Σάββατο 31 Μαρτίου 2018
Safety and Efficacy of a Halobetasol/Tazarotene Fixed Combination in the Treatment of Moderate-to-Severe Plaque Psoriasis: Results of two Phase 3 randomized controlled trials
Topical corticosteroids are the mainstay of psoriasis treatment; long-term safety concerns limit use. Combination with tazarotene may optimize efficacy, minimizing safety/tolerability concerns, In patients with moderate-to-severe plaque psoriasis treated with HP/TAZ lotion, improvement is noted within 2 weeks with few adverse effects observed after 8 weeks., HP/TAZ lotion may provide a realistic topical option for psoriasis management
Use of immunology and immunodeficiency topics in UpToDate
Publication date: Available online 30 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): E. Richard Stiehm, Elizabeth C. Tepas, Anna M. Feldweg
Type 2 biomarkers and prediction of future exacerbations and lung function decline in adult asthma
Publication date: Available online 30 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Ruth Semprini, Mathew Williams, Alex Semprini, Alice McDouall, James Fingleton, Cecile Holweg, Mark Weatherall, Richard Beasley, Irene Braithwaite
BackgroundType 2 biomarkers that predict both likelihood of future severe exacerbations and response to monoclonal antibody therapy in asthma, would be useful clinically in identifying patients both at greater risk of hospitalization, and most likely to benefit from monoclonal antibody therapy.ObjectiveTo describe the association between the Type 2 biomarkers, blood eosinophils, FeNO, serum periostin, serum IgE and time to severe exacerbation in a broad asthma population.MethodsParticipants from two adult asthma cohorts with baseline measurements of blood eosinophils, FeNO, serum periostin and serum IgE were reviewed after at least 12 months to obtain an exacerbation history, corroborated with general practitioner and hospital medical records. The association between baseline Type 2 biomarkers and time to exacerbation was described by Cox Proportional Hazard Ratios (HR) using multivariate models.Results212 participants were followed for a median (range) 3.8 (1.1 to 5.3) years. 67/212 (32%) had at least one severe exacerbation. The HR (95% CI) of baseline Type 2 biomarkers and time to exacerbation were: blood eosinophils per 0.1x109/L increase 0.89 (0.76-1.05), P=0.17; log FeNO per 0.693 increase 0.65 (0.52-0.81), P<0.001; log serum periostin per 0.693 increase 0.62 (0.35-1.09), P=0.10; log serum IgE per 0.693 increase 0.89 (0.80-1.00), P=0.05.ConclusionThe positive association between Type 2 biomarkers and risk of severe exacerbations in populations with severe refractory asthma does not extend to mild and moderate asthma. Non-Type 2 asthma may represent a phenotype associated with an increased risk of severe exacerbations in a broad asthma population.
Follicular Traction Urticaria
Publication date: Available online 31 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Shiven S. Patel, Richard F. Lockey
Xantogranuloma necrobiótico, manifestación cutánea de las gammapatías monoclonales
Publication date: Available online 31 March 2018
Source:Actas Dermo-Sifiliográficas
Author(s): I. Pérez-López, J.D. Herrera-García, A. Martínez-López, E. García-Durá
Réplica a: «Mancha de vino de Oporto adquirida: ¡no es una simple mancha!»
Publication date: Available online 31 March 2018
Source:Actas Dermo-Sifiliográficas
Author(s): J.F. Millán-Cayetano, J. del Boz, P. García-Montero, M. de Troya Martín
Mancha de vino de Oporto adquirida: ¡no es una simple mancha!
Publication date: Available online 30 March 2018
Source:Actas Dermo-Sifiliográficas
Author(s): A. Abdelmaksoud, M. Vestita
Las decisiones editoriales en las revistas dermatológicas: ¿es el factor de impacto un arma de doble filo?
Publication date: Available online 31 March 2018
Source:Actas Dermo-Sifiliográficas
Author(s): P. Hernández Bel
The role of folic acid-conjugated polyglycerol coated iron oxide nanoparticles on radiosensitivity with clinical electron beam (6 MeV) on human cervical carcinoma cell line: In vitro study
Publication date: Available online 30 March 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Hamid Fakhimikabir, Mohamad Bagher Tavakoli, Ali Zarrabi, Alireza Amouheidari, Soheila Rahgozar
Background and PurposeThe objective of this study was to investigate the therapeutic effect of Folic Acid-Conjugated polyglycerol coated iron oxide nanoparticles on the radiosensitivity of HeLa cells when irradiated with 6 MeV electron beams.Materials and MethodsDifferent concentrations of iron oxide nanoparticles (PG-SPIONs and FA-PG-SPIONs (25, 50, 100, 200 μg ml−1)) were synthesized by the thermal decomposition technique. The effect of PG-SPIONs and FA-PG-SPIONs in combination with radiation (2, 4, 6 Gy) on the viability of cells and cell survival were estimated using the trypan blue dye exclusion test and MTT assay immediately and 48 h after irradiations, respectively.ResultsIt was observed that the penetration rate of uptake for cells treated with >50 μg ml−1 FA-PG-SPIONs was more than that of non-targeted nanoparticles. The data obtained by trypan blue dye exclusion test showed no significant reduction in cell viability for all groups in comparison with control group. The results revealed that increasing the radiation doses in the presence of the concentrations of the nanoparticles increased the value of radiosensitivity. The most radiosensitivity was obtained at the highest concentration of FA-PG-SPIONs (200 μg ml−1) as well as the longest radiation doses.ConclusionIt was revealed that higher concentrations of the FA-PG-SPIONs in combination with 6 MeV electron beams could enhance radiosensitization of HeLa cells.
Editorial board
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 3
Actinomycose révélée par une ulcération du palais et de la gencive
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 3
Author(s): F. Dessirier, J.-P. Arnault, J. Denamps, H. Sevestre, C. Attencourt, C. Lok
IntroductionL'actinomycose est une infection bactérienne granulomateuse chronique extensive. Elle est rarement révélée par une ulcération buccale.ObservationUne femme diabétique de 76 ans était traitée par dabrafenib pour un mélanome stade IV. Lors d'une consultation de suivi, on constatait deux lésions ulcérées du palais dur et de la gencive, infiltrées et hyperalgiques. Il n'y avait pas de signe associé. Le bilan biologique était sans particularité. La première hypothèse diagnostique évoquée était celle d'un carcinome épidermoïde muqueux survenu sous inhibiteurs de BRAF, bien que cette situation soit très peu décrite dans la littérature. L'examen histologique montrait un grain actinomycosique. La tomodensitométrie du massif facial ne montrait pas d'ostéite. Une antibiothérapie par amoxicilline était instaurée pendant quatre mois, avec une évolution favorable.DiscussionLes actinomycètes sont des bactéries filamenteuses Gram positif, saprophytes de la cavité buccale et du tractus gastro-intestinal, qui deviennent pathogènes sous l'influence de plusieurs facteurs. L'atteinte cervico-faciale, sous la forme d'un nodule inflammatoire péri-mandibulaire avec fistulisation secondaire à la peau ou dans la bouche, est la présentation la plus classique de l'actinomycose. Aucun cas d'infection opportuniste n'a été décrit à notre connaissance sous inhibiteurs de BRAF ; seuls deux cas de tuberculose ont été rapportés avec le sorafenib. Chez notre patiente, les soins dentaires et le diabète sont les deux facteurs favorisants retenus. Nous rappelons par ailleurs l'importance de l'examen des muqueuses chez les patients traités par inhibiteurs de BRAF.BackgroundActinomycosis is a chronic and extensive granulomatous, bacterial infection. Revelation by oral ulceration is rare.Patients and methodsA 76-year-old patient with diabetes was treated with dabrafenib for stage IV melanoma. A follow-up visit revealed two ulcerated, infiltrated and hyperalgesic lesions of the palate and gingiva. There were no associated signs. The laboratory findings were normal. The possibility of squamous cell carcinoma occurring with BRAF inhibitors was discussed, despite the rarity of such cases in the literature. Histological examination showed an actinomycotic grain. A scan of the facial mass showed no osteitis. Antimicrobial therapy was initiated with amoxicillin for four months, with a favorable outcome.DiscussionActinomycetes are Gram-positive filamentous saprophytic bacteria of the oral cavity and the gastrointestinal tract. They can become pathogenic under the influence of several factors. Cervicofacial involvement in the form of a peri-mandibular inflammatory nodule with secondary fistulation on the skin or in the mouth is the classic presentation. To our knowledge, no cases of opportunistic infection under BRAF inhibitors have been described. Only two cases of tuberculosis have been reported with sorafenib. The initial presentation led to suspicion of squamous cell carcinoma. In our patient, poor oral hygiene and diabetes were the two key factors considered. Moreover, this is the first case reported under dabrafenib, which does not appear to be a favoring factor. We would stress the importance of mucosal examination in patients treated with BRAF inhibitors.
Hydrochlorothiazide et cancers cutanés
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 3
Author(s): J.-L. Schmutz
Linguistic convention and worldly fact
Abstract
Truth by convention, once thought to be the foundation of a uniquely promising approach to explaining our access to the truth in nonempirical domains, is nowadays widely considered an absurdity. Its fall from grace has been due largely to the influence of an argument that can be sketched as follows: our linguistic conventions have the power to make it the case that a sentence expresses a particular proposition, but they can't by themselves generate truth; whether a given proposition is true—and so whether the sentence that expresses it is true—is a matter of what the world is like, which means it isn't a matter of convention alone. The consensus is that this argument is decisive against truth by convention. Strikingly, though, it has rarely been formulated with much precision. Here I provide a new rendering of the argument, one that reveals its structure and makes transparent just what assumptions it requires, and then I assess conventionalists' prospects for resisting each of those assumptions. I conclude that the consensus is mistaken: contrary to what is almost universally thought, there remains a promising way forward for the conventionalist project. Along the way, I clarify conventionalists' commitments by thinking about what truth by convention would need to be like in order for conventionalism to do the epistemological work it's intended to do.
Παρασκευή 30 Μαρτίου 2018
The retroauricular subcutaneously pedicled island flap for reconstruction of auricular conchal defects
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Occupational subacute cutaneous lupus erythematosus caused by outdoor work
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Immune privilege disruption in folliculotropic mycosis fungoides: investigation of major histocompatibility complex antigen expression
International Journal of Dermatology, EarlyView.
Paederus dermatitis – touched by champion flies – three clinical manifestations of pederin toxin‐inflicted dermatitis
International Journal of Dermatology, EarlyView.
Can the epoxides of cinnamyl alcohol and cinnamal show new cases of contact allergy?
Contact Dermatitis, EarlyView.
Reactive glia promote development of CD103+CD69+ CD8+ T‐cells through programmed cell death‐ligand 1 (PD‐L1)
Immunity, Inflammation and Disease, EarlyView.
Biologics for pityriasis rubra pilaris treatment: a review of the literature
Pityriasis rubra pilaris (PRP) is a rare inflammatory papulosquamous skin disease, often refractory to conventional therapies. The off-label use of biologics, such as anti-TNF, -IL-12/IL-23, -IL-17 agents, has been proven successful, in the last two decades, in PRP treatment.Our aim was to analyse the literature for the use of biologics in PRP treatment. We conducted a review by "Pubmed" and "clinicaltrial.gov" searches. 68 articles met our selection criteria and were herein discussed. Out of 86 PRP patients, the vast majority of which treated with anti-TNF, -IL-12/IL-23, and -IL-17 biologics, either alone or in combination therapy, a marked-to-complete response (50-78%), a partial response (11-25%) or no/poor response (11-25%) was observed.
Dual neutralization of both IL-17A and IL-17F with bimekizumab in patients with psoriasis: results from BE ABLE 1, a 12-week randomized, double-blinded placebo-controlled phase 2b trial
Neutralizing interleukin (IL)-17F in addition to IL-17A may provide a more complete and specific approach to inhibiting inflammation.
Epinephrine in Severe Allergic Reactions: The European Anaphylaxis Register
Publication date: Available online 30 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Linus B. Grabenhenrich, Sabine Dölle, Franziska Ruëff, Jean-Marie Renaudin, Kathrin Scherer, Claudia Pföhler, Regina Treudler, Alice Koehli, Vera Mahler, Thomas Spindler, Lars Lange, Maria Beatrice Bilò, Nikolaos G. Papadopoulos, Jonathan O.B. Hourihane, Roland Lang, Montserrat Fernández-Rivas, George Christoff, Ewa Cichocka-Jarosz, Margitta Worm
BackgroundCurrent guidelines recommend intramuscular administration of epinephrine as the first-line drug for the emergency treatment of severe allergic reactions (anaphylaxis), but no randomized trial evidence supports this consensus.ObjectiveWe aimed to assess anaphylaxis treatment practices over 10 years, covering several European regions, all allergen sources, and all age groups.MethodsThe European Anaphylaxis Register tracks elicitors, symptoms, emergency treatment, diagnostic workups, and long-term counseling for anaphylaxis incidents through web-based data entry from tertiary allergy specialists, covering information from the emergency respondent, patient, tertiary referral, and laboratory/clinical test results.ResultsWe analyzed 10,184 anaphylaxis incidents. In total, 27.1% of patients treated by a health professional received epinephrine and, in total, 10.5% received a second dose. Successful administration was less frequent in German-speaking countries (minimum 19.6%) than in Greece, France, and Spain (maximum 66.7%). Over the last decade, epinephrine administration from a health professional almost doubled to reach 30.6% in 2015-2017, half of which was applied intramuscularly. A total of 14.7% of lay- or self-treated cases were treated with an autoinjector. Of those without treatment, 22.4% carried a device for administration. No change in successful administration by lay emergency respondents was found over the last 10 years. Of the reaction and patient characteristics analyzed, only clinical severity considerably influenced the likelihood of receiving epinephrine, with 66.9% of successful administrations in near-fatal (grade IV) reactions.ConclusionsDespite clear recommendations, only a small proportion of anaphylaxis incidents are treated with epinephrine. We demonstrated a slight increase in treated patients when handled by professionals, but stagnation in lay- or self-treated anaphylaxis. The reaction circumstances, the respondent's professional background, and patient characteristics did not explain which reactions were treated.
A threshold dose distribution approach for the study of PDT resistance development
Publication date: Available online 30 March 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Clara Maria Gonçalves de Faria, Natalia Mayumi Inada, José Dirceu Vollet-Filho, Vanderlei Salvador Bagnato
Cerebra: “All-Human”, “All-Too-Human”, “All-Too-Transhuman”
Abstract
In thinking the passage from the "all-human cerebrum" (H.G. Wells) to what one might call the contemporary "all-too-human" cerebrum in neo-liberal societies and beyond to the "all-too-transhuman" cerebrum in the cybernetic society, in contrasting Wells's idea of a new world order with the dystopia of the disordering un-world (Nancy in The creation of the world or globalization, State University of New York Press, Albany, 2002/2007), in considering the prospects of a "world brain" faced with the realities of the "global mnemotechnical system" (Bernard Stiegler), in highlighting the differences between the global and authoritarian instrument of "control" in Wells and the descriptions of the control society by Deleuze, and finally, in critiquing the "unifying of the general intelligence services of the world" in Wells (World brain, Methuen & Co., Ltd., London, 1938, pp. 3–4) and the capturing of the "general intellect" (Wark in General intellects: twenty-one thinkers for the twenty-first century. Verso Books, London, 2017), this paper maps the contemporary prospects of the "world brain" against the backdrop of the worldweariness of the present.
An electrical plasma dissection tool for surgical treatment of chronic ulcers: Results of a prospective randomised trial
International Wound Journal, EarlyView.
An unusual presentation of a common condition: Allergic contact dermatitis
International Wound Journal, EarlyView.
Fast 5DOF needle tracking in iOCT
Abstract
Purpose
Intraoperative optical coherence tomography (iOCT) is an increasingly available imaging technique for ophthalmic microsurgery that provides high-resolution cross-sectional information of the surgical scene. We propose to build on its desirable qualities and present a method for tracking the orientation and location of a surgical needle. Thereby, we enable the direct analysis of instrument–tissue interaction directly in OCT space without complex multimodal calibration that would be required with traditional instrument tracking methods.
Method
The intersection of the needle with the iOCT scan is detected by a peculiar multistep ellipse fitting that takes advantage of the directionality of the modality. The geometric modeling allows us to use the ellipse parameters and provide them into a latency-aware estimator to infer the 5DOF pose during needle movement.
Results
Experiments on phantom data and ex vivo porcine eyes indicate that the algorithm retains angular precision especially during lateral needle movement and provides a more robust and consistent estimation than baseline methods.
Conclusion
Using solely cross-sectional iOCT information, we are able to successfully and robustly estimate a 5DOF pose of the instrument in less than 5.4 ms on a CPU.
Viewing Others as Equals: the Non-cognitive Roots of Shared Intentionality
Abstract
We propose two adjustments to the classic view of shared intentionality (our capacity to share mental states of various sorts) as based on conceptual-level cognitive skills. The first one takes into account that infants and young children display this capacity, but lack conceptual-level cognitive skills. The second one seeks to integrate cognitive and non-cognitive skills into that capacity. This second adjustment is motivated by two facts. First, there is an enormous difference between human infants and our closest living primate relatives with respect to the range and scale of goal sharing and cooperation. Second, recent evidence suggests that there are hardly any differences in their mental-state attribution capacities. We argue therefore that our distinctively human capacity for shared intentionality is due to the effect on our cognitive skills of a (probably inborn) practical attitude. Accordingly, we propose that cognitive and practical skills, working together, produce our capacity for shared intentionality, and review evidence suggesting that the practical skill in question consists in the ability to adopt an attitude of equality.
In vivo evaluation of EGFRvIII mutation in primary glioblastoma patients via complex multiparametric MRI signature
Abstract
Background
Epidermal growth factor receptor variant III (EGFRvIII) is a driver mutation and potential therapeutic target in glioblastoma. Non-invasive in vivo EGFRvIII determination, using clinically acquired multiparametric MRI sequences, could assist in assessing spatial heterogeneity related to EGFRvIII, currently not captured via single-specimen analyses. We hypothesize that integration of subtle, yet distinctive, quantitative imaging/radiomic patterns using machine learning may lead to non-invasively determining molecular characteristics, and particularly the EGFRvIII mutation. Methods
We integrated diverse imaging features, including the tumor's spatial distribution pattern, via support vector machines, to construct an imaging signature of EGFRvIII. This signature was evaluated in independent discovery (n = 75) and replication (n = 54) cohorts of de novo glioblastoma, and compared with the EGFRvIII status obtained through an assay based on next-generation sequencing. Results
The cross-validated accuracy of the EGFRvIII signature in classifying the mutation status in individual patients of the independent discovery and replication cohorts was 85.3% (specificity = 86.3%, sensitivity = 83.3%, area under the curve [AUC] = 0.85) and 87% (specificity = 90%, sensitivity = 78.6%, AUC = 0.86), respectively. The signature was consistent with EGFRvIII+ tumors having increased neovascularization and cell density, as well as a distinctive spatial pattern involving relatively more frontal and parietal regions compared with EGFRvIII− tumors. Conclusions
An imaging signature of EGFRvIII was found, revealing a complex, yet distinct macroscopic glioblastoma phenotype. By non-invasively capturing the tumor in its entirety, the proposed methodology can assist in evaluating the tumor's spatial heterogeneity, hence overcoming common spatial sampling limitations of tissue-based analyses. This signature can preoperatively stratify patients for EGFRvIII-targeted therapies, and potentially monitor dynamic mutational changes during treatment.Insect community composition and functional roles along a tropical agricultural production gradient
Abstract
High intensity agricultural production systems are problematic not only for human health and the surrounding environment, but can threaten the provision of ecosystem services on which farm productivity depends. This research investigates the effects of management practices in Costa Rica on on-farm insect diversity, using three different types of banana farm management systems: high-input conventional system, low-input conventional system, and organic system. Insect sampling was done using pitfall and yellow bowl traps, left for a 24-h period at two locations inside the banana farm, at the edge of the farm, and in adjacent forest. All 39,091 individual insects were classified to family level and then morphospecies. Insect species community composition and diversity were compared using multivariate statistics with ordination analysis and Monte Carlo permutation testing, and revealed that each of the management systems were significantly different from each other for both trap types. Insect diversity decreased as management intensity increased. Reduced insect diversity resulted in fewer functional groups and fewer insect families assuming different functions essential to ecosystem health. Organic farms had similar species composition on the farm compared to adjacent forest sites, whereas species composition increasingly differed between farm and forest sites as management intensity increased. We conclude that while organic production has minimal impact on insect biodiversity, even small reductions in management intensity can have a significantly positive impact on on-farm insect biodiversity and functional roles supported.
Metal accumulation in Raphanus sativus and Brassica rapa : an assessment of potential health risk for inhabitants in Punjab, Pakistan
Abstract
Pakistan is an agricultural country and due to the shortage of clean water, most of the irrigated area (32,500 ha) of Pakistan was supplied with wastewater (0.876 × 109 m3/year). Concentrations of heavy metals in radish (Raphanus sativus) and turnip (Brassica rapa) taken from vegetable fields in Sargodha, Pakistan, were measured. Untreated wastewater was used persistently for a long time to irrigate these vegetable fields. A control site was selected that had a history of fresh groundwater irrigation. Mean metal concentrations were found for irrigation water, soil, and vegetables. In irrigation water, concentrations of Mo and Pb at three sites and Se at sites II and III were higher than the recommended limits. In vegetables, concentrations of Mo and Pb were above the maximum permissible limits. High bioconcentration factor was observed for Zn (12.61 in R. sativus and 11.72 in B. rapa) at site I and high pollution load index was found for Pb (3.89 in R. sativus and 3.87 in B. rapa) at site II. The differences in metal concentrations found in samples depended upon different soil nature and assimilation capacities of vegetables at different sites which in turn depended upon different environmental cues. The entrance of metal and metalloids to human body may happen through different pathways; however, the food chain is the chief route through which metals are transferred from vegetables to individuals. Health risk index observed for metals, (Mo, As, Ni, Cu, and Pb) higher than 1 indicated high risk through consumption of these vegetables at three sites.
Modelling equilibrium adsorption of single, binary, and ternary combinations of Cu, Pb, and Zn onto granular activated carbon
Abstract
Elevated concentrations of heavy metals in water can be toxic to humans, animals, and aquatic organisms. A study was conducted on the removal of Cu, Pb, and Zn by a commonly used water treatment adsorbent, granular activated carbon (GAC), from three single, three binary (Cu-Pb, Cu-Zn, Pb-Zn), and one ternary (Cu-Pb-Zn) combination of metals. It also investigated seven mathematical models on their suitability to predict the metals adsorption capacities. Adsorption of Cu, Pb, and Zn increased with pH with an abrupt increase in adsorption at around pH 5.5, 4.5, and 6.0, respectively. At all pHs tested (2.5–7.0), the adsorption capacity followed the order Pb > Cu > Zn. The Langmuir and Sips models fitted better than the Freundlich model to the data in the single-metal system at pH 5. The Langmuir maximum adsorption capacities of Pb, Cu, and Zn (mmol/g) obtained from the model's fits were 0.142, 0.094, and 0.058, respectively. The adsorption capacities (mmol/g) for these metals at 0.01 mmol/L equilibrium liquid concentration were 0.130, 0.085, and 0.040, respectively. Ideal Adsorbed Solution (IAS)-Langmuir and IAS-Sips models fitted well to the binary and ternary metals adsorption data, whereas the Extended Langmuir and Extended Sips models' fits to the data were poor. The selectivity of adsorption followed the same order as the metals' capacities and affinities of adsorption in the single-metal systems.
Cortical Bone Graft and GTR Membrane as “Ceiling Effect” in Alveolar Bone Grafting
Abstract
Background
In orofacial cleft deformity cases, bone grafting is a very essential step in reconstruction of the residual alveolar cleft defect.
Material and Methods
Though various authors have put forth different techniques and graft sources for alveolar bone grafting, at our center, we have used iliac crest as the graft source and cortical bone graft with GTR membrane as "ceiling effect".
Results
We have evaluated a series of cases of secondary alveolar bone grafting done with this technique by same surgeon at our center and have found great success.
Conclusion
In this clinical paper, we describe our surgical technique and also the key points from surgeons experience to ensure a better result.
Techniques to Improve Reliability and Predictability of the Dorsal Pedicled Tongue Flap in Closure of Palatal Defects and Oronasal Fistulae
Abstract
Introduction
Despite the improvement in surgical techniques in cleft palate surgery, oronasal fistulas continue to remain a challenge, usually the result of residual palatal and alveolar clefts and post-palatoplasty defects. The tongue flap is an extremely versatile, sturdy, reliable and efficient means of closure of anterior as well as posterior, unilateral and bilateral palatal defects, effectively functionally obliterating the oronasal communication, owing much of its success to its highly vascular structure, good mobility, texture match, central location and low donor site morbidity. However, it has a few drawbacks. Flap dehiscence and detachment during the early postoperative period is a troublesome complication owing to tongue movements during normal activities such as speaking, swallowing, yawning and coughing.
Aim
This article describes some of the methods which can be used to effectively alleviate these shortcomings.
Methods
A protocol of immobilizing the tongue by tethering it to the maxillary teeth for the 3-week postoperative period, and also maintaining the patient on nasogastric feeding, until the patient is taken up for surgical separation the pedicle, was employed in all patients in this case series.
Results
There was a successful and predictable take of the tongue flap at the donor site, namely the palatal/oronasal fistula with its successful closure, in all the patients.
Conclusion
Treatment of the oronasal fistula using a two-layer closure using the nasal mucoperiosteum together with an anteriorly based dorsal tongue flap is an easy and efficient method, whose reliability can be further increased by avoiding a common complication, namely tongue flap detachment in the postoperative period brought on by movements of the tongue, by immobilizing the tongue by tethering it to the maxillary teeth and also maintaining the patient on nasogastric feeding for the 3-week postoperative period.
Infection, Alveolar Osteitis, and Adverse Effects Using Metronidazole in Healthy Patients Undergoing Third Molar Surgery: A Meta-analysis
Abstract
Purpose
The aim of this systematic review and meta-analysis was to evaluate the risk of surgical infection, alveolar osteitis, and adverse effects using systemic metronidazole in comparison with placebo in healthy patients undergoing third molar surgery.
Materials and Methods
The eligible reports were identified from diverse science sources. Clinical trials meeting the inclusion and exclusion criteria and an acceptable Oxford Quality Score were included in this study. The evaluation of risk was done using the Risk Reduction Calculator and Review Manager 5.3., from the Cochrane Library. A significant risk reduction was assumed when the upper limit of the 95% confidence intervals was <1 and the lower limit did not cross zero (negative number) alongside a p value of <0.05 for the overall test. Data of 667 patients from five clinical trials were used for the assessment of risk.
Results
Our analysis showed no reduction of the risk of infection or dry socket in patients receiving metronidazole compared to whom took placebo. Meanwhile, the adverse effects did not exhibit a difference between the studied groups.
Conclusion
The routine use of systemic metronidazole to prevent surgical site infection and/or dry socket in healthy patients undergoing third molar surgery is not recommended.
Teaching is Oppositional: On the Importance of Supporting Experimental Teaching During Student Teaching
Abstract
This paper has two interrelated goals. The first is to introduce a framework: oppositional democracy. The second is to use this framework to address what I see as a central problem that occurs when learning to teach: the moment when someone with power tells an aspiring teacher that something she hopes to accomplish is unrealistic. The framework of oppositional democracy helps us understand this problem while also suggesting responses that free an aspiring teacher to experiment in responsible ways, thereby empowering her to work against practices she does not want to be complicit in perpetuating.
A comparative evaluation of spectrophotometric intracutaneous analysis and laser doppler imaging in the assessment of adult and paediatric burn injuries
Publication date: Available online 29 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): S. Charuvila, M. Singh, D. Collins, I. Jones
IntroductionClinical assessment of mid dermal burns can be challenging. Currently, Laser Doppler Imaging is the gold standard adjunct in the assessment of burn injuries. Whilst Laser Doppler Imaging has demonstrated reliable accuracy, it poses various limitations in everyday use including cost and ease of use. In comparison, Spectrophotometric Intracutaneous Analysis is a relatively cheaper technique which can be carried out using a modified digital camera which enables easy image acquisition. We aim to compare the accuracy of the two modalities in the assessment of mid-dermal burn injuries.MethodsWe recruited 29 patients with mid-dermal burns presenting within two to five days post burn. 45 burn regions of interest were identified and underwent imaging using both the modalities. Subsequent clinical outcome was followed and treatment remained unaffected by participation. Two clinicians then independently predicted the healing potential of each burn region retrospectively as per images from either modality.ResultsMcNemar's test indicated that there is no significant difference between the accuracy of the two modalities (p=0.61).ConclusionThe results suggest that the accuracy of Spectrophotometric Intracutaneous Analysis is comparable to that of Laser Doppler Imaging. Our experience with Spectrophotometric Intracutaneous Analysis indicates its potential as a cost effective and user friendly adjunct in decision making.
Tissue expansion in cranioplasty - a collaborative approach for all involved for improved outcomes?
Publication date: Available online 29 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Sarah Williams, Norbert Kang
The use of tissue expanders is well established in plastic surgery. However, there are currently no clear indications for tissue expansion as an adjunct to cranioplasty. We present a series of nine patients who underwent tissue expansion prior to cranioplasty after removal of an infected bone flap and/or radiotherapy. Family members of 8 patients were taught how to undertake expansion at home. Two patients experienced exposure and infection of the expander. Post-operatively two patients developed an infection of their cranioplasty implant which was removed. We recommend using tissue expansion for patients who have experienced a long interval (>6 months) after removal of their bone flap to reconstruction. Early involvement of plastic surgeons may be helpful in reducing the risk of re-operation in these complex cases. Tissue expansion done at home appears to be safe.
Screening of seaweeds in the East China Sea as potential bio-monitors of heavy metals
Abstract
Seaweeds are good bio-monitors of heavy metal pollution and have been included in European coastal monitoring programs. However, data for seaweed species in China are scarce or missing. In this study, we explored the potential of seaweeds as bio-monitor by screening the natural occurring seaweeds in the "Kingdom of seaweed and shellfish" at Dongtou Islands, the East China Sea. Totally, 12 seaweed species were collected from six sites, with richness following the sequence of Rhodophyta > Phaeophyta > Chlorophyta. The concentration of heavy metals (Cu, Cr, Ni, Zn, Pb, Cd, As) in the seaweeds was determined, and the bioaccumulation coefficient was calculated. A combination of four seaweeds, Pachydictyon coriaceum, Gelidium divaricatum, Sargassum thunbergii, and Pterocladiella capillacea, were proposed as bio-monitors due to their high bioaccumulation capabilities of specific heavy metals in the East China Sea and hence hinted the importance of using seaweed community for monitoring of pollution rather than single species. Our results provide first-hand data for the selection of bio-monitor species for heavy metals in the East China Sea and contribute to selection of cosmopolitan bio-monitor communities over geographical large area, which will benefit the establishment of monitoring programs for coastal heavy metal contamination.
Soil surface Hg emission flux in coalfield in Wuda, Inner Mongolia, China
Abstract
Hg emission flux from various land covers, such as forests, wetlands, and urban areas, have been investigated. China has the largest area of coalfield in the world, but data of Hg flux of coalfields, especially, those with coal fires, are seriously limited. In this study, Hg fluxes of a coalfield were measured using the dynamic flux chamber (DFC) method, coupled with a Lumex multifunctional Hg analyzer RA-915+ (Lumex Ltd., Russia). The results show that the Hg flux in Wuda coalfield ranged from 4 to 318 ng m−2 h−1, and the average value for different areas varied, e.g., coal-fire area 99 and 177 ng m−2 h−1; no coal-fire area 19 and 32 ng m−2 h−1; and backfilling area 53 ng m−2 h−1. Hg continued to be emitted from an underground coal seam, even if there were no phenomena, such as vents, cracks, and smog, of coal fire on the soil surface. This phenomenon occurred in all area types, i.e., coal-fire area, no coal-fire area, and backfilling area, which is universal in Wuda coalfield. Considering that many coalfields in northern China are similar to Wuda coalfield, they may be large sources of atmospheric Hg. The correlations of Hg emission flux with influence factors, such as sunlight intensity, soil surface temperature, and atmospheric Hg content, were also investigated for Wuda coalfield.
Graphical abstract
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Hyper‐immunoglobulin D syndrome with novel mutations in an afebrile infant
Pediatric Dermatology, EarlyView.
Cloning and characterization of UePrf1 gene in Ustilago esculenta
Abstract
Ustilago esculenta, an obligate parasite of Zizania latifolia, is a typical dimorphic fungus, which induces host stem swelling and inhibits host inflorescence development, but is not found in host leaves. Previous studies have shown that dimorphic switching is essential for fungal pathogenicity and is regulated by PKA and mitogen-activated protein kinase (MAPK) signaling pathways that are integrated by Prf1 in Ustilago maydis. In this study, we identified a Prf1 homolog in U. esculenta, designated UePrf1, encoding 830 amino acids, with a conserved high mobility group (HMG) domain located between amino acids 124 and 195. UePrf1 was upregulated during the mating process, which induces dimorphism in U. esculenta. In vitro, UePrf1 mutants showed defects in the mating process, including cell fusion and hyphal growth. UePrf1 mutants also show reduced expression of a genes, even during the cell fusion process. Additionally, the defect in hyphal growth of the UeKpp2 and UeKpp6 mutants (MAPK signaling pathway mutant) was partially counteracted by UePrf1 overexpression, along with induced b gene expression. These results provide evidence that UePrf1 is a key factor coordinating dimorphism in U. esculenta and suggest a conserved role for UePrf1 in the regulation of the a and b genes.Negative association of antibiotics on clinical activity of immune checkpoint inhibitors in patients with advanced renal cell and non-small cell lung cancer
Abstract
Background
The composition of gut microbiota affects anti-tumor immune responses, preclinical and clinical outcome following immune checkpoint inhibitors (ICI) in cancer. Antibiotics (ATB) alter gut microbiota diversity and composition leading to dysbiosis, which may affect effectiveness of ICI. Patients and Methods
We examined patients with advanced renal cell carcinoma (RCC) and non-small cell lung cancer (NSCLC) treated with anti-PD-(L)1 mAb monotherapy or combination at two academic institutions. Those receiving ATB within 30 days of beginning ICI were compared to those who did not. Objective response, progression-free survival (PFS) determined by RECIST1.1 and overall survival (OS) were assessed. Results
Sixteen of 121 (13%) RCC patients and 48 of 239 (20%) NSCLC patients received ATB. The most common ATB were β-lactam or quinolones for pneumonia or urinary tract infections. In RCC patients, ATB compared to no ATB was associated with increased risk of primary progressive disease (PD) (75% vs 22%, p < 0.01), shorter PFS (median 1.9 vs 7.4 months, hazard ratio (HR) 3.1, 95% confidence interval (CI) 1.4-6.9, p < 0.01), and shorter OS (median 17.3 vs 30.6 months, HR 3.5, 95% CI 1.1-10.8, p = 0.03). In NSCLC patients, ATB was associated with similar rates of primary PD (52% vs 43%, p = 0.26) but decreased PFS (median 1.9 vs 3.8 months, HR 1.5, 95% CI 1.0-2.2, p = 0.03) and OS (median 7.9 vs 24.6 months, HR 4.4, 95% CI 2.6-7.7, p < 0.01). In multivariate analyses, the impact of ATB remained significant for PFS in RCC and for OS in NSCLC. Conclusion
ATB were associated with reduced clinical benefit from ICI in RCC and NSCLC. Modulatation of ATB-related dysbiosis and gut microbiota composition may be a strategy to improve clinical outcomes with ICI.Bevacizumab may improve quality of life, but not overall survival in glioblastoma: an epidemiological study
Abstract
Background
The vascular endothelial growth factor antibody bevacizumab (Avastin®), received approval for the treatment of recurrent glioblastoma in many countries including the US and Switzerland, but not the European Union, in 2009. Here we explored the hypothesis that the approval of bevacizumab improved outcome with glioblastoma on a population level. Patients and methods
The prognostic significance of epidemiological, molecular genetic, and clinical data including treatment for glioblastoma patients diagnosed from 2010-2014 in the Canton of Zurich, Switzerland, was retrospectively analyzed using log rank test and Cox proportional hazards models. Data were compared to data for the years 2005-2009. Results
310 glioblastoma patients were identified in the years 2010-2014. Median overall survival (OS) was 13.5 months for patients with known isocitrate dehydrogenase (IDH) wildtype (wt) (IDH1R132H-non-mutant) tumors (N=248), compared with 11.3 months for IDH wt patients (P=0.761) before (2005-2009). In the IDH wt cohort bevacizumab use at any time increased from 19% in 2005-2009 to 49% in 2010-2014. Multivariate analysis did not identify bevacizumab exposure at any time to be associated with survival. Yet, upon second-line treatment, baseline doses of corticosteroids were reduced by more than half in 83% of patients on bevacizumab compared with 48% of the patients treated with bevacizumab-free regimens (P=0.007). Conclusion
This epidemiological study of a small, but clinically well annotated patient cohort fails to support the assumption that the strong increase of bevacizumab use since 2010 improved survival in glioblastoma, although clinical benefit associated with decreased steroid use may have been achieved.Strategies to support pressure injury best practices by the inter‐professional team: A systematic review
International Wound Journal, EarlyView.
Contact sensitivity in patients with venous leg ulcer: A multi‐centric Indian study
International Wound Journal, EarlyView.
Serum level of endostatin and digital ulcers in systemic sclerosis patients
International Wound Journal, EarlyView.
Statistical analysis of factors affecting re‐operative times in paediatric patients with scar deformity after deep second‐degree burn injury
International Wound Journal, EarlyView.
LV function validation of computer-assisted interventional system for cardiac resyncronisation therapy
Abstract
Purpose
Cardiac resynchronisation therapy (CRT) is an established treatment for symptomatic patients with heart failure, a prolonged QRS duration, and impaired left ventricular (LV) function; however, non-response rates remain high. Recently proposed computer-assisted interventional platforms for CRT provide new routes to improving outcomes. Interventional systems must process information in an accurate, fast and highly automated way that is easy for the interventional cardiologists to use. In this paper, an interventional CRT platform is validated against two offline diagnostic tools to demonstrate that accurate information processing is possible in the time critical interventional setting.
Methods
The study consisted of 3 healthy volunteers and 16 patients with heart failure and conventional criteria for CRT. Data analysis included the calculation of end-diastolic volume, end-systolic volume, stroke volume and ejection fraction; computation of global volume over the cardiac cycle as well as time to maximal contraction expressed as a percentage of the total cardiac cycle.
Results
The results showed excellent correlation ( \(R^{2}\) values of \(>\,0.99\) and Pearson correlation coefficient of \(>\,0.98\) ) with comparable offline diagnostic tools.
Conclusion
Results confirm that our interventional system has good accuracy in everyday clinical practice and can be of clinical utility in identification of CRT responders and LV function assessment.
Πέμπτη 29 Μαρτίου 2018
Oral bisphosphonate use and lung cancer incidence among postmenopausal women
Abstract
Background
Bisphosphonates are common medications for the treatment of osteoporosis in older populations. Several studies, including the Women's Health Initiative (WHI), have found inverse associations of bisphosphonate use with risk of breast and endometrial cancer, but little is known about its association with other common malignancies. The objective of this study was to evaluate the association of bisphosphonate use on the incidence of lung cancer in the WHI. Patients and methods
The association between oral bisphosphonate use and lung cancer risk was examined in 151,432 postmenopausal women enrolled into the WHI in 1993-1998. At baseline and during follow-up, participants completed an inventory of regularly used medications including bisphosphonates. Results
After a mean follow-up of 13.3 years, 2,511 women were diagnosed with incident lung cancer. There was no evidence of a difference in lung cancer incidence between oral bisphosphonate users and never users (adjusted hazard ratio (HR), 0.91; 95% confidence intervals (CI), 0.80-1.04; P = 0.16). However, an inverse association was observed among those who were never smokers (HR = 0.57, 95% CI, 0.39-0.84; P < 0.01). Conclusion
In this large prospective cohort of postmenopausal women, oral bisphosphonate use was associated with significantly lower lung cancer risk among never smokers, suggesting bisphosphonates may have a protective effect against lung cancer. Additional studies are needed to confirm our findings.Particulate matter on two Prunus spp. decreases survival and performance of the folivorous beetle Gonioctena quinquepunctata
Abstract
Woody plants growing along streets and construction sites play an important role in removing harmful particulate matter (PM). Researchers rarely consider the impact of different types and size fractions of PM deposited on the leaves on insect folivores. We determined differences in the accumulation of cement and roadside PM on the leaves of two Prunus species (P. padus and P. serotina) with different leaf surface structures. We also determined the effect of PM on the beetle Gonioctena quinquepunctata, the main pest of these plants. Saplings were artificially dusted in greenhouses and leaves were utilised for larval and adult insect stages feeding in laboratory conditions. Road PM accumulated in greater amounts than did cement PM, regardless of plant species. For both PM sources, P. padus accumulated twofold more than did P. serotina. Insect survival was negatively affected by PM pollution; however, neither Prunus species nor PM source variant significantly affected masses of larvae and pupae, duration of larval and pupal development or relative growth rates. The experiment showed strong negative influences of PM were noted only for adult insects, due to the grazing period being longer than that in larvae. The mass of adult insects and the efficiency of conversion of ingested food (ECI) were lower for insects exposed to PM than those for control insects. Insects compensated for lower ECI by eating a greater total amount of food (TFE). Adult insects gained significantly higher mass when fed with P. serotina than with P. padus. The effect of PM on analysed plant metabolites was insignificant. Only Prunus sp. and date of collection affected the level of condensed tannins and total phenols. Our results indicate that, when investigating the effect of the host plant on folivore performance, the accumulation of PM, as well as its type and quantity, should be taken into account.
Submandibular Gland Transfer: A Potential Imaging Pitfall [HEAD & NECK]
BACKGROUND AND PURPOSE:
The Seikaly and Jha submandibular gland transfer surgery is performed to facilitate gland shielding during radiation therapy for head and neck tumors to circumvent radiation-induced xerostomia. It results in an asymmetric postsurgical appearance of the submandibular and submental spaces. Our purpose was to characterize the morphologic and enhancement characteristics of the transferred submandibular gland and identify potential pitfalls in postoperative radiologic interpretation.
MATERIALS AND METHODS:This retrospective study identified patients with head and neck cancer who had undergone the submandibular gland transfer procedure at our institution. Chart reviews were performed to identify relevant oncologic histories and therapies. CT and MR neck imaging was reviewed to characterize morphologic and enhancement characteristics of the pre- and postoperative submandibular glands, as well as interpretive accuracy.
RESULTS:Eleven patients with oropharyngeal and nasopharyngeal squamous cell carcinomas who underwent submandibular gland transfer were identified. The transferred glands were significantly lengthened in the anteroposterior dimension compared with contralateral glands (P < .001) and displaced anteriorly and inferiorly within the submandibular and submental spaces. Enhancement patterns of the transferred submandibular glands varied, depending on the time of imaging relative to the operation and radiation therapy. Submandibular gland transfer was acknowledged in the postoperative report in 7/11 cases. Errors in interpretation were present in 2/11 reports.
CONCLUSIONS:After the submandibular gland transfer procedure, the submandibular and submental spaces lose their symmetric appearances as the transferred submandibular glands become lengthened and located more anteriorly and inferiorly, with variable enhancement characteristics. Familiarity with the postsurgical appearance of the transferred submandibular glands is key to accurate imaging interpretation.
Aneurysmal Parent Artery-Specific Inflow Conditions for Complete and Incomplete Circle of Willis Configurations [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Hemodynamics are thought to play a role in intracranial aneurysm growth and rupture. Computational fluid dynamics is frequently performed to assess intra-aneurysmal hemodynamics, using generalized flow waveforms of healthy volunteers as inflow boundary conditions. The purpose of this study was to assess differences in inflow conditions for different aneurysmal parent artery locations and variations of circle of Willis configurations.
MATERIALS AND METHODS:In a series of 96 patients with 103 aneurysms, velocity measurements were acquired using 2D phase-contrast MR imaging perpendicular to the aneurysmal parent arteries in the circle of Willis. Circle of Willis configurations were inspected for variations using multiple overlapping thin-slab-acquisition MRAs. Flow rates, velocity magnitudes, and pulsatility indices were calculated for each parent artery location in subgroups of complete and incomplete circle of Willis configurations.
RESULTS:Flow rates, velocity magnitudes, and pulsatility indices were significantly different among aneurysmal parent arteries. Incomplete circle of Willis configurations were observed in 24% of the cases. Significantly lower basilar artery flow rates were observed in configurations with hypoplastic P1 segments. Significantly higher A1 flow rates were observed in configurations with a hypoplastic contralateral A1 segment.
CONCLUSIONS:Inflow conditions vary substantially between aneurysmal parent arteries and circle of Willis configurations. We have created a collection of parent artery–specific inflow conditions tailored to the patient-specific circle of Willis configuration that can be used in future computational fluid dynamics studies analyzing intra-aneurysmal hemodynamics.
Blood Flow Mimicking Aneurysmal Wall Enhancement: A Diagnostic Pitfall of Vessel Wall MRI Using the Postcontrast 3D Turbo Spin-Echo MR Imaging Sequence [ADULT BRAIN]
SUMMARY:
Our aim was to compare the detectability of aneurysmal wall enhancement in unruptured intracranial aneurysms between conventional and motion-sensitized driven equilibrium–prepared postcontrast 3D T1-weighted TSE sequences (sampling perfection with applicationoptimized contrasts by using different flip angle evolution, SPACE). Twenty-two patients with 30 unruptured intracranial aneurysms were scanned at 3T. Aneurysmal wall enhancement was more significantly detected using conventional compared with motion-sensitized driven equilibrium–prepared SPACE sequences (10/30 versus 2/30, P < .0001). Contrast-to-noise ratio measurements did not differ between conventional and motion-sensitized driven equilibrium–prepared sequences (P = .51). Flowing blood can mimic aneurysmal wall enhancement using conventional SPACE sequences with potential implications for patient care.
Signal Change of Acute Cortical and Juxtacortical Microinfarction on Follow-Up MRI [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Although the clinical importance of cortical microinfarcts has become well-recognized recently, the evolution of cortical microinfarcts on MR imaging is not fully understood. The aim of this study was to examine the temporal changes in acute cortical microinfarcts using susceptibility-weighted imaging and conventional MR imaging.
MATERIALS AND METHODS:Patients with acute infarcts located in the cortical and/or juxtacortical region measuring ≤10 mm in axial diameter based on diffusion-weighted imaging who had a follow-up 3T MR imaging were retrospectively included in the study. All lesions did not show hypointensity on initial T2*WI. For cortical and/or juxtacortical microinfarcts detected on initial DWI, 2 neuroradiologists evaluated the follow-up MR imaging (T2WI, FLAIR, T2*WI, and SWI) and assessed lesion signal intensities and locations (cortical microinfarcts or microinfarcts with juxtacortical white matter involvement).
RESULTS:On initial DWI, 2 radiologists observed 180 cortical and/or juxtacortical microinfarcts in 35 MR imaging examinations in 25 patients; on follow-up, the neuroradiologists identified 29 cortical microinfarcts (16%) on T2WI, 9 (5%) on FLAIR, 4 (2%) on T2*, and 97 (54%) on SWI. All cortical microinfarcts detected with any follow-up MR imaging showed hyperintensity on T2WI/FLAIR and/or hypointensity on T2*WI and SWI.
CONCLUSIONS:SWI revealed conversion (paramagnetic susceptibility changes) of acute cortical microinfarcts, suggesting that a substantial number of cortical microinfarcts may contain hemorrhagic components.
An Update on the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction Trial: 1-Year Safety and Angiographic Results [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
The safety and efficacy of the PulseRider for the treatment of wide-neck, bifurcation aneurysms at the basilar and carotid terminus locations were studied in a prospective trial, the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction (ANSWER) trial, reporting on initial 6-month angiographic and clinical results. This report provides insight into the longer term durability and safety with 12-month data.
MATERIALS AND METHODS:Aneurysms treated with the PulseRider among enrolled sites were prospectively studied. Updated 12-month data on clinical and imaging end points are included.
RESULTS:Thirty-four patients were enrolled (29 women, 5 men) with a mean age of 60.9 years. The mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range, 2.3–11.6 mm). At 1 year, there were no device migrations or symptomatic in-stent stenoses. Raymond-Roy I occlusion was achieved in 53% of cases at the time of treatment and progressed to 61% and 67% at 6 and 12 months, respectively. Adequate occlusion (Raymond-Roy I/II) progressed from 88% at 6 months to 90% at 12 months. No recanalizations were observed. There was 1 delayed ischemic event. Good outcome (mRS 0–2) was achieved in 90% of patients.
CONCLUSIONS:The updated 1-year results from the ANSWER trial demonstrate aneurysm stability and an acceptable safety profile for aneurysms treated at the basilar apex and carotid terminus. Prospective data from a larger set of aneurysms treated at other locations are required to assess how treatment with PulseRider compares with alternatives for treating wide-neck bifurcation aneurysms.
Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter: A Multicenter, Randomized, Controlled Clinical Trial (PARAT) [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
Although flow diverters have been reported with favorable clinical and angiographic outcomes in various literatures, randomized trials determining their true effectiveness and safety are still in lack. The Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter (PARAT) trial was designed to evaluate the safety and efficacy of the Tubridge flow diverter in the treatment of large or giant aneurysms in comparison with Enterprise stent-assisted coiling.
MATERIALS AND METHODS:This prospective, multicenter, randomized trial was conducted at 12 hospitals throughout China. Enrolled adults with unruptured large/giant intracranial aneurysms were randomly assigned (1:1) to receive either Enterprise stent-assisted coiling or Tubridge flow diverter implantation. The primary end point was complete occlusion at 6-month follow-up, while secondary end points included technical success, mortality, target vessel–related stroke, aneurysm bleeding, in-stent stenosis, parent artery occlusion, and the frequency of all adverse events.
RESULTS:Among 185 enrolled subjects, 41 withdrew before procedure initiation. Overall, 82 subjects underwent Tubridge implantation, and 62 subjects were primarily treated with stent-assisted coiling. The results of 6-month follow-up imaging included complete occlusion rates of 75.34% versus 24.53% for the Tubridge and stent-assisted coiling groups, respectively, with a calculated common odds ratio of 9.4 (95% confidence interval, 4.14–21.38; P < .001). There was a higher, nonsignificant frequency of complications for Tubridge subjects. Multivariate analysis showed a decreased stroke rate at the primary investigational site, with a marginal P value (P = .051).
CONCLUSIONS:This trial showed an obviously higher rate of large and giant aneurysm obliteration with the Tubridge FD over Enterprise stent-assisted coiling. However, this higher obliteration rate came at the cost of a nonsignificantly higher rate of complications. Investigational site comparisons suggested that a learning curve for flow-diverter implantation should be recognized and factored into trial designs.
Optimization of photo-Fenton process for the treatment of prednisolone
Abstract
Prednisolone is a widely prescribed synthetic glucocorticoid and stated to be toxic to a number of non-target aquatic organisms. Its extensive consumption generates environmental concern due to its detection in wastewater samples at concentrations ranged from ng/L to μg/L that requests the application of suitable degradation processes. Regarding the actual treatment options, advanced oxidation processes (AOPs) are presented as a viable alternative. In this work, the comparison in terms of pollutant removal and energetic efficiencies, between different AOPs such as Fenton (F), photo-Fenton (UV/F), photolysis (UV), and hydrogen peroxide/photolysis (UV/H2O2), was carried out. Light diode emission (LED) was the selected source to provide the UV radiation. The UV/F process revealed the best performance, reaching high levels of both degradation and mineralization with low energy consumption. Its optimization was conducted and the operational parameters were iron and H2O2 concentrations and the working volume. Using the response surface methodology with the Box-Behnken design, the effect of independent variables and their interactions on the process response were effectively evaluated. Different responses were analyzed taking into account the prednisolone removal (TOC and drug abatements) and the energy consumptions associated. The obtained model showed an improvement of the UV/F process when treating smaller volumes and when adding high concentrations of H2O2 and Fe2+. The validation of this model was successfully carried out, having only 5% of discrepancy between the model and the experimental results. Finally, the performance of the process when having a real wastewater matrix was also tested, achieving complete mineralization and detoxification after 8 h. In addition, prednisolone degradation products were identified. Finally, the obtained low energy permitted to confirm the viability of the process.
Spectral fitting approach for the determination of enrichment and contamination factors in mining sediments using laser-induced breakdown spectroscopy
Abstract
Monitoring of pollution index values in sediments is crucial in assessing the environmental impacts of toxic metals in a given location. These indices are typically acquired using elaborate and tedious calibration curve-dependent techniques such as (inductively coupled plasma – optical emission spectroscopy) ICP-OES and (atomic absorption spectroscopy) AAS. In this study, laser-induced breakdown spectroscopy (LIBS) was used as a simple and fast alternative method for estimating enrichment factor (EF) and contamination factor (CF) of the sediment samples obtained from selected mining sites. Quantitative analyses of three metal targets (Cd, Pb, and Zn) were done using a calibration-free LIBS method based on the Boltzmann population distribution. Both the EF and CF values calculated from classical ICP-OES method provided significantly high correspondence with the respective EF (R2 = 0.8862–0.9770, p < 0.01–0.05) and CF (R2 = 0.9454–0.9714, p < 0.01) obtained from the developed LIBS method. The intensity-based LIBS approach identified samples AC2 and CCC as the ones with the highest and lowest pollution index values, respectively. The same observation was seen using the concentration-based ICP-OES technique which showed good correlation between the two methods. The correlation results showed the potential of the curve-fitting LIBS analysis in evaluating the level of metal contamination in an area without the preparation of matrix-matched calibration curves.
A comparative evaluation of spectrophotometric intracutaneous analysis and laser doppler imaging in the assessment of adult and paediatric burn injuries
Clinical assessment of mid dermal burns can be challenging. Currently, Laser Doppler Imaging is the gold standard adjunct in the assessment of burn injuries. Whilst Laser Doppler Imaging has demonstrated reliable accuracy, it poses various limitations in everyday use including cost and ease of use. In comparison, Spectrophotometric Intracutaneous Analysis is a relatively cheaper technique which can be carried out using a modified digital camera which enables easy image acquisition. We aim to compare the accuracy of the two modalities in the assessment of mid-dermal burn injuries.
Tissue expansion in cranioplasty - a collaborative approach for all involved for improved outcomes?
The use of tissue expanders is well established in plastic surgery. However, there are currently no clear indications for tissue expansion as an adjunct to cranioplasty. We present a series of nine patients who underwent tissue expansion prior to cranioplasty after removal of an infected bone flap and/or radiotherapy. Family members of 8 patients were taught how to undertake expansion at home. Two patients experienced exposure and infection of the expander. Post-operatively two patients developed an infection of their cranioplasty implant which was removed.
The Burden of Rhinitis and the Impact of Medication Management within the Community Pharmacy Setting
Publication date: Available online 29 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Rachel Tan, Biljana Cvetkovski, Vicky Kritikos, David Price, Kwok Yan, Peter Smith, Sinthia Bosnic-Anticevich
BackgroundThe burden of rhinitis is high. It is unknown to what extent this burden is related to inappropriate medication use.ObjectiveThis study aimed to identify the way in which people with rhinitis medicate their condition and to evaluate the appropriateness of this medication management.MethodsPharmacy customers who visited Sydney metropolitan community pharmacies and purchased medication for nasal symptoms were the sampling frame for this study. To determine the condition for which the participants were seeking medication and the appropriateness of their medication selection, the following data were collected with a researcher-administered questionnaire: participant's demographics, symptoms, medication selected. An expert panel of clinical researcher pharmacists and specialist respiratory physician evaluated the appropriateness of medication selection based on the Allergic Rhinitis and its Impact on Asthma international guidelines.ResultsTwo hundred and ninety-six participants were recruited from 8 pharmacies; 63.2% had a doctor's diagnosis for the symptoms for which they were selecting treatment. Seventy percent of participants self-selected their medications. Seventy-one percent of the participants were identified as having rhinitis. Overall, 16.5% of participants who had rhinitis selected optimal medications. Sixteen percent of participants with allergic rhinitis reported wheezing (6.3% selected optimal medications).ConclusionsThe majority of the participants with rhinitis selected suboptimal medications from community pharmacy highlighting the significant burden of rhinitis in community pharmacy and the contribution of medication management. Pharmacists need to take a proactive and evidence-based role in the management of rhinitis supported by clinical pathways when need to be articulated and promoted in all rhinitis guidelines.
Differential diagnoses of diaper dermatitis
Pediatric Dermatology, Volume 35, Issue S1, Page s10-s18, March/April 2018.
Introduction: Hot topics in neonatal skin care from the 13th World Congress of Pediatric Dermatology (Chicago, IL – July 6‐9, 2017)
Pediatric Dermatology, Volume 35, Issue S1, Page s3-s4, March/April 2018.
Issue Information ‐ Table of Contents
Pediatric Dermatology, Volume 35, Issue S1, Page s2-s2, March/April 2018.
Prevention and treatment of diaper dermatitis
Pediatric Dermatology, Volume 35, Issue S1, Page s19-s23, March/April 2018.
Issue Information ‐ Editorial Board
Pediatric Dermatology, Volume 35, Issue S1, Page s1-s1, March/April 2018.
Skin barrier in the neonate
Pediatric Dermatology, Volume 35, Issue S1, Page s5-s9, March/April 2018.
Radiation exposure for intraoperative 3D scans in a hybrid operating room: how to reduce radiation exposure for the surgical team
Abstract
Background
Hybrid operating rooms are used in different fields of surgery. In orthopedic surgery, the possibility of a 3D scan of difficult anatomical regions (spine, pelvis) showed promising results not only in navigated screw placement. The associated exposure to radiation raises questions regarding potential risks for the operating room personal and the patient. The present study focuses on scatter radiation during 3D scans in a hybrid operating room, the adjacent rooms, and methods to reduce radiation exposure.
Material and Methods
\(\hbox {RaySafe}^{\mathrm{TM}}\) i2 dosimeters were used to measure scatter radiation during 3D scans of different anatomical regions in different distances and heights in a hybrid operating room. The 3D scans were performed with a floor-based flat-panel robotic C-arm with 3D scan capability (Artis Zeego, Siemens; Germany). The 3D scans were performed using a human cadaver. The 3D scans were performed using a standard and a dose reduction protocol (DRP).
Results
The highest scatter radiation was measured during 3D scans of the pelvis on the side of the surgical assistant (39.5 Sv in height of 1 m) compared to the side of the main surgeon (23 Sv in height of 1 m). Scatter radiation was less on the position of the scrub nurse (6.8 Sv in height of 1 m) and during 3D scans of the other anatomical regions. The radiation dosage was about 66% less with the DRP. Low values of scatter radiation were measured behind a radiation protection wall and with open doors in the adjacent rooms.
Conclusion
While performing a scan scatter radiation was measured everywhere in the operating room especially during 3D scans of the pelvic girdle. Therefore, settings with lower dosage should be used whenever possible. Personnel should stand behind a radiation safety wall or leave the operating room and close the doors. For this study, six behavioral rules to avoid radiation in a hybrid operating room were established.
Breast Cancer following Augmentation Mammaplasty: A Case-Control Study
Background: The purpose of this study was to determine whether augmentation mammaplasty, implant type, and implant location affect breast cancer detection, stage, and treatment. Methods: An institutional case-control study was performed of patients with prior breast augmentation undergoing breast cancer treatment from 2000 to 2013. Controls were propensity matched and randomized, and data were retrospectively reviewed. Results: Forty-eight cases and 302 controls were analyzed. Palpable lesions were detected at a smaller size in augmentation patients (1.6 cm versus 2.3 cm; p
Enhanced Recovery Pathway in Microvascular Autologous Tissue-Based Breast Reconstruction: Should It Become the Standard of Care?
Background: Enhanced recovery pathway programs have demonstrated improved perioperative care and shorter length of hospital stay in several surgical disciplines. The purpose of this study was to compare outcomes of patients undergoing autologous tissue–based breast reconstruction before and after the implementation of an enhanced recovery pathway program. Methods: The authors retrospectively reviewed consecutive patients who underwent autologous tissue–based breast reconstruction performed by two surgeons before and after the implementation of the enhanced recovery pathway at a university center over a 3-year period. Patient demographics, perioperative data, and 45-day postoperative outcomes were compared between the traditional standard of care (pre–enhanced recovery pathway) and enhanced recovery pathway patients. Multivariate logistic regression was performed to identify risk factors for length of hospital stay. Cost analysis was performed. Results: Between April of 2014 and January of 2017, 100 consecutive women were identified, with 50 women in each group. Both groups had similar demographics, comorbidities, and reconstruction types. Postoperatively, the enhanced recovery pathway cohort used significantly less opiate and more acetaminophen compared with the traditional standard of care cohort. Median length of stay was shorter in the enhanced recovery pathway cohort, which resulted in an extrapolated $279,258 savings from freeing up inpatient beds and increase in overall contribution margins of $189,342. Participation in an enhanced recovery pathway program and lower total morphine-equivalent use were independent predictors for decreased length of hospital stay. Overall 45-day major complication rates, partial flap loss rates, emergency room visits, hospital readmissions, and unplanned reoperations were similar between the two groups. Conclusion: Enhanced recovery pathway program implementation should be considered as the standard approach for perioperative care in autologous tissue–based breast reconstruction because it does not affect morbidity and is associated with accelerated recovery with reduced postoperative opiate use and decreased length of hospital stay, leading to downstream health care cost savings. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.How to Diagnose and Treat Breast Implant–Associated Anaplastic Large Cell Lymphoma
Learning Objectives: After reading this article, the participant should be able to: 1. Describe the diagnostic criteria for breast implant–associated (BIA) anaplastic large cell lymphoma (ALCL). 2. Appropriately evaluate a patient with suspected BIA-ALCL, including appropriate imaging, laboratory tests, and pathologic evaluation. 3. Understand the operative treatment of BIA-ALCL, and indications for systemic chemotherapy and/or radiation therapy in advanced disease. 4. Understand treatment outcomes and prognosis based on stage of disease. Summary: The goal of this continuing medical education module is to present the assessment of a patient with suspected breast implant–associated anaplastic large cell lymphoma, the evaluation and diagnosis, the preoperative oncologic workup, the formation and execution of a surgical treatment plan, and the inclusion of adjunct treatments when indicated. In addition, staging and disease progression for treatment of breast implant–associated anaplastic large cell lymphoma are discussed.Low-Dose Insulin as an Antiscarring Therapy in Breast Surgery: A Randomized Controlled Trial
Background: The role of insulin in expediting wound healing is firmly established within the context of major trauma and burns; however, only limited clinical evidence exists as to its effects on scar formation. This study aims to build on previous laboratory work to examine the potential antiscarring properties of insulin in a clinical environment. Methods: Ninety-one patients undergoing bilateral aesthetic breast operations were recruited to receive low-dose insulin and placebo injections to the medial 3 cm of their submammary incisions within the context of a randomized, intrapatient, placebo-controlled trial, and scar quality was assessed at 3-, 6-, and 12-month reviews using the Manchester Scar Scale. Results: Across the cohort at 12-month review, the insulin-treated scars had lower scar scores (p = 0.055) compared with placebo. Subgroup analysis of individuals with heavier scars showed that median scar scores were significantly lower for the insulin-treated scars with regard to both scar contour (p = 0.048) and scar distortion (p = 0.045). Conclusions: Subcutaneous insulin injections reduced the appearance of scarring in this study compared with placebo. The greatest effect was seen in those participants who showed heavier scars and, as such, insulin has a role as an antiscarring therapy in individuals likely to be affected by heavier scarring. Further research is required to more precisely delineate which subjects may benefit most from this treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve
Summary: In reanimation surgery, effortless smile can be achieved by a nonfacial donor nerve. The underlying mechanisms for this smile development, and which is the best nonfacial neurotizer, need further clarification. The aim of the present study was therefore to further explore the natural coactivation between facial mimic muscles and muscles innervated by the most common donor nerves used in smile reanimation. The study was conducted in 10 healthy adults. Correlation between voluntary facial muscle movements and simultaneous electromyographic activity in muscles innervated by the masseter, hypoglossal, and spinal accessory nerves was assessed. The association between voluntary movements in the latter muscles and simultaneous electromyographic activity in facial muscles was also studied. Smile coactivated the masseter and tongue muscles equally. During the seven mimic movements, the masseter muscle had fewer electromyographically measured coactivations compared with the tongue (two of seven versus five of seven). The trapezius muscle demonstrated no coactivation during mimic movements. Movements of the masseter, tongue, and trapezius muscles induced electromyographically recorded coactivation in the facial muscles. Bite resulted in the strongest coactivation of the zygomaticus major muscle. The authors demonstrated coactivation between voluntary smile and the masseter and tongue muscles. During voluntary bite, strong coactivation of the zygomaticus major muscle was noted. The narrower coactivation pattern in the masseter muscle may be advantageous for central relearning and the development of a spontaneous smile. The strong coactivation between the masseter muscle and the zygomaticus major indicates that the masseter nerve may be preferred in smile reanimation.5000 Free Flaps and Counting: A 10-Year Review of a Single Academic Institution’s Microsurgical Development and Outcomes
Background: The establishment of an effective clinical and academic culture within an institution is a multifactorial process. This process is cultivated by dynamic elements such as recruitment of an accomplished and diverse faculty, patient geographic outreach, clinical outcomes research, and fundamental support from all levels of an institution. This study reviews the academic evolution of a single academic plastic surgery practice, and summarizes a 10-year experience of microsurgical development, clinical outcomes, and academic productivity. Methods: A 10-year retrospective institutional review was performed from fiscal years 2006 to 2016. Microsurgical flap type and operative volume were measured across all microsurgery faculty and participating hospitals. Microvascular compromise and flap salvage rates were noted for the six highest volume surgeons. Univariate and multivariable predictors of flap salvage were determined. Results: The 5000th flap was performed in December of 2015 within this institutional study period. Looking at the six highest volume surgeons, free flaps were examined for microvascular compromise, with an institutional mean take-back rate of 1.53 percent and flap loss rate of 0.55 percent across all participating hospitals. Overall, 74.4 percent of cases were breast flaps, and the remaining cases were extremity and head and neck flaps. Conclusions: Focused faculty and trainee recruitment has resulted in an academically and clinically productive practice. Collaboration among faculty, staff, and residents contributes to continual learning, innovation, and quality patient care. This established framework, constructed based on experience, offers a workable and reproducible model for other academic plastic surgery institutions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.Factors Affecting Women’s Success in Academic and Private Practice Plastic Surgery
Summary: Because plastic surgery trainees generally spend the majority of their training in academic centers and may have minimal exposure to other practice models, it can be difficult to decide which is the best route to achieve satisfaction and success. Surgeons need to be aware of benefits and challenges associated with different practice models and with workplace factors in general that contribute to happiness at work. This article reviews common practice models and provide specific and practical advice for the female surgeon.
Absorbable Antibiotic Beads Prophylaxis in Immediate Breast Reconstruction
Background: Breast reconstruction with tissue expanders is the most common mode of reconstruction following mastectomy. Infection necessitating tissue expander removal is a significant complication leading to patient distress and increased health care costs. Methods: Over 3 years, 127 breast reconstructions with tissue expanders were performed by a single surgeon. Fifty-nine of these reconstructions were performed using a standardized protocol in which patients washed with chlorhexidine several days before surgery and received intravenous antibiotics preoperatively. Intraoperatively, the submuscular pocket was irrigated with triple-antibiotic solution and the skin was prepared again with povidone-iodine before expander placement. This group was referred to as the preintervention group. Sixty-eight of the reconstructions were performed using the standardized protocol with the addition of biodegradable antibiotic beads (Stimulan with vancomycin and gentamicin) in the submuscular pocket. This group made up the postintervention group. The primary outcome was the rate of infection necessitating tissue expander removal. Results: The rate of tissue expander loss caused by infection was 11.9 percent in the preintervention group and 1.5 percent in the postintervention group (p = 0.024). Higher body mass index was associated with a statistically significant increase in infections necessitating expander removal. Conclusion: The use of absorbable antibiotic beads in the submuscular pocket reduced the risk of periprosthetic implant infection necessitating implant removal by 8-fold. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Antibiotic Prophylaxis after Immediate Breast Reconstruction: The Reality of Its Efficacy
Background: Numerous techniques are used to prevent infection after immediate implant-based breast reconstruction. Postoperative antibiotic prophylaxis is commonly prescribed to decrease the risk of reconstructive failure, despite conflicting evidence regarding its effectiveness. The authors studied whether postoperative antibiotic prophylaxis decreases the risk of infection-related explantation in the setting of immediate prosthesis-based breast reconstruction. Methods: Using Truven MarketScan databases, the authors identified all patients who underwent immediate implant reconstruction between January of 2010 and June of 2014 with at least 6 months of follow-up. Postoperative antibiotic prophylaxis was defined as any oral antibiotic course to be taken postoperatively based on prescriptions filled within 14 days preoperatively through 24 hours after discharge. Reconstructive failure, defined as explantation because of infection, was the primary outcome. Secondary outcomes of interest included wound complications, infection, and readmission for infection. Multivariable regression analyses controlled for demographic variables/comorbidities. Results: Of the 7443 patients, 6049 (81 percent) filled prescriptions for postoperative antibiotic prophylaxis. These patients were equally likely to develop a wound complication (OR, 0.93; 95 percent CI, 0.71 to 1.23) or infection (OR, 0.89; 95 percent CI, 0.70 to 1.14), undergo explantation because of infection (OR, 0.82; 95 percent CI, 0.57 to 1.18), or require readmission for infection (OR, 1.21; 95 percent CI, 0.82 to 1.78) compared with those who did not receive antibiotics. There was no significant difference in the risk of infection-related outcomes based on postoperative antibiotic prophylaxis duration. Conclusions: Postoperative antibiotic prophylaxis was not associated with a reduced risk of infection or explantation following prosthesis-based breast reconstruction. Given rising rates of antibiotic resistance, focusing instead on technical considerations and the management of comorbid conditions may more effectively enhance the safety of breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Trends in Physician Payments for Breast Reconstruction
Background: Prosthetic breast reconstruction rates have risen in the United States, whereas autologous techniques have stagnated. Meanwhile, single-institution data demonstrate that physician payments for prosthetic reconstruction are rising, while payments for autologous techniques are unchanged. This study aims to assess payment trends and variation for tissue expander and free flap breast reconstruction. Methods: The Blue Health Intelligence database was queried from 2009 to 2013, identifying women with claims for breast reconstruction. Trends in the incidence of surgery and physician reimbursement were characterized by method and year using regression models. Results: There were 21,259 episodes of breast reconstruction, with a significant rise in tissue expander cases (incidence rate ratio, 1.09; pA New Composite Eyeball-Periorbital Transplantation Model in Humans: An Anatomical Study in Preparation for Eyeball Transplantation
Background: Vascularized composite allotransplantation offers a new hope for restoration of orbital content and perhaps vision. The aim of this study was to introduce a new composite eyeball-periorbital transplantation model in fresh cadavers in preparation for composite eyeball allotransplantation in humans. Methods: The composite eyeball-periorbital transplantation flap borders included the inferior border, outlined by the infraorbital rim; the medial border, created by the nasal dorsum; the lateral border, created by the lateral orbital rim; and the superior border, created by the superior part of the eyebrow. The pedicle of the flap included the facial artery, superficial temporal artery, and external jugular vein. The skin and subcutaneous tissues of the periorbital region were dissected and the bony tissue was reached. A coronal incision was performed and the frontal lobe of the brain was reached by means of frontal osteotomy. Ophthalmic and oculomotor nerves were also included in the flap. After a "box osteotomy" around the orbit, the dissection was completed. Methylene blue and indocyanine green injection (SPY Elite System) was performed to show the integrity of the vascular territories after facial flap harvest. Results: Adequate venous return was observed within the flap after methylene blue dye injection. Laser-assisted indocyanine green angiography identified a well-defined vascular network within the entire composite eyeball-periorbital transplantation flap. Conclusions: For the first time, a novel composite eyeball-periorbital transplantation model in human cadavers was introduced. Good perfusion of the flap confirmed the feasibility of composite eyeball-periorbital transplantation in the clinical setting. Although harvesting of the flap is challenging, it introduces a new option for reconstruction of the periorbital region including the eyeball.Comparison of Cartilage-Scoring and Cartilage-Sparing Otoplasty: A Retrospective Analysis of Complications and Aesthetic Outcome of 1060 Ears
Background: Various techniques are used to correct prominent ears. The authors describe their experience with four different otoplasty techniques in 565 patients with congenital deformities of the ears (1060 ears) that were performed in their hospital during an 11-year period (2002 to 2012). Methods: The authors divided the techniques into two groups: group I, cartilage-sparing techniques (i.e., IA, Mustardé; and IB, Furnas); and group II, cartilage-cutting techniques (i.e., IIA, Chongchet; and IIB, concha shell reduction). The authors compared early and late and minor and major complications, recurrence rates, and revision surgery. Furthermore, aesthetic outcome was scored by three different groups (consultant plastic surgeons, plastic surgery residents, and laymen) on a visual analogue scale using a blinded random selection of preoperative and postoperative photographs. Results: The percentage of complications without the need for reoperation was 20 percent and 21 percent in the cartilage-sparing and cartilage-cutting groups, respectively (p = 0.44). In 6 percent of all cases, a reoperation of the otoplasty was required (7 percent and 6 percent in the cartilage-sparing and cartilage-cutting groups, respectively). Aesthetic postoperative results showed that the cartilage-cutting group scored significantly lower on postoperative shape (p = 0.04), result (p = 0.03), and satisfaction (p = 0.04) compared with the cartilage-sparing group. Conclusions: The study shows that patients who have undergone operations with cartilage-sparing or cartilage-cutting techniques have a similar rate of complications and need for reoperation. However, the cartilage-sparing techniques have a better aesthetic outcome, as judged by the different groups. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Patient-Reported Outcome Measures Used in Gender Confirmation Surgery: A Systematic Review
Background: The usefulness of patient-reported outcome measures is emphasized along with the development of patient-centered care. When implementing patient-reported outcome measures, evidence of the instrument's validity, reliability, and responsiveness in the target population is necessary to secure accurate reporting of the patient's experience. The aim of this study was to identify the literature in which structured patient-reported outcome measures have been used to evaluate the results of gender confirmation surgery, and to systematically evaluate the validity of these instruments. Methods: A systematic review of the current literature was performed to identify structured patient-reported outcome measures used to evaluate the outcome of gender confirmation surgery. The identified instruments' validity in the transgender population was assessed for adherence to international guidelines for development and validation of health outcomes instruments. Results: A total of 110 instruments were identified: 64 ad hoc; six generic; 24 evaluating psychiatric, social, or psychosocial aspects; nine evaluating function but only valid in other patient groups; five ad hoc with some formal development/validation; and two specific for gender dysphoria. Conclusions: There is a lack of patient-reported outcome measures that are valid for the transgender population and concurrently sensitive enough to evaluate gender confirmation surgery without the influence of other gender confirming interventions. Basing research on instruments without confirmed validity decreases the validity of the study itself; thus, previous research using patient-reported outcome measures to evaluate gender confirmation surgery can be considered to have a low level of evidence. To obtain valid patient-reported outcome measures, specific for evaluating the results of gender confirmation surgery, development of new instruments or adaptation of existing instruments is needed.Critical Differences between Microscopic (MIFE) and Macroscopic (MAFE) Fat Embolism during Liposuction and Gluteal Lipoinjection
Background: Liposuction and gluteal lipoinjection are two of the most frequent surgical procedures in body contouring surgery, and two of the most important complications are microscopic (MIFE) and macroscopic (MAFE) fat embolism. Despite a high index of morbidity and mortality, few reports exist about these complications, and although they have the same causal agent, their etiopathogenesis, clinical evolution, treatment, prognosis, and prevention are totally different. Therefore, the authors performed a comprehensive review of the literature to exhaustively analyze both pathologic conditions and present the differences between them. Methods: A detailed search was carried out in PubMed of studies on humans from 1946 to March of 2017 in any language and including the keywords microscopic fat embolism and macroscopic fat embolism with either liposuction or gluteal lipoinjection. The articles found were selected according to the search criteria and were analyzed to provide the final data and recommendations. Results: Of the 1245 and 26 articles that were found on complications related to liposuction and gluteal lipoinjection, respectively, only 41 on liposuction and microscopic fat embolism and seven on gluteal lipoinjection and microscopic fat embolism met the specific criteria for inclusion in the analysis. Only two articles on liposuction and two on gluteal lipoinjection referred to macroscopic fat embolism as a complication. Conclusion: Although microscopic fat embolism and macroscopic fat embolism are pathologic conditions with high morbidity and mortality rates in association with liposuction and gluteal lipoinjection, few reports about them exist; therefore, the authors made recommendations based on this study for their diagnosis, prevention, and treatment.Fermentation products in the cystic fibrosis airways induce aggregation and dormancy-associated expression profiles in a CF clinical isolate of Pseudomonas aeruginosa
Abstract
Pseudomonas aeruginosa is a well-known dominant opportunistic pathogen in cystic fibrosis (CF) with a wide range of metabolic capacities. However, P. aeruginosa does not colonize the airways alone, and benefits from the metabolic products of neighboring cells—especially volatile molecules that can travel between different parts of the airways easily. Here, we present a study that investigates the metabolic, gene expression profiles, and phenotypic responses of a P. aeruginosa clinical isolate to fermentation products lactic acid and 2,3-butanediol, metabolites that are produced by facultative anaerobic members of the CF polymicrobial community and potential biomarkers of disease progression. Although previous studies have successfully investigated the metabolic and transcriptional profiles of P. aeruginosa, most have used common lab reference strains that may differ in important ways from clinical isolates. Using transcriptomics and metabolomics with gas chromatography time of flight mass spectrometry (GCTOF-MS), we observe that fermentation products induce pyocyanin production along with expression of genes involved in P. aeruginosa amino acid utilization, dormancy and aggregative or biofilm modes of growth. These findings have important implications for how interactions within the diverse CF microbial community influence microbial physiology, with potential clinical consequences.Effect of clarification pH of sorghum juice on the composition of essential nutrients for fermentation
Abstract
The growing demand to replace fossil fuels with renewable alternatives has generated an urgent and imminent global need to find new non-fossil sources. Sweet sorghum is widely recognized as a highly promising biomass energy crop with particular potential to complement sugarcane for ethanol production. Our aim in this study was to evaluate the influence of pH during the clarification method on the composition of essential nutrients in the sorghum juice and how this affects the efficiency of the ethanol fermentation process. We found that a higher pH directly affected residual concentrations of key nutrients (P, Ca, Zn, Mn) and as a consequence the efficiency of ethanol fermentation. In conclusion we recommend a clarification procedure at pH 6–6.5 in order not to significantly affect nutritional parameters important for the yeast fermentation process.Effect of ethanol and butanol on autotrophic growth of model homoacetogens
Abstract
Research efforts aimed at increasing ethanol and butanol productivity from syngas are currently gaining attention. For most model carboxydotrophic bacteria, production rates, yields and maximum product titers have been studied in detail, but little is known on alcohol toxicity in these bacteria. The aim of this work was to investigate the inhibitory effects of ethanol and butanol on the growth of Clostridium ljungdahlii PETC, Clostridium carboxidivorans P7, and 'Butyribacterium methylotrophicum DSM3468'. Experiments to determine inhibitory effects due to product accumulation were carried out using a synthetic mixture of CO:CO2:H2 as a substrate. These conditions were chosen to mimic gaseous effluents of biomass and waste gasification plants. Inhibition effects were recorded as changes in growth parameters. No significant inhibition was observed for ethanol at concentrations below 15 g/L. The three species exhibited higher sensitivity to butanol. Half inhibition constants for butanol could be estimated for P7 (IC50 = 4.12 g/L), DSM3468 (IC50 = 1.79 g/L), and PETC (IC50 = 9.75 g/L). In conclusion, at least for the tested strains, there is no urgent need to overcome alcohol inhibition in eventual industrial production of alcohols from syngas fermentation.
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Does CBD Oil Lower Blood Pressure? This article was originally published at SundayScaries." Madeline Taylor POSTED ON January 13, 20...
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
