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Lipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients' symptoms. A 39-year-old female presented with asymmetric progressive initially unilateral lower limb swelling with severe pain with subsequent skin ulceration. Conservative management failed to improve her condition. After excluding other causes and detailed radiologic investigation, lipedema was diagnosed with an associated impaired skin perfusion. Trial of local wound care and compression therapy failed to improve the condition. Subsequent soft tissue debulking with circumferential liposuction and ulcer debridement and immediate compression showed dramatic improvement of the symptoms and skin perfusion. The unique nature of this case sheds light on lipedema as a loose connective tissue disease. Inflammation and microangiopathies explain the associated pain with hypoperfusion and ulceration being quite atypical and in part might be related to the large buildups of matrix proteins and sodium contents leading to fragility in microvessels with frequent petechiae and hematoma and subsequent tissue ischemia. Conservative measures like compression therapy plays a significant role in disease course. Surgical debulking with liposuction was shown to be efficacious in reducing the soft tissue load with improvement in limb pain, edema, circumference, and skin perfusion that was seen in our patient. Lipedema is a frequently misdiagnosed condition with disabling features. Skin involvement in lipedema with potential hypoperfusion was shown and it requires further investigation. [ABSTRACT FROM AUTHOR]

This study aimed to present a novel markerless augmented reality (AR) system using automatic registration based on machine-learning algorithms that visualize the facial region and provide an intraoperative guide for facial plastic and reconstructive surgeries. This study prospectively enrolled 20 patients scheduled for facial plastic and reconstructive surgeries. The AR system visualizes computed tomographic data in three-dimensional (3D) space by aligning with the point clouds captured by a 3D camera. Point cloud registration consists of two stages: the preliminary registration gives an initial estimate of the transformation using landmark detection, followed by the precise registration using Iterative Closest Point algorithms. Computed Tomography (CT) data can be visualized as two-dimensional slice images or 3D images by the AR system. The AR registration error was defined as the cloud-to-cloud distance between the surface data obtained from the CT and 3D camera. The error was calculated in each facial territory, including the upper, middle, and lower face, while patients were awake and orally intubated, respectively. The mean registration errors were 1.490 ± 0.384 mm and 1.948 ± 0.638 mm while patients were awake and orally intubated, respectively. There was a significant difference in the errors in the lower face between patients while they were awake (1.502 ± 0.480 mm) and orally intubated (2.325 ± 0.971 mm) when stratified by facial territories (p = 0.006). The markerless AR can accurately visualize the facial region with a mean overall registration error of 1–2 mm, with a slight increase in the lower face due to errors arising from tube intubation. [ABSTRACT FROM AUTHOR]

Background: To assess the appropriate energy expenditure requirement for liver transplant (LT) recipients in South Korea, 4 commonly used predictive equations were compared with indirect calorimetry (IC).Methods: A prospective observational study was conducted in the surgical intensive care unit (ICU) of an academic tertiary hospital between December 2017 and September 2018. The study population comprised LT recipients expected to remain in the ICU >48 hours postoperatively. Resting energy expenditure (REE) was measured 48 hours after ICU admission using open-circuit IC. Theoretical REE was estimated using 4 predictive equations (simple weight-based equation [25 kcal/kg/day], Harris-Benedict, Ireton-Jones [ventilated], and Penn State 1988). Derived and measured REE values were compared using an intraclass correlation coefficient (ICC) and Bland-Altman plots.Results: Of 50 patients screened, 46 were enrolled, were measured, and completed the study. The Penn State equation showed 65.0% agreement with IC (ICC, 0.65); the simple weight-based (25 kcal/kg/day), Harris-Benedict, and Ireton-Jones equations showed 62.0%, 56.0% and 39.0% agreement, respectively. Bland-Altman analysis showed that all 4 predictive equations had fixed bias, although the simple weight-based equation (25 kcal/kg/day) showed the least.Conclusion: Although predicted REE calculated using the Penn State method agreed with the measured REE, all 4 equations showed fixed bias and appeared to be inaccurate for predicting REE in LT recipients. Precise measurement using IC may be necessary when treating LT recipients to avoid underestimating or overestimating their metabolic needs. [ABSTRACT FROM AUTHOR]

Background/aim: To evaluate whether core needle biopsy specimens (CNBS) would be better than surgical specimens (SS) for evaluating phosphoproteins as biological markers in breast cancer., Materials and Methods: This retrospective analysis included a total of 99 patients who had invasive breast cancer and were treated surgically between January 2012 and July 2013. The expression of phosphorylated ribosomal protein S6-kinase-1 (p-S6K1), phosphorylated protein kinase B (p-AKT), and estrogen receptor (ER) were assessed immunohistochemically on both CNBS and SS for each patient., Results: The expression rate of phosphoprotein at any intensity was higher on CNBS than on SS (p-S6K1, 99.0% versus 59.6%; p-AKT, 94.9% versus 56.6%). p-S6K1and p-AKT expression was classified as negativity (absence to weak staining) or positivity (moderate to strong staining) for further analysis. For p-S6K1, 24.2% of patients showed positivity on CNBS and negativity on SS, while 7% of the patients showed negativity on CNBS and positivity on SS. For p-AKT, 70.7% of the patients showed positivity on CNBS and negativity on SS, while only 1.0% of patients showed negativity on CNBS and positivity on SS., Conclusion: CNBS may be the more appropriate specimen type for immunohistochemical examination of phosphoprotein expression in invasive breast cancer., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)