding the risk of local recurrence in our subgroup analysis with differentiation by kind of tissue, grading of the sarcoma, and perioperative multimodal therapy. Conclusions: In a large and homogenous cohort of extremity and pelvic sarcomas, we did not find significant differences between the groups of incisional and core-needle biopsy regarding the risk of local recurrence. The excision of the biopsy tract after incisional biopsy in the context of the definitive tumor resection seems to be the decisive factor for this result. [ABSTRACT FROM AUTHOR]

Background: Lumbar spine pain is now a common affliction. In 90% of cases, the pain is of ambiguous and multicausal etiology, described as non-specific lower back pain (NLBP). Various models of this dysfunction were examined. The most popular model presents the pain as a result of an insult and secondary to changes in tension and lumbar muscles degeneration. There is no unequivocal solution concerning the cause of lumbar spine pain in the literature. Aim of the study: To examine the differences in muscles reactivity in the lumbar region in cases who suffer from lumbar spine pain in comparison to otherwise healthy controls. Material and methods: In total, 50 participants (24 men and 26 women) aged 18-45, including 24 people with pain, and 26 without ailments were included in the study. The visual analogue scale was used to measure pain intensity. The participants were assessed to determine the reactivity of the soft tissues of the lumbar part of the body. Selected muscles of this area were examined using a myotonometer, which shows five parameters relevant to viscoelastic tissues. Results: There were significant differences in the level of the pain (p<0.001), hypokinesia of the left abdominal rectus (p<0.05), asymmetry indicators for the creep parameter of the erector spinalis and abdominal external oblique muscle, and the stiffness of abdominal rectus (p<0.05). No significant differences for the remaining parameters were found. Conclusions: Tissue reactivity of selected muscles of the lumbar spine shows slight differences because of pain afflictions occurring in this area. [ABSTRACT FROM AUTHOR]

Background: Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature. Objective: To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance. Materials and methods: The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health's Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow‐up were included. Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed. Results: A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT). Conclusions: NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage. Clinical relevance: Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Current standard of care for most intermediate and high‐grade soft‐tissue sarcomas (STS) includes limb‐preserving surgical resection with either neoadjuvant radiation therapy (NRT) or adjuvant radiation therapy. To date, there have been a few studies that attempt to correlate histopathologic response to NRT with oncologic outcomes in patients with STS. Methods: Using our institutional database, we identified 58 patients who received NRT followed by surgical resection for primary intermediate or high‐grade STS and 34 patients who received surgical resection without NRT but did receive adjuvant radiation therapy or did not receive any radiation therapy. We analyzed four histologic parameters of response to therapy: residual viable tumor, fibrosis/hyalinization, necrosis, and infarction (each ratiometrically determined). Data were stratified into two binary groups. Unadjusted, 5‐ and 10‐year overall survival, and relapsed‐free survival (RFS) were calculated using the Kaplan–Meier method. Results: Analysis of pathologic characteristics showed that patients treated with NRT demonstrate significantly higher tumor infarction, higher tumor fibrosis/hyalinization, and a lower percent viable tumor compared with patients not treated with NRT (p < 0.0001). Based on Kaplan–Meier curve analysis and multivariate cox proportional hazard model for OS and RFS, patients treated with NRT and showing >12.5% tumor fibrosis/hyalinization have significantly higher overall survival and recurrence‐free survival at 5 and 10 years. Discussion and Conclusion: We have identified three histopathologic characteristics—fibrosis, hyalinization, and infarction—that may serve as predictive biomarkers of response to NRT for STS patients. Future prospective studies will be needed to confirm this association. [ABSTRACT FROM AUTHOR]