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Introduction: Vaginoplasty is performed to create a neovagina for transgender individuals who seek surgical transition or for cisgender individuals with congenital or acquired absence of a vagina (or "cisvagina"). The current knowledge of the bacterial microenvironment of the neovagina is limited. The objective of this study was to conduct a systematic review of current knowledge regarding the microbiome of the neovagina in transgender women. Methods: A systematic review of three medical databases (PubMed, MEDLINE, Web of Science) was performed in December 2021. Articles were included if they discussed the bacterial flora of the post-surgical neovagina in transgender women. Articles were excluded if their primary focus was pathogenic disease of the neovagina. Articles were summarized qualitatively and organized into a table. Results: Ten articles were identified for the review. Surgical techniques included penile inversion vaginoplasty (PIV) and intestinal/sigmoid vaginoplasty. PIV neovaginas were most similar to cisvaginas with bacterial vaginosis, whereas intestinal vaginoplasty resulted in microbiomes comparable to that of the colorectum. Oral probiotic supplements may be able to encourage the growth of Lactobacillus in the neovagina. Maintenance protocols relating to cleaning are largely surgeon- and institution-dependent, and evidence regarding the use of estrogen and its effect on the neovagina is limited. Conclusions: The microbiome of the neovagina is distinct from that of the cisvagina, and it differs based on surgical technique. Further research is warranted to better characterize the effect of different surgical techniques, patient characteristics, estrogen use, and cleaning habits on the health of the neovaginal microbiome. [ABSTRACT FROM AUTHOR]

The understanding of gender has expanded contributing to gaps in gender-affirming care. Traditional gender-affirming surgeries focus on binary results, diminishing room for affirmation of other identities. Surgeons are faced with the challenge of deciding whether a variation of gender-affirming surgery can be safely performed per request. The ethical question of when a surgeon may say yes or no to these varying requests comes after the consideration of premorbid conditions, body habitus, age, social and family support, individuals' goals, and risk assessment. Preoperative evaluations must take into account surgical experience, barriers to care, increased risk profile, and the surgeon's personal biases. [ABSTRACT FROM AUTHOR]

Viscoelastic testing including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) has gained increasing popularity across many medical fields in recent years. As TEG/ROTEM testing usesawhole blood sample and evaluates interactions between cellular components i.e., platelets, red blood cells and the clotting factors, these evaluations are uniquely capable of assessing coagulation in an in-vitro environment, resembling native conditionsunlike those of conventual clotting tests (CCTs). While viscoelastic based protocols and applications are more commonplace in hepatic and cardiac surgery and trauma scenarios, results have attracted the attention of additional disciplines including microsurgery. TEG/ROTEM tests, with their ability to assess forreal-time risk of excessive bleeding or thrombosis, may be useful in the monitoring of microsurgery patients who may be at an increased risk for flap failure. The following review of TEG/ROTEM testing focuses on the most common applications of these coagulation tests and the evidence that does or does not support such uses. A systematic review and metaanalysis of the current application of TEG/ROTEM in microsurgery is reported along with an emphasis on the future that it might hold for the field. [ABSTRACT FROM AUTHOR]

Gender dysphoria refers to the medical condition experienced by individuals whose physical anatomy is not consistent with their gender identity. Surgery is a safe and effective treatment for many individuals, yet the current demand for surgery exceeds the number of trained surgeons. This article reviews gender-affirming surgical procedures and emphasizes an individualized approach within the context of a multidisciplinary team. We review pre-, intra-, and postoperative care including the preoperative requirements for surgery. [ABSTRACT FROM AUTHOR]

Penile inversion vaginoplasty helps to alleviate gender dysphoria and improve quality of life in many transgender individuals. Overall, the procedure is associated with high post‐operative satisfaction, even when complications occur. Adverse events related to vaginoplasty are commensurate with other genitourinary reconstructive procedures performed for other diagnoses (ie, cancer or congenital issues). Here, we explore the incidence of complications following vaginoplasty, emphasizing the challenges in defining and managing these adverse events. In addition, outcome measures to assess patient satisfaction will be reviewed. [ABSTRACT FROM AUTHOR]

Objective: Chronic spontaneous urticaria (CSU) is defined as urticaria with an unknown etiology which persists for more than 6 weeks. CSU is an uncomfortable cutaneous condition that occurs due to an immune-mediated inflammatory reaction. Many studies have demonstrated that vitamin D deficiency and single-nucleotide polymorphisms in the vitamin D receptor (VDR) impact the immune response. In the current study, the frequency of the Taq1 polymorphism in the VDR gene were compared between patients with CSU and individuals without CSU. Methods: In a case–control study, a group of CSU patients (n = 100) was compared with a group of healthy age- and gender-matched individuals as a control group (n =100) who visited our center between 2015 and 2017. After DNA extraction from EDTA-containing blood, polymerase chain reaction (PCR–RFLP) was used to determine the presence of the Taq1 polymorphism. Serum vitamin D levels were measured using ELISA method (Abcam, Cambridge, USA). Results: Genotyping for Taq1 polymorphism showed that TT, Tt and tt genes frequency in the CSU group were 36%, 54%, and 10% respectively. The TT, Tt and tt genotypes had a distribution of 50%, 47% and 3% respectively in the control group. The mean serum vitamin D level in the CSU group was 19.88 ± 8.14 ng/ml, which was not significantly correlated with the Taq1 polymorphism (P = 0.841). There was a significant relationship between Taq1 gene polymorphism (tt genotype) and CSU (P = 0.038). Tt genotype increased the risk of CSU (odds ratio = 1.596), and inheritance of tt genotype increased the risk even further (odds ratio = 4.630). Conclusion: The frequency of Taq1 genotype polymorphism in the VDR gene was significantly higher in patients with CSU compared to the control group. The tt genotype polymorphism may be a risk factor for CSU. [ABSTRACT FROM AUTHOR]

The global pandemic of coronavirus 2019, or COVID-19, has undeniably impacted all facets of healthcare, affecting both its function and provision. Due to the cessation of all non-emergent surgical cases in the USA and worldwide, the professional lives and practices of many physicians have been negatively affected. However, among different physicians and specifically plastic surgeons, cosmetic/aesthetic plastic surgeons have been disproportionately affected by the COVID-19 pandemic as the majority of their cases are semi-elective and elective. The ability to perform semi-elective and elective cases is dependent on state and local authorities' regulations, and it is currently uncertain when the ban, if ever, will be completely lifted. Financial constraints on patients and their future inability to pay for these procedures due to the COVID-19-related economic recession are things to consider. Overall, the goal of this unprecedented time for cosmetic/aesthetic plastic surgeons is for their medical practices to survive, to conserve cash flow although income is low to none, and to maintain their personal finances. In this paper, the authors review the financial impacts of the current COVID-19 pandemic on the practices of cosmetic plastic surgeons in the USA and worldwide, along with some potential approaches to maintain their practices and financial livelihoods. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Surgical treatment of trigger finger involves release of A1 pulley. Some authors have theorized that the loss of A1 pulley can lead to ulnar subluxation of flexor tendons, which can be prevented by release of A1 pulley radially, even in a nonrheumatoid hand. However, there is no evidence in literature to either support or oppose this hypothesis. Occasionally, difficulty is encountered to precisely identify where A1 ends and A2 begins. While incomplete release of A1 can cause relapse of triggering, release of substantial A2 can cause bowstringing. Knowledge of the safe limit of concomitant A2 release is beneficial. The study was conducted in 12 cadaver upper extremity specimens. A1 pulleys of 48 fingers were divided at the radial (24 fingers) or ulnar (24 fingers) attachment. A 20lb traction force was applied on the flexor tendons. Any subluxation or bowstringing was noted. The experiment was repeated following serial release of the A2—initially 25%, followed by 50% and 100%. No bowstringing or subluxation was noted when A1 pulley was opened, either by radial or ulnar incision. The same was true for A1 + 25% A2 release. When A1 + 50% A2 pulley were released, bowstringing was observed in 3/48 fingers. When A1 + 100% of the A2 pulley were released, bowstringing occurred in all cases. The location of incision for release of the A1 pulley has no effect on bowstringing or tendon subluxation. Release of additional 25% of the A2 pulley can be performed safely, which corresponds to the level of palmar digital crease. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate outcomes of image-guided transrectal/transvaginal (TR/TV) drainage for symptomatic pelvic fluid collections (SPFCs). Materials and methods: Single-center retrospective study of 150 consecutive patients (36 males, 114 females, average age 41 years) who underwent attempted TR/TV drainages of SPFCs during an 11-year, 5-month period. All patients presented with pain and had SPFCs with rectal or vaginal contact on preceding diagnostic CT. Routine technique included Foley catheter insertion, image-guidance with ultrasound and fluoroscopy, 18 g/20 cm Chiba needles, and Seldinger technique for catheter insertion. No anoscope or speculum was used. SPFCs causes were classified by etiology including postoperative—70 (47%); gynecologic—49 (33%); and gastrointestinal—31 (21%). Resolutions of the SPFCs without the need for surgical intervention, collection recurrence, and complications were assessed. Surgical management after attempted TR/TV drainage was considered a failure. Results: Technical success was achieved in 172/180 procedures [TR 128/134 (95%); TV 44/46 (96%)]. TR/TV drainage successfully managed SPFCs in 141/150 patients (94% success rate) and 145/150 patients (97%) did not require surgical intervention; 4 patients with failed TR/TV drainage attempts were managed conservatively. In 5 patients requiring surgery, 4 were after technically successful TR/TV and 1 was after a failed TR attempt. Complications occurred in 4 (3%) patients: 2 bladder punctures (both resolved with medical management), 1 propagation of sepsis, and 1 hemorrhagic return from TR drainage that prompted surgical exploration. Conclusion: Transrectal and transvaginal drainage had high technical success rates and were successful in managing the majority (141/150; 94%) of patients with pelvic fluid collections. [ABSTRACT FROM AUTHOR]

While free tissue transfer has long been established as a reliable microsurgical technique in the adult population, its application in pediatric reconstruction is a relatively recent phenomenon. Despite initial concerns regarding minute vessel diameters, increased propensity for vasospasm, and limited tissue availability, pediatric free tissue transfer is now a widely used technique that has demonstrated an acceptable level of donor and recipient site morbidity in children. Five flaps commonly used in the reconstruction of lower extremity trauma are discussed in this paper: the latissimus dorsi, rectus abdominis, anterolateral thigh, gracilis, and the subscapular and parascapular flaps. The indications, blood supply, advantages, and disadvantages of each are detailed. Incredible progress has been made in the application of microsurgical techniques to the pediatric population over the last several decades. With a healthy understanding of the anatomy and functionality of the donor site, the reconstructive surgeon can repair a variety of complex injuries with an acceptable morbidity and mortality rate. [ABSTRACT FROM AUTHOR]

Objective: The mechanisms of contrast-induced nephropathy are not fully understood and sensitive biomarkers of contrast-induced nephropathy are yet to be found. We investigated whether urinary fibrinogen could be a potential biomarker for contrast-induced nephropathy.Methods: To create a contrast-induced nephropathy model, mice received a prostaglandin synthesis inhibitor (indomethacin) and a nitric oxide synthase inhibitor (Nω-Nitro-L-arginine methyl ester) intraperitoneally followed by a different dose of iodixanol. In the control group, normal saline was administered. Urinary fibrinogen and serum creatinine were analyzed using enzyme-linked immunosorbent assay. Kidneys were used to quantify fibrinogen using qRT-PCR and Western blot and for histopathological examination.Results: Histopathological examination demonstrated mild renal injury in the low-dose group, and moderate renal injury in the high-dose group. Urinary fibrinogen levels were significantly increased in an iodixanol dose-dependent manner (control vs. low-dose group, P < 0.05; control vs. high-dose group P < 0.01). Serum creatinine levels were only increased in the high-dose group (P < 0.01 compared to control), but not in the low-dose group. For fibrinogen-gene expression, in the low-dose group, Fgγ increased (qRT-PCR, Western blot, P < 0.05) in the high-dose group, Fgβ and Fgγ decreased (qRT-PCR, P < 0.01; Western blot, P < 0.05), and Fgα increased (qRT-PCR, P < 0.05; Western blot, P < 0.05).Conclusions: We propose that urinary fibrinogen could be used as a potential biomarker for early contrast-induced nephropathy diagnosis. [ABSTRACT FROM AUTHOR]

The article presents the discussion on COVID-19 vaccine candidates in development and the US Food and Drug Administration (FDA) showing approval of three vaccines. Topics include high-income countries tend to have higher vaccination rates and more stringent requirements than low- and middle-income countries (LMICs); and local and transient effects such as injection site soreness, mild fever, dizziness, nausea, and fatigue.

Background: Laparoscopic liver resection (LLR) is proposed as an alternative to open liver resection (OLR) for treatment of liver tumors. The aim of this study was to compare the surgical and oncological outcomes of LLR versus OLR in benign and malignant solid liver tumors. Study Design: In this case-matched study, charts of 497 patients with liver lesions who had LLR or OLR in our center were retrospectively reviewed. Among them, 54 consecutive patients with benign or malignant solid liver tumors who had LLR were matched with a similar number of patients with OLR based on the pathology and extent of liver resection. Additionally, the surgical and oncological outcomes such as operating room time, amount of blood transfusion requirement, free resection margin rate, length of hospital stay, complication rate, perioperative mortality, and survival were compared between the two groups. Results: Demographics, pathological characteristics of the tumor, and extent of liver resection were similar between the two groups. Twenty-nine (54%) patients in each group had malignant lesions. There were no statistically significant differences between the two groups in terms of operating room time, amount of blood transfusion requirement, free resection margin, or postoperative complication rate or survival. However, hospital stay was significantly shorter in the laparoscopic group (5.9 versus 9 days, P=.006). Although no perioperative mortality was observed in patients with benign tumors, among the patients with malignant tumors, 2 died perioperatively in each group. Conclusions: Our results in accordance with previous studies demonstrated that although the oncological outcomes of LLR and OLR were comparable, LLR patients had a shorter hospital stay. [ABSTRACT FROM AUTHOR]

This study aimed to determine the relation between Helicobacter pylori infection and insulin resistance in healthy subjects. In a cross-sectional case control study between January and April 2007, a total of 71 healthy subjects without the exclusion criteria completed the study. Forty-three (60.6%) patients were H. pylori positive and 28 (39.4%) patients were H. pylori negative. Age and body mass index of the patients were not significantly different between the two groups (32.2 +/- 14.2 vs. 33 +/- 8.05 years and 23.15 +/- 4.5 vs. 24.04 +/- 3.2 kg/m(2), respectively). H-pylori-positive patients had significantly higher HOMA-IR level compared to H-pylori-negative patients (3.54 +/- 2.2 vs. 2.46 +/- 1.9, respectively) (P < 0.05). Fasting serum insulin level was significantly higher in the H-pylori-positive group compared with the H-pylori-negative group (19.41 +/- 3.08 vs. 16.57 +/- 2.02 microU/ml, respectively) (P < 0.05). Our findings suggest recognition of H. pylori infection as a risk factor for insulin resistance. [ABSTRACT FROM AUTHOR]