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Clinical significance of internal mammary (IM) lymph node biopsy during microvascular free flap breast reconstruction remains controversial. Some microsurgeons may choose to biopsy an IM lymph node during routine IM vessel dissection. The authors reviewed the results of IM lymph node biopsy during autologous breast reconstruction.

A retrospective chart review of patients who underwent autologous breast reconstruction during a seven-year period (January 2010 to January 2017) was performed. Patient demographic data, disease staging, flap details, pathology reports, and adjuvant treatment were evaluated.

A total of 230 patients with a mean age of 52.1 (SD 9.3) underwent IM lymph node biopsy (n=297). Single IM lymph node was removed in 169 patients, 2 nodes were removed in 56 patients, 3 nodes in 4 patients, and 4 nodes in a single patient. Histopathologic analysis demonstrated presence of IM lymph node metastasis in 16 patients (7.0%). Thirteen patients were found to have metastatic IM lymph nodes in the setting of immediate reconstruction. Three patients were found to have metastatic IM lymph nodes in the setting of delayed. Five out of 16 patients (31.3%) had negative axillary sentinel lymph node biopsy and IM lymph nodes were the only site of nodal metastases. All five of these patients were upstaged accordingly and received adjuvant therapy based on the discussion at the multidisciplinary breast tumor conference.

Opportunistic internal mammary lymph node sampling during autologous breast reconstruction can be performed with minimal morbidity and has significant impact on the disease staging and adjuvant treatment.

Opportunistic internal mammary lymph node sampling during autologous breast reconstruction can be performed with minimal morbidity and has significant impact on the disease staging and adjuvant treatment.To synthesize the available evidence regarding lip repositioning surgery (LRS) and quantify the short- and long-term reduction in excessive gingival display (EGD) with the procedure. Additionally, evaluate the effect of myotomy on the results. Seven electronic databases were searched up to May 2020 by two independent reviewers. Studies evaluating the exclusive use of LRS to treat EGD were included. After risk of bias assessment, the data were quantitatively evaluated with random-effects meta-analysis. The initial database search yielded 368 studies, of which 16 were selected for full-text review. Finally, eight studies were included. The random effects model exhibited an EGD reduction of 2.87 mm (95% CI 1.91-3.82) after 3 months of LRS. These results decreased after 6 months (2.71 mm; 95% CI 1.95-3.47) and 12 months (2.10 mm; 95% CI 1.48-2.72). Meta-analysis comparing the performance of myotomy showed greater EGD reduction at 6 months than without myotomy (P less then  0.02). LRS is an effective approach for treating EGD, and it has satisfactory results up to 6 months. After this period, the effectiveness appears to progressively decrease over time indicating substantial relapse at 12 months. Myotomy seems a suitable alternative to increase the stability of LRS. Lip repositioning surgery is an effective procedure to improve smile esthetics in the short-term (up to 6 months). After this period, the efficacy of LRS seems to decrease progressively, and an approximately 25% relapse may be expected after 12 months. Clinicians should combine the procedure with other approaches, such as plastic periodontal surgeries, restorative procedures, or botulin toxin injections for more predictable and stable outcomes.A simple and convenient concept of blood sampling followed by a fully automated analysis is presented. PX-12 chemical structure A disposable sampling kit is used for accurate self-sampling of capillary blood from a finger prick. A high-throughput blood sampling is thus enabled, which is essential in many clinical assays and considerably improves life quality and comfort of involved subjects. The collected blood samples are mailed to a laboratory for a fully automated dried blood spot (DBS) processing and analysis, which are performed with a commercial capillary electrophoresis instrument. Quantitative results are obtained within 20 min from the DBS delivery to the laboratory. The presented concept is exemplified by the determination of warfarin blood concentrations and demonstrates excellent analytical performance. Moreover, this concept is generally applicable to a wide range of endogenous and exogenous blood compounds and represents a novel and attractive analytical tool for personalized health monitoring.

The optimal approach to deal with severe coronary artery calcification (CAC) during percutaneous coronary intervention (PCI) remains ill-defined.

We conducted an electronic database search of all published studies comparing Orbital versus Rotational Atherectomy in patients undergoing PCI.

Eight observational studies were included in the analysis. Overall, there were no significant differences in Major-adverse-cardiac-events/MACE (OR 0.81, CI 0.63-1.05, p = .11), myocardial-infarction/MI (OR 0.75, CI 0.56-1.00, p = .05), all-cause mortality (OR 0.82, CI 0.25-2.64, p = .73) or Target-vessel-revascularization/TVR (OR 0.72, CI 0.38-1.36, p = .31). However, OA was associated with lower long-term MACE (1-year), (OR 0.66, CI 0.44-0.99, p = .04), long-term TVR (OR 0.40, CI 0.18-0.89, p = .03), and short-term MI (in-hospital and 30-day) (OR 0.64, CI 0.44-0.94, p = .02). OA was associated with more coronary artery dissections (OR 2.61, CI 1.38-4.92, p = .003) and device-related coronary perforations (OR 2.79, CI 1.08-7.19, p = .03). There were no differences in cardiac tamponade (OR 1.78, CI 0.37-8.69, p = .47). OA was noted to have significantly lower fluoroscopy time (MD -3.96 min, CI -7.67, -0.25; p = .04) compared to RA. No significant difference was noted in terms of contrast volume between the two groups (OR -4.35 ml, CI -14.52, 23.22; p = .65).

Although there was no difference in overall MACE, MI, all-cause mortality and TVR, OA was associated with lower long-term MACE and short-term MI. OA is associated with lower fluoroscopy time but higher rates of coronary artery dissection and coronary perforation.

Although there was no difference in overall MACE, MI, all-cause mortality and TVR, OA was associated with lower long-term MACE and short-term MI. OA is associated with lower fluoroscopy time but higher rates of coronary artery dissection and coronary perforation.