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Background A delayed seroma around breast implants is the most common clinical presentation of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). Interleukin-9 (IL-9), IL-10, and IL-13 concentrations are significantly higher in BIA-ALCL than in benign seromas, offering a means to distinguish between these conditions. Objectives The aim of this research was to test the ability of a lateral flow assay (LFA) to detect high concentrations of IL-9 rapidly. In addition, the authors compared CD30 and IL-9 LFAs for distinguishing BIA-ALCL from benign seromas. Methods Samples of 26 seromas (15 benign, 11 malignant) were tested on in-house-prepared LFA strips for IL-9 and CD30. Nanoparticle-conjugated antibodies specific to IL-9 and CD30 were used for detection. The intensity of both the test line (TL) and a control line (CL) were analyzed and the TL/CL ratio was calculated. IL-9 protein and IL-9 transcription factor PU.1 were stained in BIA-ALCL lines and clinical samples. Results The IL-9 LFA could reliably distinguish BIA-ALCL from benign seromas when the IL-9 concentration was >10 ng/ml. The CD30 LFA was positive in all 11 malignant cases. In 1 case with only faint CD30 and IL-10 TLs, the IL-9 LFA was clearly positive. Immunohistochemistry showed that IL-9 and PU.1 were present in tumor cells in BIA-ALCL lines and clinical samples. Conclusions Concentrations of IL-9 >10 ng/ml reliably distinguished BIA-ALCL from benign seromas. Moreover, the IL-9 LFA could detect BIA-ALCL when both the CD30 and IL-10 LFAs were not definitive, suggesting a multiplex LFA measuring IL-9, CD30, and IL-10 might be more effective in detecting BIA-ALCL in selected cases. [ABSTRACT FROM AUTHOR]

Background Silicone breast implant design has evolved over the last 50 years. Regulatory bodies including the FDA require data to support the modifications designed to improve the safety, efficacy, longevity, and biocompatibility of breast implants. Objectives The authors reviewed the 3-year data on the safety and effectiveness of Motiva (Establishment Labs Holdings, Inc. Alajuela, Costa Rica) SmoothSilk silicone gel-filled breast implants submitted to the FDA. The current submitted data include the primary breast augmentation and revisional augmentation cohorts. Methods The Motiva IDE is a prospective, single-arm, multicenter, 10-year pivotal study in which data are collected on breast augmentation, reconstruction, and revisional surgery. Three-year data were submitted to the FDA on adverse events, reoperations, patient and physician satisfaction, connective tissue diseases, and quality of life validated instruments. A subset of the patients underwent annual magnetic resonance imaging (MRI) at years 1, 2, and 3 to screen for implant rupture. Results A total of 451 patients were implanted in the primary augmentation cohort and 109 patients in the revisional augmentation cohort. There were 218 patients enrolled in the MRI cohort. Reported rates for reoperation for any reason were 6.1% in the primary augmentation cohort (92.4% follow-up) and 25.8% in the revisional augmentation cohort (88.7% follow-up). Discussion Motiva implants were first introduced in 2010. The 3-year Motiva data suggests that the leading cause of revisional surgery has shifted from capsular contracture and rupture to more subjective indications for reoperation such as malposition and size change. Conclusions Three-year data from the primary augmentation and revisional augmentation cohorts submitted to the FDA demonstrate the safety and efficacy of the Motiva implants. There were low complication rates for implant-related complications and high surgeon and patient satisfaction. Level of Evidence: 2 [ABSTRACT FROM AUTHOR]

A case of symptom improvement after implant removal without capsulectomy is presented with a review of the literature. [ABSTRACT FROM AUTHOR]

Innovation in healthcare has led to the development of numerous implantable medical devices (IMDs). However, advances in our knowledge of breast implant–associated malignancies have raised questions about the prevalence, etiology, and management of malignancies associated with non-breast IMDs. The objective of this study was to examine the prevalence and characteristics of malignancies associated with non-breast IMDs. An expert medical librarian developed the search strategy for this review. Databases included MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. In addition, gray literature sources were searched, and relevant references from systematic reviews and meta-analyses were included. The PRISMA guideline was followed for the review. Risk of bias was evaluated with the JBI Critical Appraisal tools. A total of 12,230 articles were reviewed, with a total of 77 meeting inclusion criteria. Risk of bias was highest with case reports (moderate, average of 65.1% with range of 37.5% to 100%) and low for the remaining study types. In total, 616 cases of IMD-associated malignancies were identified. Malignancies associated with IMDs were reported in the head and neck (543, 88.1%), lower extremity (57, 9.6%), thorax (9, 1.4%), abdomen (3, 0.5%), and genitourinary system (2, 0.3%). The most common malignancy type in the lower extremity was sarcoma, in the head and neck was squamous cell carcinoma, and in the thorax was lymphoma. This study is the first comprehensive systematic review of its kind. Overall, the oncologic risk of IMDs is low. The discussion of malignancy is an important part of the overall consent process, and malignancy should be considered with any new signs or symptoms in the anatomic area of an implant. More data are needed to better understand how primary malignancies occur around IMDs and how to reduce this risk. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background Systemic symptoms associated with breast implants (SSBI) is a term used to describe a group of patients who attribute a variety of symptoms to their implants. Previous studies have shown symptom improvement after implant removal in these patients irrespective of whether part or all the implant capsule has been removed. Objectives The aim of this study was to evaluate implant removal with no capsule removed in symptomatic and control subjects. Methods Eligible study subjects were sequentially enrolled at 5 investigator sites. The SSBI Cohort included patients with systemic symptoms they attributed to their implants who requested explantation. The Non-SSBI Cohort included subjects without systemic symptoms attributed to their implants who requested explantation with or without replacement. All subjects agreed to undergo explantation without removal of any capsule. Results Systemic symptom improvement was noted in SSBI subjects without removal of the implant capsule, comparable to the results of our previously published study. SSBI patients showed a 74% reduction in self-reported symptoms at 6 months with no capsulectomy which was not statistically different from partial or total capsulectomies (P =.23). Conclusions Explantation with or without capsulectomy provides symptom improvement in patients with systemic symptoms they associate with their implants. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

U.S. Department of Education studies reveal that, by various measures, almost 75 percent of college students today are "non-traditional." While the "non-traditional" label used to refer mostly to students beyond the 18-to-22 age range (about 40 percent of college students are older than 22), the phrase now connotes students of all ages who are progressing through school with a market basket of courses taken at various institutions over a period of years, in both full-time and part-time programs. Nontraditional students have gone to college in increasingly large numbers since the first G.I. Bill in 1944 supported veterans who needed retooling to enter the postwar economy. Public policy has long supported the presence of adult students in higher education as a means to achieve national economic goals through a more skilled workforce. However, most of the conversation in government and policy circles today about higher-education goals still assumes that nearly all college students are full-time, traditional undergraduates. Rather than relying on traditional metrics such as four- or six-year graduation rates, it would be better for boards and institutional leaders to draft specific plans for assessing educational outcomes for nontraditional students across a set of learning objectives tailored to students' workforce knowledge, skills, and competencies. Boards that want their universities to excel in meeting local and national workforce-development goals should consider several characteristics that mark successful programs for adult students. The author stresses that the ultimate measure of success for higher education is how many citizens are able to acquire the advanced knowledge, skills, values, and competencies necessary to ensure personal success and one's national competitiveness in the challenging 21st century global economy one faces.

Participation in accreditation processes, on visiting teams as well as through institutional self-study, is an excellent opportunity for individual academics to augment their professional expertise in a range of higher education issues: strategic planning and assessment, resource management and capital investments, curriculum planning and program development, and academic and corporate governance. At the same time, robust engagement with accreditation processes can help colleges and universities address challenging issues through using planning and self-study to drive institutional change. In this chapter, the author first considers the benefits of participation on accreditation teams for members and the chair. She then presents a case study on the role that accreditation played in moving one institution from crisis to success.

Recent catastrophes have brought about numerous critiques and changes to campus communications. In this article, the author shares the lessons she has learned from the crises she experienced during her 18 years of being the president of Trinity (Washington) University. Furthermore, Joan Hinde Stewart, president of Hamilton College, adds her thoughts on why certain types of crises are necessary for a college's existence.

The article discusses the U.S. federal law known as Title IX of the Education Amendments of 1972 and the admissions policies of Catholic colleges in the U.S. Topics explored include the promotion of equality for women following the enactment of Title IX, the transformative effect of the co-education system on Catholic colleges, and the modernization of policies and services of Catholic women's colleges particularly for pregnant students.

Background High-resolution ultrasound (HRUS) is widely employed in plastic surgery practices to detect implant rupture prior to revisional surgery. Published research has found a good overall accuracy of shell failure detection. The literature often references a learning curve associated with incorporating this imaging technique into a medical practice, but it has yet to be visualized or defined. Objective This study was undertaken to calculate current testing statistics for use of HRUS to detect shell failure and to define the learning curve associated with the predicted improvement reflected by statistics of test and surgeon proficiency. Methods A retrospective review of sequential in-office HRUSs on patients with breast implants was conducted across 2 plastic surgery practices. Preoperative ultrasound reports and intraoperative findings were compared. Test statistics were calculated for each group of 10 subsequent patients, and a regression analysis was performed to define the learning curve. Results A total of 480 implants were examined and averages for all test statistics were calculated. All were higher than most of the previously reported literature standards. The regression analysis showed a linear improvement for both sensitivity and specificity over time, with significant improvement in sensitivity. Conclusion Results show that HRUS is highly effective in detecting shell failure in breast implants. There is also a calculable linear improvement for all test values of the HRUS over time. Surgeons were able to remain above the literature standard for sensitivity after their 60th HRUS reading. This improvement shows that continued use and practice of the imaging technique allow for more accurate findings. [ABSTRACT FROM AUTHOR]

TENSIONS EXIST IN THE ACADEMY about the dialogue of Indigenous knowledge(s). Indigenous societies are exercising self-determination. Contradictions exist as universities are urged to Indigenize the academy without a clear understanding [...]

The US FDA in response to concerns that patients undergoing breast implant surgery were not adequately informed about the risks of receiving an implanted medical device mandated a patient decision checklist (PDC) in October 2021. Breast implant manufactures communicated with plastic surgeons in 2022 regarding the use of the PDC as a condition for the sale of breast implants. Plastic surgeons voiced concerns over the accuracy of content in the PDC and its confusing statements about risk of adverse events associated with breast surgery. In April 2022, the Aesthetic Society developed a survey that was sent to its members regarding their experiences with the PDC. This was a 5-question survey and one additional place for comments. The purpose for this survey was to develop data on the six-month experience of plastic surgeons using the PDC. A total of 206 Aesthetic Society members (9%) participated in the survey (1849 total active members in the United States). Patients deserve appropriate information prior to breast implant surgery to make an informed decision after reviewing the potential risks and benefits. The authors believe that there is still more work to be done on an ideal PDC will make it fair and balanced and that it scientifically describes risk incidence in a way that patients understand and can be updated. [ABSTRACT FROM AUTHOR]

Background There has been an increasing need to acquire rigorous scientific data to answer the concerns of physicians, patients, and the FDA regarding the self-reported illness identified as breast implant illness (BII). There are no diagnostic tests or specific laboratory values to explain the reported systemic symptoms described by these patients. Objectives The aim of this study was to determine if there are quantifiable laboratory findings that can be identified in blood, capsule tissue pathology, or microbes that differentiate women with systemic symptoms they attribute to their implants from 2 control groups. Methods A prospective blinded study enrolled 150 subjects into 3 cohorts: (A) women with systemic symptoms they attribute to implants who requested implant removal; (B) women with breast implants requesting removal or exchange who did not have symptoms attributed to implants; and (C) women undergoing cosmetic mastopexy who have never had any implanted medical device. Capsule tissue underwent detailed analysis and blood was sent from all 3 cohorts to evaluate for markers of inflammation. Results No significant histologic differences were identified between the cohorts, except there were more capsules with synovial metaplasia in the non-BII cohort. There was no statistical difference in thyroid-stimulating hormone, vitamin D levels, or complete blood count with differential between the cohorts. Next-generation sequencing revealed no statistically significant difference in positivity between Cohort A and B. Of the 12 cytokines measured, 3 cytokines, interleukin (IL)-17A, IL-13, and IL-22, were found to be significantly more often elevated in sera of subjects in Cohort A than in Cohorts B or C. The enterotoxin data demonstrated an elevation in immunoglobulin G (IgG) anti– Staphylococcus aureus enterotoxin A in Cohort A. There was no correlation between the presence of IgE or IgG anti- Staphylococcal antibody and a positive next-generation sequencing result. Conclusions This study adds to the current literature by demonstrating few identifiable biomedical markers to explain the systemic symptoms self-reported by patients with BII. [ABSTRACT FROM AUTHOR]