Zlatko Devcic

The Efficacy of Hepatic 90Y Resin Radioembolization for Metastatic Neuroendocrine Tumors: A Meta-Analysis

90Y resin radioembolization is an emerging treatment in patients with liver-dominant metastatic neuroendocrine tumors (mNETs), despite the absence of level I data. The aim of this study was to evaluate the efficacy of this modality in a meta-analysis of the published literature. Methods: A comprehensive review protocol screened all reports in the literature. Strict selection criteria were applied to ensure consistency among the selected studies: human subjects, complete response data with time interval, resin microspheres, more than 5 patients, not a duplicate cohort, English language, and separate and complete data for resin-based 90Y treatment of mNET if the study included multiple tumor and microsphere types. Selected studies were critically appraised on 50 study criteria, in accordance with the research reporting standards for radioembolization. Response data (Response Evaluation Criteria in Solid Tumors) were extracted and analyzed using both fixed and random-effects meta-analyses. Results: One hundred fifty-six studies were screened; 12 were selected, totaling 435 procedures for response assessment. Funnel plots showed no evidence of publication bias (P = 0.841). Critical appraisal revealed a median of 75% of desired criteria included in selected studies. Very high between-study heterogeneity ruled out a fixed-effects model. The random-effects weighted average objective response rate (complete and partial responses, CR and PR, respectively) was 50% (95% confidence interval, 38%–62%), and weighted average disease control rate (CR, PR, and stable disease) was 86% (95% confidence interval, 78%–92%). The percentage of patients with pancreatic mNET was marginally associated with poorer response (P = 0.030), accounting for approximately 23% of the heterogeneity among studies. The percentage of CR and PR correlated with median survival (R = 0.85; P = 0.008). Conclusion: This meta-analysis confirms radioembolization to be an effective treatment option for patients with hepatic mNET. The pooled data demonstrated a high response rate and improved survival for patients responding to therapy.

Antibiotics in head and neck surgery in the setting of malnutrition, tracheotomy, and diabetes.

The objectives of this study are to compare short vs. long antibiotic prophylaxis in the setting of malnutrition, diabetes, and tracheotomy.

Evolving Attractive Faces Using Morphing Technology and a Genetic Algorithm: A New Approach to Determining Ideal Facial Aesthetics†

Objectives: The objectives of this study were to: 1) determine if a genetic algorithm in combination with morphing software can be used to evolve more attractive faces; and 2) evaluate whether this approach can be used as a tool to define or identify the attributes of the ideal attractive face.

Nasal Tip Projection and Facial Attractiveness

Six nasal tip projection (NTP) ratios from Goode, Simons, Baum, Powell, and Crumley guide clinical and academic practice on quantifying NTP, but none have been empirically correlated with facial attractiveness. This studys objectives were to determine: 1) if there is a correlation between these ratios and facial attractiveness; and 2) which of the six ratios has the greatest linkage to overall facial attractiveness.

The Virtual Focus Group: A Modern Methodology for Facial Attractiveness Rating

Background: Traditional focus groups have been essential to facial aesthetics research. Although they are currently the criterion standard in acquiring facial attractiveness ratings, they retain many shortcomings. This studys objectives were twofold: to determine whether attractiveness scores obtained from a social network site correlate with those from the traditional focus group method; and to evaluate whether this methodology could be a superior tool in evaluating facial attractiveness. Methods: Forty facial portraits were rated for attractiveness scores using three different subject recruitment methods: traditional live focus groups (n = 123 raters), Internet-based rating (n = 857 raters), and a novel method using a combination of focus groups and a social network site (i.e., Facebook) (n = 1775 raters). Each facial image was scored on a 10-point Likert scale. Regression analysis compared each approach to the traditional method. Results: The methods varied in terms of data accrual time, rater demographics/ages, researchers accessibility, necessity for subject incentives, researcher labor, and rater effort/accuracy. A strong correlation (0.922) existed between the online social network-based rating and focus group method. A minimum of 992 raters achieved stabilization of the attractiveness scores using social network–based rating. Conclusions: This study shows significant advantages to using a social network site–based method over both Internet-based rating and traditional focus groups for evaluating facial attractiveness. The main benefits include exponential increase in raters, minimized researcher time/labor, rater scores comparable to those of the focus group method, nonnecessity of rater monetary incentives, and selectable demographics/ages of raters. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

A web-based method for rating facial attractiveness†‡§

To determine if facial attractiveness scores from a novel Internet‐based facial attractiveness rating method correlate with those from the traditional focus group rating method, and whether this method can be an alternative for rating and evaluating facial attractiveness.

A Quantitative Approach to Determining the Ideal Female Lip Aesthetic and Its Effect on Facial Attractiveness

Importance Aesthetic proportions of the lips and their effect on facial attractiveness are poorly defined. Established guidelines would aid practitioners in achieving optimal aesthetic outcomes during cosmetic augmentation. Objective To assess the most attractive lip dimensions of white women based on attractiveness ranking of surface area, ratio of upper to lower lip, and dimensions of the lip surface area relative to the lower third of the face. Design, Setting, and Participants In phase 1 of this study, synthetic morph frontal digital images of the faces of 20 white women ages 18 to 25 years old were used to generate 5 varied lip surface areas for each face. These 100 faces were cardinally ranked by attractiveness through our developed conventional and internet-based focus groups by 150 participants. A summed ranking score of each face was plotted to quantify the most attractive surface area. In phase 2 of the study, 4 variants for each face were created with 15 of the most attractive images manipulating upper to lower lip ratios while maintaining the most attractive surface area from phase 1. A total of 60 faces were created, and each ratio was ranked by attractiveness by 428 participants (internet-based focus groups). In phase 3, the surface area from the most attractive faces was used to determine the total lip surface area relative to the lower facial third. Data were collected from March 1 to November 31, 2010, and analyzed from June 1 to October 31, 2016. Main Outcomes and Measures Most attractive lip surface area, ratio of upper to lower lip, and dimension of the lips relative to the lower facial third. Results In phase 1, all 100 faces were cardinally ranked by 150 individuals (internet-based focus groups [n = 130] and raters from conventional focus groups [conventional raters] [n = 20]). In phase 2, all 60 faces were cardinally ranked by 428 participants (internet-based focus groups [n = 408] and conventional raters [n = 20]). The surface area that corresponded to the range of 2.0 to 2.5 × 104 pixels represented the highest summed rank, generating a pool of 14 images. This surface area was determined to be the most attractive and corresponded to a 53.5% increase in surface area from the original image. With the highest mean and highest proportions of most attractive rankings, the 1:2 ratio was deemed most attractive. Conversely, the ratio of 2:1 was deemed least attractive, having the lowest mean at 1.61 and the highest proportion of ranks within 1 with 310 votes (72.3%). Conclusions and Relevance Using a robust sample size, this study found that the most attractive lip surface area represents a 53.5% increase from baseline, an upper to lower lip ratio of 1:2, and a surface area equal to 9.6% of the lower third of the face. Lip dimensions and ratios derived in this study may provide guidelines in improving overall facial aesthetics and have clinical relevance to the field of facial plastic surgery. Level of Evidence NA.

Technical and Anatomic Factors Influencing the Success of Inferior Vena Caval Stent Placement for Malignant Obstruction

PURPOSE To evaluate the outcomes of inferior vena cava (IVC) stent placement for malignant obstruction and to identify anatomic and procedural factors influencing technical and clinical success. MATERIALS AND METHODS A total of 57 patients (37 male, 20 female; age range, 22-86 y) underwent 62 IVC stent placement procedures using 97 stents (47 Wallstents, 15 S.M.A.R.T. stents, 18 Wallflex stents, 17 others) from 2005 to 2016 for malignant IVC obstruction caused by hepatic metastases (n = 22; 39%), primary hepatic malignancy (n = 16; 28%), retroperitoneal metastases (n = 16; 28%), or other primary malignancy (n = 5; 9%). Presenting symptoms included lower-extremity edema (n = 54; 95%), ascites (n = 28; 50%), and perineal edema (n = 14; 25%). Sixteen percent (n = 10) and 10% (n = 6) of the procedures involved tumor and bland thrombus, respectively. RESULTS Stent placements resulted in 100% venographic patency and significantly decreased pressure gradients (P < .0001). Lower-extremity swelling, perineal swelling, and abdominal distension improved within 7 days in 83% (35 of 42), 100% (9 of 9), and 40% (6 of 15) of patients, respectively, and at 30 days after the procedure in 86% (25 of 29), 89% (8 of 9), and 80% (4 of 5) of patients, respectively. Increased pre- and post-stent placement pressure gradients were associated with worse outcomes. A 4% stent misplacement rate (4 of 97) was related to the use of Wallstents with caudal stent tapering, asymmetric deployment superior to the obstruction, suprahepatic IVC involvement, and decreased stent adherence to the IVC wall as a result of local mechanical factors. CONCLUSIONS Stent placement is reliable, rapid, and durable in improving malignant IVC syndrome. Understanding of technical and anatomic factors can improve accuracy and avoid complications of stent misplacement.

Morphometric facial analysis: a methodology to create lateral facial images

IntroductionCurrently, the majority of research in facial analysis using computational morphing methods focuses exclusively on analysis of frontal facial projections. Lateral facial morphing analysis has not been extensively investigated, and landmark features critical to specify registry points are unknown. This study aims to (1) determine the quantity of registry points (RP) required to create realistic lateral faces and (2) determine key facial registry point landmarks required to create synthetic lateral faces.Method36 synthetic lateral faces with a 50 to 250 RP were created to determine the ideal quantity of RP to create a realistic lateral image; ear, eyebrow, eye, nose, lips, hairline, facial outline, and overall outline were evaluated by an expert panel of seven evaluators using a 1 to 5 point Lickert scale rating system.ResultANOVA single-variable analyses revealed significant differences when comparing templates of 200 and 250 RP with 50 and 100 RP templates (p < 0.05). Furthermore, analysis of all key landmark areas of the face indicated significant differences between different registry points except for 200 and 250 registry point markers. Kruskal-Wallis statistical analysis revealed the landmarks varied significantly from 50 to 200 RP,but had no significance with 200 and 250 RP.ConclusionThe most ideal quantity of RP used for the creation of realistic lateral faces was in the range of 200 RP. Defined lateral facial registry point landmarks generated successful realistic faces.

Percutaneous Pulmonary Embolism Thrombectomy and Thrombolysis: Technical Tips and Tricks

Catheter-directed therapy (CDT) is now acknowledged as a treatment option for select patients with acute massive or submassive pulmonary embolism (PE), and more patients are being considered for CDT if there is available expertise. Therefore, interventionalists should be aware of the variety of catheter-based treatment options, specific pitfalls to avoid during therapy, and the appropriate treatment endpoints. This article reviews currently available techniques and protocols for treating acute massive and submassive PE, with tips to safely and successfully perform percutaneous PE interventions.