Publication date: Available online 24 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Gaolei Zhang, Hongguang Chen, Zhen Zhen, Jianyou Chen, Sheng Zhang, Qin Qin, Xiaoyan Liu
Δευτέρα 23 Ιουλίου 2018
Methods for Decreasing the Incidence of Moist Desquamation in Patients Undergoing Radiotherapy
Publication date: Available online 24 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Raagini Suresh, Florence Yuen, Jenny E. Murase
Nail photography tricks for pediatric and geriatric patients
Publication date: Available online 24 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Sanjeev Gupta, Archana Singal, Kartikay Aggarwal, Ravi Shankar Jangra
Lightening Becker’s Nevus with Topical Glycolic Acid
Publication date: Available online 24 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Yiping Zhong, Yongjun Chen, Lining Huang, Hui Wang, Tingting Yan, Bin Yang, Mao-Qiang Man
Trans-Vertical Mastectomy With Immediate Implant-Based Reconstruction: A Retrospective, Observational Study
Abstract
Background
In women with large and ptotic breasts requiring a mastectomy and immediate, implant-based reconstruction, long flaps pose a high risk for flap ischemia and necrosis. A new trans-vertical incision for skin-reducing mastectomy is described, which reduces the skin envelope and lifts the breast. Objective
To describe the new mastectomy access incision and assess its efficacy and safety when followed by immediate implant-based reconstruction. Methods
This is a retrospective analysis of 70 consecutive patients (101 breasts) with large and ptotic breasts undergoing a unilateral (n=39; 55.7%) or bilateral (n=31; 44.3%) skin-reducing mastectomy using the trans-vertical approach, either for breast cancer or risk reduction. All received immediate one- (n=86; 85.5%) or two-stage (n=15; 14.5%) implant-based reconstruction using acellular dermal matrix. Results
Mean age was 50.1 years and mean body mass index (BMI) was 25.6 kg/m2. After a median follow-up of 4.9 years, the number of breasts with minor and major complications was 21 (20.8%) and 26 (25.7%), respectively. The most common major complications were skin-flap necrosis (n=12; 11.9%) and infection (n=8; 7.9%). All occurred within 3 months post-surgery. There were 7 cases of capsular contracture (6.9%), and 5 reconstruction failures (5.0%). Higher BMI (p<0.01) and breast weight (p<0.05) were associated with increased complication rates. According to BREAST-Q, 55/64 patients (85.9%) were somewhat or very satisfied with the aesthetic outcome. Conclusions
The trans-vertical approach is an effective, reproducible and safe alternative to conventional skin-reducing mastectomy, with favorable aesthetic outcomes, in patients with large and ptotic breasts.Association of Plasma Pentraxin-3 Levels with Retinopathy and Systemic Factors in Diabetic Patients
Metabolic Syndrome and Related Disorders, Ahead of Print.
DNA methylation-based classification of ependymomas in adulthood: implications for diagnosis and treatment
Abstract
Background
Ependymal tumors are glial tumors that commonly manifest in children and young adults. Their classification has remained entirely morphological until recently, and surgery and radiotherapy are the main treatment options, especially in adults. Here we sought to correlate DNA methylation profiles with clinical and pathological characteristics in the prospective cohort of the German Glioma Network. Methods
Tumors from 122 adult patients with myxopapillary ependymoma, ependymoma, anaplastic ependymoma, subependymoma or RELA fusion-positive ependymoma classified according to the World Heath Organization classification (WHO) 2016 were subjected to DNA methylation profiling using the Illumina HumanMethylation450 BeadChip platform. Molecular data were correlated with histologic features and clinical characteristics. Results
At a median follow-up of 86.7 months, only 22 patients experienced progression (18.0%) and 13 patients (10.7%) died. Each tumor could be assigned to one of the previously defined molecular ependymoma subgroups. All histologic subependymomas corresponded to subependymoma (SE) DNA methylation subgroups, but the reverse was not true: 19 histologic ependymomas (WHO grade II) were allocated to molecular SE groups. Similarly, all histological myxopapillary ependymomas were assigned to the molecularly defined SP-MPE class, but this molecular subgroup additionally included 15 WHO grade II ependymomas by histology. Overall, WHO grade II ependymomas distributed into seven molecular subgroups. Conclusions
Most adult patients with ependymoma show a favorable prognosis. Molecular classification may provide diagnostic and prognostic information beyond histology and facilitate patient stratification in future clinical trials. The prognostic significance of a subependymoma or myxopapillary ependymoma DNA methylation phenotype without according histology requires further study.The secreted glycolytic enzyme GPI/AMF stimulates glioblastoma cell migration and invasion in an autocrine fashion but can have antiproliferative effects
Abstract
Background
Aerobic glycolysis confers several advantages to tumor cells, including shunting of metabolites into anabolic pathways. In glioblastoma cells, hypoxia induces a flux shift from the pentose phosphate pathway towards glycolysis and a switch from proliferation to migration. The mechanistic link between glycolysis and migration is poorly understood. Since glucose-6-phosphate isomerase (GPI) is identical to the secreted autocrine motility factor (AMF), we investigated whether GPI/AMF regulates glioblastoma cell invasion. Methods
The expression and hypoxic regulation of GPI/AMF and its receptor AMFR were analyzed in glioblastoma tissues and cell lines. Functional effects were studied in vitro and in xenograft models. Results
High GPI/AMF expression in glioblastomas was found to be associated with a worse patient prognosis, and levels were highest in hypoxic pseudopalisades. Hypoxia upregulated both GPI/AMF and AMFR expression as well as GPI/AMF secretion in vitro. GPI/AFM stimulated cell migration in an autocrine fashion, and GPI/AMF expression was upregulated in migratory cells but reduced in rapidly proliferating cells. Knockdown or inhibition of GPI/AMF reduced glioblastoma cell migration but in part stimulated proliferation. In a highly invasive orthotopic glioblastoma model, GPI/AMF knockdown reduced tumor cell invasion but did not prolong survival. In a highly proliferative model, knockdown tumors were even larger and more proliferative than controls; however, perivascular invasion, provoked by simultaneous Bevacizumab treatment, was reduced. Conclusions
GPI/AMF is a potent motogen for glioblastoma cells, explaining in part the association between glycolysis and migration. Targeting GPI/AMF is, however, problematic since beneficial anti-invasive effects may be outweighed by unintended mitogenic effects.Low-Cd tomato cultivars ( Solanum lycopersicum L.) screened in non-saline soils also accumulated low Cd, Zn, and Cu in heavy metal-polluted saline soils
Abstract
Many reclaimed tidal flat soils feature high salinity and heavy metal (HM) accumulation. Consumption of vegetables cultivated in this type of cropland may cause health risks. Low-Cd tomato cultivars (Solanum lycopersicum L.) were identified in non-saline soil in our previous studies (Tan et al. 2014). However, further research should determine whether these low-Cd cultivars will maintain in the repeatability and stability in saline soil and whether they have low accumulation abilities for accompanying metals (such as Zn and Cu). A soil-pot trial was implemented to measure Cd, Zn, and Cu concentrations in low- and high-Cd cultivars of both common and cherry-type tomatoes grown on HM-polluted reclaimed tidal flat saline soil. Then, cultivar differences in dissolution of Cd, Zn, and Cu in soil and their uptake and redistribution in plants were analyzed. Results showed that the cherry type accumulated more Cd, Zn, and Cu than the common type. Low-Cd cultivars of both types in saline soil accumulated low concentrations of Cd, Zn, and Cu in fruits. Low HM accumulation in fruits is partly attributed to a low root/shoot (R/S) biomass ratio. Low amounts of soil HMs were dissolved because of the low level of rhizosphere organic compounds, which possibly decreased HM uptake by the roots. Low-Cd cultivars of both tomato types had a higher ability to retain HMs in the roots than their high-Cd cultivars. These findings may provide a scientific guidance for the safe cultivation of HM-polluted saline soils.
Three-dimensional graphene-based adsorbents in sewage disposal: a review
Abstract
A kind of graphene functional materials based on three-dimensional (3D) porous structure is a new star for environmental application in the past decades because it not only inherits the perfect carbon crystal structure of two-dimensional (2D) graphene sheets but also exhibits several advantages such as extremely low density, high porosity, and big surface area, all which enable diverse contaminants to easily access and diffuse into 3D networks, and make these materials ideal adsorbents with superior adsorptivity and recyclability. This review aims to summarize the recent progress in constructing 3D graphene-based adsorbents (3DGBAs) with two hybrid systems such as graphene/polymers and graphene/inorganic nanomaterials, and to provide a fundamental understanding of synthetic methods for interconnecting these nanostructures, structure–property relationships, and extensive applications in environmental protection towards adsorption of heavy metals, dyes, oils, and organic pollutants. Furthermore, we make a forecast on the future development opportunities and technical challenges, which is hoped to make an inspiration for the researchers to exploit a new family of graphene-based adsorption materials.
Graphical abstract
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Bleeding and splenectomy in Wiskott Aldrich syndrome: a single centre experience
Publication date: Available online 23 July 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Elizabeth Rivers, Austen Worth, Adrian J. Thrasher, Siobhan O. Burns
Elevation in histamine and tryptase following exercise in patients with mastocytosis
Publication date: Available online 23 July 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Joseph M. Kulinski, Dean D. Metcalfe, Michael L. Young, Yun Bai, Yuzhi Yin, Robin Eisch, Linda M. Scott, Hirsh D. Komarow
The frequency of post-traumatic stress disorder symptoms in athletes with and without sports related concussion
Purpose of this study is to investigate the presence and frequency of post-traumatic stress disorder (PTSD) symptoms in post-concussed (PC) athletes compared to a group of healthy control (HC) athletes.
Reproductive drugs and environmental contamination: quantum, impact assessment and control strategies
Abstract
Industrial and municipal solid wastes, noise, pesticides, fertilizers and vehicular emission are visible pollutants responsible for environmental contamination and ill-effects on health of all living systems. But, environmental contamination due to drugs or medicines used for different purposes in humans and animals goes unseen largely and can affect the health of living system severely. During the last few decades, the usage of drugs has increased drastically, resulting in increased drug load in soil and water. Contraceptive and fertility drugs are extensively and effectively used in humans as well as animals for different purposes. Usage of these reproductive drugs in humans is increased manifold to manage reproductive problems and/or for birth control with changing lifestyles. These drugs are excreted in urine and faeces as metabolite or conjugated forms, leading to contamination of water, milk and animal produce, which are consumed directly by humans as well as animals. These drugs are not eliminated even by water treatment plant. Consumption of such contaminated water, milk, meat and poultry products results in reproductive disorders such as fertility loss in men and increase risk of different types of cancers in humans. Therefore, assessment of impact of environmental contamination by these drugs on living system is of paramount importance. The purpose of this review article is to provide a comprehensive analysis of various research and review reports on different contraceptive and fertility drugs used in human and animals, their occurrence in the environment and their ill-effects on living systems. The approaches to control this invisible menace have also been proposed.
Structured reporting in petrous bone MRI examinations: impact on report completeness and quality
Abstract
Purpose
To investigate whether structured reports (SRs) provide benefits regarding the completeness and the clarity of reports, as well as regarding the satisfaction of the referring physicians compared to narrative freetext reports (NRs) of MRI examinations of the petrous bone.
Methods
After sample size calculation, 32 patients with clinically indicated MRI examinations of the petrous bone were included in this retrospective study. The already existing NRs were taken from the radiologic information system. The corresponding SRs were retrospectively generated by two radiologists using an online-based application. All 64 reports (one NR and one SR per patient) were evaluated by two head and neck physicians using a questionnaire.
Results
While 41% of the SRs showed no missing report key feature, all NRs exhibited at least one missing key feature (p < 0.001). SRs achieved significantly higher satisfaction rates regarding the linguistic quality and overall report quality compared to NRs: Using a 6-point Likert scale (1 = insufficient to 6 = excellent), SRs were rated with a median value of 6 [interquartile range (IQR): 1] for linguistic as well as overall quality, and NRs were rated with a median of 5 (IQR: 0) for linguistic as well as overall quality (p < 0.001).
Conclusions
Structured reporting of petrous bone MRI examinations may positively influence the completeness and quality of radiologic reports. Due to the easier readability and facilitation of information extraction, SRs improve the satisfaction level of the referring physicians.
Indoor and outdoor concentrations of BTEX and formaldehyde in Tehran, Iran: effects of building characteristics and health risk assessment
Abstract
BTEX (benzene, toluene, ethylbenzene, xylene) and formaldehyde are toxic compounds that can induce adverse health effect in humans. This study measured in-home and ambient concentrations of BTEX and formaldehyde across Tehran, Iran. These pollutants were sampled from the indoor and adjacent outdoor air of 45 houses (9 in each city zone) during the winter of 2015. Sampling was repeated three times for each house. The analyses were performed according to NIOSH procedures. The effect of flooring material, wall covering, ventilation system, heating system, height above ground, presence of attached garages, and distance from highways was evaluated. In addition, carcinogenic and non-carcinogenic risks of these compounds were assessed. The average indoor concentrations of benzene, toluene, ethylbenzene, xylene, and formaldehyde were 53.2, 21.5, 14.4, 21.1, and 17.9 μg/m3, respectively. The average outdoor concentrations of benzene, toluene, ethylbenzene, xylene, and formaldehyde were 43.5, 26.2, 10.0, 19.1, and 6.9 μg/m3, respectively. Separate regression models showed that wall coating, ventilation system, heating system, flat level, and distance from highways explained 29, 60, 16, 60, and 59% of the BTEX concentrations, respectively. Houses with oil painted walls and parquet flooring had higher concentrations of BTEX and formaldehyde, respectively. The health risk assessment found that the carcinogenic risks of benzene and formaldehyde exceeded 1 × 10−4 and represent a definite risk. New buildings can be designed based on the results of this study to use better materials and optimum building designs to reduce exposure to these toxic air pollutants.
Promoting effect of Nb doping on catalytic performance for deep oxidation of 1, 2-dichloroethane over (Ce,Cr) x O 2 -Nb 2 O 5 catalysts
Abstract
A series of Nb-doped (Ce,Cr)xO2-Nb2O5 mixed oxides with varying (Ce,Cr)xO2/Nb2O5 mass ratio were prepared by a co-precipitation method and evaluated for the catalytic performance of eliminating 1,2-dichloroethane (DCE). The results indicate that there exists a strong synergistic effect between acid sites and redox species in (Ce,Cr)xO2-Nb2O5 improving the catalytic activity for DCE oxidation. Appropriate Nb doping could promote the high dispersion and the interaction of metal oxides in the (Ce,Cr)xO2-Nb2O5 catalysts, resulting in the formation of more Cr6+ species with strong oxidizing ability and excellent mobility of oxygen species from bulk to surface to create more active sites for DCE deep oxidation. The (Ce,Cr)xO2-Nb2O5 catalysts with (Ce,Cr)xO2/Nb2O5 ratios of 2/1~1/2 exhibit excellent catalytic activity and durability for DCE degradation in dry air as well as benzene or water vapor, and less chlorinated byproduct is produced during the degradation of DCE.
Correlation of 4′-[methyl- 11 C]-thiothymidine uptake with human equilibrative nucleoside transporter-1 and thymidine kinase-1 expressions in patients with newly diagnosed gliomas
Abstract
Objective
We examined expressions of human equilibrative nucleoside transporter-1 (hENT1) and thymidine kinase-1 (TK1), the key enzyme in 4′-[methyl-11C]-thiothymidine (4DST) phosphorylation, to elucidate the mechanism of 4DST uptake in patients with newly diagnosed gliomas.
Methods
A total of 19 patients with newly diagnosed gliomas were examined with 4DST PET. Tumor lesions were identified as areas of focally increased uptake, exceeding that of normal brain background. For semi-quantitative analysis, tumor-to-contralateral normal brain tissue (T/N) ratio was determined by dividing the maximal standardized uptake value (SUV) for tumor by that of the mean SUV for reference tissue. The expressions of hENT1, TK1 and Ki-67 in tumor specimens were examined by immunohistochemistry and compared with 4DST T/N ratio.
Results
All but two gliomas showed focally increased 4DST uptake. All gliomas showed hENT1 staining, except one grade II glioma, which was also not visualized on 4DST PET. A significant correlation was observed between T/N ratio and hENT1 score (ρ = 0.90, p < 0.001). All gliomas showed TK1 staining, except two gliomas which were also not visualized on 4DST PET. There was a significant correlation between T/N ratio and TK1 score (ρ = 0.92, p < 0.001). There was a significant correlation between T/N ratio and Ki-67 index (ρ = 0.50, p < 0.03).
Conclusion
Results of this preliminary study indicate that expressions of hENT1 and TK1 appear to be important determinants of 4DST uptake in newly diagnosed gliomas.
Giftschlangen in Deutschland und Europa
Zusammenfassung
Schätzungen gehen von weltweit mehr als 5.000.000 Schlangenbissen pro Jahr aus; 2.500.000 von diesen führen zu Vergiftungserscheinungen, knapp 400.000 hinterlassen dauerhafte Folgen, und ca. 125.000 verlaufen tödlich. In Deutschland gibt es nur 2 Giftschlangen, die Kreuzotter und die Aspisviper. Bisse durch giftige Schlangen sind aber nicht nur in Deutschland, sondern auch auf dem gesamten Gebiet des geografischen Europa bis zum Beweis des Gegenteils stets als bedrohlicher Notfall einzuordnen. Jeder dieser Bisse sollte, selbst bei fehlender Symptomatik, für mindestens 24 Stunden überwacht werden, möglichst in einer mit der medizinischen Versorgung von Schlangenbissen vertrauten Einrichtung. Reisenden sollte dringend geraten werden, sich vor Reiseantritt über das am Reiseziel übliche Aufkommen giftiger Schlangen zu informieren
Antimicrobial resistance in mollicutes: Known and newly emerging mechanisms
Abstract
The review is devoted to the mechanisms of antibiotic resistance in mollicutes (class Bacilli, subclass Mollicutes), the smallest self-replicating bacteria, that can cause diseases in plants, animals and humans, and also contaminate cell cultures and vaccine preparations. Research in this area has been mainly based on the 'ubiquitous mollicute' and the main contaminant of cell cultures, Acholeplasma laidlawii (A. laidlawii). The 'omics' technologies applied to this and other bacteria have yielded a complex picture of responses to antimicrobials, including their removal from the cell, the acquisition of antibiotic resistance genes and mutations that potentially allow global reprogramming of many cellular processes. The review provides a brief summary of well-known resistance mechanisms that have been demonstrated in several mollicutes species and, in more detail, novel mechanisms revealed in A. laidlawii, including the least explored vesicle-mediated transfer of short RNAs with a regulatory potency. We hope that this review highlights new avenues for further studies on antimicrobial resistance in these bacteria for both a basic science and an application perspective of infection control and management in clinical and research/production settings.The treatment of perianal skin horseshoe melanoma by advancement flap (Y-V shaped) and the assessment of outcome over a long-term follow-up
Abstract
A horseshoe perianal skin melanoma was treated by cutaneous advancement flap (Y-V shaped) and the outcome was investigated over a long-term follow-up. Objects of investigation were the history taking, the preoperative work-up, the adopted surgical procedure, and the histological and immune-histochemical findings concerning additional lesions found during the follow-up. The follow-up lasted 140 months. In this patient, a previous breast cancer was diagnosed and treated. Local diffusion of soft tissue, nodes, and anal sphincter infiltration or distant metastasis were not shown preoperatively. A wide excision with an advancement flap Y-V was carried out. Histological findings showed a level II of Clark with Breslow 0.65 mm. No local or distant recurrences were found by follow-up. Sixty months later, two pigmented lesions (0.3 0.2 mm) were detected and removed. Histologically, a hyperpigmentation of the basal layer of epidermis and immunostaining with Melan-A and CD 117 confirmed the absence of any significant melanocytic proliferation. Ninety months after the first procedure, a new small cell carcinoma of the right lung was detected leading the patient to death after 140 months. The findings of this report raise issues related to plastic and reconstructive modality but also to oncological outcome. We were also able to recognize a possible compromised immune deficiency over a considerable life span. However, the occurrence of melanoma did not affect the unfavorable outcome, which was caused by other cancers.
Level of Evidence: Level V, prognostic study
The optimal timing of adipose derived stem cells injection to improve skin flap survival in a rat model
Abstract
Background
Skin flap surgery is a cornerstone in plastic surgery. However, flaps may encounter postoperative partial or complete necrosis. Different modalities have been used to enhance skin flap survival. Adipose-derived stem cells (ASCs) can promote angiogenesis and improve skin flap survival. We aimed to investigate the appropriate timing of ASC administration to get the maximal angiogenic effect and better skin flap survival in rat model.
Methods
Thirty-two male albino Wistar rats were used to study the role of ASCs on caudally based (2 × 8 cm) random pattern skin flap survival; the 32 male albino rats were equally divided into four groups according to timing of ASC injection. We applied the ASCs at three different timing, group A (local injection of ASCs along the flap axis simultaneously with flap elevation), group B (2 days preoperatively), and group C (7 days preoperatively). In the control group (group D), the flap was injected with phosphate buffered saline at the time of flap elevation. Skin flap survival was evaluated on the seventh postoperative day through percentage of flap survival, capillary density, and vascular endothelial growth factor (VEGF) expression.
Results
ASCs led to a statistically significant increase in skin flap viability when administered simultaneously with flap elevation or 2 days prior to flap elevation. This went along with significant increase in capillary density and VEGF expression. However, the ASCs had no effect on flap survival when injected 1 week prior to flap elevation.
Conclusions
We demonstrate that the skin flap viability can be enhanced by local ASC administration simultaneously with flap elevation or 2 days prior to flap elevation. Their beneficial effect is attributed to paracrine secretion VEGF which enhanced the skin flap vascularity. The angiogenic effect of ASCs can be maximized when the ASCs are injected at the time of flap elevation.
Level of Evidence: Not ratable
Correction to: Development and validation of a new assessment tool for suturing skills in medical students
The original version of this article contained a mistake in the section Development of total score for the assessment tool.
Towards standardization of training and practice of reconstructive microsurgery: an evidence-based recommendation for anastomosis thrombosis prophylaxis
Abstract
Background
Despite significant improvements in survival rates, free flap failures still occur even in experienced hands and are most commonly due to arterial or venous thrombosis. In the absence of an evidence-based guideline on the prevention of thrombosis, we reviewed the literature to assess the evidence base for commonly used interventions aimed at its prevention.
Methods
A comprehensive literature search was performed using the following keywords "free flap" and microsurgery with "pre-operative screening," "prevention of thrombosis," "ketorolac," "heparin," "low molecular weight heparin," "aspirin," "dextran," and "statins."
Results
Thirteen clinical studies were included in this review. No high-level evidence is available to support any perioperative or postoperative interventions aimed at reducing the risk of flap thrombosis.
Conclusions
Higher level studies are needed to investigate the clinical use of antithrombotic medications in microsurgery; however, given the small failure rates in modern practice, these will need to be large multicenter trials in order to reach sufficient power.
Level of Evidence: Level III, risk/prognostic study.
An enhanced fresh cadaveric model for reconstructive microsurgery training
Abstract
Background
Performing microsurgery requires a breadth and depth of experience that has arguably been reduced as result of diminishing operating exposure. Fresh frozen cadavers provide similar tissue handling to real-time operating; however, the bloodless condition restricts the realism of the simulation. We describe a model to enhance flap surgery simulation, in conjunction with qualitative assessment.
Methods
The fresh frozen cadaveric limbs used in this study were acquired by the University. A perfused fresh cadaveric model was created using a gelatin and dye mixture in a specific injection protocol in order to increase the visibility and realism of perforating vessels, as well as major vessels. A questionnaire was distributed amongst 50 trainees in order to assess benefit of the model. Specifically, confidence, operative skills, and transferable procedural-based learning were assessed.
Results
Training with this cadaveric model resulted in a statistically significant improvement in self-reported confidence (p < 0.005) and prepared trainees for unsupervised bench work (p < 0.005). Respondents felt that the injected model allowed easier identification of vessels and ultimately increased the similarity to real-time operating. Our analysis showed it cost £10.78 and took 30 min.
Conclusions
Perfusion of cadaveric limbs is both cost- and time-effective, with significant improvement in training potential. The model is easily reproducible and could be a valuable resource in surgical training for several disciplines.
Level of Evidence: Not ratable.
Direct augmented reality computed tomographic angiography technique (ARC): an innovation in preoperative imaging
Abstract
Background
Since the advent of free tissue transfer approximately 40 years ago, constant improvement particularly in the preoperative planning phase has led to flap success rate reaching 99% and improved patient outcomes. The use of imaging, such as computed tomographic angiography (CTA) or magnetic resonance angiography (MRA), for preoperative planning is now routine. However, current image modalities are restricted by being represented in two dimensions (2D) and have led to clinicians seeking novel methods of utilising the scan data, such as augmented (AR) or virtual reality (VR) and holograms. These mixed-reality devices facilitate a natural mode of visual perception and have the capacity to introduce tactile feedback. However, most AR devices are currently expensive, bulky and complicated and require tedious image registration processes. We illustrate our projector-based direct AR technique using CTA, or ARC, for preoperative planning.
Methods
Our bespoke ARC method consists of compact, affordable hardware (MacBook, Philips pocket projector and a 15-cm ruler) and free, open-source software (OsiriX). We have utilised this technique in six cases of perforator flaps of the thigh and abdomen (anterolateral thigh (ALT), transverse upper gracilis (TUG) and deep inferior epigastric artery perforator (DIEP) flaps.
Results
In all cases, 3D-reconstructed images of perforators from CTA were accurately projected onto the donor site. System calibration was rapid and convenient to use.
Conclusions
We illustrate a novel technique of projector-based AR CTA (or ARC) for preoperative planning in perforator flaps. The technique is affordable and readily reproducible.
Level of Evidence: Level IV, diagnostic study.
Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe?
Abstract
Background
Acellular matrices (AM) might enable a direct single-stage breast reconstruction procedure resulting in an improved efficacy of the reconstruction phase for patients. Safety concerns are an important issue due to a recent study which shows that single-stage breast reconstruction with Strattice™ resulted in more complications versus a two-stage reconstruction. Therefore, the goal of this study is to compare the short- and long-term complications of a single-stage breast reconstruction with the use of two types of AM (Strattice™ and Meso Biomatrix®) versus two-stage breast reconstruction without the use of an AM.
Methods
Cohort study with single-stage breast reconstruction with Strattice™ (n = 28) or Meso BioMatrix® (n = 20) or two-stage breast reconstruction without an AM (n = 36) at the Maastricht Academic Hospital, the Netherlands. All complications, in particular major complications with the need for re-admission to the hospital, re-exploration, and implant explantation, were the primary outcome measures. A 1-year follow-up was achieved for all patients.
Results
Baseline characteristics of all 52 patients were similar between groups. There was a significantly higher complication rate in the single-stage AM groups with loss of the implant in 40.0% of the breasts from the Meso BioMatrix® group and in 10.7% of the Strattice™ group compared to no implant loss in the control group.
Conclusions
This cohort study clearly suggests that the use of a single-stage breast reconstruction is not safe with the use of these AMs. Well-designed prospective studies that guarantee the safety of those matrices should be published before these AMs are used in implant-based surgery.
Level of Evidence: Level III, risk / prognostic study.
Can probability theory explain why closure is both intuitive and prone to counterexamples?
Abstract
Epistemic closure under known implication is the principle that knowledge of \(\varphi\) and knowledge of \(\varphi \rightarrow \psi\) , together, imply knowledge of \(\psi\) . This principle is intuitive, yet several putative counterexamples have been formulated against it. This paper addresses the question, why is epistemic closure both intuitive and prone to counterexamples? In particular, the paper examines whether probability theory can offer an answer to this question based on four strategies. The first probability-based strategy rests on the accumulation of risks. The problem with this strategy is that risk accumulation cannot accommodate certain counterexamples to epistemic closure. The second strategy is based on the idea of evidential support, that is, a piece of evidence supports a proposition whenever it increases the probability of the proposition. This strategy makes progress and can accommodate certain putative counterexamples to closure. However, this strategy also gives rise to a number of counterintuitive results. Finally, there are two broadly probabilistic strategies, one based on the idea of resilient probability and the other on the idea of assumptions that are taken for granted. These strategies are promising but are prone to some of the shortcomings of the second strategy. All in all, I conclude that each strategy fails. Probability theory, then, is unlikely to offer the account we need.
Oregon’s Expansion of Prenatal Care Improved Utilization Among Immigrant Women
Abstract
Objectives To determine whether expanding Emergency Medicaid to cover prenatal care in Oregon affected maternal health outcomes for unauthorized immigrants. Methods This study takes place in Oregon from 2003 to 2015 and includes all Emergency Medicaid and Medicaid claims for women aged 12–51 with a pregnancy related claim. To isolate the effect of expanding access to prenatal care, we utilized a difference-in-differences approach that exploits the staggered rollout of the prenatal care program. The primary outcome was a composite measure of severe maternal morbidity and mortality. Additional outcomes include adequacy of prenatal care, detection of pregnancy complications and birth outcomes. Results A total of 213,746 pregnancies were included, with 35,182 covered by Emergency Medicaid, 12,510 covered by Emergency Medicaid Plus (with prenatal care), and 166,054 covered by standard Medicaid. Emergency Medicaid Plus coverage did not affect severe maternal morbidity (all pregnancies 0.05%, CI − 0.29; 0.39; high-risk pregnancies 2.20%, CI − 0.47; 4.88). The program did reduce inadequate care among all pregnancies (− 31.75%, 95% CI − 34.47; − 29.02) and among high risk pregnancies (− 38.60%, CI − 44.17; − 33.02) and increased diagnosis of gestational diabetes (6.24%, CI 4.36; 8.13; high risk pregnancies 10.48%, CI 5.87; 15.08), and poor fetal growth (7.37%, CI 5.69; 9.05; high risk pregnancies 5.34%, CI 1.00; 9.68). The program also increased diagnosis of pre-existing diabetes mellitus (all pregnancies 2.93%, CI 2.16; 3.69), hypertensive diseases of pregnancy (all pregnancies 1.28%, CI 0.52; 2.04) and a history of preterm birth (all pregnancies 0.87%, CI 0.27; 1.47). Conclusions for Practice Oregon's prenatal care expansion program produced positive effects for unauthorized immigrant women and their children.
Beyond Higher Education as We Know it: Gesturing Towards Decolonial Horizons of Possibility
Abstract
This article addresses the conceptual challenges of articulating the ethical–political limits of 'higher education as we know it', and the practical challenges of exploring alternative formations of higher education that are unimaginable from within the dominant imaginary of the higher education field. This article responds to the contemporary conjuncture in which possible futures have been significantly narrowed, and yet these possibilities also appear increasingly unsustainable and unethical. It invites scholars of higher education to rethink the epistemological and ontological frames within which most imaginaries and institutions of higher education are embedded. If we fail to denaturalize these frames, then efforts to pluralize possible higher education futures will risk reproducing existing conceptual limitations and enduring colonial harms.
Responsibility and the limits of good and evil
Abstract
P.F. Strawson's compatibilism has had considerable influence. However, as Watson has argued in "Responsibility and the Limits of Evil" (1987/2008), his view appears to have a disturbing consequence: extreme evil exempts an agent from moral responsibility. This is a reductio of the view. Moreover, in some cases our emotional reaction to an evildoer's history clashes with our emotional expressions of blame. Anyone's actions can be explained by his or her history, however, and thereby can conflict with our present blame. Additionally, we too might have been evil if our history had been like the unlucky evildoer's. Thus, our emotional responses to the evildoer compromise our standing to blame them. Since Strawson's view demarcates moral responsibility by moral emotional responses, his view appears to be self-defeating. In this paper, I defend the Strawsonian view from the reductio and self-defeat problems. I argue that two emotions, disgust and elevation, can be moral reactive attitudes in Strawson's sense. First, moral disgust expresses neither blame nor exemption from responsibility. Instead, moral disgust presupposes blameworthiness but is instead a distinct response to the extreme wrongdoer. Secondly, moral disgust involves self-directed attitudes that explain away our apparent lack of standing to blame the evil agent. The structure of disgust as a reactive attitude is mirrored along the positive dimension by the emotion that Haidt (2003a) has called "elevation", a feeling of moral inspiration. I conclude by defending my view from objections about the moral appropriateness of disgust.
Contribution of heterotrophic bacterioplankton to cyanobacterial bloom formation in a tributary backwater area of the Three Gorges Reservoir, China
Abstract
This study investigated phytoplankton and bacterioplankton communities by flow cytometer in a tributary backwater area of the Three Gorges Reservoir, China. Samplings were conducted in two cyanobacterial bloom periods (May and August) and no algal-blooms period (November) of 2014, representing three different operational stages of the reservoir, i.e., reservoir discharge period, fluctuating period in the summer flood season, and high water level in the impoundment period. Phyto- and bacterioplankton exhibit a wide range of variability along the depth profiles of the water column. In the investigated two cyanobacterial bloom periods, prokaryotes accounted for over 50% of the total phytoplankton. As for bacterioplankton, low nucleic acid bacteria were dominant in August and November. A positive correlation was observed between phytoplankton (pico- and nanophytoplankton), Chl a, and bacterioplankton. High nucleic acid groups and prokaryotes were highly coupled in May and August, which indicated that this high nucleic acid group could probably contribute to the explanation of cyanobacterial bloom formation in this area.
Coastline Kriging: A Bayesian Approach
Abstract
Statistical interpolation of chemical concentrations at new locations is an important step in assessing a worker's exposure level. When measurements are available from coastlines, as is the case in coastal clean-up operations in oil spills, one may need a mechanism to carry out spatial interpolation at new locations along the coast. In this article, we present a simple model for analyzing spatial data that is observed over a coastline. We demonstrate four different models using two different representations of the coast using curves. The four models were demonstrated on simulated data and one of them was also demonstrated on a dataset from the GuLF STUDY (Gulf Long-term Follow-up Study). Our contribution here is to offer practicing hygienists and exposure assessors with a simple and easy method to implement Bayesian hierarchical models for analyzing and interpolating coastal chemical concentrations.A Randomized Controlled Trial of a Truck Seat Intervention: Part 1—Assessment of Whole Body Vibration Exposures
Abstract
Full-time vehicle and heavy equipment operators often have a high prevalence of musculoskeletal disorders, especially low back pain (LBP). In occupations requiring vehicles or heavy equipment operation, exposure to whole body vibration (WBV) has been consistently associated with LBP. LBP is the most common cause of work-related disability and continues to be the leading cause of morbidity and lost productivity in the US workforce. Using a parallel randomized controlled trial design, over a 12-month period, this study evaluated two different seating interventions designed to reduce WBV exposures. Forty professional truck drivers were initially recruited and randomly assigned to one of two groups: (i) a passive suspension/control group—20 drivers who received a new, industry-standard air-suspension seat, and (ii) an intervention group—20 drivers who received an active-suspension seat, which has been shown to reduce vertical WBV exposures by up to 50% compared to passive seats. WBV exposures from the truck seat and floor were collected during driver's full shifts (6–18 h) before (pre-intervention) and after the intervention (0, 3, 6, and 12 months post-intervention) per International Standards Organization (ISO) 2631-1 and 2631–5 WBV standards. After subject dropout and turnover, 16 truck drivers remained in each group. The pre-intervention WBV data showed that there were no differences in the daily equivalent time-weighted average WBV exposures [A(8)], vibration dose values [VDV(8)], and static spinal compression doses [Sed(8)] between the two groups (P's > 0.36). After the new seats were installed, the A(8) values showed that the active suspension/intervention group experienced much greater reduction in the vertical (z) axis [~50%; P = <0.0001; Cohen's d effect size (95% CI) = 1.80 (1.12, 2.48)] exposures when compared to in the passive suspension/control group [~20%; P = 0.23; 0.33 (−0.36, 1.02)]. The post-intervention z-axis VDV(8) and Sed(8) WBV exposure measures were not different between the two seat groups [VDV(8), P = 0.33; 0.35 (−0.32, 1.03); Sed(8), P = 0.61; 0.08 (−0.59, 0.76)]. These study findings indicate that, relative to the current industry-standard, passive air-suspension seats which are ubiquitous in all semi-trucks today, the active suspension seat dramatically reduced average continuous [A(8)] WBV exposures but not periodic, cumulative impulsive exposures [VDV(8) and Sed(8)].Retrospective Assessment of Respirable Quartz Exposure for a Silicosis Study of the Industrial Sand Industry
Abstract
Background
In 2016, the OSHA PEL for crystalline silica was reduced, renewing interest in evaluating risk of silicosis from occupational exposures. The industrial sand industry, which deals with high-purity quartz sands, is the setting for a current epidemiologic investigation of silicosis risk and progression. In support of that investigation, respirable quartz (RQ) exposures were retrospectively estimated for 67 workers with silicosis and 167 matched control workers from 21 industrial sand plants, in which some started work as early as 1929. Methods
A job exposure matrix (JEM) was constructed by integrating a modern (post-1970) RQ exposure database containing more than 40000 measurements with archival particle count exposure data from a 1947 survey. A simulation algorithm was used to develop a conversion factor to convert the archival particle count data into modern measures of RQ by randomly generating 100000 virtual dust particles of varying diameters corresponding to the size distributions of 14 archival particle size distribution samples. The equivalent respirable mass and particle counts of the virtual particles were calculated, totalled, and ratioed to derive the conversion factor. The JEM was integrated with individual job histories to calculate average and cumulative exposure for each case and control. Multiple exposure estimates were derived for unprotected exposures as well as for exposures adjusted for estimated respiratory protective equipment use and efficiency. Results
The mean of the count to respirable mass conversion factors derived from 14 archival particle size samples was 157 µg m−3 per mppcf (SD: 42; range: 96–263) with no statistical difference across process areas (drying, screening, vibrating, binning, bulk loading, bagging), P = 0.29. The JEM demonstrated an industry-wide decrease in prevailing exposures to RQ of up to about 2 orders of magnitude from the distant (1929) to the recent (2012) past. Unadjusted cumulative exposures for cases and controls were statistically different (P < 0.001) with respective medians (range) of 3764 µg m−3 year (221–25121) and 1595 µg m−3 year (0–16446). Adjustment of exposure for use of respiratory protection showed modest reductions in estimated exposure: median adjusted cumulative exposures assuming a protection factor of 5 were 86% and 77% of the unadjusted values for cases and controls, respectively. Conclusions
The industrial sand industry offers a unique setting for examination of silicosis risk because of the high silica content of industrial sand and a long history of radiographic silicosis surveillance of industry workers. However, the great majority of silicosis cases in this industry are found among former workers and are associated with exposures occurring in the distant past, which necessitates extensive retrospective exposure assessment and increases the likelihood of exposure misclassification. Nonetheless, the estimated cumulative exposures for silicosis cases and controls in this work were significantly different, with the median cumulative exposure for cases being more than twice that of their matched controls.Respiratory Health Outcomes, Rhinitis, and Eczema in Workers from Grain Storage Facilities in Costa Rica
Abstract
Objectives
To examine the associations of inhalable grain dust exposure with respiratory health outcomes, rhinitis, and eczema reported by workers from rice, wheat, and maize storage facilities. Methods
A cross-sectional study of 136 workers (73 operators and 63 administrative staff and other workers) from eight Costa Rican grain storage facilities was conducted in 2014–2015. Full-shift personal inhalable dust samples from all workers were collected. Study participants were administered a short version of the European Community Respiratory Health Survey questionnaire to identify symptoms of asthma, chronic bronchitis, rhinitis, and eczema. Associations between grain dust exposure and health outcomes were assessed using multivariable logistic and negative binomial regression models adjusted for age, smoking history, grain type, and presence of pets or farm animals in the home. Results
The median inhalable grain dust concentration was 2.0 (25th to 75th percentile: 0.3–7.0) mg m−3. Higher concentrations of inhalable dust were associated with increased odds of (i) asthma symptoms or medication use [adjusted Odds ratio (ORa) per 10-fold increase in dust concentration 2.7; 95% confidence interval (CI): 1.3–6.7]; (ii) a score of at least two out of five symptoms suggestive of asthma (ORa 1.2; 95% CI: 1.0–1.3); and (iii) eczema (ORa 3.6; 95% CI: 1.7–9.6). No associations of inhalable grain dust exposure with chronic bronchitis and rhinitis were observed. Conclusions
High exposure to inhalable dust in Costa Rican grain storage facilities was associated to asthma symptoms and eczema in workers.A Randomized Controlled Trial of a Truck Seat Intervention: Part 2—Associations Between Whole-Body Vibration Exposures and Health Outcomes
Abstract
This randomized controlled trial study was conducted to determine whether two different seating interventions would reduce exposure to whole-body vibration (WBV) and improve associated health outcomes. Forty professional truck drivers were randomly assigned to two groups: (i) a control group of 20 drivers who received a new, industry-standard air-suspension seat, and (ii) an intervention group of 20 drivers who received an active-suspension seat. This study collected regional body pain (10-point scale), low back disability [Oswestry Disability Index (ODI)], physical and mental health [the Short Form 12-item Health Survey (SF-12)], and work limitations [Work Limitation Questionnaire (WLQ)] before and 3, 6, and 12 months after the seating intervention. WBV exposures were also collected during the same time periods. Due to dropouts at the 12-month time period, only data up to 6 months post-intervention were included in the analyses. The post-intervention A(8) WBV exposures were lower in both groups with a more substantial WBV exposure reduction (~50%) in the intervention group compared to the control group (~26%). There was little to no change in the impulsive exposures [VDV(8) and Sed(8)] post-intervention and no differences between the two groups. The self-reported musculoskeletal health outcomes showed that intervention group experienced a greater reduction in the low back pain (LBP) and other musculoskeletal outcomes than the control group. The LBP reduction in the intervention group was clinically meaningful (>25%); however, none of the changes in pain reached statistical significance (P's > 0.22). The SF-12 health scores demonstrated that the intervention group's physical health improved after the intervention (P's < 0.06) while the control group experience little to no improvement (P's > 0.11). The WLQ scores showed that the intervention group generally experienced reduced (improved) work limitation over time whereas the control group showed inconsistent changes in work limitation scores. These study findings indicate that reducing truck drivers' exposure to WBV through seating intervention can lead to improvements in LBP and other health outcomes.The Ethics and Politics of Precarity: Risks and Productive Possibilities of a Critical Pedagogy for Precarity
Abstract
This paper discusses Butler's theory on the possibility of precarity to serve as the nexus of ethical relations, while also exploring some of the pitfalls of her theorization to reconceptualize the pedagogical implications of a critical pedagogy for precarity. In particular, the paper asks: How can precarity—understood as an ambivalent concept, as a paradoxical nexus of both possibilities and constraints—function pedagogically in a way that challenges its moralization? How can educators engage with precarity in ways that 're-frame' it so that both the dangers and prospects of ethics and politics of precarity are properly acknowledged and critically interrogated in pedagogical practice? The risks and possibilities of a critical pedagogy for precarity are addressed, highlighting that there are several complexities involved as much as there are opportunities for ethical transformation and political action in school and beyond.
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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
