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BackgroundHand rejuvenation is an increasingly popular cosmetic procedure for hand atrophy and aging. The objective of this study is to systematically evaluate the techniques, outcomes, and complications of surgical hand rejuvenation.MethodsA systematic review was undertaken using a computerized search. Publication descriptors, methodological details, techniques, outcomes, and complications were extracted. Articles were assessed using the MINORS and Cochrane instruments.ResultsThirty-one studies were included. Most studies were published in the last five years (51.6 percent) and were prospective case series (35.5 percent). The mean age of patients was 56 (range 21–82), while the mean sample size was 47 (range 10–220). The most commonly examined interventions were Radiesse (32.2 percent) and fat grafting (32.2 percent). Major complications were not observed in any study, while minor complications such as edema and pain were temporary. Injection techniques varied, however, the proximal to distal fanning technique and using a cannula was associated with a lower risk of complications. Both Radiesse and fat grafting had robust long-term esthetic outcomes.ConclusionsHand rejuvenation is a safe and efficacious surgical intervention to reduce dorsal hand atrophy. Further studies are needed to compare the long-term outcomes of common interventions. Level of Evidence IIIThis 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.

Focal adhesions are protein complexes that anchor cells to the extracellular matrix. During migration, the growth and disassembly of these structures are spatiotemporally regulated, with new adhesions forming at the leading edge of the cell and mature adhesions disassembling at the rear. Signalling proteins and structural cytoskeletal components tightly regulate adhesion dynamics. Paxillin, an adaptor protein within adhesions, is one of these proteins. Its phosphorylation at serine 273 (S273) is crucial for maintaining fast adhesion assembly and disassembly. Paxillin is known to bind to a GIT1-βPIX-PAK1 complex, which increases the local activation of the small GTPase Rac. To understand quantitatively the behaviour of this system and how it relates to adhesion assembly/disassembly, we developed a mathematical model describing the dynamics of the small GTPases Rac and Rho as determined by paxillin S273 phosphorylation. Our model revealed that the system possesses bistability, where switching between uninduced (active Rho) and induced (active Rac) states can occur through a change in rate of paxillin phosphorylation or PAK1 activation. The bistable switch is characterized by the presence of memory, minimal change in the levels of active Rac and Rho within the induced and uninduced states, respectively, and the limited regime of monostability associated with the uninduced state. These results were validated experimentally by showing the presence of bimodality in adhesion assembly and disassembly rates, and demonstrating that Rac activity increases after treating Chinese Hamster Ovary cells with okadaic acid (a paxillin phosphatase inhibitor), followed by a modest recovery after 20 min washout. Spatial gradients of phosphorylated paxillin in a reaction-diffusion model gave rise to distinct regions of Rac and Rho activities, resembling polarization of a cell into front and rear. Perturbing several parameters of the model also revealed important insights into how signalling components upstream and downstream of paxillin phosphorylation affect dynamics.

BackgroundOur objective is to evaluate the evidence on the aesthetic effect and complications of skin-OOM strip resection compared to skin only upper blepharoplasty. MethodsA systematic search of EMBASE, PubMed, Cochrane and Google Scholar databases was performed using our search strategy through to 31 December 2019. Only comparative studies of the two upper blepharoplasty techniques were included. Three reviewers performed study selection process, data extraction, and quality assessment.ResultsA total of six articles were eligible for final inclusion. The included studies consist of two controlled retrospective cohorts and four small randomized controlled studies (RCT). Three of which, were double blinded. Those RCTs were assigned level 2 evidence due to small size and methodological limitations. The sample size of included was studies 407 in the two retrospective studies and 57 in the four RCTs. The outcomes showed that resection of OOM along with skin in upper blepharoplasty showed no difference in long-term aesthetic outcome when skin only procedure is performed. Muscle strip resection was associated with initially higher ophthalmological morbidity (edema, bruising, pain, dry eye, sluggish eye closure and lagopthalmos). Those resolved a few weeks later with conservative treatment.ConclusionThe resection of OOM along with skin in upper blepharoplasty showed no difference in long-term aesthetic outcome and was associated with initially higher ophthalmological morbidity compared to skin only procedure. While we are not suggesting that OOM resection is never required, the evidence strongly support its preservation during standard upper blepharoplasty.Level of Evidence IIIThis 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.

It is important to determine the most effective method of delivering light onto a specimen for minimal light induced damage. Assays are presented to measure photo-bleaching of fluorophores and photo-toxicity to living cells under different illumination conditions. Turning the light off during part of the experimental time reduced photo-bleaching in a manner proportional to the time of light exposure. The rate of photo-bleaching of EGFP was reduced by 9-fold with light pulsing on the micro-second scale. Similarly, in living cells, rapid line scanning resulted in reduced cell stress as measured by mitochondrial potential, rapid cell protrusion and reduced cell retraction. This was achieved on a commercial confocal laser scanning microscope, without any compromise in image quality, by using rapid laser scan settings and line averaging. Therefore this technique can be implemented broadly without any software or hardware upgrades. Researchers can use the rapid line scanning option to immediately improve image quality on fixed samples, reduce photo-bleaching for large high resolution 3D datasets and improve cell health in live cell experiments. The assays developed here can be applied to other microscopy platforms to measure and optimize light delivery for minimal sample damage and photo-toxicity.

Cell migration is an important biological phenomenon involved in many homeostatic and aberrant physiological processes. Phosphorylation of the focal adhesion adaptor protein, paxillin, on serine 273 (S273) has been implicated as a key regulator of cell migration. Here, it is shown that phosphorylation on paxillin S273 leads to highly migratory cells with small dynamic adhesions. Adhesions at protrusive edges of the cell were more dynamic than adhesions at retracting edges. Temporal image correlation microscopy revealed that these dynamic adhesions undergo rapid binding of paxillin, PAK1 and βPIX. We identified membrane proximal adhesion subdomains in protrusive regions of the cell that show rapid protein binding that is dependent on paxillin S273 phosphorylation, PAK1 kinase activity and phosphatases. These dynamic adhesion subdomains corresponded to regions of the adhesion that also show co-binding of paxillin/PAK1 and paxillin/βPIX complexes. It is likely that parts of individual adhesions are more dynamic while others are less dynamic due to their association with the actin cytoskeleton. Variable adhesion and binding dynamics are regulated via differential paxillin S273 phosphorylation across the cell and within adhesions and are required for regulated cell migration. Dysregulation through phosphomutants, PAK1-KD or βPIX mutants resulted in large stable adhesions, long protein binding times and slow cell migration. Dysregulation through phosphomimics or PAK1-CA led to small dynamic adhesions and rapid cell migration reminiscent of highly migratory cancer cells. Thus, phosphorylation of paxillin S273 is a key regulator of cell migration through recruitment of βPIX and PAK1 to sites of adhesion.

Background The methodological quality of open access studies has long been questioned due to increasing popularity and accessibility. The objective of this study is to compare the methodological quality of open access versus traditional journal publications in the plastic surgery literature. Methods Four traditional plastic surgery journals with their sister open access journals were chosen. For each of the eight journals, 10 articles were randomly selected for inclusion. Methodological quality was examined using validated instruments. Publication descriptors were compared to methodological quality values using ANOVA. Logistic regression was used to compare quality scores between open access and traditional journals. Results There was a wide distribution of levels of evidence, with a quarter being level one. Regression of non-randomized studies indicated a significantly higher proportion of traditional journal articles were of high methodological quality (89.6%) when compared to open access journals (55.6%; p  < 0.05). This difference persisted in three quarter of the sister journal groups. No publication descriptions were associated with methodological quality. Conclusions Methodological quality scores were higher among traditional access journals. Higher degrees of peer review may be necessary to ensure appropriate methodological quality in open access plastic surgery publications. 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 .

Background Excess opioid prescriptions heavily correlate with substance abuse. This study investigates prescription patterns, self-reported records concerning opioid use, pain management, and disposal routes for unused medication after hand surgeries. Methods This retrospective observational study was conducted over a three-month period from October 1, 2018, to January 1, 2019. Patients undergoing six common hand surgery procedures were included. Surgeries were performed at one tertiary center by nine plastic surgeons. Prescription information was obtained through the provincial narcotic monitoring program. Telephone interviews were conducted to collect data about the use of post-operative opioids, pain scores and disposal. Patients who could not be reached or had incomplete data were excluded. Results The study identified 62 patients, to which 1231 opioid pills were prescribed postoperatively over three months. Approximately 782 (63.6%) of these pills remained unused, and no refills of opioids was required. Patients who had undergone ligament reconstruction and tendon interposition had opioid pills prescribed most frequently (83.3%). On average, 36.1 dispensable tablets were prescribed per procedure, with Hydromorphone being the most commonly prescribed opioid. Large proportion of patients (77%) failed to discard left-over tablets properly. About 73% of patients required one or more analgesics, commonly acetaminophen. There was no significant variation found in both the self-reported pain score and total pain period between the patient groups who used opioids and those who did not. Conclusions Surplus opioids were commonly prescribed following the analysed hand surgeries. These medications were often discarded improperly. Our results highlight a need to review opioid prescribing patterns for common hand surgeries, to reduce diversion and abuse. Level of Evidence Level III, therapeutic study.

Cell migration is an important biological phenomenon involved in many homeostatic and aberrant physiological processes. Understanding the underpinnings of such processes provide insight into potential methods of therapeutic perturbation. Here, we have shown that phosphorylation of serine 273 of a key cell-matrix adhesion protein, paxillin, binds to a GIT1-βPIX-PAK1 protein complex and promotes a highly motile cellular phenotype with small cell-matrix adhesions that assemble and disassemble rapidly. We proceed to show by means of autocorrelative imaging methods, that the molecular binding/unbinding of paxillin and its binding partners to cell-matrix adhesion complexes are more dynamic when S273 is phosphorylated and the tri-molecular protein complex is intact and active. In addition, we have shown a polarization of both adhesion assembly and disassembly rates and molecular dynamics between the leading and trailing edges of individual cells. Finally, we have used cross correlative imaging techniques to spatially map protein co-dynamic interactions of paxillin and its downstream partners across cells, providing insight to adhesion assembly mechanisms and demonstrating polarization of the paxillin-tri-molecular protein complex within individual adhesions.

Livestock are a critical part of our food systems, yet their abundance globally has been cited as a driver of many environmental and human health concerns. Issues such as soil, water, and air pollution, greenhouse gas emissions, aquifer depletion, antimicrobial resistance genes, and zoonotic disease outbreaks have all been linked to livestock operations. While many studies have examined these issues at depth at local scales, it has been difficult to complete studies at regional or national scales due to the dearth of livestock data, hindering pollution mitigation or response time for tracing and monitoring disease outbreaks. In the U.S. the National Agricultural Statistics Service completes a Census once every 5 years that includes livestock, but data are only available at the county level leaving little inference that can be made at such a coarse spatiotemporal scale. While other data exist through some regulated permitting programs, there are significant data gaps in where livestock are raised, how many livestock are on site at a given time, and how these livestock and, importantly, their waste emissions, are managed. In this perspective, we highlight the need for better livestock data, then discuss the accessibility and key limitations of currently available data. We then feature some recent work to improve livestock data availability through remote-sensing and machine learning, ending with our takeaways to address these data needs for the future of environmental and public health management.