PURPOSE: Lymphoscintigraphy (LS) is often obtained prior to sentinel lymph node biopsy (SLNB), especially in areas likely to have multiple or aberrant drainage patterns. This study aims to determine the incidence and characteristics of melanoma patients with a negative LS and to review the management options and surgical recommendations. METHODS: This is a retrospective study of patients with primary cutaneous melanoma who underwent SLNB between 2005 and 2016. Patients with nonvisualized lymph nodes on preoperative LS were compared in a 1:4 ratio with a randomly selected unmatched cohort drawn from all melanoma patients who underwent preoperative LS within the time period of the study. Demographic, clinical and outcome data were compared between these groups. RESULTS: A negative LS was seen in 2.3% of all cases (25 in 1073). In both univariate and multivariate analyses, predictive patient and tumor-specific factors for negative LS included older age and head and neck location. Patients with a non-visualized SLN had significantly worse overall survival compared with patients who had a visualized SLN, but there was no difference in melanoma-specific survival. In 16 of the 25 cases (64%), at least one SLN was found intraoperatively despite the negative LS. CONCLUSION: Older patients with head and neck melanomas are more likely to experience nodal nonvisualization on LS. In patients who have nodal nonvisualization, the surgeon should attempt SLNB at the time of excision of the primary lesion since a SLN can still be found in a majority of cases, and it offers prognostic information. CONFLICTS OF INTEREST AND SOURCE OF FUNDING: None of the authors have a financial interest in or a commercial association with any of the products, devices, or drugs mentioned in this manuscript. There was no source of funding for this manuscript. CORRESPONDING AUTHOR: Dr. Deepak Narayan, Yale University School of Medicine, Section of Plastic Surgery, 330 Cedar Street, P.O. Box 208041, New Haven, CT, 06520-8041, United States. Phone number: (203) 785-2570, Fax number: (203) 785-5714, deepak.narayan@yale.edu ©2018American Society of Plastic Surgeons
Τρίτη 17 Ιουλίου 2018
“Anatomic Basis of the Gastroepiploic Vascularized Lymph Node Transfer: A Radiographic Evaluation Using Computed Tomography Angiography (CTA)”
PURPOSE: The omentum, nourished by the gastroepiploic vessels, has gained popularity as an option for vascularized lymph node transfer (VLNT). The anatomy of the gastroepiploic vessels, omentum, and lymph nodes (LN) has not been investigated. The purpose of this study is to describe the right gastroepiploic artery (GEA) and related structures by using computed tomography angiography (CTA). MATERIALS AND METHODS: A retrospective analysis was conducted on 34 patients who received CTA. Statistical models were applied to identify right GEA and LN anatomical characteristics. RESULTS: The right GEA was identified in 33 of 34 patients. It was found to have a diameter of 2.49mm at its origin (SD 0.66). The gastroduodenal artery length prior to right GEA takeoff was 3.09cm (SD 1.31). Twenty-five patients had lymph nodes in the right GEA lymphosome. There were 2.7 LNs identified per patient (SD 2.12). The distance from the right GEA origin to the most proximal LN was 3.99cm (SD 2.21). The distance from the GEA origin to the third LN was 9.12cm (SD 5.06). Each LN was within 7.00mm (SD 6.2) of the right GEA. CONCLUSIONS: When using the right GEA donor site for VLNT, the plastic surgeon should anticipate using a pedicle length of 4cm, a total flap length of 9cm with 3cm of surrounding tissue in order to obtain at least 3 lymph nodes for transfer. CTA is an effective imaging modality that can be used for patient-specific surgical navigation prior to vascularized lymph node transfer. Financial Disclosure Statement: Ketan Patel is a consultant for Novadaq Corp and receives textbook royalties from Elsevier Corp. All other authors have no disclosures. Corresponding Author: Ketan M. Patel, M.D., Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, ketan.patel@med.usc.edu ©2018American Society of Plastic Surgeons
Comparison of Pediatric Intercalary Allograft Reconstructions With and Without a Free Vascularized Fibula
Introduction: Lower extremity intercalary allograft reconstruction has traditionally been used to facilitate limb salvage. Combing the allograft with a vascularized fibula graft (FVFG) has been described; however there is a paucity of data comparing the outcome of these reconstructions. Material and Methods: 29 pediatric patients (15 males, 14 females) underwent lower extremity limb salvage with the use of intercalary cadaveric allograft at a mean age of 12 years. The most common diagnosis was osteosarcoma (n=18). Patients were reconstructed with an allograft alone (n=11) or supplemented with a FVFG (n=18). Results: The mean time to union of the allograft was 11 months, with 10 patients requiring additional bone grafting. There was no difference in the need for an additional bone graft (OR 0.87, P=1.0) between patients with a FVFG and those without. The allograft was revised in 3 patients due to fracture (n=2) and fracture and infection (n=1). In all these patients the allograft was not supplemented with a FVFG (P
Correlation between Quantity of Transferred Lymph Nodes and Outcome in Vascularized Submental Lymph Node Flap Transfer for Lower Limb Lymphedema
Background: Vascularized lymph node transfer (VLNT) has shown promising results in the treatment of lower limb lymphedema, but little is known about the number of lymph nodes needed for the transfer to achieve optimal results. This study investigated the correlation between number of transferred lymph nodes in submental VLNT and outcomes regarding limb circumference reduction and cellulitis incidence. Methods: Thirty-five patients who had received submental VLNT to an ankle for lower limb lymphedema, post-gynecological cancer treatment, were included in the study. Limb circumference was determined via tape measurement pre- and postoperatively and was used to calculate the circumferential difference. Ultrasonography was performed postoperatively to determine the number of lymph nodes within the transferred flap. Patients were divided into groups A-C depending on the number of transferred lymph nodes: 1-2 (n=10), 3-4 (n=14) and 5-8 (n=11), respectively. Results: The mean age was 60.0 ± 9.2 years. All flaps survived. The mean improvement of circumferential difference for the whole cohort was 19.8 ± 9.2 %. Groups B and C both had significantly higher improvements in the circumferential difference than group A (p=0.04 and p=0.02, respectively), but when compared to each other, the difference was non-significant. All groups had significant reductions in cellulitis incidence postoperatively. Conclusions: Submental VLNT for lower limb lymphedema reduced the incidence of cellulitis, regardless of the number of transferred lymph nodes. The transfer of 3 or more lymph nodes provided significantly better outcome regarding limb circumference reduction than the transfer of 2 or fewer lymph nodes. FINANCIAL DISCLOSURE STATEMENT: The authors have nothing to disclose. No funding was received for this article. AUTHOR CONTRIBUTIONS: JG and MHC were responsible for the study idea, design and follow-through. JG, SYC and WHC were responsible for data collection. All authors were involved in the interpretation of results. JG and MHC were responsible for statistical analysis. All authors were involved in critical review and approval of the final result. IRB NUMBER: 101-3481B ACKNOWLEDGMENTS: The authors would like to thank Miffy Chia-yu Lin, M. Sc., for her assistance in the preparation of tables and figures for this manuscript. CORRESPONDING AUTHOR: Ming-Huei Cheng, MD, MBA, FACS, Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Center of Tissue Engineering, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan , Telephone: +886 3 281200 ext. 2172, Fax: +886 3 3972681, E-mail: minghueicheng@gmail.com, minghuei@adm.cgmh.org.tw ©2018American Society of Plastic Surgeons
Influence of Repaired Cleft Lip and Palate on Layperson Perception following Orthognathic Surgery
Background: Facial scarring and disharmony due to clefting is associated with psychosocial stress which may be improved by orthognathic surgery. The authors examine how a history of clefting influences change in layperson perception of a patient following orthognathic surgery. Methods: 1000 laypeople were recruited through Mechanical Turk to evaluate patient photographs pre- and post-orthognathic surgery. Nineteen patients – 5 with unilateral and 4 with bilateral clefting – were included. Respondents assessed 6 personality traits, 6 emotional expressions, and likelihood of 7 interpersonal experiences on a scale from 1-7. Results: Using Mann-Whitney U and independent samples t-tests, changes in all aspects of social perception post-procedure differed significantly between cleft vs. non-cleft cohorts (p
“Incidents of Mandibular Distraction Osteogenesis for Hemifacial Microsomia.”
Background: This article mainly focused on the safety and unexpected incidents of mandibular distraction osteogenesis in treating patients with hemifacial microsomia. Methods: Records of 71 patients with hemifacial microsomia treated by mandibular distraction osteogenesis from February 2010 to March 2015 were examined in this retrospective study. The modified mandibular osteotomy was conducted under the assistance of three-dimensional (3D) reconstruction, computer-aided design and rapid prototyping technique. Distraction was conducted 4-7 days postoperatively at a frequency of 1 mm/d; moreover, the distractor was kept in place for 4 to 13 months after the first operation before it was removed. The scope of distraction ranged from 20 to 40 mm. All incidents encountered during and following the mandibular distraction process were documented in the medical records of patients. The patients were followed up for an average of 34.4 months after the second-stage operation. Results: The overall rate of incidents was 36.6%. Of them, minor incidents, which could be resolved with or without noninvasive therapy, were observed in 18.3% of all procedures in this series. Meanwhile, the rate of moderate incidents necessitating invasive therapy was reported to be 12.7%, while that of major incidents that could not be resolved with invasive therapy was 5.6%. Conclusions: Mandibular distraction osteogenesis is a widely used procedure for treating patients with hemifacial microsomia. It is extremely important to be fully aware of variety of incidents occurring during and following the surgical procedure to minimize the incidence of such incidents. Financial Disclosure Statement: All authors has no financial conflict to disclose. The study was funder by Special Fund for Scientific Research in the Public Interest from National Health and Family Planning Commission of the People's Republic of China (No. 201502016), and 2015 Major Project of School/Institution of Plastic Surgery Hospital, Chinese Academic of Medical Sciences (No.Z2015008). Corresponding author: Zhiyong Shi, MD, Department of maxillofacial surgery, Plastic Surgery Hospital (Institude), Chinese Academy of Medical Sciences, Peking Union Medical College; No.33 Badachu Road, Shijingshan District, Beijing, 100144, China. zhangzy1011@163.com ©2018American Society of Plastic Surgeons
“Interposition Vein Grafting in Head and Neck Free Flap Reconstruction”
Background: Many surgeons are hesitant to use interposition vein grafting in head and neck microvascular free flap surgery due to concerns for elevated risk of flap loss. Methods: We conducted a review of patients who underwent head and neck free flap reconstruction between 2005 and 2015. The effect of vein grafts on flap compromise and flap loss were analyzed using univariate and multivariate models. Results: A total of 3240 free flaps were performed. Vein grafts were used in 241 flaps (7.4%). The free flap compromise rate was 14.5% with vein grafts and 3.4% without vein grafts (p
Long-term results in isolated metopic synostosis- the Oxford experience in 22 years.
Background: Metopic synostosis causing trigonocephaly is treated by fronto-orbital-advancement and remodelling to correct the deformity, cerebral distortion and to treat intracranial hypertension in a small number of cases. This study's aim was to evaluate complications, revisions and long-term outcomes. Methods: A retrospective chart review was performed on consecutive metopic craniosynostosis patients treated between February 1995 and February 2017 at the Oxford Craniofacial Unit. Results: 245 patients with isolated metopic synostosis were seen. 202 patients underwent fronto-orbital-advancement and remodelling. 50 (25%) female; 152 (75%) male. Mean age at surgery was 16.8 months. Mean weight preoperatively was 12kg. All patients received blood transfusion. Mean postoperative stay was 6 days. Average follow-up time was 8 years (range 0.5-22 years). There were 8 (4%) major complications. 6 (2.9%) patients required secondary calvarial-expansion for late raised intracranial pressure. 31 (15%) had other subsequent procedures including wire removal (8%) and forehead shape contouring (4%) with alloplastic onlay. Raised intracranial pressure prior to surgery was confirmed in 2 cases by intracranial pressure monitoring. Conclusion: Trigonocephaly is caused by metopic synostosis and is treated by fronto-orbital advancement and remodelling in order to restore both internal and external skull configuration. Following surgery, we identified a 2.9% risk of late raised intracranial pressure requiring a secondary calvarial-expansion, necessitating prolonged follow up in all cases. Temporal hollowing and forehead contour defects were not uncommon, resulting in a need for onlay recontouring in selected cases. This is the largest reported series of metopic synostosis. Financial disclosure statement: The authors have no financial disclosures. Presented at: 17th biennal congress of the International Society of Craniofacial Surgery (ISCFS), 24th-28th October 2017, Cancun, Mexico. Correspondence should be address to: Hamidreza Natghian M.D., Oxford Craniofacial Unit, Level LG1, West Wing, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU, Oxford, United Kingdom. Email: Hamidreza.natghian@gmail.com ©2018American Society of Plastic Surgeons
“Targeted Muscle Reinnervation in the Lower Leg: An Anatomic Study.”
Introduction: Targeted muscle reinnervation (TMR) re-routes the ends of cut nerves to re-innervate small motor nerves of nearby muscles, with the goal of reducing neuroma pain and/or improving prosthesis function. Anatomical roadmaps for TMR have been established in the upper extremity and thigh, but not for the lower leg. Methods: The major branch points (MBPs) of motor nerves and the motor entry points (MEPs) to muscles of the leg were dissected in five cadaver specimens. Leg length was defined as distance from lateral femoral condyle to lateral malleolus. The distances from the lateral femoral condyle to MBPs and MEPs were recorded as a percentage of leg length to identify targets for TMR. Results: The tibialis anterior and extensor digitorum longus were both acceptable targets in the anterior compartment, with an average 4.4 MEPs within 10-80% and 3 MEPs within 20-80% leg length, respectively. The peroneus longus was the best target in the lateral compartment, with an average 5.8 MEPs within 20-70% leg length. The gastrocnemius and soleus were both acceptable targets in the superficial posterior compartment, with an average 4.4 MEPs within 0-40% and 6.2 MEPs within 20-80% leg length, respectively for each muscle. The flexor digitorum longus was the best target in the deep posterior compartment, with an average 6 MEPs within 30-90% leg length. Conclusions: TMR is technically feasible in the lower leg. This cadaveric study provides a roadmap for incision placement and identification of motor nerve targets. Financial Disclosure Statement: Dr. Ko is a speaker for Checkpoint Surgical, Cleveland OH. Dr. Dumanian is a speaker for Axogen, Inc. Alachua, FL. No funding was received for this article. Corresponding author: Gregory Dumanian, MD, ivision of Plastic Surgery, Northwestern Memorial Hospital, 675 N. St. Clair St, Suite19-250, Chicago, IL 60611 USA. email: gdumania@nm.org ©2018American Society of Plastic Surgeons
Sphenoid Dysplasia in Neurofibromatosis: Patterns of Presentation and Outcomes of Treatment
Introduction: Sphenoid wing dysplasia in patients with neurofibromatosis type 1 (NF-1) may result in challenging and significant changes, including ultimately vision loss. We describe the radiographic patterns of sphenoid dysmorphology with time and age, and the impact of surgical intervention on preservation of vision. Methods: A retrospective study was performed at a single pediatric hospital, identifying subjects with NF-1. Records were reviewed in their entirety for each subject, with attention to opthamalogic evaluation. Radiographic images were digitally analyzed and scored for sphenoid transformations on a grade of 0-3. Results: Fifty-two subjects were identified. On initial imaging, 42.31% had a normal sphenoid (grade 0), 32.69% had an abnormal contour (grade 1), 11.54% had thinning (grade 2), and 13.46% had a gross defect (grade 3). Among the 45 subjects with serial imaging, 55.56% demonstrated progression of the deformity of at least one grade. Deformity progression correlated with length of imaging interval. Enucleation was noted to occur more often in subjects with a gross sphenoid defect (p
Leaching of metals from asphalt pavement incorporating municipal solid waste incineration fly ash
Abstract
Rising municipal solid waste incineration (MSWI) makes it imperative to recycle the fly ash (FA). FA can be solidified by asphalt and then applied in the asphalt road. However, little information on the metal leaching and associated with risks from asphalt solidified forms for FA is available. In the present study, metal leaching characteristics and long-term leaching potential from the asphalt-based FA matrices was determined based on the national standard method and simulating the actual using of the solidified forms in highways, respectively. The immobilization effect of asphalt on MSWI FA is well. Leaching velocity was in the order of magnitude of 10~10−6 cm h−1 during the entire leaching period. At the early age, leaching velocity of metals is high, especially Zn, Cd, and Ba. Cumulative leaching concentration of metals and leaching time has positive correlation. Only considering the leaching of simulating acid, leaching of metals in asphalt-based matrices is very slow, and the leaching toxicity of metals is lower than the Chinese National Standard.
Real-world cost-effectiveness of cetuximab in the third-line treatment of metastatic colorectal cancer based on patient chart review in the Netherlands
To assess the cost effectiveness of cetuximab in third-line treatment of patients with KRAS wild-type (wt) metastatic colorectal cancer (mCRC) in routine clinical practice compared with best supportive care (BSC)...
Pilomatricome : corrélation dermatopathologie-dermatoscopie
Publication date: Available online 17 July 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): P. Huet, G. Barnéon, B. Cribier
Fabrication of pure and moxifloxacin functionalized silver oxide nanoparticles for photocatalytic and antimicrobial activity
Publication date: Available online 17 July 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Sirajul Haq, Wajid Rehman, Muhammad Waseem, Vera Meynen, Saif Ullah Awan, Shaukat Saeed, Naseem Iqbal
Abstract
This paper reports the synthesis of silver oxide (Ag2O) and moxifloxacin functionalized silver oxide (M-Ag2O) nanoparticles for photocatalytic and antimicrobial activity. The Ag2O nanoparticles were synthesized by using 2 dimethyl amino ethanol as reducing agent. The BET surface area measured from N2 adsorption method was found to be 16.89 m2/g. The mix (cubic and hexagonal) phase of silver oxide (Ag2O) nanoparticles was confirmed by X-rays diffraction (XRD). The extra diffracted peaks were observed after moxifloxacin fictionalization. The scanning electron micrographs display spherical shaped particles of different sizes. The elemental composition and weight percent of both samples were studied by energy dispersive X-ray (EDX). The decrease in the weight percent of silver with the subsequent increase in the weight percent of carbon and oxygen revealed the successful loading of moxifloxacin onto Ag2O NPs. The two stages of weight loss due to the removal of physisorbed and chemisorbed water was examined during thermogravimetric analysis (TGA). The optical band gap derived from the diffuse reflectance spectrum (DRS) was 1.83 eV, which corresponds to the transmittance edge of 676 nm. The Fourier transform infrared (FTIR) band at 668.56 cm−1 confirms the successful synthesis of moxifloxacin functionalized silver oxide (Ag2O) nanoparticles. The pure Ag2O nanoparticles were used for the degradation of rhodamine 6G and 98.56% dye was degraded in 330 min. The bacterial species selected for the present study were Bacillus subtilis, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Candida albicans and Aspergillus Niger. Both pure and functionalized Ag2O NPs were screened against selected bacterial and fungal species and they showed improved activity with the volume of samples taken in wells. However, the activity of Ag2O NPs against fungi was found less effective than bacteria which may be due to the difference in the composition of the cell wall. Further gram-positive bacteria showed more resistance toward both samples as compared to the gram-negative bacteria. It was concluded that Ag2O NPs upon conjugation with moxifloxacin displayed promising antimicrobial activity.
Less painful and effective intralesional injection method for lichen simplex chronicus
Publication date: Available online 17 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Han Mi Jung, Sung Hye Eun, Ji Hae Lee, Gyong Moon Kim, Jung Min Bae
Femoral artery ultrasound for improving the detection of atherosclerosis in psoriasis
Publication date: Available online 17 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Alvaro Gonzalez-Cantero, Jorge Gonzalez-Cantero, Ana Isabel Sanchez-Moya, Cristina Perez-Hortet, Salvador Arias-Santiago, Jose Luis Martin-Rodriguez, Cristina Schoendorff-Ortega, Jorge Luis Gonzalez-Calvin
Early Stage Melanoma and Hematopoietic Stem Cell Transplantation Outcomes
Publication date: Available online 17 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Charles J. Puza, Paul J. Mosca, Adela R. Cardones
Bullous disorders associated with anti-PD-1 and anti-PD-L1 therapy: A retrospective analysis evaluating the clinical and histopathologic features, frequency, and impact on cancer therapy
Publication date: Available online 17 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Jacob Siegel, Mariam Totonchy, William Damsky, Juliana Berk-Krauss, Frank Castiglione, Mario Sznol, Daniel P. Petrylak, Neal Fischbach, Sarah B. Goldberg, Roy H. Decker, Angeliki M. Stamatouli, Navid Hafez, Earl J. Glusac, Mary M. Tomayko, Jonathan S. Leventhal
Abstract
Background
Bullous disorders associated with anti-PD-1/PD-L1 therapy are increasingly reported and may pose distinct therapeutic challenges. Their frequency and impact on cancer therapy are not well established.
Objective
To evaluate the clinical and histopathologic findings, frequency, and impact on cancer therapy of bullous eruptions due to anti-PD-1/PD-L1 therapy.
Methods
We retrospectively reviewed the medical records of patients evaluated by the onco-dermatology clinic and consultative service of Yale New Haven Hospital from 2016 to 2018.
Results
We identified 9 patients who developed bullous eruptions of 853 patients (∼1%) treated with anti-PD-1/PD-L1 therapy at our institution during the study period: 7 presented with bullous pemphigoid, 1 presented with bullous lichenoid dermatitis, and 1 presented with linear IgA bullous dermatosis in the context of vancomycin therapy. 8 patients required systemic steroids, 5 required maintenance therapy, and 8 required interruption of immunotherapy. All 9 patients had an initial positive tumor response or stable disease, but 4 went on to develop disease progression.
Limitations
This was a retrospective study from a single tertiary care center.
Conclusion
Bullous disorders developed in approximately 1% of patients treated with anti-PD-1/PD-L1 therapy at our institution and frequently resulted in interruption of immune therapy and management with systemic corticosteroids and occasionally steroid-sparing agents.
Combination of paromomycin plus human anti-TNF-α antibodies to control the local inflammatory response in BALB/ mice with cutaneous leishmaniasis lesions
Cutaneous leishmaniasis (CL) is caused by a broad range of species of the genus Leishmania. In the skin lesions that appear following the phlebotomine bite, pro- and anti-inflammatory cytokines play different roles in resistance/susceptibility and determine the immunopathogenesis of Leishmania spp. infection [1]. Therefore, T helper 1 (Th1) inflammatory cytokines, especially interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and interleukin (IL)-12, are crucial in the initiation of protective immunity against L.
Religion and the Plastic Surgeon: an Imam, a Minister, and a Rabbi Walk into a Surgical Centre
Abstract
Cultural competency has become a keystone in forming a successful doctor–patient relationship to provide culturally appropriate services that respect patients' ethno-cultural beliefs, values, attitudes, and conventions. In cosmetic surgery, an often-overlooked aspect of a patient's cultural is his and her religious beliefs. In response to this paucity of resources for cosmetic surgeons to enable them to properly service their religious patients, this project was undertaken. This review article covers the three main Abrahamic religions (Judaism, Christianity, and Islam) and was written with the assistance of a prominent bioethicist from each religion (see Acknowledgements). In discussing each religion, the article has been divided into two sections. The first section is a general overview of the religion's relationship with cosmetic surgery as summary provided by the consulting bioethicist. The second portion is an annotated review of additional resources providing the reader further details on that religion. For example, our bioethicists provide a general perspective on Christianity as a whole, and the annotated review focuses on differences between Catholics and Protestants. We recognize the heterogeneity that is inherent in religion and the cultural and geographic biases that affect it. However, we aim to provide the reader a broad and basic foundation of the relationship between Judaism, Christianity, and Islam with cosmetic surgery to begin to create common ground between the physician and the patient and improve the process of shared decision-making and thus our outcomes. This paper should be seen as a foundation to build upon rather than an authoritative source, and specific patient concerns should be addressed with the patient's own religious advisor.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Performance of ceria/iron oxide nano-composites based on chitosan as an effective adsorbent for removal of Cr(VI) and Co(II) ions from aqueous systems
Abstract
A novel chitosan/ceria/iron oxide (CS/ceria/Fe3O4) nano-composite adsorbent was synthesized for removal of Cr(VI) and Co(II) ions from aqueous systems in a batch system. The adsorbents were characterized by field emission scanning electron microscopy (FESEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), transmission electron microscopy (TEM), thermal gravimetric analysis (TGA), and Brunauer- Emmett-Teller (BET) analyses. The behavior of swelling kinetics was also studied. The effect of several adsorption parameters including CeO2 and Fe3O4 contents, initial pH, contact time, initial Cr(VI) and Co(II) concentration, and temperature on the adsorption capacity was studied. The double exponential model revealed a better fit with the kinetic data of Cr(VI) and Co(II) ions. The Cr(VI) and Co(II) adsorption process well fitted the Langmuir model. The maximum adsorption capacities estimated from Langmuir isotherm model were 315.4 and 260.6 mg/g for Cr(VI) and Co(II) ions, respectively. Also, thermodynamic parameters were used to distinguish the nature of Cr(VI) and Co(II) adsorption. The reusability of CS/ceria/Fe3O4 nano-composite was evaluated with stripping agents of 0.1 M NaOH and 0.1 M HNO3. Finally, the evaluation of Cr(VI)-Co(II) coexisting system confirmed that the presence of Co(II) ions played an inhibitor role on the Cr(VI) adsorption.
A Randomized, Placebo-Controlled, Double-Blind, Prospective Clinical Trial of Botulinum Toxin Type A in Prevention of Hypertrophic Scar Development in Median Sternotomy Wound
Abstract
Background
Linear hypertrophic scar is a common surgical problem that can be difficult to manage, especially for the median sternotomy scar. Botulinum toxin type A (BTA) is widely used in cosmetic surgery and has been shown to improve scar quality recently. The aim of this study was to evaluate the efficacy of BTA injected in the early postoperative of median sternotomy on preventing scar formation.
Methods
In this prospective randomized controlled trial, 19 consecutive patients who underwent median sternotomy were enrolled. The median sternotomy wound in each patient was divided into the upper half and the lower half. Both halves of the wound were randomized to receive the treatment with either BTA or normal saline. At 6-month follow-up, scars were assessed using the Vancouver Scar Scale, scar widths were measured, and patients were asked to evaluate their overall satisfaction.
Results
Seventeen patients with median sternotomy wounds completed the entire study. At 6-month follow-up, the mean Vancouver Scar Scale score for the BTA-treated group was 3.44 ± 1.68 and for the normal saline control group was 6.29 ± 2.39, and there was a statistically significant difference between the two groups (P < 0.05). There were also significant improvements in scar width and patient satisfaction for the BTA-treated halves of the wounds (P < 0.05).
Conclusions
The study demonstrates that early postoperative BTA injection can decrease scar formation and reduce scar width in median sternotomy wounds, and the overall appearance is more satisfactory.
Level of Evidence I
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Systematic Review of Quality-of-Life Measurement After Aesthetic Rhinoplasty
Abstract
Introduction
The assessment of outcomes in aesthetic rhinoplasty is highly relevant because patient satisfaction and improved health-related quality of life (QoL) are the predominant factors in determining success. The patient-reported outcome measures (PROMs) employed in rhinoplasty research studies are remarkably diverse, thus yielding difficulties with data analysis. The aim of this article is to provide a comprehensive review of the literature to reveal the relevance of the QoL assessment for rhinosurgeons.
Methods
A systematic literature search with the terms "Rhinoplasty" and "Quality of Life" was conducted using PubMed/MEDLINE, Google Scholar and Cochrane databases. Primarily, all publications related to QoL following aesthetic rhinoplasty between 2002 and 2017 were identified. As a secondary selection, we focused on articles with a prospective study design, a significant cohort size (at least 50 patients) and a follow-up period of at least 6 months after aesthetic rhinoplasty.
Results
A total of 62 PROM studies assessing QoL following aesthetic rhinoplasties were obtained. We ascertained an increasing publication rate of QoL articles over the last 15 years. Only 17 studies satisfied comprehensive inclusion criteria of a high qualitative study selection. The Rhinoplasty Outcome Evaluation was the most frequently used QoL questionnaire of the secondary selection (70.6%). The total number of 16 various questionnaires exhibit high heterogeneity.
Conclusion
Our data strengthen the increasing importance of the assessment of QoL after rhinoplasty. Despite a lack of reliable publications with considerable heterogeneity and large variability in outcomes, functional-aesthetic rhinoplasty leads to a significant improvement of patient's health-related QoL.
Level of Evidence II
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Surfactants in the sea surface microlayer, subsurface water and fine marine aerosols in different background coastal areas
Abstract
This study aims to determine the concentrations of surfactants in the surface microlayer (SML), subsurface water (SSW) and fine mode aerosol (diameter size < 1.5 μm) at different coastal stations in Peninsular Malaysia. The concentrations of anionic and cationic surfactants were determined through colorimetric methods as methylene blue active substances (MBAS) and disulphine blue active substances (DBAS), respectively. Water-soluble ions, for the determination of fine mode aerosol sources, were determined using ion chromatography (IC) for anions (SO42−, NO3−, Cl− and F−) and cations (Na+, K+, Ca2+ and Mg2+). Principal component analysis (PCA), combined with multiple linear regression (MLR), was used to identify the possible sources of surfactants in fine aerosol. The results showed the concentrations of surfactants as MBAS and DBAS in the SML ranged between 0.23 ± 0.03 and 0.35 ± 0.01 μmol L−1 and between 0.21 ± 0.02 and 0.29 ± 0.01 μmol L−1, respectively. The enrichment factors (Efs) ratios between MBAS and DBAS in the SML and SSW ranged between 1.04 ± 0.01 and 1.32 ± 0.04, respectively. The station that is located near to tourism and industrial activities recorded the highest concentrations of surfactants in SML and SSW. The concentrations of surfactants in fine aerosol ranged between 62.29 and 106.57 pmol m−3. The three possible sources of fine aerosol during the northeast monsoon were aged sea spray/biomass burning (which accounted for 69% of the atmospheric aerosol), nitrate/mineral dust (23%) and sulphate/fresh sea salt (8%). During the southwest monsoon, the three main sources of atmospheric aerosol were biomass burning (71%), secondary inorganic aerosol (23%) and sea spray (6%). This study suggests anthropogenic sources are main contributors to the concentrations of surfactants in SML, SSW and fine aerosols.
Ecological and human health risk assessments in the context of soil heavy metal pollution in a typical industrial area of Shanghai, China
Abstract
The purpose of this study was to identify the concentrations, sources, and potential ecological and health risks of heavy metals in soils from a typical industrial area in Shanghai, China. A total of 28 surface soil samples were collected and analyzed for As, Cd, Cr, Cu, Pb, Ni, Zn, and Hg from the BAO steel industry in June and July 2016. Classic multivariate statistical and geostatistical analysis methods were used to detect the sources of heavy metals, and the ecological risk index (RI) and hazard index (HI) were calculated to assess the potential ecological and health risks. The results showed significant pollution levels, which were derived from the industrial production process and closely related to the spatial layout of the functional areas of the industry. The ecological risk assessment indicated that a very high concentration zone with values ranging from 2045 to 3417 mg kg−1 represented considerable ecological risk in the range of 300 to 600. The main dominant factor affecting the ecological risk is toxicity rather than concentration. The health risk assessment indicated that noncarcinogenic risk was mainly caused by Cr, and the average HI value for adults was 6.48, while it was 39.01 for children. Thus, children face higher threats to heavy metals in soils. The average carcinogenic risk values for Ni, Cr, Cd, and As were 7.97E-09, 5.2E-07, 2.1E-10, and 2.1E-09, respectively, all of which were below the threshold values (1.0E − 04). These results provide basic information for the control and environmental management of heavy metal pollution in steel industrial regions.
Assessment, Truth and Religious Studies
Abstract
This paper addresses the question of what should determine whether students' answers to closed questions are marked as correct or incorrect in the context of formal religious education, and when their answers to open ended questions should be given more or less credit. Drawing on insights from Craig Bourne, Emily Caddick Bourne and Clare Jarmy, I argue that a combination of judged truth, and a range of well-argued cases about what ought to be believed given certain premises should constrain these assessment practices. Furthermore, I argue that if we cannot find any consistent, nonarbitrary account of how judgements of correctness and merit are in fact being made in the context of formal religious education, then this tells more against current practice's inconsistency and arbitrariness than against these constraints on how judgements of correctness and merit should be made.
The Relation Between the Lower Lateral Cartilages and the Function of the External Nasal Valve
Abstract
Introduction
The position of the lower lateral cartilages (LLC) is closely related to the function of the external nasal valve (ENV). When there is a cephalic malposition of these cartilages, the nasal alae have inadequate support, which leads to ENV insufficiency during deep inspiration.
Methods
Retrospective study with 60 patients evaluated: the positioning of the LLC and the occurrence of ENV insufficiency; the effectiveness of structuring the medial and lateral walls of the ENV; and the frequency of the grafts used for structuring it.
Results
Of the 60 operated cases, 37 patients (62%) had ENV insufficiency, in 23 cases there was cephalic malposition of the LLC, and in the latter group 17 patients (74%) presented this insufficiency. A structured ENV was effective in the treatment of this insufficiency (p = 0.001). A lateral crural strut graft was performed in 24 cases (40%) of 60 patients operated. The alar contour graft was performed from 2013 to 2015 in 4 patients (22%) of 18 cases operated, and between 2016 and 2018 it was performed in 29 patients (69%) out of 42 cases. The columellar strut was routinely used from 2013 to mid-2016 in 33 cases (100%), and after that period until the present day the tongue-in-groove technique was performed in 11 cases (41%) and in the remaining 16 cases (59%) the caudal septal extension graft was performed.
Conclusion
Cephalic malposition of the LLC is an important red flag of ENV insufficiency. This insufficiency should be treated by structuring the walls of the ENV.
Level of Evidence IV
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Talking our way to systematicity
Abstract
Do we think in a language-like format? Taking the marker of language-like formats to be the property of unconstrained systematicity, this paper considers the following master argument for the claim that we do: (1) language is unconstrainedly systematic, (2) if language is unconstrainedly systematic then so is thought, (3) so thought is unconstrainedly systematic. It is easy to feel that there is something right about this argument, that there will be some way of filling in its details that will vindicate the idea that our thought must be unconstrainedly systematic given that the language in which we express it is. Clearly, however, the second premise needs support—we need a principled reason for moving from the unconstrained systematicity of language to the unconstrained systematicity of thought. This paper gives three passes at formulating such a principle. This turns out to be much harder than it might seem. We should, I conclude, resist falling too easily for the lure of this master argument for the language-like format of thought.
Investigation on spatiotemporal distribution of aerosol optical properties over two oceanic regions surrounding Indian subcontinent during summer monsoon season
Abstract
Columnar spectral aerosol optical depths (AODs) and total suspended particulate matter (TSPM) concentrations were collected on board the Oceanographic Research Vessel (ORV) of Sagar Kanya (SK) during 7–21 June 2014 (SK-313) and 31 July–14 August 2015 (SK-323) over the Arabian Sea (AS) and Bay of Bengal (BoB), respectively, for the two successive years during summer monsoon season. AOD measured at 500 nm (AOD500) varied significantly from 0.08 to 0.66 (0.07 to 0.60), with a mean of 0.48 ± 0.13 (0.34 ± 0.13) over the BoB (AS) during SK-313 (SK-323). It simply implies that aerosol load was higher over BoB, not variability as the standard deviations of AOD over both oceans are identical (0.13). Daily AOD500 ranged between 0.15 and 0.60 accounted for 70–75% of the total occurrences over two oceanic regions. Mean Ångström exponent (α or alpha) and Ångström turbidity coefficient (β or beta) were found to be 0.43 ± 0.17 (0.39 ± 0.19) and 0.37 ± 0.15 (0.27 ± 0.13), respectively, which are higher over the AS during SK-323 (SK-313) that indicate predominance of coarse-relative to fine-mode particles. On the other hand, the spectral curvature and second derivative of alpha (α′) also showed significant contribution of coarse-mode particles over fine during the two campaigns. Further, column aerosol size distribution (CSD) derived from the King's inversion also exhibited bimodal distribution with a predominant peak observed in the coarse mode (~1.0 μm) compared to the fine mode at a geometric mean radius at ~0.1 μm over two oceans. The observed data showed that the two marine regions are significantly influenced by various types of aerosols with a predominance of mixed type (MT) of aerosols. From the morphological study, it is inferred that the particles are a flake, spherical, irregular, and in flower and aggregated shapes conducted for the TSPM samples collected during SK-323 over the AS. Finally, the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model is used to study the impact of long-distance transported aerosols and identify their sources.
Multicenter, randomized controlled, observer‐blinded study of a nitric oxide generating treatment in foot ulcers of patients with diabetes—ProNOx1 study
Wound Repair and Regeneration, EarlyView.
Technical feasibility, radiation dosimetry and clinical use of 18 F-sodium fluoride (NaF) in evaluation of metastatic bone disease in pediatric population
Abstract
Purpose
The role of 18F-fluoride (18F-NaF) PET-CT for the detection of bone metastases in adults is well established and is considered superior to conventional bone scintigraphy. However, data pertaining use of 18F-NaF PET-CT in pediatric oncology is relatively sparse. The aim of the present study is to retrospectively analyze and share a single-center experience of 18F-NaF PET-CT in pediatric population and to provide preliminary information regarding imaging technique, feasibility of this modality in young patients and radiation dosimetry measurements in pediatric oncology cases.
Materials and methods
Twenty-four pediatric patients (mean age 8.0 ± 3.9) were included in the study for retrospective analysis. All patients were referred for primary staging or restaging for potential osseous metastatic disease and PET-CT scan was performed by injecting 2.2 MBq/kg (0.06 mCi/kg) of 18F-NaF.
Results
Nine patients were imaged for primary staging and in all cases increase osteoblastic activity was seen in the primary tumor and of these, metastatic bone disease was identified in 2/9 patients. In the restaging group comprising 15/24 patients, metastatic deposits were identified in 3/15 whilst no disease was seen in the remaining 12 patients. Patients were injected a mean dose of 90.35 ± 22.9 MBq with an estimated mean effective absorbed doses of 2.98 ± 0.75 mSv for 18F-NaF and 3.37 ± 2.4 mSv for CT alone. Mean cumulative effective dose of 18F-NaF PET-CT scan was 5.11 ± 2.7 mSv.
Conclusions
18F-NaF PET-CT may be a feasible alternative to 99mTc MDP for radionuclide bone scintigraphy in the evaluation of pediatric bone pathology. Due to its better pharmacokinetics, there is potential that osseous staging can be achieved with relatively low doses and with a similar radiation burden as with 99mTc-MDP imaging.
Examining Risk of Workplace Violence in Canada: A Sex/Gender-Based Analysis
Abstract
Objectives
Workplace violence (WPV) is a serious issue, resulting in significant negative health outcomes. Understanding sex/gender differences in risk of WPV has important implications for primary prevention activities. Methods
Utilizing two waves of the Canadian General Social Survey on Victimization (N = 27,643), we examined the likelihood of WPV, and sub-categories of WPV, for women relative to men. Using a sex/gender analytical approach, a series of logistic regression models examined how the associations between being a woman and each of the outcomes changed upon adjustment for work and socio-demographic characteristics. Results
After adjustment for work hours, women were at more than twice the risk of WPV compared to men (odds ratio = 2.12, 95% confidence interval 1.52–2.95). Adjustment for work characteristics attenuated, but did not eliminate this risk. Differences in associations were observed across sub-categories of violence, with adjustment for work characteristics attenuating sex/gender differences in physical WPV, but having minimal impact on sex/gender differences in sexual WPV. Conclusions
Work characteristics explain a substantial proportion of the sex/gender differences in risk of physical WPV. However, even after adjustment for work characteristics, women still showed an elevated risk relative to men for almost all types of violence (as defined by nature of the violence, sex of the perpetrator, and relationship to the perpetrator) examined in this study. Future investigations should examine why these differences between women and men remain, even within similar occupational contexts.
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
