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Background: COVID-19 is characterized by a heterogeneous clinical presentation, ranging from mild symptoms to severe courses of disease. 9-20% of hospitalized patients with severe lung disease die from COVID-19 and a substantial number of survivors develop long-COVID. Our objective was to provide comprehensive insights into the pathophysiology of severe COVID-19 and to identify liquid biomarkers for disease severity and therapy response., Methods: We studied a total of 85 lungs (n = 31 COVID autopsy samples; n = 7 influenza A autopsy samples; n = 18 interstitial lung disease explants; n = 24 healthy controls) using the highest resolution Synchrotron radiation-based hierarchical phase-contrast tomography, scanning electron microscopy of microvascular corrosion casts, immunohistochemistry, matrix-assisted laser desorption ionization mass spectrometry imaging, and analysis of mRNA expression and biological pathways. Plasma samples from all disease groups were used for liquid biomarker determination using ELISA. The anatomic/molecular data were analyzed as a function of patients' hospitalization time., Findings: The observed patchy/mosaic appearance of COVID-19 in conventional lung imaging resulted from microvascular occlusion and secondary lobular ischemia. The length of hospitalization was associated with increased intussusceptive angiogenesis. This was associated with enhanced angiogenic, and fibrotic gene expression demonstrated by molecular profiling and metabolomic analysis. Increased plasma fibrosis markers correlated with their pulmonary tissue transcript levels and predicted disease severity. Plasma analysis confirmed distinct fibrosis biomarkers (TSP2, GDF15, IGFBP7, Pro-C3) that predicted the fatal trajectory in COVID-19., Interpretation: Pulmonary severe COVID-19 is a consequence of secondary lobular microischemia and fibrotic remodelling, resulting in a distinctive form of fibrotic interstitial lung disease that contributes to long-COVID., Funding: This project was made possible by a number of funders. The full list can be found within the Declaration of interests / Acknowledgements section at the end of the manuscript., Competing Interests: Declaration of interests HHK received fees for lectures and consultations from Roche Pharma AG, Novartis, AstraZeneca, Genomic Health, Pfizer, and Amgen, all outside the present study. MMH received fees for lectures and consultations from Acceleron, Actelion, Bayer, GSK, Janssen, MSD, and Pfizer, all outside the present study. TW declares funding by the German Ministry of Research and Education. MAK and DJL declare the possession of “Nordic Bioscience” stock options. BS received fees for lectures from Boehringer Ingelheim. The other authors have no potential conflicts of interest to report., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: The eyelids reconstruction presents an aesthetic, but above all, a functional challenge. It must allow the good protection of the cornea. The development of perforator flaps is major in recent years and is gradually spreading to the face, which has pushed us to apply it to palpebral surgery., Material and Method: Since 2014, in the maxillofacial surgery department of St Etienne, four patients have benefited from a palpebral reconstruction. A temporal perforator flap, dissected on a perforator of the superficial temporal artery was performed for the anterior lamella and a palatal mucosa graft for the tarsal reconstruction., Results: The results were satisfying. Functionally, this technique allowed good occlusion of the eyelid and prevented the occurrence of ocular complications. On the aesthetic view, the position of the neo-eyelids is satisfying. No patient need retouching. The perforator flap allowed a significant mobilization without distortion of neighboring tissues, and maintaining frontal contractility., Discussion: This contemporary approach to flap dissection provides a good functional result, reduces the sequelae of the donor site and does not impose a secondary aesthetic gesture. However, despite these advantages, this type of dissection has the disadvantage of being technically more delicate and requires a trained operator., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

We report the first series of melanomas (MMs) where the surgical margins were evaluated both by ex vivo confocal microscopy (EVCM) and in vivo reflectance confocal microscopy (RCM). We evaluated the surgical margins of 42 cutaneous MMs of lentigo maligna/lentigo maligna melanoma type and 2 mucosal MMs with EVCM. Cutaneous MMs also underwent RCM mapping. Imaging results were compared with histopathology. The rate of correct identification of the tumor margins (invaded or not invaded) was 97.6% for RCM (evaluations of cutaneous MMs) and 95.5% for EVCM (evaluations of both cutaneous and mucosal MMs). Our study showed that the MM extension is visible under EVCM and that the combination of in vivo RCM and EVCM can be a new strategy for the evaluation of surgical margins of MMs., (© 2020 Wiley-VCH GmbH.)

Facial rehabilitation from facial epithets is part of the facial surgeon's therapeutic arsenal. The primary technique requires taking imprints on the patient, which has major drawbacks such as discomfort and difficulties for precisely recording anatomical surfaces. In this paper, we present a technical improvement in the design of facial epithesis, introducing application of a 3D printing technology. By exploiting digital data in DICOM format, it is possible to produce a digital copy of an epithesis. Based on this copy a model can be printed and then used to support the final prosthesis., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: Ex vivo confocal microscopy is a recent imaging technique for the perioperative control of skin tumour margins. Up to date, it has been used in the fluorescence mode and with vertical sections of the specimen margins. The aim of this study was to evaluate its use in the reflectance mode and with a horizontal ('en face') scanning of the surgical specimen in a series of basal cell carcinoma of the eyelid., Design: Prospective consecutive cohort study was performed at the University Hospital of Saint-Etienne, France., Participants: Forty-one patients with 42 basal cell carcinoma of the eyelid participated in this study., Methods: Basal cell carcinomas were excised with a 2-mm-wide clinically safe margin. The surgical specimens were analysed under ex vivo confocal microscopy in the reflectance mode and with an en face scanning in order to control at a microscopic level if the margins were free from tumour invasion. Histopathogical examination was later performed in order to compare the results., Main Outcome Measures: Sensitivity and specificity of ex vivo confocal microscopy for the presence of tumour-free margins., Results: Ex vivo confocal microscopy results were consistent with histopathology in all cases (tumour-free margins in 40 out of 42 samples; sensitivity and specificity of 100%)., Conclusions: Ex vivo confocal microscopy in the reflectance mode with an 'en face' scanning can control tumour margins of eyelid basal cell carcinomas and optimize their surgical management. This procedure has the advantage on the fluorescent mode of not needing any contrast agent to examine the samples., (© 2016 Royal Australian and New Zealand College of Ophthalmologists.)

Introduction: The condylar region is a frequent localization of mandibular fractures; there are various types of management. Mini-invasive endoscopic surgery is an alternative to open reduction. We had as goal to evaluate the outcome of this technique., Material and Methods: We performed a monocentric retrospective study of patients consecutively operated for a condylar fracture (type II to V in the Spiessl and Schroll classification) with intraoral route and endoscopic assistance, during 30 months. We assessed the functional and radiological outcomes, and the complications., Results: Twenty-two patients (25 fractures) were included. Seventeen patients (19 fractures) could be followed (mean follow-up: 16.7 months). The mean values were: interincisal opening, 45mm (±8.4); protrusion, 8.3mm (±1.9); ipsilateral excursion of the jaw: 8.6mm (±2); contralateral excursion: 8.7mm (±4). Three routes were used combined with a preauricular approach. The fracture reduction was good for 10 of the 19 fractures and poor for 3. The complications were: 3 cases of infection, 1 case of fixation failure with good consolidation; for combined approaches: 2 cases of temporary facial palsy and 2 cases of Frey syndrome., Discussion: Endoscopic assistance for the surgical management of the fracture of mandibular condyle is a reliable technique, with a good functional outcome, and a low rate of specific complications, especially for facial nerve lesion or esthetic outcome., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The prediction of protein sub-cellular localization is an important step toward elucidating protein function. For each query protein sequence, LocTree2 applies machine learning (profile kernel SVM) to predict the native sub-cellular localization in 18 classes for eukaryotes, in six for bacteria and in three for archaea. The method outputs a score that reflects the reliability of each prediction. LocTree2 has performed on par with or better than any other state-of-the-art method. Here, we report the availability of LocTree3 as a public web server. The server includes the machine learning-based LocTree2 and improves over it through the addition of homology-based inference. Assessed on sequence-unique data, LocTree3 reached an 18-state accuracy Q18=80±3% for eukaryotes and a six-state accuracy Q6=89±4% for bacteria. The server accepts submissions ranging from single protein sequences to entire proteomes. Response time of the unloaded server is about 90 s for a 300-residue eukaryotic protein and a few hours for an entire eukaryotic proteome not considering the generation of the alignments. For over 1000 entirely sequenced organisms, the predictions are directly available as downloads. The web server is available at http://www.rostlab.org/services/loctree3., (© The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.)

Introduction: The major complications of free flap surgery are anastomotic obstructions. The coupler, mechanical anastomosis using a double ring eversion system, yields higher venous patency rates than sutured anastomoses, and requires less operating time. We present our initial experience with this coupler in free flap surgery., Material and Methods: We conducted this retrospective study between November 2011 and June 2012. We focused on complications having occurred in the first 10 patients having undergone free flap reconstruction (11 flaps) with end-to-end venous anastomosis using this coupler. Five flaps were used to fill cervico-facial defects in carcinologic surgery: one for mandibular osteoradionecrosis, one for cranioplasty coverage, one for cranial base reconstruction, two for skin defects in lower limb (heel, leg). One was an antebrachial radial flap, four anterolateral thigh flaps, five fibular flaps, and one latissimus dorsi flap. Fifteen veins were anastomosed. The diameters of the couplers used were 2.5 mm (3/15), 3 mm (6/15), and 3.5 mm (6/15)., Results: There were no venous complications. One flap failed because of arterial ischemia., Discussion: The coupler is a fast and reliable alternative to usual sutures in free flap reconstructions, for head and neck as well as for limbs., (Copyright © 2013. Published by Elsevier Masson SAS.)