Christopher R. Davis

Aesthetic surgery and Google: ubiquitous, unregulated and enticing websites for patients considering cosmetic surgery.

BACKGROUNDnPatient safety is a fundamental issue in aesthetic surgery. In an attempt to improve safety, the Department of Health (DoH) and Professor Sir Bruce Keogh published a review in 2013 of the regulation of cosmetic interventions. Proposals included: (1) Banning free consultations; (2) Restricting time-limited promotional deals; (3) Two-stage written pre-operative consent; (4) Consultations with a medical professional rather than a sales consultant. The Cosmetic Surgical Practice Working Party (CSWP) recommended a two week cooling off period before surgery. This study quantified compliance with the above national initiatives by aesthetic surgery providers in the UK.nnnMETHODSnTo replicate a patient searching for aesthetic surgery providers, cosmetic surgery UK was searched via Google. The top fifty websites of aesthetic surgery providers were included in the study. Websites were analysed for compliance with the DoH Keogh and CSWP recommendations. When clarification was required, aesthetic surgery providers were contacted via telephone. Pearsons Chi-squared test compared actual compliance with national recommendations of full compliance.nnnRESULTSnFifty cosmetic surgery providers in the UK entered the study. Consultations with the operating surgeon occurred in 90% of cases. Mean compliance with all parameters from the national guidelines was 41%, significantly less than the desired level of full compliance (P < 0.001). The majority offered free consultations (54%) and promotional deals (52%), of which 27% were time limited. No provider stipulated compliance with two stages of signed consent.nnnCONCLUSIONnThis study demonstrated low compliance with national guidelines for aesthetic surgery. Aggressive sales techniques and enticing offers by aesthetic surgery providers were widespread. Statutory government guidelines on aesthetic surgery and increased public awareness into potential risks from inappropriate cosmetic surgery may improve patient decision making and safety.

Progenitor Cell Dysfunctions Underlie Some Diabetic Complications

Stem cells and progenitor cells are integral to tissue homeostasis and repair. They contribute to health through their ability to self-renew and commit to specialized effector cells. Recently, defects in a variety of progenitor cell populations have been described in both preclinical and human diabetes. These deficits affect multiple aspects of stem cell biology, including quiescence, renewal, and differentiation, as well as homing, cytokine production, and neovascularization, through mechanisms that are still unclear. More important, stem cell aberrations resulting from diabetes have direct implications on tissue function and seem to persist even after return to normoglycemia. Understanding how diabetes alters stem cell signaling and homeostasis is critical for understanding the complex pathophysiology of many diabetic complications. Moreover, the success of cell-based therapies will depend on a more comprehensive understanding of these deficiencies. This review has three goals: to analyze stem cell pathways dysregulated during diabetes, to highlight the effects of hyperglycemic memory on stem cells, and to define ways of using stem cell therapy to overcome diabetic complications.

How to train plastic surgeons of the future

INTRODUCTIONnPlastic surgery is a competitive and over-subscribed career choice despite minimal medical school exposure. We quantify factors influencing career interest in plastic surgery, speciality appeal and workforce planning. These findings optimise and refine evidence-based plastic surgery training and postgraduate selection criteria.nnnMETHODSnMedical students from two national plastic surgery courses complete a post-course questionnaire. Data categories included past experience and career interest in plastic surgery, sources of exposure, motivational factors, and sub-speciality interest. Data were recorded on modified Likert scales, with linear regression and t-test analyses performed.nnnRESULTSn175 students completed the questionnaire (81% response). Duration of medical student exposure to plastic surgery was significantly associated with career interest (Linear coefficient 0.12, 95% CI 0.08-0.17, Pxa0<xa00.0001; r(2)xa0=xa00.15). 75xa0h experience is a significant cut-off to categorise students. Mean (95% CI) career interest is 31 percentage points higher in students with >75xa0h experience (89.2%, 83.2-95.2) compared to students with ≤75xa0h experience (58.1%, 52.9-63.3) (Pxa0<xa00.0001). Influential sources included: (1) Operating Room (2) Consultant/Attending interaction (3) Resident interaction. Motivational factors towards a career in plastic surgery included operative satisfaction (91%), improving patient quality of life (89%), and reconstructive surgery (88%). Sub-speciality interests included: (1) Hand and Upper Limb (28%); (2) Cleft Lip and Palate (26%); (3) Burns (15%).nnnCONCLUSIONnThis study identified influential and motivational factors upon a career in plastic surgery. Medical student exposure can be tailored to maximise positive educational exposure to optimise evidence-based plastic surgery training and workforce planning.

Sutureless Microsurgical Anastomosis Using an Optimized Thermoreversible Intravascular Poloxamer Stent.

Background: Sutureless microvascular anastomosis has great translational potential to simplify microvascular surgery, shorten operative times, and improve clinical outcomes. The authors developed a transient thermoreversible microvascular stent using a poloxamer to maintain vessel lumen patency before application of commercially available adhesives to seal the anastomosis instead of sutures. Despite technical success, human application necessitates bovine serum albumin removal from existing formulations; rapid poloxamer transition between states; and increased stiffness for reliable, reproducible, and precise microvascular approximation. Methods: Two commercially available poloxamers were used in this study (P407 and P188). After removing bovine serum albumin, each poloxamer was tested at varying concentrations either alone or in combination to determine the optimal preparation for sutureless microvascular anastomosis. Transition temperature and formulation stiffness were tested in vitro by rheometry, with the most promising combinations tested in an established in vivo model. Results: Increasing poloxamer concentration resulted in an increase in stiffness and decrease in transition temperature. Pure P188 without bovine serum albumin, dissolved in phosphate-buffered saline to a 45% concentration, demonstrated desirable rheologic behavior, with precise gel transition and increased gel stiffness compared with our previous formulation of 17% P407 (96 kPa versus 10 kPa). These characteristics were optimal for microsurgical intravascular use, offering surgical precision and control between liquid and solid states, depending on the surgically controlled local temperature. Conclusions: Use of 45% P188 without bovine serum albumin demonstrated optimal rheologic and translational properties as a microvascular stent for sutureless anastomosis. Rapid transition, increased stiffness, and safety profile demonstrate safe translational application for human clinical trials.

Gene Therapy and Free Flaps for Therapeutic Reconstructive Surgery

Surgery, whether alone or in combination with adjuvant or neoadjuvant therapy, is a major component in the treatment of oncological disease. Patients with ablative defects following surgical resection may undergo reconstructive surgery, with the aim of returning the patient to a premorbid level, for example, a mastectomy for cancer clearance and a breast reconstruction for chest wall reconstruction. However, despite multidisciplinary involvement, aggressive surgical margins, and additional therapy, tumor recurrence may occur. Autologous tissue used for reconstruction may provide a potential therapeutic source to patients and promote long-term tumor eradication by secreting therapeutic factors. This review focuses on gene therapy as a means of ex vivo transduction of autologous tissue and describes how reconstructive tissue can offer both reconstructive and therapeutic roles in the form of therapeutic flaps.

Clinical Management of Wound Healing and Hypertrophic Scarring

In health, wound healing in adult humans results in the deposition of fibrotic tissue, known as scar. This process is similar throughout the body, and when it occurs in tissues such as the heart, lung, or liver, it can result in end-organ dysfunction. When normal homeostatic mechanisms fail and dysfunctional wound healing prevails, the result can range from nonhealing ulcers requiring amputation to large debilitating scars. This chapter provides an overview of the cellular and molecular processes underlying cutaneous wound healing. Mechanisms involved in dysfunctional wound healing are highlighted, ranging from nonhealing ulcers to fibroproliferative disease. Current therapies for dysfunctional healing are discussed, with an emphasis on emerging therapeutic concepts and opportunities for further research.

Understanding regulatory pathways of neovascularization in diabetes

Diabetes mellitus and its associated comorbidities represent a significant health burden worldwide. Vascular dysfunction is the major contributory factor in the development of these comorbidities, which include impaired wound healing, cardiovascular disease and proliferative diabetic retinopathy. While the etiology of abnormal neovascularization in diabetes is complex and paradoxical, the dysregulation of the varied processes contributing to the vascular response are due in large part to the effects of hyperglycemia. In this review, we explore the mechanisms by which hyperglycemia disrupts chemokine expression and function, including the critical hypoxia inducible factor-1 axis. We place particular emphasis on the therapeutic potential of strategies addressing these pathways; as such targeted approaches may one day help alleviate the healthcare burden of diabetic sequelae.