Πέμπτη 27 Σεπτεμβρίου 2018
A Man With Tonsillitis and Hepatitis
A previously well Australian-born 28-year-old gentleman was diagnosed with a stage 1 non-seminomatous testicular cancer, for which he underwent a left radical orchidectomy, followed by a single cycle of adjuvant chemotherapy with bleomycin, etoposide and cisplatin. One week later, he presented to hospital with a one-day history of fevers, rigors and severe sore throat. There was no recent travel or animal contact, nor was there any risk factor for blood-borne viruses. He had recently entered into a new relationship with a female partner. On physical examination he was noted to have bilateral swollen, erythematous tonsils with exudates, associated with bilateral tender cervical lymphadenopathy. No visible mucocutaneous vesicles or ulcers were found. Initial investigation results showed neutrophilia of 13.4 × 10^9/L (2.0–8.0) but lymphopenia of 0.4 × 10^9/L (1.0–4.0), and a normal liver function test. Blood film demonstrated toxic changes of leukocytes with occasional reactive lymphocytes. Heterophile antibody test for infectious mononucleosis was negative. He was given penicillin following which he developed a widespread blanching macular rash two days later. He was then discharged home.
Immunology of Wound Healing
Abstract
Purpose of Review
Chronic wounds are a tremendous burden on the healthcare system and lead to significant patient morbidity and mortality. Normal cutaneous wound healing occurs through an intricate and delicate interplay between the immune system, keratinocytes, and dermal cells. Each cell type contributes signals that drive the normal phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This paper reviews how various immunological cell types and signaling molecules influence the way wounds develop, persist, and heal.
Recent Findings
Concurrent with the achievement of hemostasis, neutrophils are the first cells to migrate to the wound bed, brought in by pro-inflammatory signals including IL-8. Their apoptosis and engulfment by macrophages (efferocytosis) provides a key signal to the local immune milieu, including macrophages, to transition to an anti-inflammatory, pro-repair state, where angiogenesis occurs and granulation tissue is laid down. Myofibroblasts, activated through contractile forces and signaling molecules, then drive remodeling, where granulation tissue becomes scar. Unchecked inflammation at this stage can result in abnormal scar formation.
Summary
Although the derangement of immune signals at any stage can result in impaired wound healing, recent research has shown that the key transition point lies between the inflammatory and the proliferative phases. This review summarizes the events that facilitate this transition and discusses how this process can be disrupted, leading to chronic, non-healing wounds.
Detection of Leukocortical Lesions in Multiple Sclerosis and Their Association with Physical and Cognitive Impairment: A Comparison of Conventional and Synthetic Phase-Sensitive Inversion Recovery MRI [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Cortical lesions are common in multiple sclerosis and are included in the latest diagnostic criteria. The limited sensitivity of cortical MS lesions on conventional MR imaging can be improved by phase-sensitive inversion recovery. Synthetic MR imaging could provide phase-sensitive inversion recovery without additional scanning, but the use of synthetic phase-sensitive inversion recovery remains to be validated. We aimed to compare the ability and clinical value of detecting leukocortical lesions with conventional and synthetic phase-sensitive inversion recovery in MS.
MATERIALS AND METHODS:Twenty-one patients with MS prospectively underwent conventional and synthetic phase-sensitive inversion recovery, 3D T1-weighted, and T2 FLAIR imaging. Two neuroradiologists independently performed blinded phase-sensitive inversion recovery lesion assessments; a consensus rating with all sequences was considered the criterion standard. Lesion volumes were segmented. All participants underwent standardized cognitive and physical examinations and Fatigue Severity Scale assessment. Results were analyzed with multiple linear regressions.
RESULTS:Interrater and criterion standard agreement for leukocortical lesions was excellent for both conventional and synthetic phase-sensitive inversion recovery (intraclass correlation coefficient = 0.79–0.97). Leukocortical lesion volumes for both sequences were associated with lower information-processing speed (P ≤ .01) and verbal fluency (P ≤ .02). Both phase-sensitive inversion recovery sequences showed a positive effect on the association when combining volumes of leukocortical lesions and white matter lesions with information-processing speed (P ≤ .005) and verbal fluency (P ≤ .03). No associations were found between leukocortical lesion volumes and physical disability or fatigue.
CONCLUSIONS:Synthetic and conventional phase-sensitive inversion recovery have a sensitivity similar to that of leukocortical MS lesions. The detected leukocortical lesions are associated with cognitive dysfunction and thus provide clinically relevant information, which encourages assessment of cortical MS involvement at conventional field strengths.
Vessel Wall MRI for Targeting Biopsies of Intracranial Vasculitis [ADULT BRAIN]
SUMMARY:
Central nervous system vasculitides are elusive diseases that are challenging to diagnose because brain biopsies have high false-negative rates. We sought to test the ability of contrast-enhanced, high-resolution 3D vessel wall MR imaging to identify vascular inflammation and direct open biopsies of intracranial target vessels and adjacent brain parenchyma. Eight of 9 specimens revealed vascular inflammation. We conclude that vessel wall MR imaging can identify inflamed intracranial vessels, enabling precise localization of biopsy targets.
Low Wall Shear Stress Is Associated with Local Aneurysm Wall Enhancement on High-Resolution MR Vessel Wall Imaging [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Some retrospective studies have found that the aneurysm wall enhancement on high-resolution MR vessel wall postgadolinium T1WI has the potential to distinguish unstable aneurysms. This study aimed to identify hemodynamic characteristics that differ between the enhanced and nonenhanced areas of the aneurysm wall on high-resolution MR vessel wall postgadolinium T1WI.
MATERIALS AND METHODS:TOF-MRA and high-resolution MR vessel wall T1WI of 25 patients were fused to localize the enhanced area of the aneurysm wall. Using computational fluid dynamics, we studied the aneurysm models. Mean static pressure, mean wall shear stress, and oscillatory shear index were compared between the enhanced and nonenhanced areas.
RESULTS:The aneurysmal enhanced area had lower wall shear stress (P < .05) and a lower oscillatory shear index (P = .021) than the nonenhanced area. In addition, the whole aneurysm had lower wall shear stress (P < .05) and a higher oscillatory shear index (P = .007) than the parent artery.
CONCLUSIONS:This study suggests that there are hemodynamic differences between the enhanced and nonenhanced areas of the aneurysm wall on high-resolution MR vessel wall postgadolinium T1WI.
Corticopallidal Connectome of the Globus Pallidus Externus in Humans: An Exploratory Study of Structural Connectivity Using Probabilistic Diffusion Tractography [FUNCTIONAL]
BACKGROUND AND PURPOSE:
Electrophysiologic abnormalities of the globus pallidus externus have been shown in several disease processes including Parkinson disease, dystonia, and Huntington disease. However, the connectivity, nuclear structure, and function of the globus pallidus externus are still not well-understood. Increasing evidence for the existence of direct corticopallidal connections challenges traditional understanding of the connectivity of the globus pallidus externus; nevertheless, these corticopallidal connections have yet to be fully characterized in humans. The objective of this study was to assess the corticopallidal connections of the globus pallidus externus by means of probabilistic diffusion-weighted MR imaging tractography using high-resolution, multishell data.
MATERIALS AND METHODS:Imaging data from the open-access Human Connectome Project data base were used to perform probabilistic tractography between the globus pallidus externus and the cerebral cortex using 34 distinct cortical regions. Group averages were calculated for normalized percentages of tracts reaching each of the cortical targets, and side-to-side comparison was made.
RESULTS:Cortical connectivity was demonstrated between the globus pallidus externus and multiple cortical regions, including direct connection to putative sensorimotor, associative, and limbic areas. Connectivity patterns were not significantly different between the right and left hemispheres with the exception of the frontal pole, which showed a greater number of connections on the right (P = .004).
CONCLUSIONS:Our in vivo study of the human globus pallidus externus using probabilistic tractography supports the existence of extensive corticopallidal connections and a tripartite functional division, as found in animal studies. A better understanding of the connectivity of the globus pallidus externus may help to understand its function and elucidate the effects of programming the higher contacts in pallidal deep brain stimulation.
Expanding the Distinctive Neuroimaging Phenotype of ACTA2 Mutations [PEDIATRICS]
BACKGROUND AND PURPOSE:
Arg179His mutations in ACTA2 are associated with a distinctive neurovascular phenotype characterized by a straight course of intracranial arteries, absent basal Moyamoya collaterals, dilation of the proximal internal carotid arteries, and occlusive disease of the terminal internal carotid arteries. We now add to the distinctive neuroimaging features in these patients by describing their unique constellation of brain malformative findings that could flag the diagnosis in cases in which targeted cerebrovascular imaging has not been performed.
MATERIALS AND METHODS:Neuroimaging studies from 13 patients with heterozygous Arg179His mutations in ACTA2 and 1 patient with pathognomonic clinicoradiologic findings for ACTA2 mutation were retrospectively reviewed. The presence and localization of brain malformations and other abnormal brain MR imaging findings are reported.
RESULTS:Characteristics bending and hypoplasia of the anterior corpus callosum, apparent absence of the anterior gyrus cinguli, and radial frontal gyration were present in 100% of the patients; flattening of the pons on the midline and multiple indentations in the lateral surface of the pons were demonstrated in 93% of the patients; and apparent "squeezing" of the cerebral peduncles in 85% of the patients.
CONCLUSIONS:Because α-actin is not expressed in the brain parenchyma, only in vascular tissue, we speculate that rather than a true malformative process, these findings represent a deformation of the brain during development related to the mechanical interaction with rigid arteries during the embryogenesis.
Usefulness of Vessel Wall MR Imaging for Follow-Up after Stent-Assisted Coil Embolization of Intracranial Aneurysms [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Follow-up with MRA for intracranial aneurysms after stent-assisted coiling is complicated by imaging artifacts. We evaluated the usefulness of an alternative method: vessel wall MR imaging.
MATERIALS AND METHODS:We conducted a single-center, retrospective review of medical records of 47 patients who underwent 3D TOF-MRA, vessel wall MRI, and DSA after stent-assisted coiling between March 2016 and January 2018. We evaluated the mean value of the signal intensity in the stented artery and the contralateral normal artery on vessel wall MRI. The quality of visualization was further compared between TOF-MRA and vessel wall MRI. Furthermore, we evaluated the diagnostic accuracy and concordance rate of TOF-MRA and vessel wall MRI for assessing the patency of the stented parent artery. DSA was used as a reference test.
RESULTS:The mean signal intensities of the stented and normal arteries on vessel wall MRI were not significantly different (P = .133). The mean scores for the visualization of the stented parent artery on vessel wall MRI were significantly superior to those of TOF-MRA images (P < .001). Vessel wall MRI reached an excellent positive predictive value (100%). However, TOF-MRA had a poor positive predictive value (11%; 95% CI, 9%–12%). The likelihood ratios of vessel wall MRI and TOF-MRA were 27.36 (P < .001) and 2.98 (P = .225), respectively. The concordance rate of vessel wall MRI and TOF-MRA with DSA for evaluating the state of the stented artery was 100% ( = 1) and 28% ( = 0.038), respectively.
CONCLUSIONS:Vessel wall MRI may be useful in evaluating the patency of stented arteries after stent-assisted coil embolization for intracranial aneurysms.
Treatment of Intracranial Aneurysms with Self-Expandable Braided Stents: A Systematic Review and Meta-Analysis [INTERVENTIONAL]
BACKGROUND:
The safety and efficacy of treatment with self-expandable braided stents (LEO and LVIS) required further investigation.
PURPOSE:Our aim was to analyze the outcomes after treatment with braided stents.
DATA SOURCES:A systematic search of 3 databases was performed for studies published from 2006 to 2017.
STUDY SELECTION:According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting patients treated with LEO or LVIS stents.
DATA ANALYSIS:Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and neurologic outcomes.
DATA SYNTHESIS:Thirty-five studies evaluating 1426 patients treated with braided stents were included in this meta-analysis. Successful stent delivery and complete aneurysm occlusion were 97% (1041/1095; 95% CI, 95%–98%) (I2 = 44%) and 88.3% (1097/1256; 95% CI, 85%–91%) (I2 = 72%), respectively. Overall, treatment-related complications were 7.4% (107/1317; 95% CI, 5%–9%) (I2 = 44%). Ischemic/thromboembolic events (48/1324 = 2.4%; 95% CI, 1.5%–3.4%) (I2 = 27%) and in-stent thrombosis (35/1324 = 1.5%; 95% CI, 0.6%–1.7%) (I2 = 0%) were the most common complications. Treatment-related morbidity was 1.5% (30/1324; 95% CI, 0.9%–2%) and was comparable between the LEO and LVIS groups. Complication rates between the anterior (29/322 = 8.8%; 95% CI, 3.4%–12%) (I2 = 41%) versus posterior circulation (10/84 = 10.5%; 95% CI, 4%–16%) (I2 = 0%) and distal (30/303 = 8%; 95% CI, 4.5%–12%) (I2 = 48%) versus proximal aneurysms (14/153 = 9%; 95% CI, 3%–13%) (I2 = 46%) were comparable (P > .05).
LIMITATIONS:Limitations were selection and publication biases.
CONCLUSIONS:In this analysis, treatment with the LEO and LVIS stents was relatively safe and effective. The most common complications were periprocedural thromboembolisms and in-stent thrombosis. The rate of complications was comparable among anterior and posterior circulation aneurysms, as well as for proximal and distally located lesions.
Characteristics of MR Neuroimaging Services Billed by Radiologists versus Nonradiologists [PRACTICE PERSPECTIVES]
BACKGROUND AND PURPOSE:
Although most neuroimaging examinations are interpreted by radiologists, many nonradiologists provide interpretation services. We studied day of the week, site of service, and patient complexity differences for common Medicare MR neuroimaging examinations interpreted by radiologists versus nonradiologists.
MATERIALS AND METHODS:Using carrier claims files for a 5% sample of Medicare beneficiaries from 2012 to 2014, we identified all claims for brain and lumbar spine MR imaging examinations. Services were categorized by physician specialty, day of the week, and the site of service. Patient complexity was calculated using Charlson Comorbidity Indices. The 2 was performed to test statistical significance.
RESULTS:A provider specialty could be identified for 568,423 brain and lumbar spine MR imaging examinations. Of weekday examinations, radiologists interpreted 475,288 (92.3%), and nonradiologists, 39,510 (7.7%). Of weekend examinations, radiologists interpreted 52,028 (97.0%) and nonradiologists 1597 (3.0%). Radiologists interpreted 145,904 (98.7%) examinations in the inpatient hospital and emergency department settings versus 1882 (1.3%) by nonradiologists. Of all examinations, 44,547 of those interpreted by radiologists (8.4%) were on the most clinically complex patients versus 2139 (5.2%) for nonradiologists. All interspecialty differences for day of the week, the site of service, and patient complexity were statistically significant (P < .001).
CONCLUSIONS:Although radiologists interpret most common MR neuroimaging examinations for Medicare beneficiaries, in contrast to nonradiologists, they disproportionately render those services on weekends, in higher acuity sites, and on more complex patients. To optimize access and minimize disparities in necessary neuroimaging, quality metrics should consider such service characteristics.
MR Neurography of the Lumbosacral Plexus for Lower Extremity Radiculopathy: Frequency of Findings, Characteristics of Abnormal Intraneural Signal, and Correlation with Electromyography [SPINE]
BACKGROUND AND PURPOSE:
MR neurography enables high resolution imaging of peripheral nerves. Our aim was to evaluate the utility of MR neurography in lumbosacral radiculopathy and correlate abnormal intraneural signal with history, physical examination, and abnormal electrodiagnostic study findings.
MATERIALS AND METHODS:Retrospective review of lumbosacral MR neurography examinations performed from December 2014 through January 2017 on a 3T scanner was undertaken. MR neurography examinations were independently reviewed in a blinded fashion by 2 radiologists, and the intraneural signal was graded on a 0–2 scale relative to adjacent vasculature. Abnormal nerve signal was correlated with subjective and objective findings from clinical notes in the electronic medical record and compared with results of electrodiagnostic studies (nerve conduction study/electromyography).
RESULTS:Three hundred three lumbosacral MR neurography examinations were performed during the study period, 64 of which met the inclusion criteria, including symptoms of radiculopathy on electromyography performed within 3 months of MR neurography. Twenty-nine (45%) MR neurography examinations had abnormal intraneural signal. There was no statistically significant correlation between subjective clinical findings and intraneural signal abnormality on MR neurography. There was a statistically significant correlation between abnormal intraneural T2 signal and findings of active radiculopathy on electromyography (P < .001).
CONCLUSIONS:Lumbosacral MR neurography appears to demonstrate abnormal intraneural signal in a substantial portion of patients with clinical symptoms of lower extremity radiculopathy and correlates with findings of active radiculopathy on electromyography. This finding further bolsters the growing body of evidence on the utility of MR neurography and suggests that abnormal intraneural signal may provide a useful adjunct to electrodiagnostic testing. Further research is required to evaluate the prognostic value of MR neurography, which may help guide therapeutic decision-making.
Was motiviert Patienten mit atopischen Erkrankungen zur Suche nach Informationen im Internet? Ergebnisse einer Fokusgruppenstudie zu Erwartungen und Anforderungen
Zusammenfassung
Hintergrund
Menschen mit leichten bis mittelschweren Allergien sind häufig nicht ausreichend therapiert, obwohl gute Möglichkeiten zur Prävention und Selbsttherapie existieren. Nutzerfreundliche, webbasierte, evidenzgeleitete Angebote könnten den eigenständigen Umgang mit der Allergie und die Gesundheitskompetenz stärken, da diese niedrigschwellig sind und schnell verfügbar, wenn Menschen Unterstützung suchen. Damit sie gefunden bzw. gelesen werden, sollten Anbieter und Entwickler Kenntnisse über Informationsbedarf, -bedürfnisse und das aktuelle Nutzerverhalten haben.
Fragestellung
Was gibt den Anstoß, nach Informationen zum Thema Allergie zu suchen? Welche Anforderungen stellen die Betroffenen an webbasierte Angebote?
Material und Methode
In 4 deutschen Städten wurden 3 Einzelinterviews und 4 Fokusgruppen mit 37 Teilnehmenden (19 bis 81 Jahre; Heuschnupfen, n = 30; Asthma, n = 17; Neurodermitis, n = 15) durchgeführt, aufgezeichnet und wortgetreu transkribiert. Ein multiprofessionelles Team entwickelte ein System zur Kodierung der Texte (2 unabhängige Kodierer, Analysesoftware MAXQDA).
Ergebnisse
Betroffene suchen in der Regel erst bei konkretem Handlungsbedarf nach Informationen. Impulse sind u. a. Symptome, Hinweise aus dem sozialen Umfeld, der Beginn der Allergiesaison oder ein allergiebedingter Kontakt mit dem Gesundheitssystem. Ein webbasiertes Angebot sollte inhaltlich v. a. zu Behandlungsmöglichkeiten informieren, individualisierte Unterstützung bei konkreten Handlungsstrategien für den Alltag liefern und adäquate Selbstmanagementkompetenzen der Betroffenen fördern.
Diskussion
Um die Selbstmanagementfähigkeit zu fördern, sollte ein Informationsangebot auf allergische Symptome, die Therapiemöglichkeiten und auf Hilfestellung bei der Alltagsbewältigung ausgerichtet sein.
Mehr Versorgungsqualität durch dermatologische Versorgungsforschung
Zusammenfassung
Es gibt Krankheiten, die sind für die jeweiligen Patienten spürbar, für alle anderen aber nicht sichtbar. Und es gibt Hautkrankheiten, die aufgrund ihrer deutlich sichtbaren Lokalisation an der Hautoberfläche häufig auch für andere leicht erkennbar sind. Dennoch hat sich die Dermatologie in den letzten Jahren von einem traditionell optischen Fach, geprägt von der klinischen Beobachtung, zu einem kausal orientierten Fach gewandelt. In immer kürzeren Abständen entstehen neue Therapiemöglichkeiten, welche die Dermatologie vor eine Vielzahl an Herausforderungen stellen. Dabei stellen sich nicht nur Fragen nach Nutzen und Wirksamkeit, sondern auch nach Finanzierung, nach Selbstregulierung und nach dem ganzheitlichen Wohl kranker Menschen. Der entscheidende Faktor bei allen Abwägungen für und wider einer Neuerung oder Veränderung ist dabei die Hoheit über fundierte Daten zur tatsächlichen Versorgungssituation. Der Berufsverband der deutschen Dermatologen (BVDD) und die Deutsche Dermatologische Gesellschaft (DDG) haben mit der Einrichtung des Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm) die Notwendigkeit einer koordinierten versorgungswissenschaftlichen Forschung erkannt und bereits 2005 die Weichen für eine langfristige Aufstellung der dermatologischen Versorgungsforschung gestellt.
Handekzemregister: Hintergründe, Nutzen und Ausblick
Zusammenfassung
Hintergrund
Populationsbezogene Studien weisen für das Handekzem (HE) eine 1‑Jahres-Prävlenz von bis zu 10,0 % aus, bei 5–7 % davon handelt es sich um schwere chronische HE (CHE), die das Leben der Betroffenen stark beeinträchtigen. Registerdaten helfen, Krankheitslast und Versorgung des HE unter Alltagsbedingungen zu erforschen und zu optimieren.
Fragestellung
Welche Registerdaten werden in der Forschung zum HE bisher ausgewertet? Welche Erkenntnisse konnten bisher mit Registerdaten zum HE gewonnen werden, und wo liegen deren Limitationen?
Material und Methode
Dies ist eine Übersichtsarbeit über bisherige Publikationen, in denen Registerdaten in Forschungsarbeiten zum HE verwendet wurden. Die Arbeiten stammen überwiegend aus Deutschland, zum Teil aber auch aus Skandinavien und der Schweiz.
Ergebnisse
Das weltweit bisher einzige Krankheitsregister zum HE ist das Chronische Handekzem Register zum Patienten-Langzeitmanagement (CARPE), das in Deutschland und später auch in der Schweiz durchgeführt wurde. Mithilfe von CARPE konnten erstmals die Charakteristika des CHE sowie der Verlauf der Erkrankung im Versorgungsalltag beschrieben werden. In Dänemark wurden Daten aus öffentlichen Registern (z. B. Berufskrankheitenregister) genutzt, um Patienten mit (beruflichen) HE zu identifizieren und zu befragen. Register für berufsbedingte Hautkrankheiten wurden in den 1990er-Jahren in Nordbayern und dem Saarland etabliert, die dort registrierten Patienten weisen in über 90 % der Fälle ein HE auf.
Schlussfolgerung
Handekzemregister liefern wichtige Daten aus der Versorgungsrealität und geben damit einen wichtigen Einblick in die Versorgungssituation dieser Dermatose. In Krankheitsregistern lässt sich die Vollständigkeit der Daten erfassen, während dies bei der Nutzung von öffentlichen Melderegistern selten möglich ist.
The anatomy of the superficial temporal artery in patients with unilateral microtia.
This is a retrospective study that evaluated the anatomical distribution of the superficial temporal artery (STA) in supply of the temporoparietal fascial (TPF) flap for use in unilateral microtia patients undergoing reconstruction. We aimed to determine if embryologic arrest of pharyngeal arch development would lead to aberrant STA which impedes reliable harvest of the TPF flap in patients requiring microtia repair.
Erythema dyschromicum perstans: A case report and systematic review of histologic presentation and treatment
Erythema dyschromicum perstans (EDP) can be difficult to diagnose and treat; therefore, we reviewed the literature to assess whether histology can be used to differentiate lichen planus pigmentosus (LPP) from EDP and determine which treatments are the most effective for EDP. We also present a case of a patient who was treated successfully with narrow-band ultraviolet B (NB-UVB).
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Odontogenic Maxillofacial Space Infections: A 5-Year Retrospective Review in Navi Mumbai
Abstract
Purpose
The aim of this study is to comprehensively review and analyse pure odontogenic maxillofacial space infections in a tertiary care hospital in Navi Mumbai over a period of 5 years.
Methods
A retrospective analysis of 315 patients treated at Dr. D. Y. Patil Dental College and Hospital at Nerul, Navi Mumbai, from January 2007 to December 2011 was done. Multiple variables were analysed. Localised infections like dentoalveolar infections without space involvement and infection of non-odontogenic cause were excluded from the study.
Results
Analysis of the records was done. Majority of patients were from lower socioeconomic background and were daily wage workers who had either consulted a general physician or a general dental practitioner or had self-medicated themselves before presenting to us with acute symptoms. Early recognition and prompt treatment involving intravenous antibiotics with extraction of involved tooth/teeth and incision and drainage helped in resolution of infections in a span of 72 h. Medically compromised patients had longer duration of hospital stay as compared to the patients who had no underlying medical condition. Majority of space infections involved multiple spaces and local anaesthesia with sedation was found to be the satisfactory mode of anaesthesia. Complications were very few.
Conclusion
We concurred that any form of odontogenic maxillofacial space infection should be rendered prompt and aggressive treatment and hospitalisation should be recommended wherever required.
Induced Polyethylene Glycol Fusion in Rat Facial Nerves?
To the Editor In their recent article, Brown et al(E7) conclude that "polyethylene glycol fusion has shown efficacy in the surgical repair of spinal nerve injuries, but this finding was not replicated in facial nerve injury repair." Problematically, Brown et al almost certainly did not induce polyethylene glycol (PEG)-mediated fusion repair of facial nerves in rats. We come to this conclusion for the following 3 reasons:
Association of Skin and Cartilage Variables With Composite Graft Healing in a Rabbit Model
This animal model study investigates the ideal ratio of skin to cartilage and studies the importance of the perichondrial attachment for graft survival.
Superiorly Pediculated Superficial Musculoaponeurotic System Ligament Flap
This Surgical Pearl presents the technique for the superiorly pediculated SMAS ligament flap to hide nasal tip irregularities at the end of rhinoplasty.
Mediators of the Association Between Religious Service Attendance and Mortality
Abstract
Mounting evidence consistently shows associations between religious service attendance and reduced risk of mortality; yet research identifying mediators remains limited. Using prospective data from the Health and Retirement Study (2006-2014; n=5,200), we evaluated a range of potential mediators. After robust control for confounders (demographic, health, health behaviors, and social factors), among positive psychological factors, we observed mediation through increased life satisfaction (5.27% ; P=<.001) and possibly positive affect (1.52%; P=.06)—but not optimism, mastery, or purpose. Among dimensions of psychological distress, we observed mediation through reductions in hopelessness (1.92%; P=.01), trait anger (1.98%; P=.03), state anger (2.23%; P=.03), and possibly loneliness (1.21%; P=.06), but not cynical hostility or negative affect, and some evidence that increased anxiety (−3.61%; P=.008) and possibly depressive symptoms (−1.14%; P=.05) increased odds of mortality. Among social factors we observed mediation through contact with friends (10.73%; P=.005), but not living with a spouse, contact with children, or other family. Among health behaviors we observed mediation through exercise (5.38%; P=<.001), negative mediation through alcohol frequency (−2.55%; P=.03) and possibly body mass index (−2.34%; P=.08), but not smoking. These results highlight a range of mediators that may underlie the association between religious service attendance and reduced risk of mortality.Intraoperatives molekulares Bioimaging von Kopf-Hals-Karzinomen
Zusammenfassung
Hintergrund
Präoperativ werden umfassende onkologische Staging-Informationen gewonnen, um leitlinienorientierte Therapien für Patienten mit Kopf-Hals-Karzinomen zu definieren. Die präoperativen onkologischen Informationen können jedoch nicht verlustfrei in die intraoperative Situation transferiert werden. Trotz der steten Entwicklung der modernen Medizin sind für die intraoperative Detektion und Demarkierung malignen Gewebes lediglich klinische visuelle und taktile Informationen maßgebend.
Ziel der Arbeit
Ziel der Arbeit war die Entwicklung einer intraoperativen spezifischen Visualisierung invasiver Karzinomzellen in Echtzeit.
Material und Methoden
In Gewebe- und Zellkulturexperimenten wurden mittels Immun(fluoreszenz)histologie, Immunzytologie, Durchflusszytometrie (FACS), quantitativer Echtzeit-Polymerasekettenreaktion (qRT-PCR) und Western Blot die Expression und Regulation eines Biomarkers für invasive Karzinomzellen charakterisiert. Funktionelle Analysen erfolgten durch Invasions- und Migrations-Assays. Für In-vivo-Studien wurde ein „head and neck squamous cell carcinoma mouse-based patient-derived xenotransplant model" (HNSCC-PDX-Mausmodell) etabliert, um eine Visualisierung invasiver Karzinome mittels funktionalisierten RGD-Peptide kliniknah zu simulieren.
Ergebnisse
Das RGD bindende Integrin αvβ6 wurde als stabiler Biomarker invasiver Karzinomzellen identifiziert. Funktionalisierte RGD-Peptide zeigten eine selektive Bindung an Integrin αvβ6 zur Detektion αvβ6-positiver invasiver Karzinomzellen. Im HNSCC-PDX-Mausmodell konnte eine molekulare Bildgebung invasiven Karzinomgewebes (Bioimaging) etabliert werden.
Schlussfolgerung
Ein molekulares Bioimaging ermöglicht eine erweiterte Visualisierung der Lokalisation und Ausdehnung invasiven Karzinomgewebes in Echtzeit. Dieser intraoperative Informationsgewinn kann kurative chirurgische Therapieansätze unterstützen.
PMT1 deficiency extends the shortened replicative lifespan of TED1-deficient yeast in a Hac1p-dependent manner
Abstract
Protein O-mannosyltransferase-1 (Pmt1p) deficiency extends the replicative lifespan (RLS) of Saccharomyces cerevisiae, which is related to the activation of the unfolded protein response (UPR), an important pathway for alleviating endoplasmic reticulum (ER) stress. Trafficking of Emp24p/Erv25p-dependent cargo disrupted 1 (Ted1p) has been reported as a binding partner of yeast Pmt1p. We explored the potential relationship between Pmt1p and Ted1p in the cell lifespan and ER stress responses. The TED1-deleted strain (ted1Δ) had a shorter RLS with no increase in UPR activity. However, PMT1 deficiency prolonged the short lifespan of ted1Δ in a manner dependent on Hac1p, an upstream transcription factor of the UPR pathway. In addition, PMT1 deficiency enhanced the UPR activity and alleviated the ER stress resistance of the ted1Δ strain. Thus, the enhanced UPR activity was hypothesized to explain the longevity of the pmt1Δted1Δ strain, but this long-lived pmt1Δted1Δ strain showed decreased ER stress resistance compared with the short-lived ted1Δ strain. Taken together, our results suggest a possible relationship between PMT1 and TED1 regarding lifespan regulation and the ER stress response.Genome mining for the search and discovery of bioactive compounds: The Streptomyces paradigm
Abstract
The need for new antimicrobials is indisputable. The flight from natural products in drug discovery was unfortunate. However, the revolution that is genome mining, enabled by the explosion in sequencing technology, is a cause for hope. Nevertheless, renewed search and discovery is still a challenge. We explore novel metabolite diversity and the challenges in Streptomyces. Estimating novel bioactive metabolites remaining to be discovered is an important driver for future investment. Frequent re-discovery of known natural products was a major factor in big pharma exiting search and discovery and remains a reality. We explore whether this is exhaustive isolation and frequent lateral gene transfer. Analyzing all biosynthetic gene clusters across all genomes is challenging. Therefore, representative examples of the patterns of secondary metabolite diversity suggest re-discovery is linked to frequent expression in frequently isolated (and frequently mis-identified) strains. Lateral gene transfer of complete biosynthetic clusters is less frequent than might be perceived but frequent gene exchange implies a massive combinatorial biosynthesis experiment. Genome sequencing emphasizes rare expression of many secondary metabolite gene clusters and diversification at the finest levels of phylogenetic discrimination. And, we are only just beginning to unravel the impact of ecology. The hidden diversity suggests that cluster cloning and heterologous expression in microbial cell factories will explore this diversity more effectively.Phenotypes of Recurrent Wheezing in Preschool Children: Identification by Latent Class Analysis and Utility in Prediction of Future Exacerbation
Publication date: Available online 26 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Anne M. Fitzpatrick, Leonard B. Bacharier, Theresa W. Guilbert, Daniel J. Jackson, Stanley J. Szefler, Avraham Beigelman, Michael D. Cabana, Ronina Covar, Fernando Holguin, Robert F. Lemanske, Fernando D. Martinez, Wayne Morgan, Wanda Phipatanakul, Jacqueline A. Pongracic, Robert S. Zeiger, David T. Mauger, NIH/NHLBI AsthmaNet
Abstract
Background
Recurrent preschool wheezing is a heterogeneous disorder with significant morbidity, yet little is known about phenotypic determinants and their impact on clinical outcomes.
Objective
Latent class analysis (LCA) was used to identify latent classes of recurrent preschool wheeze and their association with future exacerbations and inhaled corticosteroid (ICS) treatment response.
Methods
Data from five clinical trials of 1,708 children age 12-71 months with recurrent wheezing were merged. LCA was performed on 10 demographic, exposure and sensitization variables to determine the optimal number of latent classes. The primary outcome was the annualized rate of wheezing exacerbations requiring systemic corticosteroids during the study intervention period; the secondary outcome was the time to first exacerbation. Exploratory analyses examined the effect of daily ICS treatment on exacerbation outcomes.
Results
Four latent classes of recurrent wheezing were identified; these were not distinguished by current symptoms or historical exacerbations but differed with regard to allergen sensitization and/or exposures. Annualized exacerbation rates (mean ± SEM/year) were 0.65 ± 0.06 for class 1 ("minimal sensitization"), 0.93 ± 0.10 for class 2 ("sensitization with indoor pet exposure"), 0.60 ± 0.07 for class 3 ("sensitization with tobacco smoke exposure"), and 0.81 ± 0.10 for class 4 ("multiple sensitization and eczema") (p < 0.001). In a research setting of high adherence, daily ICS treatment improved exacerbation rates in classes 2 and 4 but not the other groups.
Conclusion
Sensitization and exposure assessments are useful in the prediction of future exacerbation and may identify children most likely to respond favorably to daily ICS treatment.
Long-term Outcome of Peanut Oral Immunotherapy Facilitated Initially by Omalizumab
Publication date: Available online 26 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Christina S.K. Yee, Sultan Albuhairi, Elizabeth Noh, Kristel El-Khoury, Shervin Rezaei, Azza Abdel-Gadir, Dale T. Umetsu, Elizabeth Burke-Roberts, Jennifer LeBovidge, Lynda Schneider, Rima Rachid
Abstract
Background
We successfully used omalizumab to faciliate peanut oral immunotherapy (OIT) in children with reactivity to ≤50mg peanut protein and with high peanut-IgE (median 229 kU/L).
Objective
We report on long-term OIT outcomes in these patients, including dosing changes, adverse events, peanut immunoglobulin changes and quality of life (QoL).
Methods
Patients were followed for up to 72 months (67 months maintenance). Outcomes were collected on peanut dose amount, form and frequency, as well as adverse events, (QoL), and laboratory studies.
Results
Of 13 patients initially enrolled, 7 patients (54%) continued on peanut OIT through month 72; 6 (46%) discontinued therapy because of adverse reactions. Maintenance peanut protein dose varied between 500-3,500mg. Most patients consumed different peanut-containing products. All patients experienced at least one adverse event, and one patient developed eosinophilic eosphagitis. Peanut- IgE, Arah1-IgE and Arah2-IgE, peanut-SPT, Peanut-IgE:IgE ratio, and Arah2-IgE:Arah2-IgG4 ratio decreased on OIT. Peanut-IgG4, Arah1-IgG4, Arah2-IgG4 initially increased on OIT then decreased, though not falling to baseline levels. In patients who stopped OIT, there was a trend for reversal of these biomarker changes. Higher peanut-IgE and Arah2-IgE at study month 12 was associated with discontinuation. Patient and parent QoL improved from baseline, even in patients who discontinued OIT.
Conclusion
While adjunctive omalizumab allowed for faster and successful desensitization in patients with high peanut-IgE, almost half of patients discontinued OIT within 72 months because of reactions. Patients who stopped therapy had higher month 12 peanut-IgE and Arah2-IgE. It is possible that these patients might benefit from longer omalizumab administration.
Early exposure to cow’s milk protein is associated with a reduced risk of cow’s milk allergic outcomes.
Publication date: Available online 26 September 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Rachel L. Peters, Jennifer J. Koplin, Shyamali C. Dharmage, Mimi L.K. Tang, Vicki L. McWilliam, Lyle C. Gurrin, Melanie Neeland, Adrian J. Lowe, Anne-Louise Ponsonby, Katrina J. Allen
Abstract
Background
Overall early exposure to allergenic foods in the infant's diet is a new strategy for preventing food allergy to that allergen, but the optimal timing of exposure for different allergens is not known.
Objectives
We aimed to examine the relationship between exposure to cow's milk protein in the first 3 months of life and risk of cow's milk allergy at age 12 months.
Methods
HealthNuts is a longitudinal population-based food allergy study which recruited 5276 12-month old infants. Skin prick testing to cow's milk was conducted on the second half of the cohort (n=2715) and sensitisation defined as a wheal ≥ 2mm. Cow's milk allergy was defined as a parent reported reaction to cow's milk consistent with IgE-mediated allergy together with evidence of sensitisation. Early exposure to cow's milk protein was captured through parental questionnaire administered at one year of age and defined as consumption of cow's milk-based infant formula during the first 3 months of life.
Results
Forty-two percent of infants were exposed to cow's milk in the first 3 months of life (n= 1977/4712) and 87% of these infants were also breastfed. Early exposure to cow's milk protein was associated with a reduced risk of cow's milk sensitisation (aOR 0.44, 95% CI 0.23-0.83), parent-reported reactions to cow's milk (aOR 0.44, 95% CI 0.29-0.67) and cow's milk allergy (aOR 0.31, 95% CI 0.10-0.91) at age 12-months. Age at exposure to cow's milk protein was not associated with the risk of other food allergies.
Conclusion
Exposure to cow's milk protein in the first 3 months of life was associated with a reduced risk of cow's milk allergy. These findings are from an observational study and clinical trials are warranted to further assess this association before any recommendations to infant feeding guidelines can be made.
Multiple Acral Syringomas
Publication date: Available online 27 September 2018
Source: Actas Dermo-Sifiliográficas (English Edition)
Author(s): C. Gómez-de Castro, B. Vivanco Allende, B. García-García
Reconstructing Probabilistic Realism: Re-enacting Syntactical Structures
Abstract
Probabilistic realism and syntactical positivism were two among outdated theories that Feigl criticised on account of their semantical poverty. In this paper, I argue that a refined version of probabilistic realism, which relies on what Feigl specified as the pragmatic description of the symbolic behaviour of scientists' estimations and foresight, is defendable. This version of statistical realism does not need to make the plausibility of realist thesis dependent on the conventional acceptance of a constructed semantic metalanguage. I shall rely on the Prediction Error Minimisation theory (PEM) to support my probabilistic version of realism with a scientifically-informed and naturalistically plausible statistical account of the theories-world relationship which has a pragmatic ring to it.
Laser-assisted photodynamic therapy for actinic keratosis: A systematic review and meta-analysis
Publication date: Available online 27 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Theresa Steeb, Justin Gabriel Schlager, Christoph Kohl, Thomas Ruzicka, Markus V. Heppt, Carola Berking
Abstract
Background
Photodynamic therapy (PDT) is an effective intervention for actinic keratosis (AK) and field-cancerization. Ablative fractional laser may facilitate the delivery of photosensitizers and thereby improve the effects of PDT.
Objective
To summarize the current evidence on the efficacy and safety of laser-assisted PDT.
Methods
We performed a systematic literature research in Medline, Embase, and CENTRAL and hand-searched pertinent trial registers for eligible randomized controlled trials (RCTs). Results from individual studies were pooled using a random-effects model. The risk of bias was estimated with the Cochrane Risk of Bias Tool and the quality of evidence of the outcomes with the GRADE approach.
Results
Out of 817 records initially identified, 7 RCTs were included in the qualitative analysis and 4 in the meta-analysis. Laser-assisted PDT showed significantly higher clearance rates compared to PDT monotherapy (risk ratio 1.33, 95% CI 1.24 to 1.42, I2=25%, p<0.01). There was no difference in pain intensity between laser-assisted PDT and other interventions (mean difference 0.31, 95% CI to 0.12 to 0.74, I2=0%, p=0.16). The included studies showed a high risk of bias.
Limitations
The clinical heterogeneity of included studies.
Conclusion
Laser-assisted PDT is more efficient but not more painful than PDT or laser treatment only.
Results of a nationwide epidemiologic survey of autosomal recessive congenital ichthyosis and ichthyosis syndromes in Japan
Publication date: Available online 26 September 2018
Source: Journal of the American Academy of Dermatology
Author(s): Michiko Kurosawa, Ritei Uehara, Atsushi Takagi, Yumi Aoyama, Keiji Iwatsuki, Masayuki Amagai, Masaki Nagai, Yosikazu Nakamura, Yutaka Inaba, Kazuhito Yokoyama, Shigaku Ikeda
Background
Autosomal recessive congenital ichthyosis (ARCI) and ichthyosis syndrome (IS) are rare genetic skin disorders.
Objective
To estimate the number of patients with ARCI and IS in Japan and clarify the clinicoepidemiologic features of these diseases.
Methods
We performed a nationwide survey of patients treated for ARCI or IS during January 2005-December 2009. We developed diagnostic criteria and conducted a primary survey in a stratified random sample of Japanese hospitals to quantify the number of outpatients and inpatients with ARCI or IS. We performed a secondary survey of clinicoepidemiologic features in positive cases.
Results
The estimated number of patients receiving treatment for ARCI and IS during 2005-2009 was 220 (95% confidence interval [CI] 180-260). The estimated disease distribution was as follows: 95 (95% CI 80-110) patients with nonbullous congenital ichthyosiform erythroderma, 30 (95% CI 20-40) with lamellar ichthyosis, 15 (95% CI 10-20) with harlequin ichthyosis, and 85 (95% CI 50-120) with IS.
Limitations
Patients with a mild case of the disease might not have visited a dermatology department, potentially causing underestimation of affected patients.
Conclusion
We report the estimated number of patients with ARCI and IS in Japan and sex differences in the age distribution.
The Infraorbital Artery: Clinical Relevance in Esthetic Medicine and Identification of Danger Zones of the midface
Publication date: Available online 27 September 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): K. Hufschmidt, N. Bronsard, R. Foissac, P. Baqué, T. Balaguer, B. Chignon-Sicard, J. Santini, O. Camuzard
Summary
Background
Over the past decade, cosmetic injections of dermal fillers or fat have become a popular procedure in facial rejuvenation in an overconsuming society. However, complications such as arterial embolism and occlusion can occur even with experienced injectors, especially in high-risks zones namely the glabella, the nasal dorsum or the nasolabial fold. The aim of this study was to define the vascular danger zones of the infraorbital area in order to provide guidelines helping avoid them.
Materials and Methods
The infraorbital artery, its main branches and their anastomoses with neighbouring vessels were studied in 18 fresh cadavers. Mimetic injections of inked hyaluronic acid were performed in the infraorbital area in the interest of analysing its distribution and to determine potential vascular risks towards the infraorbital artery and its branches.
Results
The infraorbital artery and its branches were located in common injection regions and anastomosed to the supratrochlear artery, the dorsal nasal artery and the angular artery through the nasal branch of the infraorbital artery. Two danger zones could be depicted: injections can be risky when performed too superficially in the midcheek area, and likewise risky when performed in a periosteal layer in infraorbital hollow or tear-trough correction, because of an obvious possibility of retrograde embolism.
Conclusion
The infraorbital artery can be involved in anatomic mechanism of arterial occlusion, further blindness and stroke, among the related neighbouring arteries. Based on the findings of this study, injections to the periosteum layer in tear-trough correction and above the periosteum on the zygomatic arch is not advised.
Efficacy of Feracrylum as Topical Hemostatic Agent in Therapeutically Anticoagulated Patients Undergoing Dental Extraction: A Comparative Study
Abstract
Aims and Objective
To compare the efficacy of feracrylum with tranexamic acid (TXA), following dental extraction in patients who are therapeutically anticoagulated with warfarin.
Study Design
Sixty patients on warfarin were randomly divided into three groups. Groups 1 and 2 patients were given feracrylum (1%), and TXA (5%) solution pressure pack and a control group (Group 3) was given normal saline (NS) pressure pack after extraction. Postoperative bleeding was assessed and graded numerically and periodically (0, 1, 2, 5 and 7 days). The values were statistically analyzed.
Results
Sixty patients (M:F::37:23) with a mean age of 56 years who were therapeutically anticoagulated for different medical conditions were included. The mean warfarin dosage was 3.5 mg, and the mean INR was 2.83. Out of 27 patients who showed bleeding on day of extraction, eight, ten and nine patients belonged to groups I, II and III, respectively, and the difference was nonsignificant. Out of 15 patients who showed bleeding on post-extraction day 1, one, five and nine patients belonged to groups I, II and III, respectively. The difference was statistically significant on day 1 and nonsignificant in the next follow-ups.
Conclusion
Local hemostatic agents like TXA and feracrylum arrest bleeding without having any systemic action and without the necessity of altering the anticoagulant regimen. Feracrylum has an added advantage of a single application, formation of a mechanical barrier and an additional antimicrobial effect. These agents should be incorporated in the protocol for managing patients on oral anticoagulants.
Problemas de la CIE-10 para la codificación de diagnósticos dermatológicos. Estudio DIADERM
Publication date: Available online 27 September 2018
Source: Actas Dermo-Sifiliográficas
Author(s): G. González-López, I. García-Doval, A. Molina-Leyva, M.A. Descalzo-Gallego, R. Taberner, Y. Gilaberte, A. Buendía-Eisman, P. Fernández-Peñas
Resumen
Introducción y objetivos
La codificación de la enfermedad dermatológica en la 10.ª edición de la Clasificación Internacional de Enfermedades (CIE-10) presenta algunas carencias, motivo por el cual en 1999 se desarrolló una adaptación para Dermatología. En el estudio DIADERM se recogieron 10.999 diagnósticos de consulta ambulatoria realizados por dermatólogos a través de una muestra representativa nacional en España. El objetivo del presente trabajo es analizar los diagnósticos de DIADERM en los que no fue posible asignar un código diagnóstico con la CIE-10 adaptada, encontrar las causas y comprobar si la nueva CIE-11, en fase de borrador, permite codificar el diagnóstico.
Material y métodos
Se incluyeron todos los diagnósticos dermatológicos de DIADERM en los que no se pudo asignar un código diagnóstico con la CIE-10 adaptada. Se cuantificaron y se recogieron los diagnósticos incluidos para los que la CIE-10 adaptada y el borrador de la CIE-11 carecen de códigos específicos.
Resultados
A partir de un total de 10.999 diagnósticos del estudio DIADERM, se incluyeron 41 diagnósticos dermatológicos que no tenían código asignado, de los que, tras ser revaluados, 19 pudieron ser codificados, pero en 22 y en 17 diagnósticos, la CIE-10 adaptada y la CIE-11 provisional carecían de código específico, respectivamente.
Conclusiones
La CIE-10 adaptada a Dermatología contiene códigos diagnósticos que permiten clasificar adecuadamente a la inmensa mayoría de los diagnósticos dermatológicos vistos en consulta habitual. No obstante, presenta pequeñas carencias a la hora de clasificar ciertas enfermedades dermatológicas, sobre todo las de descubrimiento o desarrollo más reciente; algunos de estos problemas han sido resueltos en la nueva CIE-11. Con base en los resultados, se proponen algunas modificaciones para la CIE-11.
Abstract
Background and objectives
The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) has some shortcomings when it comes to coding certain dermatological disorders. To overcome these shortcomings, a compatible version of the ICD-10 specifically adapted to dermatology was produced in Spain in 1999. The recent DIADERM study recorded 10 999 dermatological diagnoses using a representative sample of dermatologists working at outpatient clinics in Spain. The aims of the current study were to identify diagnoses from the DIADERM study that could not be coded using the adapted ICD-10, determine why, and check if they could be coded using the draft ICD-11.
Material and methods
We included all dermatological diagnoses from the DIADERM study that could not be assigned a code from the adapted ICD-10. We then quantified and recorded all the diagnoses that could not be coded using either the adapted ICD-10 or the draft ICD-11.
Results
Of the 10 999 diagnoses analyzed, 41 had not been assigned a code. Of these, 19 were assigned an adapted ICD-10 code on reassessment. However, the adapted ICD-10 and the draft ICD-11 lacked specific codes for 22 and 17 diagnoses, respectively.
Conclusions
The adapted ICD-10 can be used to correctly code the vast majority of dermatological diagnoses seen in routine clinical practice. Nevertheless, the system does have some minor shortcomings when it comes to coding certain diseases, particularly newly discovered and emerging diseases. Some of these problems, however, were resolved with the new ICD-11. Based on our findings, we propose some modifications to the ICD-11.
Graphical abstract
La agenda oculta
Publication date: Available online 26 September 2018
Source: Actas Dermo-Sifiliográficas
Author(s): E. Martínez-García, A. Buendía-Eisman
Reconstrucción palpebral inferior mediante «colgajo triangular de Mutaf»
Publication date: Available online 26 September 2018
Source: Actas Dermo-Sifiliográficas
Author(s): P. Fernández Canga, E. Varas Meis, J. Castiñeiras González, M. Espasandín Arias, M.Á. Rodríguez Prieto
El colgajo del lector en cirugía dermatológica
Publication date: Available online 26 September 2018
Source: Piel
Author(s): Nuria Blázquez-Sánchez, Juan Bosco Repiso-Jiménez, Cristina García-Harana, Magdalena de Troya-Martín
Spectroscopic Properties of Lumiflavin: A Quantum Chemical Study
Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.
Inhibitory Effect of Lupeol on MMPs Expression using Aged Fibroblast through Repeated UVA Irradiation
Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.
Chronic wounds in Australia: A systematic review of key epidemiological and clinical parameters
International Wound Journal, EarlyView.
Epidemiology of Aspergillus species causing keratitis in Mexico
Mycoses, Volume 0, Issue ja, -Not available-.
Nagashima‐type palmoplantar keratoderma and malignant melanoma in Japanese patients
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
Beware what lies beneath: a case of a gigantic cutaneous squamous cell carcinoma
Clinical and Experimental Dermatology, EarlyView.
Herpes vegetans in a human immunodeficiency virus‐negative kidney transplant patient
Clinical and Experimental Dermatology, EarlyView.
Risk factors associated with frontal fibrosing alopecia: a multicentre case–control study
Clinical and Experimental Dermatology, EarlyView.
Diabetic scleroedema successfully treated by topical hyaluronidase injection: efficacy of magnetic resonance imaging
Clinical and Experimental Dermatology, EarlyView.
Successful treatment of PAPA syndrome with minocycline, dapsone, deflazacort and methotrexate: a cost‐effective therapy with a 2‐year follow‐up
Clinical and Experimental Dermatology, EarlyView.
WhatsApp platforms in tropical public health resource‐poor settings
International Journal of Dermatology, EarlyView.
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
