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Both acute and chronic tendinopathy result in high morbidity, requiring management that is often lengthy and expensive. However, limited and conflicting scientific evidence surrounding current management options has presented a challenge when trying to identify the best treatment for tendinopathy. As a result of shortcomings of current treatments, response to available therapies is often poor, resulting in frustration in both patients and physicians. Due to a lack of understanding of basic tendon-cell biology, further scientific investigation is needed in the field for the development of biological solutions. Optimization of new delivery systems and therapies that spatially and temporally mimic normal tendon physiology hold promise for clinical application. This review focuses on the clinical importance of tendinopathy, the structure of healthy tendons, tendon injury, and healing, and a discussion of current approaches for treatment that highlight the need for the development of new nonsurgical interventions.

Background Labia minora length is used in classification systems and to determine labiaplasty candidacy, with shorter labia leading to nonsurgical recommendations. Objectives The aim of the study was to investigate the correlation between labia length and symptomatology. Methods Patients undergoing labiaplasty from January 2017 to May 2023 underwent chart review. Data collected included age, exposed, and total labia length. Patients completed a preoperative survey with possible scores from 0 to 13 to gauge complaints and symptoms. Results Out of 50 charts with complete data, the average age was 34. Exposed labia lengths were 10.1 mm (right) and 11.4 mm (left); total lengths from sulcus to edge measured 32.0 mm (right) and 33.4 mm (left). Survey scores averaged 6.5 (range, 2-11) median of 7. The correlation between exposed labia length and symptoms yielded Pearson correlation coefficient values (R) of 0.25 for both right and left sides, with coefficient of determination (r2) values at 0.06. For total labia length, R values were 0.08 (right) and 0.06 (left), and r2 values were 0.007 (right) and 0.003 (left). Conclusions The correlation between a patient's exposed and total labia length and reported symptomatology is weak. Patients with longer labia can experience few symptoms, just as those with shorter labia can have a high degree of symptomatology. Rather than use labia length as a primary factor determining labiaplasty candidacy, the focus should be on patient-reported symptoms. Level of Evidence: 2

Current practice recommendations from the American Society of Hematology recognize rituximab, TPO-RAs and splenectomy as valid second-line therapies for ITP, with patient education and shared decision making encouraged to choose between these options. The short-term response rate for rituximab is approximately 60%, with approximately 25% of patients maintaining a durable rise in platelet count at 5 years. Splenectomy removes the primary site of platelet clearance and autoantibody production and has the highest rate of durable response (60%–70%) compared with other ITP therapies.

Background/Objectives: As breast reconstruction techniques continue to progress, patient satisfaction with aesthetic outcomes has become an increasingly important marker of success. Obtaining optimal symmetry often requires secondary procedures whether reconstruction is unilateral or bilateral, implant-based or autologous, immediate or delayed. Consequently, determining the ideal method to achieve symmetry, particularly in challenging scenarios, such as the radiated breast, is nuanced and requires experienced decision-making. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, including the PubMed, Cochrane Library, and Embase bibliographic databases, to identify original articles addressing asymmetry in both implant-based and autologous breast reconstruction. Studies based on benign breast disease or oncoplastic reconstruction for partial mastectomy/lumpectomy defects were excluded. Results: The search initially yielded a total of six hundred and fifty unique articles. After complete assessment of inclusion and exclusion criteria, a total of forty-one articles were included in total. Conclusions: This article provides a systematic review of the current literature available to guide surgeons on managing asymmetry in breast reconstruction and highlights case examples of frequently encountered clinical challenges. A novel treatment algorithm was then generated to serve as a comprehensive decision-making guide for both patients and surgeons.

Goals/Purpose Incorporating adequate aesthetic surgery training into integrated plastic surgery programs in the United States has remained a challenge for several decades.[1-4] Specifically, residents report low confidence in performing facial cosmetic procedures compared to breast and body contouring.[1-2] This becomes increasingly relevant in the setting of heightened specialty creep and the rise in demand for cosmetic procedures overall according to the 2022 ASPS procedural statistics which show a 19% increase in cosmetic surgery procedures compared to the pre-pandemic 2019 report.[5] In a survey of 257 residents, 26.4% felt confident performing a lower blepharoplasty, 25% performing a facelift, 16.5% performing an endoscopic brow lift, and 14% performing a rhinoplasty.[2] This resident-reported difficulty with facial cosmetic procedures has shown little progress over time in reported survey data despite an increase in minimum cosmetic case numbers and length of training. A comprehensive aesthetic training also includes exposure to non-surgical interventions such as neuromodulators, injectables, non-surgical body contouring and facial rejuvenation technology. Though non-invasive fat reduction (ie. cryolypolysis) and non-surgical skin tightening (ie. radiofrequency micro-needling) have increased in demand since 2019 (77% and 22%, respectively), residents rarely have hands-on exposure to these treatment modalities.[5] Several integrated plastic surgery programs have a dedicated year of professional development or research, providing an opportunity for programs to fill this gap between cosmetic surgery training and real-world demand. Methods/Technique A junior cosmetic fellowship curriculum was created at a single institution focused on increasing confidence in performing aesthetic surgery, exposure to non-surgical cosmetic procedures, and increasing exposure to the business side of private practice. The fellowship was designed for a single resident during the professional development year of integrated plastic surgery training, completed between the third and fourth clinical years. The junior fellow spent the year within a single, multi-office private aesthetics practice in both the surgical and non-surgical setting. Over the course of the first four months (July 2023 - October 2023), the clinical experience of the Stanford junior cosmetic fellow was queried. Analysis of surgical case volume and non-surgical patient load was performed. This was then used to project surgical cases anticipated to be completed by year end. This was compared to case log minimums for graduating integrated plastic surgery residents in the United States, an essential metric of assessing resident experience and competence. Financial analysis of the non-surgical treatments by the junior fellow was performed. Using the initial four-month data, projections were also estimated to determine profitability for the practice over the course of the year-long fellowship. Results/Complications Over the span of the initial four months, the junior cosmetic fellow completed 69 cases, 58% of which were breast / body and 42% of which were focused on facial rejuvenation. It is estimated that at completion of the fellowship, this projects to 207 cases, exceeding the cosmetic ACGME program requirements for graduation. Total sales generated by the junior fellow during the first four months were as follows:$22,802, $ 90,257,$78,563, and $ 75,084 USD. Therefore, total sales by year end are estimated to be $800,118 in non-surgical treatments – demonstrating expertise of the junior fellow in non-surgical procedures and also profitability for the practice. Conclusion Increasing resident comfort with aesthetic surgical and non-surgical procedures is imperative as the demand for cosmetics continues to rise. Here we highlight the creation of a junior cosmetic fellowship, designed for programs with a year of professional development in their plastic surgery curriculum, to bridge the gap of cosmetic resident education. This junior fellowship model increases overall resident comfort in aesthetics and experience with facial procedures, a known weakness in resident training. Also, the addition of a junior fellow has shown to be financially lucrative for a practice, encouraging private practice attendings to consider this teaching model. Beyond the scope of programs with a dedicated year for professional development, this fellowship model may encourage embedded fellowships or incorporating mini-fellowships of 3-6 months in aesthetic surgery into residency programs outside of the traditional chief resident cosmetic experience.

While surgical options exist to treat lymphedema after axillary lymph node dissection (ALND), the lymphatic microsurgical preventive healing approach (LYMPHA) has been introduced as a preventive measure performed during the primary surgery, thus avoiding the morbidity associated with lymphedema. Here, we highlight details of our operative technique and review postoperative outcomes. For our patients, limb measurements and body composition analyses were performed pre- and postoperatively. Intraoperatively, axillary reverse lymphatic mapping was performed with indocyanine green (ICG) and lymphazurin. SPY-PHI imaging was used to visualize the ICG uptake into axillary lymphatics. Cut lymphatics from excised nodes were preserved for lymphaticovenous anastomosis (LVA). At the completion of the microanastomosis, ICG was visualized draining from the lymphatic through the recipient vein. A retrospective review identified nineteen patients who underwent complete or partial mastectomy with ALND and subsequent LYMPHA over 19 months. The number of LVAs performed per patient ranged between 1–4 per axilla. The operating time ranged from 32–95 min. There were no surgical complications, and thus far one patient developed mild lymphedema with an average follow up of 10 months. At the clinic follow up, ICG and SPY angiography were used to confirm intact lymphatic conduits with an uptake of ICG across the axilla. This study supports LYMPHA as a feasible and effective method for lymphedema prevention.

Novel experimental techniques are required to make the next big leap in neutron electric dipole moment experimental sensitivity, both in terms of statistics and systematic error control. The nEDM experiment at the Spallation Neutron Source (nEDM@SNS) will implement the scheme of Golub & Lamoreaux [Phys. Rep., 237, 1 (1994)]. The unique properties of combining polarized ultracold neutrons, polarized 3 He, and superfluid 4 He will be exploited to provide a sensitivity to ∼ 10 −28   e  · cm. Our cryogenic apparatus will deploy two small (3 L) measurement cells with a high density of ultracold neutrons produced and spin analyzed in situ. The electric field strength, precession time, magnetic shielding, and detected UCN number will all be enhanced compared to previous room temperature Ramsey measurements. Our 3 He co-magnetometer offers unique control of systematic effects, in particular the Bloch-Siegert induced false EDM. Furthermore, there will be two distinct measurement modes: free precession and dressed spin. This will provide an important self-check of our results. Following five years of “critical component demonstration,” our collaboration transitioned to a “large scale integration” phase in 2018. An overview of our measurement techniques, experimental design, and brief updates are described in these proceedings.

A cryogenic apparatus is described that enables a new experiment, nEDM@SNS, with a major improvement in sensitivity compared to the existing limit in the search for a neutron Electric Dipole Moment (EDM). It uses superfluid \\(^4\\)He to produce a high density of Ultra-Cold Neutrons (UCN) which are contained in a suitably coated pair of measurement cells. The experiment, to be operated at the Spallation Neutron Source at Oak Ridge National Laboratory, uses polarized \\(^3\\)He from an Atomic Beam Source injected into the superfluid \\(^4\\)He and transported to the measurement cells as a co-magnetometer. The superfluid \\(^4\\)He is also used as an insulating medium allowing significantly higher electric fields, compared to previous experiments, to be maintained across the measurement cells. These features provide an ultimate statistical uncertainty for the EDM of \\(2-3 10^-28\\) e-cm, with anticipated systematic uncertainties below this level.

Novel experimental techniques are required to make the next big leap in neutron electric dipole moment experimental sensitivity, both in terms of statistics and systematic error control. The nEDM experiment at the Spallation Neutron Source (nEDM@SNS) will implement the scheme of Golub & Lamoreaux [Phys. Rep., 237, 1 (1994)]. The unique properties of combining polarized ultracold neutrons, polarized \\(^3\\)He, and superfluid \\(^4\\)He will be exploited to provide a sensitivity to \\( 10^-28\\,e \\,\\, cm\\). Our cryogenic apparatus will deploy two small (\\(3\\, L\\)) measurement cells with a high density of ultracold neutrons produced and spin analyzed in situ. The electric field strength, precession time, magnetic shielding, and detected UCN number will all be enhanced compared to previous room temperature Ramsey measurements. Our \\(^3\\)He co-magnetometer offers unique control of systematic effects, in particular the Bloch-Siegert induced false EDM. Furthermore, there will be two distinct measurement modes: free precession and dressed spin. This will provide an important self-check of our results. Following five years of \"critical component demonstration,\" our collaboration transitioned to a \"large scale integration\" phase in 2018. An overview of our measurement techniques, experimental design, and brief updates are described in these proceedings.