Summary: The use of de-epithelialized oral vestibular flap (boot flap) for treating free border deformity in unilateral cleft lip and for the correction of whistling lip deformity in bilateral cleft lip is reported. A 22-year-old patient with a Tessier no. 0 median cleft was referred after having undergone median lip repair, facial bipartition for correction of orbital hypertelorism, and nasal reconstruction using a scalping forehead flap at a different hospital. The patient presented with vermilion notching and a reverse V-shaped deformity of the upper lip. The standard bilateral cleft lip repair technique was modified, and satisfactory results were obtained. Specifically, a bilateral boot flap procedure was performed on the oral vestibule along the central suture line of the primary repair. The boot flap was designed to be shorter than that used in standard cases of bilateral cleft lip. The surface mucosa was de-epithelialized before flap elevation, and a subcutaneous pedicle was created beneath the flap, which was then connected to the orbicularis oris muscle. Bilateral subcutaneous pockets were dissected, into which the boot flap was inserted and fixed using absorbable sutures. The donor site was closed by advancing the bilateral mucosal flaps. Full-thickness skin from the nasal dorsum was grafted onto the pigmented forehead donor area of the scalping flap, and direct suturing was performed to narrow the nasal dorsum. The postoperative course was uneventful, and vermilion notching did not recur during a 7-year follow-up.
The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation, with prognostic value in interstitial lung disease (ILD). However, the association between baseline NLR and the therapeutic efficacy of nintedanib remains unclear. This study investigates the relationship between baseline NLR values and clinical outcomes in patients with idiopathic pulmonary fibrosis (IPF) and progressive fibrosing-ILD (non-IPF ILD) receiving nintedanib therapy. This retrospective multicenter study included 406 patients—169 with IPF and 237 with non-IPF ILD—who initiated nintedanib treatment between 2019 and 2023 across 15 institutions in Japan. Patients were stratified into low- and high-NLR groups using a cutoff of 2.86. Comparative analysis assessed survival time, forced vital capacity (FVC) changes, and acute exacerbations. The high-NLR group demonstrated shorter median survival time in the overall study population (1,171 vs. 1,386 days; p =0.025). In subgroup analyses, higher NLRs were associated with shorter survival time in patients with IPF (778 vs. 1,447 days; p =0.006), but not in the non-IPF ILD group. While nintedanib mitigated FVC decline in most subgroups, this effect was attenuated in patients with IPF and high-NLR, with no statistically significant benefit (-8.63
This subgroup analysis assessed the efficacy and safety of semaglutide in the Japanese subgroup versus the overall trial population of ESSENCE (part 1) and evaluated the impact of baseline characteristics. ESSENCE is an ongoing, phase 3, multicenter, randomized, double-blind, placebo-controlled trial that includes 1197 participants with biopsy-defined metabolic dysfunction-associated steatohepatitis and liver fibrosis stage 2 or 3 randomized 2:1 to receive once-weekly subcutaneous semaglutide 2.4 mg or placebo for 240 weeks (NCT04822181). The results of an interim analysis for efficacy conducted at week 72 involving the first 800 randomized participants are reported here (part 1). One hundred and sixteen of the first 800 randomized participants included in the interim analysis for efficacy were Japanese and received semaglutide (n = 78) or placebo (n = 38). Compared with the overall population, Japanese participants were older and had a lower body mass index. Resolution of steatohepatitis and no worsening of liver fibrosis was achieved by 63.1 and 36.8 https://clinicaltrials.gov/study/NCT04822181
