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Patients undergoing SSRF at LI and LII TCs have no significant difference in risk of mortality. Additionally, there is an annually growing trend across all centers in SSRF performed both for flail and non-flail segments.This article is intended to engage international facial plastic and reconstructive surgeons so they can maximally benefit from the increased connectivity fostered by the Internet. Facial plastic surgeons are encouraged to participate in the educational programs being developed by the International Federation of Facial Plastic Surgery Societies. Many international surgeons grapple with the issues surrounding the development or expansion of their own facial plastic and reconstructive surgery practices. The Strategy Circle and suggestions on how to acquire knowledge and surgical skills are discussed. Practical recommendations to assist in transitioning a practice to facial plastic and reconstructive surgery are provided.This article offers a practical approach for cosmetic surgeons to develop and enhance their clinical practice by offering pearls that have worked for the author. Leadership of staff is the cornerstone of developing a successful business practice by hiring, retaining, and inspiring key talent. It is important to develop a clear vision for a practice and to articulate a unique selling proposition that can attract patients and be effectively communicated by authentic videos. Peers can be a source of accountability and feedback and can help provide support and structure to a business owner.Social media has become a rising popular online medium for facilitating the exchange of information and ideas for the purpose of education and networking, especially in the realm of plastic surgeon. It is important for facial plastic surgeons in private practice to recognize the influence of and engagement in social media, particularly among younger adults given the ongoing movement of cosmetic patients seeking facial rejuvenation treatments at an earlier age. This article discusses the most recent trends in social media and facial plastic surgery as well as the benefits and challenges of social media in private practice.Facial plastic surgery has thrived in both academic and private settings. In this article, 3 surgeons comment on a variety of selected topics that are pertinent to their lives as academic and private practice surgeons.Skin resurfacing techniques allow improvement of skin texture and color. This includes the effacement of wrinkles, signs of photoaging, and the softening of scars. Laser resurfacing, chemical peels, and dermabrasion are associated with overlapping risks of complications. The most common of these include infection, hypopigmentation, hyperpigmentation, and scarring. Patient evaluation helps provide treatment that gives the maximal benefit with a minimization of risks. This includes understanding the extent of each patient's issues (Glogau scale) and Fitzpatrick type. A thorough knowledge of potential risks will reduce their incidence and optimize early recognition and treatment of these complications when they do occur.Complications in facial plastic surgery can occur in both surgical and nonsurgical procedures. Many complications can be prevented through thorough preprocedural evaluation, patient counseling, and close postoperative monitoring. Despite the best efforts complications will happen and identifying them early is critical to prevent long-term sequelae. It is important to know how to both manage the complication and guide the patient through the recovery process.This article seeks to inform facial plastic surgeons about the evolving issues that affect contemporary medical literature and the publishing landscape. We hope to shed light on the key metrics that influence a journal's decision to accept a particular submission and how these metrics are predicated on a rapidly changing landscape within the academic and public community. The key metrics are citations, number of views, and social media or public attention. These metrics produce what we call "high impact" articles. This article introduces bibliometric terms and further defines the metrics that are most important to a journal.Surgical education is under tremendous pressure due to ever-increasing medical knowledge and demands on trainees' time. They must continually learn more in less time due to work hour limitations, regulations, and electronic medical record demands. Surgical training must become more efficient. There is an unprecedented array of education and training opportunities for resident preparation. The preparation for each case has to be maximal. Preoperative, intraoperative, and postoperative simulation and discussions improve the educational benefit of the trainee experience. For the teaching surgeon, putting a scalpel in residents' hands requires patience, knowledge, judgment, and a leap of faith in the resident.Patient satisfaction is the ultimate measure of success in cosmetic facial plastic surgery. Gemcitabine A successful outcome depends on patient selection, technical performance, and postoperative care. Patient perception can be influenced by physician-patient interactions. Surgical training focuses on diagnosis-identifying variations in physical condition and treatment. Although these skills are essential to a well-trained and successful facial plastic surgeon, the importance of proper patient selection, management of expectations, and empathetic communication in cosmetic surgery are often overlooked in education and cannot be understated. This article outlines the contributing factors to difficult physician-patient relationships and strategies for mitigating these situations.Body dysmorphic disorder and borderline personality disorder are common in esthetic practices and occur in up to 15% of patients. Operating on these patients may not only lead to dissatisfaction but may also worsen their premorbid condition and can induce negative behavior toward the practice. Preventing surgery and referring patients for cognitive therapy is essential. An adequate understanding of these conditions and the available screening tools is indispensable for all esthetic practitioners. Unrealistic emotional attribution to a facial shape, multiple procedures, a near-normal nose at the outset, childhood trauma, multiple comorbid mental conditions, and social dysfunction are red-flags to consider.In this article the authors discuss and analyze technological devices also known as energy-based devices and their use in skin rejuvenation, facial contouring, skin tightening, and other applications in facial plastic surgery. Energy has been applied in some form to tissue since the beginning of recorded history. The practice of applying heat to tissue with the use of cauters was used for thousands of years as an invaluable method of controlling hemorrhage. Continuous improvement of methods for using the beneficial effects of heat on tissue eventually led to the development of the basic concepts of electrosurgery we know today.The facial plastic surgeon faces increasing competition in the aesthetic world for both surgical and nonsurgical services. Incorporating nonsurgical options in practice, such as "liquid facelifts," aesthetic services, and products, increases both patient satisfaction and office revenue stream. A successful nonsurgical practice can be built with minimal expense by focusing on the most critical and popular options to offer patients.Facial plastic surgeons need to be very much more than excellent surgeons. They need to understand and have the ability to bring each patient into the practice family of the surgeon, the administrative and clerical staff, the nurses, the technicians, and the aestheticians. The entire staff must "own" the practice and the patient management philosophy of the surgeon. This article is the author's philosophy and method of guiding his patients through their journey of rejuvenative facial surgery based on 44 years of experience.The American College of Cardiology (ACC) collaborated with the American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Pediatric Echocardiography to develop Appropriate Use Criteria (AUC) for multimodality imaging during the follow-up care of patients with congenital heart disease (CHD). This is the first AUC to address cardiac imaging in adult and pediatric patients with established CHD. A number of common patient scenarios (also termed "indications") and associated assumptions and definitions were developed using guidelines, clinical trial data, and expert opinion in the field of CHD.1 The indications relate primarily to evaluation before and after cardiac surgery or catheter-based intervention, and they address routine surveillance as well as evaluat of Rarely Appropriate tests in clinical practice.

Predicting left ventricular recovery (LVR) after acute ST-elevation myocardial infarction (STEMI) is challenging and of prognostic importance. Our objective was to evaluate the usefulness of noninvasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LVR and in-hospital complications after STEMI.

Ninety-three patients with anterior STEMI (mean age, 59±12years) treated by percutaneous coronary intervention (PCI) were prospectively enrolled and underwent a transthoracic Doppler echocardiography within 24-48hours after PCI and a median of 92days at follow-up. Myocardial work is derived from the strain-pressure relation, integrating in its calculation the noninvasive arterial pressure. Segmental LVR was defined as a normalization of wall motion abnormalities of the affected segments and global recovery as an absolute improvement of left ventricular ejection fraction (LVEF)>5% in patients with baseline LVEF≤50%. In-hospital complications were defined as a compositW is an independent predictor of segmental and global LVR and is significantly impaired in patients with in-hospital complications.Echocardiography has always been a journey from scientific observation to clinical application. Whether in theranostics, understanding the performance of the systemic right ventricle, or uncovering the predictive power of echocardiographic data in congenital heart disease, the author's experiences highlight how echocardiographers at the frontier of scientific inquiry making observations today are inundated with data. It becomes apparent that new clinical applications, if they are to be successful, depend more than ever on effective management of the information we collect. In light of this realization, the 21st Feigenbaum lecture explores analytic intelligence-one path echocardiography might now take on its march from observation to application.Ocular tuberculosis (OTB) encompasses all forms of intra- and extra-ocular inflammation associated with Mycobacterium tuberculosis (Mtb) infection. However, the organism is rarely found in ocular fluid samples of diseased eyes, rendering the pathomechanisms of the disease unclear. This confounds clinical decision-making in diagnosis and treatment of OTB. Here, we critically review existing human and animal data related to ocular inflammation and TB pathogenesis to unravel likely pathomechanisms of OTB. Broadly there appear to be two fundamental mechanisms that may underlie the development of TB-associated ocular inflammation a. inflammatory response to live/replicating Mtb in the eye, and b. immune mediated ocular inflammation induced by non-viable Mtb or its components in the eye. This distinction is significant as in direct Mtb-driven mechanisms, diagnosis and treatment would be aimed at detection of Mtb-infection and its elimination; while indirect mechanisms would primarily require anti-inflammatory therapy with adjunctive anti-TB therapy.