Background: Auricle reconstruction is among the most challenging procedures in plastic and reconstructive surgery, and the choice of framework material is a critical decision for both surgeons and patients. This meta-analysis compared the outcomes of autologous auricle reconstruction using costal cartilage with those of alloplastic reconstruction using porous polyethylene implants.Methods: A literature review was conducted using the PubMed and Embase databases to retrieve articles published between January 2000 and June 2024. The outcomes analyzed included postoperative complications such as framework exposure, infection, skin necrosis, hematoma, and hypertrophic scars, as well as patient satisfaction. The proportions of reconstructive outcomes from each selected study were statistically analyzed using the “metaprop” function in R software.Results: Fourteen articles met our inclusion criteria. The group undergoing polyethylene implant reconstruction exhibited higher rates of framework exposure, infection, and skin necrosis, whereas the autologous reconstruction group experienced higher rates of hematoma and hypertrophic scars. Of all the complications, framework exposure was the only one to show a statistically significant difference between the two groups (p < 0.0001). In terms of patient satisfaction, those who underwent autologous cartilage reconstruction reported a higher rate of satisfaction, although this difference did not reach statistical significance in the meta-analysis (p = 0.076).Conclusion: There is no statistically significant difference in postoperative complications such as infection, hematoma, skin necrosis, and hypertrophic scars between auricle reconstructions using autologous costal cartilage and those using polyethylene implants. However, reconstructions with polyethylene implants show a significantly higher rate of framework exposure.

Genetic information is not yet used for the clinical diagnosis of advanced fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Herein, we investigated whether incorporating genetic information regarding PNPLA3 and TM6SF2 into existing non-invasive fibrosis scoring systems could improve their predictive accuracy, particularly in patients with type 2 diabetes mellitus (T2DM), a high-risk population for MASLD-related complications. Data were collected from a cohort of 637 patients with biopsy-proven MASLD. All participants underwent liver stiffness measurement (LSM), serum marker analysis, and genotyping for PNPLA3 (rs738409), TM6SF2 (rs58542926), and other relevant single nucleotide polymorphisms. We evaluated the benefit of adding genetic information to existing non-invasive tests (NITs) – including the Agile 3+, Fibrosis-4 (FIB-4) index, and NAFLD fibrosis score (NFS). Decision curve analysis in the validation cohort (n = 238) demonstrated that incorporating PNPLA3 and TM6SF2 genetic information marginally enhanced net clinical benefit across all three models over a range of threshold probabilities (10-50%). At a 30% threshold probability, the net benefit of genotype-enhanced models increased from 22.0 to 22.8 per 100 patients for Agile 3+, from 17.0 to 18.4 for NFS, and from 13.0 to 16.9 for FIB-4. In the T2DM subgroup (n = 121), genotype incorporation led to small but statistically significant improvements in discrimination for NFS (AUROC increase: 0.053, p = 0.001) and FIB-4 (AUROC increase: 0.058, p = 0.010), while Agile 3+ showed a favorable trend (AUROC increase: 0.016, p = 0.058). Incorporating PNPLA3 and TM6SF2 genetic information into non-invasive fibrosis scoring systems for MASLD provides limited but measurable improvements, with statistically significant AUROC gains for NFS and FIB-4, particularly among patients with T2DM. Further validation is required before routine clinical implementation can be recommended. Our research demonstrates that incorporating PNPLA3 and TM6SF2 genetic information into non-invasive fibrosis tests provides modest but measurable improvements in clinical utility for patients with metabolic dysfunction-associated steatotic liver disease, particularly those with type 2 diabetes mellitus – a high-risk population prone to accelerated fibrosis progression and liver-related complications. These findings are relevant for clinicians managing these patients, as genotype-enhanced models (particularly NAFLD fibrosis score and Fibrosis-4 index) showed statistically significant improvements in diagnostic accuracy, enabling better identification of patients requiring closer monitoring. In practice, genetic information could be integrated into routine risk stratification, especially in settings where elastography is unavailable, allowing serum-based tests to more accurately identify high-risk patients who warrant referral for biopsy or specialist evaluation. However, given the modest absolute improvements and tertiary care derivation, further validation in diverse populations is essential before routine clinical implementation can be recommended.

Importance: Despite the existing guideline’s recommendation of metformin therapy as the initial approach for managing diabetes mellitus (DM), there remains a scarcity of comprehensive documentation regarding metformin’s impact on outcomes that are important for patients. Objectives: The objective of this study was to assess the potential impact of metformin treatment on the risk of death in individuals diagnosed with both gastric cancer and pre-existing diabetes mellitus (DM); Design, Setting, and Participants: The study made use of a dataset encompassing nationwide health insurance claims, allowing for a retrospective analysis of all patients with a history of gastric cancer diagnosis (classified under International Classification of Diseases 10th Revision code: C16.X) spanning from 1 January 2002 to 31 December 2012. The primary objective was to observe death within a 5-year follow-up period. The study population comprised 63,664 individuals who fell into two categories: those treated with metformin (n = 29,548) and those who did not receive metformin treatment (n = 34,116). This classification was based on the initial treatment allocation following the diagnosis of gastric cancer. Exposures: Metformin treatment, comorbidities, concurrent medication, and procedural information. Outcomes: All-cause death, disease-specific death, cardiovascular death. Results: During the 5-year follow-up period, the metformin treatment group exhibited a lower cumulative incidence of all-cause death (27.5%) in comparison to the group not receiving metformin treatment (32.8%). Furthermore, the relative hazards for all-cause death were significantly reduced in the metformin treatment group (HR: 0.80, 95% CI 0.78–0.82), indicating a lower risk of death when compared to the non-metformin group. In addition, metformin treatment was associated with lower occurrences of disease-specific death (related to gastric cancer) and cardiovascular death when compared to the group not undergoing metformin treatment. Conclusions: The findings demonstrated that the use of metformin was effective at improving prognosis among gastric cancer patients documented with prior DM. In this population-based cohort study, metformin treatment was associated with reduced risk of mortality.

Park J, et al. Yonsei Med J. 2024 Nov;65(11):636-644. https://doi.org/10.3349/ymj.2023.0503