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Josef Haik,1–4 Or Givol,2 Rachel Kornhaber,1,5 Michelle Cleary,6 Hagit Ofir,1,2 Moti Harats1–3 1Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Ramat Gan, 2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Burn Injury Research Node, Institute for Health Research University of Notre Dame Fremantle, Fremantle WA, Australia; 4Talpiot Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; 5Faculty of Health, 6School of Health Sciences, College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia Abstract: Acute auricular hematoma can be caused by direct blunt trauma or other injury to the external ear. It is typically seen in those who practice full contact sports such as boxing, wrestling, and rugby. “Cauliflower ear” deformity, fibrocartilage formation during scarring, is a common complication of auricular hematomas. Therefore, acute drainage of the hematoma and postprocedural techniques for preventing recurrence are necessary for preventing the deformity. There are many techniques although no superior method of treatment has been found. In this case report, we describe a novel method using needle aspiration followed by the application of a magnet and an adapted disc to the affected area of the auricular. This minimally invasive, simple, and accessible method could potentially facilitate the treatment of cauliflower ear among full contact sports athletes. Keywords: cauliflower ear, hematoma, ear deformity, athletic injuries, wrestling, case report

Remote learning has been an increasingly growing field in the last two decades. The Internet development, as well as the increase in PC's capabilities and bandwidth capacity, has made remote learning through the internet a convenient learning preference, leading to a variety of new interfaces and methods. In this work, we consider a remote learning interface, developed in a Computer Integrated Manufacturing (CIM) Laboratory, and evaluate the contribution of different interface components to the overall performance and learning ability of end users. The evaluated components are the control method of the robotic arm and the use of a three-dimensional simulation tool before and during the execution of a robotic task. An experiment is designed and executed, comparing alternative interface designs for remote learning of robotic operation. A teleoperation task was given to 120 engineering students through five semesters. The number of steps required for completing the task, the number of errors during the execution, and the improvement rate during the execution were measured and analyzed. The results provide guidelines for a better design of an interface for remote learning of robotic operation. The main contribution of this paper is in the introduction of a new teaching tool for laboratories and the supplied guidelines for an efficient design of such tools. (Contains 14 figures.)

Background: Medical tourism is a rapidly expanding multi-billion-dollar industry. Reduced costs, all-inclusive vacation packages that include cosmetic surgery, globalization, and affordable flight expenses have encouraged patients to seek aesthetic procedures in different countries. Cosmetic medical tourism is associated with high complication rates, such as severe infections, wound dehiscence, pain or discomfort, aesthetic dissatisfaction, and even death., Patients and Methods: A twelve-year survey of medical records was conducted using ADAMS healthcare database software. Data regarding patient demographics, the country of the original procedure, the operation type, complications, and subsequent treatment were recorded., Results: Fifty-six patients have been admitted to the Department of Plastic and Reconstructive Surgery. The youngest patient was 18, and the oldest was 65, with an average age of 37.46. The majority were females (n = 51, 91.07%). The most common procedure was liposuction (n = 40), followed by abdominoplasty (38). Only eleven patients had a single procedure while travelling; on average, they had 2.34 procedures in a single trip. Patients presented with an average POD of 30.9. The most common complaint was dehiscence at the surgical site. Eleven patients required re-operation. The average hospitalization length in the Plastic and Reconstructive Surgery Department was 4.4 days., Conclusions: Medical tourism has a positive impact on patients and caregivers alike. However, the combination of multiple procedures in a short time, relatively short follow-up, different microbial environments, and more led to substantial complications, which had a devastating effect on many patients., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflicts of interest to disclose. This study was authorized by an internal review board following the Declaration of Helsinki. For this type of study, informed consent is not required., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Purpose: Traditional vocal fold pathology recognition typically requires expertise of laryngologists and advanced instruments, primarily through direct visualization. This study aims to augment this conventional paradigm by introducing a parallel diagnostic procedure. Our objective is to harness a machine-learning algorithm designed to discern intricate patterns within patients' voice recordings to distinguish not only between healthy and hoarse voices but also among various specific disorders., Materials and Methods: We employed a machine-learning algorithm, utilizing transfer learning on the HuBERT model with Saarbruecken Voice Database samples. The study was conducted in two stages: a binary classifier distinguishes healthy and hoarse voices, while a subsequent multi-class classifier identifies specific voice disorders. Data from 2103 sessions, including over 25,000 components, representing diverse pathologies and healthy individuals, was analyzed. The models were trained, validated, and tested with a focus on robustness and accuracy in diagnosis., Results: The binary classifier achieved 82 % accuracy in distinguishing healthy from pathological voices. The multi-class algorithm which aims to identify specific laryngeal disorders obtained the highest accuracy (>93 %) for Laryngeal Dystonia. Noteworthy is the persistent challenge posed by Laryngeal Dystonia, a condition lacking a definitive diagnostic modality., Conclusions: Our findings demonstrate the feasibility of utilizing machine-learning algorithms to process voice samples, categorizing them into distinct pathologies. This approach holds potential for enhance patient triage, streamline diagnostics, and elevate overall patient care. Particularly valuable for challenging diagnoses, such as Laryngeal Dystonia, this method underscores the transformative role of machine learning in optimizing healthcare practices., Competing Interests: Declaration of competing interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

This study was designed to compare VR stereoscopical three-dimensional (3D) imaging with two-dimensional computed tomography angiography (CTA) images for evaluating the abdominal vascular anatomy before autologous breast reconstruction., Methods: This prospective case series feasibility study was conducted in two tertiary medical centers. Participants were women slated to undergo free transverse rectus abdominis muscle, unilateral or bilateral deep inferior epigastric perforator flap immediate breast reconstruction. Based on a routine CTA, a 3D VR model was generated. Before each procedure, the surgeons examined the CTA and then the VR model. Any new information provided by the VR imaging was submitted to a radiologist for confirmation before surgery. Following each procedure, the surgeons completed a questionnaire comparing the two methods., Results: Thirty women between 34 and 68 years of age were included in the study; except for one, all breast reconstructions were successful. The surgeons ranked VR higher than CTA in terms of better anatomical understanding and operative anatomical findings. In 72.4% of cases, VR models were rated having maximum similarity to reality, with no significant difference between the type of perforator anatomical course or complexity. In more than 70% of the cases, VR was considered to have contributed to determining the surgical approach. In four cases, VR imaging modified the surgical strategy, without any complications., Conclusions: VR imaging was well-accepted by the surgeons who commented on its importance and ease compared with the standard CTA presentation. Further studies are needed to determine whether VR should become an integral part of preoperative deep inferior epigastric perforator surgery planning., Competing Interests: Disclosure: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Study Design: Systematic review of hyaluronic acid (HA)-related complications., Objective: To systematically review all available literature including case reports and case series to identify a pattern for the management of vascular compromise resulting in facial skin ischemia and ocular manifestations following HA injection., Methods: This review was based on a systematic search of 3 electronic databases PubMed, CINAHL, and Scopus for all available literature including case series and case reports from database inception to July 2019. Only a total of 52 case reports/series were eligible for review and included 107 patients., Results: The reviewed literature available was comprised from case reports/series and indicated that management of both impending skin necrosis and visual disturbances is variable with no repetitive pattern of action. Yet, successful management is time dependent as early interventions stopped progression and, in some cases, even reversed adverse effects., Conclusion: Results found no universal protocol for achieving optimal results for adverse effects and as such, we present a step-by-step algorithm for the emergency management of complications following HA injection., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Aims: We present our experience of direct to implant breast reconstruction with total musculofascial coverage, without the use of ADM., Background: The prevalence of one-stage breast reconstruction with silicone implants has increased markedly in recent years. This is attributed to advances in the surgical technique of mastectomy and to the increased rate of preventive mastectomy. The use of Acellular Dermal Matrix (ADM) became a common practice. Notwithstanding, ADM utilization may lead to higher postoperative complication rates., Methods: Between 2015 to 2018, a prospective study was conducted at the Sheba Medical Center including all patients undergoing mastectomy and immediate breast reconstruction. In this study, we included patients who underwent direct to implant reconstruction with total musculofascial coverage, without the use of ADM. We gathered demographic, oncologic and surgical features, including post-operative complications, along with aesthetic outcome., Results: A total of 20 patients (25 breasts) underwent direct to implant breast reconstruction with total musculofascial coverage. The overall complication rate was 24% (6 breasts). Minor complications (5 breasts, 20%) were manifested as delayed wound healing, minimal capsular contracture, skin necrosis and minor infection. A major complication of capsular contracture occurred in one patient. Corrective surgery due to aesthetic outcome was offered to 36% of the patients. nevertheless, only 16% chose to undergo an aesthetic reoperation., Conclusions: Immediate direct to implant breast reconstruction with total musculofascial coverage is an attractive option for single stage breast reconstruction with excellent aesthetic outcomes and low complication rates. Presumably, with a careful patient selection, the complication rates can be reduced even further.

Introduction: The elderly experience higher mortality rates and poorer outcomes compared to younger burn survivors with similar injuries., Methods: This epidemiological study reviewed records of all admitted elderly burn patients collected from five burns facilities in Israel between 1997-2016. Collected data was limited to the population aged 20+, focused on the population aged 60+., Results: Mortality rates for elderly patients increased with TBSA and increases with age. Regression analyses demonstrated a decrease in mortality of 2.9% (p=0.013) per 5 years, an overall decrease of 11.6% over the 20-year study period, with the decline more significant for older age groups. This decrease in mortality was much larger than that observed for all burns patients over this period. The most common cause of injury in the elderly population was fire, with mortality rate highest for this cause. There was no effect of gender on mortality rate. Mortality increased when smoke inhalation was present for TBSA<20%, with mortality unaffected by the presence of smoke inhalation for higher TBSA. The need for surgery correlates with high mortality rates., Conclusion: This study identified key factors that impact mortality and demonstrated a large decrease in mortality in the elderly patients over the study period., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

The opening of the National Burns Center (NBC) in Sheba Medical Center (SMC) in 2014 was a keystone point in the development of specialized burns trauma services for Israel to ensure burn care and disaster planning at international standards. The NBC is a purpose-built, level 1 burns trauma center that receives patients from Israel, Gaza, West Bank, and abroad. Hosting six intensive care and four step-down burns beds, the center serves as a referral center for patients in other health-care facilities with indication for hospitalization. In the present study, we describe the planning, design, and organization of the NBC at the SMC with reference to some of the key areas and considerations in its conception and development. With the improved survival rates of patients with extensive burns and the demographics and characteristics among burn-injury patients in Israel, the NBC has the capacity to be the center of excellence in burns care, teaching, and research within the Middle East., (© 2018 John Wiley & Sons Australia, Ltd.)

Objectives: To determine whether there is a dynamic in the location of amniotic sacs in a twin gestation, during pregnancy., Study Design: The study group comprised 63 twin pairs discordant for sex, who by vaginal sonography performed between 14 and 16 weeks' gestation, were characterized as first twin (opposite the internal os), and second twin. The order of delivery was recorded in the pregnancies that ended with vaginal birth., Results: Thirty seven of 41 (90.2%) twins who were delivered vaginally (between 32 and 41 weeks' gestation), were born in the same order as that predicted by transvaginal sonography early in pregnancy. It was found that in this small series there was a dynamic in the amniotic sac location in twin gestations during pregnancy in only about 10% of the cases., Conclusions: In roughly 90% of twins, there is no dynamic in the location of the amniotic sacs during pregnancy, and the first twin at the beginning of pregnancy intrinsically remains.

To identify a specific heterozygote advantage in familial Mediterranean fever (FMF), responsible for the high carrier rate of 1/6 in North African Jews, we studied the morbidity and mortality of 148 parents of affected patients and of 148 ethnically matched control persons. Our data demonstrate an apparently reduced prevalence of asthma in the heterozygotes compared with the control persons (3 vs. 6). There were no significant differences between the 2 groups in fertility rate, number of pregnancies and deliveries, or the prevalence of common diseases. Our data are in agreement with previous studies which demonstrated decreased asthma prevalence in FMF patients. It further confirmed, these findings suggest that identification of the FMF gene on 16p may provide an insight into asthma.