Three-dimensional printing for restoration of the donor face : A new digital technique tested and used in the first facial allotransplantation patient in Finland

Background and aims: Prosthetic mask restoration of the donor face is essential in current facial transplant protocols. The aim was to develop a new three-dimensional (3D) printing (additive manufacturing; AM) process for the production of a donor face mask that fulfilled the requirements for facial restoration after facial harvest. Materials and methods: A digital image of a single test person's face was obtained in a standardized setting and subjected to three different image processing techniques. These data were used for the 3D modeling and printing of a donor face mask. The process was also tested in a cadaver setting and ultimately used clinically in a donor patient after facial allograft harvest. Results: and Conclusions: All the three developed and tested techniques enabled the 3D printing of a custom-made face mask in a timely manner that is almost an exact replica of the donor patient's face. This technique was successfully used in a facial allotransplantation donor patient. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Peer reviewe

A data analysis library for gravitational wave detection

One of the main goals of Pulsar Timing Arrays (PTAs) is the direct detection of gravitational waves (GWs). A first detection will be a major leap for astronomy and substantial effort is currently going into timing as many pulsars as possible, with the highest possible accuracy. As part of the individual PTA projects, several groups are developing data analysis methods for the final stage of a gravitational-waves search pipeline: the analysis of the timing residuals. Here we report the progress of on-going work to develop, within a Bayesian framework, a comprehensive and user friendly analysis library to search for gravitational waves in PTA data

Analysis of the first IPTA Mock Data Challenge by the EPTA timing data analysis working group

This is a summary of the methods we used to analyse the first IPTA Mock Data Challenge (MDC), and the obtained results. We have used a Bayesian analysis in the time domain, accelerated using the recently developed ABC-method which consists of a form of lossy linear data compression. The TOAs were first processed with Tempo2, where the design matrix was extracted for use in a subsequent Bayesian analysis. We used different noise models to analyse the datasets: no red noise, red noise the same for all pulsars, and individual red noise per pulsar. We sampled from the likelihood with four different samplers: "emcee", "t-walk", "Metropolis-Hastings", and "pyMultiNest". All but emcee agreed on the final result, with emcee failing due to artefacts of the high-dimensionality of the problem. An interesting issue we ran into was that the prior of all the 36 (red) noise amplitudes strongly affects the results. A flat prior in the noise amplitude biases the inferred GWB amplitude, whereas a flat prior in log-amplitude seems to work well. This issue is only apparent when using a noise model with individually modelled red noise for all pulsars. Our results for the blind challenges are in good agreement with the injected values. For the GWB amplitudes we found h_c = 1.03 +/- 0.11 [10^{-14}], h_c = 5.70 +/- 0.35 [10^{-14}], and h_c = 6.91 +/- 1.72 [10^{-15}], and for the GWB spectral index we found gamma = 4.28 +/- 0.20, gamma = 4.35 +/- 0.09, and gamma = 3.75 +/- 0.40. We note that for closed challenge 3 there was quite some covariance between the signal and the red noise: if we constrain the GWB spectral index to the usual choice of gamma = 13/3, we obtain the estimates: h_c = 10.0 +/- 0.64 [10^{-15}], h_c = 56.3 +/- 2.42 [10^{-15}], and h_c = 4.83 +/- 0.50 [10^{-15}], with one-sided 2 sigma upper-limits of: h_c <= 10.98 [10^{-15}], h_c <= 60.29 [10^{-15}], and h_c <= 5.65 [10^{-15}]

Dexamethasone in head and neck cancer patients with microvascular reconstruction : No benefit, more complications

Objectives: Glucocorticoids are widely used in association with major surgery of the head and neck to improve postoperative rehabilitation, shorten intensive care unit and hospital stay, and reduce neck swelling. This study aimed to clarify whether peri-and postoperative use of dexamethasone in reconstructive head and neck cancer surgery is associated with any advantages or disadvantages. Materials and methods: This prospective double-blind randomized controlled trial comprised 93 patients. A total dose of 60 mg of dexamethasone was administered to 51 patients over three days peri-and post-operatively. The remaining 42 patients served as controls. The main primary outcome variables were neck swelling, length of intensive care unit and hospital stay, duration of intubation or tracheostomy, and delay to start of possible radiotherapy. Complications were also recorded. Results: No statistical differences emerged between the two groups in any of the main primary outcome variables. However, there were more major complications, especially infections, needing secondary surgery within three weeks of the operation in patients receiving dexamethasone than in control patients (27% vs. 7%, p = 0.012). Conclusions: The use of dexamethasone in oral cancer patients with microvascular reconstruction did not provide a benefit. More major complications, especially infections, occurred in patients receiving dexamethasone. Our data thus do not support the use of peri-and postoperative dexamethasone in oropharyngeal cancer patients undergoing microvascular reconstruction. (C) 2016 Elsevier Ltd. All rights reserved.Peer reviewe

Pharmacological Management of Cardiorenal Syndromes

Cardiorenal syndromes are disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The pharmacological management of Cardiorenal syndromes may be complicated by unanticipated or unintended effects of agents targeting one organ on the other. Hence, a thorough understanding of the pathophysiology of these disorders is paramount. The treatment of cardiovascular diseases and risk factors may affect renal function and modify the progression of renal injury. Likewise, management of renal disease and associated complications can influence heart function or influence cardiovascular risk. In this paper, an overview of pharmacological management of acute and chronic Cardiorenal Syndromes is presented, and the need for high-quality future studies in this field is highlighted

Nine years of experimental warming did not influence the thermal sensitivity of metabolic rate in the medaka fish Oryzias latipes

A pressing challenge is to determine whether and how global-change drivers influence species physiology and survival. Recently, researchers have proposed the metabolic theory of ecology, defending the hypothesis of a universal thermal dependence of metabolic rate or, alternatively, the metabolic cold adaptation theory, stating that local adaptation can influence the thermal sensitivity of metabolic rate. However, the long-term (i.e. multigenerational) consequences of warming for the thermal sensitivity of metabolic rate remain largely unexplored although it determines energy use and is crucial for species response to climate change. In this study, we used an evolutionary experiment with medaka fishes Oryzias latipes maintained for more than 12 generations at warm and cold temperatures (30 and 20°C, respectively) to address this issue. Our objective was to investigate whether thermal adaptation influences the relationship between temperature and mass-corrected metabolic rate and how this may occur. In agreement with the universal thermal dependence hypothesis, we found that warming did not significantly influence the thermal sensitivity of mass-corrected metabolic rate: neither the intercept nor the slope of the temperature–metabolic rate relationship differed among fish lineages. Our small-scale laboratory experiment thus indicated that there is limited potential for evolutionary change in medaka fish metabolic rate in response to warmer temperatures. Overall, we provide evidence that 9 years of experimental warming did not influence the thermal sensitivity of metabolic rate. Our results highlight the invariability of the thermal dependence of metabolic rate, which has important implications for adaptation to climate warming. This finding suggests a limited potential for metabolic adaptations in response to long-term temperature changes, which may have negative consequences for the persistence of fish populations under climate change

Renal function and the effects of vericiguat in patients with worsening heart failure with reduced ejection fraction : insights from the VICTORIA (Vericiguat Global Study in Subjects with HFrEF) trial

Aims Vericiguat reduced the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization in patients with worsening HF with reduced ejection fraction (HFrEF) and a lower limit of baseline estimated glomerular filtration rate (eGFR) of 15 mL/min/1.73 m(2). We evaluated the relationship between the efficacy of vericiguat and baseline and subsequent changes in renal function. Methods and results In VICTORIA, core laboratory serum creatinine was measured at baseline (n = 4956) and weeks 16, 32, and 48. Worsening renal function (WRF), defined as an increase >= 0.3 mg/dL in creatinine from baseline to week 16, was assessed via a Cox model with respect to subsequent primary events. Mean age was 69 years, 24% were female, and mean baseline eGFR was 61 mL/min/1.73 m(2). During 48 weeks of treatment, the trajectories in eGFR and creatinine with vericiguat were similar to placebo (P = 0.50 and 0.18). The beneficial effects of vericiguat on the primary outcome were not influenced by baseline eGFR (interaction P = 0.48). WRF occurred in 15% of patients and was associated with worse outcomes (adjusted hazard ratio 1.28, 95% confidence interval 1.11-1.47; P < 0.001), but the beneficial effects of vericiguat on the primary outcome were similar in patients with or without WRF (interaction P = 0.76). Conclusion Renal function trajectories were similar between vericiguat- and placebo-treated patients and the beneficial effects of vericiguat on the primary outcome were consistent across the full range of eGFR and irrespective of WRF.Peer reviewe

Application of the FACE-Q rhinoplasty module in a mixed reconstructive and corrective rhinoplasty population in Finland

The FACE-Q Rhinoplasty module is a patient-reported outcome instrument developed for the assessment of primarily aesthetic outcomes of rhinoplasty. The aim of our study was to produce a Finnish version of the instrument and validate it for use in patients undergoing nasal reconstruction as well as those treated with a rhinoplasty. Finnish versions of the FACE-Q scales Satisfaction with Nose, Satisfaction with Nostrils and Adverse Effects: Nose, were translated following established guidelines. Patients undergoing nasal resection, reconstruction or rhinoplasty in Helsinki University Hospital plastic surgery department in 2009-2019 were identified using theatre records. A total of 240 Finnish-speaking patients 18-85 years old were approached with a postal survey questionnaire. The questionnaire included the translated FACE-Q modules and those for Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress and Satisfaction with Outcome, as well as the general health-related quality of life instrument 15 D. The FACE-Q scales translated readily to Finnish. Eighty-three patients (35%) responded to the survey. Most FACE-Q scales performed well with high internal consistency (Cronbach's alphas 0.87-0.92) and repeatability. Only the Adverse Effects: Nose scale displayed poor consistency and a floor effect with 18% of the patients reporting no adverse outcomes. Answers to the Appearance-Related Psychosocial Distress scale were skewed towards no experienced stress. Answers to the other scales were normally distributed with weak correlation with 15 D dimensions. The Finnish translations of the FACE-Q Rhinoplasty scales perform well at assessing a diverse group of patients including those undergoing nasal reconstruction as well as those undergoing rhinoplasty.Peer reviewe

Long-term quality of life after surgery of head and neck cancer with microvascular reconstruction : a prospective study with 4.9-years follow-up

Purpose The aim of this study was to evaluate the long-term health-related quality of life (HRQoL) of head and neck cancer patients with microvascular surgery. Surgical treatment causes great changes in patient HRQoL. Studies focusing on long-term HRQoL after microvascular reconstruction for head and neck cancer patients are scarce. Methods We conducted a prospective study of 93 patients with head and neck cancer and microvascular reconstruction in Helsinki University Hospital Finland. HRQoL was measured using the 15D instrument at baseline and after a mean 4.9-years follow up. Results were compared with those of an age-standardized general population. Results Of the 93 patients, 61 (66%) were alive after follow-up; of these, 42 (69%) answered the follow-up questionnaire. The median time between surgery and HRQoL assessment was 4.9 years (range 3.7-7.8 years). The mean 15D score of all patients (n = 42) at the 4.9-years follow up was statistically significantly (p = 0.010) and clinically importantly lower than at baseline. The dimensions of "speech" and "usual activities" were significantly impaired at the end of follow up. There was a significant difference at the 4.9-years follow-up in the mean 15D score between patients and the general population (p = 0.014). After follow up, patients were significantly (p <0.05) worse off on the dimensions of "speech," "eating," and "usual activities." Conclusions Long-term HRQoL was significantly reduced in the whole patient cohort. Speech and usual activities were the most affected dimensions in head and neck cancer patients with microvascular reconstruction at the end of the 4.9-years follow up.Peer reviewe

Virtual 3D planning and prediction accuracy in two bimaxillary face transplantations in Helsinki

Conclusions: 3D planning is feasible , provides close to accurate bone reconstruction in face transplantation. Preoperative virtual transplantation assists planning and improves the outcome in bimaxillary face transplantation. (c) 2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Pub-lished by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )Peer reviewe