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Δευτέρα 16 Οκτωβρίου 2017

Epidermal nevus syndromes: New insights into whorls and swirls

Abstract

Knowledge of the molecular underpinnings of many epidermal nevi and epidermal nevus syndrome has expanded rapidly in recent years. In this review and update on epidermal nevus syndrome, we will cover recent genetic discoveries involving epidermal nevi, including nevus sebaceus, keratinocytic epidermal nevus, nevus comedonicus, congenital hemidysplasia with ichthyosiform nevus and limb defects syndrome, phakomatosis pigmentokeratotica, Becker's nevus, porokeratotic adnexal ostial nevus, inflammatory linear verrucous epidermal nevi, and cutaneous-skeletal hypophosphatemia syndrome. We will discuss how newly defined mutations relate to the biology reflected in the cutaneous patterns seen in these mosaic disorders and how new molecular data has informed our understanding of these diseases and shaped management decisions.



Alopecic and aseptic nodule of the scalp in a girl

Abstract

Alopecic and aseptic nodule of the scalp is a rare entity characterized by the presence of nodules or cysts with sterile punctured material and negative cultures accompanied by nonscarring alopecia in the scalp of young men. We describe a case in which an 11-year-old girl presented with a nodular, fluctuant, round lesion on the vertex with localized alopecia. High-resolution ultrasound showed a hypoechoic lesion with increased flow on Doppler imaging and culture of the citrine-yellowish material obtained by puncture was negative. The patient showed complete clinical response to treatment with topical indomethacin.



Hermansky-Pudlak syndrome: Report of two patients with updated genetic classification and management recommendations

Abstract

Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder caused by mutations in one of nine genes involved in the packaging and formation of specialized lysosomes, including melanosomes and platelet-dense granules. The cardinal features are pigmentary dilution, bleeding diathesis, and accumulation of ceroid-like material in reticuloendothelial cells. Pulmonary fibrosis induced by tissue damage is seen in the most severe forms, and one subtype is characterized by immunodeficiency. We describe two patients with HPS type 1 and review the updated gene-based classification, clinical features, and recommendations for evaluation and follow-up.



Scanning electron microscopy study of hair shaft changes related to hardness of water

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Lujain M Alahmmed, Ebtehal A Alibrahim, Abdullah F Alkhars, Mohammed N Almulhim, Sayed Ibrahim Ali, Feroze Kaliyadan

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):740-740

Introduction and Aims: Brittleness and breakage of hair is a common complaint in the geographical area of Saudi Arabia where we work. This area has a high level of hardness in normal tap water. We aimed to study and compare structural differences and relative deposition of calcium and magnesium salts on the hair shaft surface using scanning electron microscopy (SEM) between hair shaft samples from normal, healthy volunteers treated with hard and soft water. Methods: Hair samples obtained from 20 healthy volunteers were divided into two groups. One group was treated with hard water for 3 weeks and the second with soft water for the same duration. SEM was used to assess hair shaft surface damages and relative deposition of calcium and magnesium on the surface of the hair. Results: There was no statistically significant difference between the study and control group as far as surface changes under SEM were concerned. As far as the relative deposition of calcium and magnesium was concerned, there was no statistically significant difference in calcium deposition between the control and study samples (P = 0.28). On the other hand, magnesium deposition showed a significant difference between both groups (P = 0.001), with a higher level in samples washed with hard water. Conclusions: Hard water may be associated with increased deposits on the hair shaft surface, however, this does not necessarily translate into evident structural surface changes, as evidenced by SEM.

Combination of A-T advancement flap and crescentic flap: A novel approach to repair surgical defect above the eyebrow

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Snehal Desale, Chih-Jung Hsu

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):717-719



Vitiligo pathogenesis is interlinked with pigment homeostasis: A new concept

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Ratnam Attili, Sasi Kiran Attili

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):630-634



Development of dysplastic nevus during radotinib therapy in patients with chronic myeloid leukemia

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Yu Ri Woo, Jong Sic Kim, Dong Wook Kim, Hyun Jeong Park

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):704-707



The nail as an investigative tool in medicine: What a dermatologist ought to know

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Chander Grover, Shikha Bansal

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):635-643

The nail is an important skin appendage, but not many dermatologists are aware of the importance it receives outside our specialty. This article focuses on the nail in non-dermatological contexts. The nail is a keratinized matrix capable of continuous growth with the ability to incorporate various compounds within its structure. Therefore it can be used to monitor long-term consumption of drugs. It is also an excellent source of germ-line DNA for genetic analyses. With an increased undrstanding of nail physiology, there is now a better understanding of its connection to various pathologies as well. Nails, being peripherally placed, are easy to sample without significant discomfort to the patient, making them a valuable diagnostic tool. For this narrative review, we carried out a PubMed search using the key words "nail clipping," "nail DNA," "nail diabetes mellitus;" "nail clipping oncology," and "nail forensics". Retrieved articles were searched for information pertaining to non-dermatologic uses of nail for evaluation, which is presented in a narrative fashion. It is clear from recent literature that the nail is not just an inert skin appendage, but a dynamic window into the ever-changing metabolic and genetic milieu. We highlight the numerous roles of nail specimens, as well as point towards future research needed therein.

Pseudoainhum and autoamputation associated with lamellar ichthyosis

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Biswanath Behera, Debasis Gochhait, Devinder Mohan Thappa

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):728-729



Encouraging curricular research: A new agenda for IJDVL

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Saumya Panda, Yogesh S Marfatia

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):627-629



Clinical and serological characteristics of nail psoriasis in Indian patients: A cross-sectional study

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Deepashree Daulatabad, Chander Grover, Bineeta Kashyap, Amit Kumar Dhawan, Archana Singal, Iqbal R Kaur

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):650-655

Background: Nail involvement in psoriasis is common with a lifetime incidence of 80-90%. It may reflect severity of cutaneous involvement and predict joint disease. Yet it remains, poorly studied and evaluated especially in Indian psoriatic patients. Aim: The present study was undertaken to evaluate clinical and serological profile of nail involvement in psoriasis and to assess quality of life impairment associated with nail involvement in Indian patients. Methods: Consecutive patients with nail psoriasis were assessed for severity of cutaneous disease (psoriasis area severity index score) and nail disease (nail psoriasis severity index score). The impairment in quality of life attributable to nail disease was scored with nail psoriasis quality of life 10 score. All patients were also assessed for joint disease and tested for inflammatory and serological markers as erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Results: In our cohort of 38 patients with nail psoriasis, 9 had concomitant psoriatic arthritis. The mean psoriasis area severity index was 14.4 ± 9.6 (range = 0.4–34). The most commonly recorded psoriatic nail changes were pitting (97.4%), onycholysis (94.7%) and subungual hyperkeratosis (89.5%). The mean nail psoriasis severity index score was 83.2 ± 40.1 (range = 5–156) and mean nail psoriasis quality of life 10 was 1.1 ± 0.4. Erythrocyte sedimentation rate and C-reactive protein were raised in 22/38 (57.9%) and 15/38 (39.5%) patients, respectively; rheumatoid factor was positive in 5/38 (13.2%) and anti-cyclic citrullinated peptide antibody was raised in 4/38 (10.5%) patients. Limitations: Small sample size and lack of a control group. Conclusions: In Indian patients with nail psoriasis, severity of nail involvement was found to be poorly correlated with the extent of cutaneous disease. In addition the impact of nail disease on patient's quality of life was found to be minimal. This suggests the need for a quality of life questionnaire suited to the Indian population. Serological markers were raised overall in the study patients and more so in the patients with concomitant arthritis.

Low-dose methotrexate combined with superficial X-ray in the treatment of folliculotropic mycosis fungoides: A case report

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Yanan Jiang, Ruzeng Xue, Weijia Wang, Yongfeng Chen

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):710-713



Dermoscopy and patch testing in patients with lichen planus pigmentosus on face: A cross-sectional observational study in fifty Indian patients

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Vinod Kumar Sharma, Vishal Gupta, Piyush Pahadiya, Kamal Kumar Vedi, Sudheer Arava, M Ramam

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):656-662

Background: Lichen planus pigmentosus (LPP) is a common cause of facial melanosis in the dark-skinned population. At present, information on dermoscopy and patch testing in LPP is limited. Objectives: To describe dermoscopic findings and study the role of patch testing in patients with LPP on the face. Methods: Facial lesions of 50 patients with LPP were studied dermoscopically, followed by histological evaluation. Patch and photopatch tests with the Indian Standard Series and Scandinavian series, respectively, and patient's own cosmetics were performed on all patients. Results: The most common dermoscopic finding was dots and/or globules (43/50, 86%) in different patterns: hem-like (20.9%), arcuate (18.6%), incomplete reticular (39.5%), complete reticular (7%), and not otherwise specified (14%). Other patterns were exaggerated pseudoreticular pattern, accentuation of pigmentation around follicular openings, targetoid appearance, and obliteration of the pigmentary network. There were 26 relevant patch tests in 17 (34%) patients: para-phenylenediamine (n = 5), nickel (n = 3), colophony, perfume mix and fragrance mix (n = 2 each), thiuram mix and 3,3,4,5-tetrachlorosalicylanilide (n = 1 each), and patients' own products (n = 9). The only positive photopatch test was to fentichlor. No clinical or histological finding differed significantly based on patch test results. The only dermoscopic finding to be statistically associated with a positive patch test was the non-characteristic arrangement of dots/globules (P = 0.042). Limitations: Dermoscopic features were not correlated with clinical features or disease duration. Implications of patch testing on the management of LPP cannot be commented upon as ours was a cross-sectional study. Conclusions: The present study describes the dermoscopic findings of facial lesions in LPP. Our patch test results suggest a probable role of allergens in causing LPP on the face.

Combination of two types of nail brace for the treatment of complicated ingrown toenails

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Che-Wei Liu, Yu-Chen Huang

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):722-725



Unusually high incidence of multifocal epithelial hyperplasia in children of the Nahuatl population of Mexico

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Constantino Ledesma-Montes, Amilcar Mendez-Mendoza

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):663-666

Background: Multifocal epithelial hyperplasia is an uncommon disease of the oral mucosa caused by the human papilloma virus. Aim: To study the clinical and pathological findings of multifocal epithelial hyperplasia detected during an oral examination of 343 Mexican Nahuatl children from a single primary school in El Paso de Cupilco, Mexico. Methods: A thorough oral examination was performed in all children and clinical data (age, gender, location and number of lesions) were documented and analyzed. Results: Multifocal epithelial hyperplasia was diagnosed in 110 of the 343 children (32.3%). The ages of the children varied from 5 to 15 years, and of these, 56.3% were girls. The lesions were asymptomatic, 0.2 to 3.0 cm in diameter, soft, round to oval, smooth surfaced, sessile papulonodules, similar in colour to that of the surrounding mucosa. The lesions were commonly seen on the buccal mucosa and tongue, and most affected children (85%) had less than 5 lesions. Children in the 7 to 10 years age group were most often affected. Limitations: Human papillomavirus typing was not done owing to a lack of facilities. Conclusions: There is a high incidence of multifocal epithelial hyperplasia in Nahuatl children with a predilection for females.

Yellapragada SubbaRow – The unsung Indian biochemist behind methotrexate and other drugs

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Ankit H Bharti, Yogesh S Marfatia

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):733-735



Urocytological evaluation of pemphigus patients on long term cyclophosphamide therapy: A cross sectional study

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Sujay Khandpur, Saurabh Singh, Saumyaranjan Mallick, Vinod Kumar Sharma, Venkat Iyer, Amlesh Seth, Mahesh Kumawat

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):667-672

Background: Cyclophosphamide therapy is associated with several urological complications including urinary bladder malignancy. Data on urologic complications of chronic cyclophosphamide therapy for dermatologic conditions is not available. Objectives: To study the urocytological profile of pemphigus patients on long-term cyclophosphamide therapy. Materials and Methods: In a cross-sectional study, consecutive patients who had received cyclophosphamide therapy for pemphigus for more than 12 months were included. All patients were subjected to urinalysis including microscopy, culture, and urine cytology. Immunocytochemical staining for cytokeratin 20 (CK-20) on urine sediments and ELISA (enzyme-linked immunosorbent assay) for nuclear membrane protein-22 (NMP-22) were performed in all cases. In patients with urinary symptoms, microscopic hematuria, or those detected with abnormal urine sediment cytology, NMP-22, and CK-20 positivity, cystoscopy, and other relevant investigations were also done. Results: A total of 44 patients (43 of pemphigus vulgaris and one of pemphigus foliaceus) were recruited. Mean duration of cyclophosphamide intake was 2.9 ± 1.7 years (range 1–8 years) with a mean cumulative dose of 53 ± 28.4 g (range 6.5–141 g). Twenty-one cases (47.7%) each were asymptomatic and symptomatic with episodic urinary symptoms [of which two had urinary tract infection (UTI)] and two patients had gross hematuria. Urine cytology revealed mild urothelial nucleomegaly with hyperchromasia in four patients. However, CK-20 and NMP-22 were negative in all samples. Cystoscopy was performed in 21 cases and did not reveal any sign of bladder malignancy. Limitations: A relatively small sample size and lack of long-term follow-up were limitations. Conclusions: In our study, no serious urologic complications were found in pemphigus cases on chronic cyclophosphamide therapy.

Low plasma zinc levels in androgenetic alopecia

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Kumpol Aiempanakit, Sawangpong Jandee, Kanokphorn Chiratikarnwong, Thavatchai Chuaprapaisilp, Sauvarat Auepemkiate

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):741-741



Cutaneous plasmacytosis: A rare entity with unique presentation

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Subhra Dhar, Lalthleng Liani, Kamlakar Patole, Sandipan Dhar

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):673-676

Primary cutaneous plasmacytosis is a rare cutaneous disorder with extensive cutaneous plaques/papules mainly on the trunk and face. Cases have mostly been documented from Japan. We present here a rare case of cutaneous plasmacytosis from India of Mongolian descent. This 50-year-old female from Mizoram had extensive maculo-papular violaceous plaques distributed on the face, axillae, trunk and lower extremities. Initial and repeat skin biopsy revealed dense perivascular and periadnexal mature plasma cells. She also had lymphadenopathy. Serum protein electrophoresis did not reveal any M band and the Bence Jones protein was negative in urine. The patient had multiple superficial lymph nodes and a biopsy from the cervical lymph node showed effacement of normal nodal architecture by sheets of plasma cells. Immuno histochemistry was done from both skin and lymph node biopsies. The kappa and lambda tight chains were not restricted; there by proving the polyclonal nature of the plasma cells. The novelty of the case lies in its classical clinical presentation with histopathological documentation.

Follicular psoriasis - dermoscopic features at a glance

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Biswanath Behera, Debasis Gochhait, Raj Remya, MR Resmi, Rashmi Kumari, Devinder Mohan Thappa

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):702-704



Cardio-pulmonary involvement in systemic sclerosis: A study at a tertiary care center

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Geetakiran Arakkal, Sudha Rani Chintagunta, Vasavilatha Chandika, Sudha Vani Damarla, Srinivas Manchala, B Udaya Kumar

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):677-682

Background: Systemic sclerosis is a multisystem disorder characterized by microangiopathy, dysregulation of the immune system and massive deposition of collagen in the connective tissue of the skin, blood vessels and various internal organs. Although the mortality from renal crises has dropped significantly due to the use of angiotensin-converting enzyme inhibitors, cardiac and pulmonary involvement accounts for significant morbidity and mortality. We studied 28 patients with systemic sclerosis at Gandhi Medical College and Hospital, Hyderabad, over a period of two years for cardiopulmonary involvement. Aim: The aim of this study was to analyze the cardiopulmonary involvement in systemic sclerosis. Methods: All patients with systemic sclerosis attending the dermatology outpatient department were included in the study. The diagnosis of systemic sclerosis was made based on the American Rheumatology Association criteria, and was further confirmed by skin biopsy and serological investigations. X-ray chest, electrocardiogram, two-dimensional ECHO, high-resolution computed tomography chest, pulmonary function tests and bronchoalveolar lavage were done to evaluate cardiopulmonary involvement. Observations: Out of 28 patients, 17 had diffuse systemic sclerosis and 11 had limited systemic sclerosis. Mean duration of symptoms was 2.9 years. Abnormalities in chest X-ray were found in 16 patients. Pulmonary function tests showed a restrictive pattern in 23 patients. High-resolution computed tomography of the chest showed evidence of interstitial lung disease in 21 patients, while five patients each had pleural effusion and cardiomegaly. Bronchoalveolar lavage showed different cellular patterns such as neutrophilia, eosinophilia and lymphocytosis. Pulmonary arterial hypertension was observed in seven patients and isolated pulmonary arterial hypertension in two patients. Electrocardiogram abnormalities were found in twenty patients. Two-dimensional ECHO was abnormal in 17 patients with valvular abnormalities being the most common finding. Overall, pulmonary involvement was observed in 27 patients and cardiac involvement in 17 patients. Limitations: A small sample size was a limitation of this study. Diffusing capacity of lung for carbon monoxide, and right cardiac catheterization were not done, as these were not available at our centre. Conclusions: In our patients, pulmonary involvement was more common than cardiac involvement. Interstitial lung disease and cardiac involvement were more commonly seen in diffuse systemic sclerosis whereas pulmonary hypertension was more frequent in limited systemic sclerosis. Hence, it is important to screen the patients for cardiopulmonary involvement for early diagnosis and treatment and a better prognostic outcome.

An outlandish association of Klinefelter syndrome

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R Sivayogana, A Ramesh, V Sampath

Indian Journal of Dermatology, Venereology, and Leprology 2017 83(6):708-709



Effectiveness of a Smartphone Application for the Management of Metabolic Syndrome Components Focusing on Weight Loss: A Preliminary Study

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


Comparative responses of diazotrophic abundance and community structure to the chemical composition of paddy soil

Abstract

Diazotrophy is considered as one of the most crucial and dynamic phenomena in the rice field and also a major source of nitrogen input. The objective of this study was to elucidate possible interactions between diverse and dominant diazotrophic bacterial community and organic carbon composition of the paddy soil. Our results suggest that most abundantly found diazotrophs belong to a proteobacteria group and uncultured bacterial forms. A gene abundance study clearly showed significantly higher diazotrophic abundance (P < 0.01) at Chandauli (CHN) as compared to Varanasi (VNS) and Ghazipur (GHJ) districts of Eastern Uttar Pradesh, India, with nitrogenase reductase (nifH) copy number between 1.44 × 103 and 3.34 × 103 copy g−1 soil. Fourier-transform infrared (FT-IR) spectroscopy data identified –CO–, C=O ( \( {\mathrm{NH}}_{2^{-}} \) and –NH–), \( {\mathrm{CH}}_{2^{-}} \) , and OH– as dominant organic functional groups in the paddy soil. Multivariate analysis was performed to get a clear and more accurate picture of interactions between free-living diazotrophs and abiotic soil factors. Regression analysis suggested a similar trend of distribution of different functional groups along each site. Relative abundance and diversity of diazotrophic population increased in response to FT-IR-based soil organic fractions. Maximum number of FT-IR spectral peak at sites in the Chandauli district augmented its bacterial diazotrophic diversity and abundance. Taken together, the present study sheds light on the substrate-driven composition of the microbial population of selected paddy areas.



The endothelial prostate-specific membrane antigen is highly expressed in gliosarcoma and visualized by [ 68 Ga]-PSMA-11 PET: a theranostic outlook for brain tumor patients?

gliomagliosarcomaPSMAtheranostics

Evaluation of antioxidant potential of essential oils of some commonly used Indian spices in in vitro models and in food supplements enriched with omega-6 and omega-3 fatty acids

Abstract

The aim of this study was to evaluate and compare the antioxidant potential of essential oils of some commonly used Indian spices (black pepper, cinnamon, clove, coriander and cumin) in various in vitro models and in food supplements enriched with omega-6 and omega-3 fatty acids. In vitro antioxidant potential was evaluated using 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical-scavenging and Fe2+ ion-chelating methods and lipid oxidation stabilisation potential was evaluated in bulk soybean oil-fish oil mixture and their oil-in-water emulsions using peroxide value (PV), p-anisidine value (p-AV) and total oxidation value as indicators of oxidation. Combination effects using DPPH radical scavenging and Briggs-Rauscher oscillating reaction methods were also evaluated. Test essential oils showed varying degrees of radical scavenging and Fe2+ ion-chelating efficacy. Clove and coriander oils showed significantly higher (P < 0.05) radical scavenging and Fe2+ ion-chelating potential over other tested essential oils as well as BHT and ∞-tocopherol. The anti-lipid peroxidative potential of test essential oils was found in the following decreasing order: clove > coriander > BHT > cinnamon > α-tocopherol > cumin > black pepper. Furthermore, clove and coriander oils showed synergistic antioxidant activity in combination both in DPPH radical scavenging and Briggs-Rauscher oscillating reaction methods whereas other possible combinations showed additive effects. Strong radical scavenging and Fe2+-chelating as well as anti-lipid peroxidative activities of clove and coriander oils provide evidence that clove and coriander oils may serve as a potential source of natural antioxidants for retarding lipid oxidation of food supplements enriched with omega-6 and omega-3 fatty acids.



Characterization of disease burden, comorbidities and treatment use in a large US based cohort: Results from the Corrona Psoriasis Registry

Psoriasis is an immunodysregulatory inflammatory disease associated with comorbidities impacting quality of life. With the advent of new treatments, there is growing need to assess the long term safety and efficacy of treatments in a real-world setting.

The pedicled posteromedial thigh (pPMT) perforator flap and its application in loco-regional soft tissue reconstructions

The posteromedial thigh (PMT) perforator flap is a valuable reconstructive option. In its pedicled form the experience is currently limited to a few case reports. The purpose of this article is to describe various clinical applications of the pedicled posteromedial thigh flap (pPMT) for reconstruction of loco-regional soft tissue defects.

Zygomatico-orbital artery: the largest artery in the temporal area

The zygomatico-orbital artery is the largest artery in the temporal area. With the increasing number of reconstructive and aesthetic surgeries in the area, in-depth understanding of this artery is needed. Thus, the aim of this anatomical study was to determine more information on the zygomatico-orbital artery using contrast-enhanced three-dimensional computer tomography (CT) and color-flow Doppler sonography. Based on CT images taken between October 2015 and October 2016 for diagnosing and treating maxillofacial conditions, 50 patients were selected.

A possible implication of reduced levels of LIF, LIFR, and gp130 in vasculopathy related to systemic sclerosis

Abstract

Leukemia inhibitory factor (LIF) is a member of IL-6 family, which serves as a potent chemoattractant for neutrophils as well as a potent angiostatic factor. LIF has been implicated in various autoimmune inflammatory diseases, but its role still remains elusive in systemic sclerosis (SSc). Therefore, we investigated the potential role of LIF in the development of SSc by evaluating the clinical correlation of serum LIF levels, the expression of LIF and its receptors in skin samples, and in vitro experiments with human dermal microvascular endothelial cells. Serum LIF levels were significantly decreased in patients with SSc, especially in those with disease duration of < 1 year compared with healthy controls. As for clinical correlation, SSc patients with digital ulcers exhibited serum LIF levels significantly lower than those without. In immunohistochemistry, the expression of LIF and its receptors, LIF receptor and gp130, was remarkably decreased in dermal blood vessels of SSc lesional skin relative to those of healthy control skin. Furthermore, gene silencing of transcription factor Fli1, whose deficiency is involved in the development of SSc vasculopathy, suppressed the expression of LIF, LIF receptor, and gp130 and Fli1 bound to the promoters of those genes in human dermal microvascular endothelial cells. Collectively, these results suggest that decreased serum LIF levels may be associated with vasculopathy in SSc and that Fli1 deficiency may contribute to the inhibition of LIF-dependent biological effects on SSc endothelial cells by suppressing the expression of LIF, LIF receptor, and gp130.



Dermoscopy Can Indicate the Grade of Actinic Keratoses

Publication date: Available online 15 October 2017
Source:Actas Dermo-Sifiliográficas (English Edition)
Author(s): P. Zaballos Diego




Mycobacterium avium Infection after Acupoint Embedding Therapy

imageSummary: Nontuberculous mycobacterium is a ubiquitous environmental organism that is unusual to cause a true infection, but it can cause severe cutaneous infections. In this case report, we present a successful treatment for a Chinese patient with Mycobacterium avium cutaneous infection after acupoint embedding therapy. We managed to conduct pathogenic detection, drug sensitive test, and multidisciplinary consultation. Finally, a systematic treatment strategy of nontuberculous mycobacterium was performed. Twenty-two-month follow-up revealed excellent outcome without any recurrence.

Immediate Nipple-Areolar Complex Reconstruction for Patients Undergoing Implant-Based Reconstruction or Therapeutic Mammoplasty

imageBackground: We report a technique of immediate nipple-areolar complex (NAC) reconstruction for patients undergoing skin-sparing mastectomy and implant-based breast reconstruction or therapeutic mammoplasty with central excision. Methods: Immediate nipple reconstruction is performed using a modified C-V flap planned along the edge of the incision. The areola is reconstructed using a full-thickness skin graft taken from skin usually discarded during the procedure. Immediate NAC reconstruction using this technique was performed on 32 breasts in 21 patients. This included 19 risk-reducing mastectomies, 9 therapeutic mastectomies, and 2 major revisions to existing implant reconstruction. Reconstruction was direct to implant in 29 breasts and by expander in 1 breast. The device was placed in a pre- or post-pectoral plane utilizing dermal sling and/or acellular dermal matrix as determined on a case-by-case basis. Immediate NAC reconstruction was also performed on 2 patients undergoing therapeutic mammoplasty with central excision. Results: Mean follow-up is 12 months (5–27 months), and cosmetic results have been good. There have been no significant complications, and no revisional surgery has been required. Conclusion: The application of simple techniques for NAC reconstruction in the primary procedure allows reconstruction of the whole breast in a single stage. There is an immediate focal point to the reconstruction to improve cosmesis, patient satisfaction, and psychosocial function without delay.

Plastic Surgery Resident Operative Performance Trends: How Soon Do Independent Residents Catch Up?

No abstract available

Optimizing Nipple Position following Nipple-Sparing Mastectomy

imageBackground: The best treatment for nipple malposition following nipple-sparing mastectomy is prevention. This article reviews basic elements for success in nipple-sparing mastectomy and offers an option to patients with grade 2–3 breast ptosis who strongly desire to preserve the nipple. Methods: Retrospective review identified patients undergoing nipple-sparing mastectomy and immediate reconstruction. Results: Patient selection centered on realistic goals for postoperative breast size, nipple position, and when not to save the nipple. The choice of device considered projection and nipple centralization as equal components and led to wider, lower profile devices selectively for the first stage of reconstruction. In severe grade 2–3 nipple ptosis, an inferior vertical incision or wedge excision was used to enhance nipple position postoperatively. Eighteen consecutive patients underwent 32 implant-based breast reconstructions following nipple-sparing mastectomy with the vertical incision. The average age was 45 years old, and the average body mass index was 26.7. Direct-to-implant reconstruction was performed in 25%, whereas 75% had tissue expander-implant reconstruction. Overall complications included infection (3%) and nipple necrosis (3%) leading to explant in 1 reconstruction. Conclusions: The final nipple position following nipple-sparing mastectomy can be optimized with preoperative planning. The vertical incision, combined with proper patient selection and choice of device, may increase eligibility for nipple-sparing procedures in patients with grade 2–3 ptosis who desire nipple preservation.

End-to-End Lymphaticovenular Anastomosis Does Not Disturb the Contraction of Collecting Lymph Vessels

imageNo abstract available

Prepectoral Implant-Based Breast Reconstruction

imageBackground: The development of acellular dermal matrices (ADMs) has facilitated single-stage implant breast reconstruction (IBR) following skin-sparing mastectomy. The conventional approach of postpectoral implant placement with lower pole ADM confers a good cosmetic result by improving lower pole projection and control, while minimizing issues of implant visibility, palpability, and rippling. This is balanced with potential disadvantages including pain, disruption of pectoral muscle function, and animation. We report the results of a prospective study of prepectoral IBR with total ADM coverage. Methods: Prepectoral IBR with total ADM coverage was performed in 106 patients (166 breasts) in our institution from 2013 to 2017. The cohort included patients undergoing immediate IBR (113 breasts) and revision of existing submuscular IBR (53 breasts). Patient demographics, surgical complications, and outcomes from a prospective database were analyzed. Results: At a mean follow-up of 485 days, patient satisfaction and cosmetic outcomes have been good, with no significant capsular contractures or animation deformity. Minor complications including delayed healing, red breast, or seroma occurred in 14 breasts (8.4%). Major complications including necrosis and implant loss occurred in 5 breasts (3 patients), with a total explantation rate of 3%. No patients required more than an overnight stay in hospital, and there were no delays to adjuvant treatment in therapeutic cases. Conclusion: Prepectoral implant placement with ADM cover is emerging as an alternative approach for IBR. This method facilitates breast reconstruction with a good cosmetic outcome for patients who want a quick recovery without potential compromise of pectoral muscle function and associated problems.

Capturing Plastic Surgery on Film—Making Reconstruction Visible

imageSummary: The Swiss Plastic Surgery Association (http://ift.tt/2jFDI9U) decided to produce a corporate video to illustrate the concept of "plastic surgery of confidence" to the public. We show the diversity of specializations and the vast range of tasks that surgeons passionately handle day in and day out. We wanted to convey 2 main messages: first, that plastic surgery is more than just cosmetic surgery, and second, that plastic surgery in Switzerland is synonymous with quality and confidence. We selected 17 topics that we felt had good filmic potential and would best explain to the public what plastic surgery is about. This included the selection of appropriate patients, experts, and locations from all over the country. We thought it crucial to show the initial preoperative situation, as only in this case would the achievement of reconstruction be evident and comprehensive to the layman audience. The actual production was filmed in 5 different locations and took 5 days of shooting. We recorded 17 surgeons, 9 patients, and about 30 voluntary background actors. From 23 hours of footage, we created a 7 minute, 22 second corporate video, recorded in 3 of the Swiss national languages. The video was presented to the public online in June 2016, on the same day as the National Open Day of Plastic Surgery in Switzerland. The video is available online. We evaluated the impact of the video using a questionnaire for lay people and observed that it could substantially improve the perception of our specialty, especially regarding the reconstructive aspect. We feel that a freely available corporate video is a very useful means to promote plastic surgery and help patients better understand what it is all about.

Bilateral Free Flap Breast Reconstruction Outcomes: Do Abdominal Scars Affect Bilateral Flaps?

imageBackground: The incidence of bilateral mastectomies is increasing along with the rates of breast reconstructions. A substantial number of patients will present with abdominal scars after Cesarean section, laparoscopy, laparotomy, and so on. The aim of this study was to evaluate the impact of prior abdominal scars on complication rates in abdominal bilateral free flap breast reconstruction. Methods: All consecutive patients with autologous free flap breast reconstruction between 2007 and 2014 were eligible. The relevant demographic and clinical data were prospectively collected into a study-specific database. Complications and reoperations were prospectively registered after postoperative outpatient visits. Results: Overall, 493 patients underwent abdominally based breast reconstruction during the study period: unilateral (n = 250; 50.7%) or bilateral (n = 243; 49.3%). In the bilateral group, the abdominal scar locations were Pfannenstiel (n = 73; 30.1%), midline (n = 16; 6.6%), lower oblique (n = 17; 7.0%), upper oblique (n = 5; 2.1%), and laparoscopic (n = 69; 28.4%). Four (1.7%) flap failures (including 1 converted to a pedicled transverse rectus abdominis flap) were registered, all occurring in patients from the scar group: 3 with Pfannenstiel incision and 1 patient with prior laparoscopy. Pfannenstiel scar was associated with higher risk of hematoma at the recipient site when compared with no scar group (13.7% versus 2.2%; P = 0.006). Partial flap necrosis, infection, and seroma occurred in 14 (5.9%), 8 (3.4%), and 5 (2.1%) patients, respectively, and no differences between the scar groups were identified. Conclusion: Surgical outcomes of bilateral reconstructions in patients with abdominal scars are generally comparable with ones in patients without prior surgery; however, some problems have been identified. These procedures might have some intraoperative considerations and often require increased operative times. Apart from the traditional preoperative computed tomography angiography, intraoperative imaging (e.g., fluorescence angiography) may be advocated in patients with abdominal scars.

Reconstruction of Near-Total Loss of the Upper and Lower Lips due to Purpura Fulminans with Local Tissue and a Dual-Skin Paddled Anterolateral Thigh Flap

imageSummary: It is difficult to totally reconstruct the lip, achieving good functional and aesthetic results. There have been few reports of reconstructing complete lip defects. Moreover, upper and lower lip necrosis by purpura fulminans has not been reported. We present a case of a 60-year-old male purpura fulminans patient with upper and lower lip necrosis. Fortunately, our patient had retained his oral commissure function. We reconstructed this defect with an orbicularis oris muscle-skin-mucosal pedicled flap derived from the region between the nasolabial folds for upper lip; a similar bipedicled flap for the lower lip and the donor site was closed with a dual-skin paddled anterolateral thigh flap. Postoperative results were satisfactory, that is, no lip tightness or aperture restriction was seen, and symmetry had been achieved. The new lips exhibited complete sensory recovery. Drooling was minimal during rest and feeding. We could select a method that combined the advantages of local and free flaps. We consider our method for this defect is superior to those described in previous studies, in that the restoration of lip sensation and oral sphincter function can be achieved to some extent in 1 stage while preserving the oral commissure function.

Two-Stage Prosthetic Breast Reconstruction after Mastectomy with or without Prior Postmastectomy Radiotherapy

imageBackground: Two-stage prosthetic breast reconstruction with initial insertion of a tissue expander followed by an implant after a period of inflation is a well-established breast reconstruction option. Most of the current literature concentrates on the immediate setting, and there are only a few reports into delayed cases, especially after postmastectomy radiotherapy (RT). We performed a retrospective review of our experience over a 12.5-year period. Methods: Between June 1998 and December 2010, a total of 671 patients received prosthetic-only breast reconstruction. Of these, 170 (25.3%) underwent delayed 2-stage prosthetic breast reconstruction after mastectomy for cancer. Patients were divided into group A, no postmastectomy RT (n = 150), and group B, postmastectomy RT (n = 20). The primary factor examined was the failure of the reconstruction from loss of prosthesis with or without smoking. Other complications, as well as rates of revisional surgery were also recorded. Results: Expander or implant loss occurred in 3 of 150 patients in group A (2.0%) and 3 of 20 patients in group B (15%; P = 0.02). For nonsmokers, implant loss was 1.6% and 5.6%, respectively (P = NS). Smoking was associated with 1 of the 3 losses in group A and 2 of the 3 in group B (smokers, n = 2; P

Diversity and Inclusion in Plastic Surgery Education: A National Survey by the American Council of Academic Plastic Surgeons

imageIntroduction: To date, there have been few studies in the field of plastic surgery examining the knowledge, attitudes, and behavior of educators and residents regarding diversity and inclusion, especially for the purposes of enhancing resident education, improving diversity efforts, and addressing health care disparities. Methods: An anonymous survey was provided electronically to a total of 462 American Council of Academic Plastic Surgeon members and 91 program coordinators (PCs), and 1,029 plastic surgery residents at 91 institutions across the United States. We analyzed the responses from PCs and program directors (PDs). Results: We collected responses from 34 institutions (37%), and 16.8% of American Council of Academic Plastic Surgeon members including 34 PCs and 44 PDs. We found that PDs were more likely to be male (86%) and above the age of 40 years (97%) compared with PCs (5% male and 61% above 40 years). Both groups were majority White. Fifty-nine percentage of PDs have a parent/guardian who attained a graduate degree versus 15% of PCs. Forty-eight percentage of PDs speak another language compared with 16% of PCs. More importantly, 95% of PDs had an opportunity to engage in diversity and inclusion-related activities in the last 6 months as compared with 43% of PCs; however, we did not find a statistical difference based on knowledge of increasing institutional capacity of diversity and inclusion between the 2 groups. PCs were more likely to witness discrimination (64%) than PDs (40%) in the health care setting, with body type/weight emerging as the most common type of discrimination. Very few respondents (10%) indicated they discriminated against others. Conclusions: Plastic surgery educators are committed to diversity and inclusion. Improvements can be made by incorporating PCs more frequently in activities related to the topic along with focused training on improving diversity on an institutional rather than individual level. Our study suggests body type/weight is the most common type of discrimination witnessed by the entire cohort and that diversity and inclusion remains a sensitive topic.

Comparative Effectiveness of Needle Aponeurotomy and Collagenase Injection for Dupuytren’s Contracture: A Multicenter Study

imageBackground: Although the efficacy of collagenase clostridium histolyticum (CCH) injections has been demonstrated by randomized clinical trials, the relative effectiveness of CCH remains uncertain. Our aim was to compare the outcomes of CCH with those of percutaneous needle aponeurotomy (PNA) in daily clinical practice. Methods: We analyzed data from patients undergoing PNA or CCH between 2011 and 2014 at 7 practice sites in the Netherlands. We examined the degree of improvement in contracture and adverse effects at 6–12 weeks after surgery or the last injection. Additionally, we invited patients to complete the Michigan Hand Questionnaire before and at 6–12 months follow-up. To minimize the risk of bias, we used propensity score matching. Results: Among 130 matched patients (93% Tubiana I or II) undergoing PNA (n = 46) and CCH (n = 84), improvement in contracture was similar: 26 degrees (65% improvement from baseline) for PNA versus 31 degrees (71%) for CCH for affected metacarpophalangeal joints (P = 0.163). This was 16 degrees (50% improvement) versus 17 degrees (42%) for affected proximal interphalangeal joints (P = 0.395), respectively. No serious adverse effects occurred in either of the 2 treatment groups. Of the mild adverse effects, only skin fissures and sensory disturbances were seen in both groups. Through 1-year follow-up, patients reported similar improvements in the overall Michigan Hand Questionnaire score (PNA 5.3 points versus CCH 4.9 points; P = 0.912). Conclusions: In patients with mild contractures (Tubiana I or II), CCH was as effective as PNA in reducing contractures. Both treatments were safe and improved hand function to a similar extent in daily practice.

Breast Reduction: Decreasing Complications and Improving Long-Term Aesthetic Results with Parenchymal Sutures

imageBackground: The inverted T/keyhole pattern is commonly used for large breast reductions. This technique relies on the breast skin to retain the shape. With the passage of time "fallout" (pseudoptosis) occurs impairing the cosmetic result. A technique is described that uses parenchymal sutures and inframammary fold (IMF) reinforcement sutures to maintain the intraoperative shape. Methods: A retrospective study of 25 consecutive patients (50 breasts) where the IMF was reinforced and parenchymal sutures were inserted. The patients were followed up and the nipple to notch and nipple to IMF distance was measured and compared with that marked preoperatively and set intraoperatively. Complications, especially T junction breakdown, were also recorded. Results: The mean age was 38 years (range, 16–62 years) with a mean follow-up of 12 months. The mean body mass index was 31 (range, 22–41). The mean mass of tissue excised was 925 g (range, 340–1,800 g) per side. The distance from the suprasternal notch to the nipple remained unchanged. The distance from the nipple to the IMF remained the same as that marked preoperatively except in 3 patients who developed pseudoptosis. Only 3 patients had wound dehiscence. Conclusion: Parenchymal and superficial fascial system sutures combined with IMF reinforcement contributes to maintaining the aesthetic result and decreasing complications, in weight stable patients.

Anatomical Study of Perfusion of a Periosteal Flap with a Lateral Pedicle

imageBackground: Pedicled periosteal flaps are commonly used for tissue defects between the base of the skull and the midfacial area. This study aimed to clarify the 3-dimensional vascular distribution of temporal region flaps. Methods: Ten fresh cadavers were used. Full-thickness cranial flaps were elevated from the cranial bone and each layer was detached separately. Contrast enhancement of the full thickness of the scalp, macroscopic evaluation, and histologic analyses were performed. Radiographs were obtained and image analysis was performed using a 3-dimensional monitor. Results: The mean number of deep vessels extending from the parietal branch of the superficial temporal artery was 68.7, including 14.2 and 54.5 vessels on the proximal and distal sides, respectively. The mean number of deep vessels extending from the frontal branch of the superficial temporal artery was 71.6, including 17.6 and 54.0 vessels on the proximal and distal sides, respectively. There were significantly more perforating branches in the distal area than in the proximal area of both the frontal and parietal branches (P = 0.005). There was no significant difference in the number of perforating branches between the frontal and parietal branches. Conclusions: Contrast-enhanced images of the loose areolar tissue and periosteal layers revealed vessels that extended radially. We successfully identified the 3-dimensional structure of the perforating vessels peripheral to the temporal fossa. Our findings provide a theoretical foundation for the feasibility of elevating a periosteal/loose areolar tissue flap with a reliable blood supply without sacrificing the temporal muscle.

Autoimmune Syndrome Induced by Adjuvants (ASIA) after Silicone Breast Augmentation Surgery

imageSummary: Generally, the main complications of silicone implantation are local symptoms. However, some patients develop late-onset systemic symptoms often associated with a rare form of hyperactive immune response, as part of a syndrome known as autoimmune syndrome induced by adjuvants (ASIA). Reported cases of ASIA have shown resolution with explantation, but not with immunomodulatory therapy. In this report, we described a case of a previously healthy 23-year-old woman, who has undergone silicone breast implant augmentation, for aesthetic reasons, and developed localized cutaneous impairment 3 years postsurgery. She received a diagnosis of ASIA with a new presentation: Lupus-like manifestation through localized cutaneous impairment. This patient's symptoms were managed without the need for surgical intervention, which has not been previously reported, because the patient did not want an explantation for aesthetic reasons. The patient was started on hydroxychloroquine, 400 mg per day, and remains asymptomatic after 2 years of treatment. The exact predisposition to ASIA is still unknown. Without implant explantation and with immunomodulatory treatment, this patient's condition substantially improved. Based on our current understanding of this disease, it might not be prudent to indicate breast augmentation with silicone implants in patients with documented autoimmune reaction to an adjuvant, an established autoimmune condition, or genetic predisposition. However, if a patient does develop silicone-induced ASIA, explantation is no longer the only successfully reported option, as these symptoms can be managed with immune suppression.

Corrected Cephalometric Analysis to Determine the Distance and Vector of Distraction Osteogenesis for Syndromic Craniosynostosis

imageBackground: The purpose of this study was to confirm the utility of a corrected cephalometric analysis to facilitate the planning of distraction osteogenesis with Le Fort III osteotomy for syndromic craniosynostosis. Methods: This prospective study involved 4 male and 2 female patients (mean patient age, 8 years 9 months; age range, 4 years 6 months to 13 years 2 months) with Crouzon syndrome who were treated with Le Fort III maxillary distraction using our previously described system of analysis of a corrected cephalogram and who underwent clinical follow-up. Lateral cephalograms were obtained immediately after device removal. Results: Distraction of orbitale moved the vector downward to the adult profile, but there was slightly less elongation than the adult profile for the distraction distance. The desired and real mean angles after distraction of point A were 29.2 ± 7.9° and 6.1 ± 8.5°, respectively, and the desired and the real mean distances after distraction of point A were 30.6 ± 12.7 mm and 29.4 ± 4.1 mm, respectively. Conclusions: Using the corrected cephalometric analysis, the distance and vector of distraction osteogenesis with Le Fort III osteotomy could be determined in patients with syndromic craniosynostosis. The distraction system brought the patients' facial bones to the planned position using controlling devices.

Scar Tissue Causing Saphenous Nerve Entrapment: Percutaneous Scar Release and Fat Grafting

imageSummary: Painful neuropathies can be caused by nerve compression or neuromas. Nerve compressions can arise from scar adhesions causing painful posttraumatic entrapment of nerve branches via fibrosis. The classical treatment methods include neurolysis and nerve transposition. In this case, we present the treatment of recurrent scar entrapment of the saphenous nerve with percutaneous neurolysis and lipofilling in a patient who had previously undergone an open neurolysis procedure. Resolution of the condition without any complications was noted during the 2-month clinical follow-up. Percutaneous neurolysis and lipofilling are shown to be safe and reproducible methods for the treatment of neuropathic compressive scars.

Evaluation of 4 Outcomes Measures in Microtia Treatment: Exposures, Infections, Aesthetics, and Psychosocial Ramifications

imageBackground: In craniofacial microsomia, microtia and canal atresia pose formidable reconstructive challenges. We review our institutional experience in treating microtia and atresia to identify variables associated with 4 outcomes measures: complications, surgical revisions, aesthetic outcomes, and psychosocial function. Methods: Craniofacial microsomia patients treated at the University of California Los Angeles Craniofacial Clinic between 2008 and 2014 greater than 13 years of age (n = 68) were reviewed for microtia and atresia treatment and outcomes. Results: In total, 91.2% of patients diagnosed with craniofacial microsomia presented with microtia, affecting 75 ears. Both a male and right-sided predominance were observed. Fifty-six patients (90.3%) underwent autologous external ear reconstruction at an average age of 8.5 years. Age, type of incision, and size of cartilage framework did not predict total number of surgeries or complications. Severity of ear anomalies correlated with increased number of surgeries (P

Successful Second Microsurgical Replantation for Amputated Penis

imageSummary: Penile amputation is a rare emergency, but the best method for its repair is required due to the organ's functional and societal role. Since the first successful microsurgical replantation of the amputated penis, microsurgical techniques have matured and become the standard treatment for the penile replantation. However, the successful second microsurgical replantation for amputated penis has been rarely reported. We present the case of a 40-year-old man with schizophrenia who had a past history of penile self-mutilation and successful replantation at another hospital 2 years ago. After stopping oral medication for schizophrenia, he again cut his penis with a kitchen knife. We successfully replanted the amputated penis by anastomosing both circumflex arteries, the superficial dorsal vein, and the deep dorsal vein using microsurgical techniques. Postoperatively, the foreskin of the replanted penis gradually developed partial necrosis, requiring surgical debridement. The aesthetic and functional results were satisfactory and retrograde urethrography showed no evidence of leakage and stricture of the urethra. Although skin necrosis after penile replantation has been reported as an unavoidable process owing to the nature of injury, the rate would be higher after secondary replantation because of scar formation due to the previous operation. Therefore, our case of successful secondary replantation suggests that skin necrosis would be a predictable postoperative complication and the debridement timing of the devitalized foreskin should be closely monitored, and also secondary amputation is not a contraindication of replantation.

PSTM 2017 Abstract Supplement

No abstract available

Validity, Reliability, and the Questionable Role of Psychometrics in Plastic Surgery

imageSummary: This report examines the meaning of validity and reliability and the role of psychometrics in plastic surgery. Study titles increasingly include the word "valid" to support the authors' claims. Studies by other investigators may be labeled "not validated." Validity simply refers to the ability of a device to measure what it intends to measure. Validity is not an intrinsic test property. It is a relative term most credibly assigned by the independent user. Similarly, the word "reliable" is subject to interpretation. In psychometrics, its meaning is synonymous with "reproducible." The definitions of valid and reliable are analogous to accuracy and precision. Reliability (both the reliability of the data and the consistency of measurements) is a prerequisite for validity. Outcome measures in plastic surgery are intended to be surveys, not tests. The role of psychometric modeling in plastic surgery is unclear, and this discipline introduces difficult jargon that can discourage investigators. Standard statistical tests suffice. The unambiguous term "reproducible" is preferred when discussing data consistency. Study design and methodology are essential considerations when assessing a study's validity.

Recall of Prenatal Counselling Among Obese and Overweight Women from a Canadian Population: A Population Based Study

Abstract

Objective The objective of this study was to evaluate the recall of prenatal counselling received among overweight and obese women in primary care settings. Methods A sample of 1996 women with singleton, term deliveries and pre-pregnancy BMI >18.5 kg/m2 were identified from the All Our Babies pregnancy cohort. Information on socio-demographic characteristics and women's experiences with prenatal counselling on nutrition, vitamin and mineral supplements, exercise, weight gain, employment, alcohol and drug use, and smoking during pregnancy were collected through questionnaires administered at <25 weeks and 34–36 weeks gestation. Multivariable logistic regression analyses explored the associations between pre-pregnancy BMI and the domains of prenatal counselling, controlling for confounders. Results Women reported high levels of comfort asking questions and satisfaction with their health care provider. Women reported getting information about nutrition (69.3%), weight gain (67.8%), exercise (64.4%), vitamins and minerals supplementation (86.1%). Obese women (211, 10.6%) were more likely than normal weight women (1313, 65.8%) to be Caucasian (p = 0.004), less educated (p = 0.001), and to have been born or lived in Canada for at least 5 years (p = 0.01). There was no difference in the prenatal advice received on nutrition, weight gain and exercise in pregnancy between obese, overweight, and normal weight women. Conclusions for Practice Pre-pregnancy BMI did not appear to influence the recall of prenatal counselling women receive in community health care centers. Given the importance of nutrition and weight gain during pregnancy, and guidelines for weight gain based on pre-pregnancy BMI, there are missed opportunities in knowledge exchange between women and providers in the prenatal period.



The State of Essential Newborn Care by Delivery Location in Bangladesh

Abstract

Introduction Essential newborn care (ENC) around the time of birth is critical in improving neonatal survival. There is currently a gap in our knowledge of the use of ENC by place of delivery in Bangladesh. This study assesses the provision of ENC and examines the odds of newborns receiving ENC by different levels of delivery care in Bangladesh. Methods Descriptive statistics and logistic regressions were performed on ENC practices from the 2011 Bangladesh Demographic and Health Survey dataset. ENC practices included nonapplication of substances to the cord; application of antiseptic to the cord; drying newborn within 5 min; wrapping newborn within 5 min; delaying first bath until the first 72 h; and breastfeeding within 1 h. Key predictors included home delivery with a lay attendant, delivery with primary healthcare services and delivery with higher-level healthcare services. Results Coverage of ENC practices was low. Women who delivered with primary and higher-level healthcare services generally reported greater odds of their newborns receiving recommended ENC than women who had home delivery with a lay attendant, the referent category. However, the odds of delayed first bath until 72 h and breastfeeding within 1 h were not statistically different for newborns who were delivered with primary healthcare services. Discussion These findings have significant public health implications as primary healthcare facilities are the first point of entry into the healthcare system. Provision of ENC, particularly delayed first bath until 72 h and breastfeeding within 1 h, should be encouraged for all healthy mother-newborn pairs in Bangladesh.



The Impact of Sex of Child on Breastfeeding in the United States

Abstract

Background Sex of child has been shown to impact breastfeeding duration in India, Australia, Scandinavia, Latin America, and, within the US, in a sample in Eastern Connecticut and in a separate sample of Indian and Chinese immigrants. Objectives The objective of this study is to examine differences in breastfeeding initiation and duration by sex of child across racial/ethnic groups in the US. Methods We used the Pregnancy Risk Assessment Monitoring System 2009–2010 and logistic regression to examine whether sex of child impacts breastfeeding initiation and duration for at least 8 weeks by women's racial/ethnic group. Results Among the 66,107 women in our sample representing 12 different race/ethnic groups, Hispanic women (n = 9049) had lower odds of breastfeeding initiation (adjusted odds ratio [AOR] = 0.81, 95% CI 0.71–0.93) and breastfeeding duration (AOR = .87, 95% CI 0.80–0.96) if they have sons compared to Hispanic women who have daughters. Sex of child did not impact the odds of breastfeeding initiation or duration among any other race/ethnic group. Conclusion We have shown that, for Hispanics in the US, sex of child may have an impact on breastfeeding, a health behavior that has a variety of positive impacts on infants throughout their lives. Boys, relative to girls, were at a disadvantage in breastfeeding initiation and duration. Future work is necessary to unpack the mechanisms behind these findings. In particular, how sex of child impacts how mothers and fathers view the nutritional needs of their children and breastfeeding more broadly.



Exercise to Support Indigenous Pregnant Women to Stop Smoking: Acceptability to Māori

Abstract

Objectives Smoking during pregnancy is harmful for the woman and the unborn child, and the harms raise risks for the child going forward. Indigenous women often have higher rates of smoking prevalence than non-indigenous. Exercise has been proposed as a strategy to help pregnant smokers to quit. Māori (New Zealand Indigenous) women have high rates of physical activity suggesting that an exercise programme to aid quitting could be an attractive initiative. This study explored attitudes towards an exercise programme to aid smoking cessation for Māori pregnant women. Methods Focus groups with Māori pregnant women, and key stakeholder interviews were conducted. Results Overall, participants were supportive of the idea of a physical activity programme for pregnant Māori smokers to aid smoking cessation. The principal, over-arching finding, consistent across all participants, was the critical need for a Kaupapa Māori approach (designed and run by Māori, for Māori people) for successful programme delivery, whereby Māori cultural values are respected and infused throughout all aspects of the programme. A number of practical and environmental barriers to attendance were raised including: cost, the timing of the programme, accessibility, transport, and childcare considerations. Conclusions A feasibility study is needed to design an intervention following the suggestions presented in this paper with effort given to minimising the negative impact of barriers to attendance.



Early Preterm Birth Across Generations Among Whites and African-Americans: A Population-Based Study

Abstract

Objectives To determine the extent to which non-Latina White and African-American mother's gestational age is associated with extremely early (<30 weeks), modestly early (30–33 weeks), and late (34–36 weeks) infant preterm birth (PTB) rates. Methods Race-specific stratified and multivariable logistic regression analyses were performed on the Illinois Transgenerational Birth File of non-Latino White and African-American infants (born 1989–1991) and their mothers (born 1956–1976). Results White mothers (n = 184) born at <30 weeks had a greater extremely early infant PTB rate than White mothers (n = 131,980) born at term: 1.6 versus 0.5%, respectively; RR = 3.6 (1.2, 11.0). African-American mothers (n = 269) born at <30 weeks had a greater extremely early infant PTB rate than African-American mothers (n = 34,885) born at term: 4.1 versus 2.1%, respectively; RR = 2.0 (1.1, 3.6). In logistic regression models the adjusted (controlling for maternal age, education, parity, prenatal care, marital status, and cigarette smoking) OR of extremely early PTB for White and African-American mothers born <30 (compared to ≥37) weeks equaled 4.0 (1.2, 12.6) and 2.3 (1.2, 4.3), respectively. The adjusted OR of modestly early PTB for White and African-American mothers born 30–33 (compared to ≥37) weeks equaled 1.6 (1.0, 2.5) and 1.3 (0.9, 1.7), respectively. The adjusted OR of late PTB for White and African-American mothers born 34–36 (compared to ≥37) weeks equaled 1.2 (1.0, 1.3) and 1.1 (1.0, 1.2), respectively. Conclusions A generational association of extremely early, but not modestly early or late, PTB exists among non-Latino Whites and African-Americans.



Emergency Contraception in Mexico: Trends in Knowledge and Ever-Use 2006–2014

Abstract

Objectives A package of interventions to introduce emergency contraception (EC) to Mexico was implemented, resulting in the addition of EC to the national family planning guidelines in 2004. We describe EC knowledge and use among women in Mexico over time. Methods We used the 2006, 2009, and 2014 of waves of a nationally representative demographic survey (ENADID). We assessed EC knowledge and usage in women ages 15–29 who are not using permanent methods and tested whether EC knowledge and use is changing over time after controlling for socio-demographic characteristics using logistic regression. Results Our sample included n = 99,223 (population N = 40,234,355) women ages 15–29. Overall, knowledge of EC increased over time: 62% in 2006 to 79% in 2009 to 83% in 2014 (p < 0.001). Among young women who have used contraception (n = 42,883; N = 16,816,701), the proportion that reported EC use increased from 3 to 11% to 29% (p < 0.001). Compared to non-users, women who had ever used EC were more likely to be using no method of contraception (44 vs. 35%) or barrier method (22 vs. 17%). Demographic factors including lower wealth, lower education, indigenous status and rural living are significantly associated with less EC knowledge and use. Stratified multivariate analysis found that demographic disadvantages magnify lower EC use among rural residents compared to non-rural residents. Conclusions for Practice Knowledge and use of EC are growing rapidly in Mexico, but disparities persist in demographically disadvantaged women, particularly those living in rural areas. Women who use EC appear to be at higher risk of unintended pregnancy based on current contraceptive use.



An Evaluation of the Addition of Critical Congenital Heart Defect Screening in Georgia Newborn Screening Procedures

Abstract

Objectives Each year in the U.S., approximately 7200 infants are born with a critical congenital heart defect (CCHD). The Georgia Department of Public Health (DPH) mandated routine screening for CCHD starting January 2015. The current study evaluated hospital performance of the mandated CCHD screenings in Georgia. Methods Utilizing the DPH newborn screening surveillance system, data from 6 months before and after the mandate were analyzed for reports submitted and positive CCHD screening results. Chi square tests of independence were performed to examine the association between reporting of results for CCHD screening after the mandate and hospital nursery level [level I (well-baby/newborn); level II (special care); level III (neonatal intensive care unit—NICU)] and NICU submissions. Results In the 6 months following implementation, reports of the screening increased, but the DPH had not received information for approximately 40% of newborns. Hospitals with level III nurseries had poorer reporting rates compared to hospitals with level I or II nurseries. Newborn screening (NBS) cards submitted by NICUs were less likely to contain the CCHD screening results compared to cards submitted by regular Labor and Delivery units. Conclusions for Practice Further attention should focus on improving both CCHD screening and reporting of screening results within hospitals with level III nurseries and from NICUs at all hospital levels. Identifying and addressing the root of the issue, whether it be hospital compliance with CCHD screening or reporting of the results, will help to improve screening rates for all newborns, especially those most vulnerable.



Maternal Education Gradients in Infant Health in Four South American Countries

Abstract

Objective We investigate gradients (i.e. differences) in infant health outcomes by maternal education in Argentina, Brazil, Chile, and Venezuela and explore channels related to father's education, household labor outcomes, and maternal health, fertility, and use of prenatal services and technology. Methods We employ secondary interview and birth record data similarly collected across a network of birth hospitals from the early 1980s through 2011 within the Latin American Collaborative Study of Congenital Anomalies (ECLAMC). Focusing on children without birth defects, we estimate gradients in several infant health outcomes including birth weight, gestational age, and hospital discharge status by maternal education using ordinary least squares regression models adjusting for several demographic factors. To explore channels, we add as covariates father's education, parental occupational activity, maternal health and fertility history, and use of prenatal services and technology and evaluate changes in the coefficient of maternal education. We use the same models for each country sample. Results We find important differences in gradients across countries. We find evidence for educational gradients in preterm birth in three countries but weaker evidence for gradients in fetal growth. The extent to which observed household and maternal factors explain these gradients based on changes in the regression coefficient of maternal education when controlling for these factors as covariates also varies between countries. In contrast, we generally find evidence across all countries that higher maternal education is associated with increased use of prenatal care services and technology. Conclusions Our findings suggest that differences in infant health by maternal education and their underlying mechanisms vary and are not necessarily generalizable across countries. However, the positive association between maternal education and use of prenatal services and technology is more consistent across examined countries.



Improving Safe Sleep Modeling in the Hospital through Policy Implementation

Abstract

Introduction Sleep-related infant deaths are major contributors to Tennessee's high infant mortality rate. The purpose of this initiative was to evaluate the impact of policy-based efforts to improve modeling of safe sleep practices by health care providers in hospital settings across Tennessee. Methods Safe sleep policies were developed and implemented at 71 hospitals in Tennessee. Policies, at minimum, were required to address staff training on the American Academy of Pediatrics' safe sleep recommendations, correct modeling of infant safe sleep practices, and parent education. Hospital data on process measures related to training and results of crib audits were compiled for analysis. Results The overall observance of infants who were found with any risk factors for unsafe sleep decreased 45.6% (p ≤ 0.001) from the first crib audit to the last crib audit. Significant decreases were noted for specific risk factors, including infants found asleep not on their back, with a toy or object in the crib, and not sleeping in a crib. Significant improvements were observed at hospitals where printed materials or video were utilized for training staff compared to face-to-face training. Discussion Statewide implementation of the hospital policy intervention resulted in significant reductions in infants found in unsafe sleep situations. The most common risk factors for sleep-related infant deaths can be modeled in hospitals. This effort has the potential to reduce sleep-related infant deaths and ultimately infant mortality.



Association of the Familial Coexistence of Child Stunting and Maternal Overweight with Indigenous Women in Guatemala

Abstract

Objectives This study investigated the association of the familial coexistence of child stunting and maternal overweight with indigenous women in Guatemala. Methods We selected 2388 child–mother pairs from the data set of the Living Standards Measurement Study conducted in Guatemala in 2000. This study examined the association between maternal and household characteristics and the nutritional status of children aged 6–60 months and mothers aged 18–49 years by using multivariable logistic regression models. Results Compared with non-indigenous households, a significantly higher percentage of indigenous households exhibited stunted child and overweight mother (SCOM) pairs (15.9 vs. 22.2%). Compared with normal-weight mothers, overweight mothers were less likely to have stunted children [adjusted odds ratio (AOR) 0.66, 95% confidence interval (CI) 0.50–0.88]. However, compared with mothers who were not short and overweight, short and overweight mothers were significantly more likely to have stunted children (AOR 1.80, 95% CI 1.19–2.73) and were more likely to be indigenous women living in urban areas (AOR 3.01, 95% CI 1.19–7.60) or rural areas (AOR 3.02, 95% CI 1.28–7.14). The order of observed prevalence of SCOM pairs in different types of households was as follows: urban indigenous (25.0%), rural indigenous (21.2%), rural non-indigenous (19.8%), and urban non-indigenous households (10.7%). Conclusions for Practice Urban indigenous households were more likely to have SCOM pairs. This study provided useful information for identifying the most vulnerable groups and areas with a high prevalence of the familial coexistence of child stunting and maternal overweight.



Parental and Child Factors Associated with Under-Estimation of Children with Excess Weight in Spain

Abstract

Objective Understanding obesity misperception and associated factors can improve strategies to increase obesity identification and intervention. We investigate underestimation of child excess weight with a broader perspective, incorporating perceptions, views, and psychosocial aspects associated with obesity. Methods This study used cross-sectional data from the Spanish National Health Survey in 2011–2012 for children aged 2–14 years who are overweight or obese. Percentages of parental misperceived excess weight were calculated. Crude and adjusted analyses were performed for both child and parental factors analyzing associations with underestimation. Results Two–five year olds have the highest prevalence of misperceived overweight or obesity around 90%. In the 10–14 year old age group approximately 63% of overweight teens were misperceived as normal weight and 35.7 and 40% of obese males and females. Child gender did not affect underestimation, whereas a younger age did. Aspects of child social and mental health were associated with under-estimation, as was short sleep duration. Exercise, weekend TV and videogames, and food habits had no effect on underestimation. Fathers were more likely to misperceive their child´s weight status; however parent's age had no effect. Smokers and parents with excess weight were less likely to misperceive their child´s weight status. Parents being on a diet also decreased odds of underestimation. Conclusions for practice This study identifies some characteristics of both parents and children which are associated with under-estimation of child excess weight. These characteristics can be used for consideration in primary care, prevention strategies and for further research.



Percutaneous Mesh Expansion (PME): A Regenerative Wound Closure Alternative.

BACKGROUND: Puncture wounds in the 1-mm range usually heal without scars. Stacking rows of these punctures offers a scarless method to generate tissue by mesh expansion. We developed a percutaneous mesh expansion (PME) procedure and present our experience for its wound closure application. METHODS: Over a six-year period we applied PME to 65 consecutive patients 58-101 years-old (mean, 72) with 67 full thickness calvarial defects 2.5x3-7x8cm (mean, 14cm2) that would have all required flaps for closure. Thirty-six were still anticoagulated, and 20 had prior scalp resections. After tumescent epinephrine anesthesia, we temporarily approximate the wound by placing it under strong tension. Using 1.1-mm cutting point needles that selectively sever tissues under tension, we inflict rows of staggered alternating punctures over a distance 5X the defect width. This results in 20% expansion of the meshed area, generating the tissue necessary for defect coverage. When the tension is completely released, closure is done with simple sutures or staples. We avoid over-meshing, especially close to the wound edges and performed no undermining or additional incisions. RESULTS: At 6 weeks follow up, all defects were healed with only a straight resection scar. However, of the 10 defects >5x5 cm, five had wound healing delay and three required a small skin graft. No other complication was observed. CONCLUSION: PME is a minimally invasive procedure that harnesses the body's natural capabilities to regenerate across small gaps. It sums these regenerated gaps in a mesh pattern that expands tissues to close complex wounds without flaps or additional incisions. (C)2017American Society of Plastic Surgeons

Minimally Invasive, spring-assisted correction of sagittal suture synostosis. Technique, outcome and complications in 83 cases.

Background: This series describes the results of minimally invasive strip craniotomy with additional spring distraction. Methods: Included are the first 83 consecutive patients who underwent this procedure (Jan 1, 2010-Jan 1, 2014). Outcome parameters were collected prospectively and included surgical parameters and complications, the occurrence of papilledema, skull growth, cephalic index and photographic scores Results: Duration of surgery was 63 min: 19% required blood transfusion and complications were minor. Postoperative papilledema occurred in two patients (2.4 %). Head growth increased after insertion of the springs and declined afterwards to 0.7 SD, comparable to earlier cohorts in our center. Cephalic index increased from 67 before surgery to 74 post-surgery and showed a small decrease during the 4-year follow-up. Photographic scores confirmed the initial improvement and showed a trend to further improvement during follow-up. Conclusions: In this cohort, spring-assisted, minimally invasive strip craniotomy was safe and effective. Results were similar to those from other techniques, but with smaller incisions, shorter interventions, reduced blood loss, and a lower incidence of postoperative papilledema. (C)2017American Society of Plastic Surgeons

The fate of the adipose-derived stromal cells during angiogenesis and adipogenesis after cell-assisted lipotransfer.

Background: Cell-assisted lipotransfer (CAL) is a process in which fat grafting is supplemented with autologous adipose-derived stromal cells (ASCs). Since the efficacy of the technique was demonstrated, studies have focused on the mechanism by which CAL enhances the rate of graft survival. However, the microenvironmental changes in donor and recipient tissue associated with CAL remain unclear. Methods: We introduced an animal model of CAL using two different transgenic reporter mice. Donor fat from GFP-expressing C57BL/6J mice and donor ASCs from DsRed-expressing C57BL/6J mice were co-transplanted into recipient C57BL/6J mice. During adipose remodeling after CAL, the fate of each donor adipocyte and donor ASC was traced using immunofluorescent staining with the whole-mount method. Results: ASC supplementation altered inflammation and promoted angiogenesis and subsequent revascularization in recipient tissue. Tracing at postoperative week 4 revealed that survived donor ASCs participated in angiogenesis by differentiating into endothelial cells. Moreover, newly differentiated fat from donor ASCs and recipient tissue integrated with survived donor fat, leading to improved retention of the graft. ASC supplementation resulted in a quantitative difference in angiogenesis and adipogenesis during adipose remodeling according to the concentration of ASCs. Conclusions: We characterized the dynamic changes occurring in donor ASCs and fat as well as recipient tissue by tracing these cellular components following CAL. Our findings highlight the therapeutic value of CAL in tissue transplantation. (C)2017American Society of Plastic Surgeons

A Comparison of Functional Outcomes and Therapeutic Costs: Single Digit Replantation versus Revision Amputation.

Background: The functional outcomes and therapeutic costs between digit replantation and revision amputation has remained controversial. Methods: Total 1023 patients with single digit traumatic amputation or devascularization who received successful digit replantation (failure excluded) or revision amputation from 1 January 2013 to 1 January 2016 were included in this study. All cases were subgrouped based on Tamai level of amputation and injured fingers. The Clinical outcomes were assessed by Michigan hand outcomes questionnaire (MHQ) one year after the initial surgery. We also compared the cost of treatment, the duration of hospitalization and sick leave between the two treatments. Results: Replantation of small (level I - V), ring (level I - III) and long (level I) fingers showed no functional benefit compared with initial revision amputation. In contrast, replantation of thumb (level I-V), index (I-V), long (II-V) and ring (IV-V) fingers had better outcomes. The cost of replantation was higher and the duration of hospitalization and sick leave of replantation were also longer compared with revision amputation group. Conclusions: Single amputated injuries of small (level I - V), ring (level I - III) and long (level I) fingers are a relative contradiction for replantation. Replantation of thumb (level I-V), index (I-V), long (II-V) and ring (IV-V) fingers showed extra benefit compared with revision amputation. (C)2017American Society of Plastic Surgeons

Early Macrophage Infiltration Improves the Fat Graft Survival by Inducing Angiogenesis and Hematopoietic Stem Cell Recruitment.

Background: Fat grafting is a popular soft tissue filler method; however, its results are variable and technique-dependent. Macrophages are present in fat grafts and closely associated with tissue regeneration. We hypothesized that activation/depletion of early macrophages in transferred fat improves/impairs fat graft survival. Methods: Mouse inguinal fat (~150 mg) was transferred autologously. Fat grafting was first performed without other manipulations to obtain baseline information. Then, liposome-encapsulated clodronate and macrophage-colony stimulating factor were used in a mouse fat grafting model for local macrophage depletion or activation. We examined the graft stromal vascular fraction (SVF) by fluorescence-activated cell sorting (FACS) at 1, 2, 4, and 12 weeks post-transplantation in manipulation/control groups. Graft weight, vascularization, and secreted factors were also compared. Results: FACS of graft SVF cells demonstrated that at 1 week post-transplantation 24+/-3% of cells were macrophages with high TNF-[alpha] expression. At 4 weeks post-transplantation, massive angiogenesis (p=0.014, vs. Week 1) was observed in the grafts, and 33+/-6% of SVF cells were macrophages with high TGF-[beta] expression. Early depletion of macrophages resulted in incompetent angiogenesis, feeble Sca-1+/CD45+ stem cell recruitment, and eventually a poor retention rate (34+/-6 mg vs. control 84+/-15 mg, p=0.006), whereas up-regulated macrophages allowed better angiogenesis and survival (117+/-12 mg vs. control 84+/-15 mg, p=0.043). Conclusions: In fat grafting, macrophages and their polarization initiated changes in the levels of dominant secreted factors and influenced blood-derived stem cell infiltration, indicating that macrophages were crucial for tissue revascularization. The macrophage manipulation models described here show that graft macrophage number can profoundly influence graft survival. (C)2017American Society of Plastic Surgeons

Appropriateness of the Use of MRI in the Diagnosis and Treatment of Wrist Ligamentous Injury.

Background: When diagnosing wrist ligamentous injury, we hypothesize that MRI is used injudiciously and is associated with unnecessary cost. Methods: A retrospective review was conducted of patients, ages 20-60 years, who underwent an MRI for possible wrist ligamentous injury at a tertiary care center between 2009 and 2014. Treatment recommendation was classified as non-operative, operative, or equivocal. If the MRI-directed treatment recommendation differed from the pre-MRI treatment recommendation, we noted that the MRI influenced patient care (impact study). The cost estimate of an impact study was calculated by dividing the total studies performed by the number of studies that impacted the treatment recommendation and multiplying this value by the institutional wrist MRI cost (USD $2,246, 2016). Results: 140 patients were included. MRI affected treatment recommendation in 28% of patients. Independent predictors of MRI impact on treatment recommendation were: "question specific injury," or "question scapholunate injury." (OR 9.46 (3.18 - 28.16), P

"Anterior skull base and pericranial flap ossification after frontofacial monobloc advancement".

Background: Frontofacial monobloc advancement (FFMBA) creates a communication between the anterior cranial fossa and nasal cavities. To tackle this issue, trans-orbital pericranial pedicled flaps (PF) are routinely performed in our center. This study aimed to assess the post-operative ossification of the anterior skull base and PF following FFMBA, and to identify factors influencing this ossification. Methods: Measurements of the skull base only (SB) and of the ossified PF together with the SB (SB-OPF) were performed on CT scans at the naso-frontal (NF) and the naso-ethmoido-frontal (NEF) junctions. The total thickness of the skull vault was measured and a qualitative defect score for the anterior skull base was computed. Results: Twenty-two patients who underwent FFMBA at a median age of 3.1 years (1.9 - 3.6) were included: 14 with Crouzon (CS), 5 with Pfeiffer (PS) and 3 with Apert syndrome (AS). One year and five years after surgery, the distraction gap was completely ossified in the anterior skull base midline in all patients. SB-OPF was thicker in patients than in controls at these two time points (p

"Important Details in Performing and Interpreting the Scratch Collapse Test".

The utility of the Scratch Collapse Test (SCT) has been demonstrated in examination of patients with carpal and cubital tunnel syndromes and long thoracic and peroneal nerve compressions. In our clinic, this lesser known test plays a key role in peripheral nerve examination where localization of the nerve irritation or injury is not fully understood. Test utility and accuracy in patients with more challenging presentations likely correlates with tester understanding and experience. This paper offers a clear outline of all stages of the test in order to improve inter-rater reliability. The nuances of test performance are described, including a description of situations where the SCT is deemed inappropriate. Four clinical scenarios where SCT may be useful are included. Corresponding video content is provided to improve performance and interpretation of SCT. (C)2017American Society of Plastic Surgeons

Early Postoperative Fever in Pediatric Patients undergoing Cochlear Implant Surgery

Abstract

Early Post-Operative Fever after cochlear Implant surgery is not uncommon.

We assessed all pediatric patients undergoing cochlear implants and addressed the patients with post-operative fever.

A hundred and thirty surgeries were performed; of all patients 25 developed early postoperative fever.

The workup did not identify the cause of fever in any of the patients. Fever resolved without any additional Intervention.

There was no difference in fever or infection rate in patients that received prophylactic antibiotic, whether prolonged (one week) versus or only perioperative treatment (one day).

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Barbed Expansion Sphincter Pharyngoplasty for the Treatment of Oropharyngeal Collapse in OSAS: a Retrospective Study on 17 patients

Abstract

Expansion Sphincter Pharyngoplasty (ESP) was introduced in 2007 and represents a promising surgical technique to treat patients with oropharyngeal walls collapse with reduced morbidity and high success rates.

Between December 2012 and January 2015 17 patients underwent ESP at the department of Otorhinolaryngology of the University of Brescia (Italy), using barbed knotless sutures to improve the biomechanical effect of sutures on tissue collapse (BESP).

Patients with moderate to severe OSAS and BMI < 30 kg/m2, who did not tolerate or refused ventilation therapy, were selected for BESP based on the presence of oropharyngeal collapse, as determined by upper airway examination and drug-induced sleep endoscopy.

Overall success of BESP was 94,1%. Postoperative oxygen desaturation index (ODI) showed significant improvement (P<0.01). Likewise, Epworth Sleepiness Scale score was significantly reduced (P<0.05). No patient complained of uncontrolled pain after the procedure and/or reported unsatisfactory analgesia at follow-up visits.

Albeit limited by the sample size and duration of follow-up, our experience confirms the validity of BESP in this selected patient population.

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The Triangular rotation advancement flap for congenital longitudinal earlobe cleft

Abstract

The Earlobe is an essential part of the facial aesthetics. Almost all cultures of the world use the earlobe for improving their appearances. Deformities or absence of the earlobe is a cause of distress to many individuals.

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Unique profile of antimicrobial peptides expression in polymorphic light eruption lesions compared to healthy skin, atopic dermatitis, and psoriasis

Abstract

Background

Polymorphic light eruption (PLE) has been attributed to type IV, most likely delayed-type hypersensitivity response (adaptive immunity) but little is known on innate immunity, especially antimicrobial peptides (AMPs) in the disease. Abnormalities in AMP expression have been linked to pathological skin conditions such as atopic dermatitis (AD) and psoriasis.

Methods: AMP profiling was done in PLE skin samples (n,12) compared with that of healthy (n,13), atopic (n,6) and psoriatic skin (n,6).

Results

Compared to healthy skin, we observed increased expression of psoriasin and RNAse7 (both mostly in stratum corneum and granulosum of the epidermis), HBD-2 (in the cellular infiltrate of the dermis), and LL37 (mostly in and around blood vessels and glands) in PLE lesional skin, a similar expression profile as present in psoriatic skin and different to that of AD (with little or no expression of psoriasin, RNAse7, HBD-2 and LL37). HBD-3 was downregulated in PLE compared to its high expression in the epidermis and dermis of healthy skin, AD and psoriasis.

Conclusion

The unique profile of differentially expressed AMPs in PLE implies a role in the pathophysiology of the disease, possibly directly or indirectly linked to the microbiome of the skin.

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Tea Polyphenols for the Prevention of UVB-induced Skin Cancer

Abstract

Skin cancer is the most common type of cancer with increasing incidence rate and public health burden. Solar Ultraviolet (UV) radiation causes an array of damaging cellular and molecular events that eventually lead to the development of skin cancer. Despite increased awareness about sun protection, the exposure rate remains high with less than 15% of men and 30% of women using sunscreen on a regular basis. Therefore, there is an imperative need for the development of novel preventive approaches. Skin cancer chemoprevention using phytochemicals either as dietary supplements or by topical applications has gained considerable attention due to their low toxicity, availability, and anti-carcinogenic properties. Tea, the second most commonly consumed beverage in the world, is a rich source of promising phytochemicals known as polyphenols. In this review, we discuss the findings of various in vitro, in vivo and human studies signifying the chemopreventive effects of tea polyphenols against UVB-induced skin cancer. This is accomplished by exploring the role of tea polyphenols in DNA repair, inflammation, oxidative stress, signaling pathways, and epigenetics. Finally, this review discusses a variety of innovative delivery methods that enhance the photochemopreventive effects of tea polyphenols against skin cancer.

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Effect of MRI on breast tissue expanders and recommendations for safe use

Publication date: Available online 15 October 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Andrew A. Marano, Peter W. Henderson, Martin R. Prince, Stephen M. Dashnaw, Christine H. Rohde
IntroductionFerromagnetic port-containing breast tissue expanders are currently labeled MRI-unsafe because of the presumption that magnets should not enter the machine. However, designating these devices as MRI-unsafe can lead to unnecessary procedures or suboptimal imaging choices. This study provides an ex vivo analysis of how breast tissue expanders behave when subjected to strong magnetic fields to determine which variables might affect clinical risk.MethodsThree different brands of tissue expanders were evaluated in three MRI environments. Translational force was determined using the deflection angle method. Torque on empty, saline-filled, and air-filled expanders was evaluated on a 0–4 scale. Magnetic field was measured using a gaussmeter. The weight required to prevent displacement of the expanders was determined for both air- and saline-filled expanders. Temperature over time was measured using an alcohol thermometer.ResultsMagnetic field strength, deflection angle, and torque were the greatest in 3T MRI environments and varied by device manufacturer (Sientra > Mentor > Allergan). Saline-filled expanders required 240 mL and air-filled required 360 mL volume to make the torque undetectable, and the effect of torque could be mitigated with prone positioning. A weight of 120 g was required to prevent displacement of a saline-filled tissue expander and 870 g for an empty expander. There were no appreciable changes in temperature.ConclusionsPreviously described risks may be reduced by using a 1.5T MRI, device selection, filling expanders with saline, and prone positioning. MRI can be considered in patients with breast tissue expanders when appropriate peri-procedural choices have been made so that the benefits of undergoing MRI outweigh the risks.



Zygomatico-orbital artery: the largest artery in the temporal area

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Publication date: Available online 16 October 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Dong Hun Choi, Jeung Ryeol Eom, Jeong Woo Lee, Jung Dug Yang, Ho Yun Chung, Byung Chae Cho, Kang Young Choi
The zygomatico-orbital artery is the largest artery in the temporal area. With the increasing number of reconstructive and aesthetic surgeries in the area, in-depth understanding of this artery is needed. Thus, the aim of this anatomical study was to determine more information on the zygomatico-orbital artery using contrast-enhanced three-dimensional computer tomography (CT) and color-flow Doppler sonography. Based on CT images taken between October 2015 and October 2016 for diagnosing and treating maxillofacial conditions, 50 patients were selected. We examined the patients' morphological classification; anatomical information of the artery, such as the bifurcation points and main course; diameter, depth, and overall length of the artery; and its association with the facial nerve. Doppler sonography was used to determine the presence of a concomitant vein. The zygomatico-orbital artery was classified into three types based on its bifurcation and relationship with other arteries. The artery bifurcates from the external carotid artery, rises sharply, and crosses the zygomatic arch anterior to the porion. Subsequently, it runs toward the lateral canthus horizontally and transfers to the palpebral and superficial orbital arteries. The mean diameter was 2.52 mm, and the mean depth was 5.61 mm. The average length was 8.50 cm. The artery overlapped with the temporal branch of the facial nerve 1-3 cm posterior to the lateral canthus. No concomitant vein was found. This study provides information on the zygomatico-orbital artery that may be useful in various clinical settings and in the prevention of procedural complications.



Understanding Evolutionary Impacts of Seasonality: An Introduction to the Symposium

Abstract
Seasonality is a critically important aspect of environmental variability, and strongly shapes all aspects of life for organisms living in highly seasonal environments. Seasonality has played a key role in generating biodiversity, and has driven the evolution of extreme physiological adaptations and behaviors such as migration and hibernation. Fluctuating selection pressures on survival and fecundity between summer and winter provide a complex selective landscape, which can be met by a combination of three outcomes of adaptive evolution: genetic polymorphism, phenotypic plasticity, and bet-hedging. Here, we have identified four important research questions with the goal of advancing our understanding of evolutionary impacts of seasonality. First, we ask how characteristics of environments and species will determine which adaptive response occurs. Relevant characteristics include costs and limits of plasticity, predictability, and reliability of cues, and grain of environmental variation relative to generation time. A second important question is how phenological shifts will amplify or ameliorate selection on physiological hardiness. Shifts in phenology can preserve the thermal niche despite shifts in climate, but may fail to completely conserve the niche or may even expose life stages to conditions that cause mortality. Considering distinct environmental sensitivities of life history stages will be key to refining models that forecast susceptibility to climate change. Third, we must identify critical physiological phenotypes that underlie seasonal adaptation and work toward understanding the genetic architectures of these responses. These architectures are key for predicting evolutionary responses. Pleiotropic genes that regulate multiple responses to changing seasons may facilitate coordination among functionally related traits, or conversely may constrain the expression of optimal phenotypes. Finally, we must advance our understanding of how changes in seasonal fluctuations are impacting ecological interaction networks. We should move beyond simple dyadic interactions, such as predator prey dynamics, and understand how these interactions scale up to affect ecological interaction networks. As global climate change alters many aspects of seasonal variability, including extreme events and changes in mean conditions, organisms must respond appropriately or go extinct. The outcome of adaptation to seasonality will determine responses to climate change.

Life History Adaptations to Seasonality

Abstract
Seasonality creates a template for many natural processes and evolutionary adaptations. Organisms are often faced with an annual cycle consisting of a productive (favorable) and unproductive period. This yearly cycle along with other seasonal variations in abiotic factors and associated biotic interactions form strong selection pressures shaping the scheduling of annual activities and the developmental stages and modes of life through the year. Annual decisions impact trade-offs that involve both current and future reproductive value (RV), and life history theory provides the foundation to understand these linkages between phenology and an organism's full life. Annual routine models further allow for multiple annual decisions to be optimized and predicted with respect to lifetime consequences. Studies of life history adaptations to seasonality are concerned with questions such as: within the productive season, should growth come first, followed by reproduction, or the other way around? What is the best time to diapause or migrate, and how will this timing impact other life history traits? Should energy reserves be built, to transfer resources from 1 year to the next, and allow for the spatial and temporal freedom of capital breeding? If offspring value is low during parts of the productive season, what is then the best alternative to reproduction: accumulate stores, grow, or wait in safety? To help answer these and other questions, I provide an overview of key theoretical concepts and some of the main life schedules, annual routines, and trade-offs involved. Adaptations to the unproductive period include diapause (dormancy), embryonic resting stages (eggs, seeds), energy reserves, and seasonal migrations. Adaptations to the productive window include rapid growth, high reproductive effort, capital breeding, and reproduction entrained to the annual cycle and with precise timing. Distinct annual routines, large body size, energy storage capacities, and parental care are also adaptations to seasonality. Phenotypic plasticity and state-dependence are important parts of these traits and are adaptations in their own. I give particular attention to timing of breeding and the associated birth-time dependent contributions to fitness. Seasonality in offspring value impacts the scheduling of growth, storage, and reproduction and may create parent–offspring conflicts over breeding timing. A combined offspring and parent value perspective should be adopted more broadly, also because of the management implications. I further argue for strategic but careful use of latitudinal (and altitudinal) gradients, and more attention to the role of seasonally varying predation risk as a selective force.