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Aim: Fibroblasts are common cells in subcutaneous tissue and they have an important role on healing process. Although patients who are receiving first-generation low molecular weight heparins are more likely to experience skin responses, there is no study evaluating the effect of bemiparin sodium on subcutaneous fibroblasts following administration. In the present study, we aimed to evaluate the effects of bemiparin sodium on fibroblast cell viability in cell culture model. Material and Methods: The L929 cells were incubated for 12 hours in 96-well culture dishes. Fresh medium containing different concentrations of bemiparin was added in five different concentrations (Dilution I: 3,500 IU; Dilution II: 1,750 IU; Dilution III: 875 IU; Dilution IV: 437.5 IU; Dilution V: 218.75 IU). A control group was established with drug-free culture medium. Cell viability analysis was performed after 48 hours of incubation by the standard 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) method. The change in cell morphology was examined at each dilution by direct and acridine orange/propidium iodide staining. Results: The highest cytotoxic effect was observed in dilution I compared to the control group (p<0.05). There is a clear deviation from the fibroblastic morphology of the cells in dilution I. The cells have a round morphology with degeneration and nuclear condensation. Conclusion: Although it seems that high doses of bemiparin may have a negative effect on fibroblast cells in subcutaneous tissue, it can be considered that the cytotoxic effects of high concentrations of the drug at the application site will not be clinically significant due to using a single dose per day. [ABSTRACT FROM AUTHOR]

Background The veins in the upper limb are classified as superficial or deep, with deep veins, such as the venae comitantes and axillary vein, coming after the major arteries. The subcutaneous tissue contains the superficial veins, which link to the deep veins. These veins include the basilic, cephalic, median cubital, and median antebrachial veins. These superficial veins are clinically significant for phlebotomy, transfusion, and cardiac catheterization, and it joins the median cubital vein at the elbow. It is essential to comprehend the structure and patterns of cubital superficial veins in order to design dialysis access and minimise hazards. Materials and Methods Studying the superficial venous organisation in the cubital fossa of 192 MBBS preclinical sciences students, ages 18 to 24, was a cross-sectional observational study carried out at the Nobel Medical College Teaching Hospital in Nepal. A tourniquet and skin marker/tailor's chalk were used in the study to examine 384 anterior aspects of the arms. Six sets of veins were distinguished from the skin's veins. Tiny veins, cubital wounds, or thick tissue layers disqualified students. Results A study of 192 preclinical sciences students at Nobel Medical College Teaching Hospital in Biratnagar found that type II variant was the most common venous pattern in the cubital fossa region, followed by type I in 24.75%, and the lowest being the type VI pattern in 3.35%. Conclusion It was discovered that the patterns of superficial veins at the cubital fossa did not significantly alter based on the gender or nationality of the individual. Overall, the most common venous pattern was type II, though type I was more frequently seen in female subjects but the difference was statistically insignificant.

The temporal fascia is a double lamina sandwiching a thick fat layer above the zygomatic bony arch. To characterize each lamina, their developmental processes were examined in fetuses. We observed histological sections from 22 half-heads of 10 mid-term fetuses at 14–18 weeks (crown-rump length, 95–150 mm) and 12 near-term fetuses at 26–40 weeks (crown-rump length, 215–334 mm). The superficial lamina of the temporal fascia was not evident at mid-term. Instead, a loose subcutaneous tissue was attached to the thin, deep lamina of the temporal fascia covering the temporalis muscle. At near-term, the deep lamina became thick, while the superficial lamina appeared and exhibited several variations: i) a monolayered thick membrane (5 specimens); ii) a multi-layered membranous structure (6) and; iii) a cluster of independent thick fasciae each of which were separated by fatty tissues (1). In the second and third patterns, fatty tissue between the two laminae was likely to contain longitudinal fibrous bands in parallel with the deep lamina. Varying proportions of the multi-layered superficial lamina were not attached to the zygomatic arch, but extended below the bony arch. Whether or not lobulation or septation of fatty tissues was evident was not dependent on age. The deep lamina seemed to develop from the temporalis muscle depending on the muscle contraction. In contrast, the superficial lamina developed from subcutaneous collagenous bundles continuous to the cheek. Therein, a difference in development was clearly seen between two categories of the fasciae. [ABSTRACT FROM AUTHOR]

The World Health Organization, in response to the growing burden of fungal disease, established a process to develop a fungal priority pathogens list. This systematic review aimed to evaluate the epidemiology and impact of eumycetoma. PubMed and Web of Science were searched to identify studies published between 1 January 2011 and 19 February 2021. Studies reporting on mortality, inpatient care, complications and sequelae, antifungal susceptibility, risk factors, preventability, annual incidence, global distribution, and emergence during the study time frames were selected. Overall, 14 studies were eligible for inclusion. Morbidity was frequent with moderate to severe impairment of quality of life in 60.3%, amputation in up to 38.5%, and recurrent or long-term disease in 31.8%–73.5% of patients. Potential risk factors included male gender (56.6%–79.6%), younger age (11–30 years; 64%), and farming occupation (62.1%–69.7%). Mycetoma was predominantly reported in Sudan, particularly in central Sudan (37%–76.6% of cases). An annual incidence of 0.1/100   000 persons and 0.32/100  000 persons/decade was reported in the Philippines and Uganda, respectively. In Uganda, a decline in incidence from 3.37 to 0.32/100    000 persons between two consecutive 10-year periods (2000–2009 and 2010–2019) was detected. A community-based, multi-pronged prevention programme was associated with a reduction in amputation rates from 62.8% to 11.9%. With the pre-specified criteria, no studies of antifungal drug susceptibility, mortality, and hospital lengths of stay were identified. Future research should include larger cohort studies, greater drug susceptibility testing, and global surveillance to develop evidence-based treatment guidelines and to determine more accurately the incidence and trends over time. [ABSTRACT FROM AUTHOR]

Subcutaneous tissue mechanics are important for drug delivery. Yet, even though this material is poroelastic, its mechanical characterization has focused on its hyperelastic response. Moreover, advancement in subcutaneous drug delivery requires effective tissue mimics such as hydrogels for which similar gaps of poroelastic data exist. Porcine subcutaneous samples and gelatin hydrogels were tested under confined compression at physiological conditions and strain rates of 0.01%/s in 5% strain steps with 2600 s of stress relaxation between loading steps. Force-time data were used in an inverse finite element approach to obtain material parameters. Tissues and gels were modeled as porous neo-Hookean materials with properties specified via shear modulus, effective solid volume fraction, initial hydraulic permeability, permeability exponent, and normalized viscous relaxation moduli. The constitutive model was implemented into an isogeometric analysis (IGA) framework to study subcutaneous injection. Subcutaneous tissue exhibited an initial spike in stress due to compression of the solid and fluid pressure buildup, with rapid relaxation explained by fluid drainage, and longer time-scale relaxation explained by viscous dissipation. The inferred parameters aligned with the ranges reported in the literature. Hydraulic permeability, the most important parameter for drug delivery, was in the range k 0 ∈ [ 0.142 , 0.203 ] mm 4 /(N s). With these parameters, IGA simulations showed peak stresses due to a 1-mL injection to reach 48.8 kPa at the site of injection, decaying after drug volume disperses into the tissue. The poro-hyper-viscoelastic neo-Hookean model captures the confined compression response of subcutaneous tissue and gelatin hydrogels. IGA implementation enables predictive simulations of drug delivery. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to propose a systematic approach for managing thick-skinned rhinoplasty patients. Methods: A retrospective review of the treatment of 26 thick-skinned patients with aesthetic and/or functional problems over a period of three years from January 2018 to January 2021 with a follow up for one year. A presurgical evaluation of skin was carried out initially. Skin thickness due to sebaceous overactivity was treated with retinoic acid derivatives, and skin thickness due to increased adipose tissue or hypertrophic fibrofatty layers was treated surgically. Open rhinoplasty was performed in all patients and a strong osseocartilaginous framework was created with the skin stretched as much as the aesthetic tolerance allowed. Results: Post-operative outcomes were based on subjective assessment, photographic evaluation and the Rhinoplasty Outcome Evaluation questionnaire, which indicated significant patient satisfaction. Conclusion: Using this systemic approach for treating thick-skinned rhinoplasty patients, predictable results with improved aesthetic satisfaction in patients were achieved. [ABSTRACT FROM AUTHOR]

Abstract is missing (Short communication)

Objective: This research compares the efficacy of subcutaneous soft tissue and temporalis fascia in tympanic membrane grafting for large tympanic membrane perforations. Methods: A retrospective cohort study compared tympanic membrane graft success rate and hearing outcomes in 248 patients who underwent tympanoplasty using subcutaneous soft tissue (n = 118) or temporalis fascia (n = 130) via the post-auricular approach. Results: Comparable results were observed in both groups. Tympanic membrane graft success rate was 98.3 per cent (116 ears) in the subcutaneous soft tissue group and 98.5 per cent (128 ears) in the temporalis fascia group. The rate of air–bone gap closure within 20 dB was 54.2 per cent (64 ears) and 60.0 per cent (78 ears) in the soft tissue and temporalis fascia groups, respectively (p = 0.360). Conclusion: Subcutaneous soft tissue is a reliable and readily available tympanic membrane graft material in both revision and primary tympanoplasty for large tympanic membrane perforations. [ABSTRACT FROM AUTHOR]

Background The injection of illicit, nonregulated foreign materials is increasingly common and has negative consequences relative to the inflammatory process that ensues. Objectives The aim of this study was to identify anatomical and imaging characteristics after the cosmetic injection of illicit foreign materials. Methods A retrospective review of clinical and imaging records was performed. The issues analyzed were the anatomical site, type of injected substance, imaging method for diagnosis, and patterns of migration. Results Data on 413 patients were collected. Most patients were female, with a mean age of 44 years. The most commonly infiltrated region was the buttocks (n = 284; 53.58%) followed by the breast (n = 99; 18.67%). Magnetic resonance imaging was the most common method of diagnosis in those patients who had an imaging study (159 out of 168). The most frequent depth of foreign material detected by imaging was the muscular plane (n = 103; 61.30%). Migration was detected in 56.55% of patients who had an imaging study. Most infiltrated substances were unknown; biopolymers were the most commonly identified substances. Depending on the type of substance, migration rates varied from 13% to 29%; rate differences were not statistically significant (P =.712). Migration was more common when the depth of infiltration was in muscle (77.66%) than in subcutaneous tissue (23.4%); this difference was statistically significant (P <.0001). Conclusions Deep infiltration is related to greater migration rates, apparently regardless of the substance injected. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background/Objective: Stiff skin syndrome (SSS) is a rare disorder characterized by "rock hard" indurated skin affecting different body parts. The localized variant poses a diagnostic challenge, as it is frequently mistaken for other inflammatory connective tissue disorders. The aim of this study is to provide insightful clinical, radiologic and diagnostic data that might prove useful for the evaluation, management and treatment of pediatric patients with segmental SS. Methods: This single‐center cohort study included patients ≤18 years diagnosed with localized SSS from 1988 to 2021 in a quaternary pediatric healthcare center in Toronto, Canada. Data included demographics, clinical, histopathologic and radiologic features, treatments, and clinical course. Data were summarized with descriptive statistics (mean, standard deviation, medians, interquartile ranges [IQRs]) and frequencies. Results: A total of 11 patients were included. The sclerotic changes were measured clinically and radiologically, by a total of 16 imaging studies: 13 magnetic resonance imaging (MRI) and 3 ultrasound. MRI readings showed abnormal high signal intensity of the affected tissue correlating with the anatomical site of involvement in all cases, specifically, in the shoulder/pelvic girdle with limb extension. Shear wave ultrasound elastography (SWE) demonstrated higher values within the dermis compared to the control site. Conclusion: The presence of segmental sclerotic changes that affects the pelvic/shoulder girdle with extension to the extremities, in the absence of inflammation on biopsy and abnormal signaling intensity on imaging is suggestive of SSS. Skin SWE is a feasible, noninvasive, and objective instrument to evaluate and monitor sclerotic changes overtime, it could be potentially extrapolated to other pediatric skin sclerotic conditions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the possible renal and hepatic alteration by root canal filling pastes in mice. Material and Methods: Fifty-four mice were divided into nine groups and received one polyethylene tube implant containing two filling pastes (CTZ or calcium hydroxide pastes). Empty polyethylene tubes were used as a negative control. All tubes were implanted subcutaneously in the back of the mice. After time intervals of 7, 21, and 63 days, 1.5 mL of blood was collected by cardiac puncture, and serum samples were used for serological testing. Urea, creatinine, aspartate transferase (AST), alanine transferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT) were evaluated. Data were analyzed by 2-way ANOVA (p0.05). No differences were observed in the interactions (material*experimental time intervals) and the biochemical parameters analyzed (p>0.05). Conclusion: CTZ and calcium hydroxide pastes did not cause hepatic and renal alterations in mice, demonstrating the pastes' safety.

Pacinian corpuscles are mechanoreceptors frequently found between the dermis and subcutaneous tissues of the hands and feet. They are responsible for sensitivity to vibration and pressure. Pacinian corpuscle hyperplasia is a rare cause of induration in the palms of the hands or the soles of the feet, often of unknown origin or occasionally related to neurofibromatosis. It can be characterized by magnetic resonance imaging and is included in the differential diagnosis of anechoic lesions on high-resolution soft tissue ultrasound. The definitive diagnosis is made through histopathologic examination. In this case report, we present the findings of a 29-year-old patient who presented with painful nodules on the palms of both hands, with typical findings on ultrasound and magnetic resonance imaging indicative of Pacinian corpuscle hyperplasia. We also discuss the imaging findings and the differential diagnosis through a non-systematic review. Pacinian corpuscle hyperplasia is a rare condition that can be readily identified by high-resolution ultrasound and magnetic resonance imaging, and it should be considered in the differential diagnosis of hand nodules.

Nodular fasciitis (NF) is a benign, reactive, myofibroblastic proliferative solitary lesion that commonly develops in the subcutaneous or superficial fascia. We present a case of a 35-year-old male with a rapidly enlarging upper eyelid mass postiatrogenic incisional trauma. Subsequent en toto excisional biopsy demonstrated NF. Given the rapid clinical course of this patient and the reactive nature of NF, we hypothesize that the initial incisional trauma likely incited an inflammatory response resulting in rapid proliferation and growth of the lesion. NF accounts for <1% of all orbital lesions, and is often a clinically and pathologically difficult diagnosis to make given its propensity to mimic other benign and malignant conditions. Therefore, we recommend that en toto biopsies of orbital lesions in this anatomical area be performed rather than incisional biopsies. [ABSTRACT FROM AUTHOR]

Objective: Rare coexistence of disease or pathology. Background: Spontaneous abscesses are generally typical in patients with significant risk factors and have been linked to numerous muscle groups. The sternocleidomastoid muscle, however, piqued our interest as an unusual location, especially in this patient who, other than diabetes mellitus, had no associated risk factors or signs of trauma. Case Report: A 61-year-old man appeared with neck pain, erythema, and swelling that had been present for 9 days and for which he had previously been examined in the Emergency Department. He was discharged on oral doxycycline after initial computed tomography (CT) of the neck revealed infiltration without collection. He returned with worsening symptoms and new-onset fever and chills. Vital signs were normal on assessment, with no evidence of trauma. Swelling was observed near the right sternocleidomastoid muscle insertion. A repeat CT scan of the neck revealed an abscess 2.5 cm in diameter. He was originally treated with empiric antibiotics before being moved to targeted medications. Incision and drainage were completed without complication. The patient was given a 6-week course of oral antibiotics. Conclusions: Spontaneous intramuscular abscesses are uncommon in people who have had no previous trauma or other known risk factors, but could be encountered in diabetic patients with non-optimal blood glucose levels, due to bacteremia. As a result, these cases require a high level of suspicion to be recognized and treated early. The scarcity of literature on this illness makes determining the cause challenging. However, by highlighting this case, we intend to raise awareness and facilitate early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Subcutaneous (SC) delivery is a preferred route of administration for biotherapeutics but has predominantly been limited to volumes below 3 mL. With higher volume drug formulations emerging, understanding large volume SC (LVSC) depot localization, dispersion, and impact on the SC environment has become more critical. The aim of this exploratory clinical imaging study was to assess the feasibility of magnetic resonance imaging (MRI) to identify and characterize LVSC injections and their effect on SC tissue as a function of delivery site and volume. Healthy adult subjects received incremental injections of normal saline up to 5 mL total volume in the arm and up to 10 mL in the abdomen and thigh. MRI images were acquired after each incremental SC injection. Post-image analysis was performed to correct imaging artifacts, identify depot tissue location, create 3-dimensional (3D) SC depot rendering, and estimate in vivo bolus volumes and SC tissue distention. LVSC saline depots were readily achieved, imaged using MRI, and quantified via subsequent image reconstructions. Imaging artifacts occurred under some conditions, necessitating corrections applied during image analysis. 3D renderings were created for both the depot alone and in relation to the SC tissue boundaries. LVSC depots remained predominantly within the SC tissue and expanded with increasing injection volume. Depot geometry varied across injection sites and localized physiological structure changes were observed to accommodate LVSC injection volumes. MRI is an effective means to clinically visualize LVSC depots and SC architecture allowing assessment of deposition and dispersion of injected formulations. Trial Registration: Not applicable for this exploratory clinical imaging study. [ABSTRACT FROM AUTHOR]

Subcutaneous injection, which is a preferred delivery method for many drugs, causes deformation, damage, and fracture of the subcutaneous tissue. Yet, experimental data and constitutive modeling of these dissipation mechanisms in subcutaneous tissue remain limited. Here we show that subcutaneous tissue from the belly and breast anatomical regions in the swine show nonlinear stress–strain response with the characteristic J-shaped behavior of collagenous tissue. Additionally, subcutaneous tissue experiences damage, defined as a decrease in the strain energy capacity, as a function of the previously experienced maximum deformation. The elastic and damage response of the tissue are accurately described by a microstructure-driven constitutive model that relies on the convolution of a neo-Hookean material of individual fibers with a fiber orientation distribution and a fiber recruitment distribution. The model fit revealed that subcutaneous tissue can be treated as initially isotropic, and that changes in the fiber recruitment distribution with loading are enough to explain the dissipation of energy due to damage. When tested until failure, subcutaneous tissue that has undergone damage fails at the same peak stress as virgin samples, but at a much larger stretch, overall increasing the tissue toughness. Together with a finite element implementation, these data and constitutive model may enable improved drug delivery strategies and other applications for which subcutaneous tissue biomechanics are relevant. [ABSTRACT FROM AUTHOR]

Background: There are debates concerning the use of dorsogluteal and ventrogluteal sites for safe intramuscular injection. The ventrogluteal site is the first choice, but sometimes health professionals prefer the dorsogluteal site for intramuscular injection due to such factors as subcutaneous, muscle, and tissue thicknesses, and needle size, which should, therefore, be determined for safe intramuscular injection. Aim: The aim of this study was to compare the subcutaneous, muscle, and total tissue thicknesses of the dorsogluteal (posterior superior iliac spine and the greater trochanter of the femur and anterior superior iliac spine and coccyx) and ventrogluteal (V and G) sites for safe intramuscular injection. Methods: This was a cross-sectional study. The sample consisted of 91 voluntary participating nurses. Intramuscular injection sites (dorsogluteal and ventrogluteal) were determined using anthropometric characteristics and four methods. Muscle, subcutaneous, and total tissue thicknesses were measured using ultrasonography. Results: There was a significant difference in muscle, subcutaneous, and total tissue thicknesses between the dorsogluteal (posterior superior iliac spine and the greater trochanter of the femur and anterior superior iliac spine and coccyx) and ventrogluteal (V and G) (p< .05). Female participants had greater subcutaneous tissue thickness than males. Conclusions: The results show that the ventrogluteal G site is the safest site for injection. If the ventrogluteal site is unsuitable, the dorsogluteal (anterior superior iliac spine and coccyx) site is a safe site for injection in terms of subcutaneous tissue thickness, presence of vessels, and distance to the nerve. [ABSTRACT FROM AUTHOR]

Neonatal jaundice is one of the most common problems encountered in the first week after birth. Neonates who develop significant hyperbilirubinemia require phototherapy. Delay in the diagnosis and management of jaundice may lead to neonatal morbidity and mortality. Total Serum Bilirubin (TSB) estimation is considered the gold standard method. However, this invasive procedure causes pain, anxiety, and may lead to infection and iatrogenic anaemia, especially in preterm neonates. Transcutaneous Bilirubin (TcB) estimation, which measures bilirubin through the skin, has been proposed as an alternative screening method for hyperbilirubinemia in term and near-term neonates. Aim: To compare TcB to TSB in preterm neonates of 30-34 6/7 weeks gestational age before, during, and after phototherapy. Materials and Methods: This hospital-based prospective cohort study was conducted at SDMCMS&H, Dharwad, Karnataka, India, between December 2019 and November 2020. A total of 100 preterm neonates between 30 to 34 6/7 weeks of gestation with clinically suspected jaundice were enrolled in the study. TSB was measured in the laboratory using the Diazo Method, while TcB was measured using the Drager jaundice meter JM 103. TcB and TSB were measured and compared in preterm neonates with clinically suspected jaundice before phototherapy, during phototherapy (8 to 12 hours after initiation), and after 12-18 hours of discontinuation of phototherapy. The collected data was analysed statistically using the mean, standard deviation, dependent t-test, Karl Pearson’s correlation coefficient, and scatter plots. Results: This study enrolled 100 neonates diagnosed with neonatal jaundice, of which 57 were males and 43 were females, resulting in a male-to-female ratio of 1:1.3. Phototherapy was administered to neonates with TSB values, with 79% of the babies between 30-32 weeks and 21% between 32-34 weeks. In the present study, TcB and TSB were compared before, during, and after phototherapy, and the results were analysed, showing statistical significance. The mean TcB levels were 12.05, 9.66, and 7.23 before, during, and after phototherapy, respectively. The mean TSB levels were 11.28, 10.16, and 7.65 before, during, and after phototherapy, respectively. Based on Karl Pearson’s correlation coefficient, a positive correlation was found between TcB and TSB before (r=0.8319, p-value

Contextualization: Radiofrequency is a resource frequently used in clinical practice for the treatment of localized adiposity, to promote lipolysis from thermal stimulation. Radiofrequency presents different parameters of energy, frequency and intensity, as well as different modes: capacitive and resistive. Objective: To investigate the comparative effects of radiofrequency lipolysis with capacitive electrical transfer (TEC) and resistive electrical transfer (TER). Methods: This is an experimental study, 30 women participated who were randomly selected. The volunteers were evaluated with perimetry in 5 points (P1, P2, P3, P4, P5), plicometry right (PD) and left (PE) and ultrasonography of the abdominal region (USG) pre and post -treatment. These women were divided into 3 groups, G1: (n: 10) received 10 minutes of TEC and 20 minutes of TER G2: (n: 10) received 20 minutes of TER; o G3: n: 10 received 10 minutes of TEC. The treatment was applied during 10 sessions, in an area of 225 cm2. Results: Measures of reduction of the 8 variables were observed between pre and post-treatment: USG= 0.48 cm, Pd= 0.26 cm, Pe= 0.45 cm, P1= 2.30 cm, P2 =2, 65 cm, P3= 2.46 cm, P4 =2.42 cm and P5 =2.20 cm. Differences were statistically significant (p<0.05) for Pd and highly significant (p<0.01) for the other variables. Conclusions: The three treatments were effective for lipolysis. However, adverse effects (fibrosis) were present in G1 and G2, in which TER was used, therefore, TEC is recommended for the treatment of lipolysis. [ABSTRACT FROM AUTHOR]

Palpation evaluates the fascia, a three-dimensional web of connective tissues. We propose altered fascia system displacement in patients with myofascial pain syndrome. This study determined the concurrent validity of palpation and musculoskeletal ultrasound (MSUS) videos played on Windows Media Player 10 (WMP) when evaluating the direction of the fascia system's displacement at the end of the cervical active range of motion (AROM). This cross-sectional study used palpation as index test and MSUS videos on WMP as reference test. First, three physical therapists palpated right and left shoulders for each cervical AROM. Second, during cervical AROM, PT-Sonographer recorded the fascia system displacement. Third, using the WMP, the physical therapists evaluated the direction of skin, superficial and deep fascia displacements at the end of cervical AROM. MedCalc Version 19.5.3 determined the "exact" Clopper-Pearson Interval (CPI). We found strong accuracy between palpation and MSUS videos on WMP when determining the direction of skin displacement during cervical flexion and extension (CPI= 78.56 to 96.89). There was moderate agreement between palpation and MSUS videos on WMP when determining the direction of the skin, superficial fascia, and deep fascia displacements during cervical lateral flexion and rotation (CPI= 42.25 to 64.13). Skin palpation during cervical flexion and extension may be useful in evaluating patients with myofascial pain syndrome (MPS). It is unclear what fascia system was evaluated when shoulders were palpated at the end of cervical lateral flexion and rotation. Palpation as diagnostic tool for MPS was not investigated. [ABSTRACT FROM AUTHOR]

Macrophages perform diverse functions within tissues during immune responses to pathogens and injury, but molecular mechanisms by which physical properties of the tissue regulate macrophage behavior are less well understood. Here, we examine the role of the mechanically activated cation channel Piezo1 in macrophage polarization and sensing of microenvironmental stiffness. We show that macrophages lacking Piezo1 exhibit reduced inflammation and enhanced wound healing responses. Additionally, macrophages expressing the transgenic Ca2+ reporter, Salsa6f, reveal that Ca2+ influx is dependent on Piezo1, modulated by soluble signals, and enhanced on stiff substrates. Furthermore, stiffness-dependent changes in macrophage function, both in vitro and in response to subcutaneous implantation of biomaterials in vivo, require Piezo1. Finally, we show that positive feedback between Piezo1 and actin drives macrophage activation. Together, our studies reveal that Piezo1 is a mechanosensor of stiffness in macrophages, and that its activity modulates polarization responses.

Autosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform replication among 456,893 European participants. Common alleles on chromosome Xq23 are strongly associated with reduced total cholesterol, LDL cholesterol, and triglycerides (min P = 8.5 × 10-72), with similar effects for males and females. Chromosome Xq23 lipid-lowering alleles are associated with reduced odds for CHD among 42,545 cases and 591,247 controls (P = 1.7 × 10-4), and reduced odds for diabetes mellitus type 2 among 54,095 cases and 573,885 controls (P = 1.4 × 10-5). Although we observe an association with increased BMI, waist-to-hip ratio adjusted for BMI is reduced, bioimpedance analyses indicate increased gluteofemoral fat, and abdominal MRI analyses indicate reduced visceral adiposity. Co-localization analyses strongly correlate increased CHRDL1 gene expression, particularly in adipose tissue, with reduced concentrations of blood lipids.

TMEM39A encodes an evolutionarily conserved transmembrane protein and carries single-nucleotide polymorphisms associated with increased risk of major human autoimmune diseases, including multiple sclerosis. The exact cellular function of TMEM39A remains not well understood. Here, we report that TMEM-39, the sole Caenorhabditis elegans (C. elegans) ortholog of TMEM39A, regulates lysosome distribution and accumulation. Elimination of tmem-39 leads to lysosome tubularization and reduced lysosome mobility, as well as accumulation of the lysosome-associated membrane protein LMP-1. In mammalian cells, loss of TMEM39A leads to redistribution of lysosomes from the perinuclear region to cell periphery. Mechanistically, TMEM39A interacts with the dynein intermediate light chain DYNC1I2 to maintain proper lysosome distribution. Deficiency of tmem-39 or the DYNC1I2 homolog in C. elegans impairs mTOR signaling and activates the downstream TFEB-like transcription factor HLH-30. We propose evolutionarily conserved roles of TMEM39 family proteins in regulating lysosome distribution and lysosome-associated signaling, dysfunction of which in humans may underlie aspects of autoimmune diseases.

Objective: Rare coexistence of disease or pathology. Background: Spontaneous abscesses are generally typical in patients with significant risk factors and have been linked to numerous muscle groups. The sternocleidomastoid muscle, however, piqued our interest as an unusual location, especially in this patient who, other than diabetes mellitus, had no associated risk factors or signs of trauma. Case Report: A 61-year-old man appeared with neck pain, erythema, and swelling that had been present for 9 days and for which he had previously been examined in the Emergency Department. He was discharged on oral doxycycline after initial computed tomography (CT) of the neck revealed infiltration without collection. He returned with worsening symptoms and new-onset fever and chills. Vital signs were normal on assessment, with no evidence of trauma. Swelling was observed near the right sternocleidomastoid muscle insertion. A repeat CT scan of the neck revealed an abscess 2.5 cm in diameter. He was originally treated with empiric antibiotics before being moved to targeted medications. Incision and drainage were completed without complication. The patient was given a 6-week course of oral antibiotics. Conclusions: Spontaneous intramuscular abscesses are uncommon in people who have had no previous trauma or other known risk factors, but could be encountered in diabetic patients with non-optimal blood glucose levels, due to bacteremia. As a result, these cases require a high level of suspicion to be recognized and treated early. The scarcity of literature on this illness makes determining the cause challenging. However, by highlighting this case, we intend to raise awareness and facilitate early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

To test the anisotropy of human tendons in conventional B-mode ultrasound, we prospectively performed ultrasound scans of 40 normal patella tendons and 24 patella tendons with chronic tendinopathy in adults. We scanned all tendons in longitudinal orientation (parallel to tendon fibers) using a linear array transducer (8.5 MHz) with beam steering at 0°, 5°, 10°, 15° and 20°. We used ImageJ histogram analysis to process B-mode images offline for assessing backscatter as a function of angle, known as backscatter anisotropy, between normal tendons and the subcutaneous tissues and between normal tendons and tendons with tendinopathy. We compared the results using the slopes of linear regression lines drawn through the angle-dependent data, and we concluded that the tissue anisotropy was significantly different if the 95% confidence intervals of the line slopes for different tissues did not overlap. We observed significant differences between normal tendons and both the adjacent subcutaneous tissues and tendons with tendinopathy. However, the difference in the regression slopes between tendons with tendinopathy and the adjacent subcutaneous soft tissues was not significant. It appears that changes in anisotropic backscatter could be used to detect tendon abnormalities and in assessing the significance of disease and the effectiveness of therapy. [ABSTRACT FROM AUTHOR]

Background: Nurses often administer intramuscular injections at the gluteal site. This study aimed to determine gluteal muscle and subcutaneous tissue thicknesses in adults. Methods: Systematic review and meta-analysis. The databases Turkish Medline, Ulakbim, National Thesis Center, Cochrane, Web of Science, Science Direct, PubMed, CINAHL Plus with Full text (EBSCO host), OVID and SCOPUS were screened using the keywords 'intramuscular injection', 'subcutaneous tissue thickness', 'muscle tissue thickness' and 'needle length' between April and May 2021. The studies were evaluated with ultrasound. This study was reported according to the PRISMA recommendations. Results: Six studies met the eligibility criteria. The total sample size was 734 (women: 432, men: 302). The V method revealed that the ventrogluteal site had a muscle and subcutaneous tissue thickness of 38.071 ± 2.119 and 19.927 ± 2.493 mm, respectively. The geometric method revealed that the ventrogluteal site had a muscle and subcutaneous tissue thickness of 35.989 ± 4.190 and 19.661 ± 3.992 mm, respectively. The geometric method also revealed that the dorsogluteal site had a thickness of 42.560 ± 8.840 mm. According to the V method, females had thicker subcutaneous tissue at the ventrogluteal site than males (Q = 5.37, df = 1, p = 0.0204). Body mass index did not affect the subcutaneous tissue thicknesses at the ventrogluteal site. Conclusion: The results show that gluteal muscle, subcutaneous and total tissue thicknesses vary across injection sites. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the frequency and MRI features of a subcutaneous anterior knee mass herniated from the infrapatellar fat pad (IPFP) through a focal defect of the patellar retinaculum (PR). Materials and methods: This study included 94 patients (44 men; age range, 1–80 years; mean age, 52 years) with clinically palpable subcutaneous anterior knee masses who underwent MRI between January 2007 and July 2022. Two radiologists retrospectively reviewed MRI findings of subcutaneous masses associated with a focal PR defect (location and size of the defect and characteristics of the mass). Results: Among 94 patients, 15 (16%; 5 men; age range, 49–80 years; mean age, 67 years) had subcutaneous masses herniated from the IPFP through a focal PR defect. The defect was single (13/15, 87%) and more frequently observed in the lateral than in the medial (11/15, 73% vs. 4/15, 27%) PR. The defect occurred in the anterior segment (15/15, 100%) and was more frequently observed in the lower (10/15, 67%) than in the middle (5/15, 33%) and upper portions (0/15, 0%). The mean maximum length of the defect in axial and oblique planes was 14 mm and 25 mm, respectively. The defect-associated subcutaneous masses included lipomatous lesion (6/15, 40%), osteochondromatous lesion (5/16, 33%), and synovial fluid or ganglion cyst (4/15, 27%). Conclusion: Subcutaneous anterior knee masses were associated with a focal PR defect in 16% cases. The location of a focal PR defect was characterized by the lateral, anterior, and lower segments. [ABSTRACT FROM AUTHOR]

Gas gangrene occurs in several animal species and is caused by one or more clostridial species. In horses, the disease is most often caused by Clostridium perfringens type A. Although Clostridium sordellii has been associated with gas gangrene in ruminants and humans, cases of the disease associated with this microorganism have not been described in horses, to our knowledge. We report herein 8 cases of gas gangrene caused by C. sordellii in horses. These cases were characterized by myonecrosis and cellulitis, associated with systemic changes suggestive of toxic shock. The diagnosis was confirmed by gross and microscopic changes combined with anaerobic culture, fluorescent antibody test, immunohistochemistry, and/or PCR. The predisposing factor in these cases was an injection or a traumatic skin injury. C. sordellii should be considered as a possible etiologic agent in cases of gas gangrene in horses.

PurposeBolus injection of fluid into subcutaneous tissue results in accumulation of fluid at the injection site. The fluid does not form a pool. Rather, the injection pressure forces the interstitial matrix to expand to accommodate the excess fluid in its volume, and the fluid becomes bound similar to that in a hydrogel. We seek to understand the properties and dynamics of externally tumesced (swollen) subcutaneous tissue as a first step in assessing whether tumescent antibiotic injections into wounds may provide a novel method of treatment.MethodsSubcutaneous injections of saline are performed in live and dead pigs and the physical properties (volume, expansion ratio, residence time, apparent diffusion constant) of the resulting fluid deposits are observed with diffusion-weighted magnetic resonance imaging, computed tomography, and 3D scanning.ResultsSubcutaneous tissue can expand to a few times its initial volume to accommodate the injected fluid, which is dispersed thoroughly throughout the tumescent volume. The fluid spreads to peripheral unexpanded regions over the course of a few minutes, after which it remains in place for several hours. Eventually the circulation absorbs the excess fluid and the tissue returns to its original state.ConclusionsGiven the evidence for dense fluid dispersal and several-hour residence time, a procedure is proposed whereby tumescent antibiotic injections are used to treat drug-resistant skin infections and chronic wounds that extend into the subcutaneous tissue. The procedure has the potential to effectively treat otherwise untreatable wounds by keeping drug concentrations above minimum inhibitory levels for extended lengths of time.

Caenorhabditis elegans larval development requires the function of the two Canal-Associated Neurons (CANs): killing the CANs by laser microsurgery or disrupting their development by mutating the gene ceh-10 results in early larval arrest. How these cells promote larval development, however, remains a mystery. In screens for mutations that bypass CAN function, we identified the gene kin-29, which encodes a member of the Salt-Inducible Kinase (SIK) family and a component of a conserved pathway that regulates various C. elegans phenotypes. Like kin-29 loss, gain-of-function mutations in genes that may act upstream of kin-29 or growth in cyclic-AMP analogs bypassed ceh-10 larval arrest, suggesting that a conserved adenylyl cyclase/PKA pathway inhibits KIN-29 to promote larval development, and that loss of CAN function results in dysregulation of KIN-29 and larval arrest. The adenylyl cyclase ACY-2 mediates CAN-dependent larval development: acy-2 mutant larvae arrested development with a similar phenotype to ceh-10 mutants, and the arrest phenotype was suppressed by mutations in kin-29 ACY-2 is expressed predominantly in the CANs, and we provide evidence that the acy-2 functions in the CANs to promote larval development. By contrast, cell-specific expression experiments suggest that kin-29 acts in both the hypodermis and neurons, but not in the CANs. Based on our findings, we propose two models for how ACY-2 activity in the CANs regulates KIN-29 in target cells.

Human dirofilarial infection usually presents as pulmonary coin lesion or as subcutaneous nodule. We report the case of a 60-year-old female presented clinically with swelling in the lower-outer quadrant of the right breast for 2 weeks. Ultrasound reported as atypical lesion suggest fine-needle aspiration cytology (FNAC) correlation and follow-up. Clinical examination – subcutaneous nodule of size 2 cm × 2 cm presents in the lower-outer quadrant. Clinical suspicious of carcinoma was considered and FNAC was done. Aspirated pus-like material and adult worm about 4 cm in length were attached to the needle. Smear was air-dried and stained with Giemsa. Smears were cellular and showed numerous neutrophils, eosinophils, and a few histiocytes in a necrotic background and also noted coiled adult dirofilarial worm. Cellblock was prepared and it showed the cut section of dirofilarial worm with cuticle, muscular layer, intestine, and reproductive tube. We report this case entity due to diagnostic confusion with breast malignancy clinically and radiologically.

Recently, the superficial fascia has been recognized as a specific anatomical structure between the two adipose layers—the superficial adipose tissue (SAT) and the deep adipose tissue (DAT). The evaluation of specific characteristics of cells, fibers, blood circulation, and innervation has shown that the superficial fascia has a clear and distinct anatomical identity, but knowledge about lymphatic vessels in relation to the superficial fascia has not been described. The aim of this study was to evaluate the presence of lymphatic vessels in the hypodermis, with a specific focus on the superficial fascia and in relation to the layered subdivision of the subcutaneous tissue into SAT and DAT. Tissue specimens were harvested from three adult volunteer patients during abdominoplasty and stained with D2-40 antibody for the lymphatic endothelium. In the papillary dermis, a huge presence of lymphatic vessels was highlighted, parallel to the skin surface and embedded in the loose connective tissue. In the superficial adipose tissue, thin lymphatic vessels (mean diameter of 11.6 ± 7.71 µm) were found, close to the fibrous septa connecting the dermis to the deeper layers. The deep adipose tissue showed a comparable overall content of lymphatic vessels with respect to the superficial layer; they followed the blood vessel and had a larger diameter. In the superficial fascia, the lymphatic vessels showed higher density and a larger diameter, in both the longitudinal and transverse directions along the fibers, as well as vessels that intertwined with one another, forming a rich network of vessels. This study demonstrated a different distribution of the lymphatic vessels in the various subcutaneous layers, especially in the superficial fascia, and the demonstration of the variable gauge of the vessels leads us to believe that they play different functional roles in the collection and transport of interstitial fluid—important factors in various surgical and rehabilitation fields. [ABSTRACT FROM AUTHOR]

Objectives: To contribute to a more in-depth assessment of shape, volume, and asymmetry of the lower extremities in patients with lipedema or lymphedema utilizing volume information from MR imaging. Methods: A deep learning (DL) pipeline was developed including (i) localization of anatomical landmarks (femoral heads, symphysis, knees, ankles) and (ii) quality-assured tissue segmentation to enable standardized quantification of subcutaneous (SCT) and subfascial tissue (SFT) volumes. The retrospectively derived dataset for method development consisted of 45 patients (42 female, 44.2 ± 14.8 years) who underwent clinical 3D DIXON MR-lymphangiography examinations of the lower extremities. Five-fold cross-validated training was performed on 16,573 axial slices from 40 patients and testing on 2187 axial slices from 5 patients. For landmark detection, two EfficientNet-B1 convolutional neural networks (CNNs) were applied in an ensemble. One determines the relative foot-head position of each axial slice with respect to the landmarks by regression, the other identifies all landmarks in coronal reconstructed slices using keypoint detection. After landmark detection, segmentation of SCT and SFT was performed on axial slices employing a U-Net architecture with EfficientNet-B1 as encoder. Finally, the determined landmarks were used for standardized analysis and visualization of tissue volume, distribution, and symmetry, independent of leg length, slice thickness, and patient position. Results: Excellent test results were observed for landmark detection (z-deviation = 4.5 ± 3.1 mm) and segmentation (Dice score: SCT = 0.989 ± 0.004, SFT = 0.994 ± 0.002). Conclusions: The proposed DL pipeline allows for standardized analysis of tissue volume and distribution and may assist in diagnosis of lipedema and lymphedema or monitoring of conservative and surgical treatments. Key Points: • Efficient use of volume information that MRI inherently provides can be extracted automatically by deep learning and enables in-depth assessment of tissue volumes in lipedema and lymphedema. • The deep learning pipeline consisting of body part regression, keypoint detection, and quality-assured tissue segmentation provides detailed information about the volume, distribution, and asymmetry of lower extremity tissues, independent of leg length, slice thickness, and patient position. [ABSTRACT FROM AUTHOR]

Objectives: To compare rates of surgical‐site infections following continuous, as compared with interrupted, subcutaneous tissue closure technique during cesarean delivery (CD). Methods: A retrospective cohort study during 2008–2018. The study group included women who underwent either elective or emergent CD with continuous subcutaneous tissue closure, while the control group comprised those with interrupted subcutaneous tissue closure. We excluded women with suspected infectious morbidity before CD. The primary outcome was surgical‐site infection (SSI) rate. Results: The final analysis included 6281 women. We performed continuous subcutaneous tissue closure in 37.4% (1867/4988) of scheduled CD, and 45.8% (592/1293) of emergent CD. The rate of SSI was significantly lower following continuous than interrupted subcutaneous tissue closure, in both elective CD (2.7% versus 4.5%, respectively, P = 0.031) and emergent CD (3.2% versus 5.4%, respectively, P = 0.036) in nulliparous and multiparous women. Similarly, secondary outcomes such as re‐admission rates, postoperative maternal fever, and need for antibiotic treatment were significantly lower following continuous subcutaneous closure. Conclusions: Continuous subcutaneous closure technique during CD yields a lower rate of surgical‐site complications compared with the interrupted technique. Synopsis: Continuous subcutaneous suturing, compared with interrupted suturing, during cesarean delivery reduced the rates of surgical‐site infections. [ABSTRACT FROM AUTHOR]

Background and Objectives: Approximately 20–40% of patients affected with renal cell carcinoma (RCC) develop either distant metastatic or locally recurring disease following radical nephrectomy. Soft tissue, skin, and the central nervous system are less common metastatic sites. We present the case of a patient who has received a diagnosis of RCC; it was found that she had no metastases at the time of nephrectomy but had metastases in the soft tissue and subcutaneous tissue of the scalp 27 years later. As far as we can tell, this is the longest period elapsed between primary renal tumor and subcutaneous/soft tissue metastasis; moreover, this case is the first report of a combined soft tissue/subcutaneous metastasis from RCC. Case presentation: A 73-year-old woman underwent right radical nephrectomy 27 years earlier for clear cell renal cell carcinoma (CCRCC). She presented at our unit because she noticed swelling in the left temporal region; after radiological exams, a benign lesion was suspected. The patient underwent surgical eradication, but the massive bleeding did not allow the removal of the lesion. A biopsy of the mass was performed and the histological examination was consistent with RCC metastases. Conclusions: Metastases from renal cell carcinoma to the subcutaneous and soft tissues are rare. It is essential to take into account RCC metastases in the differential diagnostic of the new starting mass of the head and neck, and the necessity for close and continuous surveillance of patients diagnosed with renal cancer even after a long disease-free period should be emphasized. [ABSTRACT FROM AUTHOR]

Mitigation of the foreign body response (FBR) and successful tissue integration are essential to ensuring the longevity of implanted devices and biomaterials. The use of porous materials and coatings has been shown to have an impact, as the textured surfaces can mediate macrophage interactions with the implant and influence the FBR, and the pores can provide space for vascularization and tissue integration. In this study, we use a new class of implantable porous biomaterials templated from bicontinuous interfacially jammed emulsion gels (bijels), which offer a fully percolating, non-constricting porous network with a uniform pore diameter on the order of tens of micrometers, and surfaces with consistent curvature. We demonstrate that these unique morphological features, inherent to bijel-templated materials (BTMs), can enhance tissue integration and vascularization, and reduce the FBR. Cylindrical polyethylene glycol diacrylate (PEGDA) BTMs, along with PEGDA particle-templated materials (PTMs), and non-templated materials (NTMs), were implanted into the subcutaneous space of athymic nude mice. After 28 days, implants were retrieved and analyzed via histological techniques. Within BTMs, blood vessels of increased size and depth, changes in collagen deposition, and increased presence of pro-healing macrophages were observed compared to that of PTM and NTM implants. Bijel templating offers a new route to biomaterials that can improve the function and longevity of implantable devices. STATEMENT OF SIGNIFICANCE: All implanted biomaterials are subject to the foreign body response (FBR) which can have a detrimental effect on their efficacy. Altering the surface chemistry can decrease the FBR by limiting the amount of proteins adsorbed to the implant. This effect can be enhanced by including pores in the biomaterial to allow new tissue growth as the implant becomes integrated in the body. Here, we introduce a new class of self-assembled biomaterials comprising a fully penetrating, non-constricting pore phase with hyperbolic (saddle) surfaces for enhanced tissue integration. These unique morphological characteristics result in dense blood vessel formation and favorable tissue response properties demonstrated in a four-week implantation study.

• Gliding after trochanteric fracture surgery is associated with subcutaneous tissue thickness and the dense connective tissue thickness ratio. • There was no correlation between the range of motion and muscle strength, which are key factors during physical therapy. • Gliding is an important factor with trochanteric fracture for lateral femoral pain. [ABSTRACT FROM AUTHOR]

Clear cell hidradenoma (CCH) is a rare tumor of the sweat glands of eccrine or apocrine differentiation. It can occur anywhere in the body, but common sites of involvement are the head, face, trunk, and extremities. Although several reports have described sonographic findings of CCH, only one study on the axilla mentioned its strain elastographic findings. Here, we present a case of CCH in the right calf with its sonographic and strain elastographic findings in a tumor that looked like an epidermoid tumor.

Resumen: Introducción: La lipoatrofia semicircular (LS) puede tener presentaciones clínicas variadas, sin criterios diagnósticos claros. Se han propuesto varios factores etiopatogénicos, incluyendo determinados ambientes laborales. En este manuscrito se pretende describir las características de un brote de casos sospechosos de LS que se inició en mayo de 2008 entre trabajadores del Ayuntamiento de Madrid. Con base en la experiencia acumulada, se describen las acciones realizadas por el Servicio de Salud Laboral y se proponen unos criterios clínicos con implicación pronóstica que permitan categorizar los casos. Material y método: Estudio observacional retrospectivo tipo serie de casos que incluye datos recogidos de forma prospectiva de los pacientes revisados en el Servicio de ITS/Dermatología del Ayuntamiento Madrid entre 2008 y 2021. Se lleva a cabo la descripción de las medidas realizadas desde Salud Laboral. A través del registro y análisis estadístico de las variables recogidas durante la evaluación clínica de los pacientes, se proponen unos patrones clínicos definidos. Resultados: Se estudiaron 75 mujeres y un hombre, seguidas en su mayoría durante un período con mediana de 37 meses. Los síntomas locales fueron poco frecuentes (14,5%). Se propone la clasificación de las pacientes en 4 grupos: LS típica, LS unilateral, lipoatrofia en banda en miembros inferiores y lipoatrofia inespecífica. Al comparar los 2 primeros grupos con los 2 últimos, pudo constatarse una evolución clínica más favorable (76 versus 25,8% de mejoría total o parcial de las lesiones), además de una asociación negativa con la presencia de hipertrofia del tejido subcutáneo (p

Human dirofilarial infection usually presents as pulmonary coin lesion or as subcutaneous nodule. We report the case of a 60‑year‑old female presented clinically with swelling in the lower‑outer quadrant of the right breast for 2 weeks. Ultrasound reported as atypical lesion suggest fine‑needle aspiration cytology (FNAC) correlation and follow‑up. Clinical examination – subcutaneous nodule of size 2 cm × 2 cm presents in the lower‑outer quadrant. Clinical suspicious of carcinoma was considered and FNAC was done. Aspirated pus‑like material and adult worm about 4 cm in length were attached to the needle. Smear was air‑dried and stained with Giemsa. Smears were cellular and showed numerous neutrophils, eosinophils, and a few histiocytes in a necrotic background and also noted coiled adult dirofilarial worm. Cellblock was prepared and it showed the cut section of dirofilarial worm with cuticle, muscular layer, intestine, and reproductive tube. We report this case entity due to diagnostic confusion with breast malignancy clinically and radiologically. [ABSTRACT FROM AUTHOR]

Background: Masson's tumor, also known as IPEH (intravascular papillary endothelial hyperplasia), is a rare benign vascular process, comprising approximately 2% of vascular tumors of the skin and subcutaneous tissue. IPEH presenting as a neck mass is rare, with only 5 reports of anterior neck mass and 7 cases of lateral neck lesions, of which 1 was in an external jugular vein aneurysm. To the best of our knowledge, the localization of intravascular papillary endothelial hyperplasia in the supraclavicular region is rarely reported. Case Report: We describe our management of a non-traumatic and non-painful mass on the right supraclavicular region in 24-year-old woman. Ultrasound revealed a heterogeneously hypoechoic mass with intense vascularization. Magnetic resonance imaging (MRI) showed a formation with lobulated contours and closely related to muscular layers of serratus anterior muscle. The findings of ultrasound-guided biopsy (FNA) were inconclusive. Complete removal of the mass was performed. Histopathological examination showed a well-circumscribed lesion with numerous small papillary structures. The papillae had hyalinized hypocellular cores covered by flattened endothelium. Immunohistochemical analysis showed endothelial positivity for CD34 and CD31. These features are typical of IPEH. No recurrence had occurred at 12 months after surgery. Conclusions: The differential diagnosis of malignant tumors like angiosarcoma is important because the prognosis significantly differs. Surgical excision is the treatment of choice. In our experience, the size of the lesion and its critical landmarks have not influenced the outcomes of the surgical procedure in terms of potential functional damages. [ABSTRACT FROM AUTHOR]

The superficial fascia has received much attention in recent years due to its important role of compartmentalizing the subcutaneous tissue. Ultrasound (US) imaging, owing to its high definition, provides the possibility of better visualizing and measuring its thickness. The aim of this study was to measure and compare, with US imaging, the thickness of superficial fascia in the arm and forearm in different regions/levels. An observational study has been performed using US imaging to measure superficial fascia thickness in the anterior and posterior regions at different levels in a sample of 30 healthy volunteers. The results for superficial fascia thickness revealed statistically significant differences (p < 0.0001) in the arm between the anterior and posterior regions; in terms of forearm, some statistically significant differences were found between regions/levels. However, in the posterior region/levels of the arm, the superficial fascia was thicker (0.53 ± 0.10 mm) than in the forearm (0.41 ± 0.10 mm); regarding the anterior regions/levels, the superficial fascia of the arm (0.40 ± 0.10 mm) was not statistically different than the forearm (0.40 ± 0.12 mm). In addition, the intra-rater reliability was good (ICC2,k: 0.88). US helps to visualize and assess the superficial fascia inside the subcutaneous tissue, improving the diagnosis of fascial dysfunction, and one of the Us parameters to reliably assess is the thickness in different regions and levels. [ABSTRACT FROM AUTHOR]

Surgical sealants have been used for sealing or reconnecting ruptured tissues but often have low adhesion, inappropriate mechanical strength, cytotoxicity concerns, and poor performance in biological environments. To address these challenges, we engineered a biocompatible and highly elastic hydrogel sealant with tunable adhesion properties by photocrosslinking the recombinant human protein tropoelastin. The subcutaneous implantation of the methacryloyl-substituted tropoelastin (MeTro) sealant in rodents demonstrated low toxicity and controlled degradation. All animals survived surgical procedures with adequate blood circulation by using MeTro in an incisional model of artery sealing in rats, and animals showed normal breathing and lung function in a model of surgically induced rat lung leakage. In vivo experiments in a porcine model demonstrated complete sealing of severely leaking lung tissue in the absence of sutures or staples, with no clinical or sonographic signs of pneumothorax during 14 days of follow-up. The engineered MeTro sealant has high potential for clinical applications because of superior adhesion and mechanical properties compared to commercially available sealants, as well as opportunity for further optimization of the degradation rate to fit desired surgical applications on different tissues.

Malnutrition is a common problem among hospitalized older patients. Peripheral parenteral nutrition (PN) can improve patient outcomes but can also lead to complications that affect future treatment. Older inpatients, in particular, are expected to be prone to these catheter-related complications. However, the impact of peripheral PN on older inpatients has been rarely investigated. In the current study, the impact of PN on short peripheral catheters (SPCs) was evaluated by comparing signs and symptoms at the time of catheter removal between 22 patients with PN and 27 without. In addition to external clinical assessment, sonographic investigations of the SPC site were performed. The prevalence of external signs and symptoms of complications was similar between the patients (all P > 0.05). However, subcutaneous edema was found by ultrasound in > 80% of patients with PN, compared with 55.6% of those without PN (P = 0.051). Unlike cases without PN, all patients with PN who presented with external signs and symptoms developed subcutaneous edema (P = 0.022). Multivariate analysis demonstrated that administration of PN was independently associated with subcutaneous edema (adjusted odds ratio = 6.88, 95% confidence interval = 1.083-75.486, P = 0.040). For several decades, phlebitis has been the primary focus of complications related to peripheral PN in clinical settings. However, our results imply that peripheral PN causes subcutaneous edema, which can lead to catheter failure in older inpatients. This study contributes to understanding the etiology of catheter failure during peripheral PN in this population.

Abstract Introduction: This study aims to test the effect of phenytoin as an inhibitor of the process of dystrophic calcification in bovine pericardium and porcine leaflets implanted in the subcutaneous tissue of rats. Methods: Isolated segments of biomaterials were implanted subcutaneously in young rats. The study groups received 500 mg phenytoin per kilogram of diet per day. After 90 days, samples were collected and quantitative calcification assessment by optical microscopy, radiological studies with mammography, and atomic emission spectrometry were performed. Results: Inflammatory reaction was a frequent finding in all groups when analyzed by optical microscopy. The calcium level assessed by atomic absorption spectrophotometry was significantly lower in the study groups using phenytoin compared to the control groups (control bovine pericardium group X=0.254±0.280 µg/mg; study bovine pericardium group X=0.063±0.025 µg/mg; control porcine aortic leaflets group X=0.640±0.226 µg/mg; study porcine aortic leaflets group X=0.056±0.021 µg/mg; P