{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:54:16Z","timestamp":1785866056550,"version":"3.56.0"},"reference-count":76,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":215,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current diagnostic tools for upper arm laxity assessment\u2014including the pinch test and two-dimensional photographic scales\u2014fail to characterize the underlying tissue composition, leading to inappropriate treatment selection and preventable complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To introduce the Melfa-Anastasia Arm Laxity System (MAALS), a precision medicine framework integrating high-frequency ultrasound (HFUS) biometry with a cylindrical geometric model for objective, compositional assessment of brachial architecture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MAALS employs a noncontact stand-off technique (HFUS, 18-22\u2005MHz) to measure superficial adipose tissue thickness (SAT) and triceps muscle thickness (M) at the mid-brachial sentinel point. Two dimensionless indices are derived: the adipose saturation percentage (%SAT = SAT\/Rtot \u00d7 100) and the muscle filling ratio (MFR = M\/Rtot), where Rtot is the total brachial radius calculated from arm circumference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on preliminary anatomically rational thresholds, MAALS defines five phenotypes (0-4): normotrophic (0), adipose hypertrophy (1), mixed morphology (2), pure cutaneous ptosis with critical vascular risk zone (%SAT &amp;lt; 20%, SAT &amp;lt; 4-5\u2005mm; liposuction contraindicated) (3), and sarcopenic\/atrophic (4). Each phenotype carries specific therapeutic indications ranging from prevention to regenerative strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MAALS is presented as a conceptual precision medicine framework requiring prospective validation, not as an established clinical standard. By providing objective compositional characterization of brachial architecture, it offers a structured basis for safer, more individualized treatment planning, future multicenter validation studies, and integration with AI-based segmentation technologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence: 5 (Therapeutic)<\/jats:title>\n                    <jats:p\/>\n                  <\/jats:sec>","DOI":"10.1093\/asjof\/ojag150","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:40:49Z","timestamp":1784029249000},"source":"Crossref","is-referenced-by-count":0,"title":["New Proposal in the Approach to Brachial Remodeling: The Melfa-Anastasia Arm Laxity System (MAALS)"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1009-0527","authenticated-orcid":false,"given":"Melfa","family":"Fabrizio","sequence":"first","affiliation":[{"name":"Surgery 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