Burn wound progression is complex and caused by additive effects of inadequate tissue perfusion, free radical damage, and systemic alterations in the cytokine milieu of burn patients, leading to protein denaturation and necrosis. Even though insufficient evidence exists for causal inferences, infection, tissue desiccation, edema, circumferential eschar, impaired wound perfusion, metabolic derangements, advanced age, and poor general health play important roles. Although consensus-building research is ongoing, current mainstays of treatment include adequate fluid resuscitation, nutritional support, and local wound care, with an emphasis on topical antimicrobial agents and biosynthetic dressings. Identifying early indicators by elucidating possible interacting or synergistic mechanisms and by developing preventative strategies will enhance prevention and treatment.
SummaryFlhB, an integral membrane protein, gates the type III flagellar export pathway of Salmonella . It permits export of rod/hook-type proteins before hook completion, whereupon it switches specificity to recognize filament-type proteins. The cytoplasmic C-terminal domain of FlhB (FlhB C ) is cleaved between Asn-269 and Pro-270, defining two subdomains: FlhB CN and FlhB CC . Here, we show that subdomain interactions and cleavage within FlhB are central to substratespecificity switching. We found that deletions between residues 216 and 240 of FlhB CN permitted FlhB cleavage but abolished function, whereas a deletion spanning Asn-269 and Pro-270 abolished both. The mutation N269A prevented cleavage at the Flh-B CN -FlhB CC boundary. Cells producing FlhB(N269A) exported the same amounts of hook-capping protein as cells producing wild-type FlhB. However, they exported no flagellin, even when the fliC gene was being expressed from a foreign promoter to circumvent regulation of expression by FlgM, which is itself a filament-type substrate. Electron microscopy revealed that these cells assembled polyhook structures lacking filaments. Thus, FlhB(N269A) is locked in a conformation specific for rod/hook-type substrates. With FlhB(P270A), cleavage was reduced but not abolished, and cells producing this protein were weakly motile, exported reduced amounts of flagellin and assembled polyhook filaments.
Microwave ablation with a novel device results in consistently sized and shaped lesions. Importantly, we did not observe any significant heat-sink effect using this device, a major difference from RFA techniques. This system offers a viable alternative for creating fast, large ablation volumes for treatment in liver cancer.
BACKGROUND
Poly-l-lactic acid (PLLA) is a well-established biostimulator that induces neocollagenesis, allowing for volume loss correction. Although PLLA is FDA approved to treat mid-to-lower facial wrinkling, it has grown increasingly popular as a nonsurgical, minimally invasive procedure for soft-tissue volume augmentation of other extremities. However, research detailing PLLA buttock injections is still lacking.
OBJECTIVE
The purpose of this study is to determine the safety and efficacy of PLLA for buttock augmentation.
MATERIALS AND METHODS
A clinical retrospective review of 60 patients (ages 23–54 years) were followed for 2 years by 2 investigators. Patients underwent 1 to 3 treatments, spaced 4 to 6 weeks apart, and received 2 to 12 vials per session (based on the patient budget). Pretreatment and post-treatment photographs were assessed by the primary and secondary investigator in blinded and double-blinded surveys, respectively. The Global Aesthetic Improvement Scale was used to quantify improvements in volume, skin texture, and cellulite dimpling.
RESULTS
Poly-l-lactic acid allows for visible volume amplification, improved skin texture, and softened cellulite dimpling in the buttocks when at least 20 vials are used.
CONCLUSION
Poly-l-lactic acid is safe and effective for overall aesthetic enhancement of the buttocks if used in adequate quantity (minimum 20 vials) for all women, independent of age or the number of sessions.
Learning Objectives:
After studying this article and viewing the video, the participant should be able to: 1. Accurately describe the relevant aesthetic anatomy and terminology for common female genital plastic surgery procedures. 2. Have knowledge of the different surgical options to address common aesthetic concerns and their risks, alternatives, and benefits. 3. List the potential risks, alternatives, and benefits of commonly performed female genital aesthetic interventions. 4. Be aware of the entity of female genital mutilation and differentiation from female genital cosmetic surgery.
Summary:
This CME activity is intended to provide a brief 3500-word overview of female genital cosmetic surgery. The focus is primarily on elective vulvovaginal procedures, avoiding posttrauma reconstruction or gender-confirmation surgery. The goal is to present content with the best available and independent unbiased scientific research. Given this relatively new field, data with a high level of evidence are limited. Entities that may be commonly encountered in a plastic surgery practice are reviewed. The physician must be comfortable with the anatomy, terminology, diagnosis, and treatment options. Familiarity with requested interventions and aesthetic goals is encouraged.
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